A possible link between reflux and otitis media with effusion

In addition to causing classic symptoms such as heartburn, gastroesophageal reflux (GER) is thought to cause a number of non-GI symptoms, such as cough and sore throat. Animal studies also suggest that GER may cause eustachian tube dysfunction. Now, a study from Japan indicates that there may be a link between GER and otitis media with effusion (OME) in adults.

Sone and associates studied 60 adults who had unexplained OME. The participants completed a questionnaire designed to identify symptoms of GER, and pepsinogen levels in their middle ear effusions were measured.

The 14 patients who had GER symptoms had higher levels of pepsinogen in their middle ear effusions than those who had no evidence of GER. Patients with GER also were more likely to have bilateral OME. Four of the patients with GER were given proton pump inhibitor therapy, which reduced pepsinogen levels in addition to reducing GER symptoms.

The authors note that GER may cause edema of the mucosa near the eustachian tube. The resulting difference in pressure between the middle ear cavity and the nasopharynx may cause some reflux material to enter the middle ear from the pharynx. This transient reflux and the conversion of pepsinogen to pepsin in the presence of acid could result in further eustachian tube dysfunction.