Gastroesophageal reflux disease in children with chronic otitis media with effusion. J Craniofac Surg. 2013;24:380-383. [PMID: 23524698 DOI: 10.1097/SCS.0b013e31827feb08]

Extralaryngeal Manifestations of Laryngopharyngeal Reflux Disease

Extralaryngeal manifestations of laryngopharyngeal reflux are widely recognised, although evidence to support mechanistic pathways is still lacking. Evidence to support reflux contribution to the following disorders is accumulating: otitis media, sinusitis, obstructive sleep apnea, dental erosions, subglottic and tracheal stenosis, inflammatory lung disease and lung transplant rejection. Acid likely only plays a small part in symptom generation and therefore proton pump inhibitor therapy will not provide sustained relief for many, and should no longer be considered as a diagnostic trial. Multifaceted management including behavioural modifications, barrier protection, antiinflammatory approaches and occasionally surgery are more effective.

Causal association of gastroesophageal reflux disease with chronic sinusitis and chronic disease of the tonsils and adenoids

BACKGROUND

Exploring bidirectional causal associations between gastroesophageal reflux disease (GERD) and chronic disease of the tonsils and adenoids and chronic sinusitis, respectively.

METHODS

We first conducted a TSMR (two-sample mendelian randomization) study using the results of the inverse variance weighting method as the primary basis and bidirectional MR to rule out reverse causation. Subsequently, MVMR (multivariate MR) analysis was performed to identify phenotypes associated with SNPs and to explore the independent effect of GERD on two outcomes. Finally, we calculated MR-Egger intercepts to assess horizontal polytropy and Cochran's Q statistic to assess heterogeneity and ensure the robustness of the study.

RESULTS

For each standard deviation increase in genetically predicted GERD rate, there was an increased risk of chronic disease of the tonsils and adenoids (OR 1.162, 95% CI 1.036-1.304, P: 1.06E-02) and of developing chronic sinusitis (OR 1.365, 95% CI 1.185-1.572, P: 1.52E-05), and there was no reverse causality. Causality for TSMR was obtained on the basis of IVW (inverse variance weighting) and appeared to be reliable in almost all sensitivity analyses, whereas body mass index may be a potential mediator of causality between GERD and chronic sinusitis.

CONCLUSION

There is a causal association between GERD and chronic disease of the tonsils and adenoids and chronic sinusitis, respectively, and the occurrence of GERD increases the risk of developing chronic disease of the tonsils and adenoids and chronic sinusitis.

The effects of treating GERD on the outcomes of otitis media with effusion: A systematic review and meta-analysis

OBJECTIVE

Gastroesophageal reflux disease (GERD) may cause otitis media with effusion (OME). However, whether treating GERD can benefit patients with OME has not been well studied.

METHODS

We systematically searched PubMed, Embase, Cochrane Library, and Wanfang databases. The search period was from the establishment of the databases until December 31, 2022. Clinical studies related to GERD treatment on the outcomes of OME were included. Two reviewers independently conducted literature screening and data extraction according to the inclusion and exclusion criteria. To evaluate the quality of the included studies, we used the NOS assessment tool and the RevMan 5.4. Subgroup analysis was conducted to reduce the risk of heterogeneity, and Egger and Begg funnel plots were used to evaluate publication bias. Meta-analysis was performed using Stata14.0 and Review Manager 5.4 software.

RESULTS

Finally, 21,744 patients from 16 studies were included. The results showed that the rate of GERD in OME patients was 0.56 (95 % confidence interval (CI): 0.33, 0.79), while it was 0.04 (95 % CI: 0.03, 0.05) in the adult GERD population. The combined risk ratio (RR) of OME in patients with versus without GERD was 1.58 (95 % CI: 1.35, 1.85; p < 0.01). The efficacy rate of GERD treatment in OME patients was 0.59 (95 % CI: 0.44, 0.74), especially for those with chronic OME (0.64, 95 % CI: 0.36, 0.92). Compared to the control group, treatment with GERD improved the symptoms and efficacy of OME (OR = 1.65; 95 % CI: 0.95, 2.85; p > 0.05). The hearing loss cure rate was 0.70 (95 % CI: 0.57, 0.82).

CONCLUSION

GERD has been suggested to be a high-risk factor for OME. Treatment of GERD can improve the symptoms of OME. However, further studies are required to verify these findings.

Correlation between cough and gastroesophageal reflux in children

For many decades, the scientific community of medical professionals has wondered if there is a correlation between cough and gastroesophageal reflux. This problem is relevant for doctors of various specialties. The importance of this issue is due to practical application since it determines the tactics of diagnosis and treatment both for cough and gastroesophageal reflux. The article provides an analysis of Russian and foreign literature data, based on which we can conclude that there is a correlation between gastroesophageal reflux (gastroesophageal reflux disease) and cough.

Patients Requiring Gastrostomy Tube Insertion After Total Laryngectomy Have a Higher Incidence of Otitis Media

Background and Objectives

Some reports propose an increased risk of otitis media and hearing impairment after total laryngectomy. However, the incidence of otitis media following laryngectomy and the mechanism remain unclear. This study aimed to identify the incidence and risk factors of otitis media after total laryngectomy.

Subjects and Methods

This retrospective cohort study assessed 77 patients who underwent total laryngectomy from 2010 to 2020 in a tertiary referral center. Serial imaging studies (computed tomography [CT], magnetic resonance imaging, and positron emission tomography-CT) were used to assess otitis media.

Results

The study enrolled 58 patients (mean age, 67.0±7.7 years; male, 56 [96.6%]); nine (15.5%) underwent a gastrostomy tube (four preoperatively and five postoperatively). Otitis media was confirmed in seven (12.1%) patients. Gastrostomy tube insertion was the only significant risk factor for otitis media (p=0.012). Of the nine patients who underwent gastrostomy tube insertion, four developed otitis media; all four had the procedure after laryngectomy.

Conclusions

This study found an increased incidence of otitis media after total laryngectomy. Swallowing difficulties likely contribute to otitis media as it occurred more frequently in patients requiring postoperative gastrostomy tube insertion.

Outcome of Gastroesophageal Reflux Therapy in Children with Persistent Otitis Media with Effusion

Introduction Otitis media with effusion (OME) is considered one of the most common disorders that affect children during the first years of life. There are many risk factors of persistent middle ear effusion; one of these risk factors is gastroesophageal reflux. Association between persistent OME and gastroesophageal reflux diseases (GERDs) could be explained by respiratory tract infections, insufficient ciliary clearance, and poor drainage of the Eustachian tube.

Objective To investigate whether the control of gastroesophageal reflux plays a role in the management of persistent OME and decreases tympanostomy tube insertion

Method A cross-sectional study was conducted on 50 children complaining of persistent OME. Their ages ranged between 5 and 12 years old. All children were subjected to full history taking, audiological assessment and 24-hour esophageal pH monitoring. The study group was divided according to pH results into two groups: GERD positives and GERD negatives.

Result The prevalence of GERD in persistent OME was 58%. There were statistically significant differences in the hearing levels and middle ear condition before and after the treatment (p < 0.05). The percentage of improvement of children complaining of persistent OME after antireflux treatment was 52%.

Conclusion Gastroesophageal reflux disease should be considered in patients with persistent OME. The administration of proton pump inhibitor (PPI) can set aside superfluous surgical treatment (such as tympanostomy).

Frequency of gastroesophageal reflux disease in children with adenoid hypertrophy

OBJECTIVES

Recent studies have suggested that the reflux of gastric contents can cause adenoid hypertrophy (AH). The frequency of gastro-oesophageal reflux disease (GERD) in this AH population is unknown, but according to studies using pH-metry it may be as high as 65%. The aim of this study was to estimate the frequency of GERD among children with AH.

METHODS

This was a cross-sectional, multicentre, prospective study of children with AH selected for adenoidectomy. The diagnosis of AH was made by a single laryngologist using a flexible fiberscope. All children had 24-hr multichannel intraluminal pH-impedance (MII/pH) assessment. A GERD diagnosis was made using BioVIEW software analysis after manual review by a single investigator.

RESULTS

38 consecutive patients (21 males, mean age 6.58 years) were enrolled in the study. GERD was diagnosed in 5 (13.2%) patients. A total of 1462 gastro-oesophageal reflux events (GERs) were detected by MII/pH and the majority (60.9%) were acidic. The only significant differences between the GERD-positive and GERD-negative groups were the total number of GERs, and the number of acid GERs.

CONCLUSION

It is first study using MII/pH to assess the frequency of GERD in children with AH. The data suggest that GERD in children with AH seems to be not as common as it was previously raised. Further studies are needed to confirm these results.

Impact of early gastroesophageal reflux disease on childhood otologic outcomes

OBJECTIVE

Recent evidence has suggested that children with gastroesophageal reflux disease (GERD) face increased risk for otologic disease. This study aims to evaluate otologic outcomes in children with GERD using a large pediatric hearing database.

METHODS

Data pertaining to children with GERD in the first year of life were extracted from the Audiological and Genetic Database. Subgroups included children with uncomplicated GERD, complicated GERD (with esophagitis), and GERD requiring surgery (fundoplication or fundoplasty). Main outcome measures included hearing loss (HL) prevalence, type, severity, and progression. Children without GERD in the first year of life served as controls.

RESULTS

5747 children were diagnosed with GERD in the first year of life. Evidence of HL was present in 40.9% children with uncomplicated GERD, 63.1% in children with complicated GERD, 75% in children with GERD requiring surgical intervention, and 43.3% in controls (p < 0.001). Children with GERD requiring surgery demonstrated the highest odds of developing any HL (aOR 3.02 [1.40-7.26]), moderate-to-profound HL (aOR 3.44 [1.56-7.29]), and mixed HL (aOR 4.58 [2.07-9.65]) relative to children with uncomplicated or complicated GERD. GERD requiring surgery was independently associated with Eustachian tube dysfunction (aOR 2.41 [1.17-5.20]) and tympanostomy tube placement (aOR 6.23 [3.05-13.01]).

CONCLUSION

GERD diagnosed within the first year of life is associated with pediatric hearing impairment and otologic issues, including otitis media, Eustachian tube dysfunction, and need for tympanostomy tube placement. GERD requiring surgical intervention is particularly associated with hearing loss in this population. Children with GERD and HL deserve close audiologic follow-up.

Swallowing behaviours and feeding environment in relation to communication development from early infancy to 6 years of age: a scoping review protocol

INTRODUCTION

Understanding the influences of early swallowing function and feeding environment on the development of communication will enhance prevention and intervention initiatives for young children. This scoping review will help elucidate key elements affecting the developmental trajectory of communicative systems, typically robust and well-developed by formal school entry. We aim to (1) map the current state of the literature in a growing field of interest that has the potential to advance knowledge translation, (2) identify existing gaps and (3) provide research direction for future investigations surrounding feeding-swallowing functions and environment that support or forestall communication development in young children.

METHODS AND ANALYSIS

We are proposing a scoping review to identify the breadth and depth of the existing literature regarding swallowing-feeding functions and environment relative to the onset and progression of communicative behaviours from infancy to 6 (<6;0) years of age. Our protocol delineates rigorous methods according to Arskey and O'Malley's framework and includes elaborations by Levac and colleagues. We will search the literature based on 10 databases, 17 peer-reviewed journals, 4 conference proceedings and 6 grey literature sources. Two authors will independently screen abstracts and review full articles, remaining blind to each other's results. A third author will contribute to resolving any discrepant results from both the abstract and article review. Subsequently, we will extract data and chart information from accepted articles using a pre-established data collection form. We will stratify results according to healthy versus impaired swallowing-feeding functions and communication development.

ETHICS AND DISSEMINATION

Our scoping review does not require ethical approval. We will disseminate our final study results through international and national conference presentations, publication in a peer-reviewed journal and knowledge translation activities with stakeholders.

A Clinical Trial of Proton Pump Inhibitors to Treat Children with Chronic Otitis Media with Effusion

OBJECTIVE

Gastroesophageal reflux (GER) is considered a cause of otitis media with effusion (OME). This study aimed to investigate whether OME can be effectively treated with a proton pump inhibitor (PPI), therefore implicating GER as a causative factor of OME.

MATERIALS AND METHODS

A PPI or placebo was randomly administered to enrolled subjects for 4-8 weeks. To monitor effusion status, subjects underwent monthly pneumatic otoscopy and acoustic reflectometry. At enrollment and at completion of treatment, subjects underwent an audiogram and tympanogram for assessing changes in hearing due to altered fluid levels in the middle ear. After the treatment period, tympanostomy tube placement was recommended for subjects with unresolved effusion.

RESULTS

This study enrolled 16 patients with an average age of 5.17 years. Between the treatment and placebo groups, there was no significant difference in the need for tympanostomy tubes. At completion of this study, patients receiving Lansoprazole demonstrated a significant improvement in pure tone average (p<0.01) and speech recognition thresholds (p=0.04). Four patients (25%) from the cohort dropped out of the study. Eight patients (50%) from the cohort required tympanostomy tube placement.

CONCLUSION

Owing to difficulties with recruitment and small sample size, this study was unable to demonstrate the use of PPI in treating OME. A larger study is needed for further evaluation of this process.

Prospective Study of Gastroesophageal Reflux, Use of Proton Pump Inhibitors and H2-Receptor Antagonists, and Risk of Hearing Loss

OBJECTIVES

Gastroesophageal reflux disease (GERD) is common and often treated with proton pump inhibitors (PPIs) or H2-receptor antagonists (H2-RAs). GERD has been associated with exposure of the middle ear to gastric contents, which could cause hearing loss. Treatment of GERD with PPIs and H2-RAs may decrease exposure of the middle ear to gastric acid and decrease the risk of hearing loss. We prospectively investigated the relation between GERD, use of PPIs and H2-RAs, and the risk of hearing loss in 54,883 women in Nurses' Health Study II.

DESIGN

Eligible participants, aged 41 to 58 years in 2005, provided information on medication use and GERD symptoms in 2005, answered the question on hearing loss in 2009 or in 2013, and did not report hearing loss starting before the date of onset of GERD symptoms or medication use. The primary outcome was self-reported hearing loss. Cox proportional hazards regression was used to adjust for potential confounders.

RESULTS

During 361,872 person-years of follow-up, 9842 new cases of hearing loss were reported. Compared with no GERD symptoms, higher frequency of GERD symptoms was associated with higher risk of hearing loss (multivariable adjusted relative risks: <1 time/month 1.04 [0.97, 1.11], several times/week 1.17 [1.09, 1.25], daily 1.33 [1.19, 1.49]; p value for trend <0.001). After accounting for GERD symptoms, neither PPI nor H2-RA use was associated with the risk of hearing loss.

CONCLUSIONS

GERD symptoms are associated with higher risk of hearing loss in women, but use of PPIs and H2-RAs are not independently associated with the risk.

Prevalence and characteristics of gastroesophageal reflux in children with otitis media in Isfahan, Iran

BACKGROUND

Otitis media (OM) is the most common cause of childhood hearing loss and reason to visit the pediatrician. Furthermore, gastroesophageal reflux (GER) has been associated with a variety of upper aerodigestive tract symptoms or diseases, such as sinusitis, laryngitis, and otits. The objective of the present study was to determine the frequency of GER in children, aged 3 months to 7 years, with OM.

MATERIALS AND METHODS

This retrospective case-control study was conducted on 50 children with OM and 50 healthy children. Presence of GER as the main variables was diagnosed by clinical examination in all studied children using the questionnaires with 2 age-stratified versions of the pediatric GER disease symptoms for children 2 years old and younger, and children 3-7 years old.

RESULTS

The prevalence of GER in children with OM and controls was 58% and 22% respectively (P = 0.0005). The frequency of irritability, congestion, and feeding complex in children with OM were significantly more than in control groups. Among children with recurrent acute OM (AOM), and chronic serous OM (CSOM) the prevalence of GER was significantly more than controls (61.1%, vs. 22% for AOM, P = 0.004, and 72.7% vs. 22%, P= 0.003). In children with AOM, regurgitation, vomiting, irritability and congestion were significantly higher than controls included. In children with CSOM, regurgitation, vomiting, and congestion were significantly higher than controls.

CONCLUSION

Results show a significant association between GER and OM, AOM and CSOM in children with OM compares to healthy children. This shows that looking for GER in children with OM may help improving treatments outcomes.

Epidemiology of chronic rhinosinusitis, selected risk factors, comorbidities, and economic burden

Chronic rhinosinusitis (CRS) is a relevant and prevalent medical condition in Germany, Europe and the world. If analysed in detail, the prevalence of CRS shows regional and temporary variety. In this review, currently available data regarding the prevalence of CRS is therefore sorted by country and/or region, time point of data collection and the CRS-definition employed. Risk factors like smoking and gastroesophageal reflux are discussed regarding their influence on CRS prevalence. Moreover, comorbidities of CRS, like asthma, conditions of the cardiovascular system and depression are listed and their influence on CRS is discussed. Furthermore, data on CRS prevalence in special cohorts, like immunocompromised patients, are presented. To estimate the economic burden of CRS, current data e.g. from Germany and the USA are included in this review.

An evaluation of olfactory function in adults with gastro-esophageal reflux disease

CONCLUSION

To the best of the authors' knowledge, this study is the first to evaluate the olfactory function of adult patients diagnosed with GERD. The results revealed that adults with GERD have diminished olfactory function.

OBJECTIVE

This study aimed to evaluate the olfactory abilities of subjects using the 'Sniffin' Sticks' olfactory test.

METHODS

A total of 35 men and women aged 18-60 years with a diagnosis of GERD and 45 healthy controls were included in the study. The Sniffin' Sticks olfactory test results of the two groups were compared, and the relationship between the study findings and the olfactory parameters was evaluated.

RESULTS

The odor threshold (10.1; 9.5, p = 0.016), odor identification (9.6; 8.1, p < 0.001), and odor discrimination (10.7; 8.9, p < 0.001) of the GERD group were significantly lower than those of the control group. A statistically significant positive correlation was detected between the accompanying chronic pharyngitis, chronic sinusitis, and odor parameters. A significant correlation was not detected between the laryngeal findings and the olfactory parameters.

Associations between peripheral vertigo and gastroesophageal reflux disease

We hypothesize that peripheral vertigo is associated with gastroesophageal reflux disease (GERD). Two mechanisms could be considered – gastric acids may directly irritate the respiratory mucosa and cause inflammation, or Helicobacter pylori (H. pylori) could be present and cause local infection. Reflux material (Hydrochloric acid (HCl) and pepsin) could get into the middle ear via Eustachian tube and affect osseous structures directly. Disturbance of ossicles could cause tinnitus, which is more common for peripheral vertigo. H. pylori could also get in the esophagus and in the upper respiratory tract via gastroesophageal reflux, and could cause tympanosclerosis and fixation of ossicles. In our study group, 120 of 153 (78.4%) patients had gastroesophageal reflux disease (GERD). Diagnostic tests of H. pylori (rapid urease test or blood antibody test) were performed for 96 of 120 (80%) patients with GERD and were found positive for 32 of 96 (33.3%) patients. Peripheral vertigo was present in 93 of 120 (77.6%) patients with GERD compared to 33 of 126 (26%) patients without GERD (χ(2)=9.016, p=0.003). H. pylori and peripheral vertigo coexisted in 26 of 126 patients (20.6%) (OR 1.36; 95% CI 0.49-3.74, p=0.55). Our study demonstrated statistically significant association between peripheral vertigo and GERD but not between peripheral vertigo and H. pylori. Further more extensive investigations are needed in order to explore our hypothesis.

Symptoms and diagnosis of acid vs non-acid gastroesophageal reflux induced cough

AIM: To compare the symptoms and diagnosis of acid and non-acidic gastroesophageal reflux induced cough (GERC).

METHODS: Forty patients diagnosed with GERC were collected between January 2011 and December 2013 at our hospital, including 21 cases of acid GERC (DeMeester score ≥ 12.70) and 19 cases of non-acid GERC (DeMeester score < 12.70). The clinical symptoms, gastroesophageal reflux diagnostic questionnaire (GerdQ) score, and DeMeester score were compared between the two groups.

RESULTS: The age and incidence of reflux were significantly lower in the non-acid GERC group than in the acid GERC group (χ² = 6.686, P = 0.010). There were no significant differences in the nature of cough, cough duration, frowsty bosom, history of stomach problems or complicated obstructive sleep apnea syndrome (OSAS) between the two groups (P > 0.05). Compared with the acid GERC group, the non-acid GERC group had significantly lower GerdQ score and DeMeester score (χ² = 2.337, P = 0.003), although there was no significant difference between daytime and nighttime cough (P > 0.05).

CONCLUSION: Acid and non-acid GERC differs little in terms of clinical symptoms and should be diagnosed based on comprehensive evaluation including GerdQ and DeMeester scores.