Objectives: To estimate pepsinogen-1 (PG1) levels in middle ear effusion (MEE) and serum of children had
bilateral chronic otitis media with effusion (OME) and to evaluate reliability of intraoperative laryngoscopic
determination of Reflux Finding Score (RFS) for presence and severity of laryngopharyngeal reflux (LPR).
Patients & Methods: Thirty children with OME were asked to complete the Reflux Symptom Index (RSI) scoring
sheet with a score >5 is strongly suggestive of LPR. Patients older than 6 years underwent upper gastro-esophageal
endoscopy (GEE) for GERD grading according to the Los Angeles classification of esophagitis. After induction of
anesthesia and prior to tracheal intubation all patients underwent laryngeoscopic examination for laryngeal
manifestations of GERD and RFS scoring >11 is strongly suggestive of LPR. Then, patients were intubated and
underwent myringotomy with insertion of Gromet's tube after collection of MEE samples. MEE and serum samples
were collected for ELISA estimation of Human PG1 levels. Results: PG1 was detected in MEE of 23 patients
(Group A), but none in MEE of 7 patients (Group B). RSI score was non-significantly higher, while RFS score was
significantly (p=0.034) higher in group A compared to group B. Serum PG1 levels were non-significantly higher in
patients of group B than group A. Mean PG1 levels in MEE of total and Group A patients were significantly
(p=0.002, 0.001, respectively) higher than mean serum levels, while was significantly (p=0.001) lower than mean
serum levels in Group B. FRS scorings showed positive significant correlation with PG1 levels of MEE, body mass
index (BMI) and RSI scorings. PG1 levels of MEE showed positive significant correlation with RSI scores and
BMI, while showed negative significant correlation with age and male gender. Conclusion: Measurable amounts
of PG1 were detected in 76.7% of studied patients with significantly higher levels than serum levels. RSI and RFS
could define patients with LPR. Obesity prevalence was 70% and showed positive significant correlation with RSI
and RFS scoring and with PG1 levels estimated in MEE. Upper GEE may be unnecessary invasive investigation
for children with OME unless indicated. |
