Sone Michihiko, Kato Toshinari, Suzuki Yasuyuki, Arao Harumi, Sugiyama Kishiko, Ishida Kazuya, Izawa Kazuhiro, Takasu Akihiko, Nakashima Tsutomu
Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Auris Nasus Larynx. 2011 Apr;38(2):203-7. doi: 10.1016/j.anl.2010.08.004. Epub 2010 Oct 28.
To investigate relevance and characteristics of gastroesophageal reflux (GER) in adult patients with otitis media with effusion (OME) of unknown etiology who attended private clinics.
A total of 186 adults with OME of unknown etiology (OME group) and 156 adults without OME (control group) were asked to answer a questionnaire specific for the diagnosis of GER disease. Pepsinogen (PG) levels in the middle-ear effusions (MEEs) of the OME group were measured using a chemiluminescence enzyme immunoassay kit. Distributions of PG concentrations by age or body mass index (BMI) in the OME group were analyzed. Patients with high PG levels received proton pump inhibitors (PPIs) and their responses were evaluated.
Symptoms of GER were reported by significantly more patients in the OME group than in the control group (43.0% vs. 12.8%). Patients with GER symptoms tended to have higher MEE PG concentrations than those without symptoms. PG levels did not show a significant difference by age. However, high PG levels were less found in patients over 60 years old with high BMI >25. This tendency was not observed in patients under 60 years old. PG levels decreased in seven out of ten patients with high PG concentrations after PPI therapy, corresponding with palliation of GER-related symptoms. Two patients had high MEE bilirubin concentration, and OME resolved in these patients after instruction about lifestyle factors related to GER, including sleeping position.
GER symptoms were more prevalent than expected in patients with OME of unknown etiology. BMI might affect GER-related OME, especially in elderly patients. Instruction about lifestyle factors related to GER, especially in patients who do not respond to PPI therapy, may be effective for patients with intractable OME.
探讨病因不明的成人分泌性中耳炎（OME）患者胃食管反流（GER）的相关性及特征，这些患者就诊于私人诊所。
共186例病因不明的OME成人患者（OME组）和156例无OME的成人患者（对照组）被要求回答一份针对GER疾病诊断的问卷。使用化学发光酶免疫分析试剂盒测量OME组中耳积液（MEE）中的胃蛋白酶原（PG）水平。分析OME组中PG浓度按年龄或体重指数（BMI）的分布情况。PG水平高的患者接受质子泵抑制剂（PPI）治疗，并评估其反应。
OME组报告有GER症状的患者明显多于对照组（43.0%对12.8%）。有GER症状的患者其MEE中PG浓度往往高于无症状患者。PG水平在年龄方面未显示出显著差异。然而，BMI>25的60岁以上患者中PG高水平较少见。60岁以下患者未观察到这种趋势。PPI治疗后，10例PG浓度高的患者中有7例PG水平下降，同时GER相关症状缓解。2例患者MEE胆红素浓度高，在接受关于与GER相关的生活方式因素（包括睡眠姿势）的指导后，这些患者的OME得到缓解。
病因不明的OME患者中GER症状比预期更普遍。BMI可能影响与GER相关的OME，尤其是在老年患者中。对于难治性OME患者，特别是对PPI治疗无反应的患者，关于与GER相关的生活方式因素的指导可能有效。
