title: Chronic middle ear disease and gastroesophageal reflux disease: a causal relation?
abstract: OBJECTIVE
  To describe one patient with a puzzling therapy-resistant unilateral chronic otitis media, analyze his diagnosis, and describe three similar patients with the same symptoms and signs, i.e., a chronic ear problem together with gastroesophageal reflux disease (GERD).
  
  
  METHODS
  Thorough analysis of one patient with a chronic ear problem and GERD, both of which responded favorably after antireflux therapy consisting of omeprazole and conservative antireflux measures (raising the head of the bed by 20 to 25 cm, avoiding meals and drinks 3 hours before retiring, and other dietary and lifestyle modifications), and a search for more patients with similar coexisting conditions.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Patients with chronic ear problems and GERD were thoroughly analyzed by the otorhinolaryngologist and the gastroenterologist. The latter used endoscopy and Savary-Miller's classification of esophagitis, a 24-hour ambulatory dual esophageal pH monitoring, and esophageal manometry.
  
  
  RESULTS
  Four patients were identified who had a chronic ear problem and simultaneous GERD. It is reasoned that the GERD leads to nasopharyngitis and this to a chronic ear problem. All the patients responded favorably to anti-GERD therapy.
  
  
  CONCLUSIONS
  GERD may manifest itself as an extraesophageal manifestation, such as nasopharyngitis, leading to ear disease. Therapy-resistant chronic middle ear disease may be caused by GERD.
authors.affiliation: Department of Otorhinolaryngology-Head Neck Surgery, University Hospitals, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Poelmans
authors.forename: J
authors.initials: J
authors.lastname: Tack
authors.forename: L
authors.initials: L
authors.lastname: Feenstra
mesh_terms: D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004724:Endoscopy / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D009304:Nasopharyngitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D009853:Omeprazole / Q000627:therapeutic use; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011187:Posture; D014433:Tympanoplasty
chemical_list: D000897:Anti-Ulcer Agents; D009853:Omeprazole