title: Recurrent acute otitis media and gastroesophageal reflux disease in children. is there an association?
abstract: OBJECTIVE
  To investigate whether there is a relationship between gastroesophageal reflux disease (GERD) and recurrent acute otitis media (RAOM) in infants and children. Possible risk factors are also explored.
  
  
  METHODS
  221 consecutive children who had symptoms and signs associated with GERD and had undergone a prolonged ambulatory 24-h esophageal pH-monitoring. Thirty-four children were excluded from the study due to age, neurological deficits, congenital abnormalities, immunodeficiency syndromes or other chronic systemic disorders. The remaining 187 children (96 boys and 91 girls), aged between 40 days and 33 months (mean age of 18.3 months) were assigned into three groups according to their Reflux Index (RI%). Group A: 49 children (26.2%) without GERD (control group); Group B: 78 children (41.7%) with low to moderate RI; and Group C: 60 children (32.1%) with severe GERD. Parental interviews and personal medical files of the National Health System were used for data collection. However, episodes of acute otitis media were taken into account only if they were diagnosed by a physician. The follow-up period ranged from 6 to 8 years in order to cover the peaks of otitis media incidence in childhood.
  
  
  RESULTS
  The results revealed that 6 children from Group A (12.24%), 11 from Group B (14.1%) and 19 from Group C (31.67%) presented episodes of RAOM. The difference was statistically significant (p=0.01). Furthermore, in children who received anti-reflux treatment, the incidence of RAOM substantially decreased and eventually became approximate to that of the control Group A (12.32%). Logistic regression revealed that the strongest risk factor for recurrent otitis media was severe GERD (odds ratio, 4), then attendance at day-care centres (odds ratio, 3), followed by allergies (odds ratio, 2.7).
  
  
  CONCLUSIONS
  Severe GERD could be implicated in the multifactorial etiology of RAOM in infants and children.
authors: Department of Otorhinolaryngology, Penteli Children's General Hospital, Athens, Greece.
authors: George P
authors: GP
authors: Kotsis
authors: Thomas P
authors: TP
authors: Nikolopoulos
authors: Ioannis E
authors: IE
authors: Yiotakis
authors: George X
authors: GX
authors: Papacharalampous
authors: Dimitrios C
authors: DC
authors: Kandiloros
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D016022:Case-Control Studies; D002675:Child, Preschool; D015897:Comorbidity; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology*; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010033:Otitis Media / Q000175:diagnosis* / Q000453:epidemiology*; D012008:Recurrence; D012016:Reference Values; D012720:Severity of Illness Index; D017678:Sex Distribution