title: Association between otitis media and gastroesophageal reflux: a systematic review.
abstract: OBJECTIVE
  To systematically review the association between otitis media and gastroesophageal/laryngopharyngeal reflux in children.
  
  
  METHODS
  Cochrane library, MEDLINE (1966-September 2011), EMBASE (1974-September 2011), proceedings of International Symposia on Recent Advances in Otitis Media, and reference lists of relevant selected articles.
  
  
  METHODS
  Studies with planned data collection, in children with chronic otitis media with effusion/recurrent acute otitis media, assessing gastroesophageal/laryngopharyngeal reflux, pepsin/pepsinogen in middle ear, or antireflux therapy, were included.
  
  
  RESULTS
  Of 242 initial studies, 15 met inclusion criteria. The authors found a mean prevalence of gastroesophageal reflux disease in children with chronic otitis media with effusion of 48.4% (range, 17.6%-64%) and in children with recurrent acute otitis media of 62.9% (range, 61.5%-64.3%). A mean prevalence of laryngopharyngeal reflux of 48.6% (range, 27.3%-70.6%) was found in children with otitis media. Mean pepsin/pepsinogen presence in otitis media was 85.3% (range, 60%-100%) and of enzymatic activity was 34.2% (range, 14.5%-73%). Two randomized trials could not find benefit after antireflux treatment for 3 months, with an absolute rate difference (95% confidence interval) of 0.23 (0.023-0.42) and 0.13 (-0.086 to 0.34), respectively. Reporting of adverse events was limited, or absent, in most studies.
  
  
  CONCLUSIONS
  The prevalence of gastroesophageal reflux disease in children with chronic otitis media with effusion/recurrent acute otitis media may be higher than the overall prevalence for children. Presence of pepsin/pepsinogen in the middle ear could be related to physiologic reflux. A cause-effect relationship between pepsin/pepsinogen in the middle ear and otitis media is unclear. Antireflux therapy for otitis media cannot be endorsed based on existing research.
authors.affiliation: Universidade Federal de Ciencias da Saude de Porto Alegre, Brazil. mmiura.voy@terra.com.br
authors.forename: Mauricio Schreiner
authors.initials: MS
authors.lastname: Miura
authors.forename: Miguel
authors.initials: M
authors.lastname: Mascaro
authors.forename: Richard M
authors.initials: RM
authors.lastname: Rosenfeld
mesh_terms: D002648:Child; D002908:Chronic Disease; D015897:Comorbidity; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D010033:Otitis Media / Q000175:diagnosis / Q000453:epidemiology; D010034:Otitis Media with Effusion / Q000175:diagnosis* / Q000453:epidemiology*; D010434:Pepsin A / Q000032:analysis*; D020116:Pepsinogen A / Q000032:analysis; D015995:Prevalence; D014481:United States / Q000453:epidemiology
chemical_list: D020116:Pepsinogen A; D010434:Pepsin A