title: Pepsin deteriorates prognosis of children with otitis media with effusion who undergo myringotomy or tympanostomy tube insertion.
abstract: OBJECTIVE
  To investigate the concentrations of pepsin and pepsinogen within the middle ear cavity and determine whether pepsin and pepsinogen affect the prognosis of children with otitis media with effusion (OME).
  
  
  METHODS
  All middle-ear lavage fluid from patients with OME undergoing myringotomy (M subgroup) or tympanostomy tube insertion (T subgroup) was collected and pepsin and pepsinogen were detected using enzyme-linked immunosorbent assay. After close follow-up over 2 years, the effects of pepsin and pepsinogen on the prognosis of the patients with OME in the M and T subgroups were analyzed.
  
  
  RESULTS
  The average pepsin and pepsinogen concentrations were significantly lower in the M subgroup (n=54; 24.38±16.10mg/mL and 286.49±91.95mg/mL, respectively) than in the T subgroup (n=55; 45.56±16.60mg/mL and 664.92±107.06mg/mL; t=2.484, P=0.018 and t=2.670, P=0.011, respectively). In the M subgroup, the average time to tympanic membrane healing and tympanic pressure restoration to normal was much longer in pepsin(+) patients (17.0±2.0 days and 26.0±2.5 days, respectively) than in pepsin(-) patients (14.0±1.1 days and 22.0±1.0 days; t=3.871, P=0.001 and t=5.734, P=0.000, respectively), and the hearing level of pepsin(+) patients with OME ascended to 13.08±1.19dB, which was much lower than that of pepsin(-) patients (18.29±1.27dB; t=11.001, P=0.000). In the T subgroup, the complication rate including otorrhea and myringosclerosis was much higher in patients with high pepsin concentrations than in those with low pepsin concentrations (P<0.05). Finally, in both subgroups, the recurrence rates of OME in pepsin(+) or patients with high pepsin concentrations (34.6% [9/26] and 28.6% [10/35]) were significantly higher than those in pepsin(-) or low pepsin concentrations (10.7% [3/28] and 5.0% [1/20]; χ(2)=4.456, P=0.035 and χ(2)=4.420, P=0.036). However, pepsinogen had no significant effect on OME prognosis or recurrence.
  
  
  CONCLUSIONS
  Pepsin but not pepsinogen could postpone tympanic membrane healing and pressure restoration in children with OME undergoing myringotomy and increase the incidence of recurrence and complications including otorrhea and myringosclerosis for those undergoing tympanostomy tube insertion. Therefore, pepsin could be considered a poor prognostic factor for OME, further emphasizing the important role of pepsin in OME pathogenesis.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, The Second Hospital, Xi'an JiaoTong University, Xi'an, Shan'Xi Province, China.
authors.forename: Hua-Nan
authors.initials: HN
authors.lastname: Luo
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, The Second Hospital, Xi'an JiaoTong University, Xi'an, Shan'Xi Province, China.
authors.forename: Si-Jing
authors.initials: SJ
authors.lastname: Ma
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, The Second Hospital, Xi'an JiaoTong University, Xi'an, Shan'Xi Province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Sheng
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, The Second Hospital, Xi'an JiaoTong University, Xi'an, Shan'Xi Province, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Yan
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, The Second Hospital, Xi'an JiaoTong University, Xi'an, Shan'Xi Province, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Hou
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, The Second Hospital, Xi'an JiaoTong University, Xi'an, Shan'Xi Province, China.
authors.forename: Kang
authors.initials: K
authors.lastname: Zhu
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, The Second Hospital, Xi'an JiaoTong University, Xi'an, Shan'Xi Province, China. Electronic address: renxiaoyong@vip.sina.com.
authors.forename: Xiao-Yong
authors.initials: XY
authors.lastname: Ren
mesh_terms: D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006309:Hearing; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects; D010034:Otitis Media with Effusion / Q000201:enzymology* / Q000503:physiopathology / Q000601:surgery*; D010434:Pepsin A / Q000032:analysis*; D020116:Pepsinogen A / Q000032:analysis*; D011312:Pressure; D011379:Prognosis; D012008:Recurrence; D014432:Tympanic Membrane / Q000502:physiology / Q000601:surgery*; D014945:Wound Healing
chemical_list: D020116:Pepsinogen A; D010434:Pepsin A
keywords: Myringotomy; Otitis media with effusion; Pepsin; Pepsinogen; Tympanostomy tube insertion