Otologic findings in children with gastroesophageal reflux

Nearly 90-95% of children with drool have physiologic gastroesophageal reflux (GER) that usually resolves by 12-15 months of age; however, 5-10% of children with drool have pathologic GER. Of these children, most recover clinically by 18 months of age without therapy, yet 10% develop chronic, recurrent gastroesophageal reflux disease (GERD) with sequelae. The respiratory symptoms associated with GER consist mainly of bronchial asthma and laryngospasm, but often include a persistent cough of unknown aetiology, obstructive apnoea, and an obstructive respiratory syndrome confined to the nasopharynx. Gastric acid reflux, enters the adenoids, causes oedema of the tubal orifices, and later leads to relapsing diseases of the middle ear in children.To evaluate the incidence of otologic manifestations in children with GER and the efficacy of treatment, comparing two different groups of children (i.e., treated versus untreated).From January 2005 to November 2006, audiologic screening of newborns and suckling children (0-24 months of age) at risk for auditory illness was heeld at the University Dept. of Otolaryngology in Catania. Seventy-three children (average age 13 months) were selected after failing acoustic otoemissions for chronic bilateral catarrhal pathology involving the middle ear (tympanometry type B) and were positive for at least one of the different signs of GER at the time of hystory-taking. The children were randomised and subdivided into two groups: 1 a group of 40 children (27 females and 13 males; average age 12 months) who received treatment; and 2 a group of 29 children (16 males and 13 females; average age 14 months) who did not receive treatment. Four children were lost to follow up after completing the study. All children enrolled in the study underwnt a rhinopharynxlaryngeal fibroscopy with flexible optics, a gastric ultrasound scan after clinical observation, and a multichannel pHmetry for 18 - 24 h.Resolution and improvement of the reflux occurred in 52.5 and 40% of the cases in the treated group, respectively, versus complete resolution and an improvement in symptoms of 45 and 30% of cases, respectively, in the control goup.The hypothesis of a correlation between reflux and chronic middle otitis of the serous-mucous type was confirmed in the present study. Adopting a preventive treatment strategy may be useful in reducing the possibility of ear involvement.