الفهرس 
Introduction
Prognostic and risk factors in OMEOnly 14 pages are availabe for public view
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Abstract
Laryngopharyngeal reflux (LPR) is now of major interest as an aetiologic factor for the chronic inflammatory condition of the middle ear in cases of otitis media with effusion (OME) in children.
Microaspiration of gastric contents into the middle ear in children is possible and can be a major cause of their chronic middle ear problems.
Aim of work:
This prospective case series study is designed in an attempt to identify any possible etiological relationship between gastroesophageal reflux (GERD) and OME in children. This is verified by detecting the presence or absence of gastric juice in the middle ear in cases of OME. If gastric contents had refluxed into the middle ear, pepsin will be present in the effusion. Material and methods:
Middle ear effusions were collected from 50 children (age range from 12 months to 10 years) who had undergone myringotomy and tympanostomy tube placement for persistent OME. Total pepsin/pepsinogen concentrations in effusions were measured by ELISA. Ambulatory 24hour dualprobe pH monitoring was additionally performed in 31 children divided into 2 groups.
-GroupI included 17 children (out of the 50 children) who had undergone surgical interference for their OME, and
-group II included 14 children with OME which responded to the usual conservative lines of medical treatment.
Results: The concentrations of pepsin/pepsinogen in middle ear effusions ranged from 0.08 to 15.1 g/ml with a mean value of 2.63 g/ml and a standard deviation (SD) equals to 3.67 g/ml, while their concentrations in serum ranged from 11.94 to 49.25 ng/ml with a mean value of 22.21 ng/ml and a standard deviation (SD) equals to 6.9 ng/ml. The concentrations of pepsin/pepsinogen in the effusions of 50 children were up to 540 times higher than the levels in their serum. Dualprobe pH monitoring showed that 22/31 (71%) of the studied children had significant acid reflux documented by either the esophageal probe or the pharyngeal probe and all of them had LPR. There is a significant positive correlation between the level of pepsin/pepsinogen assayed in the effusions of the 17 children (GroupI) and the number of pharyngeal reflux episodes measured by pH monitoring whether using a threshold of pH <4 (r =0.584 , p =0.014) or pH <5 (r =0.543, p =0.024). Conclusion: LPR may be an essential component in the successful diagnosis and management of OME in pediatric patients, and its control may lead to improved outcome of medical and surgical interventions, as well as decreased morbidity, in children with LPR related OME or other tubo tympanic disorders. Analysis of pepsin/pepsinogen in effusions of children, using ELISA, can be considered a reliable marker for assessment of reflux in children with OME.