Function of the Eustachian Tube After Weekly Exposure to Pepsin/Hydrochloric Acid

Abstract

Gastroesophageal reflux may induce ET dysfunction.

Recurrent acute otitis media and gastroesophageal reflux disease in children. Is there an association?

“…Repeated nasopharyngeal acid/pepsin exposure caused eustachian-tube dysfunction in rats as well as lesions in the middle ear [13][14][15]. In 1996, Parsons suggested that otitis media and sinusitis are atypical manifestations of GERD [16].…”

The Effects of Gastric Reflux and Artificial Saliva on Eustachian Tube Functions in a Xerostomised Rat Model

“…Efüzyonlu hastaların kulak efüzyon sıvısında pepsin/pepsinojen veya Helicobacter pylori bakterisinin saptanması, reflü tanısının konması, reflü öyküsü olan hastalarda orta kulak patolojilerinin ortaya konması, gastrik sıvı verilerek veya cerrahi ile deneysel olarak reflü oluşturulan hayvan modellerinde östaki disfonksiyonunun veya efüzyonlu otitis media oluştuğunun gösterilmesi bu ilişkiyi açıkça ortaya koymaktadır. 5,10,[18][19][20][21][22][23] Çalışmamızda, David White ve ark.nın tanımladığı deneysel gastrik reflü modeli kserostomili sıçanlarda uygulanarak, erken dönemde östaki borusunda ortaya çıkan histopatolojik değişiklikler değerlendirilmiştir. 5 Majör tükürük bezleri tümüyle çıkarılan ve aside maruz bırakılan sıçanların uzun süre yaşatılması mümkün olmayacağından, çalışma sadece erken dönemle (1 hafta) sınırlı tutulmuştur.…”

Gastric pepsin in middle ear fluid of children with otitis media: Clinical implications

“…Refl uxate may induce mucosal infl ammation through production of an acidic environment, toxicity of conjugated bile acids, and osmotic damage [14,15]. However, the consensus is that mucosal damage is principally mediated by proteolytic activity from pepsin [17•].…”

“…Exposure of the nasopharyngeal orifi ce of the eustachian tube to simulated refl ux in rats has resulted in persistent abnormalities in pressure equalization [15,22], and a gerbil model of EORD demonstrated that refl uxate can readily penetrate the eustachian tube and enter the middle ear cleft [24].…”

“…Once these refl ux events cross a biologic threshold, pathologic changes are produced in the esophagus or upper aerodigestive tract and are termed gastroesophageal refl ux disease (GERD) or extraesophageal refl ux disease (EORD) [9,10,11•]. As otitis media is produced by eustachian tube dysfunction [12,13], EORD is likely to produce infl ammation of the tubal mucosa and surrounding structures of the nasopharynx [12, 14,15]. Alterations in native mucosal defense mechanisms, together with mucosal infl ammation, have been shown to result from refl ux events [16•].…”