Study On The Relationship Between Laryngopharyngeal Reflux And Otitis Media With Effusion In Adult

Obective:Otitis media with effusion(OME)is one of the common causes of hearing loss and ear discomfort in patients.Although the incidence rate is very high,little is known about the cellular and molecular inflammatory reactions involved in the disease process.Laryngopharyngeal reflux(LPR)is one of the hotspots in the study the pathogenesis of OME.Due to the lack of large-scale clinical studies,the pathogenesis of LPR in OME is still under exploration.At present,the research object of the etiology and pathogenesis of OME at home and abroad is mainly children,and the research content is mainly the relevant control of gastric contents.The relevant research of adult OME and LPR is less,and the relevant evaluation of eustachian tube dysfunction is still blank.In order to study the presence or absence of LPR in adult OME patients,this study takes OME adult patients as the main research object,evaluates the presence or absence of LPR in patients from subjective and objective perspectives through relevant symptom and sign scales,and detects the positive rate and concentration of pepsin in middle ear effusion of OME patients,and compares it with patient serum to verify that gastric contents participate in the pathogenesis of OME through reflux.Meanwhile,in order to study whether there is eustachian tube dysfunction in adult LPR,through the seven eustachian tube dysfunction scoring table and related instruments,the subjective and objective evaluation of whether there is eustachian tube dysfunction in patients is carried out to further verify the correlation between reflux and eustachian tube dysfunction,explore the etiology of adult OME,and clarify the specific pathogenesis of adult OME.Method:1.76 OME patients who visited Otorhinolaryngology Head and Neck Surgery of Shaanxi Provincial People’s Hospital from May 2017 to May 2018 were selected as the research objects.Patients were instructed by professional doctors to fill in the Reflux Symptom Index(RSI)form according to their personal conditions,and then two otolaryngologists filled in the Reflux Finding Score(RFS)form through laryngoscopy.2.36 OME patients who underwent tympanostomy tube insertion or puncture in Otorhinolaryngology Head and Neck Surgery of Shaanxi Provincial People’s Hospital from May 2017 to December 2017 were included.The middle ear effusion of the patients was collected and its pH was determined.The positive rate and concentration of pepsinand pepsinogen A in the effusion were detected by enzyme immunoassay technology,and the plasma of the patients was collected for detection as control.3.53 patients with OME and LPR who came to Otorhinolaryngology Head and Neck Surgery of Shaanxi Provincial People’s Hospital from May 2017 to May 2018 were selected as research subjects.Patients were instructed by professional doctors to fill in seven eustachian tube dysfunction scoring forms according to their personal conditions,and their eustachian tube functions were measured by eustachian tube pressure meter.Results:1.The positive rate of RSI form was 69.74%(53/76)in 76 adult OME patients.The positive rate of RFS score table was 60%(45/75)in 75 adult OME patients.Most OME patients have LPR,and there is no significant difference between men and women.2.MEEs samples from OME patients are mostly acidic in pH range of 6.0-7.5.The positive rate of pepsin was 100%,its concentration range was 13.02-155.15ng/ml,the average concentration of pepsinogen A in MEEs was 489.49±261.71 ng/m,and that in control group was 72.0±24.06 ng/ml.3.The positive rate of the seven items eustachian tube dysfunction scale in 53 adult LPR patients with OME was 100%(53/53).43 adult LPR patients with OME had eustachian tube dysfunction on one or both sides with 100%(43/43)of eustachian tube pressure meter.Conclusion:1.Laryngeal reflux in adults is correlated with the incidence of otitis media with effusion.2.Pepsin in adult middle ear effusion is caused by laryngopharyngeal reflux.Pepsin may cause secretory otitis media through injury mechanism.3.Eustachian tube dysfunction may be one of the intermediate links of otitis media with effusion caused by adult laryngopharyngeal reflux.