Study of Anti-reflux Medication as a Potential Treatment for Glue Ear in Children

Summary

The accumulation of fluid behind the ear drum without any acute inflammation is known as otitis media with effusion (OME). It is the most common cause of acquired hearing loss during childhood. Long-term complications of OME include linguistic, developmental, and social development delays due to hearing loss. The cause of OME is not known; however, low grade infection of the middle ear, poor function of the eustachian tube between the ear and the throat, and adenoid hypertrophy have all been suggested as possible etiologies. Recent detection of the stomach enzyme pepsin in middle ear fluid has led some to propose that OME is related to the reflux of stomach contents into the ear, via the eustachian tube. The purpose of the investigators study is to determine whether anti-reflux medication may have a positive impact by clearing the accumulation of fluid in the middle ear with the aim of preventing or reducing hearing loss in children diagnosed with OME. Empiric anti-reflux therapy with proton pump inhibitor (PPI) medication is safe, proven and cost-effective. It is used widely as a diagnostic and treatment strategy in the presence of the signs and symptoms of gastroesophageal reflux disease (GERD). The signs and symptoms of GERD include heartburn, recurrent vomiting or regurgitation, acid taste in mouth, throat irritation, voice problems, heartburn, difficult or painful swallowing, asthma and recurrent pneumonia. This pilot study will be a double-blinded, randomized, placebo-controlled trial that will compare resolution rates for OME in children treated with lansoprazole or placebo for three months. At the end of the study, those patients who have persistent middle ear effusions will be brought to the operating room and have the fluid aspirated and sent for analysis for pepsin.

Timeline

Start

2010-03

Primary completion

2014-06

Completion

2014-06

Publications

• Background Bluestone CD, Beery QC, Andrus WS. Mechanics of the Eustachian tube as it influences susceptibility to and persistence of middle ear effusions in children. Ann Otol Rhinol Laryngol. 1974 Mar-Apr;83:Suppl 11:27-34. doi: 10.1177/0003489474083s1103. No abstract available.
• Background Charbel S, Khandwala F, Vaezi MF. The role of esophageal pH monitoring in symptomatic patients on PPI therapy. Am J Gastroenterol. 2005 Feb;100(2):283-9. doi: 10.1111/j.1572-0241.2005.41210.x.
• Background Crapko M, Kerschner JE, Syring M, Johnston N. Role of extra-esophageal reflux in chronic otitis media with effusion. Laryngoscope. 2007 Aug;117(8):1419-23. doi: 10.1097/MLG.0b013e318064f177.
• Background Deal L, Gold BD, Gremse DA, Winter HS, Peters SB, Fraga PD, Mack ME, Gaylord SM, Tolia V, Fitzgerald JF. Age-specific questionnaires distinguish GERD symptom frequency and severity in infants and young children: development and initial validation. J Pediatr Gastroenterol Nutr. 2005 Aug;41(2):178-85. doi: 10.1097/01.mpg.0000172885.77795.0f.
• Background Fass R, Ofman JJ, Gralnek IM, Johnson C, Camargo E, Sampliner RE, Fennerty MB. Clinical and economic assessment of the omeprazole test in patients with symptoms suggestive of gastroesophageal reflux disease. Arch Intern Med. 1999 Oct 11;159(18):2161-8. doi: 10.1001/archinte.159.18.2161.
• Background Fiellau-Nikolajsen M, Lous J, Vang Pedersen S, Schousboe HH. Tympanometry in three-year-old children. I. A regional prevalence study on the distribution of tympanometric results in a non-selected population of 3-year-old children. Scand Audiol. 1977;6(4):199-204. doi: 10.3109/01050397709043121.
• Background Fiellau-Nikolajsen M, Lous J. Prospective tympanometry in 3-year-old children. A study of the spontaneous course of tympanometry types in a nonselected population. Arch Otolaryngol. 1979 Aug;105(8):461-6. doi: 10.1001/archotol.1979.00790200023005.
• Background Fiellau-Nikolajsen M. Tympanometry and secretory otitis media. Observations on diagnosis, epidemiology, treatment, and prevention in prospective cohort studies of three-year-old children. Acta Otolaryngol Suppl. 1983;394:1-73. No abstract available.
• Background Gerson LB, Robbins AS, Garber A, Hornberger J, Triadafilopoulos G. A cost-effectiveness analysis of prescribing strategies in the management of gastroesophageal reflux disease. Am J Gastroenterol. 2000 Feb;95(2):395-407. doi: 10.1111/j.1572-0241.2000.01759.x.
• Background Golz A, Netzer A, Angel-Yeger B, Westerman ST, Gilbert LM, Joachims HZ. Effects of middle ear effusion on the vestibular system in children. Otolaryngol Head Neck Surg. 1998 Dec;119(6):695-9. doi: 10.1016/S0194-5998(98)70039-7.
• Background Grace AR, Pfleiderer AG. Dysequilibrium and otitis media with effusion: what is the association? J Laryngol Otol. 1990 Sep;104(9):682-4. doi: 10.1017/s0022215100113611.
• Background Heavner SB, Hardy SM, White DR, Prazma J, Pillsbury HC 3rd. Transient inflammation and dysfunction of the eustachian tube secondary to multiple exposures of simulated gastroesophageal refluxant. Ann Otol Rhinol Laryngol. 2001 Oct;110(10):928-34. doi: 10.1177/000348940111001007.
• Background Hicks DM, Ours TM, Abelson TI, Vaezi MF, Richter JE. The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers. J Voice. 2002 Dec;16(4):564-79. doi: 10.1016/s0892-1997(02)00132-7.
• Background Jonaitis L, Pribuisiene R, Kupcinskas L, Uloza V. Laryngeal examination is superior to endoscopy in the diagnosis of the laryngopharyngeal form of gastroesophageal reflux disease. Scand J Gastroenterol. 2006 Feb;41(2):131-7. doi: 10.1080/00365520600577940.
• Background Keles B, Ozturk K, Gunel E, Arbag H, Ozer B. Pharyngeal reflux in children with chronic otitis media with effusion. Acta Otolaryngol. 2004 Dec;124(10):1178-81. doi: 10.1080/00016480410017134.
• Background Lieu JE, Muthappan PG, Uppaluri R. Association of reflux with otitis media in children. Otolaryngol Head Neck Surg. 2005 Sep;133(3):357-61. doi: 10.1016/j.otohns.2005.05.654.
• Background Lous J, Fiellau-Nikolajsen M. Epidemiology and middle ear effusion and tubal dysfunction. A one-year prospective study comprising monthly tympanometry in 387 non-selected 7-year-old children. Int J Pediatr Otorhinolaryngol. 1981 Dec;3(4):303-17. doi: 10.1016/0165-5876(81)90055-0.
• Background Lous J. Secretory otitis media in schoolchildren. Is screening for secretory otitis media advisable? Dan Med Bull. 1995 Feb;42(1):71-99. No abstract available.
• Background Rodriguez-Tellez M. Supra-oesophageal manifestations of gastro-oesophageal reflux disease. Drugs. 2005;65 Suppl 1:67-73. doi: 10.2165/00003495-200565001-00010.
• Background Rozmanic V, Velepic M, Ahel V, Bonifacic D, Velepic M. Prolonged esophageal pH monitoring in the evaluation of gastroesophageal reflux in children with chronic tubotympanal disorders. J Pediatr Gastroenterol Nutr. 2002 Mar;34(3):278-80. doi: 10.1097/00005176-200203000-00009.
• Background Shekelle P, Takata G, Chan LS, Mangione-Smith R, Corley PM, Morphew T, Morton S. Diagnosis, natural history, and late effects of otitis media with effusion. Evid Rep Technol Assess (Summ). 2002 Jun;(55):1-5. doi: 10.1037/e439822005-001. No abstract available.
• Background Tasker A, Dettmar PW, Panetti M, Koufman JA, P Birchall J, Pearson JP. Is gastric reflux a cause of otitis media with effusion in children? Laryngoscope. 2002 Nov;112(11):1930-4. doi: 10.1097/00005537-200211000-00004.
• Background Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis. 1989 Jul;160(1):83-94. doi: 10.1093/infdis/160.1.83.
• Background White DR, Heavner SB, Hardy SM, Prazma J. Gastroesophageal reflux and eustachian tube dysfunction in an animal model. Laryngoscope. 2002 Jun;112(6):955-61. doi: 10.1097/00005537-200206000-00004.
• Background Vaezi MF. Therapy Insight: gastroesophageal reflux disease and laryngopharyngeal reflux. Nat Clin Pract Gastroenterol Hepatol. 2005 Dec;2(12):595-603. doi: 10.1038/ncpgasthep0358.
• Background Velepic MM, Velepic MS, Starcevic R, Manestar D, Rozmanic V. Gastroesophageal reflux and sequelae of chronic tubotympanal disorders in children. Acta Otolaryngol. 2004 Oct;124(8):914-7. doi: 10.1080/00016480410022499.
• Background Al-Saab F, Manoukian JJ, Al-Sabah B, Almot S, Nguyen LH, Tewfik TL, Daniel SJ, Schloss MD, Hamid QA. Linking laryngopharyngeal reflux to otitis media with effusion: pepsinogen study of adenoid tissue and middle ear fluid. J Otolaryngol Head Neck Surg. 2008 Aug;37(4):565-71.

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Indications