DIAGNOSTIC RELIABILITY OF INTRAOPERATIVE FIBEROPTIC LARYNGOSCOPIC REFLUX FINDING SCORING AND ESTIMATION OF MIDDLE EAR EFFUSION PEPSINOGEN-1 LEVELS IN CHILDREN WITH CHRONIC OTITIS MEDIA WITH EFFUSION

Naslshah G. H. Kazem MD, Mohamed Elsayed MD, Mohamed H. G. MD, Azza M. El-Bermawy MD, Ola GH Kazem MD and Lamiaa Z Mobarak MD

ABSTRACT

Objectives: To estimate pepsinogen-1 (PG1) levels in middle ear effusion (MEE) and serum of children had bilateral chronic otitis media with effusion (OME) and to evaluate reliability of intraoperative laryngoscopic determination of Reflux Finding Score (RFS) for presence and severity of laryngopharyngeal reflux (LPR). Patients & Methods: Thirty children with OME were asked to complete the Reflux Symptom Index (RSI) scoring sheet with a score >5 is strongly suggestive of LPR. Patients older than 6 years underwent upper gastro-esophageal endoscopy (GEE) for GERD grading according to the Los Angeles classification of esophagitis. After induction of anesthesia and prior to tracheal intubation all patients underwent laryngeoscopic examination for laryngeal manifestations of GERD and RFS scoring >11 is strongly suggestive of LPR. Then, patients were intubated and underwent myringotomy with insertion of Gromet's tube after collection of MEE samples. MEE and serum samples were collected for ELISA estimation of Human PG1 levels. Results: PG1 was detected in MEE of 23 patients (Group A), but none in MEE of 7 patients (Group B). RSI score was non-significantly higher, while RFS score was significantly (p=0.034) higher in group A compared to group B. Serum PG1 levels were non-significantly higher in patients of group B than group A. Mean PG1 levels in MEE of total and Group A patients were significantly (p=0.002, 0.001, respectively) higher than mean serum levels, while was significantly (p=0.001) lower than mean serum levels in Group B. FRS scorings showed positive significant correlation with PG1 levels of MEE, body mass index (BMI) and RSI scorings. PG1 levels of MEE showed positive significant correlation with RSI scores and BMI, while showed negative significant correlation with age and male gender. Conclusion: Measurable amounts of PG1 were detected in 76.7% of studied patients with significantly higher levels than serum levels. RSI and RFS could define patients with LPR. Obesity prevalence was 70% and showed positive significant correlation with RSI and RFS scoring and with PG1 levels estimated in MEE. Upper GEE may be unnecessary invasive investigation for children with OME unless indicated.

Keywords: chronic otitis media with effusion, Middle ear effusion pepsinogen-1 level, Reflux Finding Score, Obesity.