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It is almost 20 years since the Lancet publication by Tasker et al describing gastric juice in the glue ear of children. This paper attempts to look at the body of literature which has focused specifically on the clinical association of reflux in OME, rather than just the presence of pepsin/pepsinogen in middle ear fluid. This recent meta-analysis paper is from a group in Wuhan, China, and looked at data from 16 studies involving a sample size of 1961, the majority involving paediatric patients. The inclusion criteria included documented otitis media with effusion for three months, and a broad heterogeneity of investigation of middle ear reflux using techniques of involving pepsin/pepsinogen concentrations, H. pylori testing in the middle ear, anti-reflux treatment and 24-hour pH monitoring in known OME patients. The results of the association of reflux and OME was found to be significant with a pooled OR of 4.52 (95% CI: 2.42–8.44; p<0.001), using random-effects model. The detailed subgroup analysis of the various methods used to demonstrate the association between OME and reflux showed that the presence of pepsin in the middle ear fluid is highly significant, and treatment with anti-reflux medication significantly improved the signs and symptoms of OME. The authors used statistical methods to try and demonstrate publication bias and none was identified. The methodology of the included studies was mainly cross-sectional studies, with only four randomised controlled trials. The paper acknowledges that these studies represent a relatively small sample size overall. The authors conclude, based on the data presented, that symptoms and signs of reflux should be screened for when paediatric patients present with OME, and a trial of treatment given prior to surgical intervention. 

The Relationship Between Otitis Media With Effusion and Gastroesophageal Reflux Disease: A Meta-analysis.
Wu Z-H, Tang Y, Niu X, et al.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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