Chronic middle ear disease and gastroesophageal reflux disease: A causal relation?

Objective: To describe one patient with a puzzling therapy-resistant unilat eral chronic otitis media, analyze his diagnosis, and describe three simila r patients with the same symptoms and signs, i.e., a chronic ear problem to gether with gastroesophageal reflux disease (GERD). Study Design: Thorough analysis of one patient with a chronic ear problem a nd GERD, both of which responded favorably after antireflux therapy consist ing of omeprazole and conservative antireflux measures (raising the head of the bed by 20 to 25 cm, avoiding meals and drinks 3 hours before retiring, and other dietary and lifestyle modifications), and a search for more pati ents with similar coexisting conditions. Setting: Tertiary referral center. Methods: Patients with chronic ear problems and GERD were thoroughly analyz ed by the otorhinolaryngologist and the gastroenterologist. The latter used endoscopy and Savary-Miller's classification of esophagitis, a 24-hour amb ulatory dual esophageal pH monitoring, and esophageal manometry. Results: Four patients were identified who had a chronic ear problem and si multaneous GERD. It is reasoned that the GERD leads to nasopharyngitis and this to a chronic ear problem. All the patients responded favorably to anti -GERD therapy. Conclusions: GERD may manifest itself as an extraesophageal manifestation, such as nasopharyngitis, leading to ear disease. Therapy-resistant chronic middle ear disease may be caused by GERD.