Related Experiment Video
Updated: Mar 25, 2026
High-Speed Human Temporal Bone Sectioning for the Assessment of COVID-19-Associated Middle Ear Pathology
Published on: May 18, 2022
Pepsinogen identification in the middle ear fluid of children with otitis media with effusion
Aytuğ Buyruk1, Üstün Osma, Mustafa Deniz Yılmaz
1Department of Otolaryngology, Afyon State Hospital, 03030 Afyon, Turkey.
Insights
Pepsinogen, an enzyme linked to acid reflux, was found in higher concentrations in middle ear fluid of children with otitis media with effusion. This suggests pepsinogen may indicate reflux contributing to middle ear conditions.
Area of Science:
- Otolaryngology
- Gastroenterology
- Biochemistry
Background:
- Otitis media with effusion (OME) is common in children.
- Gastroesophageal reflux (GER) is a potential contributing factor to OME.
- Pepsinogen, a marker of gastric acid production, has been implicated in reflux-related conditions.
Purpose of the Study:
- To investigate the presence and concentration of pepsinogen in middle ear fluid (MEF) of children with OME.
- To explore the relationship between pepsinogen levels in MEF and serum.
- To discuss the potential role of pepsinogen in the pathogenesis of OME.
Main Methods:
- 33 children diagnosed with OME were enrolled.
- Middle ear fluid samples were collected during surgery.
- Pepsinogen and albumin levels in MEF and serum were measured and compared.
Main Results:
- Mean pepsinogen concentration was significantly higher in MEF compared to serum (262.4 ng/mL vs. 102.6 ng/mL).
- Mean albumin concentration was significantly lower in MEF compared to serum (1.1 g/dL vs. 5.8 g/dL).
- The highest pepsinogen levels were observed in patients with purulent effusion.
Conclusions:
- Findings support the theory of pepsinogen translocation from the esophagus to the middle ear via gastroesophageal reflux.
- Pepsinogen in MEF may serve as a reliable biomarker for assessing gastroesophageal reflux in OME.
- This study highlights a potential link between GER and OME pathogenesis.
Objectives:
This study aims to investigate the presence and concentration of pepsin/pepsinogen in middle ear fluid and to discuss the potential mechanisms involved in the pathogenesis of this condition.
Patients And Methods:
A total of 33 children (21 boys, 12 girls; mean age 5.7±2.4 years; range 3 to 13 years) diagnosed with otitis media with effusion and scheduled for operation were enrolled into the study. Fluids aspirated from the middle ear were assessed for the presence of pepsinogen and albumin and blood samples were drawn simultaneously for comparison.
Results:
Mean pepsinogen concentration was statistically significantly higher in middle ear fluids compared with serum samples (262.4 ng/mL [range: 211.7 ng/mL - 301.1 ng/mL] versus 102.6 ng/mL [range: 80.7 ng/mL - 134.5 ng/mL], respectively) (p<0.001). On the other hand, mean albumin concentration was significantly lower (1.1 g/dL [range: 0.01 g/dL - 9.5 g/dL] versus 5.8 g/dL [range: 0.9 - 9.5 g/dL], respectively) (p<0.001). The highest pepsinogen concentration was detected in patients with purulent effusion (275.3 ng/mL).
Conclusion:
Our findings support the theory of gastro-esophageal reflux related pepsinogen transition to the middle ear and indicate that pepsinogen may a reliable biochemical marker for the assessment of gastro-esophageal reflux.
