Role of Laryngopharyngeal Reflux Disease in Eustachian Tube Dysfunction: A Systematic Review

To investigate the role of laryngopharyngeal reflux disease (LPRD) in the development of Eustachian tube dysfunction (ETD) and related otitis media (OM) in adults.

Two independent investigators searched PubMed, Scopus, and Cochrane databases for studies reporting laryngopharyngeal reflux disease (LPRD) findings in patients with ETD or OM according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Bias analysis was conducted using Methodological Index for Non-Randomized Studies (MINORS) and the tools of the Clarity Group and Evidence Partners.

Twenty clinical studies (2100 patients) met inclusion criteria. LPRD prevalence ranged from 20.3 to 32.6% in ETD and 21.0 to 73.3% in OME using symptom-based approaches, increasing up to 58.0% and 77.4%, respectively, with objective diagnostic methods. Conversely, ETD was identified in 40.0-54.5% and OME in 32.1% of patients with suspected LPRD or confirmed GERD. Pepsin and trypsin were detected in up to 39.6% of middle ear effusions. Animal models supported refluxate-induced inflammation and progressive Eustachian tube impairment. Substantial diagnostic heterogeneity and low-to-moderate methodological quality (mean MINORS: 6.7±1.6) were observed.

Available evidence suggests a probable association between LPRD, ETD, and related OM in adults, supported by converging clinical and animal data. However, methodological limitations-including reliance on symptom-based reflux diagnosis and inconsistent ETD/OME criteria-preclude definitive causal conclusions. Prospective controlled studies using HEMII-pH monitoring and standardized otologic diagnostic criteria are needed.