Article

Gastroesophageal Reflux and Eustachian Tube Dysfunction in an Animal Model^†^‡^§

Corresponding Author

David R. White MD

[email protected]

Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, University of Michigan, Ann Arbor, Michigan, U.S.A.

David R. White, MD, CB 7070, 610 Burnett-Womack Clinical Sciences Building, University of North Carolina Hospitals, Chapel Hill, NC 27599-7070, U.S.A.Search for more papers by this author

S. Brett Heavner MD,

S. Brett Heavner MD

Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, University of Michigan, Ann Arbor, Michigan, U.S.A.

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Stuart M. Hardy MD,

Stuart M. Hardy MD

University of North Carolina, Chapel Hill, North Carolina, and the Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

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Jiri Prazma MD, PhD,

Jiri Prazma MD, PhD

Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, University of Michigan, Ann Arbor, Michigan, U.S.A.

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David R. White MD,

Corresponding Author

David R. White MD

[email protected]

Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, University of Michigan, Ann Arbor, Michigan, U.S.A.

David R. White, MD, CB 7070, 610 Burnett-Womack Clinical Sciences Building, University of North Carolina Hospitals, Chapel Hill, NC 27599-7070, U.S.A.Search for more papers by this author

S. Brett Heavner MD,

S. Brett Heavner MD

Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, University of Michigan, Ann Arbor, Michigan, U.S.A.

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Stuart M. Hardy MD,

Stuart M. Hardy MD

University of North Carolina, Chapel Hill, North Carolina, and the Department of Otolaryngology—Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

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Jiri Prazma MD, PhD,

Jiri Prazma MD, PhD

Department of Otolaryngology—Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, University of Michigan, Ann Arbor, Michigan, U.S.A.

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First published: 02 January 2009

https://doi.org/10.1097/00005537-200206000-00004

Citations: 89

^†

Presented at the Meeting of the Southern Section of the Triological Society, Marco Island, Florida, January 13, 2001.

^‡

Supported by the National Organization for Hearing Research.

^§

This Manuscript received the 2001 Lloyd Storrs Resident Award (First Place).

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Abstract

Objective To explore the possible relationship between gastroesophageal reflux and eustachian tube dysfunction in an animal model.

Study Design Randomized trial.

Methods Twenty Sprague-Dawley rats were randomly assigned into two groups, the control (phosphate-buffered saline, n = 10) and experimental (hydrochloric acid [HCl]/pepsin, n = 10) groups. All rats underwent an operation to implant a polyethylene tube into the posterior nasopharynx, through which phosphate-buffered solution or simulated gastric juice (0.5 mg/mL pepsin in 0.01 HCl) was infused at a rate of 0.1 mL/h for 20 minutes three times a day for 7 days. Passive opening pressure (POP), passive closing pressure (PCP), active clearance of positive pressure (ACPP) and active clearance of negative pressure (ACNP) were measured before catheter implantation, on postoperative day 5, and after days 1, 3, 5, and 7 of infusion. Mucociliary clearance time (MCCT) was measured after day 7 of infusion. Statistical analysis used a two-way analysis of variance (POP, PCP, ACPP, and ACNP) and Mann-Whitney rank sum test (MCCT).

Results Significant increases in POP (P = .004), PCP (P <.001), ACPP (P <.001), ACNP (P <.001), and MCCT (P <.001) were demonstrated in the HCL/pepsin group compared with the control group. No significant difference was seen between preoperative and postoperative values.

Conclusions Nasopharyngeal exposure to simulated gastric juice causes eustachian tube dysfunction in rats. Specifically, middle ear pressure regulation and mucociliary clearance of middle ear contents were disabled. These results support recent reports in the literature linking nasopharyngeal reflux to eustachian tube dysfunction and secondary development of otitis media.

References

1 Teele DW, Klein JO, Fosner B, The Greater Boston Otitis Media Study Group. Epidemiology of otitis media during the first seven years of life in children in Greater Boston: a prospective cohort study. J Infect Dis 1989; 160: 83–94.
10.1093/infdis/160.1.83
CAS PubMed Web of Science® Google Scholar
2 Stool SE, Field MJ. The impact of otitis media. Pediatr Infect Dis J 1989; 8(1 Suppl): Sll–S14.
10.1097/00006454-198901001-00006
Google Scholar
3 Paradise JL, Haggard MP, Lous P, et al. Developmental implications of early-life otitis media. Int J Pediatr Otorhi-nolaryngol 1995; 32(Suppl): S37–S44.
10.1016/0165-5876(94)01140-S
PubMed Web of Science® Google Scholar
4 Bluestone CD. Pathogenesis of otitis media: role of eustachian tube. Pediatr Infect Dis J 1996; 15: 281–291.
10.1097/00006454-199604000-00002
CAS PubMed Web of Science® Google Scholar
5 Bluestone CD, Doyle WJ. Anatomy and physiology of the eustachian tube and middle ear related to otitis media. J Allergy Clin Immunol 1988; 81: 997–1003.
10.1016/0091-6749(88)90168-6
CAS PubMed Web of Science® Google Scholar
6 Cucchiara S, Santamaria F, Minella R, et al. Simultaneous prolonged recordings of proximal and distal intraesopha-geal pH in children with gastroesophageal reflux disease and respiratory symptoms. Am J Gastroenterol 1995; 90: 1791–1796.
CAS PubMed Web of Science® Google Scholar
7 Deschner WK, Benjamin SB. Extraesophageal manifestations of gastroesophageal reflux disease. Am J Gastroenterol 1989; 84: 1–5.
CAS PubMed Web of Science® Google Scholar
8 Halstead LA. Role of gastroesophageal reflux in pédiatrie upper airway disorders. Otolaryngol Head Neck Surg 1999; 120: 208–214.
10.1016/S0194-5998(99)70408-0
CAS PubMed Web of Science® Google Scholar
9 Euler AR. Upper respiratory tract complications of gastroesophageal reflux in adult and pediatric-age patients. Dig Dis 1998; 16: 111–117.
10.1159/000016854
CAS PubMed Web of Science® Google Scholar
10 Gray S, Miller R, Myer CM III, Cotton RT. Adjunctive measures for successful laryngotracheal reconstruction. Ann Otol Rhinol Laryngol 1987; 96: 509–513.
10.1177/000348948709600506
CAS PubMed Web of Science® Google Scholar
11 Cherry J, Marguiles SI. Contact ulcer of the larynx. Laryn- goscope 1968; 73: 1937–1940.
10.1288/00005537-196811000-00007
Web of Science® Google Scholar
12 Kaufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991; 101: 1–65.
Google Scholar
13 Leape LL, Holder TM, Franklin JD, et al. Respiratory arrest in infants secondary to gastroesophageal reflux. Pediatrics 1977; 60: 924–927.
10.1542/peds.60.6.924
CAS PubMed Web of Science® Google Scholar
14 Barbero GJ. Gastroesophageal reflux and upper airway disease. Otolaryngol Clin North Am 1996; 29: 27–38.
CAS PubMed Web of Science® Google Scholar
15 Phipps CD, Wood WE, Gibson WS, et al. Gastroesophageal reflux contributing to chronic sinusitis in children: a prospective analysis. Arch Otolaryngol Head Neck Surg 2000; 126: 831–836.
10.1001/archotol.126.7.831
CAS PubMed Web of Science® Google Scholar
16 Schappert SM. Office visits for otitis media: United States, 1975-1990. Adv Data 1992; 214: 1–19.
PubMed Google Scholar
17 Vandenplas Y, Belli D, Benhamou PH, et al. Current concepts and issues in the management of régurgitation of infants: a reappraisal-management guidelines from a working party. Acta Paediatr 1996; 85: 531–534.
10.1111/j.1651-2227.1996.tb14079.x
CAS PubMed Web of Science® Google Scholar
18 Little JP, Matthews BL, Glock MS, et al. Extraesophageal pédiatrie reflux: 24-hour double-probe pH monitoring of 222 children. Ann Otol Rhinol Laryngol Suppl 1997; 169: S1–S16.
CAS PubMed Google Scholar
19 Pinckney LE, Currarino G. Reflux of barium into the middle ear during upper gastrointestinal series. Radiology 1980; 135: 653–654.
10.1148/radiology.135.3.7384451
CAS PubMed Web of Science® Google Scholar
20 Contencin P, Maurage C, Ployet M, et al. Nasopharyngeal pH monitoring in infants and children with chronic rhinophar-yngitis. Int J Pediatr Otorhinolaryngol 1991; 22: 249–256.
10.1016/0165-5876(91)90079-Q
PubMed Web of Science® Google Scholar
21 Butehorn HF III, Downs BW, Prazma JP, et al. Acute gastroesophageal reflux and eustachian tube function. In: Abstracts of the 1999 Midwinter Meeting of the Association for Research in Otolaryngology. Mt. Royal, NJ: Association for Research in Otolaryngology, 1999: 808.
Google Scholar
22 Heavner SB, Hardy SM, White DR, McQueen CT, Prazma J, Pillsbury HC III. Function of the eustachian tube after weekly exposure to pepsin/hydrochloric acid. Otolaryngol Head Neck Surg 2001; 125: 123–129.
10.1067/mhn.2001.116448
CAS PubMed Web of Science® Google Scholar
23 Wittenborg MH, Neuhauser EB. Simple roentgenographic demonstration of eustachian tubes and abnormalities. Am J Roentgenol Radium Ther Nucl Med 1963; 89: 1194–1200.
CAS PubMed Web of Science® Google Scholar
24 Hurst DS. The association of otitis media with effusion and allergy as demonstrated by intradermal skin testing and eosinophil cationic protein levels in both middle ear effusions and mucosal biopsies. Laryngoscope 1996; 106: 1128–1137.
10.1097/00005537-199609000-00017
CAS PubMed Web of Science® Google Scholar
25 Holma B, Lindegren M, Andersen JM. pH Effects on ciliomotility and morphology of respiratory mucosa. Arch Environ Health 1977; 32: 216–226.
10.1080/00039896.1977.10667285
PubMed Web of Science® Google Scholar
26 Park K, Bakaletz LO, Coticchia JM, et al. Effect of influenza A virus on ciliary activity and dye transport function in the chinchilla eustachian tube. Ann Otol Rhinol Laryngol 1993; 102: 551–558.
10.1177/000348949310200711
CAS PubMed Web of Science® Google Scholar
27 Ohashi Y, Nakai Y, Koshimo H, et al. Ciliary activity in the in vitro tubotympanum. Arch Otorhinolaryngol 1986; 243: 317–319.
10.1007/BF00460209
CAS PubMed Web of Science® Google Scholar
28 Cassidy KT, Geisinger KR, Kraus BB, et al. Continuous versus intermittent acid exposure in production of esophagitis in feline model. Dig Dis Sei 1992; 37: 1206–1211.
10.1007/BF01296561
CAS PubMed Web of Science® Google Scholar
29 Flisberg K, Ingelstedt S, örtegren U. Controlled ‘ear aspiration’ of air: a ‘physiological’ test of the tubal function. Acta Otolaryngol Stockh (Suppl) 1963; 182: 35–38.
10.3109/00016486309139990
Google Scholar
30 Bakaletz LO, Griffith SR, Lim DJ. Effect of prostaglandin E2 and bacterial endotoxin on the rat of dye transport in the eustachian tube of the chinchilla. Ann Otol Rhinol Laryngol 1989; 98: 278–282.
10.1177/000348948909800408
CAS PubMed Web of Science® Google Scholar
31 Miller GF. Eustachian tubal function in normal and diseased ears. Arch Otolaryngol 1965; 81: 41–48.
10.1001/archotol.1965.00750050046011
PubMed Web of Science® Google Scholar
32 Shikowitz MJ, Ilardi CF, Gero M. Immotile cilia syndrome associated with otitis media with effusion: a case report. In: DJ Lim, CD Bluestone, JO Klien, JD Nelson, eds. Recent Advances in Otitis Media: Proceedings of the Fourth International Symposium. Philadelphia: Decker, 1988: 304–307.
Google Scholar
33 Bothwel MR, Parsons DS, Talbot A, et al. Outcome of reflux therapy on pédiatrie chronic sinusitis. Otolaryngol Head Neck Surg 1999; 121: 255–261.
10.1016/S0194-5998(99)70181-6
PubMed Web of Science® Google Scholar

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Gastroesophageal Reflux and Eustachian Tube Dysfunction in an Animal Model^†^‡^§