Otitis Media With Effusion Clinical Trial
Official title:
Role of Empiric Anti-reflux Therapy in Pediatric Otitis Media With Effusion - a Pilot Study
The accumulation of fluid behind the ear drum without any acute inflammation is known as
otitis media with effusion (OME). It is the most common cause of acquired hearing loss
during childhood. Long-term complications of OME include linguistic, developmental, and
social development delays due to hearing loss.
The cause of OME is not known; however, low grade infection of the middle ear, poor function
of the eustachian tube between the ear and the throat, and adenoid hypertrophy have all been
suggested as possible etiologies. Recent detection of the stomach enzyme pepsin in middle
ear fluid has led some to propose that OME is related to the reflux of stomach contents into
the ear, via the eustachian tube.
The purpose of the investigators study is to determine whether anti-reflux medication may
have a positive impact by clearing the accumulation of fluid in the middle ear with the aim
of preventing or reducing hearing loss in children diagnosed with OME. Empiric anti-reflux
therapy with proton pump inhibitor (PPI) medication is safe, proven and cost-effective. It
is used widely as a diagnostic and treatment strategy in the presence of the signs and
symptoms of gastroesophageal reflux disease (GERD). The signs and symptoms of GERD include
heartburn, recurrent vomiting or regurgitation, acid taste in mouth, throat irritation,
voice problems, heartburn, difficult or painful swallowing, asthma and recurrent pneumonia.
This pilot study will be a double-blinded, randomized, placebo-controlled trial that will
compare resolution rates for OME in children treated with lansoprazole or placebo for three
months. At the end of the study, those patients who have persistent middle ear effusions
will be brought to the operating room and have the fluid aspirated and sent for analysis for
pepsin.
Otitis media with effusion (OME) is a condition characterized by the accumulation of
non-purulent fluid in the middle ear space, in the absence of acute inflammation. OME is
diagnosed 2.2 million times annually (U.S. Department of Health & Human Services, 2000). It
is a condition in which more then 50% of children will experience in their first year of
life (National Institutes of Health, 1993). Although many episodes resolve spontaneously,
30% to 40% persist, and 5% to 10% of episodes last 1 year or longer (Yoshinaga-Itano, 1995).
It is particularly more common among children between the ages of one and three years and in
seasons where the prevalence of upper respiratory tract infections is high; with an
incidence of 10% to 30%. It occurs frequently even up to the age of seven, with a prevalence
of 3% to 8%(Fiellau et al, 1997; Fiellau et al, 1983; Lous et al, 1981; Teele et al, 1989).
OME is the most common cause of acquired hearing loss in childhood. Long-term hearing
complications from OME are associated with linguistic, developmental, and social
consequences; especially if the OME is bilateral and of long duration (Fiellau et al, 1983;
Golz et al, 1998; Grace et al, 1990; Lous et al, 1995). The etiology of OME is uncertain;
however, low-grade infection, poor eustachian tube function, formation of biofilms, and
adenoidal infection or hypertrophy have all been suggested as possible etiologies (Faden et
al, 1998; Hall-Stoodley et al, 2006).
Recently, there has been good scientific evidence to suggest that OME is a supraesophageal
manifestation of gastroesophageal reflux disease (GERD), and more specifically
laryngo-pharyngeal reflux (LPR). Tasker et al (2002) investigated the potential role of
gastric reflux in the development of OME in children who underwent myringotomy. Of 65 tested
effusion samples, 59 (91%) effusions gave a positive result. The concentrations of
pepsin/pepsinogen were roughly estimated to be about 1000 times higher than those found in
the serum obtained from a number of controls. They speculated that pepsin found in middle
ear effusion (MEE) was most probably due to micro-aspiration of gastric contents passing
through the eustachian tube (ET) and reaching the middle ear. Lieu et al (2005) performed a
pilot study where they replicated the finding of pepsin/pepsinogen in 17 of 36 (77%) middle
ear fluid aspirates, obtained from 22 children who underwent tympanostomy tube placement for
chronic or recurrent otitis media (OM).
Based on our literature review, we believe there is sufficient scientific evidence to
support the empiric treatment of suspected GERD and LPR in patients with OME. Empiric
anti-reflux therapy is a safe, proven, cost-effective diagnostic and treatment strategy used
widely in the presence of other signs and symptoms of suspected GERD. This pilot study will
be a double-blinded, randomized control trial. It will compare hearing outcomes for children
with OME being treated with lansoprazole versus placebo for three months. We believe there
is sufficient evidence to support the use of this strategy in patients with suspected GERD
and LPR who present with OME.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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