Association of Pepsin With Inflammatory Signaling and Effusion Viscosity in Pediatric Otitis Media

Objective Otitis media (OM) is a common inflammatory disease spectrum. Cytokine signaling, neutrophil activity, and mucin hypersecretion during recurrent and chronic OM contribute to persistent, viscous middle ear (ME) effusions, hearing loss, and potential for developmental delay. Extraesophageal r...

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Bibliographic Details
Published in:The Laryngoscope 2022-02, Vol.132 (2), p.470-477
Main Authors: Samuels, Tina L., Khampang, Pawjai, Espahbodi, Mana, McCormick, Caroline A., Chun, Robert H., McCormick, Michael E., Yan, Ke, Kerschner, Joseph E., Johnston, Nikki
Format: Article
Language:English
Subjects:
Child
Child, Preschool
Cross-Sectional Studies
Cytokines
Ear diseases
extraesophageal reflux
Female
Humans
Infant
Laryngopharyngeal reflux
Laryngoscopy
Male
middle ear epithelial cell line
Neutrophils
nonacid reflux
otitis media therapeutics
Otitis Media with Effusion - etiology
Pediatrics
Pepsin A - physiology
Viscosity
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Summary:Objective Otitis media (OM) is a common inflammatory disease spectrum. Cytokine signaling, neutrophil activity, and mucin hypersecretion during recurrent and chronic OM contribute to persistent, viscous middle ear (ME) effusions, hearing loss, and potential for developmental delay. Extraesophageal reflux (EER), specifically pepsin, triggers inflammatory signaling in respiratory mucosa and is associated with OM. The objective of this study was to investigate the association of pepsin with ME inflammatory signaling and the outcomes and examine causality in vitro. Study Design Cross‐sectional study. Methods ME fluid (MEF) and preoperative audiometric data were collected from 30 pediatric subjects undergoing tympanostomy tube placement for recurrent OM or OM with effusion. MEF viscosity was characterized by the surgeon. Pepsin, inflammatory molecules, and mucin were assayed by enzyme‐linked immunosorbent assay (ELISA). ME epithelial primary culture was exposed to 0.1 to 1 mg/ml pepsin at pH 5, 6, and 7 for 30 minutes, and cytokine expression was assayed via qPCR. Results Pepsin was observed in the MEF of 77% of patients (range 71–2,734 ng/ml). Pepsin correlated with effusion viscosity, interleukins −6 and −8, neutrophil elastase, and mucin 5B (P 
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.29749