Pepsinogen identification in the middle ear fluid of children with otitis media with effusion

Kulak Burun Bogaz Ihtis Derg. 2016;26(2):73-8. doi: 10.5606/kbbihtisas.2016.83669.


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.

Publication types

  • Comparative Study

MeSH terms

  • Acoustic Impedance Tests / methods
  • Adolescent
  • Albumins / analysis
  • Audiometry, Pure-Tone / methods
  • Biomarkers / analysis
  • Child
  • Child, Preschool
  • Ear, Middle / enzymology*
  • Female
  • Gastroesophageal Reflux / enzymology
  • Humans
  • Male
  • Otitis Media with Effusion / blood
  • Otitis Media with Effusion / enzymology*
  • Otitis Media, Suppurative / enzymology
  • Otoscopy / methods
  • Pepsin A / analysis
  • Pepsin A / blood
  • Pepsinogen A / analysis*
  • Pepsinogen A / blood
  • Serum Albumin / analysis


  • Albumins
  • Biomarkers
  • Serum Albumin
  • Pepsinogen A
  • Pepsin A