Association Between Laryngopharyngeal Reflux and Media Otitis: A Systematic Review

Otol Neurotol. 2021 Aug 1;42(7):e801-e814. doi: 10.1097/MAO.0000000000003123.


Objectives: To investigate the relationship between laryngopharyngeal reflux (LPR) and recurrent (ROM) or chronic otitis media with effusion (COME).

Databases: PubMed, Scopus, and Cochrane Library.

Methods: Three authors searched articles published between January 1980 and September 2020 about the association between LPR and the development of recurrent or chronic otitis media. Inclusion, exclusion, diagnostic criteria, and clinical outcome evaluation of included studies were analyzed using PRISMA criteria. The bias analysis of included studies was evaluated with the Tool to assess Risk of Bias of the CLARITY group.

Results: Twenty-six clinical and three experimental articles met our inclusion criteria, accounting for 1,624 children and 144 adults with COME or ROM. According to the pH study type, the prevalence of LPR and gastroesophageal reflux disease (GERD) in OM patients were 28.7% (range, 8-100%) and 40.7 (range, 18-64%), respectively. The majority of studies identified pepsin or pepsinogen in middle ear effusion, with a range of mean concentrations depending on the technique used to measure pepsin. There was an important heterogeneity between studies regarding definition of COME, ROM, and LPR, exclusion criteria, methods used to measure pepsin/pepsinogen in middle ear secretions and outcome assessments.

Conclusion: The association between LPR and OM is still unclear. Future clinical and experimental studies are needed to investigate the association between LPR and OM in both children and adults through extensive gastric content analysis in middle ear suppurations and impedance-pH monitoring considering acid, weakly acid, and alkaline reflux events.

Publication types

  • Systematic Review

MeSH terms

  • Child
  • Humans
  • Laryngopharyngeal Reflux* / complications
  • Laryngopharyngeal Reflux* / epidemiology
  • Otitis Media with Effusion* / complications
  • Otitis Media with Effusion* / epidemiology
  • Otitis Media*
  • Pepsin A
  • Pepsinogen A


  • Pepsinogen A
  • Pepsin A