The Impact of GERD on Middle Ear Health: A Systematic Review With Focus on Psychobehavioral Factors

RESUMO

Sarah fahad alotaibi*, Salem Mansour Abokhanjar, Ghadi Salaiman Aljohani, Khaled Waleed Alomran, Rawan Ibrahim Sangoura, Abdullah Mfwadh Alanazi, Raghad Naif Matrouk Alotaibi, Abdalrahman T. Albader, Razan Abdullah AlQahtani

Background: Otitis Media with Effusion (OME) is a leading cause of hearing loss in children and a significant otologic concern in adults. Emerging research has proposed a potential pathophysiological link between gastroesophageal reflux disease (GERD) and OME, wherein refluxate reaches the middle ear, contributing to mucosal inflammation and fluid accumulation.

Objective: This systematic review aims to evaluate the evidence for a clinical and mechanistic association between GERD and OME, assess the diagnostic utility of reflux biomarkers such as pepsin in middle ear effusions, and analyze the impact of GERD treatment on OME outcomes across Pediatric and adult populations.

Methods: A systematic search of PubMed, Scopus, Cochrane Library, and Google Scholar was conducted for studies published from 2000 to 2025. Studies included involved diagnosed cases of GERD and/or OME and reported prevalence, diagnostic markers, or treatment outcomes. Data were extracted and quality assessed using the Cochrane Risk of Bias Tool and PRISMA guidelines.

Results: Nineteen high-quality studies were included, comprising systematic reviews, meta-analyses, cohort, case-control, and observational designs. Evidence indicated a GERD prevalence of 30–66% among OME patients. Pepsin was detected in 52–86% of middle ear aspirates, and multiple studies reported symptom improvement and reduced OME recurrence following GERD therapy. Genetic evidence also suggests a causal association between GERD susceptibility and chronic otitis media.

Conclusions: There is robust multidisciplinary evidence supporting the involvement of GERD in the pathogenesis of OME. Early reflux evaluation and targeted ant reflux therapy may improve otologic outcomes, particularly in recurrent or treatment-resistant cases. Standardized diagnostic and therapeutic protocols are essential for advancing care.