New research confirms previous findings that pepsin, the main digestive enzyme in stomach juice, is often found in middle ear fluid obtained from children with chronic otitis.

This suggests an association between the ear problem and gastro-esophageal reflux disease, or GERD, in which gastric juice leaks into the throat. However, these children do not show an increased rate of GERD symptoms.

“Further research is needed to say that GERD actually causes otitis media,” lead author Dr. Judith E. C. Lieu, from Washington University in St. Louis, told Reuters Health.

If there is a cause-and-effect relationship, “I think there could be a total change in the paradigm of how we treat otitis media. Right now, we treat it primarily as an infectious disease,” she added, rather than as a complication of GERD.

If a direct association is established, otitis media could one day be managed with anti-reflux agents, possibly helping many children avoid the need for the placement of drainage tubes in the eardrum - a procedure known as tympanostomy - and other interventions, Lieu pointed out.

The researcher and her colleagues studied 34 children with a history of recurrent or chronic middle-ear disease, otitis media. All of the subjects were candidates for insertion of tympanostomy tubes.

A total of 36 ear fluid samples from 22 children were tested for pepsin, and parents were asked if the children had shown symptoms of GERD.

Two-thirds of ear fluid samples contained pepsin or its precursor, pepsinogen. However, GERD symptoms were no more common in the study group than in a comparison group of children without otitis.

Lieu said that a key to establishing a causal link between GERD and otitis would be to show that the pepsin or pepsinogen came from the stomach and not from elsewhere. Besides the stomach, these proteins “could be coming from the blood or possibly from production in the middle ear itself.”

Lieu concluded that her group hopes to conduct a study to do just that.