الفهرس 
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Abstract
OME is primarily a chronic inflammatory condition and the causes of inflammation are multifactorial. But much controversy remains regarding its pathogenesis. An increasing weight of clinical evidence suggests that the refluxed gastric contents may reach to the hypopharynx and nasopharynx (laryngopharyngeal reflux). Reflux of acid and pepsin into the middle ear from the nasopharynx is possible due to the angle of immature Eustachian tube in children. This would cause inflammation of the nasopharynx and Eustachian tube leading to Eustachian tube dysfunction. Gastric reflux may therefore be the primary factor in the initiation of OME.
This study is designed in an attempt to identify any possible etiological relationship between GERD and OME in children. This is verified by detecting the presence or absence of gastric juice in the middle ear in cases of OME. If gastric contents had refluxed into the middle ear, pepsinogen will be present in high concentration in the middle ear effusion , higher than serum concentration.
In this study our sample consisted of 25 children. Mean age was 6.44±1.72, 16 of the study sample are found with pepsinogen in the middle ear and 9 were not found to have pepsinogen in the middle ear. Table (1 &3).
All effusions collected from the 25 child with OME contained pepsinogen protein. The concentrations of pepsinogen protein measured in the
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effusions were found to be higher than the levels found in the serum of the same patients as detected in each case separately.
Immunohistochemical analysis of middle ear biopsy samples demonstrated that the middle ear is not capable of secreting pepsinogen These data show those serum pepsinogens are not being concentrated in the effusion; therefore the pepsinogen detected in the middle ear effusions unlikely to have originated from a transudate of plasma. The only other source is reflux of gastric contents. In this study we estimate level of pepsinogen in middle ear and also in serum estimated by biochemical assays, we found that middle ear concentration (595.9±521.4) ng/ml was statistically significant higher than serum concentration (63.12±14.5) ng/ml, and also we found significant positive correlation between serum absorption and serum concentration also significant positive correlation between middle ear absorption and concentration, (table 2).
This study showed that there were no significant differences between group with pepsinogen in the middle ear and group without regarding age & sex. (table 3).
In this study we showed significant difference between group with and without pepsinogen in middle ear regarding middle ear & serum concentrations (table 4).
This study showed that there were no significant differences between group with pepsinogen in the middle ear and group without regarding upper respiratory disorder except recurrent OM. . (table 5).
And this study showed that there were significant differences between group with pepsinogen in the middle ear and group without regarding GER symptoms , and that suggest that vomiting is very important cause of presence of pepsinogen in the middle ear. (table 6).
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And also our study shows that there was high significant differences between pepsinogen level in serum & middle ear. (table 7).