咽喉反流性疾病在咽鼓管功能障碍中的作用：一项系统综述
Role of Laryngopharyngeal Reflux Disease in Eustachian Tube Dysfunction: A Systematic Review.
文献信息
| PMID | 42760216 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Jerome R Lechien |
| 作者单位 | Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, Paris Saclay University, Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3), Paris, France; Department of Otolaryngology, Elsan Group, Paris, France; Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium. Electronic address: Jerome.Lechien@umons.ac.be. |
| 期刊 | Journal of voice : official journal of the Voice Foundation |
| SCI 分区 | Q1 |
| IF | 2.4 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 探讨咽喉反流性疾病（LPRD）在成人咽鼓管功能障碍（ETD）及相关中耳炎（OM）发生中的作用。
方法： 两名独立研究者按照系统综述和荟萃分析首选报告条目（PRISMA）指南，检索了PubMed、Scopus和Cochrane数据库中报告ETD或OM患者咽喉反流性疾病（LPRD）检查结果的研究。采用非随机研究方法学指数（MINORS）以及Clarity Group和Evidence Partners的工具进行偏倚分析。
结果： 20项临床研究（2100例患者）符合纳入标准。采用基于症状的方法时，LPRD在ETD中的患病率为20.3%至32.6%，在OME中为21.0%至73.3%；采用客观诊断方法时，患病率分别增至高达58.0%和77.4%。相反，在疑似LPRD或确诊GERD的患者中，ETD的检出率为40.0%-54.5%，OME为32.1%。在中耳积液中，胃蛋白酶和胰蛋白酶的检出率高达39.6%。动物模型支持反流物诱导的炎症和进行性咽鼓管损伤。观察到显著的诊断异质性以及低至中等的方法学质量（MINORS平均分：6.7±1.6）。
结论： 现有证据提示，成人LPRD、ETD及相关OM之间可能存在关联，并得到临床和动物数据的相互印证。然而，方法学局限性——包括依赖基于症状的反流诊断以及ETD/OME标准不一致——使无法得出明确的因果结论。需要采用HEMII-pH监测和标准化耳科诊断标准的前瞻性对照研究。
英文摘要
OBJECTIVE: To investigate the role of laryngopharyngeal reflux disease (LPRD) in the development of Eustachian tube dysfunction (ETD) and related otitis media (OM) in adults.
METHODS: Two independent investigators searched PubMed, Scopus, and Cochrane databases for studies reporting laryngopharyngeal reflux disease (LPRD) findings in patients with ETD or OM according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Bias analysis was conducted using Methodological Index for Non-Randomized Studies (MINORS) and the tools of the Clarity Group and Evidence Partners.
RESULTS: Twenty clinical studies (2100 patients) met inclusion criteria. LPRD prevalence ranged from 20.3 to 32.6% in ETD and 21.0 to 73.3% in OME using symptom-based approaches, increasing up to 58.0% and 77.4%, respectively, with objective diagnostic methods. Conversely, ETD was identified in 40.0-54.5% and OME in 32.1% of patients with suspected LPRD or confirmed GERD. Pepsin and trypsin were detected in up to 39.6% of middle ear effusions. Animal models supported refluxate-induced inflammation and progressive Eustachian tube impairment. Substantial diagnostic heterogeneity and low-to-moderate methodological quality (mean MINORS: 6.7±1.6) were observed.
CONCLUSION: Available evidence suggests a probable association between LPRD, ETD, and related OM in adults, supported by converging clinical and animal data. However, methodological limitations-including reliance on symptom-based reflux diagnosis and inconsistent ETD/OME criteria-preclude definitive causal conclusions. Prospective controlled studies using HEMII-pH monitoring and standardized otologic diagnostic criteria are needed.