Recent findings from studies of populations of children with and without otitis media show that a poor ability to equalize negative pressure is a fundamental deficit of eustachian tube function. Not only was active function found to be poor in children with otitis media with effusion, it was also impaired in healthy children, as compared to adults. However, the deficit improved with age and time. The active rather than the passive tubal function seems to be of critical importance with respect to proneness to recurrent acute otitis media and secretory otitis media. This suggests the involvement of primarily a eustachian tube opening dysfunction or muscular opening hypofunction in children, which is considered to be a primary endogenous etiologic factor. In a subgroup of children with recurrent acute otitis media or secretory otitis media, habitual sniffing in combination with closing failure and poor active function may be a possible mechanism for the development of otitis media.
In a retrospective study of 179 otitis-prone children and 305 controls, various possible predisposing factors for acute otitis media (AOM) were compared. The children were matched for age and sex. There were 61% boys and 39% girls in the otitis-prone group and 58% boys and 42% girls among the controls. Eighty-eight (49%) of the otitis-prone children experienced > or = 11 episodes of AOM and 162 (53%) of the controls had none or at the most one episode of AOM. There were no differences between the groups concerning dwelling districts, the size of family, number of siblings or the education and occupation of the parents. In the otitis-prone group there were more fathers who had been otitis-prone as children. This was not seen for the mothers when comparing all the children, but was seen when comparing the most otitis-prone (> or = 11 AOM) with the controls (0-1 AOM). The otitis-prone children more often had siblings who were otitis-prone compared with the controls. There were no differences between the two groups regarding pregnancy, birthweight or duration of breast-feeding. Thus, male gender and heredity for middle-ear problems appeared to be of importance for otitis-proneness.
In a retrospective study of 179 otitis-prone children and 305 controls, various possible predisposing factors for acute otitis media (AOM) were compared. The children were matched with the controls for age and sex. There were 61% boys and 39% girls in the otitis-prone group and 58% boys and 42% girls among the controls. Information about the family and living conditions, the children's illnesses, ear, nose and throat (ENT) operations and possible allergies were obtained from a questionnaire, and the children were called for a physical examination. The otitis-prone children had more middle-ear problems with pathological tympanograms and conductive hearing loss than the controls. No differences were found in bacterial colonization of the nasopharynx. Besides AOM and secretory otitis media, the otitis-prone children had more other ENT diseases and had consequently undergone more ENT operations and hospitalizations than the controls. There were no differences between the two groups regarding allergy, day care or parental smoking alone, but on comparing children with combinations of these factors there were more otitis-prone children than controls exposed, indicating an additive effect. The combination of different factors, less important separately, may for some children mean the difference between becoming otitis-prone or not.
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