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Aims: To assess co-morbidity and risk factors for otitis media, tonsillopharyngitis, and lower respiratory infections in school children. Methods: Logistic regression analysis of co-morbidity and risk factors for airway infections in a population based sample of 10 year old children living in Oslo, Norway. Main outcome measures: otitis media, tonsillopharyngitis, and lower respiratory infections in past 12 months. Results: Airway infections in 10 year old children were common, and significant co-morbidity was found between the various airway infections. Home dampness was a risk factor for all infections, adjusted odds ratios ranging from 1.2 (95% CI 1.0 to 1.5) to 1.4 (95% CI 1.1 to 1.6) for otitis media and tonsillopharyngitis respectively. Atopic disease was a constitutional risk factor, particularly strong for lower airway infections (adjusted odds ratio 2.4, 95% CI 1.8 to 3.1). African or Asian ethnicities were associated with the airway infections, adjusted odds ratios ranging from 1.2 (95% CI 0.9 to 1.7) to 1.7 (95% CI 1.2 to 2.3). Conclusions: Respiratory tract infections were common in 10 year old children. There was substantial comorbidity between upper and lower airway infections. Environmental and constitutional factors were identified and positively associated with the infections. Results support the hypothesis of 1957 that the whole respiratory tract is one unit.

To estimate the relative contribution of genetic and environmental effects on the variance in the liability of recurrent tonsillitis.

ObjectivesEstimates of occupation-specific tinnitus prevalence may help identify high-risk occupations where interventions are warranted. The authors studied the effect of occupation on prevalence of bothersome tinnitus and estimated the attributable fraction due to occupation. The authors also studied how much of the effect remained after adjusting for noise exposure, education income, hearing thresholds and other risk factors.DesignA prospective cohort study.SettingA health survey of the Nord-Trøndelag county of Norway.ParticipantsA sample of the general adult population (n=49 948).Primary outcome measureThe primary outcome measure is bothersome tinnitus.ResultsOccupation had a marked effect on tinnitus prevalence. The effect of occupation on tinnitus was reduced in men by controlling for self-reported occupational noise exposure and in women by controlling for education and income. Adding hearing loss as a predictor increased the effect of occupation somewhat. In men, age-adjusted prevalence ratios of tinnitus ranged from 1.5 (workshop mechanics) to 2.1 (crane and hoist operators) in the 10 occupations with highest tinnitus prevalence. In women, the most important contribution to the tinnitus prevalence was from the large group of occupationally inactive persons, with a prevalence ratio of 1.5.ConclusionThis study found a moderate association between occupation and bothersome tinnitus.

A retrospective case record study of 20 patients in Oslo operated on for chronic otitis media with labyrinthine fistula between 1986 and 1999 was performed in order to estimate the incidence of, and identify predictors for, labyrinthine fistulas. The incidence of fistula was 0.3 per 100 000, with a median age at diagnosis of 37 years. The median duration of chronic otitis media prior to labyrinthine fistula detection was significantly correlated with age at surgery. Subjective hearing loss (90%), otorrhoea (65%) and dizziness (50%) were presenting symptoms. Modified canal-wall-down mastoidectomy was performed in all patients. Preoperative hearing levels could not predict postoperative hearing outcome. Positive signs of fistula were found in only 4 patients (20%). Correspondingly, computerized tomography (CT) diagnosed the fistula in 11 patients (55%). The seven patients presenting without dizziness and with a negative CT scan and fistula test were characterized by lower age, absence of previous middle ear surgery, lower preoperative pure-tone thresholds for bone conduction and better hearing outcome after surgery. In conclusion, the identification of a younger group of patients presenting with fewer symptoms indicates that fistulas should be suspected in all patients undergoing surgery for chronic middle ear and mastoid disease.

There is a substantial genetic contribution to individual variation in hearing thresholds.

Objectives To study the extent to which otitis media in childhood is associated with adult hearing thresholds. Furthermore, to study if the effects of otitis media on adult hearing thresholds are moderated by age or noise exposure. Design Population-based cohort study of 32,786 participants who had their hearing tested by pure-tone audiometry in primary school and again at ages ranging from 20–56 years. 3066 children were diagnosed with hearing loss, the remaining sample had normal childhood hearing. Results Compared to participants with normal childhood hearing, those diagnosed with childhood hearing loss caused by otitis media with effusion (n=1255), chronic suppurative otitis media (n=108) or hearing loss after recurrent acute otitis media (n=613) had significantly reduced adult hearing thresholds in the whole frequency range (2 dB/17–20 dB/7–10 dB, respectively). The effects were adjusted for age, sex and noise exposure. Children diagnosed with hearing loss after recurrent acute otitis media had somewhat improved hearing thresholds as adults. The effects of chronic suppurative otitis media and hearing loss after recurrent acute otitis media on adult hearing thresholds were larger in participants tested in middle adulthood (ages 40 to 56 years) than in those tested in young adulthood (ages 20 to 40 years). Eardrum pathology added a marginally increased risk of adult hearing loss (1–3 dB) in children with otitis media with effusion or hearing loss after recurrent acute otitis media. Our study could not reveal significant differences in the effect of self-reported noise exposure on adult hearing thresholds between the groups with otitis media and the group with normal childhood hearing. Conclusions This cohort study indicates that chronic suppurative otitis media and recurrent acute otitis media in childhood are associated with adult hearing loss, underlining the importance of optimal treatment in these conditions. It appears that ears with a subsequent hearing loss after otitis media in childhood age at a faster rate than those without, however this should be confirmed by studies with several follow-up tests through adulthood.

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