The risk factors established for recurrent acute otitis media and capable of being modified were the use of pacifiers and care in daycare centers. The probable risk factors were privation of mother's milk, presence of siblings, craniofacial abnormalities, passive smoking and presence of adenoids. No modifiable factor was classified as unlikely. Among those that need further study are allergy, gastroesophageal reflux and passive smoking during gestation.

Objectives: Chronic otitis media is currently associated with an increase in air conduction thresholds. However, a few groups reported a decrease in sensorineural function in these patients. This study evaluates the occurrence of sensorineural hearing loss in patients with chronic otitis media.Methods: The records of patients with unilateral chronic otitis media were reviewed. Eighty-four patients met the inclusion criteria that were normal otoscopy and normal hearing in the contra lateral ear. Bone conduction threshold averages were calculated over 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz and 4000 Hz frequencies. We compared the bone conductions threshold averages between the normal ear and the ear with chronic otitis media. Thresholds were examined separately for each frequency.Results: The bone conduction threshold averages in the normal side were smaller than those of the chronic otitis media ear. The threshold shift was statistically significant in each frequency (P Ͻ 0.001 t Student test) but in 500 Hz (P ϭ 0.16). There were no differences between the groups when we analyzed the role of age or in the role of the cholesteatoma presence in the sensorineural hearing loss.Conclusions: This study shows that chronic otitis media is associated with decrease in cochlear function. Neither the P231

Objective: Review evidence about modifiable risk factors for recurrent acute otitis media.Source of data: MEDLINE with no language restriction, from January 1966 to July 2005, using descriptors acute otitis media/risk factors. Two hundred and fifty-seven articles were obtained. These included randomized clinical trials, cohorts, case-control and cross-sectional studies that contained analyses of modifiable risk factors for the development of recurrent acute otitis media as the main objective and with samples of individuals up to the age of 18 years. Except when relevant, the following were excluded: non-systematic reviews, reports of cases, series of cases, and medical society guidelines. Summary of data:Nine risk factors linked to the host and eight linked to the environment were identified. Of the first group, allergy, craniofacial abnormalities, gastroesophageal reflux and the presence of adenoids were classified as modifiable. In the second category, upper airway infections, day care center attendance, presence of siblings/family size, passive smoking, breastfeeding and use of pacifiers were included. Afterwards, the risk factors were classified in accordance with levels of evidence. Conclusions:The risk factors established for recurrent acute otitis media and capable of being modified were the use of pacifiers and care in daycare centers. The probable risk factors were privation of mothers milk, presence of siblings, craniofacial abnormalities, passive smoking and presence of adenoids. No modifiable factor was classified as unlikely. Among those that need further study are allergy, gastroesophageal reflux and passive smoking during gestation. J Pediatr (Rio J)