Assessment of the association between atopic conditions and tympanostomy tube placement in children

Abstract

This study assesses the relationship between otitis media and atopic conditions in children by comparing the incidence of tympanostomy tube placement between children with and without atopic conditions: asthma, allergic rhinitis, and atopic dermatitis. Study subjects were a cohort of 323 healthy children who participated in a study of vaccine response. All episodes of tympanostomy tube placement and physician diagnoses of allergic rhinitis and atopic dermatitis were collected through comprehensive medical record review. Asthma status was ascertained through application of established criteria. We compared incidence rates of tympanostomy tube placement between children with and without atopic conditions. We fitted data to a Poisson regression model to calculate relative risk ratios (RRs) and their corresponding 95% confidence intervals (95% CI). Three subjects were excluded who did not have parental authorization for using records for research. Of the remaining 320 subjects, 170 (53%) were male subjects, 268 (94%) were white, 124 (39%) were asthmatic patients, and 20 (6%) had tympanostomy tube placement. Children with asthma before the index date of tympanostomy tube placement were more likely to have tympanostomy tube placement compared with those without asthma (RR, 19.33; 95% CI, 11.41; 32.75; p < 0.001). We found a similar association between asthma ever (before or after index date) and the incidence of tympanostomy tube placement (RR, 1.53; 95% CI, 0.93-2.53; p = 0.095). This was true for children with allergic rhinitis compared with those without allergic rhinitis (RR, 1.70; 95% CI, 1.01-2.86; p = 0.007). Atopic dermatitis was not associated with the incidence of tympanostomy tube placement. Asthma or allergic rhinitis may be unrecognized risk factors for recurrent or persistent otitis media. However, given the small sample size of the study, a cohort study with a larger sample size is necessary.

Risks for infection in patients with asthma (or other atopic conditions): Is asthma more than a chronic airway disease?

“…Children with asthma or other atopic conditions had higher rates of tympanostomy tube placement (a surrogate marker for frequent and persistent ear infections) than those without asthma (risk ratio [RR], [95% CI]: 1.53 [0.93-2.53] or other atopic conditions (RR: 1.70 [1.01-2.86]). 30 Other studies corroborated these study findings with adjusted ORs of 1.40 to 2.70. 36-39 …”

“…Also, oral corticosteroid therapy among patients using vitamin D was not associated with increased risk of pneumonia but decreased the risk of pneumonia. 99 The study findings described above on the association of asthma with the increased risks of serious pneumococcal disease, 28 B pertussis , 50 S pyogenes upper respiratory infections, 40 recurrent/persistent otitis media, 30 H1N1 influenza, 56 community-acquired E coli BSI, 52 and herpes zoster 91 among patients with asthma were independent of the use of inhaled or systemic corticosteroids. Talbot et al 31 reported similar findings.…”

“…There are several potential causal relationships between atopic conditions and microbial infections or colonization: protective (eg, the “hygiene hypothesis”), 22,23 provocative (eg, rhinovirus or bacterial colonization), 24,25 and contextual effects (eg, the microbiome hypothesis), 26,27 as well as reverse causality 20,28-30 (Figure 1). This paper focuses on the effect of atopic conditions on the risk of infections, termed reverse causality .…”

Development and initial testing of Asthma Predictive Index for a retrospective study: an exploratory study

“…(11) Since its development, it has been extensively used in asthma research and has shown excellent construct validity and reliability (0.72–92) of the criteria. (11, 24–28) As most subjects with probable asthma (85%) became definite asthma over time we combined both probable and definite asthma. (11) The onset date of asthma (asthma index date) by PAC, was defined as the earliest constellation of symptoms found in the medical record that met the PAC for asthma regardless of physician diagnosis of asthma.…”

Asthma and severity of 2009 novel H1N1 influenza: a population-based case–control study

“…2–11 Indeed, previous studies showed that people with asthma had increased risk of microbial infections than those without asthma. 12–20 A recent prospective study that compared rates of H1N1 infection between children with and without asthma showed that children with asthma had a higher risk of H1N1 infection during the second peak of the pandemic than non-asthmatics. 21 …”