Determinants of chronic otitis media with effusion in preschool children: a case–control study

Abstract

BackgroundChronic otitis media with effusion (COME) is a prevalent upper airway infection resulting in hearing loss. The aim of this research was to determine risk factors for COME in preschool children.MethodsA case–control design was conducted in Auckland, New Zealand from May 2011 until November 2013. The cases were children aged 3 and 4 years referred for tympanostomy tube placement due to a diagnosis of COME (n = 178). The controls were a random sample of healthy children aged 3 and 4 years from primary care practices (n = 209). The children’s guardians completed an interviewer-administered questionnaire that covered topics including socio-demographic information, pregnancy and birth, infant feeding practices, home environment, and respiratory health. In addition, skin prick tests for atopy were performed. Odds ratios (OR) estimating the risk of COME independently associated with the exposures were calculated using a logistic regression model.ResultsChildren with COME frequently had nasal obstruction (OR: 4.38 [95% CI: 2.37–8.28]), always snored (OR: 3.64 [95% CI: 1.51–9.15]) or often snored (OR: 2.45 [95% CI: 1.04–5.96]), spent more hours per week in daycare (OR per hour/week: 1.03 [95% CI: 1.00–1.05]), had frequent colds (OR: 2.67 [95% CI: 1.59–4.53]), had siblings who had undergone tympanostomy tube placement (OR: 2.68 [95% CI: 1.22–6.02]), underwent long labour (OR: 2.59 [95% CI: 1.03–6.79]), and had early introduction of cow’s milk (OR: 1.76 [95% CI: 1.05–2.97]). Asian ethnicity (OR: 0.20 [95% CI: 0.07–0.53]) and having older siblings (OR: 0.54 [95% CI: 0.31–0.93]) were inversely associated with COME.ConclusionCOME in preschool children was associated with pathogen exposure, respiratory infection, and nasal obstruction. Strategies to prevent pathogen transmission warrant investigation. The novel findings of long labour and early cow’s milk introduction require replication in future studies.

Higher serum 25(OH)D concentration is associated with lower risk of chronic otitis media with effusion: a case-control study

“…Case and control characteristics are shown in Table . These results resemble those from all enrolled subjects including controls who did not provide blood samples (n = 387), which have been discussed previously .…”

“…In a multivariable model adjusting for potential confounders (age, sex, deprivation index, ethnicity, breastfeeding duration, tobacco smoke exposure and season of blood sampling), higher 25(OH)D concentration remained significantly associated with a lower risk of COME (OR 0.86 per 10 nmol/L; 95% CI 0.77–0.97) (Table ). Adding previously identified risk factors (prolonged labour, cow's milk exposure before 13 months, older siblings, siblings with tympanostomy tubes, frequent colds, day care hours per week, frequent snoring and frequent nasal obstruction) to this model did not alter the association between higher serum 25(OH)D concentration and a lower risk of COME (OR 0.81 per 10 nmol/L; 95% CI 0.70–0.93).…”

“…As previously described, a case–control study of children aged three and four years was conducted in Auckland, New Zealand (latitude 36°S) . Briefly, the cases were children diagnosed with COME, who had been referred for tympanostomy tube placement, and the controls were a random selection of healthy children recruited from primary care practices.…”

“…25(OH)D concentration and season of blood sampling were entered into a multivariable logistic regression model along with age, sex, NZDep, tobacco smoke exposure, breastfeeding duration and ethnicity which were identified as potential confounding variables. A second multivariable logistic regression model that included risk factors previously identified for COME (prolonged labour, cow's milk exposure before 13 months, older siblings, siblings with tympanostomy tubes, frequent colds, day care hours per week, frequent snoring and frequent nasal obstruction) was also entered into a multivariable logistic regression model with age, sex, NZDep, ethnicity, tobacco smoke exposure, breastfeeding duration, season of blood sampling and serum 25(OH)D concentration. A p value of 0.05 or less was considered to indicate statistical significance.…”

Is iron deficiency in children a risk factor in chronic otitis media with effusion?

“…When this condition continues for three months, it is classified as chronic otitis media with effusion (COME). 1,2 OME is the most common cause of hearing loss in childhood worldwide and affects about 80% of children. 3 Risk factors for COME can be summarized as age, ethnicity, and family history, inadequate intake of breast milk, upper respiratory tract infections, and congenital malformations of the upper respiratory tract.…”