DOI QR코드

DOI QR Code

Risk factors for persistent otitis media with effusion in children: a case-control study

  • Lee, Ju Yeon (Department of Pediatrics, Jeju National University Hospital) ;
  • Kim, Se-Hyung (Department of Otorhinolaryngology, Jeju National University School of Medicine) ;
  • Song, Chan Il (Department of Otorhinolaryngology, Jeju National University School of Medicine) ;
  • Kim, Young Ree (Department of Laboratory Medicine, Jeju National University School of Medicine) ;
  • Kim, Yoon-Joo (Department of Pediatrics, Jeju National University School of Medicine) ;
  • Choi, Jae Hong (Department of Pediatrics, Jeju National University School of Medicine)
  • Received : 2018.04.03
  • Accepted : 2018.05.31
  • Published : 2018.06.30

Abstract

Background: Otitis media with effusion (OME) is defined as middle ear effusion without acute signs of infection. OME usually resolves spontaneously; however, persistent OME may require the insertion of a ventilation tube. This study investigated risk factors for persistent OME in children who undergo ventilation tube insertion. Methods: Children who were admitted to undergo ventilation tube insertion at Jeju National University Hospital between August 2015 and July 2016 were enrolled as the case group. Healthy children without persistent OME from August 2016 to July 2017 were enrolled as the control group. Baseline characteristics and predisposing factor data were collected using an interview questionnaire. Middle ear fluids were collected from the case group. Results: A total of 31 patients underwent ventilation tube insertion. The mean age of the case group was 4.53 years, with a male-to-female ratio of 21:10. Twenty-nine (93.5%) children attended a daycare center, and 21 (67.7%) had experience with bottle feeding. Fifteen (48.4%) children in the case group and 3 (9.7%) in the control group first attended a daycare center at <1 year of age (odds ratio=9.96; 95% confidence interval=2.44-39.70; p=0.001). No bacteria were found in middle ear fluid collected from the 31 operated children. Nasopharyngeal bacterial colonization was found in 13 (41.9%) and 17 (54.8%) children in the case and control groups, respectively. Conclusion: Earlier attendance at a daycare center was the only predisposing factor for ventilation tube insertion in our study. The aseptic nature of middle ear fluids found in children with OME highlights the efficacy of antimicrobial use.

Keywords

References

  1. Teele DW, Klein JO, Rosner BA. Epidemiology of otitis media in children. Ann Otol Rhinol Laryngol Suppl 1980;89:5-6.
  2. Williamson IG, Dunleavey J, Bain J, Robinson D. The natural history of otitis media with effusion--a three-year study of the incidence and prevalence of abnormal tympanograms in four South West Hampshire infant and first schools. J Laryngol Otol 1994;108:930-4.
  3. Tos M. Epidemiology and natural history of secretory otitis. Am J Otol 1984;5:459-62.
  4. Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg 2016;154(1 Suppl):S1-41. https://doi.org/10.1177/0194599815623467
  5. Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngol Head Neck Surg 2013;149(1 Suppl):S1-35.
  6. Williamson I. Otitis media with effusion in children. BMJ Clin Evid 2011;2011. pii: 0502.
  7. Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM. Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life. J Pediatr 1993;123:702-11. https://doi.org/10.1016/S0022-3476(05)80843-1
  8. Alles R, Parikh A, Hawk L, Darby Y, Romero JN, Scadding G. The prevalence of atopic disorders in children with chronic otitis media with effusion. Pediatr Allergy Immunol 2001;12:102-6. https://doi.org/10.1046/j.0905-6157.2000.00008.x
  9. Gok U, Bulut Y, Keles E, Yalcin S, Doymaz MZ. Bacteriological and PCR analysis of clinical material aspirated from otitis media with effusions. Int J Pediatr Otorhinolaryngol 2001;60:49-54. https://doi.org/10.1016/S0165-5876(01)00510-9
  10. Kreiner-Moller E, Chawes BL, Caye-Thomasen P, Bonnelykke K, Bisgaard H. Allergic rhinitis is associated with otitis media with effusion: a birth cohort study. Clin Exp Allergy 2012;42:1615-20. https://doi.org/10.1111/j.1365-2222.2012.04038.x
  11. Faden H, Duffy L, Wasielewski R, Wolf J, Krystofik D, Tung Y. Relationship between nasopharyngeal colonization and the development of otitis media in children. J Infect Dis 1997;175:1440-5. https://doi.org/10.1086/516477
  12. Garcia-Rodriguez JA, Fresnadillo Martínez MJ. Dynamics of nasopharyngeal colonization by potential respiratory pathogens. J Antimicrob Chemother 2002;50(Suppl S2):59-73.
  13. Korean Otologic Society. Korean clinical practive guideline: otitis media in children 2014 [Internet]. Seoul: Korean Medical Guideline Information Center; 2014 [cited 2018 April 3]. http://www.otologicalsociety.or.kr
  14. Ahn JH, Yoon TH, Pae KH, Kim TS, Chung JW, Lee KS. Clinical manifestations and risk factors of children receiving triple ventilating tube insertions for treatment of recurrent otitis media with effusion. Pediatrics 2006;117:e1119-23. https://doi.org/10.1542/peds.2005-2520
  15. Pestalozza G, Romagnoli M, Tessitore E. Incidence and risk factors of acute otitis media and otitis media with effusion in children of different age groups. Adv Otorhinolaryngol 1988;40:47-56.
  16. Casselbrant ML, Mandel EM, Doyle WJ. Information on comorbidities collected by history is useful for assigning Otitis Media risk to children. Int J Pediatr Otorhinolaryngol 2016;85:136-40. https://doi.org/10.1016/j.ijporl.2016.03.040
  17. Kim EJ, Kwon YR, Song KH, Jang WN, Lee J, Chang JK, et al. A study on risk factors of recurrent otitis media. Korean J Pediatr Infect Dis 2010;17:91-100. Korean. https://doi.org/10.14776/kjpid.2010.17.2.91
  18. Rovers MM, Zielhuis GA, Ingels K, van der Wilt GJ. Day-care and otitis media in young children: a critical overview. Eur J Pediatr 1999;158:1-6. https://doi.org/10.1007/s004310050999
  19. Khanna R, Lakhanpaul M, Bull PD; Guideline Development Group. Surgical management of otitis media with effusion in children: summary of NICE guidance. Clin Otolaryngol 2008;33:600-5. https://doi.org/10.1111/j.1749-4486.2008.01844.x
  20. Poetker DM, Lindstrom DR, Edmiston CE, Krepel CJ, Link TR, Kerschner JE. Microbiology of middle ear effusions from 292 patients undergoing tympanostomy tube placement for middle ear disease. Int J Pediatr Otorhinolaryngol 2005;69:799-804. https://doi.org/10.1016/j.ijporl.2005.01.012
  21. Kim SH, Jeon EJ, Hong SM, Bae CH, Lee HY, Park MK, et al. Bacterial species and antibiotic sensitivity in korean patients diagnosed with acute otitis media and otitis media with effusion. J Korean Med Sci 2017;32:672-8. https://doi.org/10.3346/jkms.2017.32.4.672
  22. Holder RC, Kirse DJ, Evans AK, Peters TR, Poehling KA, Swords WE, et al. One third of middle ear effusions from children undergoing tympanostomy tube placement had multiple bacterial pathogens. BMC Pediatr 2012;12:87.
  23. Ngo CC, Massa HM, Thornton RB, Cripps AW. Predominant bacteria detected from the middle ear fluid of children experiencing otitis media: a systematic review. PLoS One 2016;11:e0150949. https://doi.org/10.1371/journal.pone.0150949
  24. Farajzadah Sheikh A, Saki N, Roointan M, Ranjbar R, Yadyad MJ, Kaydani A, et al. Identification of Alloiococcus otitidis, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae in children with otitis media with effusion. Jundishapur J Microbiol 2015;8:e17985.
  25. Jervis-Bardy J, Carney AS, Duguid R, Leach AJ. Microbiology of otitis media in Indigenous Australian children: review. J Laryngol Otol 2017;131(S2):S2-11.
  26. Mills N, Best EJ, Murdoch D, Souter M, Neeff M, Anderson T, et al. What is behind the ear drum? The microbiology of otitis media and the nasopharyngeal flora in children in the era of pneumococcal vaccination. J Paediatr Child Health 2015;51:300-6. https://doi.org/10.1111/jpc.12710
  27. Nourizadeh N, Ghazvini K, Gharavi V, Nourizadeh N, Movahed R. Evaluation of nasopharyngeal microbial flora and antibiogram and its relation to otitis media with effusion. Eur Arch Otorhinolaryngol 2016;273:859-63. https://doi.org/10.1007/s00405-015-3637-2