Risk Of Recurrent Acute Otitis Media Research Articles

Adenoidectomy as an Adjuvant to Primary Tympanostomy Tube Placement

Adenoidectomy at initial tympanostomy tube placement (TT) may reduce the rate of repeated surgery for otitis media. To assess the effectiveness of primary adenoidectomy as an adjuvant to TT (Ad + TT) compared with TT alone. PubMed and EMBASE electronic databases were searched with no publication year restrictions beyond those of the individual databases. Articles that compared outcomes of children having undergone primary Ad + TT with children having undergone TT alone for middle ear disease. Medical literature addressing Ad + TT was systematically reviewed. Data extracted included study design, age of children, and follow-up time frame. Level of evidence was assessed, and data were pooled where possible. Proportion of children requiring repeated TT (r-TT). Secondary outcomes included proportion of children with recurrent acute otitis media (RAOM), otitis media with effusion (OME), otorrhea, or any combination of the 3. Fifteen articles met inclusion criteria. Ten studies (n = 71,353) reported that primary Ad + TT decreased the risk of r-TT or risk of RAOM, OME, or otorrhea compared with TT alone. Four studies (n = 538) reported no difference between Ad + TT groups compared with TT-only groups in the prevention of r-TT or of RAOM, OME, or otorrhea. Despite significant heterogeneity, limited meta-analysis and pooling of data revealed that the estimated rate of r-TT for children undergoing primary adenoidectomy was 17.2% (95% CI, 12.2%-22.2%) vs 31.8% (95% CI, 23.9%-39.8%) for children undergoing primary TT only. When stratified by age younger than 4 years, the protective effects of adenoidectomy were diminished. The current evidence suggests that primary Ad + TT may be superior to TT only in decreasing the risk of r-TT and the risk of RAOM, OME, or otorrhea. Limitations include heterogeneity of the source data, with the predominance of retrospective data as well as studies with older children supporting the superiority of adjuvant adenoidectomy. The practice of Ad + TT may decrease the risk of repeated surgery in children older than 4 years.

Genetic susceptibility to otitis media in childhood

Otitis media (OM) is a common disease in early childhood characterized by inflammation of the middle ear cavity. Heritability studies suggest that there is a substantial genetic component (40%-70%) to the risk of recurrent acute OM, defined as three or more episodes in 6 months or four or more episodes in a year, or chronic OM with effusion (COME), defined as middle ear fluid for ≥ 3 months. To date, only a handful of the regions/genes underlying this genetic susceptibility have been identified. These include several regions of linkage on chromosome 3p25, 10q22, 10q26, 17q12, and 19q13 identified by two genome-wide linkage scans, which appear to harbor susceptibility loci. Fine mapping of these regions has yet to identify the causative genes. Several candidate genes studies have also been reported, with candidates selected on the basis of a plausible biological role in OM or through OM mouse models. Reviewed in this article, these studies have identified positive association at 21 genes, including FBXO11, TLR4, and TNF, with association at five of these replicated in independent populations. However, these studies have been based on small sample sizes, and it is only recently that well-powered OM cohorts suitable for genome-wide association studies (GWAS) have become available. Results from such GWAS will identify novel genes involved in this complex disease. Identification of the genes that contribute to OM susceptibility in childhood will provide important insights into the biological complexity of this disease that could ultimately contribute to improved preventative and therapeutic strategies to reduce the incidence of this disease.

Risk factors affecting the occurrence of acute otitis media among 2-3-year-old urban children.

The factors affecting the occurrence and recurrence of acute otitis media (AOM) were studied among 471 2-3-year-old children in two cities in Finland. Of these children, 188 had experienced greater than or equal to 3 attacks of AOM, 76 had had 1-2 attacks and 207 no otitis attacks (= control group). The study showed that the risk of recurrent AOM was increased among those children attending day-care nurseries as well as among those who had several siblings. Proneness to rhinorrhea and exposure to passive smoking at home was associated with an increased risk of AOM, while prolonged breast-feeding (greater than 6 months) seemed to reduce it. No correlation was found between the risk of recurrent AOM and the place of residence or type of housing, the parental otitis history, or atopic diathesis of a child. Thus the study suggested that to protect a young child from AOM we should promote breast-feeding and home-care for babies as well as avoid smoking in the home.