Why are NICU infants at risk for chronic otitis media with effusion?

Risk Factors for Chronic and Recurrent Otitis Media in Children: A Review Article

Otitis media is an inflammation of the mucous membrane of the middle ear, which includes mastoid air cells, the middle ear cavity, the Eustachian tube, and the mastoid antrum. Otitis media can be either acute, less than six weeks, or chronic, which lasts for more than six weeks. Recurrent otitis media refers to three episodes of the disease occurring within six months or four episodes within one year. There are many risk factors for otitis media among children; however, some of such factors may vary based on the type of otitis media. To highlight the risk factors of chronic and recurrent otitis media in pediatrics. Scientific databases were used to search for articles related to our objective. Various terms were used for the search process. The types of articles included in our review were original articles, review articles, meta-analyses, and systematic reviews written in the English language and concerned with our subject. The topic was discussed under four main titles; the first overviewed the prevalence and risk factors of otitis media, the second title discussed chronic otitis media and its risk factors, the third title discussed recurrent otitis media and its risk factors, and the last title discussed the risk factors of both chronic and recurrent otitis media. There are various risk factors for chronic and recurrent otitis media, and they include allergy, passive smoking, male gender, and snoring. Also, genetics may have a common role, but this needs further investigation.

[Clinical protocol: audiological assessment of infants in Russian Federation. Part II]

This is the second part of the previously published clinical protocol of audiological assessment in infants. The goal of the protocol is unification approaches to audiological diagnosis of the infants. The following sections were included in the second part of the protocol: behavioral testing in infants, testing sequence, duration of the examination and necessity in follow-up, hearing assessment in special cases (premature children, children with congenital infections, after meningitis, with external ear abnormalities, single-sided deafness, with hydrocephalus and shunts, with auditory neuropathy spectrum disorder, with mild hearing loss and otitis media with effusion), medical report.

[Morphological changes in the epithelium of the auditory tube with prolonged respiratory support in children of the first year of life]

OBJECTIVE

To analyze the condition of the epithelium of the cartilaginous part of the auditory tube in premature and full-term infants with prolonged respiratory support using noninvasive assisted ventilation (continuous positive airway pressure - CPAP) and artificial lung ventilation (ventilator).

MATERIAL AND METHODS

All the obtained material is distributed relative to the gestation period into the main and control groups. The main group (25 children) is represented by premature and full-term live-born children who were on respiratory support for a period of several hours to 2 months, the average gestation period of which was 30 weeks and 40 weeks, respectively. The control group (8 children) is represented by stillborn newborns with an average gestation period of 28 weeks. The study was conducted posthumously.

RESULTS

Prolonged use of respiratory support in premature and full-term children, regardless of the type (CPAP or ventilator), leads to a violation of the row of cilia of the ciliated epithelium, various inflammatory processes, as well as to the expansion of the ducts of the mucous glands of the epithelium of the auditory tube, which affects its drainage system.

CONCLUSION

Prolonged respiratory support causes destructive changes in the epithelium of the auditory tube, which make it difficult to evacuate the mucous discharge from the tympanic cavity. This negatively affects the ventilation function of the auditory tube and in the future may lead to the development of chronic exudative otitis media.

Comparison of 1000 Hz-, 226 Hz-probe tone tympanometry and magnetic resonance imaging in evaluating the function of middle ear in infants

INTRODUCTION

Universal newborn hearing screening proved to be an effective measure to screen out hearing-disability infants at a younger age, from which testified the existence of middle ear fluid or effusion was one major source of referred screening result. Some reports had verified the comparative advantage of using the 1000-Hz probe tone for tympanometry in infants, while little was known about the accordance to imaging manifestations, especially the findings of Magnetic Resonance Imaging (MRI).

OBJECTIVE

To investigate the diagnostic consistency between 226 Hz-, 1000 Hz- probe tone tympanometry and MRI in infants after hearing screening.

METHOD

226 Hz and 1000 Hz probe-tone tympanometry were tested followed by MRI in 58 infants. According to MRI results, patients were divided into Group 1 with abnormal middle ears with fluid, Group 2 with normal middle ears. Tympanometry included tympanograms, volume of ear cannal (Vec, mL), compliance of peak (Y, mmho), the width at the pressure of ±50dapa (TW, daPa), the pressure of the peak (TPP, daPa). The data were analyzed by statistic software SPSS19.0.

RESULTS

In group 2, 92.41% were negative tympanograms(n = 73), 7.59% was positive tympanograms(n = 6) at 1000 Hz; while 91.14% was negative tympanograms (n = 72), 8.86% was positive tympanograms (n = 7) at 226 Hz. In group 1, 80.00% were positive tympanograms(n = 28), 20.00% was negative tympanograms (n = 7) at 1000 Hz; while 80.00% was negative tympanograms (n = 28), 20.00% was positive tympanograms (n = 7) at 226 Hz. McNemar test demonstrated that there was no significant difference between 1000 Hz and MRI diagnosis (P = 1.000), while significant difference between 226 Hz and MRI test (P = 0.001). Diagnostic concordance rate between 1000 Hz tympanometry and MRI (Kappa = 0.730, p = 0.000) was significantly higher than 226 Hz tympanometry (Kappa = 0.134, p = 0.095). Normal data of 1000 Hz tympanometry showed Vec was 0.71 ± 0.28ml, Y was 0.82 ± 0.49mmho, TW was 124.60 ± 27.68dapa, and TPP was 11.83 ± 73.73dapa.

CONCLUSION

1000 Hz tympanometry significantly had a better diagnostic agreement with MRI than 226 Hz. Clinically, 1000 Hz but not 226 Hz tympanometry is recommended to diagnose otitis middle ear fluid in infants.

[Newborn Hearing Screening and Subsequent Diagnostic Evaluation: Analysis and Outcomes of 6,063 Infants Born in a Community Hospital]

A retrospective study was conducted to examine the implementation status of newborn hearing screening (NHS) of 6,063 infants born in a single community hospital in Japan between 2005 and 2013. An automated auditory brainstem response device was used for NHS and an auditory brainstem response was mainly used for further diagnostic evaluation. Although the participation rate in the NHS was 88.8% in 2013, increasing year by year, it failed to reach 100% probably because NHS is a charged option under the current Japanese healthcare system. Among 40 (0.66%) infants who finally failed their NHS, 34 were referred for subsequent diagnostic evaluation and the remaining 6 were lost to follow-up. Thirty-one of these 34 were diagnosed as having hearing impairment and 3 (0.05%) were identified as having normal hearing, which is considered as a false positive. Both the final referral rate and the hearing impairment rate were significantly higher in the high-risk than in the low-risk group. Compared to the previous national report, the rate of bilateral hearing impairment (0.33%) was significantly higher in this study. Ten (38.5%) out of 26 in the high-risk group were most often diagnosed with otitis media with effusion (OME), while 4 (50%) out of 8 in the low-risk group were diagnosed as having sensorineural hearing loss. Seven (35%) out of 20 with bilateral hearing impairment attained a normal hearing level at a median age of 18 months. Although the primary aim of NHS is early detection of congenital permanent hearing loss, OME is observed commonly in NHS-failed infants. It is therefore important to examine the middle ear status carefully as part of the diagnostic evaluation. Thirty-four infants underwent further diagnostic evaluation at a median age of 46 days, and hearing aids were given in 10 of them at a median age of 5.6 months without delay. Because high-risk patients often tend to be lost to follow-up, otolaryngologists have to give a detailed explanation to caregivers and to build a solid support system for children with hearing impairment.

Prevalence and risk factors of chronic otitis media: the Korean National Health and Nutrition Examination Survey 2010-2012

Background

The performance of nationwide studies of chronic otitis media (COM) in adults has been insufficient in Korea. We evaluated the prevalence and risk factors of COM in Korea.

Methods

This study was conducted using data from the fifth Korean National Health and Nutrition Examination Survey (n = 23,621). After excluding the subjects under 20 year old and suffered from cancers, 16,063 patients were evaluated for COM. Participants underwent a medical interview, physical examination, endoscopic examination, and blood and urine test. COM was diagnosed by trained residents in the Department of Otorhinolaryngology using an ear, nose, and throat questionnaire and otoendoscopy findings. Data on the presence and absence of COM were collected. Multivariate logistic regression analyses were performed to identify its risk factors.

Results

Of the 16,063 participants aged above 20 year old, the weighted prevalence of COM was 3.8%. In the multivariate analyses, the following factors showed high odds ratios (ORs) for COM: pulmonary tuberculosis (adjusted OR, 1.78; 95% confidence interval [CI], 1.06-3.01), chronic rhinosinusitis (adjusted OR, 1.87; 95% CI, 1.17-2.98), mild hearing impairment (adjusted OR, 1.95; 95% CI, 1.34-2.85), moderate hearing impairment (adjusted OR, 4.00; 95% CI, 2.21-7.22), tinnitus (adjusted OR, 1.82; 95% CI, 1.34-2.49), increased hearing thresholds in pure tone audiometry in the right ear (adjusted OR, 1.02; 95% CI, 1.01-1.03), and left ear (adjusted OR, 1.03; 95% CI, 1.02-1.04). The following factors showed low odds ratios for COM: hepatitis B (adjusted OR, 0.28; 95% CI, 0.08-0.94) and rhinitis (adjusted OR, 0.60; 95% CI, 0.42-0.88). In addition, high levels of vitamin D, lead, and cadmium, EQ-5D index; and low red blood cell counts were associated with development of COM (Student’s t-test, P < 0.01).

Conclusions

Our population-based study showed that COM is not rare in Korea, and its development may be associated with various host and environmental factors. Further research on its relationships and the pathogenesis are needed.

Incidence and factors associated with sensorineural and conductive hearing loss among survivors of congenital diaphragmatic hernia

PURPOSE

The reported incidence of sensorineural hearing loss (SNHL) in long-term survivors of congenital diaphragmatic hernia varies widely in the literature. Conductive hearing loss (CHL) is also known to occur in CDH patients, but has been less widely studied. We sought to characterize the incidence and risk factors associated with SNHL and CHL in a large cohort of CDH patients who underwent standardized treatment and follow-up at a single institution.

METHODS

We retrospectively reviewed charts of all CDH patients in our pulmonary hypoplasia program from January 2004 through December 2012. Categorical variables were analyzed by Fisher's exact test and continuous variables by Mann-Whitney t-test (p≤0.05).

RESULTS

A total of 112 patients met study inclusion criteria, with 3 (2.7%) patients diagnosed with SNHL and 38 (34.0%) diagnosed with CHL. SNHL was significantly associated with requirement for ECMO (p=0.0130), prolonged course of hospitalization (p=0.0011), duration of mechanical ventilation (p=0.0046), requirement for tracheostomy (p=0.0013), and duration of loop diuretic (p=0.0005) and aminoglycoside therapy (p=0.0003).

CONCLUSIONS

We have identified hearing anomalies in over 30% of long-term CDH survivors. These findings illustrate the need for routine serial audiologic evaluations throughout childhood for all survivors of CDH and stress the importance of targeted interventions to optimize long-term developmental outcomes pertaining to speech and language.

Risk factors for chronic and recurrent otitis media-a meta-analysis

Risk factors associated with chronic otitis media (COM) and recurrent otitis media (ROM) have been investigated in previous studies. The objective of this study was to integrate the findings and determine the possible risk factors for COM/ROM based on our meta-analysis. A comprehensive search of electronic bibliographic databases (PubMed, Embase, CNKI and Wanfang database) from 1964 to Dec 2012, as well as a manual search of references of articles, was performed. A total of 2971 articles were searched, and 198 full-text articles were assessed for eligibility; 24 studies were eligible for this meta-analysis. Regarding risk factors for COM/ROM, there were two to nine different studies from which the odds ratios (ORs) could be pooled. The presence of allergy or atopy increased the risk of COM/ROM (OR, 1.36; 95% CI, 1.13–1.64; P = 0.001). An upper respiratory tract infection (URTI) significantly increased the risk of COM/ROM (OR, 6.59; 95% CI, 3.13–13.89; P<0.00001). Snoring appeared to be a significant risk factor for COM/ROM (OR, 1.96; 95% CI, 1.78–2.16; P<0.00001). A patient history of acute otitis media (AOM)/ROM increased the risk of COM/ROM (OR, 11.13; 95% CI, 1.06–116.44; P = 0.04). Passive smoke significantly increased the risk of COM/ROM (OR, 1.39; 95% CI, 1.02–1.89 P = 0.04). Low social status appeared to be a risk factor for COM/ROM (OR, 3.82; 95% CI, 1.11–13.15; P = 0.03). Our meta-analysis identified reliable conclusions that allergy/atopy, URTI, snoring, previous history of AOM/ROM, Second-hand smoke and low social status are important risk factors for COM/ROM. Other unidentified risk factors need to be identified in further studies with critical criteria.

Haemophilus influenzae and Streptococcus pneumoniae: living together in a biofilm

Streptococcus pneumoniae and Haemophilus influenzae are both commensals of the human nasopharynx with an ability to migrate to other niches within the human body to cause various diseases of the upper respiratory tract such as pneumonia, otitis media and bronchitis. They have long been detected together in a multispecies biofilm in infected tissue. However, an understanding of their interplay is a recent field of study, and while over recent years, there has been research that has identified many specific elements important in these biofilms, to date, it remains questionable whether the relationship between H. influenzae and S. pneumoniae is competitive or cooperative. Additionally, the factors that govern the nature of the interspecies interaction are still undefined. This review aims to collate the information that has emerged on the cocolonization and co-infection by S. pneumoniae and nontypeable H. influenzae (NTHi) and their formation of a multispecies biofilm.

Effects of secondhand smoke exposure on the health and development of african american premature infants

Objective. To explore the effects of secondhand smoke exposure on growth, health-related illness, and child development in rural African American premature infants through 24 months corrected age. Method. 171 premature infants (72 boys, 99 girls) of African American mothers with a mean birthweight of 1114 grams. Mothers reported on household smoking and infant health at 2, 6, 12, 18, and 24 months corrected age. Infant growth was measured at 6, 12, 18, and 24 months, and developmental assessments were conducted at 12 and 24 months. Results. Thirty percent of infants were exposed to secondhand smoke within their first 2 years of life. Secondhand smoke exposure was associated with poorer growth of head circumference and the development of otitis media at 2 months corrected age. Height, weight, wheezing, and child development were not related to secondhand smoke exposure. Conclusion. Exposure to secondhand smoke may negatively impact health of rural African American premature infants. Interventions targeted at reducing exposure could potentially improve infant outcomes.

Conductive hearing loss in children with bronchopulmonary dysplasia: a longitudinal follow-up study in children aged between 6 and 24 months

AIMS

To determine the occurrence of isolated and recurrent episodes of conductive hearing loss (CHL) during the first two years of life in very low birth weight (VLBW) infants with and without bronchopulmonary dysplasia (BPD). STUDY DESIGN, SUBJECTS AND OUTCOME MEASURES: In a longitudinal clinical study, 187 children were evaluated at 6, 9, 12, 15 18 and 24 months of age by visual reinforcement audiometry, tympanometry and auditory brain response system.

RESULTS

Of the children with BPD, 54.5% presented with episodes of CHL, as opposed to 34.7% of the children without BPD. This difference was found to be statistically significant. The recurrent or persistent episodes were more frequent among children with BPD (25.7%) than among those without BPD (8.3%). The independent variables that contributed to this finding were small for gestational age and a 5 min Apgar score.

CONCLUSIONS

Recurrent CHL episodes are more frequent among VLBW infants with BPD than among VLBW infants without BPD.

Tympanometry in infants with middle ear effusion having been identified using spiral computerized tomography

PURPOSE

This study was carried out to evaluate the diagnostic value of 226 and 1000 Hz probe-tone tympanometry in infants with effusion in the middle ear.

METHODS

For this study, we recruited 52 infants with ages 42 days to 6 months as clinical subjects in a hearing-ability screening program. After a spiral computerized tomography (CT) scan of the patients, we tested their hearing using tympanometry of 2 probe-tone frequencies: 226 and 1000 Hz. The patients were divided into 2 groups according to the results of the CT scan: group 1 patients had normal middle ears without fluid, and group 2 patients had ears with fluid. We recorded the tympanograms and their percentage of every type and compared the tympanometric results with CT to get the concordance rate between tympanometry and CT diagnose while obtaining the normal values of 1000 Hz tympanometric measures.

RESULTS

The 226 Hz probe-tone tympanograms of middle ears with fluid differed greatly from those without. At 226 Hz, their tympanograms were single-peaked tympanograms (51.06%), double-peaked tympanograms (44.68%), flat tympanograms (2.13%), and negative-pressure tympanograms (2.13%) for the group with normal middle ears, but single-peaked tympanograms (77.19%), double-peaked tympanograms (19.30%), and flat tympanograms (3.51%) for the group with middle ear effusion. The 1000 Hz probe-tone tympanograms included single-peaked or flat-type tympanograms in both the normal middle ear group and the group with middle ear effusion. The group with normal middle ears was identified by spiral CT, and its tympanograms mostly had a single peak (97.87%) during 1000 Hz tympanometry. Tympanograms of the middle ear effusion group mostly had a flat curve (98.25%). When the Liden/Jerger classification system was used to evaluate the tympanograms, normal tympanograms were single-peaked, and flat tympanograms indicated middle ear effusion. According to this standard, the concordance rate between the 1000 Hz tympanometry (98.08%) and CT diagnosis was higher than when 226 Hz tympanometry (25%) (P < .05) was performed, and the value of kappa was equal to 0.961 between 1000 Hz tympanometry and CT diagnosis.

CONCLUSIONS

In clinical practice, 1000 Hz tympanometry, not 226 Hz, is recommended to determine the presence of middle ear fluid in infants younger than 6 months.

Recurrent otitis media with effusion in preterm infants with histologic chorioamnionitis--a 3 years follow-up study

BACKGROUND

Recurrent otitis media with effusion (OME) is a leading cause of acquired hearing loss in childhood. Histological chorioamnionitis (HCA) is an important cause of preterm delivery and neonatal morbidity and mortality. Here, we tested the hypothesis of an association between recurrent OME during the first 3 years of life and HCA in very low birth weight (VLBW) infants.

METHODS

A total of 110 randomly selected VLBW preterm newborns with HCA and 135 gestational age and gender-matched, HCA-negative VLBW infants were evaluated prospectively during the first 3 years of life for the presence of OME, as diagnosed on the basis of otoscopy, type B or C tympanogram, ipsilateral absence of transient evoked otoacoustic emissions responses, and ipsilaterally increased threshold at diagnostic auditory brain responses evaluation. Potential risk factors for OME were also examined in the two groups.

RESULTS

The HCA-positive infants showed a approximately six times higher frequency of recurrent OME (P<0.0001), increased frequency (>5/yr) of clinical otitis media episodes (P=0.000020), approximately five times higher frequency of adenoid hypertrophy (P<0.00001), a significant seasonal pattern of birth with autumn predominance (P<0.00001), and the first OME occurred earlier (P<0.0001), as compared to the HCA-negative counterparts. Recurrent OME was significantly associated with HCA (O.R.=17.76, 95% CI: 8.98-35.13, P<0.00001), adenoid hypertrophy (O.R.=9.96, 95% CI: 5.17-19.18, P<0.00001), frequency of acute otitis episodes >5/yr (O.R.=8.91, 95% CI: 1.96-40.41, P=0.0005), and birth in autumn (O.R.=5.58, 95% CI: 2.79-11.12, P<0.00001).

CONCLUSIONS

These findings indicate that HCA is a previously unrecognized risk factor for the development of recurrent bilateral OME in VLBW preterm infants during the first 3 years of life.

High frequency immittance for neonates: a normative study

CONCLUSION

High frequency immittance measurements demonstrate promise in clarifying middle ear status for neonates but age- and gender-specific norms should be consulted.

OBJECTIVE

To describe high frequency immittance measurements using a 1000 Hz probe tone for a sample of 278 neonatal ears (0-4 weeks of age) in order to compile normative tympanometric and acoustic reflex criteria.

SUBJECTS AND METHODS

Assessment of neonatal ears included 1000 Hz probe tone immittance measurements (tympanograms and ipsilateral acoustic reflexes), and distortion product oto-acoustic emission (DPOAE) screening. Results were compared and normative values were compiled for immittance measures in ears controlled for normal middle ear functioning (n=250).

RESULTS

Comparison of immittance results to OAE screening outcome provides estimates of sensitivity and specificity for middle ear fluid with tympanometry of 57% and 95%, and 57% and 90% for acoustic reflex presence, and 58% and 87% for combined tympanogram and acoustic reflex results, respectively. Normative data indicate that static peak admittance values differ significantly across gender and age with the 5th percentile cut-off value for the entire sample at 1.4 mmho. The 90% range of tympanic peak pressure normative values increases with increasing age from 140 daPa for neonates 1 week of age to 210 daPa for neonates 2-4 weeks of age. Acoustic reflexes were elicited at 93+/-9 dB with a 90% normality range of 80-105 dB.

What is new in otitis media?

The "wait and see" approach in acute otitis media (AOM), consisting of postponing the antibiotic administration for a few days, has been advocated mainly to counteract the increased bacterial resistance in respiratory infections. This approach is not justified in children less than 2 years of age and this for several reasons. First, AOM is an acute inflammation of the middle ear caused in about 70% of cases by bacteria. Redness and bulging of the tympanic membrane are characteristic findings in bacterial AOM. Second, AOM is associated with long-term dysfunction of the inflamed eustachian tube (ET), particularly in children less than 2 years of age. In this age group, the small calibre of the ET together with its horizontal direction result in impaired clearance, ventilation and protection of the middle ear. Third, recent prospective studies have shown poor long-term prognosis of AOM in children below 2 years with at least 50% of recurrences and persisting otitis media with effusion (OME) in about 35% 6 months after AOM. Viruses elicit AOM in about 30% of children. A prolonged course of AOM has been observed when bacterial and viral infections are combined because viral infection is also associated with ET dysfunction in young children. Bacterial and viral testing of the nasopharyngeal aspirate is an excellent tool both for initial treatment and recurrence of AOM. Antibiotic treatment of AOM is mandatory in children less than 2 years of age to decrease inflammation in the middle ear but also of the ET particularly during the first episode. The best choice is amoxicillin because of its superior penetration in the middle ear. Streptococci pneumoniae with intermediary bacterial resistance to penicillin are particularly associated with recurrent AOM. Therefore the dosage of amoxicillin should be 90 mg/kg per day in three doses. In recurrent AOM with beta-lactamase-producing bacilli, amoxicillin should be associated with clavulanic acid at a dose of 6.4 mg/kg per day. The duration of the treatment is not established yet but 10 days is reasonable for a first episode of AOM. OME may be a precursor initiating AOM but also a complication thereof. OME needs a watchful waiting approach. When associated with deafness for 2-3 months in children over 2 years of age, an antibiotic should be given according to the results of the bacterial resistance in the nasopharyngeal aspirate. The high rate of complications of tympanostomy tube insertion outweighs the beneficial effect on hearing loss. The poor results of this procedure are due to the absence of effects on ET dysfunction. Pneumococcal vaccination has little beneficial effects on recurrent AOM and its use in infants needs further studies. Treatment with amoxicillin is indicated in all children younger than 2 years with a first episode of AOM presenting with redness and bulging of the tympanic membrane. Combined amoxicillin and clavulanic acid should be given in patients with beta-lactamase-producing bacteria. The duration of treatment is estimated to be at least 10 days depending on the findings by pneumo-otoscopy and tympanometry. Bacterial and viral testing of the nasopharyngeal aspirate is highly recommended particularly in children in day care centres as well as for regular follow-up. The high recurrence rate is due to the long-lasting dysfunction of the eustachian tube and the immune immaturity of children less than 2 years of age.

Low prevalence of hearing impairment among very low birthweight infants as detected by universal neonatal hearing screening

OBJECTIVES

To (a) study the prevalence of hearing impairment in a cohort of very low birthweight (VLBW) infants and (b) evaluate the effectiveness of transient evoked otoacoustic emissions (TEOAE) as a first stage in-hospital hearing screening tool in this population.

STUDY DESIGN

The study group was a cohort of 346 VLBW infants born in 1998-2000 at The Sheba Medical Center. The prevalence of hearing impairment in the study group was compared with that of all other newborn infants participating in a universal newborn hearing screening programme during the same period. To evaluate the effectiveness of TEOAE, a control group of 1205 healthy newborns who had no known risk factors for hearing impairment was selected. The results and follow up of hearing screening for these infants were examined retrospectively.

RESULTS

Only one VLBW infant (0.3%) was diagnosed with bilateral sensory-neural hearing loss. In addition, nine infants (2.7%) were diagnosed with conductive hearing loss. Bronchopulmonary dysplasia and low Apgar score were the most significant factors for predicting the occurrence of conductive hearing loss. The percentage of VLBW infants who successfully passed the in-hospital TEOAE screening was 87.2, compared with 92.2% in the full term control group. No false negative cases were detected on follow up.

CONCLUSIONS

The study shows a low incidence of sensory-neural hearing loss in a cohort of VLBW infants and a relatively high incidence of conductive hearing loss. TEOAE screening was found to be an effective first stage in-hospital hearing screening tool in this population.

Birth characteristics and recurrent otitis media with effusion in young children

OBJECTIVE

To study the association between birth characteristics and the recurrence of otitis media with effusion (OME).

METHODS

Prospective cohort study on 136 children aged 2-7 years, who received tympanostomy tubes for bilateral otitis media with effusion. Checkups were planned 1 week after tube insertion and once every 3 months thereafter. An otologist examined the ear status to assess tube extrusion and otitis media with effusion recurrence. Outcome measure was the recurrence of otitis media with effusion within 6 months after documentation of spontaneous tube extrusion. Birth characteristics were investigated in relation with the recurrence of otitis media with effusion in 90 children with known clinical outcome.

RESULTS

No statistically significant associations were found between various birth characteristics and the recurrence of otitis media with effusion. Multivariate analyses showed positive but fairly weak associations between recurrence of otitis media with effusion and low birth weight (<2500 g) and/or low gestational age (<37 weeks) and/or a history of incubator care (odds ratio (OR) 1.95, 95% confidence interval (CI): 0.21-18.2), male sex (OR 1.85, 95% CI: 0.56-6.13) and maternal medication use during pregnancy (OR 4.80, 95% CI: 0.57-40.72). A remarkable finding was the asymmetrical distribution of certain birth characteristics within the group of children with recurrence of otitis media with effusion: children with unilateral recurrence had a relatively lower gestational age, lower birth weight, lower 'birth length to birth weight' ratio than the children with bilateral recurrence.

CONCLUSION

These findings suggest that determination of birth characteristics cannot help us in the treatment strategy for recurrent otitis media with effusion in childhood.