A case-control study of nutritional factors associated with chronic suppurative otitis media in Yemeni children

Clinical impact of major pathogenic genotypes of Pseudomonas aeruginosa associated with refractory chronic suppurative otitis media

PURPOSE

Chronic suppurative otitis media (CSOM) is characterized by persistent inflammation of the mucous membrane of the middle ear and mastoid. One of the primary causative agents of CSOM is P. aeruginosa, known for its production of virulent toxins and enzymes. Some cases of CSOM, improvement may not occur despite treatment lasting three weeks, leading to what is termed refractory CSOM. This research aims to characterize the P. aeruginosa strains isolated from patients with refractory CSOM in Gyeongsangnam-do, South Korea, providing insights into their pathogenic profiles.

METHODS

We conducted a retrospective analysis of P. aeruginosa isolates from the otorrhea of patients diagnosed with CSOM at a tertiary hospital in Gyeongsangnam-do, over a period from January 2005 to August 2022. The strains were examined using multilocus sequence typing (MLST) and toxin gene assay to assess genetic diversity and virulence.

RESULTS

39 samples were obtained from 13 cases of refractory CSOM and 15 cases of non-refractory CSOM. The findings unveiled that the P. aeruginosa cultured from patients with refractory CSOM belonged to the P. aeruginosa sequence type 235 (ST235) strain, which harbors the exoU gene as a major virulence factor.

CONCLUSION

The detection of ST235 in refractory CSOM signifies a challenging clinical scenario. Given the genotype's strong virulence and antibiotic resistance, identifying ST235 through MLST can guide effective management approaches, including potential surgical intervention. This study underscores the necessity of broader epidemiological investigations to understand ST235 behavior and advocates for patient education to mitigate the impacts of this formidable pathogen in CSOM.

Association of iron deficiency with chronic suppurative otitis media in adults

BACKGROUND

Chronic suppurative otitis media (CSOM) is a prevalent chronic inflammatory disease globally. Current research suggests a possible association between anaemia and the development of CSOM.

OBJECTIVES

The objective of this trial was to investigate the relationship between iron metabolism and chronic suppurative otitis media (CSOM) in adults aged 20-60 years.

MATERIALS AND METHODS

A consecutive sampling case-control study was used. The study participants were divided into a case group (42 children diagnosed with CSOM) and a control group (42 children with normal ears). Haemoglobin (Hb), Hematocrit (Hct), mean corpuscular volume of erythrocytes (MCV), serum iron level (SI), unsaturated iron-binding capacity (UIBC), total iron-binding capacity (TIBC), transferrin (TF), ferritin (Fer) were tested in all the participants, and the results were compared with the normal ranges of the World Health Organization (WHO). The comparative analysis of cases and controls was performed using the Fisher extract test, independence t-test, or Mann-Whitney U test. p-value <.05 was considered statistically significant for correlation.

RESULTS

There were 61 patients with CSOM and 61 controls included in the study. In the case group, 16 out of 61 patients (26.2%) had low ferritin levels and in the control group, 1 out of 61 patients (1.6%) had low ferritin levels (p < .001). In the case group, 6 (9.8%) of 61 patients had IDA, and in the control group, there were no patients with IDA among 61 patients (p = .027). There were significant differences in SI, UIBC, and Fer parameters between the groups.

CONCLUSIONS

In adult patients, the incidence of iron deficiency was higher in CSOM patients than in controls. Iron deficiency may be considered a potential risk factor for chronic suppurative otitis media, and serum iron parameters should be evaluated in these CSOM patients and further studies should be conducted to better understand the potential link between iron deficiency and CSOM.

Risk factors associated with the development of chronic suppurative otitis media in children: Systematic review and meta-analysis

OBJECTIVES

Chronic suppurative otitis media (CSOM) is defined as persistent discharge through a tympanic membrane perforation for greater than 2 weeks. It is associated with a significant disease burden, including hearing loss, and reducing its incidence could significantly improve short- and long-term health. We aimed to identify risk factors associated with the development of CSOM in children.

DESIGN AND SETTING

Systematic review and meta-analysis of studies set in community, primary and secondary care settings, identified from Medline, Embase and Cochrane databases from 2000 to 2022.

PARTICIPANTS

Children 16 years old and below.

MAIN OUTCOME MEASURES

Clinical diagnosis of CSOM.

RESULTS

In total, 739 papers were screened, with 12 deemed eligible for inclusion in the systematic review, of which, 10 were included in the meta-analysis. Risk factors examined included perinatal, patient, dietary, environmental and parental factors. Meta-analysis results indicate that atopy (RR = 1.18, 95% CI [1.01-1.37], p = .04, 2 studies); and birth weight <2500 g (RR = 1.79 [1.27-2.50], p < .01, 2 studies) are associated with an increased risk of CSOM development. Factors not associated were male sex (RR = 0.96 [0.82-1.13], p = .62, 8 studies); exposure to passive smoking (RR = 1.27 [0.81-2.01], p = .30, 3 studies); and parental history of otitis media (RR = 1.14 [0.59-2.20], p = .69, 2 studies).

CONCLUSION

Optimal management of risk factors associated with CSOM development will help reduce the burden of disease and prevent disease progression or recurrence. The current quality of evidence in the literature is variable and heterogeneous. Future studies should aim to use standardised classification systems to define risk factors to allow meta-analysis.

The association of iron deficiency anemia on chronic suppurative otitis media in children: A case-control study

Background

Chronic suppurative otitis media (CSOM) is the most common infectious disease in the world and the leading cause of hearing loss in children in developing countries. Iron deficiency anemia (IDA) is often found in children with CSOM.

Objective

This study was conducted to determine the association between IDA and the incidence of CSOM in children.

Method

This research is a case-control study using consecutive sampling. Participants were divided into case group which are children diagnosed with CSOM (n = 42) and control group which are children with normal ear (n = 42). All participants were examined for serum iron (FE), hemoglobin (Hb), total iron-binding capacity (TIBC), and ferritin levels. The analysis used in this study includes the chi-square test or fisher extract test and independence t-test or Man Whitney test with p < 0.05.

Result

The measurement results obtained values of Hb (13.00 ± 1.34 g/dL; p < 0.001), FE (95.13 ± 40.84 g/dL; p < 0.001), TIBC (354.18 ± 62.44 g/dL; p = 0.016), and ferritin levels (17.57 ± 8.55 g/dL; p < 0.001). Participants who experienced IDA were 21.43% which in the case group was 31.0% and control group was 11.9% (OR = 3.32; p = 0.033).

Conclusion

IDA can increase the incidence of CSOM in children.

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Iron deficiency anemia is a risk factor for CSOM in Children.

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Children with iron deficiency anemia have a 3-fold risk of experiencing CSOM.

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Supplement iron needs to be given as a preventative for CSOM in children.

Risk factors for acute otitis media in primary school children: a case-control study in Central Java, Indonesia

Background: Acute otitis media (AOM) is the most common disease in young children requiring antibiotic treatment. Information on AOM-related determinant risk factors in primary school children is still limited, particularly in Indonesia. This study aims to identify risk factors related to AOM in primary school children in Banyumas Regency, Central Java, Indonesia.

Design and Methods: This is an analytical study with a casecontrol design in Banyumas Regency, Indonesia. 3574 children from 6 regions of the Banyumas Regency were recruited for the screening of AOM detection, and confirmation of AOM diagnosis was determined by Otolaryngologist. One hundred and twentyfive cases and 125 control were involved in this study. Data collection was carried out using a structured questionnaire focusing on several variables such as household cooking fuel, house environment, smoking exposure, knowledge of parents, and nutrition status. Univariate, bivariate using chi-square and multivariate with regression logistic was conducted for data analysis.

Results: This study highlights the risk of household firewood use (p=0.003), poor nutritional status (p=0.009), and a family history of ear infections (p=0.015) with an increased risk of otitis media.

Conclusions: Household firewood use, poor nutritional status and family history of ear infection are factors associated with the occurrence of acute otitis media. It is necessary to provide public health education to prevent exposure to fuel at risk for children and to improve their nutritional status.

Factors associated with the development of paediatric chronic otitis media by age nine: a prospective longitudinal cohort study of 6560 children

OBJECTIVE

This study aimed to analyse social, health and environmental factors associated with the development of chronic otitis media by age nine.

METHOD

This was a prospective, longitudinal, birth cohort study of 6560 children, reviewed at age nine. Chronic otitis media defined as previous surgical history or video-otoscopic changes of tympanic membrane retraction, perforation or cholesteatoma. Non-affected children were used as the control group.

RESULTS

Univariate analysis demonstrated an association between chronic otitis media and otorrhoea, snoring, grommet insertion, adenoidectomy, tonsillectomy, hearing loss, abnormal tympanograms and preterm birth. Multivariate analysis suggests many of these factors may be interrelated.

CONCLUSION

The association between chronic otitis media and otorrhoea, abnormal tympanograms and grommets supports the role of the Eustachian tube and otitis media (with effusion or acute) in the pathogenesis of chronic otitis media. The role of snoring, adenoidectomy and tonsillectomy is unclear. Associations suggested by previous studies (sex, socioeconomic group, parental smoking, maternal education, childcare, crowding and siblings) were not found to be significant predictors in this analysis.

Serum sclerostın levels ın chronıc otıtıs medıa wıth and wıthout cholesteatoma

SUMMARY OBJECTIVE Sclerostin is a glycoprotein that plays a catabolic role in bone and is involved in the regulation of bone metabolism by increasing the osteoclastic bone resorption. In this study, serum sclerostin levels were measured in chronic otitis media (COM) with and without cholesteatoma, assuming that it might have a role in the aetiopathogenesis of bone resorption. METHODS A total of 44 patients with cholesteatomatous COM (cCOM) (n = 22) and non-cholesteatomatous COM (ncCOM) (n = 22) were included in this study, and 26 healthy volunteers without any chronic ear disease problem(s) constituted the control group (n = 26). RESULTS No significant difference was not found in terms of serum iPTH, ALP, and vitamin D levels between ncCOM, cCOM, and the control groups. A significant difference was found in terms of serum sclerostin, Ca, and P levels between ncCOM, cCOM, and the control groups (p<0.05). Serum sclerostin levels in the study groups were significantly higher but their serum Ca and P levels were significantly lower compared to the control group. CONCLUSION We think that serum sclerostin concentrations, which were significantly higher in patients with cCOM and ncCOM compared to healthy controls are associated with bone erosion. There is a need for further studies with larger samples in order to determine the relationship between sclerostin and bone erosion in cholesteatoma to help in establishing preventive measures against cholesteatoma and set new targets for the development of non-surgical treatments.

The association between vitamin D status and infectious diseases of the respiratory system in infancy and childhood

PURPOSE

Respiratory tract infections (RTIs) are a major cause of illness worldwide and the most common cause of hospitalization for pneumonia and bronchiolitis. These two diseases are the leading causes of morbidity and mortality among children under 5 years of age. Vitamin D is believed to have immunomodulatory effects on the innate and adaptive immune systems by modulating the expression of antimicrobial peptides, like cathelicidin, in response to both viral and bacterial stimuli. The aim of this review is to summarize the more recently published data with regard to potential associations of 25-hydroxyvitamin D [25(OH)D] with infectious respiratory tract diseases of childhood and the possible health benefits from vitamin D supplementation.

METHODS

The literature search was conducted by using the PubMed, Scopus, and Google Scholar databases, with the following keywords: vitamin D, respiratory tract infection, tuberculosis, influenza, infancy, and childhood.

RESULTS

Several studies have identified links between inadequate 25(OH)D concentrations and the development of upper or lower respiratory tract infections in infants and young children. Some of them also suggest that intervention with vitamin D supplements could decrease both child morbidity and mortality from such causes.

CONCLUSIONS

Most studies agree in that decreased vitamin D concentrations are prevalent among most infants and children with RTIs. Also, normal to high-serum 25(OH)D appears to have some beneficial influence on the incidence and severity of some, but not all, types of these infections. However, studies with vitamin D supplementation revealed conflicting results as to whether supplementation may be of benefit, and at what doses.

Vitamin D and Otitis Media

PURPOSE OF REVIEW

To examine the relationship between vitamin D and otitis media.

RECENT FINDINGS

Vitamin D deficiency has been associated with several respiratory diseases, including otitis media. Vitamin D supplementation may reduce the risk of otitis media. This relationship may be explained by vitamin D supporting the immune system by upregulating antimicrobial peptides which are effective against otopathogens and biofilm formation, supporting a less inflammatory immune response, or promoting beneficial commensal bacteria. This review will explore risk factors of both otitis media and vitamin D deficiency, the evidence of vitamin D being beneficial for various forms of otitis media, and possible mechanisms of action.

Plasma Selenium and Cadmium Levels in Patients with Chronic Otitis Media in a Turkish Population and Their Relation to Inflammation Markers

Chronic otitis media (COM) is a multifactorial process, for which a clear etiology has not yet been established. The aims of the present study were to evaluate selenium (Se) and cadmium (Cd) levels in patients with COM and to analyze the correlation between Se and Cd with inflammation markers. The study population consisted of 88 participants: 45 healthy controls (group 1) and 43 patients with COM (group 2). Demographic data, Se, Cd, C-reactive protein (CRP), and white blood cell count (WBC) levels were all recorded. Se and Cd measurements were performed in a graphite furnace atomic absorption spectrophotometer (Perkin Elmer Analyst 800) using Zeeman background correction. The Se and Cd levels were compared between the groups and the correlation between Se and Cd with inflammation markers was analyzed. No statistically significant difference was determined between the groups in terms of demographic data (p > 0.05). CRP and WBC levels were significantly higher in group 2 than in group 1 (p < 0.05). Se levels were significantly lower in group 2 than in group 1, at 23.40 ± 12.08 μg/L vs. 37.31 ± 22.44 μg/L (p < 0.05). Cd levels were significantly higher in group 2 than in group 1, at 1.79 ± 1.63 μg/L vs. 0.68 ± 0.45 μg/L (p < 0.05). When all the cases were evaluated together, a statistically significant negative correlation was determined between Se and CRP (r = - 0.239, p = 0.013) and a positive correlation between Cd and CRP (r = 0.266, p = 0.006), WBC (r = 0.258, p = 0.008). Our results could propose that Se deficiency and Cd excess could play a crucial and additive role in the etiopathogenesis of COM. However, further investigations with larger numbers of patients are warranted to determine the exact role of these elements.

A model of chronic, transmissible Otitis Media in mice

Infection and inflammation of the middle ears that characterizes acute and chronic otitis media (OM), is a major reason for doctor visits and antibiotic prescription, particularly among children. Nasopharyngeal pathogens that are commonly associated with OM in humans do not naturally colonize the middle ears of rodents, and experimental models in most cases involve directly injecting large numbers of human pathogens into the middle ear bullae of rodents, where they induce a short-lived acute inflammation but fail to persist. Here we report that Bordetella pseudohinzii, a respiratory pathogen of mice, naturally, efficiently and rapidly ascends the eustachian tubes to colonize the middle ears, causing acute and chronic histopathological changes with progressive decrease in hearing acuity that closely mimics otitis media in humans. Laboratory mice experimentally inoculated intranasally with very low numbers of bacteria consistently have their middle ears colonized and subsequently transmit the bacterium to cage mates. Taking advantage of the specifically engineered and well characterized immune deficiencies available in mice we conducted experiments to uncover different roles of T and B cells in controlling bacterial numbers in the middle ear during chronic OM. The iconic mouse model provides significant advantages for elucidating aspects of host-pathogen interactions in otitis media that are currently not possible using other animal models. This natural model of otitis media permits the study of transmission between hosts, efficient early colonization of the respiratory tract, ascension of the eustachian tube, as well as colonization, pathogenesis and persistence in the middle ear. It also allows the combination of the powerful tools of mouse molecular immunology and bacterial genetics to determine the mechanistic basis for these important processes.

Is vitamin D deficiency a public health concern for low middle income countries? A systematic literature review

PURPOSE

Vitamin D deficiency has been receiving increasing attention as a potential public health concern in low and lower-middle income countries (LMICs), of which there are currently 83. We aimed to conduct a comprehensive systematic literature review (SLR) of available data on vitamin D status and prevalence of vitamin D deficiency in all 83 LMICs.

METHODS

We followed the general methodology for SLRs in the area of serum 25-hydroxyvitamin D. Highest priority was placed on identifying relevant population-based studies, followed by cross-sectional studies, and to a lesser extent case-control studies. We adopted the public health convention that a prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D < 25/30 nmol/L) at > 20% in the entire population and/or at-risk population subgroups (infants, children, women of child-bearing age, pregnancy) constitutes a public health issue that may warrant intervention.

RESULTS

Our SLR revealed that of the 83 LMICs, 65% (n = 54 countries) had no published studies with vitamin D data suitable for inclusion. Using data from the remaining third, a number of LMICs had evidence of excess burden of vitamin D deficiency in one or more population subgroup(s) using the above convention (Afghanistan, Pakistan, India, Tunisia and Mongolia) as well as possibly other LMICs, albeit with much more limited data. Several LMICs had no evidence of excess burden.

CONCLUSION

Vitamin D deficiency is a public health issue in some, but certainly not all, LMICs. There is a clear need for targeting public health strategies for prevention of vitamin D deficiency in those LMICs with excess burden.

Etiological factors associated with chronic suppurative otitis media in a population of Han adults in China

OBJECTIVE

Risk factors for chronic suppurative otitis media (CSOM) were not clearly established. The study was to investigate the etiological factors for CSOM from a population of Han adults in China.

METHODS

A case-control study was conducted at Second Affiliated Hospital of Xi'an Jiaotong University, School of Medicine in China. A total of 416 individuals participated in this study, which included 206 cases and 210 controls.

RESULTS

Multivariate logistic regression analysis revealed male (OR = 0.42; 95% CI: 0.21-0.83), BMI increasing (OR = 0.85; 95% CI: 0.77-0.93), URTI (OR = 152.85; 95% CI: 34.11-684.93), smoke/passive smoke (OR = 7.11; 95% CI: 3.36-15.07), residential location (urban area) (OR = 0.27; 95% CI: 0.13-0.56), serum calcium increasing (OR = 0.09; 95% CI: 0.01-0.71) were prime risk factors for CSOM. Univariate analysis revealed that low socioeconomic status (OR= 2.33; 95% CI: 1.57-3.45) and hepatitis B (OR = 4.90; 95% CI: 1.82-13.21) were risk factors together with the above variables.

CONCLUSION

This study has identified several variables as risk factors for CSOM, suggesting better healthcare, living condition, as well as better nutrition might decrease the development of CSOM. Further studies are necessary to assess the outcome of CSOM after interventions in the etiological factors.

Association between vitamin D and development of otitis media: A PRISMA-compliant meta-analysis and systematic review

BACKGROUND

Nutrients related to serum vitamin D level were previously shown to be significantly associated with the risk of many chronic diseases. This study aimed to assess potential relationships between serum vitamin D level and otitis media (OM) risk.

METHODS

PubMed, EMBASE, and Cochrane Library databases were searched till Aug 18, 2015 for studies of quantitative OM risk estimates in relation to serum vitamin D level. The odds ratio and weighted mean difference, with 95% confidence intervals (CIs), were used to measure the relationship between serum vitamin D level and OM risk.

RESULTS

Of the 89 articles identified by database search, 5 studies reported data of 16,689 individuals were included in our meta-analysis. We noted participants with OM was associated with lower level of plasma vitamin D when compared with patients without OM (weighted mean difference -5.67; 95% CI -8.08 to -3.26, P < 0.001). Furthermore, as compared with control group, serum vitamin D level was not associated with the risk of OM (odds ratio 0.80, 95% CI 0.47-1.38, P = 0.425). Subgroup analyses suggested that participants with acute OM might associate with lower serum vitamin D level.

CONCLUSIONS

Plasma vitamin D level might play an important role on the progression of acute OM, whereas no significant impact in patients with chronic OM.

A review of dietary selenium intake and selenium status in Europe and the Middle East

This is a systematic review of existing data on dietary selenium (Se) intake and status for various population groups in Europe (including the United Kingdom (UK)) and the Middle East. It includes English language systematic reviews, meta-analyses, randomised controlled trials, cohort studies, cross-sectional and case-control studies obtained through PUBMED searches from January, 2002, to November, 2014, for European data and from 1990 to November 2014, for Middle Eastern data. Reports were selected if they included data on Se intake and status. The search identified 19 European/UK studies and 15 investigations in the Middle East that reported Se intake and Se concentration in water and/or food and 48 European/UK studies and 44 investigations in the Middle East reporting Se status. Suboptimal Se status was reported to be widespread throughout Europe, the UK and the Middle East, and these results agreed with previous reports highlighting the problem. Eastern European countries had lower Se intake than Western European countries. Middle Eastern studies provided varying results, possibly due to varying food habits and imports in different regions and within differing socioeconomic groups. In conclusion, Se intake and status is suboptimal in European and Middle Eastern countries, with less consistency in the Middle East.

Co-morbidities in children presenting with chronic suppurative otitis media--a South African study

BACKGROUND

Chronic suppurative otitis media (CSOM) is common among children in southern Africa. Managing associated co-morbidities may result in earlier disease resolution.

METHODS

Children <13 years of age with otorrhoea lasting >4 weeks were recruited to the study. Each child underwent a full clinical examination, a blood count, an HIV test and CD4 cell count, if found to be infected.

RESULTS

The study included 86 children, and the median age was 4.6 years. HIV infection was present in 45 of 83 children (54.2%), of which 23 (51.1%) were receiving antiretroviral treatment at the time of presentation. Underweight was present in 22 of 85 (25.9%) children and in 17 of the 45 (37.8%) HIV-infected children. One or more clinical signs (not aural-related) were found in 46 of 86 (53.4%) children. Cholesteatoma was found in 23 of 113 (20.4%) ears, and 9 of 86 (10.5%) children had serious associated aural or intracranial complications.

CONCLUSIONS

A high percentage of children with CSOM have associated pathology that needs to be diagnosed to optimally manage CSOM.

Meta-analysis of Zn, Cu and Fe in the hair of Chinese children with recurrent respiratory tract infection

Trace elements play an important role in maintaining the normal metabolic and immune function. The onset of recurrent respiratory tract infection (RRI) is associated with the immune function, genetic factors and nutritional status. However, the association between the levels of trace elements and RRI remains inconclusive. We aimed to investigate the alterations of hair levels of zinc (Zn), copper (Cu) and iron (Fe) in Chinese children with RRI by performing a meta-analysis. A predefined electronic databases search was performed to identify eligible studies for the analysis of hair Zn, Cu or Fe levels in Chinese children with RRI. Thirteen studies were included. RRI patients displayed significantly lower levels of hair Zn (13 studies, random effects SMD: - 1.215, 95% CI: - 1.704 to - 0.725, p < 0.0001), Cu (11 studies, random effects SMD: - 0.384, 95% CI: - 0.717 to - 0.052, p = 0.023) and Fe (12 studies, random effects SMD: - 0.569, 95% CI: - 0.827 to - 0.312, p < 0.0001) compared with controls. No evidence of publication bias was observed. Sensitivity analysis did not change the results significantly. In conclusion, the deficiency of Zn, Cu and Fe may be contributing factors for the susceptibility of RRI in Chinese children. However, more studies in different ethnicities should be performed in the future.

Vitamin A deficiency is associated with gastrointestinal and respiratory morbidity in school-age children

Infection is an important cause of morbidity throughout childhood. Poor micronutrient status is a risk factor for infection-related morbidity in young children, but it is not clear whether these associations persist during school-age years. We examined the relation between blood concentrations of micronutrient status biomarkers and risk of gastrointestinal and respiratory morbidity in a prospective study of 2774 children aged 5-12 y from public schools in Bogotá, Colombia. Retinol, zinc, ferritin, mean corpuscular volume, hemoglobin, erythrocyte folate, and vitamin B-12 concentrations were measured in blood at enrollment into the cohort. Children were followed for 1 academic year for incidence of morbidity, including diarrhea with vomiting, cough with fever, earache or ear discharge with fever, and doctor visits. Compared with adequate vitamin A status (≥30.0 μg/dL), vitamin A deficiency (<10.0 μg/dL) was associated with increased risk of diarrhea with vomiting [unadjusted incidence rate ratio (IRR): 2.17; 95% CI: 0.95, 4.96; P-trend = 0.03] and cough with fever (unadjusted IRR: 2.36; 95% CI: 1.30, 4.31; P-trend = 0.05). After adjustment for several sociodemographic characteristics and hemoglobin concentrations, every 10 μg/dL plasma retinol was associated with 18% fewer days of diarrhea with vomiting (P < 0.001), 10% fewer days of cough with fever (P < 0.001), and 6% fewer doctor visits (P = 0.01). Every 1 g/dL of hemoglobin was related to 17% fewer days with ear infection symptoms (P < 0.001) and 5% fewer doctor visits (P = 0.009) after controlling for sociodemographic factors and retinol concentrations. Zinc, ferritin, mean corpuscular volume, erythrocyte folate, and vitamin B-12 status were not associated with morbidity or doctor visits. Vitamin A and hemoglobin concentrations were inversely related to rates of morbidity in school-age children. Whether vitamin A supplementation reduces the risk or severity of infection in children over 5 y of age needs to be determined.

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.

Vitamin D deficiency associated with increased incidence of gastrointestinal and ear infections in school-age children

BACKGROUND

Vitamin D deficiency (VDD) is highly prevalent among children worldwide. The effects of VDD include alterations of the immune response and increased risk of infection but little evidence exists in school-age children. We investigated the association of vitamin D status with morbidity in a prospective study of school-age children from Bogotá, Colombia.

METHODS

We measured plasma 25-hydroxyvitamin D (25(OH)D) concentrations in a random sample of 475 children (mean ± standard deviation age: 8.9 ± 1.6 years) and followed them for an academic year. Caregivers were asked to record daily information on the incidence of morbidity episodes using pictorial diaries. Baseline vitamin D status was classified according to 25(OH)D concentrations as deficient (<50 nmol/L), insufficient (≥50 and <75 nmol/L) or sufficient (≥75 nmol/L). We used Poisson regression to estimate incidence rate ratios and 95% confidence intervals for days with diarrhea, vomiting, diarrhea with vomiting, cough with fever and earache or discharge with fever, comparing vitamin D-deficient with vitamin D-sufficient children. Estimates were adjusted for child's age, sex and household socioeconomic status.

RESULTS

The prevalence of VDD was 10%; an additional 47% of children were vitamin D-insufficient. VDD was associated with increased rates of diarrhea with vomiting (adjusted incidence rate ratio: 2.05; 95% confidence interval: 1.19, 3.53) and earache/discharge with fever (adjusted incidence rate ratio: 2.36; 95% confidence interval: 1.26, 4.44). VDD was not significantly related to cough with fever.

CONCLUSIONS

These results suggest that VDD is related to increased incidence of gastrointestinal and ear infections in school-age children. The effect of correcting VDD on reducing risk of these infections needs to be tested in supplementation trials.

Role of Vitamin D in Children with Respiratory Tract Infection

It has recently been shown that vitamin D (VitD) plays an important role in host defences, inflammation and immunity. We reviewed PubMed and selected all of the studies published over the last 15 years concerning VitD deficiency and VitD supplementation in children with respiratory tract infections. Our analysis showed that VitD seems to be very important because of its part in the complexity of the immune system. However, there are few pediatric studies and most have various limitations. First of all, the literature mainly refers to studies concerning the prevalence of VitD insufficiency and deficiency in specific pathologies. Secondly, it is extremely difficult to identify a common specific range of normal, insufficient and deficient VitD levels. Thirdly, the available studies of VitD supplementation often combined VitD with the use of other micronutrients, thus obscuring the role of VitD itself. Finally, different doses have been used for VitD supplementation. These observations clearly highlight the fact that further studies are needed to evaluate the impact of VitD deficiency and insufficiency in terms of the epidemiology and outcomes of pediatric respiratory tract infection, and whether VitD supplementation favours a positive outcome.

Vitamin A supplementation in preschool children and risk of hearing loss as adolescents and young adults in rural Nepal: randomised trial cohort follow-up study

OBJECTIVE

To determine whether vitamin A supplementation administered in the preschool years can lower the risk of hearing loss in adolescence and adulthood.

DESIGN

Follow-up study of adolescents and young adults who, as preschool aged children in 1989, were enrolled into a cluster randomised, double blinded, placebo controlled trial of vitamin A supplementation.

SETTING

South central, rural Nepal.

PARTICIPANTS

2378 adolescents and young adults aged 14 to 23, representing 51% of those who finished the original trial and 71% of those living in the study area in 2006.

INTERVENTIONS

Every four months for 16 months preschool children were visited at home, given an oral 200,000 IU dose of vitamin A (half dose at age 1-11 months, quarter dose at <1 month) or placebo and the parents were queried about any childhood illnesses in the previous week, including purulent discharge from the ears.

MAIN OUTCOME MEASURES

Prevalence of mild or worse hearing loss (≥ 30 dB) in the most affected ear and tympanometric measures of middle ear function (peak height, ear canal volume, and gradient).

RESULTS

During the original trial, the prevalence of middle ear infection during the preschool years did not differ between the supplement groups. By adolescence and early adulthood, a non-significant 17% reduction in hearing loss occurred among those who had periodically received vitamin A compared with placebo as preschool aged children (odds ratio 0.83, 95% confidence interval 0.62 to 1.12). Among participants with any ear discharge in early childhood, vitamin A supplementation was associated with a reduced risk of hearing loss, by 42% (0.58, 0.37 to 0.92) compared with controls, after adjusting the confidence interval for the design effect of the original trial. Abnormal tympanometric peak height of the middle ear system was less likely among participants supplemented with vitamin A in childhood.

CONCLUSION

In undernourished settings, periodic, high dose vitamin A supplementation may reduce the risk of hearing loss associated with purulent ear infections in early childhood.