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Middle ear effusion: rate and risk factors in Australian children attending day care
S A Skull1, P S Morris, A Yonovitz
1Centre for Disease Control Darwin, Territory Health Services, Casuarina, NT, Australia.
Insights
Middle ear effusion (MEE) is common in Darwin day care children, affecting 37% of examinations. Younger age and family history are key risk factors for this common childhood condition.
Area of Science:
- Pediatrics
- Epidemiology
- Otolaryngology
Background:
- Otitis media, specifically middle ear effusion (MEE), is a prevalent childhood condition.
- No prior longitudinal studies on MEE existed for non-Aboriginal Australian children.
- Understanding MEE prevalence and risk factors in day care settings is crucial for early intervention.
Purpose of the Study:
- To determine the rate and identify risk factors for middle ear effusion (MEE) in Australian children under four years old attending day care.
- To provide longitudinal data on MEE in a non-Aboriginal Australian pediatric population.
- To inform clinical practice and public health strategies regarding childhood ear infections.
Main Methods:
- A prospective cohort study involving 252 children under 4 years old across 9 day care centers in Darwin.
- Fortnightly tympanometry assessments over a 12-fortnight period (March-September 1997).
- Multivariate analysis to identify significant risk factors associated with the presence of MEE (Type B tympanograms).
Main Results:
- Middle ear effusion (MEE) was detected on average 4.4 times per child over 12 fortnights, representing 37% of all examinations.
- Identified risk factors included younger age, family history of ear infection, previous tympanostomy tube (grommet) insertion, ethnicity, and specific day care centers.
- A history of wheeze was found to be a protective factor (RR 0.57).
Conclusions:
- Middle ear effusion (MEE) is highly prevalent in Darwin day care attendees, highlighting a significant public health concern.
- Early childhood MEE can potentially impact hearing, learning, and speech development.
- While some risk factors are identified, many are not easily modifiable, suggesting a need for further research into environmental factors, particularly within the day care setting.
Abstract:
There have been no previous longitudinal studies of otitis media conducted in non-Aboriginal Australian children. This paper describes the rate and risk factors for middle ear effusion (MEE) in children attending day care in Darwin, Australia. A prospective cohort study of 252 children under 4 years was conducted in 9 day care centres over 12 fortnights between 24 March and 15 September 1997. Tympanometry was conducted fortnightly and multivariate analysis used to determine risk factors predicting MEE. The outcome of interest was the rate of type B tympanograms per child detected in either ear at fortnightly examinations. After adjusting for clustering by child, MEE was detected on average 4.4 times in 12 fortnights (37% of all examinations conducted). Risk factors associated with presence of effusion were younger age, a family history of ear infection, previous grommets (tympanostomy tubes), ethnicity and the day care centre attended. A history of wheeze appeared protective. These effects were modest (RR 0.57-1.70). Middle ear effusion is very common in children attending day care in Darwin. This has clinical importance, since MEE during early childhood may affect optimal hearing, learning and speech development. There is little scope for modification for many of the risk factors for MEE predicted by this model. Further study of the day care environment is warranted.