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Risk factors for persistence of bilateral otitis media with effusion
Insights
Identifying persistent otitis media with effusion (OME) in children is key. Factors like season, hearing loss, and referral route predict persistence, but watchful waiting remains standard for most cases.
Area of Science:
- Pediatric Otolaryngology
- Epidemiology of Childhood Illnesses
Background:
- Otitis media with effusion (OME) is a common childhood condition.
- Persistent bilateral OME requires targeted management strategies.
- Current guidelines recommend a 12-week watchful waiting period before surgical intervention.
Purpose of the Study:
- To identify risk factors for persistent bilateral OME in children aged 3.25 to 6.75 years.
- To assess the impact of various factors on OME persistence over a 12-week period.
- To inform management decisions regarding watchful waiting versus early intervention.
Main Methods:
- A cohort of 639 children with bilateral OME and no prior ear/throat surgery was followed for 12 weeks.
- Multivariate analysis was used to assess risk factors for OME persistence.
- Spontaneous resolution rates were calculated based on different audiometric cut-offs.
Main Results:
- Spontaneous resolution rates varied from 26% to 65% based on audiometric criteria.
- Significant risk factors for persistent OME included time of year (July-December), hearing level (≥30 dB HL), and referral route with prior audiometry.
- Parental report of OME duration, acute otitis media history, parental smoking, and tympanic membrane retractions were not significant predictors.
Conclusions:
- Specific risk factors can increase the odds of persistent OME by over sixfold.
- Despite identified risk factors, the overall proportion of persistent cases does not warrant bypassing the standard watchful waiting period for most children.
- Management strategies may need refinement for the small subset with extreme risk factor combinations.
Abstract:
Otitis media with effusion (OME) is a common, episodic condition in childhood. The subset that has persistent bilateral OME is important to identify so that their management can be targeted. Most guidelines suggest a watchful-waiting period before a decision is made on the appropriateness of surgical intervention. In the UK this usually takes place in a specialist setting (otorhinolaryngology) over a period of 12 weeks. A cohort of children (n = 639), between the ages of 3.25 and 6.75 years with bilateral OME that had no previous ear or throat surgery, was followed up over 12 weeks during the recruitment phase of a multi-centre, randomised controlled study. This allowed multiple factors for persistence to be assessed. The overall spontaneous resolution rate in this cohort was between 26% and 65%, depending on the audiometric cut-off by which a persisting condition was defined. Three significant risk factors-time of year when first seen (July to December); hearing level (>or= 30 dB HL in the better ear); and a route of referral that included prior audiometry--were identified in the multivariate analysis for persistent OME both in isolation and when accompanied by each of three audiometric cut-offs (>or= 15, >or= 20 and >or= 25dB HL). In this age group, parental report of duration of OME, history of acute otitis media, parental smoking and pars tensa retractions were not significant factors for persistence. These risk factors in combination can increase the odds ratio of persistence more than sixfold. However, the proportion persisting is insufficient to bypass a period of watchful waiting, except perhaps in extreme combinations which apply to less than 7% of the cohort.