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Otolaryngological surgery and upper respiratory tract infections in children: an epidemiological study
Insights
Early pediatric upper airway surgeries are common, with middle ear procedures most frequent. Surgery is linked to infections, but decisions are influenced by factors beyond medical evidence, like maternal education.
Area of Science:
- Pediatric Otolaryngology
- Epidemiology
- Public Health
Background:
- Upper airway surgeries are frequently performed in young children.
- The relationship between these surgeries and respiratory infections requires further investigation.
Purpose of the Study:
- To assess the incidence of various upper airway surgical procedures in preschool children.
- To examine the association between these surgeries, upper respiratory tract infections, and child/maternal factors.
Main Methods:
- Population-based cross-sectional study of 3,763 children aged 3-4 years in Oslo, Norway.
- Outcome measures included adenoidectomy, tonsillectomy, myringotomy, and ventilation tube insertion.
- Statistical analysis using adjusted odds ratios (ORadj) to determine independent factors.
Main Results:
- By age 4, 13% of children had undergone surgery, with two-thirds involving middle ear procedures.
- Children with surgery had a nearly fivefold higher incidence of recurrent otitis media (ORadj = 5.19).
- Low maternal education (ORadj = 1.61) and childhood atopy (ORadj = 1.58) independently increased surgery probability.
Conclusions:
- Early pediatric otolaryngological surgery is prevalent, with middle ear surgery being most common.
- Surgical decisions are not solely based on specific infection types, suggesting multifactorial influences.
- Maternal education and child's atopy are significant factors in surgical treatment decisions, highlighting potential non-medical evidence influences.
Abstract:
The objective of the study was to assess the occurrence of different procedures of upper airway surgery and estimate their relationship to specific upper respiratory tract infections and constitutional factors. In a population-based cross-sectional study in Oslo. Norway, of 3,763 preschool children 3 to 4 years of age, the otolaryngological surgeries adenoidectomy, tonsillectomy, myringotomy, ventilation tube insertion, and combinations of these were the outcome measures. The results showed that by 4 years of age, 13% (n = 501) had undergone operation, and approximately two thirds of the operations involved middle ear surgery. Although surgery was related to the occurrence of upper respiratory tract infections, the type of surgery was not related to the specific infection. In the children with operations, the occurrence of recurrent otitis media (> or = 3 infections in the previous 12 months) was almost fivefold higher than in children without operations (adjusted adds ratio [ORadj] = 5.19 [3.15 to 8.54]). A low level of maternal education (ORadj = 1.61 [1.05 to 2.7] compared to the group with a high level of education) and atopy on the part of the child (ORadj = 1.58 [1.20 to 2.07]) increased the probability for upper airway surgery independently of the experience of infections. In conclusion, early pediatric otolaryngological surgery is common. The decisions for surgical treatment vary substantially and are not closely related to the specific infections. The influence of other factors such as maternal education indicates that decisions for surgery are not entirely based on medical evidence.