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Cranial Indicators Identified for Peak Incidence of Otitis Media
Anthony S Pagano1,2, Eugene Wang3, Derek Yuan4
1New York University School of Medicine, Department of Cell Biology, New York, NY.
Insights
Infant Eustachian tube (CET) anatomy, specifically its shorter, horizontal orientation, correlates with peak acute otitis media (AOM) incidence. Skeletal development changes align with AOM
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Development
- Human Anatomy
Background:
- Acute otitis media (AOM) is a prevalent pediatric illness, with peak incidence in early childhood.
- The cartilaginous Eustachian tube (CET) and associated structures differ significantly between infants and adults, potentially contributing to AOM.
- Limited research exists on normal Eustachian tube growth trajectories in relation to AOM development.
Purpose of the Study:
- To investigate the relationship between skeletal growth changes and the known peak ages of acute otitis media (AOM) occurrence.
- To test hypotheses regarding the coincidence of craniofacial development and AOM incidence.
- To analyze the morphological development of the cartilaginous Eustachian tube (CET) throughout infancy and childhood.
Main Methods:
- Utilized 32 three-dimensional landmarks to analyze craniofacial growth across five dental eruption stages (Stage 1: edentulous neonates to Stage 5: adults).
- Applied Generalized Procrustes Analysis and principal components analysis to quantify skeletal growth patterns.
- Calculated univariate measures to assess specific morphological changes in the cartilaginous Eustachian tube (CET).
Main Results:
- The most rapid skeletal growth occurred in Stage 1 (neonates), significantly impacting upper respiratory tract proportions.
- Infants (Stage 1) exhibited the shortest and most horizontally oriented CETs.
- Major growth changes in CET morphology occurred during the transition to Stage 2 (around 5 months, coinciding with peak AOM incidence) and stabilized by Stage 3 (around 6 years).
Conclusions:
- Skeletal development, particularly the morphology of the cartilaginous Eustachian tube (CET), is closely linked to peak ages of acute otitis media (AOM) incidence.
- These findings suggest that anatomical factors related to craniofacial growth play a crucial role in the high prevalence of AOM in young children.
- Understanding these developmental relationships may offer insights into the etiology of this common pediatric disease.
Abstract:
Acute otitis media (AOM) is one of the most common pediatric conditions worldwide. Peak age of occurrence for AOM has been identified within the first postnatal year and it remains frequent until approximately six postnatal years. Morphological differences between adults and infants in the cartilaginous Eustachian tube (CET) and associated structures may be responsible for development of this disease yet few have investigated normal growth trajectories. We tested hypotheses on coincidence of skeletal growth changes and known ages of peak AOM occurrence. Growth was divided into five dental eruption stages ranging from edentulous neonates (Stage 1) to adults with erupted third maxillary molars (Stage 5). A total of 32 three-dimensional landmarks were used and Generalized Procrustes Analysis was performed. Next, we performed principal components analysis and calculated univariate measures. It was found that growth change in Stage 1 was the most rapid and comprised the largest amount of overall growth in upper respiratory tract proportions (where time is represented by the natural logarithmic transformation of centroid size). The analysis of univariate measures showed that Stage 1 humans did indeed possess the relatively shortest and most horizontally oriented CET's with the greatest amount of growth change occurring at the transition to Stage 2 (eruption of deciduous dentition at five postnatal months, commencing peak AOM incidence) and ceasing by Stage 3 (approximately six postnatal years). Skeletal indicators appear related to peak ages of AOM incidence and may contribute to understanding of a nearly ubiquitous human disease. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 300:1721-1740, 2017. © 2017 Wiley Periodicals, Inc.
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