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Factors affecting the occurrence of otitis media with effusion in preschool and elementary school children: a

Ratna Dwi Restuti¹, Susyana Tamin², Dwi Agustawan Nugroho¹

¹Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.

|September 28, 2022

Insights

Laryngopharyngeal reflux (LPR) significantly increases the risk of otitis media with effusion (OME) in children. This finding highlights LPR as a key factor for developing OME prevention strategies.

Area of Science:

Pediatric Otolaryngology
Gastroenterology
Public Health

Background:

Otitis media with effusion (OME) is a common childhood condition with potential long-term consequences.
Identifying modifiable risk factors is crucial for developing effective prevention strategies.

Purpose of the Study:

To investigate the risk factors for OME in children, with a specific focus on laryngopharyngeal reflux (LPR).
To assess the association between LPR, adenoid hypertrophy, and allergic rhinitis with OME in a pediatric population.

Main Methods:

A comparative cross-sectional study involving 2016 preschool and elementary school children in Jakarta, Indonesia.
Data collection included medical history, ear, nose, and throat examinations, tympanometry, and flexible fibreoptic nasopharyngolaryngoscopy.
LPR was diagnosed using the Reflux Finding Score, adenoid hypertrophy via nasopharyngolaryngoscopy, and allergic rhinitis via a validated questionnaire.

Main Results:

Children with OME had a significantly higher proportion of LPR (78.3%) compared to those without OME (52.2%).
LPR was associated with a 3.3-fold increased probability of OME (OR 3.3; p=0.01).
No significant association was found between adenoid hypertrophy or allergic rhinitis and OME in this cohort.

Conclusions:

Laryngopharyngeal reflux is a significant risk factor for otitis media with effusion in children.
Clinicians should consider LPR in the evaluation of children with OME and vice versa.
Further research into LPR as a target for OME prevention is warranted.

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Abstract

Objective:

Identify the risk factors for otitis media with effusion (OME), especially laryngopharyngeal reflux (LPR), adenoid hypertrophy and allergic rhinitis, that could be used to develop prevention strategies in children.

Design:

A comparative cross-sectional study was conducted to make sure the adequacy of proportions of OME and non-OME cases in finding the related factors.

Setting:

History taking, ear/nose/throat (ENT) examination, and tympanometry were performed in preschool and elementary schools. Flexible fibreoptic nasopharyngolaryngoscopy was performed in a bronchoesophagology outpatient clinic in a tertiary referral hospital in Jakarta, Indonesia.

Participants:

Preschool and elementary children in East Jakarta, Indonesia were recruited for this study. A total of 2016 participants underwent history taking, ENT examination and tympanometry. The case group was 46 children with OME, and the control group was 46 children without OME. The number of subjects fulfilled the minimum sample size for two proportions comparison.

Main Outcome Measures:

A type B tympanogram indicated OME. A Reflux Finding Score of more than 7 indicated LPR. Adenoid hypertrophy was diagnosed using flexible fibreoptic nasopharyngolaryngoscopy. Allergic rhinitis was diagnosed using a questionnaire based on the International Study of Asthma and Allergies in Childhood phase III that has been validated for Indonesians.

Results:

The proportion of LPR in the OME group was significantly higher than in the non-OME group, at 78.3% and 52.2%. The probability of OME occurrence in patients with LPR was 3.3 times higher than in patients without LPR (OR 3.3; 95% CI 1.33 to 8.189; p=0.01). There was no significant relationship between adenoid hypertrophy and OME (p=0.211; 95% CI 0.71 to 3.97), and also between allergic rhinitis and OME (p=0.463; 95% CI 0.61 to 4.28).

Conclusion:

The probability of OME occurrence in patients with LPR was 3.3 times higher than in patients without LPR. LPR should be considered in patients with OME and vice versa.

Keywords:

Audiology Laryngology Paediatric otolaryngology

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