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Modifiable risk factors for developing otitis media with effusion in children under 12 years in high-income
Aye Paing1, Laura Elliff-O'Shea2, John Day3
1Centre for Guidelines, National Institute for Health and Care Excellence, London, UK aye.paing@nice.org.uk.
Insights
Frequent ear infections and exposure to other children are key predictors for developing otitis media with effusion (OME) in children. Further research is needed to explore other modifiable risk factors for OME.
Area of Science:
- Pediatrics
- Otolaryngology
- Epidemiology
Background:
- Otitis media with effusion (OME) is a common childhood condition.
- Identifying modifiable risk factors for OME is crucial for prevention and management.
Purpose of the Study:
- To systematically review and assess modifiable risk factors associated with the development of otitis media with effusion (OME) in children under 12 years of age.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Embase, MEDLINE, INAHTA, CENTRAL, CDSR, Epistemonikos) for cohort studies published between 2000 and November 2022.
- Studies included a minimum of 40 children per arm/prognostic factor.
- Risk of bias was assessed using the Quality in Prognosis Studies checklist, and evidence quality was evaluated using GRADE methodology.
Main Results:
- Seven studies involving over 2.7 million children were included, with very low overall evidence quality.
- Strong associations with OME development were found for fluid/pus discharge from ears and exposure to other children.
- Other associated factors included frequent coughs/colds, breathing problems, and previous ear infections in the past year.
- Adenoid hypertrophy showed a strong association with recurrent OME.
Conclusions:
- Upper respiratory tract infections, ear infections, adenoid hypertrophy, and exposure to other children are potential predictors for OME development.
- Limited evidence exists for other potential modifiable risk factors such as breastfeeding, household smoking, gastro-oesophageal reflux, dummy use, and swimming.
- Further observational studies are recommended to investigate these other potential modifiable risk factors for OME.
Objective:
To systematically assess the modifiable risk factors for developing otitis media with effusion (OME) in children under 12 years.
Methods:
We searched Embase, MEDLINE, INAHTA database, CENTRAL, CDSR and Epistemonikos for cohort studies with ≥40 children per arm/prognostic factor, published in English from 2000 to November 2022. We assessed risk of bias using the Quality in Prognosis Studies checklist, and overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Outcomes were analysed as risk ratio (RR), OR or Peto OR.
Results:
Seven studies totalling 2 760 292 children were included. The evidence was very low quality. Fluid or pus discharge from ears (OR 2.1, 95% CI 1.01 to 4.35) and exposure to other children (RR 2.79, 95% CI 1.98 to 3.93) (OR 5.21, 95% CI 2.9 to 9.36) were strongly associated with development of OME. Coughs/colds ≥5 times (OR 1.91, 95% CI 1.22 to 2.99), breathing problems ≥5 times (RR 1.78, 95% CI 1.26 to 2.53) and ear infections (RR 1.95, 95% CI 1.39 to 2.72) in past year were associated with development of OME. Adenoid hypertrophy was strongly associated with development of fluctuating OME (recurrent OME) (OR 9.96, 95% CI 5.17 to 19.19). There was scare evidence for some potential modifiable risk factors, including breast feeding, household smoking, gastro-oesophageal reflux, dummy use and swimming.
Conclusions:
Upper respiratory tract infection, ear infection, adenoid hypertrophy and exposure to other children could be the predictors for development of OME. Further observational studies are needed to investigate other potential modifiable risk factors.
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