Chronic otitis media with effusion in children with adenoidal hypertrophy: Development of a diagnostic prediction
Yu Wu1, Yuan Jiang2, Yan-Xun Han1
1Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Insights
This study identifies key risk factors for chronic otitis media with effusion (COME) in children with adenoidal hypertrophy (AH). A new nomogram helps predict COME risk, aiding early diagnosis and intervention for better child development.
Area of Science:
- Otolaryngology
- Pediatric Health
- Medical Diagnostics
Background:
- Chronic otitis media with effusion (COME) significantly impacts child development.
- Adenoidal hypertrophy (AH) is a common condition in children, often associated with COME.
- Accurate risk assessment for COME in children with AH is crucial for timely intervention.
Purpose of the Study:
- To identify risk factors for COME in children with adenoidal hypertrophy (AH).
- To develop and validate a clinical prediction nomogram for COME risk in this population.
- To enhance diagnostic accuracy and aid clinical decision-making.
Main Methods:
- Retrospective analysis of 311 children with AH diagnosed via lateral nasopharyngeal radiographs.
- Utilized least absolute shrinkage and selection operator (LASSO) for risk factor identification.
- Employed Firth's penalized logistic regression and internal validation (bootstrapping) to build and assess the predictive model.
Main Results:
- Identified young age, vitamin D3 deficiency, degree of AH, and tympanometry results as key risk factors.
- The predictive nomogram achieved a high C-index of 0.945 (internal validation: 0.934).
- The model demonstrated good calibration and clinical utility across various risk thresholds.
Conclusions:
- A validated nomogram incorporating age, vitamin D3 levels, AH degree, and tympanometry effectively predicts COME risk in children with AH.
- This tool can assist clinicians and families in assessing and managing COME risk.
- Early identification and intervention can mitigate the adverse effects of COME on child development.
Abstract:
Chronic otitis media with effusion (COME) is a prevalent condition that poses significant risks to the growth and development of children with adenoidal hypertrophy (AH). This study investigates the risk factors associated with COME in children diagnosed with AH and establishes a clinical prediction nomogram to enhance diagnostic accuracy. The study included 311 children with AH, diagnosed through lateral nasopharyngeal radiographs, from the Department of Otorhinolaryngology Head and Neck Surgery at the First Affiliated Hospital of Anhui Medical University. Risk factors were identified using the least absolute shrinkage and selection operator (LASSO), while Firth's penalized logistic regression analysis was employed to further refine the variables and develop a predictive model. The model's performance was assessed using the C-index, calibration curve, and decision curve analysis, with internal validation conducted through bootstrapping. The resulting predictive nomogram included four key risk factors: young age, vitamin D3 deficiency, degree of AH, and tympanometry results. The model exhibited strong predictive capabilities, achieving a C-index of 0.945 (95% confidence interval: 0.941, 0.949). Bootstrapping validation confirmed a high C-index of 0.934. The calibration curve demonstrated good alignment, while the decision curve indicated a net benefit across thresholds of 10%-90%. This nomogram-incorporating tympanometry, AH degree, serum vitamin D3 levels, and age-serves as a valuable tool for clinicians and families in assessing the risk of COME in children with AH.
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