Abstract
Otitis media (main types: acute otitis media and otitis media with effusion) is one of the most common childhood infections, particularly before the age of 3 years. The main causes are viral and/or bacterial ear infections, commonly accompanied by or following upper respiratory tract infection. Besides these infections, other risk factors, such as male sex, young age, genetic predisposition, low socioeconomic status, low vitamin A and C intake, and bottle-feeding are discussed. There is indication that exposure to environmental tobacco smoke is a major environmental risk factor, although additional effects of the exposure to ambient air pollutants is uncertain. Although some studies reported statistically significant increased risk for otitis media in children with high exposure to ambient air pollutants, the risks were not consistent among the studies. Owing to the scarcity of available data, far-reaching conclusions cannot be drawn yet. However, the evidence of an increased risk for environmental tobacco smoke exposure and identified increased risk for ambient air pollution exposure in some studies should stimulate future research using otitis media as one of the major outcomes in air pollution epidemiology.
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References and Recommended Reading
Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM:Otitis media. Lancet 2004, 363:465–473. Excellent review on OM, and its pathogenesis, pathophysiology, treatment, and intervention.
Freid VM, Makuc DM, Rooks RN: Ambulatory health care visits by children: principal diagnosis and place of visit. Vital Health Stat 1998, 13:1–23.
Bondy J, Berman S, Glazner J, Lezotte D: Direct expenditures related to otitis media diagnoses: extrapolations from a pediatric medicaid cohort. Pediatrics 2000, 105:E72.
Senturia BH, Bluestone CD, Klein JO, et al.: Report of the ad hoc committee on definition and classification on otits media and otits media with effusion. Ann Otol Rhinol Laryngol 1980, 89:3–4.
Bluestone CD: Definitions, terminology, and classification. In Evidence-based Otitis Media. Edited by Rosenfeld RM, Bluestone CD. Hamilton, ON: BC Decker, 1999:85–103.
Graham NMH: The epidemiology of acute respiratory infections in children and adults: a global perspective. Epidemiol Rev 1990, 12:149–178.
Mauderly JL: Susceptibility of young and aging lungs to inhaled pollutants. In Susceptibility to inhaled pollutants. Edited by Utell MJ, Frank. Philadelphia: American Society for Testing and Materials; 148–161.
Dhooge IJ: Risk factors for the development of otitis media. Curr Allergy Asthma Rep 2003, 3:321–325.
Holgate ST, Samet J, Koren HS, Maynard RL (eds.): Air pollution and health. London: Academic Press; 1999.
Green RE, Cooper NK: Passive smoking and middle ear effusion in children of British servicemen in West Germany: a point prevalence survey by clinics of outpatient attendance. J R Army Med Corps 1991, 137:31–33.
Kallail KJ, Rainbolt HR, Bruntzel MD: Passive smoking and middle ear problems in Kansas public school children. J Commun Disord 1987, 20:187–196.
Ra L: Passive smoking and hearing loss in infants. Irish Med J 1992, 85:111–112.
Strachan DP, Cook DG: Health effects of passive smoking. 4. Parental smoking, middle ear disease and adenotonsillectomy in children. Thorax 1998, 53:50–56.
U.S. Department of Health and Human Services (1986). The Health Consequences of Involuntary Smoking. A Report of the Surgeon General. DHHS pub. No. (PHS) 87-8398. U.S. Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, Office of Smoking.
National Research Council (NRC): Environmental tobacco smoke: measuring exposure and assessing health effects. Committee on Passive Smoking, Board on Environmental Studies and Toxicology, NRC. Washington, DC: National Academy Press; 1996.
Dostal M, Hertz-Picciotto I, James R, et al.: Childhood morbidity and air pollution in the Teplice program. Cas Lek Cesk 2001, 140:658–661.
Caceres Udina MJ, Alvarez Martinez JA, Argente Del Castillo J, et al.: Incidence, air pollution and risk factors of acute otitis media in the first year of life: a prospective study (Spanish). An Pediatr (Barc) 2004, 60:133–138.
Koltai PJ: Effects of air pollution on the upper respiratory tract of children. Otolaryngol Head Neck Surg 1994, 111:9–11.
Heinrich J, Frye C, Hoelscher B, et al.: [Environmental surveys in the areas of Bitterfeld, Hettstedt and a comparative area in 1992–2000] (German). Gesundheitswesen 2002, 64:675–682.
Heinrich J, Hoelscher B, Frye C, et al.: Improved air quality in reunified Germany and decreases in respiratory symptoms. Epidemiology 2002, 13:394–401.
Heinrich J, Hoelscher B, Wichmann HE: Decline of ambient air pollution and respiratory symptoms in children. Am J Respir Crit Care Med 2000, 161:1930–1936.
Heinrich J, Hoelscher B, Wjst M, et al.: Respiratory diseases and allergies in two polluted areas in East Germany. Environ Health Perspect 1999, 107:53–62.
Frye C, Hoelscher B, Cyrys J, et al.: Association of lung function with declining ambient air pollution. Environ Health Perspect 2003, 111:383–387.
Holtby I, Elliott K, Kumar U: Is there a relationship between proximity to industry and the occurrence of otitis media with effusion in school entrant children? Public Health 1997, 111:89–91. Living close to the industrial polluter was associated with increased risk for OM.
Karmaus W, Kuehr J, Kruse H: Infections and atopic disorders in childhood and organochlorine exposure. Arch Environ Health 2001, 56:485–492.
Ribeiro H, Cardoso MR: Air pollution and children’s health in Sao Paulo (1986-1998). Soc Sci Med 2003, 57:2013–2022. This study displays descriptive data on the temporospatial association between otits and ambient air pollution.
Sprem N, Branica S: Effects of sulphur dioxide and smoke on the incidence of secretory otitis media. Arh Hig Rada Toksikol 1993, 44:229–232.
Brauer M, Hoek G, van Vliet P, et al.: Air pollution from traffic and the development of respiratory infections and asthmatic and allergic symptoms in children. Am J Respir Crit Care Med 2002, 166:1092–1098. The combined diagnosis of ear, nose, and throat infections were statistically significantly associated with GIS-modeled traffic-related ambient air pollutants in a big Dutch baby cohort study of more than 4000 children.
Gehring U, Bischof W, Fahlbusch B, et al.: House dust endotoxin and allergic sensitization in children. The INGA Study Group. Am J Respir Crit Care Med 2002, 166:939–944. A re-analysis in a subset showed increased risks of OM for GIS-modeled, traffic-related air pollutants.
Ohashi Y, Nakai Y, Ikeoka H, et al.: Acute effects of sulfur dioxide exposure on the middle ear mucosa. Ann Otol Rhinol Laryngol 1989, 98(4_Pt_1):301–307.
Jørgensen B, Lundbye-Christensen S, Song XK, et al.: A longitudinal study of emergency room visits and air pollution for Prince George, British Columbia. Stat Med 1996, 15:823–836.
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Heinrich, J., Raghuyamshi, V.S. Air pollution and Otitis media: A review of evidence from epidemiologic studies. Curr Allergy Asthma Rep 4, 302–309 (2004). https://doi.org/10.1007/s11882-004-0075-4
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DOI: https://doi.org/10.1007/s11882-004-0075-4