Abstract
BACKGROUND: Glue ear (otitis media with effusion) is the most common reason for surgical intervention in children. AIM: To determine the yield and predictive value of a set of risk factors that predict persistence of glue ear over the interval from general practice referral to ear, nose and throat (ENT) consultation to ensure the appropriateness of referrals. DESIGN OF STUDY: Nested case control study SETTING: Sixteen ENT departments in the UK. METHOD: With the aid of audiometry and tympanometry, diagnostic information was collected on 548 children from 16 ENT departments after referral by their general practitioner (GP), as a lead-in to a clinical trial, the Trial of Alternative Regimens in Glue Ear Treatment (TARGET). Using cases and controls, children were classified as either having or not having persistent glue ear. Parental reports on an extensive list of risk factors were also collected. RESULTS: After adjustment for time waiting to be seen from GP referral and age at referral, four main significant factors emerged for persistence of glue ear. These were: referral between July and December (OR [odds ratio] = 1. 73, 95% CI = 1.15 to 2.6); having a mother who smokes ten or more cigarettes per day (OR = 1.7, 95% CI = 1.1 to 2.8); multiple upper airway symptoms (OR = 2.2, 95% CI = 1.5 to 3.2; and siblings with a history of glue ear (OR = 1.6 for one sibling versus none). CONCLUSION: For a child who is referred between July and December; who has two or more upper airway symptoms, who has a sibling who has had glue ear, and who has a mother who smokes ten or more cigarettes per day, the odds of having persistent glue ear are over ten times that of a child without adverse values on these factors.
Full Text
The Full Text of this article is available as a PDF (189.9 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bennett K. E., Haggard M. P. Accumulation of factors influencing children's middle ear disease: risk factor modelling on a large population cohort. J Epidemiol Community Health. 1998 Dec;52(12):786–793. doi: 10.1136/jech.52.12.786. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bennett K., Haggard M., Churchill R., Wood S. Improving referrals for glue ear from primary care: are multiple interventions better than one alone? J Health Serv Res Policy. 2001 Jul;6(3):139–144. doi: 10.1258/1355819011927387. [DOI] [PubMed] [Google Scholar]
- Bennett K., Higson J., Haggard M. Do GPs have the techniques for 'watchful waiting' in glue ear? Br J Gen Pract. 1998 Mar;48(428):1079–1080. [PMC free article] [PubMed] [Google Scholar]
- Charlton A. Children and passive smoking: a review. J Fam Pract. 1994 Mar;38(3):267–277. [PubMed] [Google Scholar]
- Collet J. P., Burtin P., Gillet J., Bossard N., Ducruet T., Dürr F. Risk of infectious diseases in children attending different types of day-care setting. Epicrèche Research Group. Respiration. 1994;61 (Suppl 1):16–19. doi: 10.1159/000196375. [DOI] [PubMed] [Google Scholar]
- Daly K., Giebink G. S., Le C. T., Lindgren B., Batalden P. B., Anderson R. S., Russ J. N. Determining risk for chronic otitis media with effusion. Pediatr Infect Dis J. 1988 Jul;7(7):471–475. doi: 10.1097/00006454-198807000-00004. [DOI] [PubMed] [Google Scholar]
- Duncan B., Ey J., Holberg C. J., Wright A. L., Martinez F. D., Taussig L. M. Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics. 1993 May;91(5):867–872. [PubMed] [Google Scholar]
- Etzel R. A., Pattishall E. N., Haley N. J., Fletcher R. H., Henderson F. W. Passive smoking and middle ear effusion among children in day care. Pediatrics. 1992 Aug;90(2 Pt 1):228–232. [PubMed] [Google Scholar]
- Strachan D. P., Jarvis M. J., Feyerabend C. Passive smoking, salivary cotinine concentrations, and middle ear effusion in 7 year old children. BMJ. 1989 Jun 10;298(6687):1549–1552. doi: 10.1136/bmj.298.6687.1549. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Teele D. W., Klein J. O., Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis. 1989 Jul;160(1):83–94. doi: 10.1093/infdis/160.1.83. [DOI] [PubMed] [Google Scholar]
- Wilkin D., Smith A. Explaining variation in general practitioner referrals to hospital. Fam Pract. 1987 Sep;4(3):160–169. doi: 10.1093/fampra/4.3.160. [DOI] [PubMed] [Google Scholar]
- Williamson I. G., Dunleavey J., Robinson D. Risk factors in otitis media with effusion. A 1 year case control study in 5-7 year old children. Fam Pract. 1994 Sep;11(3):271–274. doi: 10.1093/fampra/11.3.271. [DOI] [PubMed] [Google Scholar]
- Zielhuis G. A., Heuvelmans-Heinen E. W., Rach G. H., van den Broek P. Environmental risk factors for otitis media with effusion in preschool children. Scand J Prim Health Care. 1989 Mar;7(1):33–38. doi: 10.3109/02813438909103668. [DOI] [PubMed] [Google Scholar]
- Zielhuis G. A., Rach G. H., van den Broek P. The natural course of otitis media with effusion in preschool children. Eur Arch Otorhinolaryngol. 1990;247(4):215–221. doi: 10.1007/BF00178987. [DOI] [PubMed] [Google Scholar]