Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1998 Dec;52(12):786–793. doi: 10.1136/jech.52.12.786

Accumulation of factors influencing children's middle ear disease: risk factor modelling on a large population cohort

K E Bennett, M P Haggard
PMCID: PMC1756656  PMID: 10396519

Abstract

STUDY OBJECTIVES: Data were analysed from a large national birth cohort to examine cumulative and interactive prediction from various risk factors for childhood middle ear disease, and to resolve conflicting evidence arising from small and incompletely controlled studies. The large sample size permitted appropriate covariate adjustment to give generality, and permit demographic breakdown of the risk factors. SETTING: A large multi-purpose longitudinal birth cohort study of all births in the UK in one week in 1970, with multiple questionnaire sweeps. PARTICIPANTS: Over 13,000 children were entered into the original cohort. Data on over 12,000 children were available at the five year follow up. MAIN OUTCOME MEASURES: For children at 5 years, parent reported data were available on health and social factors including data on two markers for middle ear disease: the occurrence of purulent (nonwax) ear discharge and suspected or confirmed hearing difficulty. MAIN RESULTS: In those children who had ever had reported hearing difficulty (suspected or confirmed), after control for socioeconomic status, three of the classic factors (male sex, mother's smoking habits since birth, and attending day care) were significantly more frequent. In those who had ever had ear discharge reported, only mother's smoking habit since birth was significantly more frequent. However, it showed an orderly dose response relation. In addition, a derived general child health score was found to be significantly associated with both the middle ear disease markers. Control for this variable in the analysis of those having reported hearing difficulty reduced the effect size of mother's smoking habit, but it remained statistically significant. For reported ear discharge, even after control for the general health score and social index, mother's smoking habits and day care attendance were both significant predictors. Mother's (but not father's) smoking habits and day care attendance were found to be significant risk factors for middle ear disease. Breast feeding effects were weak and did not generally survive statistical control. CONCLUSIONS: A child having all three risk factors (attends day care, a mother who smokes, and male sex) is 3.4 times more likely to have problems with hearing than a child who has none, based on cumulative risk. Further studies should focus on preventative risk modification and well specified intervention.

 

Full Text

The Full Text of this article is available as a PDF (148.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bauchner H., Leventhal J. M., Shapiro E. D. Studies of breast-feeding and infections. How good is the evidence? JAMA. 1986 Aug 15;256(7):887–892. [PubMed] [Google Scholar]
  2. Bexell A., Råstam L., Isacsson S. O., Ingvarsson L. Parents' response to recurrent middle ear infection in their children. Scand J Soc Med. 1990;18(1):25–30. doi: 10.1177/140349489001800104. [DOI] [PubMed] [Google Scholar]
  3. Blakley B. W., Blakley J. E. Smoking and middle ear disease: are they related? A review article. Otolaryngol Head Neck Surg. 1995 Mar;112(3):441–446. doi: 10.1016/S0194-59989570281-4. [DOI] [PubMed] [Google Scholar]
  4. Charlton A. Children and passive smoking: a review. J Fam Pract. 1994 Mar;38(3):267–277. [PubMed] [Google Scholar]
  5. 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]
  6. Daly K. A., Lindgren B., Giebink G. S. Validity of parental report of a child's medical history in otitis media research. Am J Epidemiol. 1994 Jun 1;139(11):1116–1121. doi: 10.1093/oxfordjournals.aje.a116955. [DOI] [PubMed] [Google Scholar]
  7. 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]
  8. 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]
  9. 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]
  10. Ford K., Labbok M. Breast-feeding and child health in the United States. J Biosoc Sci. 1993 Apr;25(2):187–194. doi: 10.1017/s0021932000020484. [DOI] [PubMed] [Google Scholar]
  11. Froom J., Culpepper L. Otitis media in day-care children. A report from the International Primary Care Network. J Fam Pract. 1991 Mar;32(3):289–294. [PubMed] [Google Scholar]
  12. Hinton A. Passive smoking and otitis media with effusion. BMJ. 1992 Jan 4;304(6818):53–53. doi: 10.1136/bmj.304.6818.53. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Irander K., Borres M. P., Björkstén B. Middle ear diseases in relation to atopy and nasal metachromatic cells in infancy. Int J Pediatr Otorhinolaryngol. 1993 Feb;26(1):1–9. doi: 10.1016/0165-5876(93)90191-5. [DOI] [PubMed] [Google Scholar]
  14. Kannel W. B. An epidemiological perspective in hypertension problem solving. Cardiology. 1994;85 (Suppl 1):71–77. doi: 10.1159/000176763. [DOI] [PubMed] [Google Scholar]
  15. Kraemer M. J., Richardson M. A., Weiss N. S., Furukawa C. T., Shapiro G. G., Pierson W. E., Bierman C. W. Risk factors for persistent middle-ear effusions. Otitis media, catarrh, cigarette smoke exposure, and atopy. JAMA. 1983 Feb 25;249(8):1022–1025. [PubMed] [Google Scholar]
  16. Owen M. J., Baldwin C. D., Swank P. R., Pannu A. K., Johnson D. L., Howie V. M. Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life. J Pediatr. 1993 Nov;123(5):702–711. doi: 10.1016/s0022-3476(05)80843-1. [DOI] [PubMed] [Google Scholar]
  17. Pless C. E., Pless I. B. How well they remember. The accuracy of parent reports. Arch Pediatr Adolesc Med. 1995 May;149(5):553–558. doi: 10.1001/archpedi.1995.02170180083016. [DOI] [PubMed] [Google Scholar]
  18. Rach G. H., Zielhuis G. A., van den Broek P. The influence of chronic persistent otitis media with effusion on language development of 2- to 4-year-olds. Int J Pediatr Otorhinolaryngol. 1988 Sep;15(3):253–261. doi: 10.1016/0165-5876(88)90080-8. [DOI] [PubMed] [Google Scholar]
  19. Rowe-Jones J. M., Brockbank M. J. Parental smoking and persistent otitis media with effusion in children. Int J Pediatr Otorhinolaryngol. 1992 Jul;24(1):19–24. doi: 10.1016/0165-5876(92)90062-t. [DOI] [PubMed] [Google Scholar]
  20. 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]
  21. Tainio V. M., Savilahti E., Salmenperä L., Arjomaa P., Siimes M. A., Perheentupa J. Risk factors for infantile recurrent otitis media: atopy but not type of feeding. Pediatr Res. 1988 May;23(5):509–512. doi: 10.1203/00006450-198805000-00015. [DOI] [PubMed] [Google Scholar]
  22. 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]
  23. 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]
  24. 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]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES