Relationship of environmental tobacco smoke to otitis media (OM) in children

Abstract

Introduction

Many, but not all, studies have found a correlation between environmental tobacco smoke (ETS) and acute otitis media (AOM) and other adverse otologic outcomes. Given its high personal and societal costs and the divergent findings of the effect of ETS on middle ear disease, the aim of the current study was to assess the impact and possible determinant factors of ETS on recurrent (two or more) episodes of AOM.

Methods

The study was performed at Heim Pal Children's Hospital, Ear, Nose and Throat (ENT) Department, Budapest, Hungary. Caregivers of a convenience sample of 412 children attending the ENT outpatient clinic were surveyed via a 22-item questionnaire regarding demographics, socioeconomics, and smoking behaviours of the child's family; as well as care-givers’ self report of the number of AOM episodes of the child.

Results

Of the 412 participants, 155 (38%) children's parents smoked. In bivariate analysis, two or more episodes of AOM correlated with reported hearing problems, day care enrolment, parental employment and increased age of the child. In multivariate logistic regression, parental smoking more than doubled a child's risk for recurrent AOM while increased maternal employment (e.g. part-time or full-time versus unemployed) boosted risk up to fourfold. Among children whose parents smoked, half-packs of cigarettes smoked per day and day care attendance doubled or nearly tripled, respectively, the risk of recurrent AOM episodes.

Conclusions

Childhood exposure to ETS is high among an ENT clinic population of Hungarian children. Such exposure correlates with AOM episodes, ENT operations and conductive hearing loss. Data such as these argue for strict laws smoke-free laws not only in Hungary, but also in Europe and around the world.

Introduction

Otitis media (OM) is the most common disease of childhood, with 90% incidence in the first two years of life [1]. The etiology and pathogenesis of this disease is multifactorial, but its high incidence represents a major health problem associated with increased health care costs for society (over $5 billion annually in the US) [2]. These issues support research on and eventual elimination of modifiable risk factors potentially involved in the pathogenesis of OM.

Although numerous studies have established a relationship between environmental tobacco smoke (ETS) and the development of many paediatric otolaryngologic conditions—[3], [4], [5], [6], [7], [8], [9], [10], including OM [3], [4], [5], [11], [12]—other studies have not documented these findings [13], [14], [15], [16], [17], [18]. Nonetheless, a causal relationship between exposure to cigarette smoke and middle ear disease is biologically plausible with investigations documenting ETS effects on middle ear histology [19], gene expression [15], [20], inflammation [21], and, recently, sensorineural hearing loss among non-smoking adults [22]. Alpert et al., in particular, found at the population level a decreased outpatient rate of paediatric visits for OM which was attributable to changes in household smoke-free policies as well at pneumococcal vaccination [3].

Given its high personal and societal costs [23] and the divergent findings of the effect of ETS on middle ear disease, the aim of the current study was to assess the impact and possible determinant factors of ETS on acute OM (AOM). Smoking prevalence among Hungarian adults was recently measured at 33.2% [24], and Hungary has a relatively high level of reported ETS exposure [25]. We report the results of a survey of 412 patients at a large paediatric otolaryngology clinic in Budapest, Hungary. While our results are local, these data have international implications regarding the effect of ETS on middle ear disease, and the need for further policy changes or enforcement of existing law in European countries such as Hungary.