Passive Smoking and Middle Ear Effusion Among Children in Day Care
1 From the Robert Wood Johnson Clinical Scholars Program and the Department of Pediatrics, The University of North Carolina at Chapel Hill
2 From the Department of Pediatrics, The University of North Carolina at Chapel Hill
3 From the American Health Foundation, Valhalla, NY
4 From the Robert Wood Johnson Clinical Scholars Program, The University of North Carolina at Chapel Hill
One hundred thirty-two children who attended a research day-care center were studied to determine whether passive tobacco smoke exposure was associated with an increased rate of otitis media with effusion or with an increased number of days with otitis media with effusion during the first 3 years of life. Based on preliminary studies, a serum cotinine concentration of 
2.5 ng/mL was considered indicative of exposure to tobacco smoke. Otitis media with effusion was diagnosed using pneumatic otoscopy by nurse practitioners and pediatricians who reviewed the children's health status each weekday. The 87 children with serum cotinine concentrations 2.5 ng/mL had a 38% higher rate of new episodes of otitis media with effusion during the first 3 years of life than the 45 children with lower or undetectable serum cotinine concentrations (incidence density ratio = 1.38, 95% confidence interval 1.21 to 1.56). The average duration of an episode of otitis media with effusion was 28 days in the children with elevated cotinine concentrations and 19 days in the children with lower cotinine concentrations (P < .01). It is estimated that 8% of the cases of otitis media with effusion in this population and 17.6% of the days with otitis media with effusion may be attributable to exposure to tobacco smoke.
Key Words: otitis media • passive smoking • tobacco • day care
Submitted on September 25, 1991
Accepted on January 22, 1992
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