PURPOSE OF THE STUDY.
Otitis media with effusion (OME) is often considered to be associated with allergic diseases. This study investigated the association of objectively determined OME at age 6 with asthma, eczema, allergic and nonallergic rhinitis, nasal inflammation, and eosinophilia.
A single-center birth cohort of 262 children born to asthmatic mothers from the Copenhagen Prospective Study on Asthma in Childhood study were evaluated during their sixth year of life for OME.
OME was diagnosed on the basis of otoscopic findings and tympanometry. Nasal patency was assessed twice, in and out of the pollen season, using wideband nasal acoustic rhinometry. Nasal scrapings were obtained and stained for eosinophils.
Atopic comorbidity was assessed by using standardized guidelines for asthma, allergic rhinitis, nonallergic rhinitis, and eczema. Allergic rhinitis was suspected via a history of sneezing or a blocked or runny nose after exposure to relevant allergens. Allergic sensitization was confirmed by serum-specific immunoglobulin E levels ≥0.35 kU/L as determined by ImmunoCAP (Pharmacia Diagnostics, Uppsala, Sweden) for any of the common allergens (cat, dog, horse, birch, grass, mugwort, dust mite, and molds). Potential confounders were identified including pet exposure, parental atopy, household income, tobacco smoke exposure at birth, siblings, and gender.
OME was identified in 39% (102 of 262) of patients. OME was associated with concomitant allergic rhinitis (adjusted odds ratio = 3.36, P = .02) but not with nasal mucosal swelling, nasal eosinophilia, nonallergic rhinitis, asthma, or eczema. There was no correlation between pollen season and OME (P = .48).
OME is common in children born to asthmatic mothers. The presence of allergic rhinitis in the subjects significantly increased the risk of OME.
Previous studies that have looked for an association between atopy and middle ear disease have been criticized for inconsistent definitions of OME and allergy. Many of these used questionnaires or physician subjective diagnoses and were therefore subject to bias. This study’s major strength lies in its objective measurements for OME and allergic rhinitis. The authors conclude that allergic rhinitis significantly increases the risk of having OME. This study suggests that obstruction of the eustachian tubes is not the primary mechanism leading to the development of OME; rather, the effusion appears to result from allergic inflammation of the respiratory epithelium, including the middle ear mucosa. This suggests that additional studies are needed to determine if “antiinflammatory agents” used for allergic diseases could play a role in the treatment or prevention of middle ear effusion.
- Copyright © 2013 by the American Academy of Pediatrics