Risk factors for otitis media with effusion: case-control study in Sicilian schoolchildren.

OBJECTIVE: To identify the prevalence and demographic, maternal and child risk factors for otitis media with effusion (OME) in Sicilian schoolchildren and analyse the results with reference to the review of the literature.
METHODS: Associations of possible risk factors with prevalence of otitis media with effusion (OME) were studied in a cohort of 2097 children, aged 5-14 years. In order to determine OME, otoscopy and tympanometry were performed at 3-monthly intervals beginning at term date. Sixteen epidemiologically relevant features were inventoried by means of standardized questionnaires and skin tests were performed. Univariate analysis was performed to examine the association between determinants and occurrence of OME; multivariate logistic regression analysis was made to investigate the joint effect of atopy and other determinants on OME.
RESULTS: Prevalence of OME resulted 6.8% (143/2097) and it was most strongly associated with atopy (P<0.0001; or=12.67; 95% CI=8.78-18.27). Other factors significantly associated with the prevalence of OME were snoring (P<0.0001), previous history of acute otitis media (P<0.001) and of recurrent URTIs (P<0.0001), mother's no schooling (P=0.01) and no breastfeed (P=0.05). No significance was found for school type, economic status of the family, family size, family history of presence of allergy and of ear disease, mother's work status, smoking parents and birth history. Moreover on multivariate logistic regression analysis it resulted that age, positive URTI's history and smoking exposure were found to be significant (P<0.0001).
CONCLUSIONS: OME during infancy is a common and multifactorial disease; as most of the risk factors associated with its etiology and pathogenesis, are modifiable, their modification should represent the reasonable primary care intervention leading to a decrease in OME prevalence.