Skull S A, Morris P S, Yonovitz A, Attewell R G, Krause V, Leach A J, Anand A, Scott J, Reid S, Roberts L A
Centre for Disease Control Darwin, Territory Health Services, Casuarina, NT, Australia.
Epidemiol Infect. 1999 Aug;123(1):57-64. doi: 10.1017/s0950268899002708.
There have been no previous longitudinal studies of otitis media conducted in non-Aboriginal Australian children. This paper describes the rate and risk factors for middle ear effusion (MEE) in children attending day care in Darwin, Australia. A prospective cohort study of 252 children under 4 years was conducted in 9 day care centres over 12 fortnights between 24 March and 15 September 1997. Tympanometry was conducted fortnightly and multivariate analysis used to determine risk factors predicting MEE. The outcome of interest was the rate of type B tympanograms per child detected in either ear at fortnightly examinations. After adjusting for clustering by child, MEE was detected on average 4.4 times in 12 fortnights (37% of all examinations conducted). Risk factors associated with presence of effusion were younger age, a family history of ear infection, previous grommets (tympanostomy tubes), ethnicity and the day care centre attended. A history of wheeze appeared protective. These effects were modest (RR 0.57-1.70). Middle ear effusion is very common in children attending day care in Darwin. This has clinical importance, since MEE during early childhood may affect optimal hearing, learning and speech development. There is little scope for modification for many of the risk factors for MEE predicted by this model. Further study of the day care environment is warranted.
此前尚未对澳大利亚非原住民儿童进行过中耳炎纵向研究。本文描述了澳大利亚达尔文市日托中心儿童中耳积液（MEE）的发生率及危险因素。1997年3月24日至9月15日期间，在9个日托中心对252名4岁以下儿童进行了一项前瞻性队列研究，为期12个双周。每两周进行一次鼓室图检查，并采用多变量分析来确定预测中耳积液的危险因素。关注的结果是在每两周一次的检查中，每侧耳朵检测到的B型鼓室图的发生率。在对儿童聚集情况进行校正后，在12个双周内平均每4.4次检测到中耳积液（占所有检查的37%）。与积液存在相关的危险因素包括年龄较小、耳部感染家族史、既往鼓膜切开置管术史、种族以及所就读的日托中心。喘息病史似乎具有保护作用。这些影响较小（相对危险度为0.57 - 1.70）。中耳积液在达尔文市日托中心儿童中非常常见。这具有临床重要性，因为幼儿期的中耳积液可能会影响最佳听力、学习和语言发育。对于该模型预测的许多中耳积液危险因素，几乎没有可改变的空间。有必要对日托环境进行进一步研究。
