School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12e Avenue nord, Sherbrooke, QC J1H 5N4, Canada.
BMC Pediatr. 2012 Nov 20;12:181. doi: 10.1186/1471-2431-12-181.
Eustachian tube (ET) dysfunction plays an important role in the pathogenesis of acute otitis media (AOM). Unfortunately, there is a lack of knowledge about the exact role of the ET's bony support, the temporal bone, on occurrence of AOM. This study investigates whether severe suture restriction of the temporal bone is a risk factor for development of AOM in young children.
Using a prospective cohort design, 64 children aged 6 to 18 months without prior history of AOM were followed during the cold season (September 2009 to April 2010). Temporal bone status (categorized as with or without severe suture restriction) was evaluated using palpation and a cranial bone mobility test. Information about potential baseline confounders and risk factors for AOM (gender, age, birth weight, gestational age, use of pacifier, daycare attendance, presence of siblings, low socioeconomic status, breastfeeding ≥ 6 months, parental smoking and history of upper respiratory tract infection) were also collected. Occurrence of AOM diagnosed by physicians blinded to temporal bone status was the main outcome. Data were analyzed using hierarchical linear and nonlinear (multilevel) models.
Severe suture restriction of the temporal bone was identified in 23 children (35.9%). At least one AOM episode was diagnosed in 14 (48.3%) of the ears associated with temporal bones previously identified as having severe suture restriction and in 28 (28.3%) of those without severe suture restriction. Higher risk for AOM was explained by severe suture restriction of the temporal bone (adjusted relative risk (RR), 2.26, 95% CI 1.43 to 2.91, p<.01), pacifier use (RR, 2.59, 95% CI 1.51 to 3.22, p<.01) and younger age (RR, 0.22, 95% CI 0.10 to 0.52, p=.001).
The study results indicate that severe suture restriction of the temporal bone is a risk factor for AOM in young children. Subsequent intervention studies are needed to determine if this mechanical risk factor can be modified in young children.
咽鼓管（ET）功能障碍在急性中耳炎（AOM）的发病机制中起着重要作用。不幸的是，对于 ET 的骨性支撑——颞骨在 AOM 发生中的确切作用知之甚少。本研究旨在探讨颞骨严重缝线限制是否是幼儿发生 AOM 的危险因素。
采用前瞻性队列设计，64 名年龄在 6 至 18 个月之间、无 AOM 既往史的儿童在寒冷季节（2009 年 9 月至 2010 年 4 月）期间接受随访。使用触诊和颅骨活动性测试评估颞骨状态（分为存在或不存在严重缝线限制）。还收集了潜在的基线混杂因素和 AOM 的危险因素（性别、年龄、出生体重、胎龄、使用奶嘴、日托出勤率、兄弟姐妹、低社会经济地位、母乳喂养≥6 个月、父母吸烟和上呼吸道感染史）的信息。医生在不了解颞骨状况的情况下诊断 AOM，作为主要结局。使用分层线性和非线性（多水平）模型进行数据分析。
在 23 名儿童（35.9%）中发现颞骨严重缝线限制。在之前被确定为有严重缝线限制的颞骨相关的 14 只耳朵（48.3%）中至少诊断出一只耳朵发生 AOM，而在没有严重缝线限制的 28 只耳朵（28.3%）中也至少诊断出一只耳朵发生 AOM。颞骨严重缝线限制解释了 AOM 发生的较高风险（调整后的相对风险（RR），2.26，95%置信区间 1.43 至 2.91，p<.01），奶嘴使用（RR，2.59，95%置信区间 1.51 至 3.22，p<.01）和年龄较小（RR，0.22，95%置信区间 0.10 至 0.52，p=.001）也是 AOM 发生的危险因素。
研究结果表明，颞骨严重缝线限制是幼儿 AOM 的危险因素。需要进一步的干预研究来确定是否可以改变幼儿的这种机械危险因素。
