Walker Rebecca E, Bartley Jim, Flint David, Thompson John M D, Mitchell Edwin A
Department of Paediatrics: Child and Youth Health, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
Division of Otolaryngology-Head and Neck Surgery, Counties-Manukau District Health Board, Manukau SuperClinic™, PO Box 98743, Manukau City, Auckland, 2241, New Zealand.
BMC Pediatr. 2017 Jan 6;17(1):4. doi: 10.1186/s12887-016-0767-7.
Chronic otitis media with effusion (COME) is a prevalent upper airway infection resulting in hearing loss. The aim of this research was to determine risk factors for COME in preschool children.
A case-control design was conducted in Auckland, New Zealand from May 2011 until November 2013. The cases were children aged 3 and 4 years referred for tympanostomy tube placement due to a diagnosis of COME (n = 178). The controls were a random sample of healthy children aged 3 and 4 years from primary care practices (n = 209). The children's guardians completed an interviewer-administered questionnaire that covered topics including socio-demographic information, pregnancy and birth, infant feeding practices, home environment, and respiratory health. In addition, skin prick tests for atopy were performed. Odds ratios (OR) estimating the risk of COME independently associated with the exposures were calculated using a logistic regression model.
Children with COME frequently had nasal obstruction (OR: 4.38 [95% CI: 2.37-8.28]), always snored (OR: 3.64 [95% CI: 1.51-9.15]) or often snored (OR: 2.45 [95% CI: 1.04-5.96]), spent more hours per week in daycare (OR per hour/week: 1.03 [95% CI: 1.00-1.05]), had frequent colds (OR: 2.67 [95% CI: 1.59-4.53]), had siblings who had undergone tympanostomy tube placement (OR: 2.68 [95% CI: 1.22-6.02]), underwent long labour (OR: 2.59 [95% CI: 1.03-6.79]), and had early introduction of cow's milk (OR: 1.76 [95% CI: 1.05-2.97]). Asian ethnicity (OR: 0.20 [95% CI: 0.07-0.53]) and having older siblings (OR: 0.54 [95% CI: 0.31-0.93]) were inversely associated with COME.
COME in preschool children was associated with pathogen exposure, respiratory infection, and nasal obstruction. Strategies to prevent pathogen transmission warrant investigation. The novel findings of long labour and early cow's milk introduction require replication in future studies.
分泌性中耳炎（COME）是一种常见的上呼吸道感染，可导致听力损失。本研究的目的是确定学龄前儿童患COME的风险因素。
2011年5月至2013年11月在新西兰奥克兰进行了一项病例对照研究。病例为因诊断为COME而接受鼓膜置管术的3岁和4岁儿童（n = 178）。对照是从初级保健机构随机抽取的3岁和4岁健康儿童样本（n = 209）。儿童监护人完成了一份由访谈员管理的问卷，内容包括社会人口统计学信息、怀孕和分娩、婴儿喂养方式、家庭环境和呼吸健康。此外，还进行了特应性皮肤点刺试验。使用逻辑回归模型计算估计与暴露独立相关的COME风险的比值比（OR）。
患有COME的儿童经常有鼻塞（OR：4.38 [95% CI：2.37 - 8.28]）、总是打鼾（OR：3.64 [95% CI：1.51 - 9.15]）或经常打鼾（OR：2.45 [95% CI：1.04 - 5.96]）、每周在日托中心花费更多时间（每小时/周的OR：1.03 [95% CI：1.00 - 1.05]）、经常感冒（OR：2.67 [95% CI：1.59 - 4.53]）、有接受过鼓膜置管术的兄弟姐妹（OR：2.68 [95% CI：1.22 - 6.02]）、分娩时间长（OR：2.59 [95% CI：1.03 - 6.79]）以及过早引入牛奶（OR：1.76 [95% CI：1.05 - 2.97]）。亚洲种族（OR：0.20 [95% CI：0.07 - 0.53]）和有哥哥姐姐（OR：0.54 [95% CI：0.31 - 0.93]）与COME呈负相关。
学龄前儿童的COME与病原体暴露、呼吸道感染和鼻塞有关。预防病原体传播的策略值得研究。分娩时间长和过早引入牛奶的新发现需要在未来研究中重复验证。
