Torretta Sara, Pignataro Lorenzo, Carioli Daniela, Ibba Tullio, Folino Francesco, Rosazza Chiara, Fattizzo Miriam, Marchisio Paola
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Front Pediatr. 2018 Dec 4;6:383. doi: 10.3389/fped.2018.00383. eCollection 2018.
Otitis-prone children can present some distinctive clinical patterns and although a number of known risk factors for recurrent acute otitis media (RAOM) are known, no dedicated epidemiological models have been developed to explain clinical heterogeneity. A preliminary retrospective pilot study was planned to evaluate the possible effect of allergic disease in the development of different disease phenotypes in otitis-prone children aged 3-10 years, particularly the absence (simple RAOM), or presence of episodes of otitis media with effusion between acute infections (RAOM with OME). Analysis was based on the data contained in 153 charts (55.6% males, mean age of 59.4 ± 16.4 months). 75.8% of children had a simple RAOM and 24.2% a RAOM with OME. Atopy or allergy were documented in respectively 47.7 and 41.3% of children considered as a whole. The prevalence of atopy or allergy was significantly higher in the children with a RAOM with OME (atopy: 73.0 vs. 39.5%, < 0.001; allergy: 60.0 vs. 36.1%, = 0.049), who also more frequently showed adenoidal hypertrophy ( = 0.016), chronic adenoiditis ( = 0.007), conductive hearing loss ( = 0.004), and impaired tympanometry ( < 0.001). These data suggest that children with a RAOM with OME are clinically different from children with simple RAOM, as they have a more complex clinical presentation that includes not only adenoidal disease and audiological impairment, but also an underlying allergy or atopy. The possibility that the factors mentioned above may be differently involved in the heterogeneous clinical manifestations occurring in otitis-prone children needs to be further investigated in epidemiological studies.
易患中耳炎的儿童可能呈现出一些独特的临床模式，尽管已知一些复发性急性中耳炎（RAOM）的风险因素，但尚未建立专门的流行病学模型来解释临床异质性。一项初步的回顾性试点研究计划评估变应性疾病在3至10岁易患中耳炎儿童不同疾病表型发展中的可能作用，特别是急性感染之间无（单纯RAOM）或有中耳积液发作（伴中耳积液的RAOM）的情况。分析基于153份病历中的数据（男性占55.6%，平均年龄59.4±16.4个月）。75.8%的儿童患有单纯RAOM，24.2%患有伴中耳积液的RAOM。总体而言，分别有47.7%和41.3%的儿童记录有特应性或变应性。伴中耳积液的RAOM儿童中特应性或变应性的患病率显著更高（特应性：73.0%对39.5%，<0.001；变应性：60.0%对36.1%，=0.049），他们也更频繁地出现腺样体肥大（=0.016）、慢性腺样体炎（=0.007）、传导性听力损失（=0.004）和鼓室导抗图异常（<0.001）。这些数据表明，伴中耳积液的RAOM儿童在临床上与单纯RAOM儿童不同，因为他们有更复杂的临床表现，不仅包括腺样体疾病和听力损害，还包括潜在的变应性或特应性。上述因素在易患中耳炎儿童中不同程度地参与异质性临床表现的可能性需要在流行病学研究中进一步调查。
