Herzog C, Homøe P, Koch A, Niclasen J, Dammeyer J, Lous J, Kørvel-Hanquist A
Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.
Center for Infectious Disease Epidemiology, Statens Serum Institute, Copenhagen, Denmark.
Int J Pediatr Otorhinolaryngol. 2020 Jun;133:109961. doi: 10.1016/j.ijporl.2020.109961. Epub 2020 Feb 19.
Otitis Media (OM) is one of the most common infections among children in developed countries and may result in temporary conductive hearing loss (HL) if accompanied by middle ear effusion (MEE). Ventilation tube insertion (VTI) is recommended as treatment for recurrent acute OM or chronic MEE with HL. HL may lead to impaired development of psychosocial skills. However, evidence for the developmental consequences of OM and the effect of VTI is inconsistent. The objectives of this study were to investigate 1) whether OM in early childhood is associated with long-term consequences of psychosocial development and 2) if VTI prevents the possible negative consequences of OM.
This study examined prospectively collected data from 52.877 children registered in the Danish National Birth Cohort (DNBC). Information about previous OM-episodes and VTI was obtained through systematic follow-up interviews at seven years, and The Strength and Difficulties Questionnaire (SDQ) containing questions about psychological wellbeing was completed. Five groups were defined based on OM-exposure and the presence of VTI. Baseline characteristics were analysed, and comparison of mean SDQ-scores for the five exposure groups was conducted. Means were adjusted for à priori defined confounding factors.
Data from 52,877 children in the DNBC showed an association between OM and poorer SDQ-scores. VTI was associated with an additional increase, i.e. worsening, of the SDQ-score for boys, and only a slight beneficial effect on the girls' outcome. The groups differed in their baseline characteristics in e.g. maternal education, socio-economic status, breastfeeding, and prematurity.
Significant associations between parent-reported OM in early childhood and later psychosocial health difficulties were found. VTI did not resolve this association.
中耳炎（OM）是发达国家儿童中最常见的感染之一，如果伴有中耳积液（MEE），可能会导致暂时性传导性听力损失（HL）。推荐插入通气管（VTI）作为复发性急性中耳炎或伴有HL的慢性MEE的治疗方法。HL可能导致心理社会技能发展受损。然而，关于中耳炎的发育后果以及VTI效果的证据并不一致。本研究的目的是调查：1）幼儿期的中耳炎是否与心理社会发展的长期后果相关；2）VTI是否能预防中耳炎可能产生的负面影响。
本研究检查了丹麦国家出生队列（DNBC）中登记的52877名儿童的前瞻性收集数据。通过7岁时的系统随访访谈获得了既往中耳炎发作和VTI的信息，并完成了包含心理健康问题的《长处与困难问卷》（SDQ）。根据中耳炎暴露情况和VTI的存在定义了五组。分析了基线特征，并对五个暴露组的平均SDQ得分进行了比较。对先验定义的混杂因素进行了均值调整。
DNBC中52877名儿童的数据显示，中耳炎与较差的SDQ得分之间存在关联。VTI与男孩SDQ得分的额外增加（即恶化）相关，而对女孩的结果只有轻微的有益影响。这些组在诸如母亲教育程度、社会经济地位、母乳喂养和早产等基线特征方面存在差异。
发现父母报告的幼儿期中耳炎与后期心理社会健康困难之间存在显著关联。VTI并未消除这种关联。
