Sun Deping, Shen Yang, Xiong Panhui, Xu Xiaoli, Yang Yucheng
Department of Otorhinolaryngology Head and Neck Surgery, University-Town Hospital of Chongqing Medical University, 55 Middle University Town Road, Chongqing High-Tech Zone, Chongqing, 401331, People's Republic of China.
Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China.
Eur Arch Otorhinolaryngol. 2025 Mar 10. doi: 10.1007/s00405-025-09301-3.
The purpose of this study is to examine the influence of allergic rhinitis (AR) and asthma on the incidence of otitis media (OM), which in turn serves as a mediator for the need for tympanostomy tube placement (TTP).
A comprehensive logistic regression analysis was performed, incorporating multiple variables to assess the relationship between AR, asthma, and the likelihood of TTP. OM was considered the mediating variable in this relationship. The analysis adjusted for a range of demographic and health-related covariates to ascertain the independent effects of the allergic conditions. Mediation analysis was utilized to evaluate the extent to which otitis media influences the association between AR and asthma and the need for TTP. Additionally, sensitivity analyses were conducted to assess the robustness of the findings against potential missing data.
The study revealed significant associations between AR and asthma with the prevalence of OM, which in turn significantly increased the odds of TTP. Specifically, the odds ratios (ORs) for AR were 2.46, 2.44, and 2.19 across models 1, 2, and 3, respectively, indicating a robust correlation with TTP. Asthma also showed a consistent positive relationship with TTP, with ORs of 1.95, 1.94, and 1.56 for the respective models. Mediation analysis provided evidence that OM significantly mediated the relationship between AR and TTP, with an Average Causal Mediation Effect (ACME) of 0.02219, translating to 2.22% of the total effect being mediated through OM. For asthma, the ACME was 0.01395, indicating a 1.4% mediation effect. The Average Direct Effects (ADE) for AR and asthma were 0.03151 and 0.02084, respectively, suggesting substantial direct and indirect effects on TTP. Sensitivity analyses, accounting for missing data, further substantiated the robustness of these associations, with adjusted ORs for AR and asthma remaining highly significant.
The study concludes that AR and asthma are key drivers of OM, which acts as a mediator for TTP. The significant mediation effects highlight the importance of managing these allergic conditions to potentially reduce the incidence of ear infections and the necessity for TT surgery. Further research is encouraged to explore the intricate links between allergic conditions and otological health, facilitating the development of more effective clinical interventions.
本研究旨在探讨变应性鼻炎（AR）和哮喘对中耳炎（OM）发病率的影响，而中耳炎反过来又是鼓膜置管（TTP）需求的一个中介因素。
进行了一项全面的逻辑回归分析，纳入多个变量以评估AR、哮喘与TTP可能性之间的关系。在这种关系中，OM被视为中介变量。该分析对一系列人口统计学和健康相关协变量进行了调整，以确定变应性疾病的独立影响。采用中介分析来评估中耳炎在多大程度上影响AR与哮喘之间的关联以及TTP的需求。此外，还进行了敏感性分析，以评估研究结果对潜在缺失数据的稳健性。
研究揭示了AR和哮喘与OM患病率之间存在显著关联，而这反过来又显著增加了TTP的几率。具体而言，在模型1、2和3中，AR的优势比（OR）分别为2.46、2.44和2.19，表明与TTP存在稳健的相关性。哮喘与TTP也呈现出一致的正相关关系，各模型的OR分别为1.95、1.94和1.56。中介分析提供的证据表明，OM显著介导了AR与TTP之间的关系，平均因果中介效应（ACME）为0.02219，这意味着总效应中有2.22%是通过OM介导的。对于哮喘，ACME为0.01395，表明中介效应为1.4%。AR和哮喘的平均直接效应（ADE）分别为0.03151和0.02084，表明对TTP有显著的直接和间接效应。考虑缺失数据的敏感性分析进一步证实了这些关联的稳健性，AR和哮喘的调整后OR仍然高度显著。
该研究得出结论，AR和哮喘是OM的关键驱动因素，而OM是TTP的中介因素。显著的中介效应凸显了控制这些变应性疾病对于潜在降低耳部感染发病率以及TT手术必要性的重要性。鼓励进一步研究探索变应性疾病与耳科健康之间的复杂联系，以促进更有效的临床干预措施的发展。
