Acta Otolaryngol, Suppl. 360: 135-137, 1979
A POPULATION STUDY O F OTITIS MEDIA I N CHILDHOOD
B. Vinther, 0. Elbrand and C. Brahe Pedersen
total of 494 children with a n average age of a view to elucidating the frequency of both acute and secretory otitis media and their relationship. if any. to a number of social factors. Of the children, 41 % had had at least one attack of otitis media, in 49% of these associated with aural discharge. 70%' of the children were attending day-care centres, and the incidence of otitis media was highest in this group. According to Jerger's classification of the tympanometric curves, 5 1 % of these were of type A , 17'36 of type B, and 32% of type C. Significantly higher frequencies of types B and C curves were found among children attending day-care centres
Ah.strcict. A
Acta Otolaryngol Downloaded from informahealthcare.com by Queen's University on 01/05/15 For personal use only.
3i years were studied with
The acute and t h e secretory otitis media are common diseases of childhood. With a view to the elucidation of the frequency of these diseases and their relationship, if any, to a number of social factors, a total of 494 children from the municipality of Aarhus, all born in 1974, i.e. of an average age of 3; years, were studied. METHOD During the year 1974 a total of 3500 children were born in the municipality of Aarhus. The children studied were divided into four groups as shown in Table 1; 33 children were included in two, or sometimes three, groups, thus giving a total number of cases of 527. Of the series of 494 children studied, 236 were girls and 258 boys. The children accompanied by one of the parents were summoned by letter for examination; 86% of those concerned appeared for examination. In all cases, a medical history was taken, but in 4 % physical examination and tympanometry were not performed because the children were unwilling to submit to the procedures.
The clinical study consisted in the taking of a thorough somatic and social history with answers to a total of 93 standardized questions, including many subquestions, an otological examination and tympanometry. As the study was retrospective, the diagnosis of acute otitis media was based on the information given to the parents by the doctors who had treated the children. RESULTS AND DISCUSSION In the four groups, 26% of the randomly selected children had previously had otitis media, as against 42% living in newer houses in a residential suburb, 41 95 living in poor housing conditions and 63% of those previously admitted to our E N T department. In all, 41 5% had had otitis media at least once, and these children had, on the average, had 3.8 attacks. If the most seriously affected group, viz. those who has previously been admitted to our department, is excluded, an average of 36% in the first three groups had previously had acute otitis media. Of all the children with previous otitis media, 49% had had aural discharge, and there was no significant difference among the four groups. The first attack of otitis media had occurred before the age of 1 year in 51 %, and before the age of 2 in 75 % of the children, which was found to be of great importance for the recurrence rate (Fig. I), which showed a linear fall with increasing age. This observation is in agreement with those made by Howie (1973, for example, who also reported that children in whom otitis media developes before the age of 1 year carry a significantly A 1 IU
~ ~ l l ) / U tl& l'\
.$llPP/ -360
B. Vinther et al.
136
Table I. The nirmher o f children stridird divided into foiir grorrps No
Table 11. Tympunometric ,firitlings (number qf' ears) related t o drry-crire (it home or outside home
Acta Otolaryngol Downloaded from informahealthcare.com by Queen's University on 01/05/15 For personal use only.
At home Randomly selected From a newer residential suburb Living under poor housing conditions Previously admitted to E N T department
153 I20 142 I12
Total
527
greater risk of recurrence than those who have their first attack of otitis media after that age. Strangert (1976) showed that in children under the age of 18 months significantly more attacks of otitis media occurred among those who attended day-care centres than in those who were cared for in their homes, whereas no such difference was demonstrated in children over 18 months. In our series, 37% of the children cared for at home had had otitis media as against 45% of the children in day-care centres (day nurseries, babyminders, kindergartens). However, this difference is not significant ( p = 0.16), even in children attending day-care centres as early as from the age of 3-6 months. Among other observations, it may be mentioned that there were significantly more at-
RECURRENCk RATE
% 100
I
:
! 3
: 6
: 9
12
: 15
AGE
I
:
!
:
:
:
:
18
21
24
27
30
13
36 (MONTHS)
Fig. 1. Recurrence rate related to first attack of otitis media.
Taympanometric curve Type A Type B Type C
Outside home
~
I7
180 26 76
'?r
I1
%
64 9 27
264 117 201
45 20 35
tacks of otitis media in children living in flats than in those living in houses. The recurrence rate was also higher among children with a birth weight either below 2500 or above 4 000 g. On the other hand, we found no correlation between the number of attacks of otitis media and such factors as the social status of the parents, number of siblings, length at birth, smoking habits of the parents, or breast feeding, even when this was related to its duration. Tympanometry revealed that, according to Jerger's classification, the curves obtained in 51 % of the children were of type A, i.e. normal or slightly negative middle-ear pressure, in 17 % of type B, i.e. flat tympanometric curves, and in 32% of type C, i.e. a negative air pressure greater than -100 mmH,O. As regards the 17% with flat curves it is known with great certainty that they have effusion in the middle ear. This result is in agreement with those of several previous investigations in which 10-20% showed flat curves. An analysis of the tympanometric curves in the four groups did not disclose any difference, even in the most seriously affected group, i.e. those who had previously been admitted t o our E N T department. The tympanometric findings in children who had previously had otitis media did not differ from those in children who had never had otitis media. Nor was any correlation revealed between previous adenotomy and the tympanometric findings at the time of examination. The relationship between home care and day-care centres as compared with the tym-
Acta Otolaryngol Downloaded from informahealthcare.com by Queen's University on 01/05/15 For personal use only.
Population study of otitis media in childhood
panometric findings is seen from Table 11. The preponderance of type A curves in children cared for at home and of B and C curves in children attending day-care centres is significant (p
A POPULATION STUDY O F OTITIS MEDIA I N CHILDHOOD
B. Vinther, 0. Elbrand and C. Brahe Pedersen
total of 494 children with a n average age of a view to elucidating the frequency of both acute and secretory otitis media and their relationship. if any. to a number of social factors. Of the children, 41 % had had at least one attack of otitis media, in 49% of these associated with aural discharge. 70%' of the children were attending day-care centres, and the incidence of otitis media was highest in this group. According to Jerger's classification of the tympanometric curves, 5 1 % of these were of type A , 17'36 of type B, and 32% of type C. Significantly higher frequencies of types B and C curves were found among children attending day-care centres
Ah.strcict. A
Acta Otolaryngol Downloaded from informahealthcare.com by Queen's University on 01/05/15 For personal use only.
3i years were studied with
The acute and t h e secretory otitis media are common diseases of childhood. With a view to the elucidation of the frequency of these diseases and their relationship, if any, to a number of social factors, a total of 494 children from the municipality of Aarhus, all born in 1974, i.e. of an average age of 3; years, were studied. METHOD During the year 1974 a total of 3500 children were born in the municipality of Aarhus. The children studied were divided into four groups as shown in Table 1; 33 children were included in two, or sometimes three, groups, thus giving a total number of cases of 527. Of the series of 494 children studied, 236 were girls and 258 boys. The children accompanied by one of the parents were summoned by letter for examination; 86% of those concerned appeared for examination. In all cases, a medical history was taken, but in 4 % physical examination and tympanometry were not performed because the children were unwilling to submit to the procedures.
The clinical study consisted in the taking of a thorough somatic and social history with answers to a total of 93 standardized questions, including many subquestions, an otological examination and tympanometry. As the study was retrospective, the diagnosis of acute otitis media was based on the information given to the parents by the doctors who had treated the children. RESULTS AND DISCUSSION In the four groups, 26% of the randomly selected children had previously had otitis media, as against 42% living in newer houses in a residential suburb, 41 95 living in poor housing conditions and 63% of those previously admitted to our E N T department. In all, 41 5% had had otitis media at least once, and these children had, on the average, had 3.8 attacks. If the most seriously affected group, viz. those who has previously been admitted to our department, is excluded, an average of 36% in the first three groups had previously had acute otitis media. Of all the children with previous otitis media, 49% had had aural discharge, and there was no significant difference among the four groups. The first attack of otitis media had occurred before the age of 1 year in 51 %, and before the age of 2 in 75 % of the children, which was found to be of great importance for the recurrence rate (Fig. I), which showed a linear fall with increasing age. This observation is in agreement with those made by Howie (1973, for example, who also reported that children in whom otitis media developes before the age of 1 year carry a significantly A 1 IU
~ ~ l l ) / U tl& l'\
.$llPP/ -360
B. Vinther et al.
136
Table I. The nirmher o f children stridird divided into foiir grorrps No
Table 11. Tympunometric ,firitlings (number qf' ears) related t o drry-crire (it home or outside home
Acta Otolaryngol Downloaded from informahealthcare.com by Queen's University on 01/05/15 For personal use only.
At home Randomly selected From a newer residential suburb Living under poor housing conditions Previously admitted to E N T department
153 I20 142 I12
Total
527
greater risk of recurrence than those who have their first attack of otitis media after that age. Strangert (1976) showed that in children under the age of 18 months significantly more attacks of otitis media occurred among those who attended day-care centres than in those who were cared for in their homes, whereas no such difference was demonstrated in children over 18 months. In our series, 37% of the children cared for at home had had otitis media as against 45% of the children in day-care centres (day nurseries, babyminders, kindergartens). However, this difference is not significant ( p = 0.16), even in children attending day-care centres as early as from the age of 3-6 months. Among other observations, it may be mentioned that there were significantly more at-
RECURRENCk RATE
% 100
I
:
! 3
: 6
: 9
12
: 15
AGE
I
:
!
:
:
:
:
18
21
24
27
30
13
36 (MONTHS)
Fig. 1. Recurrence rate related to first attack of otitis media.
Taympanometric curve Type A Type B Type C
Outside home
~
I7
180 26 76
'?r
I1
%
64 9 27
264 117 201
45 20 35
tacks of otitis media in children living in flats than in those living in houses. The recurrence rate was also higher among children with a birth weight either below 2500 or above 4 000 g. On the other hand, we found no correlation between the number of attacks of otitis media and such factors as the social status of the parents, number of siblings, length at birth, smoking habits of the parents, or breast feeding, even when this was related to its duration. Tympanometry revealed that, according to Jerger's classification, the curves obtained in 51 % of the children were of type A, i.e. normal or slightly negative middle-ear pressure, in 17 % of type B, i.e. flat tympanometric curves, and in 32% of type C, i.e. a negative air pressure greater than -100 mmH,O. As regards the 17% with flat curves it is known with great certainty that they have effusion in the middle ear. This result is in agreement with those of several previous investigations in which 10-20% showed flat curves. An analysis of the tympanometric curves in the four groups did not disclose any difference, even in the most seriously affected group, i.e. those who had previously been admitted t o our E N T department. The tympanometric findings in children who had previously had otitis media did not differ from those in children who had never had otitis media. Nor was any correlation revealed between previous adenotomy and the tympanometric findings at the time of examination. The relationship between home care and day-care centres as compared with the tym-
Acta Otolaryngol Downloaded from informahealthcare.com by Queen's University on 01/05/15 For personal use only.
Population study of otitis media in childhood
panometric findings is seen from Table 11. The preponderance of type A curves in children cared for at home and of B and C curves in children attending day-care centres is significant (p
