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Evidence summaries

Cigarette Smoke as a Risk Factor for Otitis Media

Exposure to cigarette smoke appears to be associated with acute otitis media. Level of evidence: "B"

The exposure of a child to cigarette smoke has been found to be a strong risk factor for acute otitis media in several studies 1,2,3,4, 12, while other studies have not established this relationship or it has been weak 5,6,7,8. One possible explanation for these negative results is that in risk factor studies the data on the smoking habits of the parents is usually based on self-reports, and as the adverse effects of smoking are well known, the data on parental smoking may not be reported reliably. In a meta-analysis of Uhari et al 9 exposure to cigarette smoke was found to be a major risk factor for acute otitis media (RR 1.66; 95% CI 1.33 to 2.06). Etzel et al 10 aimed to avoid the possible bias resulting from self-reports by parents by measuring the serum cotinine concentrations of 132 children attending a day care centre and by comparing these data with episodes of otitis media in these children. Children who had been exposure to cigarette smoke (cotinine concentration > 2.5 ng/mL) had 38% more episodes of otitis compared with the other children (95% CI for the difference 21% to 56%). A proposed mechanism for the role of tobacco smoke is the observed association with higher risk of nasopharyngeal colonization and infection by Streptococcus pneumoniae 11.

Comment:The quality of evidence is downgraded by inconsistency (variability in results).

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    References

    • Ståhlberg MR, Ruuskanen O, Virolainen E. Risk factors for recurrent otitis media. Pediatr Infect Dis 1986 Jan-Feb;5(1):30-2. [PubMed]
    • Pukander J, Luotonen J, Timonen M, Karma P. Risk factors affecting the occurrence of acute otitis media among 2-3-year-old urban children. Acta Otolaryngol 1985 Sep-Oct;100(3-4):260-5. [PubMed]
    • Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM. Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life. J Pediatr 1993 Nov;123(5):702-11. [PubMed]
    • Stenstrom R, Bernard PA, Ben-Simhon H. Exposure to environmental tobacco smoke as a risk factor for recurrent acute otitis media in children under the age of five years. Int J Pediatr Otorhinolaryngol 1993 Aug;27(2):127-36. [PubMed]
    • Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 1989 Jul;160(1):83-94. [PubMed]
    • Sipilä M, Karma P, Pukander J, Timonen M, Kataja M. The Bayesian approach to the evaluation of risk factors in acute and recurrent acute otitis media. Acta Otolaryngol 1988 Jul-Aug;106(1-2):94-101. [PubMed]
    • Alho OP, Koivu M, Sorri M, Rantakallio P. Risk factors for recurrent acute otitis media and respiratory infection in infancy. Int J Pediatr Otorhinolaryngol 1990 Jun;19(2):151-61. [PubMed]
    • Kero P, Piekkala P. Factors affecting the occurrence of acute otitis media during the first year of life. Acta Paediatr Scand 1987 Jul;76(4):618-23. [PubMed]
    • Uhari M, Mäntysaari K, Niemelä M. A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis 1996 Jun;22(6):1079-83. [PubMed]
    • Etzel RA, Pattishall EN, Haley NJ, Fletcher RH, Henderson FW. Passive smoking and middle ear effusion among children in day care. Pediatrics 1992 Aug;90(2 Pt 1):228-32. [PubMed]
    • Greenberg D, Givon-Lavi N, Broides A et al. The contribution of smoking and exposure to tobacco smoke to Streptococcus pneumoniae and Haemophilus influenzae carriage in children and their mothers. Clin Infect Dis 2006;42(7):897-903. [PubMed]
    • Maw AR, Parker AJ, Lance GN et al. The effect of parental smoking on outcome after treatment for glue ear in children. Clin Otolaryngol Allied Sci 1992;17(5):411-4. [PubMed]

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