Prevalence rates of otitis media with effusion from 0 to 2 years of age: healthy-born versus high-risk-born infants

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Abstract

In a prospective–longitudinal study, prevalence rates of otitis media with effusion (OME) were analysed in 150 healthy-born and 100 high-risk-born infants, aged 0–2 years. In order to determine OME, otoscopy and tympanometry were performed at 3-monthly intervals beginning at term date. The Maastricht Otitis Media with Effusion Study (MOMES) algorithm was used to standardize the diagnosis. The distribution of relevant background characteristics was similar in both groups except for gestational age and birth weight, which were significantly lower (P<0.001) in the high-risk-born group. The ratio of unilateral:bilateral OME was 2:3. Prevalence rates of OME were strongly associated with age (P<0.001). During the first months of life, OME prevalence rates increased rapidly in both groups, but did not differ significantly. However, from the age of 6 months on, OME prevalence rates of the high-risk group became significantly higher compared with the normal group (P<0.05). The peak prevalence of OME (59% in the high-risk group versus 49% in the normal group) was observed around the age of 10 months. Although gradually decreasing prevalence rates were noted in both groups with aging, the differences between high-risk and normal infants remained, at least up to 24 months. In conclusion, OME is a very prevalent, age-dependent disorder during infancy, especially in high-risk infants. Peak prevalence of OME was found in the second half of the first year of life.

Introduction

Otitis media with effusion (OME) has been suggested as a common and multifactorial disease in childhood [1]. Since it is accompanied by fluctuating hearing loss, varying between 10 and 50 dB, adverse developmental effects have been attributed to it. Especially during the first years of life—often quoted as the most sensitive period in lifetime—OME appears to have detrimental effects on speech and language development [2], [3].

Although much research has been done on the epidemiology of OME in childhood [4], [5], data concerning prevalence and risk factors during the first years of life are still scarce, fragmentary and even controversial [6], [7], [8], [9], [10]. The reasons for this might be differences in case-finding methods, observation intervals, prevalence settings, population characteristics as well as intervention procedures such as treatment with antibiotics or with ventilation tubes. To justify screening and intervention programmes, we need more information about the prevalence rates during infancy—i.e. the percentage of infants in a given population that are affected with OME during the first years of life. Prevalence rates of OME during infancy can give us also tools for a better understanding of the aetiology and pathogenesis of OME, since immunological, anatomical, physiological and environmental aspects are constantly changing during the first years of life.

The literature reveals that high-risk-born infants in neonatal intensive care units (NICU) have a high incidence of OME [11], [12]. This high incidence is suggested to be related to the use of nasotracheal tubes for ventilation in the NICU [11], [12], [13], [14]. Some researchers suggest that early episodes of otitis media experienced in the NICU could affect the long-term otological course of former NICU patients [15], [16]. However, little is known as to what extent this high incidence persists after discharge into the community. As part of a large prospective–longitudinal study, named the Maastricht Otitis Media with Effusion Study (MOMES) [17], prevalence rates of unilateral and bilateral OME were investigated in healthy-born infants and compared with prevalence rates in high-risk-born infants from 0 to 2 years.

Section snippets

Subjects

Between October 1989 and April 1995, 150 healthy-born and 100 high-risk-born neonates were recruited soon after birth in the University Hospital Maastricht, The Netherlands. The high-risk-born neonates were admitted to the NICU, and complied with the high-risk register as recommended by the Joint Committee on Infant Hearing (i.e. risk factors such as very low birth weight, preterm, or perinatally asphyxiated) [18]. All healthy-born neonates were recruited from the General Delivery Outpatient

Subjects and follow-up

The high-risk-born group consisted of 61 preterm (gestational age less than 33 weeks) and 54 very low birth weight (birth weight less than 1500 g) infants. Most of these infants were treated with nasally placed ventilation (n=81) or feeding tubes (n=94). Between the high-risk and healthy-born group no significant differences were found either for the distribution of other background characteristics (Table 1) or for follow-up or treatment.

Unfortunately, 37 healthy-born (25%) and 14

Discussion

OME is often referred to as a silent disease as it often occurs asymptomatically, especially during infancy. Because of its prospective–longitudinal design and the application of a standardized diagnostic algorithm, the MOMES research offered unique epidemiological data of OME during infancy. Several points must be considered in interpreting the findings.

Before the MOMES project was started, both otoscopists (L.A. and J.E.) were trained and validated by the head of the ORL department (E.M.).

Acknowledgements

The authors express their appreciation to Professor Dr. J.J. Manni and Ms M. Chenault, B.A., Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Maastricht, the Netherlands, for helpful comments on the manuscript. This research is supported by the Heinsius-Houbolt Foundation and the Maastricht ENT Research Foundation, The Netherlands.

References (37)

  • J.L. Paradise et al.

    Otitis media in 2253 Pittburgh-area infants: prevalence and risk factors during the first two years of life

    Pediatrics

    (1997)
  • M. Tos et al.

    Tympanometry in 2-year-old children. Seasonal influence on frequency of secretory otitis and tubal function

    ORL

    (1979)
  • T.J. Balkany et al.

    Middle ear effusions in neonates

    Laryngoscope

    (1978)
  • B.F. Jaffe et al.

    Tympanic membrane mobility in the newborn with seven months follow-up

    Laryngoscope

    (1970)
  • W.H. Kitchen et al.

    Health and hospital readmissions of very low birth weight and normal birth weight children

    Am. J. Dis. Child.

    (1990)
  • D.J. DeSa

    Mucosal metaplasia and chronic inflammation in the middle ear of infants receiving intensive care in the neonatal period

    Arch. Dis. Child.

    (1983)
  • M.C. McCormick

    The contribution of low birth weight to infant mortality and childhood morbidity

    New Engl. J. Med.

    (1985)
  • J. Engel et al.

    Otitis media with effusion in early childhood and the effects on hearing and language development: a prospective longitudinal study

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