Otitis media: relationship to tonsillitis, sinusitis and atopic diseases

doi:10.1016/0165-5876(95)01299-0

International Journal of Pediatric Otorhinolaryngology

Volume 35, Issue 2, April 1996, Pages 127-141

https://doi.org/10.1016/0165-5876(95)01299-0 Get rights and content

Abstract

In order to estimate the co-morbidity between ear infections and related childhood diseases, data about the occurrence of recurrent ear infections, tonsillitis, sinusitis and atopic diseases from a population based sample of 7992 Norwegian twins were analysed. Correlational results revealed two general clusters, one consisting of upper respiratory tract infections (URI), the other defined by the atopic diseases. Overall, associations between the diseases were greater in males. The sizes of the correlations within each subgroup of infections were moderate, but significant, ranging from 0.191 to 0.363. Similar results were found for the relationship within the subgroup of atopies, with correlations ranging from 0.134 to 0.466. The correlations between the infectious and atopic diseases were weak. Both ear infections and tonsillitis seemed to be predisposing factors for sinusitis. The relative risk of sinusitis among individuals with a history of ear infections was 3.4 (1.9–6.2) and 1.9 (1.2–3.0) for males and females, respectively. Ear infections conferred an increase in tonsillitis, estimated at 2.3 (1.6–3.0) and 2.0 (1.2–3.6) for males and females, respectively. In conclusion, the present study finds evidence for a common predisposition of upper respiratory infections as well as for atopic diseases, but only moderate correlation between the subgroups. Specifically, between ear infections and hay fever there was no covariation.

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Rhinitis prevalence and association with atopic dermatitis: A systematic review and meta-analysis
2021, Annals of Allergy, Asthma and Immunology
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A total of 341 studies were included in the qualitative analysis, of which 22 studies were not included in the quantitative analysis. These 22 studies all confirmed the positive association between AD and rhinitis.16-37 Six cohort studies evaluated the influence of age at onset of AD on the association between AD and rhinitis.
Atopic dermatitis (AD) and rhinitis are common atopic diseases that may co-occur owing to an overlap in pathophysiology. Although most cases of both diseases are mild and managed with topical anti-inflammatory medicaments, the advent of new systemic and biologic treatments targeting type 2 inflammation in both diseases warrants further insight in the exact overlap of AD and rhinitis.
To determine the association between AD and rhinitis.
A systematic review and meta-analysis of the databases PubMed, Embase, and CNKI were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled prevalence and pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated.
The search resulted in 10,422 citations, and 341 and 302 articles were included in the qualitative and quantitative analyses, respectively. The pooled prevalence of rhinitis was 40.5% (95% CI 39.0-42.0) in patients with AD and 18.0% (95% CI 16.7-19.2) in the reference individuals without AD. The pooled prevalence of having both rhinitis and asthma was 14.2% (95% CI 13.0-15.5) in patients with AD. There was an association between AD and rhinitis (OR 3.00, 95% CI 2.83-3.18), allergic rhinitis (OR 3.25, 95% CI 2.26-4.66), and nonallergic rhinitis (OR 1.99, 95% CI 1.39-2.86), respectively.
Rhinitis, both allergic and nonallergic forms, is very common in patients with AD. Future investigations should clarify how medications targeting both diseases should be indicated in these patients.
Sphenoid sinus development in patients with acquired middle ear cholesteatoma
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Furthermore, the development of the mastoid has been reported to be associated with pathogenesis in COM and AMEC [21,22], as chronic middle ear inflammation during childhood could inhibit pneumatization by hindering the development of the air-cell system [23,24]. Since sinusitis has been also reported to be associated with otitis media in childhood [25], evaluating the relationship between the severity and duration of rhinosinusitis might help us to understand the pathogenesis of COM and AMEC. However, it is generally difficult to examine whether the severity and duration of rhinosinusitis directly affects the pathophysiology of COM and AMEC.
In this study, we examine the relationship between developmental insufficiency of mastoid air cells and abnormal morphology of the paranasal sinuses in patients with chronic otitis media (COM) and acquired middle ear cholesteatoma (AMEC) using precise image assessment, in order to evaluate whether the anatomical features of paranasal sinuses has any impact on the pathogenesis in COM and AMEC.
A total of 127 patients, including 45 COM patients and 82 AMEC patients, were enrolled for this study. The existence of nasal septal deviation, the existence of paranasal sinus opacification, the modified Lund–Mackay score, the diameters of the paranasal sinuses, the Vidic classification, mastoid development, and cranial size were assessed by CT examination. A further 76 adult patients who underwent high-resolution CT imaging of their skull bone for other diseases were enrolled as the control.
The AMEC group showed a significantly shorter sphenoid length (P < 0.01) and lower Vidic classification score (P < 0.01) compared to the control group in this study. In addition, we observed that patients with AMEC had less pneumatization of the mastoid air cells compared to the control individuals, and that the sphenoid length of the poor MC score group was significantly shorter than that of the good MC score group.
Our results suggested that the developmental deficiency in sphenoid length caused by long-standing pediatric rhinosinusitis might indicate the potential of chronic middle ear inflammation in childhood and impact the pneumatization of mastoid air cells. Therefore, chronic rhinosinusitis during the childhood and adolescence might play a role in the pathophysiology of AMEC.
Risk factors for otitis media effusion in children who have adenoid hypertrophia
2015, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
It is not clear whether, by increasing AH, atopy directly or indirectly causes OME. However, atopy in combination with other factors, such as exposure to tobacco smoke or breast-milk deprivation, seems to be a risk factor for OME [9], as shown by Caffarelli et al. [24] and Apostolopoulos et al. [12]; but again, there are several reports with contradictory findings [14,18,23,25–28]. In our study, the presence of a congenital disease was a significant risk factor for OME.
Many studies have shown that children with adenoid hypertrophy (AH) are more likely to have chronic otitis media with effusion (COME). However, not every child with AH has COME. In this study, we investigated the socio-demographic risk factors of children who underwent surgery for AH, including a subgroup with COME. Our aim was to identify the factors involved in the development of COME.
The study population consisted of 170 pediatric patients (118 males, 52 females) who underwent adenoidectomy between 2005 and 2008. The patients were divided into two groups, those with AH alone and those with AH and COME (AH + COME). Major factors such as age, gender, breast-milk feeding, bottle-feeding, tobacco smoke exposure, familial predisposition, allergies, congenital diseases, and school attendance were compared between the two groups.
AH alone was detected in 102 of the patients, 68% of whom were male, and AH + COME in the remaining 68, of whom 72% were male. The mean age was 6.5 years in the AH group and 5.3 years in the AH + COME group. There were no significant differences between the two groups with respect to breast-feeding, bottle-feeding, familial predisposition, tobacco exposure, and allergies. However, the relationships between COME and male sex, congenital diseases, and school attendance were significant.
COME is seen in young children with AH. Among the socio-demographic features examined in this study, only male sex, congenital diseases, and school attendance were statistically significant risk factors for COME development.
The diagnosis and management of rhinitis: An updated practice parameter
2008, Journal of Allergy and Clinical Immunology
Citation Excerpt :
Furthermore, the administration of antimicrobials increases the carriage of antimicrobial-resistant strains of certain bacterial pathogens, such as Streptococcus pneumonia, especially in children. 78,79,83,84 Although it is generally believed that atopic children experience more episodes of acute otitis media and acute sinusitis compared with nonallergic children, this has not been firmly established.77,85,86 Differentiating allergic rhinitis from infectious rhinosinusitis or adenoiditis may be difficult, especially in children, because the symptoms overlap and even purulent nasal drainage may be present in noninfectious rhinitis.
These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology.
The American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing “The diagnosis and Management of Rhinitis: An Updated Practice Parameter.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.
Recurrent otitis media and tonsillitis: common disease predisposition
2006, International Journal of Pediatric Otorhinolaryngology
To estimate the relative contribution of genetic and environmental effects to the association between recurrent otitis media and recurrent tonsillitis.
Self-report questionnaire data from a population-based cohort of 9479 Norwegian twins born from 1967 to 1979. Recurrent otitis media and recurrent tonsillitis were main outcome measures. Structural equation modelling was used to fit alternative biometric models to the twin data and to estimate the relative contribution of genetic and environmental effects to the association between otitis media and tonsillitis.
The lifetime prevalence was 11.7% (95% CI: 11.0–12.3) for recurrent tonsillitis and 11.2% (95% CI 10.5–11.9) for recurrent otitis media. Tetrachoric correlations were greater in monozygotic than in dizygotic twins in both males and females. A model specifying additive genetic effects and individual environmental effects for otitis media and tonsillitis and non-additive genetic effects for tonsillitis yielded the best fit. There was no evidence for sex differences in the genetic source or magnitude of the genetic effects. There was a substantial overlap in genetic factors influencing variation in liability to otitis media and tonsillitis.
Common genetic factors contribute substantially to comorbidity between recurrent otitis media and recurrent tonsillitis.
Risk factors for otitis media with effusion in Chinese schoolchildren: A nested case-control study and review of the literature
2006, International Journal of Pediatric Otorhinolaryngology
To identify the risk factors for otitis media with effusion (OME) in Chinese schoolchildren and analyse the results with reference to the review of the literature.
The study subjects were 6–7-year-old children drawn from a school-screening program for OME in Hong Kong. Both positive and negative screens attended a hospital clinic for further assessment with repeated otoscopic examination and tympanometry as well as pure tone audiometry within 3 weeks after the initial school-screening. During the visit, parents were interviewed to provide information with regard to the children's birth history, neonatal history, socio-economic background, otological history, past health, and medical history. These data formed the basis in the estimation of potential risk factors for OME.
In the univariate analysis of 127 cases and 173 controls, significantly elevated odds ratios (OR) for OME were detected on the symptoms of atopy (OR = 2.21, p = 0.04), hearing loss (OR = 4.13, p = 0.001), nasal obstruction (OR = 1.94, p = 0.005), rhinorrhoea (OR = 1.61, p = 0.04), tonsillitis in the past 12 months (OR = 1.82, p = 0.02), and previous history of acute otitis media (OR = 6.89, p < 0.001). However, only three of them were found to be significant in the multivariate logistic regression model: nasal obstruction (OR = 1.67, 95% CI: 1.01–2.75); acute tonsillitis (OR = 1.68, 95% CI: 1.00–2.80), and previous acute otitis media episodes (OR = 5.75, 95% CI: 2.60–12.69).
Risk factors identified in the Chinese schoolchildren for OME were comparable with previous western reports. A previous attack of acute otitis media was a major determinant for middle ear effusion.

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Research reportOtitis media: relationship to tonsillitis, sinusitis and atopic diseases

Abstract

Am. J. Otolaryngol.

Auris. Nasus. Larynx

Otitis Media: the Immunological Factor

Risk factors in early childhood for the development of atopic diseases

Allergy

Otitis media and sinusitis in children. Role of Branhamella catarrhalis

Drugs

Epidemiology of clinical allergy

Intro. Monogr. Allergy

Sex-specific effects for body mass index in the new Norwegian twin panel

Genet. Epidem.

A Preprocessor for Lisrel

Research report
Otitis media: relationship to tonsillitis, sinusitis and atopic diseases