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Original research
Modifiable risk factors for developing otitis media with effusion in children under 12 years in high-income countries: a systematic review
  1. Aye Paing1,
  2. Laura Elliff-O’Shea1,
  3. John Day2,
  4. Devavrata Joshi3,
  5. Stephanie Arnold4,
  6. Tamsin Holland Brown5,6,
  7. Veronica Kennedy7
  1. 1Centre for Guidelines, National Institute for Health and Care Excellence, London, UK
  2. 2Betsi Cadwaladr University Health Board, Bangor, UK
  3. 3Parkbury House Surgery, St Albans, UK
  4. 4National Institute for Health and Care Excellence, London, UK
  5. 5Department of Paediatrics, University of Cambridge, Cambridge, Cambridgeshire, UK
  6. 6Community paediatrics, Cambridgeshire Community Services NHS Trust, Saint Ives, Cambridgeshire, UK
  7. 7Paediatric Audiology Department, Bolton NHS Foundation Trust, Bolton, UK
  1. Correspondence to Dr Aye Paing; aye.paing{at}nice.org.uk

Abstract

Objective To systematically assess the modifiable risk factors for developing otitis media with effusion (OME) in children under 12 years.

Methods We searched Embase, MEDLINE, INAHTA database, CENTRAL, CDSR and Epistemonikos for cohort studies with ≥40 children per arm/prognostic factor, published in English from 2000 to November 2022. We assessed risk of bias using the Quality in Prognosis Studies checklist, and overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Outcomes were analysed as risk ratio (RR), OR or Peto OR.

Results Seven studies totalling 2 760 292 children were included. The evidence was very low quality. Fluid or pus discharge from ears (OR 2.1, 95% CI 1.01 to 4.35) and exposure to other children (RR 2.79, 95% CI 1.98 to 3.93) (OR 5.21, 95% CI 2.9 to 9.36) were strongly associated with development of OME. Coughs/colds ≥5 times (OR 1.91, 95% CI 1.22 to 2.99), breathing problems ≥5 times (RR 1.78, 95% CI 1.26 to 2.53) and ear infections (RR 1.95, 95% CI 1.39 to 2.72) in past year were associated with development of OME. Adenoid hypertrophy was strongly associated with development of fluctuating OME (recurrent OME) (OR 9.96, 95% CI 5.17 to 19.19). There was scare evidence for some potential modifiable risk factors, including breast feeding, household smoking, gastro-oesophageal reflux, dummy use and swimming.

Conclusions Upper respiratory tract infection, ear infection, adenoid hypertrophy and exposure to other children could be the predictors for development of OME. Further observational studies are needed to investigate other potential modifiable risk factors.

  • Audiology
  • Child Health
  • Child Development
  • Paediatrics

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/archdischild-2024-327454

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • X @ayechanpaing411, @hearglueear

    • Contributors All authors (AP, LEO’S, JD, DJ, SA, TMHB and VK) contributed to the study concept and design and interpretation of results. SA was responsible for designing and carrying out the search strategy. ACP performed the study selection, data extraction, data analysis and quality assessment and drafted the manuscript. LEO’S contributed to the study selection, data extraction, data analysis and quality assessment. All authors (AP, LEO’S, JD, DJ, SA, TMHB and VK) contributed to the revision of the manuscript. The final manuscript was approved by all authors. AP is guarantor of this work.

    • Funding AP, LEO’S and SA are employees of NICE, which is funded by the Department of Health and Social Care to develop clinical guidelines. TMHB, DJ, JD and VK are clinicians within the NHS. No authors received specific funding from NICE, the Department of Health and Social Care or the NHS to write this review. The views expressed in this publication are those of the authors and not necessarily those of NICE.

    • Competing interests A full list of interests for the whole committee for the 2023 NICE guideline on ‘Otitis media with effusion in under 12s’ (National Institute for Health and Care Excellence, 2023) is available at https://www.nice.org.uk/guidance/ng233/history. TMHB has been involved in assistive technology research and development (without financial gain) of a device, app and website (www.hearglueear.co.uk) to help children once they have glue ear. The authors declare no potential conflicts of interest associated with this article.

    • Provenance and peer review Not commissioned; externally peer-reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.