Evaluating the Relationship Between Second-hand Smoke Exposure and Recurrent Otitis Media in Children Under Five

Abstract

Recurrent otitis media (ROM) is a major health problem in the world, among young children, as it causes hearing impairment, delayed speech, and heavy expenses of medical care. Environmental risk factors have been considered to be a major determinant of ROM susceptibility and second-hand smoke (SHS) is one such commonly occurring and potentially controllable exposure. Past literature has some limitations of not having consistent diagnostic criteria, poor control of confounding factors, and not having factored in new sources of exposure like the electronic cigarette vapor, leaving an essential gap in research. The main strength of this study is that it presents a current, modified measurement of the relationship between SHS exposure and ROM in the susceptible under-five group in particular. A hospital-based case-control study is done involving 215 children with ROM and 222 healthy controls of three tertiary care hospitals. The validated caregiver questionnaires are used to gather data on SHS exposure and possible confounders that are then verified by medical record review. Multivariate logistic regression analysis is utilized to estimate adjusted odds ratio and control daycare attendance, breastfeeding history, number of siblings, use of pacifier and socioeconomic status. The exposure to SHS is reported in 61.9 versus 31.1 in the cases and controls respectively. When the SHS exposure is adjusted to control the confounders, there is a significant relationship between SHS exposure and ROM (adjusted odds ratio = 3.42; 95% confidence interval: 1.86-6.28; p < 0.001). It shows a definite relation between dose and response, also the adjusted odds ratio is getting bigger as the number of smokers in the house more than one smoker is 2.84 and more than two smokers is 4.37. These results support the fact that SHS exposure is an important and independent risk factor of ROM in children younger than five and the need to implement specific preventive measures is paramount.