The exposure of a child to cigarette smoke has been found to be a strong risk factor for acute otitis media in several studies «Ståhlberg MR, Ruuskanen O, Virolainen E. Risk fact...»1, «Pukander J, Luotonen J, Timonen M, Karma P. Risk f...»2, «Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson D...»3, «Stenstrom R, Bernard PA, Ben-Simhon H. Exposure to...»4, «Maw AR, Parker AJ, Lance GN et al. The effect of p...»12, while other studies have not established this relationship or it has been weak «Teele DW, Klein JO, Rosner B. Epidemiology of otit...»5, «Sipilä M, Karma P, Pukander J, Timonen M, Kataja M...»6, «Alho OP, Koivu M, Sorri M, Rantakallio P. Risk fac...»7, «Kero P, Piekkala P. Factors affecting the occurren...»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 «Uhari M, Mäntysaari K, Niemelä M. A meta-analytic ...»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 «Etzel RA, Pattishall EN, Haley NJ, Fletcher RH, He...»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 «Greenberg D, Givon-Lavi N, Broides A et al. The co...»11.
Comment:The quality of evidence is downgraded by inconsistency (variability in results).
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