title: Prevalence of recurrent otitis media in habitually snoring school-aged children.
abstract: BACKGROUND
  The pathophysiology of obstructive sleep apnea (OSA) and recurrent otitis media (ROM) is intimately associated with the presence of adenotonsillar hypertrophy in children. However, it remains unclear whether habitually snoring children have a higher prevalence of ROM and whether they require tympanostomy tube placement more frequently.
  
  
  METHODS
  Questionnaires collected from parental surveys of 5- to 7-year-old children attending the public schools in Louisville, KY were retrospectively reviewed for the presence of habitual snoring (HS), ROM, and the need for tympanostomy tube insertion.
  
  
  RESULTS
  There were 16,321 surveys with complete datasets (51.2% boys; 18.6% African American (AA) with a mean age of 6.2+/-0.7 years). Of these children, 1844 (11.3%) were HS (53% boys; 25.9% AA); and, of these, 827 HS had also a positive history of ROM (44.8%) with a slight predominance in males (55%). In addition, 636 of these children underwent placement of tympanostomy tubes (i.e., 34.4% of all HS and 76.9% of ROM). Among the 14,477 non-snoring children (NS), ROM was reported in 4247 NS children (29.3%; p<0.000001; odds ratio [OR]: 1.95; confidence interval [CI]: 1.77-2.16) of which 57.6% were boys, and 1969 NS with ROM underwent tympanostomy tube placement (i.e., 46.3% of those with ROM and 13.6% of all non-snoring children). Thus, the risk for tympanostomy tube placement was also greater among HS compared to NS children (p<0.00001; OR: 2.19; CI: 1.98-2.43).
  
  
  CONCLUSIONS
  Habitual snoring is associated with a significant increase in the prevalence of recurrent otitis media and the need for tympanostomy tube placement. Further studies aiming to assess the prevalence of obstructive sleep apnea among children with ROM are needed.
authors.affiliation: Division of Pediatric Sleep Medicine and Kosair Children's Hospital Research Institute, Department of Pediatrics, University of Louisville, 570 South Preston Street, Suite 204, Louisville, KY 40202, USA. david.gozal@louisville.edu
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.forename: Leila
authors.initials: L
authors.lastname: Kheirandish-Gozal
authors.forename: Oscar Sans
authors.initials: OS
authors.lastname: Capdevila
authors.forename: Ehab
authors.initials: E
authors.lastname: Dayyat
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Kheirandish
mesh_terms: D000234:Adenoids / Q000473:pathology; D015984:Causality; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000150:complications / Q000453:epidemiology; D007629:Kentucky; D008297:Male; D008876:Middle Ear Ventilation / Q000706:statistics & numerical data*; D010033:Otitis Media / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D014066:Palatine Tonsil / Q000473:pathology; D012008:Recurrence; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000453:epidemiology; D012913:Snoring / Q000150:complications / Q000453:epidemiology*