title: Acute otitis media severity: association with cytokine gene polymorphisms and other risk factors.
abstract: BACKGROUND
  We have previously shown an association between polymorphisms of proinflammatory cytokine genes and susceptibility to upper respiratory tract infection and acute otitis media. It has not been known whether polymorphisms or risk factors are associated with the severity of acute otitis media.
  
  
  OBJECTIVE
  To evaluate the influences of proinflammatory cytokine gene polymorphisms and other risk factors on severity of acute otitis media following upper respiratory tract infection.
  
  
  METHODS
  In a prospective, longitudinal study, children aged 6-35 months were followed for one year for occurrences of upper respiratory tract infection and acute otitis media. Children were studied for TNFα(-308), interleukin (IL)-6(-174) and IL-1β(+3953) polymorphisms, taking into account age, gender, race, family history of otitis, tobacco smoke exposure, breast feeding, day of upper respiratory tract infection at the time of diagnosis and pneumococcal vaccine status. Symptoms and signs of acute otitis media were graded according to a validated scale. The association between acute otitis media clinical severity, polymorphic genotypes, and risk factors were analyzed using statistical models that account for multiple episodes of acute otitis media per child.
  
  
  RESULTS
  A total of 295 episodes of acute otitis media in 128 subjects was included. More severe acute otitis media symptoms were associated with young age (P=0.01), family history of acute otitis media (P=0.002), tobacco smoke exposure (P=0.008), and early diagnosis of otitis after onset of upper respiratory tract infection (P=0.02). Among children with a bulging or perforated tympanic membrane (206 episodes, 104 subjects), those who had the IL-1 β(+3953) polymorphism, experienced higher symptom scores (P<0.02).
  
  
  CONCLUSIONS
  This is the first report of the association between risk factors and acute otitis media severity. Risk factors such as tobacco smoke exposure and a positive family history appear to be more significantly associated with acute otitis media severity than proinflammatory gene polymorphisms. Clinical severity may be an important factor contributing to the incidence and costs of acute otitis media, because children with more severe symptoms might be more likely to be brought for a medical visit, receive a diagnosis of acute otitis media, and be prescribed an antibiotic.
authors: Division of General Academic Pediatrics, Department of Pediatrics, The University of Texas Medical Branch at Galveston, TX, United States.
authors: David P
authors: DP
authors: McCormick
authors: James J
authors: JJ
authors: Grady
authors: Alejandro
authors: A
authors: Diego
authors: Reuben
authors: R
authors: Matalon
authors: Krystal
authors: K
authors: Revai
authors: Janak A
authors: JA
authors: Patel
authors: Yimei
authors: Y
authors: Han
authors: Tasnee
authors: T
authors: Chonmaitree
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D016001:Confidence Intervals; D016207:Cytokines / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D053583:Interleukin-1beta / Q000235:genetics; D015850:Interleukin-6 / Q000235:genetics; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D010033:Otitis Media / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*; D011110:Polymorphism, Genetic; D011379:Prognosis; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*; D018570:Risk Assessment; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics
chemical_list: D016207:Cytokines; D053583:Interleukin-1beta; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha