title: Relationship of environmental tobacco smoke to otitis media (OM) in children.
abstract: BACKGROUND
  Many, but not all, studies have found a correlation between environmental tobacco smoke (ETS) and acute otitis media (AOM) and other adverse otologic outcomes. Given its high personal and societal costs and the divergent findings of the effect of ETS on middle ear disease, the aim of the current study was to assess the impact and possible determinant factors of ETS on recurrent (two or more) episodes of AOM.
  
  
  METHODS
  The study was performed at Heim Pal Children's Hospital, Ear, Nose and Throat (ENT) Department, Budapest, Hungary. Caregivers of a convenience sample of 412 children attending the ENT outpatient clinic were surveyed via a 22-item questionnaire regarding demographics, socioeconomics, and smoking behaviours of the child's family; as well as care-givers' self report of the number of AOM episodes of the child.
  
  
  RESULTS
  Of the 412 participants, 155 (38%) children's parents smoked. In bivariate analysis, two or more episodes of AOM correlated with reported hearing problems, day care enrolment, parental employment and increased age of the child. In multivariate logistic regression, parental smoking more than doubled a child's risk for recurrent AOM while increased maternal employment (e.g. part-time or full-time versus unemployed) boosted risk up to fourfold. Among children whose parents smoked, half-packs of cigarettes smoked per day and day care attendance doubled or nearly tripled, respectively, the risk of recurrent AOM episodes.
  
  
  CONCLUSIONS
  Childhood exposure to ETS is high among an ENT clinic population of Hungarian children. Such exposure correlates with AOM episodes, ENT operations and conductive hearing loss. Data such as these argue for strict laws smoke-free laws not only in Hungary, but also in Europe and around the world.
authors.affiliation: Department of Otorhinolaryngology, Heim Pal Children's Hospital, 13 Delej utca, H-1089 Budapest, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Csákányi
authors.forename: Antal
authors.initials: A
authors.lastname: Czinner
authors.forename: John
authors.initials: J
authors.lastname: Spangler
authors.forename: Todd
authors.initials: T
authors.lastname: Rogers
authors.forename: Gábor
authors.initials: G
authors.lastname: Katona
mesh_terms: D002656:Child Day Care Centers; D002675:Child, Preschool; D004651:Employment; D005260:Female; D006801:Humans; D006814:Hungary; D016015:Logistic Models; D008297:Male; D010033:Otitis Media / Q000453:epidemiology* / Q000209:etiology; D010290:Parents; D012008:Recurrence; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D014028:Tobacco Smoke Pollution