title: Habitual use of push and pull plastic bottle caps is more prevalent among children with recurrent acute otitis media.
abstract: OBJECTIVE
  The use of a pacifier has been reported to be a causative factor of recurrent acute otitis media (RAOM) because the negative pressure which is generated during sucking may cause a negative intra-tympanic pressure and favour the reflux of nasopharyngeal secretions into the Eustachian tube. Push and pull (P&P) plastic bottle caps, recently marketed in Italy, might also induce negative nasopharyngeal pressure. This study was aimed to investigate if there is a difference in the prevalence of habitual use of P&P plastic bottle caps among children with a positive history of RAOM and healthy controls.
  
  
  METHODS
  A telephonic interview was performed in order to retrospectively evaluate the prevalence of habitual use of P&P plastic bottle cap among children with a history of RAOM and healthy controls, comparable to the former for environmental risk factors for RAOM.
  
  
  RESULTS
  Data were obtained from 57 Caucasian patients (males=36/57; 63.2%) with a median age of 59 (range=21-90) months, including 28 children with a history of RAOM and 29 healthy controls. Habitual use of P&P plastic bottle cap was significantly (p=0.047) more frequent in children with a history of RAOM (14/28; 50.0%) than in control group (7/29; 24.2%). Multivariate logistic regression analysis adjusted for age confirmed a significant association (p<0.01; Pseudo R(2)=0.2) between the use of P&P plastic bottle cap and a positive history of RAOM (adjusted OR=4.0; range=1.1-15.0).
  
  
  CONCLUSIONS
  Our preliminary data show a significantly increased prevalence of P&P plastic cap bottle habitual users among children with a history or RAOM and support the need for larger studies to confirm the role of using P&P bottles as risk factor of RAOM and to identify the age groups at higher risk.
authors.affiliation: Department of Clinical Sciences and Community Health, ENT Clinic, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. sara.torretta@gmail.com
authors.forename: Sara
authors.initials: S
authors.lastname: Torretta
authors.forename: Paola
authors.initials: P
authors.lastname: Marchisio
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cappadona
authors.forename: Elena
authors.initials: E
authors.lastname: Baggi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pignataro
mesh_terms: D000208:Acute Disease; D001903:Bottle Feeding / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D010033:Otitis Media / Q000209:etiology*; D041361:Pacifiers / Q000009:adverse effects*; D010969:Plastics; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D010969:Plastics