title: Factors influencing the development of otitis media among Sicilian children affected by upper respiratory tract infections.
abstract: BACKGROUND
  Upper respiratory tract infection is a nonspecific term used to describe an acute infection involving the nose, paranasal sinuses, pharynx and larynx. Upper respiratory tract infections in children are often associated with Eustachian tube dysfunction and complicated by otitis media, an inflammatory process within the middle ear. Environmental, epidemiologic and familial risk factors for otitis media (such as sex, socioeconomic and educational factors, smoke exposure, allergy or duration of breastfeeding) have been previously reported, but actually no data about their diffusion among Sicilian children with upper respiratory tract infections are available.
  
  
  OBJECTIVE
  To investigate the main risk factors for otitis media and their prevalence in Sicilian children with and without upper respiratory tract infections.
  
  
  METHODS
  A case-control study of 204 children with upper respiratory tract infections who developed otitis media during a 3 weeks monitoring period and 204 age and sex-matched healthy controls. Seventeen epidemiologically relevant features were inventoried by means of standardized questionnaires and skin tests were performed. Univariate analysis and multivariate logistic regression analysis were used to examine the association between risk factors and occurrence of otitis media.
  
  
  RESULTS
  Otitis media resulted strongly associated to large families, low parental educational attainment, schooling within the third years of life (p<0.05); children were more susceptible to develop otitis media in the presence of asthma, cough, laryngopharyngeal reflux disease, snoring and apnea (p<0.05). Allergy and urban localization increased the risk of otitis media in children exposed to smoke respectively of 166% and 277% (p<0.05); the joint effect of asthma and presence of pets in allergic population increased the risk of recurrence of 11%, while allergy, cough and runny nose together increased this risk of 74%.
  
  
  CONCLUSIONS
  Upper respiratory tract infections and otitis media are common childhood diseases strongly associated with low parental educational attainment (p=0.0001), exposure to smoke (p=0.0001), indoor exposure to mold (p=0.0001), laryngopharyngeal reflux disease (p=0.0002) and the lack of breast-feeding (p=0.0014); an increased risk of otitis media recurrences was observed in the presence of allergy, persistent cough and runny nose (p=0.0001). The modification of the identified risk factors for otitis media should be recommended to realize a correct primary care intervention.
authors.affiliation: Section of Otolaryngology, Department of Experimental Biomedicine and Clinical Neurosciences, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Martines
authors.affiliation: Section of Otolaryngology, Department of Experimental Biomedicine and Clinical Neurosciences, Università degli Studi di Palermo, Palermo, Italy. Electronic address: pietrosalvago@libero.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Salvago
authors.affiliation: Section of Otolaryngology, Department of Experimental Biomedicine and Clinical Neurosciences, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Ferrara
authors.affiliation: Sport and Exercise Sciences Research Unit, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Messina
authors.affiliation: Section of Audiology, Department of Biotechnology and Medical and Forensic Biopathology, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Mucia
authors.affiliation: Department of Science for the Promotion of Health, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Plescia
authors.affiliation: Section of Otolaryngology, Department of Experimental Biomedicine and Clinical Neurosciences, Università degli Studi di Palermo, Palermo, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Sireci
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D010033:Otitis Media / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Fatores de risco; IVAS; Otite média; Otitis media; Risk factors; URTI