title: Tobacco Smoke Exposure and Eustachian Tube Disorders in US Children and Adolescents.
abstract: OBJECTIVE
  To describe the association between active, environmental tobacco smoke (ETS) exposure and the prevalence of eustachian tube dysfunction (ETD) in the U.S. pediatric population.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  U.S. representative demographic and audiometric data from the National Health and Nutrition Examination Survey (NHANES);2005-2010.
  
  
  METHODS
  The study consisted of 2,977 children aged 12-19 years. ETD was defined as middle ear pressure <100mm H20. ETS was defined as non-active smoking in individuals with serum cotinine over the limit of detection (≥0.015 ng/mL) and <10 ng/mL(N = 1559).
  
  
  RESULTS
  The prevalence of ETD was 6.1%. After multivariate adjustment for age, sex, body mass index, education level, ethnicity, or having a cold, sinus problem or earache during the last 24 hours, compared to unexposed children, the odds ratios (95% confidence interval) of ETD for those exposed to ETS ages 12-15 in the first, second and third tertile of cotinine concentrations were, respectively, 1.38 (0.53-3.60), 0.99 (0.53-3.60) and 2.67 (1.12-6.34). Similarly, the odds ratios (95% confidence interval) of ETD for those exposed to ETS ages 16-19 in the first, second and third tertile of cotinine concentrations were, respectively, 1.28 (0.48-3.41), 0.99 (0.40-2.48) and 2.86 (1.19-6.88).
  
  
  CONCLUSIONS
  These data suggest that children and adolescents exposed to high concentrations of ETS may have an increased prevalence of ETD.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Mira A
authors.initials: MA
authors.lastname: Patel
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: David J
authors.identifier: http://orcid.org/0000-0003-3429-6017
authors.initials: DJ
authors.lastname: Mener
authors.affiliation: Department of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Department of Preventive Medicine and Public Health, School of Medicine at Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Garcia-Esquinas
authors.affiliation: Department of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Agrawal
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Sandra Y
authors.initials: SY
authors.lastname: Lin
mesh_terms: D000158:Acoustic Impedance Tests; D000293:Adolescent; D002648:Child; D003367:Cotinine / Q000097:blood; D004781:Environmental Exposure / Q000009:adverse effects*; D005064:Eustachian Tube / Q000187:drug effects* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D011312:Pressure; D012906:Smoke / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult; D014026:Nicotiana
chemical_list: D012906:Smoke; D003367:Cotinine