Risk Factors for Refractory and Delayed De novo Otitis Media Requiring Pressure Equalization Tube Insertion

Objective: Limited data exists regarding risk factors for otitis media in older children and specifically those for which surgical intervention is performed. This study investigated potential risk factors in this older age group who required pressure equalization tube (PET) insertion. Study design: Retrospective cohort study Setting: Tertiary care pediatric academic medical center Subjects and methods: Children 6-12 years old undergoing PET insertion between October 1, 2010 and September 30, 2011. Data was stratified into two separate age cohorts (6-7 versus 8-12-year-olds) and compared using chi-square analysis. Results: A total of 263 patients met study criteria. PET insertion was most common in 6 year-olds (36%, 95/263). Presence of siblings (p=0.03) and history of recurrent upper respiratory tract infection (p< 0.01), otalgia (p< 0.05), otorrhea (p< 0.001), and nasal discharge (p< 0.001) were common in the older cohort. No statistical difference was found for history of recurrent acute otitis media, allergy, asthma, or atopy between the two groups (p=0.23-0.92), although the overall prevalence of these conditions was high in both cohorts. Conclusion: The 8-12-year-olds had a history of recurrent upper respiratory tract infection and more infectious symptoms than the 6-7-year-olds. Atopy can lead to a heightened susceptibility to upper respiratory tract infections and potential increase in the relative risk of otitis media. In our patient population, while there was no statistically significant difference in history of asthma, allergy, or atopy, the overall prevalence within both cohorts was relatively high. Therefore, this study provides insight into many pertinent and potentially modifiable risk factors for older children requiring PET insertion.