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Am Fam Physician. 2002;66(4):666

Otitis media is a common infection in young children. Risk factors for developing recurrent infections include a positive family history, child care outside the home, presence of siblings, early onset of otitis media, atopy, male gender, not being breastfed, and parental smoking. Multiple studies have looked at the impact of environmental tobacco smoke (passive smoking) on children and the incidence of otitis media infections. Some have found a link between parental smoking and recurrent otitis media. Several studies have suggested that maternal smoking places children at more risk for these infections than paternal smoking. In addition, maternal smoking during pregnancy has been associated with increased adverse neonatal events and childhood morbidity. Lieu and Feinstein evaluated the relative risk for otitis media in children from environmental tobacco smoke, maternal smoking during pregnancy, or both.

The participants in the study were infants older than two months and children younger than 12 years who were enrolled in the Third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988 to 1994. Parents of these children answered a questionnaire that included information about otitis media events and the number of recurrences, environmental tobacco smoke exposure and the source, and if the mother smoked during pregnancy. In addition, in 60 percent of the participants, serum cotinine, a metabolite of nicotine, was measured as another method of assessing passive smoke exposure.

The cumulative incidence of otitis media in the study population (11,728 participants) was 69 percent. Thirty-eight percent of the participants were exposed to passive smoke, 23 percent to gestational smoke, and 19 percent to both. The occurrence of otitis media was not increased in children with only passive smoke exposure but was slightly increased by gestational and combined smoke exposure. The children with combined smoke exposure had a significant increase in the risk for recurrent otitis media.

The authors conclude that passive smoke exposure did not increase the risk for developing otitis media. Gestational smoke exposure and combined gestational and passive smoke exposure only slightly increased the risk for otitis media and had marginal clinical significance. However, children exposed to combined gestational and passive smoke were much more likely to develop recurrent otitis media infections. These results suggest that physicians should consider developing interventions to discourage smoking in pregnant women and new mothers.

editor's note: Multiple studies have demonstrated the adverse impact of smoking during pregnancy and after delivery. Lieu and Feinstein add to this information with regard to recurrent otitis media. Based on their data, physicians who provide prenatal care should assist their pregnant patients with smoking cessation strategies as determined by the patients' willingness to quit. Educational material concerning the negative impact of tobacco use during pregnancy should be provided. In addition, routine follow-up and support for those who do quit is important to assist them in maintaining abstinence.—k.e.m.

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