Factors influencing the presence of otitis media with effusion 16 months after initial diagnosis in a cohort of school-age children in rural Greece: a prospective study.

Objective: Few studies have specifically assessed the risk factors for persistence or recurrence of OME in a cohort of school-age children. The generally accepted etiological factors for OME occurrence may not apply in the same way when the presence of OME over a year from original diagnosis is assessed.

Methods: A cohort of 250 school-age children with unilateral or bilateral OME, identified through screening of 5121 asymptomatic children was re-examined 16 months later. All were assessed for a variety of demographic, family and medical factors. Measures included tympanometry, acoustic reflexes and a complete otolaryngologic examination.

Results: At 16 months after initial confirmation of OME, 56 out of 250 children (22.4%) suffered from OME, 21 bilateral and 31 unilateral. Presence of OME at 16 months was not associated with gender, blood group, gestational age and weight, history of breast feeding, paternal education level and smoking history, history of allergy, previous use of antibiotics, or with surgery (myringotomy, insertion of ventilation tubes or adenotonsillectomy). In multiple backward-eliminating logistic regression, the only factors associated with OME presence after 16 months were episodes of AOM during the study period (odds ratio 2.75 (95% CI: 1.13-8.17), p=0.04) and younger age (odds ratio 0.53 (95% CI: 0.32-0.79), p=0.002 for each 2 years of increase in age).

Conclusion: Seventy-eight percent of school-age children identified with OME through screening will be free of disease 16 months later. The threshold for referral, or surveillance could however justifiably be lower in children who (a) have once been identified with OME and (b) are (relatively) younger, or have experienced an episode of acute otitis media.