Predictors of chronic Suppurative otitis media in children

Objective: To determine which factors predict development of chronic suppurative otitis media (CSOM) in children. Design: Case-control study, with univariate and multivariate logistic regression analysis applied to determine which factors independently predict CSOM. Subjects: Prognostic factors for CSOM were identified in ( 1) 100 children with CSOM and 161 controls aged 1 to 12 years and ( 2) 83 children who developed CSOM in the presence of a tympanostomy tube and 136 children with tympanostomy tubes who did not develop CSOM. Results: Independent predictors for CSOM were previous tympanostomy tube insertion ( odds ratio [ OR], 121.4 [95% confidence interval {CI}, 38.9-379.3]); having had more than 3 upper respiratory tract infections in the past 6 months ( OR, 12.2 [ 95% CI, 3.5-42.3]); having parents with a low education level ( OR, 14.1 [ 95% CI, 2.9-68.6]); and having older siblings ( OR, 4.4 [ 95% CI, 1.6-12.6]). Independent predictors for CSOM after tympanostomy tube insertion were having experienced more than 3 episodes of otitis media in the past year ( OR, 4.9 [ 95% CI, 2.2-11.0]; attending day care ( OR, 3.6 [ 95% CI, 1.7-7.8]); and having older siblings ( OR, 2.6 [ 95% CI, 1.2-5.5]). Conclusions: Treatment with tympanostomy tubes is the most important prognostic factor for CSOM in children. In children who are being treated with tympanostomy tubes for persistent middle ear effusion, the most important prognostic factor for CSOM is a history of recurrent episodes of acute otitis media. This information should be taken into consideration and discussed with parents when considering insertion of tympanostomy tubes in children.