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Original Article |

Relationship Between Pediatric Obesity and Otitis Media With Effusion FREE

Jong Bin Kim, MD; Dong Choon Park, MD, PhD; Chang Il Cha, MD, PhD; Seung Geun Yeo, MD, PhD
[+] Author Affiliations

Author Affiliations: Department of Otorhinolaryngology, College of Medicine, Kyung Hee University, Seoul, Korea (Drs Kim, Cha, and Yeo), and Department of Obstetric and Gynecology, College of Medicine, Catholic University, Suwon, Korea (Dr Park).


Arch Otolaryngol Head Neck Surg. 2007;133(4):379-382. doi:10.1001/archotol.133.4.379.
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Published online

Objective  To investigate the relationship between pediatric otitis media with effusion and obesity, as determined by body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) and serum triglyceride (TG) and total cholesterol (TC) concentrations.

Design  A prospective, nonrandomized, case-control study.

Setting  University-affiliated hospital.

Subjects  The experimental group comprised 155 children aged 2 to 7 years, who received unilateral or bilateral ventilation tube insertion for the treatment of otitis media with effusion. The control group comprised 118 children with no history of otitis media with effusion, who underwent operations for conditions other than ear diseases. Based on BMI and serum TG and TC concentrations, we divided the experimental group into 2 subgroups, those who were and were not obese.

Main Outcome Measures  We determined the difference between the experimental and control groups in BMI and serum TG and TC concentrations and the difference between the obese and nonobese subgroups in frequency of ventilation tube insertion.

Results  Mean ± SD BMI (22.0 ± 3.4 vs 16.3 ± 2.4) (P = .01) and mean ± SD TC level (195.0 ± 31.0 mg/dL vs 159.3 ± 26.9 mg/dL [5.05 ± 0.80 mmol/L vs 4.13 ± 0.70 mmol/L]) (P = .04), but not mean serum TG level (109.4 ± 40.4 mg/dL vs 90.0 ± 52.3 mg/dL [1.24 ± 0.46 mmol/L vs 1.02 ± 0.59 mmol/L]) (P = .13), were significantly higher in the experimental group than in the control group. Frequency of ventilation tube insertion, however, did not differ significantly between the obese and nonobese subgroups, whether divided by BMI (P = .10) or serum TG (P = .12) or TC (P = .07) concentration.

Conclusion  Childhood obesity may be associated with the occurrence of otitis media with effusion.

Figures in this Article

Despite the development of antibiotics and surgical techniques, the frequency of otitis media with effusion (OME) has been increasing,1 and the association between OME and age, sex, seasons, lifestyle, nutrition, environment, and allergy have been characterized. The incidence of childhood overweight and obesity has also been increasing, but the association between childhood obesity and OME has not yet been determined. Obesity occurs from the excessive accumulation of fat in various tissues, particularly in hypodermal tissues. Obesity is generally defined by body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) and accompanied by elevated serum triglyceride (TG) and total cholesterol (TC) concentrations.2 To determine whether obesity has an effect on the development of OME, we compared BMI and TG and TC concentrations in children with and without OME; and to evaluate whether the severity of chronic OME is associated with childhood obesity, we determined the frequency of ventilating tube insertion in obese and nonobese children with OME.

The experimental group comprised children aged 2 to 7 years with OME who visited the Department of Otorhinolaryngology at Kyung Hee University, Seoul, Korea, from March 2004 to February 2006, for unilateral or bilateral ventilating tube insertion. The control group comprised children with no history of OME who underwent surgery for conditions other than ear diseases. The purpose of the experiment was explained to parents or guardians, and only subjects who agreed to participate in the study in advance were included. Children with head and neck anomalies, systemic diseases, chronic diseases, or suspected of having AIDS were excluded from this study.

Body mass index and TG and TC concentrations were measured in each child and compared between the groups. To measure serum TG and TC values, a 4-mL blood sample was drawn from each child in the morning under fasting conditions and centrifuged at 3000 rpm for 15 minutes at 4ºC. Serum was decanted, and serum TG and TC concentrations were determined biochemically using a serum automated analyzer (Hitachi 7600; Hitachi Ltd, Tokyo, Japan).

In addition, the experimental group was divided into obese and nonobese subgroups, based on BMI according to age and sex and TG and TC concentrations, and the frequency of ventilating tube insertion in the 2 subgroups was compared. Body mass index was compared with normal values according to age and sex, and children with a BMI higher than the 95th percentile were defined as obese in Korea. Serum TG and TC concentrations were compared with normal values according to age and sex, and children with TG and TC concentrations higher than normal were defined as obese in Korea.3

Statistical analysis was performed using SPSS version 11 (SPSS Inc, Chicago, Ill), and groups were compared using the Mann-Whitney test, with the significance level set at P<.05.

The experimental group comprised 155 children (85 boys and 70 girls), all of whom underwent ventilating tube insertion for chronic OME, while the control group comprised 118 children (76 boys and 42 girls), all of whom underwent surgery for conditions other than ear diseases and had no history of OME. The mean ± SD BMI was significantly higher in the experimental group than in the control group (22.0 ± 3.4 vs 16.3 ± 2.4) (P = .01) (Figure 1), as was the mean ± SD serum TC (195.0 ± 31.0 mg/dL vs 159.3 ± 26.9 mg/dL [5.05 ± 0.80 mmol/L vs 4.13 ± 0.70 mmol/L]) (P = .04) but not the mean ± SD serum TG concentration (109.4 ± 40.4 mg/dL vs 90.0 ± 52.3 mg/dL [1.24 ± 0.46 mmol/L vs 1.02 ± 0.59 mmol/L]) (P = .13) (Figure 2).

Place holder to copy figure label and caption
Figure 1.

Mean ± SD body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of the experimental and control groups. The difference between the 2 groups was statistically significant (P = .01).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Mean ± SD serum triglyceride and total cholesterol concentrations of the experimental and control groups. The difference between the 2 groups was statistically significant only for serum total cholesterol concentrations (P = .04). To convert triglycerides to millimoles per liter, multiply by 0.0113; to convert cholesterol to millimoles per liter, multiply by 0.0259.

Graphic Jump Location

When we divided the experimental group into obese (65 children [41.9%]) and nonobese (90 children [58.1%]) subgroups according to BMI, we found that their mean ± SD BMI was 22.0 ± 3.4 and 15.7 ± 1.3, respectively (Figure 3). When serum TG concentration was used to subdivide the experimental group into obese (54 children [34.8%]) and nonobese (101 children [65.2%]) subgroups, the mean ± SD serum TG concentrations were 149.9 ± 49.2 mg/dL (1.79 ± 0.55 mmol/L) and 69.0 ± 19.6 mg/dL (0.78 ± 0.22 mmol/L), respectively. When we divided the experimental group into obese (30 children [19.2%]) and nonobese (125 children [80.8%]) subgroups based on serum total TC concentration, we found that their mean ± SD TC concentrations were 226.0 ± 15.9 mg/dL (5.85 ± 0.41 mmol/L) and 164.0 ± 19.8 mg/dL (4.25 ± 0.51 mmol/L), respectively (Figure 4). The frequency of ventilating tube insertion in the experimental group was not related to obesity, whether measured by BMI or TG or TC concentration (Figure 5).

Place holder to copy figure label and caption
Figure 3.

Mean ± SD body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of the obese and nonobese subgroups of the experimental group.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Mean serum triglyceride and total cholesterol concentrations of the obese and nonobese subgroups of the experimental group. To convert triglycerides to millimoles per liter, multiply by 0.0113; to convert cholesterol to millimoles per liter, multiply by 0.0259.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

Mean frequency of ventilation tube insertion for treatment of otitis media with effusion in the experimental group. The differences between the obese and nonobese subgroups, as classified by body mass index (calculated as weight in kilograms divided by height in meters squared) and serum triglyceride and total cholesterol concentrations, were not significant (P>.05).

Graphic Jump Location

Otitis media with effusion is a condition in which fluid is retained in the middle ear cavity, but without otalgia, fever, and other symptoms.4 This condition has been shown to be caused by complex reactions involving the dysfunction of the eustachian tubes, infection, infection in the mucosa, immune deficiency, and allergy, among others.5 The incidence of OME varies widely, being reported as 50% in British children,6 33% in children residing in Pittsburgh, Pa,7 8.7% in Japanese children,8 8% in Nigerian children,9 and 4.5% to 16.4% in Korean children, with the latter differing according to surveyed regions.1012

Among the factors thought to influence the effects of OME are age, sex, race, season of the year, hereditary factors, number of family members, smoking status of parents, diseases experienced by children, and nursing methods. Factors shown to predispose to OME include upper respiratory tract infection, age, race, and attendance in day care center nurseries, whereas factors that do not significantly influence OME include bronchitis, cystic fibrosis, socioeconomic status, smoking by parents, and antibiotic abuse.13 Factors investigated, but not definitively shown to predispose to OME, include hypertrophic tonsils, sex, geographical living area, housing conditions, and genetic predisposition, whereas factors not fully investigated include immotile ciliary syndrome, immunodeficiencies, and swimming. In particular, attendance at various types of day care centers, which include many children, increases the risk of OME, and the risk of this condition is particularly associated with younger age at time of admission.14

Obesity is a collection of symptoms rather than a disease, and it appears to be due to the excess accumulation of adipose tissues, particularly hypodermal fat, in the body. The risk of adult obesity is associated with obesity during childhood and adolescence, with 50% to 75% of adult obesity shown to originate from juvenile obesity.15 In childhood and adolescent obesity, both the size and number of adipocytes are increased, making it more difficult to treat than adult obesity, with a high likelihood of recurrence after treatment.16

Obesity is usually diagnosed by methods involving height and weight, with BMI being the most commonly used. For children, those with a BMI higher than the 95th percentile by age and sex are defined as obese. Using these criteria, we found that obesity was significantly correlated with hypodermal fat and body fat, and, among those children who underwent ventilating tube insertion for OME, 41.9% were obese and 58.1% were not.

Among the factors used to screen for the health risks of obesity, serum TG and TC concentrations have been used to predict the risk of development of cardiovascular diseases. Although serum TG and TC concentrations were found to be significantly higher in obese than in nonobese individuals,17 the definite standards for obesity have not yet been established. For both TG and TC, we defined obesity as values not within the normal range for age and sex. Using serum TG concentration as the standard, we found that 34.7% of children who underwent ventilating tube insertion were obese, whereas with serum TC concentration as the standard, only 19.2% were obese.

Obesity is associated with mild systemic inflammation, accompanied by increases in the concentrations of C-reactive protein, interleukin 6, and other markers of inflammation.18

The incidence of asthma is increased in obese patients, with 75% of patients visiting the emergency department for treatment of asthma being obese or overweight.19 Longitudinal studies have shown that obesity precedes asthma, and the relative risk of developing asthma is increased with increased obesity.20 In addition, obesity is a risk factor for airway hyperresponsiveness. In this condition, tumor necrosis factor α reacts with tumor necrosis factor receptors on smooth muscles in the airway, increasing airway constriction. In addition to tumor necrosis factor α, leptin, adiponectin, and plasminogen activator inhibitor-1 have been shown to induce airway hyperresponsiveness.21

Various factors have been used to evaluate the severity of OME, including the frequency of ventilation tube insertion22 and the number of hospital visits because of OME.23 Using the former criteria, we found that in obese children, as defined by BMI and TG and TC concentrations, the incidence of OME, while high, was not associated with the frequency of ventilating tube insertion. In comparing children with and without OME, we found that childhood obesity was significantly higher in children with OME. This finding suggests that childhood obesity could have an effect on the development of OME.

Correspondence: Seung Geun Yeo, MD, PhD, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea (yeo2park@yahoo.co.kr).

Submitted for Publication: July 3, 2006; accepted November 25, 2006.

Author Contributions: Drs Kim, Park, and Yeo had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Kim, Park, and Yeo. Analysis and interpretation of data: Cha and Yeo. Drafting of the manuscript: Yeo. Critical revision of the manuscript for important intellectual content: Park, Cha, and Yeo. Statistical analysis: Kim and Yeo. Study supervision: Park, Cha, and Yeo.

Financial Disclosure: None reported.

Bluestone  CDBerry  QC Concept on the pathogenesis of middle ear effusion. Ann Otol Rhinol Laryngol 1976;85(suppl 25, pt 2)182- 186
PubMed
de Lusignan  SHague  Nvan Vlymen  J  et al.  A study of cardiovascular risk in overweight and obese people in England. Eur J Gen Pract 2006;1219- 29
PubMed Link to Article
Ahn  HS Pediatrics. 8th ed. Seoul, Korea: Daehan Printing & Publishing; 2005:1232-1248
Casselbrant  MLBrostoff  LMCantekin  EI  et al.  Otitis media with effusion in preschool children. Laryngoscope 1985;95428- 436
PubMed Link to Article
Ilicali  OCKeles  NDeger  KSavas  I Relationship of passive cigarette smoking to otitis media. Arch Otolaryngol Head Neck Surg 1999;125758- 762
PubMed Link to Article
Brooks  DN School screening for middle ear effusion. Ann Otol Rhinol Laryngol 1976;85(suppl 25, pt 2)223- 229
PubMed
Casselbrant  MLBrostoff  LMCantekin  EI Otitis media effusion in preschool children. Laryngoscope 1985;95428- 436
PubMed Link to Article
Morimoto  K Epidemiological analysis of otitis media with effusion in children. Nippon Jibiinkoka Gakkai Kaiho 1991;94678- 684
PubMed Link to Article
Ogisi  FO Impedance screening for otitis media with effusion in Nigerian children. J Laryngol Otol 1988;102986- 988
PubMed Link to Article
Chea  SWHwang  KS The point prevalence of otitis media with effusion among kindergarten and elementary school children in Annsan area. Korean J Otolaryngol 1999;42700- 703
Pyo  SYHong  NPCoo  JHAhn  HYCha  CIJo  JH The prevalence of otitis media with effusion among kindergarten and elementary school children in Song Buk, Seoul, Korea and risk factors. Korean J Otolaryngol 2000;431158- 1165
Kim  JGSohn  YT Prevalence of otitis media with effusion in kindergarten children in Taegu area. Korean J Otolaryngol 1995;381695- 1702
Van Cauwenberge  PB Relevant and irrelevant predisposing factors in secretary otitis media. Acta Otolaryngol Suppl 1984;414147- 153
PubMed Link to Article
Dewey  CMidgeley  EMaw  R The relationship between otitis media with effusion and contact with other children in a British cohort studied from 8 months to 3½ years: the ALSPAC Study Team: Avon Longitudinal Study of Pregnancy and Childhood. Int J Pediatr Otorhinolaryngol 2000;5533- 45
PubMed Link to Article
Charney  EGoodman  HCMcBride  MLyon  BPratt  R Childhood antecedents of adult obesity. N Engl J Med 1976;2956- 9
PubMed Link to Article
Moon  SJ Nutrition problems in Korea. Korean J Nutr 1996;29371- 380
Choi  DHPark  ES A study on the obesity incidence rate and fat intake, serum total cholesterol/triglyceride concentrations by obese index in the elementary school students. J East Asian Soc Dietary Life 2005;1529- 39
Fantuzzi  G Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol 2005;115911- 919
PubMed Link to Article
Thomson  CCClark  SCamargo  CA  Jr Body mass index and asthma severity among adults presenting to the emergency department. Chest 2003;124795- 802
PubMed Link to Article
Camargo  CA  JrWeiss  STZhang  SWillett  WCSpeizer  FE Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch Intern Med 1999;1592582- 2588
PubMed Link to Article
Nawrocki  ARScherer  PE The delicate balance between fat and muscle: adipokines in metabolic disease and musculoskeletal inflammation. Curr Opin Pharmacol 2004;4281- 289
PubMed Link to Article
Boston  MMcCook  JBurke  BDerkay  C Incidence of and risk factors for additional tympanostomy tube insertion in children. Arch Otolaryngol Head Neck Surg 2003;129293- 296
PubMed Link to Article
Curns  ATHolman  RCShay  DK Outpatient and hospital visits associated with otitis media among American Indian and Alaska Native children younger than 5 years. Pediatrics 2002;109 ((3)) E41
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.

Mean ± SD body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of the experimental and control groups. The difference between the 2 groups was statistically significant (P = .01).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Mean ± SD serum triglyceride and total cholesterol concentrations of the experimental and control groups. The difference between the 2 groups was statistically significant only for serum total cholesterol concentrations (P = .04). To convert triglycerides to millimoles per liter, multiply by 0.0113; to convert cholesterol to millimoles per liter, multiply by 0.0259.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Mean ± SD body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of the obese and nonobese subgroups of the experimental group.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Mean serum triglyceride and total cholesterol concentrations of the obese and nonobese subgroups of the experimental group. To convert triglycerides to millimoles per liter, multiply by 0.0113; to convert cholesterol to millimoles per liter, multiply by 0.0259.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

Mean frequency of ventilation tube insertion for treatment of otitis media with effusion in the experimental group. The differences between the obese and nonobese subgroups, as classified by body mass index (calculated as weight in kilograms divided by height in meters squared) and serum triglyceride and total cholesterol concentrations, were not significant (P>.05).

Graphic Jump Location

Tables

References

Bluestone  CDBerry  QC Concept on the pathogenesis of middle ear effusion. Ann Otol Rhinol Laryngol 1976;85(suppl 25, pt 2)182- 186
PubMed
de Lusignan  SHague  Nvan Vlymen  J  et al.  A study of cardiovascular risk in overweight and obese people in England. Eur J Gen Pract 2006;1219- 29
PubMed Link to Article
Ahn  HS Pediatrics. 8th ed. Seoul, Korea: Daehan Printing & Publishing; 2005:1232-1248
Casselbrant  MLBrostoff  LMCantekin  EI  et al.  Otitis media with effusion in preschool children. Laryngoscope 1985;95428- 436
PubMed Link to Article
Ilicali  OCKeles  NDeger  KSavas  I Relationship of passive cigarette smoking to otitis media. Arch Otolaryngol Head Neck Surg 1999;125758- 762
PubMed Link to Article
Brooks  DN School screening for middle ear effusion. Ann Otol Rhinol Laryngol 1976;85(suppl 25, pt 2)223- 229
PubMed
Casselbrant  MLBrostoff  LMCantekin  EI Otitis media effusion in preschool children. Laryngoscope 1985;95428- 436
PubMed Link to Article
Morimoto  K Epidemiological analysis of otitis media with effusion in children. Nippon Jibiinkoka Gakkai Kaiho 1991;94678- 684
PubMed Link to Article
Ogisi  FO Impedance screening for otitis media with effusion in Nigerian children. J Laryngol Otol 1988;102986- 988
PubMed Link to Article
Chea  SWHwang  KS The point prevalence of otitis media with effusion among kindergarten and elementary school children in Annsan area. Korean J Otolaryngol 1999;42700- 703
Pyo  SYHong  NPCoo  JHAhn  HYCha  CIJo  JH The prevalence of otitis media with effusion among kindergarten and elementary school children in Song Buk, Seoul, Korea and risk factors. Korean J Otolaryngol 2000;431158- 1165
Kim  JGSohn  YT Prevalence of otitis media with effusion in kindergarten children in Taegu area. Korean J Otolaryngol 1995;381695- 1702
Van Cauwenberge  PB Relevant and irrelevant predisposing factors in secretary otitis media. Acta Otolaryngol Suppl 1984;414147- 153
PubMed Link to Article
Dewey  CMidgeley  EMaw  R The relationship between otitis media with effusion and contact with other children in a British cohort studied from 8 months to 3½ years: the ALSPAC Study Team: Avon Longitudinal Study of Pregnancy and Childhood. Int J Pediatr Otorhinolaryngol 2000;5533- 45
PubMed Link to Article
Charney  EGoodman  HCMcBride  MLyon  BPratt  R Childhood antecedents of adult obesity. N Engl J Med 1976;2956- 9
PubMed Link to Article
Moon  SJ Nutrition problems in Korea. Korean J Nutr 1996;29371- 380
Choi  DHPark  ES A study on the obesity incidence rate and fat intake, serum total cholesterol/triglyceride concentrations by obese index in the elementary school students. J East Asian Soc Dietary Life 2005;1529- 39
Fantuzzi  G Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol 2005;115911- 919
PubMed Link to Article
Thomson  CCClark  SCamargo  CA  Jr Body mass index and asthma severity among adults presenting to the emergency department. Chest 2003;124795- 802
PubMed Link to Article
Camargo  CA  JrWeiss  STZhang  SWillett  WCSpeizer  FE Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch Intern Med 1999;1592582- 2588
PubMed Link to Article
Nawrocki  ARScherer  PE The delicate balance between fat and muscle: adipokines in metabolic disease and musculoskeletal inflammation. Curr Opin Pharmacol 2004;4281- 289
PubMed Link to Article
Boston  MMcCook  JBurke  BDerkay  C Incidence of and risk factors for additional tympanostomy tube insertion in children. Arch Otolaryngol Head Neck Surg 2003;129293- 296
PubMed Link to Article
Curns  ATHolman  RCShay  DK Outpatient and hospital visits associated with otitis media among American Indian and Alaska Native children younger than 5 years. Pediatrics 2002;109 ((3)) E41
PubMed Link to Article

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