Blog: Health Matters to Me
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Cigarette Smoke & Ear Infections

The AAP's Policy Statement on Environmental Tobacco Smoke cites numerous studies showing a link between second-hand smoke and ear infections.

Date: 2/13/2008 8:58:18 PM ( 16 y ) ... viewed 6577 times

Cigarette Smoke & Ear Infections

Doctor's Guide reports a study from Archives of Pediatrics & Adolescent Medicine on children in smoking households:

Children living with 2+ smokers, 85% higher risk of persistent or recurrent middle ear infections
Children whose mother smoked 10+ cigarettes a day, 68% higher risk
Children exposed to smoke from 10+ cigarettes a day, 40% higher risk

The University of Calgary (where the study was done) have a press release with pretty much the same facts.
The AAP's Policy Statement on Environmental Tobacco Smoke cites numerous studies showing a link between second-hand smoke and ear infections. If that's not enough, they also document increased pneumonia, bronchitis, a four-times-higher risk of illness requiring hospitalization, exacerbation of asthma, and increased risk of SIDS among children exposed to cigarette smoke.
A 1992 study cited by the AAP shows a 38% higher rate of otitis among children exposed to any tobacco smoke during the first three years of life.
A 1997 study of over 2000 children in Pittsburgh also showed more middle ear infections in children who were exposed to tobacco smoke during the first two years of life, and fewer such infections in children who were breastfed longer. However, it's important to note that those were not the major relationships in the data: "The most important sociodemographic risk factors for otitis media appear to be low socioeconomic status and repeated exposure to large numbers of other children, whether at home or in day care."
The factor of exposure to other children is brought home by another article whose abstract reports "Day care attendance in the first year of life was associated with two or more doctor-diagnosed ear infections....For children attending day care, exposure to pets in day care, the presence of a rug or carpet in the area where the child slept in day care, and a nonresidential setting for day care all were independent predictors of two or more doctor-diagnosed ear infections."
Poking around a bit more, I find the practice guidelines for otitis media with effusion (OME) developed jointly by the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Academy of Otolaryngology. ("Otitis Media with Effusion", by the way, is just the fancy way to say "middle ear infection with fluid".) Among the salient facts:

"Most children have at least one episode of otitis media with effusion before entering school."
"Longitudinal studies of otitis media with effusion show spontaneous resolution of the condition in more than half of children within 3 months from development of the effusion. After 3 months the rate of spontaneous resolution remains constant, so that only a small percentage of children experience otitis media with effusion lasting a year or longer. In most children, episodes of otitis media with effusion do not persist beyond early childhood."
Risk factors include:
- Bottle-feeding rather than breast-feeding infants.
- Passive smoking.
- Group child-care facility attendance
Treatment options are first to just wait for it to go away, second to give antibiotics ("14 percent increase in the resolution rate when antibiotics were given"), third myringotomy with insertion of tympanostomy tubes, but only after three months or on evidence of hearing loss.
Treatments NOT recommended include steroids, antihistamines, decongestants, adenoidectomy, tonsillectomy.
Treatments for which they could not find any scientific studies to evaluate: "chiropractic, holistic, naturopathic, traditional/ indigenous, homeopathic". Interestingly enough, this lack of evidence doesn't make the Academies condemn those treatments; they just say "no recommendation was made".

If you prefer, you can read the AAFP's recommendations for parents, but they've certainly removed a lot of detail in boiling it down for laymen.
My reading of the evidence (and yours may be different!) is that it's not a good idea to expose young children to cigarette smoke, but it's an even worse idea to expose them to other sick children.

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