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Parental smoking and middle ear infection in children

Episodes of acute middle ear infection are common in young children. This paper reviews the evidence relating parental smoking to middle ear disease in children.


Young children have an increased risk of recurrent middle ear infection and glue ear if either parent smokes. With the evidence to date, it is not possible to quantify that risk.


DP Strachan, DG Cook. Parental smoking, middle ear disease and adenotonsillectomy in children. Thorax 1998 53: 50-56.


The literature was searched using MEDLINE and Embase until 1997. Bibliographies of identified papers were then reviewed. The studies were grouped according to the outcome measure.

Otitis media is an infection and inflammation of the middle ear. Thirteen studies examining acute otitis media were identified but were too disparate for a meta-analysis. Nine studies examined recurrent otitis media, defined as numerous episodes of physician-diagnosed acute otitis media. The number of episodes ranged from two to five or more by the time the child had reached a specified age (e.g. by the age of two) or within a specified time period (e.g. six months). The ages of children (totalling 6,381) ranged from less than a year old to five years old. There were five cohort studies, three case-control studies and one survey.

Four studies measured the presence of middle ear effusion (glue ear) by tympanometry (measuring middle ear function) or otoscopy (examination of the ear). Three cohort studies and one survey investigated 1,768 children aged between two and seven years.

Seven studies (six case-control and one cohort) examined outpatient referral or operative intervention for glue ear. The childrens ages varied between studies from one to twelve years old and the outcomes differed between studies (e.g. operation for glue ear, grommet insertion or outpatient referral).


The risk of recurrent acute otitis media increased by 48% in children if either parent smoked (odds ratio 1.48, 95% confidence interval 1.08 to 2.04).

The risk of glue ear increased by 38% if either parent smoked (odds ratio 1.38, 95% confidence interval 1.23 to 1.55).

There was no association between parental smoking and referral for glue ear (odds ratio 1.21, 95% confidence interval 0.95 to 1.53).


The conclusion that can be drawn from this paper is that there is an increased risk of middle ear infection and glue ear in children whose parents smoke. The quantification of that risk needs to be treated with circumspection because of the differences between papers and the results were unadjusted for factors which may also contribute to these outcomes, for example, socio-economic class. No association was found between parental smoking and referral for surgery for glue ear. As this condition commonly resolves spontaneously prior to surgery, it appears that parental smoking does not affect the spontaneous resolution of glue ear (although it does affect its onset).