Health-related quality of life in children with otitis media

doi:10.1016/j.ijporl.2005.03.013

International Journal of Pediatric Otorhinolaryngology

Volume 69, Issue 8, August 2005, Pages 1031-1041

https://doi.org/10.1016/j.ijporl.2005.03.013 Get rights and content

Summary

Background:

Growing interest in health-related quality of life (HRQoL) in children with otitis media has brought the need to study the currently available HRQoL instruments with respect to their results and their applicability in clinical practice and research of otitis media.

Objective:

To review existing literature on health-related quality of life research in children with otitis media with respect to: (1) the measured impact of otitis media on HRQoL; and (2) the applicability of HRQoL instruments used in research and clinical practice based on their characteristics and contents.

Methods:

A search was performed in EMBASE (1988–November 2004) and on NLM Gateway (1966–November 2004) for studies assessing health-related quality of life or functional health status by means of disease-specific or generic questionnaires in children aged 0–18 years with chronic or recurrent otitis media with effusion or acute otitis media. The bibliographies of the selected articles were searched manually.

Results:

Only 13 of the 141 retrieved articles retrieved fulfilled the criteria for inclusion. In these studies, physical suffering (pain, high fever, etc.), difficulties with hearing or speech, behavioural problems, or emotional distress were reported to be the most important problems experienced by children with otitis media. Almost all instruments applied in these studies measure functional health status instead of health-related quality of life. Data on validity and reliability of these instruments are incomplete.

Conclusions:

Recurrent or chronic otitis media is reported to have a substantial and negative effect on various domains of functional health status and health-related quality of life of children. The OM-6 appears to be the best available instrument to assess functional health status in children with OM in a research setting. However, the lack of true HRQoL instruments as well as incomplete data on their reliability and validity, limit both our current knowledge of HRQoL in OM and the application of current instruments in both research and clinical practice.

Introduction

Otitis media (OM) is one of the most common disorders in childhood [1], [2], [3] and may have a considerable impact on health-related quality of life (HRQoL) [4], [5], [6] and functional health status (FHS) of children and their caregivers [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]. Whereas functional health status reflects the physical, psychological or emotional and social functioning of a child, health-related quality of life adds a valuation or affective response to this functioning. Up to now, most studies have focussed on the effects of OM and its treatment on hearing, language and psychosocial development [7], [21], [22], [23], [24], [25], [26]. Only a few studies have addressed the broader scope of health-related quality of life as an outcome measure in OM [27], [28], [29], [30]. Growing interest in HRQoL in children in general and those with OM in particular, however, has brought the need for knowledge of currently available HRQoL instruments and their applicability in clinical practice and research [14], [31], [32], [33], [34]. Haggard et al. have previously reviewed some important studies [28]. Their narrative review was part of a discussion on general issues regarding HRQoL assessment in OM, such as generic versus disease-specific instruments and scaling, and focussed on methodology. We aimed to perform a meta-analysis of the available studies on various HRQoL and FHS assessments in children with recurrent OM, addressing both their methodology and outcome. Due to heterogeneity of the studies regarding population, follow-up, outcome measures and instruments used, pooling of the results in a meta-analysis proved impossible. Therefore, a systematic review was conducted, providing an overview of: (1) the effect of OM on HRQoL and FHS of children assessed with various HRQoL instruments; and (2) the applicability of these HRQoL instruments in research and clinical practice on the basis of their characteristics and contents.

Section snippets

Search strategy

A literature search was performed in EMBASE for articles dating from 1988 to November 2004 and on NLM Gateway from 1966 to November 2004, using the search terms that are proposed by EMBASE for otitis media (‘otitis media’ or ‘chronic otitis media’ or ‘mucoid otitis media’ or ‘secretory otitis media’ or ‘serous otitis media’) or ‘acute otitis media’ and ‘quality of life’ or ‘health status’ or ‘functional status’. Search terms were entered as MESH headings as well as text or keywords. Limitations

Results

The search resulted in 141 citations. The manual search and expert discussion yielded one extra article [28]. After applying the criteria for inclusion and exclusion, only 13 articles remained for inclusion [29], [30], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44]. In addition, we included results regarding reliability and validity of the TAIQOL from our own work published in a thesis [45]. Ninety-two articles were excluded because QoL in OM was not the subject of study, 16 were

Discussion

In recent years, various studies have aimed to assess health-related quality of life in children with OM. Some of them have been reviewed previously as part of a general discussion of methodological issues in HRQoL assessment in children with OM [28]. This is the first systematic review of both methodology and outcomes of HRQoL assessment in OM. Heterogeneity of the studies precluded pooling of results in a meta-analysis.

The negative impact of AOM on the child's functioning appeared to be

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The association between otitis media in early childhood with later behaviour and attention problems: A longitudinal pregnancy cohort
2023, International Journal of Pediatric Otorhinolaryngology
The present study aims to investigate the association between an early history of recurrent otitis media (OM) with or without ventilation tube insertion (VTI) and later behavioural problems in childhood and adolescence.
Parental reports in a longitudinal pregnancy cohort were used to classify children into three groups; recurrent OM without VTI (rOM group; n = 276), recurrent OM with VTI (VTI group; n = 62), and no history of early-life recurrent OM as a reference group (n = 1485). The Child Behaviour Checklist (CBCL) was administered at ages 5, 8, 10, and 13 years and data were analysed for psychological wellbeing. Mixed-effects regression modelling was used to investigate the associations between a history of rOM and CBCL T-scores across all ages for rOM and VTI groups compared to the reference group. All analyses were controlled for a wide range of confounding variables.
The analyses revealed a significant association between recurrent OM and behavioural problems. While there was a general decline in scores (i.e. improvement) observed over the duration of the follow-up period, children in the rOM group displayed significantly higher scores for internalising and externalising behaviours at ages five, eight and 10 years. Attention scores were significantly higher across all ages in the rOM group. A transient increase in internalising behaviour was observed in the VTI group at ages eight and 10 years. Logistic regression models showed an increased overall likelihood for the rOM group only to fall within the abnormal clinical range for internalising and externalising behaviours.
Early-life recurrent OM with and without VTI was associated with increased behavioural and attention problems in early and late childhood. This suggests that recurrent OM can have a significant impact on children's behaviour and attention that can persist into early adolescence.
Efficacy and safety of balloon dilation of eustachian tube in children: Systematic review and meta-analysis
2022, International Journal of Pediatric Otorhinolaryngology
Eustachian tube dysfunction is a common condition that may lead to otitis media with effusion, hearing loss and developmental delays in children. We sought to determine the efficacy and safety of balloon dilation of the eustachian tube (BDET) in the pediatric population.
Original studies of BDET in a pediatric population were identified in PubMed, Embase, Web of Science, Cochrane, Clinicaltrials.gov and CINAHL.
Outcomes of efficacy included audiometric findings and adverse events were summarized for each study.
Seven articles were included involving 408 children with a mean age of 9.9 years old (95%CI 8.8, 11.1) and a mean follow up of 19.2 months (95%CI 15, 23). Type B tympanograms decreased after BDET from 64.2% (95%CI 53.3, 73.8) to 16.1% (95%CI 8.5, 28.4). Air-bone gap (ABG) decreased after BDET from a mean of 25.3 dB (95%CI 18.9, 31.6) to 10.2 dB (95%CI 8.9, 11.5). The pooled estimate of adverse events after BDET was 5.1% (95%CI 3.2, 8.1), the majority being self-limited epistaxis with no major adverse events reported. Three studies compared BDET to ventilation tube insertion; analysis of post-operative ABG showed a greater decrease in the BDET group (mean difference −6.4 dB; 95%CI -9.8, −3.1; p = 0.002).
Although there are no prospective randomized control trials, BDET ± tympanostomy tube placement may produce outcomes that are comparable to tympanostomy tube placement in the treatment of otitis media with effusion in the pediatric population. Most children undergoing the procedure are those with recalcitrant disease. The procedure is safe with the most common complication being epistaxis.
Pneumococcal Disease: A Systematic Review of Health Utilities, Resource Use, Costs, and Economic Evaluations of Interventions
2019, Value in Health
Citation Excerpt :
Preference-based health-related quality-of-life outcomes (health utilities) and estimates of economic costs associated with pneumococcal diseases and their sequelae are key input parameters to these economic models. Nevertheless, previous reviews on the impact of pneumococcal disease on health-related quality of life have only focused on a small number of pneumococcal infections, such as otitis media13 and sepsis.14 Hospitalization and long-term sequelae caused by pneumococcal diseases have economic consequences at various levels, including the individual, household, government, and overall society.
Pneumococcal diseases cause substantial mortality, morbidity, and economic burden. Evidence on data inputs for economic evaluations of interventions targeting pneumococcal disease is critical.
To summarize evidence on resource use, costs, health utilities, and cost-effectiveness for pneumococcal disease and associated interventions to inform future economic analyses.
We searched MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, EconLit, and Cochrane databases for peer-reviewed studies in English on pneumococcal disease that reported health utilities using direct or indirect valuation methods, resource use, costs, or cost-effectiveness of intervention programs, and summarized the evidence descriptively.
We included 383 studies: 9 reporting health utilities, 131 resource use, 160 economic costs of pneumococcal disease, 95 both resource use and costs, and 178 economic evaluations of pneumococcal intervention programs. Health state utility values ranged from 0 to 1 for both meningitis and otitis media and from 0.3 to 0.7 for both pneumonia and sepsis. Hospitalization was shortest for otitis media (range: 0.1-5 days) and longest for sepsis/septicemia (6-48). The main categories of costs reported were drugs, hospitalization, and household or employer costs. Resource use was reported in hospital length of stay and number of contacts with general practitioners. Costs and resource use significantly varied among population ages, disease conditions, and settings. Current vaccination programs for both adults and children, antibiotic use and outreach programs to promote vaccination, early disease detection, and educational programs are cost-effective in most countries.
This study has generated a comprehensive repository of health economic evidence on pneumococcal disease that can be used to inform future economic evaluations of pneumococcal disease intervention programs.
Expression of endoplasmic reticulum stress-related mRNA in otitis media with effusion
2019, International Journal of Pediatric Otorhinolaryngology
The endoplasmic reticulum (ER) is an intracellular organelle involved in the synthesis and secretion of proteins. The ER stress response, which protects cells from cytotoxic proteins such as unfolded proteins, is related to several diseases including inflammation. In this study, we investigated the effect of ER stress on the pathophysiology of otitis media with effusion (OME).
Thirty-nine pediatric patients who were diagnosed with OME and underwent ventilation tube insertion were enrolled in this study. Exudate from the middle ear cavity was collected through ventilation insertion, and ER stress gene expression was analyzed via real-time polymerase chain reactions(PCR).
There were no significant differences in ER stress-related mRNA expression between effusion culture-positive and culture-negative groups (p > 0.05). Expression of the C/EBP-homologous protein (CHOP) was higher in the otitis-prone group than in the non-otitis-prone group (p < 0.05). The most common type of fluid was mucoid, and inositol-requiring enzyme 1α expression was higher in serous fluid than in mucoid, mucopurulent, or purulent fluid (p < 0.05).
Endoplasmic reticulum stress-related responses are activated in pediatric OME patients, and specific ER-stress related pathways are related to both the characteristics of fluid and the frequency of OME. Thus, ER stress-related responses affect the pathophysiology of OME in pediatric OME patients.
The prospective relationship between postpartum PTSD and child sleep: A 2-year follow-up study
2018, Journal of Affective Disorders
: The main aim of this study was to examine the prospective impact of maternal postpartum PTSD on several standardized child sleep variables two years postpartum in a large, population-based cohort of mothers. Moreover, we investigated the influence of numerous potential confounding maternal and child factors. Finally, we tested potential reverse temporal associations between child sleep eight weeks postpartum and maternal PTSD symptoms two years postpartum.
: This study is part of the population-based Akershus Birth Cohort, a prospective cohort study at Akershus University Hospital, Norway. Data from the hospital's birth record, from questionnaires at 17 weeks gestation, eight weeks and two years postpartum were used. At two years postpartum, 39% of the original participants could be retained, resulting in a study population of n = 1480. All child sleep variables significantly correlated with postpartum PTSD symptoms were entered into multiple linear regression analyses, adjusting for confounding factors.
: Postpartum PTSD symptoms were related to all child sleep variables, except daytime sleep duration. When all significant confounding factors were included into multivariate regression analyses, postpartum PTSD symptoms remained a significant predictor for number and duration of night wakings (β = 0.10 and β = 0.08, respectively), duration of settling time (β = 0.10), and maternal rating of their child's sleep problems (β = 0.12, all p<.01. Child sleep at eight weeks postpartum was not significantly related to maternal sleep two years postpartum when controlling for postpartum PTSD at eight weeks.
: Child outcomes were based on maternal reporting and might be influenced by maternal mental health.
: Our results showed for the first time that maternal postpartum PTSD symptoms were prospectively associated with less favorable child sleep, thus increasing the risk of developmental or behavioral problems through an indirect, but treatable pathway. Early detection and treatment of maternal postpartum PTSD may prevent or improve sleep problems and long-term child development.
Middle ear disease in Danish toddlers attending nursery day-care – Applicability of OM-6, disease specific quality of life and predictors for middle ear symptoms
2018, International Journal of Pediatric Otorhinolaryngology
Otitis media (OM) is a very common childhood disease and impacts child quality of life (QoL) to different extends. The aim of this study was to investigate the difference in quality of life between three groups of children; Children with symptoms of ear disease within the last 4 weeks, children without any ear disease and children scheduled for ventilating tube treatment. Furthermore, we investigated predictors for experiencing middle ear symptoms. Lastly, we assessed psychometric properties of OM-6 used to assess QoL.
Four hundred ninety-four children attending nursery day-care aged 6–36 months were enrolled in the study. Caregivers were asked to recall the child's history of symptoms related to middle ear infection. The Danish version of otitis media-6 questionnaire was used to measure the children's quality of life. Data from children treated with ventilating tubes were included from a previously published study. Logistic regression was applied for determining possible predictors for experiencing ear related symptoms.
The study had an 87% response rate, with a total of 342 children included. At the inclusion 32 (9%) children were included in the 4-week group and, while 307 children were allocated to the non-4 week group. The children in the 4-week group were significantly younger and were more likely to have siblings with a history of middle ear infection than the non-4week group. Furthermore, QoL was significantly worse in the 4-week group compared to the non-4week group. Only subtle differences were found between children with acute symptoms compared to children scheduled for tube treatment.
As expected, children with acute symptoms of OM experience lowered QoL compared to children with no symptoms and young age as well as having siblings with a history of middle ear problems were found to be possible predictors for experiencing middle ear symptoms. Children with acute symptoms differed from children scheduled for ventilating tubes on domains related to long-term problems from OM. OM-6 has shown to be a valid instrument for assessing disease specific QoL in children with OM, however a more large-scale instrument might be necessary for detecting subtle differences between subgroups of children with OM.

View all citing articles on Scopus

¹: Present address: Julius Center for Health Sciences and Primary Care, Kramatweg 53-II, 1095 JW Amsterdam, The Netherlands. Tel.: +31 20 470 27 24.

²: Tel.: +31 30 250 93 81; fax: +31 30 250 54 85.

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REVIEW ARTICLEHealth-related quality of life in children with otitis media

Summary

Background:

Objective:

Methods:

Results:

Conclusions:

Introduction

Section snippets

Search strategy

Results

Discussion

Vaccine

J. Allergy Clin. Immunol.

Int. J. Pediatr. Otorhinolaryngol.

Int. J. Pediatr. Otorhinolaryngol.

J. Clin. Epidemiol.

Int. J. Pediatr. Otorhinolaryngol.

Mayo Clin. Proc.

J. Clin. Epidemiol.

Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study

J. Infect. Dis.

Otitis media: back to basics

Pediatr. Infect. Dis. J.

Clinical epidemiology of otitis media

Pediatr. Infect. Dis. J.

‘You have to live it to understand it…’—family experiences with chronic otitis media in children

Ambul. Child Health

Communication tactics used by parents of children with OME (glue ear)

Psychol. Health Med.

Children's quality of life measures

Arch. Dis. Child.

Users’ guides to the medical literatureXII. How to use articles about health-related quality of life. Evidence-Based Medicine Working Group

J. Am. Med. Assoc.

Measuring quality of life

Arch. Dis. Child.

Quality of life in adults and children with asthma and rhinitis

Allergy

The proxy problem: child report versus parent report in health-related quality of life research

Qual. Life Res.

A critical appraisal of the quality of quality-of-life measurements

J. Am. Med. Assoc.

Quality of life studies: definitions and conceptual issues

Quality of life, health status, and clinical research

Med. Care

Health related quality of life assessment in children: a review of the literature

Rev. Eur. Psychol. Appl.

What are quality of life measurements measuring?

Br. Med. J.

Distinction of quality of life, health related quality of life, and health status in children referred for rheumatologic care

J. Rheumatol.

Methodological considerations in the assessment of health-related quality of life in children

Acta Paediatr. Suppl.

Pediatric outcomes research: development of an outcomes instrument for tonsil and adenoid disease

Laryngoscope

Language, speech, and educational outcomes of otitis media

J. Otolaryngol.

Effects of otitis media with effusion on hearing in the first 3 years of life

J. Speech Lang. Hear. Res.

Effects of early middle ear effusion on child intelligence at three, five, and seven years of age

J. Pediatr. Psychol.

Language, speech sound production, and cognition in three-year-old children in relation to otitis media in their first three years of life

Pediatrics

Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years

N. Engl. J. Med.

Quality of life and child behavior

Quality of life for children with otitis media

Arch. Otolaryngol. Head Neck Surg.

Otitis media health status evaluation: a pilot study for the investigation of cost-effective outcomes of recurrent acute otitis media treatment

Ann. Otol. Rhinol. Laryngol.

REVIEW ARTICLE
Health-related quality of life in children with otitis media