Tobacco smoke, day care, middle-ear surgery, and costs in young children

We identified important health risk factors for middle ear surgery in children during their first two years of life. We enrolled 199 children at age two months; we followed 128 subjects for 18 months; and 116 subjects returned for the two-year follow up. We performed repeated physical examinations and obtained health risk data during the two-year follow up. Twenty-nine children required placement of pressure-equalizing tubes for recurrent otitis media. Using the placement of pressure equalizing tubes as the dependent variable, we conducted a multiple logistic regression analysis using gender, race, number of siblings at home, number of children at home, maternal education, infant feeding practices, day care attendance, and smokers at home. Controlling for all other variables, day care attendance and smoking in the home independently increased the risk of ear surgery (day care: odds ratio=3.94, smoking: odds ratio=3.26). A child in day care who was also exposed to tobacco smoke at home had a 38 percent chance of having surgery, as compared with a 5% chance for children in the non-day-care non-smoke exposed environment. Our hospital and physician fees for pressure-equalizing tube placement are $4452 per patient. Additional costs were incurred by parents who missed work because of the surgery. Our data suggest that significant reductions in otitis-related morbidity, complications, and costs could be achieved by reducing exposure to large groups of young children at day care and eliminating tobacco smoke exposure at home.