Pediatric Infection and Vaccine

  • 제17권2호
  • /
  • Pages.91-100
  • /
  • 2010
  • /
  • 2384-1079(pISSN)
  • /
  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
권호 표지

소아 재발성 중이염의 위험인자에 대한 연구

A Study on Risk Factors of Recurrent Otitis Media

  • 김은진 (한일병원 소아청소년과) ;
  • 권영란 (경희대학교 의과대학 소아과학교실) ;
  • 송강훈 (경희대학교 의과대학 소아과학교실) ;
  • 장원녕 (한일병원 소아청소년과) ;
  • 이진 (한일병원 소아청소년과) ;
  • 장진근 (한일병원 소아청소년과) ;
  • 차성호 (경희대학교 의과대학 소아과학교실)
  • Kim, Eun Jin (Department of Pediatrics, Han-Il General Hospital) ;
  • Kwon, Young Ran (Department of Pediatrics, College of Medicine, Kyunghee University) ;
  • Song, Kang Hoon (Department of Pediatrics, College of Medicine, Kyunghee University) ;
  • Jang, Won Nyung (Department of Pediatrics, Han-Il General Hospital) ;
  • Lee, Jin (Department of Pediatrics, Han-Il General Hospital) ;
  • Chang, Jin Keun (Department of Pediatrics, Han-Il General Hospital) ;
  • Cha, Sung Ho (Department of Pediatrics, College of Medicine, Kyunghee University)
  • 투고 : 2010.06.12
  • 심사 : 2010.08.10
  • 발행 : 2010.12.25
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적 : 재발성 중이염은 말하기, 언어, 인지 능력 지연 및 저하를 유발할 수 있으며, 청력 소실 혹은 손상을 초래할 수 있다. 또한 재발성 중이염을 앓는 소아들은 예방적 항생제 투여, 고막 절개와 튜브 삽입, 아데노이드 절제의 고려 대상이 된다. 하지만 재발성 중이염의 위험인자에 관한 연구는 매우 부족하며, 국내에서는 이에 관한 연구가 아직까지 없다. 이에 저자들은 우리나라의 소아 재발성 중이염의 위험인자들에 대해 알아보고자 하였다. 방법 : 2009년 7월부터 2010년 1월까지 한일 병원과 경희의료원 소아청소년과 외래를 방문한 60개월 미만의 소아를 대상으로, 104명의 재발성 중이염군과 331명의 대조군을 대면조사를 통해 조사하였다. 성별, 모유수유, 인공 젖꼭지 사용, 어린이집 이용, 알레르기 비염 병력, 모세기관지염의 병력, 소득 수준, 부모 흡연, 집안에서의 흡연, 폐구균 백신 및 인플루엔자 백신 접종력 등의 항목을 조사하였다. 각각의 위험인자와 재발성 중이염간의 연관성을 확인하기 위해 카이제곱 검정을 통한 단변량 분석을 시행하였고, 단변량 분석에서 의미 있었던 위험인자들 간의 교란변수를 보정하기 위해 이분형 로지스틱 회귀분석을 통한 다변량 분석도 시행하였다. 결 과 : 단변량 분석에서는 어린이집 이용, 알레르기 비염, 아토피, 모세기관지염, 부모 흡연, 집안에서의 흡연, 낮은 사회경제 상태가 의미 있는 위험인자였다. 하지만 폐구균 백신 접종은 통계적 유의성이 없었다. 교란변수를 보정한 다변량 분석에서는 아토피, 부모 흡연, 집안에서의 흡연을 제외한, 어린이집 이용(P<0.001, OR=2.85), 알레르기 비염(P=0.026, OR=2.32), 모세기관지염(P=0.003, OR=2.33), 낮은 경제상태(P=0.005, OR=2.00)가 의미 있는 독립적인 위험인자였다. 결론 : 알레르기 비염과 모세기관지염의 병력이 있고, 낮은 사회경제 상태에 있으며, 어린이집을 이용하고 있는 소아일수록 재발성 중이염에 걸릴 위험이 높았다.

Purpose : Recurrent otitis media (ROM) is usually defined as ${\geq}$3 distinct and well-documented episodes within 6 months or ${\geq}$4 episodes within 12 months. ROM is sufficiently important to warrant consideration of chemoprophylaxis, tympanostomy tube placement. There also is evidence that children with ROM are at risk for both hearing loss and speech delay. However, studies of ROM have been notably insufficient. In addition, even though environmental, racial, and sociocultural differences can affect risk factors, few studies have been conducted with regard to recurrent otitis media in Korea. Methods : This study was conducted from July 2009 to January 2010 with infants and children who were younger than 60 months old, who visited the out-patient clinics at Han-Il General Hospital and Kyunghee University Hospital. Data were collected by interview using a pre-formed sheet. Among a total of 892 infants and children, 457 were excluded, and the remaining 435 were allocated to 104 with ROM and 331 as a control group. Results : Attendance at daycare centers (P<0.001, OR=2.85), allergic rhinitis (P=0.026, OR=2.32), past history of bronchiolitis (P=0.003, OR=2.33), and low socioeconomic status (P=0.005, OR=2.00) were found to have a close significant correlation with ROM. Risk factors such as sex, having a sibling, breast-feeding, use of pacifiers, atopy, pneumococcal vaccination, influenza vaccination, smoking of parents, and indoor smoking are not relevant. Conclusion : Attendance at daycare centers, allergic rhinitis, past history of bronchiolitis, and low socioeconomic status have been identified as risk factors for ROM.

키워드

참고문헌

  1. Casselbrant ML, Kaleida PH, Rockette HE, Paradise JL, Bluestone CD, Kurs-Lasky M, et al. Efficacy of antimicrobial prophylaxis and of tympanostomy insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial. Pediatr Infect Dis J 1992;11: 278-86. https://doi.org/10.1097/00006454-199204000-00004
  2. Klein JO. Nonimmune strategies for prevention of otitis media. Pediatr Infect Dis J 2000;19:S89-92. https://doi.org/10.1097/00006454-200005001-00013
  3. Teele DW, Klein JO, Rosner BR. Epidemiology of otitis media during of the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 1989;160:83-94. https://doi.org/10.1093/infdis/160.1.83
  4. Pukander J, Luotonen J, Timonen M, Karma P. Risk factors affecting the occurrence of acute otitis media among 2-3-Year-Old Urban Children. Acta Otolaryngol 1985;100:260-5. https://doi.org/10.3109/00016488509104788
  5. Poehling KA, Szilagyi PG, Grijalva CG, Martin SW, LaFleur B, Mitchel RD, et al. Reduction of frequent otitis media and pressure-equalizing tube insertion in children after introduction of pneumococcal conjugate vaccine. Pediatrics 2007;119:707-15. https://doi.org/10.1542/peds.2006-2138
  6. Shin IH, Park DC, Byun JY, Park MS, Cha CI, Yeo SG. Decreased serum immunoglobuin in recurrent otitis media with effusion. Immune Network 2007;7:75-9. https://doi.org/10.4110/in.2007.7.2.75
  7. Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Otitis media-principles of judicious use of antimicrobial agents. Pediatrics 1998;101:S165-71.
  8. Lanphear BP, Byrd RS, Auinger P, Hall CB. Increasing prevalence of recurrent otitis media among children in the United States. Pediatrics 1997;99:e1.
  9. Teele DW, Klein JO, Chase C, Menyuk P, Rosner BA. Otitis media in infancy and intellectual ability, school achievement, speech, and language at age 7 years. J Infect Dis 1990;162:685-94. https://doi.org/10.1093/infdis/162.3.685
  10. Hobbard TW, Paradise JL, McWilliams BJ, Elster BA, Taylor FH. Consequences of unremitting middle ear disease in early life. N Engl J Med 1985;312:1529-34. https://doi.org/10.1056/NEJM198506133122401
  11. Uhari M, Mantysaari K, Niemela M. A meta-analytic review of the risk factors for acute otitis media, Clin Infect Dis 1996;22:1079-83. https://doi.org/10.1093/clinids/22.6.1079
  12. American Academy of Pediatrics. Subcommittee on management of AOM. Diagnosis and management of acute otitis media. Pediatrics 2004;113:1451-65. https://doi.org/10.1542/peds.113.5.1451
  13. Paradise JL, Rockette HE, Colborn DK, Bernard BS, Smith CG, Kurs-Lasky M, et al. Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics 1997;99: 318-33. https://doi.org/10.1542/peds.99.3.318
  14. Wald ER, Dashefsky B, Byers C, Guerra N, Taylor F. Frequency and severity of infections in day care. J Pediatr 1988;112:540-6. https://doi.org/10.1016/S0022-3476(88)80164-1
  15. Hardy AM, Fowler MG. Child care arrangements and repeated ear infections in young children. Am J Public Health 1993;83:1321-5. https://doi.org/10.2105/AJPH.83.9.1321
  16. Park YK, Lee KS. Study of allergy by multiple allergosorbent test chemiluminescent assay in otitis media with effusion patients. Korean J Otolaryngol 1996;39:925-31.
  17. Jang CH. Characterization of cytokines present in pediatric recurrent otitis media with effusion: comparison of allergy and nonallergy. Korean J Otolaryngol 2000;43: 808-12.
  18. Andrade MA, Hoberman A, Glustein J, Paradise JL, Wald ER. Acute otitis media in children with bronchiolitis. Pediatrics 1998;101:617-9. https://doi.org/10.1542/peds.101.4.617
  19. Shazberg G, Revel-Vilk S, Shoseyov D, Ben-Ami A, Klar A, Hurvitz H. The clinical course of bronchiolitis associated with acute otitis media. Arch Dis Child 2000;83: 317-9. https://doi.org/10.1136/adc.83.4.317
  20. Kafetzis DA, Astra H, Tsolia M, Liapi G, Mathioudakis J, Kallergi K. Otitis and respiratory distress episodes following a respiratory syncytial virus infection. Clin Microbiol Infect 2003;9:1006-10. https://doi.org/10.1046/j.1469-0691.2003.00715.x
  21. Rovers MM, Zielhuis GA, Ingels K, van der Wilt GJ. Day-care and otitis media in young children: a critical overview. Eur J Pediatr 1999;158:1-6. https://doi.org/10.1007/s004310050999
  22. Vinther B, Pedersen CB, Elbrond O. Otitis media in children. Sociomedical aspects with special reference to day-care conditions. Clin Otolaryngol 1984;9:3-8. https://doi.org/10.1111/j.1365-2273.1984.tb01465.x
  23. Tainio VM, Savilahti E, Salmenpera L, Arjomaa P, Silmes MA, Perheentupa J. Risk factors for infantile recurrent otitis media: atopy but not type of feeding. Pediatr Res 1988;23:509-12. https://doi.org/10.1203/00006450-198805000-00015
  24. Alho OP, Kilkku O, Oja H, Koivu M, Sorri M. Control of the temporal aspect when considering risk factors for acute otitis media. Arch Otolaryngol Head Neck Surg 1993;119:444-9. https://doi.org/10.1001/archotol.1993.01880160092014
  25. Strachan DP, Cook DG. Health effects of passive smoking. Parental smoking, middle ear disease and adenotonsillectomy in children. Thorax 1998;53:50-6. https://doi.org/10.1136/thx.53.1.50
  26. Greemberg D, Givon-Lavi N, Broides A, Blancovich I, Peled N, Dagan R. The contribution of smoking and exposure to tobacco smoke to Streptococcus pneumoniae and Haemophilus influenzae carriage in children and their mothers. Clin Infect Dis 2006;42:897-903. https://doi.org/10.1086/500935
  27. Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen JR, et al. Efficacy, safety and immunogenecity of heptavalent pneumococcal conjugate vaccine in children. Pediatr Infect Dis J 2000;19:187-95. https://doi.org/10.1097/00006454-200003000-00003
  28. Eskola J, Kilpi T, Palmu A, Jokinen J, Haapakoski J, Herva E, et al. Efficacy of pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001;344: 403-9. https://doi.org/10.1056/NEJM200102083440602
  29. Veenhoven R, Bogaert D, Uiterwaal C, Brouwer C, Kiezebrink H, Bruin J, et al. Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomized study. Lancet 2003;361:2189-95. https://doi.org/10.1016/S0140-6736(03)13772-5
  30. Bogaert D, Veenhoven RH, Sluijter M, Wannet WJ, Rijkers GT, Clarke SC, et al. Molecular epidemiology of pneumococcal colonization in response to pneumococcal conjugate vaccination in children with recurrent acute otitis media. J Clin Microbiol 2005;43:74-83. https://doi.org/10.1128/JCM.43.1.74-83.2005
  31. Pichichero ME, Casey JR, Hoberman A, Schwartz R. Pathogens causing recurrent and difficult-to-treat acute otitis media. 2003-2006. Clin Pediatr(Phila) 2008;47: 901-6. https://doi.org/10.1177/0009922808319966