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Year : 2012  |  Volume : 18  |  Issue : 4  |  Page : 223-224

Smoking and middle ear pathology: Are we listening?

Department of Internal Medicine,Princess Durru Shehvar Children's and General Hospital, Hyderabad,Andhra Pradesh, India

Date of Web Publication19-Dec-2012

Correspondence Address:
Dilip Gude
Department of Internal Medicine, Princess Durru Shehvar Children's and General Hospital, Hyderabad, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-7749.104805

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How to cite this article:
Gude D. Smoking and middle ear pathology: Are we listening?. Indian J Otol 2012;18:223-4

How to cite this URL:
Gude D. Smoking and middle ear pathology: Are we listening?. Indian J Otol [serial online] 2012 [cited 2021 Apr 13];18:223-4. Available from: https://www.indianjotol.org/text.asp?2012/18/4/223/104805


Having read the article on the effect of smoking on the outcome of tympanoplasty by Swain et al., [1] I would like to discuss the link between smoking and middle ear infections. Several meta-analyses indicate that passive smoking leads to an increased risk of OM in children of 50-80%. Children exposed to second hand smoke (SHS) and incidence of middle ear disease was studied and it was found that exposure to SHS, particularly to smoking by the mother, significantly increases the risk of middle ear disease in childhood. The said risk is higher for middle ear disease requiring surgery. [2] Even lower exposure of maternal smoking in pregnancy is associated with an increased risk of acute otitis media (OM) in early childhood. Children with at least one parental smoker are at higher chances of being admitted to hospital for grommet insertion and more likely to have had previous surgery for OM with effusion. [3] Middle ear effusions are associated with hearing impairments which in-turn may lead to abnormalities or lags in children's hearing, speech, and cognition.

A study from India showed that smokers/tobacco users compared to non-users are at higher risk for chronic suppurative otitis media, acute otitis media, suppurative otitis media and for sensorineural hearing loss. [4] An Australian study concluded that exposure to SHS increased the risk of specialist-diagnosed OM in children. [5] Childhood SHS exposure is known to correlate with the number of acute OM episodes, ENT operations (adeno-tonsillectomies etc.) and conductive hearing loss. A study from Istanbul pointed that frequency of smoking in both parents and mothers alone was a statistically significant factor among children with OM with effusion. [6] Apart from OM, SHS exposure of infants has negative consequences on growth and upper and lower respiratory tract infections. Breast-feeding is believed to augment the growth of infants passively exposed to tobacco smoke and protect them against infections.

Smoking increases the acquisition of periodontal pathogens and periodontal disease, colonization by respiratory pathogens (lesser interfering microbes and more potential pathogens), and the occurrence of otitis media and other upper respiratory tract diseases. In a study parents who smoked harbored 16 potential pathogens while 19 were found in their children. Concordance with pathogens in the parent was high among the OM prone children of smoking parents. [7] Factors like increased adherence of bacteria to the respiratory epithelium, depressed local immune function and decreased mucociliary action may explain the link between smoking and the development of OM. Adult smokers with OM with effusion and children who are passive smokers have significantly low middle ear ciliary beat frequency compared to those not exposed to cigarette smoke. [8] Higher recovery of organisms resistant to antimicrobials is noted in those with sinusitis who smoked.

The association between smoking and middle ear diseases is clearly established. Clinicians need to counsel patients (both active and passive smokers) about smoking and the heightened risk and related complications so as to avoid delayed diagnoses that may lead to permanent hearing loss.

  Acknowledgement Top

We thank our colleagues and staff of the department of Internal medicine for their perpetual support.

  References Top

1.Swain SK, Samal R, Pani SK. Effect of smoking on outcome of tympanoplasty. Indian J Otolaryngol 2011;17:120-2.  Back to cited text no. 1
2.Jones LL, Hassanien A, Cook DG, Britton J, Leonardi-Bee J. Parental smoking and the risk of middle ear disease in children: A systematic review and meta-analysis. Arch Pediatr Adolesc Med 2012;166:18-27.  Back to cited text no. 2
3.Hinton AE. Surgery for otitis media with effusion in children and its relationship to parental smoking. J Laryngol Otol 1989;103:559-61.  Back to cited text no. 3
4.Gaur K, Kasliwal N, Gupta R. Association of smoking or tobacco use with ear diseases among men: A retrospective study. Tob Induc Dis 2012;10:4.  Back to cited text no. 4
5.Jacoby PA, Coates HL, Arumugaswamy A, Elsbury D, Stokes A, Monck R, et al. The effect of passive smoking on the risk of otitis media in Aboriginal and non-Aboriginal children in the Kalgoorlie-Boulder region of Western Australia. Med J Aust 2008;188:599-603.  Back to cited text no. 5
6.Gultekin E, Develioðlu ON, Yener M, Ozdemir I, Külekçi M. Prevalence and risk factors for persistent otitis media with effusion in primary school children in Istanbul, Turkey. Auris Nasus Larynx 2010;37:145-9.  Back to cited text no. 6
7.Brook I, Gober AE. Recovery of potential pathogens in the nasopharynx of healthy and otitis media-prone children and their smoking and nonsmoking parents. Ann Otol Rhinol Laryngol 2008;117:727-30.  Back to cited text no. 7
8.Agius AM, Wake M, Pahor AL, Smallman LA. Smoking and middle ear ciliary beat frequency in otitis media with effusion. Acta Otolaryngol 1995;115:44-9.  Back to cited text no. 8


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