Researchers have documented that the use of pacifiers or dummies to aid babies in sucking, a natural reflex present both in preterm and full term infants to obtain nourishment, which also provides a soothing effect, is a risk factor for developing recurrent middle ear infections such as acute otitis media (AOM). The study has been published in the recent advanced online edition of the Family Practice.
Although, several previous studies have identified the association between pacifiers and AOM, there is lack of concrete evidence owing to methodological limitations. In the current investigation, Dr Maroeska Rovers, a lead scientist at Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Netherlands, and coworkers, conducted a 5-year dynamic cohort study on 495 children, aged between 0 to 4 years, to assess the risk of AOM associated with the use of pacifiers. At the baseline, the parents of the children were asked to fill a questionnaire regarding the use of dummies and potential confounders. Physicians diagnosed AOM using the International Classification of Primary Care coding system (based on the symptoms, complaints, interventions, diseases and diagnosis). It was found that 35% of 216 children, who had used pacifier at baseline, developed at least 1 episode of AOM, compared to 32% of 260 children who had not used a pacifier. Similarly, 16% of the pacifier group, in comparison with 11% of the other group, experienced recurrent AOM. Additionally, the use of pacifier with the occurrence of AOM and recurrent AOM showed an adjusted odds ratio of 1.3 and 1.9, respectively. Considering the findings, the study demonstrated an increase in the risk of recurrent AOM in children who had used pacifiers. The scientists suggest that parents have to be informed about the negative effects of pacifier, which could in turn facilitate the reduction in the recurrence of AOM in children diagnosed with the infection.
Previously, Warren et al. (Pediatric Dentistry, 2001) had conducted a similar study to evaluate the role of pacifiers in the occurrence of otitis media in 1,375 infants (recruited from 8 hospital postpartum units in Iowa), during their first year of life. During the volunteer cohort study, information about the child’s health, such as the incidence of childhood diseases, including otitis media at 6 weeks and 3, 6, 9, and 12 months of age were collected from the parents. It was found that one or more episodes of otitis media were experienced by more than 70% of the infants in the 12-month period and the rate was more in the second half of the children’s first year of life. The researchers analyzed the factors linked with otitis media by multivariate analysis, which used generalized estimating equations and demonstrated that pacifier use, age, male sex, and greater number of childcare days were associated with the occurrence of the middle ear infection. The study concluded that the use of pacifier was one of the controllable or modifiable risk factors for otitis media.
Otitis media, an inflammation of middle ear, is common in childhood and is usually associated with viral upper respiratory tract infection. Allergy, infection (with bacteria or virus), blockage of the Eustachian tube and nutritional deficiency, are the 4 main etiological factors for otitis media. The bacterial or viral infection is the most common cause for AOM. Sudden severe earache, tinnitus, sense of fullness in the ear, fever, headache, nausea, change in sleep pattern and appetite, fluid discharge from ear, and difficulty in speaking or hearing are the commonly associated symptoms of AOM. Some of the diagnostic tools used include examination with an otoscope, audiogram and tympanogram, and the treatment modalities vary depending on the underlying cause. According to the 2004 statistics of the American Academy of Pediatrics, more than 5 million cases of AOM occur annually in US children, accounting for more than 10 million annual antibiotic prescriptions.
One major complication of recurrent acute otitis media is damage to the ear bones, which could lead to total deafness. The current study, which has demonstrated the pacifier use as a risk factor for AOM, could help in reducing the recurrence of infection and its associated complications as the use of pacifier can be easily abated. This might further decrease the annual prescription of antibiotics, thereby lessening the prevalence or development of resistant bacteria.
References
1. Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Fam Pract. 2008 Jun 17. [Epub ahead of print].
2. Warren JJ, Levy SM, Kirchner HL, Nowak AJ, Bergus GR. Pacifier use and the occurrence of otitis media in the first year of life. Pediatr Dent. 2001 Mar-Apr;23(2):103-7.
