Passive Smoking and Glue Ear

[mancie]

I recently watched BBC panorama programme first broadcast on 13th April 2010 entitled "Spoilt Rotten". This was a documentary following the lives of doctors and children being treated in a major UK hospital, treatments were for according to the program "entirely preventable conditions". Young obese children, young children with tooth decay etc. The point of the program was to show a broken society wasting money on treating preventable diseases.

I would like to start a discussion about the program as I noted that during the program children with Glue Ear were shown.

The ENT nurse was shown asking the parents if they smoked and the implication from the program and the nurse was that the glue ear experienced by their child was directly caused by passive smoking and therefore preventable hearing loss. The nurse even went as far as to say that the parents smoking outside the house would not improve the matter as by having smoke on their clothing near to the children causes glue ear. The ENT nurse also said she could "see the effect on ear canals" where children had been around smoking, some kind of yellowing of the hairs in the canal apparently. Anyone care to comment on this?

I recently reminded myself of some of the evidence of passive smoking and glue ear, one study actually found passive smoking was a significant protective factor against recurrent glue ear! In general the evidence about passive tobacco smoking appears to be mixed. See the recently published review paper: Epidemiology, natural history, and risk factors: Panel report from the Ninth International Research Conference on Otitis Media
Daly etl al. 2010

It does seem common sense to not smoke around children, but I was little concerned about the way the program seemed to imply glue ear was entirely caused by passive smoking (in these children) and so an avoidable disease.

Do we really think there is currently strong evidence that passive smoking is a significant risk factor for glue ear. Should ENT Nurses effectively bully individuals to stop smoking appearing to state with certainty that the parents smoking directly caused their Child's glue ear?

It would be great to have a debate, if anyone else has any other evidence would be great to share it as I did not conduct an extensive literature review and I am not a glue ear expert. It could be there is strong evidence. However, I am still concerned that the smokers seemed to be told that their child's glue ear was definitively caused by their 2nd hand smoke.

I should also point out that I do not smoke and think that it is generally a good idea to encourage people to stop smoking but this program did appear to show some perhaps exaggerated claims and was a little worrying.

[Ali]

From my reading, smoking has often been mentioned as a risk factor for otitis media, but no specific mechanism has been described. So in most situations, it could probably be described as a compounding factor but not the sole cause.

[incus]

Interesting topic, thanks for raising it.

A group of BSc 4th year students on the EBP Module i teach recently selected this topic (glue ear and passive smoking) for a critical review. They found very strong evidence of a link. Of 4 key papers 3 had strong evidence of a link and the best one is a high quality systematic review showing an odds ratio of 1.4 (95% ci 1.23-1.55). The others were (i think) 2 cohort studes and a case-control study

Sys review
Strachan, D.P., Cooke, D.G. 1998. Parental smoking, middle ear disease and adenotonsillectomy in children. British Medical Journal, Thorax : Vol 53: 50 – 56.

Etzel, R.A, et al 1992. Passive smoking and middle ear effusion among children in day care. Official Journal of the American Academy of Pediatrics. Vol 90: 2: 228 -232.

Strachan, D.P. 1990. Impedance tympanometry and the home environment in 7 year old children. Journal of Laryngology and Otology: Vol 104: 4 – 8.

Engel, J., et al. 1999. Risk Factors of Otitis media with effusion during infancy. International Journal of Pediatric Otorhinolaryngology: Vol 48: 239 – 249

If you PM me I'll send a copy of their poster

[mancie]

Good, many thanks for your reply, it looks like there is strong evidence. I will endeavour to read the aforementioned studies.

A link of course does not prove the Glue Ear cases reported in the program were definitively cases of "preventable disease". It was probably wrong for the program to imply this. It would have been better to simply say (in the program, and to the parents) a link has been established between glue ear and passive smoking. Risk factor rather than cause.

[incus]

Good, many thanks for your reply, it looks like there is strong evidence. I will endeavour to read the aforementioned studies.

A link of course does not prove the Glue Ear cases reported in the program were definitively cases of "preventable disease". It was probably wrong for the program to imply this. It would have been better to simply say (in the program, and to the parents) a link has been established between glue ear and passive smoking. Risk factor rather than cause.

The difficulty with that view is that one could never say that an indivdual case is preventable, although on a population basis we know many are ( even if we don't know the exact mechanism).

If someone smokes and gets lung cancer is it preventable?

I seems to me entirely fair and justified to say to parents who smoke that they are likely to cause their child problems and should try to stop. In terms of affecting behaviour one has to give a clear message. One could see in the programme how strong denial and the ability to dismiss advice can be.

[mancie]

Good point.

It is of course human nature to be reluctant ( and deny advise) when it requires a change in behaviour, especially one that you are addicted to.