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    Familial link of OM requiring tympanostomy tubes

    Genetics and a shared environment appear to play an important role in those patients with otitis media (OM) requiring tympanostomy tubes.

    A recent study1 found that there is a significant familial link in otitis media requiring tympanostomy tubes (OMwTT) in both close and distant relatives, with shared environments possibly playing a role, given the fivefold increased risk seen in siblings. This fresh data could help clinicians better treat and manage this patient population, particularly those patients with a strong family history of this very common pediatric disease.

    “The familial link obviously does not distinguish whether there is a genetic or an environmental component completely. However, what it does suggest is that there is some component of genetic susceptibility for a child to receive tympanostomy tubes if they have a relative with tympanostomy tubes,” says Jeremy D. Meier, MD, assistant professor, University of Utah, Division of Otolaryngology-Head and Neck Surgery, Salt Lake City, and coauthor of the study.

    Otitis media is one of the most common inflammatory diseases seen in children, with approximately 75% of children having experienced at least 1 episode of the disease by age 3 years. Tympanostomy tube placement, whether for recurrent or chronic OM, is the most common procedure performed in children in an ambulatory setting. Otitis media requiring tympanostomy tubes is a complex disease process that is not completely understood, begging the need for further investigation and elucidation.

    Meier and colleagues recently conducted a retrospective, observational cohort study with population-based matched controls aiming to determine the familial risk of OM requiring tympanostomy tubes. Using an extensive genealogical database linked to medical records, the researchers calculated the familial risk of OMwTT for relatives of probands (46,249 patients diagnosed with OMwTT from 1996 to 2013) compared with random population controls matched 5:1 on sex and birth year from logistic regression models.

    Data showed that the median age at time of tympanostomy tube placement was 1 year. First-degree relatives of patients with OMwTT, primarily siblings, had a fivefold increased risk of OMwTT. In comparison, there was only a 1.5-fold and 1.4-fold increased risk in second-degree relatives and more extended relatives (third-, fourth-, and fifth-degree), respectively.

    According to Meier, clinicians should be wary in patients with a strong family history of tympanostomy tubes or recurrent OM, as the apparent familial link can impact the decisions made in the treatment and management of predisposed patients.

    “Clinicians should counsel the parents and guardians of those patients who have had recurrent OM that they may be at higher risk of contracting infections throughout the cold winter season, and precautions could be taken to help minimize that risk,” Meier says.

    Without suggesting a predisposition bias, this new data could potentially help those parents or guardians who are on the fence about whether or not tympanostomy tube placement would be the appropriate choice for their child.

    It is possible that a child will not do as well without tympanostomy tubes, Meier says, and will likely have more episodes of OM. Therefore, perhaps it may be of advantage to already have the tympanostomy tubes placed before OM can develop. This proactive approach could save much morbidity, particularly in those patients who are at a higher risk of OM.

    The association that makes certain family’s eustachian tubes more susceptible to ear infection needs to be further elucidated and, in view of the study results, a shared environment appears to be a common denominator in these predisposed patients. According to Meier, the question is whether it is environmental in terms of a smoking risk, a daycare risk, or a familial cultural predisposition such as hygiene that could at least in part play a role in these patients developing OM. Other than the environmental and those aspects discussed, there could be a cultural bias in terms of an access to care issue. Certain families may have special issues such as socioeconomic or geographic proximity to the next healthcare provider; these could play a role in increasing the susceptibility of these patients to develop OM.

    According to Meier, there is also a risk of bias if parents had had tympanostomy tubes and have siblings that had tympanostomy tubes. They could be more likely to just proceed with another child because they saw how well tympanostomy tubes fared in the past.

    “In younger children with recurrent OM who also may have parents and/or siblings with a history of tympanostomy tube placement, I would probably pull the trigger a little bit sooner in terms of recommending tympanostomy tube placement,” Meier says.

    There appears to be mounting evidence regarding the genetic susceptibility for children for recurrent OM causing severe enough disease that they would need tympanostomy tubes. According to Meier, future studies will still have to tease out how much of that is genetic and how much is environmental. Based on those results, individualizing care based on family history could be realized in these patients.

    REFERENCE

    1. Padia R, Alt JA, Curtin K, et al. Familial link of otitis media requiring tympanostomy tubes. Laryngoscope. 2017;127(4):962-966.


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