Otitis media: prevention instead of prescription

Acute otitis media is one of the most frequent childhood infections, with up to 85% of infants having an episode by their first birthday.1 Though frequently self-limiting, it is not without significant economic implications. It is estimated that otitis media costs the American healthcare system US$3 billion per year.2 The most common symptoms experienced are fever and otalgia, which is often severe.

Recurrent otitis media, defined as three or more episodes in 6 months, has been associated with hearing deficits and speech delay. Even an isolated episode of acute otitis media can have severe complications including mastoiditis and intracranial spread of infection. Eespite this prevalence and associated morbidity, our treatment options are limited. Antibiotic therapy has not been shown to reduce its duration or risk of complications substantially.3 Therefore, there is increasing emphasis on addressing the modifiable risk factors for acute otitis media, which include attendance at nursery school (relative risk [RR] 2.45), parental smoking (RR 1.66), and the use of a pacifier (RR 1.24).4 While it is difficult to persuade parents against the use of a pacifier, for example, using an episode of acute otitis media as a prompt to offering smoking advice may improve the health of both parents and children alike. We decided to investigate our cohort of children with otitis media and audit the number of parents that had been given smoking cessation advice.

The gold standard was proposed that 100% of parents should have been given cessation advice within 6 months of their child's diagnosis.

Sixty-one children were diagnosed with otitis media in a period from January 2004 to December 2007, of which seven had recurrent otitis media. Ninety parents were identified using Vision, the surgery's computer system, of which 41 (45.6%) were smokers at the time of their child's infection. Twenty-four (58.5%) parents had been given smoking advice at some point, but only 11 of these were given advice within 6 months of the diagnosis of acute otitis media.

Of the seven children with recurrent otitis media, five had at least one smoking parent and there were seven smoking parents in total. None of the parents in this high risk group had been given any smoking advice.

We were aware that not all of the parents given smoking advice were as a result of the child suffering with acute otitis media. In addition, we could only identify parents who were registered with our practice. There was no way of including adults in the home who were not parents or guardians.

This audit was presented to the partners, and a plan was made to put up reminders to discuss smoking with the parents of any children presenting with acute otitis media. The audit is to be repeated in 1 year to allow sufficient numbers of cases to present.

We realise that this is just one of many motivational factors that can be used to encourage patients to stop smoking, but smoking cessation is such a high priority that this window of opportunity should not be overlooked. Prevention rather than prescriptions must remain our ideal in the management of otitis media.

• © British Journal of General Practice, 2008.