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An Ear Full of Childhood Obesity

No doubt obesity is associated with a wide range of health problems affecting almost every organ system.

But acute earache is perhaps not a health problem that immediately comes to mind when we consider the health risks of excess weight.

According to a paper by Stefan Kuhle and colleagues from University of Alberta, School of Public Health, published in the latest issue of Pediatric Obesity, acute middle ear infections (otitis media) may be far more common in obese than in normal weight kids.

This prospective cohort study, linked data from a population-based survey of Grade 5 students (aged 10-11 years) in the Canadian province of Nova Scotia in 2003 with Nova Scotia administrative health data via Health Card numbers.

Relative to normal weight children, obese children had twice as many healthcare provider contacts for severe purative otitis media (ICD9: 382; ICD10: H65-66), incurred more costs per otitis media-related visit ($47 vs. $24) and were two-and-a-half times more likely to have repeated otitis media infections.

There was a significant dose-risk effect with overweight kids fitting nicely between normal weight and obese kids in terms of increased risk.

This risk was independent of a range of socioeconomic factors, history of breastfeeding, presence of an allergic disorder or chronic adenoid/tonsil disorders.

Although, association does not prove causality, it is worth noting that this finding has considerable biological face value.

Thus, the authors provide the following possible explanation for this relationship:

“…obesity has been linked with low-grade systemic inflammation, which may produce a milieu that increases the risk of otitis media or lead to chronic otitis media. Alternatively, gastroesophageal reflux, which is seen more frequently in individuals with higher BMI may enter the middle ear through the Eustachian tube and cause otitis media. Finally, in obese individuals fatty tissue may accumulate around the Eustachian tube thereby compromising ventilation of the middle ear.”

As the authors also point out, this finding may have considerable public health implications:

“Acute otitis media is the second most common reason for visits to a family physician, accounting for 10– 15% of all childhood visits. Recurrent otitis media may result in long-term sequelae such as learning disability, impaired linguistic development or hearing disorder, or sleep apnoea because of the development of chronic adenoid/tonsil disorder.”

But the cost implications are also worth noting:

“We were able to show that the per capita physician costs for otitis media between 2001 and 2006 were 92% higher ($47 vs. $24) in obese children compared with normal weight children. This cost differential is second only to that of chronic adenoid/tonsil disorder (230%) out of the 10 childhood disorders examined”

While the study does not provide any insights into whether reducing childhood obesity would reduce ear infections or whether or not obese kids need to adopt any other precautions to avoid earaches, it certainly points to an under appreciated risk factor for this common and excruciatingly painful condition.

Edmonton, Alberta

ResearchBlogging.orgKuhle S, Kirk SF, Ohinmaa A, Urschitz MS, & Veugelers PJ (2012). The association between childhood overweight and obesity and otitis media. Pediatric obesity, 7 (2), 151-7 PMID: 22434755



  1. I was a high-side-of-normal weight kid with a lot of ear infections. Quite frankly, I blame the raging allergic rhinitis I had more than the fact I wasn’t skinny. I’m talking going to school with scabs on the sides of my nose after being awake since 4 a.m. sneezing so badly I couldn’t sleep. Oddly enough, I wasn’t exactly raring to go outside to run and exercise when I could barely breathe. I somehow doubt trying to make me skinny would have made the ear infections go away.

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  2. Increased incidence of OM is also correlated with smoking in the home.

    Just anecdotally, my SIL, who was a skinny child, is now profoundly hearing impaired. Both her parents smoked up a storm during her childhood and she had repeated ear infections. My husband (who was also a skinny kid), though brought up in the same environment, has excellent hearing and never had ear infections. I was a chubby child (and am now a chubby adult), brought up in a home with some (though minimal) second-hand smoke, who never, as I recall, suffered from ear infections. I now have somewhat lower than average hearing, though that is due to working for almost 25 years in a job that requires wearing headphones.

    I just love how some researchers try to link everything to weight. It probably makes it easier for health professionals, who, although they have no proven way of helping people to lose weight and maintain that weight loss, can still blame everything (including their mother-in-law’s yappy dog) on a patient’s “excess” weight.

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  3. That’s interesting. I had ear infections as a kid too, but I’m pretty sure that they were at their worst before I got fat. My dad smoked pipes and cigars in the house.

    Linking ear infections to weight certainly sounds far fetched to me, too. It’s like the “social contagion” thing. You know it’s got to be b.s. and you wonder how they managed to build a theoretical structure convincing enough for publication around it. However, it’s clear that standards are pretty low for studies that tie health problems to “obesity.”

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  4. Pediatricians are now being told to not use antibiotics for ear infections. I wonder if that will impact the low-level inflammation by not treating them.

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  5. I was a fat child who NEVER had an ear infection. My brother was a normal-weight child who had constant ear infections.

    I find it VERY interesting that after having weight-loss surgery at age 45 and losing 170 pounds, I had my first-ever ear infection at age 48. I’ve had 2 more since. (I’m now 54.)

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  6. It is important to understand the pathways of low grade inflammation. Both skinny and non-skinny kids can have inflammatory issues. A child having reflux issues and fatty tissue in the ear canal – really? For those few kids, that is sad and requires intervention. But low-grade systemic inflammation is extremely common and so sad because, for the most part, it is ignored. Any sign of low grade inflammation should require immediate intervention. That’s the insight. Now, can the researchers work on how to arrest low grade inflammation? If we can arrest this horrid over-response mechanism in children, then health care costs for future adults will be reduced by the billions.

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  7. In a society where parents are said to favourise their thin kids over their fat ones, and, for example, pay for college for one vs the other, could it also be that parents aren’t taking a fat child to the doctors until it becomes obvious that they have to? Add in the possibility that the parent may -yet again- be berated for the child’s weight, something they don’t have much control over, are they waiting longer, and thus allowing a bad infection to get worse?

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