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