Age: An effect modifier of the association between allergic rhinitis and Otitis media with effusion

OBJECTIVES/HYPOTHESIS: 1) To determine whether there is a significant relationship between allergic rhinitis and otitis media with effusion (OME), Eustachian tube dysfunction (ETD), or tympanic membrane retraction (TMR) in children in a nationally representative population; and 2) to determine whether age is an effect modifier of any such association because this hypothesis has yet to be tested. STUDY DESIGN: Retrospective analysis of cross-sectional national databases with limited potential for referral bias. SETTING AND SUBJECTS: National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2005-2010. METHODS: Univariate, multivariate, stratified, and subgroup analyses were performed as defined a priori. The primary outcomes were OME, ETD, or TMR; the primary predictor variable was allergic rhinitis, with age evaluated as an effect modifier. RESULTS: Data representing 1,491,045,375 pediatric visits were examined and demonstrated that age was an effect modifier of the assessed association. More specifically, in children 6 years of age or older, the presence of allergic rhinitis significantly increased the odds of OME, ETD, or TMR (odds ratio [OR] 4.20; 95% confidence interval [CI] 2.17, 8.09; P < 0.001), whereas in children less than 6 years of age there was no significant association (OR 1.13; 95% CI 0.53, 2.46; P = 0.745). CONCLUSION: Age is an effect modifier of the association between allergic rhinitis and OME; a significant relationship is observed in children 6 years of age and older, whereas there is no significant association in younger children. LEVEL OF EVIDENCE: 2c. Laryngoscope, 126:1687-1692, 2016.