소아 재발성 중이염의 위험인자에 대한 연구
A Study on Risk Factors of Recurrent Otitis Media
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목 적:재발성 중이염은 말하기, 언어, 인지 능력 지연및 저하를 유발할 수 있으며, 청력 소실 혹은 손상을 초래할 수 있다. 또한 재발성 중이염을 앓는 소아들은 예방적 항생제 투여, 고막 절개와 튜브 삽입, 아데노이드 절제의 고려 대상이 된다. 하지만 재발성 중이염의 위험인자에 관한 연구는 매우 부족하며, 국내에서는 이에 관한연구가 아직까지 없다. 이에 저자들은 우리나라의 소아재발성 중이염의 위험인자들에 대해 알아보고자 하였다. 방 법: 2009년 7월부터 2010년 1월까지 한일 병원과경희의료원 소아청소년과 외래를 방문한 60개월 미만의소아를 대상으로, 104명의 재발성 중이염군과 331명의대조군을 대면조사를 통해 조사하였다. 성별, 모유수유,인공 젖꼭지 사용, 어린이집 이용, 알레르기 비염 병력,모세기관지염의 병력, 소득 수준, 부모 흡연, 집안에서의흡연, 폐구균 백신 및 인플루엔자 백신 접종력 등의 항목을 조사하였다. 각각의 위험인자와 재발성 중이염간의연관성을 확인하기 위해 카이제곱 검정을 통한 단변량분석을 시행하였고, 단변량 분석에서 의미 있었던 위험인자들 간의 교란변수를 보정하기 위해 이분형 로지스틱회귀분석을 통한 다변량 분석도 시행하였다. 결 과:단변량 분석에서는 어린이집 이용, 알레르기 비염, 아토피, 모세기관지염, 부모 흡연, 집안에서의 흡연,낮은 사회경제 상태가 의미 있는 위험인자였다. 하지만폐구균 백신 접종은 통계적 유의성이 없었다. 교란변수를 보정한 다변량 분석에서는 아토피, 부모 흡연, 집안에서의 흡연을 제외한, 어린이집 이용(P <0.001, OR=2.85), 알레르기 비염(P =0.026, OR=2.32), 모세기관지염(P =0.003, OR=2.33), 낮은 경제상태(P =0.005,OR=2.00)가 의미 있는 독립적인 위험인자였다. 결 론 : 알레르기 비염과 모세기관지염의 병력이 있고,낮은 사회경제 상태에 있으며, 어린이집을 이용하고 있는 소아일수록 재발성 중이염에 걸릴 위험이 높았다.
Abstract
Purpose : Recurrent otitis media (ROM) is usually defined as ≥3 distinct and well-documented episodes within 6 months or ≥4 episodes within 12 months. ROM is sufficiently important to warrant consideration of chemoprophylaxis, tympanostomy tube placement. There also is evidence that children with ROM are at risk for both hearing loss and speech delay. However,studies of ROM have been notably insufficient. In addition, even though environmental, racial, and sociocultural differences can affect risk factors, few studies have been conducted with regard to recurrent otitis media in Korea. Methods : This study was conducted from July 2009 to January 2010 with infants and children who were younger than 60months old, who visited the out-patient clinics at Han-Il General Hospital and Kyunghee University Hospital. Data were collected by interview using a pre-formed sheet. Among a total of 892 infants and children, 457 were excluded, and the remaining 435 were allocated to 104 with ROM and 331 as a control group. Results : Attendance at daycare centers (P <0.001, OR=2.85), allergic rhinitis (P =0.026, OR=2.32), past history of bronchiolitis (P =0.003, OR=2.33), and low socioeconomic status (P =0.005, OR=2.00) were found to have a close significant correlation with ROM. Risk factors such as sex, having a sibling, breast-feeding, use of pacifiers, atopy, pneumococcal vaccination,influenza vaccination, smoking of parents, and indoor smoking are not relevant. Conclusion : Attendance at daycare centers, allergic rhinitis, past history of bronchiolitis, and low socioeconomic status have been identified as risk factors for ROM.
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