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Air Pollution and Otitis Media in Children: A Systematic Review of Literature

Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population & Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
National Institute of Fundamental Studies, Kandy 20000, Sri Lanka
Department of Environmental Health Sciences School of Public Health University at Albany, State University of New York, Rensselaer, NY 12144, USA
Department of Epidemiology and Biostatistics School of Public Health University at Albany, State University of New York, Rensselaer, NY 12144, USA
Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
University Centre for Rural Health, School of Public Health, University of Sydney, Sydney, NSW 2480, Australia
Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Int. J. Environ. Res. Public Health 2018, 15(2), 257;
Received: 29 December 2017 / Revised: 19 January 2018 / Accepted: 30 January 2018 / Published: 3 February 2018
(This article belongs to the Special Issue Air Quality and Health)
PDF [473 KB, uploaded 3 February 2018]


Young children are particularly vulnerable to otitis media (OM) which globally affects over 80% of children below the age of 3 years. Although there is convincing evidence for an association between environmental tobacco smoke exposure and OM in children, the relationship with ambient air pollution is not clear. We aimed to systematically review the literature on the relationship between ambient air pollution exposure and OM in children. A systematic search was performed in PubMed and EMBASE databases. Of 934 references identified, 24 articles were included. There is an increasing body of evidence supporting an association between higher ambient air pollution exposure and a higher risk of OM in children. While NO2 showed the most consistent association with OM, other specific pollutants showed inconsistent associations. Studies were mainly conducted in high/middle income countries with limited evidence from low-income countries. Although there was a general consensus that higher air pollution exposure is associated with a greater prevalence of OM, the evidence for associations with specific pollutants is inconsistent. More well-designed studies on associations between specific air pollutants as risk factors for OM are warranted, especially in low income countries with high air pollution levels. View Full-Text
Keywords: middle ear infection; otitis media; air pollution middle ear infection; otitis media; air pollution

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Bowatte, G.; Tham, R.; Perret, J.L.; Bloom, M.S.; Dong, G.; Waidyatillake, N.; Bui, D.; Morgan, G.G.; Jalaludin, B.; Lodge, C.J.; Dharmage, S.C. Air Pollution and Otitis Media in Children: A Systematic Review of Literature. Int. J. Environ. Res. Public Health 2018, 15, 257.

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