Influence of obesity and socio-linguistic factors on otitis externa treatment outcomes in children

Abstract

Background

Established risk factors for the development of otitis externa (OE) include stenotic ear canals, dermatologic disease and insertion of foreign objects. The link between obesity and susceptibility to different systemic diseases have been demonstrated, but not yet with OE.

Objective

This study was aimed at determining whether obese patients had OE infections that were more difficult to treat compared to normal weight children and investigate other measurable patient factors contributing to OE infection resolution in our unique patient population.

Methods

A chart review was conducted of all children diagnosed with OE between April 2015 and February 2024. Children with cholesteatoma, canal stenosis, or Down Syndrome were exlcuded. The time to infection resolution distribution was estimated using the Kaplan-Meier estimator, and multivariate Cox PH models measured factors influencing time to infection resolution.

Results

Of the 93 children included in the analysis, 29 (31 %) were overweight or obese, with a median age of 12.1 years. A higher percentage of overweight/obese patients were Hispanic (86 %, p < 0.001), Spanish-speaking (59 %, p = 0.005), and had public insurance (100 %, p = 0.004). Normal weight children whose parents spoke primarily Spanish, had the longest median days to infection resolution (57, IQR 196), followed by obese children with English speaking parents (52, IQR 329), then obese children with Spanish-speaking parents (48.5days, IQR124). Normal weight children of English-speaking parents had the lowest median days to infection resolution in our study (33 days, IQR 61). A multivariable Cox PH model confirmed these two factors were potentially associated with days to infection resolution (p-value of interaction = 0.053; effect size HR = 3.97,95 %CI: 0.98,16.1).

Conclusion

The results of this study suggest that patients who are overweight or obese, and those whose parental primary language was Spanish had a prolonged course of disease – with a median of 48.5 days to resolve their symptoms. Obesity was associated with increased days to OE infection resolution among children with English-speaking parents but not among children with Spanish-speaking parents, where parental language was associated with longer infection.