Risk factors associated with the development of chronic suppurative otitis media in children: Systematic review and meta‐analysis

Elliot Heward, Haroon Saeed, Sebastian Bate, Azita Rajai, John Molloy, Rachel Isba, Darren M. Ashcroft, Alastair D. Hay, Jaya R. Nichani, Iain A. Bruce

Research output: Contribution to journalArticlepeer-review


Objectives: Chronic suppurative otitis media (CSOM) is defined as persistent discharge through a tympanic membrane perforation for greater than 2 weeks. It is associated with a significant disease burden, including hearing loss, and reducing its incidence could significantly improve short- and long-term health. We aimed to identify risk factors associated with the development of CSOM in children. Design and Setting: Systematic review and meta-analysis of studies set in community, primary and secondary care settings, identified from Medline, Embase and Cochrane databases from 2000 to 2022. Participants: Children 16 years old and below. Main Outcome Measures: Clinical diagnosis of CSOM. Results: In total, 739 papers were screened, with 12 deemed eligible for inclusion in the systematic review, of which, 10 were included in the meta-analysis. Risk factors examined included perinatal, patient, dietary, environmental and parental factors. Meta-analysis results indicate that atopy (RR = 1.18, 95% CI [1.01–1.37], p =.04, 2 studies); and birth weight <2500 g (RR = 1.79 [1.27–2.50], p <.01, 2 studies) are associated with an increased risk of CSOM development. Factors not associated were male sex (RR = 0.96 [0.82–1.13], p =.62, 8 studies); exposure to passive smoking (RR = 1.27 [0.81–2.01], p =.30, 3 studies); and parental history of otitis media (RR = 1.14 [0.59–2.20], p =.69, 2 studies). Conclusion: Optimal management of risk factors associated with CSOM development will help reduce the burden of disease and prevent disease progression or recurrence. The current quality of evidence in the literature is variable and heterogeneous. Future studies should aim to use standardised classification systems to define risk factors to allow meta-analysis.

Original languageEnglish
Pages (from-to)62-73
Number of pages12
JournalClinical Otolaryngology
Issue number1
Early online date4 Oct 2023
Publication statusPublished - 1 Jan 2024


  • audiology
  • chronic otitis media
  • evidence-based medicine
  • general
  • hearing loss
  • otitis media
  • otology
  • paediatric ORL
  • systematic reviews


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