Evaluation of the effect of passive smoking on otitis media in children by an objective method: urinary cotinine analysis

Laryngoscope. 2001 Jan;111(1):163-7. doi: 10.1097/00005537-200101000-00028.


Objectives: We aimed to determine objectively the effect of the passive smoking on otitis media with effusion (OME) and recurrent otitis media (ROM) by using the method of cotinine urinalysis.

Study design: We designed a prospective case-control study with follow-up of the case group for 1 year after insertion of tympanostomy tubes to evaluate postoperative complications such as otorrhea and early extrusion (<6 months), in case a significant risk factor was found.

Methods: One hundred fourteen children between 3 and 8 years of age requiring tympanostomy tubes because of OME and ROM were chosen and compared with 40 age-matched children. Exposure to environmental tobacco smoke was assessed by cotinine urinalysis, which was performed by means of the radioimmunoassay method.

Results: In this study, 73.7% (84 of 114) of the children in the case group and 55.0% (22 of 40) of the children in the control group were found to be "exposed" (P = .0461). This difference was statistically significant. Comparing the cotinine urinalysis results with parental smoking histories, 23.1% (9 of 39) of the children without parental smoking histories were "exposed" to tobacco smoke versus 84.3% (97 of 115) of the children with parental smoking histories (at least one person smoking).

Conclusions: Our results indicate that sidestream smoking increases the risk of OME and ROM. Legal regulations and guidelines must be established to protect children from passive smoking. Because cotinine urinalysis is a noninvasive and reliable method for the determination of passive smoking, it can be used for that purpose.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Case-Control Studies
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Confidence Intervals
  • Cotinine / urine*
  • Environmental Exposure
  • Equipment Failure
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Ear Ventilation / adverse effects
  • Otitis Media / etiology*
  • Otitis Media / surgery
  • Otitis Media / urine
  • Otitis Media with Effusion / etiology*
  • Otitis Media with Effusion / surgery
  • Otitis Media with Effusion / urine
  • Parents
  • Prospective Studies
  • Recurrence
  • Reproducibility of Results
  • Risk Factors
  • Statistics, Nonparametric
  • Tobacco Smoke Pollution / adverse effects*


  • Tobacco Smoke Pollution
  • Cotinine