To review the evidence concerning the association between (different forms of) day-care and otitis media in children aged 0-4 years, we performed a meta-analysis of studies identified by a systematic search with Medline from 1966 to July 1997 and by the reference lists. Seventeen articles were classified as useful because these articles studied children of 0-4 years of age and because odds ratios as well as confidence intervals were presented or could be calculated. All these studies found a association between attending a day-care centre and otitis media. The association between otitis media and family care was less clear. Differences in study design, age of the subjects, and controlled variables did not explain the association.
Conclusion: Day-care is a risk factor for developing otitis media: the number of children seems to be important for this effect, probably due to increased exposure to otitis media pathogens.