Dental problems may play a role in RAOM

Pediatricians may want to consider taking a look inside the mouth of a child with recurrent acute otitis media. A new study from Italy reveals that repairing dental malocclusion may have positive effects on a child’s eustachian tube function and the number of episodes of acute otitis media (AOM) they have.

Andrea LovatoAndrea Lovato works in the audiology unit at Treviso General Hospital, Treviso, Italy, and is one of the authors of the study. He says he hopes that the report will remind pediatricians and otolaryngologists to look for dental malocclusion in children with recurrent middle ear diseases and refer them for orthodontic care as needed.

“Recurrent acute otitis media is a medical condition of the very young children, and most of them would experience a spontaneous resolution. In older children, from the age of 3, with RAOM, pediatricians should look for dental malocclusions,” Lovato says. “In fact, according to our results, RAOM showed better outcomes in children with dental malocclusion wearing a mandibular repositioning device, regardless of the adenoid status.”

Various forms of otitis media are common in childhood, and an estimated 80% of children experience 1 or more episodes of AOM by age 3 years with a third of them going on to have recurrent episodes, according to the study.

Recurrent acute otitis media is defined as 3 acute episodes within 6 months or 4 episodes in a year. Environmental factors such as community exposure and cigarette smoke increase the risk of developing AOM, as well as genetic and physical factors including adenoid hypertrophy and allergic rhinitis, the researchers say.

Treatment of acute episodes in RAOM is primarily limited to pain management, the study says, but antibiotics may be used in severe episodes and ventilation tubes are sometimes placed in children with RAOM with middle ear effusion or conductive hearing loss.

There has been evidence that RAOM may be more common in children with dental malocclusion-which may present with sagittal, vertical, or transversal discrepancies visible in the child’s bite-and that maxillary expansion may help. The goal of the study was to investigate if or how much treatment of dental malocclusion impacts recurrence of AOM.

Sixty-one children treated for recurrent acute otitis were tracked and underwent odontostomatologic evaluation, fiberoptic endoscopy, and skin-prick tests. The research team was able to rule out dental malocclusion as a cause for the RAOM in 29 of the patients, but 32 were diagnosed with dental malocclusion and were treated with a mandibular repositioning plate. The study notes that children in the group treated for dental malocclusion had the lowest number of acute episode recurrences when compared with the control group without dental malocclusion.

The research team estimates that dental malocclusion in children with RAOM may play a role in the development of eustachian tube problems.

Children in the study were evaluated 12 months after treatment for dental malocclusion. Orthodontists evaluated the treatment for dental malocclusion monthly, and ear-nose-throat physicians saw patients at ages 3, 6, and 12 months. Any AOM episodes during this period were diagnosed by an otolaryngologist.

Researchers found that in the year before the study, the mean number of AOM episodes was slightly higher in the group with dental malocclusion, but the difference was not significant. After intervention for dental occlusion, the group diagnosed with this problem had significantly fewer episodes of AOM. According to the report, 29 of the 32 children with recurrent otitis media and dental malocclusion had no acute episodes by the 12-month follow-up, compared with 6 of the 29 children in the group with RAOM with no dental malocclusion. Additionally, the mean duration of middle ear effusion was lower in the group treated for dental malocclusion that in the group with no dental malocclusion.

“Recurrent acute otitis media showed a significantly better resolution in children treated for dental malocclusion than in children with normal occlusion,” the report notes. “After 12 months of follow-up, 9.4% of children in [the dental malocclusion group] and 79.3% in [the group with normal occlusion] experienced recurrence of AOM.”

In regard to the extent of the treatment for dental malocclusion, researchers note that oral devices needed 1 to 3 modifications during the follow-up period.

There are some other preventive measures that also can be taken to avoid AOM in children with known dental malocclusion. “Preventive measures include avoiding cigarette smoke exposure, the main risk factor for AOM in children,” Lovato says. “From this point of view, children with dental malocclusion show no differences with the general population.”