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Clearer air means clearer ears.

Everyone knows that air pollution is bad for your child's health. It can lead to respiratory problems such as asthma, allergies, bronchitis, pneumonia and chronic cough. But most of us don't consider ears when we think about the respiratory system. Indeed, our ears, and especially our child's ears, are directly connected to the upper respiratory tract.

Ear infections develop because fluid from the back of a child's nose, known to be laden with bacteria and viruses, can track up the small tube that connects the inside of the ear (middle ear) to the back of the nose (nasopharynx). This tube, technically known as the Eustachian tube, is very short and immature in young children and makes the path from the nose to the ear a direct, easy one. This is one reason why ear infections are the most common cause of pediatric visits in any given year.

Many of the costs of ear infections are immeasurable, such as the pain a child suffers, disruption in daily schedules due to missed school, missed work, doctor visits, medications and possibly specialist visits. And some of the costs are measurable ($3-5 billion per year in the United States alone). Since ear infections are common, troublesome, and are actually considered to be a "respiratory" illness, the association between air pollution and ear infections is an important one to consider.

We are surrounded by both real and exaggerated concerns regarding global warming and its effect on children's health, now and in the future. With this issue in the forefront of the news, both from a medical as well as a political standpoint, the issue of air pollution has fallen by the wayside. But here is the good news: air pollution has improved significantly over the last ten to fifteen years, and, with that improvement, there has been a reduction in the number of ear infections in children.

In 1990, the revised Clean Air Act enabled the Environmental Protection Agency (EPA) to institute strict regulatory limits on emissions from chemical plants, utilities, and steel mills in an effort to reduce the amount of the four major air pollutants (carbon monoxide, nitrous dioxide, sulfur dioxide, and particulate matter) in the air that we and our children breathe. Every year since the late 1990s there has been an overall reduction of these four major pollutants nationwide. With this reduction, there has been a significant continuous reduction in the number of ear infections in children.

A recent study using a large data bank (the National Health Interview Survey) included more than 125,000 children over a ten-year period (1997-2006) and examined if the improvement in air quality influenced the prevalence of ear infections in children. The annual frequency of ear infections in this large group was cross-referenced with the annual air pollution data from the EPA over the same time period. Air pollution was measured based on amounts of the four major air pollutants (carbon monoxide, nitrous dioxide, sulfur dioxide, and particulate matter) for each year.

The average annual prevalence of "frequent ear infections," which was defined as "three or more ear infections per year" in this database, was 6.6%. As air quality steadily improved over the ten-year period, there was found to be a reduction in the prevalence of "frequent ear infections," This gradual improvement was statistically significant. When looking at other illnesses commonly seen in children (respiratory allergies), ear infections stood out as having the most significant reduction in frequency in this large population as the air quality steadily improved. Better air quality was significantly associated with lower prevalence of frequent ear infections in children.

We have a long way to go, both in the areas of air pollution and ear infections, but continued efforts to clean up the air will hopefully decrease ear infection rates, as well as other respiratory illnesses, even further.

Nina Shapiro, MD is the Director of Pediatric Otolaryngology and an associate professor at the David Geffen School of Medicine at UCLA. She is the author of Take a Deep Breath: Clear the Air for the Health of Your Child. You can find more information about Dr. Shapiro at

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Author:Shapiro, Nina
Publication:Pediatrics for Parents
Date:Sep 1, 2011
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