{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T11:50:50Z","timestamp":1772106650024,"version":"3.50.1"},"reference-count":33,"publisher":"BMJ","issue":"6687","license":[{"start":{"date-parts":[[1989,6,10]],"date-time":"1989-06-10T00:00:00Z","timestamp":613440000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1989,6,10]]},"abstract":"<jats:p>OBJECTIVE--To assess the contribution of passive exposure to tobacco smoke to the development of middle ear underpressure and effusion. DESIGN--Cross sectional observational study. SETTING--One third of the primary schools in Edinburgh. SUBJECTS--892 Children aged 6 1\/2 to 7 1\/2 were examined, and satisfactory tympanograms were obtained in 872. Results of assay of salivary cotinine concentrations were available for 770 children, and satisfactory tympanograms were available for 736 of these. END POINT--Correlation of the prevalence of middle ear underpressure and effusion with concentrations of the marker of nicotine, cotinine, in the saliva of the children. MEASUREMENTS AND MAIN RESULTS--Middle ear pressure and compliance were measured in both ears by impedance tympanometry. Salivary cotinine concentrations were assayed by gas-liquid chromatography. Cotinine concentrations increased with the number of smokers in the household. Girls had higher concentrations than boys, and children living in rented housing had higher concentrations than those living in housing owned by their parents. There was a trend towards more abnormal tympanometric findings with increasing cotinine concentration, the odds ratio for a doubling of the cotinine concentration being 1.14 (95% confidence interval 1.03 to 1.27). After adjustment for the sex of the child and housing tenure the odds ratio for a doubling of the cotinine concentration was 1.13 (1.00 to 1.28). CONCLUSIONS--The results of this study are consistent with those of case-control studies of children attending for an operation to relieve middle ear effusion. They indicate that the disease should be added to the list of recognised hazards associated with passive smoking. About one third of the cases of middle ear effusion in this study were statistically attributable to exposure to tobacco smoke.<\/jats:p>","DOI":"10.1136\/bmj.298.6687.1549","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"1549-1552","source":"Crossref","is-referenced-by-count":97,"title":["Passive smoking, salivary cotinine concentrations, and middle ear effusion in 7 year old children."],"prefix":"10.1136","volume":"298","author":[{"given":"D. P.","family":"Strachan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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A population study of otitis media in childhood","volume":"360","author":"Vintner, B.","year":"1979","unstructured":"Vintner B, Elbrond 0, Brahe Pedersen C. A population study of otitis media in childhood. Acta Otolaryngol[Suppl](Stockh) 1979;360:121-3.","journal-title":"Acta Otolaryngol[Suppl](Stockh)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"147","DOI":"10.3109\/00016488409122897","article-title":"Relevant and irrelevant predisposing factors in secretory otitis media","volume":"414","author":"van Cauwenberge PB","year":"1984","unstructured":"van Cauwenberge PB. Relevant and irrelevant predisposing factors in secretory otitis media. Acta Otolarvngol[Suppl](Stockh) 1984;414:147-53.","journal-title":"Acta Otolarvngol[Suppl](Stockh)"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1159\/000275946","article-title":"Elbrond 0. A prospective epidemiological study of secretory otitis media in young children related to the indoor environment","volume":"49","author":"Birch, L.","year":"1987","unstructured":"Birch L, Elbrond 0. A prospective epidemiological study of secretory otitis media in young children related to the indoor environment. ORL J Otorhinolaryngol Relat Spec 1987;49:253-8.","journal-title":"ORL J Otorhinolaryngol Relat Spec"},{"key":"ref_12","first-page":"65","article-title":"Predisposing factors for otitis media with effusion in young children","volume":"40","author":"Zielhus, G.A.; Rach, G.H.; van den Broek, P.","year":"1988","unstructured":"Zielhus GA, Rach GH, van den Broek P. Predisposing factors for otitis media with effusion in young children. 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J Epidemiol Community Health 1984;38:335-9.","journal-title":"J Epidemiol Community Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.2105\/AJPH.77.11.1435","article-title":"Comparison of test used to distinguish smokers from nonsmokers","volume":"77","author":"Jarvis, M.J.; Tunstall-Pedoe, H.; Feyerabend, C.; Vesey, C.; Saloojee, Y.","year":"1987","unstructured":"Jarvis MJ, Tunstall-Pedoe H, Feyerabend C, Vesey C, Saloojee Y. Comparison of test used to distinguish smokers from nonsmokers. Am J Public Health 1987;77: 1435-8.","journal-title":"Am J Public Health"},{"key":"ref_19","first-page":"927","article-title":"Passive exposure to tobacco smoke: saliva cotinine concentrations in a representative population sample of non-smoking schoolchildren","volume":"291","author":"Jarvis, M.J.; Russell, M.A.H.; Feyerabend, C.","year":"1985","unstructured":"Jarvis MJ, Russell MAH, Feyerabend C, et al. 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Cary, North Carolina: SAS Institute, 1985."},{"key":"ref_25","article-title":"The GLIM system manual (release 3)","author":"Baker, R.J.; Nelder, J.A.","year":"1978","unstructured":"Baker RJ, Nelder JA. The GLIM system manual (release 3). Oxford:Numerical Algorithms Group, 1978."},{"key":"ref_26","first-page":"690","article-title":"Chi-square tests on one degree of freedom: extensions of the Mantel-Haenszel procedure","volume":"58","author":"Mantel, N.","year":"1963","unstructured":"Mantel N. Chi-square tests on one degree of freedom: extensions of the Mantel-Haenszel procedure. Journal of the American Statistical Association 1963;58:690-700.","journal-title":"Journal of the American Statistical Association"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1016\/S0140-6736(84)92519-4","article-title":"Middle ear disease assessed by impedance in primary school children in south London","volume":"i:","author":"Portoian-Shuhaiber, S.; Cullinan, T.R.","year":"1984","unstructured":"Portoian-Shuhaiber S, Cullinan TR. Middle ear disease assessed by impedance in primary school children in south London. Lancet 1984;i: 1111-2.","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/0165-5876(81)90055-0","article-title":"Epidemiology of middle ear effusion and tubal dysfunction. A one-year prospective study comprising monthly tympanometry in 387 non-selected 7-year-old children","volume":"3","author":"Lous, J.; Fiellau-Nikolaisen, M.","year":"1981","unstructured":"Lous J, Fiellau-Nikolaisen M. Epidemiology of middle ear effusion and tubal dysfunction. A one-year prospective study comprising monthly tympanometry in 387 non-selected 7-year-old children. IntPeadi_atr Otorhinolaryngol 1981;3:303-17.","journal-title":"IntPeadi_atr Otorhinolaryngol"},{"key":"ref_29","first-page":"1324","article-title":"Passive smoking in adolescents: one-year stability of exposure in the home","volume":"i:","author":"Jarvis, M.J.; McNeill, A.D.; Russell, M.A.H.; West, R.J.; Bryant, A.; Feyerabend, C.","year":"1987","unstructured":"Jarvis MJ, McNeill AD, Russell MAH, West RJ, Bryant A, Feyerabend C. Passive smoking in adolescents: one-year stability of exposure in the home. Lancet 1987;i:1324-5.","journal-title":"Lancet"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"63766","DOI":"10.2307\/1267450","article-title":"Errors of measurement in statistics","volume":"10","author":"Cochran, W.G.","year":"1968","unstructured":"Cochran WG. Errors of measurement in statistics. Technometrics 1968;10:63766.","journal-title":"Technometrics"},{"key":"ref_31","first-page":"159","article-title":"Otitis media with effusion (glue ear)","author":"Maw, A.R.","year":"1987","unstructured":"Maw AR. Otitis media with effusion (glue ear). In: Kerr AG, Groves J, Evans NG, eds. Scott-Browan's otolaryngology. 5th ed. Vol 6. London: Butterworths, 1987:159-76.","edition":"5th ed."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1542\/peds.79.2.309a","article-title":"Smoke and ear effusions","volume":"79","author":"Etzel, R.A.","year":"1987","unstructured":"Etzel RA. Smoke and ear effusions. Pediatrics 1987;79:309-10.","journal-title":"Pediatrics"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1136\/bmj.293.6549.713","article-title":"Glue ear and speech development","volume":"293","author":"Maran, A.G.D.; Wilson, J.A.","year":"1986","unstructured":"Maran AGD, Wilson JA. Glue ear and speech development. 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