{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:18:25Z","timestamp":1791386305724,"version":"4.3.3"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2018,2,3]],"date-time":"2018-02-03T00:00:00Z","timestamp":1517616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Young children are particularly vulnerable to otitis media (OM) which globally affects over 80% of children below the age of 3 years. Although there is convincing evidence for an association between environmental tobacco smoke exposure and OM in children, the relationship with ambient air pollution is not clear. We aimed to systematically review the literature on the relationship between ambient air pollution exposure and OM in children. A systematic search was performed in PubMed and EMBASE databases. Of 934 references identified, 24 articles were included. There is an increasing body of evidence supporting an association between higher ambient air pollution exposure and a higher risk of OM in children. While NO2 showed the most consistent association with OM, other specific pollutants showed inconsistent associations. Studies were mainly conducted in high\/middle income countries with limited evidence from low-income countries. Although there was a general consensus that higher air pollution exposure is associated with a greater prevalence of OM, the evidence for associations with specific pollutants is inconsistent. More well-designed studies on associations between specific air pollutants as risk factors for OM are warranted, especially in low income countries with high air pollution levels.<\/jats:p>","DOI":"10.3390\/ijerph15020257","type":"journal-article","created":{"date-parts":[[2018,2,5]],"date-time":"2018-02-05T04:29:42Z","timestamp":1517804982000},"page":"257","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Air Pollution and Otitis Media in Children: A Systematic Review of Literature"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9577-9752","authenticated-orcid":false,"given":"Gayan","family":"Bowatte","sequence":"first","affiliation":[{"name":"Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population &amp; Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia"},{"name":"National Institute of Fundamental Studies, Kandy 20000, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9362-5189","authenticated-orcid":false,"given":"Rachel","family":"Tham","sequence":"additional","affiliation":[{"name":"Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population &amp; Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Perret","sequence":"additional","affiliation":[{"name":"Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population &amp; Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0028-5494","authenticated-orcid":false,"given":"Michael","family":"Bloom","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences School of Public Health University at Albany, State University of New York, Rensselaer, NY 12144, USA"},{"name":"Department of Epidemiology and Biostatistics School of Public Health University at Albany, State University of New York, Rensselaer, NY 12144, USA"},{"name":"Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanghui","family":"Dong","sequence":"additional","affiliation":[{"name":"Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilakshi","family":"Waidyatillake","sequence":"additional","affiliation":[{"name":"Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population &amp; Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinh","family":"Bui","sequence":"additional","affiliation":[{"name":"Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population &amp; Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Morgan","sequence":"additional","affiliation":[{"name":"University Centre for Rural Health, School of Public Health, University of Sydney, Sydney, NSW 2480, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Jalaludin","sequence":"additional","affiliation":[{"name":"Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Lodge","sequence":"additional","affiliation":[{"name":"Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population &amp; Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6063-1937","authenticated-orcid":false,"given":"Shyamali","family":"Dharmage","sequence":"additional","affiliation":[{"name":"Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population &amp; Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1056\/NEJM199506083322307","article-title":"Otitis media in children","volume":"332","author":"Berman","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Preciado, D. (2015). Otitis Media: State of the Art Concepts and Treatment, Springer International Publishing.","DOI":"10.1007\/978-3-319-17888-2"},{"key":"ref_3","unstructured":"Klein, J.O., and Bluestone, C.D. (1999). Textbook of Pediatric Infectious Diseases, Lippincott Williams & Wilkins. [5th ed.]."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1136\/adc.85.2.91","article-title":"Behaviour and developmental effects of otitis media with effusion into the teens","volume":"85","author":"Bennett","year":"2001","journal-title":"Arch. Dis. Child."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"32","DOI":"10.2174\/1874609810666170712145332","article-title":"Acute otitis media in children","volume":"11","author":"Leung","year":"2017","journal-title":"Recent Pat. Inflamm. Allergy Drug Discov."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Monasta, L., Ronfani, L., Marchetti, F., Montico, M., Vecchi Brumatti, L., Bavcar, A., Grasso, D., Barbiero, C., and Tamburlini, G. (2012). Burden of disease caused by otitis media: Systematic review and global estimates. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0036226"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/lary.24190","article-title":"Incremental health care utilization and costs for acute otitis media in children","volume":"124","author":"Ahmed","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1017\/S0022215116009944","article-title":"Recurrent acute otitis media detracts from health-related quality of life","volume":"131","author":"Kujala","year":"2017","journal-title":"J. Laryngol. Otol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1513\/pats.201003-027RN","article-title":"The effects of air pollutants and irritants on the upper airway","volume":"8","author":"Shusterman","year":"2011","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1001\/archpediatrics.2011.158","article-title":"Parental smoking and the risk of middle ear disease in children: A systematic review and meta-analysis","volume":"166","author":"Jones","year":"2012","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.amjoto.2008.07.009","article-title":"Histologic changes in the auditory tube mucosa of rats after long-term exposure to cigarette smoke","volume":"30","author":"Kong","year":"2009","journal-title":"Am. J. Otolaryngol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1007\/s11882-004-0075-4","article-title":"Air pollution and otitis media: A review of evidence from epidemiologic studies","volume":"4","author":"Heinrich","year":"2004","journal-title":"Curr. Allergy Asthma Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1289\/ehp.1306755","article-title":"Air pollution and respiratory infections during early childhood: An analysis of 10 European birth cohorts within the ESCAPE project","volume":"122","author":"MacIntyre","year":"2014","journal-title":"Environ. Health Perspect."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Brauer, M., Karr, C., MacIntyre, E., Clark, N., Su, J., Baribeau, A.M., Tamburic, L., Lencar, C., Demers, P., and Buzzelli, M. (2011). Woodsmoke and children\u2019s health: Findings from the border air quality study. Epidemiology, 22.","DOI":"10.1097\/01.ede.0000392250.44531.25"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kim, H.J., Kim, S.Y., Kwon, J.Y., Kim, Y.J., Kang, S.H., Jang, W.H., Lee, J.H., Seo, M.W., Song, J.J., and Seo, Y.R. (2016). Identification of potential novel biomarkers and signaling pathways related to otitis media induced by diesel exhaust particles using transcriptomic analysis in an in vivo system. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0166044"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1016\/j.ijporl.2013.08.012","article-title":"Microarray analysis of gene expression alteration in human middle ear epithelial cells induced by micro particle","volume":"77","author":"Song","year":"2013","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1111\/all.12561","article-title":"The influence of childhood traffic-related air pollution exposure on asthma, allergy and sensitization: A systematic review and a meta-analysis of birth cohort studies","volume":"70","author":"Bowatte","year":"2015","journal-title":"Allergy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1177\/000348948909800413","article-title":"Acute effects of sulfur dioxide exposure on the middle ear mucosa","volume":"98","author":"Ohashi","year":"1989","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_19","unstructured":"Wells, G.A., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2009). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses, Ottawa Hospital Research Institute."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/S0749-3797(99)00122-1","article-title":"Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services. Task Force on Community Preventive Services","volume":"18","author":"Zaza","year":"2000","journal-title":"Am. J. Prev. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.envres.2017.08.002","article-title":"Residential greenness and allergic respiratory diseases in children and adolescents\u2014A systematic review and meta-analysis","volume":"159","author":"Lambert","year":"2017","journal-title":"Environ. Res."},{"key":"ref_22","first-page":"439","article-title":"Outdoor fungi and child asthma health service attendances","volume":"25","author":"Tham","year":"2014","journal-title":"Pediatr. Allergy Immunol. Off. Publ. Eur. Soc. Pediatr. Allergy Immunol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1289\/ehp.1205281","article-title":"Early-Life exposure to outdoor air pollution and respiratory health, ear infections, and eczema in infants from the INMA study","volume":"121","author":"Aguilera","year":"2013","journal-title":"Environ. Health Perspect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1289\/ehp.9089","article-title":"Traffic-related air pollution and otitis media","volume":"114","author":"Brauer","year":"2006","journal-title":"Environ. Health Perspect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3","DOI":"10.21101\/cejph.a3950","article-title":"Differences between the spectra of respiratory illnesses in children living in urban and rural environments","volume":"22","author":"Dostal","year":"2014","journal-title":"Cent. Eur. J. Public Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1007\/s10654-005-1048-1","article-title":"Prenatal ambient air exposure to polycyclic aromatic hydrocarbons and the occurrence of respiratory symptoms over the first year of life","volume":"20","author":"Jedrychowski","year":"2005","journal-title":"Eur. J. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/01.ede.0000101292.41006.2e","article-title":"Infant otitis media and the use of secondary heating sources","volume":"15","author":"Pettigrew","year":"2004","journal-title":"Epidemiology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/EDE.0b013e3181fdb60f","article-title":"Residential air pollution and otitis media during the first two years of life","volume":"22","author":"MacIntyre","year":"2011","journal-title":"Epidemiology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.chemosphere.2016.11.079","article-title":"Association of outdoor air pollution and indoor renovation with early childhood ear infection in China","volume":"169","author":"Deng","year":"2017","journal-title":"Chemosphere"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1288\/00005537-199103000-00013","article-title":"The effect of indoor air pollutants on otitis media and asthma in children","volume":"101","author":"Daigler","year":"1991","journal-title":"Laryngoscope"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1093\/ije\/dyh071","article-title":"Household wood and charcoal smoke increases risk of otitis media in childhood in Maputo","volume":"33","author":"Navarro","year":"2004","journal-title":"Int. J. Epidemiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.otohns.2009.10.052","article-title":"Air quality improvement and the prevalence of frequent ear infections in children","volume":"142","author":"Bhattacharyya","year":"2010","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1136\/jech.48.3.237","article-title":"Is living near a coking works harmful to health? A study of industrial air pollution","volume":"48","author":"Bhopal","year":"1994","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1017\/S0022215100080099","article-title":"Environmental factors in glue ear","volume":"89","author":"Harvey","year":"1975","journal-title":"J. Laryngol. Otol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1164\/ajrccm.161.6.9906105","article-title":"Decline of ambient air pollution and respiratory symptoms in children","volume":"161","author":"Heinrich","year":"2000","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0033-3506(97)90007-X","article-title":"Is there a relationship between proximity to industry and the occurrence of otitis media with effusion in school entrant children?","volume":"111","author":"Holtby","year":"1997","journal-title":"Public Health"},{"key":"ref_37","first-page":"229","article-title":"Effects of sulphur dioxide and smoke on the incidence of secretory otitis media","volume":"44","author":"Sprem","year":"1993","journal-title":"Arh. Hig. Rada Toksikol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/00001648-200207000-00006","article-title":"Improved air quality in reunified Germany and decreases in respiratory symptoms","volume":"13","author":"Heinrich","year":"2002","journal-title":"Epidemiology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1016\/S0277-9536(03)00068-6","article-title":"Air pollution and children\u2019s health in S\u00e3o Paulo (1986\u20131998)","volume":"57","author":"Ribeiro","year":"2003","journal-title":"Soc. Sci. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1007\/s00484-017-1356-7","article-title":"Meteorological factors, air pollutants, and emergency department visits for otitis media: A time series study","volume":"61","author":"Gestro","year":"2017","journal-title":"Int. J. Biometeorol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/jnu.12195","article-title":"The air quality health index and emergency department visits for Otitis Media","volume":"48","author":"Kousha","year":"2016","journal-title":"J. Nurs. Scholarsh."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1289\/ehp.1509856","article-title":"Pediatric Emergency Visits and Short-Term Changes in PM2.5 Concentrations in the U.S. State of Georgia","volume":"124","author":"Strickland","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"ref_43","first-page":"1","article-title":"Pediatric emergency department visits and ambient Air pollution in the U.S. State of Georgia: A case-crossover study","volume":"15","author":"Xiao","year":"2016","journal-title":"Environ. Health Glob. Access Sci. Source"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1289\/ehp.0901675","article-title":"Air pollution and emergency department visits for otitis media: A case-crossover study in edmonton, Canada","volume":"118","author":"Zemek","year":"2010","journal-title":"Environ. Health Perspect."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.atmosenv.2017.03.005","article-title":"Association between prenatal exposure to industrial air pollution and onset of early childhood ear infection in China","volume":"157","author":"Deng","year":"2017","journal-title":"Atmos. Environ."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"3029","DOI":"10.1007\/s00204-016-1659-1","article-title":"Toxicity of wood smoke particles in human A549 lung epithelial cells: The role of PAHs, soot and zinc","volume":"90","author":"Dilger","year":"2016","journal-title":"Arch. Toxicol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.atmosenv.2017.05.019","article-title":"Cytotoxic and genotoxic responses of human lung cells to combustion smoke particles of Miscanthus straw, softwood and beech wood chips","volume":"163","author":"Arif","year":"2017","journal-title":"Atmos. Environ."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.ijporl.2011.12.003","article-title":"Effect of diesel exhaust particles on human middle ear epithelial cells","volume":"76","author":"Song","year":"2012","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2193","DOI":"10.1016\/j.ijporl.2014.10.011","article-title":"Middle ear inflammation of rat induced by urban particles","volume":"78","author":"Park","year":"2014","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_50","first-page":"189","article-title":"Regulation of mucin expression: Mechanistic aspects and implications for cancer and inflammatory diseases","volume":"1765","author":"Andrianifahanana","year":"2006","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1146\/annurev.physiol.70.113006.100702","article-title":"Structure and function of the polymeric mucins in airways mucus","volume":"70","author":"Thornton","year":"2008","journal-title":"Annu. Rev. Physiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1016\/j.ijporl.2009.07.016","article-title":"Effects of cigarette smoking on mucin production in human middle ear epithelial cells","volume":"73","author":"Cho","year":"2009","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1513\/pats.200908-093RM","article-title":"How much, how long, what, and where: Air pollution exposure assessment for epidemiologic studies of respiratory disease","volume":"7","author":"Brauer","year":"2010","journal-title":"Proc. Am. Thorac. Soc."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/2\/257\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T14:53:41Z","timestamp":1760194421000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/15\/2\/257"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,3]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,2]]}},"alternative-id":["ijerph15020257"],"URL":"https:\/\/doi.org\/10.3390\/ijerph15020257","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,3]]}}}