Age: An effect modifier of the association between allergic rhinitis and Otitis media with effusion.

OBJECTIVES/HYPOTHESIS 1) To determine whether there is a significant relationship between allergic rhinitis and otitis media with effusion (OME), Eustachian tube dysfunction (ETD), or tympanic membrane retraction (TMR) in children in a nationally representative population; and 2) to determine whether age is an effect modifier of any such association because this hypothesis has yet to be tested. STUDY DESIGN Retrospective analysis of cross-sectional national databases with limited potential for referral bias. SETTING AND SUBJECTS National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2005-2010. METHODS Univariate, multivariate, stratified, and subgroup analyses were performed as defined a priori. The primary outcomes were OME, ETD, or TMR; the primary predictor variable was allergic rhinitis, with age evaluated as an effect modifier. RESULTS Data representing 1,491,045,375 pediatric visits were examined and demonstrated that age was an effect modifier of the assessed association. More specifically, in children 6 years of age or older, the presence of allergic rhinitis significantly increased the odds of OME, ETD, or TMR (odds ratio [OR] 4.20; 95% confidence interval [CI] 2.17, 8.09; P < 0.001), whereas in children less than 6 years of age there was no significant association (OR 1.13; 95% CI 0.53, 2.46; P = 0.745). CONCLUSION Age is an effect modifier of the association between allergic rhinitis and OME; a significant relationship is observed in children 6 years of age and older, whereas there is no significant association in younger children. LEVEL OF EVIDENCE 2c. Laryngoscope, 126:1687-1692, 2016.