The association between iron-deficiency anemia and recurrent acute otitis media

PURPOSE: This study was designed to examine the association between iron-deficiency anemia and the frequency of recurrent acute otitis media in children, and to evaluate the effect of restoring normal hemoglobin levels on the frequency of acute otitis media attacks. MATERIALS AND METHODS: A total of 680 children with frequent episodes of acute otitis media were enrolled in the study. The levels of the hemoglobin were measured in both these children and in 200 healthy children with no history of infections. The correlation between hemoglobin level and the frequency of middle ear infections was studied and analyzed. All children with hemoglobin levels lower than 9.5 g/dL received iron supplementation until they reached a level of at least 11 g/dL, and the subsequent frequency of middle ear infections was recorded. RESULTS: The 680 children had an average of 8.3 +/- 2.7 episodes of acute otitis media per year per child, and an average hemoglobin level of 11.4 +/- 2.7 g/dL, whereas the controls had an average hemoglobin level of 13.1 +/- 2.5 g/dL. Twenty percent had hemoglobin levels below 9.5 g/dL. These children had more episodes of acute otitis media when compared with children with average levels. By increasing the hemoglobin level in these children, the frequency of the episodes of acute otitis media decreased significantly. CONCLUSIONS: This study confirms that anemic children have higher prevalence of episodes of acute otitis media in comparison to healthy, nonanemic children, and shows that there is a direct relationship between the degree of the anemia and the number of the episodes.