Habitual use of push and pull plastic bottle caps is more prevalent among children with recurrent acute otitis media

Objective: The use of a pacifier has been reported to be a causative factor of recurrent acute otitis media (RAOM) because the negative pressure which is generated during sucking may cause a negative intra-tympanic pressure and favour the reflux of nasopharyngeal secretions into the Eustachian tube. Push and pull (P&P) plastic bottle caps, recently marketed in Italy, might also induce negative nasopharyngeal pressure.This study was aimed to investigate if there is a difference in the prevalence of habitual use of P&P plastic bottle caps among children with a positive history of RAOM and healthy controls. Methods: A telephonic interview was performed in order to retrospectively evaluate the prevalence of habitual use of P&P plastic bottle cap among children with a history of RAOM and healthy controls, comparable to the former for environmental risk factors for RAOM. Results: Data were obtained from 57 Caucasian patients (males=36/57; 63.2%) with a median age of 59 (range=21-90) months, including 28 children with a history of RAOM and 29 healthy controls. Habitual use of P&P plastic bottle cap was significantly (p=0.047) more frequent in children with a history of RAOM (14/28; 50.0%) than in control group (7/29; 24.2%). Multivariate logistic regression analysis adjusted for age confirmed a significant association (p<0.01; Pseudo R2=0.2) between the use of P&P plastic bottle cap and a positive history of RAOM (adjusted OR=4.0; range=1.1-15.0). Conclusions: Our preliminary data show a significantly increased prevalence of P&P plastic cap bottle habitual users among children with a history or RAOM and support the need for larger studies to confirm the role of using P&P bottles as risk factor of RAOM and to identify the age groups at higher risk.