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A Twin and Triplet Study

Margaretha L. Casselbrant, MD, PhD; Ellen M. Mandel, MD; Patricia A. Fall, CRNP; Howard E. Rockette, PhD; Marcia Kurs-Lasky, MS; Charles D. Bluestone, MD; Robert E. Ferrell, PhD

JAMA. 1999;282:2125-2130.

Context  Anatomical, physiological, and epidemiological data indicate that there may be a significant genetic component to prolonged time with and recurrent episodes of otitis media in children.

Objective  To determine the genetic component of time with and episodes of middle ear effusion and acute otitis media (AOM) during the first 2 years of life.

Design  Prospective twin and triplet cohort study with enrollment from 1982 through 1995.

Setting  Otitis Media Research Center in the ear, nose, and throat clinic of Children's Hospital of Pittsburgh, Pittsburgh, Pa.

Patients  A total of 168 healthy same-sex twin and 7 triplet sets were recruited within the first 2 months of life; zygosity results were available for 140 sets; 138 (99%) of these were followed up for 1 year and 126 (90%) for 2 years.

Main Outcome Measures  Proportion of time with middle ear effusion, episodes of middle ear effusion, and episodes of AOM by zygosity status.

Results  At the 2-year end point, the estimate of heritability of time with middle ear effusion was 0.73 (P<.001). The estimates of discordance for 3 or more episodes of middle ear effusion were 0.04 for monozygotic twins and 0.37 for dizygotic twins (P = .01). The estimate of discordance of an episode of AOM in monozygotic twins was 0.04 compared with 0.49 in dizygotic twins (P = .005).

Conclusions  Our study suggests there is a strong genetic component to the amount of time with middle ear effusion and episodes of middle ear effusion and AOM in children.

Author Affiliations: Department of Otolaryngology, University of Pittsburgh School of Medicine (Drs Casselbrant, Mandel, and Bluestone); Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh (Drs Casselbrant, Mandel, and Bluestone, and Ms Fall); and the Departments of Biostatistics (Dr Rockette and Ms Kurs-Lasky) and Human Genetics (Dr Ferrell), University of Pittsburgh, Pittsburgh, Pa.

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