Otitis Media and Exposure to Secondhand Tobacco Smoke. Long-term tobacco smoke exposure is a risk factor for otitis media and bronchitis in children.3 In a prospective study, 175 children with recurrent otitis media were compared with an age-matched group of 175 children to determine the role of passive cigarette smoking on the incidence of this disease. The case group more commonly had exposure to secondhand smoke, with an OR of 1.88 (95% CI, 1.02-3.49) (P =.04). Prospective follow-up of the case group showed no significant difference in the clinical course of the children who were exposed to secondhand smoke and those who were not.70 Ilicali et al71 examined the development of otitis media with effusion and recurrent otitis media in 166 children 3 to 7 years old, compared with an age-matched control group of 166 children. Passive smoking was a significant risk factor for otitis media with effusion and recurrent otitis media. The case group was exposed to smoke from a mean of 19.6 cigarettes per day vs 14.4 cigarettes per day for the control group (P<.004). Only maternal smoking was a significant factor (P<.001). Moreover, in utero exposure to cigarette smoke was associated with an increased risk of otitis media. In a study carried out by Stathis et al,72 acute ear infections were associated with the mother’s consumption of 1 to 9 cigarettes (OR, 1.6; 95% CI, 1.1-2.5), 10 to 19 cigarettes (OR, 2.6, 95% CI, 1.6-4.2), and 20 or more cigarettes (OR, 3.3; 95% CI, 1.9-5.9) per day during pregnancy. For subacute ear infections, an association was present with the mother’s consumption of 10 to 19 cigarettes (OR, 2.6; 95% CI, 1.4-5.0) and 20 or more cigarettes (OR, 2.8; 95% CI, 1.3-6.0). In utero exposure to 20 or more cigarettes per day was also associated with an increased risk of ear surgery by 5 years after delivery (OR, 2.9; 95% CI, 1.3-6.6).