Air Pollution Effects on Ear Nose and Throat Disease: From Liverpool to a Global Surgical Problem

The Air Pollution Problem

In the last 15years UK diesel car use has risen from 12 to 40%. Light lorries and vans are 96% diesel.

Pollutants from diesel, like NO2 contribute to approximately 40,000 premature adult deaths in Britain each year.

Air pollution has social costs and risks the potential for economic growth. Poor air quality is estimated to have had a total cost of up to £2.7 billion through its impact on UK productivity in 2012.

Liverpool docks are the 4th busiest by tonnage in the UK. The Belfast to Liverpool route is the 3rd busiest route in the UK with 4.9million tonnes of trade per year alone. Low-grade marine fuel oil contains 3,500 times more sulphur than road diesel. In Hong Kong, this accounts for one-third to half of airborne pollutants.

Long-term exposure to higher levels of air pollution has been shown to have a 2.3x odds ratio association with hospitalisation for pneumonia in adults over 65. Why does it matter?

In European children, outdoor concentrations of traffic-related air pollutants lead to elevated asthma (1.3x), and ear/nose/throat infections (1.2x) during the first 4 years of life.

In Canada, population data shows even low levels of air pollution have been associated with 1.1x increased visits to a doctor with otitis media by the age of 2yrs.

A meta-analysis in Plos One suggested allergy/atopy, URTI, snoring, Second-hand smoke and low social status are important risk factors for otitis media.

ESCAPE was a meta-analysis of 10 European birth cohorts evidence for an association between traffic related air pollution and pneumonia in early childhood, and some evidence for an association with otitis media but subsequent papers have questioned if the sample sizes were large enough to draw conclusion

Studies from New Zealand suggest household crowding may be a risk factor for otitis media with effusion (OME). A Nigerian study found an association of chronic supporative otitis media (CSOM) with indoor woodsmoke and household crowding. A study in Malawi estimated Paediatric hearing impairment of 37%,and CSOM of 5%. Nearly half of those with hearing impairment had middle ear disease. A trend towards increased risk of CSOM was observed with sleeping in a house with >2 other children. As the general public and scientiific community develop more interest in air pollution, this should serve as a rallying call to the global surgical community to establish pollution correlations with hearing loss and ear disease in the global North and the global South, as this information is not currently known and will likely have huge implications for paediatric health and disability across the life course.

Tom Hampton References https://www.gov.uk/government/publications/air-quality-plan-for-nitrogen-dioxide-no2-in-uk-2017

https://www.nature.com/news/pollution-three-steps-to-a-green-shipping-industry-1.19369 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/646188/port-freight-statistics-2016-revised.pdf



https://www.researchgate.net/publication/7490983_Epidemiology_of_Otitis_media_in_a_local_tropical_African_population http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0188950

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