Heritability of Symptom Domains in Otitis Media: A Longitudinal Study of 1,373 Twin Pairs

Research on risk factors and pathogenesis of otitis media has emphasized the environment, but previous twin studies suggest a strong genetic component. In those studies, no attempt was made to differentiate the role of initial acute infection from the chronic airway blockage that frequently accompanies persistent effusion. The authors estimated genetic and environmental determination of both of these aspects of otitis media histories at three time points. A large and representative subset of a total population cohort of all twins born in England and Wales in 1994, was studied prospectively at ages 2, 3, and 4 years (monozygotic, n = 715; dizygotic, n = 658). For the total symptom score, the estimated heritabilities at ages 2, 3, and 4 years were 0.49, 0.66, and 0.71, respectively. All correlations for the total score found in monozygotic twins were about 0.9, but correlations were lower for dizygotic twins (p < 0.65). Shared environmental influences declined in importance over time (0.41, 0.22, and 0.16 at ages 2, 3, and 4 years, respectively). No gender differences were found in parameter estimates. Symptoms of acute infections showed lower heritability (0.57 on average) and higher shared environment (0.18) than did chronic airway blockage (0.72 heritability and 0.10 shared environment). The strong genetic component, which this study confirms, is not unitary but distributes differently across the phenotypic aspects of otitis media and probably across pathogenetic stage.