# Chronic otitis media with effusion in children with adenoidal hypertrophy: Development of a diagnostic prediction model

## TL;DR

This study creates a prediction model to help doctors diagnose chronic ear infections in children with enlarged adenoids.

## Contribution

A novel clinical prediction nomogram for COME in children with AH, incorporating four key risk factors and validated for high accuracy.

## Key findings

- The predictive model achieved a high C-index of 0.945, indicating strong predictive accuracy.
- Key risk factors include young age, vitamin D3 deficiency, degree of adenoidal hypertrophy, and tympanometry results.
- The model showed good calibration and net benefit across a wide range of clinical thresholds.

## Abstract

Chronic otitis media with effusion (COME) is a prevalent condition that poses significant risks to the growth and development of children with adenoidal hypertrophy (AH). This study investigates the risk factors associated with COME in children diagnosed with AH and establishes a clinical prediction nomogram to enhance diagnostic accuracy. The study included 311 children with AH, diagnosed through lateral nasopharyngeal radiographs, from the Department of Otorhinolaryngology Head and Neck Surgery at the First Affiliated Hospital of Anhui Medical University. Risk factors were identified using the least absolute shrinkage and selection operator (LASSO), while Firth’s penalized logistic regression analysis was employed to further refine the variables and develop a predictive model. The model’s performance was assessed using the C-index, calibration curve, and decision curve analysis, with internal validation conducted through bootstrapping. The resulting predictive nomogram included four key risk factors: young age, vitamin D3 deficiency, degree of AH, and tympanometry results. The model exhibited strong predictive capabilities, achieving a C-index of 0.945 (95% confidence interval: 0.941, 0.949). Bootstrapping validation confirmed a high C-index of 0.934. The calibration curve demonstrated good alignment, while the decision curve indicated a net benefit across thresholds of 10%–90%. This nomogram—incorporating tympanometry, AH degree, serum vitamin D3 levels, and age—serves as a valuable tool for clinicians and families in assessing the risk of COME in children with AH.