While running an ambulatory paediatric clinic, the mother of a crying baby wondered whether forceps delivered babies were more prone to otitis than other babies. To our knowledge, this association has not been reported. But, on the other hand, facial nerve injury is more common among those delivered by forceps¹; it is caused by compression of diploic bone of the mastoid process where the facial nerve is located superficially.² It is clear that this kind of extraction applies some pressure over the ear of the baby. The head vulnerability is well known: long term consequences have been recognised after mild head injury.³

To estimate the differences of proportion of acute otitis media (AOM) between children delivered by forceps and other babies we conducted an electronic medical records review of all singleton children attending a primary care paediatric clinic, born full term from 1 January 1996 to 31 December 2004. Table 1 shows the characteristics of the children. Sex was comparable, birth weight of non-operative vaginal delivery babies (NO) was lower, vacuum assisted babies (VA) were older at AOM diagnosis, and rates of neonatal admission were not comparable.

AOM was diagnosed by a history of acute onset of signs and symptoms and otoscopic examination of the eardrum.⁴

Of 1449 deliveries, there were: 754 NO, 217 F, 52 VA, and 426 CS (caesarean sections). AOM had been recorded in 234 (31.0%) of children born by NO, 87 (40.0%) of F, 15 (28.8%) of VA, and 124 (29.1%) of CS.

The analysis showed that forceps delivered babies were associated with an increase in proportion of AOM (odds ratio (OR) 1.48; 95% confidence intervals (CI) 1.08 to 2.03; p = 0.015) compared with NO.

There were no differences in AOM proportions between VA and NO (OR 0.85; 95% CI 0.46 to 1.58; p>0.3). And there were no differences in AOM proportions between CS and NO (OR 0.91; 95% CI 0.70 to 1.18; p>0.3).

Our finding could be confirmed or discarded by ongoing longitudinal studies. If it is confirmed, it will strengthen the resolve to pay careful attention to the comments of our patients.

It is already known that VA is at least as safe as forceps for the mother and the neonate. Long term consequences of operative vaginal delivery need to be explored: a prospective study should be undertaken to find if this association really exists.