Prevalence and determinants of chronic suppurative otitis media in school going children in Bareilly (Uttar Pradesh)

INTRODUCTION

In South East Asia, chronic suppurative otitis media (CSOM) remains one of the most common ear diseases having a prevalence of 5.2% in the general population.¹ Chronic otitis media (COM) equates with the term chronic “suppurative” otitis media that is no longer advocated as COM is not necessarily a result of “the gathering of pus.” However, the distinction remains between active COM, where there is inflammation and the production of pus, and inactive COM, where there is no inflammation and the production of pus.² Incidence of this disease is the higher in developing countries, because of malnutrition, overcrowding, poor hygiene, inadequate health care, and recurrent upper respiratory tract infection.³ In the developing countries, there is differential prevalence among the different socioeconomic strata of the community.⁴ The socioeconomic cost of CSOM is still very high both financially and non-financially for the society. There is a need for capacity building to reduce the burden as well as the associated risk.⁵ The HUNT study indicates that CSOM and recurrent acute otitis media in childhood are associated with adult hearing loss, underlining the importance of optimal treatment in these conditions. It suggests that ears with a subsequent hearing loss, after otitis media in childhood age at a faster rate than those without.⁶ As proposed by World Health Organization (WHO), during a WHO/CIBA workshop of otitis media experts in 1996, CSOM prevalence rate of 1-2% was considered low and 3-6% to be high. With a national average of CSOM to be 5.2%, India has been classified as the high prevalence country.^7,8 As not many studies have been conducted in Uttar Pradesh, present study was done among the school children in the urban field practice areas of dept of community Medicine, Rajshree Medical Research Institute Bareilly(UP).

METHODS

This cross-sectional study was conducted in a school of urban field practice areas of Department of Community Medicine, Rajshree Medical Research Institute Bareilly (UP), India in 01 July 16 to 30 September 16. Two schools was selected by stratified random sampling for study after enlisting all the schools in urban field practice areas of Department of Community Medicine, Rajshree Medical Research Institute Bareilly. The schools were selected in such a way that the students of all socioeconomic strata could be included. In this study, all schools children in age ranging from 6 years to 15 years were selected as a study group. Total 495 children participated in study. The study population was classified into age groups, <6 years, 6-8 year, 8-10 year, 10-12 year, and more than 12 year. A pro forma (case record form) was prepared to carry out the study. The initial school survey was carried out and the students were examined according to the pro forma (case record form), which was distributed to the children or to the respective class teachers. Moreover, the class teachers were asked to fill up the primary information in consultation with parents regarding the name, place of residence, father’s occupation, the living conditions and if possible, the history of major illness in past, in the student or family. The pro forma were collected on the next day or, on the next visit to the student. Students were then stratified according to their socioeconomic status with modified Kuppuswamy’s socioeconomic scale.⁹ All the study subjects were subjected to detailed ear, nose and throat (ENT) examination at the school. Among 445 subjects, students having ear complaints were screened and further examined with the help of the otoscope and other standard instruments used for routine ENT checkup. The prevalent chronic form of suppurative otitis media in the students was classified into safe (tubotympanic) and unsafe (atticoantral) type. Tubotympainc type: In these types central perforations of all variety were included (active, quiescent and inactive state). Atticoantral type: posterosuperior marginal perforation and perforation of pars flaccida, retractions with granulations and or cholesteatoma at similar site were included under this heading.

RESULTS

Sex, age and socioeconomic status of study participants has been depicted in Table 1 to 3. Among 495 study participants 283 (57.17%) were male and 212 (42.83%) were female. 93.13% participants were in age group 6to 12 years of age. 29.90% study participants belonged to lower socioeconomic strata and 26.06% study participants belonged to upper lower strata. The total prevalence of CSOM was found to be 6.46%. Prevalence of CSOM was 6.71% (19/283) in males and 6.13% (13/212) in females. Tubotympanic type constituting majority 26 (81.25%) cases trailed by atticoantral type 6 (18.75%) cases. The most children presented with moderate hearing impairment 14 (43.75%), and mild hearing impairment 10 (31.25%). 18 (56.25%) children had associated nasal and throat diseases. With respect to socioeconomic groups, upper lower, groups had 40.63%, and lower group had 34.37% prevalence of CSOM.

DISCUSSION

WHO deafness and hearing impairment fact sheet has given prevalence of CSOM in the South East Asia region to be 5.2%.¹ In this study, the prevalence of CSOM in school going children was found to be 6.46%. Some studies have reported the lower prevalence of CSOM as compared to our study, such as Kalpana and Chamyal in Pune of Maharashtra have reported prevalence to be 4.75%.¹⁰ Wakode et al in Yavatmal district of Maharashtra have found prevalence to be 3.0%.¹¹ In a study conducted by Minja and Machemba, on 802 primary school children in Tanzania prevalence was found to be 2.6%.¹² The reasons for these differences from our study may be different geographical location with respect to socioeconomic and environmental conditions, different age groups of the children studied and different diagnostic criteria used for diagnosing CSOM. However, other studies have reported a higher prevalence of CSOM with respect to our study, Adhikari et al have reported a prevalence of 5.7%, Akinpelu et al have found the prevalence in school going children of Nigeria to be 11.1%.^13,14 The prevalence of CSOM was found to be 7.8% in a study conducted by Jacob et al in Tamil Nadu.¹⁵ Basak et al have reported a prevalence of 37.54% which is much higher than that of our study.¹⁶ In our study no significant difference was observed in prevalence of CSOM with respect to gender and age of children, while it was observed to be significantly associated with socioeconomic status. Findings of this study is similar to study carried out by Gupta and Mittal, they had reported prevalence of tubotymanic 89.43%) and atticoantral (10.57%) in their study.⁸

CONCLUSION

The socioeconomic cost of CSOM puts an immense burden on the growth of a child. There is a need for capacity building to reduce the burden of cost of chronic as well as the associated risk. Increasing awareness about ear diseases should be one of the goals of all health-care providers. Improvement of health care facilities and awareness among health-care providers would definitely be helpful in reducing the prevalence of ear diseases in the developing countries like ours.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. World Health Organization. State of hearing and ear care in the South East Asia Region. WHO Regional Office for South East Asia. WHO-SEARO. SEA/Deaf/9. Available at: http://www.searo.who.int/LinkFiles/Publications_HEARING_&_EAR_ CARE.pdf. Accessed on 10 January 2010.
2. 2. Browning GG, Kelly G, Swan IR, Canter R, McKerrow SW. In: Gleeson MJ, Bruton MJ, editors. Scott-Brown’s Otorhinolaryngology Head and Neck. London: Edward Arnold; 2008.
3. 3. Kumar H, Seth S. Bacterial and fungal study of 100 cases of chronic suppurative otitis media. J Clin Diagn Res. 2011;5:1224-7.
4. 4. Adhikari P, Joshi S, Kharel B. Chronic suppurative otitis media in urban private school children of Nepal. Braz J Otorhinolaryngol. 2009;75(5):669-72.
5. 5. Afolabi OA, Fadare JO, Omokanye HK, Olatoke F, Odi TO, Saka MJ, et al. Socioeconomic challenges of chronic suppurative otitis media management in state tertiary health facility in Nigeria. Egypt J Ear Nose Throat Allied Sci. 2014;15(1):17-22.
6. 6. Aarhus L, Tambs K, Kvestad E, Engdahl B. Childhood otitis media: A cohort study with 30-year follow-up of hearing (The HUNT Study). Ear Hear. 2015;36(3):302-8.
7. 7. Foundation WC. Prevention of Hearing Impairment from Chronic Otitis Media. WHO/CIBA Foundation Workshop. 19-21 November; 1996.
8. 8. Gupta R, Mittal M. A study on clinical and epidemiological profile of chronic suppurative otitis media (CSOM) at a tertiary care center. Int J Med Sci Public Health. 2016;5(5):1021-4.
9. 9. Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci. 2017;5:3264
10. 10. Kalpana R, Chamyal PC. Study of prevalence and aetiology of the hearing loss amongst school going children. Indian J Otolaryngol Head Neck Surg. 1997;49(2):142-4.
11. 11. Wakode PT, Joshi SV, Gawarle SH. Chronic suppurative otitis media in school going children. Indian J Otolaryngol Head Neck Surg. 2006;58(2):152-5.
12. 12. Minja BM, Machemba A. Prevalence of otitis media, hearing impairment and cerumen impaction among school children in rural and urban Dar es Salaam, Tanzania. Int J Pediatr Otorhinolaryngol. 1996;37(1):29-34.
13. 13. Adhikari P, Kharel B, Ma J, Baral DR, Pandey T, Rijal R, et al. Pattern of otological diseases in school going children of Kathmandu Valley. Int Arch Otorhinolaryngol. 2008;12(4):502-5.
14. 14. Akinpelu OV, Amusa YB, Komolafe EO, Adeolu AA, Oladele AO, Ameye SA. Challenges in management of chronic suppurative otitis media in a developing country. J Laryngol Otol. 2008;122(1):16-20.
15. 15. Jacob A, Rupa V, Job A, Joseph A. Hearing impairment and otitis media in a rural primary school in south India. Int J Pediatr Otorhinolaryngol. 1997;39(2):133-8.
16. 16. Basak B, Gayen GC, Ray R. Pattern of aural morbidity among children in a rural tertiary care hospital. IOSR J Pharm. 2013;3(7):58.