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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 22  |  Issue : 3  |  Page : 188-192

Malnutrition among children having otitis media: A hospital-based cross-sectional study in Lucknow district


1 Department of Otorhinolaryngology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
2 Department of Pediatrics, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
3 Department of Community Medicine, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India

Date of Web Publication8-Aug-2016

Correspondence Address:
Dr. Shikhar Saxena
H. No. 113, Sector 5, Awas Vikas Colony, Near Income Tax Colony, Farrukhabad - 209 625, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-7749.187981

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  Abstract 

Introduction: Otitis media (OM) is one of the most frequent diseases affecting humans and is prevalent in both developed and developing countries. It is the leading cause of hearing loss and is associated with significant morbidity. Children are at a greater risk and suffer most frequently from Otitis media. Studies show that 80% of children would have experienced at least one episode of Otitis media by their third birthday and 40% would have six or more recurrences by the age of 7 years. Materials and Methods: Study was carried out from Department of Otorhinolaryngology & Pediatrics at Era's Lucknow Medical College and Hospital, Lucknow during a time period of January 2014 to June 2015. A total 850 subjects were included in our study between 1 – 5 years with symptoms such as ear discharge, ear pain and itching in ear. Observations and Results: Out of 851 children under study 186 (21.9%) were diagnosed as Acute Otitis Media cases, 462 (54.3%) as Chronic Otitis Media cases and rest 203 (23.9%) children were diagnosed to be affected by Otitis Media With Effusion. Out of 851 cases 510 cases were found to be malnourished i.e. 59.9%. Conclusion: Otitis media has a strong positive association with malnutrition. (P< 0.001).

Keywords: Children, Malnutrition, Otitis media


How to cite this article:
Saxena S, Bhargava A, Srivastava S, Srivastava MR. Malnutrition among children having otitis media: A hospital-based cross-sectional study in Lucknow district. Indian J Otol 2016;22:188-92

How to cite this URL:
Saxena S, Bhargava A, Srivastava S, Srivastava MR. Malnutrition among children having otitis media: A hospital-based cross-sectional study in Lucknow district. Indian J Otol [serial online] 2016 [cited 2019 Oct 16];22:188-92. Available from: http://www.indianjotol.org/text.asp?2016/22/3/188/187981


  Introduction Top


Otitis media (OM) is one of the most frequent diseases affecting humans and is prevalent in both developed and developing countries.[1] The term “otitis media” covers a wide spectrum of disease, and is used to describe illnesses with predominantly middle ear symptoms. With its diverse clinical syndromes and affected host groups, OM remains one of the challenging diseases encountered in clinical practice.[2] It is the leading cause of hearing loss and is associated with significant morbidity.[3],[4],[5],[6] Children are at a greater risk and suffer most frequently from OM. This can cause serious deterioration in the quality of life.[7] Studies show that 80% of children would have experienced at least one episode of OM by their third birthday, and 40% would have six or more recurrences by the age of 7 years.[8]

The pathogenesis of OM is thought to be multifactorial and includes  Eustachian tube More Details dysfunction, allergy, viral and bacterial invasion, reduced ciliary function of both the middle ear and Eustachian tube mucosa, smoke exposure, gastroesophageal reflux, and autoimmune and many other etiologies not yet fully understood.[9]

There are two main entities of OM: acute otitis media (AOM) and chronic suppurative otitis media (CSOM).[10] AOM is defined as the presence of inflammation in the middle ear accompanied by the rapid onset of signs and symptoms of an ear infection. Streptococcus pneumonia, Haemophilus influenzae, and  Moraxella More Details catarrhalis are the most common causative agents of AOM.

Despite antibiotic therapy, AOM can progress to CSOM, characterized by the persistent infection and inflammation of the middle ear and mastoid air cells. This condition typically involves a perforation of the tympanic membrane, with intermittent or continuous otorrhea.[11] As chronic mastoiditis and eustachian tube dysfunction persist, the tympanic membrane is weakened, which increases the likelihood of an atelectatic ear or cholesteatoma formation. Pseudomonas aeruginosa and Staphylococcus aureus are the most common pathogens implicated in CSOM.[12],[13],[14],[15] Malnutrition is globally the most important risk factor for illness and death, contributing to more than half of the deaths in children worldwide.[16]

In this study, all the children's of 1–5 years age group with AOM, chronic otitis media (COM), otitis media with effusion (OME) were included; nutritional and health assessment were done with an objective to assess the incidence of malnutrition in children with OM and to establish the correlation between malnutrition and OM.


  Materials and Methods Top


This prospective cross-sectional study was carried out from the Indoor as well as outdoor Patient Department of Otorhinolaryngology and Pediatrics at Era's Lucknow Medical College and Hospital, Lucknow during a period of January 2014 to June 2015. A total 851 subjects of both sexes were included in our study. Consent was sought from parents for their child (regardless of ear health status or history) to have an ear examination, nasal swab and swab of ear discharge if present and general child health check.

Inclusion criteria were both male and female between age 1 and 5 years with symptoms such as ear discharge, ear pain, and itching in the ear.

Exclusion criteria were any congenital anomaly, chronic illness (tuberculosis), otomycosis, malignant tumor of the outer and middle ear, infection such as malignant otitis externa.

Patients were divided into following groups:

  • Group A: 13–24 months
  • Group B: 25–36 months
  • Group C: 37–48 months
  • Group D: 49–60 months.


Clinical assessments

ENT examination was carried by otorhinolaryngologists for the diagnosis and management of OM in study subjects. Otoscopic findings were recorded on a standardized form. Assessments were made using a tympanometer (ALPS AT235), Otoscope (Welch Allyn) with Siegel's speculum for pneumatic otoscopy, and a video-endoscope (KARL STORZ 0° Endoscope) where required. The patient was categorized into AOM, COM, and OME. All patients then underwent a complete general health assessment.

Procedure methodology

The weight of children was measured to the nearest 0.1 kg and electronic weighing machine was used for weight measurement. The height of children was measured against a nonstretchable tape fixed to a vertical wall, with the participant standing on a firm/level surface and it was measured to the nearest 0.5 cm. Recumbent length (for children <24 months of age) was measured using an infant measuring board. The children were dressed in light underclothing and without any shoes during the measurement. Each measurement was done twice, and the mean of the two readings was recorded.

Nutritional status

The three indices of nutritional status namely, “Weight for Age,” “Height for Age,” and “Weight for Height” were expressed in standard deviation (SD) units from the median for the international reference populations as per WHO standards. Undernutrition is defined as underweight (weight for age <2 SD), wasting (weight for height <2 SD), and stunting (height for age <2 SD) as per WHO standards.

Statistical analysis

Data were analyzed using SPSS (version 17.0, IBM, Inc.) software package. Frequency, percentage, mean, SD, and median were used to present the data, categorical data wre analyzed by Chi-square test; P < 0.05 was considered statistically significant.


  Observations and Results Top


The present prospective study was carried out at Department of ENT, Era's Lucknow Medical College, Lucknow with an objective to assess the incidence and comparison of malnutrition in children with OM and to establish the correlation between the degree of malnutrition and OM. Of 851 children under study 186 (21.9%) were diagnosed as AOM cases, 462 (54.3%) as COM cases, and rest 203 (23.9%) children were diagnosed to be affected by OM with effusion [Figure 1]. Of 851 cases, 510 cases were found to be malnourished, i.e., 59.9% [Figure 2]. The incidence of underweight, wasting and stunting among the study population were 34.31%, 17.65%, and 58.82%, respectively [Figure 3]. In this study, we examined the association of otological diagnosis for AOM, COM, and OM with effusion among underweight, stunting, and wasting [Figure 4], [Figure 5], [Figure 6]. OM has a strong positive association with malnutrition (P < 0.001).
Figure 1: Otological distribution

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Figure 2: Malnutrition among children with otitis media

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Figure 3: Malnutrition among children

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Figure 4: Otological diagnosis according to underweight

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Figure 5: Otological diagnosis according to wasting

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Figure 6: Otological diagnosis according to stunting

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  Discussion Top


AOM is a very common condition and a leading cause of health care visits and antibiotic prescription.[10] Studies carried out in developed countries show that by their third birthday 80% of children will have experienced at least one episode of AOM [17],[18] and 40% will have six or more recurrences by the age of 7 years.[19] As with most infectious diseases, the burden of AOM varies substantially across countries, the main differences residing in the frequency of suppurative complications such as mastoiditis and meningitis and of sequelae such as hearing loss due to CSOM.[10] CSOM is an important cause of preventable hearing loss, particularly in the developing world,[20] and a reason of serious concern, particularly in children, because it may have long-term effects on early communication, language development, auditory processing, psychosocial and cognitive development, and educational progress and achievement.[21] Breastfeeding, smoking avoidance during and after pregnancy, and reduction of exposure to indoor air pollution are the pillars of prevention of AOM and its complications and sequelae [22],[23] as well as of many other infant and child conditions.

Malnutrition can make a person more susceptible to infection, and infection also contributes to malnutrition, which causes a vicious cycle. An inadequate dietary intake leads to weight loss, lowered immunity, mucosal damage, invasion by pathogens, and impaired growth and development in children. It is associated with impairments in cell-mediated immunity and reductions in neutrophil action, with decreased bacterial and myeloperoxidase activity. It lowers the body's defenses against disease and diminishes body and brain functions. Breast milk supplies the ideal mix, density, and physiological form of nutrients to promote adequate infant growth and development. It helps reduce exposure of infants to enteropathogens because of its antibacterial and antiviral properties and diminishes the risk of developing celiac disease. Breast milk may also have a similar effect on allergic, autoimmune, and inflammatory bowel diseases and certain tumors.[24] It protects against diarrhea, respiratory tract infections, OM, bacteremia, bacterial meningitis, botulism, urinary tract infections, and necrotizing enterocolitis and may improve overall vaccine response. There is enhanced protection for years after the termination of breastfeeding against pathogens such as H. influenzae type b and pneumococci, as well as the agents of OM, diarrhea, respiratory tract infections, and bronchitis.[25]

The present prospective study was carried out at Department of ENT, Era's Lucknow Medical College, Lucknow with an objective to assess the incidence of malnutrition in children with OM and to establish the correlation between malnutrition and OM. In our study, Of a total 851 cases which were studied 186 (21.9%) were diagnosed as AOM, 462 (54.3%) as COM and rest 203 (23.9%) children were diagnosed to be affected by OM with effusion. Monasta et al.[2] found AOM incidence rate 10.85%, i.e., 709 million cases each year with 51% of these occurring in under-fives and incidence of COM rate 4.76%, i.e., 31 million cases, with 22.6% of cases occurring annually in under-fives. Education on primary ear care and also the inclusion of ear care tips in the health education can provide the valuable message to the children who are affected the most by OM. This should dramatically decrease the incidence of OM in this group of population.

As 59.9% of the cases were malnourished and only 40.1% were nonmalnourished, it implies that malnutrition is a risk factor for OM. There are many national programs in India, such as Reproductive and Child Health Programme, Integrated Management of Neonatal and Childhood Illness, Integrated Child Development Services scheme, and Midday Meal Programme, but still 47% of children under 5 years in India are malnourished as reported by National Family Health Survey (NFHS-3) survey.[26] Damor Raman et al.[27] also reported 54% of malnourished children in under 5 years.

The incidence of underweight, wasting, and stunting among the study population was 34.31%, 17.65%, and 58.82%, respectively. Rao et al.[28] reported the prevalence of severe (Z-score < −3) underweight, stunting, and wasting were 11.9%, 34.5%, and 9.2%, respectively. These figures were comparable with the findings which are higher than the findings among under-five children in Kolkata done by Biswas et al.[29]

The percentage of children who were underweight (34.4%) is less as compared to the national level statistics as per NFHS-3 (43% underweight, 20% wasted, 48% stunted).[26] The percentage of children who were underweight (34.4%) is less as compared to similar studies carried out in other parts of the country (Bagalkot 65.4%) Das et al. reported at Bagalkot.[30]

The incidence of wasting in our study was 17.6% which was comparable with national and state level NFHS-3 data [26] and also with similar studies carried out in other parts of the country like Mumbai (17%) as reported by NHFS-2.[26] Studies carried out in Bagalkot (32.5%) by Badami et al.[31] and Ludhiana (42%) as reported by Sengupta et al.[32] revealed a high prevalence of wasting.

In our study, the incidence of stunting was 58.8%. It is higher than reported in the NFHS-3 which was 48%.[26] Similar studies conducted in Mumbai (47%), Punjab (16.7%), and Qatar (4.4%) noted lower prevalence of stunting as compared to the present study.[33],[34] Stunting reported in studies done by Badami et al.[31] in Bagalkot was 72.7%, done by Sengupta et al.[32] in Ludhiana was 74% and done by Soumyajit et al.[35] in West Bengal was 50.9%. Stunting is mainly the indicator of chronic malnutrition.[36]

It is comparable and also higher than reported in our study which could be explained by the migrant nature of the population, low socioeconomic status and also differences in methodology and standard used for assessment of nutritional status. This is also explained by respiratory tract or ear infections in our study because of family food insecurity inadequate care of vulnerable household members (e.g., “unfair” sharing of food within families), unhygienic living conditions (e.g., poor water supplies and poor sanitation) and inadequate health services.


  Conclusion Top


The present prospective cross-sectional study was carried out at Department of ENT, Era's Lucknow Medical College, Lucknow. Of 851 cases, 510 cases were found to be malnourished, i.e., 59.9%. OM has a strong positive association with malnutrition (P < 0.001). We aimed to reinforce an interdisciplinary approach with the Department ENT and Pediatrics for the earlier diagnosing patients of OM by establishing a positive association between the OM and malnutrition. Furthermore, if we can prevent the predisposing factors we could lessen the burden and incidence of its complication.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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