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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 24  |  Issue : 4  |  Page : 223-226

Prevalence of chronic suppurative otitis media in schoolgoing children


Department of ENT&HNS, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh, India

Date of Web Publication15-Mar-2019

Correspondence Address:
Dr. Hamjol Singh Chakkal
House No. 1185, Sector 34-C, Near Gurudwara, Chandigarh - 160 022
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_152_17

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  Abstract 


Introduction: Chronic suppurative otitis media (CSOM) is a major health problem throughout the world in underdeveloped and developing countries including India. The high prevalence of CSOM in school children in India has led us to undertake this study in schoolgoing children of rural and urban areas of Muzaffarnagar, Uttar Pradesh and to find out the various predisposing factors for the development of CSOM. Objectives: The objective is to find out the prevalence of CSOM in schoolgoing children of the rural and urban population about age, sex, and socioeconomic status. Materials and Methods: Students were randomly selected from primary schools in rural and urban areas of Muzaffarnagar, Uttar Pradesh. Cases selected was categorized in relation to age, sex, socioeconomic status, and prevalence of the safe and unsafe type of CSOM. Observations: In the present study, a cross-sectional survey was conducted in 2158 school children between the age group of 5 and 15 years. A total of 1161 children belonged to urban school whereas 997 children were from three adjacent rural government schools. A total of 78 children were found to be suffering from either unilateral or bilateral CSOM. Conclusion: The prevalence of CSOM in urban school children was 2.32%, while for rural children, it was 5.11%. 42.10% of cases of CSOM belonged to upper-lower socioeconomic group followed by lower middle group (31.57%). The tubotympanic disease was present in 87.18% of CSOM cases while 12.82% had atticoantral disease. Active CSOM was found amongst 37.18% while 62.82% had inactive disease. 42.10% had smoking father, 36.84% had indoor cooking with kerosene oil exposure, and 34.21% used unhygienic ear cleaning methods. 31.58% had a history of recurrent URI, 28.95% had chronic tonsillitis, and 21.05% of children had domain name system as associated findings with CSOM.

Keywords: Chronic suppurative otitis media, prevalence, rural and urban schools, school children


How to cite this article:
Parmar SM, Sood A, Chakkal HS. Prevalence of chronic suppurative otitis media in schoolgoing children. Indian J Otol 2018;24:223-6

How to cite this URL:
Parmar SM, Sood A, Chakkal HS. Prevalence of chronic suppurative otitis media in schoolgoing children. Indian J Otol [serial online] 2018 [cited 2019 Mar 21];24:223-6. Available from: http://www.indianjotol.org/text.asp?2018/24/4/223/254227




  Introduction Top


Chronic suppurative otitis media (CSOM) is a major health problem throughout the world in underdeveloped and developing countries including India. The WHO defines CSOM as “a stage of ear disease in which there is a chronic infection of the middle ear cleft i.e.,  Eustachian tube More Details, middle ear, and mastoid, and in which a nonintact tympanic membrane (e.g., perforation or tympanostomy tube) and discharge (otorrhea) are present.[1]

The disease usually begins in childhood as a spontaneous tympanic membrane perforation due to an acute infection of the middle ear, known as acute OM (AOM), or as a squeal of the less severe form of OM, i.e., secretory OM.[2],[3]

In India, also CSOM is the most important cause of deafness and occupies a considerable amount of clinic and operating time of otolaryngologists. Although imminently preventable, the progression from a benign upper respiratory tract infection (URTI) to an AOM with perforation and recurring/persistent infection (CSOM) leading ultimately to hearing loss is depressingly quite common in rural areas of India.[4]

The high prevalence of CSOM in school children in India has led us to undertake this study in schoolgoing children of rural and urban areas of Muzaffarnagar, Uttar Pradesh and to find out the various predisposing factors for the development of CSOM.

Ghosh and Dubey[5] found that in comparison to nonsuppurative OM the incidence of CSOM is no less in developing countries due to lack of consciousness, low socioeconomic status, and increased susceptibility to upper respiratory tract infections.

Verma et al.[4] conducted a study involving 613 children in a village in Haryana in which 94 (15.3%) of children were observed to have CSOM. About 61.7% of children had hearing impairment. CSOM contributed to 71.6% of the hearing impaired. On analysis of the association of CSOM with literacy and socioeconomic status of mothers and age, sex, and URTI in children positive correlation was observed only with URTIs (P < 0.001).

Tuli et al.[6] reported that the prevalence of deafness in rural areas is almost double that observed in urban areas, attributing it to unmanaged URTI, consequent on the low level of literacy and lack of health consciousness, along with contributing factors such as malnutrition and swimming in dirty ponds. Simple parental education in rural cleaning, avoidance of entry of water into the ears, and appropriate management of URTIs can bring down the frequency of CSOM.

Adhikari et al.[7] conducted cross-sectional study among 1070 school children aged between 5 and 12 years of Kathmandu district. They found the prevalence of CSOM to be 5.4%. The unilateral disease was seen in 79.3% and 96.5% had a tubotympanic disease.

Aims and objectives

  1. To find out the prevalence of CSOM in schoolgoing children of the rural and urban population about age, sex, and socioeconomic status
  2. To study the prevalence of safe and unsafe types of CSOM in schoolgoing children
  3. To evaluate the predisposing factors for the development of CSOM
  4. For building up of health awareness in the community through the school children.



  Materials and Methods Top


Students were randomly selected from primary schools in rural and urban areas of Muzaffarnagar, Uttar Pradesh. Help of school teachers were taken in conducting the survey. History regarding any discharge from the ears, history of deafness or any other relevant history was taken.

Discharge from ear present if any, was cleaned. Otoscopic examination was done and record of pathology found was maintained. Pure tone audiometry was conducted, if needed. History regarding predisposing/contributing factors and socioeconomic status was taken.

Cases selected was categorized in relation to age, sex, socioeconomic status, and prevalence of the safe and unsafe type of CSOM.

Record of clinical risk factors and predisposing factors was made and categorized.

Inclusion criteria

  1. Cases of CSOM
  2. Age group between 5 and 15 years.


Exclusion criteria

  1. Cases with traumatic perforation of tympanic membrane
  2. Deaf and Mute schools will be excluded from the study.


Observations

In the present study, a cross-sectional survey was conducted in 2158 school children between the age group of 5 and 15 years. Students were examined from government schools in rural and urban areas of Muzaffarnagar district, Muzaffarnagar. Otoscopy examination was done followed by detailed ENT examination of the cases with CSOM. Various observations were analyzed statistically.


  Results Top


A total of 78 students were found to have CSOM. Out of 1161 students examined in urban school, CSOM was present in 27 students (2.32%), whereas in rural schools, CSOM was present in 51 out of 997 students examined (5.11%). Hence, CSOM was found to be more prevalent in rural school children as compared to urban school children [Table 1].
Table 1: Distribution of children by chronic suppurative otitis media

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The socioeconomic status was calculated according to the modified Kuppuswamy socioeconomic status scale proposed by the Government of India, which takes into account education, occupation and income. Majority of the cases belonged to upper-lower (42.10%) and lower-middle (31.57%) class families [Table 2].
Table 2: Socioeconomic status

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Major factors were smoking habits of the father (42.10%) and indoor cooking with kerosene oil (36.84%) [Table 3].
Table 3: Sociodemographic risk factors associated with chronic suppurative otitis media (n=78)

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Major factors associated are upper respiratory infection (URI) followed by, chronic tonsillitis and chronic adenotonsillitis [Table 4].
Table 4: Clinical risk factors associated with chronic suppurative otitis media (n=78)

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  Discussion Top


Tubotympanic type of disease

In our study, most of our school children (87.18%) had a tubotympanic type of disease which was in between the findings of Olubanjo and Amusa (2008)[8] 83.7% and Olatoke et al. (99%)[9] because factors prevalent are more prone to cause tubotympanic type of disease. Kamal et al.,[10] Adhikari et al.[11] in their studies showed the prevalence of tubotympanic disease as 73.4% and 76%, respectively.

Prevalence of chronic suppurative otitis media

In the present study, the prevalence of CSOM was found to be 2.32% in urban school children and 5.11% in rural school children. As compared to others studies: Olatoke et al. (2008)[9] prevalence in rural schools with 6.0%. Kamal et al.[10] in their study showed prevalence in rural schools 7.3%. Adhikari et al.[11] in their study showed prevalence in urban school 4.8% and rural schools are 5.7%.

Unilateral disease

In our study, unilateral disease with central perforation was more common compared to bilateral disease. This agrees with other existing literature, which had reported similar findings. The prevalence of the unilateral disease is believed to be good as it proffers a better prognosis in limiting the risk of disability from accompanying hearing loss than for bilateral disease. In our study, unilateral disease was found amongst 78.95% of participants, which was in comparison with the findings of Maharjan et al. (67.24%),[12] Adhikari et al. 2009 (81.5%),[11] and Olatoke et al. (2002)[9] 79.5%.


  Summary and Conclusion Top


The present study was conducted in one urban school and three rural government schools of Muzaffarnagar District to find out the prevalence of CSOM in children. A total of 2158 schoolgoing children in the age group of 5–15 years were serially examined with the help of hand-held portable otoscope. 1161 children belonged to urban school whereas 997 children were from three adjacent rural government schools.

A total of 78 children were found to be suffering from either unilateral or bilateral CSOM.

  • The prevalence of CSOM in urban school children was 2.32%, while for rural children, it was 5.11%
  • 42.10% of cases of CSOM belonged to upper-lower socioeconomic group followed by lower middle group (31.57%)
  • The tubotympanic disease was present in 87.18% of CSOM cases while 12.82% had atticoantral disease
  • Active CSOM was found amongst 37.18% while 62.82% had inactive disease
  • 42.10% had smoking father, 36.84% had indoor cooking with kerosene oil exposure, and 34.21% used unhygienic ear cleaning methods
  • 31.58% had a history of recurrent URI, 28.95% had chronic tonsillitis, and 21.05% of children had domain name system as associated findings with CSOM.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO/CIBA Foundation Workshop. Prevention of Hearing Impairment from Chronic Otitis Media. WHO/PDH/98.4. London: CIBA Foundation; 1996.  Back to cited text no. 1
    
2.
Daly KA, Hunter LL, Levine SC, Lindgren BR, Giebink GS. Relationships between otitis media sequelae and age. Laryngoscope 1998;108:1306-10.  Back to cited text no. 2
    
3.
Tos M. Sequelae of secretory otitis media and the relationship to chronic suppurative otitis media. Ann Otol Rhinol Larngol 1990;99 Suppl 146:18-9.  Back to cited text no. 3
    
4.
Verma AK, Vohra A, Maitra A, Banerjee M, Singh R, Mittal SK, et al. Epidemiology of chronic suppurative otitis media and deafness in a rural area and developing an intervention strategy. Indian J Pediatr 1995;62:725-9.  Back to cited text no. 4
    
5.
Ghosh LM, Dubey SP. Paediatric myringoplasty in India. Auris, nasus, larynx. Int J Paediatric Otolaryngology 1991;18:209-13.  Back to cited text no. 5
    
6.
Tuli BS, Parmar TL, Kumar S. Incidence of deafness in school going children. Indian J Otol 1988;40:137-8.  Back to cited text no. 6
    
7.
Adhikari P, Sinha BK, Pokharel NR, Kharel B, Arya R. Prevalence of chronic suppurative otitis media in school children of Kathmandu district. International archives of otorhinolaryngology 2007;29.  Back to cited text no. 7
    
8.
Olubanjo OO, Amusa YB. Epidemiology of chronic suppurative otitis media in Nigerian children. The Internet Journal of Otorhinolaryngology 2008;7(2).  Back to cited text no. 8
    
9.
Olatoke F, Ologe FE, Nwawolo CC, Saka MJ. The prevalence of hearing loss among schoolchildren with chronic suppurative otitis media in Nigeria, and its effect on academic performance. Ear Nose Throat J 2008;87:E19.  Back to cited text no. 9
    
10.
Kamal N, Joarder AH, Chowdhury AA, Khan AW. Prevalence of chronic suppurative otitis media among the children living in two selected slums of Dhaka city. Bangladesh Med Res Counc Bull 2004;30:95-104.  Back to cited text no. 10
    
11.
Adhikari P, Joshi S, Baral D, Kharel B. Chronic suppurative otitis media in urban private school children of Nepal. Braz J Otorhinolaryngol 2009;75:669-72.  Back to cited text no. 11
    
12.
Maharjan M, Bhandari S, Singh I, Mishra SC. Prevalence of otitis media in school going children in Eastern Nepal. Kathmandu Univ Med J (KUMJ) 2006;4:479-82.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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