Clinical and demographic risk factors associated with chronic suppurative otitis media

https://doi.org/10.1016/j.ijporl.2007.06.005Get rights and content

Summary

Background

The incidence of chronic suppurative otitis media (CSOM) is high worldwide but increasing occurrence of complications appear peculiar to West Africa. However, knowledge of associated risk factors is sparse, we report the sociodemographic risk factors of CSOM with the aim of control of the disease and complications; and possible preventive strategies.

Method

This is a survey of children with CSOM in five sites spread in two suburban cities in two states in Nigeria. Questionnaire was administered on the informants followed by examination of the children.

Result

Of the 189 children, 114 (60%) had developed ear suppuration before 6 months of age, the number of attacks within the previous 18 months ranged between 2–12 with average of 7. Sociodemographic risk factors included low socioeconomic class in 153 (81%), 136 (72%) live in congested houses with more than 10 people and 79 (42%) belonged to families with more than 5 children. Indoor-cooking and infant daycare attendance were 117 (62%) while supine bottlefeeding was 115 (61%) and 34 (18%) of subjects had smoking father.

The clinical risk factors were upper respiratory tract infection (URI) 85 (45%), allergy 53 (28%), adenoid 54 (28%) and malnutrition 65 (34%).

The univariate analysis revealed that low social class (OR = 7.33, CI = 4.18–12.83, P = 0.0001), malnutrition (OR = 3.57, CI = 1.88–6.76, P = 0.00001), bottlefeeding (OR = 2.93, CI = 1.63–5.28, P = 0.0001), indoor-cooking (OR = 1.35, CI = 0.88–2.10, P = 0.161) and high number of people in a household (OR = 0.59, CI = 0.34–0.98, P = 0.04) are significant in development of OM; while multivariate logistic regression analysis showed malnutrition (OR = 3.48, CI = 1.633–7.425, P = 0.001), low social status (OR = 7.74, CI = 4.15–14.43, P = 0.0001) and indoor-cooking (OR = 2.34, CI = 1.18–4.66, P = 0.014), second table. Parental smoking, daycare attendance, allergy, adenoiditis/adenoidal hypertrophy and upper respiratory tract infection were not found significant.

Conclusion

Low socioeconomic class, malnutrition, congestion from high number of children in the household and bottlefeeding constitute significant risk factor. The early onset of disease (<6 months) may suggest a prenatal predisposition. We need further research for the understanding of the biologic effect of these factors while this remains a database for prevention and control of disease.

Introduction

Otitis media is the most common illness for which children receive medical care in the United States and in most parts of the world. Epidemiological studies reported a 90% incidence in children under 2 years of age [1], [2] and 60% in preschool attendees [3]. In Nigeria, the prevalence is 21.2% in children and accounted for 25% of patient attendance at the otorhinolaryngologic clinic [4], [5]. Despite this high prevalence, knowledge of the risk factors of OM in Nigeria and other developing countries is still scanty. We report the sociomedical risk factors in children with chronic otitis media looking at the peculiarity of the developing environment and to create a baseline data for use in control or eradication of the disease.

Section snippets

Method

This is a survey of the risk factors in children with chronic recurrent suppurative otitis media presenting to the hospital. For the purpose of this study, we refer to the definition of CSOM as chronic perforation with inflammation of the middle ear persisting for more than 3 months [6]. The study took place in five hospitals in two states of the country: University College Hospital, a tertiary, referral centre for otorhinolaryngology in the country; two general hospitals and two primary health

Result

The study comprised of 189 children with chronic OM with tympanic membrane perforation, 112 males and 77 females; and 100 controls. The age ranged between 30 days to 14 years.

Of these, persistent active otorrhoea was found at the time of examination in 184 (97.4%), 114/189 (60%) had developed ear suppuration before 6 months of age, the number of attacks within 18 months ranged between 2–12 with average of 7. Conductive hearing loss was seen in 100 (52.9%) of subjects and 18 (18%) of controls.

Discussion

The risk factors of childhood chronic otitis media have been reported in the developed countries, this report is an attempt at documenting such in suburban West African setting. The content of our questionnaire is similar to that of the Minnesotta OM Research Group [7] however our sample size is smaller, this could be due to difficulty in reaching out to colleagues in the country, secondly, we adjusted the questionnaire to fit the local situation wherein the study was carried out particularly

References (32)

  • C.D. Bluestone

    Studies in Otitis Media: Children's Hospital of Pittsburgh-University of Pittsburgh Progress Report

    Laryngoscope

    (2004)
  • Office of population censuses and surveys, Classification of occupations, HMSO, London,...
  • K.A. Daly et al.

    Knowledge and attitudes about otitis media risk: implications for prevention

    Pediatrics

    (1997)
  • P. Kum-Nji et al.

    Environmental tobacco smoke exposure: prevalence and mechanisms of causation of infections in children

    Pediatrics

    (2006)
  • K.A. Daly et al.

    Early otitis media among Minnesota American Indians: the little ear study

    Am. J. Public Health

    (2007)
  • J.L. da Costa et al.

    Household wood and charcoal smoke increases the risk of otitis media in childhood in Maputo

    Int. J. Epidemiol.

    (2004)

    • Cited by (0)

    View full text
    Copyright © 2007 Elsevier Ireland Ltd. All rights reserved.