1
|
Gupta A, Thai A, Santa Maria PL. Epidemiology of Chronic Suppurative Otitis Media in the United States. Ann Otol Rhinol Laryngol 2024:34894241257103. [PMID: 38822732 DOI: 10.1177/00034894241257103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
OBJECTIVE This study aimed to evaluate the prevalence, incidence, and associated demographic factors of chronic suppurative otitis media (CSOM), utilizing a nationwide healthcare claims database. METHODS This retrospective study utilized outpatient administrative claims data from the IBM MarketScan Research Database from 2007 to 2021. The database (11 246 909 584 claims with 148 147 615 unique patients) includes health data from the private-sector, Medicare/Medicaid, managed care providers, and EMR providers. Included patients had a diagnosis of CSOM based on ICD-9-CM and ICD-10-CM codes. Prevalence and health utilization were estimated by age, gender, and geographic region. RESULTS In the United States, the estimated CSOM prevalence and incidence was 0.46% and 0.03%, respectively. Among CSOM patients (n = 679 906), mean age (SD) was 8.1 (15.4) years, and 52.8% were male. Most patients (81.1%) were aged 0 to 10 years. CSOM prevalence was lower in females (OR = 0.64, 95% CI 0.64-0.65, P < .001), less common in older age (OR = 0.94, 95% CI 0.94-0.94, P < .001), and highest in the South region (OR = 2.08, 95% CI 2.06-2.09, P < .001). CONCLUSION Our results show CSOM prevalence (0.46%) is similar to other developed countries. CSOM prevalence was highest in those aged 0 to 10 years, in males and in the South region. Of note, prevalence and cost are likely significantly underestimated given limitations in accurate ICD-CM coding and the exclusion of uninsured patients. Further epidemiological studies are warranted to characterize the impact of CSOM on the US healthcare system.
Collapse
Affiliation(s)
- Ankur Gupta
- University of Louisville School of Medicine, Louisville, KY, USA
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Anthony Thai
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter Luke Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
2
|
Bhutta MF, Leach AJ, Brennan-Jones CG. Chronic suppurative otitis media. Lancet 2024; 403:2339-2348. [PMID: 38621397 DOI: 10.1016/s0140-6736(24)00259-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/12/2023] [Accepted: 02/08/2024] [Indexed: 04/17/2024]
Abstract
Chronic suppurative otitis media (CSOM) is a leading global cause of potentially preventable hearing loss in children and adults, associated with socioeconomic deprivation. There is an absence of consensus on the definition of CSOM, which complicates efforts for prevention, treatment, and monitoring. CSOM occurs when perforation of the tympanic membrane is associated with severe or persistent inflammation in the middle ear, leading to hearing loss and recurrent or persistent ear discharge (otorrhoea). Cholesteatoma, caused by the inward growth of the squamous epithelium of the tympanic membrane into the middle ear, can also occur. The optimal treatment of discharge in CSOM is topical antibiotics. In resource-limited settings where topical antibiotics might not be available, topical antiseptics are an alternative. For persistent disease, surgery to repair the tympanic membrane or remove cholesteatoma might offer long-term resolution of otorrhoea and potential improvement to hearing. Recent developments in self-fitted air-conduction and bone-conduction hearing aids offer promise as new options for rehabilitation.
Collapse
Affiliation(s)
- Mahmood F Bhutta
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK; Department of ENT, Royal Sussex County Hospital, Brighton, UK.
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Darwin, NT, Australia
| | - Christopher G Brennan-Jones
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Ear Health Group, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
3
|
Heward E, Saeed H, Bate S, Rajai A, Molloy J, Isba R, Ashcroft DM, Hay AD, Nichani JR, Bruce IA. Risk factors associated with the development of chronic suppurative otitis media in children: Systematic review and meta-analysis. Clin Otolaryngol 2024; 49:62-73. [PMID: 37794685 DOI: 10.1111/coa.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 08/08/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES Chronic suppurative otitis media (CSOM) is defined as persistent discharge through a tympanic membrane perforation for greater than 2 weeks. It is associated with a significant disease burden, including hearing loss, and reducing its incidence could significantly improve short- and long-term health. We aimed to identify risk factors associated with the development of CSOM in children. DESIGN AND SETTING Systematic review and meta-analysis of studies set in community, primary and secondary care settings, identified from Medline, Embase and Cochrane databases from 2000 to 2022. PARTICIPANTS Children 16 years old and below. MAIN OUTCOME MEASURES Clinical diagnosis of CSOM. RESULTS In total, 739 papers were screened, with 12 deemed eligible for inclusion in the systematic review, of which, 10 were included in the meta-analysis. Risk factors examined included perinatal, patient, dietary, environmental and parental factors. Meta-analysis results indicate that atopy (RR = 1.18, 95% CI [1.01-1.37], p = .04, 2 studies); and birth weight <2500 g (RR = 1.79 [1.27-2.50], p < .01, 2 studies) are associated with an increased risk of CSOM development. Factors not associated were male sex (RR = 0.96 [0.82-1.13], p = .62, 8 studies); exposure to passive smoking (RR = 1.27 [0.81-2.01], p = .30, 3 studies); and parental history of otitis media (RR = 1.14 [0.59-2.20], p = .69, 2 studies). CONCLUSION Optimal management of risk factors associated with CSOM development will help reduce the burden of disease and prevent disease progression or recurrence. The current quality of evidence in the literature is variable and heterogeneous. Future studies should aim to use standardised classification systems to define risk factors to allow meta-analysis.
Collapse
Affiliation(s)
- Elliot Heward
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Haroon Saeed
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sebastian Bate
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Azita Rajai
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Molloy
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Rachel Isba
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Lancaster University, Health Innovation One, Lancaster, UK
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jaya R Nichani
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Iain A Bruce
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| |
Collapse
|
4
|
Mathema L, Adhikari A, Poudyal P, Chalise GB, Chaudhary P, Khatri B. Chronic Otitis Media among Patients Visiting Community-Based Static Outreach Clinics. JNMA J Nepal Med Assoc 2023; 61:923-926. [PMID: 38289754 PMCID: PMC10792720 DOI: 10.31729/jnma.8369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Chronic otitis media is a chronic inflammation of the middle ear and mastoid cavity, with recurrent ear discharges or otorrhoea through a tympanic perforation for the past 3 months. It is a common cause of hearing impairment, disability, and poor scholastic performance and can lead to fatal intracranial infections and acute mastoiditis. This study aimed to find out the prevalence of chronic otitis media among patients visiting community-based static outreach clinics. Methods A descriptive cross-sectional study was conducted among patients visiting the community-based static outreach clinics from 1 January 2017 to 31 December 2019. The ethical approval was taken from the Ethical Review Board. The diagnosis of chronic otitis media was done using otoscopy. The records of patients coming to outreach clinics visiting for ear, nose and throat care were reviewed using a pre-designed study proforma. A systematic random sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Among 385 patients, 37 (9.61%) (6.67-12.55, 95% Confidence Interval) had chronic otitis media. The mean age of patients with chronic otitis media was 27.59±13.24 years, with 28 (75.67%) patients aged between 18-60 years. Among them, 30 (81.08%) had unilateral and 34 (91.89%) had a mucosal type. Conclusions The prevalence of chronic otitis media was lower than in other studies done in similar settings. Keywords community health services; otitis media; patients; prevalence.
Collapse
Affiliation(s)
- Luna Mathema
- Department of Otolaryngology & HNS, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Arun Adhikari
- Department of Otolaryngology & HNS, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Prasanta Poudyal
- Department of Otolaryngology & HNS, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Ganesh Bahadur Chalise
- Department of Otolaryngology & HNS, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Preeti Chaudhary
- Department of Otolaryngology & HNS, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| | - Bijay Khatri
- Academic and Research Department, B.P. Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Madhyapur Thimi, Bhaktapur, Nepal
| |
Collapse
|
5
|
Kesari SP, Paul S, Dey R. To Study the Burden and Risk Factors for Chronic Suppurative Otitis Media in a Population of Sikkim, India: A Hospital Based Study. Indian J Otolaryngol Head Neck Surg 2022; 74:4117-4124. [PMID: 36742467 PMCID: PMC9895629 DOI: 10.1007/s12070-021-02855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/08/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic suppurative otitis media (CSOM) denotes a chronic inflammation of the middle ear and mastoid mucosa in which the tympanic membrane is not intact and discharge is present (Verhoeff et al. in Int J Pediatr Otorhinolaryngol 70:1-12, 2006). The risk factors for the development of CSOM have not been clearly established in the available literature. Risk factors of COM include low socioeconomic status, malnutrition, high number of children in the household, family history, and passive exposure to smoking (Lasisi et al. in Int J Pediatr Otorhinolaryngol 71:1549-1554, 2007). The effects of various host and environmental factors have not been well defined. There are very few studies to assess the risk factors and disease burden in the community. The study aims to estimate the disease burden of CSOM in the state of Sikkim which would help in effective treatment and control of the disease. This study which is the first of its kind in Sikkim would help us in identification of risk factors which could be present in the Sikkimese population and this could be attributed to ethnic as well as unique geographical factors of this place. Observational study where all Sikkimese patients reporting to ENT with ENT complaints were included after taking consent, The information was noted in a specific questionnaire and all patient were subjected to Otoscopic examination. Analyses using SPSS 17.00. A total of 497 subjects had participated in the study and all the relevant data has been categorized and tabulated according to the requirements of the study.
Collapse
Affiliation(s)
- Santosh Prasad Kesari
- Department of ENT, Sikkim Manipal University, Sikkim Manipal Institute of Medical Sciences, 5th Mile Tadong, Gangtok, Sikkim 737102 India
| | - Sampriti Paul
- Sikkim Manipal University, SMIMS, Gangtok, Sikkim India
| | - Ruby Dey
- Department of Physiology, Sikkim Manipal University, SMIMS, Gangtok, Sikkim India
| |
Collapse
|
6
|
Sanyang B, de Silva TI, Kanteh A, Bojang A, Manneh J, de Steenhuijsen Piters WA, Peno C, Bogaert D, Sesay AK, Roca A. Effect of intra-partum azithromycin on the development of the infant nasopharyngeal microbiota: A post hoc analysis of a double-blind randomized trial. EBioMedicine 2022; 83:104227. [PMID: 35988464 PMCID: PMC9420482 DOI: 10.1016/j.ebiom.2022.104227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Sepsis is a leading cause of neonatal death. Intrapartum azithromycin reduces neonatal nasopharyngeal carriage of potentially pathogenic bacteria, a prerequisite for sepsis. Early antibiotic exposure has been associated with microbiota perturbations with varying effects. This study aims to understand the effect of intrapartum azithromycin intervention on the developing nasopharyngeal microbiota of the child. Methods Using 16S rRNA gene sequencing, we analysed the microbiota of 343 nasopharyngeal samples collected from birth to 12 months from 109 healthy infants selected from a double-blind randomized placebo-controlled clinical trial conducted in the Gambia (PregnAnZI-1). In the trial, 829 women were given 2g oral azithromycin or placebo (1:1) during labour with the objective of reducing bacterial carriage in mother and child during the neonatal period. The post-hoc analysis presented here assessed the effect of the intervention on the child nasopharyngeal microbiota development. Findings 55 children were from mothers given azithromycin and 54 from mothers given placebo. Comparing arms, we found an increase in alpha-diversity at day-6 (p = 0·018), and a significant effect on overall microbiota composition at days 6 and 28 (R2 = 4.4%, q = 0·007 and R2 = 2.3%, q = 0·018 respectively). At genus level, we found lower representation of Staphylococcus at day-6 (q = 0·0303) and higher representation of Moraxella at 12 months (q = 0·0443). Unsupervised clustering of samples by microbial community similarity showed different community dynamics between the intervention and placebo arms during the neonatal period. Interpretation These results indicate that intrapartum azithromycin caused short-term alterations in the nasopharyngeal microbiota with modest overall effect at 12 months of age. Further exploration of the effects of these variations on microbiome function will give more insight on the potential risks and benefits, for the child, associated with this intervention. Funding This work was jointly funded by the Medical Research Council (UK) (MC_EX_MR/J010391/1/MRC), Bill & Melinda Gates Foundation (OPP1196513), and MRCG@LSHTM Doctoral Training Program.
Collapse
|
7
|
Peace O, Rachakonda K, Kress M, Villalta F, Rachakonda G. Respiratory and Neurological Disease across Different Ethnic Groups Is Influenced by the Microbiome. Microorganisms 2021; 9:1965. [PMID: 34576860 PMCID: PMC8468464 DOI: 10.3390/microorganisms9091965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/20/2021] [Accepted: 09/09/2021] [Indexed: 12/15/2022] Open
Abstract
Acute and chronic upper respiratory illnesses such as asthma, and allergic rhinitis (AR) have been linked to the presence of microorganisms in the nose. Microorganisms can exist in symbiotic or commensal relationships with the human body. However, in certain cases, opportunistic pathogens can take over, leading to altered states (dysbiosis) and causing disease. Thus, the microflora present in a host can be useful to reflect health status. The human body contains 10 trillion to 100 trillion microorganisms. Of these populations, certain pathogens have been identified to promote or undermine wellbeing. Therefore, knowledge of the microbiome is potentially helpful as a diagnostic tool for many diseases. Variations have been recognized in the types of microbes that inhabit various populations based on geography, diet, and lifestyle choices and various microbiota have been shown to modulate immune responses in allergic disease. Interestingly, the diseases affected by these changes are prevalent in certain racial or ethnic populations. These prevalent microbiome variations in these groups suggest that the presence of these microorganisms may be significantly associated with health disparities. We review current research in the search for correlations between ethnic diversity, microbiome communities in the nasal cavity and health outcomes in neurological and respiratory functions.
Collapse
Affiliation(s)
- Odiase Peace
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville, TN 37208, USA; (O.P.); (F.V.)
| | - Kartik Rachakonda
- School of Arts and Science, Vanderbilt University, Nashville, TN 37212, USA;
| | - Miller Kress
- División of Molecular Diagnosticas, Phase2Labs, Nashville, TN 37217, USA;
| | - Fernando Villalta
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville, TN 37208, USA; (O.P.); (F.V.)
| | - Girish Rachakonda
- Department of Microbiology, Immunology and Physiology, Meharry Medical College, Nashville, TN 37208, USA; (O.P.); (F.V.)
| |
Collapse
|
8
|
Pérez-Herrera LC, Peñaranda D, Moreno-López S, Otoya-Tono AM, Gutiérrez- Velasco L, García JM, Peñaranda A. Associated factors, health-related quality of life, and reported costs of chronic otitis media in adults at two otologic referral centers in a middle-income country. PLoS One 2020; 15:e0244797. [PMID: 33382816 PMCID: PMC7775072 DOI: 10.1371/journal.pone.0244797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background Despite the high prevalence of chronic otitis media (COM) in low to middle-income countries, there are few studies regarding its associated factors, health-related quality of life, and treatment costs. This study aimed to identify associated factors of COM, assess its impact on the quality of life as well as estimate the patients’ reported costs of COM treatment in Colombia. Methods Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Questionnaires focusing on sociodemographic and clinical associated factors, quality of life, and patients’ reported costs were administered to 200 adults with COM diagnosis and 144 control adults. Otoscopic evaluation and audiometric data were collected. Results The mean age was 42.2 years (SD: 14.44). The median length of COM was 26.13 years (SD: 17.06), and 79.5% of the COM patients reported otorrhea during childhood (P-value: 0.01). The most frequently reported allergic disease among our study population was allergic rhinitis (26.5%). COM was less frequent in patients with a medium-high socioeconomic status (PR: 0.54; 95% CI: 0.39–0.72), and more frequent in patients who reported increased ear discharge due to upper respiratory tract infections (PR: 1.69; 95% CI: 1.68–1.70). The global score of the “Chronic Suppurative Otitis Media Questionnaire-12” showed a difference of 9 points between patients with active and inactive COM (P < 0.001). Patients spent between 12.07% to 60.37% of their household income on expenses related to COM. Conclusions Associated factors found in this study are consistent with previous reports. COM has a significant financial impact and affects patients’ quality of life. Worldwide research addressing these issues in poor-resource countries is scarce, further studies are needed.
Collapse
Affiliation(s)
- Lucia C. Pérez-Herrera
- Otolaryngology and Allergology Research Groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- Faculty of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Daniel Peñaranda
- Otolaryngology Department, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Sergio Moreno-López
- Otolaryngology and Allergology Research Groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- Faculty of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Ana M. Otoya-Tono
- Otolaryngology Department, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | | | - Juan Manuel García
- Faculty of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Otolaryngology Department, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Otolaryngology Section, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Augusto Peñaranda
- Faculty of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Otolaryngology Section, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- * E-mail:
| |
Collapse
|
9
|
Yazdi MMK, Ghalavand Z, Yazdi AK, Kodori M, Taheri M, Tabriz MS, Eslami G. Chronic Suppurative Otitis Media: A Case Report. Infect Disord Drug Targets 2020; 20:244-246. [PMID: 32423374 DOI: 10.2174/1871526519666190228162001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND CONTEXT Chronic Suppurative Otitis Media (CSOM) is a common cause of hearing impairment and disability. CSOM caused by Pseudomonas aeruginosa is usually treated with topical ciprofloxacin and resistance to ciprofloxacin in CSOM isolates has rarely been reported. CASE PRESENTATION A 24-year-old male patient with CSOM due to p. aeruginosa was reported. CSOM was prolonged for ten years and physician prescribed topical ciprofloxacin drops, pus suctioning and ear pH alteration. The treatment wasn't effective and the patient came back to the clinic with relapse of suppurative otitis media. P. aeruginosa was isolated as the cause of CSOM and the isolate was resistant to ciprofloxacin, aztreonam, imipenem, gentamicin, doripenem, cefepime, levofloxacin, amikacin and susceptible to colistin and ceftazidime. There were two mutations in gyrA and eight mutations were observed in nfxB genes. Finally, tympanomastoidectomy was done. CONCLUSION Usually topical antibiotics, especially ciprofloxacin, is effective against ear infections but our case was different and the P. aeruginosa isolated from CSOM was resistant to most of the antibiotics. One reason for CSOM recurrence might be surgery failure. The routine and primary treatment for CSOM did not seem sufficient and tympanomastoidectomy is suggested to be the best treatment approach for these patients.
Collapse
Affiliation(s)
- M M Karimi Yazdi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Microbiology, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Ghalavand
- Department of Microbiology, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza K Yazdi
- Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Educational Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoor Kodori
- Department of Microbiology, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Taheri
- Department of Medical Biotechnology, Biotechnology Research Center, Pasteur Institute of Iran., Tehran, Iran
| | - Mahboobeh S Tabriz
- Motahhari Burn Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Eslami
- Department of Microbiology, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Clamp PJ, De-Loyde K, Maw AR, Gregory S, Golding J, Hall A. Factors associated with the development of paediatric chronic otitis media by age nine: a prospective longitudinal cohort study of 6560 children. J Laryngol Otol 2020; 134:1-12. [PMID: 33208197 DOI: 10.1017/s0022215120002182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to analyse social, health and environmental factors associated with the development of chronic otitis media by age nine. METHOD This was a prospective, longitudinal, birth cohort study of 6560 children, reviewed at age nine. Chronic otitis media defined as previous surgical history or video-otoscopic changes of tympanic membrane retraction, perforation or cholesteatoma. Non-affected children were used as the control group. RESULTS Univariate analysis demonstrated an association between chronic otitis media and otorrhoea, snoring, grommet insertion, adenoidectomy, tonsillectomy, hearing loss, abnormal tympanograms and preterm birth. Multivariate analysis suggests many of these factors may be interrelated. CONCLUSION The association between chronic otitis media and otorrhoea, abnormal tympanograms and grommets supports the role of the Eustachian tube and otitis media (with effusion or acute) in the pathogenesis of chronic otitis media. The role of snoring, adenoidectomy and tonsillectomy is unclear. Associations suggested by previous studies (sex, socioeconomic group, parental smoking, maternal education, childcare, crowding and siblings) were not found to be significant predictors in this analysis.
Collapse
Affiliation(s)
- P J Clamp
- Department of ENT, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, UK
| | - K De-Loyde
- School of Social and Community Medicine, University of Bristol, UK
| | - A R Maw
- School of Social and Community Medicine, University of Bristol, UK
| | - S Gregory
- School of Social and Community Medicine, University of Bristol, UK
| | - J Golding
- School of Social and Community Medicine, University of Bristol, UK
| | - A Hall
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Life and Health Sciences, Aston University, Birmingham, UK
| |
Collapse
|
11
|
Pedersen CK, Zimani P, Frendø M, Spindler NJ, Chidziva C, von Buchwald C, Jensen RG. Chronic suppurative otitis media in Zimbabwean school children: a cross-sectional study. J Laryngol Otol 2020; 134:1-5. [PMID: 33016257 DOI: 10.1017/s0022215120001814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Chronic suppurative otitis media is a major cause of disabling childhood hearing loss, especially in low-income countries. Estimates on its prevalence in sub-Saharan Africa range from the lowest to the highest in the world (less than one per cent to more than five per cent). However, the prevalence of chronic suppurative otitis media in Zimbabwe is largely unknown. This study aimed to determine the prevalence of paediatric chronic suppurative otitis media and other middle-ear pathology in rural Zimbabwe. METHOD A cross-sectional study was performed in primary school children aged 4-13 years from the rural province of Mashonaland East. Participants underwent video otoscopy and tympanometry. RESULTS Out of 451 examined children, two (0.4 per cent) had chronic suppurative otitis media. Acute otitis media was present in one (0.2 per cent), otitis media with effusion was present in five (1.1 per cent) and scarring was present in 69 (15.3 per cent). CONCLUSION Chronic suppurative otitis media and otitis media sequelae were surprisingly uncommon in this sample of rural primary school children in Zimbabwe. More studies, preferably population-based, are needed to enable more precise estimates of chronic suppurative otitis media prevalence in Zimbabwe.
Collapse
Affiliation(s)
- C K Pedersen
- Department of ENT Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - P Zimani
- Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
| | - M Frendø
- Department of ENT Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Denmark
| | - N J Spindler
- Department of ENT Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C Chidziva
- Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
| | - C von Buchwald
- Department of ENT Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - R G Jensen
- Department of ENT Surgery and Audiology, University Hospital Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
12
|
Samson D, Rupa V, Veeraraghavan B, Varghese R, Isaac R, L J. Follow up of a birth cohort to identify prevalence and risk factors for otitis media among Indian children in the eighth year of life. Int J Pediatr Otorhinolaryngol 2020; 137:110201. [PMID: 32658800 DOI: 10.1016/j.ijporl.2020.110201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/26/2020] [Accepted: 06/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Otitis media, a disease highly prevalent among children worldwide, manifests clinically in both acute and chronic forms. The manner and time at which chronicity develops among Indian children is unknown. AIM To study the prevalence, manifestations and risk factors for otitis media in a birth cohort aged 8 years. METHODS A birth cohort of 107 babies was followed up at 8 years of age and ENT evaluation with nasopharyngeal swabbing for detecting Streptococcus pneumoniae and Hemophilus influenzae was performed. RESULTS The overall prevalence of otitis media was 14%, almost half the prevalence in the first 2 years of life. Eight children (7.5%) with congested, bulging eardrums and no systemic symptoms had asymptomatic acute otitis media. Another five (4.7%) children had otitis media with effusion and 2 (1.9%) had chronic suppurative otitis media. Although 10/15 (66.7%) children with otitis media had positive swabs at 8 years age, only 2 were pneumococcal vaccine (PCV-13) serotypes. Risk factor analysis showed that passive smoking was the only significant parameter associated with otitis media (p = 0.029). Nasopharyngeal swabbing showed that 51/105 (48.6%) children had positive swabs for S. pneumoniae and 5/105 (4.8%) for S.pneumoniae with non-type b H. influenzae. The ten most commonly encountered pneumococcal serotypes were 6A,4,8,16F,33B,35A,35B, 18C, 19F and 23B which together comprised 29 of the 56 (51.8%) isolates. PCV-13 serotypes formed 19/56 (33.9%) to 21/56 (37.5%) of all pneumococcal isolates. Of 6 children who had received PCV-13, 4 tested positive for S. pneumoniae at 8 years of age too. However, none were vaccine serotypes. Four of those with otitis media who had positive swabs had received no immunisation at all and 3 of them had vaccine serotypes, viz. 4, 6A and 18C respectively. CONCLUSION Indian children continue to have a high prevalence of otitis media at 8 years age. More than 1/3 of nasopharyngeal isolates at this age are vaccine serotypes. Passive smoking is an important risk factor for childhood otitis media and may contribute to the development of chronicity of the disease.
Collapse
Affiliation(s)
- Divyan Samson
- Department of ENT, Christian Medical College, Vellore, India
| | - Vedantam Rupa
- Department of ENT, Christian Medical College, Vellore, India.
| | | | | | - Rita Isaac
- RUHSA, Christian Medical College, Vellore, India
| | - Jeyaseelan L
- Biostatistics, Christian Medical College, Vellore, India
| |
Collapse
|
13
|
Shekhar H, Khokhar A, Motwani G, Daral S. Prevalence of ear morbidities among school children in Delhi, India: a cross-sectional study. Int J Adolesc Med Health 2020; 34:289-295. [PMID: 32870808 DOI: 10.1515/ijamh-2020-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/28/2020] [Indexed: 11/15/2022]
Abstract
Objectives Hearing impairment and ear diseases are among the world's leading causes of years lived with disability. Ear disorders are a major health problem in developing countries like India. The present research had been planned to screen the primary school children for ear morbidity and to study the various factors associated with ear morbidities so that corrective intervention can be initiated at the earliest. Methods A cross-sectional study was conducted among all primary school children of two schools in Aliganj, Delhi. Complete enumeration of all the school children of these two primary schools was planned for this study. Modified version of World Health Organization's (WHO's) "Ten Question Plus" screening instrument was used, followed by Otoscopy examination, in all children for confirmation of ear disease, if any. Descriptive data analysis was performed. Results Out of the total 430 study subjects, ear morbidities were found in 198 (46.0%) study participants. Presence of ear morbidity showed significant association with overcrowding, absence of a separate kitchen, passive smoking, feeding young child in lying down position, upper respiratory tract infection (URI)˃3 episodes/year and allergy (p<0.05). Conclusions This study has highlighted the need to detect ear diseases at the earliest thereby avoiding complications. The health examination in the schools must include screening students for ear diseases to reduce the burden of hearing disability. Inputs from the study may be used for effective prioritization and planning for prevention and management of ear diseases at the primary school level.
Collapse
Affiliation(s)
- Himanshu Shekhar
- Department of Community Medicine, SKMCH, Muzaffarpur, Bihar, India
| | - Anita Khokhar
- Department of Community Medicine, VMMC & Safdarjung Hospital, New Delhi, India
| | - Gul Motwani
- Department of Otorhinolaryngology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Shailaja Daral
- Department of Community Medicine, VMMC & Safdarjung Hospital, New Delhi, India
| |
Collapse
|
14
|
Filipe M, Karppinen M, Kuatoko P, Reimer Å, Riesbeck K, Pelkonen T. Suppurative otitis media in Angola: clinical and demographic features. Trop Med Int Health 2020; 25:1283-1290. [PMID: 32677730 DOI: 10.1111/tmi.13466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the demographics and clinical findings in patients with otorrhoea in Angola. METHODS A total of 411 patients with otorrhoea presenting in the ear, nose and throat clinic in Luanda and healthcare centres in other Angolan provinces underwent interview and clinical examination. We describe the demographics and clinical characteristics of the patients. RESULTS The majority (64%) of patients were children <15 years (age ranged from 1 month to 77 years; median age 10.9 years) while 31% were children <5 years. In 83% of the patients, otorrhoea had lasted >14 days at the time of the examination indicating chronic suppurative otitis media (CSOM), which was confirmed with otoscopy in 72% of patients. Acute otitis media occurred in 16% of patients and was more common in children than in adults (22% vs. 10%; P = 0.007). Median duration of otorrhoea was >12 months. Earache (67%), fever (20%), dizziness (17%), nausea and/or vomiting (6%) were the main symptoms. Adult patients reported noticing hearing impairment (HI) more often than the parents of child patients (72% vs. 50%; P < 0.0001). Reported HI correlated with otorrhoea duration (P < 0.0001), presence of earache, dizziness, and measles or meningitis in history. The level of education in the family did not correlate with symptom duration. CONCLUSIONS Otorrhoea is mainly due to CSOM and affects patients long-term in Angola. Otorrhoea duration is the strongest predictor of HI. Education on OM and its treatment is needed to prevent HI.
Collapse
Affiliation(s)
- Matuba Filipe
- Department of Otorhinolaryngology, Hospital Josina Machel, Luanda, Angola.,Faculty of Medicine, Agostinho Neto University, Luanda, Angola
| | - Mariia Karppinen
- Department of Otorhinolaryngology, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Palmira Kuatoko
- Department of Otorhinolaryngology, Hospital Josina Machel, Luanda, Angola.,Faculty of Medicine, Agostinho Neto University, Luanda, Angola
| | - Åke Reimer
- ENT-outpatient Department, Slottsstadens Läkarhus, Malmö, Sweden
| | - Kristian Riesbeck
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Tuula Pelkonen
- Department of Pediatrics, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
15
|
Acute Otitis Media and Associated Complications in United States Emergency Departments. Otol Neurotol 2019; 39:1005-1011. [PMID: 30113560 DOI: 10.1097/mao.0000000000001929] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Complications due to acute otitis media (AOM), while rare, are associated with significant morbidity and are not well characterized from an epidemiological perspective. We analyze the pattern of presentation and emergency department (ED) utilization in patients with AOM and associated complications. STUDY DESIGN Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011. SETTING Emergency Department. PATIENTS Patients who presented with a primary diagnosis of AOM or acute mastoiditis. INTERVENTION Diagnostic. MAIN OUTCOME MEASURES NEDS was queried for patient encounters with a diagnosis of AOM or acute mastoiditis based on ICD-9 codes. Complications of severe infection, including petrositis, Gradenigo's syndrome, facial paresis, labyrinthitis, meningitis, intracranial abscess, venous sinus thrombosis, and cerebrospinal fluid leak, were assessed. Weighted estimates for demographics, types of complications, socioeconomic status, and trends over time were extracted. RESULTS A weighted total of 5,811,127 ED visits were identified. The majority of patients were less than 18 years old (79.9%) with an average age of 10.1 years. Most were discharged (99.4%). There were 15,243 (0.26%) patients who presented with a complication. The most common complications were acute mastoiditis (0.16%), labyrinthitis (0.06%), and facial paresis (0.03%). Compared with patients with uncomplicated AOM, patients with complicated AOM were older (37 vs. 10-yr old), insured by Medicare (18% vs. 2.1%), and more likely to be admitted (43.6% vs. 0.4%) (p < 0.0001, for all comparisons). CONCLUSIONS ED visits related to AOM or mastoiditis are common and complications are rare. An in-depth analysis on a national level is useful for assessing healthcare utilization trends.
Collapse
|
16
|
Dewan KK, Taylor-Mulneix DL, Campos LL, Skarlupka AL, Wagner SM, Ryman VE, Gestal MC, Ma L, Blas-Machado U, Faddis BT, Harvill ET. A model of chronic, transmissible Otitis Media in mice. PLoS Pathog 2019; 15:e1007696. [PMID: 30970038 PMCID: PMC6476515 DOI: 10.1371/journal.ppat.1007696] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/22/2019] [Accepted: 03/11/2019] [Indexed: 12/15/2022] Open
Abstract
Infection and inflammation of the middle ears that characterizes acute and chronic otitis media (OM), is a major reason for doctor visits and antibiotic prescription, particularly among children. Nasopharyngeal pathogens that are commonly associated with OM in humans do not naturally colonize the middle ears of rodents, and experimental models in most cases involve directly injecting large numbers of human pathogens into the middle ear bullae of rodents, where they induce a short-lived acute inflammation but fail to persist. Here we report that Bordetella pseudohinzii, a respiratory pathogen of mice, naturally, efficiently and rapidly ascends the eustachian tubes to colonize the middle ears, causing acute and chronic histopathological changes with progressive decrease in hearing acuity that closely mimics otitis media in humans. Laboratory mice experimentally inoculated intranasally with very low numbers of bacteria consistently have their middle ears colonized and subsequently transmit the bacterium to cage mates. Taking advantage of the specifically engineered and well characterized immune deficiencies available in mice we conducted experiments to uncover different roles of T and B cells in controlling bacterial numbers in the middle ear during chronic OM. The iconic mouse model provides significant advantages for elucidating aspects of host-pathogen interactions in otitis media that are currently not possible using other animal models. This natural model of otitis media permits the study of transmission between hosts, efficient early colonization of the respiratory tract, ascension of the eustachian tube, as well as colonization, pathogenesis and persistence in the middle ear. It also allows the combination of the powerful tools of mouse molecular immunology and bacterial genetics to determine the mechanistic basis for these important processes.
Collapse
Affiliation(s)
- Kalyan K. Dewan
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
- * E-mail:
| | - Dawn L. Taylor-Mulneix
- Center for Vaccines and Immunology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Laura L. Campos
- University of Colorado Hospital, Aurora, Colorado, United States of America
| | - Amanda L. Skarlupka
- Department of Microbiology, Franklin College of Arts and Sciences, University of Georgia, Athens, Georgia, United States of America
| | - Shannon M. Wagner
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Valerie E. Ryman
- Center for Vaccines and Immunology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Monica C. Gestal
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Longhua Ma
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Uriel Blas-Machado
- Department of Pathology, Athens Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| | - Brian T. Faddis
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Eric T. Harvill
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
- Center for Vaccines and Immunology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States of America
| |
Collapse
|
17
|
Bhutta MF, Thornton RB, Kirkham LAS, Kerschner JE, Cheeseman MT. Understanding the aetiology and resolution of chronic otitis media from animal and human studies. Dis Model Mech 2018; 10:1289-1300. [PMID: 29125825 PMCID: PMC5719252 DOI: 10.1242/dmm.029983] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Inflammation of the middle ear, known clinically as chronic otitis media, presents in different forms, such as chronic otitis media with effusion (COME; glue ear) and chronic suppurative otitis media (CSOM). These are highly prevalent diseases, especially in childhood, and lead to significant morbidity worldwide. However, much remains unclear about this disease, including its aetiology, initiation and perpetuation, and the relative roles of mucosal and leukocyte biology, pathogens, and Eustachian tube function. Chronic otitis media is commonly modelled in mice but most existing models only partially mimic human disease and many are syndromic. Nevertheless, these models have provided insights into potential disease mechanisms, and have implicated altered immune signalling, mucociliary function and Eustachian tube function as potential predisposing mechanisms. Clinical studies of chronic otitis media have yet to implicate a particular molecular pathway or mechanism, and current human genetic studies are underpowered. We also do not fully understand how existing interventions, such as tympanic membrane repair, work, nor how chronic otitis media spontaneously resolves. This Clinical Puzzle article describes our current knowledge of chronic otitis media and the existing research models for this condition. It also identifies unanswered questions about its pathogenesis and treatment, with the goal of advancing our understanding of this disease to aid the development of novel therapeutic interventions. Summary: Chronic middle ear inflammation is a common disease. Animal models, and in particular mouse models, have been used to elucidate some potential mechanisms, including dysfunction in immune signalling, mucociliary function or Eustachian tube function.
Collapse
Affiliation(s)
- Mahmood F Bhutta
- Department of ENT, Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 5BE, England .,Division of Paediatrics, University of Western Australia, Subiaco, WA 6008, Australia
| | - Ruth B Thornton
- Division of Paediatrics, University of Western Australia, Subiaco, WA 6008, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, WA 6008, Australia
| | - Lea-Ann S Kirkham
- Division of Paediatrics, University of Western Australia, Subiaco, WA 6008, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, WA 6008, Australia
| | - Joseph E Kerschner
- Office of the Dean, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Michael T Cheeseman
- Division of Developmental Biology, Roslin Institute, University of Edinburgh, Midlothian, EH23 9RG, Scotland
| |
Collapse
|
18
|
Lee DW, Oh SH, Park MK, Lim YH, Hong YC. Environmental cadmium exposure is associated with elevated risk of chronic otitis media in adults. Occup Environ Med 2018; 75:515-521. [DOI: 10.1136/oemed-2017-104631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 03/01/2018] [Accepted: 03/13/2018] [Indexed: 12/24/2022]
Abstract
ObjectivesChronic otitis media (COM) is caused by an infection of the middle ear, although it may also be associated with environmental pollutants. Recent reports found that cadmium exposure could be toxic to middle ear cell lines, but the role of cadmium in the development of COM in humans has not been examined to date. We hypothesised that environmental cadmium exposure was associated with an increased risk of COM in the general population.MethodsWe analysed cross-sectional data for 5331 adults of 20 years of age or above, obtained from the Korea National Health and Nutrition Examination Survey 2010–2012. We examined the association between blood cadmium levels and COM diagnosed by an otolaryngologist.ResultsThe highest quartile group of cadmium blood concentration was associated with an OR of 3.33 (95% CI 1.78 to 7.53) for COM, after adjusting for potential confounding factors. Doubling blood cadmium concentration resulted in an OR of 1.58 (95% CI 1.19 to 2.08) for COM. These associations were robust on sensitivity analyses after excluding current smokers and former smokers and after excluding subjects with a potential history of occupational exposure to cadmium.ConclusionsThe results of our study suggest that environmental cadmium exposure is associated with increased risk of COM, and further studies are warranted to understand the pathogenetic mechanism by which COM is caused by cadmium exposure.
Collapse
|
19
|
Emmett SD, Schmitz J, Karna SL, Khatry SK, Wu L, LeClerq SC, Pillion J, West KP. Early childhood undernutrition increases risk of hearing loss in young adulthood in rural Nepal. Am J Clin Nutr 2018; 107:268-277. [PMID: 29425280 PMCID: PMC6669330 DOI: 10.1093/ajcn/nqx022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/07/2017] [Indexed: 12/04/2022] Open
Abstract
Background Prevalence of young adult hearing loss is high in low-resource societies; the reasons for this are likely complex but could involve early childhood undernutrition. Objective We evaluated preschool childhood stunting, wasting, and underweight as risk factors for hearing loss in young adulthood in Sarlahi District, southern Nepal. Design Ear health was assessed in 2006-2008 in a cohort of 2193 subjects aged 16-23 y, who as children <60 mo of age participated in a 16-mo placebo-controlled, randomized vitamin A supplementation trial from 1989 to 1991. At each of five 4-mo assessments, field staff measured children's weight, height, and mid-upper arm circumference (MUAC) and recorded validated parental history of ear discharge in the previous 7 d. Children were classified as stunted [<-2 z score height-for-age (HAZ)], underweight [<-2 z score weight-for-age (WAZ)], or wasted [<-2 z score MUAC-for-age (MUACAZ) or body mass index-for-age (BMIAZ)]. At follow-up, hearing was tested by audiometry and tympanometry, with hearing loss defined as pure-tone average >30dB in the worse ear (0.5, 1, 2, 4 kHz) and middle-ear dysfunction as abnormal tympanometric peak height (<0.3 or >1.4 mmho) or width (<50 or >110 daPa). Results Hearing loss, present in 5.9% (95% CI: 5.01%, 7.00%) of subjects, was associated with early childhood stunting (OR: 1.64; 95% CI: 1.10, 1.45), underweight (OR: 1.70; 95% CI: 1.18, 2.44) and wasting by BMIAZ (OR: 1.88; 95% CI: 1.19, 2.97) and MUACAZ (OR: 2.14; 95% CI: 1.47, 3.12). Abnormal tympanometry, affecting 16.6% (95% CI: 15.06%, 18.18%), was associated with underweight (OR: 1.46; 95% CI: 1.16, 1.84) and wasting by BMIAZ (OR: 1.80; 95% CI: 1.32, 2.46) and MUACAZ (OR: 1.42; 95% CI: 1.10, 1.84), but not stunting (OR: 1.18; 95% CI: 0.93, 1.49) in early childhood. Highest ORs were observed for subjects with both hearing loss and abnormal tympanometry, ranging from 1.87 to 2.24 (all lower 95% CI >1.00). Conclusions Early childhood undernutrition is a modifiable risk factor for early adulthood hearing loss.
Collapse
Affiliation(s)
- Susan D Emmett
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Division of Head & Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC,Duke Global Health Institute, Durham, NC,Address correspondence to SDE (e-mail: )
| | - Jane Schmitz
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sureswor L Karna
- Speech and Hearing Unit, Ganesh Man Singh Memorial ENT Centre, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Subarna K Khatry
- Nepal Nutrition Intervention Project-Sarlahi (NNIPS), Kathmandu, Nepal
| | - Lee Wu
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Steven C LeClerq
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,Nepal Nutrition Intervention Project-Sarlahi (NNIPS), Kathmandu, Nepal
| | - Joseph Pillion
- Department of Audiology, Kennedy Krieger Institute, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
20
|
Prevalence of paediatric chronic suppurative otitis media and hearing impairment in rural Malawi: A cross-sectional survey. PLoS One 2017. [PMID: 29267304 DOI: 10.1371/journal.pone.0188950.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of World Health Organization-defined chronic suppurative otitis media (CSOM) and mild hearing impairment in a population representative sample of school-entry age children in rural Malawi. A secondary objective was to explore factors associated with CSOM in this population. METHODS We performed a community-based cross-sectional study of children aged 4-6 years in Chikhwawa District, Southern Malawi, utilising a village-level cluster design. Participants underwent a structured clinical assessment, including video-otoscopy and screening audiometry. Diagnoses were made remotely by two otolaryngologists who independently reviewed clinical data and images collected in the field. Hearing impairment was classified as failure to hear a pure tone of 25dB or greater at 1, 2 or 4kHz. RESULTS We recruited 281 children across 10 clusters. The prevalence estimates of CSOM, unilateral hearing impairment and bilateral hearing impairment were 5.4% (95%CI 2.2-8.6), 24.5% (95%CI 16.3-30.0), and 12.5% (95%CI 6.2-16.9) respectively. Middle ear disease was seen in 46.9% of children with hearing impairment. A trend towards increased risk of CSOM was observed with sleeping in a house with >2 other children. INTERPRETATION We found a high burden of middle ear disease and preventable hearing impairment in our sample of school-entry age children in rural Malawi. There are important public health implications of these findings as CSOM and hearing impairment can affect educational outcomes, and may impact subsequent development. The identification and management of middle ear disease and hearing impairment represent major unmet needs in this population.
Collapse
|
21
|
Hunt L, Mulwafu W, Knott V, Ndamala CB, Naunje AW, Dewhurst S, Hall A, Mortimer K. Prevalence of paediatric chronic suppurative otitis media and hearing impairment in rural Malawi: A cross-sectional survey. PLoS One 2017; 12:e0188950. [PMID: 29267304 PMCID: PMC5739401 DOI: 10.1371/journal.pone.0188950] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/16/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of World Health Organization-defined chronic suppurative otitis media (CSOM) and mild hearing impairment in a population representative sample of school-entry age children in rural Malawi. A secondary objective was to explore factors associated with CSOM in this population. METHODS We performed a community-based cross-sectional study of children aged 4-6 years in Chikhwawa District, Southern Malawi, utilising a village-level cluster design. Participants underwent a structured clinical assessment, including video-otoscopy and screening audiometry. Diagnoses were made remotely by two otolaryngologists who independently reviewed clinical data and images collected in the field. Hearing impairment was classified as failure to hear a pure tone of 25dB or greater at 1, 2 or 4kHz. RESULTS We recruited 281 children across 10 clusters. The prevalence estimates of CSOM, unilateral hearing impairment and bilateral hearing impairment were 5.4% (95%CI 2.2-8.6), 24.5% (95%CI 16.3-30.0), and 12.5% (95%CI 6.2-16.9) respectively. Middle ear disease was seen in 46.9% of children with hearing impairment. A trend towards increased risk of CSOM was observed with sleeping in a house with >2 other children. INTERPRETATION We found a high burden of middle ear disease and preventable hearing impairment in our sample of school-entry age children in rural Malawi. There are important public health implications of these findings as CSOM and hearing impairment can affect educational outcomes, and may impact subsequent development. The identification and management of middle ear disease and hearing impairment represent major unmet needs in this population.
Collapse
Affiliation(s)
- Luke Hunt
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Victoria Knott
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Andrew W. Naunje
- Malawi-Liverpool-Wellcome Trust Clinical Research Program, Blantyre, Malawi
| | - Sam Dewhurst
- University Hospitals Leicester NHS Foundation Trust, Leicester, United Kingdom
| | - Andrew Hall
- Independent Scholar, Sheffield, United Kingdom
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|
22
|
Mukara KB, Lilford RJ, Tucci DL, Waiswa P. Prevalence of Middle Ear Infections and Associated Risk Factors in Children under 5 Years in Gasabo District of Kigali City, Rwanda. Int J Pediatr 2017; 2017:4280583. [PMID: 29348761 PMCID: PMC5733628 DOI: 10.1155/2017/4280583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/11/2017] [Accepted: 10/26/2017] [Indexed: 11/25/2022] Open
Abstract
Middle ear infections are common in children, and delay in diagnosis and treatment may result in complications such as delays in speech and language development and deafness. The aim of this study was to determine the prevalence and care seeking behaviour for middle ear infections in children under five years in Kigali city. We conducted a cross-sectional study among 810 children aged 6-59 months in Gasabo district of Kigali city, Rwanda. The prevalence of middle ear infections was 5.8%, of whom 4% had chronic suppurative otitis media. A child was less likely to develop middle ear infections if they lived in an urban setting (OR = 0.52, 95% CI: 0.285-0.958) but more likely to develop middle ear infections if exposed to household smoke (OR = 2.54, 95% CI: 1.18-5.46). Parents were unlikely to know that their child had an ear infection (OR: 0.15, 95% CI: 0.06-0.34). Middle ear infection remains a public health problem in Rwanda but many parents were not aware of its presence in the affected children. There is a need to raise awareness of parents about ear infection and to promote early care seeking from qualified health workers.
Collapse
Affiliation(s)
- Kaitesi Batamuliza Mukara
- ENT Department, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | | | - Debara Lyn Tucci
- Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, USA
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Global Health Division, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
23
|
Gestro M, Condemi V, Bardi L, Fantino C, Solimene U. Meteorological factors, air pollutants, and emergency department visits for otitis media: a time series study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1749-1764. [PMID: 28466414 DOI: 10.1007/s00484-017-1356-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/07/2017] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
AbstractOtitis media (OM) is a very common disease in children, which results in a significant economic burden to the healthcare system for hospital-based outpatient departments, emergency departments (EDs), unscheduled medical examinations, and antibiotic prescriptions. The aim of this retrospective observational study is to investigate the association between climate variables, air pollutants, and OM visits observed in the 2007-2010 period at the ED of Cuneo, Italy. Measures of meteorological parameters (temperature, humidity, atmospheric pressure, wind) and outdoor air pollutants (particulate matter, ozone, nitrous dioxide) were analyzed at two statistical stages and in several specific steps (crude and adjusted models) according to Poisson's regression. Response variables included daily examinations for age groups 0-3, 0-6, and 0-18. Control variables included upper respiratory infections (URI), flu (FLU), and several calendar factors. A statistical procedure was implemented to capture any delayed effects. Results show a moderate association for temperature (T), age 0-3, and 0-6 with P < 0.05, as well as nitrous dioxide (NO2) with P < 0.005 at age 0-18. Results of subsequent models point out to URI as an important control variable. No statistical association was observed for other pollutants and meteorological variables. The dose-response models (DLNM-final stage) implemented separately on a daily and hourly basis point out to an association between temperature (daily model) and RR 1.44 at age 0-3, CI 1.11-1.88 (lag time 0-1 days) and RR 1.43, CI 1.05-1.94 (lag time 0-3 days). The hourly model confirms a specific dose-response effect for T with RR 1.20, CI 1.04-1.38 (lag time range from 0 to 11 to 0-15 h) and for NO2 with RR 1.03, CI 1.01-1.05 (lag time range from 0 to 8 to 0-15 h). These results support the hypothesis that the clinical context of URI may be an important risk factor in the onset of OM diagnosed at ED level. The study highlights the relevance of URI as a control variable to be included in the statistical analysis in association with meteorological factors and air pollutants. The study also points out to a moderate association of OM with low temperatures and NO2, with specific risk factors for this variable early in life. Further studies are needed to confirm these findings, particularly with respect to air pollutants in larger urban environments.
Collapse
Affiliation(s)
- Massimo Gestro
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy
| | - Vincenzo Condemi
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy.
| | - Luisella Bardi
- Cuneo Department, Environmental Protection Agency of Piedmont, Turin, Italy
| | - Claudio Fantino
- S. Croce and Carle Hospital of Cuneo, SOC ORL Unit, Cuneo, Italy
| | - Umberto Solimene
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy
| |
Collapse
|
24
|
Chronic rhinosinusitis with nasal polyps is associated with chronic otitis media in the elderly. Eur Arch Otorhinolaryngol 2016; 274:1463-1470. [DOI: 10.1007/s00405-016-4363-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
|
25
|
Patel MA, Mener DJ, Garcia-Esquinas E, Navas-Acien A, Agrawal Y, Lin SY. Tobacco Smoke Exposure and Eustachian Tube Disorders in US Children and Adolescents. PLoS One 2016; 11:e0163926. [PMID: 27711178 PMCID: PMC5053406 DOI: 10.1371/journal.pone.0163926] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 09/17/2016] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To describe the association between active, environmental tobacco smoke (ETS) exposure and the prevalence of eustachian tube dysfunction (ETD) in the U.S. pediatric population. STUDY DESIGN Cross-sectional. SETTING U.S. representative demographic and audiometric data from the National Health and Nutrition Examination Survey (NHANES);2005-2010. SUBJECTS AND METHODS The study consisted of 2,977 children aged 12-19 years. ETD was defined as middle ear pressure <100mm H20. ETS was defined as non-active smoking in individuals with serum cotinine over the limit of detection (≥0.015 ng/mL) and <10 ng/mL(N = 1559). RESULTS The prevalence of ETD was 6.1%. After multivariate adjustment for age, sex, body mass index, education level, ethnicity, or having a cold, sinus problem or earache during the last 24 hours, compared to unexposed children, the odds ratios (95% confidence interval) of ETD for those exposed to ETS ages 12-15 in the first, second and third tertile of cotinine concentrations were, respectively, 1.38 (0.53-3.60), 0.99 (0.53-3.60) and 2.67 (1.12-6.34). Similarly, the odds ratios (95% confidence interval) of ETD for those exposed to ETS ages 16-19 in the first, second and third tertile of cotinine concentrations were, respectively, 1.28 (0.48-3.41), 0.99 (0.40-2.48) and 2.86 (1.19-6.88). CONCLUSION These data suggest that children and adolescents exposed to high concentrations of ETS may have an increased prevalence of ETD.
Collapse
Affiliation(s)
- Mira A. Patel
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - David J. Mener
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Esther Garcia-Esquinas
- Department of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Preventive Medicine and Public Health, School of Medicine at Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ana Navas-Acien
- Department of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Yuri Agrawal
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sandra Y. Lin
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| |
Collapse
|
26
|
Abstract
Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; 'glue ear') and chronic suppurative otitis media (CSOM). OM is among the most common diseases in young children worldwide. Although OM may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae. In developing countries, CSOM is a leading cause of hearing loss. OM can be of bacterial or viral origin; during 'colds', viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens that reside in the nasopharynx. Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane (eardrum) for AOM and hearing loss for OME; diagnostic modalities include (pneumatic) otoscopy, tympanometry and audiometry. Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent or recurrent infections. Management of OME largely consists of watchful waiting, with ventilation (tympanostomy) tubes primarily for children with chronic effusions and hearing loss, developmental delays or learning difficulties. The role of hearing aids to alleviate symptoms of hearing loss in the management of OME needs further study. Insertion of ventilation tubes and adenoidectomy are common operations for recurrent AOM to prevent recurrences, but their effectiveness is still debated. Despite reports of a decline in the incidence of OM over the past decade, attributed to the implementation of clinical guidelines that promote accurate diagnosis and judicious use of antibiotics and to pneumococcal conjugate vaccination, OM continues to be a leading cause for medical consultation, antibiotic prescription and surgery in high-income countries.
Collapse
Affiliation(s)
- Anne G. M. Schilder
- evidENT, Ear Institute, University College London, Royal National Throat Nose and Ear Hospital, 330 Grays Inn Road, London, WC1X 8DA UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tasnee Chonmaitree
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas USA
| | - Allan W. Cripps
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Queensland Australia
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York USA
| | | | - Mark P. Haggard
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
27
|
Molecular Microbiological Profile of Chronic Suppurative Otitis Media. J Clin Microbiol 2016; 54:2538-46. [PMID: 27487953 DOI: 10.1128/jcm.01068-16] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/26/2016] [Indexed: 01/13/2023] Open
Abstract
Chronic suppurative otitis media (CSOM) presents with purulent otorrhea (ear discharge), is characterized by chronic inflammation of the middle ear and mastoid cavity, and contributes to a significant disease burden worldwide. Current antibiotic therapy is guided by swab culture results. In the absence of detailed molecular microbiology studies of CSOM patients, our current understanding of the microbiota of CSOM (and indeed of the healthy ear) remains incomplete. In this prospective study, 24 patients with CSOM were recruited, along with 22 healthy controls. Culture-based techniques and 16S rRNA gene amplicon sequencing were used to profile the bacterial community for each patient. Comparisons between patients with and without cholesteatoma in the middle ear and mastoid cavity were also made. A major finding was that the middle ear of many healthy controls was not sterile, which is contradictory to the results of previous studies. However, sequencing data showed that Staphylococcus aureus, along with a range of other Gram-positive and Gram-negative organisms, were present in all subgroups of CSOM and healthy controls. Large interpatient variability in the microbiota was observed within each subgroup of CSOM and controls, and there was no bacterial community "signature" which was characteristic of either health or disease. Comparisons of the culture results with the molecular data show that culture-based techniques underestimate the diversity of bacteria found within the ear. This study reports the first detailed examination of bacterial profiles of the ear in healthy controls and patients with CSOM.
Collapse
|
28
|
Casselbrant ML, Mandel EM, Doyle WJ. Information on co-morbidities collected by history is useful for assigning Otitis Media risk to children. Int J Pediatr Otorhinolaryngol 2016; 85:136-40. [PMID: 27240512 PMCID: PMC4890165 DOI: 10.1016/j.ijporl.2016.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/25/2016] [Accepted: 03/27/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Determine if a 2-Step multivariate analysis of historical symptom/sign data for comorbid diseases can abstract high-level constructs useful in assigning a child's "risk" for different Otitis Media expressions. METHODS Seventeen items related to the symptom/sign expression of hypothesized Otitis Media comorbidities were collected by history on 141 3-year-old children. Using established criteria, the children were assigned to 1 of 3 groups: Control (no significant past Otitis Media, n=45), Chronic Otitis Media with Effusion (n=45) and Recurrent Acute Otitis Media (n=51). Principal Component Analysis was used to identify factors representing the non-redundant shared information among related items and Discriminant Analysis operating on those factors was used to estimate the best predictor equation for pairwise group assignments. RESULTS Six multivariate factors representing the assignable comorbidities of frequent colds, nasal allergy, gastroesophageal disease (specific and general), nasal congestion and asthma were identified and explained 81% of the variance in the 17 items. Discriminant Analysis showed that, for the Control-Chronic Otitis Media with Effusion comparison, a combination of 3 factors and, for the Control-Recurrent Acute Otitis Media comparison, a combination of 2 factors had assignment accuracies of 74% and 68%, respectively. For the contrast between the two disease expressions, a 2-factor combination had an assignment accuracy of 61%. CONCLUSION These results show that this analytic methodology can abstract high-level constructs, comorbidities, from low-level data, symptom/sign scores, support a linkage between certain comorbidities and Otitis Media risk and suggest that specific comorbidity combinations contain information relevant to assigning the risk for different Otitis Media expressions.
Collapse
Affiliation(s)
- Margaretha L. Casselbrant
- University of Pittsburgh School of Medicine, Department of Otolaryngology, Pittsburgh, PA, USA,Corresponding author at: Children’s Hospital of Pittsburgh of UPMC, ENT Department, Faculty Pavilion, 4401 Penn Avenue, Pittsburgh, PA 15224, USA. Tel.: +1 412 692 6213; fax: +1 412 692 6074. (M.L. Casselbrant)
| | - Ellen M. Mandel
- University of Pittsburgh School of Medicine, Department of Otolaryngology, Pittsburgh, PA, USA,Division of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - William J. Doyle
- University of Pittsburgh School of Medicine, Department of Otolaryngology, Pittsburgh, PA, USA
| |
Collapse
|
29
|
Chung JH, Lee SH, Woo SY, Kim SW, Cho YS. Prevalence and associated factors of chronic suppurative otitis media: Data from the Korea National Health and Nutrition Examination Survey, 2009-2012. Laryngoscope 2016; 126:2351-7. [DOI: 10.1002/lary.25981] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 12/13/2015] [Accepted: 02/19/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Jae Ho Chung
- Department of Otorhinolaryngology; College of Medicine; Hanyang University; Seoul South Korea
| | - Seung Hwan Lee
- Department of Otorhinolaryngology; College of Medicine; Hanyang University; Seoul South Korea
| | - Sook-Young Woo
- Biostatistics Team; Samsung Biomedical Research Institute; Seoul South Korea
| | - Seon Woo Kim
- Biostatistics Team; Samsung Biomedical Research Institute; Seoul South Korea
| | - Yang-Sun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| |
Collapse
|
30
|
Muftah S, Mackenzie I, Faragher B, Brabin B. Prevalence of Chronic Suppurative Otitis Media (CSOM) and Associated Hearing Impairment Among School-aged Children in Yemen. Oman Med J 2015; 30:358-65. [PMID: 26421117 DOI: 10.5001/omj.2015.72] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Chronic suppurative otitis media (CSOM) is one of the leading causes of preventable disabling hearing impairment (DHI) in developing countries. Early detection and management complements advances made in other survival programs, improves work capacity, and enhances learning opportunities for school children. We aimed to determine the prevalence of CSOM and associated DHI among school children aged six to 16 years in Socotra Island, Yemen. METHODS We conducted a cross-sectional community-based survey, from 20 April 2011 to 20 June 2011. The study procedures involved completing a questionnaire, an otoscopic ear examination, an audiometric test of hearing, and tuning fork tests for the type of DHI. RESULTS A total of 686 children were interviewed and examined for CSOM and associated DHI of CSOM cases. The prevalence of CSOM was 7.4%, (95% CI 5.5-9.4). CSOM status was significantly associated with DHI (p=0.001), but no significant associations were found between demographic characteristics and CSOM status. Logistic regression identified four significant independent contributing factors: history of ear discharge in the last 12 months (odds ratio (OR) 7.8, 95% CI 3.9-15.6); swimming in local pools (OR 6.0, 95% CI 1.4-25.4); recurrent respiratory tract infection more than three times per year (OR 5.3, 95% CI 2.5-11.0); and overcrowding with more than three families per house (OR 4.4, 95% CI 1.7-11.5). . CONCLUSION The burden of CSOM in the children studied indicates a high level of DHI in these communities within Yemen. A history of ear discharge, swimming in local pools, recurrent respiratory infections, and overcrowded housing were the strongest predictors for CSOM. There is a need for better ear care and screening programs for early detection and management of this disease.
Collapse
Affiliation(s)
- Salem Muftah
- WHO Collaborating Centre on Hearing Impairment, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ian Mackenzie
- WHO Collaborating Centre on Hearing Impairment, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Brian Faragher
- WHO Collaborating Centre on Hearing Impairment, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Bernard Brabin
- WHO Collaborating Centre on Hearing Impairment, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK ; Global Child Health Group, Emma Kinderziekenhuis, Academic Medical Centre, University of Amsterdam,
Amsterdam, The Netherlands ; Department of Community Child Health, Royal Liverpool Children's NHS Trust, Liverpool, UK
| |
Collapse
|
31
|
Park M, Lee JS, Lee JH, Oh SH, Park MK. Prevalence and risk factors of chronic otitis media: the Korean National Health and Nutrition Examination Survey 2010-2012. PLoS One 2015; 10:e0125905. [PMID: 25978376 PMCID: PMC4433353 DOI: 10.1371/journal.pone.0125905] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/21/2015] [Indexed: 02/02/2023] Open
Abstract
Background The performance of nationwide studies of chronic otitis media (COM) in adults has been insufficient in Korea. We evaluated the prevalence and risk factors of COM in Korea. Methods This study was conducted using data from the fifth Korean National Health and Nutrition Examination Survey (n = 23,621). After excluding the subjects under 20 year old and suffered from cancers, 16,063 patients were evaluated for COM. Participants underwent a medical interview, physical examination, endoscopic examination, and blood and urine test. COM was diagnosed by trained residents in the Department of Otorhinolaryngology using an ear, nose, and throat questionnaire and otoendoscopy findings. Data on the presence and absence of COM were collected. Multivariate logistic regression analyses were performed to identify its risk factors. Results Of the 16,063 participants aged above 20 year old, the weighted prevalence of COM was 3.8%. In the multivariate analyses, the following factors showed high odds ratios (ORs) for COM: pulmonary tuberculosis (adjusted OR, 1.78; 95% confidence interval [CI], 1.06-3.01), chronic rhinosinusitis (adjusted OR, 1.87; 95% CI, 1.17-2.98), mild hearing impairment (adjusted OR, 1.95; 95% CI, 1.34-2.85), moderate hearing impairment (adjusted OR, 4.00; 95% CI, 2.21-7.22), tinnitus (adjusted OR, 1.82; 95% CI, 1.34-2.49), increased hearing thresholds in pure tone audiometry in the right ear (adjusted OR, 1.02; 95% CI, 1.01-1.03), and left ear (adjusted OR, 1.03; 95% CI, 1.02-1.04). The following factors showed low odds ratios for COM: hepatitis B (adjusted OR, 0.28; 95% CI, 0.08-0.94) and rhinitis (adjusted OR, 0.60; 95% CI, 0.42-0.88). In addition, high levels of vitamin D, lead, and cadmium, EQ-5D index; and low red blood cell counts were associated with development of COM (Student’s t-test, P < 0.01). Conclusions Our population-based study showed that COM is not rare in Korea, and its development may be associated with various host and environmental factors. Further research on its relationships and the pathogenesis are needed.
Collapse
Affiliation(s)
- Mina Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
- * E-mail:
| |
Collapse
|
32
|
van Uem VMR, van der Veen EL, Schilder AGM, Buwalda J, Rovers MM. Systemic antibiotics for chronically discharging ears with underlying eardrum perforations. Hippokratia 2015. [DOI: 10.1002/14651858.cd009288.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vera MR van Uem
- Deventer Ziekenhuis; Department of Otorhinolaryngology; Nico Bolkesteinlaan 75 Deventer Netherlands 7416 SE
| | - Erwin L van der Veen
- University Medical Center Utrecht; Department of Otorhinolaryngology; Utrecht Netherlands
| | - Anne GM Schilder
- Faculty of Brain Sciences, University College London; evidENT, Ear Institute; 330 Grays Inn Road London UK WC1X 8DA
| | - Joeri Buwalda
- Deventer Ziekenhuis; Department of Otorhinolaryngology; Nico Bolkesteinlaan 75 Deventer Netherlands 7416 SE
| | - Maroeska M Rovers
- Radboud University Nijmegen Medical Centre; Department of Operating Rooms; Hp 630, route 631 PO Box 9101 Nijmegen Netherlands 6500 HB
| |
Collapse
|
33
|
Orji FT, Dike BO, Oji O. Determinants of non-healing ear discharge in chronic suppurative otitis media in a developing country. Eur Arch Otorhinolaryngol 2014; 272:2713-8. [DOI: 10.1007/s00405-014-3255-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
|
34
|
Gordon SB, Bruce NG, Grigg J, Hibberd PL, Kurmi OP, Lam KBH, Mortimer K, Asante KP, Balakrishnan K, Balmes J, Bar-Zeev N, Bates MN, Breysse PN, Buist S, Chen Z, Havens D, Jack D, Jindal S, Kan H, Mehta S, Moschovis P, Naeher L, Patel A, Perez-Padilla R, Pope D, Rylance J, Semple S, Martin WJ. Respiratory risks from household air pollution in low and middle income countries. THE LANCET RESPIRATORY MEDICINE 2014; 2:823-60. [PMID: 25193349 DOI: 10.1016/s2213-2600(14)70168-7] [Citation(s) in RCA: 497] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A third of the world's population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple stove with incomplete combustion, and result in a large amount of household air pollution when smoke is poorly vented. Air pollution is the biggest environmental cause of death worldwide, with household air pollution accounting for about 3·5-4 million deaths every year. Women and children living in severe poverty have the greatest exposures to household air pollution. In this Commission, we review evidence for the association between household air pollution and respiratory infections, respiratory tract cancers, and chronic lung diseases. Respiratory infections (comprising both upper and lower respiratory tract infections with viruses, bacteria, and mycobacteria) have all been associated with exposure to household air pollution. Respiratory tract cancers, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal burning and further data are needed about other solid fuels. Chronic lung diseases, including chronic obstructive pulmonary disease and bronchiectasis in women, are associated with solid fuel use for cooking, and the damaging effects of exposure to household air pollution in early life on lung development are yet to be fully described. We also review appropriate ways to measure exposure to household air pollution, as well as study design issues and potential effective interventions to prevent these disease burdens. Measurement of household air pollution needs individual, rather than fixed in place, monitoring because exposure varies by age, gender, location, and household role. Women and children are particularly susceptible to the toxic effects of pollution and are exposed to the highest concentrations. Interventions should target these high-risk groups and be of sufficient quality to make the air clean. To make clean energy available to all people is the long-term goal, with an intermediate solution being to make available energy that is clean enough to have a health impact.
Collapse
Affiliation(s)
- Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Nigel G Bruce
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jonathan Grigg
- Centre for Paediatrics, Blizard Institute, Queen Mary, University of London, London, UK
| | - Patricia L Hibberd
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Om P Kurmi
- Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kin-bong Hubert Lam
- Institute of Occupational and Environmental Medicine, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kwaku Poku Asante
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra University, Chennai, India
| | - John Balmes
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Naor Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Michael N Bates
- Divisions of Epidemiology and Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Patrick N Breysse
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sonia Buist
- Oregon Health and Science University, Portland, OR, USA
| | - Zhengming Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Deborah Havens
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Sumi Mehta
- Health Effects Institute, Boston, MA, USA
| | - Peter Moschovis
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Luke Naeher
- The University of Georgia, College of Public Health, Department of Environmental Health Science, Athens, GA, USA
| | | | | | - Daniel Pope
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jamie Rylance
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sean Semple
- University of Aberdeen, Scottish Centre for Indoor Air, Division of Applied Health Sciences, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - William J Martin
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
35
|
Hallbauer UM, Atkins MD, Tiedt NJ, Butler IRT, Pieters M, Elliott E, Joubert G, Seedat RY. Co-morbidities in children presenting with chronic suppurative otitis media--a South African study. J Trop Pediatr 2014; 60:198-202. [PMID: 24401753 DOI: 10.1093/tropej/fmt107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Chronic suppurative otitis media (CSOM) is common among children in southern Africa. Managing associated co-morbidities may result in earlier disease resolution. METHODS Children <13 years of age with otorrhoea lasting >4 weeks were recruited to the study. Each child underwent a full clinical examination, a blood count, an HIV test and CD4 cell count, if found to be infected. RESULTS The study included 86 children, and the median age was 4.6 years. HIV infection was present in 45 of 83 children (54.2%), of which 23 (51.1%) were receiving antiretroviral treatment at the time of presentation. Underweight was present in 22 of 85 (25.9%) children and in 17 of the 45 (37.8%) HIV-infected children. One or more clinical signs (not aural-related) were found in 46 of 86 (53.4%) children. Cholesteatoma was found in 23 of 113 (20.4%) ears, and 9 of 86 (10.5%) children had serious associated aural or intracranial complications. CONCLUSIONS A high percentage of children with CSOM have associated pathology that needs to be diagnosed to optimally manage CSOM.
Collapse
Affiliation(s)
- Ute M Hallbauer
- Department of Paediatrics and Child Health, University of the Free State, Bloemfontein 9300, South Africa
| | - Mark D Atkins
- Department of Paediatrics and Child Health, University of the Free State, Bloemfontein 9300, South Africa
| | - Nicholas J Tiedt
- Department of Otorhinolaryngology, University of the Free State, Bloemfontein 9300, South Africa
| | - Iain R T Butler
- Department of Otorhinolaryngology, University of the Free State, Bloemfontein 9300, South Africa
| | - Madeleine Pieters
- Department of Medical Microbiology, NHLS and University of the Free State
| | - Eugene Elliott
- Department of Medical Microbiology, NHLS and University of the Free State
| | - Gina Joubert
- Department of Biostatistics, University of the Free State, Bloemfontein 9300, South Africa
| | - Riaz Y Seedat
- Department of Otorhinolaryngology, University of the Free State, Bloemfontein 9300, South Africa
| |
Collapse
|
36
|
Reda SM, Yousef TA, Elfeky RA, Sallam MT, Gaafar RA. Could recurrent otitis media predict primary antibody deficiencies in Egyptian children? THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2014. [DOI: 10.4103/1012-5574.133179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
37
|
Bhutta MF. Epidemiology and Pathogenesis of Otitis Media: Construction of a Phenotype Landscape. Audiol Neurootol 2014; 19:210-23. [DOI: 10.1159/000358549] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/10/2014] [Indexed: 11/19/2022] Open
|
38
|
Adebola SO, Ologe FE, Alabi BS, Nwabuisi C, Fowotade A. Profile of anaerobic bacteriology of middle ear aspirates in a developing country: Does immunocompromise play a role? Anaerobe 2014; 26:31-5. [DOI: 10.1016/j.anaerobe.2014.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 12/17/2013] [Accepted: 01/01/2014] [Indexed: 10/25/2022]
|
39
|
Zhang Y, Xu M, Zhang J, Zeng L, Wang Y, Zheng QY. Risk factors for chronic and recurrent otitis media-a meta-analysis. PLoS One 2014; 9:e86397. [PMID: 24466073 PMCID: PMC3900534 DOI: 10.1371/journal.pone.0086397] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 12/09/2013] [Indexed: 11/30/2022] Open
Abstract
Risk factors associated with chronic otitis media (COM) and recurrent otitis media (ROM) have been investigated in previous studies. The objective of this study was to integrate the findings and determine the possible risk factors for COM/ROM based on our meta-analysis. A comprehensive search of electronic bibliographic databases (PubMed, Embase, CNKI and Wanfang database) from 1964 to Dec 2012, as well as a manual search of references of articles, was performed. A total of 2971 articles were searched, and 198 full-text articles were assessed for eligibility; 24 studies were eligible for this meta-analysis. Regarding risk factors for COM/ROM, there were two to nine different studies from which the odds ratios (ORs) could be pooled. The presence of allergy or atopy increased the risk of COM/ROM (OR, 1.36; 95% CI, 1.13–1.64; P = 0.001). An upper respiratory tract infection (URTI) significantly increased the risk of COM/ROM (OR, 6.59; 95% CI, 3.13–13.89; P<0.00001). Snoring appeared to be a significant risk factor for COM/ROM (OR, 1.96; 95% CI, 1.78–2.16; P<0.00001). A patient history of acute otitis media (AOM)/ROM increased the risk of COM/ROM (OR, 11.13; 95% CI, 1.06–116.44; P = 0.04). Passive smoke significantly increased the risk of COM/ROM (OR, 1.39; 95% CI, 1.02–1.89 P = 0.04). Low social status appeared to be a risk factor for COM/ROM (OR, 3.82; 95% CI, 1.11–13.15; P = 0.03). Our meta-analysis identified reliable conclusions that allergy/atopy, URTI, snoring, previous history of AOM/ROM, Second-hand smoke and low social status are important risk factors for COM/ROM. Other unidentified risk factors need to be identified in further studies with critical criteria.
Collapse
Affiliation(s)
- Yan Zhang
- Department of Otorhinolaryngology-HNS, Second Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, China
| | - Min Xu
- Department of Otorhinolaryngology-HNS, Second Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, China
- * E-mail:
| | - Jin Zhang
- Department of Otorhinolaryngology-HNS, Second Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, China
| | - Lingxia Zeng
- Department of Otorhinolaryngology-HNS, Second Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, China
| | - Yanfei Wang
- Department of Otorhinolaryngology-HNS, Second Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, China
- Departments of Otolaryngology-HNS and Genetics, and the Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, United States of America
- Transformative Otology and Neuroscience Center, Binzhou Medical University, Yantai, Shandong, China
| | - Qing Yin Zheng
- Department of Otorhinolaryngology-HNS, Second Hospital, Xi’an Jiaotong University School of Medicine, Xi’an, China
- Departments of Otolaryngology-HNS and Genetics, and the Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, United States of America
- Transformative Otology and Neuroscience Center, Binzhou Medical University, Yantai, Shandong, China
| |
Collapse
|
40
|
Lasisi AO, Arinola OG, Olayemi O. Role of elevated immunoglobulin E levels in suppurative otitis media. ACTA ACUST UNITED AC 2013; 28:123-7. [DOI: 10.1179/146532808x302143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
41
|
Hoffman HJ, Daly KA, Bainbridge KE, Casselbrant ML, Homøe P, Kvestad E, Kvaerner KJ, Vernacchio L. Panel 1: Epidemiology, natural history, and risk factors. Otolaryngol Head Neck Surg 2013; 148:E1-E25. [PMID: 23536527 DOI: 10.1177/0194599812460984] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The First International Symposium on Recent Advances in Otitis Media (OM) with Effusion was held in Columbus, Ohio, in 1975. The symposium has been organized in the United States every 4 years since, followed by a research conference to (a) assess major research accomplishments, (b) identify important research questions and opportunities, (c) develop consensus on definitions and terminology, and (d) establish priorities with short- and long-term research goals. One of the principal areas reviewed quadrennially is Epidemiology, Natural History, and Risk Factors. OBJECTIVE To provide a review of recent literature on the epidemiology, natural history, and risk factors for OM. DATA SOURCES AND REVIEW METHODS A search of OM articles in English published July 2007 to June 2011 was conducted using PubMed and related databases. Those with findings judged of importance for epidemiology, public health, and/or statistical methods were reviewed. RESULTS The literature has continued to expand, increasing understanding of the worldwide burden of OM in childhood, complications from treatment failures, and comorbidities. Novel risk factors, including genetic factors, have been examined for OM susceptibility. Population-based studies in Canada, the United States, and other countries confirmed reductions in OM prevalence. Although most studies concentrated on acute OM (AOM) or OM with effusion (OME), a few examined severe chronic suppurative OM (CSOM), a major public health problem in developing countries and for certain indigenous populations around the world. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Recent publications have reinforced earlier epidemiological findings, while extending our knowledge in human population groups with high burden of OM.
Collapse
Affiliation(s)
- Howard J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health, Bethesda, Maryland 20892, USA.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Afolabi OA, Salaudeen AG, Ologe FE, Nwabuisi C, Nwawolo CC. Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in North central Nigeria. Afr Health Sci 2012; 12:362-7. [PMID: 23382753 DOI: 10.4314/ahs.v12i3.18] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Otitis media (OM) is a major health problem in both developed and developing countries. OBJECTIVE To determine the pattern of bacterial isolates in patients with chronic suppurative otitis media(CSOM) in Ilorin, Nigeria. METHODS A prospective study carried out in University of Ilorin Teaching Hospital, Nigeria among consenting patients with CSOM attending the ENT clinic over a period of 7months. Informed consent was obtained from the patients or caregivers and approval for the study obtained from ethical committee. Structured questionnaire was administered and microbiological analysis done, data obtained was entered into SPSS statistical software and results presented in tables and figures. RESULTS A total of 134 patients aged 5-64yrs with chronic suppurative otitis media were interviewed with a mean age of 17.0 (S.D. =15.1±1.30). About 55.2% of the respondents were under 10yrs. Seventy-two (53.7%) of the respondents were males with M:F=1.2:1. The gram stain showed predominantly gram negative organisms (71.6%). Pseudomonas aeruginosa was the commonest middle ear pathogenic organism identified and the sensitivity pattern highly favoured ciprofloxacin CONCLUSION CSOM is still a childhood problem among the under tens' more prevalent among males and the commonest agent is Pseudomonas aeruginosa. Ciprofloxacin is still the most sensitive antibiotics in vitro.
Collapse
Affiliation(s)
- O A Afolabi
- Department of Ear, Nose and Throat surgery, University of Ilorin, Ilorin, Nigeria.
| | | | | | | | | |
Collapse
|
43
|
Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, Grasso D, Barbiero C, Tamburlini G. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One 2012; 7:e36226. [PMID: 22558393 PMCID: PMC3340347 DOI: 10.1371/journal.pone.0036226] [Citation(s) in RCA: 589] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/28/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Otitis media (OM) is a leading cause of health care visits and drugs prescription. Its complications and sequelae are important causes of preventable hearing loss, particularly in developing countries. Within the Global Burden of Diseases, Injuries, and Risk Factors Study, for the year 2005 we estimated the incidence of acute OM, chronic suppurative OM, and related hearing loss and mortality for all ages and the 21 WHO regional areas. METHODS We identified risk factors, complications and sequelae of OM. We carried out an extensive literature review (Medline, Embase, Lilacs and Wholis) which lead to the selection of 114 papers comprising relevant data. Data were available from 15 of the 21 WHO regions. To estimate incidence and prevalence for all countries we adopted a two stage approach based on risk factors formulas and regression modelling. RESULTS Acute OM incidence rate is 10.85% i.e. 709 million cases each year with 51% of these occurring in under-fives. Chronic suppurative OM incidence rate is 4.76 ‰ i.e. 31 million cases, with 22.6% of cases occurring annually in under-fives. OM-related hearing impairment has a prevalence of 30.82 per ten-thousand. Each year 21 thousand people die due to complications of OM. CONCLUSIONS Our study is the first attempt to systematically review the available information and provide global estimates for OM and related conditions. The overall burden deriving from AOM, CSOM and their sequelae is considerable, particularly in the first five years of life and in the poorest countries. The findings call for incorporating OM-focused action within preventive and case management strategies, with emphasis on the more affected.
Collapse
Affiliation(s)
- Lorenzo Monasta
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Taipale A, Pelkonen T, Taipale M, Bernardino L, Peltola H, Pitkäranta A. Chronic suppurative otitis media in children of Luanda, Angola. Acta Paediatr 2011; 100:e84-8. [PMID: 21477130 DOI: 10.1111/j.1651-2227.2011.02192.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Evaluation of clinical characteristics, bacteriology and hearing in paediatric patients with and without chronic suppurative otitis media (CSOM) in Luanda, Angola. METHODS Interview, clinical examination, ear-discharge culture, open air pure-tone audiometry and brainstem auditory-evoked potentials of 23 outpatients with CSOM and 23 controls in a paediatric hospital. RESULTS Of the CSOM vs. control children, 35% vs. 26% had running water, 70% vs. 70% electricity, 64% vs. 0% HIV (p<0.0001) and 36% vs. 0% tuberculosis in history (p=0.002). Ten (43%) children had bilateral CSOM. The major ear-discharge pathogens were Proteus spp. (44%) and Pseudomonas (22%). Hearing impairment of >25 dB was present in 52% of CSOM-affected ears and bilateral hearing loss in 7 (30%) CSOM children vs. zero control child (p=0.009). Only one hearing-impaired child's family had previously detected the handicap. CONCLUSION CSOM occurred in children with high co-morbidity. Persistent otorrhoea was usually caused by Proteus spp. or Pseudomonas, and often suggestive of either HIV or hearing impairment. In the developing countries, prompt diagnosis and treatment of CSOM would enhance the children's linguistic and academic development.
Collapse
Affiliation(s)
- Anni Taipale
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki University, Medical Faculty, Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|
45
|
Smith DF, Boss EF. Racial/ethnic and socioeconomic disparities in the prevalence and treatment of otitis media in children in the United States. Laryngoscope 2011; 120:2306-12. [PMID: 20939071 DOI: 10.1002/lary.21090] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Although racial/ethnic and socioeconomic disparities in child health are prevalent, little is known about them within common pediatric otolaryngic problems. Otitis media (OM) is a frequent diagnosis in children, and tympanostomy tube placement is the most common surgical treatment for OM. We sought to identify current knowledge regarding racial/ethnic and socioeconomic disparities in children with OM or tympanostomy tube placement. METHODS Qualitative systematic review of MEDLINE database for U.S.-based articles reporting on racial/ethnic or socioeconomic disparities in diagnosis or surgical treatment of OM over the last 30 years. RESULTS Of 428 abstracts identified, 15 met inclusion criteria. Articles addressed OM prevalence (12 of 15), risk factors (9 of 15), and tympanostomy tube insertion (4 of 15). Minority racial/ethnic groups studied were Black (11 of 15), Hispanic (6 of 15), American Indian/Alaska Native (2 of 15), and Asian (1 of 15). Predominant findings showed: 1) the most common identified risk factor for OM is socioeconomic status; 2) considerable variability exists concerning racial/ethnic disparities in disease prevalence; and 3) White children are more likely to undergo tympanostomy tube insertion compared to Black or Hispanic children. CONCLUSIONS Racial/ethnic and socioeconomic disparities exist for the prevalence and treatment of children with OM. Socioeconomic deprivation increases the risk of OM in children. Despite the frequency of tympanostomy tube insertion in children in the United States, few studies have addressed inequalities in access or utilization of surgical therapy. Given the changing healthcare climate and the social and economic impact of OM in children, further investigation of racial/ethnic and socioeconomic disparities targeting access to surgical treatment of OM should take precedence in health services research.
Collapse
Affiliation(s)
- David F Smith
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | |
Collapse
|
46
|
Chronic suppurative otitis media in a birth cohort of children in Greenland: population-based study of incidence and risk factors. Pediatr Infect Dis J 2011; 30:25-9. [PMID: 20700079 DOI: 10.1097/inf.0b013e3181efaa11] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inuits of the Arctic experience very high rates of chronic suppurative otitis media (CSOM), yet world-wide, very little is known about the epidemiology of CSOM. The study aims were to determine incidence, median age at debut, risk factors, and associated population attributable risks for CSOM in young children in Sisimiut, the second biggest town of Greenland (population 5400), where living conditions are relatively western and approximately 90% are Inuits. METHODS A population-based birth cohort of 465 children aged between 0 and 4 years was followed for a 2-year period (1996 to 1998), and cases of CSOM were registered based on medical history and clinical examinations. Kaplan-Meier curves were used for estimations of cumulative risk and Cox regression analyses for hazard rates associated with risk factors. RESULTS Cumulative risk of CSOM at 4 years of age was 14%, and median age at debut was 336 days. Risk factors were attending childcare centers (hazard ratio [HR]: 3.18, 95% confidence interval [CI]: 1.53- 6.61), having smokers in the household (HR: 4.56, 95% CI: 1.07-19.4), having a mother who reported a history of purulent ear discharge (3.27, 95% CI: 1.74-6.13), having a high burden of upper respiratory tract infections (HR: 1.19, 95% CI: 1.03-1.37), and being Inuit (HR: 5.56, 95% CI: 0.78-50). CONCLUSIONS Greenlandic children have high rates of CSOM with debut early in life, but the identified risk factors and the associated population attributable risks indicate that preventive measures regarding use of childcare centers and passive smoking may reduce the high frequency of CSOM in this high-risk population.
Collapse
|
47
|
Bakhshaee M, Rajati M, Fereidouni M, Khadivi E, Varasteh A. Allergic rhinitis and chronic suppurative otitis media. Eur Arch Otorhinolaryngol 2010; 268:87-91. [DOI: 10.1007/s00405-010-1290-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
|
48
|
Risk factors for otitis media among preschool, rural Indian children. Int J Pediatr Otorhinolaryngol 2010; 74:677-83. [PMID: 20416956 DOI: 10.1016/j.ijporl.2010.03.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 03/07/2010] [Accepted: 03/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To establish the role of various risk factors for otitis media among preschool, rural Indian children. METHODS A cross sectional study of 800 children was undertaken to determine the prevalence of otitis media. Thereafter, using a case control study design, all the cases and an equal number of controls were compared in terms of various common risk factors for otitis media. The 13 risk factors studied were age, sex, socioeconomic status (SES), nutritional status, balwadi attendance, duration of breast feeding, passive smoking, exposure to household smoke, persistent rhinorrhoea,positive throat culture, snoring, seasonal rhinitis and allergic rhinitis. Bivariate association between these risk factors and otitis media was studied using chi-square test of proportions. Multivariate logistic regression analysis was done by including the variables which were significant at p=0.35 in the bivariate analysis. RESULTS From the cross sectional study, the prevalence of otitis media was found to be 8.6%, roughly half the prevalence obtained 10 years previously from the same region. Otitis media with effusion (OME) was the commonest manifestation of otitis media (6%) with 3.8% having bilateral disease. Ear wax was seen in 27.5% of subjects. Eighteen (2.3%) children failed the screening audiometry test set at 40 dB HL. Sociodemographic factors among cases and controls were comparable. The prime risk factors for otitis media identified by bivariate analysis included persistent rhinorrhoea, snoring and seasonal rhinitis. On multivariate logistic regression analysis, persistent rhinorrhoea (p<0.01,O.R.=7.56, 95%C.I. 2.73 - 20.92), snoring (p=0.01,O.R.=4.89, 95% C.I.1.32 - 18.17), seasonal rhinitis(p=0.02, OR=5.93,95% CI=1.33-26.51) and passive smoking (p=0.04, O.R.=3.29, 95%C.I. 1.05-10.33) were found to be important risk factors for otitis media. Age, sex, SES, parental education, seasonal or allergic rhinitis, inadequate breast feeding and exposure to household smoke were not significant risk factors. CONCLUSIONS Otitis media continues to have a high prevalence among South Indian children. Persistent rhinorrhea, snoring, seasonal rhinitis and passive smoking are the chief risk factors for the disease. Measures to reduce the prevalence of otitis media by addressing these risk factors are urgently required.
Collapse
|
49
|
Interferon-gamma in suppurative otitis media: significance of otorrhoea type and disease outcome. The Journal of Laryngology & Otology 2009; 123:1103-7. [PMID: 19640314 DOI: 10.1017/s0022215109990600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Interferon-gamma has been reported to have an immunoregulatory role in otitis media with effusion. However, such a role remains to be determined in acute suppurative otitis media. AIM To determine the levels of interferon-gamma in middle-ear secretion in children with acute suppurative otitis media, and to determine the significance of interferon-gamma to the nature of otorrhoea and the outcome of otitis media. SETTINGS AND DESIGN Prospective, longitudinal follow up of patients selected from community and tertiary health centres. METHODS We selected children with acute suppurative otitis media, diagnosed as otorrhoea of less than three months' duration. Middle-ear secretions were collected by pipetting and stored at -80 degrees C. Interferon-gamma was assayed using enzyme-linked immunosorbent assay. The patients were treated and followed up for nine to 12 months, to separate those with resolved acute suppurative otitis media from those with chronic suppurative otitis media. RESULT The study initially included 358 cases of acute suppurative otitis media. Nine-month follow up was achieved in 304 patients (85 percent). Of these patients, acute suppurative otitis media resolved in 187 (61 percent), while chronic suppurative otitis media was evident in 117 (39 percent). The children with completed follow up comprised 173 boys and 131 girls, aged between four months and nine years (mean age 6.6 years; standard deviation 1.32). These children had purulent otorrhoea in 171 cases (56 percent) and mucoid otorrhoea in 133 cases (44 percent). The children's middle-ear secretion interferon-gamma concentrations ranged from 12 to 126 pg/ml. The mean middle-ear secretion interferon-gamma concentration was 27.2 pg/ml (standard deviation 8.8) in patients whose acute suppurative otitis media resolved, and 73.1 pg/ml (standard deviation 9.5) in those progressing to chronic suppurative otitis media. In children with purulent otitis media, the mean middle-ear secretion interferon-gamma concentration was 43.5 pg/ml (standard deviation 15.6); in those with mucoid otitis media, it was 74.3 pg/ml (standard deviation 19.1). Univariate analysis revealed significant differences in middle-ear secretion interferon-gamma concentration, comparing resolved acute suppurative otitis media and chronic suppurative otitis media cases (p = 0.00), and comparing purulent and mucoid otitis media cases (p = 0.00). Pearson correlation testing revealed significant inverse correlation between interferon-gamma concentration and middle-ear secretion immunoglobulin G concentration (p = 0.01), immunoglobulin E concentration (p = 0.03) and immunoglobulin A concentration (p = 0.00). CONCLUSION A high concentration of interferon-gamma in middle-ear secretions promotes chronicity of suppurative otitis media. Further research in this area may lead to the development of agents which assist the control of suppurative otitis media chronicity.
Collapse
|
50
|
Early onset otitis media: risk factors and effects on the outcome of chronic suppurative otitis media. Eur Arch Otorhinolaryngol 2007; 265:765-8. [PMID: 18046567 DOI: 10.1007/s00405-007-0544-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 11/14/2007] [Indexed: 10/22/2022]
Abstract
The onset of early otitis media (EOM), in the first few months of life has been reported to predict later chronic otitis media (CSOM), although the prevalence rates are increasing little is known about specific risk factors. In this survey we examined the hypothesis that higher risk factors is associated with the development of OM within 1 year compared to later onset and early onset otitis media (OM) has potential for negative outcome of CSOM. This is a survey of the age at onset of otorrhoea and associated risk factors in children with CSOM, in five sites spread in two sub-urban cities in two states in Nigeria. Questionnaires were administered on the informants followed by examination of the children. EOM was seen in 136/189 (70%) with CSOM, the age range was 1-150 months, mean of 59.25 (SD = 44.55). Of the 85 CSOM subjects with hearing loss, EOM accounted for 49 (57.7%) while 36 (42.4%) was later onset, On multivariate analysis (OR = 0.276, CI = 0.133-0.572, P = 0.001) revealing EOM was significant in the development of hearing loss however there was no correlation with the frequency of attack of otorrhoea (OR = 1.025, CI = 0.88-1.19, P = 0.75). Low socioeconomic status seen in 110/136 EOM (P = 0.000), allergy (P = 0.030) and number of people >10 in household (OR = 4.13, CI = 1.81-9.39, P = 0.001) constituted the significant risk for EOM compared to later onset. Bottlefeeding, adenoiditis/adenoid hypertrophy, indoor cooking and upper respiratory infection were not found to have statistical significance in early onset OM compared to later onset OM. This study found correlation between EOM and hearing loss and identified allergy, low social status and chronic exposure to overcrowding through increased number of children in the household significant risk factors for future research focus. This may help in controlling the prevalence of hearing loss accompanying CSOM.
Collapse
|