Persistent rhinorrhoea in rural Indian children: prevalence and consequences

Relative etiological importance of adenoid hypertrophy versus sinusitis in children with persistent rhinorrhoea

Persistent rhinorrhoea is a common, yet often neglected, problem among Indian children. This study was designed to evaluate the relative etiological importance of adenoid hypertrophy versus sinusitis in children with persistent rhinorrhea. Additionally, the association between S. pneumoniae colonization and adenoid hypertrophy was studied. Children aged 1-14 years with persistent rhinorrhea underwent clinical evaluation, rigid nasal endoscopy and xrays of the nasopharynx and paranasal sinuses to ascertain the presence of adenoid hypertrophy and sinusitis using standard criteria. Nasopharyngeal swabbing to ascertain the presence of nasopharyngeal colonization with S. pneumoniae was also performed. Adenoid hypertrophy was more consistently associated with persistent rhinorrhea than sinusitis (p < 0.0001). Coincident adenoid hypertrophy and sinusitis occurred in 57 %. S. pneumoniae was cultured in only 29 % of children. Up to 47 % of patients had features of nasal allergy. There was no association between S. pneumoniae colonization and adenoid hypertrophy (p = 0.1). Adenoid hypertrophy is an important cause of persistent rhinorrhea in children. Measures to evaluate for and treat adenoid hypertrophy should be instituted early to alleviate the problem of persistent rhinorrhoea in children. S. pneumoniae colonization of the nasopharynx is not a major etiological factor for persistent rhinorrhoea in these children. Nasal allergy may be a cause of adenoid hypertrophy in roughly half the children.

Immunogenicity, safety, and reactogenicity of the 10-valent pneumococcal non-typeable Hemophilus influenzae protein D conjugate vaccine (PHiD-CV) when co-administered with the DTPw-HBV/Hib vaccine in Indian infants: a single-blind, randomized, controlled study

In India, pneumococcal diseases are major causes of child mortality, and effective vaccines against Streptococcus pneumoniae are needed. This single-blind, randomized study assessed the immunogenicity, reactogenicity, and safety of the 10-valent pneumococcal non-typeable Hemophilus influenzae (NTHi) protein D conjugate vaccine (PHiD-CV) co-administered with DTPw-HBV/Hib in Indian infants as 3-dose primary vaccination course. A total of 360 infants were randomized (2:1) to receive either PHiD-CV co-administered with DTPw-HBV/Hib (PHiD-CV group) or a Hib vaccine co-administered with DTPw-HBV (control group) at 6, 10, and 14 weeks of age. For each vaccine pneumococcal serotype, the percentage of infants in the PHiD-CV group with antibody concentrations ≥ 0.2 µg/mL one month after the third vaccine dose was at least 98.3%, except for serotypes 6B (77.7%) and 23F (89.5%), and opsonophagocytic activity titers ≥ 8 were measured in at least 95.7% of infants, except for serotypes 1 (90.5%) and 6B (84.5%). In addition, all the infants in the PHiD-CV group were seroprotected against diphtheria, tetanus, Hib, and hepatitis B or seropositive for antibodies against pertussis and NTHi protein D (except one infant). Incidences of solicited local and general symptoms were comparable between groups, except for fever (axillary temperature ≥ 37.5°C), which seemed to occur more frequently in the PHiD-CV group. In conclusion, PHiD-CV was shown to be immunogenic and well-tolerated when co-administered with DTPw-HBV/Hib in Indian infants.

A survey of ear, nose and throat disorders in rural India

AIMS AND OBJECTIVES

The main aim of this survey was to assess the prevalence of common ear, nose and throat (ENT) disorders in the rural India.

SETTING

After initial screening of the patients at the primary health center, a week long camp was organized in a district where entire population resides in the rural area and a complete ENT examination and investigation was done by the ENT specialists.

MATERIALS AND METHODS

A total of 950 patients were found to be suffering from the ENT ailments in the total population of thirty thousands of the district (4.31%). Out of the total of 950 patients 36.6% of patients (n = 348) had ear problems, 23.57% (n = 225) had nasal problems, while 16.58% (n = 161) of patients were suffering from the throat disorders. Among the ear patients most common diagnosis was chronic suppurative otitis media (CSOM) 114 and presbyacusis 83. Deviated nasal septum and sinusitis was most common diagnosis in nasal symptoms while gastroesophageal reflux (GERD) was the commonest throat problems seen in this study. Eleven patients had various benign tumors of head and neck and only one patient was found to be having oropharyngeal malignancy. The congenital head and neck lesion was seen in only four patients.

CONCLUSIONS

In this survey 4.31% of the rural population of the district were having ENT ailments. The highest numbers rural population (35.65%) were having ear diseases. This was primarily due to low socioeconomic status and lack of awareness of the population. The nasal problem was seen in 23.57%, while throat problem was seen in 16.58%. The percentage of head neck malignancy in this survey was 0.0028.

Prevalence of hearing loss and ear morbidity among adolescents and young adults in rural southern Nepal

A cross-sectional survey was conducted among 3646 persons, 15 to 23 years of age, in the southern plains District of Sarlahi, Nepal, to assess the prevalence and severity of hearing loss and middle-ear dysfunction, and adverse effects of hearing loss on social integration. Between 2006 and 2008, subjects were enumerated and underwent otoscopic, tympanometric, and audiometric evaluations at central sites in villages. Hearing loss was diagnosed in subjects who failed a hearing screening and exhibited an average air conduction threshold value greater than or equal to 30 dBHL in the worse ear. Clinically, 32.8% of subjects exhibited a dull or retracted tympanic membrane, and 18% had abnormal tympanometry. Nearly 12% failed the hearing screening test, among whom more than half, or 6.1% overall, had hearing loss. Hearing-impaired subjects were six- to eight-fold (ORs, with 95% CIs excluding 1.0) more likely to report problems in hearing usual sounds or communicating with other people. Among young adults living in southern Nepal, hearing loss is common, and associated with social disability.

Risk factors for otitis media among preschool, rural Indian children

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.

Microbial dynamics of purulent nasopharyngitis in children

This review presents the microbiological dynamic and therapeutic options in the management of purulent nasopharyngitis (NPT). The nasopharynx (NP) of healthy children is generally colonized by relatively non-pathogenic aerobic and anaerobic organisms, some of, which possess the ability to interfere with the growth of potential pathogens. Conversely, carriage of potential respiratory aerobic pathogen such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, as well as some anaerobic bacteria (Peptostreptococcus, Fusobacterium and Prevotella spp.) increases during purulent NPT. The development of purulent NPT in children is associated with the pre-existing colonization by potential pathogens and the absence of interfering organisms in the NP. Controversy exists regarding the management of NPT as no conclusive evidence exists to date that the administration of antimicrobials will shorten the illness.