Abstract
This Retrospective observational study was done over a period of 5 years, consisting of 2530 patients with chronic otitis media (COM) attended ENT OPD of a tertiary care hospital of Central India.COM commonly occurs in the age group from 11 to 20 years (37.12%). Females are more predominantly effected than males. Mucosal type (76.4%) is more common. Complications were associated with squamous type of COM.Pus culture showed positive growth of Pseudomonas in 33.9% cases. COM is a common public health problem that is often wrongly trivialized by people. Health awareness campaign, improved health education and easy accessibility to health care facilities can reduce the morbidity and mortality of this disease and therefore can reduce the incidence of this disease.
Keywords: Chronic otitis media, Cholesteatoma, Otitis Media
Introduction
COM is a major health problem in developing countries like India despite the advances in healthcare facilities. It is one of the common diseases in ENT practice. In our country burden of the disease (prevalence in India >4%) [1] is too high considering the huge population. COM is more common in low socio-economic status groups, communities with overcrowding, inadequate housing, poor hygiene, lack of breast feeding, poor nutrition, impaired immunologic status, passive smoking, frequent upper respiratory tract infection, high rates of nasopharyngeal colonization with potentially pathogenic bacteria and inadequate or unavailable health care. COM usually presents with otorrhoea, hearing loss, otalgia etc. causing psychological trauma and financial burden to the society.
Materials and Methods
This retrospective analysis was carried out during a period of five years, from January 2010 to December 2015. All patients with COM who attended department of ENT, at a tertiary care hospital of Central India, during the above mentioned period were included in our study. A total no of 2530 patients were involved in this study. A detailed history was taken followed by meticulous clinical examination was done to evaluate the patient. Data received from this study was evaluated carefully to assess the trend of presentation of COM.
Ethical Consideration
There was no conflict of interests between the authors and proper ethical clearance from the institution was taken beforehand to perform the retrospective study in the institution.
Observation and Results
In our study, out of 2530 patients, 1249 patients (49.4%) were male and 1280 patients (50.6%) were female (male to female ratio 1:1.02). Maximum patients i.e. 936 pts (37.12%) fall within the age group between 11 and 20 years. We found that the Mucosal type (76.4%) is more common than Squamous type (23.5%). Mucosal type is more common in female and Squamous type is more common in male (239 pts). 90 patients presented with complications and all of the patients had Squamous type of COM. The most common complication was Subperiosteal abscess (40 pts) and least common is Meningitis (10 pts). In this study out of 2530 patients, unilateral ear affected were 68.8% and bilateral ear affected were 31.2%. Contralateral ear findings shows Retraction of pars tens a in 1230 (48.6%) patients followed by Normal findings in 805 (31%) patients. Ear swab for culture of micro-organisms were taken and cultures showed predominant organism as Pseudomonas in 860 patients (33.9%) followed by Staphylococcus Aereusin 450 patients (17%) (Figs. 1, 2, 3; Tables 1, 2).
Fig. 1.
Distribution according to age
Fig. 2.
Distribution according to findings of contralateral ear
Fig. 3.
Distribution according to Pus culture
Table 1.
Distribution according to findings of contralateral ear
| COM(M) | COM(SQ) | Total | |
|---|---|---|---|
| Normal | 640 (33%) | 165 (27%) | 805 (31.8%) |
| Retraction | 880 (45.5%) | 350 (58.8%) | 1230 (48.6%) |
| Old healed perforation (OHP) | 155 (8%) | 10 (1.7%) | 165 (6.5%) |
| Tympanosclerosis (TSP) | 220 (11.4%) | 70 (11.8%) | 290 (11.5%) |
Table 2.
Distribution according to Pus culture
| No. of patients | Percentage | |
|---|---|---|
| Pseudomonas | 860 | 33.9 |
| Staphylococcus aureus | 450 | 17.7 |
| Coagulase negative staph | 200 | 7.9 |
| Streptococcus | 175 | 6.9 |
| Klebsiella | 300 | 11.8 |
| Proteus | 100 | 3.9 |
| Ecoli | 305 | 12 |
| Diptheroids | 30 | 1.1 |
| Normal | 110 | 4.3 |
| Total | 2530 | 100 |
Discussion
Chronic otitis media (COM) is a disease associated with the structural change in middle ear and permanent abnormality of pars tensa or parsflaccida mostly as a sequelae of long standing middle ear effusion, inadequately treated acute otitis media or eustachian tube dysfunction and negative middle ear pressure. It is one of the common diseases in our day to day otorhinolaryngology practice. COM is more common in developing countries [2] than in developed ones. In the developing countries, poverty, ignorance, dearth of specialists and limited access to medical care amongst others conspire to worsen the course and complications of COM. Overcrowding, poor hygiene and nutrition and poor living conditions have been suggested as a basis for the widespread prevalence of COM in developing countries [3–5]. In our study, female patients are more in number than male patients with a male female ratio of 1:1.2, similar results are found by Basak et al. [7]. Maximum number of the patients presented in a age group between 11 to 20 years this results are comparable to study done by Akinpelu et al. [4] (2001–2005) This suggest that COM tends to occur more in early decades of life and to leads to permanent defect in tympanic membrane with hearing loss. COM is usually classified into two main types-Mucosal and Squamous. In our study most of the cases 1935 (76.4%) belonged to mucosal type of COM and rest of the cases 595 (23.6%) presented with Squamous type. These findings are not similar to the study conducted by Tshering et al. [8]. In the study done by Adhikari et al. [9] most of the patients revealed Retraction in contralateral ear 83.3 and 68.4% repectively. These findings were similar to our study. A study was done by Bijan et al. [6] on 1717 patients study revealed that most common complication was postaural abscess in 69 (65%) cases which is similar to our study that periosteal abscess being the commonest complication with 44% (40 out of 90 pts COM SQ). The common organisms in all the studies were Pseudomonas aeruginosa and Staphylococcus aureus. Our study correlates with the Mathew study [8].
Conclusion
Prevalence of COM is relatively high in younger age groups. Mucosal disease was more common than squamous type. Contralateral ear changes shows significant Retraction of tympanic membrane. Ear swab for pus culture shows growth of micro organism like pseudomonas and staphylococcus. Common ear diseases and their predisposing factors should be evaluated in our community in order to increase awareness about these diseases and decrease morbidity due to the disease. Recent decrease of prevalence of COM Squamous type among population is ascribed to better medical services which facilitate early diagnosis and treatment of chronic otitis media. This emphasizes the need to improve the health services in the rural areas so that chronic otitis media is diagnosed and treated at the primary level of health care.
Compliance with ethical standards
Conflict of interest
There is no conflict of interest.
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