Chronic suppurative otitis media (CSOM) is one of the most common ear diseases(1,2) in many of the developing countries including Nepal. It was found to be second only to common cold as a cause of infection in childhood(3). It is the most common cause of persistence mild to moderate hearing impairment in children and young adults(4).
The etiology and pathogenesis of otitis media are multifactorial and include genetic, infections, allergy, environmental, social and racial factors and Eustachian tube dysfunction (5). During the recent decades, the incidence of chronic suppurative otitis media has dramatically declined due to improvements in housing, hygiene and antimicrobial chemotherapy (6). There were only few cases where CSOM affected patients from the higher socioeconomic ladder and even the pathology started before the patient moved up the socioeconomic ladder (1).This study was done to compare the prevalence of chronic suppurative otitis media between two populations of school children.MATERIALS AND METHODS
This study was conducted from November 2006 to April 2007 in two government and two private schools of Kathmandu valley. There were 280 school children from government schools and 230 from private schools. Altogether, there were 510 students aged between 5-12 years. Informed consent was taken from their guardians to participate in this study. The local ethical committee approved the research.The diagnosis of CSOM was made on history and otoscopic findings. Persistent perforation of the tympanic membrane with or without otorrhoea of more than three months duration was taken as evidence of CSOM and only these cases were included. Children with traumatic perforation of tympanic membrane or children with cleft palate and congenital syndrome were excluded. Data were analyzed statistically using frequency and percentage.RESULTS
There were 280 students (Male: 124, Female: 156) in government schools and 230 students (Male: 123, Female: 108) in private schools (Table 1). The prevalence of CSOM in children of government schools revealed 5.7% (Table 2) while in private schools; it was 4.8% (Table 2). Unilateral disease was seen in 81.5% (Table 3) and 26.0% had active disease. (Table 4). Around 88.9% had tybotympanic type of disease (Table 3).DISCUSSION
Chronic suppurative otitis media (CSOM) is one of the common health problems in Nepal. It is more common in children of rural community where health facilities are least available. Poor living conditions, overcrowding, poor hygiene and nutrition have been suggested as a basis for the widespread prevalence of CSOM in developing countries (7). Okafor et al found that the majority of the patients with chronic ear disease came from communities living in subsistence agricultural or slum areas of the cities (1). Poverty is a major risk factor in developing countries and certain neglected population (8). Swimming in polluted water is an important cause of suppurative otitis media in our children.
The prevalence of CSOM varies in different countries, different populations and ethnic groups. The prevalence of CSOM in our study was found to be 5.7% in the school children of government schools while it was 4.8% in the school children of private schools. The study of Ologe and NWAWALO et al found the prevalence of CSOM to be 6.0% in rural government primary schools while 0% in the children of urban private schools (9). OKEOWO et al (10) study observed a statistically significant difference in the prevalence of CSOM among the rural children (3.6%) and urban school children (0.6%). Similarly, the prevalence of CSOM done in government school children as quoted by RUP et al (11) was 6.0%, KAMAL et al (12) was 7.3%, which was slightly higher than our study. Prevalence of CSOM among school children at Narayangunj by Chowdhury and SALAUDDIN et al (13) was 4.3%.
However, the prevalence of CSOM in private school children is lower than that of children of government schools; the difference is of 0.9% only. This can be due to difference in the socioeconomic status between these two different populations as well as due to higher educational status in private school parents. As both of these studies were done in the village development committees, which is a semi urban area, but near from the capital of Nepal, the difference on the prevalence of CSOM are not higher than studies done in other parts of the world. Still there are studies, which had a higher prevalence. MAHARJAN et al (5) showed a prevalence of CSOM to be 13.2%. WHILE BISWAS et al (4) showed 12.4%, MORRIS et al (14) showed 15.0%, OKUR et al (15) had 10.4%. However, the prevalence of CSOM in urban school children quoted by MINIJA et al was 1.3% and 9.4% in urban school children (16).
In our study almost all of our school children (88.9%) had a tubo tympanic type of diseases which was in between the findings of KAMAL et al study (73.4%) and OLOGE et al (99%) (12, 17). Our study revealed that 26.0% had active CSOM similar to the study done by OLOGE et al (17) which was (27.7%).
CSOM is more commonly found in lower socioeconomic status. Parents of government schools are relatively more illiterate than the private schools. The socioeconomic status is also low in children of government schools. Malnutrition and poor living conditions are more highly likely among the children in the rural school(9). Poor housing and sanitation are prevalent in rural area, which is supported in WHO/CIBA foundation workshop of 1996 where poor housing has been recognized as a risk factor for CSOM (8). The vast majority of the infecting organisms reach the middle ear by way of the Eustachian tube in both children and adults, most commonly from an ordinary head cold (18). Potential loss of hearing because of otitis media has important consequences on the development of speech and cognitive abilities, including academic performance of children (9).CONCLUSION
This study shows that the prevalence of chronic suppurative otitis media was higher in children of government schools than that of private schools. Though the prevalence of chronic suppurative otitis media we found is lower than the previous studies, a combined effort is needed to decline it further. Health education, improvement of socioeconomic status and health facilities will be helpful in reducing the prevalence of chronic suppurative otitis media.REFERENCES
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1. Dr. (M.S. First Year Resident, ENT & Head and Neck Surgery, T.U.Teaching Hospital, Kathmandu, Nepal.)
Dr. Prakash Adhikari, M.S. First Year Resident In ENT & Head and Neck Surgery, T.U. Teaching Hospital, Kathmandu, Nepal. Fax: 977-1-4414191 - E- mail: firstname.lastname@example.org
No financial support was availiable.
This article was submitted to SGP (Sistema de Gestão de Publicações) at R@IO on April 27, 2007 and approved on May 5, 2007 at 16:14:13