Table 1: General characteristics

Ear discharge (86%), Earache (58%) and Nasal discharge (57%) were common symptoms in present study. Vertigo (37%), post nasal drip (25%), fever (19%), tinnitus (14%), cheek pain (12%), snoring (6%), facial pain (5%) and jugular nodes (4%) were other signs and symptoms in present study.

Table 2: Distribution of symptoms

Various other nasal/nasopharyngeal co-morbidities also noted in present study such as tonsillopharyngitis (53%), allergic rhinitis (48%), asthma (37%), sinusitis (30%), adenoids (13%) and nasal polyps (5%).

Table 3: Distribution of nasal/nasopharyngeal co-morbidities

Few serious complications such as post-auricular abscess (3 patients), pyogenic meningitis (2 patients), post-auricular fistula (2 patients), mastoiditis (2 patients), temporal lobe abscess (1 patients) and facial nerve palsy (1 patients) were noted in present study.

Table 4: Incidence of Complications

DISCUSSION

Among all ear diseases, ear infections are a common but treatable cause of morbidity in children. In children and young adults, OM is the commonest cause of persistent mild to moderate hearing impairment.⁸ High prevalence of CSOM in children may be attributed to the fact that they are more prone to upper respiratory tract infections. Long-term consequences of persistent severe ear infection can arise in untreated cases like speech development disorders, poor academic and educational development and lower overall quality of life.⁹ In developing countries like India, the main predisposing factor for Otitis media is lower Socio-economic status. Overcrowding, poor hygiene and sanitation, inadequate health care and education and malnutrition lead to upper respiratory tract infection including otitis media. Infection can spread from middle ear to vital structures such as mastoid, facial nerve, labyrinth, lateral sinus, meninges and brain leading to mastoid abscess, facial nerve paralysis, deafness, lateral sinus thrombosis, meningitis and intracranial abscess.¹⁰ The treatment itself of ear diseases in childhood is associated with significant morbidity and mortality due to surgery and also puts a significant financial burden on family and health care services.¹¹ The early diagnosis and management can prove to be effective, in reducing socioeconomic burden and prevention of deafness. ¹² Various studies have reported different prevalence of CSOM as Adhikari et al.¹³ have reported a prevalence of 5.7% while Akinpelu et al.¹⁴ have found the prevalence in school going children of Nigeria to be 11.1% and Basak et al. ¹⁵ have stated a prevalence of 37.54%. The reasons for these differences may be different geographical location with respect to socioeconomic and environmental conditions, different age groups of the children studied and different diagnostic criteria used for diagnosing CSOM. The most useful symptom for diagnosis is otalgia (ear pain). Children may also display symptoms of an upper respiratory tract infection, abnormal ear tugging, fever, otorrhoea, hearing loss, irritability and not settling at night (pain increases when supine).¹⁶ Similar complaints were noted in present study. CSOM produces painless mucoid otorrhoea without fever, unless accompanied by Otitis Externa or complicated by an extra cranial or intracranial infection. Fever is noted more in Otitis Media than in Otitis Externa. Hearing loss is common among patients with CSOM and exceeds 30 dB and with a tendency to occur in about 50 to 60% of such patients.¹⁷ Conductive hearing loss is typically moderate to severe in up to two-thirds of patients and being marked at low frequencies and with increased bone conduction threshold tendency. ¹⁸ The site of the perforation corresponds to degree of hearing loss, with posterior perforations having greater decibel level loss probably as a result of loss of protection of the round window membrane from impinging sound pressure waves. ¹⁹ Safe (tubotympanic) type was more common (87%) than unsafe (atticoantral) type (13%). Similar findings were noted in other studies also.^13,20 Gupta and Mittal in their study noted CSOM distribution as tubotympanic (89.43%) and atticoantral (10.57%).²¹ Unilateral disease was seen in 85% patients and in only 15 % bilateral disease was noted. The prevalence of unilateral disease is believe to be good as it proffers a better prognosis in limiting the risk of disability from accompany hearing loss than for bilateral disease. Rakesh kumar study²² shows that among 115 patients most of the patients were between age group 11-20 years (39.13%) and CSOM was found to be more common in male patients (61.73%) than in female (38.26%) patients. The most common organisms for CSOM are seudomonas aeruginosa (46.08%); Staphylococcus aureus (33.19%); Proteus species (6.95%); Escherichia coli (3.47%); Coagulase negative Staphylococcal species (5.21%); Klebsiella species, (2.60%); and Citrobacter (1.73%). Staphylococcus aureus was more sensitive to linezolid and vancomycin and majority of gram negative isolates were sensitive to meropenem. Aspirate the discharge from the middle ear and submit for culture and sensitivity studies. Both gram positive and gram negative organisms are responsible for infection of middle ear.²³ Appropriate antimicrobial drugs should be prescribed after proper diagnosis of the causative organism and its antimicrobial susceptibility pattern. The two principal aims of management are the eradication of infection and the closure of the tympanic perforation. If the perforation does not close and the discharge doesn’t recur after conservative treatment, tympanoplasty (closure of the tympanic perforation by a soft tissue graft with or without reconstruction of the ossicular chain) with or without mastoidectomy (removing the mastoid air cells, granulations and debris) is performed restore hearing loss and eradicate the infection. Even in this era of variety of powerful antibiotics available, CSOM still consumes considerable medical expenditure, especially in the poorer sections of the society. Future studies should focus on the bacterial profile of multidrug-resistant strains resulting from indiscriminate use of antibacterial agents. An empirical antibiotic policy of a specified geographical region is of vital importance. This will have a huge positive impact by avoiding surgical procedure, minimizing the health care expenditure and more importantly preserving the quality hearing, to lead a normal social life.

CONCLUSION

Early detection of disease and health educational training, awareness programs on of the disease for school going children and parents is needed to reduce the prevalence of the disease. Improvement of health care facilities and awareness among health-care providers for early treatment would definitely be helpful in reducing the further hearing loss and other complications.

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