Risk Factor Analysis, Clinical and Microbiological Profile of Children with Symptomatic Otitis Media in a Tertiary Care Centre

INTRODUCTION: Otitis media is a common childhood infection especially in developing countries. Otitis media refers to the inflammation of the middle ear mucosa. About 80% of children experience at least one episode of otitis media within their first 3 years of life. It is the reason for every third hospital visit in a pediatric practice. Serious complications can occur from otitis media. It is the commonest cause of preventable and treatable hearing loss. Long term hearing loss can have serious impact on language and communication, psychosocial and cognitive development and academic performance of the child. Identifying the predictors and avoiding them and treating the infection with appropriate antibiotics prevent complications and results in good outcome. Good knowledge and understanding of the host and the environmental factors for development of otitis media is important in identifying a child at risk of recurrent and persistent otitis media. This helps in primary and secondary prevention of otitis media and decreasing its complications and sequelae. This study is done to analyse the risk factors associated with acute and chronic otitis media and to find the spectrum of organisms causing otitis media to enable prevention and appropriate treatment respectively. AIMS OF THE STUDY: 1. To analyse the risk factors in children < 12 years with symptomatic otitis media in a tertiary care centre. 2. To study the clinical profile of children < 12 years with symptomatic otitis media in a tertiary care centre. 3. To identify the organisms causing otitis media and their sensitivity patterns in a tertiary care centre. DISCUSSION & ANALYSIS: ACUTE OTITIS MEDIA: The occurrence of acute otitis media was highest between 1 to 5 years of age constituting 68.8% of the cases. There was a male preponderance constituting 64.8%. This is comparable with the Advisory committee on immunization recommendations. But since this study is a hospital based study, age and sex distribution has a selection bias. There was a significant association between the presence of siblings and otitis media in our study constituting to 75%. Joost et al study with 45.9% of the cases having siblings and Uhari et al study in Finland showed also showed significant association. In our study, 71.9% of the children with otitis media were exposed to passive smoking which was significant. This is comparable to Uhari et al study in Finland. But Sophia A et al study in CMC, Vellore in 2010 did not find significant association. In our study there was no significant protection found between exclusive breast feeding for 6 months and the occurrence of otitis media. But literature says there is a significant association. The lack of significant association could be attributed to the incorrect feeding positions which could lead to otitis media. Sophia A et al study in CMC Vellore and the Nigeria study also did not find a significant association. But Uhari et al study in Finland found a significant negative association between breast feeding and otitis media. In our study bad practices like pacifier usage, nose blowing and oil instillation constituted about 75% and was statistically significant. Similarly, Jose Faibes Lubianca Neto et al study attributed 25% of otitis media to pacifier usage and Uhari et al study attributed 24% and found to have a statistical significance. CONCLUSION: Our study showed that siblings, low socioeconomic class and supine nursing were significant risk factors for acute otitis media and urban locality, passive smoking, low socioeconomic class and presence of siblings were significant risk factors for chronic otitis media. Most organisms causing acute otitis media were sensitive to Ampicillin and Amoxicillin while most organisms causing chronic otitis media were sensitive to Amikacin and Gentamycin in our study.