Prevalence and risk factors of otitis media with effusion in school children in Eastern Anatolia

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Abstract

Objective

To investigate the prevalence and demographic, environmental and child associated risk factors of OME in schoolchildren in Eastern Anatolia, Turkey, and analyze the results with reference to the review of the literature.

Methods

A total of 2355 children who were attending two different primary schools, one located in low, and the other located in a high socioeconomic district of city of Van were screened and 2320 children who met the inclusion criteria were enrolled to study. Standardized questionnaires that include nine questions for determination of risk factors were delivered to the parents to be filled before examination of each child. All of the children underwent both otoscopic examination and tympanometric evaluation to provide high accuracy on the diagnosis of OME. The association between children diagnosed as OME and the answers to the questionnaires were evaluated. Also, teachers of the children were asked to complete a questionnaire evaluating child's level of school success, and the success levels of children with or without OME were compared.

Results

The prevalence of OME was found to be 10.43%. Second-hand smoking (p < 0.0001), low socioeconomic status (p < 0.001), living in a crowded house (p < 0.001), presence of atopy (p < 0.01), lack of breast-feeding (p < 0.05), presence of URTI (p < 0.0001), young age (p < 0.001) and snoring (p < 0.0001) were found to be associated with prevalence of OME. No significance was found for duration of breast-feeding, gender, birth history and previous otolaryngological operations. Also, children with OME were tended to be less successful in terms of school success.

Conclusions

The potential of OME to cause serious sequelae and complications that may affect children's life long-term, makes the disease an important health problem. Environmental, epidemiologic and familial factors play an important role in pathogenesis of OME. Caretakers must be informed about these highly modifiable risk factors, by this way the development or delayed diagnosis of the disease that may cause serious consequences can be prevented.

Introduction

Otitis media with effusion (OME) is defined as the collection of serous or mucous fluid in the middle ear cavity and mastoid cells behind an intact tympanic membrane during an inflammatory process without any signs or symptoms of acute infection. It causes conductive hearing loss by reducing tympanic membrane mobility. If it is untreated, or inadequately treated, it may lead to sequeles and complications like retraction pockets, adhesive otitis media, tympanosclerosis, permanent hearing loss and impairment in development of speech and language [1], [2], [3], [4].

Various rates have been determined in the studies investigating the prevalence of OME in preschool and school children. While the prevalence of OME varies between 1.9% and 61% according to the studies worldwide [5], [6], it was found to be between 8.7% and 18% according to the limited number of studies performed in our country [7], [8], [9]. The importance of the disease as a public health problem comes not only from its high frequency, but also from its tendency to follow a silent course. In fact it is very frequent in childhood, in almost 50% of cases of OME, neither the affected children nor their parents, describe significant complaints, and the diagnosis is generally delayed [10]. When the population of the children in Turkey has been considered, the importance of OME as a public health problem can be understood clearly. Over 25% of the population (almost 19 million of 74 million people) in Turkey is under 14 years old according to 2011 data [11]. Determination of the real prevalence and risk factors of OME could play a critical role in early diagnosis and prevention of the disease in such a huge population, which will eventually end up in lower complication rates. Studies that investigate the prevalence and/or risk factors of OME, and implying its importance in the pathogenesis of chronic ear diseases have been conducted in Turkey since late 1970s [7], [8], [9], [12], [13], [14], [15], [16], [17], [18], but unfortunately OME still remains the most common cause of chronic ear diseases, including chronic otitis media with and without cholesteatoma [19], [20].

The ‘Panel Report from the Ninth International Research Conference on Otitis Media’ suggests that the etiology of OME is multifactorial and many different factors are implicated in the pathophysiology of this disease [21]. The immaturity of function of both the Eustachian tube and the immune system is considered as the main responsible factor for the development of OME; upper respiratory tract infections (URTIs), mechanical obstruction of the nasopharynx by adenoid hypertrophy or craniofacial malformations are other common causes of OME. Also, there are some other factors that are suspected to have an influence on the pathogenesis of OME like race, gender, seasonal factors, history of allergy, humidity level of the environment, accessibility to health services, socioeconomic status, breast feeding duration, living in a crowded house or being in a crowded environment such as a kindergarden or school, passive smoking and gastroesophageal reflux [8], [22], [23], [24], [25], [26], [27], [28], [29]. However, although frequently studied, the influence of some of these factors on the pathogenesis of OME stays controversial when results of the previous studies are compared, and further investigation is needed for clarification.

The aim of this study was to investigate the prevalence and demographic, environmental and child associated risk factors of OME in the city of Van, located in Eastern region of Turkey. We also tried to demonstrate the impact of OME on children's school success.

Section snippets

Methods

A total of 2355 children who were attending two public primary schools in Van were screened and 2320 children who met the inclusion criteria were enrolled to the study. Where the first school was settled in a district with a higher socioeconomic status, second school was located in an area with a lower socioeconomic status. The ages of the children in the study were between 6 and 11 years, with a mean of 8.5 years [number of boys 1292 (55.69%) and girls 1028 (44.31%)]. The study was done with

Results

Among 2320 children that were included in the study, we found 242 (10.43%) children suffering from OME. Of 242 children who were accepted as OME, 181 (74.79%) had type B tympanogram with physical examination findings that suggests OME, 21 (8.67%) had type B tympanogram without physical examination findings of OME, 15 (6.19%) had type B tympanogram with tympanic membrane retraction and 25 (10.33%) had type C2 tympanogram with or without physical examination findings. While OME was bilateral in

Discussion

Otitis media with effusion is a common health problem in children with a trend of higher rates in younger age groups. Its importance depends not only on its significant utilization of health care [1] and antibiotics [31] but also on its potential to cause chronic hearing loss, chronic ear problems and impairment in development of speech and language [32]. The morbidity, complications and sequeles of the disease can be decreased significantly with early diagnosis and proper treatment.

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