Prevalence of Chronic Suppurative Otitis Media in Out Patient Department (OPD) in a District Level 250 Bedded General Hospital, Gopalganj, Bangladesh

Aims: To find out the prevalence and profile of chronic suppurative otitis media (CSOM) in district level of Bangladesh. Methods: This was a prospective cross sectional study which was carried out patients of chronic suppurative otitis media attended in OPD of 250 Bedded General Hospital, Gopalganj. A total number of 200 patients of CSOM were randomly selected from OPD irrespective of sex and religion during period of July 2015 to June 2016. Age ranging 060 years and person residents of Gopalganj and adjacent districts. Results: In this study 60.5% were male and 39.5%female. Male Female ratio 3:2. Majority of respondents were age group is 11 to 20 years. (36.5%). Mean age of patient 29.98 years. Maximum families 52% had monthly income of TK 10,000 to 15,000 and maximum patients were dependant (37.5%). 56 family members were highest group (60%), 60% respondent lived in Kacha house, 75% lived in rural area and 35% respondents used to bath in pond. The majority of clinical features were otorrhea (100%), deafness (32%), otalgia (42%), itchy ear (10%), tinnitus (50%), odor from ear (10%) and vertigo (5%). Most of ears (90%) were tubotymponic type of CSOM and medium size perforation were maximum (32.5%). Conclusion: Prevalence of CSOM is still high in rural area of our country and community found in younger age group. Improvement of socio-demographic factors, health awareness campaign, improved health education and easy accessibility to health care facilities can reduce the incidence of disease.


Introduction
Chronic Suppurative Otitis Media (CSOM) has been an important middle ear disease since prehistoric times. 28 Chronic Suppurative Otitis Media (CSOM) is one of the most common ear diseases in South East Asia having a prevalence of approximately 5.2% in general population. 1 Prevalence of CSOM in developing countries represents a wide range 4% to 33.3% 2 .In Bangladesh its prevalence is 12.44% 3 , 7.39%. 4 Studies in Bangladesh, India, various countries in Africa and amongst certain disadvantaged ethnic groups have shown that CSOM may have a prevalence of between 2 and 17% among children. 5 Chronic Suppurative Otitis Media is one of most common health problem in Bangladesh. Its incidence has been reported to depend on race and socio-economic factor. 6 The etiology and pathogenesis of otitis media are multifactorial and include genetic, infections, allergy, environmental, social and rural factors and Eustachian tube dysfunction. 7 Chronic Suppurative Otitis Media (CSOM) is one of the most common childhood infectious diseases worldwide and is a common cause of hearing impairment in resource limited settings, although it is infrequently seen in resource-rich settings. 8 CSOM is chronic inflammation of the middle ear associated with tympanic membrane(TM) perforation and chronic discharge (otorrhea). 8 The world Health Organization defines CSOM as otorrhea lasting at least two weeks 8 ; however, "Chronic" is more commonly are defined as symptoms persistent for >6 weeks. The most common suggested cut off for duration of suppuration is six weeks (range two weeks to three months). 9 CSOM is a major health problem in developing countries like India respites the advances in health care facilities. It is one of common disease in ENT practice. In our country burden of the disease is too high considering the huge population. CSOM is more common in low socioeconomic status groups, communities with overcrowding, made quite housing, poor hygiene, lack of breastfeeding, poor nutrition, impaired immunologic status, passive smoking, frequent upper respiratory tract infection, high rates of hospitalised colonization with potentially pathogenic bacteria and inadequate or unavailable health care. CSOM usually present with otorrhea, hearing loss, otalgia etc. causing psychological trauma and financial burden to the society. 10 During the recent decades the incidence of chronic otitis media has dramatically declined due to improvements in housing, hygiene and antimicrobial chemotherapy. 11 Racial difference, geographic and socioeconomic condition, educational status are factors that influence the prevalence of this disease. 12 The department of community medicine in All Indian Institute of Medical Science revealed CSOM in 15.3% of rural child. 13 More than eighty percent of our people are from rural areas and for practical regions a small proportion of this bulk is within the access of the national health care system. CSOM in our population is still alarming. Now it is the most common cause of deafness in our country. In our country due to lack of facilities and unawareness the people usually take less care of CSOM. Poor environmental sanitation and poor housing influence the higher incidence of disease. This study based on clinical examination of the people attended in outpatient department of 250 Bedded General Hospital. Aim of this study was find out the prevalence of CSOM in district level of Bangladesh and to find out the aetiological factors of C.SOM.
Aim of the study : To find out the prevalence and profile of chronic suppurative otitis media (CSOM) among the people of Gopalganj and neighbouring districts.

Methods
Type of the study: Cross sectional study . Place of study: ENT Outpatient Department, 250 Bedded General Hospital, Gopalganj .
Study Population: Patients of chronic suppurative otitis media (CSOM) attended in OPD.

Selection of patients: 200 patients of CSOM
were randomly selected from OPD irrespective of sex and religion.
Period of study: July 2015 to June 2016.

Statistical Analysis:
The data obtain from the study were compiled and standard scientific calculator as well as computer software were used and the results of this study analysed statistically using SPSS 20 where relevant.

Results
Two hundred cases of chronic suppurative otitis media(CSOM) were included in this study from outpatient department of ENT, 250 Bedded General Hospital Gopalganj, from July 2015 to June 2016.
In this study 121(60.5%) cases were male and 79(39.5%) cases were female. Male Female ratio 3: 2. Age ranges were 0 to 60 years.  Maximum of families 104(52%) had monthly income of TK 10,000 to 15,000 and lowest more than TK 25,000 group was 6(3%).  9 -10 10 5% Total 200 100 5-6 family members 120 (60%) were the highest group and 9-10 family members 10 (5%) were lowest group. Maximum 120 (60%) respondents lived in katcha house and minimum 4 (2%) lived in zhupri.      17 and Zakzouk and al-Mohaimed also showed similar high incidence of otitis media in their study (19.6%). 18 The lower incidence and prevalence our series can be explained by the fact that with passage of time the  19,20 . In New Zealand two different studies has shown the reduction of CSOM (Hamilton MA et al.). 21 In one study CSOM was said to reduce from 10.0% in 1974 to 2.7% 1978 (Giles M, Asher L). 21,22 In this study, the age distribution shows that highest 36.5% cases of CSOM were found in 11-20 years and age group 51-60 years were minimum (5.5%). It seems that it is not in accordance with view of Browning GG.  Arnold (1996) found that the middle ear disease is more common in boys than girls. The sex incidence of present series is similar to Siddique BH where in large series the male comprised 62.18% and female comprised 37.72% of cases. 24 The prevalence of CSOM was 30% upto TK10,000, 52% is TK 10,000-15,000, 10% upto TK 15,000 to 20,000, 5% upto TK 20,000 to 25,000 and 3% more than TK 25,000 monthly family income group. The study shows CSOM was more prevalent in lower socioeconomic conditions. Aundhkar VH found CSOM is generally found to be more prevalent in lower socioeconomic condition. 23 Siddique BH also found majority of CSOM cases is poor and very poor families. 24 In a rural based survey in Bangladesh in 1995 found CSOM is 19% is very poor and 54% is poor class. CSOM in middle and affluent class were found is 25% and 2% families respectively. 24 In this study, as an occupation the dependents were affected most (37.5%). Nazma Kamal shows that the most of the population are dependent group (83.2%) and in CSOM cases the most (93.3%) are also is dependent group. 20 In this study, most respondents (60%) were in 5-6 family members and CSOM were maximum in this group. In our study 60% families used to live in katcha house and 23% semi pakka house. This finding is well supported in WHO/CIBA foundation workshop of 1996, where poor housing has been recognised as a risk factor for CSOM. In this study maximum respondents lived in rural area (75%). In the present study most of the respondents used to bath in pond (35%) followed by river (25%) and tube well (

Conclusion
The objective of the study were to determine the prevalence of CSOM among the patients attended in ENT outpatient department and to see association of CSOM with age, sex, family members, types of housing, bath in ponds, overcrowded housing. Prevalence of CSOM is still high in rural area of our country and community found in younger age group.
Male are more affected than female, lower socioeconomic group of peoples are more prevalent. Thus improvement of these sociodemographic factors, health awareness campaign, improved health education and easy accessibility to health care facilities can reduce the incidence of this disease.