Background: The world has more than 360 million population (almost 5% of world's population) with disabling hearing loss and among them, 32 million are children. It is estimated that over 166 million people in the developing world face a severe lack of intervention services for hearing loss. There is a need to estimate the magnitude of various ear morbidities in school age children as well as to identify the various risk factors that play a role in the emergence of these morbidities.
The world has more than 360 million population (almost 5% of world's population) with disabling hearing loss and among them, 32 million are children. According to the latest reports by World Health Organisation, 6% of the Indian population has significant ear disorders.1 According to Census of India, 2011, of all the people with hearing disability in India, around 8% belong to age group 5-9 years.
Children in the school-going age group (6-16 years) represent 25% of the population in the developing countries.
In line with the above background, the present study was done in Gokulpuri, a resettlement colony in East Delhi to find prevalence of various preventable ear disorders among children. The study also aimed to find out the various risk factors for ear morbidities and the health care seeking behaviour of parents with respect to ear morbidities. The findings of our study would help in developing recommendations for reducing the burden of ear disorders in children that can be easily prevented.
1. To find prevalence of various ear disorders among children 5-11 years old..
It was a cross-sectional, community based study conducted at a resettlement colony named Gokulpuri, in East Delhi. Study was conducted for a period of one year, Jan 2017 -Dec 2017. Children in the age group 5 yrs. to 11 yrs. were included in the Hence, 367 children were enrolled into the study. A predesigned and pretested questionnaire was used in Hindi and English languages. The questionnaire had questions covering demographic and socio-economic information, risk factors for hearing disorders and health seeking behavior of subject's parents with respect to ear care of their child. Simple random sampling was used to select subjects. The investigator was trained in ENT examination by the ENT specialists at Lok Nayak hospital, Delhi for doing ear examination.
Cerumen impaction: In cases where wax was encountered in the ear canal, attempt was made to remove it using wax dissolving ear drops or water or sterile probe, only after taking consent from the parents. If the wax could not be removed and it was obstructing the view of the tympanic membrane, it was considered as morbidity. 8
Chronic suppurative otitis media (CSOM): History of ear discharge lasting for more than 2 weeks (with or without complications) with presence of a TM perforation. 8
Acute otitis media (AOM): Diagnosis of AOM was made on the basis of congestion, bulging or acute discharging (discharging <2 weeks) perforation of the tympanic membrane, mostly with a history of acute ear pain and/or fever. 8
Acute otitis externa: Acute inflammation of the external ear canal is commonly caused by bacterial or fungal infections. Signs of inflammation with or without ear discharge and fungal debris were indicative of otitis externa. 8
Foreign body impaction: It is the impaction of any external object (living or non-living) into the ear. 8
Children suspected or diagnosed with ear morbidity and/or hearing impairment were given a prescription and were referred to ENT department of Lok Nayak hospital, Delhi. The collected data was coded, compiled and entered in the Microsoft-Excel and then analyzed and statistically evaluated by using SPSS-PC-17 version. Institutional ethical permission was sought before commencement of the study.
The subjects belonged to age group 5-11 years old. Mean age among subjects was 8.1 years. Out of all the subjects surveyed, 51.2% were males and rests were females.
Maximum number of children [54.5%] belonged to lower middle socio-economic class. About half of the subjects belonged to joint family (54.5%). A good percentage of children (78.5%) were found to be completely immunized till date.
On enquiring about the educational status of head of the family, 6.3% were illiterate, 38.4% had head who had studied below high school and in rest of the families, the head was educated high school or above. In comparison, 12.5% of the mothers were illiterate and 44.4% had studied below high school and rest had educational level till high school or above.
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Total prevalence of ear morbidities in children was found to be 15.8%. Wax impaction in the ears was found to be most prevalent morbidity 10.6%. Second most common morbidity was CSOM, 3%.
There was no significant difference in the prevalence of various ear disorders among male and female children. We found that in the families whose head had education level above high school, those children had lower prevalence of infective ear disorders [
In the current study, 367 children, 5-11 years old were included. According to Aggarwal A.K. etal 7 , tympanic membrane abnormality was present in 6.2% of the children in <1 year old, 14.7% in 1-5 years old, 39.4% in 5-10 years old and 39.8 % in more than 10 years old. Hence, doing the present study in the age group 5-11 years was logical, as this population is at high risk for various preventable ear morbidities.
In our study, 93.7% of the subjects had literate head of the family (father was head in around 90% of the families) and 87.5% had literate mother. These results are consistent with those of the Census of India, 2011 for Delhi (91% and 80% male and female literacy rates, respectively). 9
In the present study, the overall prevalence of ear morbidities came out to be 15.8%. According to a Turkish study done in 2012 by Erdivanli OC etal 10 , prevalence of ear morbidities was 14.7% in 4-6 years old and 13.9% in 7-9 years old. This prevalence is less compared to current study because small age groups were studied in the Turkish study. Mishra A etal 11 found the prevalence of hearing impairment due to correctable ear morbidities, in rural school children to be 15.14%, as compared to 5.9% in urban area based children. Bandhopadhyay R etal 12 stated prevalence of 55.8 % in rural primary school children and 43% in urban primary school children. The higher prevalence among rural based children can be attributable to their low socio-economic status, reduced accessibility to health care providers, more number of quacks running clinics successfully in rural area, poor awareness about ear morbidities and unhealthy health seeking behavior.
Prevalence of CSOM was found to be 3% among subjects, ASOM 0.8%, foreign body impaction 1.1%, otitis externa 0.3% and cerumen impaction 10.6%. Chadha S K etal 13 in 2013, in their study on 5-12 years old kids found prevalence of wax impaction to be 7.93%, CSOM 4.79%, ASOM 0.65% and foreign body 0.34%. These findings are similar to the findings of present study. In 2008, Adhikari etal 14 did similar study in urban parts of Nepal and the results were, wax impaction 60.6%, CSOM 5.7%, ASOM 1.4%, otitis externa 1% and foreign body impaction 0.4%.
In the present study, prevalence of ear diseases among females was found to be more (16.8%) as compared to boys (14.1%). Upadhyay etal 15 in Nepal in 2001, prevalence of ear diseases were reported more among females than males. The finding of the present study is in contrast to the findings by Absalan A etal
In the present study, as the educational status of head of the family (mostly father) or mother increased, the prevalence of ear diseases decreased among students. Taneja M K etal 17 and Yiengprugsawan V et al18found that prevalence of ear morbidities in children decreased as educational status of father or mother increased.
We found that, ear morbidities were more prevalent among children who came from nuclear families as compared to those from joint families. In line with these findings, Srikanth etal 19 stated that caregivers from nuclear families were less aware about risk factors for OM and hence increased prevalence was seen. The low prevalence seen in the current study among joint family children can be explained as more number of care givers like grandparents are present in joint families.
We found that prevalence of preventable ear morbidities like ASOM, CSOM were less in children who were exclusively breast fed in first 6 months of life. This finding was statistically not significant. Duncan B et al 20 found that infants exclusively breast-fed for 4 or more months had half the mean number of acute otitis media episodes than did those not breast-fed at all and 40% less than those infants whose diets were supplemented with other foods prior to 4 months. Dewey K G et al 21 stated that the percentage of ASOM was 19% lower and CSOM was 80% lower in breast fed compared with formula fed infants.
For CSOM, higher prevalence was seen among those who were slapped [30%] than among those who were not 2.2%] and was statistically significant. In a study by Obiedi S H 22 , 27.5% of traumatic ear perforations were due to slap on face.
In the present study, completely immunized children were significantly protected against infective ear morbidities. Blanchard R D et al
In the present study, it was observed that children, whose parents reported frequent episodes of coryza in their children, had higher prevalence of ear morbidities than among those who did not. These results are in line with the conclusions given by Jacob et al