A Questionnaire-Based Survey of Indian ENT Surgeons to Estimate Clinic Prevalence of Acute Otitis Media, Diagnostic Practices, and Management Strategies

Abstract

Acute otitis media (AOM) is common in Indian children, but there is limited published information on its clinic prevalence, clinicians' diagnostic practices, and their management strategies. We approached 649 ear-nose-throat (ENT) surgeons to assess these aspects of AOM. We conducted the survey between May 2010 and February 2011 with the same set of ENT surgeons practising across India, once each during summer, monsoon and winter, using a validated 36-item questionnaire to record their reflective recall. 78 % (506/649) of approached ENT surgeons responded. The clinic prevalence of AOM was 43 % with peaks reported in July and December. 96 % (486/506) of the surgeons used otoscopy to diagnose AOM. 86 % (435/506) prescribed analgesics, and 89 % (449/506) prescribed decongestants. 98 % (495/506) treated AOM with an antibiotic at initial consultation: amoxicillin/clavulanic acid 78 % (395/506), amoxicillin 29 % (144/506), cefpodoxime 29 % (149/506), cefixime 28 % (141/506) and azithromycin 27 % (134/506). Amoxicillin/clavulanic acid 32 % (162/506) and cefpodoxime 27% (137/506) were mostly prescribed for relapse. The average reported duration of initial antibiotic therapy was 7 days and for relapse was 9 days. The reported clinic prevalence of AOM was higher (43 %) than anticipated (about 10 %) in ENT practice. Almost all the ENT surgeons used an otoscope to diagnose AOM. Amoxicillin/clavulanic acid was the preferred antibiotic for treating AOM either initially or for relapse. Most surgeons also used analgesics and decongestants for symptomatic relief.

Acute otitis media guidelines in selected developed and developing countries: uniformity and diversity

“…In PCV-unimmunised Chinese children with pneumococcal AOM, a significant proportion of clones were also resistant to antibiotics 28. In India, otolaryngologists reported that they treated 98% of AOM episodes with antibiotics, and amoxicillin/clavulanic acid was the first-line therapy 29. We acknowledge limitations in our study: (1) we focused on only 12 guidelines.…”

Nasopharyngeal colonization of otopathogens in South Indian children with acute otitis media – A case control pilot study

“…There is wide variation noted in the prevalence of AOM worldwide and particularly from India. While the prevalence worldwide has been reported to be around 10.8%, in India it has been reported to be between 4 and 43% based on a questionnaire and otoscopic assessment ( Ren et al., 2018 ; Monasta et al., 2012 ; DeAntonio et al., 2016 ; D’silva et al., 2013 ; Gaur et al., 2009 ; Sophia et al., 2010 ). This variation could be because of different ways of reporting AOM ( Sophia et al., 2010 ; Srikanth et al., 2009 ).…”