The changing epidemiological and complications profile of chronic suppurative otitis media in a developing country after two decades

Abstract

To evaluate the shift in epidemiological and complication profiles of chronic suppurative otitis media (CSOM) over two decades in a resource-limited economy. A retrospective analysis of the prevalence of CSOM and its complications in tertiary health institution a over a period of 2 years were compared between 203 cases seen in 2009 and December 2010 (present era); and 343 cases seen in 1990 and 1991 (previous era). Data were collected on the demographic characteristics of the patients, age of onset of otorrhoea, the disease type, laterality and complications of CSOM. The prevalence of CSOM significantly reduced from 9 % in the previous era to 5.1 % in the present era (P < 0.0001). The mean age of the recent group was 27.6 ± 19.3 years, and was 21.6 ± 18.2 years in the previous group. (P = 0.009). Although both group had peak age prevalence at 11-20 years, recent group saw more significant adult population >20 years of age (P ≤ 0.001). More significant cases of cholesteatoma were documented in the recent group (3.4 %) than previous era (0.9 %) (P = 0.02). Although no significant change was noted regarding the rates of complication of CSOM in the two eras (P = 0.18), there was a notable shift toward predominant extracranial pattern of complication in the recent group (P = 0.04). The prevalence of CSOM has shown a significant reduction after two decades and it appears that there has been a shift in the epidemiology of CSOM towards a predominantly adult population in the recent years. Despite an overall reduction in the incidence of intracranial complications of CSOM in our series, its complication rates have not changed remarkably after 20 years.

Otogenic brain abscesses: A systematic review

“…Interestingly, Proteus mirabilis was the most commonly isolated bacterial pathogen from brain abscesses of otogenic origin, although Proteus is not the most common middle ear pathogen. One possible reason for this is that in all papers the patients most commonly suffered from CSOM, in which bacteriology is known to differ from that of AOM . Moreover, the gram‐positive organisms are usually more often sensitive to the most commonly prescribed antibiotics for OM, leading to an increase of gram‐negative organisms.…”

“…One possible reason for this is that in all papers the patients most commonly suffered from CSOM, in which bacteriology is known to differ from that of AOM. 41,42 Moreover, the gram-positive organisms are usually more often sensitive to the most commonly prescribed antibiotics for OM, leading to an increase of gram-negative organisms. Some older studies have also posited that more virulent flora, such as Streptococcus pneumoniae, lead to a more fulminant suppurative meningitis, while species such as Proteus and Pseudomonas are more likely to be associated with a more indolent infection with bone erosion, chronic otitis media with or without cholesteatoma, and, rarely, intracranial abscess formation.…”

Otogenic Intracranial Abscesses, Our Experience Over the Last Four Decades

“…and Gram-negative enteric bacteria, the latter were more common in patients with otogenic IAs than non-otogenic [15] . The bacteriology of CSOM is known to differ from that of AOM [10,22] . In CSOM, with or without cholesteatoma, prolonged infection caused by typical pathogens may lead to osteitis, bone erosion, and may cause the infection to spread further [1,23] .…”

“…The mean preoperative leukocyte count was 13 (median 12, range [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], and the mean preoperative C-reactive protein (CRP) was 87 (median 85, range <5-158). Imaging was performed on all patients including computer tomography (CT) (n=10), angiography (n=8), Child: *; brain and ear: ±; Imaging re-evaluated by radiologist in 2015: §; COM: chronic otitis media; CT: computed tomography; MRI: magnetic resonance imaging; A: angiography; B: brain scintigraphy; EAC: external auditory canal; RMO: Radical mastoid operation; died due to abscess: † brain scintigraphy (n=3), and magnetic resonance imaging (MRI) (n=2).…”

“…Intracranial abscess formation may follow acute otitis media (AOM), but is more commonly associated with chronic suppurative otitis media (CSOM) [2,[5][6][7] . The development of more effective treatments for AOM and its complications has resulted in fewer chronic ear problems, at least in the developed countries [3,5,[8][9][10][11][12] . The incidence of otogenic IAs has been decreasing [13][14][15] .…”