Otitis Media in Developing Countries

OBJECTIVE: This article reviews the available information concerning the disease burden, epidemiology, and etiology of otitis media in developing countries and the likelihood that case management with appropriate antibiotic therapy can reduce the burden of this disease. METHODOLOGY: The available literature was reviewed to determine the extent to which otitis media impacts mortality and morbidity in developing countries. EPIDEMIOLOGY: In community studies, perforation was present in 0.4% to 33.3% of children and youth; otorrhea occurred in 0.4% to 6.1%; and mastoiditis occurred in 0.19% to 0.74%. In school surveys, perforation was identified in 1.3% to 6.24% of students, and otorrhea was found in 0.6% to 4.4%. Mastoiditis was diagnosed in 18% of children and youth who presented to a hospital ear, nose, and throat (ENT) clinic in Uganda. The proportion of patients presenting to ENT clinics with mastoiditis regardless of their initial symptoms varied from 1.7% to 5%. Patients presenting to these ENT clinics with mastoiditis often experience severe complications, including subperiosteal abscess, labyrinthitis, facial palsy, meningitis, and brain abscess. Hearing impairment was a major public health problem compromising the quality of life in approximately one third of the population of developing countries. ETIOLOGY: The pathogens isolated from ear aspirates in children with acute otitis media and chronic suppurative otitis (CSOM) carried out in developing countries are similar to those isolated in studies carried out in developed countries. CASE MANAGEMENT: Historical data supports the effectiveness of antibiotic therapy in reducing the frequencies of mastoiditis and CSOM complicating acute otitis media. In addition, the introduction of primary care services targeted at otitis media for high-risk populations living in developed countries may have reduced the prevalence of mastoiditis and CSOM. However, it is not clear whether there is a causal relationship between these programs and the reduction because of the use of historical controls. CONCLUSIONS: International research organizations should support controlled intervention studies to document the impact of case management of otitis in developing countries. In addition, the efficacy of a conjugated pneumococcal vaccine to prevent otitis and its complications should be evaluated in a developing country site. Pending the results of studies, developing countries should develop primary care case management programs to diagnose and treat otitis and its associated complications.