TMSS Medical College Journal

A prospective study was carried out from July 2015 to July 2017 at the Department of Otolaryngology & Head-Neck | Surgery, 250 Bedded Mohammad Ali Hospital, Bogura with the aim to evaluate the risk factors in patients with chronic | suppurative otitis media who develop complications. A total of 150 cases of chronic suppurative otitis media, consisting of 75 patients with complications and 75 paitents without complications were included im this study. Patients who | developed complications were compared with those who did not with respect to six risk factors: age at presentation; sex; socioeconomic condition; duration of ear discharge; type of perforation; and presence of cholesteatoma and or granulation. Tn the present study extracranial complications occurred in 46 patients (61.33%) and intracranial complications in 29 patients (38.675). Among the extracranial complication, postaurical abscess (47.83%) was the commonest complication. This was followed by postauricular sinus (30.44%). Meningitis (51.72%) was the most common intracranial complication. Brain abscess (31.03%) was the second most complication. Involvent of middle ear was | bilateral in 36.00% of patients with uncomplicated disease and 18.67% in patients with complications. The age of the subjects ranged from 7 to 35 years, with a mean (£SD) 19.50+6.64 years in the uncomplicated group (n=75). In the complicated group (n=75), the age of the patients ranged from 2 to 40 years, with a mean (£SD) 15.94£12.92 years. | Children (<15 years ) formed 60% of patients with complications as compared to 28% of patients without complications. In the uncomplicated group 51 patients were male (68%) and 24 patients were female (32%). In the complicated group male patients were 49 (65.33%) and female patients were 36 (34.67). The male: female ratio was roughly 2:1 in both groups. The majority (74.67%) of patients with complications were from the lower socioeconomic class. In majority | (61.53%) of patients with complications the duration of ear discharge was less then five years. Where as in most patients (51.00%) without complications the duration of ear discharge was more than five years. Attic perforations (n=33) and | posterosuperior marginal perforations (n=20) were commoner in the complicated cases (70.67%). In the complicated group, cholesteatoma was present only in 28% of cases. The results indicated that patients with complications were | younger (P<0.001). They had a shorter duration of ear discharge (P<0.001). Majority of them had attic or posterosuperior marginal perforations (P<0.001) and majority of them were accompanied with cholesteatoma (P<0.001). Complications | are more prevalent in the lower socioeconomic class (P<0.001). The sex involvement was almost similar in both complicated and uncomplicated cases (P>0.05).

Chronic suppurative otitis media (CSOM) is a worldwide health problem and is still prevalent in the modern antibiotic era. It is a potentially serious disease because of its complications. The prevalence of CSOM varies between racial and socio-economic group. There is no epidemiological study available about the exact prevalence of CSOM in Bangladesh. But few ENT out patient and ENT camp based studies indicated a high prevalence of the disease. Poor living, status poverty, ignorance, low socioeconomic condition, overcrowding and malnutrition have been suggested as a basis for the widespread prevalence of CSOM in developing countries'**. Complications of suppurative otitis media develop if infection spreads from the middle ear cleft to structures from which this mucosa lined space is usually separated by bone. Factors influencing the spread of infection beyond the middle ear space are’: i) The type and the virulence of the infecting organism; ii) The resistance of the host; and iii) The adequacy of treatment. The clinical symptoms and signs in patients with impending complications are purulent malodorous ear discharge, headache, and fever. Although the total incidence of complications of infectious ear disease has decreased, it is still high in patients suffering from CSOM with cholesteatoma*’. Serious intracraninal complications most frequently seen during acute exacerbantions of chronic suppurative infections associated with cholesteatoma®”®. The complications and mortality rate of supportive otitis media have been decreased in the western world but it is still high in the developing countries”!’. Most of our patients come from from rural areas, where aural discharge and deafness are probably ignored until complications develop. The problem therefore is to identify at an early stage patients in whom complications are likely to occur and prevent them. So, a comparative study between the complicated and uncomplicated CSOM has been undertaken to identify the risk factors for complication in CSOM.