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CSOM disease burden higher in Greenland; treatment guidelines needed
Jensen RA. Pediatr Infect Dis J 2012;31: doi: 10.1097/INF.0b013e318238c0a4.
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Chronic suppurative otitis media in children living in Greenland results in significant disease burden and increased awareness is needed, according to a recent study.
Ramon Gordon Jensen, MD, from the Department of Otolaryngology, Head and Neck Surgery, Rigshospitalet, University Hospital of Copenhagen in Copenhagen, Denmark, and colleagues concluded that there is a potential for increased treatment of otitis media (OM) in this population and that guidelines customized to conditions in Greenland are needed. The Inuit population of the Arctic regions is among those with the highest prevalences of chronic suppurative otitis media (CSOM).
According to the authors of the study, “the proportion of spontaneous healing and the findings of new cases showed that CSOM is a dynamic disease both on the individual as well as on the population level.”
The results indicate that the burden of disease from OM was larger than what can be estimated in cross-sectional studies; one in three patients at follow-up had a perforation or sequelae from recurrent or long-lasting perforations.
There were 226 participants (65% of those contacted; median age, 22 years) in the study, and 28 (12%) had present CSOM or had been surgically treated. Eleven were new cases of CSOM not seen between 1993 and 1994. Of those with CSOM in the initial 2009 study, 39% had healed spontaneously.
A total of 39 patients (17%) had CSOM in either the initial study or at follow-up. Of these, two had never received antibiotic treatment for OM, and 15 had been treated fewer than three times. Eighty individuals (35%) at follow-up had CSOM, had undergone ear surgery, or had sequelae in the form of circular atrophy or myringosclerosis.
This was a follow-up to a 2009 study on a population-based cohort of 591 children aged 3 to 8 years who were originally examined during 1993 to 1994. Follow-up was attempted among 348 individuals still living in the areas. Video otoscopy and tympanometry were used. Data on otologic disease, ear surgery, and antibiotic use for OM were collected from medical records.
It is estimated that 65 to 330 million people worldwide have CSOM, yet very little is known about the natural course of the disease.
Disclosure: The study was funded by the Commission for Scientific Research in Greenland. The authors report no financial disclosures.
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Chronic suppurative otitis media (CSOM) is an important cause of hearing impairment in developing countries. CSOM is defined as chronic inflammation of the middle ear and mastoid cavity presenting with recurrent otorrhea through perforation of the tympanic membrane (TM). In developing countries, CSOM is often considered by parents to be a "safe ear" because the chronic drainage is less likely to be associated with systemic signs of acute otitis media (AOM). Nevertheless there is significant morbidity associated with damage to the ossicles and resultant conductive hearing loss. CSOM was estimated in 2004 by the WHO to cause hearing loss in 39 to 200 million people.
Jensen and colleagues performed a follow-up study in 2009 of patients aged 18-24 years in Greenland who had been examined for middle ear disease as children who were between the ages of 3 to 8 years in 1993-1994. At follow-up, there was a 9% prevalence of CSOM and 28% of all ears in the study had atrophy or myringosclerosis; resolution of CSOM in early childhood occurred in 39%. The authors note that there was limited access to medical care and low use of antibiotics for AOM in Greenland during this period.
The study reminds us of the substantial challenges of diseases in developing regions, such as AOM, which are not life-threatening but are responsible for morbidity such as deafness that affects the quality of life and economic capability of children and adults.
Jerome O. Klein, MD
Infectious Diseases
in Children Editorial Board member
Disclosure: Dr. Klein reports no relevant financial disclosures.
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