A Survey of the Burden of Management of Chronic Suppurative Otitis Media in a Developing Country

Abstract

Background: Although the prevalence of chronic suppurative otitis media (CSOM) is much higher in developing counties, most surgical treatment techniques are not easily accessible in many poor resource countries.

Aim: The survey aims to examine the extent to which health care facilities in Nigeria are equipped to address the management challenges of CSOM.

Subjects and Methods: Online questionnaires were sent and received from otolaryngologists practicing in across Nigerian public health institutions to evaluate the institutional practice concerning management of CSOM.  Information enquired include: Proportion of CSOM among the ear, nose and throat (ENT) patient load, routinely applied treatments and challenges
facing availability of standard treatment options. Data were analyzed with Statistical Package for the Social Sciences version 15 (Chicago Illinois, USA), and presented descriptively.

Results: Responses were returned from 17 otolaryngologists (68%  [17/25]) practicing in institutions across the six geopolitical zones with a mean duration of otolaryngology services of 22.4 (14.8) years. The CSOM patients constitute an average of 25.3% (13.1) of ENT patient load, with an average of 31 (15.3) % having significant hearing loss. Surgery have never been tried in 41% (7/17) of the institutions due to lack of facilities and/or expertise. Among institutions that offer surgery, 40% (4/10) offer only cortical mastoidectomy and only 30% (3/10) offer type 1 tympanoplasty. Achievements of permanent dry ears were reported more in institutions that offer surgery. Unaffordable cost of hearing aid and lack of expertise for tympanoplasty are the major challenging factors for rehabilitation of CSOM induced hearing loss.

Conclusion: Considering the enormity of CSOM in Nigeria, and the fact that > 40% (7/17) of the public health institutions still lack facilities and/or expertise for surgical treatments for CSOM, public otolaryngological centers should not only be adequately equipped for tympanomastoid surgeries, attention should be focused on further training of experts in the operative techniques from within and outside the country.

Keywords: Chronic suppurative otitis media, Ear discharge, Hearing aids, Hearing loss, Mastoidectomy, Tympanoplasty