Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear cleft in which the tympanic membrane is not intact and discharge is present.¹ It is most frequently caused by gram negative bacilli.² Low living standard, poor socioeconomic condition, lack of education, unawareness about CSOM and inadequate knowledge of getting the treatment are also responsible for occurrence and persistence of the disease.³ CSOM may be a consequence of acute suppurative otitis media acquired in infancy or childhood. It is classified into two main groups: tubotympanic and atticoantral disease. Former is considered as 'safe' from complication while the later has been considered to be a 'dangerous' form of the disease in view of the risk of intracranial suppuration.⁴ Intracranial complications of CSOM, its morbidity and mortality are higher in our country because of poverty, lack of health education and medical facilities, maltreatment by quacks & lack of neurosurgeons.⁵

 OBJECTIVE

General Objective

In this study our main goal is to assess sociodemographic characteristics of Chronic Suppurative Otitis Media.

Specific Objectives

▪ To find out gender and age distribution of the patients

▪ To find out educational status, socioeconomic status and bathing habits of the patients

▪ To describe the residential area of the patients

▪ To classify type of hearing loss in the study group.

▪ To detect intracranial and extracranial complications of CSOM in the study group.

Type of Study: Prospective study

Place of Study: Department of Otolaryngology N.K.P Salve Institute of Medical Sciences & Research Centre and Late Mangeshkar Hospital, Nagpur.

Study Period: September 2018 to February 2019

Study Population: Fifty cases were selected by random sampling. Out of these nineteen cases were atticoantral and thirty one cases were tubotympanic variety.

Sampling Technique: Purposive

Inclusion Criteria

▪ Patients of Chronic suppurative otitis media of both types Aged 7-55 years.

▪ From inpatient department.

Exclusion Criteria

▪ Patient below 7 years and above 55 years of age

▪ Patient with inadequate information, outdoor patients, Otitis Media with Effusion, Cleft palate and Down's syndrome

Method

During the study, detail history of the patient has been taken in a prescribed data sheet with the informed consent of the patient or from the patient’s guardian. Each of the patient was under went thorough clinical examinations. Otological and microscopic examination findings were recorded and plotted on the data sheet. Some important relevant investigations were done and recorded. All the Collected data were analyzed properly.

Data Analysis

Statistical analysis was performed using the Statistical package for social science SPSS version 15.0. A descriptive analysis was performed for clinical features and results were presented as mean ± standard deviation for quantitative variables and numbers (percentages) for qualitative variables.

In table-1 shows distribution of the patients according to gender where most of the patients are male, 54%. The ratio of male and female is 1.2:1. In table-2 shows percentage of age distribution where in Tubotympanic group, 51.61% patients belong to 21-30 years age group, whereas for Atticoantral, 63.15% patients belong to 11-20 years age group.  In figure-1 shows residential area of the patients where People living in rural area (66%) are more sufferer. In table-3 shows the patients from either having primary (48%) or illiterate (20 %) suffered more from CSOM. Also, the peoples taking bath in the ponds and rivers (62%) are more sufferers. In figure-2 shows number of ear(s) involved where bilateral involvements are more common in tubotympanic type of disease &unilateral involvement is more common in atticoantral type of CSOM. In table-4 shows distribution of type of hearing loss where conductive type of hearing loss is more. In table-5 shows complications of CSOM where 28% patients developed complications, 20% had extracranial and 08% had intracranial complication. In figure-3 shows intracranial complications of CSOM where most common intracranial complication was meningitis. In table-6 shows different types of extracranial complications where most common extra-cranial complication was mastoid abscess, followed by post-auricular sinus.

Table 1: Gender distribution of patients. (n=50)

Table 2: Age distribution of patients

Table 3: Sociodemographic characteristics of the patients

Table 4: Distribution of type of hearing loss (n=71)

Figure 1: Residential area of the patients

Figure 2: Number of ear(s) involved.

Figure 3: Intracranial complications of CSOM.

Table 5: Complications of CSOM (n=50)

Table 6: Different types of extra-cranial complications. (n=10)

CSOM with and without complications Continues to affect a large number of patients particularly in developing Countries.³ CSOM is a common health problem in our country, affecting especially the lower socio-economic group of people. Low living standard, lack of education, unawareness about CSOM and inadequate knowledge of getting the treatment are also responsible for occurrence and persistence of the diseases. Fifty patients of different age groups were included in the series. The tubotympanic type of CSOM was found in 62% of patients and atticoantral type in 38% of patients. The age range was 7 to 50 years. The majority was young adults in their 2nd and 3rd decade. In tubotympanic disease 32.25% was in 2nd decade and 51.61% in 3rd decade. In atticoantral disease incidence was highest 63.15% in 2"d decade which exactly corresponded with many works.^4-6 Male to female ratio varies in different studies.^4,6,7 In this series, male to female ratio was 1.2:1. Male predominance in this study could have partly been due to derivation of study population mainly from male dominated sections of society. Females are also reluctant to come forward for treatment in our country. The majority of the patients (72%) came from poor socioeconomic group, 40% in tubotympanic, and 32% in atticoantral type of CSOM. Rural peoples (66%) were more affected, which correlated with different studies.2,^4-10 In both the types people with primary level of education (48%) and illiterate (20%) were more commonly affected, as they were less cared with discharging ears. This was similar to findings of other studies.^{4, 5, 10} Bathing habit of the study population revealed that majority of the subjects in tubotympanic (42%) and in atticoantral (20%) variety had the habit of bathing in ponds or rivers, which was a factor for reactivation of ear infection and complications.^{3, 4}  In this series, in tubotympanic variety the patients had tinnitus in 25.8% and mucosal polyp in 9.67% cases. No complications were found in tubotympanic type of disease. Majority of the atticoantral disease was associated with attic perforation 63.12%, cholesteatoma 78.94% and complications 28%. Fourteen (28%) patients developed complications, of which 10 had extracranial and 4 had intracranial complications. Most common intracranial complications were meningitis and brain abscess and extra-cranial complication was mastoid abscess, followed by post-auricular sinus, which was similar with some studies^6,3 and dissimilar with others.⁴Chronic suppurative otitis media is the most common chronic ear disease in India. It is more common in rural peoples of younger age group in poor socioeconomic classes with male predominance. Medical and surgical options are limited, with side effects and risks, and sometimes are not successful in eliminating disease. There is an urgent need to focus in the area of CSOM to prevent hearing loss and complications.

1. Bluestone CD, Stool SE, Kenna MA. In: Pediatric Otolaryngology;-3rd ed., Pa: WB Saunders Co. Philadelphia: 1996.
2. Mills RP. Management of chronic suppurative otitis media. In Scott-Brown's Otolaryngology; 6lh ed., Butterworth-Heinemann Oxford, 1997; 3/10/1-11.
3. Biswas AC, Haq AHMZ, Khan FA, Alauddin M, Dutta PG. A comparative study of prevalence of chronic suppurative otitis media (CSOM) between rural and urban school going children. J of Otorhinolaryngology 2005; 11(1/2): 17-21.
4. Chowdhury MA, Alauddin M. Comparative study between} tubotympanic and atticoantral type of chronic suppurative otitis media. Med. Res. Counc. Bull 2002; 28(1): 36-44.
5. Browning GG. Etiopathology of inflammatory conditions of external and middle ear. In: Scott-Brown's Otolaryngology 6!h Butterworth-Heinemann, Oxford , 1997; 3/3/14-21.
6. Fakir AY, Hanif A, Ahmed KU, Haroon AA. Intracranial complications of CSOM-A study of 40 cases. J of Otorhinolaryngology 1999; 5(1): 11-14.
7. Youngs R. Chronic suppurative otitis media- mucosal disease. Ludman H. Disease of the ear; 6th edition, London, Arnold 1998; 27: 374-85.
8. Naresh K, Panda, Sreedharan, Mann and Sharama SC. Prognostic factors in complicated and uncomplicated chronic otitis media. American Journal of Otolaryngology, 1996; 17 (6): 391-6.
9. Young’s R. Chronic suppurative otitis media mucosal disease. In: Ludman H, Wright T, eds. Diseases of the Ear; 6thed.London, Arnold, 1998; 27: 381.
10. Gray RF, Hawthorne M. In: Synopsis of Otolaryngology, 5th ed. Butterworth Heinemann, Oxford ,1992; 3-117.