Epidemiological Analysis of
the Patients Suffering From Ear Problems: Attending O.P.D. in a Medical College
Hospital
Shukla S. K.* Thakur Amit K., Bansal A.K. and Shrivastava P.K.
Govt. Medical College, Jagdalpur,
(Bastar) - 494001 India.
ABSTRACT:
Objective: To know the incidence of disease as per
various variables? Material and Methods: One hundred cases suffering
from Chronic Suppurative Otitis
Media were included in the study .Various variables eg.
Age, Sex, residential background, Socio-economic status, educational
qualification if any etc. were recorded and analyzed.
Statistical analysis: were expressed in terms of simple
proportion.
Results: 90 percent patients were under the age of 30
years. 61 percent males and 39 percent females. Similarly majority belongs to
rural area. 60 percent were of low socio economic class.
Conclusion: An awareness campaign about the various
causes of the disease have to be conducted among the community particularly in
the rural area.
INTRODUCTION:
Middle ear infection of varying degree is one of the
common infections of general practice in our country. Its importance lies in its
chronicity and its dreaded complications. Throughout
the country chronic infection of middle ear has been one of the commonest
problems of the Otologists. Cullon,
M.M.(1)pointed out that chronic supportive otitis
media has been a grevious affliction since the time
of Greek Physician Hippocrates , who first described acute otitis
media but thought that its origin ,secondary to the
brain abscesses.
The patients suffering from the disease are humiliated
and depressed by deafness and foul odour of
discharge. They are rendered unfit in society and for occupational employment
and are rejected by insurance companies for the claim against disease and
disability.
In view of the above, and as very few
reports of such studies were available
and in 1957 a study group of World Health Organization (W.H.O.) has expressed
the view that in order to get a comprehensive picture of disease more and more
studies have to be carried out, Garg Narendra K. (2). This prompted the authors to undertake
this study to find out the magnitude of Chronic Suppurative
Otitis Media (C.S.O.M.) as per various variables.
MATERIAL
AND METHODS:
One hundred patients of both sexes and all age groups
,attended the outpatient department of Maharani Hospital associated with Govt. Medical
College, Jagdalpur were included in the study after
their clinical examination. Whole sample was placed in three groups, (i) cases with central perforation (safe type) .(ii) cases
with attic perforation and marginal perforation situated in posterior superior
quadrant ( unsafe type ) . (iii) Mixed type i.e. includes both safe and unsafe
variety.
Patients name, age, sex .occupation, educational
qualification, environmental condition, socioeconomic status, place of
residence, family background etc were recorded in a pre drawn and pre tested proforma.
Socio economic status The cases were divided in to
three classes. Lower, Middle and Higher. Lower class includes having income up
to Rs. 5000 per annum, middle class having income above Rs. 5000 and up to Rs.
10,000 per annum and higher class includes income above Rs. 10,000 per annum.
Educational Status All cases were grouped in to five
category (i) illiterate (ii) primary education (iii)
middle education (iv) above middle education (v) children under five years of
age.
Place of residence
Rural and Urban area.
FINDINGS:
On analysis of the collected it has been revealed that
there were (Table I) 90 % cases were under the age of 30 years and the
remaining 10 % cases were above the age of 31 years.
Table I: Age Distribution of Cases
|
Age Group (in years) |
No. of Cases |
Total |
Percentage (%) |
||
|
Safe |
Unsafe |
Mixed (Bil.) |
|||
|
1 to 10 |
26 |
5 |
1 |
90 |
90 |
|
11 to 20 |
22 |
12 |
2 |
||
|
21 to 30 |
12 |
9 |
1 |
||
|
31 to 40 |
5 |
1 |
- |
10 |
10 |
|
41 to 50 |
2 |
1 |
- |
||
|
51 to onwards |
1 |
- |
- |
||
61% males and 39% females. As per sex wise, males were
more commonly affected in comparisons to their female counter parts. Both male
and female were the sufferers of all three variety (safe ,unsafe and mixed)
(Table -II) of the disease It may be due
to the fact that female patients attending the O.P.D. in less numbers in comparison
to males .This also indicate the female status in the society
Regarding socio economic status of the patients 60 %
were from low socioeconomic background and the remaining belongs to middle and
high classes.
Table II: Sex Distribution of Cases
|
Sex |
No. of Cases |
Total |
Percentage (%) |
||
|
Safe |
Unsafe |
Mixed (Bil.) |
|||
|
Male |
41 |
18 |
2 |
61 |
61 |
|
Female |
27 |
10 |
2 |
39 |
39 |
|
Total |
68 |
28 |
4 |
100 |
100 |
67 percent cases were illiterate and studied only up to
primary education.(Table III ).Table further reveal that 14 %, and 08 % cases
were studied up to middle and above middle standard respectively , remaining 11
% patients were under the age of five years. On further analysis it was noted
that 68 percent cases were of rural background.
Table III: Education Status
|
Sr. No. |
Group |
No. of
Patients |
Percentage (%) |
|
|
1 |
Illiterate |
34 |
67 |
67 |
|
2 |
Primary |
33 |
||
|
3 |
Middle |
14 |
33 |
33 |
|
4 |
Higher |
8 |
||
|
5 |
Children (below 5
years) |
11 |
||
Table IV reveals that 68 percent cases of safe
variety and out of these 23.5 percent having family history ,while 35.7 percent
of 28 percent cases suffering from unsafe variety disclose the family history
and in remaining 4 percent cases of mixed variety ,25 percent having family
history.
On further analysis of the data it was found that in
43% and 29% cases right and left ear alone respectively were involve. 28% of
cases showed that both right and left ear involved.
Table IV: Family History
|
Sr. No |
Variety of
Disease |
No. of Cases |
No. of Cases
with + ve family history |
Percentage (%) |
|
1 |
Safe type |
68 |
16 |
23.5 |
|
2 |
Unsafe type |
28 |
10 |
35.7 |
|
3 |
Mixed type (Bil.) (safe and unsafe) |
4 |
1 |
25 |
|
|
Total |
100 |
27 |
27 |
DISCUSSIONS:
Minimum age was 1.5 years and maximum age was 55 years
incidence was maximum under the age of 30 years of cases. Arya
and Mahapatra (3) observed that 80.4% cases were
under the age of the 30 years and 19.6% cases were of age above 30 years.
Baruah et. al. (4) observed that 94% cases were under the age
of 30 years while only 60 cases were above the age of 30 years and reported
extremely high prevalence among children and adults.
Bansal A.K. et. al. (5) observed more or less similar
findings and Harendra
Nath (6) also observed 84.6% and 81.6% cases under
the age of 30 years and 15.4% and 18.4% cases above the age of 30 years. In
present study minimum age was 1.5 years and maximum age was 55 years. Thus 90%
of the cases were under the age of 30 years while cases above the age of 30
years were only 10%. Thus our findings were consistent with findings of most of
the workers in recent years.
Arya and Mahapatra (3) reported
80.4% were male cases and only 19.6% were female. Baruah
et. al. (4) reported that male and female cases were 56.0% and 44.0%
respectively. Bansal A.K. et. al. (5) reported more
or less similar findings. Nath et. al. (6) also observed
the incidence of C. S. O. M. was more in males (81.6%) than females 18.4%. In
present study it was observed that 61% cases were males and only 39% cases were
females. This study and in all above mentioned studies shows disease is more
common in males than females. It may be due to the fact that female patient
attending the O.P.D. were considerably less as compared to males (Female: Male:
1: 2.8).
Das et. al. (7) observed that patient came from rural
areas more than patients from urban areas. Papastavros
et. al. (8) reported that only 33 of the patients came from rural areas and 57
from large urban centers. In present study 68% cases were from rural area and
32% from urban area. This gives a ratio of 2:1 while rural to urban population
ratio in India is 3:1.
Das et. al. (7) observed that 26% were middle class and
one percent were rich. Johnson (9) showed that otitis
media is more common in poors and illiterates due to
lack of hygiene and treatment. Lee (10) observe the severity of the diseases in
children varied directly with the social status. In present study it was
observed that 60% cases were from low socio-economic status or poor class and
remaining 40% were from middle and rich class. Thus findings of present study
tally with findings of other studies mentioned above and shows that C.S.O.M. is
more common poor class or low socio-economic group.
Das et. al. (7) observed that 73% cases were poor and
illiterate, In present study 67.0% patients were illiterate or with low
educational status and only 33% patients were with middle or higher educational
group. This shows disease is more common in illiterate and people with low
educational status.
In present study it was observed that 27 cases (27%) of
C.S.O.M. had family history of disease. Among these 16 cases were safe and 10
cases were unsafe variety and one of mixed variety, having both safe and unsafe
variety of disease. Similar environment was probable the factor causing the
disease (C.S.O.M.) among various members of the family.
Gulati et. al. (11) reported that right ear involvement (56%)
was common than left ear (44%). In this study only unilateral cases were
included. Nath (6) observed that left ear was
involved in 56% and right ear in 44% of cases. He studied only unilateral cases
of C.S.O.M. In present study right ear was involved in 43% of cases left ear in
29% of cases and bilateral involvement was in 28% of cases, finding of this
study tally with findings of Gulati et. al. (11) with
more involvement of right ear. However the selection of cases by Gulati et. al. (11) was different from that of present
study.
From above observations and discussions the authors
reached to the conclusion that there is an urgent need of bringing awareness in
the community particularly in rural / tribal areas about the various aspects of
C.S.O.M. This can be carried out with the help of various medias like
Television, Radio, Folk dances and folk songs, which are online of culture,
costumes of the local people.
ACKNOWLEDGEMENT:
The authors express their cordial thanks to Mr. Anand Singh Kanwar,
Lab-Technician, Dept. of Community Medicine, Govt. Medical College, Jagdalpur (C.G.) for his neat and excellent typing.
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Received on 25.04.2011
Modified on 24.11.2011
Accepted on 02.01.2012
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