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Prevalence of Otitis Media with Effusion among Preschool Children in Port Harcourt, Nigeria
Chibuike Nwosu, OB da Lilly-Tariah and Lucky Obukowho Onotai*
Department of ENT Surgery, University of Port Harcourt Teaching Hospital (UPTH), Nigeria
Submission: February 23, 2017; Published: March 06, 2017
*Corresponding author: Lucky Obukowho Onotai, Department of ENT Surgery, University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Rivers State, Nigeria,Email:firstname.lastname@example.org
How to cite this article: Chibuike N, O d Lilly-Tariah, Lucky O O.Prevalence of Otitis Media with Effusion among Preschool Children in Port Harcourt, Nigeria. Glob J Oto 2017; 4(4): 555644. DOI: 10.19080/GJO.2017.04.555644
Background: Otitis media with effusion (OME) is defined as inflammation of the middle ear with accumulation of non-purulent effusion or exudates within the middle ear. It is more common in young children, and it is the commonest cause of hearing loss in children worldwide. The aim of this study was to determine the prevalence of OME among children within the age of one to six years.
Methodology: This was a cross sectional study involving 226 preschool pupils selected by multi-staged sampling technique from ten (10) day-care and nursery schools from Port Harcourt metropolis, carried out between November 2014 and June 2015. The pupils had satisfied the inclusion and exclusion criteria. Tympanometry was done on each participant. Type B and C tympanograms were the indicators of OME. Data was collected and analyzed using SPSS version-20.
Results: Among the 226 pupils, 57 had OME, giving a prevalence of 25.2%. Thirty one (54.4%) out of the 57 pupils, had unilateral OME while 26 (45.6%) had bilateral OME. The peak age prevalence for OME was at the age of 2 years.
Conclusion: This study has shown a high prevalence of OME, thus making it a common disease among the preschool age group with the peak age of occurrence being at the age of two years. Therefore, parents/ guardians and teachers should be educated on early detection of hearing loss in a child such as poor response to call which could indicate presence of OME.
Keywords:Prevalence; Tympanometry; Otitis media with effusion (OME); School children
In those times (1974-1975) we had a hard job in finding the CM allergens therefore we used initially pure CM in powder so obtaining a huge reaction. Subsequently we were able to confirm the diagnosis with regular allergens. In those heroic times we had a rich collection of cases. Several babies were fed maternal milk (MM), but when they received a diet, the substitute was CM diluted 2:1 or 3:1 because of the fat difference between MM and CM . The editor of Annals of Allergy initially refused the paper, with perfect aplomb, because at his eyes it was impossible, thus the paper with the first world diagnosis of CM allergy
(CMA) must wait for publication. If I had surrendered myself to the impossible, I had not the Pediatric Allergy, Asthma and Immunology (in internet) selling seven thousands of copies and two hundreds/a month even in the 4. year of printing  CMA has a very high prevalence, from 0,013 to 45,4%  and severity especially in the first year of life.
Otitis media with effusion is more common between the age of 1 to 6 years with Peak incidence occurring at the age of 2 years . More than 50% of children will experience OME in their first year of life and by age of 10 years, 80% of children would have had one or more episode of OME . It has a bimodal age distribution with the first and largest peak occurring at the age of 2 years at a prevalence of approximately 20% . This peak occurs more during the stage of play group or nursery school
attendance. Thereafter, the prevalence declines . The second peak occurs at the age of 5 years with prevalence of about 16% when most children start attending a primary school .
Otitis media with effusion occurs most often during the first few years of life, a time that is critical for early language development . The hearing loss associated with OME impedes children’s ability to process language, thus compromising early childhood development . Children with prolonged or frequent OME are said to have delays in their comprehension and production of language, attention problems and academic difficulties in school [4,6]. Over the years there has been notable significant morbidity associated with OME, probably due to poverty, ignorance, dearth of specialists and limited access to medical care . Inadequate specialized health personnel and facilities poses problem as the Ear, nose and throat (ENT) trained personnel in our environment are still not enough to provide adequate ENT health care in both the rural and urban areas .
However, with adequate health education, availability of diagnostic facilities and trained personnel in our environment,there will be an improvement in the diagnosis of OME and
therefore reduce the morbidity associated with OME, which will
enhance their social well-being . There is paucity of study on
the prevalence of OME in the Niger Delta sub-region of Nigeria
which is characterized by high rainfall and humidity, and also
with high industrial activity , thus necessitating this study.
The aim of this study was to determine the prevalence of OME
among preschool children within the age of 1 to 6 years in Port
Harcourt. It will also serve as a basis in the estimation of the
prevalence of hearing loss in children as OME is the commonest
cause of hearing loss in children.
This was a prospective cross sectional study carried out
among preschool children in Port Harcourt Metropolis. It was
carried out between November 2014 and march 2015. The study
included public and private daycare and nursery school children
within the ages of 1-6 years. Those excluded are children
with history or features of ear diseases, tympanic membrane
perforation, previous ear surgery, congenital ear deformities.
The minimum sample size estimation was 226 pupils.
A multi-staged sampling technique was employed: using
simple random sampling, 10 schools were selected; using
population proportion to size to assign number of pupils to each
school; then using stratified sampling to select the pupils. Ethical
clearance was given by our institution (UPTH) and informed
consent was taken from the parents/guardian of all recruited
pupils. A complete ENT and physical examination was carried
out for all pupils. Tympanometry was done using Auto Tymp 262
Welch Allyn, USA. Types B and C were used as indicator of OME.
The data was collected and analyzed using SPSS version 20. P <
0.05 was considered significant and confidence interval was set
A total of 226 school pupils met the inclusion criteria and
participated in the study. There were 130 (57.5%) males and 96
(42.5%) females. The mean age of the school pupils was 3.04
(± 0.1), that for males was 3.04 (± 1.6) and female 3.07 (± 1.4).
Occupying the highest proportion (20.8%) were those aged
2 years, this is as shown in (Table 1). The prevalence of OME
among the school pupils was 25.2% (57), This is as shown in
(Table 2). The peak age prevalence of OME among the school
pupils was 2 years (36.2%), followed by 1 year (31.1%), 3 years (23.9%), 4 years (20.5%), 5 years (16.7%), 6 years (7.1 %). This
is as shown in (Table 3) and (Figure 1). There was 31 (54.4%)
unilateral and 26 (45.6%) bilateral OME out of the 57 pupils with
OME (shown in Table 4). Fifty eight (12.8%) of the ears had type
C Tympanogram while type B was 25 (5.5%), this is as shown
in Table 5. Pupils within the Pre-Nursery (1-2 years) age group
were shown to be statistically significant with the occurrence of
OME (p < 0.05). This is shown in Table 6.
The prevalence of OME in this study was 25.2%. This
shows that approximately 1 in every 4 children within the age
of 1 and 6 years have OME in Port Harcourt metropolis. This
is not surprising as this work was done in Port Harcourt, an
oil producing and industrialized area with high environmental
pollution, high rainfall and humidity . These factors are known
to increase the susceptibility to acquiring OME . This study
shows higher prevalence when compared with a study done by
Okolugbo and Ugwu  in 2009 with a reported prevalence of
15.9 % among school children in Benin City aged 5-7 years. This
relatively lower prevalence may probably be due to the lower
industrial activity and lower environmental pollution when
compared with Port Harcourt.
The work also did not capture the preschool age group
known to be of higher risk of the disease . Moreover, an earlier
study in Benin City  reported a much lower prevalence of
8% among school children aged 5-6 years. A study done in Lagos
 reported a prevalence of 18.2% among young children
aged 2-7 years. This similarity may be due to the fact that the
study captured the preschool age group and also it was done
in a similar highly industrialized and highly polluted area with
high humidity and rainfall. However, a much earlier study done
in Lagos  reported a low prevalence of 4.9% among school
entrance pupils aged 3-11 years. This low prevalence when
compared to this study, may be due to the inclusion of older
children and probably a relative lower environmental pollution
recorded over 30 years ago when the study was done.
A recent work by Amusa et al.  in Ile-ife reported a very
low prevalence of < 1% in a household random study of children< 12 years of age. This shows a very huge difference in prevalence
when compared with the index study. The difference probably
may be due to the wider age range of children involved and the
geographical nature of Ile-Ife of lower humidity and rainfall and
also lower environmental pollution . The study design may
also be a contributing factor as children were randomly selected
from their homes compared to the school based study used in
The prevalence rate in this study using only Type B
tympanogram was 5.5% and Type C 12.8%. This report is
similar to the findings reported in Benin City  with reported
prevalence rate for Type B, 6.7% and Type C, 9.2%. These findings
show a high prevalence of negative middle ear pressure relative
to effusion among children with OME, thus reinforcing the
importance of Eustachian tube dysfunction in the pathogenesis
of OME. Studies in other developing countries appear to show
a similar correlation with findings in this study. The study in
Johannesburg  among children 2-16 years attending primary
health center, reported a prevalence of 16.5% while in Malaysia
, 18.3% was reported among children visiting tertiary health
center. The similarity in reports may be due to the relatively
similar level of industrialization and resultant environmental
pollution seen among the developing countries.
Reports in developed countries are relatively higher
than the developing countries probably due to high level of
industrialization and high humidity being experienced. Joanne
et al.  reported a higher prevalence rate of 30.4% when
compared with this study among American children in the
United States between the ages of 6 months and 5 years in a
community based child health program. This relative difference
in the prevalence rate of OME may suggest that Africans may
have a better functioning Eustachian tube; however there is
little scientific evidence to support this . Hence, the need for
future research in evaluating this relative racial difference in the
functioning of the Eustachian tube.
The peak age prevalence was found to be the age of 2
years with a prevalence of 36.2%. There was an initial rise in
prevalence from the age of 1 year and peak at 2 years, then a
progressive decline with an increasing age to 6 years of age at
a prevalence of 1.7%. Also, the association between OME andcombine ages of 1-2 years was statistically significant. This
indicates a faster rate of normalization of the OME after the age
of 2 years. The development of the Eustachian tube and the level
of maturity of the immune system may explain this. This study
was comparable with the results obtained among young African
American children  with peak occurrence at 24-30 months
of age and a decline in prevalence with increasing age to the
age of 60 months. Also, similar peak age prevalence (87%) at
2 years was reported during a serial tympanometric screening
among preschool children in the Netherlands . This shows a
high prevalence of the disease among the Pre-nursery age group
which coincide with the period when they are preparing to enter
the Nursery school age. Freemantle et al.  reported a double
peak prevalence rate (20%) at both 2 and 6 years of age which is
in contrast to the single peak obtained in this study. The second
peak coinciding with the time pupils start attending primary
This study shows significant association of the disease
(OME) among the age group 1-2 years (p<0.05). This shows that
the younger age group is more prone to OME, probably because
of their being more susceptible to infections and perhaps, the
orientation of the Eustachian tube: being wider and shorter; with
reduced cartilage density when compared with older children,
making it too floppy and less stiffer which makes the Eustachian
tube not to open properly during the contraction of the tensor
veli palatini muscle . This positive correlation further
explains the peak prevalence at the age of 2 years reported in
this study. In a cohort study among day-care facilities attendants
in Lagos , there was a similar significant association between
this age group and OME.
This study has shown a high prevalence of OME, thus
making it a common disease among the preschool age group
with the peak age of occurrence being at the age of two years.
It also reported that the pre-nursery (1-2 years) age group is an
important predictor of OME.
There should be continuous education of the parents
and preschool teachers on early detection of hearing loss in a
child which could indicate the presence of OME so as to prevent
the sequelae that may arise.
Government should make policies on pre-admission
and periodic hearing evaluation and tympanometric testing at
least once yearly on preschool pupils.