Chronic suppurative otitis media in a children's hospital in Addis Ababa, Ethiopia

Our knowledge of chronic suppurative otitis media is scanty in Ethiopia. This hospital-based study was, thus, conducted prospectively over a period of 2 years among children visiting a tertiary facility in Addis Ababa. Demographic, clinical, audiometric and microbiological data were collected using a preformed questionnaire. A total of 391 patients constituting 0.6% of the hospital patient population and 22.3% of those seen at the ear, nose, and throat clinic had chronic suppurative otitis media. Most (82.1%) of them were from Addis Ababa, the male to female ratio was 1.6:1, and their median age at presentation was 5.9 years. Otorrhoea had started before the age of 2 years in 269 (68.8%), was bilateral in 215 (55.0%), recurrent in 285 (72.9%), and continuous in 106 (27.1%). Otalgia was reported in only 18%. Hearing loss was the major presenting symptom and the loss was moderate to severe (grades 2 and 3) in 32 (69.6%) and slight (grade 1) in 14 (30.4%) of the ears tested audiometrically. Malnutrition, nasopharyngitis, measles, HIV infection, tuberculosis, diabetes mellitus, neoplastic diseases, and structural abnormalities were common antecedents. Serious complications included systemic infections, otogenic meningitis, mastoiditis, and tetanus. A total of 106 bacterial isolates were cultured from ear discharges of 80 patients. Proteus species were the commonest, accounting for 40 (37.7%) followed by Staphylococcus aureus, Pseudomonas aeruginosa, and Gram negative enterics. All isolates were highly resistant to the commonly used antibiotics including penicillin, ampicillin, amoxycillin, trimethoprim-sulfamethoxazole, and chloramphenicol. Augmentin, gentamicin, and kanamycin were the only drugs to which most of the pathogens were sensitive. Marked improvement on the discharge was achieved in 64% of the 116 patients who complied with treatment. Awareness about the health implications of the disease seemed to be lacking in among the caretakers. Selective use of antibiotics and continuous aural cleansing need to be promoted. More elaborate epidemiological studies will be required to define the magnitude of the problem and identify optimal therapeutic modalities of suppurative ear disease in Ethiopia.