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A Survey of the Burden ofManagement of Chronic

Suppurative Otitis Media in

Developing Country

Adhistie Handarie Agung

Dede Yola Maulidya

Kevin Audrino Budiman

Misbahri

anda !ratama A

Journal Reading


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Intruduction


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Chronic suppurative otitis media (CSOM) cause of mild toconductive acquired hearing loss worldwide, especially in cparticularly in developing countries

CSOM often following poorly managed acute otitis mediapotential of spilling over into adulthood, accounting for recuepisodes of chronic discharging ears that can last for many

CSOM

More pronounced in developing countries despite in medicare recorded in the surgical management of CSOM

is! factors to the high rates of CSOM overcrowding, poopoor nutrition, high rates of nasopharyngeal coloni"ation wpathogenic bacteria and inadequate and unavailable health


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Surgical treatment unsatisfactory or are very e#pensivetechniques are not accessible in many poor resource count

%he purpose of the present survey is to e#amine the e#tenpublic health care facilities in &igeria are equipped to addrmanagementchallenges of CSOM among her populace


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Sub"ects and Meth


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'rospective study over a period of months ending pril *+*

Otolaryngologistsonline survey questionnaires to evaluate the avaand adequacy of material and human resources for the management in &igerian public health care facilities

%he institutions were targeted to include the - institutions thatwere accredited (full and partial) by the .est frican Collegeof Surgeons for postgraduate otolaryngology training in &igeria

/ata were collected ge of the institution, duration of its otolaryngservices, number of employed full0time otolaryngologists, data on restraining for otolaryngology, average proportion of CSOM patients to tear, nose and throat (1&%) patient load, percentage of children as wehearing loss among the CSOM patients, frequency of cholesteatoma,

available and preferred treatment options Medical treatment refers to all non0surgical treatment option and incl

antibiotics2antifungal therapy

/ata were analy"ed with Statistical 'ac!age for the SocialSciences version , Chicago Illinois, 3S and presenteddescriptively$


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esults


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4 (5-6 742*8) otolaryngologists representing their respective institutions$

4 (96 74248) rendering otolaryngology services for up to :+ years

%he duration of otolaryngology services: to 9 years, mean of **$9 (9$-) yea

number of otolaryngologists engaged in each institution range from to 5, with aof four otolaryngologists per institution$

%he average number of patient turn0out in the 1&% ranged from + to -+2clinic da

a mean of :-$

'roportion of CSOM per clinic day is *$: (:$)6$ Signi;cant hearing loss was est

averagely in :6 ($:) of the CSOM patients$


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Medical treatment is the only treatment option adopted for CSOM pa96 (424) of the institutions$

unavailability of necessary surgical instruments -56 (524), lac! of e#pertoperative technique of mastoid and middle ear surgeries 46 (924)

one institution acclaimed that non0surgical treatment almost always

chieving permanent dry ear$ mong the institutions where surgical options are routinely carried o

CSOM, 9+6 (92+) can only o


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Social embarrassment from recurrent ear discharges wasac!nowledged by --6 (24) of the respondents as the mconcern of CSOM patients,

hearing impairment on account of CSOM was recogni"ed byof the respondents as a ma=or concern of patients$

Concerning ear discharges, :6 (524) of the respondentsac!nowledged that dry ears are achieved in most patientsmainly on a temporary basis

1ighty percent of the respondents that reported achieving pears in some of their patients were related to institutions thto o


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Most respondents (-46 7248) ac!nowledge the application of haids in their institutions whereas tympanoplasty is applied in only(:24) of the institutions


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%he ma=or challenges to hearing rehabilitation of CSOM patientsuna


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Discussion


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CSOM still,poverty, ignorance, dearth of specialists and limitedmedical care amongst others conspire to worsen the course ancomplications (sometimes life0threatening) of CSOM in develo

andomi"ed clinical trials comparing medical and surgical intenot available$ Most otolaryngologists often adopt conservattreatment as the ;rst line approach, with surgery as a seconda

more than 9+6 institutions adopt medical treatments as their

only treatment option for CSOM lac! of facilities and e#perttympanomastoid operations$

few reports in the literature of tympanomastoid surgeries rof e#pertise and facilities for the tympanomastoid operation achallenges to the management outcome of CSOM in &igeria


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/isabling hearing impairment has been identi;ed as a ma=problem in patients with CSOM particularly in poor resourc

eports indicated that the production of hearing aids meet+6 of global need$ In developing countries, fewer than people who need a hearing aid have one


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Conclusion


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>ac! of e#pertise and facilities constitute a ma=or problem rehabilitation of CSOM patients$

%raining trainee resident doctors and retraining of otolaryntechniques of tympanomastoid surgery should be vigorousfrom such centers within and outside the country


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%han! ?ou

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