|Year : 2018 | Volume
| Issue : 1 | Page : 9-12
Ear screening findings among children attending staff schools of Ahmadu Bello University, Zaria
IY Shuaibu, D Chitumu, IB Mohammed, NA Shofoluwe, MA Usman, LK Lawal, A Bakari
Department of Surgery, Division of Ear, Nose and Throat, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
|Date of Web Publication||23-Mar-2018|
Dr. I Y Shuaibu
Department of Surgery, Division of Ear, Nose and Throat, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna
Source of Support: None, Conflict of Interest: None
Background/Aims: Ear disease in children is a major public health concern in developing countries. World Health Organization suggests external ear examination for all school entrants in developing countries to identify those with ear discharge and study the extent of ear diseases in the community. The aim of this survey is to screen ears of children attending Ahmadu Bello University staff schools, Zaria and to document the findings. Materials and Methods: This was a cross-sectional survey conducted at four staff schools of Ahmadu Bello University, Zaria between March and May 2013. One thousand and nineteen (1019) consecutive children aged 4–15 years from primary 1 to junior secondary school 3 (JSS 3) were included in this survey. All students were interviewed for the presence or absence of various symptoms of ear diseases followed by ear examination. Results: This survey included 1019 participants, of which 511 (50.1%) and 508 (49.9%) were males and females, respectively. The mean age and standard deviation were 9 and 2.53, respectively. Three hundred and eighty-two (37.5%) of the study population had otologic diseases whereas 637 (62.5%) did not. Impacted wax was the most common otologic disorder observed in 297 (29.1%) followed by otitis media with effusion (tentatively) 43 (4.2%), otomycosis 11 (1.1%), chronic suppurative otitis media 9 (0.9%), preauricular sinus (0.9%), and otitis externa 6 (0.6%). Conclusion: This survey highlights that ear diseases are common among children. Periodic ear examination and health education are essential.
Keywords: Children, otologic diseases, otoscopy, screening
|How to cite this article:|
Shuaibu I Y, Chitumu D, Mohammed I B, Shofoluwe N A, Usman M A, Lawal L K, Bakari A. Ear screening findings among children attending staff schools of Ahmadu Bello University, Zaria. Niger J Basic Clin Sci 2018;15:9-12
|How to cite this URL:|
Shuaibu I Y, Chitumu D, Mohammed I B, Shofoluwe N A, Usman M A, Lawal L K, Bakari A. Ear screening findings among children attending staff schools of Ahmadu Bello University, Zaria. Niger J Basic Clin Sci [serial online] 2018 [cited 2020 Feb 28];15:9-12. Available from: http://www.njbcs.net/text.asp?2018/15/1/9/228362
| Introduction|| |
Ear disease in children is a major public health concern in developing countries. The importance of ear examination in school going children cannot be overemphasized. World Health Organization (WHO) suggests external ear examination for all school entrants in developing countries to identify those with ear discharge as well as to study the extent of ear diseases in the community. Unfortunately, children in developing countries are rarely screened for such diseases. This is likely due to lack of awareness among parents, school authorities, and healthcare providers. Consequently, these children may be having ear diseases such as otitis media with effusion and impacted ear wax for long periods without being noticed. Adhikari et al. from Nepal reported 75% prevalence of otologic diseases among their pupils.
In many studies conducted among school children, wax impaction was one of the most common findings.,, This is very common condition which may be associated with discomfort to the patients usually requiring otorhinolaryngologic advice. American Academy of Otolaryngology–Head and Neck Surgery Foundation defined wax impaction as accumulated cerumen that is symptomatic or preventing needed examination of the external auditory canal, tympanic membrane, or both. Impacted wax has been classified as an ear disease, and it can cause pain, itching, tinnitus, hearing loss, or otitis externa.
Middle ear diseases in the form of otitis media with effusion (OME), acute suppurative otitis media (ASOM), and chronic suppurative otitis media (CSOM) have also been reported among pupils. CSOM is a long standing middle ear cleft infection characterized by tympanic membrane perforation and ear discharge. It is one of the most common chronic infectious diseases worldwide, especially affecting children. Hearing impairment is one of the most common sequelae of CSOM.
The WHO recognizes a prevalence of CSOM of more than 1% of children as presenting an avoidable burden which can be managed in the general healthcare context and more than 4% as representing a massive public health problem requiring urgent attention. Other otologic conditions such as foreign body, otitis externa, and otomycosis may also be seen among the pupils.
Studies aimed at screening the ears of children attending schools are very few in the literature. Thus, it is imperative to conduct this survey to identify common otologic diseases among these children and wherever possible provide appropriate intervention, inform of treatment at the school premises, or referral to the teaching hospital. Ahmadu Bello university staff schools have over 2000 students that cut across all social classes, and the children attending these schools are pooled from the university and the host community, providing a good representation of school children. The findings of this study may help the relevant authorities in the community make adequate health planning in terms of ear care, especially in our environment where poverty, lack of awareness, inadequate ear nose and throat specialist, and lack of basic facilities abound.
The aim of this study is to screen the ears of children attending Ahmadu Bello University staff schools, Zaria and to determine the prevalence of common otologic diseases in them, if any.
| Participants and Methods|| |
This is a cross-sectional survey conducted at four staff schools of Ahmadu Bello University Zaria between March and May 2013. Ethical approval was obtained from the ethical review committee of Ahmadu Bello University Teaching hospital Zaria. One thousand and nineteen (1019) consecutive children aged 4–15 years from primary 1 to junior secondary school 3 (JSS 3) were included in this survey.
All children whose parents or Guardians consented for the study were included in this survey.
Children whose parents refused to give consent as well as children who refuse to cooperate were excluded from the survey.
All students were interviewed for the presence or absence of hearing impairment, ear discharge, otalgia, tinnitus, vertigo, fever, and headache. This was followed by inspection of the external auditory canal using appropriate light source. Otoscopic examination was conducted for all children by the consultants Otorhinolaryngologist and senior registrars with the assistance of well-trained ENT nurses using ADC 5210 standard 2.5-V otoscope. This was conducted on every Thursday of the week till survey completion. All children with intact but thickened, blue, dull, or retracted  tympanic membrane or tympanic membrane with increased vascularity with or without fluid levels were labeled as otitis media with effusion, and the students were referred for further assessment with tympanometer. Students with perforated tympanic membrane with or without ear discharge of greater than 2 weeks duration were leveled as CSOM. Those with discharge less than 2 weeks were labeled as acute suppurative otitis media. Participants with impacted wax, CSOM, acute otitis media, and foreign body received treatment at the school premises, e.g., ear syringing, foreign body removal, and ear dressing/ear drops.
Data obtained was analyzed using the Statistical Package for Social Sciences (SPSS) Version 21 (SPSS Inc., Chicago, Illinois, USA). Qualitative data were summarized using frequencies and percentages. Furthermore, statistical tools of mean and standard deviation were also used.
| Results|| |
This study included 1019 participants, of which 511 (50.1%) and 508 (49.9%) were males and females, respectively. The mean age and standard deviation were 9 and 2.53 years, respectively. The age group with the highest number of participant was 7–9 years while that with the lowest was 13–15 years [Table 1].
Otoscopic examination shows that majority 667 (65.5%) of the participants had apparently normal tympanic membrane (shiny). Forty-three (4.2%) had dull and retracted tympanic membrane whereas 9 (0.9%) had perforated tympanic membrane [Table 2].
Three hundred and eighty-two (37.5%) of the study population had otologic diseases whereas 637 (62.5%) did not. Impacted wax was the most common otologic disorder observed in 297 (29.1%) followed by otitis media with effusion 43 (4.2%). Acute otitis media was the least common otologic disorders seen among the study population [Table 3].
Various forms of intervention were offered to the study participants with otologic disease. Majority of them (22.1%) had ear syringing, whereas the rest were treated with ciprofloxacin/candibiotic (Clotrimazole, Chloramphenicol, Beclomethasone, and Lidocaine) ear drops, amoxicillin, and pseudoephedrine/triprolidine (Actifed). Four (0.4%) had foreign body removal [Table 4].
| Discussion|| |
This community-based study aimed to determine the prevalence of common otologic conditions among the students of Ahmadu Bello University staff schools in Zaria. The survey found otologic diseases to be common among these children.
Impacted wax was the most common otologic disorder in this survey accounting for 29.1% of the children. This compares favorably to the findings of Ahmed et al. and Adhikari et al. Impacted wax may be associated with hearing impairment and its removal can improve hearing. Though majority of the pupils with impacted wax may not complain of hearing loss, Khair et al. suggested that even mild hearing loss can affect academic performance. Humidity, temperature, and racial differences play a role in wax production and impaction.
Otitis media with effusion (OME) has been reported to be the most common cause of conductive hearing loss in children. It may occur during an upper respiratory infection spontaneously owing to poor Eustachian tube More Details function or as an inflammatory response following AOM most often between the ages of 6 months and 4 years. This survey found 43 (4.2%) of the study population to have OME. This agrees with the findings of similar studies by Adhikari et al., Ahmed et al., and Shuaibu et al. OME is largely asymptomatic and many episodes are therefore undetected, including those in children with hearing difficulties or school performance issues.
Otomycosis is a fungal disease of the external auditory canal. It has been suggested that otomycosis is a frequent infection in the tropical region because of humidity and heat. In this study, otomycosis was found in 11 (1.1%) students. This is consistent with the the findings of Ozturk et al. and Adhikari et al. where otomycosis was found to be 0.5% and 1.2%, respectively.
CSOM is the most common infection of the ear characterized by persistent or recurrent purulent drainage from the middle ear through a persistent nonintact tympanic membrane. CSOM without prompt, proper treatment can progress to a variety of mild to life-threatening complications that can be intratemporal and intracranial. In this study, CSOM was noted in 0.9% of the study population. This is consistent with the findings of others., In similar studies among normal population, higher prevalence was observed by others.,, The low prevalence in this study may be due to low population of the under five year age group in whom incidence of ear discharge is high. Ciprofloxacin ear drops was used to treat the students with CSOM in this study in accordance with the findings from a local study by Afolabi et al., which reported that ciprofloxacin is the most effective antibiotic for the isolated organisms.
Preauricular sinus is a common congenital anomaly usually appearing as small opening adjacent to the external ear. It is mostly detected during routine examination of the ear. In this study, preauricular sinus was found in 0.9% of the study population. This corroborated the findings of Adhikari et al. of 1% in a similar study. Preauricular sinus is usually asymptomatic and requires no treatment in the absence of recurrent infections.
Otitis externa, foreign bodies in the ears, and acute otitis media were the least otologic diseases encountered in this survey. Adhikari et al. found myringitis, foreign body in the ear, and microtia as the least otologic diseases in their survey.
Inability to use audiometer and tympanometer to screen the ears of these students is a limitation as these would have helped us to relate and interpret the findings from otoscopy better.
| Conclusion|| |
This study highlights that ear diseases are common among school children. Impacted wax and otitis media with effusion are the most common otologic diseases found in this study. CSOM, otomycosis, otitis externa, foreign body, and acute otitis media were also detected. Provision of regular awareness lectures on ear care as well as periodic ear examinations will go a long way in reducing the prevalence of preventable ear diseases and their morbidities.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Adhikari P, Kharel DB, Ma J, Baral DR, Pandey T, Rijal R, et al
. Pattern of otological diseases in school going children of Kathmandu valley. Arq Int Otorhinolaringol 2008;12:502-5.
Gell FM, White E, McNewell K, Mackenzie I, Smith A, Thompson S, et al
. Practical screening priorities for hearing impairment among children in developing countries. Bull World Health Org 1992,70:645-55.
Olusanya BO, Okolo AA, Aderemi AA. Predictors of hearing loss in school entrants in a developing country. J Postgrad Med 2004;50:173-9.
] [Full text]
Gabriel OT. Cerumen impaction: Challenges and management profile in a rural health facility. Niger Med J 2015;56:390-3.
] [Full text]
Ahmed AO, Kolo ES, Abah ER, Oladigbolu KK. An appraisal of common otologic disorders as seen in a deaf population in North-Western Nigeria. Ann Afr Med 2012;11:153-6. [Full text]
Eziyi JA, Amusa YB, Nwawolo CC, Ezeanolue BC. Wax impaction in Nigerian school children. East Cent Afr J Surg 2011;16:40-5.
The American Academy of Otolaryngology–Head and Neck Surgery Foundation. Clinical practice guidelines issued for managing earwax impaction. Otolaryngol Head Neck Surg 2008;139:S1-S21.
Rolland PS. Chronic suppurative otitis media: A clinical overview. Ear Nose Throat J 2002;81(Suppl):8-10.
Aarhus L, Tambs K, Kvestad E, Engdahl B. Childhood otitis media: A cohort study with 30 year follow up of hearing (The Hunt Study). Ear Hear 2015;36:302-8.
WHO/CI BA Foundation Workshop. Prevention of hearing impairment from chronic otitis media. WHO/PDH/98.4. London: CI BA Foundation; 1996.
George B. Otitis media with effusion. In: Micheal G, editor. Scott Brown's Otolaryngology-Basic and Paediatrics. 7th
ed. Great Britain: Edward Arnold; 2008. pp 844-57.
Sanjeev KT, Sanjay KS, Bindeshwar M, Anand KS. Pattern of Ear Diseases in the Patients Attending Ear Outpatient Department of a Tertiary Center in Eastern Nepal. Br J Med Med Res 2016;11:1-8.
Khairi MDM, Noor MRM, Rahman NA, Sidek DS, Mohammad A. The effect of mild hearing loss on academic Performance in primary school children. Int J Pediatr Otorhinolaryngol 2010;74:67-70.
Adhikari P. Pattern of ear diseases in rural school children: Experiences of free health camps in Nepal. Int J Pediatr Otorhinolaryngol 2009;73:1278-80.
Strachan DP, Cook DG. Health effects of passive smoking 4. Parental smoking, middle ear disease and adenotonsillectomy in children. Thorax 1998;53:50-6.
Paradise JL, Rockette HE, Colborn DK, Bernard BS, Smith CG, Kurs-Lasky M, et al
. Otitis media in 2253 Pittsburgh-area infants: Prevalence and risk factors during the first two years of life. Pediatrics 1997;99:318-33.
Shuaibu IY, Ahmed AO, Bakari A, Usman MA. Tympanometric assessment among a select cohort of deaf students. Sub-Saharan Afr J Med 2016;3:158-62. [Full text]
Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, et al
. Clinical Practice Guideline: Otitis Media with Effusion (Update) Otolaryngol Head Neck Surg 2016;154:201-14.
Pradhan B, Tuladhar NR, Amatya RM. Prevalence of otomycosis in outpatients department of otolaryngology in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Ann Otol Rhinol Laryngol 2003;112:384-7.
Ozturk O, Silan F, Oghan F, Egeli E, Belli S, Tokmak A, et al
. Evaluation of deaf children in a large series in Turkey. Int J Pediatr Otorhinolaryngol 2005;69:367-73.
Dhingra R, Dhillon V, Monga S, Mehta AS, Kaur G, Kaur M. Sociodemographic profile and evaluation of associated factors in Chronic suppurative otitis media patients reporting to tertiary care Hospital of Punjab. IAIM 2016;3:6-10.
Ologe FE, Nwawolo CC. Chronic suppurative otitis media in school pupil in Nigeria East Afr Med J 2003;80:130-4.
Adhikari P. Chronic suppurative otitis media in school children of Kathmandu valley. Int Arch Otorhinolaryngol 2007;11:175-8.
Rupa V, Jacob A, Joseph A. Chronic suppurative otitis media: Prevalence and practices among rural south Indian children. Int J Pediatr Otorhinolaryngol 1999;48:217-21.
Afolabi OA, Salaudeen AG, Ologe FE, Nwabuisi C, Nwawolo CC. Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in north central Nigeria. Afr Health Sci 2012;12:362-7.
O'Mara W. Gwarisco L. Management of the preauricular sinus. J La State Med Soc 1999;151:447-50.
[Table 1], [Table 2], [Table 3], [Table 4]