Ratna Anggraeni1, Widya W Hartanto, Bulantrisna Djelantik, Abla Ghanie, Denny S Utama, Eka P Setiawan, Erica Lukman, Chintriany Hardiningsih, Suprihati Asmuni, Rery Budiarti, Sutji Pratiwi Rahardjo, Riskiana Djamin, Tri Mulyani, Kuswandewi Mutyara, Phyllis Carosone-Link, Cissy B Kartasasmita, Eric A F Simões. 1. From the *Department of Otorhinolaryngology, Head and Neck Surgery Faculty of Medicine Padjadjaran University/Hasan Sadikin General Hospital, Bandung, Bandung, West Java; †Department of Otorhinolaryngology, Head and Neck Surgery Faculty of Medicine Sriwijaya University/M. Hoesin Hospital, Palembang, South Sumatera; ‡Department of Otorhinolaryngology. Head and Neck Surgery Faculty of Medicine Udayana University/Sanglah Hospital, Denpasar, Bali; §Department of Otorhinolaryngology, Head and Neck Surgery Kanujoso Djatiwibowo Hospital, Balikpapan, East Kalimantan; ¶Department of Otorhinolaryngology, Head and Neck Surgery Faculty of Medicine Diponegoro University/Kariadi Hospital, Semarang, Central Java; ‖Department of Otorhinolaryngology, Head and Neck Surgery Faculty of Medicine Hasanuddin University/Wahidin Sudirohusodo Hospital, Makasar, South Sulawesi; **Health Research Unit Faculty of Medicine Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia; and ††Department of Pediatrics, Section of Infectious Diseases, University of Colorado at Denver Health Sciences Center and The Children's Hospital, Denver, CO.
Abstract
BACKGROUND: Although the epidemiology of otitis media is well-known in industrialized countries, the extent of otitis media in developing Asian countries, especially in south East Asia is not well studied. METHODS: To define the burden of otitis media and its sequelae in children 6-15 years of age, we enrolled elementary and junior high school children in 6 areas in rural and urban Indonesia. Randomly selected schools and classrooms were selected. All children were administered a questionnaire and had ear examinations, pneumatic otoscopy and screening audiometry. Children with any abnormality on examination or with a relevant history underwent diagnostic audiometry and tympanometry, if indicated. RESULTS: Of the 7005 children studied, 116 had chronic suppurative otitis media (CSOM), 30 had acute otitis media and 26 had otitis media with effusion. 2.7% of rural children had CSOM compared with 0.7% of urban children (P < 0.0001). The rates per 1000 of CSOM in rural Bali and Bandung were significantly higher (75 and 25, respectively) than in the rest of Indonesia (P < 0.05). In rural Bali, the rate per 1000 children of inactive CSOM was 63 in 6- to 9-year-old children, compared with 37 in children aged 13-15 years. Concomitantly, the rates of tympanosclerosis were 7 and 26/1000, respectively, in these age groups. CONCLUSIONS: In Indonesia, the prevalence of CSOM is relatively high with most disease occurring in rural areas. The high rates in rural Bali with early progression to tympanosclerosis suggest a significant burden of potentially vaccine preventable illness.
BACKGROUND: Although the epidemiology of otitis media is well-known in industrialized countries, the extent of otitis media in developing Asian countries, especially in south East Asia is not well studied. METHODS: To define the burden of otitis media and its sequelae in children 6-15 years of age, we enrolled elementary and junior high school children in 6 areas in rural and urban Indonesia. Randomly selected schools and classrooms were selected. All children were administered a questionnaire and had ear examinations, pneumatic otoscopy and screening audiometry. Children with any abnormality on examination or with a relevant history underwent diagnostic audiometry and tympanometry, if indicated. RESULTS: Of the 7005 children studied, 116 had chronic suppurative otitis media (CSOM), 30 had acute otitis media and 26 had otitis media with effusion. 2.7% of rural children had CSOM compared with 0.7% of urban children (P < 0.0001). The rates per 1000 of CSOM in rural Bali and Bandung were significantly higher (75 and 25, respectively) than in the rest of Indonesia (P < 0.05). In rural Bali, the rate per 1000 children of inactive CSOM was 63 in 6- to 9-year-old children, compared with 37 in children aged 13-15 years. Concomitantly, the rates of tympanosclerosis were 7 and 26/1000, respectively, in these age groups. CONCLUSIONS: In Indonesia, the prevalence of CSOM is relatively high with most disease occurring in rural areas. The high rates in rural Bali with early progression to tympanosclerosis suggest a significant burden of potentially vaccine preventable illness.
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