Melaku A, Lulseged S
Ethio-Swedish Children's Hospital, Addis Ababa.
Ethiop Med J. 1999 Oct;37(4):237-46.
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.
在埃塞俄比亚，我们对慢性化脓性中耳炎的了解甚少。因此，这项基于医院的研究在亚的斯亚贝巴一家三级医疗机构对儿童进行了为期2年的前瞻性研究。使用预先设计的问卷收集人口统计学、临床、听力测定和微生物学数据。共有391名患者患有慢性化脓性中耳炎，占医院患者总数的0.6%，占耳鼻喉科门诊患者的22.3%。其中大多数（82.1%）来自亚的斯亚贝巴，男女比例为1.6:1，就诊时的中位年龄为5.9岁。269例（68.8%）在2岁前开始耳漏，215例（55.0%）为双侧耳漏，285例（72.9%）为复发性耳漏，106例（27.1%）为持续性耳漏。仅18%的患者报告有耳痛。听力损失是主要的就诊症状，在接受听力测定的耳朵中，32只（69.6%）为中度至重度（2级和3级）听力损失，14只（30.4%）为轻度（1级）听力损失。营养不良、鼻咽炎、麻疹、艾滋病毒感染、结核病、糖尿病、肿瘤性疾病和结构异常是常见的前驱疾病。严重并发症包括全身感染、耳源性脑膜炎、乳突炎和破伤风。从80例患者的耳分泌物中培养出共106株细菌分离株。变形杆菌属最为常见，占40株（37.7%），其次是金黄色葡萄球菌、铜绿假单胞菌和革兰氏阴性肠杆菌。所有分离株对常用抗生素包括青霉素、氨苄西林、阿莫西林、甲氧苄啶-磺胺甲恶唑和氯霉素均具有高度耐药性。阿莫西林克拉维酸钾、庆大霉素和卡那霉素是大多数病原体敏感的仅有的几种药物。在116例接受治疗的患者中，64%的患者耳漏情况有明显改善。看护者似乎对该疾病对健康的影响缺乏认识。需要推广抗生素的选择性使用和持续的耳部清洁。需要进行更详尽的流行病学研究，以确定该问题的严重程度，并确定埃塞俄比亚化脓性耳部疾病的最佳治疗方式。
