CHAPTER TWO

LITERATURE REVIEW
2.0 INTRODUCTION
This chapter discusses the literature related to the prevalence and associated risk factors of otitis
media among under five children. The review is conceptualized under the objectives of the study
and focuses mainly on prevalence of otitis media, environmental related factors such as upper
respiratory tract infections, feeding position and parental smoking also we focus child related
factors of otitis media such as age, gender and malnutrition.

2.1 PREVALENCE OF OTITIS MEDIA

Global AOM incidence rate (new episodes per hundred people per year) is, according to
ourEstimates, 10.85% i.e. 709 million cases each year with 51% of these occurring in children
underfive years of age (U5). Global incidence rate ranges from 3.64 for Europe Central (40% of
cases 11 occurring in children 0–5) to 43.36 and 43.37 for Sub-Saharan Africa West (56% in U5)
andCentral (58% in U5) respectively (Monasta, 2012).

2.2.0 ENVIRONMENTAL RELATED FACTORS OF OTITIS MEDIA

2.2.1UPPER RESPIRATORY TRACT INFECTION AND OTITIS MEDIA
Upper respiratory tract infection (URTI) is a nonspecific term used to describe acute infections
involving the nose, par nasal sinuses, pharynx and larynx which serve as gateways to the trachea,
bronchi, and pulmonary alveolar spaces; of them rhinitis and sinusitis usually coexist and are
concurrent in most individuals; thus, the correct terminology is now rhino-
sinusitis(Meltzer,2004)

Upper respiratory infection in young children is often complicated by otitis media (Winther, et
el, 2006). Literature data reported that 29% to 50% of all Upper respiratory tract infection
develop into otitis media (OM) (Revai, et el, 2007 and Tasnee et al (2008) found a high
prevalence of symptomatic viral URI among young children, and >60% of cases were
complicated by Acute otitis media(AOM) and/or otitis media with effusion(OME).

2.2.2 PARENTAL SMOKING AND OTITIS MEDIA

Study on 70 patients referring to an ENT clinic, 49 patients had exposure to cigarette smoke due
to parents’ smoking. Out of 49 patients have otitis media (OM), the majority were below eight
years, which could be explained by the children of younger ages being present near and
dependent on their parents and hence increased continuous exposure to cigarette smoke. Also,
the prevalence of acute otitis media (AOM) has been reported significantly more in the children
with smoking parents (Einolghozati et al, 2007). Smoking by each family member is thought to
considerably increase the risk of acquiring OM in children (JonesL et al, 2012).
2.2.3 FEEDING POSITION AND OTITIS MEDIA
A study by Hirsch (2000) found that the nipple of a feeding bottle or pacifier will reach the
junction of hard and soft palate in an infant. The sucking action in turn will lift the soft palate.
The rising of the soft palate will contract the tensor veli palatine muscle. As a result the
Eustachian tube becomes actively patent, providing an ideal situation for the manifestation of
Otitis media Research of Chaithra et el (2017) found that Out of 130 infants 79 were fed in
supine position and 51 infants were fed in upright position.

2.3.0 CHILD RELATED FACTORS OF OTITIS MEDIA:

2.3.1 AGE
The infection is more common in infants beyond neonatal period and when found in newborns, it
is either an isolated infection, or it is related with sepsis, pneumonia or meningitis. The incidence
declines after the age the first year of life, except for a limited reversal of the downward trend
between five and six years of age, which is associated with time most children enter into school.
It is fewer common in children of seven years and above ( Erwin et al., 2006
A study by Amusa et al. (2005) aimed to measure community prevalence of otitis media ( OM)
in a sample of 600 Nigerian children aged below than 12 years. This study found the prevalence
of OM to be 14.7% (88/600), with a highest in children 1–4 years of age (55/600; 9.2%).

2.3.2 GENDER
As with most infectious childhood diseases, AOM seems to occur significantly more often in
males than in females. Different prospective series Stenstroni C et al(1994) showed that the total
number of episodes of AOM and the number of episodes of recurrent otitis media are indeed
higher in male subjects, as well as the number of visits due to AOM and the number of
performed niyringotomies and tympanocenteses (Schilder AG, et.al, 2004).

2.3.3: MALNUTRITION
No case of malnutrition was found in 1344 (67.3%) of the children, including 29 of those who
had otitis. Moderate malnutrition was identified in 369 (18.9%) children, including 16 of those
who had otitis and severe malnutrition in 269 children (13.8%), including 13 of those who had
otitis ( spero, 2016). In the study conducted by Lasisi AO, et al, (2007) malnutrition is one of the
significant risk factors in causation of chronic suppurative otitis media. Elemraid MA,(2009) has
also reported an association of otitis media with deficiencies of micronutrients like zinc and
vitamins such as vitamin A.

2.4 SUMMARY
World health organization (WHO) has reported that hearing impairment in 42 million people
(above 3 years) in the world was mainly caused by otitis media (manche et el, 2016).
There is a lot of risk factors which otitis media relate and we will research some factors such us
Upper respiratory infection, parental smoking, malnutrition, feeding position.