title: Hearing impairment in otitis media with effusion: a cross-sectional study based in Pokhara, Nepal.
abstract: OBJECTIVE
  Otitis media with effusion (OME) is a major cause of childhood hearing impairment (HI) in the developing world, but its prevalence has never been quantified in Nepal. This study therefore set out to determine the proportion of cases of OME complicated by HI and to identify associated factors.
  
  
  METHODS
  This was a cross-sectional prevalence survey carried out in rural, urban and Tibetan schools in and around Pokhara, Nepal. HI was the primary outcome, and was defined as a middle-frequency pure tone average >25 dB on audiological testing. The study population was defined as children aged four years and older, attending primary school and with a diagnosis of OME.
  
  
  RESULTS
  One hundred and eleven schoolchildren with a combined total of 172 ears affected by OME underwent audiometric assessment. HI was most prevalent in the rural Nepali population; 27% (95%CIs 18-38%) had HI, with a mean hearing loss of 22 dB (15-25 dB). In the Tibetan population, 16% (8-29%) had HI, with a mean loss of 17 dB (12-22 dB). The urban Nepali population had the least HI; 4% (1-13%) were affected, with a mean loss of 16 dB (15-19 dB). The difference in prevalence between the urban and rural Nepali populations was statistically significant (p>0.05). Logistic regression analysis did not identify any associated factors.
  
  
  CONCLUSIONS
  HI is a common complication of OME in Nepal. There is hitherto-unreported variation between populations in the number of cases of OME complicated by HI. This study identified higher rates of morbidity amongst rural populations but was unable to identify associated factors.
authors: College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors: Richard J
authors: RJ
authors: Bagshaw
authors: Elizabeth H
authors: EH
authors: Wall
authors: George
authors: G
authors: Dowswell
authors: Thomas P C
authors: TP
authors: Martin
authors: Michael C F
authors: MC
authors: Smith
mesh_terms: D000293:Adolescent; D001299:Audiometry; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D009390:Nepal / Q000453:epidemiology; D010034:Otitis Media with Effusion / Q000150:complications*; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D014505:Urban Population