Otitis media in indonesian urban and rural school children.
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.
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.
Ratna
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Anggraeni
Widya W
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Hartanto
Bulantrisna
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Djelantik
Abla
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Ghanie
Denny S
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Utama
Eka P
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Setiawan
Erica
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Lukman
Chintriany
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Hardiningsih
Suprihati
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Asmuni
Rery
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Budiarti
Sutji Pratiwi
SP
Rahardjo
Riskiana
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Djamin
Tri
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Mulyani
Kuswandewi
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Mutyara
Phyllis
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Carosone-Link
Cissy B
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Kartasasmita
Eric A F
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Simões
D000158:Acoustic Impedance Tests; D000293:Adolescent; D001299:Audiometry; D002648:Child; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D010033:Otitis Media / Q000175:diagnosis / Q000453:epidemiology*; D038781:Otoscopy; D015995:Prevalence; D011446:Prospective Studies; D012424:Rural Population; D013334:Students; D011795:Surveys and Questionnaires; D014505:Urban Population