Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 15  |  Issue : 2  |  Page : 135-139

Acute otitis media complicating upper respiratory tract infection: Knowledge and treatment outcomes in health professionals


Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medical Sciences, University of Jos, Plateau State, Nigeria

Date of Web Publication24-Dec-2013

Correspondence Address:
Adeyi A Adoga
Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medical Sciences, University of Jos, Plateau State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2276-7096.123600

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  Abstract 

Background: Upper respiratory tract infections (UTRIs), which may be complicated by acute otitis media (AOM), account for a large number of visits to the primary physician especially in the developed world.
Materials and Methods: This study aims to determine the knowledge and treatment outcomes of UTRIs complicated by AOM in health professionals at the Jos University Teaching Hospital.
Results: One hundred and forty-one participants aged 25-59 years with a mean age of 42 years (standard deviation (SD= ±12.5) ±12.5) were studied, constituting 94 males and 47 females giving a male to female ratio of 2:1. One hundred and twenty-five (88.7%) participants had experienced an UTRI within the last year of the study of which 37 (26.2%) had spread to the ears. Four (3.2%) participants presented to the otolaryngologist with AOM. None presented to the primary care physician. Thirty-seven (36%) participants used drug combinations, while 66 (64%) used single drug regimens. Eighty-four (81.6%) participants used various antibiotics with seven (6.8%) using a bacteriostatic and bactericidal antibiotic in combination. Four (3.2%) participants obtained prescriptions from the otolaryngologist, 99 (79.2%) got their medications over-the-counter, while 22 (17.6%) had spontaneous resolution of symptoms without the use of medications. All participants had complete resolution of symptoms following treatment. Conclusion: Education of health professionals on the otologic complications of UTRIs is vital to prevent debilitating sequelae.

Keywords: Acute otitis media, Adults, Health Professionals, Upper Respiratory Tract Infection


How to cite this article:
Adoga AA, Nimkur TL. Acute otitis media complicating upper respiratory tract infection: Knowledge and treatment outcomes in health professionals. J Med Trop 2013;15:135-9

How to cite this URL:
Adoga AA, Nimkur TL. Acute otitis media complicating upper respiratory tract infection: Knowledge and treatment outcomes in health professionals. J Med Trop [serial online] 2013 [cited 2022 Oct 4];15:135-9. Available from: https://www.jmedtropics.org/text.asp?2013/15/2/135/123600


  Introduction Top


Infections of the upper respiratory tract are a major cause of visits to the primary care physician and a major reason for significant loss of school and work days. [1],[2] Upper respiratory tract infections (URTI) include common cold, laryngitis, pharyngitis/tonsillitis, acute rhinosinusitis, and acute otitis media (AOM); [3] constituting about 87.5% of the total episodes of respiratory infections. [4] These infections are mainly viral in origin and self-limiting. [5] The number of viruses isolated from patients with URTI exceed 200 with the commonest being rhinovirus. [6] However, about 15% of acute pharyngitis may be caused by bacteria as well, that is, Streptococcus pyogenes and group A beta hemolytic Streptococcus. [7] Other bacterial pathogens include  Moraxella More Details catarrhalis, Hemophilus influenza, and Staphyloccocus aureus. [4] Transmission is by means of respiratory droplets or contact with objects exposed to the virus or bacteria and involves the direct invasion of the mucosal lining of the upper respiratory tract with symptoms resulting from the inflammatory response of the immune system to the invading pathogens and from the toxins produced by these pathogens.

Because of the proximity of the nasopharynx and the ears, infections can spread to involve the middle ear as a result of mucociliary clearance abnormalities and  Eustachian tube More Details dysfunction. [8] URTI causes excess mucous congestion with obstruction of the Eustachian tube and proliferation of bacterial flora in the middle ear with subsequent infection. The manifestation of fullness in the ears, reduction in hearing, otalgia, tinnitus, and later otorrhea may follow the acute symptoms of rhinorrhea, nasal obstruction, sneezing, headaches, facial pressure, and cough with or without pyrexia. These symptoms usually last about 7-10 days following 1-5 days of exposure depending on the immune status of the individual.

Two forms of otitis media exist and they are AOM that is an acute symptomatic disease and otitis media with effusion (OME) that is an asymptomatic disease characterized by fluid collection in the middle ear. [9] URTI and AOM are closely linked with 29-50% of all cases of URTI developing into AOM. [10],[11] AOM is a complication of UTRIs whose pathogenesis involves both bacteria and viruses. Viral URTI is a major risk factor for AOM because it increases the risk of bacterial AOM by promoting the replication of bacteria and increasing the process of inflammation within the nasopharynx and the Eustachian tube with subsequent enhancement of bacterial entry into the middle ear cavity. These features are however commoner in children who are more susceptible [12],[13] with rarities in adults.

Treatment depends on the etiological factor and is generally by means of analgesics, decongestants, antibiotics if indicated, and ancillary modalities like steam inhalation. These drugs mentioned are usually available as over-the-counter medications used by individuals on the appearance of symptoms.

The ready availability of antibiotics and medications over-the-counter has made the complications of rhinosinusitis rare. However, occasionally complications do arise and should be taken seriously. These complications could be orbital infections, osteomyelitis of the frontal bone, intracranial infections, and cavernous sinus thrombosis.

This study was done to determine if health professionals in our center had experienced an ear infection following an UTRI, their knowledge of this phenomenon, steps they took for treatment, and the outcomes of treatment.


  Materials and Methods Top


This is a prospective, cross-sectional, questionnaire-based study done at the Jos University Teaching Hospital, Jos.

Clearance for this study was obtained from the hospital's ethical clearance committee.

Validated questionnaires were issued to participants and the following parameters were assessed: Age, gender, occupation/specialty, experience of an UTRI in the past 1 year, their knowledge of spread of an UTRI to involve the ears, the type of treatment received, and the outcome of treatment on clinic follow-up of each participant.

Obtained data was analyzed using Epi info software database and statistics software version 3.3.5.

Improperly filled questionnaires were excluded from this study.


  Results Top


One hundred and forty-one questionnaires out of 180 administered were properly filled and these were analyzed.

Participants were aged between 25 and 59 years with a mean age of 42 years (standard deviation (SD) ±12.5), constituting 94 males and 47 females giving a male to female ratio of 2:1. [Table 1] indicates the age and gender distribution of the participants with the majority being in the age group 35-39 years.
Table 1: Age distribution of participants studied


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Thirty-four (24.1%) nurses participated in the study followed by 22 (15.6%) resident doctors and 20 (14.2%) intern doctors. The other participants are as shown in [Table 2].
Table 2: Frequency distribution of professionals studied


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One hundred and twenty-five (88.7%) participants had experienced an URTI within the last 1 year of the study, while 16 (11.3%) had none. Of the 125 with URTI 37 (26.2%) had spread of infection to involve the ears. Only four (3.2%) of these presented to the otolaryngology outpatient department of the hospital and were diagnosed with AOM. None of the participants in this study presented to the primary care physician. The symptoms experienced [Figure 1] were nasal obstruction (n = 37), rhinorrhea (n = 37), cough (n = 17), reduced hearing (n = 26), tinnitus (n = 8), and otalgia (n = 18).
Figure 1: Symptoms experienced by participants

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Ninety-six (76.8%) participants affirmed they know URTI can spread to involve the ears.

One hundred and three (82.4%) participants used various medications with treatment commenced in an average of 3 days (range = 1-5 days) of onset of symptoms. Thirty-seven (36%) participants used drug combinations, while 66 (64%) used single drug regimens. Eighty-four (81.6%) used various antibiotics with seven (6.8%) using a bacteriostatic and bactericidal antibiotic in combination. Four (3.2%) participants obtained prescriptions from the otolaryngologist, 99 (79.2%) got their medications over-the-counter, while 22 (17.6%) had spontaneous resolution of symptoms without the use of medications or supportive mechanisms of treatment [Figure 2]. All participants had complete resolution of symptoms following treatment as evidenced by findings on otoscopy done in the otorhinolaryngology outpatient clinic by the authors.
Figure 2: Source of relief from symptoms

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  Discussion Top


Majority of UTRIs are due to self-limiting infections involving the upper respiratory tract with superimposed bacterial infection worsening and prolonging symptoms.

Our study has attempted to determine the involvement of the middle ear following UTRIs in health professionals in our institution, their knowledge of this phenomenon, treatment of this condition, and the outcomes of treatment.

Epidemiological data in Nigeria is scarce, but our study reveals a prevalence rate of 88.7% of URTI amongst health workers in our institution. This compares favorably with a report from another part of the world. [4]

Although UTRIs are commoner in children especially complicated by AOM, [3],[5] our study shows a higher prevalence in the 35-39 years age group. Excessive mucous congestion occurring in the Eustachian tube during a bout of URTI and proliferation of bacteria in the middle ear leading to otitis media occurs in all age groups with increased prevalence in children as a result of the horizontal predisposition of the Eustachian tube in children.

A large percentage of the participants in our study had experienced an URTI within 1 year of the study period, but only a significant few had features of AOM and yet only 3.2% presented to the otolaryngologist. None presented to a general practitioner. This is comparable to other studies in which 22-32% of URTI cases were complicated by AOM. [14],[15],[16]

Over-the-counter treatment was commenced by the large majority in an average of 3 days following the development of symptoms. In a country like ours with shortage of manpower where a large number of individuals without formal training in pharmacy have over the years procured, stored, and sold drugs to the population is common practice. Majority of individuals in our society prefer procuring over-the-counter medications for various ailments before presenting to the primary physician or specialist, doing so only when complications arise or the disease condition has advanced. This practice is also shown amongst health professionals in this study. This can be attributed to the ease with which over-the-counter medications are obtained and/or the stress that may be involved in getting to see a specialist in the government hospitals.

These patent's medicine dealers who combine the work of the pharmacist, nurse, and the doctor albeit illegally have become more functional than any one of these. [17] The negative effect on healthcare delivery by this group is unprecedented and their control is therefore essential by law and its enforcement.

The relatively early commencement of treatment by the participants in our study could very well explain the resultant complete resolution of symptoms in all participants and the relatively high percentage of our participants who know that AOM can complicate the course of an UTRI commencing this early treatment may have resulted in the relatively low percentage of clinically diagnosed AOM.

None of the participants in this study presented to the primary care physician contrasting with the findings from other studies in which majority of patients presented mostly to the primary care physician with complicated presentations being referred to the otorhinolaryngologist. [1],[2] Participants in this study presented to the specialist ab initio because of the availability of specialists rather than to the primary care physician.

No complications arose in any of the participants in this study, and those seen primarily by the otorhinolaryngologist the symptoms immediately surfaced probably because of the availability of otolaryngologists in the center and the knowledge they had about the symptoms and the need to present appropriately.

A significant number of our participants had complete resolution of symptoms without the use of medications. Randomized placebo-controlled trials have shown that antibiotics have limited efficacy in treating a large proportion of respiratory tract infections in both adults and children because these conditions are known to be largely self-limiting and complications are rare even when antibiotics are withheld. [3] Inappropriate prescription of antibiotics has the potential of causing drug-related adverse effects and increasing the prevalence of antibiotic resistant organisms. Withholding antibiotic usage is however true in the acute, viral stage. In the occasion of superimposed bacterial infections, antibiotic use is inevitable.

Antibiotic combination therapy is used to prevent the emergence of resistant microbial strains, treat emergency cases during the process of etiological diagnosis, and to take advantage of antibiotic synergism. This is noted to be effective when two bactericidal agents are combined, but antagonism occurs in vitro on combination of a bacteriostatic and a bactericidal antibiotic. [18]

There is the need to educate the populace, health professionals inclusive on the fact that the 'common cold' could run a complicated course with the development of an AOM which will inevitably require more aggressive treatment.

The limitation in this study is the specific antibiotics used by the participants during their course of URTI were not exactly sought at the time of this study.

It is recommended that health professionals seek the attention of a primary care physician in the event they develop an URTI who would prescribe the necessary medications and refer to the otorhinolaryngologist if complications arise rather than procure over-the-counter drugs and especially antibiotics, which may be inappropriate with probable development of antibiotic resistance.

 
  References Top

1.Hayward G, Thompson MJ, Perera R, Del Mar CB, Glasziou PP, Heneghan CJ. Corticosteroids for the common cold. Cochrane Database Syst Rev 2012;8:CD008116.  Back to cited text no. 1
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2.Zalmanavici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev 2009;4:CD005149.  Back to cited text no. 2
    
3.Respiratory tract infections: Prescribing antibiotics for self limiting respiratory tract infections in adults and children in primary care. London: National Institute for Health and Clinical Excellence (UK) Guidance, 2008.  Back to cited text no. 3
    
4.John N, Lodha R, Kabra SK. Upper respiratory tract infections. Indian J Pediatr 2001;68:1135-8.  Back to cited text no. 4
    
5.Dasaraju PV, Liu C. Infections of the respiratory system. In: Baron, editor. Medical Microbiology. 4 th ed, chapter 93. Galverston (TK): University of Texas Medical Branchcoat Galverston; 1996.  Back to cited text no. 5
    
6.Makela MJ, Puhakka T, Ruuskanen O, Leinonen M, Saikku P, Kimpimaki M et al. Viruses and bacteria in the aetiology of the common cold. J Clin Microbiol 1998;36:539-42.  Back to cited text no. 6
    
7.Bison AL. Acute pharyngitis. N Engl J Med 2001;344:205.  Back to cited text no. 7
    
8.Wald ER. Acute otitis media and acute bacterial sinusitis. Clin Infect Dis 2011;52(suppl 4):5277-83.  Back to cited text no. 8
    
9.Bluestone CD, Klein JO. Definitions, terminology and classification. In: Otitis media in infants and children. 4 th ed. Hamilton, Ontario: BC Decker; 2007. p. 1-19.  Back to cited text no. 9
    
10.Winter B, Doyle WJ, Alper CM. A high prevalence of new onset otitis media during parent diagnosed common colds. Int J Pediatr Otorhinolaryngol 2006;70:1725-30.  Back to cited text no. 10
    
11.Koivunen P, Kontiokari T, Niemelä M, Pokka T, Uhari M. Time to development of acute otitis media during an upper respiratory tract infection in children. Pediatr Infect Dis J 1999;18:303-5.  Back to cited text no. 11
    
12.Fried VM, Mukuc DM, Rooks RN. Ambulatory health care visits by children: Principal diagnosis and place of visits. Vital Health Stat 13 1998;137:1-23.  Back to cited text no. 12
    
13.Stussman BJ. National hospital ambulatory medical care survey: 1993 emergency department summary. Atlanta: Vital health statistics of the centres for disease control and prevention/National centre for health statistics. 1996;271:1-15.  Back to cited text no. 13
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14.Kalu S, Ataya RS, McCormick DP, Patel JA, Revai K, Chonmaitree T. Clinical spectrum of acute otitis media complicating upper respiratory tract viral infection. Pediatr Infect Dis J 2011;30:95-9.  Back to cited text no. 14
    
15.Revai K, Dobbs LA, Nair S, Patel JA, Grady JJ, Chonmaitree T. Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: The effect of age. Pediatrics 2007;119:e1408-12.  Back to cited text no. 15
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16.Chonmaitree T, Revai K, Grady JJ, Clos A, Patel JA, Nair S et al. Viral upper respiratory tract infection and otitis media complication in young children. Clin Infect Dis 2008;46:815-23.  Back to cited text no. 16
    
17.Adikwu MU. Sales practices of patent medicine sellers in Nigeria. Health Policy Plan 1996;11:202-5.  Back to cited text no. 17
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18.Daschner FD. Combination of bacteriostatic and bactericidal drugs: Lack of significant in vitro antagonism between penicillin, cephalothin and rolitetracycline. Antimicrob Agents Chemother 1976;10:802-8.  Back to cited text no. 18
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