TITLE: EPIDEMIOLOGY OF TYMPANIC EFFUSIONS IN ALBANIAN CHILDREN
GjergjiBizhga, Medical Doctor
University Military Hospital,
ENT service
Abstract
Objectives: To evaluate prevalence of TE in children 6-10 years old, group -age more affected of TE, relation between TE and upper respiratory airway infections, (tonsillitis chronic, vegetatio adenoidea, congenital anomalies of palatum, chronic sinusitis ), gender distribution, social economic situation in families is related with TE in children, if TE affect school learning.
Material and methods: Study is based in simple randomized selection. Chosen test was Chi squared test. This is a epidemiological transversal study. 1054 children were screened, divided in five age based categories. Sample’s fraction 1,7%.
Results: Prevalence of tympanic effusions according to age was 4-6 years old children, 17% in 7 years old children, 15% in 8 years old children, 14% in 9 years old children, 21% in 10 years old children. T relations Tympanic effusion resulted with statistical significant relation with upper respiratory airways (p=0.04), especially in 10 years old children category. They resulted more common in males than females. Socioeconomic conditions doesn’t t appear to interfere with in frequency of disease (p=0.17).
Key word:
Tympanic
Effusions
Children
Background
Tympanic effusions are much more than those presented to doctor because of symptoms. TE have significant relations to upper respiratory airway infections. TE without complains appear and resolve spontaneously, cases that persist for a longer period, may be complicated to other more difficult diseases to treat with easy interventions, and are associated with learning and speaking difficulties, and can lead to intellectual impairment.
Abstrakt
Objektivat: Te vleresoje prevalence e efuzioneve timpanike ne femijet e moshes 6-10 vjec, grup mosha me e prekur e efuzioneve timpanike, lidhjen midis ET dhe infeksioneve te rrugeve te siperme te frymemarrjes, (tonsillitis kronik, vegetatio adenoidea, anomalite kongjenitale te palatumit , sinuzitin kronik ), shperndarjes sipas gjinise, situaten socioekonomike te familjeve dhe lidhjet e tyre me efuzionet timpanike ne femije, nese ato prekin perparimin ne mesime.
Materiali dhe metoda: Studimi basohet ne perzgjedhjen e thjeshte te rastesishme. Test ii zgjedhur test ii hi katrorit. Ky eshte nje studim epidemiologjik transversversal. 1054 femije jane depistuar, ndare ne 5 kategori moshore. fraksioni i mostres 1,7%.
Rezultatet: Prevalenca e efuzioneve timpanike ne femijet e moshes 4-6 years rezultoi: 17% ne 7 vjecaret, 15%, ne femijet 8 vjec, 14% ne femijet 9 vjec, 21% ne femijet 10 vjec. Efuzionet timpanike rezultuan ne lidhje statistikisht te rendesishme me infeksionet e rrugeve te siperme respiratore (p=0.04), vecanerisht ne kategorine e femijeve 10 vjecare. Efuzionet timpanike rezultuan me te shpeshte ne meshkuj se ne femra. Kushtet socio ekonomike nuk duken te ndikojne ne shpeshtesine e semundjes. (p=0.17).
Fjale kyc:
Efuzion
Timpanik
Femije
Hyrje
Efuzionet timpanike jane me te shumta ne numer se ato te paraqitura te mjeku per shkak te simptomave. Efuzionet timpanike kane lidhje me infeksionet e rrugeve te siperme respiratore. Efuzionet timpanike pa ankesa shfaqen dhe zhduken spontanisht, rastet qe persistojne per nje kohe te gjate mund te nderlikohen me semundje te tjera me te veshtira per tu trajtuar me nderhyrje te lehta dhe shoqerohen me veshtiresi ne te folur dhe te mesuar dhe mund te cojne prapambetje intelektuale dhe shoqerore te mevonshme.
MATERIAL AND METHOD
- This study is realized in kindergartens and schools of Tirana which, are randomly selected.
- There are 60 000 children from 6-14 years old enrolled in Tirana kindergarten and elementary schools .
- 1054 children are screened, divided in 5 base aged categories.
- Sample is approx. 1,7 %.
Children divided in age-based categories
Table 1
| Age | 6 years | 7 years | 8 years | 9 years | 10years |
| Number (1054) | 234 | 218 | 200 | 206 | 200 |
All categories have approx. same numbers
Screening is performed in elementary schools. We have used this equipment : Otoskop, Oroskopi, Rhinoskop,, Camertonale tests, Tympanometer AT 235 produced in 2003 for screening.
METHOD
Method of choosing children: Simple randomised selection. Test chosen : Chi squared. Study type: Epidemiological transversal(8)
Upper airways infections(vegetation adenoidea, sinusitis, tonsillitis,.. )
Socioeconomic conditions divided in three categories according to living conditions, incomes, educational level of parents.
School performance is divided in three categories according to scores, physical development and artistically abilities.
Results
Tab 2 Prevalence of TE according to age
| Age | 6 years | 7years | 8 years | 9 years | 10 years | total |
| Effusion | 41 | 36 | 30 | 28 | 42 | 177 |
| 17% | 17% | 15% | 14% | 21% | 17% | |
| Screened | 243 | 218 | 200 | 206 | 200 | 1054 |
No significant relations between TE and age, shown from chi squared test. P=0.23
Table 3 : Prevalence of upper airways infections
| Age | 6 years | 7 years | 8 years | 9 years | 10 years | total |
| Upper airways | 88 | 76 | 70 | 65 | 70 | 369 |
| ways.infe | 38% | 35% | 35% | 32% | 35% | 35% |
| Screened | 230 | 218 | 200 | 206 | 200 | 1054 |
Chi squared test has shown no statistical significant relations between upper respiratory airways and age. P=0.36
Table 4. Ratio of TE to upper respiratory airways infections.
| Age | 6 Years | 7 Years | 8 Years | 9 Years | 10 Years | Total |
| Nr.of chilldren. | 230 | 218 | 200 | 206 | 200 | 1054 |
| Acut.upper way inf | 88 | 76 | 70 | 65 | 70 | 369 |
| Tympanic effusion | 41 | 36 | 30 | 28 | 42 | 177 |
| Ratio | 46% | 47% | 43% | 60% | 48% |
Chi squared test has shown a significant relation between upper respiratory airways infection and TE and upper respiratory airways infections, especially in 10 years old children. P=0.04
Table 5. Male/female ratio with TE, according to age
| Age | 6 Years | 7 Years | 8 Years | 9 Y ears | 10 Years | Total |
| Male | 23 | 20 | 18 | 12 | 25 | 98 |
| Female | 18 | 16 | 12 | 16 | 17 | 79 |
| Ratio | 1,28 | 1,25 | 1,5 | 0,75 | 1,47 | 1,2 |
Chi squared test has shown a significant relation (association) between male/female ratio between effusion and age. P=0.05 TE are more frequent in boys.
Table 6. Social-economic conditions of children families in study
| Age | 6 Years | 7 Year | 8 Years | 9 Years | 10 Years | Total |
| Good performance | 15 | 11 | 11 | 14 | 51 | |
| Average performance | 11 | 10 | 10 | 16 | 47 | |
| Bad performance | 10 | 9 | 7 | 12 | 38 |
No statistical significant relation between TE and family conditions has been able to be shown.P-0.17
Table 7. Ratio between school performance and TE according to age
| Age | 6 years | 7 years | 8 years | 9 years | 10 years | total |
| Good | 9 | 10 | 6 | 7 | 8 | 40 |
| Average | 11 | 11 | 8 | 7 | 9 | 46 |
| Low | 20 | 15 | 16 | 14 | 25 | 90 |
No statistical significant relation between TE and school performance has been shown.P=0.19
Discussions
According to screening s data, tympanic effusions without complains was present in 17% of children .Table 1
This results higher than in previous studies in our country (14),(11), which show a incidence of TE 12 %, this dedicated to technical evolution, using of tympanometric equipment, which remains high quality evaluation of middle ear effusions(9). Prevalence of TE statistically results the same in different groups. Table2.
We noticed that TE had statistically significant relations with upper airways infection. Prevalence of foci in upper airways was statistically not important in group-ages on the study, Tab3, this enforces idea that upper airways infections are determinant factors in appearing and maintaining
TE. Children that resulted with effusion did not had complained pain or had not been treated for diseases related to ear. Not finding any infection focus in over 50% of children supports hypothesis of unknown pathogenesis of TE.(1),(5)
We believe that some children of risk for developing Tympanic Effusion escaped the screening because this study is carried out during winter and probably a part of children were absent to school because of acute flu, so they missed the screening.
Other studies point out that are two peaks of TE exacerbations 6-36 months and 4-7 years old. (6),(8). This was not possible to be shown in our study where the first one was not included on the study and the second was categorized in one group -age that resulted with the same incidence to the others.
Variation of the age was from 4-10 years, but children 4-6 years old were categorized in 6 years old children category, so we lack the data for each separate year of life.
Literature data also support this conclusion (3),(4).
Incidence of upper respiratory infections in relations to age groups was not significant statistically important.
Incidence of tympanic effusions resulted more frequent in boys than girls. Table.4 (but its evolution and consequences are similar). We cannot specially comment it the other authors referred that TE is more frequent in boys.(16)
Incidence of effusions related to different socioeconomic situation (living conditions, incomes, cultural level), resulted the same, this make in evidenced that TE is a disease of all social levels and the severity as well. Table 5
Our data are similar and comparable with other authors from different countries, despite different health care system and socio-economic level.(13)(15).
Effusions and school performance resulted without statistically significant relation.Tab.6
As a transversal study, we could not dynamically evaluate the evolution of TE in time.
Hearing impairment leads to attention lack and so it may affect learning but this needs more extended in time studies, because consequences would be obvious in the future.(7)
Conclusions
Conclusions: TE are a frequent disease, they appear with the same frequency in all different levels of society, have significant relations with upper respiratory airways, and with other factors also, which interfere to their prognosis.
Bibliography
- Austin F David : Catarral Diseases of the middle ear 1995; 1092-1103.(Ballenger)
- Burazeri G, Metodologjia e kerkimit shkencor ne shendet publik. 2002; 3-110.
- Charles D. Bluestone Otorinolaringology 1999, M. English MD, Otitis media and related conditions, 1 –28. ( The Laryngoscop 1999)
- Deweese, David, M.D Otorhinolaringology, 1990; 378-383.
- Kay , David MD , Natural history of untreated otitis media. Laryngoscop 2003, 1645- 1654
- Joseph, Donald and Jerry Templer Otorinolaringology 1992, Editor Gerald M. English,MD.p 28 , 3;Tonsillectomi and adenoidectomy,1- 7.
- Fanary Valerie, MD Long Effect of adenotonsillectomy on quality of life in pediatric patients.The laryngoskop 2003 /1639 –1644
- Gates A George, Otorinolaringology , head and neck surgery; chapter 156 ,second edition ;acute otitis media and otitis media with effusion1993, .2808-2822.
- Grimes, Allison M.A, Introduction to acoustic impedance 2000; 359 -373
- Harrison Keneth, Diseases of the ear , nose and throat; Non supurative otitis media; 1990 /121-135.(Scott- Browns)
- Kellici A Efuzionet timpanike, [Dissertacion}, Universitegti I Tiranes, 1981
- lee K .J, M.D Essential otolaringology , head , neck surgery ;1992;159 –161.
13. Paparella Michael, MD. Susgical procedures in different forms of otitis media 1999.; 164-1, p 10.
14. Radovani Pjerin, Efuzionet e veshit te mesem [ Dissertacion] 1982 ,
1-2,36-37,40-44,53-73,
15. Shambaugh, George E, JR., MD surgery of the Ear . 1995; 76- 79
16. Tos Mirko, Ventiloating tubes for middle ear effusion; Gerald M.English;
Otorinolaringology .1- 10.(J.B. LippincottCompany;Laryngoscop 1994)
17. Richard M.Rosenfeld, MD,MPH; Natural history of untreated otitis media.
The Laryngoscop 2003 / 1645-165
,
Gjergji Bizhga (Master degree)
Spitali Qendror Ushtarak
Mjek otorhinolaringolog
mobil +355682267414
Phone+355422247339