A Questionnaire-Based Survey of Indian ENT Surgeons to Estimate Clinic Prevalence of Acute Otitis Media, Diagnostic Practices, and Management Strategies

Abstract

Acute otitis media (AOM) is common in Indian children, but there is limited published information on its clinic prevalence, clinicians' diagnostic practices, and their management strategies. We approached 649 ear-nose-throat (ENT) surgeons to assess these aspects of AOM. We conducted the survey between May 2010 and February 2011 with the same set of ENT surgeons practising across India, once each during summer, monsoon and winter, using a validated 36-item questionnaire to record their reflective recall. 78% (506/649) of approached ENT surgeons responded. The clinic prevalence of AOM was 43% with peaks reported in July and December. 96% (486/506) of the surgeons used otoscopy to diagnose AOM. 86% (435/506) prescribed analgesics, and 89% (449/506) prescribed decongestants. 98% (495/506) treated AOM with an antibiotic at initial consultation: amoxicillin/clavulanic acid 78% (395/506), amoxicillin 29% (144/506), cefpodoxime 29% (149/506), cefixime 28% (141/506) and azithromycin 27% (134/506). Amoxicillin/clavulanic acid 32% (162/506) and cefpodoxime 27% (137/506) were mostly prescribed for relapse. The average reported duration of initial antibiotic therapy was 7days and for relapse was 9days. The reported clinic prevalence of AOM was higher (43%) than anticipated (about 10%) in ENT practice. Almost all the ENT surgeons used an otoscope to diagnose AOM. Amoxicillin/clavulanic acid was the preferred antibiotic for treating AOM either initially or for relapse. Most surgeons also used analgesics and decongestants for symptomatic relief.