THE GLOBAL BURDEN OF CHILDHOOD OTITIS MEDIA AND HEARING IMPAIRMENT: A SYSTEMATIC REVIEW

Abstract

INTRODUCTION: The World Health Organization resolved that chronic otitis media and resultant hearing impairment are significant global health problems and called for more detailed epidemiological information, particularly the association between prevalence and socioeconomic variables. OBJECTIVE: We sought to determine the worldwide prevalence of otitis media (OM) and hearing impairment (HI) and their risk factors. METHODS: We searched Medline, Embase, and Cinahl for population-based studies with incidence or prevalence data on OM and HI (>25 dB) in children (<18 years), without language restrictions. Studies identified through reference lists were also included. We examined the effect of socioeconomic and health variables on OM and HI prevalence. RESULTS: The search strategy identified 1504 studies with substantial methodologic variation. They included studies (n = 108) that provided a combined sample size of 250 978 children. Acute OM incidence ranged from 0.6 to 1.7 episodes per child per year. The highest OM prevalence rates were in Inuits (81%) and Australian Aborigines (84%). HI prevalence ranged from <1% (Greece) to 23% (Australian Aborigines), and HI was significantly more common in children with OM (odds ratio [OR]: 8.11 [95% confidence interval (CI): 6.91–9.52]). In meta-analysis, increased OM prevalence was associated with not breastfeeding (OR: 1.28 [95% CI: 1.03–1.59]) and parental smoking (OR: 1.73 [95% CI: 1.42–2.10]), but male gender (OR: 1.04 [95% CI: 0.90–1.20]) and urbanization (OR: 0.72 [95% CI: 0.28–1.83]) were not significant. Some studies reported increased OM prevalence with overcrowding, lower maternal education, and poorer household sanitation. CONCLUSIONS: Indigenous children have the highest prevalence of OM and its complications. OM remains a significant cause of preventable childhood HI, and many of the risk factors are modifiable.