Prevalence and risk factors of Otitis Media with effusion in school children in Qassim Region of Saudi Arabia

Objective: To determine the prevalence of otitis media with effusion (OME) among school children in Qassim region of Kingdom of Saudi Arabia and to determine relevant risk factors in affected children. Methods: Through a cross-sectional study, 1488 children in the age range 6-12 years were randomly selected from 25 primary schools in Qassim region. A questionnaire was used to determine risk factors for OME. Otoscopy and tympanometry were used to diagnose and confirm OME. Pure tone average for children with confirmed OME was measured. Teachers of children were asked to complete a questionnaire evaluating child’s level of school performance. Results: Prevalence of OME in the study population was 7.5% (112/1488). In univariate analysis, it was strongly associated with age less than 8 years (p< 0.0001; OR= 4.23, 95% CI: 2.85-6.29 ), family size more than 4 members in the household((p<0.0001; OR= 4.45, 95% CI: 2.23-8.88), mother education less than secondary school education (p<0.0001; OR=2.2, 95% CI: 1.47-3.29), recurrent acute otitis media (AOM) (p<0.0001; OR=5.73, 95% CI: 3.47-9.45), and hearing loss symptom (p< 0.0001; OR= 3.39, 95% CI: 1.92-5.99). It is less strongly associated with history of preschool AOM (p= 0.002; OR= 3.15, 95% CI: 1.67-5.97), nasal discharge (p= 0.003; OR= 1.91, 95% CI: 1.24-2.93) and snoring (p=0.03; OR= 1.76, 95% CI: 1.06-2.94). OME was significantly higher in schools located in rural districts (p<0.001, OR= 2.82, 95% CI: 1.86 -4.28). In multivariate regression model, five of these factors were found to be predictors of OME: age less than 8 years (OR= 5.052, 95% CI:3.289-7.762), family size more than4 members in the household) (OR= 4.192, 95% CI: 2.033-8.643), rural school district (OR=3.037, 95% CI: 1.933-4.772), mother education lower than secondary school education) (OR=2.041, 95% CI:1.602-3.877) and recurrent AOM (OR=4.914, 95% CI: 2.677-9.02). Children with OME tend to have poorer school performance compared to normal children (p=0.067). No significant correlation was found between OME and type of feeding during the first two years of life (p=0.62; OR= 0.87, 95% CI: 0.51-1.49), preschool daycare attendance (p=0.17; OR= 0.71, 95% CI: 0.44-1.16), home exposure to cigarette smoke (p=0.4; OR= 1.34, 95% CI:0.68 -2.65), visits to ENT clinic (p=0.13; OR= 0.58, 95% CI:0.29-1.18), and ENT operations (p=0.12; OR= 0.46, 95% CI: 0.17-1.27). Conclusion: Prevalence of OME in Qassim region reaches 7.5% in school children. Age less than 8 years, family size more than 4 members in the household, mother education less than secondary school education, living in rural area and recurrent AOM are found to be predictors of OME in Qassim region. In this population of children, otoscopy and tympanometry should be used as screening tools for OME.