Do Socio-Economic Factors Play a Role in Delayed Presentation of Complicated Chronic Otitis Media (Squamous)?

Abstract

Introduction The influence of Socioeconomic (SE) status on delayed reporting and consequent complications in cases of Chronic Otitis Media-squamous (COMS) has been investigated. Materials and Methods This prospective observational study included 34 patients with complicated COMS who presented to Otolaryngology Department at a tertiary care teaching hospital between December 2012 and December 2016. The patients were classified into 5 classes namely upper, upper middle, lower middle, upper lower, and lower based on a standardised real-time Kuppuswamy’s SE status scale (KS) taking an average of consumer price indices for Industrial workers over 4 years (Jan ‘12 to Dec ‘16) as 267 and calculating their incomes. Level of education and occupation of the head of the family were the other components of KS which was calculated for each presenting patient. Results Of the 34 patients, 15 were males (44%) and 19 females (56%) with their ages ranging from 18 months to 61 years (Mean-24.1 years, SD-17.3). 15 of the 34 patients (44.1%) were in the Upper-lower SE class as per KS Scale, 13 were in lower-middle class (38.23%), 5 were in Upper-middle class ( 14.70%) and 1 patient belonged to Upper class (2.9%). Though the literacy levels are integral to KS Scale a differential analysis showed 23 of the 34 patients/guardians had education level poorer or equal to Intermediate high school (67.64%). The time gap between onset of symptoms of COMS and presentation with complications of COMS ranged from 9 months to 8 years with a mean time gap of 3.48 years (SD-2.01). There were 24 Extra-cranial complications and 21 Intra-cranial complications with 10 patients having more than one complications. There was a strong inverse correlation between Time gap and composite KS (-0.51). A differential analysis showed that Time gap most strongly correlated with Education level of the head of the family (-0.615), followed by total family income (-0.403) and occupation of the head of the family (-0.329). Conclusion There is a strong association between the SE status of the family and the occurrence of complications in COMS that is otherwise highly amenable to successful management. Level of education, nature of employment and family income that constitute KS scale have significant inverse correlation with delayed reporting and consequent complications of COMS. Level of Education is the greatest influence on the time gap.

Keywords

• Otitis Media
• Complications
• Social Class
• Literacy
• Income