Otitis media (OM) is one of the most common ear infections affecting individuals of all age groups, with a higher prevalence in children due to anatomical and immunological factors (1). It is an inflammatory condition of the middle ear, classified into acute otitis media (AOM), otitis media with effusion (OME), and chronic suppurative otitis media (CSOM), each presenting with distinct clinical characteristics and complications (2). AOM is a sudden infection associated with ear pain, fever, and tympanic membrane inflammation, whereas OME involves fluid accumulation in the middle ear without symptoms of acute infection. CSOM is a persistent infection characterized by otorrhea and potential hearing impairment (3).

The incidence of OM varies across populations, influenced by multiple risk factors such as age, recurrent upper respiratory infections, exposure to secondhand smoke, poor hygiene, overcrowding, and socioeconomic status (4,5). Studies indicate that younger children, particularly those under five years of age, are more susceptible due to an immature immune system and a shorter, more horizontal Eustachian tube, which facilitates bacterial and viral entry into the middle ear (6). Environmental factors, including air pollution and passive smoking, further contribute to the increased risk of OM (7).

OM remains a significant public health concern due to its potential complications, such as hearing loss, speech and language delays, and, in severe cases, intracranial infections (8). Early diagnosis and management are crucial to preventing long-term consequences, particularly in children who rely on auditory input for speech and cognitive development (9). This study aims to assess the incidence of OM and its subtypes in a given population while identifying associated risk factors to facilitate better prevention and management strategies.

Study Design and Population

This cross-sectional study was conducted to assess the incidence and associated risk factors of otitis media (OM) and its subtypes in a selected population. A total of 500 participants, ranging from pediatric to adult age groups, were included through stratified random sampling. Individuals with a history of middle ear infections, recurrent upper respiratory tract infections, or exposure to known risk factors were considered for the study.

Inclusion and Exclusion Criteria

Participants of all age groups who provided informed consent and had no history of ear surgery or congenital ear malformations were included. Individuals with immunodeficiency disorders, recent antibiotic therapy (within the last two weeks), or chronic systemic diseases affecting ear health were excluded to avoid confounding factors.

Data Collection

Demographic and clinical data were gathered through structured questionnaires and medical history interviews. Information on potential risk factors, such as age, gender, socioeconomic status, passive smoking exposure, recurrent respiratory infections, and hygiene practices, was recorded. Clinical examinations were performed by otolaryngologists to confirm the diagnosis.

Clinical Examination and Diagnosis

Otoscopic examination was conducted to identify signs of acute otitis media (AOM), otitis media with effusion (OME), and chronic suppurative otitis media (CSOM). Tympanometry and pure-tone audiometry were utilized for further confirmation, particularly in cases suspected of OME. The diagnostic criteria for each subtype were based on established guidelines, including tympanic membrane appearance, middle ear effusion, and the presence of otorrhea.

Statistical Analysis

Data were analyzed using SPSS version 25.0. Descriptive statistics, including mean and standard deviation, were used for demographic data. The incidence of OM and its subtypes was calculated as a percentage of the study population. Logistic regression analysis was performed to determine the association between risk factors and OM, with a significance level set at p<0.05.

Ethical Considerations

Ethical approval was obtained from the institutional ethics committee before initiating the study. Informed consent was obtained from all participants, and for minors, consent was provided by their guardians. The study adhered to the principles of the Declaration of Helsinki, ensuring confidentiality and voluntary participation.

Demographic Characteristics

A total of 500 participants were included in the study, with a mean age of 25.4 ± 12.3 years. The study population comprised 260 males (52%) and 240 females (48%). Among them, 220 (44%) were children aged 10 years or younger, while 280 (56%) were adults above 10 years (Table 1).

Incidence of Otitis Media and its Subtypes

The overall incidence of otitis media (OM) in the study population was 35% (n=175). Among these cases, acute otitis media (AOM) was the most prevalent subtype, affecting 50.3% (n=88) of the OM cases. Otitis media with effusion (OME) accounted for 30.3% (n=53), while chronic suppurative otitis media (CSOM) was observed in 19.4% (n=34) of the affected individuals (Table 2).

Association of Risk Factors with Otitis Media

Logistic regression analysis identified significant associations between OM and various risk factors. Recurrent respiratory infections were the strongest predictor, with an odds ratio (OR) of 2.45 (95% CI: 1.78–3.38, p<0.01). Exposure to secondhand smoke was also significantly associated with OM (OR: 1.89, 95% CI: 1.21–2.97, p=0.02). Additionally, lower socioeconomic status (OR: 1.67, 95% CI: 1.09–2.56, p=0.04) showed a moderate association. Poor hygiene practices demonstrated a weak association with OM but did not reach statistical significance (OR: 1.45, 95% CI: 0.98–2.10, p=0.07) (Table 3).

These findings indicate that environmental and socioeconomic factors play a crucial role in the prevalence of OM, particularly among children and individuals with frequent upper respiratory infections. ​​

Table 1: Demographic Characteristics of the Study Population

Table 2: Incidence of Otitis Media and its Subtypes

Table 3: Association of Risk Factors with Otitis Media

The findings of this study indicate a significant incidence of otitis media (OM) in the population, with acute otitis media (AOM) being the most prevalent subtype. This aligns with previous research that has reported AOM as the most frequently diagnosed middle ear infection, particularly in young children (1). The high prevalence of OM in children under ten years can be attributed to anatomical and physiological factors, including an immature immune system and a shorter Eustachian tube, which facilitates pathogen entry into the middle ear (2,3).

Recurrent respiratory infections were identified as a major risk factor for OM, demonstrating a strong association with the condition. Upper respiratory tract infections (URTIs) contribute to Eustachian tube dysfunction and subsequent middle ear fluid accumulation, leading to OM development (4,5). This finding is consistent with studies highlighting the role of bacterial and viral infections, such as Streptococcus pneumoniae, Haemophilus influenzae, and respiratory syncytial virus, in the pathogenesis of OM (6,7).

Exposure to secondhand smoke was another significant risk factor, as passive smoking increases susceptibility to respiratory infections and impairs mucociliary clearance in the Eustachian tube, predisposing individuals to OM (8,9). Similar studies have established a link between household smoking and increased OM risk, particularly in children from low-income families (10). The adverse impact of environmental pollutants, such as air pollution, further exacerbates the risk, as these factors contribute to chronic inflammation and impaired immunity (11).

Socioeconomic status also influenced OM prevalence, with individuals from lower socioeconomic backgrounds being more affected. Limited access to healthcare, poor hygiene, and overcrowding are contributing factors that increase the likelihood of recurrent infections and untreated middle ear conditions (12,13). Several studies have emphasized that poor living conditions and inadequate medical attention can lead to chronic forms of OM, such as chronic suppurative otitis media (CSOM), which is associated with long-term complications, including hearing loss and speech impairment (14,15).

The impact of OM on overall health, particularly in children, is significant, as persistent infections and hearing impairment can lead to delayed speech development, poor academic performance, and social difficulties (16). Early diagnosis and appropriate management are crucial in preventing complications. Preventive measures, including vaccination against pneumococcal and influenza infections, reducing passive smoking exposure, and improving healthcare access, can significantly reduce OM incidence (17,18).

Although this study provides valuable insights into OM prevalence and associated risk factors, certain limitations must be acknowledged. The cross-sectional design restricts the ability to establish causality between risk factors and OM. Additionally, self-reported data on socioeconomic status and environmental exposure may introduce recall bias. Future studies should consider longitudinal approaches to better understand the progression and long-term impact of OM.

In conclusion, this study highlights the high burden of OM in the population, with recurrent respiratory infections, passive smoking, and low socioeconomic status emerging as key risk factors. Addressing these factors through preventive strategies and early medical interventions can help reduce the incidence and complications associated with OM.

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