Infections affecting the middle ear are a common childhood occurrence. Some cases may present with ear discharge through a tympanic membrane perforation which may heal spontaneously. However, up to 5% or more cases of those affected have persistent ear discharge. A number of barriers contribute towards delayed presentation at health facilities for treatment of ear infections [1,2]. Ear infections in the middle ear can cause fluid to build up behind the eardrum. If there is too much fluid, there is a risk of perforation of the eardrum, which can lead to ear discharge [2,3].

Acute otitis media (AOM) is an inflammation of the middle ear mucosa presenting acutely with symptoms of otalgia and fever. These infections account for the majority of antibiotic prescriptions in young children. Some cases of acute ear infection may present with ear discharge through a tympanic membrane perforation. The perforation may heal spontaneously in 6-12 weeks. However, up to 41% of cases have persistent ear discharge; chronic suppurative otitis media (CSOM). This disease entity also presents with symptoms of tinnitus, hearing loss and persistent discharge refractive to medical treatment usually implying cholesteatoma. Treatment is by antibiotic ear drops and surgery for repair of the persistent tympanic membrane perforation and treatment of complications. Complications are dire and include neck abscesses, mastoiditis, facial nerve paralysis, labyrinthitis, and lateral sinus thrombosis, meningitis and brain abscess [3-5]. It is estimated that 330 million people have CSOM of which 60% have hearing loss; the majority of those affected are children. Hearing loss adversely affects speech and language development and  school  performance  in children  and may eventually diminish prospects for gainful employment in adulthood. Moreover, 28,000 deaths are attributed to complications due to CSOM [2,3,6].

Compelling evidence shows that the painless nature of CSOM renders it an overlooked condition among children. Risky health seeking practices among adolescent children have been shown to significantly contribute towards an increase in otitis media. Optimal health seeking behaviour often depends on accessibility of health facilities coupled with knowledge and understanding of the benefit of modern medical treatment as opposed to local customs and belief among children [4-6].

Numerous researches have been conducted on Knowledge for ear infections in various regions of India, but very few of these studies have been conducted in the state of Himachal Pradesh.

Objectives of The Study

To evaluate the Knowledge and care seeking practices for ear infections among school going adolescents children of Himachal Pradesh.

Research Approach 

Descriptive

Research Design

Cross-sectional survey design

Study Area

Whole state of Himachal Pradesh

Study Duration

Between October 2022 to December 2022

Study Population

All school going adolescent children who were studying in the Himachal Pradesh for 12 months or more. 

Sample Size

400 school going adolescents’ children assuming 50% have adequate knowledge regarding ear infection, 5% absolute error, 95% confidence level, and 5% non-response rate.

Study Tool

A google form questionnaire consisting of questions regarding socio-demography, knowledge and care seeking practices for ear infection was created. The questionnaire was initially pre-tested on a small number of school children to identify any difficulty in understanding by the respondents. 

Description of Tool

Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: age, gender etc.

Questionnaire

The questionnaire contains questions regarding knowledge and care seeking practices for ear infections   

Validity Of Tool 

By the experts in this field

Data Collection

Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like WhatsApp groups, Facebook, Instagram etc. in both rural and urban area of Himachal Pradesh till the 400 responses were collected. 

Data Analysis

Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

Ethical Considerations

Participants confidentiality and anonymity was maintained.

The goal of the current study was to assess knowledge and care seeking practices for ear infections among school going adolescents children in Himachal Pradesh through a non-experimental descriptive survey. A total of 400 respondents took part in the study, with 262 (65.5 percent) were males and 138 (34.5%) were female school children. The mean age of the participants was 15.3±6.1 years. In our study, 381 (97.25%) school children reported that they had knowledge of symptoms of ear infections, 61.5 % (246) had Knowledge about prevention, 116(29%) had Knowledge about treatment, 125 (31.25%) had Knowledge of causes of ear infections, and 289 (72.25%) had Knowledge about consequences of infections (Table 1). 

Table 1: Knowledge For Ear Infections

264(66%) school children reported that Hearing loss was the most common consequence of ear infections. Other consequences included, persistence of the disease 11.25% (45), extension of disease to other organs 14% (56) and death 2.25% (9). In contrast, 2.5% (10) school children reported that ear infections have no consequences while 4% (16) didn’t know about any consequences. While as 47.25% (189) of school children would seek treatment from a health facility, 45.75% (183) would seek help from a traditional healer/ Self-medication/Any medicine by Parents while 7% (28) would not seek treatment.  Family, teachers and health workers were the preferred source of health information for 34.5% (138),25.5% (102) and 25.25% (101) school children respectively. Practicing of ear self-cleaning was reported by 356(89%) school children (Table 2).

Table 2: Care Seeking Practices for Ear Infections

Ear infections are the most common reason that children visit doctors.Ear infections are also known as glue ear, secretory otitis media, middle ear infection, or serous otitis media.Infections in the ear are well understood, and their common occurrence means that research is frequently carried out. The purpose of this study was to determine the level of knowledge and care seeking practices for ear infections among school going adolescents children in Himachal Pradesh. In this study, we found that the majority of respondents were knowledgeable about ear infections and had good Care seeking Practices. Similar results were reported in the study done by Hussam Ahmed M. Alruwaili et al. [2] and Mukara, K.B. et al. [1].

Ear infections are extremely common, especially among school going children. This is due to an immature immune system and differences in the anatomy of the ear. There is no guaranteed way to prevent infection, but there are a number of recommendations that will reduce the risk:Washing hands often. This prevents potentially spreading of bacteria to your child and can help prevent those catching colds and flu. Avoid exposing a child to second-hand smoke.  Children who spend time around people who are smoking more likely to get ear infections. Avoid letting your child play with sick children, and try to minimize their exposure to group care or large groups of children. Do not use antibiotics unless necessary. Ear infections are more likely in children who have had an ear infection within the previous 3 months, especially if they were not treated with appropriate antibiotics [6-8].

Ear infections are a part of most people’s childhood. They can be painful and debilitating, but they present very few long-term problems if properly managed. As children were become more aware of this, they are more likely to seek treatment for it, reducing the chances of secondary complications caused by untreated Ear infections. This may, in a small way, reduce the burden on the healthcare system [4,5].

Limitations of The Study 

The present study has certain limitations such as cross sectional in nature, and small sample size that made difficult to generalize the findings. Apart from   that, the questionnaire was administered online, making it impossible to ensure that the participants did not search for answers online or through reference books while answering the questions. If the participants have done this, it could lead to a negative skewing of the data, providing inaccurate information about the level of knowledge about Ear infections.   Future research should be focused on larger sample and qualitative studies such as focus group interviews to identify barriers to promote appropriate knowledge and practices about. Ear infections among school children

The majority of school children had good knowledge and positive attitudes and practices about ear infection. More effort should be put in improving health service accessibility and delivery since this is a barrier to health care seeking practices.

1. Mukara, K.B. et al. “Knowledge and care seeking practices for ear infections among parents of under five children in Kigali, Rwanda: A cross-sectional study.” BMC Ear, Nose and Throat Disorders, vol. 17, 2017, pp. 1–9.

2. Alruwaili, H. et al. “Knowledge and practices regarding ear hygiene among Saudi Adolescents.” International Journal of Medical and Development Countries, vol. 5, 2021, pp. 224–228.

3. Dosemane, D. et al. “Knowledge, attitude and practice of ear care in Coastal Karnataka.” Journal of Clinical and Diagnostic Research, vol. 9, no. 12, 2015, p. MC01.

4. “Myringosclerosis.” Medical News Today, www.medicalnewstoday.com/articles/myringosclerosis. Accessed January 2023.

5. “Ear discharge: Causes, symptoms, and treatment.” Medical News Today, www.medicalnewstoday.com/articles/324651#summary. Accessed January 2023.

6. “Ear infection (Otitis Media).” Cleveland Clinic, my.clevelandclinic.org/health/diseases/8613-ear-infection-otitis-media. Accessed January 2023.

7. “Ear discharge.” Seattle Children’s, www.seattlechildrens.org/conditions/a-z/ear-discharge/. Accessed January 2023.

8. “Ear discharge: Causes and prevention.” Healthline, www.healthline.com/health/ear-discharge#prevention. Accessed January 2023.