INCIDENCE OF IMPACTED CERUMEN DETECTED BY OTOSCOPY AMONG PRIMARY-SCHOOL CHILDREN IN LAHORE, PAKISTAN: A CROSS-SECTIONAL STUDY
Keywords:
cerumen impaction; earwax; otoscopy; primary-school children; conductive hearing loss; socioeconomic status; school health screening; Lahore.Abstract
Background: Cerumen is a normal, protective secretion of the external auditory canal, but when it accumulates and obstructs the canal it becomes one of the commonest causes of reversible conductive hearing loss. In children, even mild hearing loss during the years of speech and language acquisition can impair communication, learning and school performance, yet impacted cerumen is frequently silent and routine ear screening is rarely carried out in schools in Pakistan.
Objective: To determine the incidence of impacted cerumen detected by otoscopy among primary-school children in Lahore, and to examine its relationship with age, sex and socioeconomic status.
Methods: An observational, descriptive cross-sectional study was carried out from 12 October to 31 December 2015 on 2,016 apparently healthy children (4,032 ears), aged 3–12 years, selected by cluster sampling from four primary schools representing the four educational zones of Lahore. Both ears of every child were examined with a hand-held magnifying otoscope. Canal colour, the translucency and position of the tympanic membrane, and the presence and consistency of cerumen were recorded. Total obstruction of the external auditory canal by cerumen, preventing visualisation of the tympanic membrane, was classified as impaction. Data were analysed in SPSS version 17.
Results: Cerumen impaction was identified in 855 children, an overall incidence of 42.4%. The rates in boys (42.7%) and girls (42.0%) did not differ appreciably. The incidence declined steadily with age, from 48.8% in 3–5-year-olds to 37.5% in 9–12-year-olds, and rose sharply as socioeconomic status fell, affecting 53.1% of children from lower-income backgrounds versus 29.0% in the upper group. Involvement was bilateral in 60.1% of affected children, and the impacted wax was hard in 58.5%. Most affected children (70.3%) were asymptomatic. Otological findings other than impacted cerumen were present in a further 329 children (16.3%).
Conclusion: Impacted cerumen is highly prevalent among primary-school children in Lahore, affecting more than four in ten children, is usually bilateral and asymptomatic, and is strongly associated with low socioeconomic status. Routine school-based otoscopic screening is recommended to allow early detection and simple treatment, thereby preventing avoidable hearing impairment and its downstream effect on learning.
