A Disease of the Poor: Socio- Economic Issues.
Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, Kerala, India.www.drpaulose.comÂ Â www.snorefreesleep.com
CSOM is more prevalent in the poor socio economic group in India mainly in the rural areas. It is commonly associated with poverty-related conditions such as malnutrition, over-crowding, substandard hygiene, frequent upper respiratory tract infections and inadequate primary health care.
In a developing country like India, ear infections and deafness are usually neglected conditions due to insufficient funds, work force, facilities, and knowledge. The estimated cost of treatment for chronic suppurative otitis media is higher than the monthly minimum wage for individuals in this country where the cost of health care is the sole responsibility of the patient. The government sector hospital cannot solely cater to all the needs of this large number of patients.
Chronic suppurative otitis media like any chronic disease, can limit an individual\’s employability and quality of life. They are particularly disadvantaged because of scarcity of work, poor living conditions and limited health care. As long as health care delivery fails to target high-risk groups in developing countries, infections like CSOM will persist. Therefore, improving equal access to good health care and ensuring health care programs respond appropriately to individual health needs is a critical factor to ultimately ridding the world of this disease.
It is an infection characterized by recurrent middle ear discharge through a persistent tympanic membrane perforation, which can be managed at the primary health care level thereby preventing the development of deafness and even fatal complications
The World Health Organization (WHO) global estimate for disabling hearing impairment (degree of severity more than 40 dB) has more than doubled from 120 million people in 1995 to 278 million in 2005. A total of 364 million people have mild hearing impairment, while 624 million are estimated to have some level of hearing impairment and 80% of these live in low and middle-income countries
The aims of managing the chronic discharging ear are early detection and timely, appropriate intervention to eradicate the disease permanently or to reduce its effects (i.e., ear discharge, hearing loss and other complications) if eradication is not possible. This can be solved by regular aural toileting, antibiotic treatment, middle ear reconstruction and the use of hearing aids for rehabilitation.
We in jubilee Hospital, the only Christian mission hospital in the city of Trivandrum have the arduous task of treating so many poor patients coming daily to our clinic with CSOM. Our resources are also limited but try our level best to give affordable treatment to those who can afford and helping those poor categories in the face of our limited and diminishing resources.