Is Chronic Suppurative Otitis Media a Neglected Tropical Disease

Chronic suppurative otitis media (CSOM) is one of the most common childhood diseases worldwide, and according to the World Health Organization (WHO), it affects anywhere between 65 and 330 million people worldwide, but mainly in the developing countries [1,2,3]. A recent epidemiological study estimated that countries with the highest incidence rates of CSOM resided in impoverished tropical and subtropical regions, although there is also an abnormally high prevalence of CSOM among vulnerable populations in high-income countries such as Aboriginal and indigenous peoples living in Australia and Alaska, United States, respectively [2,4] (Fig. 1). Although the exact definition of CSOM is still under debate, WHO currently defines it as a chronic inflammation of the middle ear cavity with recurrent discharge through tympanic perforation for a period of three months or greater [2] (Fig. 2). CSOM is believed to occur most frequently within the first six years of childhood, often following poor management of acute otitis media (AOM) [2,5,6]. Because the exact point in time as to when AOM becomes CSOM is still heavily debated, accurate diagnosis of CSOM remains a difficult task. Overall, the Global Burden of Disease Study 2010 assigned 4.68 million disability-adjusted life years (DALYs) to otitis media, a disease burden that is almost as high as the intestinal helminth infections [7].