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J Audiol Otol > Volume 27(3); 2023 > Article
Harinath, Lakshmanan, James, and Maruthy: Recovery From Otitis Media and Associated Factors Among 1- to 6-Year-Old Children in South India: A Longitudinal Study


Background and Objectives

This study was aimed at assessing recovery from otitis media (OM) and variables associated with it among 1- to 6-year-old children.

Subjects and Methods

We assessed 87 children with OM otologically and audiologically. Medicines were prescribed, and medication compliance was ensured. The children were followed up after 3 months to judge the status of OM as resolved or recurrent. Data were statistically analyzed to derive the risk of recurrence of OM with effusion (OME) and acute OM by degree of hearing loss, type of tympanogram, age group, and sex.


The overall recurrence rate was 26%. The risk of recurrence was higher for OME (odds ratio [OR]=4.33; 95% confidence interval [CI]: 1.90 to 9.83); at AC auditory brainstem peak V responses up to 40 dBnHL (OR=5.20; 95% CI: 2.05 to 13), 50 dBnHL (OR=3.47; 95% CI: 0.5 to 23), and 60 dBnHL (OR=16.09; 95% CI: 4.36 to 1.2); in B (OR= 3.16; 95% CI: 1.36 to 7.33) and C tympanograms (OR=2.83; 95% CI: 0.70 to 11.41); and in the age group of 5-6 years (OR=8, 95% CI: 2.23 to 28). The risk of recurrence of OM did not differ between male and female patients.


The rate of recurrence was comparable to or lower than that reported in the pediatric population of other countries. The findings suggest that children with OME, severe pathology, or age of 5-6 years require more attention and frequent monitoring to minimize the risk of recurrence.


Otitis media (OM) is the most common pathology seen in children, next only to the common cold. The global annual incidence of acute OM is 10.85% and half of them are reported to occur under the age of 5 years [1]. OM is known to show bimodal peak prevalence; one peak before 2 years of age and the other peak at 5 to 7 years of age [2,3]. If left untreated, acute OM can result in chronic suppurative OM (CSOM), mastoiditis, labyrinthitis, petrositis, facial nerve paralysis, meningitis, subdural abscess, extradural abscess, and thrombophlebitis [4].
OM normally does not occur just once. In fact, multiple episodes of the disease are quite common. Klein, et al. [5] reported that 33% of all their subjects had three or more episodes of OM by 3 years, 24% by 2 years, and 17% by 18 months. The ratio of unilateral to bilateral OM is 2:3 [6]. To understand the nature of acute OM, Mandel, et al. [7] followed 148 children (aged 1 to 8 years) by weekly otoscopy for a period of 6 months. They found that OM peaks in December and March, and the duration of a new episode was short. Gibney, et al. [8] followed 31 Aboriginal children (aged less than 8 years) with acute OM for 3 weeks or longer till the infection resolved. Results showed that 70% of the children had persistent sign of OM [8]. In a study in the Oxford area, 95 full-term infants were tracked for their tympanometry findings every month for 3 years. They found that children susceptible to OM with effusion tend to have more episodes of effusion rather than increased duration of effusion [9]. In general, most children who develop OM experience the disease for more than 2 months before spontaneous resolution [10].
Even if acute OM persists for a short duration, the associated effusion in the middle ear may persist for weeks or even months, often without clinical signs. Roland, et al. [11] reported the median number of days before the resolution of OM to be 72 days. In up to 30% of the children with acute OM, fluid remains in the ear for 3 to 12 months. The important predictors of outcomes in OM are age, severity of the disease, and nasopharyngeal colonization patterns [12]. Children whose symptoms failed to improve early in the course of the disease were the ones who were younger and had more severe disease. Colonization with Streptococcus pneumoniae was associated with more severe OM than that with other pathogens like Moraxella catarrhalis and Haemophilus influenzae.
A high incidence of OM is reported among the Indian population [13]. Jacob, et al. [14] found OM in 17.6% of the 284 children aged 6 to 10 years. Specifically, the incidence of OM with effusion was found to be 3.06%, while the incidence of acute OM was 0.65%. The exact reason for high incidence of OM in the Indian population is not very clear. However, genetic factors, difference in the Eustachian tube, poor socioeconomic standards, poor nutrition, and lack of health education have been speculated as the contributing factors [15,16]. According to Beery, et al. [16], though Eustachian tubes in the Indian population allow better ventilation of the middle ear cavity, they have poorer protective function making middle ear an easy target for bacterial invasion from the throat. Irrespective of the reasons, the high incidence of OM deserves serious consideration in Indian children. Dhingra [15] even reported a significant difference between rural (46 per thousand) and urban populations (16 per thousand) in the prevalence of OM in India.
Although OM is a highly prevalent pathology in children of India, the nature of OM and the course of recovery is not yet explored in the country. Considering that the genetic, sociocultural, environmental, and economic factors in India are different compared to the developed countries, one can expect that the course of recovery is different in the cohort here compared to that in the developed countries. The recovery with reference to infection as well as hearing status needs exploration and such exploration warrants longitudinal follow-up of the subjects. American Academy of Paediatrics (AAP) [17] recommends that children with OM should be re-examined at 3 or 6 months until the effusion is no longer present and should identify children with risk of hearing impairment or other complications. However, no such time schedule or protocol for follow-up is in practice in India. Hence, the present study longitudinally followed young children diagnosed with OM up to 3 months of diagnosis. The follow-up examinations were done to track the status of the infection, findings in tympanometry, and the hearing sensitivity. The study attempted to derive the relationship between risk of OM and the characteristics of the subject, otological findings, tympanometric findings, and hearing sensitivity. The aim of this study was to eventually make recommendations for follow-up protocol in cases of OM.

Subjects and Methods

The study examined children with OM during their first episode and after 3 months to understand the nature of recurrence of infection and its effects on hearing sensitivity. The Institutional Ethics Committee of Ramachandra Institute of Higher Education and Research where the study was conducted had approved the study (Ref: IEC-NI/16/JUL/54/48). Written informed consent was obtained form all the parents of children for evaluation.

Screening for OM

The study population was recruited from outpatient units of ENT, Pediatrics, and Audiology of Sri Ramachandra Hospital. Children in the age range of 1 to 6 years were screened for their motor development, speech-language development, and ear infections. Children with normal development but showing clinical signs and symptoms suggestive of OM were the potential participants of the study. Distorted or missing cone of light, air bubbles in the middle ear, fluid in middle ear, and dull and bulging tympanic membrane were considered the signs of OM [18]. Children with chronic suppurative OM, congenital or late onset sensorineural hearing impairment, anomalies of the external ear, congenital conductive hearing impairment, developmental delay, cerebral palsy, autism spectrum disorders, mental subnormality, genetic syndrome, cleft lip and palate, history of surgical intervention for OM with effusion were excluded from the study. The otorhinolaryngologist examined each ear otoscopically to check for any obstruction in the ear canal. Children with wax in the ear canal were sent for wax removal. Based on the specific clinical signs observed, otorhinolaryngologist diagnosed the presence and type of OM in that ear.

Test procedure

Baseline evaluation

An experienced otorhinolaryngologist visually inspected each ear of the child using a microscope. The observed otoscopic signs were noted down and a corresponding diagnosis was made. The child was then evaluated by an experienced (more than 15 years) audiologist to determine the middle ear status and hearing sensitivity. Middle ear status was assessed using tympanometry and acoustic reflexes. A calibrated GSI 39 immittance meter (Grason-Stadler, Eden Prairie, MN, USA) was used for the purpose. A probe tone of 226 Hz was used to derive the admittance while pressure in the ear canal was swept from +200 daPa to -400 daPa. The resultant tympanogram was noted down for its peak static admittance, peak pressure, gradient, equivalent ear canal volume, and the type of tympanogram. Tympanograms were classified as per the criteria given by Feldman [19].
The hearing thresholds were derived by tracking thresholds of auditory brainstem responses (ABRs) in air conduction (AC-ABR) and bone conduction (BC-ABR) modalities. ABRs were recorded using Neuro-Audio AEP equipment (version 10, Neurosoft, Ivanovo, Russia). The children were tested within 2 days of the identification of OM and the thresholds were tracked in ears with OM. If found necessary, sedative drug was given to make the child sleep. The electrode sites were FPz (positive), ipsilateral mastoid (negative), and contralateral mastoid (ground). Click-evoked ABR was recorded as per the stimulus and acquisition parameters given by Katz, et al. [20]. The audiologist visually inspected the recorded waveform to mark wave I, III, and V. ABR threshold was defined as the lowest intensity at which wave V was recordable. If peak V was present at 20 dBnHL, it was considered as hearing sensitivity within normal limits [21].
BC-ABR was meant to ensure that hearing loss, if any, is of conductive type, and there is no sensorineural hearing loss. To record BC-ABR, clicks were presented through a bone vibrator B 71 placed on the forehead. In order to elicit ear-specific BC-ABR, the non-test ear was masked by delivering broadband noise at 50 dBSPL through TDH-39 headphone. All the other stimulus and acquisition parameters remained as that of AC-ABR. The method of deriving BC-ABR threshold and BC hearing sensitivity was also same as that of AC-ABR.

The treatment of OM

All the children who completed audiological evaluation were medically treated by the Otorhinolaryngologist. Medication (antibiotics, antihistamines, and decongestants) was prescribed for 5 to 7 days and its dosage depended on the severity of infection. The parents were counseled regarding the risk factors of OM. The children were monitored telephonically for consumption of the medicines as per the prescription. All the children strictly complied with the prescribed treatment.

Follow-up testing

The participants were re-evaluated at the end of 3 months after their first episode. Otoscopy, immittance evaluation, and ABR (AC & BC) were repeated during the follow-up evaluation. Based on the results of otoscopy and impedance audiometry at 3 months follow-up, the middle ear status was diagnosed as either “recurrent” or “resolved.” It was considered “resolved,” if the tests revealed normal findings. Otherwise, it was considered “recurrent.” In the present study, recurrent OM was operationally defined as an episode of OM after 3 months of their initial episode [22].
A total of 1,040 children were screened, of whom, 130 children were found to have unilateral/bilateral acute OM or OM with effusion (OME). However, the parents of only 114 children gave informed consent for further evaluation. In all these 114 children, it was the first episode of OM. On testing with AC-ABR, 1 child was found to have auditory neuropathy spectrum disorder and therefore was excluded from the study. In 3 children, BC-ABR thresholds were elevated, indicating the presence of sensorineural hearing loss. They were also excluded from the study. Of the 110 children, 23 did not turnup for the follow-up evaluation, resulting in 87 children who completed the entire study protocol.


The data distribution was tested using Shapiro-Wilk test of normality. Owing to non-normal distribution, non-parametric tests were used for statistical analysis. Odds ratio with 95% confidence interval was derived to find the risk of recurrence of OM and chi-square test was used to assess the significance of difference in recurrence of OM across age groups, sex, types of middle ear pathologies, types of tympanogram, and degree of conductive hearing loss.


Of the 110 children enrolled in the study, 23 children did not come for follow-up evaluation mainly due to the distance of travel to the hospital. Totally 87 children with data of type of OM, tympanogram, and AC-ABR threshold at two points constitute the participants of the present study. Of the 87 children, 75 children had bilateral OM, 11 children had unilateral OM, and 1 child had acute otitis media (AOM) on one ear and chronic otitis media (COM) on the other ear.
Table 1 shows the impact of the type of OM, degree of conductive hearing loss, type of tympanogram, age, and sex on the recurrence of OM. In ears with OME, the recurrence rate was 38% (rounded off to the nearest whole number), whereas it was 12% in acute OM. Results showed a significantly higher risk of recurrence in OME compared to acute OM (p<0.0001).
When examining the relationship between the degree of conductive hearing loss and OM recurrence, the risk of recurrence was significantly lower (p=0.005) for AC-ABR threshold was 20 and 30 dBnHL compared to 40, 50, and 60 dBnHL.
Similarly, in the relationship between the type of tympanogram and OM recurrence, the results showed a significantly higher risk of recurrence in ears with B and Cs type tympanograms compared to C and As type tympanograms (p=0.006).
Regarding the child’s age and OM recurrence, the results showed a significantly higher risk of recurrence of OM in the 5 to 6-year age groups compared to other groups (p=0.005).
However, in terms of the child’s sex and the recurrence of OM, there was no significant difference in the risk of recurrence between the two sex (p=0.155).


In the current study, the participants were assessed twice with an interval of 3 months. It was found that 26% of the cases had OM on both occasions. This was true in spite of all of them pursuing the prescribed medical treatment without fail. Whether it is termed as persistence of OM or recurrence of OM is debatable. However, it is operationally referred to as “recurrence” in the current study, in line with the earlier studies [22]. Recurrence rate of 26% found in the current study is lower than that reported in pediatric population of Taiwan (33% during a 1 year period) [23], Finland (28% during 1 year period) [24], and higher than indigenous children of Australia (18%). Across various earlier studies conducted in the other countries, the recurrence varies from 9% to 73% [8,22-26], attributable to differences in compliance with treatment, socioeconomic status, climatic conditions, and genetic factors. Compared to other countries higher incidence of OM has been reported among the Indian population [14,27]. Yet, the recurrence of OM appears comparable to or even lower than some of the other countries.
In the current study, we found that the risk of recurrence was significantly higher in ears with OME compared to that with AOM. The risk of recurrence of OME found in the current study (38%) was comparable to that reported by some of the earlier studies (35%) [28,29] and lower than that (50%) reported by Zielhuis, et al. [30]. The auditory deprivation caused by hearing loss secondary to OM is shown to result in deficits in cochlear and neural structures [31,32], deviations in auditory brainstem responses [33], and poor speech in noise perception [34,35]. The higher recurrence rate in ears with OME suggests that this group is at a greater risk of auditory deprivation during the developmental age. Therefore, ears with OME need greater attention and closer supervision in terms of more frequent follow-ups to minimize the recurrence compared to those with AOM.
The risk of recurrence was found to be higher in ears with higher degree of hearing loss and in ears with B or Cs type tympanogram. Higher degree of hearing loss and, B or Cs type tympanogram are indications of greater damage to middle ear, in turn suggestive of more severe pathology. This hints at the direct association between severity of OM and its probability of recurrence. It also reflects the importance of audiological test findings in predicting the prognosis and planning the course of management in cases with OM. Ears with higher degree of hearing loss and ears with B or Cs type tympanogram need closer supervision and more frequent follow-ups than the other cases with OM. Earlier studies had revealed the characteristics of hearing loss that result from OM [36,37]. However, the current study is the first one to show the relationship between audiological findings and recurrence of OM.
The current study also assessed the association between demographic variables (age and sex) and the risk of recurrence of OM. Results showed higher risk of recurrence in 5 to 6-year-old group compared to the younger age group. Although the exact reason for the finding is not clear, we suspect that it is because of the higher incidence of other inflammations such as tonsillitis or adenoiditis in this group [38]. Some of the earlier studies have revealed the recurrence of OM in children up to 12 years of age [3,39] with maximum prevalence at 5 years of age. The comparison between males and females revealed no significant difference in the recurrence of OM. The incidence and prevalence of OM are shown to vary between the two sex but the risk of recurrence appears to be comparable.


Neurosoft, Russia for equipment support


Conflicts of Interest

The authors have no financial conflicts of interest.

Author Contributions

Conceptualization: all authors. Data curation: Sathya Harinath. Formal analysis: Sathya Harinath. Investigation: Sathya Harinath. Methodology: all authors. Supervision: Somu Lakshmanan, Saji James, Sandeep Maruthy. Visualization: Somu Lakshmanan, Saji James, Sandeep Maruthy. Writing—original draft: Sathya Harinath. Writing—review & editing: Somu Lakshmanan, Saji James, Sandeep Maruthy. Approval of final manuscript: all authors.

Table 1.
Effect of type of OM, degree of conductive hearing loss, type of tympanogram, age, and sex on recurrence of otitis media
Parameter No. of ears
OR (95% CI) p
Total Recurrent OM OM resolved
Type of OM <0.0001
 AOM 74 9 65 Reference
 OME 88 33 55 4.33 (1.90 to 9.83)
AC-ABR threshold (dBnHL) 0.005
 20 46 2 44 0.24 (0.04 to 1.13)
 30 62 10 52 Reference
 40 38 19 19 5.20 (2.05 to 13.16)
 50 5 2 3 3.47 (0.51 to 23.47)
 60 11 9 2 16.09 (4.38 to 124.00)
Type of tympanogram 0.006
 As 9 0 9 -
 B 81 29 52 3.16 (1.36 to 7.33)
 C 60 9 51 Reference
 Cs 12 4 8 2.83 (0.70 to 11.41)
Age (yrs) 0.005
 1 to 2 35 3 32 Reference
 >2 to 3 13 3 10 3.20 (0.55 to 18.42)
 >3 to 4 23 1 22 0.48 (0.04 to 4.97)
 >4 to 5 21 5 16 3.33 (0.70 to 15.73)
 >5 to 6 70 30 40 8.00 (2.23 to 28.61)
Sex 0.155
 Male 92 19 73 Reference
 Female 70 23 47 1.88 (0.92 to 3.82)

OM, otitis media; OR, odds ratio; CI, confidence interval; AOM, acute otitis media; OME, otitis media with effusion; AC-ABR, auditory brainstem response in air conduction


1. Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One 2012;7:e36226.
crossref pmid pmc
2. Zielhuis GA, Rach GH, van den Bosch A, van den Broek P. The prevalence of otitis media with effusion: a critical review of the literature. Clin Otolaryngol Allied Sci 1990;15:283–8.
crossref pmid
3. Zhang Q, Wei J, Xu M, Zhang Q, Zhang X, Zhang Z, et al. Prevalence of otitis media with effusion among children in Xi’an, China: a randomized survey in China’s mainland. Ann Otol Rhinol Laryngol 2011;120:617–21.
crossref pmid pdf
4. Vergison A, Dagan R, Arguedas A, Bonhoeffer J, Cohen R, Dhooge I, et al. Otitis media and its consequences: beyond the earache. Lancet Infect Dis 2010;10:195–203.
crossref pmid
5. Klein JO, Teele DW, Mannos R, Menyuk P, Rosner BA. Otitis media with effusion during the first three years of life and development of speech and language. editor. Recent Advances in Otitis Media with Effusion. In: Lim DJ. Toronto: B.C: Decker Inc;1984. p.332–4.

6. Engel J, Anteunis L, Volovics A, Hendriks J, Marres E. Risk factors of otitis media with effusion during infancy. Int J Pediatr Otorhinolaryngol 1999;48:239–49.
crossref pmid
7. Mandel EM, Doyle WJ, Winther B, Alper CM. The incidence, prevalence and burden of OM in unselected children aged 1-8 years followed by weekly otoscopy through the “common cold” season. Int J Pediatr Otorhinolaryngol 2008;72:491–9.
crossref pmid pmc
8. Gibney KB, Morris PS, Carapetis JR, Skull SA, Smith-Vaughan HC, Stubbs E, et al. The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study. BMC Pediatr 2005;5:16
crossref pmid pmc pdf
9. Hogan SC, Stratford KJ, Moore DR. Duration and recurrence of otitis media with effusion in children from birth to 3 years: prospective study using monthly otoscopy and tympanometry. BMJ 1997;314:350–3.
crossref pmid pmc
10. Zielhuis GA, Rach GH, van den Broek P. The natural course of otitis media with effusion in preschool children. Eur Arch Otorhinolaryngol 1990;247:215–21.
crossref pmid pdf
11. Roland PS, Finitzo T, Friel-Patti S, Brown KC, Stephens KT, Brown O, et al. Otitis media. Incidence, duration, and hearing status. Arch Otolaryngol Head Neck Surg 1989;115:1049–53.
crossref pmid
12. Hotomi M, Yamanaka N, Samukawa T, Suzumot M, Sakai A, Shimada J, et al. Treatment and outcome of severe and non-severe acute otitis media. Eur J Pediatr 2005;164:3–8.
crossref pmid pdf
13. McShane D, Mitchell J. Middle ear disease, hearing loss and educational problems of American Indian children. J Am Indian Educ 1979;19:7–11.

14. Jacob A, Rupa V, Job A, Joseph A. Hearing impairment and otitis media in a rural primary school in South India. Int J Pediatr Otorhinolaryngol 1997;39:133–8.
crossref pmid
15. Dhingra PL. Diseases of Ear, Nose and Throat. 2nd ed. New Delhi: Elsevier;1998.

16. Beery QC, Doyle WJ, Cantekin EI, Bluestone CD, Wiet RJ. Eustachian tube function in an American Indian population. Ann Otol Rhinol Laryngol Suppl 1980;89(3 Pt 2):28–33.
crossref pdf
17. Harlor AD Jr, Bower C.; Committee on Practice and Ambulatory Medicine; Section on Otolaryngology-Head and Neck Surgery. Hearing assessment in infants and children: recommendations beyond neonatal screening. Pediatrics 2009;124:1252–63.
crossref pmid pdf
18. Isaacson G. Otoscopic diagnosis of otitis media. Minerva Pediatr 2016;68:470–7.
19. Feldman AS. Tympanometry: application and interpretation. Ann Otol Rhinol Laryngol 1976;85(2 Suppl 25 Pt 2):202–8.
crossref pmid pdf
20. Katz J, Chasin M, English K, Hood LJ, Tillery KL. Handbook of Clinical Audiology. 7th ed. Philadelphia, PA: Wolters Kluwer;2015.

21. Roeser RJ, Valente M, Hosford-Dunn H. Audiology Diagnosis. 2nd ed. New York: Thieme;2007.

22. Damoiseaux RA, Rovers MM, Van Balen FA, Hoes AW, de Melker RA. Long-term prognosis of acute otitis media in infancy: determinants of recurrent acute otitis media and persistent middle ear effusion. Fam Pract 2006;23:40–5.
crossref pmid
23. Wang PC, Chang YH, Chuang LJ, Su HF, Li CY. Incidence and recurrence of acute otitis media in Taiwan’s pediatric population. Clinics (Sao Paulo) 2011;66:395–9.
crossref pmid pmc
24. Pukander J, Karma P, Sipilä M. Occurrence and recurrence of acute otitis media among children. Acta Otolaryngol 1982;94:479–86.
crossref pmid
25. Marchisio P, Cantarutti L, Sturkenboom M, Girotto S, Picelli G, Dona D, et al. Burden of acute otitis media in primary care pediatrics in Italy: a secondary data analysis from the Pedianet database. BMC Pediatr 2012;12:185
crossref pmid pmc pdf
26. Liese JG, Silfverdal SA, Giaquinto C, Carmona A, Larcombe JH, Garcia-Sicilia J, et al. Incidence and clinical presentation of acute otitis media in children aged <6 years in European medical practices. Epidemiol Infect 2014;142:1778–88.
crossref pmid
27. Chadha SK, Sayal A, Malhotra V, Agarwal AK. Prevalence of preventable ear disorders in over 15,000 schoolchildren in northern India. J Laryngol Otol 2013;127:28–32.
crossref pmid
28. Triglia JM, Roman S, Nicollasi R. [Serous otitis media]. J Pediatrie Pueric 2004;17:83–100. French.

29. Fiellau-Nikolajsen M. Tympanometry in three-year-old children: prevalence and spontaneous course of MEE. Ann Otol Rhinol Laryngol Suppl 1980;89(3 Pt 2):223–7.
30. Zielhuis GA, Rach GH, van den Broek P. Screening for otitis media with effusion in preschool children. Lancet 1989;1:311–4.
crossref pmid
31. Papp Z, Rezes S, Jókay I, Sziklai I. Sensorineural hearing loss in chronic otitis media. Otol Neurotol 2003;24:141–4.
crossref pmid
32. Webster DB, Webster M. Effects of neonatal conductive hearing loss on brain stem auditory nuclei. Ann Otol Rhinol Laryngol 1979;88(5 Pt 1):684–8.
crossref pmid pdf
33. Maruthy S, Mannarukrishnaiah J. Effect of early onset otitis media on brainstem and cortical auditory processing. Behav Brain Funct 2008;4:17
crossref pmid pmc
34. Sandeep M, Jayaram M. Effect of early otitis media on speech identification. Australian and New Zealand Journal of Audiology 2008;30:38–49.
35. Tomlin D, Rance G. Long-term hearing deficits after childhood middle ear disease. Ear Hear 2014;35:e233–42.
crossref pmid
36. Jayaram M. WHO project report 1. Assessment of etiological factors of conductive hearing loss. Mysore: All India Institute of Speech and Hearing;2007.

37. Parsram K, Jalvi R. NIHH-WHO project. Assessment of etiological factors for conductive hearing impairment in general population in Mumbai (all age groups). Mumbai: Ali Yavar Jung National Institute of Speech & Hearing Disabilities;2007.

38. Marseglia GL, Poddighe D, Caimmi D, Marseglia A, Caimmi S, Ciprandi G, et al. Role of adenoids and adenoiditis in children with allergy and otitis media. Curr Allergy Asthma Rep 2009;9:460–4.
crossref pmid pdf
39. Mark A, Matharu V, Dowswell G, Smith M. The point prevalence of otitis media with effusion in secondary school children in Pokhara, Nepal: a cross-sectional study. Int J Pediatr Otorhinolaryngol 2013;77:1523–9.
crossref pmid
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