its evolution can run through serious complications and irreversible damage [ 1 , 2 ] , mainly in our areas which are characterized by low medication and delays in referral specialist consultations .
the issue of the com in developing countries still lies not only in its diagnostic approaches , but also in its treatment modalities .
the purpose of this study was to analyze the epidemiological , clinical , and therapeutic aspects of this disease at the university hospital of ouagadougou .
  this prospective descriptive study focused on 79 patients with com , aged from 6 months to 75 years .
these cases have been collected from march 1 2009 , to february 29 2010 , in the ent ward of the university hospital ( chu - yo ) of ouagadougou .
it included all patients with com who came in consultation during the said period in the service and had given their informed consent .
the diagnosis of com was based upon the following arguments : chronic inflammation of the middle ear lasting for more than 3 months with otorrhea or not , and changes in the eardrum , eardrum perforation or not , pure tone threshold audiometry showing a hearing loss .
patients had a follow - up control check on the 15th , 30th , 60th , and 90th days after treatment .
controls evaluated local changes ( ending of otorrhea , aspect of the eardrum , and the bottom case , with research of complications ) .
we developed a data collection sheet taking into account age , gender , history , datasheet of the clinical examination , further investigations , treatment , and evolution .
seventy - nine patients ( 0.96% ) were recruited during the study period among a group of 8200 patients who had consulted .
there were 43 men ( 54.3% ) and 36 women ( 45.70% ) with a sex ratio of 1.19 .
the most common age was that from 0 to 15 years with a frequency of 32 cases or 40.50% of cases .
twenty - one patients or 25% had had their first special consultation after more than 10 months of disease development .
the main reasons for consultation were otorrhea , 53 cases ( 67.10% ) , followed by earache , 13 cases ( 16.50% ) , and hearing loss , 8 cases ( 10.13% ) .
ent histories found in our patients were listed in table 1 . contributing factors found in our patients were shown in table 2 . bilateral com ( 35.40% )
was relatively more common than unilateral shapes taken as isolated cases : right ( 30.40% ) and left ( 34.20% ) . among the 158 ears examined , 107 showed com .
germs were found in 36 cases . there were 9 cases of staphylococcus aureus ( 25.01% ) , 8 cases of pseudomonas aeruginosa ( 22.20% ) , and 5 cases of proteus mirabilis ( 13.90% ) .
the rest of the germs ( 26.47% ) were varied ( streptococcus , escherichia coli , klebsiella , and providencia ) .
antibiogram testing was performed in 31 cases . among the antibiotics tested , ciprofloxacin and ceftriaxone were the most active , with respective rates in 26 cases or 83.90% and in 24 cases or 77.40% of cases .
the pure tone threshold audiometry was performed in all cases , but the types of hearing loss were identified in 76 cases ( 96.20% ) .
conductive hearing loss in 38 cases ( 50% ) and mixed hearing loss in 32 ( 42.10% ) were the most represented types in our series .
this deafness was of varying intensity but dominated by the mild degree in 36 cases ( 47.37% ) .
our patients received only medical treatment in 59 cases ( 74.68% ) : local antibiotherapy and anti - inflammatory treatment were systemically used , respectively , in 52 cases ( 88.13% ) and 51 cases ( 86.44% ) .
it consisted mainly in a paracentesis ( 7 cases ) in case of failure of medical treatment in the com , a myringoplasty ( 6 cases ) , and a radical mastoidectomy in 4 cases of cholesteatoma .
the response to treatment was favorable with lesion stabilization in 63 cases ( 86.35% ) .
they concerned mastoiditis in 3 cases ( 3.80% ) , peripheral facial paralysis in 3 cases ( 3.80% ) , and meningoencephalitis in 1 case ( 1.27% ) .
postotitis sequelae were dominated by deafness in 76 cases ( 96.20% ) of variable intensity .
in our experience , 79 patients with chronic otitis media were examined in 1 year , an amount of 0.96% of consultants .
indeed , the actual frequency of this disease is difficult to specify in our conditions of exercise where health facilities , qualified staff , and technical facilities are limited . therefore , there is underreporting of cases in our context .  
the highest frequencies of com cases were recorded during the period from march to june and during the month of december .
this corresponds in burkina faso to the period of the dry , dusty harmattan winds on the one hand and the cold on the other hand , that undermine the mucosa , favoring acute respiratory infections including acute otitis medium ( aom ) .
it thus plays an important role in the genesis of com [ 7 , 8 ] . according to triglia et al .   in france ,
the average length of the otitis episode in cold period is nearly three times longer than in warm weather .
the seasonal influence is thus a significant factor in the genesis and maintenance of com .  
the age group most represented in our study was that of 015 years with a frequency of 40.50% .
these results are comparable to those of david and peter   in the us , which recorded a rate of 39% for the age group from 0 to 15 years .
we agree with these authors that at this age the immune immaturity of the child and the anatomical features of the ent area predispose them to aom and thus to com .   
the average delay for specialized consultation in our study was 6 months and 10 months for more than 25% of patients .
this delay in specialist consultation could be partly accounted for by the lack of third - party payment ( medical costs are entirely borne by the patient ) , and secondly , it is due to the importance of self - medication and the weight of traditional treatment in our context . to this
could be added the low impact of the symptoms of this disease , which constitutes a trivializing factor in our regions .
simple com was the most represented in our series ( 71.02% ) with a rather central perforation ( 61.73% of cases ) .
these results are comparable to those of other authors such as home et al . from denmark   which noted a predominance of central perforation with a frequency of 86% .
com with effusion seems to be less frequent in our context ( 24.30% of cases ) .
nevertheless , many of this simple com might be genuine com with effusion seen at its superinfected and open stage .
but this scarcity is relative for us since many cases certainly go unnoticed when you do not have a microscope for otology consultation .
moreover , in our developing countries , many patients , carriers of com , do not consult ent .
anyway , we must keep in mind the specific gravity of cholesteatoma com [ 5 , 11 ] . among the contributing factors encountered , in - ear instillation of traditional products ( 46.09% ) was
rhinitis and nasopharyngitis , classic predisposing factors , are taken into account in the genesis of com by their chronic impairment of tubal function .
however , in our context , we should first blame ear instillation of traditional products ( 46.09% ) of badly known chemical nature .
they will probably increase the risk of transition to chronicity and the development of extensive lesions .
unfortunately , the low purchasing power of patients , the influence of sociocultural habits ( including pond baths ) , and disregard of the risks incurred induce this therapeutic use .  
the treatment of com is medicosurgical [ 1 , 6 , 10 , 12 ] . it not only helps to curb the infection process and the inflammatory process but also prevents otogenes complications .
topical antibiotics and anti - inflammatory are very important : 88.61% and 87.34% , respectively , of cases in our series .
paracentesis and myringoplasty were the most practiced surgical interventions in our series followed by mastoidectomy .
this surgical treatment concerned , respectively , four main directions : otitis media with effusion , simple open - spandrel com , infectious complications , and cholesteatoma [ 7 , 13 ] .
the early care and the quality of technical facilities are important assets for the prognosis [ 3 , 6 ] . however , endotemporal complications are frequent in our series .
the sequelae were primarily functional in our study , dominated by deafness with important socioprofessional consequences .
the management of these sequelae is also a fundamental step in the management of com .

 being a relatively common condition in our context , com remains a public health problem that is often wrongly trivialized by people .
we should undoubtedly focus on prevention through public awareness , an appropriate care of upper respiratory tract infections , and early treatment of aom .
 
 objectives . the aim of this study was to analyze the epidemiological and clinical aspects of chronic otitis media and its therapeutic processes in our context . patients and methods . in a prospective study over a period of 1 year ( march 2009february 2010 ) , 
 79 patients with chronic otitis media have been cared for in the otolaryngology ward of the university hospital of ouagadougou . 
 results . chronic otitis media ( com ) 
 commonly occurs in the age group from 0 to 15 years ( 40.50% ) . 
 otorrhea was the main reason for consultation in 53 cases ( 67.10% ) ; the most frequently encountered clinicopathological forms were simple com ( 71% ) followed by otitis media with effusion ( 24.30% ) . 
 intra - auricular instillations of traditional products ( 46.09% ) were the dominant favoring factor . 
 treatment was essentially through medication in 59 cases with a stabilization of lesions . 
 endotemporal complications were noticed in 6 cases . conclusion . 
 the fight against chronic otitis media is carried out through preventive measures of education the of people . 
1. Introduction
2. Patients and Methods
3. Results
4. Discussion
5. Conclusion