Antibiogram guided optimized medical treatment in chronic otitis media: A useful interventional strategy before surgery?

BACKGROUND: Chronic otitis media is a middle ear cleft disease presenting with tympanic membrane perforation and discharge. Wet ear after tympanoplasty and discharging mastoid cavity are problematic in clinical practice. MATERIAL AND METHODS: 1050 patients of age 10 to 50 years presenting with active ear discharge and clinically diagnosed with unilateral chronic suppurative otitis media were included in the study. The patients were equally divided into two equal groups, Group ET, and AT. All patients were prescribed topical ciprofloxacin, oral levocetirizine 5 mg and n-acetyl cysteine 600 mg BD for one week. Swabs of ear discharge were collected in ET groups for antibiogram. Both groups were evaluated on next visit and treatment changed in AT groups and result observed in next visit. Surgical outcome was evaluated at end of 2 yrs. RESULT: A total of 1158 organisms were isolated in culture out of which, 69.94 % were aerobes, 13.47 % anaerobes and 16.58 % were fungi. On the second visit in group AT, treatment of 85.14 % patients was changed in accordance with culture sensitivity report. In patients with mucosal disease, only 46.87 % patients of group ET had a favorable outcome in comparison to 90.28 % patients of group AT while in patients with squamosal disease, 17.56 % patients of group ET and 28.99 % patients in group AT had a dry ear. Surgeries in AT group were found to have statistically significant higher success rate as compared to ET group.

Effects of ciprofloxacin or co-amoxicillin with and without antidepressants on behavioral deficit in rats induced with chronic suppurative otitis media.

Chronic suppurative otitis media (CSOM) is chronic infection of middle ear which is usually managed with antibiotic therapy. This infection may cause the depression and cognitive changes in patients. The aim of present study was to evaluate the effect of antibiotic (ciprofloxacin and co-amoxicillin) with antidepressant or without antidepressants (bromazepam and imipramine) at low doses on rats with induced with CSOM. Pseudomonas aeruginosa was used to induce CSOM by in rat ear (tympanic bulla). The rats were divided into eight groups having six animals in each group. Neuropharmacological activities and gross behavior were observed in open field activity, force swimming cage, maze test, light and dark activity box and traction test. Observations were noted weekly after the administration of ciprofloxacin (15.3mg/kg), co-amoxicillin (15.3mg/kg), imipramine (1.15mg/kg) and bromazepam (0.09mg/kg) intraperitoneally. The altered behavior and depression was observed in control positive but reverted back in groups maintained on antidepressants with antibiotics with significant improved locomotor activity, memory in memory cage, muscular co-ordination and body balance and decreased anxiety. On the other hand, groups treated with only antibiotics showed significant improvement only in force swimming and traction test at day 14. Therefore, the antidepressant effects of the drugs can be employed to attenuate stress and depression in patients with CSOM.

Otitis media crónica supurativa por Mycobacterium tuberculosis. Un reto diagnóstico / Chronic suppurative otitis media by Mycobacterium tuberculosis. A diagnostic challenge

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A study of bacterial pathogens and antibiotic susceptibility patterns in chronic suppurative otitis media.

OBJECTIVE: To assess the frequency of bacterial agents in chronic suppurative otitis media and the antibiotic susceptibility patterns of isolates among patients. METHODS: A total of 185 patients clinically diagnosed with chronic suppurative otitis media were interviewed and middle-ear effusion samples were collected using sterile swabs. All bacterial isolates were identified by conventional microbiological methods. Antibiotic susceptibility patterns of the isolates were determined by Kirby-Bauer disc diffusion. RESULTS: Staphylococci spp. (64.9 per cent) were the most prevalent bacteria isolated, followed by Klebsiella spp. (12.9 per cent) and Pseudomonas aeruginosa (10.3 per cent). The most effective antibiotic for treatment of bacterial chronic suppurative otitis media was ciprofloxacin. Statistical analysis showed no significant difference in bacterial infestations among chronic suppurative otitis media patients and the antimicrobial susceptibility patterns of the bacterial isolates based on gender and age (p > 0.05). CONCLUSION: Our findings highlight the importance of a continuous and periodic evaluation of the bacteriological profile and antibiotic susceptibility patterns in chronic suppurative otitis media patients for efficacious treatment of the infection.

[Screening for effective antibiotics in chronic suppurative otitis media].

Objective:To explore the method of screening effective antibiotics in active stage of otitis media, in order to lay ground for rational clinical application of antibiotics in this scenario.Method:The clinical data of 198 patients diagnosed as otitis media were analyzed. Based on the results of bacterial culture and drug sensitivity test of middle ear secretion, the clinical availability and the ototoxicity of corresponding drugs, first and second line drugs were screened to control infection. The therapeutic effect of drugs was summarized.Result:In 21 out of 198 cases, there was no growth of common bacteria, while in the remaining 177 cases, there were 36 cases(20.34%) of coagulase negative staphylococcus, which was sensitive to linezolid, vancomycin, cefuroxime, levofloxacin, SMZ-TMP, and rifampin; 30 cases(16.95%) of pseudomonas aeruginosa, which was sensitive to meropenem, imipenem, ceftazidime, amikacin, and piperacillin; and 26 cases(14.69%) of staphylococcus aureus, which was sensitive to linezolid, vancomycin, oxacilin, gentamycin, levofloxacin, ciprofloxacin, moxifloxacin. Drugs that were administrated based on experience including: local use of levofloxacin eardrops, cefuroxime and moxifloxacin as first line oral antibiotics, and ceftazidime as second line oral antibiotics. There were 3 cases of post-operational infection, which recovered after systemic and local use of sensitive drugs and dressing.Conclusion:In otitis media, sensitive antibiotics chosen from results of bacterial culture and drug sensitivity test, are useful in reducing the complication of infection after surgery.

WITHDRAWN: Interventions for ear discharge associated with grommets (ventilation tubes).

BACKGROUND: The insertion of grommets (also known as ventilation or tympanostomy tubes) is one of the most common surgical procedures performed on children. Postoperative otorrhoea (discharge) is the most common complication with a reported incidence ranging from 10% to 50%. In the UK, many ENT surgeons treat with topical antibiotics/steroid combinations, but general practitioners, mainly through fears of ototoxicity, are unlikely to prescribe these and choose systemic broad-spectrum antibiotics. OBJECTIVES: 1. To identify the most effective non-surgical management of discharge from ears with grommets in place.2. To identify the risks of non-surgical management for this condition (e.g. ototoxicity), and to set benefits of treatment against these risks. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2005), MEDLINE (1966 to 2005) and EMBASE (1974 to 2005). We also searched the CINAHL, AMED, LILACS, ISI WEB OF KNOWLEDGE, ISI PROCEEDINGS, mRCT, NNR, ZETOC, KOREAMED, CSA, MEDCARIB, INDMED and SAMED databases. The date of the last search was February 2005. SELECTION CRITERIA: Randomised controlled trials of adults or children, with any type of grommet and an ear with discharge were included. The trials compared treatment with placebo or one treatment with another. The primary outcome measure was the duration of the discharge. DATA COLLECTION AND ANALYSIS: The trials were selected independently according to the above criteria by the four reviewers. Differences in opinion over the inclusion of studies were resolved by discussion. The studies were graded using the CASP critical appraisal tool. Analyses were based on the presence of discharge seven days from the onset of treatment. MAIN RESULTS: There was very little good quality evidence. Four studies were included, all of them investigating different interventions and therefore a meta-analysis was not possible.Only one study demonstrated a significant difference. Oral amoxicillin clavulanate was compared to placebo in 79 patients. The odds of having a discharge persisting eight days after starting treatment was 0.19 (95% CI 0.07 to 0.49) . The number needed to treat to achieve that benefit is 2.5. Participants in both arms of this study also received daily aural toilet. The results will therefore not be applicable to most settings including primary care. No significant benefit was shown in the two studies investigating steroids (oral prednisolone with oral amoxicillin clavulanate and topical dexamethasone with topical ciprofloxacin ear drops), or the one study comparing an antibiotic-steroid combination (Otosporin®) drops versus spray (Otomize®) (although more patients preferred the spray form). AUTHORS' CONCLUSIONS: The authors of this review have been unable to identify the most effective intervention or to assess the associated risks. Research is urgently needed into the effectiveness of oral versus topical antibiotics in this group of patients. Clinicians considering antibiotic treatment need to balance any potential benefit against the risks of side effects and antibiotic resistance.

Occurrence of otitis media in children and assessment of treatment options.

BACKGROUND: Otitis media is a more frequent occurrence in children, and the disease may progress from an acute to chronic state if appropriate and timely intervention is not initiated. METHODS: A total of 212 children aged 6 months to 10 years were examined and treated for otitis media, in a 13-month hospital-based study. RESULTS: Acute otitis media was diagnosed in 130 (61.3 per cent) of the patients. There were 82 (38.7 per cent) chronic suppurative otitis media cases. The incidence of acute otitis media and chronic suppurative otitis media in the first year of life was 54.6 per cent and 45.1 per cent respectively. Chronic suppurative otitis media patients were assigned to one of three treatment groups. Recovery occurred in 70.4 per cent of amoxicillin-treated patients, in 88.9 per cent of amoxicillin-clavulanic acid treated patients and in 96.4 per cent of culture and antibiotic sensitivity test patients. Relapses were seen only in the amoxicillin (five cases) and amoxicillin-clavulanic acid (two cases) groups. CONCLUSION: The success rate in patients treated with antibiotics makes this option mandatory for an established diagnosis.

Preparation of levofloxacin thermo-sensitive gel and clinical application in the treatment of suppurative otitis media.

CONCLUSION: The levofloxacin thermo-sensitive gel prepared using 17% poloxamer 407 (P407) can successfully treat suppurative otitis media (SOM) through the well-controlled release of levofloxacin targeted against the inflammation. OBJECTIVE: To evaluate the preparation method and therapeutic effect of levofloxacin thermo-sensitive gel used in the treatment of SOM. METHODS: The phase inversion temperatures of 16%, 17%, 18%, 19%, and 20% P407 or P407 solution with 3 mg/ml levofloxacin were determined and the one close to 34(°)C was selected as the optimal concentration. Then a model of SOM was induced by injection of 0.1 ml Staphylococcus aureus (1 × 10(8)/L) in the left ear of 32 Sprague Dawley (SD) rats. Normal saline injected in the right ear was used as the control. Then rats were treated with 0.1 ml normal saline (group A), levofloxacin (group B), P407 (group C), and levofloxacin thermo-sensitive gel (group D) (n = 8). The tympanic membranes were evaluated by otoscopy and hematoxylin and eosin (H&E) staining. RESULTS: The optimal concentration of P407 was 17% and the release of levofloxacin in thermo-sensitive gel followed zero-order kinetics. Levofloxacin thermo-sensitive gel and levofloxacin drops could both alleviate the local inflammation in the first 3 days, but levofloxacin drops could not inhibit the recurrence of SOM, while the levofloxacin gel performed continuous drug delivery into inflammation without recurrence.

Bacteriology of chronic suppurative otitis media (CSOM) in children in Garissa district, Kenya: a point prevalence study.

OBJECTIVES: To identify by type and sensitivity to drugs the bacteria found in ears of school-going children with chronic otitis media in Garissa district. STUDY DESIGN: This was a descriptive prevalence study of CSOM bacterial flora in eligible ears conducted among a cohort of children attending public and private primary as well as Islamic religious schools, screened for chronic ear discharge in Garissa district, Kenya. Procedure and bacteriological techniques: We used sterile swab-sticks to collect a specimen of the discharge from eligible ears of consenting pupils at the induction stage of the zinc supplementation trial for treatment of chronic suppurative otitis media conducted between January and July 2010. All pupils below 18 years present on day of visit were eligible. Both aerobic and anaerobic bacterial cultures were done to identify clinically and epidemiologically important bacteria. Sensitivity tests were based on disc diffusion methods. Results are presented as frequencies and proportions. RESULTS: Of the pupils seen, 61% were still in pre- or lower primary school. Majority were aged 13 and 14 years. Of the 261 ear swab samples processed, 336 isolates - either in mixed or pure flora - were identified, being almost exclusively aerobes. Proteus spp., Enterococcus, Staphylococcus aureus and Pseudomonas spp. were isolated in 32.7%, 28.6%, 12.8% and 11.3% respectively. Proteus was susceptible to majority of the antibiotics tested for, while Enterococcus was poorly susceptible. CONCLUSIONS: Aerobic bacteria were most prevalent in this study. Several of the bacteria identified are known to require iron for their growth. This may be important for CSOM treatment if biofilm formation is involved in pathogenesis. Majority of the isolates were susceptible to basic antibiotics compared to Enterococcus bacteria. This portends an important consideration for clinical management and therapeutic decision-making. Additionally, given the prevalence of Enterococcus bacteria, which is an indicator of faecal contamination of the environment, there is need to consider relevant public health components in managing childhood CSOM besides the clinical ones alone.

Pattern of chronic suppurative otitis media.

This observational study was conducted to know the bacteriological pattern of chronic suppurative otitis media. For this 110 patients of Chronic Suppurative Otitis Media (CSOM) were selected from January 2006 to December 2007 at the out patient department of Otolaryngology and Head Neck surgery, BSMMU and Dhaka Medical College Hospital, Dhaka. Among the 110 patients unilateral involvement was 76.36% and bilateral involvement was 23.64%. Ninety percent patients presented with tubotympanic variety and 10% patients presented with attico-antral variety. Bacteriologically pure growth was found in 79.09% cases, mixed growth in 10.91% cases, no growth in 10% cases. Only aerobic bacteria were isolated in the present series. Pseudomonas aeruginosa was the most common organism (43.68%) isolated in pure culture followed by staphylococcus aureus 27.59%, E. coli 10.35%, Kleibsiella spp. 9.19%, proteus spp. 8.04%. Amikacin was the most effective antibiotic followed by Gentamycin, Ciprofloxacin, Ceftazidime, Cetriaxone. Before giving therapy bacterial growth and sensitivity pattern is to be known where facilities are available.

Bacteriological agents of chronic discharging ears and their antibiotic sensitivity pattern in Ido - Ekiti, Nigeria.

AIMS AND OBJECTIVES: To identify bacterial agents of chronic discharging ear and determine their antibiotic sensitivities pattern in Ido - Ekiti, Nigeria. PATIENTS AND METHODS: Swab specimens of each chronically (>8 weeks) discharging ears of patients with chronic suppurative otitis media (CSOM) presenting to the Ear, Nose and Throat (ENT) clinic of the Federal Medical Centre, Ido Ekiti were bacteriologically cultured aerobically and the antibiotic sensitivity pattern of the recovered organisms determined by the modified Kirby-Bauer disc-diffusion method over a three year period starting from January 2005. RESULTS: Seventy eight patients with CSOM whose age ranged between 3 months and 85 years were seen during the study period with 73.1% of them having unilateral disease and majority were children < 15 years (71.8%). Out of 99 ear swabs that were examined, 87.9% were culture positive with 90.8% yielding a single isolate. Coliforms (34.7%) were the most frequent isolated group of organisms. Other isolates included Staphylococcus aureus (26.3%), Proteus spp (24.2%), Pseudomonas spp (9.5%) and Klebsiella spp (5.3%). Sparfloxacin and ciprofloxacin showed highest activity on all the isolates unlike cefuroxime and ceftiaxone to which all isolates were resistant. CONCLUSION: Chronic discharging ear is caused by bacteria agents most sensitive to quinolones but resistant to cefuroxime and ceftiaxone. Treatment of patients with CSOM in Ido-Ekiti with the quinolones is recommended except where contraindicated.

Uso de ceftriaxona en monodosis para el tratamiento de la otitis media aguda supurada en pacientes de edad pediátrica / Ceftriaxone´s use in monodoses for the treatment of otitis media acute suppurativa in pediatric age patients

La otitis media aguda supurada es muy frecuente en pediatría. El 80 por ciento de los niños en edad preescolar y el 50 por ciento de los lactantes hacen un cuadro de supuración de oídos dos veces al año. Objetivo: evaluar la efectividad de la ceftriaxona en dosis única en pacientes pediátricos con otitis media aguda supurada. Método: se realizó un ensayo clínico, fase IV, durante el segundo semestre del año 2008, a 51 niños ingresados con el diagnóstico de Otitis Media Aguda Supurada, en el Hospital Pediátrico Provincial de Camagüey Eduardo Agramante Piña. Resultados: se encontró un ligero aumento del sexo masculino; con predominio significativo de la raza blanca. Existió una alta incidencia en los pacientes menores de un año. El 58,8 por ciento de los pacientes recibieron tratamiento previamente con antimicrobianos. El tratamiento antimicrobiano utilizado con mayor frecuencia fue la amoxicillina, la penicilina y el Claforan. Más del 66 por ciento presentó una evolución favorable dentro de las 72h siguientes al tratamiento con la monodosis de ceftriaxona. En 48 de los pacientes estudiados se obtuvo una evolución otoscópica favorable, lo que correspondió a un 94,12 por ciento de los casos estudiados. Al estudiar el comportamiento de los pacientes según edad y otras enfermedades asociadas, se pudo observar que sólo dos pacientes no presentaron otras enfermedades asociadas. Conclusiones: se logró una evolución favorable dentro de las 72h siguientes al tratamiento con la monodosis de ceftriaxona en casi la totalidad de los casos (AU)

Otitis media acute suppurativa is very frequent disease in pediatrics. The 80 percent of children in preschool age and 50 percent of infants make ear suppuration twice a year. Objective: to evaluate the efficacy of an only dose of ceftriaxone in pediatric patients with otitis media acute suppurativa. Method: a phase IV clinical trial was performed, during the second semester of 2008 to 51 children admitted with otitis media acute suppurativa as diagnosis, at the provincial pediatric hospital of Camagüey Eduardo Agramonte Piña. Results: a slight increase of the masculine sex was found; with significant prevalence of the white race (44,86 percent). There was a high incidence in patients under one year (29) for 56,9 percent. The 58,8 percent (30) of patients previously received antimicrobial treatment. The most frequent antimicrobial treatment used was amoxicillin (44,1 percent), penicillin (20,5 percent) and claforan (11,7 percent). More than the 66 percent presented a favorable evolution within 72 hours next to the treatment with ceftriaxone monodoses. In 48 of studied patients a favorable otoscopic evolution was obtained, what corresponded to 94,12 percent of studied cases. Conclusions: a favorable evolution was achieved within 72 hours following to the treatment with ceftriaxone monodoses in more than the half of cases (AU)

Uso de ceftriaxona en monodosis para el tratamiento de la otitis media aguda supurada en pacientes de edad pediátrica / Ceftriaxone´s use in monodoses for the treatment of otitis media acute suppurativa in pediatric age patients

La otitis media aguda supurada es muy frecuente en pediatría. El 80 por ciento de los niños en edad preescolar y el 50 por ciento de los lactantes hacen un cuadro de supuración de oídos dos veces al año. Objetivo: evaluar la efectividad de la ceftriaxona en dosis única en pacientes pediátricos con otitis media aguda supurada. Método: se realizó un ensayo clínico, fase IV, durante el segundo semestre del año 2008, a 51 niños ingresados con el diagnóstico de Otitis Media Aguda Supurada, en el Hospital Pediátrico Provincial de Camagüey Eduardo Agramante Piña. Resultados: se encontró un ligero aumento del sexo masculino; con predominio significativo de la raza blanca. Existió una alta incidencia en los pacientes menores de un año. El 58,8 por ciento de los pacientes recibieron tratamiento previamente con antimicrobianos. El tratamiento antimicrobiano utilizado con mayor frecuencia fue la amoxicillina, la penicilina y el Claforan. Más del 66 por ciento presentó una evolución favorable dentro de las 72h siguientes al tratamiento con la monodosis de ceftriaxona. En 48 de los pacientes estudiados se obtuvo una evolución otoscópica favorable, lo que correspondió a un 94,12 por ciento de los casos estudiados. Al estudiar el comportamiento de los pacientes según edad y otras enfermedades asociadas, se pudo observar que sólo dos pacientes no presentaron otras enfermedades asociadas. Conclusiones: se logró una evolución favorable dentro de las 72h siguientes al tratamiento con la monodosis de ceftriaxona en casi la totalidad de los casos.

Otitis media acute suppurativa is very frequent disease in pediatrics. The 80 percent of children in preschool age and 50 percent of infants make ear suppuration twice a year. Objective: to evaluate the efficacy of an only dose of ceftriaxone in pediatric patients with otitis media acute suppurativa. Method: a phase IV clinical trial was performed, during the second semester of 2008 to 51 children admitted with otitis media acute suppurativa as diagnosis, at the provincial pediatric hospital of Camagüey Eduardo Agramonte Piña. Results: a slight increase of the masculine sex was found; with significant prevalence of the white race (44,86 percent). There was a high incidence in patients under one year (29) for 56,9 percent. The 58,8 percent (30) of patients previously received antimicrobial treatment. The most frequent antimicrobial treatment used was amoxicillin (44,1 percent), penicillin (20,5 percent) and claforan (11,7 percent). More than the 66 percent presented a favorable evolution within 72 hours next to the treatment with ceftriaxone monodoses. In 48 of studied patients a favorable otoscopic evolution was obtained, what corresponded to 94,12 percent of studied cases. Conclusions: a favorable evolution was achieved within 72 hours following to the treatment with ceftriaxone monodoses in more than the half of cases.

[Treatment of patients with acute and chronic suppurative middle ear diseases using ozone preparations].

Methods of clinical application of gaseous ozone and ozonated solutions are described with special reference to the treatment of patients with acute and chronic suppurative middle ear diseases. Results of otoscopy, microbiological and cytological studies confirm therapeutic efficiency of the above techniques as accelerating recovery of patients with this pathology. It is recommended to include ozonotherapy as an additional method in the combined treatment of acute and chronic suppurative otitis media.

[The use of sinupret in the combined treatment of acute otitis media in children].

This controlled prospective study included 40 children (18 boys and 22 girls) hospitalized for the treatment of acute suppurative otitis media. Mean age of the patients was 4.5 years. Their condition was evaluated after cessation of purulent discharge and closure of perforation while acoustic impedancometry still revealed the presence of exudate in the tympanum. The treatment included administration of nasal decongestants, systemic antibacterial therapy, sanation of the nasal and pharyngonasal cavities by transposition or puncture of maxillary sinuses. Some patients (study group) were given sinupret in age-adjusted doses. Signs of exudates disappeared within a mean of 4.2 days after the onset of therapy compared with 7.7 days in the control group (p<0.01). It is concluded that the inclusion of sinupret in the combined treatment of acute suppurative otitis media promotes rapid and efficacious sanation of the tympanic cavity and hearing restoration.

Current bacteriology of suppurative otitis: resistant patterns and outcomes analysis.

INTRODUCTION: Antibiotic resistance has complicated the management of the draining ear. In this study, we examine the factors predisposing to resistance, as well as the role culture played in the management of these patients. MATERIALS AND METHODS: A retrospective chart review was performed on all patients with a complaint of otorrhea during a 3-year period. Demographic factors, the patients diagnosis, previous antimicrobial use, the organism isolated, the resistance pattern of the organism, the treatment instituted, the treatment changed, and the efficacy of treatment were all examined. RESULTS: Previous antibiotic use resulted in a significantly increased rate of resistance only for the diagnosis of otitis externa (p = 0.01). No other factors were found to be clinically significant. The previous use of ototopical quinolones was shown to be correlated with a significant increase in quinolone resistance (p = 0.01). Methicillin-resistant Staphylococcus aureus isolated was shown to have 60% and 33% resistance rates to clindamycin and trimethoprim/sulfamethoxazole, respectively. The overall treatment failure rate was 36% but rose to 50% for infections involving highly resistant bacteria (p = 0.01). Treatment was changed based on culture results in 21% of cases. CONCLUSION: Previous antibiotic use is correlated with increased bacterial resistance in the case of otitis externa. Highly resistant bacteria were associated with an increased rate of treatment failure. Culture plays an essential role in the management of refractory otorrhea.

The role of retinol in the etiology and outcome of suppurative otitis media.

Vitamin A deficiency is still a serious public health problem affecting an estimated 127 million preschool children. The resulting immunological dysfunctions lead to increased risks of respiratory tract infections, diarrhoeal diseases and blindness, among others. The aim of this study is to determine the significance of the role of serum retinol in the etiology of acute suppurative otitis media (ASOM) and its chronicity (CSOM). In a prospective follow-up of patients with ASOM for 6-9 months, serum retinol determination was done using the high performance liquid chromatography. Participants comprised 358 ASOM and 52 control subjects. Six-month follow-up was achieved in 264 subjects (74%); of these, there was persistence of otorrhoea (CSOM) in 116, while 148 had resolved ASOM. Of the 264 subjects, 146 were males and 118 were females, between the ages of 6 months and 9 years and a mean of 7 years (SD = 2.32), whereas the control subjects comprised 29 males and 22 females, between the ages of 6 months and 11 years and a mean of 7.8 years (SD = 3.6). The range of serum retinol in the ASOM subjects was 1.63-2.64 microg/L, mean of 1.53 microg/L, median value of 2.61 microg/L and (SD = 0.16). Among control subjects, the range was 2.5-2.8 microg/L, mean of 2.58 microg/L and median value of 2.61 microg/L (SD = 0.14) (Table 1). The range of serum retinol in the resolved ASOM subjects was 1.61-2.63 microg/L, mean of 2.07 microg/L and median value of 2.09 microg/L (SD = 0.16) while the CSOM subjects ranged between 0.8-2.86 microg/L, mean of 1.58 microg/L and median value of 1.28 microg/L, (SD = 0.48) (Table 2). Univariate analysis using unpaired t test to compare the mean serum retinol revealed significant difference between ASOM and control (P = 0.0000) and between resolved ASOM and CSOM (P = 0.0000). In conclusion, hyporetinolaemia was a significant etiological factor in the etiology ASOM and CSOM, suggesting retinol supplementation as one strategy in control of SOM.