The symptoms of Chronic Otitis Media (COM) include middle ear inflammation that lasts for a long time, perforation of the tympanic membrane, frequent discharge from the ear, and hearing loss of different degrees [1]. Because of its substantial contribution to avoidable hearing loss and related illness, it continues to be a big public health concern, especially in developing nations. Populations experiencing low socioeconomic level, poor hygiene, and limited access to healthcare bear a disproportionate share of the burden of COM [2, 3].

Rural and underserved areas sometimes report greater rates of COM, however the disease's incidence varies considerably around the world. Key causes to its development and persistence include environmental and behavioral factors such overcrowding, insufficient sanitation, malnutrition, and recurrent upper respiratory tract infections [4, 5]. Urban populations, on the other hand, have easier access to healthcare services, but they are also more likely to be affected by air pollution, allergies, and lifestyle-related diseases, all of which might increase the likelihood of middle ear infections [6].

Disease distribution is impacted by socioeconomic determinants of health, as seen by the gap in risk factors and prevalence between urban and rural populations. The implementation of focused preventive interventions and the reduction of disease burden depend on the early identification of these determinants [7, 8]. Public health measures should be guided by a greater understanding of the epidemiological variations between rural and urban areas, which has not been well addressed in the many studies on COM [9, 10].

The purpose of this cross-sectional study was to compare 40 individuals with Chronic Otitis Media across urban and rural areas, as well as to identify any risk factors for this condition.

This cross-sectional study was conducted to evaluate the prevalence and risk factors of Chronic Otitis Media (COM) in rural and urban populations. The study was conducted at the Department of ENT, Chettinadu Hospital and Research Institute, Kelambakkam, Chengalpattu, Chennai, Tamil Nadu between September 2024 to August 2025. A total of 40 patients clinically diagnosed with COM were included in the study, comprising 20 patients from rural areas and 20 from urban areas. Ethical approval was obtained from the Institutional Ethics Committee prior to the commencement of the study.

Procedure:
All patients underwent a detailed clinical evaluation, including history taking and otoscopic examination. Diagnosis of COM was confirmed based on the presence of tympanic membrane perforation, chronic ear discharge, and hearing impairment. Patients were categorized into rural and urban groups based on their place of residence. Relevant clinical findings and risk factors were documented systematically.

Data Collection:

Data were collected using a pre-structured and pre-validated questionnaire. Information recorded included demographic details (age, gender), socioeconomic status, personal hygiene practices, living conditions (overcrowding), history of upper respiratory tract infections, allergy status, exposure to environmental pollutants, and access to healthcare facilities. Clinical examination findings were also recorded.

Inclusion Criteria:

• Patients aged ≥5 years diagnosed with Chronic Otitis Media
• Patients willing to participate and provide informed consent
• Both male and female patients
• Patients belonging to either rural or urban populations

Exclusion Criteria:

• Patients with acute otitis media
• Patients with history of ear trauma or previous ear surgery
• Patients with congenital ear abnormalities
• Patients unwilling to participate in the study

Statistical Analysis:

Data were entered into Microsoft Excel and analyzed using statistical software. Descriptive statistics such as mean, standard deviation, frequencies, and percentages were used to summarize the data. The chi-square test was applied to assess the association between risk factors and the prevalence of COM in rural and urban groups. A p-value of less than 0.05 was considered statistically significant.

A total of 40 patients diagnosed with Chronic Otitis Media (COM) were included in the study, comprising 20 patients from rural areas and 20 from urban populations. The findings are presented below.

Table 1: Demographic Distribution of Study Participants

There was a little more male predominance overall, although the distribution was similar between rural and urban groups, according to the demographic profile (Table 1).

Table 2: Prevalence of COM in Rural vs Urban Population

Table 2 shows that the prevalence of COM was 35% in urban areas and 65% in rural areas.

Table 3: Socioeconomic and Environmental Risk Factors

Table 3 shows that compared to urban patients, rural patients were more likely to experience negative socioeconomic and environmental factors, such as overcrowding, inadequate sanitation, and low socioeconomic level.

Table 4: Clinical Risk Factors Associated with COM

Table 4 shows that patients living in urban areas were more likely to suffer from allergies and pollutants, whereas those living in rural areas were more likely to experience recurrent infections of the upper respiratory tract.

Table 5: Laterality and Type of COM

In rural areas, patients were more likely to experience bilateral involvement, but in urban areas, unilateral cases were more common. The majority of cases in both groups were of the mucosal type of COM (Table 5).

Table 6: Access to Healthcare and Treatment-Seeking Behavior

Rural patients were more likely to delay seeking treatment, according to Table 6, while urban patients had better access to healthcare and were more likely to follow up.

This study revealed that the prevalence of Chronic Otitis Media (COM) was markedly greater in the rural population (65%) than in the urban population (35%). This discovery underscores the ongoing gap in illness burden between rural and urban areas, largely shaped by variations in socioeconomic and environmental factors. The prior study indicated analogous trends, revealing that rural communities demonstrated a greater frequency of COM attributable to inadequate living conditions and restricted access to healthcare services [11-13]. This study's demographic analysis indicated a marginal male majority (52.5%), with a mean age of 28.6 ± 12.4 years. This aligns with prior studies indicating that males experience greater exposure to environmental risk factors and occupational hazards that contribute to ear infections. Nevertheless, gender distribution in COM has been inconsistently reported, indicating that both sexes exhibit equal susceptibility contingent upon exposure [14-16]. This study found that critical socioeconomic risk variables, including low socioeconomic level (75%), overcrowding (60%), and inadequate cleanliness (70%), were markedly more common among rural patients. These variables are pivotal in the etiology of COM by facilitating recurring infections and postponing therapy. The prior study indicated overcrowding and inadequate sanitation as significant factors contributing to the elevated prevalence of COM in disadvantaged populations [17-19]. This study found that recurrent upper respiratory tract infections (URTI) were more prevalent among rural patients (65%), while urban patients had a greater correlation with allergies (45%) and exposure to pollution (50%). The findings indicate that infectious causes predominate in rural areas, whereas environmental and lifestyle variables are more significant in urban populations. The prior work established a substantial correlation between upper respiratory tract infections and Eustachian tube dysfunction, a recognized risk factor for chronic otitis media [20-22]. This study found that bilateral involvement was more prevalent among rural patients (46%) than urban patients (29%), suggesting a more advanced or neglected condition in rural areas. The prevalence of mucosal type COM in both groups corresponds with previous studies indicating it as the most frequent clinical manifestation. In the prior study, postponed diagnosis and insufficient therapy were linked to heightened bilateral illness [23]. This study revealed significant disparities in healthcare access and treatment-seeking behavior between the two groups. A greater percentage of rural patients (65%) encountered treatment delays, while urban patients exhibited superior follow-up practices (70%). This gap underscores the significance of healthcare accessibility and awareness in disease management. The prior study shown that prompt medical intervention and consistent follow-up markedly diminished complications and chronicity [24, 25]. This study's findings align with existing literature, confirming that Chronic Otitis Media is significantly affected by modifiable risk factors, including hygiene, socioeconomic level, and healthcare access. Addressing these variables via focused public health interventions is crucial to alleviating the burden of COM, especially in rural populations [26, 27].

This study revealed that modifiable risk factors, including inadequate sanitation, overcrowding, low socioeconomic level, and delayed healthcare access, contribute to a higher prevalence of Chronic Otitis Media (COM) in rural people compared to urban populations. Patients residing in rural areas displayed a greater illness load and more severe clinical presentation, including a more pronounced involvement of both sides of the body and a delay in seeking therapy. Environmental pollution and allergy disorders were more significant risk factors in urban populations, which exhibited a lower prevalence. The importance of social and environmental factors in the onset and course of COM is emphasized by these studies. Thus, in order to lessen the impact of Chronic Otitis Media, it is crucial to raise awareness, encourage early diagnosis, improve hygiene practices, and increase healthcare accessible, particularly in rural regions. To successfully address these inequities, it is strongly suggested to implement targeted public health interventions and community-based programs.

Funding

None

Conflict of Interest:

None.

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