Otogenic Tetanus: Continuing Clinical Challenge in the Developing Country

Abstract

 Background: Otogenic tetanus is a vaccine preventable disease which continues to be of public health significance. Objectives: To evaluate patients with otogenic tetanus and identify the factors that predisposes patients to it. Methodology: This is a 16-year retrospective review of all patients managed for otogenic tetanus at the Department of Otorhinolaryngology, University College Hospital, Ibadan. The essential clinical data collected include demographic data, clinical presentations, tetanus immunization history, duration of hospital admission, management and outcome. Results: There were 66 subjects made up of 45 (68.2%) males and 21 (31.8%) females. Their age ranged between 2 and 65years, mean of 7.7 years but the under 5years constituted the majority, 56.1%. All patients presented with ear discharge, lock jaw and spasms. The onset of symptoms ranged between 3 and 8 days with a mean of 4.3 ± 3.3days. Only 21.2% had history of completed childhood tetanus immunisation. No patient had booster shots. About 98% had history of use of herbs, charcoal, honey, cigarette, methylated spirit or deodorant in the discharging ear. All were managed with antibiotic ear dressing, tetanus toxoid, human tetanus immunoglobulin, antibiotic therapy and sedative but only 3% had airway management. The duration of hospital admission ranged from 18 days to 105 days and there were 12.1% death. Conclusion: Otogenic tetanus is still a major problem in developing countries and this can be prevented if recommended childhood tetanus vaccination and booster shots regimen are properly taken. Health education on ear hygiene and care of the ear may prevent this disease.