Middle ear problems and head and neck cancer in Greenland / the Arctic
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1 Middle ear problems and head and neck cancer in Greenland / the Arctic Preben Homøe, MD, Ph.D, DMSc Consultant, Assoc. Prof. Department of Otolaryngology, Head & Neck Surgery and Audiology Rigshospitalet University Hospital of Copenhagen Denmark e.mail: phom@regionh.dk
2 What is middle ear disease or otitis media? CHRONIC SUPPURATIVE OTITIS MEDIA (CSOM) ACUTE OTITIS MEDIA (AOM) CHRONIC OTITIS MEDIA (COM)
3 What s the problem? CSOM occurs at the critical time of language acquisition. Hearing loss Delayed language and speech Impaired communication abilities Behaviour, concentration Educational difficulties Chronic otorrhea Parent s lost days at work, Stigmatization, contagious Complications: Intra-cerebral infection deaths/year worldwide
4 Chronic suppurative otitis media: CSOM The problem WHO 2004: million people worldwide WHO 1996: A prevalence of >1% of COM in children in a defined community indicates that there is an avoidable burden of the disease A prevalence of >4% indicates a massive public health problem of COM which needs urgent attention in targeted populations.
5 Monasta et al: April 30, 2012: Global CSOM incidence rate estimates Worldwide prevalence of CSOM: million cases Cases with hearing loss (WHO def.) 20 million cases Developing countries Access to healthcare is limited Poverty Indigenous populations Aboriginees in Australia Polynesians Inuit = Eskimos in the Arctic - Greenland
6 Ear surveys in Greenland Major towns -Nuuk Sisimiut Ilulissat Timeline: : First survey in Nuuk and Sisimiut : Prospective cohort study in Sisimiut : Follow-up studies of the cohorts incl. the mother and child birth cohort in Nuuk, Sisimiut and Ilullissat
7 Principal study sites
8 CSOM/COM the Greenlandic experience Cohort studies: : 3-8 year-olds Maniitsoq > 6% Kangamiut : 3-8 year-olds Sisimiut 12% Nuuk 7% : 0-4 year-olds Sisimiut 14% 2008: year-olds Sisimiut: 19% 2009: year-olds Sisimiut+Nuuk: 17%
9 Ear surveys in Greenland Cholesteatoma epidemiology Hearing-screening of 167 schoolchildren Epidemiology of OM in 740 unselected children Middle ear and nasopharyngeal microbiology in 54 children with AOM and 201 unselected children Risk factors for OM in 591 children
10 Ear surveys in Greenland Prospective 2-year population-based cohort studies incl. 465 children between 0-4 years old incl. MBL study Long-term follow-up surveysof the above cohortsincl hearing loss Natural historyand tympanicmembrane dynamicsin COM/CSOM POP s and OM in approx. 200 Greenlandic children Biofilm in chronic- and chronic suppurative OM Hereditary hearing loss and GJB-2 mutations Mobile ear surgery results in 274 ear surgeries
11 Study methods Data source: the Danish/Greenlandic Civil Registration System Ethical approvement 1. Clinical examination Otoscopy, otomicroscopy, digital video-otoscopy Tympanometry Audiometry (pure-tone AC and BC) 2. Questionnaires 3. Medical files (paper and electronic)
12 Methods Office Work 1. Evaluation of clinical, laboratory and paraclinical findings Comparison with findings at follow-up examinations 2. Investigation of possible associations between background information and CSOM using binomial logistic regression and multivariate regression analyses. Background information collected in the studies: - Socioeconomic factors (educational level, housing conditions) - Family history of CSOM or OM - Use of childcare - Breast feeding - Smoking - Diet - Crowding 3. Describtion of hearing loss in the cohorts
13 Scientific contributions until now 1. 5 theses: 3 ph.d., 1 doctoral and 1 master 2. Internationally reviewed publications: > Other publications: several
14 The last publication
15 How could this be done? Collaboration
16 Head and neck cancer in Greenland Nasopharynx cancer highly elevated EBV related Salivary gland cancer highly elevated EBV related High rate of HPV associated cervical cancer oropharynx cancer? Survival is very poor < 35% 5-year crude survival
17 Head and neck cancer in Greenland
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