Otogenic Tetanus in Children – A Systematic Review and Analytical Study

Background: Otogenic tetanus may follow ear suppuration or ear injury. Straightforward diagnosis may not be possible if the otolaryngologist is not familiar with the entity; infrequently it may masquerade complications of otitis media as well. Practical difficulty in evaluation and management of otogenic tetanus due to the paucity of available literature prompted us to undertake this systematic review.

Aims: To compile the available data on otogenic tetanus by literature review; to encompass and analyze the varied perspectives of this enigmatic condition.

Methodology: PubMed/MEDLINE database supplemented with relevant search in world wide web using Google/ Google scholar were used as data sources for obtaining relevent articles on the topic; duplicate publications and studies on tetanus other than otogenic origin were excluded. Extracted and shortlisted articles were abstracted, analyzed and collated.

Results: Otogenic tetanus is commoner in children; it is the commonest sub type of tetanus in post-neonatal age group. Chronic otitis media is the major suppurative ear disease predisposing to otogenic tetanus though acute ear suppuration has also been implicated. Tetanus resulting from ear trauma runs a more severe course. Mortality in otogenic tetanus was found to be significantly lower compared to generalized tetanus.

Conclusions: Being aware of the condition is primarily important in diagnosis and management of otogenic tetanus. Immunization history need be elicited in all children developing otitis media. Prompt primary immunization, appropriate booster doses, meticulous care of the discharging ear and proper treatment ear injury are essential preventive strategies.