262 Nigerian Journal of Clinical Practice • Jul-Sep 2011 • Vol 14 • Issue 3 Review Article Classification and management challenges of otitis media in a resource-poor country TS Ibekwe, OGB Nwaorgu 1 Department of Surgery (ENT), College of Health Sciences, University of Abuja, 1 Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria Abstract The clinical features and sequelae of otitis media (OM) vary depending on the duration, severity and progression of the disease. As a result, opinions on the modes of classifcation and management protocols have differed over the years. The need to critically appraise these opinions according to the peculiarities of each region is imperative. This work was aimed at reviewing the world literature on the subject and also highlights the limitations in management in our region. A wide literature search was conducted using the following search engines: PubMed, AJOL and University of Toronto Library. Also incorporated were essential materials obtained from the authors’ clinical practices. The search engines returned 22,903 related articles on OM. Further fltration yielded 88 articles on “classifcation and management” and these were obtained in full and thoroughly read. Extracted materials for review spanned between 1980 and 2008. OM is prevalent the world over with potentially severe complications if inadequately managed, especially in the developing countries. It is of note that in the developing countries, poverty, ignorance, dearth of specialists and limited access to medical care amongst others conspire to worsen the course and complications of OM. Key words: Classifcations, complications, management, otitis media Date of Acceptance: 14-April-2010 Address for correspondence: Dr. T. S. Ibekwe, Department of Surgery (ENT), College of Health Sciences, University of Abuja, PMB 117, Garki, Abuja, Nigeria. E-mail: ibekwets@yahoo.com Access this article online Quick Response Code: Website: www.njcponline.com DOI: 10.4103/1119-3077.86764 PMID: 22037065 Introduction Otitis media (OM) is a global middle ear disease with health-economic burden, especially in Africa and other developing nations where the disease prevalence could be as high as 11% with severe economic implications. [1-4] It presents with varied clinical features depending on the duration, severity and progression of the disease. As a result of the complex contiguous relationship of the middle ear and essential intracranial structures, severe complications (intracranial and extracranial) can result from untreated or poorly treated OM. A sound knowledge of the anatomy and physiology of the ear is necessary for the management of this disease. Therefore, it is imperative that a brief description of these features be given prior to further discussions on this disease entity (further readings on from standard texts, e.g. Scott brown series). [5] Classification of Otitis Media OM is a broad subject which could be classified according to:(1) duration – acute OM and chronic OM; (2) nature of fluid/discharge – suppurative and non-suppurative OM; (3)OM with effusion and aero-OM; (4) causative organism – bacterial OM (common) and specific OM, for example, tubercular and syphilitic OM (less common). The dynamism in the field of otology has brought about a current classification of choice by Browning et al., [6] which de-emphasizes the words “suppurative” and “non- suppurative” OM, since it is a progression of same pathologic process. Furthermore, one could lead to the other depending on the prevailing factors. Thus, OM could be further