Prevalence and Pattern of Ear Disease Among Primary School Students in Samoa: Preliminary Results from ENT Clinic Outreach to Urban, Rural and Remote Settings

Objectives: To assess the prevalence and pattern of ear disease among students attending primary school in urban, rural, and remote regions of Samoa in order to develop an evidence-based national school ear and hearing health program. Methods: Retrospective clinical data review of all primary school students seen by the Ear, Nose & Throat Clinic of Samoa during school-based outreach visits from March 2022 to April 2024. A purposefully designed spreadsheet was created to extract the following information from the clinical records: school location (urban, rural, remote), gender (male, female), age (years), age category (0-4, 5-9, 10-14, 15+ years), right ear diagnosis, left ear diagnosis. Data were entered into the SPSS statistical software package for descriptive statistical analysis and association tests of significance. Results: A total of 1491 primary school students were seen for ear health examinations (51.1% male, 48.9% female), with a mean age of 9.1 years (SD = 2.3). Five primary schools were included, representing urban (n = 865), rural (n = 258), and remote (n = 368) settings. Overall, 682 (45.7%) students had normal ear examination results for both ears, 237 (15.9%) had an ear pathology in 1 ear only, and 568 (38.1%) had ear pathology in both ears. Bilateral ear pathology was significantly higher among students who were in the 5 to 9 age group (P < .00001), female (P = .035), and from rural settings (P = .0001). The most common pathology was impacted cerumen (36.8%), followed by otitis media with effusion (7.5%). Overall prevalence of chronic suppurative otitis media (CSOM) was 2.6% (n = 39 students). Following the school visits, no further intervention was required for 1180 students (79%), mostly due to successful cerumen and foreign body removals for 468 students (31.4%). Conclusion: Impacted cerumen is a significant issue among Samoan school-aged students, and future school-based ear health programs should include staff members trained in cerumen removal. CSOM prevalence suggests an avoidable burden of disease that must be addressed.