Evaluation of Biochemical and Pathological Markers of Oxidative Stress and Inflammation in Pediatric Chronic Otitis Media and Their Public Health and Critical Care Implications: A Clinical Study

Abstract

Background: Pediatric chronic otitis media is a common and clinically important condition that contributes significantly to hearing impairment, recurrent infection, poor academic performance, and long-term developmental difficulties in children. Persistent inflammation and oxidative stress may play a major role in the progression and chronicity of the disease, yet these biological mechanisms remain underexplored in routine clinical practice.

Objective: To evaluate the biochemical and pathological markers of oxidative stress and inflammation in pediatric chronic otitis media and to assess their clinical, public health, and critical care implications.

Methods: This cross-sectional clinical study was conducted from June 2024 to June 2025 at Gujranwala Medical College, Gujranwala, Pakistan and Sahara Medical College, Narowal, Pakistan. A total of 100 pediatric patients aged 3–14 years diagnosed with chronic otitis media were enrolled through consecutive sampling. Clinical evaluation, otoscopic assessment, hearing assessment, and biochemical analysis were performed in all patients. Serum malondialdehyde, total antioxidant capacity, nitric oxide, C-reactive protein, interleukin-6, and tumor necrosis factor-alpha were measured. Histopathological examination was performed in surgically managed cases.

Results: Most patients had unilateral disease, prolonged symptoms, and clinically significant hearing impairment. Elevated levels of malondialdehyde, nitric oxide, C-reactive protein, interleukin-6, and tumor necrosis factor-alpha were observed, while total antioxidant capacity was reduced. Higher oxidative and inflammatory marker levels were significantly associated with greater disease severity, hearing impairment, bilateral disease, and longer symptom duration. Histopathology revealed chronic inflammatory infiltrate, granulation tissue, mucosal edema, epithelial hyperplasia, fibrosis, and vascular congestion.

Conclusion: Pediatric chronic otitis media is associated with significant oxidative stress, inflammatory activation, and pathological tissue injury. These findings highlight its broader clinical and public health importance and support the need for earlier diagnosis, timely treatment, and preventive intervention in affected children.