The epidemiology of otorrhea is difficult to fully understand. Since the most common cause of this disorder worldwide is external and middle-ear infections, the rate of otorrhea will be higher in populations with a high rate of ear disease, such as Native Americans and Australian aborigines (1). The local environment also plays a role in the epidemiology of otorrhea. Increased rates of otitis externa are reported in individuals who swim in dirty water, such as lakes and ponds, as compared with those who spend more time in controlled aquatic environments. Increased rates of otitis media also are reported in those who have smokers in their household. An additional factor is the rate at which myringotomy tubes (PE tubes) are placed, since some studies indicate that over half of the individuals who receive PE tubes have drainage at some point while the tubes are in place (2).
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