Tetanus; a dreadful complication of ear piercing, ear instrumentation and chronic otorrhea in children of Southern Punjab Pakistan.


  • Sumera Akram THQ Hospital Renala Khurd.
  • Muhammad Ahmed Khan CMH Zhob.
  • Imran Qaisar Quaid-e-Azam Medical College Bahawalpur.
  • Sagheer Ahmad CMH Attok.
  • Abdul Rehman Bahawalpur Medical & Dental College Bahawalpur.




Chronic Otitis Media, Ear Piercing, Ear Instrumentation, Immunization, Otorrhea, Quacks, Tetanus, Tetanus Vaccination


Objective: Tetanus remains a major public health problem in the developing countries despite the availability of active immunization and passive immunization since long. Non-sterile ear piercing and instrumentation pose a constant threat of developing tetanus associated with morbidity and mortality. Study Design: Retrospective Cross-sectional study. Setting: Department of Pediatric, Bahawal Victoria Hospital Bahawalpur. Period: June 2019 to June 2022. Material & Methods: The data of children admitted with tetanus following ear piercing, ear cleaning/instrumentation and chronic ear discharge was collected. The data included their age, gender, history of ear piercing, instrumentation and chronic ear discharge (otorrhea), duration between piercing/instrumentation and development of signs & symptoms of tetanus, history of tetanus vaccination (during routine childhood EPI vaccination), history of tetanus toxoid administration after the causative event, residence, socioeconomic status, education status of parents and outcome of cases. Results: Total 17 cases of otogenic tetanus (tetanus following ear piercing, ear instrumentation and with chronic otorrhea) were admitted in pediatric department of the hospital during study period. Age range was between 03 to 13 years with mean age 7.71+2.80 years. Of these cases, there were 12 females (70.6%) and 5 males (29.4%). Nine cases developed tetanus after ear piercing, five cases developed tetanus following ear instrumentation and three cases had history of chronic ear discharge. Conclusion: Tetanus is an uncommon but dreadful complication of non-sterile ear piercing, ear instrumentation and chronic discharging ears in chronic otitis media, and is still occurring in our country.

Author Biographies

Sumera Akram, THQ Hospital Renala Khurd.

MBBS, FCPS, Consultant Pediatrician Pediatrics, 

Muhammad Ahmed Khan, CMH Zhob.

MBBS, FCPS (ENT), Assistant Professor ENT, 

Imran Qaisar, Quaid-e-Azam Medical College Bahawalpur.

MBBS, FCPS, Assistant Professor Pediatrics, 

Sagheer Ahmad, CMH Attok.

MBBS, FCPS (Pediatrics), Child Specialist, 

Abdul Rehman, Bahawalpur Medical & Dental College Bahawalpur.

MBBS, FCPS, Professor Pediatrics,