An Audit of Patients Attending ENT OPD at a Medical College in Western UP

Full text

DOI: 10.21276/aimdr.2018.4.4.EN3
Original Article
ISSN (O):2395-2822; ISSN (P):2395-2814
Annals of International Medical and Dental Research, Vol (4), Issue (4) Page 12
Section: Ear, Nose & Throat
An Audit of Patients Attending ENT OPD at a Medical
College in Western UP.
Nilank Saroha
1
, Nitin Tomar
1
1
Assistant Professor, Department of ENT & HNS, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India.
Received: May 2018
Accepted: May 2018
Copyright: © the author(s), publisher. Annals of International Medical and Dental Research (AIMDR) is an
Official Publication of “Society for Health Care & Research Development”. It is an open-access article distributed
under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-
commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: ENT ailments are one of the most common causes for patients to attend hospitals. The present study was
undertaken to assimilate data on patients visiting ENT OPD in consecutive 3 months, so that the trend of diseases in this
part of Uttar Pradesh could be studied. Objective: To study the epidemiological profile of otorhinolaryngology disorders in
the patients attending ENT OPD, Muzaffarnagar Medical College. Methods: This was a retrospective record based study,
done in department of ENT &HNS from January to March 2018. Results: More than half of the patients were male. Rural
community dominated OPD attendance. Most common ailments for attending ENT OPD were pertaining to throat and neck
with female preponderance, of which most frequent diagnosis was pharyngitis. Next in line were otological diseases with
CSOM as most common. Patients with nasal complaints were least with allergic rhinitis as most common diagnosis.
Discussion: The literature available with respect to the aims and objectives was reviewed. Conclusion: Our OPD is with
male preponderance and rural dominated. Maximum patients were suffering from throat and neck problems and nasal
complaints were least.
Keywords:
Epidemiology, audit, Chronic Suppurative Otitis Media, pharyngitis, allergic rhinitis.
INTRODUCTION
The most common problems warranting a visit to a
doctor or a health care provider in developing
countries are related to ear nose and throat (ENT).
[1,2]
A supportive study by Bleach suggests that in a
general hospital the workload of ENT specialists
have been on a rise.
[3]
Another outpatient study
suggests that there is a rise in ENT emergencies and
need for ENT specialists for their appropriate
management.
[4]
Muzaffarnagar district has a population of 41,43,512
according to census 2011 with 71.25% rural
population. Muzaffarnagar Medical College caters to
the patients of Muzaffarnagar and nearby districts
namely, Meerut, Shamli and Bijnor.
Early diagnosis and management will result in
reduction of morbidity and mortality.
[5]
In studies it
has been noted that Otitis Media and its sequelae are
most common cause of preventable hearing loss in
children in developing countries.
[6,7]
The major
burden reported in India & other developing
countries by WHO is due to Chronic Suppurative
Otitis Media.
[8]
Name & Address of Corresponding Author
Dr. Nitin Tomar
Department of ENT and HNS,
Muzaffarnagar Medical College,
Muzaffarnagar, Uttar Pradesh, India.
There is a very vast disparity according to the region
in incidence of ENT diseases.
[9]
The aim of this
study is to identify the epidemiological profile of
patients attending ENT OPD so as to define the
prevalent otorhinolaryngological diseases in this
area. Epidemiological data regarding common
otorhinolaryngological disorder will be helpful in
guiding and planning regarding management of
common disorders.
Aims and Objectives
To study the epidemiological profile of
otorhinolaryngology disorders in the patients
attending OPD, Muzaffarnagar Medical College and
Hospital at Muzaffarnagar.
MATERIALS AND METHODS
This retrospective study was carried out in the
Department of ENT at Muzaffarnagar Medical
College and Hospital. The procedure was in
accordance with the ethical standards of the
institution and with the Helinski Declaration of
1975, as revised in 2000.
• All the patients who attended or referred to ENT
OPD from 1st January 2018 to 31st March 2018 are
included in the study.
• Patients records were obtained from ENT OPD
record register.
• All the patients were categorised according to age,
gender, residence and clinical diagnosis. The results
were expressed as percentage.

Saroha & Tomar; Audit of Patients Attending ENT OPD
Annals of International Medical and Dental Research, Vol (4), Issue (4) Page 13
Section: Ear, Nose & Throat
Inclusion criteria
1) All new patients attending ENT OPD during
consecutive 3 months.
Exclusion criteria:
1) Follow up cases.
2) Patients presenting in emergency department.
RESULTS
A total of 5850 patients attended ENT OPD during 3
consecutive months. Out of these, 3041(51.98%)
were males and 2809(48.02%) females. Male:
female ratio was 1.08:1 [Figure 1]. More than half of
the patients belonged to rural community, 3328
patients (56.89%) [Figure 2]. Most frequent age
group presenting to ENT OPD was 21-30 years
(25.20%). Overall, first 5 decades accounted for
84.62%, thereafter percentage dropped as age
increased [Figure 3].
Figure 1: Sexwise distribution of patients
Figure 2: Rural v/s urban population
Figure 3: Age-wise distribution of patients
Table 1: Involvement of Ear, Nose & Throat.
Disease M F Total %
Ear 1073 1020 2093 35.58
Nose 667 307 974 16.65
Throat&neck 1301 1482 2783 47.57
Total 3041 2809 5850 100
Table 2: Disease wise distribution of patients [Ear].
Diagnosis Male % Female % Total %
CSOM 345 16.48 387 18.49 732 34.97
Wax 123 05.88 135 06.45 258 12.33
ET dysfn. 98 04.68 68 03.25 166 07.93
Otitis ext. 73 03.49 62 02.96 135 06.45
Tinnitus 37 01.77 38 01.82 75 03.58
Presbycusis 74 03.54 54 02.58 128 06.12
OME 52 02.48 64 03.06 116 05.54
ASOM 55 02.63 66 03.15 121 05.78
Trauma 44 02.10 31 01.48 75 03.58
Medical fit 38 01.82 0 0 38 01.82
BPPV 37 01.77 15 0.72 52 02.48
Foreign Body 23 01.10 17 0.81 40 01.91
Otomycosis 34 01.62 45 02.15 79 03.77
Others 40 01.91 38 01.82 78 03.73
Total 1073 51.27 1020 48.73 2093 100
Table 3: Disease wise distribution of patients [Nose].
Diagnosis Male % Female % Total %
AR 187 19.20 104 10.68 291 29.88
DNS 160 16.43 64 06.57 224 22
Epistaxis 124 12.73 31 03.18 155 15.91
ITH 38 03.90 20 02.05 58 05.95
Ac.Rhinitis 51 05.24 28 02.87 79 08.11
Adenoids 42 04.31 30 03.08 72 07.40
CRS 17 01.75 5 0.51 22 02.26
Trauma 10 01.03 5 0.51 15 01.54
Vestibulitis 19 01.95 10 01.03 29 02.98
AC polyp 5 0.51 3 0.31 8 0.82
Mass nose 5 0.51 2 0.21 7 0.72
Others 9 0.92 5 0.51 14 01.44
Total 667 68.48 307 31.52 974 100

Saroha & Tomar; Audit of Patients Attending ENT OPD
Annals of International Medical and Dental Research, Vol (4), Issue (4) Page 14
Section: Ear, Nose & Throat
Table 4: Disease wise distribution of patients [Throat & Neck]
Diagnosis Male % Female % Total %
Pharyngitis 465 16.71 567 20.37 1032 37.08
Tonsillitis 278 09.99 230 08.26 508 18.25
Thyroid 5 0.18 196 07.04 201 07.22
GERD 168 06.04 155 05.57 323 11.61
Lymphadenitis 83 02.98 78 28.03 161 05.79
Malignancy 30 01.08 22 0.79 52 01.87
Laryngitis 72 02.59 47 01.69 119 04.28
Oral Ulcer 47 01.69 27 0.97 74 02.66
Neck swelling 35 01.26 28 01.01 63 02.26
SMF 27 0.97 38 01.37 65 02.34
Stomatitis 28 01.01 17 0.61 45 01.62
Globus Ph. 5 0.18 42 01.51 47 01.69
Vocal nodule 8 0.29 15 0.54 23 0.83
V. Cord palsy 8 0.29 2 0.07 10 0.36
Foreign Body 6 0.22 3 0.11 9 0.32
Others 16 0.57 15 0.54 31 01.11
Total 1301 46.75 1482 53.25 2783 100
In our study, majority of the patients (47.57%) had
throat and neck ailment as the reason to attend OPD,
followed by otological problem. Least number of
patients had nasal complaints. Males outnumbered
females in all categories except throat and neck
[Table 1].
Patients with otological disorder were 2093 with
51.27% males. Most common diagnosis amongst ear
diseases was CSOM (34.97%) followed by wax
(12.33%) [Table 2]. A total of 974 patients
presented with nasal complaints with 68.48% males.
Most frequent diagnosis was allergic rhinitis
(29.88%). It was followed by DNS (22%) and
epistaxis (15.91%) [Table 3]. Maximum patients
were with complaints pertaining to throat and neck
(1482) with female preponderance (53.25%).
Amongst these, most common diagnosis was
pharyngitis in 37.08%, followed by tonsillitis
(18.25%). About 15% patients presented with neck
mass [Table 4].
DISCUSSION
In our study, a total of 5850 patients attended ENT
OPD in three months. Ours was rural dominated
attendance (56.89%), which is explainable by the
population statistics of this area.
We found male preponderance in our study, with
male: female ratio as 1.08:1, which is again
reflection of demographic profile of our place.
Similar results have been quoted in other studies.
Bleach et al,
[3]
in a UK based study, reported in their
study a male: female ratio of 1.1:1. According to a
study by Mina et al, the ratio of male: female was
1.13:1.
[10]
It was 1.17:1 in another study.
[11]
If we talk about age distribution, most common age
group involved was 21-30, constituting 25.20%
followed by age group 11-20 and age group 31-40.
This is in accordance with a study by Das et al where
most frequent age group was 21-30 (20.82%),
followed by 11-20 and 31-40 age group,
[11]
as young
age group is most common age group to seek
medical advice in ENT field.
[12,13]
It was noticed in
our study that first four decades accounted for
73.25% of total which is quite close to that of Mina
et al; 72.59%.
[10]
In our study, maximum patients had attended ENT
OPD for throat and neck complaints, followed by ear
diseases and least with nasal disorder.
Amongst ear diseases, most cases were noted to be
of CSOM, which accounted for 34.97% with female
predominance followed by wax. This finding is in
tandem with a study by Das et al.
[11]
Mina et al found
wax to be more common than CSOM.
[10]
Most
common disease of ear in developing countries is
CSOM, which is further leading to a major burden
on health care system and society.
[14,15]
The major
burden of ear diseases being chronic suppurative
otitis media is also reported by WHO.
[8]
WHO
census also shows Wax or impacted Cerumen to be
most common cause of reversible hearing loss in our
country.
[16]
Nasal complaints were reported to be least, only
16.65% of total OPD. In other studies also it was
noted that nasal complaints were least of all cause of
bringing patients to OPD.
[10,11]
The most frequent
diagnosis was allergic rhinitis (29.88%). In other
studies also it was noted that allergic rhinitis is most
upcoming disease.
[13]
Due to increase in pollution
allergic rhinitis and its comorbidities are on rising
trend. Next was DNS which has been reported as
most common diagnosis by Mina et al in their
study.
[10]
Throat and neck disorders accounted for the largest
group with 47.57% of total OPD. Most common
diagnosis was pharyngitis (37.08%) with female
preponderance. Mina et al also reported pharyngitis
to be most common throat disease.
[10]
It was
followed by tonsillitis and GERD, in that order.
In future, another study can be planned for longer
duration. Data from all leading referral hospitals of
this region should be compiled so that population of
whole of Uttar Pradesh is targeted in the study. The
data should also have a log on treatment given to the
patient so that accurate treatment protocols should be
prepared.

Saroha & Tomar; Audit of Patients Attending ENT OPD
Annals of International Medical and Dental Research, Vol (4), Issue (4) Page 15
Section: Ear, Nose & Throat
CONCLUSION
Our study concludes that the data of patients
attending ENT OPD has male preponderance and
most patients are from rural background. Young age
group is the one which predominate OPD
attendance. Throat and neck complaints account for
the maximum number of patients whereas nasal
disorders are least. Amongst the subgroups, CSOM
is the most common ear disease, allergic rhinitis is
most frequent nasal disorder and pharyngitis is most
reported throat disease.
From the data compiled in this study, common ENT
complaints should be evaluated for their cause and
available treatment to reduce the burden on tertiary
health care centres. The health workers and primary
health care centres should be trained to deal with
basic diseases and rehabilitation so that in ENT
specialists could deal surgical management.
Abbreviations: CSOM-Chronic Suppurative Otitis
Media, OME-Otitis Media With Effusion, ASOM-
Acute Suppurative Otitis Media, BPPV- Benign
Paroxysmal Positional Vertigo, AR- Allergic
Rhinitis, DNS- Deviated Nasal Septum, ITH-
Inferior Turbinate Hypertrophy, CRS- Chronic
Rhinosinusitis, GERD-Gastro Esophageal Reflux
Disease, SMF- Sub Mucosal Fibrosis
REFERENCES
1. ISD Scotland. Scottish Health Statistics. Edinburgh:
Information and Statistics Division, National Health Service in
Scotland, 1998.
2. McCormick A, Fleming D, Charlton J. 4th National Study
1992-1993. London, UK: Office of National Statistics,
HMSO; 1995. Morbidity statistics from general practice.
3. Bleach N, Mady S, Williamson PA. Emergency workload in
otolaryngology. Ann R Coll Surg Engl. 1994;76:335–338.
4. Obon PJ, Esteban R, Pueyo LJ. An outpatient study in ENT
(otorhinolaryngology) emergencies at a general hospital. Acta
otorhinolaryngol. 1995;46(4):298–304.
5. Kitcher ED, Jangu A, Baidoo K. Emergency ear, nose and
throat admissions at the korle-bu teaching hospital. Ghana
Med J. 2007;41(1):9–11.
6. Kishve SP, Kumar N, Aarif SSM, Kalakoti P. Ear, nose and
throat disorders in paediatric patients at a rural hospital in
India. Australasian Med J 2010; 3(12):786–790.
7. Zakzouk SM, Jamal TS, Daghistani KJ. Epidemiology of
acute otitis media among Saudi children. Int J Pediatr
Otorhinolaryngol. 2002;25;62(3):219-22.
8. Child and Adolescent Health and Development Prevention of
Blindness and Deafness. World Health Organization, Geneva,
Switzerland, 2004.
9. Khan AR, Khan SA, Arif AU, Waheed R. Analysis of ENT
diseases at Khyber Teaching Hospital, Peshawar. J Med Sci
2013;21(1)7-9.
10. Mina R, Bisht RS, Sikarwar V, Arya A. An epidemiological
profile of otorhinolaryngological disorders in the patients
attending ENT OPD of H.N.B Base teaching hospital of
VCSGGRMS & RI, Srinagar, Pauri, Garhwal. Int J Med Res
Rev 2015;3(11):1333-1338.
11. Das BK. Epidemiological Profile And Parameters of Ent
Diseases And Emergencies At Faamch Barpeta. IOSR J Den
Med Sci 2017;16:23–27.
12. Symvoulakis EK, Klinis S, Alegakis A, Kyrmizakis DE,
Drivas EI, Rachiotis G, et al. Epidemiologic profile of
otorhinolaryngological, head and neck disorders in a tertiary
hospital unit in Greece: a challenge for general practitioners?
BMC Ear Nose Throat Disord. 2006;6:12-18.
13. Emerson LP, Job A, Abraham V. A model for provision of
ENT health care service at primary and secondary hospital
level in a developing country. Biomed Res Int.
2013;2013:562-643.
14. Gupta A, Gupta. A study of prevalence of complications of
suppurative otitis media in rural area of Loni. Ind J Otol
1996;2:177-83.
15. Akinpelu OV, Amusa YB, Komolafe EO, Adeolu AA,
Oladele AO, Ameye SA. Challenges in management of
chronic suppurative otitis media in a developing country. J
Laryngol Otol. 2008;122(1):16-20.
16. World Health Organization. State of hearing and ear care in
the South East Asia Region. WHO Regional Office for South
East Asia. WHO-SEARO. SEA/Deaf/9. (Available at
http://www.searo.who.int/LinkFiles/Publications_
HEARING_&_EAR_ CARE.pdf ).
How to cite this article: Saroha N, Tomar N. An Audit of
Patients Attending ENT OPD at a Medical College in
Western UP. Ann. Int. Med. Den. Res. 2018; 4(4):EN12-
EN15.
Source of Support: Nil, Conflict of Interest: None declared