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FREQUENCY OF DISEASES PRESENTING IN ENT OPD AT AYUB TEACHING HOSPITAL ABBOTTABAD

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Introduction: Patient presents with ear, nose and throat diseases in ENT OPD to otolaryngologist/ENT specialist. ENT diseases are serious public health problems because of their universal distribution the morbidities which they cause due to inherent physiological function that take place in head and neck region. Objectives of our study were to know frequency of ENT diseases in patients presenting at ENT OPD at Ayub Teaching Hospital Abbottabad. Methods: A cross sectional study was done in Ayub Teaching Hospital Abbottabad from December 2015. to August 2016. Patients presenting at ENT OPD of Ayub Teaching Hospital Abbottabad were selected for study. Data about their ENT problems and concerned information were collected from them through well structured questionnaire. Data after collection was entered and analysed using SPSS-16. Results: The minimum age is 1 and maximum age is 80 years. Out of total 250 patients, 129 (51.6%) were males and 121(48.4%) were females, majority of patients 181 (72.4%) were from Abbottabad and majority of patients 165(66.0%) were poor. The most common cases in ENT OPD were bilateral ear wax 15.2% followed by acute otitis media 13.2% and allergic rhinitis 13.2%. Conclusion: It is concluded from our research that most common problems of ENT disorders are bilateral ear wax, allergic rhinitis, acute otitis media, chronic supporative otitis media and deviated nasal septum. The most common causes are infection, poor hygiene and poor nutrition.
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FREQUENCY OF DISEASES PRESENTING IN ENTOPD
AT AYUB TEACHING HOSPITAL ABBOTTABAD
Qayyum Fahad Shah,1Fayyaz Salma2
1Ayub Medical College, Abbottabad, Pakistan
2Al-Muslim Public School Battagram, Mansehra, Pakistan
Primljen/Received 30. 01. 2019. god. Prihva}en/Accepted 06. 06. 2019. god.
Abstract: Introduction: Patient presents with ear,
nose and throat diseases in ENT OPD to otolaryngolo-
gist/ENT specialist. ENT diseases are serious public
health problems because of their universal distribution
the morbidities which they cause due to inherent physi-
ological function that take place in head and neck re-
gion. Objectives of our study were to know frequency
of ENT diseases in patients presenting at ENT OPD at
Ayub Teaching Hospital Abbottabad.
Methods: A cross sectional study was done in
Ayub Teaching Hospital Abbottabad from December
2015. to August 2016. Patients presenting at ENT OPD
of Ayub Teaching Hospital Abbottabad were selected
for study. Data about their ENT problems and concer-
ned information were collected from them through
well structured questionnaire. Data after collection
was entered and analysed using SPSS-16.
Results: The minimum age is 1 and maximum age
is 80 years. Out of total 250 patients, 129 (51.6%) were
males and 121 (48.4%) were females, majority of pati-
ents 181 (72.4%) were from Abbottabad and majority of
patients 165 (66.0%) were poor. The most common ca-
ses in ENT OPD were bilateral ear wax 15.2% followed
by acute otitis media 13.2% and allergic rhinitis 13.2%.
Conclusion: It is concluded from our research
that most common problems of ENT disorders are bila-
teral ear wax, allergic rhinitis, acute otitis media, chro-
nic supporative otitis media and deviated nasal septum.
The most common causes are infection, poor hygiene
and poor nutrition.
Key words: Frequency, ENT diseases, Otitis media,
ENT OPD patients of Ayub Teaching Hospital, Abbottabad.
INTRODUCTION
Patient presents with ear, nose and throat diseases
in ENT OPDto otolaryngologist/ ENT specialist (1).
The pattern of ENT diseases is quiet variable depend-
ing on age and group varying from community to com-
munity. They may be congenital or acquired in origin.
Acquired diseases may be infectious, inflammatory,
neurological and vascular or they may be due to some
trauma. Complications occur in hearing, breathing,
phonation, swallowing, speech, olfaction, taste and
protection of lower respiratory tract (2).
In ENT OPD the most presenting ear diseases are
ear infection, conductive hearing loss, otitis externa
and chronic otitis media (3). The otitis media is the
most common disease in young patient because of its
more horizontal orientation in children than adults (4).
In a survey done by WHO chronic suppurative otitis
media (CSOM) was reported to be the most common
cause of hearing loss in children in developing countri-
es. Survey on prevalence of CSOM have shown the
global burden of illness from CSOM involves 65-330
million individuals 60% of whom suffer from signifi-
cant defect (5). In ear diseases oral medication respon-
se is excellent while surgical intervention is less frequ-
ently required (6).
Diseases of nose which presents the ENT OPD are
nasal deformities, tumours, disease of nasal vestibule,
nasal septum deviation, nasal polyps, rhinitis, epistaxis,
etc. Causes of nasal diseases are trauma, nose surgery
and infections. Complication that occurs due to nasal di-
seases are meningitis, cavernous sinus thrombosis and
septal abscess (7). Acommon problem of nose affecting
60 million Africans each year is epistaxis. Most of its ca-
ses are minor and manageable but some presents as a life
threatening problem. Common local causes are trauma,
anatomical deformities and tumours. Cardiovascular di-
seases and hypertension are its systemic causes (8). Epi-
staxis is a common problem in children in Kiesselbach
area due to local irritation in children (9). Epistaxis is
initially treated by first aid measures but other times
need some special measures to treat (10).
DOI: 10.24125/sanamed.v14i2.315
UDK: 616.2(549)"2015/2016"
2019; 14(2): 175–180 ID: 278334476
ISSN-1452-662X Original article
Most common throat diseases in outdoor patient
department are sore throat, tonsillitis, pharyngitis and
cancers. Causes of throat disease are usually a viral in-
fection but other causes include allergies. Complication
of throat diseases is acute rheumatic fever; acute glome-
rular nephritis and peritonsillar abscess formation (11).
Second most common cancer of the respiratory tract is
the laryngeal cancer. Risk factor for this type of cancer is
cigarette smoking, alcohol consumption and may be hu-
man papilloma virus 16 and helicobacter pylori (12). In-
cidence of multiple primary tumours in head and neck
region ranges from 10-35 percent (13).
In head and neck malignancies laryngeal cancer ac-
counts approximately for 20% of all cases. Treatment
for laryngeal include total laryngectomy (Tl), alone or
with neck dissection (ND), radiotherapy alone (RT), TL
followed by RT and combined chemotherapy (14).
Children going to schools are more prone to ENT di-
seases because of cross infections. This chronic problem
not only hampers developmental progress and school
performance but also cause physical and emotional suffe-
ring (15). Foreign bodies in ear usually found in children
below age of ten years it may be iatrogenic or accidental.
Tracheobronchial foreign bodies are the major cause of
mortality and morbidity in paediatric age group (16).
It has been concluded from a study carried out in
India that smoking is the main cause of middle ear dis-
eases in children and adults .Among adults hearing loss
is more common with smoking (17).
According to a study done in Peshawar the inci-
dence of common ENT diseases presenting in OPD are
chronic tonsillitis 37%, CSOM 14%, rhinitis due to de-
viated nasal septum 67%.
A study done on prevalence of allergic rhinitis in
Oman showed that 7% patients with nasal symptoms
attended the ENT OPD (18). A study performed in
France on allergic rhinitis and it`s affect on sleep sho-
wed that sleep impairment was significantly worse
with allergic rhinitis. Everyday living is also impacted
by allergic rhinitis due to lack of sleep (19). Studies
showed that aeroallergens are the primary triggers for
respiratory tract diseases (20).
Asthma is a worldwide common disease in chil-
dren and adults (21). According to a report of WHO
asthma a life threatening disease roughly effect 100 and
150 million people around the globe and over 180,000
deaths occur from this condition annually. About 8% of
Swiss population suffers from asthma. There are about 3
million asthmatics in Japan and 4 million in Germany. A
rough estimate in India indicates a prevalence of betwe-
en 10% and 15% in 5-11 year old children (22). The pre-
valence of asthma in Pakistan is increasing day by day
with an annual increase of 5% of which 20% to 30% are
children between 13 and 15 years of age. Nearly 20 mil-
lion people about 12% of Pakistani adult population are
suffering from disease (23).
According to a study done at Military Hospital At-
tockotomycosis (a fungal ear infection common in trop-
ical countries) is a common condition often seen in ENT
OPD and in this study its prevalence is about 7% among
patients who presented with sign and symptoms of otitis
media. Its various predisposing factors are humid clima-
te, presence cerumen, instrumentation of ear and increa-
se use of antibiotics (24). Otitis media with effusion is
also a common medical in Indian children and its preva-
lence has been quoted 16.6% in children of age 5 to 7
(25). According to a report of WHO 5% of world popu-
lation 360 million people has disabling hearing loss (a
person who is not able to hear as well as someone with
normal hearing _hearing threshold of 20 decibel or be-
low in both ears is to have hearing loss) (26).
A study done on symptoms of ENT diseases sho-
wed that headache was the main symptom in patients
presented in ENT OPD (27).
A study done on ear ,nose and throat diseases sho-
wed that common ear, nose and throat disorders were
seen in patients aged < 15 years are otitis media, obstruc-
tive adenoids and foreign bodies in the ear whereas hear-
ing loss, rhino sinusitis and tumours were the common di-
sorder of ENT in patient aged 16 years and above (28).
Chronic rhino sinusitis (CRS) a clinical syndrome
characterized by mucosal infection of nose and parana-
sal sinuses is one of the most prevalent chronic disea-
ses worldwide. It is the second most chronic condition
in United States, affecting one in seven American
adults (29). In USA prevalence of sinusitis is estimated
to be 14% of global population. Patients with particular
disease more often develop sinusitis such as 25-30% of
allergic patients, 43% of asthmatic patients, 37% of pa-
tients with transplants and 54-68% of patients with
AIDS (30). Studies from tertiary care centres indicate a
high prevalence of fungal rhino sinusitis in India. This
was found in 70% young males in 10-39 years age gro-
up from rural India (31).
MATERIAL AND METHODS
This was a cross sectional descriptive type of study
at Ayub Teaching Hospital Abbottabad. The study was
done over a period from December 2015 to June 2016.
The sample size was 250. Non Probability convenient
sampling. Patients with different ENT diseases present-
ing at ENT OPD of Ayub Teaching hospital Abbottabad
were included. All patients who are in emergency condi-
tion were excluded. Data was collected using a structu-
ral questionnaire after pretesting. The data after collec-
tion was entered and analyzed using statistical software
SPSS-16. Mean and standard deviation were calculated
176 Qayyum Fahad Shah, Fayyaz Salma
for quantitative variables like age, monthly family inco-
mes etc. while frequencies and percentages were calcu-
lated for categorical variables like gender, socioecono-
mic etc. Results were displayed as tables and graphs.
RESULTS
Table 1. Gender of patients
Table 1 shows that out of total 250 patients, 129
(51.6%) were males and 121 (48.4%) were females.
Table 2. Socioeconomic status
Table 2 shows that majority 165(66%) of patients
were poor, 72 (28.8%) belonged to middle class and 13
(5.2%) were from upper class.
Figure 1 shows that out of 250 patients, 28 (11.2%)
were laborer, 21 (8.4%) were businessman, 54 (21.6%)
were government servant, 18 (7.2%) were housewife, 8
(3.2%) were farmers, 77 (30.8%) had other jobs and 44
(17.6%) had no jobs.
Table 3 shows that out of total 250 patients, 33
(13.2%) were suffering from acute otitis media, 21
(8.4%) had acute pharyngitis, 11 (4.4%) had acute sinusi-
tis, 13 (5.2%) had acute tonsillitis, 33 (13.2%) had aller-
gic rhinitis, 38 (15.2%) had bilateral ear wax, 10 (4.0%)
had chronic pharyngitis, 27 (10.8%) had chronic suppo-
rative otitis media, 26 (10.4%) had chronic tonsillitis, 20
(8.0%) had deviated nasal septum, 7 (2.8%) had epistaxis
and 11 (4.4%) were suffering from otitis externa.
Figure 2 shows that out of total 250 patients, 193
(77.2%) patients had duration of illness below 1 year,
46 (18.4%) had 1 to 5 years, 7 (2.8%) had 6 to 10 years
and 4 (1.6%) had above 10 years duration of illness.
Table 4. Nature of visit
Table 4 shows that out of total 250 patients, 117
(46.8%) patients had first visit to hospital and 133
(53.2%) patients were follow up.
FREQUENCY OF DISEASES PRESENTING IN ENT OPD AT AYUB TEACHING HOSPITAL ABBOTTABAD 177
Frequency Percentage (%)
Male 129 51.6%
Female 121 48.4%
Total 250 100%
Frequency Percent
Poor 165 66.0%
Middle 72 28.8%
Upper 13 5.2%
Total 250 100.0%
Figure 1. Occupation
Table 3. Diagnosis
Frequency Percent
Acute otitis media 33 13.2%
Acute pharyngitis 21 8.4%
Acute sinusitis 11 4.4%
Acute tonsillitis 13 5.2%
Allergic rhinitis 33 13.2%
Bilateral ear wax 38 15.2%
Chronic pharyngitis 10 4.0%
Chronic supporative otitis media 27 10.8%
Chronic tonsillitis 26 10.4%
Deviated nasal septum 20 8.0%
Epistaxis 7 2.8%
Otitis externa 11 4.4%
Total 250 100.0%
Figure 2. Duration of illness
Nature of visit Frequency Percent
First 117 46.8
Follow up 133 53.2
Total 250 100.0
Figure 3. Any treatment taken before
Figure 3 shows that out of total 250 patients, 142
(56.8%) had taken medical treatment, 9 (3.6%) had ta-
ken surgical treatment, 4 (1.6%) had taken other treat-
ment and 95 (38.0%) had taken no treatment before.
DISCUSSION
The pattern of ENT disease is quiet variable de-
pending on age & group varying from community to
community. A prospective cross sectional study of all
consecutive patients coming to otolaryngology clinic
in Oman was done on allergic Rhinitis and associated
co morbidities. In this study allergic Rhinitis was noted
in 48% of patients. According to our study out of 250
cases 33 patients (13.2%) were of allergic rhinitis. The
difference in result is due to sample size which is small
in our study (18).
A study done in India on the Prevalence of preven-
table ear disorders in primary school children (aged 5
to 12 years) through pro-forma questionnaire in 15718
primary school children. Most common ENT disorders
seen in these children were Ear wax in 7.93%, chronic
otitis media in 4.79% & 3.66% suffered from otitis me-
dia with effusion. Acute otitis media was detected in
0.65% children and foreign bodies were found in
0.34%. According to our study, out of 250 patients of
bilateral ear wax are (15.2% , chronic otitis media
10.8% and acute otitis media 13.2%. Difference in re-
sults is due to sample size and age groups (32).
In our study patient occupational classes showed
that there were more patients in lower occupational
classes than in those in upper classes. Same results are
showed by a study done in England by SL Isaac et al
(33). A prospective study carried out at ENT depart-
ment of KMC Peshawar Pakistan from April 2011 to
May 2012 a total of 32800 patients showed the distri-
bution of diseases systemically that is ear diseases we-
re 47%, 36% Nasal complaints and 17% Laryngop-
haryngeal. In our study ear diseases are 43.6%. Nasal
complaints are 28% and 28.4% complaints are of
Laryngopharyngeal problems. The difference in frequ-
ency distribution is due to large size (4).
A prospective study was conducted at tertiary care
hospital in Peshawar Pakistan. Most of the ENT disor-
ders were diagnosed in those infants were Pharyngitis
(30%) Otitis media 29.33%, tonsillitis (25.33%) and
Nasal Obstruction (5.3 %.) This study shows that ENT,
diseases are more common in children (34). In our
study cases of tonsillitis are 16%, Pharyngitis 12.4%
and otitis media 24%. Results are different because of
difference in age group.
A study done in Nepal on prevalence of ENT dise-
ases in children shows that low socioeconomic status,
overcrowding & joint families might be responsible for
the high prevalence of ENT diseases (35).
CONCLUSION
From this study, frequency of ENT diseases
among patients presenting at ENT OPD at Ayub Teach-
ing Hospital Abbottabad, we concluded that 15.2% pa-
tients had bilateral ear wax, 13.2% had allergic rhinitis
and acute otitis media, 10.8% had chronic suppurative
otitis media, 10.4% had chronic tonsillitis, 8.4% had
acute pharyngitis, 8% had deviated nasal septum, 5.2%
had acute tonsillitis, 4.4% had acute sinusitis and otitis
externa, 4% chronic pharyngitis and 2.8% had epista-
xis. The main determinant is that ENT diseases are mo-
re in males and lower socio-economic families because
of poor nutrition, poor housing and poor hygiene.
This study shows that allergic rhinitis, bilateral
ear wax acute and chronic suppurative otitis media
and pharyngitis are the common ear, nose and throat
disorders.
Abbreviations
ENT — Ear, Nose and Throat (Otorhinola-
ryngology)
OPD — Outpatient department
SPSS — Statistical Package for the Social Sci-
ences
WHO — World health organization
CSOM — chronic supprative otitis media
TL — Total laryngectomy
ND — Neck dissection
RA — Radiotherapy alone
CRS — Chronic rhino sinusitis
USA — United States of America
AIDS — Acquired immunodeficiency syndrome
Conflict of Interest
No author has any potential conflict of interest.
Financial Disclosure
The work received no external financial support.
Licensing
This work is licensed under a Creative Commons
Attribution 4.0 International (CC BY 4.0) License.
178 Qayyum Fahad Shah, Fayyaz Salma
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FREQUENCY OF DISEASES PRESENTING IN ENT OPD AT AYUB TEACHING HOSPITAL ABBOTTABAD 179
Sa`etak
U^ESTALOST OBOLJENJA KOD PACIJENATA PREGLEDANIH
U ORL AMBULANTI U AJUB UNIVERZITETSKOJ BOLNICI ABBOTTABAD
Qayyum Fahad Shah,1Fayyaz Salma2
1Ayub Medical College, Abbottabad, Pakistan
2Al-Muslim Public School Battagram, Mansehra, Pakistan
Uvod: Pacijent se ambulantno javlja specijalisti
otorinolaringologije zbog poreme}aja uva, grla i nosa.
Oboljenja koja zahvatuju regiju uha, grla i nosa su
ozbiljni javno zdravstveni problem prvenstveno zbog
njihove univerzalne distribucije morbiditeta, koja za-
hvata region glave i vrata. Ciljevi na{e studije bili su da
se uo~i frekventnost ORL bolesti kod pacijeata, koji se
javljaju specijalisti otorinolaringologije u Ajub Uni-
verzitetskoj Bolnici Abotabad.
Metod: Ova studija izvedena je u Ajub Univerzi-
tetskoj Bolnici Abotabad u periodu od decembra 2015.
do avgusta 2016. godine. Pacijenti koji su se javili spe-
cijalisti otorinolaringologije u Ajub Univerzitetskoj
bolnici Abotabad bili su uklju~eni u studiju. Podaci ve-
zani za ORL simptomatologiju, kao i ostale informaci-
je od zna~aja, bili su sakupljani kroz dobro strukturisan
upitnik. Podaci nakon sakupljanja su kompjuterski
uneti i obra|ivani koriste}i SPSS-16.
Rezultati: Najmla|i pacijent je imao 1 godinu, a
najstariji 80 godina. Od ukupno 250 pacijenata, 129
(51,6%) su bili mu{karci, a 121 (48,4%) `ene. [tavi{e
ve}inu pacijenata, 181 (72,4%) ~inili su stanovnici
Abotabada i ve}ina njih je bila niskog materijalnog sta-
nja i to 165 (66,5%). Naj~e{}i broj pacijenata je imao
obostrano zapu{enje spolja{njeg u{nog kanala, zbog
pove}ane u{ne masti (15,2%), na drugom mestu su
pacijenti sa akutnim zapaljenjem srednjeg uha (13,2%)
i oni sa alergijskim rinitisom, koji je imalo 13,2% is-
pitanika.
Zaklju~ak: Mo`e se zaklju~iti iz na{e studije da
je naj~e{}i problem ORL patologije obostrano zapu{e-
nje spolja{njeg u{nog kanala u{nom masti, alergijski
rinitis, akutni otitits media, hroni~ni supurativni otitis
media i devijacija nosne pregrade. Naj~e{}i uzrok su
infekcije, slaba higijena i smanjena uhranjenost.
Klju~ne re~i: u~estalost, ORL bolesti, otitis media.
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180 Qayyum Fahad Shah, Fayyaz Salma
Correspondence to/Autor za korespondenciju
Dr. Shah Fahad Qayyum
Gohar Sons, Peeple Chowk
Nowshera cantt.
Pakistan
tel: 00923439149039
email: sfask2013ªgmail.com
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