Pattern of ENT- Head and Neck Diseases in Outpatient Department in a District Level Hospital in Bangladesh

Aims: To determine the pattern of OtorhinolaryngologyHead and Neck diseases in Gopalganj and neighbouring districts. Methods: This was a prospective cross sectional study which was carried out patients of ENTHead & Neck diseases attendant in 250 Bedded General Hospital, Gopalganj. A total 8700 patients were attendant in OPD during period of July 2015 to June 2016. Result: In this study 45.55% were male & 54.45% female. Male female ratio 1:1.2. Age ranges from 0 to 90 years, mean age of patients 44.522 years(SD 26.16), majority of patients were age group 0 to 15 (39.10%). Top most ten diseases were chronic tonsillitis (9.50%), adenoid hypertrophy (9%), acute otitis media(7.70%),chronic otitis media(7.59%), rhinitis(7.16%), acute tonsillitis(6.50%), wax(6.40%), hearing loss & tinnitus(5.70%), rhinosinusitis (3.24%), deviated nasal septum (2.80%). Conclusion: The findings help defining the content and extent of medical curriculum in otorhinolaryngology, there by enriching the local medical graduates in their pursuit of relevant knowledge and skill in managing the relatively common and prevailing ENT diseases in Bangladesh. Therefore, there is a need for increased awareness of the people in developing countries especially in Bangladesh through social campaigns and health education aimed at providing quality ear, nose, and throat health care services.


Introduction:
Pattern of otorhinolaryngology head and neck diseases in outpatient department (ENT OPD) varies depending on the countries to large extent. Knowing the pattern of such diseases in Bangladesh would help define the content and extend of medical curriculum involving otorhinolaryngology head and neck diseases. This is relevant, as the local medical graduates would then have relatively enriched knowledge and skill in managing the relatively common and prevailing diseases. In this regard, a study of the otorhinolaryngology head and neck diseases in outpatient department (OPD) of 250 Bedded General Hospital, Gopalganj was carried out to determine the pattern of otorhinolaryngology head and neck diseases in Gopalganj, Bangladesh. 1 Otitis media is the most common disease in young patients as the Eustachian tube is more horizontal in children as compared to adult. The complications of acute otitis media are acute mastoiditis, which complicates the facial nerve paralysis. The response to oral medication in ear disease is excellent, while surgical interventions are less frequently required. In paediatric population, tonsillectomy for chronic tonsillitis is the commonest surgical procedure performed. Chronic tonsillitis usually presents with recurrent sore throat with frequent absenteeism from school. Allergic Rhinitis adversely affects quality of life. It may enhance the comorbidity of asthma and sinusitis with growing concept of airway disease. There is a lot of regional differences in the incidence of ENT diseases. 2 Wide varieties of Ear, Nose, and Throat diseases present to the Otorhinolaryngologist, head and neck surgeons. The pattern of these diseases may vary from community to community or hospital-to-hospital based on the availability of specialist personnel or facilities for the management of such diseases, which are either congenital or acquired origin. The acquired diseases include infections, inflammatory diseases, neurologic diseases, vascular diseases, trauma, benign and malignant etc. Ear, Nose and throat diseases are serious public health problems with universal distribution affecting all age groups. The knowledge of ear, nose, throat, head and neck diseases very important because of the type of morbidities which they cause due to impairment of the inherent physiologic functions that usually take place in the head and neck region. These include problems of hearing, breathing, swallowing, and phonation, speech, olfaction, and taste, protection of the lower respiratory tract and clearance of secretions. Aesthetic problems of the face and psychological problems may occur in neoplasm and neurological diseases of the head and neck region. In some situations, these morbidities may lead to social embarrassment, occupational, school and economic losses in the community, knowledge of these ear, nose, and throat diseases can help the administrator and policy makers in the community to make adequate strategic health planning, especially in developing countries, where poverty, ignorance, insufficient personnel, and lack of basic health facilities abound. It will also assist the educational sector to define a better medical curriculum for training in otorhinolaryngology, head and neck surgery in developing countries. Despite its importance in formulating health care planning and services, there is a dearth in literature on the pattern of ear, nose, and throat diseases in developing countries and especially in Bangladesh. Therefore, this study was designed to pattern of ear, nose and throat diseases in a district level hospital and to create awareness of its importance in public health. 3

Aim of The Study:
To determine the pattern of Otorhinolaryngology Head and Neck diseases in Gopalganj and neighbouring districts.

Material and Method:
The study was conducted using the following method and materials.  Study Method: For the collection data, we used a pretested data sheet, prior to interview verbal consent was taken and the purpose of the study was elaborate clearly.

Statistical Analysis:
All the data were checked and verified throughly. The data obtain from the study were compiled and standard scientific calculator as well as computer software were used and the results of this study analysed statistically using SPSS 20 where relevant.

Result:
A total 8700 patients attended in OPD during period of July 2015 to June 2016. In this study male 3963 (45.55%) & female4737( 54.45%). Male female ratio 1: 1.2. Age range 0 to 90. Mean age 44.522(SD 26.16).              There are large regional differences in the ENT diseases. Prevalence reported in Greece, 4 Scotland 5 , Austria 6 , Spain 7 and France 8 is significantly different from that found in this study.
In our setup, Chronic tonsillitis(9.50%), Adenoid hypertrophy(9%), Acute otitis media(7.70%). Chronic otitis media(7.59%), Rhinitis(7,16%), Acute tonsillitis ( 10 . It is therefore conceivable that a local study with the findings found and discussed above would prove to be relevant and beneficial to the development of medical ENT curriculum in the local university and subsequent medical Practice 1 .

Conclusion:
This study on ENT OPD Patients in the local hospital has shown patterns of ENT diseases common locally and some diseases not of same prevalence as other countries. Many locally common ENT disease have been identified. The findings help defining the content and extent of medical curriculum in otorhinolaryngology, there by enriching the local medical graduates in their pursuit of relevant knowledge and skill in managing the relatively common and prevailing ENT diseases in Bangladesh.
This study showed that chronic tonsillitis (9.50%), adenoid hypertrophy (9%), acute otitis media (7.70%),chronic otitis media(7.59%), rhinitis(7.16%), acute tonsillitis (6.50%), wax(6.40%), hearing loss & tinnitus (5.70%), rhinosinusitis (3.24%), deviated nasal septum (2.80%) are the common Otorhinolaryngology Head and Neck diseases in OPD of district level of Bangladesh, although these disorders are not yet considered to be public health importance, they contribute significantly to the existing burden of health problems in our environment. The possibility of low level of public enlightenment on ear, nose and throat disorders, financial constraint, and lack of time or negligence of health cannot be ruled out as important factors contributing to pattern of presentation.
Therefore, there is a need for increased awareness of the people is developing countries especially in Bangladesh through social campaigns and health education aimed at providing quality ear, nose, and throat health care services. Due to increase in ENT disease, awareness must be made in medical graduates to diagnosis and treat these diseases in order to minimize complications.