Sociodemographic characteristics of the patients of Tonsillitis attended in OPD of a district level Hospital

Aim: To find out the tonsillitis patients and also find out its sociodemographic characteristics in district level of Bangladesh. Method: This was a prospective cross sectional study, which was carried in out patients of tonsillitis attended in OPD of 250 Bedded General Hospital, Gopalganj. All the patients of acute tonsillitis, chronic tonsillitis and adenoid hypertrophy were selected from OPD irrespective of sex during the period of July 2015 to June 2016. Age ranges from 0-90 years and person residents of Gopalganj and adjacent districts. Result: In this study 45.54% were male and 54.46% were female. Male female ratio 1:1.2.Majority of patients were age group 0-15 years (55.97%) Mean age of patient 45 years. Maximum family had monthly income TK 10,000 to 20,000 and maximum patients were dependent (30%) 5-6 family members were highest group, 60% patients lived in katcha house, 75% lived in rural area 35% patients used to bath in pond and majority of patients primary and JSC qualification. The majority of signs and symptoms were sore throat (100%), red, swollen tonsil (26%); white pus filled spots on the tonsil (38%); swollen lymph node in neck (60%) and bad breath (halitosis) (38%). Conclusion: Tonsillitis is still high in rural area of our country and commonly found in younger age group. Thus improvement of related socioeconomic factors, health awareness campaign, improved health education and early accessibility can reduce the incidence of disease.


Introduction:
The tonsil begins developing early in the third month of fetal life. They arises from the endoderm lining, the second pharyngeal pouch, and the mesoderm of the second pharyngeal membrane and adjacent regions of the first and second arches. Heinrich Wilhelm Gottfried von Waldeyer-Hartz first described the incomplete ring of lymphoid tissue, situated in the naso-oropharynx, in 1884. Waldeyer's ring consists of four tonsillar structures.(namely, the pharyngeal, tubal, palatine and lingual tonsils) as well as small collections of lymphatic tissue disbursed throughout the mucosal lining of the pharynx (Mucosa-associated Lymphoid Tissue, MALT).

Pharyngeal Tonsil (Adenoids):
Situated superior-posteriorly to the torus tubaris, in the roof of the nasopharynx, the pharyngeal tonsil is primarily responsible for 'screening' the air that enters through the nostrils.

Tubal Tonsils (Gerlach's Tonsil):
The tubal tonsils are also located in the roof of the nasopharynx. They are bilateral and posterior to the torus tubaris, in the fossa of Rosenmuller (pharyngeal recess).
Lingual Tonsils: The numerous protrusions located at the posterior third of tongue are collectively known as the lingual tonsils. Mucosa-associated Lymphoid tissue (MALT) is found through out the mucosal lining of the body. The tonsils serve immune acquisition and immune defence by antigen presentation, which is why they contain T-lymphocyte, macrophages and germinal centres of Blymphocytes. They are the first and earliest to reach station of the mucosa associate lymphoid tissue system in human. During upper respiratory tract infection (URTI), the pharyngeal and palatine tonsils become enlarge, resulting in adenoiditis or tonsillitis respectively. The inflammation is typically of bacterial origin. Consequently, hypertrophied lymphoid tissue may lead to obstruction of the airway. 20,21,22,23,24,25 Tonsillitis is inflammation of tonsils, typically of rapid onset. 1 It is a type of pharyngitis. 2 Symptoms may include sore throat, fever, enlargement of tonsils, trouble swallowing and large lymph nodes around the neck. 3 Tonsillitis is most commonly caused by a viral infection, with about 5 to 40% of cases caused by a bacterial infection. 3,4 When caused by the bacterium group A streptococcus, it is referred to as strep throat. 19 Rarely bacteria such as Neisseria gonorrhoea, Corynebacterium diphtheriae or Haemophilus influenzae may be the cause. 3 About 7.5% people have a sore throat in any three month period and 2% people visit a doctor for tonsillitis each year. 6 It is most common in school aged children and typically occurs in the fall and winter month. 3,4. The majority of people recover with or without medication. 3 In 40% of people, symptoms resolve within three days and in 80% symptoms resolve within one week, regardless of if streptococcus is present. 7 Antibiotics decrease symptom duration by approximately 16 hours. 7 The incidence of tonsillitis is not completely known, research indicate that 15-30% of sore throats in children and 5-10% sore throats in adults are bacterial tonsillitis. 8,9,10 The prevalence of tonsillitis is not completely known. Research on Norwegian twins indicates recurrent tonsillitis prevalence of approximately 11,700 per 100,000 individual. 11 A study on primary school children in Turkey indicated recurrent tonsillitis prevalence of approximately 12,100 per 100,000 individual. 12 Acute tonsillitis from S. pyogenes primarily affect children between 5-15 years old. 13 Research on tonsillitis patients that it is more common in female than male. 11,14 There is no racial predisposition to tonsillitis. There is no geographic predisposition to tonsillitis.
Aim of the study: To find out the tonsillitis patients and also find out its sociodemographic characteristics among the people of Gopalganj and neighbouring districts.

Methods:
The study was conducted using the following method and material.
Type of the study: Prospective cross sectional study.
Place of the study: ENT Outpatient Department, 250 Bedded General Hospital, Gopalganj.

Selection of patients:
All the patients of acute tonsillitis, chronic tonsillitis and adenoid hypertrophy were selected from OPD irrespective of sex and religion.
Period of study : July 2015 to June 2016.
Study method: For the collection of 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 complied and standard calculator as well as computer software were used and the result of this study analysed statistically using SPSS 20 where relevant.          Table shows the common signs and symptoms including with tonsillitis. Majority of signs and symptoms were sore throat (100%); red, swollen tonsil (26%); pain when swallowing (74%); high temperature (26%); white pus filled spots on the tonsils (38%); swollen lymph node in neck (60%) and bad breath (halitosis) (38%).

Discussion:
Tonsillitis is one of the most common throat disease of all age and its related sociodemographic characteristics provides a rich source for exploring issues. This is important both for scientific understanding and for policy analysis. It offers a unique opportunity in Bangladesh for the study of a range of topics necessary to understand the economic, social, psychological and health elements of the disease process and to inform policy in these areas. The study gives an over view of the demographic characteristics of the patient attended in out patient department (OPD) of 250 bedded general hospital, Gopalganj, such as age and sex, as well as other socio-demographic variables, such monthly family income, occupation, number of family members, type of housing, habitat, educational qualification and common signs and symptoms of patients. In the present series, maximum patients lived in rural area (75%). As study area was a district level hospital, so maximum patients came from rural area.
In this study, educational qualification of tonsillitis patients, majority was wirh primary and JSC qualification.

Conclusion:
The objective of the study were tonsillitis and its related sociodemographic characteristics of patients attended in Outpatient Department (OPD), That is association of tonsillitis with age, sex, monthly family income, occupation, number of family members, type of housing, habitat, water source for bathing and educational attainment. Tonsillitis is still high in rural area of our country and community found in younger age group. Female are more affected, lower socioeconomic group and lower educational attainment peoples are more affected. Thus improvement of these sociodemographic factors, health awareness campaign, improved health education and easy accessibility to health care facilities can reduce the incidence of this disease.