|Year : 2017 | Volume
| Issue : 3 | Page : 126-129
Ear, nose, and throat disorders in a nigerian rural community
Waheed Atilade Adegbiji1, Shuaib Kayode Aremu2, O Akeem Laisi3
1 Department of ENT, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
2 Department of ENT, Federal Teaching Hospital, Ido Ekiti, Ekiti State, Nigeria
3 Department of ENT, University College Hospital, Ibadan, Oyo State, Nigeria
|Date of Web Publication||14-Feb-2018|
Shuaib Kayode Aremu
Federal Teaching Hospital Ido-Ekiti/Afe-Babalola University, Ado-Ekiti,Ekiti State
Source of Support: None, Conflict of Interest: None
Aims and Objectives: This study aimed at assessing the prevalence of ear, nose, and throat with head and neck diseases in a rural community in Oyo State, Nigeria. Materials and Methods: This is a prospective community-based study of ear, nose, and throat diseases. The study was carried out over a period of 3 months (January to March 2017). Verbal consent was obtained from the village head and participants. A total of 738 individuals were enrolled into the study. Interview-assisted questionnaire was administered to obtain bio data and otorhinolaryngological history from all participants, followed by examination and investigation. Data obtained were collated and statistically analyzed using SPSS version 16. Results: A total of 738 consented participants had various forms of ear, nose, and throat disorders. They constituted 435 (58.9%) males and 303 (41.1%) females, with a male: female ratio of 1:1. Majority of enrollee were dependent age groups. These age groups were 27.4% (1–10), 25.5% (11–20), and 14.1% (51–60). The occupational status revealed that 28.9% were employed; 9.3% were retired; 45.5% were children/students/apprenticeship; and 16.3% were artisans, homemakers, and farmers. Nasal diseases (34.4%) were the most common otorhinolaryngological, head and neck disorders while ear, nose, and throat with head and neck diseases were responsible for 43.4%, 14.6%, and 7.6%, respectively. The common diseases were wax impaction (11.7%), sinusitis (14.4%), and allergic rhinitis (22.6%). Less prevalent otorhinolaryngological, head and neck diseases were vertigo/balance disorder (0.9%), cervical spondylosis (1.6%), and pharyngitis/tonsillitis (2.0%). Common procedures performed included impacted earwax removal (22.8%), aural toilet/dressing (14.4%), pure tone audiometry (32.5%), tympanometry (18.4%), endoscopy (9.8%), and antral irrigation (5.7%). Referred cases of 7.2% were recorded. The barriers experienced by these villagers in seeking otorhinolaryngological, head and neck services were distance/transport (42.8%), cost of hospital service (38.4%), fear of surgery (24.1%), hospital protocol (37.0%), cumbersome investigation (17.5%), and hospital workers (27.6%). Conclusions: This study revealed that the nasal diseases were most prevalent in the community and highlighted the major challenges encountered in seeking otorhinolaryngological, head, and neck cares.
Keywords: Ear, ear disease, nose, head, neck disease, nose disease, throat barrier, throat disease
|How to cite this article:|
Adegbiji WA, Aremu SK, Laisi O A. Ear, nose, and throat disorders in a nigerian rural community. J Sci Soc 2017;44:126-9
| Introduction|| |
Otorhinolaryngological, head and neck disorders are common causes for seeking health care worldwide. It is of important to note that ear, nose, and throat diseases are serious public health problems with universal distribution and affecting all age groups.,
These diseases are classified into two main categories. These are congenital and acquired diseases based on the time of presentation. Based on etiological causes, they are further divided into inflammatory (infective or reactive) diseases, neurologic diseases, toxicity, metabolic disorders, vascular diseases, trauma, neoplasm (benign and malignant tumors), and so on.
The only tertiary care center is about 30 km away from the community. In our study area, there is no general hospital. There are primary health-care centers. Otorhinolaryngological, head and neck disorders are common conditions seen by general practitioners practicing in this community. In developing countries, otorhinolaryngological services are overcrowded, with patients suffering from acute and chronic complaints and usually result in long waiting hours.,, These patients present with different forms of ear, nose, and throat clinical features. Otologic complaints constituted the majority of all the patients and this include earache, hearing loss, and vertigo.,,,,
There is a paucity of literature on the outlook of otorhinolaryngology in the community in the sub-Saharan Africa. This study aimed at determining the epidemiologic profile of the common otorhinolaryngological, head and neck diseases to assist the primary care providers to have better focus on them. The finding may be useful in planning the ear, nose, and throat health care of any rural community.
| Materials and Methods|| |
This is a prospective community-based otorhinolaryngological, head and neck study. This study was carried out in Akanran, Olorunda, and five surrounding villages. These communities are about 30 km from Ibadan, the Oyo state capital. The link roads were rough with poor accessibility, no regular electricity supply, and there was no pipe-borne water.
They were predominantly farmers. There was no higher institution of learning in the community. The village head and the family head were seen during village and landlord meeting. The village head and family head were health educated on otorhinolaryngological, head and neck diseases. The scope of our study was explained to them.
The study was carried out over a period of 6 months, from January 2017 to March 2017. Verbal consent was obtained from village head, family head, participants, or their guardian. A total number of 738 participants were enrolled into the study.
Data were obtained using interview-assisted questionnaire. The information obtained included their bio data such as age, sex, occupation, religion, and marital status. Detailed otorhinolaryngological, head and neck history on the various diseases were obtained including the past medical and surgical history. Their family and social history on alcohol, smoking, and so on was obtained. Detailed otorhinolaryngological examination and pure tone audiometry were done. Free medical treatment and minor ear, nose, and throat procedure were given. Participants who required further investigation and major surgery were referred to the tertiary center.
The data obtained were collated and analyzed using SPSS Version 16 (IBM Company, New York).
| Results|| |
A total of 1086 consented participants were enrolled into the study. Among which a total of 738 participants were suffering from various forms of ear, nose, and throat disorders. There were 435 (58.9%) males and 303 (41.1%) females; with a male:female ratio of 1:1. The age distribution of the patients is shown in [Table 1]. Majority of participants were dependent age groups, i.e., 202 (27.4%) in the first decade, 188 (25.5%) in the second decade, and 104 (14.1%) in the sixth decade.
The occupational status revealed that 213 (28.9%) were employed, 69 (9.3%) were retired, 336 (45.5%) were children/students/apprenticeship, and 120 (16.3%) were artisans, homemakers, and farmers.
Nasal diseases, i.e., 254 (34.4%) were the most common otorhinolaryngological, head and neck disorders. Ear, nose, and throat with head and neck diseases were responsible for 320 (43.4%), 108 (14.6%), and 56 (7.6%) respectively of the recorded otorhinolaryngological, head and neck diseases. This is shown in [Figure 1].
The common ear, nose, throat with head and neck diseases are shown in [Table 2]. Common ear diseases were ear wax impaction in 86 (11.7%), tinnitus in 39 (5.3%), and hearing loss in 59 (8.0%) cases. Common sinonasal diseases were sinusitis in 106 (14.4%) and allergic rhinitis in 167 (22.6%) cases. Common throat diseases were adenoid/tonsillitis in 39 (5.3%) and gastroesophageal reflux disease in 41 (5.6%) cases. Common head and neck diseases were head and neck mass in 32 (4.3%) and cervical spondylosis in 12 (1.6%) cases.
Common procedures performed included impacted earwax removal [Figure 2] in 168 (22.8%), aural toilet/dressing in 106 (14.4%), pure tone audiometry in 240 (32.5%), tympanometry in 136 (18.4%), endoscopy in 72 (9.8%), and antral irrigation in 42 (5.7%) cases. Fifty-three referred cases (7.2%) were recorded in various otorhinolaryngological, head and neck conditions. This was necessitated because of the scope of our program.
The barriers to otorhinolaryngological services encountered by the villagers' areas are illustrated in [Figure 3]. These barriers included distance/transport 316 (42.8%), cost of hospital service 283 (38.4%), fear of surgery 178 (24.1%), hospital protocol 273 (37.0%), cumbersome investigation 129 (17.5%), and hospital workers 204 (27.6%).
| Discussion|| |
The major findings in this study include a high prevalence of otorhinolaryngologic diseases and predilection for the extreme of ages, although there was gender predominance. A hospital-based study revealed that adolescents and young adults are seem to be the patients who seek more otorhinolaryngological care. Some works reported that the number of females was slightly more than that of the males in their finding.,
There are various types of ear, nose, throat, head, and neck diseases diagnosed in this work. In this study, there are both similarities and differences to other otorhinolaryngological epidemiological studies on the prevalence of different types of ear, nose, and throat diseases. Common otorhinolaryngological disorder in this study is sinonasal diseases. This may be due to high proportion of children in the study. High percentage of upper respiratory tract infection in this age group is due to their low immune status, overcrowded living conditions, and low socioeconomic status of the study population. A rural community study revealed otological diseases as the most prevalent diseases in the otorhinolaryngological, head and neck epidemiological study. Acute throat infection is the most common top ten otorhinolaryngological disorders observed in another emergency epidemiological work. It was also noted that throat infection is the leading ear, nose, throat, head, and neck infection due to zoonotic agent. In this case, infectious disorders are the leading reason for consultation. It was also noted that half of the patients who used the emergency department service have an infectious disorder.,,,,,
In this study, further analysis of sinonasal disorder revealed allergic rhinitis as the most prevalent diagnosed disease. Sinusitis which usually resulted from complicated allergic rhinitis is the second most common diagnosed disease. This may be due to abundant plant and animal allergens in their environment. Emergency otorhinolaryngological, head and neck epidemiological study revealed epistaxis as the most common sinonasal pathology in their casualty department. A hospital-based study found nasal foreign body as the most common sinonasal disease.
Otological disorders are the second most common otorhinolaryngological, head and neck diseases. Ear wax impaction is the most prevalent ear disease followed by chronic suppurative otitis media. Impacted ear wax is most likely due to ear hygiene, self-ear picking, and indiscriminate ear picking with any object in case of allergic, itchy ear. Chronic suppurative otitis media and/or otitis externa were found to be the most common ontological diseases., This depends on the types of epidemiological study.
Gastroesophageal reflux disorder is the most prevalent throat disease in this work. This may be due to high frequency of peptic ulcer diseases in the study population. It may also be related to their occupation and social lifestyle. Acute tonsillitis is the most common throat disorder and this is attributed to the kind of epidemiological research work.,
This work further enumerates the pattern of barrier which hindered the study population to freely access otorhinolaryngological, head and neck surgeon. Among these are distance to the nearest tertiary health facility, poor nonmotorable raid network, and poor economic status of the studied population. These observed results point that general practitioners could be trained to provide a first appropriate contact care for patients with common otorhinolaryngological, head and neck disorders.
| Conclusions|| |
This otorhinolaryngological rural community study revealed nasal diseases as the most common. This pattern of distribution was probably due to low socioeconomic status, lack of proper facility for patient management, and poor knowledge on disease prevention.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
Famuyiwa OO, Olorunshola DA, Derin A. Some family factors in sickle cell anaemia in Lagos, Nigeria. Niger Med Pract 1998;35:70-3.
Kishve SP, Kumar N, Kishve PS, Aarif SM, Kalakoti P. Ear, nose and throat disorders in paediatric patients at a rural hospital in India. Australas Med J 2010;3:786-90.
Ibekwe TS, Nwaorgu OG, Onakoya PA, Ibekwe PU. Spectrum of otorhinolaryngology emergencies in the elderly in Ibadan, Nigeria. Niger J Med 2005;14:411-4.
Johnson KD, Winkelman C. The effect of emergency department crowding on patient outcomes: A literature review. Adv Emerg Nurs J 2011;33:39-54.
Pines JM, Iyer S, Disbot M, Hollander JE, Shofer FS, Datner EM, et al.
The effect of emergency department crowding on patient satisfaction for admitted patients. Acad Emerg Med 2008;15:825-31.
Pines JM, Pollack CV Jr., Diercks DB, Chang AM, Shofer FS, Hollander JE, et al.
The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain. Acad Emerg Med 2009;16:617-25.
Lo AX, Harada CN. Geriatric dizziness: Evolving diagnostic and therapeutic approaches for the emergency department. Clin Geriatr Med 2013;29:181-204.
Ozono Y, Kitahara T, Fukushima M, Michiba T, Imai R, Tomiyama Y, et al.
Differential diagnosis of vertigo and dizziness in the emergency department. Acta Otolaryngol 2014;134:140-5.
Lawhn-Heath C, Buckle C, Christoforidis G, Straus C. Utility of head CT in the evaluation of vertigo/dizziness in the emergency department. Emerg Radiol 2013;20:45-9.
Bashir K, Alessai GS, Salem WA, Irfan FB, Cameron PA. Physical maneuvers: Effective but underutilized treatment of benign paroxysmal positional vertigo in the ED. Am J Emerg Med 2014;32:95-6.
Saber Tehrani AS, Coughlan D, Hsieh YH, Mantokoudis G, Korley FK, Kerber KA, et al.
Rising annual costs of dizziness presentations to U.S. Emergency departments. Acad Emerg Med 2013;20:689-96.
Galletti B, Mannella VK, Santoro R, Rodriguez-Morales AJ, Freni F, Galletti C, et al.
Ear, nose and throat (ENT) involvement in zoonotic diseases: A systematic review. J Infect Dev Ctries 2014;8:17-23.
Ette VF. Pattern of ear, nose and throat foreign bodies seen in Uyo Nigeria. Ibom Med J 2012;5:21-23. [DOI: 220.127.116.11].
Sogebi OA, Olaosun AO, Tobih JE, Adedeji TO, Adebola SO. Pattern of ear, nose and throat injuries in children at Ladoke Akintola University of Technology teaching hospital, Osogbo, Nigeria. Afr J Paediatr Surg 2006;3:61-3. [Full text]
Figueiredo RR, Azevedo AA, Kós AO, Tomita S. Complications of ENT foreign bodies: A retrospective study. Braz J Otorhinolaryngol 2008;74:7-15.
Barman D, Maridal S, Goswami S, Hembram R. Three years audit of the emergency patients in the department of ENT of a rural medical college. J Indian Med Assoc 2012;110:370-4.
Timsit CA, Bouchene K, Olfatpour B, Herman P, Tran Ba Huy P. Epidemiology and clinical findings in 20,563 patients attending the LariboisiA, Bouchital ENT adult emergency clinic. Ann Otolaryngol Chir Cervicofac 2001;118:215-24.
Adedeji TO, Sogebi OA, Bande S. Clinical spectrum of ear, nose and throat foreign bodies in north Western Nigeria. Afr Health Sci 2016;16:292-7.
Rao RS, Subramanyam MA, Nair NS, Rajashekhar B. Hearing impairment and ear diseases among children of school entry age in rural South India. Int J Pediatr Otorhinolaryngol 2002;64:105-10.
Singh A, Kumar S. A survey of ear, nose and throat disorders in rural India. Indian J Otolaryngol Head Neck Surg 2010;62:121-4.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]