Department of ENT & Head-Neck Surgery,BIRDEM General Hospital,122 Kazi Nazrul Islam Avenue, Shahbagh, Dhaka
Department of Transfusion Medicine & Clinical Haematology,BIRDEM General Hospital,122 Kazi Nazrul Islam Avenue, Shahbagh, Dhaka
Department of Community Medicine,Ibrahim Medical College,122 Kazi Nazrul Islam Avenue, Shahbagh, Dhaka
Background and objectives:The magnitude of health problems
related to ear, nose and throat (ENT) in Bangladesh has not been estimated in a
larger scale and very little is known about the prevalence and types of ENT diseases. Some studies, however, addressed
the prevalence of otitis among school children and very few of them reported
hearing defect. This study aims to assess the overall types of ENT diseases encountered by the otolaryngologists at a
referral or tertiary hospital.
Methods: The cross sectional study was conducted in Bangladesh
Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic
Disorders (BIRDEM). All patients registerd in the ENT-OPD from
January to April in 2017 were included in the study for analysis. Diseases were diagnosed on the basis of clinical history,
general and systemic examinations and relevant laboratory and imaging
Results: A total of 435 (M:F=177:258) registered patients were
analyzed. 44 0f them had no ENT diseases. Diseases of ear showed the highest
prevalence (41.1%) followed by that of throat (31.7%) and nose (17.1%). There was
no significant difference in ear and nose diseases between male and female
groups. The throat diseases were significantly higher in female than the male group
(37.2% vs.22.6%, p=0.018). Regarding infections of the specific organs: suppurative
otitis media was the most common (acute and chronic suppurative otitis media 25.5%)
followed by tonsillitis (7.1%), rhinitis (4.4%) and sinusitis (1.4%). These
infections showed no significant difference between male and female patients;
neither there was any significant difference between the diabetic and
Conclusion: Diseasesof earweremostcommonfollowedbythroatandnose.Both acute and chronic otitis media constituted one-fourth of all
registered cases. The diabetic patients showed
no increased risk for ENT diseases.
IMC J Med Sci 2018; 12(1): 22-26
Address for Correspondence: Dr. Badhan Kumar Dey, Registrar,
Department of ENT & Head-Neck Surgery, BIRDEM General Hospital, 122 Kazi
Nazrul Islam Avenue, Shahbagh, Dhaka. E-mail: email@example.com
Several studies have reported the
prevalence and types of ear, nose and throat
(ENT) diseases among Bangladeshi population [1-6]. Some population based
studies addressed chronic suppurative otitis media (CSOM) among children in
Bangladesh. The comparison of CSOM in children showed higher prevalence in rural
(6.02%) than urban (2.07%) area . Other study among Bangladeshi rural
children reported rate of CSOM as 5.2% . In two slum populations of Dhaka City, the prevalence of CSOM among
children was 7.4% . The types of ENT diseases varied from country to country.
For Nigeria, the prevalence of diseases of ear, nose and throat were 62.7%,
23.0% and 9.6%, respectively . In Senegal, the rates were 22.8%, 54.6% and
22.4%  and in India, the rates were 36.6%, 23.5% and 16.58% respectively .
It is important to note that the
disorders of ENT are not confined to these organs only but also affect quality
of life rendering health care very expensive. For example, chronic sinusitis (CS) is a prevalent and
disabling condition of the paranasal sinuses affecting approximately 31 million
people in the United States with an estimated USD 8.6 billion health care
expenditures . CS is reported to affect quality of life more than
other chronic conditions, such as congestive heart failure, chronic obstructive
pulmonary disease (COPD), and chronic back pain [11-13]. Without objective
evidence of inflammation, it is challenging to distinguish CS from conditions
with overlapping symptoms, such as allergic rhinitis or migraine .
Furthermore, it is difficult to use symptoms alone to differentiate between CS
subtypes, such as CS with nasal polyps and CS without nasal polyps .
Sometimes, ENT disorders are linked with other systemic illness like pemphigus vulgaris . For Bangladesh, it may be important
to consider ENT problems related to zoonotic diseases . Because the
Bangladeshi people are constantly exposed to zoonotic health hazards. Despite
all these vulnerability of Bangladeshi people there is very little informationin this regard. On the other hand,
diabetes is thought to increase the risk and severity of ENT disorders. Very insufficient
data on the diseases of ENT are available even in a referral hospital. This
study addressed the characteristics and types of ENT diseases in a tertiary
This cross-sectional study was
conducted in the department of ENT (otolaryngology) in BIRDEM general hospital
(Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and
Metabolic Disorders). BIRDEM is a national referral center for diabetes and
other metabolic diseases. The ENT department has almost all standard diagnostic
facilities to deal with diseases of ear, nose and throat. The department has
both out-patient (ENT-OPD) and in-patient (hospital) wings and delivers
services to diabetic as well as non-diabetic patients. This center registers
more than twenty thousand patients per year.
All patients registered in
the ENT-OPD from January 2017 to April 2017 were included in this study for
analysis. Each patient underwent otolaryngological examinations. Diagnosis of diseases was
based on clinical history, general and systemic
examinations and relevant otolaryngological investigations. In relevant
cases, throat, nasal or ear swabs were collected to identify the causative microorganisms
in the Microbiological laboratory. Histopathological examinations were
undertaken in the Department of Pathology. The Department of Radiology and
Imaging helped in diagnosing sinusitis and CSOM.
435 (M:F=177:258) registered patients were analyzed for this study. Among them
44 patients have not been suffering from ENT diseases. The diseases of ear,
nose and throat were 41.1% (M:F=45.2:38.4), 17.1% (20.3 : 14.7) and 31.7% (22.6:37.2)
respectively [Table 1]. The distribution of diseases of ear, nose and throat according
to age-quartile have been shown in Table
1. There was no difference between male and female patients for diseases of ear
and nose. Only significant difference was observed in case of the throat diseases.
The female patients had significantly higher throat diseases than the males
(p<0.05). This may be due to very high prevalence of throat diseases in the
lowest age quartile (<40 years; M : F= 14.9 : 35.3; p = 0.018).
prevalence of tonsillitis, sinusitis, ASOM, CSOM, rhinitis
and DNS according to sex and glycemic status (diabetic and non-diabetic: DM
& NDM) are shown in Table 2. Both types of otitis media (ASOM 13.3%, CSOM 12.2%)
was the most prevalent (one-fourth) of all ENT patients while the least common
ailment was sinusitis (1.4%). The prevalence of tonsillitis was 7.1%, rhinitis
4.4% and DNS 3.7%. No significant difference was observed between male and
female participants. There was no significant difference between diabetic and
non diabetic participants. Out of total enrolled participants, 18.8%
had different degree of hearing loss due to mechanical causes namely impacted
wax, foreign body, etc.
Table-1: Distribution of cases according to age and gender with overall ear, nose and throat
Table-2: Distribution of tonsillitis, sinusitis, ASOM, CSOM, rhinitis
and DNS according to gender and glycemic status (diabetes vs. non-diabetic
attempted to determine the types and prevalence of specific types of ENT
diseases encountered in a tertiary (national referral) hospital. In Bangladesh,
most studies addressed ENT diseases among school children [1,3-6]. Tarafder et al addressed
only hearing impairment .
this study possibly is the first to explore the types of ENT diseases commonly
observed in a tertiary hospital. As there was no age limit it included both children
and adult. The age below 20 years comprised 5% and below 40 years comprised
25%. It was apparent that the study population represented a wide age range.
Moreover, the study enabled us to assess the types of ENT ailments commonly referred
to a tertiary hospital.
of the participants had otitis, which was the highest ailments referred to ENT department
of BIRDEM. This finding is consistent with the previous studies carried out in
Bangladesh [1,3-5]. The prevalence of ENT diseases observed in this study are
very much consistent with the findings of West Bengal . Our findings showed
that the diseases of ear, nose and throat
were 41.1%, 17.1% and 31.7% respectively. In West Bengal, Barman D et al reported almost similar results: otological, nasal and throat cases were 42.41%, 28.98% and 28.60%,
respectively . Hearing
impairment due to mechanical causes (foreign body, impacted ear wax) of this study also simulates the past findings .
The study had some major limitations. It
did not include some important and relevant risk factors [18-20]. Occupation
could have given valuable information as well as zoonotic link to ENT diseases .
Likewise, family income and poor living conditions could also be a risk for
specific ENT illness [8,20].
This study revealed that otitis (ASOM and CSOM) was the most
prevalent ailment registered in a tertiary health care center. Of the ENT
diseases, highest number of patients presented with ear diseases followed by
throat illnesses. The throat diseases were significantly higher in female than in
the male participants. Hearing impairment was found mostly due to mechanical
causes like foreign body and impacted wax. The diabetic patients showed no
excess risk for ENT diseases. Further study may be undertaken considering these
limitations. This study suggests that some important risk factors mentioned
above (limitation) should be investigated and identified to improve ENT health
We are very grateful to all the employees of the Department of
ENT, BIRDEM. We are also indebted to the Departments of Radiology and Imaging, Pathology,
Microbiology and Clinical Biochemistry for their active cooperation.
BKD was involved in patient
selection, reception, registration, diagnosis and confirmation of diagnosis. AD
was involved in literature review. MMR was involved in data entry, data
editing, analysis and interpretation. MAS was involved in manuscript writing
and overall supervision.
declare no conflict of interest.
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