Pediatric Otological Disorders: An In-Hospital Study

Introduction: Social factors influencing the likelihood of developing pediatric Ear, Nose, and Throat (ENT) disorders include socioeconomic status, the type of family, overcrowding, and access to health care, which are prevalent in developing countries like Nepal. Nepalese populations are not well documented with regards to pediatric ENT disorders. Objective: The aim of the study was to determine the prevalence of ENT disorders in pediatric patients attending hospitals. Methods: This is a cross-sectional descriptive study that was conducted at Janaki Medical College, Janakpur between January and September of 2021. Consecutive children from Janaki Medical College between the ages of 6 months and 18 years with otological complaints participated in the study. Afterward, the diagnosis was derived from patients’ OPD cards or by contacting them by phone. Results: The mean ages of male and female participants were 3.2± 2.7 years old and 4.9 ± 2.6 years respectively. Out of the study participants who complained about otological complaints, the majority (37.45%) had ear wax on their ears, followed by foreign bodies (21.30%) and acute otitis externa (9.2%). Among foreign bodies encountered, rubber (35.48%) was most common, followed by seed (24.19%). Conclusions: Pediatric ear diseases are very common. In the majority of cases, ear wax and foreign bodies were found. By raising awareness about ear hygiene and disease, we can reduce the problems associated with them. Keywords: Ear, nose, and throat; otology; pediatric; prevalence.

Ear Wax and its Impaction: Clinical Findings and Management

Cerumen, sometimes known as "earwax," is a natural material that cleans, coats, and smooths the external auditory canal. It is the most common cause of ear canal obstruction. While cerumen blockage of the ear canal is usually painless, it can result in a variety of implications, for example, loss of hearing, tinnitus, overflowing, itching, otalgia, discharge, odour, and cough. Ear wax becomes a concern only when it causes hearing loss or other ear-related ailments. Cerumen build-up can arise for various causes, including an inability to self-clear, overproduction or underproduction of its essential components due to delayed skin movement, or mechanical difficulties such as usage of cotton buds or hearing aids. Wax can obstruct the understanding and view of the tympanic membrane and must be gone for investigative purposes or to take imprints before installing hearing support or creating earplugs. Cerumen impaction is usually innocuous; however, it might be associated with more significant symptoms. The removal of affected cerumen is typically regarded safe. However, as eardrum tear, canal laceration, and unsuccessful ear wax elimination. These dangers can be reduced by recognizing risky individuals and customising care measures to their specific needs. All common cerumen removal strategies are Cerumenolytics (ear wax emollient agents), irrigation, and manual elimination. It is also prudent not to interfere if asymptomatic individuals and tympanic membrane visualization are not required.

Screening for hearing loss in the setting of primary care, and the most common used tests

Hearing loss is considered among the most common chronic disorders affecting people worldwide, especially older adults and geriatrics. More than half of older adults have age-related hearing loss, which worsens with age. The role of public health to estimate and manage the issue is crucial as early screening and management for hearing loss patients can be promising. The symptoms and signs of hearing loss can appear one up to two years before the significant hearing affection. Major lessons learned from this review are that elderly individuals and geriatrics are the most common targeted population for age-related hearing loss, followed by ear wax accumulation. Therefore, routine checkup for people who are 50 years for audiological disorders is a must. Associated disorders secondary to hearing loss include depression and anxiety, which significantly burden productivity over time. To our knowledge, we performed the first complex review regarding the screening for hearing loss within the setting of primary care centers and mentioned the most standard test used to diagnose and detect the issue as early as possible.

Knowledge, Attitudes, and Practices of Self-ear Cleaning in Makkah Region, Cross-sectional Study

Background and aim: Cerumen or ear wax is a normal secretion from sebaceous and ceruminous glands found in the external auditory canal. Wrong self-ear cleaning attempts may lead to cerumen impaction, injuries, and otitis externa. we have concluded this study to assess the local community's knowledge about ear-cleaning, attitudes toward ear care, and self-ear cleaning practices. Methods: Cross-sectional online survey performed in May 2021 among general population to assess knowledge, attitudes, and practices of self-ear cleaning. We included all people aged between 18 to 90 years who live in Makkah region, also we excluded health care workers and who had previous ears, nose, and throat injuries. Results: A total of 544 participants responded to the survey, 351 (64.5%) were males and 193 (35.5%) were females, age between 18 to 55. Forty-four (8.1%) of participants thought that it is harmful to self-clean your ear. In contrast, 274 (50.4%) thought that we do not have to remove the wax from our ears constantly. About 32% of them clean to remove the dirt and 29.30% clean to improve their ear hygiene. Conclusion: Self-ear cleaning is a widespread practice, and most respondents showed a lack of knowledge regarding ear-cleansing mechanisms. In order to rectify the erroneous views, more public health education is needed to dissuade people from practicing self-ear cleaning and teach them about the function of cerumen and problems associated with self-ear cleaning.

Full paper

Background: Khalwa is a boarding school that specializes in teaching Quran and Islamic principles. Otorhino-laryngological diseases are very common in children, and the cause of considerable morbidity. They include a range of diseases from as simple as common cold to as disabling as hearing loss. This study aims to determine the pattern of ORL diseases in Mustafa Alfadni,Khalwa and more specifically to assess the presence of symptoms and signs of Ear, Nose and Throat diseases and to measure it’s prevalence among Khalwa students.Methods: this study was a cross-sectional facility- based study, carried out at Mustafa Alfadni Quran recitation (Khalwa) in suburb of Sharq alneel in Khartoum state. All of the students of this Khalwa were involved. Data was collected using a structured questionnaire composed of demographic data, medical and health history, clinical examination using check list followed by physical assessment by a tuning fork for weber’s and rhinne tests, otoscope. diagnosis was done by an Ear, Nose and Throat specialist. Statistical analysis was conducted using SPSS software.Results: 116 khalwa students aged between 6 and 24 years with mean of 13.7 +-2.7 years were involved. 10.4% of the respondents were complaining of ear pain, 7.8% were suffering from tinnitus, 18.1% complained of nasal obstruction, 6% of them were suffering from facial pain, 23% were complaining of sneezing. 18.8% of the respondents suffered from epistaxis and 14.7% of them had sore throat. Medical examination revealed that, 25.8% had ear wax. The tympanic membrane in 4.4% was retracted, in 1.8% was bulging and in 2.6% there was effusion behind it and it was perforated in 1.8%. Hearing loss was 20.8% as a conductive hearing loss, and 4.2% were found to have sensorineural hearing loss. 16% had tonsillitis, and 10.5% had otitis media.Conclusion: Khalwa students were suffering from ear discharge, sneezing, epistaxis and sore throat beside ear wax and tympanic membrane disturbance that complicated with hearing loss recommended to have health services and health education program in the Khalawi to decrease the suffering of otitis media and hearing loss and prevent its’ complication as well.

1426 Assessing the Impact Of COVID-19 On ENT Referrals at A West London General Practice

Aim The COVID-19 pandemic has resulted in initial GP consultations being conducted via telephone. This quality improvement initiative quantified this impact on ENT referrals conducted at a West London GP, using education to improve awareness of the relevant NICE guidance to reduce inappropriate referrals. Method An initial retrospective audit comparing number and urgency of ENT referrals and the appropriateness of ENT referrals (using NICE guidance) during the face to face (F2F) period (August 2019 – February 2020) and telephone period (March – September 2020) was performed. Results were presented locally to GPs, with education measures on relevant NICE guidance implemented. Further PDSA cycles occurred during October and November 2020. Results In total, 16 ENT referrals were made during the F2F period (routine n = 15; urgent n = 1); 3 were inappropriate. 31 referrals were made between March and September 2020 (routine n = 27, urgent n = 2, 2WW n = 2); 4 were inappropriate. Further cycles in October 2020, and November 2020 identified 13 referrals (routine n = 10, 2WW n = 3), and 2 referrals (routine n = 2) respectively. 1 inappropriate referral was made during October and none in November. Conclusions Locally, it appears that the number of routine referrals has increased since the advent of the initial lockdown. This may be partially explained by the practice losing the ability to perform some ENT services, such as ear wax micro-suctioning. Education to increase awareness of relevant guidance has been shown to reduce the number of inappropriate referrals to ENT services.

Study on Hearing Impairment in Bangladesh

Background : Hearing impairment is one of the leading causes of disability in Bangladesh. Since half the cases can be prevented through public awareness, early detection and timely management, planning of public health interventions become necessary. To achieve this, a nationwide level of evidence is required. This survey was conducted with the aim of determining the prevalence of hearing impairment in Bangladesh. Materials and methods : The study was a cross-sectional one, conducted between January to May 2013, where a multistage, geographically clustered sampling approach was used. A total of 52 primary sampling units were selected, and from each unit households were selected at random followed by random selection of an individual from each household. In total, 5,220 people were targeted out of which data collection could be completed from 4260 individuals. (82%). Following clinical assessment of study subjects, hearing status was assessed by pure tone audiometry and otoacoustic emission test. Results : The mean age was 32 years among which 58% were females. Among men, there were 29% students, 28% agriculture workers and 14% business men. A major portion of females (63%) were home makers. On clinical examination, 11.5% respondents had impacted ear wax, 6.2% had chronic middle ear infections with eardrum perforation, and 5.3% had otitis media with effusion.On hearing assessment, 34.6% respondents had some form of hearing loss (>25dB in better ear). Conductive hearing loss was found in 12.0%, sensorineural in 4.5% and mixed in 3.8%, where the latter two increased in prevalence with age. Out of the total respondents, 9.6% had disabling hearing loss according to WHO criteria, with a higher prevalence in adults > 60 years(37%). Logistic regression analysis showed age, socioeconomic status, presence of ear wax, chronic suppurative otitis media, otitis media with effusion and otitis externa were significant predictors of disabling hearing loss. Conclusion : The major causes of conductive hearing loss are chronic suppurative otitis media and otitis media with effusion. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 72-76