Ear Nose Throat ( ENT ) disorders in Government Schools of Far-Western Nepal

Background: ENT disorders specially hearing impairment nega vely impacts students’ development of academic, language and social skills. If le undiagnosed, these condi ons may result in signifi cant irreversible damage such as varying degree of hearing loss that can aff ect the social or professional performance of the individuals in later stages of life. Students going to government school in our country generally come from under privileged society. We inves gated the occurrence of ENT diseases among various government school students in Kailali district. Methods: Nine government school of Kailai district were chosen at random. All students of those school present on the day of examina on went rou ne ENT examina ons. Brief history, if any, was recorded and fi ndings were noted. The study was done throughout the month of September, 2013. Results: There were a total of 2256 students enrolled in the study. There were 1126 male and 1130 female students. Mean age of the students was 9.88 years. Forty One percent of students had ENT problems. Ear wax was the most common (17%) fi ndings followed by suppura ve ear diseases, o s media with eff usion as so on in decreasing frequency. Conclusions: ENT diseases and specially ear diseases are important health problems among school children of Nepal. Regular school health services, screening program, public awareness, improvement of socioeconomic status, mely referral to a specialist doctor can help to reduce the diseaserelated burden. INTRODUCTION ENT diseases may cause life-long or sometimes life-threatening problems. Congenital or acquired hearing Impairment hinders students’ development of academic, language and social skills.1 Chronic o s media is an infl ammatory process of the middle ear and mastoid cavity, which may be related to several condi ons such as cholesteatoma and o s media with eff usion (OME) etc. It mostly presents with a tympanic membrane (TM) abnormality, like perforation or retrac on, and suppura ve discharge noted in the external ear canal. Due to its insidious progress and irreversible damage, the disease is an important pediatric health topic especially in developing or underdeveloped countries.2 Hearing loss is considered to be the main health issue that aff ects quality of life, aff ec ng approximately one-third of these popula ons. The World Health Report (1997) described hearing impairment as ‘a serious problem in young children because it retards language development and school progress, both of which have a signifi cant impact in later life’.3 School health program is an important aspect of any community health program. School health services provide an ideal pla orm to detect the health problems early and treat them.4 About 42% of the total popula on are children below the age of 16.5 There are no reliable data on the current prevalence of ENT disorders in school children. There are few studies in Nepal targe ng hospital based children or a certain disease only.6,7,8,9 The main goal of the current study was to determine the occurrence of ENT disorders among schoolchildren in a district of far-west Nepal. METHODS It was a cross-sec onal descrip ve study. The study was done throughout the month of September, 2013. Nine government school of kailali district were chosen at random. All the students of those school present on the day of examina on were included in the study. A brief history, if any, was taken. General ENT examina on was done. Age, sex, complains, fi ndings and diagnosis were recorded. Medical advice and counselling were given to those having posi ve fi ndings. Prior to the study, consents were obtained from the principals or Head-master of the schools, and families of the students. The occurrence was calculated by dividing the number of the students with posi ve fi nding by the total number of students and 95% confi dence interval (CI) was used. Statistical analysis of the data was done using the Sta s cal Package for the Social Sciences (SPSS-17) program. Results with a p value <0.05 were considered signifi cant. Original Article L M Coll J 2013; 1(2): 86-88


INTRODUCTION
ENT diseases may cause life-long or sometimes life-threatening problems.Congenital or acquired hearing Impairment hinders students' development of academic, language and social skills. 1 Chronic o s media is an infl ammatory process of the middle ear and mastoid cavity, which may be related to several condi ons such as cholesteatoma and o s media with eff usion (OME) etc.It mostly presents with a tympanic membrane (TM) abnormality, like perforation or retrac on, and suppura ve discharge noted in the external ear canal.Due to its insidious progress and irreversible damage, the disease is an important pediatric health topic especially in developing or underdeveloped countries. 2Hearing loss is considered to be the main health issue that aff ects quality of life, aff ec ng approximately one-third of these popula ons.The World Health Report (1997) described hearing impairment as 'a serious problem in young children because it retards language development and school progress, both of which have a signifi cant impact in later life'. 3School health program is an important aspect of any community health program.School health services provide an ideal pla orm to detect the health problems early and treat them. 4About 42% of the total popula on are children below the age of 16. 5 There are no reliable data on the current prevalence of ENT disorders in school children.There are few studies in Nepal targe ng hospital based children or a certain disease only. 6,7,8,9e main goal of the current study was to determine the occurrence of ENT disorders among schoolchildren in a district of far-west Nepal.

METHODS
It was a cross-sec onal descrip ve study.The study was done throughout the month of September, 2013.Nine government school of kailali district were chosen at random.All the students of those school present on the day of examina on were included in the study.A brief history, if any, was taken.General ENT examina on was done.Age, sex, complains, fi ndings and diagnosis were recorded.Medical advice and counselling were given to those having posi ve fi ndings.
Prior to the study, consents were obtained from the principals or Head-master of the schools, and families of the students.
The occurrence was calculated by dividing the number of the students with posi ve fi nding by the total number of students and 95% confi dence interval (CI) was used.Statistical analysis of the data was done using the Sta s cal Package for the Social Sciences (SPSS-17) program.Results with a p value <0.05 were considered signifi cant.

DISCUSSION
Our study showed almost equal male and female students.In a study by Adhikari P, there were nearly twice the number of male students than that of females. 9We found in the fi eld that there were various NGOs working for the children, women and other classes of people.Maybe it was due to these organiza ons that the a endance of female children were higher than in other studies.We have found that 41% of students had one or another ENT diseases.
It was higher than a study by Maharjan M. et al which showed 33% of the school students had ENT problems. 6ar wax was the most common diagnosis comprising of 17.3% of the total school popula on.Wax was the most common diagnosis in many studies in our country and abroad. 9,10,11,12It was followed by CSOM-TT and OME.
There has been a lot of studies showing OME as a major cause of hearing loss in children. 6,9,12,13,14There were 169 (7.5%) cases of CSOM of which 18.3 percent were a coantral variety.The occurrence of CSOM is comparable to a study done in Bangladesh, but the a co-antral variety in our study is much higher. 15A co-antral CSOM has to be managed at earliest by surgical method due to high incidence of complica ons in this variety.There were 74 (3.28%) cases of non otogenic diseases comprising mainly of allergic rhini s, chronic rhinosinusi s, acute and chronic pharyngi s.There are very few studies which takes into account of non otogenic diseases in addi on to the ear diseases.
We have found that the most common diseases are those which gives rise to hearing loss in children.
Adequate hearing is one of the main factors for good psychosocial development, by which individuals may express their thoughts, feelings, and wishes, and acquire life experience and knowledge.Children require normal hearing or adequately corrected hearing to facilitate the formal educa on.

CONCLUSION
ENT diseases and specially ear diseases are important health problems among school children of Nepal.Regular school health services, screening program, public awareness, improvement of socioeconomic status, mely referral to a specialist doctor can help to reduce the disease-related burden.

Table 3 : diagnosis * sex Crosstabula on
RESULTSThere were a total of 2256 students enrolled in the study.Their age was as shown in table 1.There were 1126 male and 1130 female students with M:F ra o of 0.9964:1.Of total, 1332 (59%) students had normal ENT fi ndings.The rest 41% had posi ve fi ndings.The diagnosis based on the fi ndings are shown in

table 2 .
It shows ear wax was the most common fi ndings (17.3%) in the school students.It was followed by chronic suppura ve o s media, tubotympanic variety (CSOM-TT), O s media with eff usion etc. in descending frequencies.Rela onship between sex and normalcy was compared by chi-square test as shown in table3.It showed males had signifi cantly more diseases than the females (p=0.009).