THE PREVALENCE AND ATTITUDE OF EAR NOSE THROAT (ENT) INFECTIONS\PROBLEMS

* Mariam JaberAlatowiAljehani 1 , Sarah Khaled Alrasheed 1 , Hatem Mohammed Ahmed 1 and Nahid Ebrahim Fallatah 2 . 1. Medical intern, Taibah University. 2. Family Medicine Consultant, Taibah University. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Specific objectives: -1. To identify the main complaints of (ENT) infections \problems among Taibah University Medical students. 2. To know the frequency of (ENT) infections \problems per year among them.

Introduction: -
ENT is a part of medicine that deals with ear, nose and throat disorders. However, ENT diseases are serious public health problems with universal distribution affecting all age groups [1,2]. Although, ear, nose and throat diseases are very important because of the type of morbidities, which may lead to impairment of the physiological functions. These include problems of hearing, breathing, swallowing, phonation, speech, olfaction, taste, and protection of the lower respiratory tract and clearance of secretions [4,5]. Globally, Ear infections considered as one of the leading causes of health care visits and its complications represent important causes of preventable hearing loss, especially in developing countries [1]. While around 0.5% of all upper respiratory tract infections are complicated by sinusitis, the incidence in UK of acute sinusitis ranges from 15 to 40 episodes per 1000 patients per year and it is the secondmost common infectious disease seen by general physicians [2]. However, acute throat infections are the most common infectious diseases seen by family physicians and they are responsible for 2% to 4% of all visits [4,5]. Regarding The prevalence of ear, nose and throat problems in the community, it appears that ENT disorders occur frequently in society. Therefore, ENT diseases may lead to various types of complications that affect daily life activity such as, hearing loss, obstructive sleep apnea and cardiopulmonary complications. Philip C Hannaford et al, conducted a study at Scotland in 2005. A total of 15,788 individuals aged over 14 years were participated in the study, they reported the incidence of ear, nose and throat symptoms, participants' sociodemographic characteristics and epidemiological distributions. 50% of respondents reported currently having hearing difficulties, while between 13% and 18% of respondents reported persistent nasal symptoms and hay fever, respectively. However, 31% had at least one episode of severe sore throat or tonsillitis and nearly 29% experience unsteadiness, light-headedness or feeling faint. Based upon research, ENT symptoms common among community with variations according to age, gender and occupations, however most of these affected participants manage their ENT problems without consulting the health services [7]. Ayotunde et al, (Nigeria, 2013) reported the prevalence of ear, nose and throat diseases and its related complication. 58% of the adult patients presented with ear disorders of which 34.5% were cases of hearing loss while, Rhinosinusitis was the second most predominant ear, nose and throat disorders among adult patients [1,9]. In addition, a total of 1047 patients came to ENT HAJJ clinic, Saudi Arabia, 85.5% were diagnosed of upper respiratory tract infections including pharyngitis, viral upper respiratory tract infection and tonsillitis, 24% of them were admitted with average admission rate of 2 patients per day and 94 % of them received antibiotics as part of their main therapy according to Ameen Z.Alherabi (KSA, 2008) [14].
Regarding general attitude toward ear, nose and throat problems, Dilys Addeyand Adrian Shephard showed that majority of participants stating that they tend to see how symptoms develop and if they don't disappear quickly, they take appropriate medications. Only a small proportion of respondents prefer to avoid medication and just get on with life, putting up with the discomfort. While, respondents suffering from throat discomfort caused by perceived bacterial or viral infection or cold or influenza were most likely to use medicated products which contain a medicinal substance or active ingredient, hot drinks, throat sweets, or consult a GP. Those suffering from hay fever or allergy most frequently consulted a GP or took medicated products. There was also a tendency for respondents who suffered a higher degree of perceived discomfort and those who had suffered for longer periods (>4 days) to use medicated treatments (UK, France, Poland, and Malaysia, 2013) [10,13]. According to Philip C Hannaford et al, (Scotland, 2005), 23% with hearing problem who ever visited the general physician while 38% with sever sore throat or tonsillitis and only 16% with nose problem [11]. Although, the most frequently observed symptoms leading to the emergency room consultation were: pain, sudden loss of hearing, bleeding, a swallowed foreign body while, The most frequent nasal sign was epistaxis, the most frequent auditory condition was acute external and middle ear otitis, and the most frequent pharyngeal condition was ingestion of a foreign body among 20.563 adult patients attended the ENT emergency clinic over 18 months (Timsit CA et al , France , 2001) [8]. Due to lack of researches in our region, we need more studies to evaluate the prevalence of ear nose throat diseases and patients' attitude towards illness as it has been considered as a rapidly escalating public health problem affecting various populations with different age groups. The aim of this study is to estimate the prevalence of (ENT) diseases and to assess the altitude that used by medical students to ward their Ear, Nose, and Throat problems among medical students, Taibah University, Al-Madinah Al-Monawara In Kingdom of Saudi Arabia, 2016.

Methodology: -
Aim of study: The aim of study to identify the prevalence of Ear, Nose and Throat infections\problems among medical students in Al-Madinah Al-Monawara, KSA, 2016. The study Was conducted during the period from (September to October, 2016).

Study area:
The study area will be carry out in the medical college, Al Madinah AL-Monawara, Taibah University, Kingdom of Saudi Arabia. A Taibah University which is situated in the City of Medina, Kingdom of Saudi Arabia where our Prophet Mohammed (Peace be upon him). Taibah university consists of several college one of them is medical college, being the first medical college in AL-Madinah Al-Monawara, the medical college was established as the beginning of «Faculty of Medicine and Medical Sciences»." Study design \ population: A Cross sectional survey will be carry out in the medical college; male and female sections, Al Madinah AL-Monawara, Taibah University, Saudi Arabia, 2016.
Data collection tools and techniques: using electronic self-administered questionnaire in English Google form. The results will be tabulated and analyzed by using SPSS version 20. We will carry out the pilot of study on 15 members of medical students to detect if there is any difficulty of answering, and these members are not included in our study. The pilot questionnaire will be corrected by ENT specialist.
Benefit of the study: A lot of heath care units can utilize the results of the study in raising the awareness about the diseases associates with higher serum lipids especially in Saudi Arabia population, also, the results can alert the individuals who are at risk for elevation of serum lipid to rectify the problem by healthy lifestyle choices.

Conflict of interest and funding:
The investigators have no conflict of interest. They have not received any research grant from any company or organization for this project.
Ethical consideration: Ethical approval to conduct the study will be obtained from the right ethical committee of medical College (REC-CM), Taibah University. All human subjects research carried out in college of medicine, Taibah University, must be reviewed and approved prior to the involvement of human subjects in research. Ethical consideration will be considered. Privacy and confidentiality are assuring. electronic consent was obtained from every participant after explanation of the objective and methodology of the study.

Results: -
By the end of the survey period, data had been collected from 289 individuals, one hundred and twenty-nine (44%)of whom were men and one hundred fifty-nine (55%) were women. The students were within the age range of 18-25 years old, with total mean age of both sexes 23 years old, and the majority of the participants were females (55.0%) as shown in Figure1. Interestingly, a high prevalence of ENT problems was observed among those who completed our questionnaire,257 (91, 7%).Also, what stands out in figure 1 is the high prevalence of throat infection alone (54.7%). We found a positive correlation between the prevalence of throat, nose and ear diseases and the area of residency.As can be seen from Table 1 and Figure 2, a high prevalence of ENT diseases reported significantly more in urban residents. Generally, students with ear diseases were 123 (42.6%), the nose diseases were reported in 173.0 (59.9%) and those with throat diseases were 271.0 (93.8%) and their associations with gender are illustrated in Table 2. Approximately ninety three percent of respondents reported having the attack of throat infection, most of them (59%) have this attack once to two times per year and while only six percent rarely complain of throat infection as depicted in figure 2. Regarding those who reported having throat infection, throat pain was the most common symptom as reported bya total of 227 (78%), and the least common symptom during throat infection attack was fever with only (48%) as set out in Table 3. Twenty-six (9%) of participants underwent tonsillectomy, and in most of them it was done between the age of three to six years old (13%).We found no specific relation between participants who had their tonsils removed and recurrent throat infection, as seen in Table 4. Furthermore, we reported that 173 (59.9%) of respondents developed nose infection symptoms, while 116(40.1%) did not usually suffer from nose infection. Most common symptoms reported among them was nasal discharge in (40.5%), and the least common one was fever (18.3%) as in Figure 2. Nearly 4.8% of participants had their adenoids removed, and in most of them it was done between the age of three and six years old as in Figure 3. In addition, a total of 30.8% of participants had nasal epistaxis attack while 61.6% did not suffer from this as illustrated in Figure 5 and Table 5. Moreover, about 123 individuals (42.6%) had ear infection, most of them (96) developed this attack once to two times per year as shown in Figure 6. It can be seen from the data in Table 6 that most of them (32.9%) complained of ear pain. According to the attitude of participants towards their ENT problems as presented in Table 7, approximately 45.5% of participants received their antibiotics prescriptions from doctors. In the other hand, about 32% of respondents managed their ENT symptoms by taking over the counter drugs or other medications including prescribed antibiotics from home. And a minority about 4.5% did not do anything regarding their illness. Also, around 75 individuals (26%) visited the emergency department due to ENT problems \infection, and most of them (16.6%) did that because their symptoms lasted more than one day, and only 1% of them sought medical help in the ER because they noticed discharges as set out in Table 8.

Discussion: -
An ample variation between the prevalence of ENT disorders and attitude was recognized in this study. We found a high prevalence of ENT problems among 257 respondents (91,7%). And the most common complain among all ENT disorders was throat infection alone. As mentioned before, the prevalence of throat problems was 271.0 (93.8%), nose problems 'prevalence was 173.0 (59.9%), and the prevalence of ear problems was 123 (42.6%). Comparatively, these results are contrary to data obtained in a study conducted in Hospital & University of Ibadan, Nigeria. In this study the prevalence of throat diseases was 479 (9.6%), Nose disorders' prevalence was 1153 (23.0%), and the prevalence of ear problems was 3136 (62.7%) [1]. This discrepancy could be attributed to differences of hygiene level, degree of temperature and personal habit. Regarding ear disorders, a Scottish study reported that most of the participants (32.9%) complained of ear pain, but (9%) complained of diminished hearing. This study had a wide range of age and showed a high prevalence of hearing loss among men aged above 75 years old [11]. According to nose diseases, an international longitudinal research which was a community-based study of more than 11000 individuals aged 20-44 years old from 14 countries in Europe and America found persistent nasal discharge was the most common nasal symptom [13]. This inconsistency may be due to the narrow range of age that we used in our study. Concerning, the attitude of respondents in our study towards ENT problems, around 26% of them visited the emergency department, most of them (16.6%) did that because they noticed a discharge. However, In a study conducted in Nottingham, 18% of respondents visited their GP in the previous two years for hay fever, but in a Scottish study, 17% of respondents visiting their GP for nasal problems [11,12].

Limitations: -
The generalizability of these results is subject to certain limitations. For instance, inclusion of a greater number of participants was not feasible. Also, inability to obtain a detailed history that measures severity of symptoms, their effect on quality of life, and potential risk factors such as smoking, allergy, close contact with infected patients and other occupational hazards. More in-depth study of participants' knowledge about ENT diseases and considering socioeconomic and demographic aspects would be undoubtedly advantageous to get a fuller understanding of patterns of help-seeking behavior. Furthermore, the scope of this study was limited in terms of its external validity. The methodology that was implemented in data collection yielded qualitative data that only can be interpreted relative to participants' populations.

Conclusions: -
Ear, nose and throat infections \problems occur widely among study's participants. The most prevalent complain of the respondents with ear, nose and throat disorder was throat infection alone. The majority of participants received antibiotics prescriptions from doctors, and most of them visited the emergency department due to ear, nose and throat problems.

Recommendations: -
A high prevalence of ENT diseases among medical students necessitates a larger exploit for media in spreading awareness about this issue. Since many ENT diseases are infectious, and hence could be preventable by variable means which include: 1-Students must understand their responsibilities to protect themselves as individuals and their responsibilities to protect patients from the hazards of infectious diseases. 2-The university and the individual student have a duty of care towards both students and patients to minimize the risk of spreading or contracting infectious or air-borne diseases. 3-The university has a legal duty to ensure the safety of students and patients. If a student or patient is knowingly or unknowingly infected during the course of a student's clinical experience, the university may be held legally liable. It is not sufficient to have infectious diseases policies in place; it is necessary 755 to ensure programs are implemented and that students comply. 4-Students are responsible for understanding and practicing infection control practices, including standard and additional precautions, in their clinical experiences. 5-Implementation for an immunization program including vaccinations and related tests for specified infectious diseases are a must. 6-Medical students have an ethical duty to be aware of their immunity or infectious status to ensure they do not place others at risk of infection. 7-promote the concept of health seeking behavior among medical students towards ENT diseases and infections by getting contact with specialized otolaryngologists, in despite of having a background of the illness. Ultimately, we encourage to conduct further studies on the same subject to include all medical students in all over the Kingdom of Saudi Arabia.