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ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 5  |  Page : 606-609

Otorhinolaryngological emergencies in a Tertiary Hospital in Port Harcourt


Department of Ear Nose and Throat Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Date of Acceptance19-Oct-2016
Date of Web Publication17-May-2017

Correspondence Address:
U M Ibekwe
ENT Surgery Department, University of Port Harcourt Teaching Hospital, Port Harcourt
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1119-3077.196988

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   Abstract 

Background: Emergencies are not uncommon in a typical otorhinolaryngological (ORL) clinic. The knowledge of the profile and prevalence of these emergencies will go a long way in helping to equip as well as aid proper and prompt management of these conditions so as to reduce their morbidity and mortality. Patients and Methods: A descriptive retrospective 8 years review of all patients that presented to the ENT Surgery Department from January 2004 to December 2012. This includes referrals from the accident and emergency as well as the children emergency ward. The patients case files, the ward, and theatre records were the source of data. Data collected included; age, sex, presentations, diagnosis, and management. Results: There were a total number of 5660 patients that presented as emergencies, however only 2160 cases were real emergencies. Males were 1328 and females 832 with a ratio of 1.6:1. The age ranged from 6 months to 70 years. The age range 0-10 years were the most affected 670 (31.02%) followed by age range 21-30 years 534 (24.72%). The least was 61-70 years 26 (1.20%). Foreign body aspiration/ingestion/insertion was the commonest emergency 900 cases (41.7%) followed by trauma 650 (30.09%). There were five cases (0.23%) of mortality recorded. Respiratory distresses from upper airway obstruction, dysphagia, and odynophagia were the common presentations. Direct laryngoscopy, esophagoscopy, and tracheostomy were the commonest form of management. Conclusion: ORL emergencies are common. The pediatric age group is the most affected; foreign body and trauma comprise the commonest emergency in our environment.

Keywords: Emergencies, foreign body, otorhinolaryngological, trauma


How to cite this article:
Ibekwe U M. Otorhinolaryngological emergencies in a Tertiary Hospital in Port Harcourt. Niger J Clin Pract 2017;20:606-9

How to cite this URL:
Ibekwe U M. Otorhinolaryngological emergencies in a Tertiary Hospital in Port Harcourt. Niger J Clin Pract [serial online] 2017 [cited 2020 Apr 7];20:606-9. Available from: http://www.njcponline.com/text.asp?2017/20/5/606/196988


   Introduction Top


Otorhinolaryngological (ORL) emergencies occur in every society, however, it has been found that majority of these consultations are not real emergencies.[1],[2]. In some studies, only about 10% were found to be truly urgent cases.[3],[4]

While variety of the ORL disorders that present as emergencies are most of the time benign, some are critical requiring prompt diagnosis and treatment. There are those that are also potentially life threatening. It is of note also that some of these emergencies are avoidable causes of death and disability.[5],[6]

Foreign body injuries are the commonest cause of ORL emergencies [7],[8] occurring more in children.[9] Foreign bodies in the larynx and oesophagus are major causes of morbidity and mortality especially in the extremes of age.[10]

Other forms of emergencies include traumatic injuries [11] such as cut throat, blunt, and penetrating neck injuries as well as gunshot injuries with their attendant mortalities.[12] These emergencies involving the aerodigestive tract can be life threatening as well as challenging even to the otolaryngologist. Acute tonsillitis with its complications, acute epiglottitis, corrosive ingestions as well as epistaxis can be seen as serious emergencies requiring prompt intervention.

There is a paucity of the study of these emergencies in our environment, this study, therefore, is to determine the profile of these emergencies, the management, and challenges so as to improve on the morbidity and mortality of these conditions.


   Patients and Methods Top


This is a descriptive retrospective 9 years review of all patients that presented as emergencies to the ENT Surgery Department from January 2004 to December 2012. This includes referrals from accident and emergency as well as children's emergency ward. The patients' case files' ward and theatre records were the source of data.

Data collected included sex, age, diagnosis, presentations, and management. These emergencies are grouped using Cuchi's etiological classification [13] with some modification. The results are presented in simple statistical tables.


   Results Top


There were a total number of 5660 patients that presented as emergencies, however, only 2160 cases were real emergencies. Males were 1328 and females 832 with a ratio of 1.6:1.

The age ranged from 6 months to 70 years. The age range 0-10 years were most affected 670 (31.02%) followed by age range 21-30, 534 (24.72%). The least was 61-70, 26 (1.20%) [Table 1].
Table 1: Age distribution

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Foreign body was the commonest emergency seen in 900 cases (41.7%) followed by blunt trauma/RTA in 650 (30.09%). Infections and inflammation constituted the third commonest group of emergencies seen in 383 cases (17.73%) shown in [Table 2].
Table 2: The ORL emergencies

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The commonest emergency seen in the age group 0-10 years was foreign body 480 cases representing 71.6% of the whole presentation in this group. They form 22.24% of the 41.70% foreign body emergencies. While blunt trauma/RTA, Road traffic accident. was commonly seen in the ages 21-30 and 31-40 years [Table 3].
Table 3: Age distribution of the emergencies

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While majority of the foreign bodies seen in the ages 0-10 years ranged from peanuts to ornamental beads, that of the ages from 21 to 70 comprised of fish bones and dentures.

Commonest clinical feature seen was respiratory distress from upper airway obstruction following foreign body aspiration and ingestion as well as dysphagia and odynophagia. This was seen in about 85% of all the patients presenting with foreign body and comprised 35.42% of total number of the patients. Most of the patients were investigated radiologically using plain lateral soft tissue X-ray of the neck.

Majority of the patients in the age range of 0-10 years with foreign body had emergency tracheostomy done. Esophagoscopy and direct laryngoscopy and tracheostomy were ultimately the commonest form of management of these emergencies [Table 4].
Table 4: Procedures

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There were five cases (0.23%) of mortality recorded. There were five cases(0.23%) of mortality recorded, as shown in [Table 5].
Table 5: Complications

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   Discussion Top


In this study, even though there were 5660 apparent emergencies, the real emergencies were 2160 representing 38.2% of the total consultations. This gives credence to the observations of some earlier studies that not all the emergencies were found to be urgent cases.[1],[3] There was a male preponderance similar to findings of farnetip [14] unlike others that found more females involved.[2],[15]

The finding of 38.2% as real emergencies compared to other findings of 62.7% and 61.26%[16],[17] appears lower, however Rivero et al.[4] had a similar rate of 30-40% as well as Sanches-Alcon et al.[18] with 56%. Timsit et al.[3] has the lowest rate of 10%. These differences we do not have plausible explanation for except that the societies are different as well as the times and exposures.

The age group 0-10 years was found to be most affected comprising 31.02% of all cases seen and foreign body was the commonest form of emergency encountered (41.70%). It is known that this is the age range that is most affected by this condition [8],[19] most of the foreign bodies in this age group was aspirated while ingestion was commoner in the older age groups. The nature of the foreign body differs as well. In the age group 0-10 years, it was mainly ornamental beads and peanuts, the older ones ingested mainly fish bones and dentures. The inserted foreign bodies seen as emergencies were due to injuries following the insertions and unskilled attempts at removal.

Trauma is very high on the table; the 2nd commonest cause of emergency presentations 30.09%, some other studies found it to be the 3rd commonest [14] the ages 21-30 years comprises 10.41% of this. Majority of the trauma cases were seen in the ages from 21 years spanning to 40 years, it is noticed to disappear after age 50 years. This is apparently the age range of active work life, therefore more exposure to potential hazards.

Epistaxis, in this study, even though is seen in the very young age was found more in the age group 31-40 years unlike some researchers that had bimodal presentations [20],[21] while others found it more in the extremes of age, however, with different a etiological factors in these age groups.[22] It accounts for approximately 1 in 200 visits to the Emergency Department,[22] however, here it accounts for 9.26% of all emergency presentations.

It was also found that inflammatory/infective conditions constituted like some other researchers also found, the 3rd commonest ORL emergencies.[23] However, some found it the commonest [18],[24] with fb in the second position. In this study, tonsillar infections with its complications as well as corrosive ingestions and burns are all grouped under infections/inflammations.

In an earlier study done in Ibadan Nigeria, there were 20% of the cases found as real emergencies with upper airway obstruction being the commonest presentation. The study, however, was done in the geriatric age group only.[25]

The commonest presentation here is respiratory distress from upper airway obstruction, dysphagia/odynophagia, however some studies found sudden hearing loss, pains, and hemorrhage as the most frequent presentation.[3]

The commonest investigative tool employed in these conditions was plain X-ray of the lateral soft tissue of the neck done especially in cases of fb and infection/inflammation group of emergencies.

These patients were often managed surgically. Examination under anesthesia, esophagoscopy, tracheostomy, and direct larynygoscopy were commonly done. Tracheostomy was done in majority of the group 0–10 years with foreign body emergencies as well as in all the adults that presented with cut throat injuries. In this very young age even the foreign bodies in the hypopharynx/esophagus especially in the cricopharyngeal part still presented with respiratory distress from upper airway obstruction.

In terms of complications, tracheal stenosis was seen in three cases of cut throat injuries that had damage to their trachea from the injury. There was also a patient that developed aneurysm of the external jugular following gunshot injury to the neck. The five cases of mortality were from foreign body aspirations that presented late (three cases) and died before intervention could be instituted. While the remaining two cases were cut throat injuries that died following complete transection of the trachea and severe sepsis.

The challenges in the management of these patients noted were as follows, absence of fluoroscopy to determine promptly the location of fbs such as dentures. Dependence is on soft tissue signs which sometimes can be unreliable. In children, lack of appropriate sized scopes and grasping forceps can be challenging to the surgeon. Absence of venturi system for bronchoscopic fbs makes removal of such fbs very difficult with attendant dangers of respiratory failure.


   Conclusion Top


ORL emergencies are common. The children are more affected. Prompt diagnosis and appropriate management is necessary so as to reduce morbidity and mortality.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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[Pubmed] | [DOI]



 

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