Geriatric Otorhinolaryngology , Head and Neck Emergency in a Nigerian Teaching Hospital , Ado Ekiti

Background: Issues of geriatric otolaryngologic emergency have not been widely applied despite an increase in the geriatric population. This study aimed at determining the prevalence, sociodemographic features, etiology, clinical features, complications and sources of referral of geriatric otorhinolaryngological, head and neck emergency in our center. Materials and Methods: This was a prospective hospital-based study of geriatric otorhinolaryngology emergency in the Ear, Nose and Throat Department of Ekiti State University Teaching Hospital. The study was carried out between October 2016 and September 2018. Data were obtained by using a pretested interviewers questionnaire. All data were collated and analyzed using SPSS version 18.0. The data were expressed by frequency table, percentage, bar charts, and pie charts. Results: Geriatric otorhinolaryngology, head and neck emergency accounted for 5.3%. Major prevalence age group was 43.9% in the age group (60 64). There were 38.6% of males with a male to female ratio of 1:1.5. The main etiology of geriatric otorhinolaryngology emergency was 29.5% trauma/road traffic accident/foreign body impaction and 25.8% tumor. Main anatomical distribution of geriatric otorhinolaryngology emergency was 38.6% throat diseases and 31.1% ear diseases. The most frequent clinical features were the pain in 27.3%, hearing loss in 21.2%, tinnitus in 15.9%, bleeding in 14.4%, difficulty breathing in 12.9% and discharge in 11.4%. Common diagnosis in this study was 15.9% sinonasal tumor, 14.4% upper aerodigestive foreign body impaction, 10.6% earwax impaction and 19.8% otitis externa. Acute presentation (<13 weeks) occurred in 1 week in 74.2% and 2 13 weeks in 19.7%. Commonest time of presentation was daytime in 65.9%. Major sources of referral were 43.2% general practitioner and 31.1% casualty officHow to cite this paper: Adegbiji, W.A., Aremu, S.K. and Aluko, A.-A.A. (2019) Geriatric Otorhinolaryngology, Head and Neck Emergency in a Nigerian Teaching Hospital, Ado Ekiti. International Journal of Otolaryngology and Head & Neck Surgery, 8, 81-90. https://doi.org/10.4236/ijohns.2019.83009 Received: March 13, 2019 Accepted: April 5, 2019 Published: April 8, 2019 Copyright © 2019 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access W. A. Adegbiji et al. DOI: 10.4236/ijohns.2019.83009 82 Int. J. Otolaryngology and Head & Neck Surgery ers. Presentation of geriatric otorhinolaryngology emergency was mainly ear, nose and throat clinic in 59.8% with accident and emergency in 28.8%. Commonest associated comorbid illnesses among the geriatric patients were 18.2% hypertension, 14.4% arthritis, and 9.8% diabetes mellitus. Conclusion: Geriatric otorhinolaryngological emergency is a common pathology associated with comorbid illnesses. Detailed clinical assessment is mandatory for effective management outcome.


Introduction
Geriatric otorhinolaryngology is a relatively new emerging ear, nose and throat subspecialty which developed in response to the health challenges from a rise in life expectancy worldwide [1] [2].The rise in life expectancy is more rapid in developed countries than in developing countries and this is associated with increased health challenges to the health workers and government [3] [4] [5].This is due to the advancement of medical knowledge and its application through health services [6] [7] [8].
Geriatric Otorhinolaryngologic emergency health care is an integral part of any discipline of ear, nose and throat health practice and it is considered as an indicator of quality health care system.There is a need for every specialist hospital to have specialized emergency services to manage all forms of emergencies in ear, nose, throat, head, and neck round the clock.
Geriatric otorhinolaryngologic illnesses and injuries are common clinical disorders which are encountered in general otolaryngologic emergencies practices.In the elderly due to the aging phenomenon, cognitive impairment and associated comorbid diseases there may be alteration of these diseases presentation.All these may make it difficult for geriatric patients to provide an accurate history with difficulty in arriving at accurate diagnosis and management.The challenges of the elderly ear, nose and throat patients for the otorhinolaryngologist, head and neck surgeon in the emergency room have been a perennial discussion [9] [10] [11] [12].
There is a paucity of the study on geriatric otorhinolaryngologic, head and neck emergencies in developing countries and Nigeria in particular.This study aimed at determining the prevalence, sociodemographic features, etiology, clinical features, complications and sources of referral of geriatric otorhinolaryngological, head and neck emergency in our center.Consent was obtained from the patients.All the consented geriatric patients with ear, nose, and throat emergency were enrolled in the study.A pretested semi-structured self-administered questionnaire was designed and used to collect data.

This
Data were obtained by using a pretested interviewers questionnaire.Data obtained from each patient during the study included Sociodemographic data, presenting symptoms, duration of symptoms and pre-hospital and hospital management.P ≤ 0.05 was taken as significant.These were followed by detailed ear, nose and throat examination.All findings on history and examinations were documented.
Treatment interventions for emergency cares were noted.Associated complications from the emergency or its pre-hospital and hospital treatments were also documented.
All data were collated and analyzed using SPSS version 18.0.The data were expressed by the frequency table, percentage, bar charts, and pie charts.
Ethical clearance for this study was sought for and obtained from the ethical committee of the institution.

Results
Geriatric otorhinolaryngology, head and neck emergency accounted for 132 (5.3%) of the 2473 patients seen in our ear, nose and throat department during the study period.

Discussion
Geriatric otorhinolaryngologic emergency conditions are common otorhinolaryngologic workload in our institution with high prevalence as noted in this study.This is similar to the report of other studies in Nigeria and beyond [13] [14].This is because geriatrics population is on the rise worldwide which has led to its projected increase in the near future even in developing countries due to global human development report released by the United Nations Development Programme (UNDP) [15].nant urban dwellers.These findings are contrary to findings in other studies [16] [17].This could be due to the geographical difference in the study population.
The finding is however similar to report from a study done southern part of Nigeria [18].Geriatric otorhinolaryngologic emergency conditions are similar to other forms of emergencies with the mostly early presentation, common presentation during the day time and were referred mainly by general practitioners or casualty officers [25].
The process of aging leads degenerative changes with resultant organs dysfunction among the geriatric patients.This leads to the associated comorbid illnesses in geriatric patients which must be ruled out by detailed clinical assessment.The major comorbid illnesses in this study were hypertension, arthritis, diabetes mellitus, and cardiopulmonary diseases.A similar finding was reported in other studies [26] [27] [28].

Conclusion
The geriatric otorhinolaryngological emergency is a common pathology.They are associated with comorbid illnesses and disabilities at presentation.Detailed clinical assessment is mandatory for effective management outcome.Provision of adequate personnel and equipment by policymakers are strongly advised.

Limitation
The study was a hospital-based study and such the data may not absolutely represent what is obtained in the entire community.

Funding
There was no financial support.It is a self-sponsored research study.
was a prospective hospital-based study of geriatric patients who presented with history and clinical features of otorhinolaryngology emergency in the Ear, Int.J. Otolaryngology and Head & Neck Surgery Nose and Throat Department of Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.The study was carried out between October 2016 and September 2018.

Figure 2 .
Figure 2. Duration of emergency prior to presentation.

Figure 3 .
Figure 3.Time of presentation among the patients.

Figure 4 .
Figure 4. Pattern of presentation among the patients.

Table 2
Table 3 demonstrated the aetiology among the patients.Anatomical distribution of geriatric otorhinolaryngology, head, and neck emergency were 51 (38.6%) throat diseases, 41 (31.1%) ear diseases and 28 (21.2%)Int.J. Otolaryngology and Head & Neck Surgery nose diseases.Figure 1 showed the anatomical distribution of the emergency among patients.The most frequent clinical features of the geriatric otorhinolaryngology, head and neck emergency in this study were pain in 36 (27.3%), hearing loss in 28 There was an acute presentation (<13 weeks) otorhinolaryngology emergency of both 1 week in 98 (74.2%) and 2 -13 weeks.In 26 (19.7%) and were commoner than chronic otorhinolaryngology emergency (≥13 weeks) in 29 (7.5%).Duration of emergency prior to presentation is illustrated in Figure 2. In this study, commonest time of presentation of geriatric otorhinolaryngology, head, and neck emergency was daytime in 87 (65.9%).The other presentation was at night and late night in 24 (18.2%) and 21 (15.9%)respectively.Figure 3 demonstrated time of presentation among the patients.Major sources of referral were from 57 (43.2%) general practitioner, 41 (31.1%) casualty officers, and 22 (16.7%)self-reporting.Table 6 sources of referral among the patients.

Table 1 .
Age group distribution of the patients.

Table 2 .
Sociodemographic features among the patients.

Table 4 .
Clinical features of the emergency among the patients.

Table 5 .
Diagnosis of emergency among the geriatric patients.

Table 6 .
Sources of referral among the patients.

Table 7 .
Comorbid illnesses among geriatric otorhinolaryngology, head and neck emergency.
Figure 1.Anatomical distribution of the emergency among patients.