LMC journal Vol. 2.indd


86

Ear Nose Throat (ENT) disorders in Government Schools of Far-Western Nepal
Acharya A1, Singh MM1, Shrestha A1 and Pokharel B2

1Department of ENT Head & Neck Surgery, 2School of Nursing, Lumbini Medical College (LMC), Tansen, Palpa, Nepal

Corresponding author: Dr. Acharya Anup, Lecturer, Department of ENT Head & Neck Surgery, 
Lumbini Medical College (LMC), Tansen, Palpa, Nepal; email: anupent@gmail.com, anupent@outlook.com.

ABSTRACT
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 disease-
related 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



87

Table-1: Age characteris  cs of the students.

Total Students 2256
Minimum age 4 years
Maximum age 16 years
Mean age 9.88 years
Std. Devia  on 2.484

Table 2: Diagnosis with their frequencies

sex Total
f m

diagnosis
0 698 635 1333
1 432 491 923

Total 1130 1126 2256

Chi-square= 6.742, P= 0.009

Table 3: diagnosis * sex Crosstabula  on

Condi  on Frequency Percent
normal 1333 59.0
wax 391 17.3
csom  138 6.1
ome 126 5.6
ET dysfunc  on 39 1.7
derma   s pinna 33 1.5
o   ts externs 33 1.5
csom as 31 1.4
otomycosis 17 .8
Allergic Rhini  s 12 .5
aom 12 .5
ur  12 .5
epistaxis 9 .4
infected lobule 9 .4
chronic nasal ves  buli  s 7 .3
acute pharyngi  s 6 .3
crs 6 .3
perichondri  s 6 .3
asom 5 .2
chronic laryngi  s 5 .2
DNS 5 .2
FB ear 3 .1
post auricular lylmphadeni  s 3 .1
pre auricular lymphadeni  s 3 .1
acute nasal ves  buli  s 2 .1
chronic allergic pharyngi  s 2 .1
pre auricular sinus (infected) 2 .1
suppura  ve cervical lymphadeni  s 2 .1
viral paro   s 2 .1
cheek celluli  s 1 .0
neck abscess (superfi cial) 1 .0
Total 2256 100.0

RESULTS
There 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, tubo-
tympanic 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 table 3. It showed males had signifi cantly more 
diseases than the females (p=0.009).

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.9 We 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.6 
Ear 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.9,10,11,12 It 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.6,9,12,13,14 There were 169 
(7.5%) cases of CSOM of which 18.3 percent were a   co-
antral 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.15 A   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.

A Acharya et al



88

Journal of Lumbini Medical College

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