Abstract
Background
Tonsillitis is defined as an inflammation of the tonsils, which is a common clinical condition caused by either bacterial or viral infections. It affects a significant percentage of the population especially children. Chronic tonsillitis (CT) is described as when an individual suffers from seven or more attacks of tonsillitis per year.
Aim
This study aimed to determine the prevalence and management of CT among patients attending all secondary care hospitals in Rabak city, Sudan.
Methods
A cross-sectional descriptive study was conducted in June-September 2022. A structured questionnaire was used to screen 297 Patients who presented to all ENT clinics within the study period. Out of the 297 patients, 77 patients were confirmed to be having CT based on the inclusion criteria. Data collected were analyzed using SPSS version 21 and arranged into a simple frequency table.
Results
The prevalence of CT was found to be 25.9 % (77) among all screened patients. The majority (67.5%) of the patients with CT were male, and mostly between the age of 11-20 years (32.4%). A considerable number of them (32.4%) were residing in the urban-industrial part of the city, and about 36.3% are not working. All the patients with CT complained of throat pain, while 88% presented with red inflamed tonsils. Laboratory investigations of these patients revealed 64% to have Neutrophilia, while 54 and 50% had high ESR and positive ASO titer, respectively. 57% of the patients underwent tonsillectomy while (30%) were managed medically.
Conclusion
The prevalence of CT was found to be high in the agro-industrial area of Rabak city and more among teenagers, and most cases were managed by tonsillectomy.
Introduction
Ear, nose, and throat (ENT) disease particularly tonsillitis represent a considerable health burden in Sudan with the high cost to the Sudanese National Health Service. This is due to high incidence, cost of treatment, and complications [1]. Understanding the knowledge and magnitude of ENT diseases will aid the health authorities to implement its management and preventive programs.
Tonsillitis is inflammation of the tonsils, a common clinical condition caused by either bacterial or viral infection [2,3]. It affects a significant percentage of the population, especially children. Chronic tonsillitis (CT) is described as when an individual suffers from seven or more attacks of acute tonsillitis per year [4]. Acute tonsillitis is characterized by visible streaks of pus or cheesy material on the tonsillar surface, and the entire tonsil may become enlarged and hyperemic suggestive of an inflammatory process. Tonsillitis is caused mainly by β-hemolytic Streptococcus, called strep throat, and to a lesser extent by Staphylococcus aureus and several other bacteria. The more common symptoms of acute tonsillitis are sore throat, red swollen tonsils, pain when swallowing, fever, cough, headache, tiredness, chills, swollen lymph nodes in the neck, and pain in the ears or neck, and the less common symptoms include nausea, stomachache, vomiting, furry tongue, bad breath, and change in voice and difficulty in opening the mouth [5]. There are three approaches to the management of CT: conservative, use of antibiotics, or by tonsillectomy. Surgical removal of the tonsils provides the definitive treatment [6].
Although the CT rate was expected to be high in the agro-industrial area of Rabak city in Sudan because of the environmental pollution, there are not enough data on its epidemiology in the area. This study aimed to determine the prevalence, clinical features, laboratory findings, and treatment modalities of patients with CT among patients reporting to secondary care hospitals in Rabak city, Sudan.
Materials & Methods
Ethical considerations
This research was approved by the Ministry of Health Research Committee, White Nile province, with ethical clearance no (5). Moreover, verbal notified consent was obtained from all participants and or their informants.
Study design
A cross-sectional, observational hospital-based research was performed in the time of June to September 2022 including all patients who visited the secondary ENT hospital of Rabak city, Sudan, who suffered from sore throats (297). Patients were seen by two ENT consultants, and diagnosis of CT was done in the ENT clinics using a head mirror, light source, and tongue depressors. Any patient with a sore throat and who had seven or more attacks of acute tonsillitis was diagnosed with CT (77 out of 297). Demographic data, clinical features, lab investigations, and treatment modalities of CT were reported in this study.
Study population
Patients visiting Rabak secondary ENT hospital complaining of sore throat and who were diagnosed later with chronic tonsillitis (seven or more attacks of acute tonsillitis) during the research period who fit the research inclusion criteria were joined voluntarily.
Inclusion Criteria
The research inclusion criteria comprise both sex and all age groups, who lived in Rabak town, Sudan, and who were diagnosed with CT by ENT consultants. The whole number of permitted participants was 77 out of 297 patients.
Exclusion Criteria
The study exclusion criteria comprise any participants with deficient investigations. (n=3) were excluded.
Sample size estimation
The formula of sample size calculation (N = PQZ2/d2) was used to calculate the sample size (N = 77).
Where N = sample size, P = prevalence of CT disorders factor, Q = 1−p, Z = constant 95% occurred 1.96, and d = desired margin.
Data collection procedure
Data were collected using a structured questionnaire. The participants were approached with questions concerning their sociodemographic details, and ENT-related complaints such as sore throat (estimated with a scale system of severity graded from 1 to 10), whilst the ENT professionals applied and reported clinical examinations, ENT-related diagnosis, investigations, and management. Moreover, checking the records of the treated patients. All patients had gone through a comprehensive history and a full physical examination by ENT professionals. Relevant investigations were carried out according to the patient’s complaint.
Data analysis
The patients’ data were processed statistically using the SPSS version 21. A descriptive statistical summarization was performed. The result was considered significant at a p-value less than 0.05.
Results
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