Brief Reports

Brief Reports

Indian Pediatrics 1999;36: 1256-1258

Pediatric Emergencies in Otolaryngology in a Metropolitan City

Sunil Kumar, Achal Gulati

From the Department of Otorhinolaryngology, Maulana Azad Medical College and Associated Lok Nayak and G.B. Pant Hospital, New Delhi 110 002, India.
Reprint requests: Dr. Achal Gulati, Professor, Department of Otorhinolaryngology, Maulana Azad Medical College and Associated Lok Nayak and G.B. Pant Hospital, New Delhi 110 002, India.
Manuscript received: January 18, 1999;
Initial review completed: February 22, 1999;
Revision accepted: July 26, 1999

Nearly one third of otorhinolaryngological outdoor attendance is comprised by the pediatric age group(1). This prompted us to analyze the otorhinolaryngological emergenceis in this age group in our setting to provide a baseline data which may assist in future planning.

Methods

A retrospective analysis of cases presenting as emergencies was done in the Department of ENT of the Lok Nayak Hospital, New Delhi from January, 1992 to January, 1994. All consecutive cases in the pediatric age group upto the 12 years were studied. The cases either came directly from casualty or were referred from Pediatric Emergency Services.

Observations

During the 2 years period a total of 2678 ENT emergency calls were attended. Out of these 902 (33.7%) calls were from the pediatric age group. There was slight preponderance of male (519 males and 383 females). Only 170 (19%) cases required admission either for close observation, systemic antibiotics or for surgical procedures. The maximum number of cases were seen in age group of 3-4 years. The foreign-bodies in nose, ear and aerodigestive tract collectively, 399 (44.2%) cases, topped the list. Among the foreign-bodies, nose 176 (45%) was the commonest site followed by ear 102 (25%), esophagus 83 (21%) and bronchus 18 (4%).

The next common problem was that of infective conditions 206 (22.8%) and majority of these infections were related to ear as shown in Table I. Epistaxis accounted for 111 (12.3%) cases. There were 30 (3.3%) cases of lacerated wounds on lip, nose, palate and tongue.

Table I^__ Frequency Distribution of Infective Cases.

Site	Disease	Number
Otological
	ASOM	58
	CSOM with/without
	complications	29
	Otitis externa	22
	Otomycosis	16
Laryngological
	Diphtheria	16
	Acute tonsillits	11
	Laryngotracheobronchitis	9
	Ludwig's angina	5
	Retropharyngeal abscess	5
	Acute laryngitis	4
	Oral thrush	3
	Papillomatosis	2
Rhinological
	Septal abscess/hematoma	5
Others
	Mumps	2
	Submandibular lymphadenitis	3
	Peritonsilitis	3
	Lymph node abscess neck	13

ASOM_Acute suppurative otitis media.
CSOM_Chronic suppurative otitis media.

Discussion

Injuries form major bulk of emergencies in children followed by respiratory disorders and gastrointestinal problems, however, ENT problems were reported only in 3.6% of cases(2). In the present study no such systematic analysis was made in all pediatric emergency cases. Only pediatric cases referred to oto-laryngology were studied. In our study pediatric patients accounted for 33.7% (n = 902) out of total 2678 ENT emergency calls. In another study, children comprised 39% of subjects reporting at night time and at weekend to Otolaryngology service(3). This figure is comparable to our study.

The commonest problem encountered was foreign body insertion and the nose was most frequent site in this study. Different frequencies have been reported for foreign bodies insertion in other data sets(4,5). The next common problem encountered was of infections of different sites. The bulk of these were acute and chronic infections of ear, accounting for 9.6% of all infective cases. Otitis externa and acute otitis media dominated the picture(5). In the present study 16 cases of diphtheria were also seen.

Majority of ENT emergencies in pediatric age group were not life threatening and could have been dealt with on an OPD basis. However, because of parental anxiety, these presented to emergency services. Many of the cases could also have been managed in the Pediatric Emergency Department itself. A little training of pediatric residents in dealing with such cases might help to reduce the burden on ENT emergency services.

Parents, teachers and other health functionaries should be educated to identify these situations and bring them to medical notice immediately. The help of mass media and print media should be taken to propagate the message which should be simple and short and reinforced periodically(6).

An increased emphasis on the ENT train- ing of medical student and practitioner is required(5). A short posting of pediatric residents in otolaryngology is also desirable to familiarize them with the common emergencies. This study provides baseline data on pediatric otolaryngology emergencies for future planning.

References

1. Pracy R. Introduction. In: Scott-Brown's Otolaryngology, vol 6, 5th edn. Ed. Evans JNG. London, Butterworth, 1987; p 1-3.

2. Kiberd B, Sinclair H. A survey of new attenders at a pediatric accident and emergency department. Irish J Med Scie 1994; 163: 282-286.

3. McShane DP. Analysis of night-time weekend Otolaryngology service. Irish J Med Sci 1989; 158: 150-152.

4. O'Driscoll K, Donnelly MJ, McShane DP, Burns H. An audit of the ENT Casualty service at the Royal Victoria Eye and Ear hospital. Irish J Med Sci 1993; 162: 462-465.

5. Agarwal R, Hampal S, Flood LM. The open access to ENT casualty service. J Laryngo Otology 1992; 106: 719-723.

6. National Seminar on Prevention of Childhood Accidents_A Report. National Institute of Public Cooperation and Child Development, New Delhi, 1987; pp 6-23.