“Pattern of Disease among the Patients Suffering from Otitis Externa in ENT Outpatient Department at Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh”

Abstract

Introduction: Otitis externa is a common otologic problem affecting between 5% -20% of patients seen in an otolaryngological practice in the tropical and subtropical regions of the world, a general practitioner can expect to see 16 new cases per year. Objective: To assess the pattern of disease among the patients suffering from otitis externa in ENT outpatient department at shaheed ziaur rahman medical college hospital, bogura, Bangladesh. Materials and Methods: This prospective study was carried out on the patients suffering from aural symptoms suggestive of otitis externa in ENT outpatient department of Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh. Among 202 patients (222 affected ears) with the aural symptoms suggestive of otitis externa and 111 healthy control (222 ears), from January 2019 to December 2020. We also included age and sex matched 111 healthy individuals to serve as control, which provided total 222 control units. The patients having symptoms suggestive of otitis externa were randomly selected from the ENT outpatient department of SZRMCH. Results: Our study maximum 71(35.1%) patients were in the 21 -30 years age group followed by 47 (23.2%) were in the 11 -20 years age group. 30 (14.8%) patients were within 31 - 40 years. 18 (8.9%) patients were within both 41 -50 years and > 60 years of age groups. Out of the total 202 patients 113 (55.9%) patients were male and remaining 89 (44.0%) were female. The male -female ratio was 1.3:1. Shows that 106 (52%) patients were smoker and 96 (48%) patients were non-smoker. Maximum number of 169(76.1%) cases were acute otitis externa, which had been suffering for less than two months. Rest 53(23.8%) were chronic cases suffering for more than two months. Most of the ears had multiple complains of which commonest was itching in 203 (91.4%) affected ears, followed by earache in 177(79.7%) ears, sense of blocked ear in 132 (59.4%) ears, discharge in 114 (51.3%) ears, deafness in 26 (11.7%) ears and tinnitus in 17 (7.6%) affected ears. From the results of microscopic examination and culture of ear swab we detected pure bacterial growth in 48 (21.6%) acute cases and 10 (4.5%) chronic cases, pure fungal growth in 74 (33.3%) acute cases and 22 (9.9%) chronic cases, mixed bacterial and fungal growth in 16 (7.2%) acute cases and 10 (4.5%) chronic cases, no growth or contamination in 32 (14.4%) acute cases and 10 (4.5%) cases. Most of the ears were affected by fungal infection accounting 49.0% (109 cases), followed by bacterial infection in 31.9% ears. Out of 71 cases of otitis externa caused by bacteria 29 (40.8%) were due to Pseudomonas aeroginosa, 26 (36.6%) were due to Staphylococcus aureus, 10 (14.0%) were due to E.coli and 6 (8.4%) were due to Proteus mirabilis. Among the culture positive ears 13 (38.2%) were due to Aspergillus, 9 (26.4%) were due to Candida, 6 (17.6%) Penicillium, 3 (8.8%) Mucor and 3 (8.8%) were due to other fungal strains. The microbiological and culture finding of ear swabs among the healthy population of bacterial isolates of which 10 (16.6%) were Staphylococcus aureus, 26 (43.3%) were Staphylococcus epidermidis, 8 (13.3%) were Diphtheroids, 7 (11.6%) were E. coll. 3 (5.0%) were Proteus and 6 (10.0%) were Pseudomonas aeroginosa. Conclusion: From this study it is also evident that although bacteria could be detected from control cases but the isolation of fungus were negligible. Most of the bacteria were normal commensal. Whereas in diseased ear presence of fungus in the ear canal was highly significant, which signifies the prerequisite of an altered aural flora and fauna for the development of fungal infection.