Release: September 9, 2001
Contact: Kenneth Satterfield(703) 519-1563[email protected]303-228-8460 (9/7-9/12)
EAR, NOSE, AND THROAT SYMPTOMS RUN RAMPANT IN HOSPITAL WARDS
An inpatient stay for any reason can aggravate
hearing, nasal, and swallowing functions.
Denver, CO -- It has been well established that risk factors such as age, smoking, and intubation predispose patients to potential ear, nose, and throat problems. However, there are few physician guidelines for screening, prevention, and management of these problems.
An inpatient hospital stay can highlight or exacerbate existing ear, nose, and throat disorders, even when the reason for admittance is for other medical probems. Accordingly, New York otolaryngologists set out to heighten awareness of ear, nose, and throat disorders that can be associated with specific risk factors present in a hospital environment. The findings will possibly lead to more rigorous screening and management guidelines in the future.
The authors of the study, "ENT Symptoms Run Rampant on the Wards," are Raymond Howard, MD, Andrew Goldman, MD, Marina Boruk, MD, Maria Pallotta, PA, and Krishnamurthi Sundaram, MD, all from the Department of Otolaryngology-Head &Neck Surgery, State University of New York Medical Center at Brooklyn, Brooklyn, NY. Their findings were presented at the American Academy of Otolaryngology--Head and Neck Surgery Foundation Annual Meeting/OTO EXPO, being held September 9-12, 2001, at the Colorado Convention Center, Denver, CO.
Methodology: The authors developed a survey, listing a variety of common ear, nose, and throat symptoms, and administered the questionnaire to a random sample of 557 inpatients at two hospitals in Brooklyn, New York; one a large public city hospital, the other, a large private Jewish hospital.
The survey was conducted bed-by-bed, floor-by-floor. Excluded from the study were patients in (1) the intensive care units and post-anesthesia care units, (2) on ventilators, (3) admitted on the pediatric services, (4) the operating rooms or undergoing bedside procedures, (5) patients who were not present at the bedside, (6) patients admitted on the psychiatric service, (7) patients with illness that prevented reliable communication or comprehension, (8) patients admitted on the otolaryngology service, (9) patients for whom the otolaryngology service was consulted, (10) patients who had seen an otolaryngologist within six months prior to admission, and (11) patients for whom an interpreter could not be obtained expeditiously.
There were three main organ systems surveyed which were subdivided into four symptoms. All patients were asked to subjectively assess the degree of severity of each symptom during their current hospital admission. A five-point ordinal scale was used. A severity score of one meant the patient did not experience the symptom during the hospitalization, and an answer of five represented extreme bother by the symptom. A severity score of three or greater was considered clinically significant.
Results: A total of 557 patients were surveyed during six consecutive weeks. Twenty-three patients were unable to complete the questionnaire due to malaise caused by their illness. The mean age of the patients surveyed was 51 years with a range of 20 years to 92 years. 54 percent of the patients were female, and 46 percent were male. 324 patients (62 percent) surveyed responded to having at least one ear, nose, or throat (ENT) symptom. 282 patients (54 percent) expressed having greater than one symptom, and 230 (71 percent) of the patients who had symptoms stated that the severity was a score of 3 or greater. Key findings included:
* Age: Patients who were 70 years of age and older had more hearing-related symptoms. Difficulty in hearing was the most prevalent symptom (92 percent). No one-organ system prevailed as having a predominance of symptoms in patients between the ages of 40 and 69. However, patients younger than 40 were found to have a predominance of rhinologic symptoms, particularly nasal airway obstruction (45 percent). In the two age groups where a specific organ system was found to be especially problematic, the corresponding mean severity scores were also substantially higher than those of the other organ systems.
* Tobacco use: Patients who had a history of heavy smoking showed a significant overall increase in incidence of ENT symptoms when compared with those who had no smoking history. Of the 413 (79 percent) patients who had a history of smoking tobacco products, only 28 (seven percent) stated they had no ear, nose, and throat disorders. Thirty-three (30 percent) of 109 non-smokers answered no problem for all symptoms. No clinical significance was found when comparing ear symptoms vs. nose symptoms vs. throat symptoms in the patients with histories of smoking.
* Alcohol use: The results showed that patients who were dependent on alcohol mirrored that of the patients who were heavy smokers. All of the patients who showed a dependency on alcohol were also smokers, except for two. Data on these two individuals has no clinical significance.
* Administration of oxygen: The use of supplemental (non-humidified) oxygen delivered by a nasal tube had a profound outcome on patients with rhinologic symptoms. The findings revealed that 123 patients had received oxygen therapy via nasal canula for greater than 24 hours during their hospital stay. Of that group, 69 (56 percent) responded to having difficulty breathing through the nose, and 72 (59 percent) noted a decrease in their ability to smell and taste.
* Intubation: Eighty three percent of patients intubated with an endotracheal tube and 68 percent with nasogastric tubes during their hospitalization experienced problems with their throat. There was a much higher incidence of hoarseness (78 percent) found in patients with endotracheal intubation than any other symptom.
* Gender: A preponderance of nose complaints was seen in male patients; in contrast, female patients complained of a large number of ear problems.
* Prior medical history: 178 patients (76 percent) who had a prior history of ENT symptoms and had been evaluated by an otolaryngologist showed symptoms corresponding to the same organ. Only 19 (11 percent) of these patients stated that their symptoms were preexisting.
Conclusion: A substantial number of hospital inpatients experience ear, nose, and throat symptoms that cause significant distress. Specific factors such as age, a prior history otolaryngologic illness, recent intubation, oxygen therapy via nasal delivery, smoking tobacco products, and alcohol use have a positive correlation with the presence of ENT symptoms. The authors recommend physicianinstruction on how to identify high-risk patients who would benefit from early intervention by an ear, nose, and throat specialist.
- end -
RSS