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Research Article
*Corresponding Author: Sphoorthi Basavannaiah, Assistant Professor, Department of ENT, Subbaiah Institute Of Medical Sciences, NH-13, Purle, Holebenavalli Post, Shimoga- 577222, Karnataka, India.
Citation: Basavannaiah S. (2020). How can Head & Neck disorders be a liability to Indian population: Hindrance & Nuisance or Hesitance & Negligence? Journal of Clinical Otorhinolaryngology, 2(2): Doi: 10.31579/2692-9562/008
Copyright: © 2020. : Sphoorthi Basavannaiah, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 07 July 2020 | Accepted: 09 July 2020 | Published: 13 July 2020
Keywords: head; neck; malignancy; disorders; limitation; negligence; ENT OPD; CA
Introduction: Head & Neck disorders still remains a “global burden” in the world map till date. With the increasing trend of cancer in the present day scenario and raising parameters of aetiology with varied clinical occurrence, there has been a major plunge at the way things are perceived by a common man in day to day life.
Aims & Objectives: To find out the various causes for Head & Neck disorder at our set up. Also to put together and touch upon aspects like risk factors, symptomatology associated with nature of the disease process in this belt of Malnad region.
Methodology: 352 patients with Head & Neck disorders were considered for the study over a period of 1 year who were evaluated clinically and radiologically. After initial evaluation, most of them were referred to higher centre for further management.
Results: Nearly 75% of patients presented with malignancy with 5 times predominance in males and around 97% patients belonging to the region from oral cavity up to larynx as they have a common epithelial origin.
Conclusion: Head & Neck disorders are never to be neglected as it the “runway” to the crux of the body system. Any sort of limitation or hesitation can cost life and well-being.
With rapid progress of technology in the field of medical sciences, various Head & Neck disorders there still remain the “global affliction” in the world map till date. With the increasing tendency of malignancy in the present day scenario, with both escalating and hovering penchant from epidemiology to aetiology to predisposing & triggerring factors moving on to varied clinical incidence to waver cure rates, there has been a major plunge at the way things are looked at from both surgeon’s perspective and patient’s perception. But, despite all the known specifics, still there is one common thing that lingers in every Indian mindset regarding the lack of audacity or awareness either in the form of hesitancy or negligency towards the health focus [1, 13].
Objectives: It is to educate the population that health must be prioritised everytime but not only when basic amenities in life such as breathing, swallowing & speaking are at stake.
Study design: Descriptive study.
Place of study: This study was conducted at Subbaiah Institute of Medical Sciences, Shimoga (Tertiary Care Hospital).
Study period: 1 year (from September 2018 to August 2019).
Selection criteria:
A random sample of 352 patients (pts) who consulted the ENT outpatient department with various Head & Neck disorders were assessed & evaluated clinically and provisional diagnosis was made. Following which, “triple test” was adapted and required management algorithm was amended in all the patients both conservatively as well as surgically.
Inclusion criteria:
Exclusion criteria:
Procedure of the study:
Over a period of 1 year, a random sample of 352 pts who consulted ENT OPD with various causes of Head & Neck disorders were clinically evaluated after taking a detailed & thorough history. Following which a possible diagnosis was made. After arriving at a diagnosis after clinical evaluation with diagnostic endoscopy, next step is doing the “Triple test”.
Triple test includes mainly:
In some pts with advanced disease, further radiological investigations such as X-ray chest, USG abdomen with pelvis were done to rule out distant metastasis.
After the triple test along with further required laboratory investigations, management was advised based on the diagnosis which was mainly surgical and specimen postoperatively was sent for histo-pathological reporting for re-confirmation of the diagnosis made clinically.
Patients requiring advanced treatment with diagnosis of malignancy were referred to higher centre such as for growth of oral cavity/oropharynx/laryngopharynx with extensive secondaries, as they would need postoperative radiation following neck dissection. While thyroid swellings, be it Papillary CA, Follicular CA, Anaplastic CA, Medullary CA, Solitary thyroid nodule, Simple nodular goitre, Multinodular goitre in all these cases either Total thyroidectomy or Hemithyridectomy was done accordingly. Following the Histopathological confirmation, tumors requiring radioactive iodine were referred to higher centre.
On the other hand, Salivary gland tumors such as Pleomorphic adenoma, Warthin’s tumor, CA parotid, CA submandibular gland, Minor salivary gland all were surgically excised and sent for Histopathological examination. Based on the diagnosis arrived from histopathological report, patients were referred to higher centres in those needing postoperative radiation. The cases with minimal secondaries after excision of primary tumor needing minimal neck dissection were done here.
Most of the patients who were treated here as well as outside were followed up. On follow up, majority of patients showed good response to treatment provided to them. While a few of them did show recurrence or residual growth as they did not complete their course of treatment either due to financial crisis or ignorance of their health. All patients submitted the informed written consent during the study period. Ethical clearance was taken from Institutional Ethics Committee before the start of the study.
The observations are depicted both in diagrammatic as well as tabular representation below-
Not all Head & Neck conditions are malignant in nature until proven otherwise. The hallmark aspect to assess any Head & Neck condition is “Triple test”. The early the condition is evaluated the better is the morbidity, mortality and in turns the prognosis. Any H & N condition must not be neglected and ignored hence must be intervened to the earliest. Though all the above mentioned facts are known but still they are been re- emphasized as Indians mindset is still in infancy stage in majority of them. People still hinder & hesitate when it comes to prioritising health. They reach upto the outlets only when their basic necessity in life such as swallow/ breathe/ speech & blood are compromised and encountered. Though it is been repeatedly said not to deter & dither, still this longstanding burden prevails in Indian population. That is one of the reason why India is still in the “developing phase”, as health is still not been given utmost importance as it had to be given as malignancy remains in the hit list of causes despite all the odds. This study is also focussed to bring to light the necessity to re-emphasize, re-collect and re-deem the importance of education and awareness among the population regarding the false apprehensions regarding these disorders.
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