“PATTERN AND OUTCOME OF OTOLARYNGOLOGICAL AND FACIAL INJURY IN ROAD TRAFFIC ACCIDENTS AT A TERTIARY CARE CENTRE IN EASTERN NEPAL”

Otolaryngological trauma is prevalent in road traﬃc accidents (RTA), with or without mul�ple organ injuries


INTRODUCTION
Road traffic accidents (RTA) are a significant contributor to death and disability and colleagues found 1 globally. Atreya an increasing trend in RTA in Nepal, with 25,788 vehicles collision in 2019/20. burden of disease study 2 Global es mated that road traffic injuries caused 73 million Disability adjusted life Years (DALYs) in 3 2019. Otolaryngological trauma is prevalent in RTA cases, with or without mul ple organ injuries, since it is one of the most 4 exposed part, vulnerable to trauma. Road traffic accident is an important cause of ENT (Ear, nose, throat) injuries in developing countries. Otolaryngological trauma incurs high costs of care due to prolonged admission, costly procedures and complica ons. In developing countries, like Nepal, the morbidity and mortality of RTA associated ENT injuries remain neglected. ENT injuries are preventable and can be avoided as a cause of death and disability. The causes and mechanism of ENT injuries have been reported to vary with age and geographic [5][6][7] distribu on. This study aims at repor ng the prevalent number and pa ern of Otolaryngological/ ENT injuries in cases of road traffic accidents (RTA) and their outcome. The results thus obtained will help to provide base line informa on and necessary ac ons to be taken by health policy makers. It will also create an awareness among the health care workers in e m e rge n c y d e p a r t m e nt to p e r fo r m a t h o ro u g h otolaryngological examina on and ENT consulta on.

METHODOLOGY
This is a prospec ve, descrip ve study of 90 pa ents a ending the emergency department of Nobel Medical College, Biratnagar, Nepal secondary to road traffic accidents (RTA), who were diagnosed as cases of head and neck trauma and having ENT (Ear, Nose, Throat) injuries. This study was carried out over one year, from 15 October,2020 to 14 October, 2021. Ethical clearance was obtained from Ins tu onal review commi ee (381/2020). Informed consent was obtained from the par cipants/guardian before enrolling the par cipants in the study. All the cases of RTA with ENT injury, presen ng to emergency were included. The cases who did not provide consent for study were excluded. Convenient sampling method was applied. A er triage and resuscita on, a detailed history, as pertaining to age, gender, me of arrival to emergency, mode of injury/trauma, and presen ng symptom was recorded in a proforma. A er general physical examina on, local otorhinolaryngological examina on (Otoscopy, Rhinoscopy, Examina on under microscope, Laryngoscopy) was done as per requirement on all the pa ents and recorded. X ray, Computed tomography (CT Scan), Magne c resonance Imaging (MRI) was done, as needed. Other inves ga ons as per requirement were done, like, rou ne biochemical and haematological examina on. Cerebrospinal fluid (CSF) examina on was done, as indicated. Pa ents with minor injuries were treated and discharged to be followed up in ENT OPD. Other cases were admi ed and treated. Mul -disciplinary treatment was provided, as per the nature of injury. Depending on the type of injury, the pa ents were treated either conserva vely or by surgery. All pa ents were followed up ll discharged or death. Outcome variables were the complica ons, admi ed or discharged, length of stay in the hospital, disability and mortality. Sta s cal data analysis was done using SPSS so ware (Sta s cal Package for the Social Sciences, version 17.0, SPSS Inc, Chicago, Ill, USA). Data was summarized in form of propor ons and frequency tables for categorical variables. Con nuous variables were summarized using range. Pvalues were computed for categorical variables using Fisher's exact test. A p-value of less than or equals to 0.05 was considered to cons tute a sta s cally significant 5,8 difference. Table 1: Age and Gender distribu on (Range 4-80 years)

RESULTS
As shown in Table 1, out of 90 pa ents examined, 69(76.66%) were male, and 21 (23.33%) were female pa ents. The age ranging from 4 -80 years. The overall mean age was 32.33 years ±13.29, with mean male age 32.59 years ±12.46 and mean female age 31.48 years±16.05. Most of the cases were in the age group of >18-40 years, 66(73.33%), followed by >40-60 years age group, 16(17.77%). Least were in the less than and up to 18 years age group, 4 (4.44%) and above 60 years, 4 (4.44%). Table 2, the commonest injury was that of motorbike accident, 44(48.88%), followed by motor vehicle in 31(34.44%) cases. Non-motor vehicle/cycle or pedestrians were 15 cases. Males were more common in each mode of injury. The me of presenta on to emergency ranged from 1-122 hours, with a mean me of 16.24 hours±19.61.  As shown in Table 3, males were common in both motor vehicle (including motor cycle), 60(66.66%) and, non-motor vehicle (including cycle and pedestrian accident) group 9(10%),as compared to the number of female. Out of a total of 90 cases, 68 (75.55%) pa ents had mul ple injury, along with head and neck injury.

DISCUSSION
In our study, male, 69(76.66%) were more commonly affected with ENT trauma and injury, following road traffic accidents (RTA) compared to female,21(23.33%), with an age range of 4-80 years. The mean age was 32.33 years±13.29. Most of the cases were in the younger age group. A similar study by Singhai and co-authors also found 8 male to be commoner. Those affected were of younger age group, with a mean age of 27.2 years. Similar results were reported by Madubueze and colleagues. The reason of male, and younger age group to be affected could be because that they are more ac ve, outgoing for jobs and slightly carefree in a tude leading to a risky behaviour, 9 making them prone to accidents. The mode of injury was divided in to motor vehicle/motor cycle group and non-motor vehicle/cycle/pedestrian group. Motor vehicle/motor cycle injury was found in 75(83.33%) cases, in our study, which was the commoner one as compared to non-motor vehicle/cycle/pedestrian group. Male were commoner in each category. 10 Road traffic accidents are a common cause of ENT injury. ENT injuries secondary to RTA were more frequent in male 8 in a similar study. The me of presenta on to emergency ranged from 1-122 hours, with a mean me of 16.24 hours±19.61, in our study. The mean me of arrival to emergency department was 18 5 hours in a study by Gilyoma and colleagues. Other studies also reported similar me of presenta on to the 7 emergency. Injuries to the ear, nose and throat can occur as an isolated injury or may be associated with mul ple injuries. Out of a total of 90 cases, 68 (75.55%) pa ents had mul ple injury, along with head and neck injury in our study. Mul ple injury along with ENT injury is commonly reported in other studies 9,10 as well. Face, and ENT region injuries are commonly reported in various studies, because face and ENT region is the most 11,12 exposed and unprotected part of body.
The clinical presenta on depends on the part of head and neck region involved. The commonest presen ng complaints of ear trauma was hearing loss,20(22.47%), along with, other various symptoms like otalgia, nnitus, bleeding ears and ver go. Other presenta ons were lacera on, perfora on of tympanic membrane, temporal bone fracture, facial palsy and CSF otorrhoea. Epistaxis , 20(36.36%) was the commonest presenta on of nose injury, along with other symptoms and condi ons like nasal bone fracture, CSF rhinorrhoea, lacera on, Le Fortes' fracture and septal hematoma. Similarly, abrasion, fracture of laryngeal framework, hematoma and dysphonia were common presenta on in 21 (65.62%) cases. Lacera on and open wounds of neck were also found in our study. Similar pa ern of injury of ear, nose and neck/throat was reported in a study, where ear injury was the commonest 5 10 (59%). Ear injury was common in other studies as well. Pain (99%), bleeding from different regions (74%) are the most common presen ng symptoms in trauma pa ents. Lacera on/ cut injury of various parts of ENT region and 13,14 facial nerve palsy were reported in various other studies.

CONCLUSION
Otolaryngological trauma is common in road traffic accidents, and motor vehicle accidents are more common. Road traffic accidents are more common in male, and mostly it affects the younger age group. Ear was most commonly affected by injury and the complica ons were also common. Surgical repair was more common in nose injury.

LIMITATIONS OF THE STUDY
Since this was a single centred study with a limited number of par cipants, the conclusions may not be applicable to en re popula on. Only the cases where ENT consulta on was sought for has been included, minor injury being discharged by emergency doctors.