Figure 1: Audit Cycle
Summary of Data from Initial Audit Cycle
During the first cycle of the audit, data was collected from the patients that presented to the ENT OPD in Dec 2021. Only the patients that had an exclusive ear problem were chosen.
A total of 354 patients were involved. It was found that 59.3% of these patients were males and 40.7% were females. The most common and predominant presenting ear complaints were ear discharge (27.1%), pain in the ear (20.3%), Ear fullness (17.6%), ear itch (15.3%), and hearing loss (13.6%). In addition, other less common complaints included tinnitus (2.8%), vertigo (1.7%), foreign body impaction in the ear (1.2%), and bleeding (0.6%) from the ear.
On establishing the diagnosis, it was found that wax Impaction was the most common ear problem encountered (26.6%), followed by CSOM (24.9%), otomycosis (11.9 %), Hearing loss (7.9%), and then Acute Otitis Media, Otitis Externa and Eustachian tube dysfunction (each 5.6%).
The details of the established diagnosis are in Table 1.
Of all these patients that reported an ear problem, 52.5% (186 out of 354) needed ear suctioning. And of those that needed ear suctioning, 44.1% had wax impaction, 35.5% had CSOM that required suction for clearing pus from the canal, 12.9% had otomycosis requiring suctioning of the fungal debris and another 4.3% had Acute otitis media who required discharge suctioning. Suctioning was also required for a few cases with ear bleeds and foreign bodies in the ear.
So, it was found that more than half of the patients with ear problems require suction; wax, discharge from the ear, and fungal debris in the ear are the 3 most common reasons. It was recommended that since a significant percentage of 52.5 is requiring ear suction, it should be started in the OPD department so that the unnecessary referral to the ENT MOT would be reduced.