During last decades, the period used for specialized subjects such as otorhinolaryngology has been reducing, as knowledge of diseases has been increasing . Several investigations concerning educational needs have been performed in otorhinolaryngology [2, 3, 4, 5], but none of them described patients' profile and their most frequent complaint.
Currently, otorhinolaryngology is considered a specialization area with wide participation field, frequently competing its market with other medical fields, such as plastic surgery, oral and maxillofacial surgery, head and neck surgery, neurology, among others. It is possible to choose several sub-specialties within such specialty. When new otorhinolaryngologists conclude their residence or specialization, they frequently enter the job market, frequently in order to open their own private clinic. In order to do so, both financial (physical space, propaedeutic devices) and intellectual (either choosing sub-specialty or not) investments are necessary. Knowing patients who seek our medical attention is essential to plan and manage professional career.
This study aims at describing the profile of patients who seek clinical and surgical otorhinolaryngologic medical attention in a private clinic, where there is no public health assistance. MATERIAL AND METHOD
All consultations and clinical analysis, as well as surgeries performed at only one otorhinolaryngology private clinic between January 1, 2005 and December 31, 2005 were analyzed. All medical visits and surgeries were performed by the senior author, and analysis and auxiliary procedures were performed by assistant doctors and by speech therapists.
The clinic at issue has great reference frequency by other doctors and health professionals, once it is located within a reference hospital and has diagnosis equipment in audiology (audiometer, immitanciometer, BERA, vectoelectronistagmography, acoustic otoemissions), videodiagnosis (rigid and flexible nasolaryngofibroscope and laryngoestroboscope) and polissonography. Reference by other otorhinolaryngologist is low, so all complementary analysis which were requested out of the clinic were excluded from this study, that is, all analysis which were not originated from consultations performed by the senior author.
Consultations were classified in three groups: "New Consultation" - patients who attended first consultation in last 30 days; "Second visit" - patients who attended consultation for previous clinical analysis in last thirty days; "Postoperative follow-up" - patients who come back within 90 days after a surgical procedure.
The following aspects were analyzed in each consultation: consultation date, patients' age and gender, main complaint, and probable diagnosis. In addition to this, diagnostic procedures, complementary exams and surgeries were analyzed. Minor procedures under local anesthesia were excluded in order to provide better analysis representation.
Data were compiled in a data bank and analyzed in Epiinfo 2000. The present study was approved by this institution's Ethics Committee under report number 035/2004. RESULTS
15,235 medical consultations were performed during 2005, out of which 9,183 were new (60%), 2,746 were second visits (18%) and 3,306 were postoperative follow-up (21%). 51% of patients were male and 49% were female. Age varied from 0 to 95 years, with mean 30.4 ± 18 years (Picture 1).
Picture 1 - Distribution of patients assisted in Otorhinolaryngology private clinic in 2005 according to age.
Concerning annual distribution, it is almost homogeneous, once November and December presented a lower number of visits once they are vacation months in Brazil (Picture 2).
Picture 2 - Distribution of consultations in Otorhinolaryngology private clinic in 2005 according to month.
Main diseases were grouped in 7 groups (Picture 3):
Picture 3 - Distribution of consultations in Otorhinolaryngology private clinic in the year of 2005 according to nosology group.
I - Acute Infectious Diseases: 2,282 consultations
Most frequent diseases were: acute rhino sinusitis (798), acute middle otitis (791), infection of superior airways (571).
II - Rhinologic diseases: 4,094 consultations
Most frequent diseases were: allergic rhinitis (1,756) hypertrophic rhinitis (1,051), nasal septal nasal septum deviation (866) and anterior epistaxis (221).
III - Otological Diseases: 4,937 consultations
The group was divided into flowing sub-groups (Picture 4):
Picture 4 - Distribution of otological complaints in Otorhinolaryngology private clinic in the year of 2005 according to nosology subgroups.
IIIa - Inner ear diseases: dysacusis with or without vertigo and tinnitus (1,776), vertigo (366) and tinnitus (353) isolated; IIIb - middle ear and mastoid diseases: middle otitis with effusion (277) and simple middle otitis (271); IIc - external ear diseases: cerumen impactation (1094) and external otitis (417).
IV - Laryngological Diseases: 2.291 consultations
They were divided into: Iva - globus complaint and cough: 1,498 consultations divided into laryngitis caused by gastroesophageal reflux and acute laryngitis; IVb - dysphonia complaints: 793 consultations, vocal fold nodule predominance.
V - Oral and Pharyngeal Diseases: 1.175 consultations
Most frequent pathologies were hypertrophy and pharyngeal tonsil (431), chronic and recurrent tonsillitis (379) and hypertrophy of palatine tonsil (365).
VI - Apnea Syndrome and Sleep Obstructive Hypopnea: 566 consultations
VII - Cervical-Facial Tumors: 141 consultations
Mainly cervical nodules and tonsilmegalies (99); goiter (19) and malignant neoplasias (19).
Percentage of second visits was 19.2% with higher rates for cases of head and neck neoplasias and middle ear diseases, mastoid and inner ear (Table 1).Complementary Analysis
Complementary exams, performed in the clinic by doctors and speech therapists are represented in picture 5. Most performed ones were videonasolaryngoscopy and videolaryngostroboscopy (1954) and audiometry (1614), generally with immitanciometry (1404). Other procedures are less frequently performed: BERA (619), vectoelectronistagmography (343) and polissonography (166).
Picture 5 - Complementary exam performed in Otorhinolaryngology private clinic in the year of 2005.
1181 surgeries were performed by the senior author in 2005. Most frequent surgeries were turbinectomy associated or not to septoplasty (416) and tonsilectomy associated or not to adenoidectomy (386). It is interesting to point out the high number of plastic surgeries performed (117), due to clinical reference in facial aesthetic surgery. The main representant of this group was rhinoplasty (94), which is 80% of aesthetic surgeries, with less participation of otoplasty surgeries and face lift (ritidoplasty, blepharoplasty, frontoplasty) (Table 2).
Otological surgeries performed were myringotomy to place spool (22), tympanoplasty (14), mastoidectomy (14), estapedoctomy (12). Endonasal surgeries were sinusectomy with or without polipectomy (43), cauterization of sphenopalatine artery (5), access to hipophysis tumors (3), inverted papilloma (2), Killian polypus (1), dacriocistorrhinostomy (1) and decompression of orbit through ophtalmopathy of Graves (1). Among head and neck surgeries, surgeries were parotidectomy (7), thyroidectomy (6) and malignant neoplasias surgeries of larynx, tongue and retromolar trigons with cervical emptying (4). DISCUSSION
It is necessary to establish the kind of relation between Medicine undergraduation and Medical residence, in order to clarify their role in medical education. In order to do so, it is necessary to accurately define educational objectives which are desired to be reached with medical residence [6, 7, 8], and knowing the profile of patients with whom doctors will deal in their daily routine is essential.
Otorhinolaryngology is an intermediate specialty, placed among 15 first Brazilian ones and holds 1.6% of Brazilian special practitioner , offering possibilities of participation both technical and cognitive areas, offering professionals a promising career.
Despite of consultations distribution in all Otorhinolaryngology and Cervical-Facial Surgery knowledge field, the main frequency of otorhinolaryngology office was otology. Rhinology, otorhinolaryngology and laryngology follow in this order.
The presence of a videonasolaryngoscope and an audiometer and immitanciometer is essential. The highest frequency of such complementary analysis is trustworthy, once just the analyses which were required by the senior author were considered, as it has already been mentioned. Other less performed but more expensive procedures were BERA, vectoelectronistagmography and polissonography. Mensal income is positively related to the ones who present higher number of medical devices to have complementary analysis at office .
Concerning surgeries, the main role of simple surgical procedures such as turbinectomy with or without septoplasty and tonsillectomy with or without adenoidectomy is recognized, which add up 68% of all surgeries. The high number of uvulopalatofaringoplasties is also observed, due to the presence of polyssonography in the clinic.
Concerning facial aesthetic surgeries, it is noticed that great percentage sought otorhinolaryngology assistance. Many patients take the opportunity they undergo other procedures (mainly septoplasty and turbinectomies) and add aesthetic procedures. Professionals who develop surgical skills in a sub-specialty, in this case, facial plastic surgery, have higher surgical and income possibilities . CONCLUSIONS
Knowing general otorhinolaryngology is important once the main areas are very frequent in private practice, and otology, rhinology and laryngology are more frequent. Most frequent complementary analyses were videonasolaryngoscopy, audiometry and immitanciometry. Simple surgeries, turbinectomy/septoplasty and adenotonsillectomy, represent the most frequent ones on otorhinolaryngology clinic, which can be expanded through sub-specialty. In the present study, facial plastic surgery represented an important part of surgeries performed. REFERENCES
1. Lund VJ. Otolaryngology in the curriculum - 10 years on: discussion paper. J R Soc Med 1990;83(6):377-9.
2. Carr MM, Brown DH, Reznick RK. Needs assessment for an undergraduate otolaryngology curriculum. Otolaryngol Head Neck Surg 1999;120(6):865-8.
3. Ganzel TM, Martinez SA. Are we teaching medical students what they need to know? Otolaryngol Head Neck Surg 1989;100(4):339-44.
4. Lawrence PF, Alexander RH, Bell RM, Folse R, Hayne JL, Laub VW. Determining the content of a surgical curriculum. Surgery 1983;94:309-15.
5. Spivey BE. A technique to determine curriculum content. J Med Educ 1971;46:269-74.
6. Marcondes E. Residência médica e pós-graduação. Rev Hosp Clin Fac Med Univ São Paulo 1975;30(4):384-6.
7. Kassab P. Residência médica e pós-graduação. Rev Assoc Med Bras 1978;24(6):185.
8. Patrocínio LG, Silveira GC, Patrocínio TG, Patrocínio JA. Avaliação de necessidades para um currículo de otorrinolaringologia na graduação. Rev Bras Otorrinolaringol 2002;68(1):107-11.
9. Machado MH. Perfil do médico no Brasil: análise preliminar. Rio de Janeiro: FIOCRUZ; 1996.
10. Maniglia JV. Perfil do egresso da residência em otorrinolaringologia e cirurgia de cabeça e pescoço da Santa Casa de Franca, da Faculdade de Medicina de São José do Rio Preto e da Clínica Maniglia. [Tese de Livre Docência]. Faculdade de Medicina de São José do Rio Preto; 2004.
1. Otorhinolaryngologist (Physician of the Otorhinolaryngology department of the Faculdade de Medicina da Universidade Federal de Uberlândia)
2. Physician (Resident doctor of the Otorhinolaryngology department of the Faculdade de Medicina da Universidade Federal de Uberlândia)
3. Master degree (Head of the Laryngology and Voice of the Otorhinolaryngology department of the Faculdade de Medicina da Universidade Federal de Uberlândia)
4. Professor (Head of the Otorhinolaryngology department of the Faculdade de Medicina da Universidade Federal de Uberlândia)
Departamento de Otorrinolaringologia, Hospital Santa Genoveva, Uberlândia, Minas Gerais, Brasil.
Lucas Gomes Patrocínio
Rua XV de Novembro, 327 / aptº. 1600 - Bairro Centro
Uberlândia/MG - CEP: 38.400-214
Phone/Fax: (55) 34 - 215-1143 E-mail: email@example.com
This article was submitted to SGP (Sistema de Gestão de Publicações) of R@IO on January 10th, 2007 (code 208) and approved on July 3rd, 2007.