Pattern of Pharyngitis and Tonsillitis Patients at ENT Clinic of Wlingi Hospital in 2019-2021 Pola Pasien Faringitis dan Tonsilitis di Klinik THT RSUD Wlingi tahun 2019-2021

A survey conducted by the Ministry of Health in 2010-2012 in seven provinces in Indonesia found that the number of ENT disease sufferers in Indonesia was approximately 35.6 million, or 16.8% of the total population. Pharyngitis and tonsillitis are examples of ENT cases often faced in daily practice. Both diseases indicate symptoms that resemble Covid-19, which has become a problem recently. This study aimed to analyze pharyngitis and tonsillitis patient visits at the ENT clinic of Wlingi Hospital during the Covid-19 in 2019-2021. Benefit of this study is to know pattern of pharyngitis and tonsillitis at the ENT clinic of Wlingi hospital in 2019-2021 during Covid-19 time. This research used a descriptive statistics method with an epidemiological cross-sectional design. The data in this study were secondary data from the medical records of ENT clinic patients at Wlingi Hospital and were analyzed univariately. Sampling in this study was done using the total sampling method. Based on medical record data at the ENT clinic of Wlingi Hospital in 2019-2021, there were 2292 visits in 2019, 1811 visits in 2020, and 1255 visits in 2021. Based on medical record data for pharyngitis and tonsillitis cases at the ENT clinic of Wlingi Hospital in 2019-2021, there were 247 pharyngitis and tonsillitis case visits in 2019, 114 pharyngitis and tonsillitis case visits in 2020, and 69 pharyngitis and tonsillitis case visits in 2021. There was a decrease in the number of pharyngitis and tonsillitis case visits in the ENT clinic of Wlingi Hospital during 2019-2021.


INTRODUCTION
Ear, Nose, and Throat (ENT) diseases are often found in society and in everyday life.A survey conducted by the Ministry of Health in 2010-2012 in seven provinces in Indonesia found that the number of people with ENT disease in Indonesia was around 35.6 million, or 16.8% of the total population.The Ministry of Health of the Republic of Indonesia stated that nasal and sinus disease ranks 25th among the top 50 diseases in Indonesia (±102,817 outpatients in hospitals) (1).Pharyngitis and tonsillitis are examples of ENT diseases often found in daily practice.
Pharyngitis is inflammation of the pharynx, (2) which is a part of the Upper Respiratory Tract Infection (URI) and is quite often found (3).The Indonesian Basic Health Research in 2018 reported that the prevalence of URI, including pharyngitis, is 9.3%.Jambi Provincial Health Office in 2016 reported that URI was included in the top 10 diseases in Jambi city (4).Bali Provincial Health Office in 2016 reported that acute pharyngitis was one of the 10 most common diseases in patients in health facilities (77,042 visits), especially in pharmacies (5).Effendi and Evelin, in their research, found that acute pharyngitis was the most common URI diagnosis, with a total of 44.23% from 104 patients at Beji Depok Health Center during the period of January-June 2019 (6).
Acute pharyngitis is the acute inflammation of the oropharynx, characterised by sore throat and pharyngeal erythema, also symptoms and signs of a bacterial cause like sudden onset of fever and anterior cervical lymphadenopathy.Acute pharyngitis is usually a selflimiting illness with an average length of illness between 1-2 weeks.Chronic pharyngitis is a persistent pharyngitis more than 12 weeks.On examination, there is increased mucus secretion which may cover pharyngeal mucosa or pharyngeal wall may be studded with reddish nodules and appears thick (7).
Tonsillitis is an inflammatory process in the palatine tonsil area and is often found in children aged 5-15 years (8).In 2012, from epidemiological data on ENT diseases in seven provinces in Indonesia, chronic tonsillitis (3.8%) had the highest prevalence after acute pharyngitis.The Indonesian Ministry of Health stated that tonsillitis in Indonesia is around 23% (9).Kendari City Health Office reported that tonsillitis was ranked 13th out of the top 20 diseases in Kendari city in 2013-2015 (10).Bogor City Health Office in 2015 reported that acute tonsillitis had a prevalence of 2.52% (11).Based on data from the ENT department of Ulin Hospital Banjarmasin in 2012, chronic tonsillitis occupies the 8th place among the top 10 ENT diseases, with 345 patient visits.In 2014, the number of th chronic tonsillitis patients became 431 and was in 5 place out of 10 ENT diseases at Ulin Hospital Banjarmasin (12).Data from the medical record of the larynx pharynx subsection of the ENT Head and Neck at Dr. M. Djamil Central General Hospital Padang in 2010 showed that the incidence of tonsillitis was 465 out of 1,110 visits (13).
Acute tonsillitis is inflammation of the tonsils (Waldeyer ring).Like acute pharyngitis, acute tonsillitis characterized by sore throat, trouble swallowing, fever, and large lymph nodes around the neck.Enlargement of the tonsils found on examination.Acute tonsillitis usually goes away within 1-2 weeks.Chronic tonsillitis is a persistent tonsillitis more than 12 weeks.On examination, tonsillar crypts are full of infected cheesy material, tonsils enlargement that may interfere with speech, deglutition, and respiration, or small tonsils with history of repeated sore throats (14).
Pharyngitis and tonsillitis generally cause throat discomfort, fatigue, and low-grade fever.Patients with moderate and severe infections usually complain of throat pain, difficulty swallowing, headache, fatigue, and fever (2,8).Both diseases have symptoms resembling the Coronavirus Disease 2019 (Covid-19), which has become a pandemic.As of February 2021, there were more than 100 million cases in 219 countries, with a total death toll of more than 2 million people (15).In Indonesia, as of July 2021, the number of Covid-19 cases was more than 2 million, and the death rate was more than 50,000 (16).In Covid-19, symptoms such as fever, cough, shortness of breath, fatigue, and muscle aches are reported (17).Covid-19 can infect all individuals in all age groups and economic statuses.Older age groups and groups with comorbidities, such as diabetes, cancer, and other chronic diseases, have a higher risk of infection (18).
Symptoms of pharyngitis and tonsillitis that are often encountered resemble those of Covid-19.Therefore, patients sometimes are afraid to have themselves checked due to fear of contracting Covid-19.Therefore, the researchers were interested in conducting research regarding the analysis of pharyngitis and tonsillitis patient visits at the ENT clinic of Wlingi Hospital in 2019-2021 during the Covid-19 time.Also, lack of data of about pharyngitis and tonsillitis pattern in Wlingi piqued authors' interest to conduct research.

METHOD
This study was a descriptive study on secondary data that aimed to analyze the visits of patients with pharyngitis and tonsillitis at the ENT clinic of Wlingi Hospital in 2019-2021.
The subjects of this study were all patients with pharyngitis and tonsillitis who visited the ENT clinic of Wlingi Hospital in 2019-2021.The data were collected in the form of examination records obtained from the medical records of patients with pharyngitis and tonsillitis who underwent examinations at the ENT clinic of Wlingi Hospital in 2019-2021.The collected data analyzed by descriptive statistics method, then processed using Microsoft Office 2016 and Microsoft Excel 2016 and presented as a distribution table with explanations arranged in narrative form and grouped according to the research objectives.

RESULTS
The results showed a gradual decrease in the number of visits at the ENT clinic of Wlingi Hospital, starting from 2267 total visits in 2019 to 1811 total visits in 2020 and 1255 total visits in 2021.The data describes a mean decrease of 506 patients per year, or 25.4%.Patient visits at the ENT clinic of Wlingi Hospital were dominated by ear disease from 2019 to 2021.Patients with pharyngitis who visited the ENT clinic of Wlingi Hospital in 2019-2021 were dominated by patients with an age range of 45-64 years, followed by patients with an age range of 25-44 years.Furthermore, patients with tonsillitis who visited the ENT clinic of Wlingi Hospital in 2019-2021 were dominated by patients with an age range of 5-14 years, followed by patients with an age range of 15-24 years (Table 3).Patients with pharyngitis who visited the ENT clinic of Wlingi Hospital in 2019-2021 were dominated by women, which was 62.6%.Meanwhile, patients with tonsillitis who visited the ENT clinic of Wlingi Hospital in 2019-2021 were dominated by women, which was 50.3%.This figure is slightly different from the number of male patient visits (Table 4).(20).Setyorini analyzed the number of patient visits at a hospital in Bangil before and during the Covid-19 pandemic in 2019-2020 and concluded that a decrease in the number of pharmacy and radiology patients was because patients were afraid to go to the hospital due to Covid-19, while an increase in the number of laboratory patients was due to the increases in rapid antibody and rapid antigen examinations (21).It can be predicted that during the Covid-19 time starting from 2019, the number of visits decreased in almost all health facilities.Puspita found a relationship between anxiety in diabetes mellitus patients and the fear of being exposed to Covid-19, which caused patients to avoid making outpatient visits to the internal medicine clinic (22).According to Azizah, several influencing factors to making outpatient visits during the Covid-19 pandemic are the completeness of facilities and the application of health protocols in health facilities, the attitude and ethics of health workers in providing services, and the ease of accessing health service information (23).
Pattern of Pharyngitis and Tonsillitis Patients... Sari mentioned that pharyngitis was not influenced by gender (30), but a study by Trilana in 2013 showed that pharyngitis was more common in males (31).From the research results, patients with pharyngitis who visited the ENT outpatient clinic at Wlingi Hospital were dominated by females (62.6%).Pontin, in his research, stated that tonsillitis was not influenced by gender (32), but a study conducted by Priyanka in 2019 showed that tonsillitis cases were more common in males (33).From the research results, patients with tonsillitis who visited the ENT clinic of Wlingi Hospital were also dominated by females (50.3%), showing a slightly different percentage to the males.These two findings differ from the results of several other studies, but from the theory obtained, there is no significant difference between pharyngitis and tonsillitis related to gender.

Disease Variation
According to Renner, there are several non-infectious and environmental causes of sore throat, such as smoking, shouting, and smoke inhalation (using firewood or burning trash) (34).There is lack of data about smoking in Wlingi (districts of Blitar), but there are several studies conducted in city of Blitar.A study conducted by Qoni in 2022 showed that the smoking behaviour of 52.6% subjects in city of Blitar is included in the category of high (35).Sunarianto, in his research, stated that there was a relationship between age and smoking behaviour from Blitar motorcycle club (36).These findings may contribute to number of visits at the ENT outpatient clinic of Wlingi.
The results of this study confirm a decrease in the number of visits at the ENT outpatient clinic of Wlingi Hospital in 2019-2021, that the most common disease was ear disease.Patients with pharyngitis who visited the ENT outpatient clinic of Wlingi Hospital in 2019-2021 were dominated by patients with an age range of 25-44 years, while tonsillitis was dominated by patients with an age range of 5-24 years.Patients with pharyngitis and tonsillitis who visited the ENT outpatient clinic at Wlingi Hospital in 2019-2021 were dominated by females.

Table 1 . Number of patient visits and type of disease in the ENT clinic of Wlingi Hospital in 2019-2021
Pattern of Pharyngitis and Tonsillitis Patients...

Table 1 . Number of patient visits and type of disease in the ENT clinic of Wlingi Hospital in 2019-2021
Based on Table2, the variations in pharyngitis and tonsillitis cases found in the ENT clinic of Wlingi Hospital in 2019-2021 were acute pharyngitis, chronic pharyngitis, acute tonsillitis, and chronic tonsillitis.From the data obtained, patients with acute pharyngitis visited more than those with acute tonsillitis.