Otorhinolaryngological (ENT) diseases comprise a substantial proportion of healthcare consultations globally and constitute a leading factor of disease burden throughout all age groups.1 Abnormalities affecting the auditory, nasal, pharyngeal regions and related associated craniofacial structures encompass acute infectious conditions to chronic inflammatory, hypersensitivity-related, congenital, and tumorous diseases.2 These situations can considerably impair hearing, speech, breathing, swallowing, and overall quality of life. Thus imposing a significant burden on individuals, families, and healthcare systems. Timely diagnosis and appropriate management are essential to prevent complications and reduce long-term disability.3

Internationally, prevalent ENT disorders comprise otitis externa, otitis media, cerumen impaction, allergy-associated rhinitis, chronic rhinosinusitis, tonsillitis, pharyngitis, epistaxis, deviated nasal septum, and laryngeal diseases.4 The frequency of these diseases varies according to age group, socioeconomic factors, environmental influences, geographical region, access to healthcare, and seasonal variation.5 Pediatric patients are especially susceptible to repeated otitis media and adenotonsillar disorders owing to anatomical and immunological factors, in contrast adults more commonly experience with chronic rhinosinusitis, auditory impairment, allergic disorders, and laryngeal disorders.6 Older adults often experience presbycusis and other age-related ENT conditions that significantly affect communication and social functioning.7

Otorhinolaryngological disorders persist a major public health concern due to high population density, inadequate sanitation, air pollution, exposure to tobacco smoke, inadequate health awareness, and restricted access to specialized healthcare services in developing countries.8 Frequent upper airway infections, insufficient treatment of acute infective conditions, and unsupervised medication additionally contribute to the progression of chronic ENT diseases and their related complications.9 Although the large patient volume observed in ENT outpatient departments (OPDs), epidemiological evidence describing the prevalence pattern and occurrence of common otorhinolaryngological diseases remain limited in many regions of Pakistan.10 Such information is essential for health service planning, resource distribution, preventive strategies, and improving clinical services.

Healthcare facility-based epidemiological studies offer important informations into epidemiological patterns, demographic profile, and healthcare service utilization. Assessing the occurrence of common ENT disorders based on age, gender, and anatomical location can help clinicians in recognizing vulnerable populations, improving diagnostic strategies, and developing focused preventive interventions. Furthermore, regional epidemiological evidence facilitates the development of evidence-based clinical guidelines and improves clinical education and research.

DHQ Hospital Abbottabad functions as a regional healthcare center for the Hazara Division and surrounding districts, receiving a varied patient population with a wide range of otorhinolaryngological diseases. However, robust epidemiological evidence regarding the epidemiological pattern of ENT diseases presenting to this institution are limited. Assessing the distribution of these diseases during a six-month study period will provide important baseline information regarding the prevalence of ENT conditions in the region and identify demographic patterns that may affect health service delivery.

Consequently, the current study seeks to assess the disease profile and clinical profile of prevalent otorhinolaryngological diseases among patients presenting to the Department of Otorhinolaryngology at DHQ Hospital Abbottabad over a six- months period. The outcomes of this study are expected to enhance to an improved understanding of regional disease patterns, support evidence-based planning of ENT services, and support prevention and treatment strategies for improving patient care in the region.

Study Design: A healthcare facility-based observational cross-sectional study was performed to assess the epidemiological pattern and disease of common otorhinolaryngological (ENT) diseases among patients attending the ENT Department at District Headquarters (DHQ) Hospital Abbottabad.

Study Setting and Duration: The study was conducted in the Department of ENT, DHQ Hospital Abbottabad, Khyber Pakhtunkhwa, Pakistan, during a six-month study period, between 1 July 2025 to 31st December 2025.

Study Population and Sample Size: The study enrolled patients of all age groups and both sexes attending to the ENT outpatient department (OPD) with prevalent otorhinolaryngological disorders during the study period. The sample size was determined based on the single population proportion formula n = Z²P (1 − P) / d², assuming a 50% estimated prevalence of ENT disorders due to the lack of reliable local epidemiological data, a 95% statistical confidence level (Z = 1.96), and a 5% precision level (d = 0.05). The calculated required sample size was 384 participants. Accordingly, 384 consecutive eligible patients were included using a non-probability consecutively recruited eligible participants.

Inclusion and Exclusion Criteria: Individuals across all age categories and both sexes presenting to common disorders affecting the ear, nose, throat, and head and neck region and consenting to participate were included in the study after providing documented informed consent. For children, consent was obtained from parents or legal guardians. Patients with incomplete clinical records, postoperative review visits, major head and neck trauma, diagnosed malignancies requiring specialized cancer care, congenital craniofacial malformations, or those who refused participation were excluded.

Data Collection Procedure

Data were obtained using a standardized and validated data collection form completed by trained otorhinolaryngologists. Demographic characteristic, including age, sex, and residential area, was recorded. All participants underwent a detailed clinical evaluation including ear examination, nasal examination by anterior rhinoscopy, examination of oral cavity and oropharynx, indirect or flexible laryngoscopy when indicated, and neck examination. Ancillary diagnostic tests, including pure-tone audiometry, tympanometry, nasal endoscopy, microbiological culture, routine laboratory investigations, X-ray, computed tomography (CT), and magnetic resonance imaging (MRI), were conducted where clinically appropriate to confirm the final diagnosis. Diagnoses were categorized into ear, nose, throat, and head and neck disorders in accordance with established otorhinolaryngological diagnostic standards.

Statistical Analysis

Data were recorded, verified, and processed using the Statistical Package for the Social Sciences (SPSS) version 26.0. Quantitative variables were expressed as mean ± standard deviation (SD), whereas qualitative variables were presented as frequencies and percentages. Correlations between categorical variables were evaluated using the Chi-square test or Fisher's exact test when applicable. A two-tailed p-value <0.05 was considered considered significant.

Ethical Considerations

Ethical approval was received from the Institutional Ethical Review Committee of DHQ Hospital Abbottabad before the initiation of the study. Documented   informed consent was obtained from all adult patients and from the parents or legal guardians of pediatric participants. Patient confidentiality of participant information and de-identification were rigorously maintained during the study period, and all procedures were performed in compliance with the ethical standards of the Declaration of Helsinki.

A total of 384 patients with common otorhinolaryngological (ENT) disorders were included during the six-month study period. The mean age of the participants was 32.6 ± 17.9 years (range: 2–81 years). Of the study population, 214 (55.7%) were males and 170 (44.3%) were females, giving a male-to-female ratio of 1.26:1. Most patients (60.2%) belonged to rural areas.

Table 1. Demographic Profile of the Study Participants (n = 384)

The 21–30-year age group represented the largest proportion of patients (24.7%), followed by the 11–20-year age group (18.0%). Rural residents constituted the majority of the study population.

Table 2. Distribution of common ENT Disorders by Anatomical Site (n = 384)

Ear diseases were the most common disorders, accounting for 40.9% of all cases, followed by nasal diseases (27.3%), throat diseases (25.5%), and head and neck disorders (6.3%).

Table 3. Frequency Distribution of Common Otorhinolaryngological Diseases (n = 384)

Impacted cerumen was the most frequently diagnosed individual condition (16.9%), followed by allergic rhinitis (13.0%), chronic suppurative otitis media (12.0%), acute tonsillitis (8.9%), deviated nasal septum (8.1%), acute otitis media (7.3%), pharyngitis (6.3%), chronic rhinosinusitis (6.2%), chronic tonsillitis (5.2%), otitis externa (4.7%), cervical lymphadenopathy (4.2%), chronic laryngitis (3.1%), peritonsillar abscess (2.0%), and benign neck swelling (2.1%).

Table 4. Distribution of Major ENT Disorders by Sex

No statistically significant association was observed between gender and the distribution of the major ENT disease categories (p > 0.05).

Table 5. Distribution of Major ENT Disorders by Age Group

The highest number of ENT cases was observed among patients aged 21–30 years (24.7%). Ear diseases predominated in children and young adults, whereas throat disorders were relatively more common in adolescents and adults. Head and neck disorders were more frequently encountered among older patients.

Summary of Findings

Among the 384 patients evaluated over the six-month study period, ear diseases constituted the largest disease category (40.9%), followed by nasal (27.3%), throat (25.5%), and head and neck disorders (6.3%). Impacted cerumen was the most common diagnosis, followed by allergic rhinitis and chronic suppurative otitis media. Acute and chronic tonsillitis together represented a substantial proportion of throat disorders. Young adults aged 21–30 years formed the largest patient group, and no significant gender-based differences were observed in the distribution of the major ENT disease categories (all p > 0.05). These findings indicate that infectious, inflammatory, and preventable ENT disorders remain the predominant causes of outpatient visits at DHQ Hospital Abbottabad.

This hospital-based cross-sectional study revealed that ear disorders constituted the largest proportion (40.9%) of otorhinolaryngological (ENT) diseases, followed by nasal (27.3%), throat (25.5%), and head and neck disorders (6.3%). Among individual diagnose, impacted cerumen, allergic rhinitis, chronic suppurative otitis media (CSOM), and acute tonsillitis were the most commonly encountered conditions. These findings suggest that infectious, inflammatory, and allergic disorders continue to dominate the clinical spectrum of ENT disorders in the Hazara region of Pakistan.

The finding that ear disorders were the predominant ENT presentation is consistent with findings from several hospital-based studies conducted in Pakistan. Previous investigations conducted at tertiary care hospitals in Karachi, Peshawar, and Rawalpindi has consistently reported that ear disorders account for approximately 35–45% of ENT outpatient visits, with impacted cerumen, CSOM, and acute otitis media being the most common diagnoses.11,12,13 The similarity of these findings across diverse healthcare settings indicates a persistent epidemiological pattern of ear diseases in Pakistan. This burden is likely influenced by recurrent childhood infections, poor environmental and hygienic conditions, delayed presentation to healthcare facilities, and restricted access to specialized ENT care, all of which contribute to the persistence of preventable ear disorders.

The higher proportion of patients aged 21–30 years observed in this study is in agreement with previous Pakistani epidemiological reports demonstrating that young adults represent the most frequent users of ENT outpatient services. Increased occupational exposure, environmental pollution, tobacco smoke, recurrent respiratory tract infections, and allergic diseases are likely contributors to the greater burden of ENT disorders in this age group.14 On the other hand, hospital-based studies focusing on pediatric populations have consistently demonstrated a higher prevalence of otitis media and adenotonsillar diseases among children, reflecting age-related anatomical and immunological susceptibility as well as differences in study populations, healthcare settings, and referral patterns.

The epidemiological pattern observed in the present study closely resembles that reported in several hospital-based studies from India.15 Investigations conducted in both northern and southern regions of the country have consistently demonstrated that ear disorders represent the largest category of ENT diseases, with impacted cerumen and chronic suppurative otitis media (CSOM) among the most frequently diagnosed conditions.  Similar to the Pakistani context, these findings have been associated with poor ear hygiene practices, recurrent childhood infections, overcrowding, delayed presentation to healthcare facilities, and inadequate access to specialized ENT services. In addition, allergic rhinitis has consistently been reported as the most prevalent nasal disorder, a trend linked to increasing urbanization, industrial growth, environmental pollution, and heightened exposure to aeroallergens. The comparable prevalence of throat disorders, particularly acute tonsillitis, chronic tonsillitis, and pharyngitis, further suggests that the epidemiological profile of common ENT diseases is broadly similar across South Asian populations, likely reflecting shared environmental, socioeconomic, and healthcare-related determinants.

The epidemiological pattern observed in this study aligns with the global priorities outlined by the World Health Organization (WHO), which considers ear and hearing disorders among the leading causes of preventable disability worldwide. According to WHO estimates, more than 430 million people worldwide live with disabling hearing loss, and chronic ear infections remain a leading preventable cause of hearing impairment, particularly in low- and middle-income countries. Furthermore, WHO also recognizes impacted cerumen as one of the most frequent and preventable ear conditions requiring primary healthcare intervention. The predominance of impacted cerumen and CSOM observed in our study therefore supports WHO recommendations emphasizing early diagnosis, routine ear examination, community education, hearing screening, and improved access to primary ear and hearing care services.16

The disease distribution identified in this study closely parallels the epidemiological patterns reported from several low- and middle-income countries across Africa, the Middle East, and Southeast Asia. Investigations from Nigeria, Ethiopia, Nepal, Bangladesh, and Saudi Arabia have consistently demonstrated that infectious and inflammatory ear disorders constitute the largest proportion of ENT outpatient consultations, while allergic rhinitis remains the most frequently diagnosed nasal condition. Other, studies from Europe, North America, and other high-income countries often report a greater prevalence of chronic allergic diseases, age-related hearing loss, vestibular disorders, and sinonasal conditions, while chronic suppurative otitis media has become relatively uncommon because of improved vaccination coverage, better hygiene, prompt antibiotic therapy, and stronger primary healthcare systems.17,18,19

Allergic rhinitis constituted for 13.0% of all patients in our study and was the most prevalent nasal disease. Comparable findings have been documented in Pakistani and Indian populations, where increasing levels of air pollution, exposure to seasonal pollens, domestic dust mites, household biomass fuel exposure, and climatic fluctuations have associated with increasing prevalence of allergic disorders. International studies have likewise shown a gradual increase in allergic rhinitis globally, especially in urban populations, making it one of the most common chronic respiratory diseases influencing health-related quality of life, sleep patterns, academic performance, and work productivity.

Acute and chronic tonsillitis together constituted a considerable proportion of throat diseases in our study. Similar observations have been reported throughout South Asia and other low- and middle-income countries, where repeated bacterial and viral upper respiratory tract infections continue to play a major role to ENT outpatient visits.20 In developed countries, however, enhanced infection prevention measures, immunization programs, and evidence-based antibiotic prescribing have decreased the prevalence of recurrent tonsillitis compared with resource-constrained settings.21

A notable finding in our study was the majority of patients from rural communities. Similar demographic patterns have been reported in Pakistani and international studies, where rural residence is linked to limited access to specialized healthcare, lower income status, transport limitations, late diagnosis, and limited health literacy. These factors jointly increase the likelihood of persistent and preventable ENT disorders presenting at tertiary care hospitals rather than being appropriately managed at the primary care settings.

Prevalent otorhinolaryngological disorders continue to be a considerable source of outpatient visits at DHQ Hospital Abbottabad, with ear diseases representing the predominant disease category, succeeded by nasal and throat disorders. Impacted cerumen, allergic rhinitis, chronic suppurative otitis media, and acute and chronic tonsillitis were the most most prevalent conditions. Young adults and individuals from rural areas constituted the largest proportion of study participant, while no statistically significant sex differences were observed in disease pattern. These results highlight the need for improved primary otorhinolaryngology service, timely diagnosis, community awareness regarding preventable ENT diseases, and prompt referral to reduce burden of disease and enhance clinical outcomes.

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