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Table of Contents
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 126-135

Public perception in the management and prevention of common ear, nose, and throat diseases in Saudi Arabia

Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia

Date of Submission25-Oct-2019
Date of Decision09-Dec-2019
Date of Acceptance13-Jan-2020
Date of Web Publication02-Apr-2020

Correspondence Address:
Abdulmajeed Bin Dahmash
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Imam Muhammad Ibn Saud Islamic University, 7544, Othman Bin Affan Rd., Al-Nada, Riyadh 13317-4233
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JNSM.JNSM_50_19

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Objective: The objective was to evaluate the awareness and knowledge of and attitudes toward common ear, nose, and throat (ENT)-related diseases among Saudi Arabian adults in Riyadh, Saudi Arabia. Methods: A cross-sectional quantitative study was conducted in Riyadh in April 2018 through 2500 self-administered, convenient sampling technique online questionnaires. Sociodemographic data, as well as knowledge regarding common ENT-related conditions, were collected and evaluated. Results: Of the 2500 distributed questionnaires, 1611 responses were received (response rate = 64.4%). The majority of participants (79.4%) had poor knowledge of ENT-related diseases (<50% score). In terms of general knowledge, 69.6% of the participants correctly answered the questions related to the safety of cotton buds for the ears and 17.75% and 19.9% correctly answered the questions related to the role of Vitamin C in the treatment of the common cold and the difference between dizziness and vertigo, respectively. Most participants had acceptable knowledge when questioned on hearing loss (score ≥50%), whereas only 18.37% scored correctly regarding the use of hearing aids in infants. The question related to the initial step in controlling nasal allergies was the highest scoring question (95.65%). The most common information resources were community, social media, and Internet websites. Conclusion: Lack of awareness of ENT-related issues is common among people in Riyadh. In addition, our findings imply that there is a need to educate and increase public awareness, especially through community-based public health campaigns and awareness programs, as community was the major information source among participants in this study.

Keywords: Community, ear, hearing loss, knowledge, larynx, Saudi Arabia, throat

How to cite this article:
Alkholaiwi F, Alharbi MM, Aldayel AY, Shadid AM, Almutairi FE, Dahmash AB. Public perception in the management and prevention of common ear, nose, and throat diseases in Saudi Arabia. J Nat Sci Med 2020;3:126-35

How to cite this URL:
Alkholaiwi F, Alharbi MM, Aldayel AY, Shadid AM, Almutairi FE, Dahmash AB. Public perception in the management and prevention of common ear, nose, and throat diseases in Saudi Arabia. J Nat Sci Med [serial online] 2020 [cited 2023 Jan 30];3:126-35. Available from: https://www.jnsmonline.org/text.asp?2020/3/2/126/281873

  Introduction Top

Ear, nose, and throat (ENT)-related symptoms are among the most common causes for visiting a primary health-care physician worldwide.[1],[2] According to the World Health Organization, there are almost 278 million people with moderate-to-profound two-sided hearing loss. Two-thirds of those affected reside in developing countries and the causes of hearing loss are preventable.[3] Between 2003 and 2004, 16.1% of United States (US) adults were reported to have experienced hearing loss.[4] Among nasal diseases, the prevalence of rhinosinusitis was estimated to be 16% among the US adult population in 2004,[5] and more than 11 million people in the US exhibited some sort of permanent noise-induced hearing loss.[6],[7],[8],[9],[10],[11],[12] Head-and-neck cancer is associated with significant morbidity, mortality, and associated health costs in the US,[13] as it is the 10th most common malignancy in the US and accounts for around 3% of all adult cancers.[14]

Prior studies worldwide suggest that the knowledge of and attitudes toward ENT-related diseases are not sufficient.[13],[15],[16],[17] There is no published data on the prevalence of ENT-related diseases in Saudi Arabia. To the authors' knowledge, there is no published paper that looked into the public perception on general ENT-related symptoms with a specific questionnaire.

This study aimed to evaluate the awareness of the general Saudi population and the attitudes toward common ENT-related diseases among Saudi Arabian adults in Riyadh, Saudi Arabia.

  Methods Top

Study design, setting, and population

A quantitative, cross-sectional, online questionnaire-based study was conducted in April 2018 among Saudi adults (≥18 years old) in Riyadh, Saudi Arabia.


To measure public awareness in the management and prevention of common ENT-related diseases, the authors developed their own questionnaire consisting of 23 questions subdivided into three main sections [Table 1]: eight questions refer to general knowledge; eight are directed toward ear and hearing diseases; and seven concentrate on nose, throat, and laryngeal diseases. The questionnaire included demographic variables (age, gender, marital status, level of education, and occupation), and the last part of the questionnaire concentrated on the resources used by the participants to access knowledge about ENT-related diseases. The questionnaire included a question about city of residence, and only respondents from Riyadh city were included. A pilot questionnaire was designed and the study was conducted, and the questionnaire was modified. Knowledge questions included a self-reported 3-point Likert scale represented as “true,” “false,” or “I don't know.” The questionnaire was developed by a board-certified otolaryngologist to cover the most common ENT-related conditions and to try to cover the most common misconceptions among the Saudi population. After that, the questionnaire was translated into Arabic with the aid of the translation team at our college and then, it was reviewed and modified by a senior otolaryngologist [Appendix 1].
Table 1: Questionnaire used to evaluate public awareness of common ear, nose, and throat-related diseases

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Data collection

A random selection of 2500 Saudi adults in Riyadh, Saudi Arabia, aged between 18 and 60 years old, which included both males and females, was acquired with the help of a local advertising company. A link to the online questionnaire was sent to the participants, along with consent for participation in the study through E-mail and text messages. The link of the questionnaire was sent five times during a 1-month period. Repetitive responses from the same participant were not allowed.

Ethical aspect

Institutional review board approval was obtained from the Medical Research Unit, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia. Informed consent was obtained from the participants through the online questionnaire, and they were asked to complete the questionnaire in their free time. The participants were not paid for their participation, and their identities remained confidential.

Data analysis

Data analysis was performed using the Statistical Package for Social Sciences software version 23.0 (SPSS Inc., Armonk, New York, USA). Categorical data were summarized as counts and percentages. Descriptive statistics were performed to assess the number of respondents who answered each question correctly. The percentage of correct responses for each participant was also calculated. The knowledge score for each participant was calculated as follows: correct responses were marked as +2, wrong responses as −2, and I don't know responses as −1. This method was used because “I don't know” response is considered a knowledge deficit to the question and considered negative rather than neutral in terms of level of knowledge. Participants' knowledge was classified as “excellent” if they obtained a ≥75% score, “good” if they had a score between 74% and 50%, and “poor” if their score was <50%. Acceptable knowledge was defined as obtaining a knowledge score ≥50%.

A univariate analysis was performed using the Chi-square test of independence. The Chi-square test of independence was used to assess whether the observed distribution of knowledge categories (acceptable vs. unacceptable) across various demographic parameters was significantly different from what is expected under the null hypothesis. For demographic parameters with more than two groups (e.g., age), a statistically significant initial result for the Chi-square test was followed by post hoc comparisons (using the same test) to compare the distribution of knowledge categories between each pair of groups. P values for the post hoc tests were adjusted for a false discovery rate to avoid the inflation of a type I error.

Variables that were statistically significant in the abovementioned step were used to construct a model (multivariate logistic regression test) to identify independent predictors of having an acceptable level of knowledge with their odd ratios (ORs) and confidence interval (CI). P <0.05 was considered statistically significant.

A sample size calculation was performed a priori. Based on the demographic survey performed in 2016, 2,576,516 Saudis aged between 18 and 60 live in Riyadh. This number was considered the population of interest (Saudi residents in Riyadh aged between 18 and 60 years). The Epi Info tool (Epi Info™, CDC, Atlanta, GA, USA, 2011)was then used for a sample size calculation. Based on a 95% CI and a 3% CI, a random sample of 1067 participants was needed.

  Results Top

In total, 1611 Saudi adults in Riyadh completed the online survey with a response rate of 64.4%. In addition, 736 were males (45.7%) and 875 were females (54.3%). Participants aged 18–30 years represented the majority of the study sample (n = 1064, 66%). Most participants were single and had a university education. Additional demographic data are summarized in [Table 2].
Table 2: Demographic data of the study participants (n=1611)

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Only 37 (2.3%) participants had an excellent knowledge level, whereas 297 (18.4%) had a good knowledge level. The remaining majority (n = 1277, 79.4%) had a poor level of knowledge regarding ENT-related diseases (<50% score).

[Table 3] shows the percentage of correct answers for each question in the three main sections. An important finding was that the percentage of correct questions did not exceed 70% for any of the questions in the general section, whereas it reached more than 90% for some questions in the other two sections. Results for the general sections show that the first question (cotton buds) was the highest scoring question (n = 1121, 69.58%), whereas question 6 (Vitamin C and common cold treatment) was the lowest scoring (n = 286, 17.75%). A low percentage of correct answers was also noted for question 8 (dizziness and vertigo are the same) (n = 321, 19.9%). Results show that question 16 (sudden hearing loss) was the question answered correctly by most participants (n = 1556, 96.59%), whereas question 14 (hearing aids and children <12 months) scored the lowest (n = 296, 18.37%). Question 19 (initial step to control nasal allergy) was the highest scoring question in the nose and throat section (n = 1541, 95.65%), whereas question 21 (tonsillectomy and immunodeficiency) was the lowest scoring question (n = 540, 33.52%).
Table 3: Respondents' awareness of ear, nose, and throat-related diseases

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The association of knowledge with the different variables using the Chi-square test is summarized in [Table 4]. Knowledge is positively and statistically significantly correlated with the age of the participants (P< 0.001). Female respondents tended to have better knowledge compared to male respondents (P< 0.001), and married respondents showed a statistically significant relation to the knowledge score (P< 0.001). Knowledge is positively correlated with education level, where having a higher educational level is a positive predictor of having a better knowledge level (P = 0.001). Knowledge was higher among employees and other groups (retired, businesspersons, and unemployed) compared to the students' group (P = 0.007).
Table 4: Associations among demographic variables and the level of knowledge of the respondents about ear, nose, and throat-related diseases

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A binary logistic regression analysis was performed to determine the association between the awareness of ENT-related diseases and the demographic variables. After adjusting for the confounders (age group, gender, education level, occupation, and being single or not), [Table 5] shows that the older respondents aged 41–60 years were more likely to have an acceptable knowledge level compared with the reference group of younger respondents aged 18–30 years (odds ratio [OR] = 1.918, 95% CI = 1.206–3.049). Male respondents in this study were less likely to have an acceptable level of knowledge compared to female respondents (OR = 0.582, 95% CI = 0.438–0.773). Meanwhile, single respondents in this study were less likely to have an acceptable level of knowledge compared to married respondents (OR = 0.910, CI = 0.647–0.1279).
Table 5: Acceptable level of knowledge about the ear, nose, and throat-related diseases

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Community was the most common source of knowledge, while social media came in second place and Internet websites came in third.

  Discussion Top

The findings of this study illustrated that the majority of Saudi adults in Riyadh city (n = 1277, 79.3%) have poor knowledge of common ENT-related diseases. Most of the participants were between 18 and 30 years of age, accounting for 1064 (66%) participants. Although younger participants showed poor knowledge in comparison to older participants, this can be explained by the fact that the older population is more prone to having illness and more likely to have experienced ENT-related diseases in the past.[18] Therefore, they are more likely to have visited their physicians and read more about diseases than the younger population. In addition, this finding is strengthened by a study conducted in Saudi Arabia that suggested that the older population has better knowledge than the younger population in complementary and alternative medicine.[19] Furthermore, female respondents were more likely to be aware of ENT-related diseases. Moreover, females are generally responsible for taking care of family health problems rather than males, and this was supported by a cross-sectional study with 254 participants in Milan, Italy, that disclosed females had better knowledge in comparison to males about ear and hearing management.[5] In addition, married participants in our study had a significantly more acceptable level of knowledge when compared to single participants, while Balkhy et al.'s study on swine influenza pandemic awareness in Saudi Arabia showed that marital status had no influence on participant knowledge.[20]

In this study, most of the participants believe that cotton buds are an unsafe way to clean the ears. On the other hand, a study among a Nigerian population showed poor knowledge of and attitudes toward cotton bud use.[21] In addition, the findings exemplified that most participants had poor knowledge of the relationship between Vitamin C and the common cold. However, there is a lack of evidence to support the idea that Vitamin C prevents and treats the common cold.[22],[23],[24] Al-Haddad et al. in their study on general knowledge and practices related to the common cold in Taif, Saudi Arabia, among 1487 respondents showed that 46% take Vitamin C when they have a cold.[25]

There is a lack of studies in the literature concerning knowledge of common ENT-related diseases or symptoms among the general population, so the authors encourage future papers in this area in other geographical locations. Moreover, there is a need for ENT-related public health campaigns, in addition to health educational programs that can bridge this gap in public awareness concerning ENT-related diseases. This can be highlighted by the most common source of information among participants in this study, as the results showed that community members were the most common source of information in most cases (67.2%) concerning acquired awareness and knowledge regarding the survey questions. This was followed by social media (44.4%) and Internet websites (39.4%), highlighting the importance of media, health education programs, and public health campaigns regarding ENT-related conditions.

One of the key limitations of this study is that some misconceptions have not been added to our questionnaire, as it is not possible to include every misconception, and we advise future researchers who wish to use our questionnaire to modify it further. Another limitation includes the lack of evidence that the participants answered the questionnaire based on prior knowledge. Furthermore, we have not excluded medical or health-care professional personnel from our study. As the results of the present study are collected through an online survey, there is a real possibility of the results being subject to response bias. Our questionnaire requires an Internet access and a smart phone or a computer to fill the survey, meaning that those who are poor were unable to fill our questionnaire in addition to individuals with poor vision and individuals who are illiterate.

Based on the findings of this study, we recommend the establishment of educational programs and the implementation of public health campaigns for ENT-related conditions directed at all age groups in Saudi Arabia to improve the level of awareness. In addition, further studies are recommended with stronger measures to verify these findings and to determine which factors affect the knowledge regarding these ENT-related diseases.

  Conclusion Top

Knowledge deficiencies were common among the people of Riyadh, Saudi Arabia, concerning common ENT-related diseases. Thus, our findings imply the importance of raising awareness through educational programs, especially community-based public health campaigns, as community was identified as a major information source by the participants in this study. These public awareness programs can aid in decreasing both the incidence and spread of contagious ENT conditions. Further studies are recommended with stronger measures to control and verify the sociodemographic datasets to confirm these findings and evaluate the factors influencing knowledge of these ENT-related diseases.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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