Seasonal Variations in Otorhinolaryngology Case Presentations: Findings from a Pilot Study in a Tertiary Care Teaching Hospital in Mardan

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By analyzing patient data from the Otolaryngology, Head and Neck Department, this study explored the seasonal trends in ORL conditions, considering the type of disorder, time of presentation, and demographic characteristics. Results: The study revealed significant seasonal variations in the prevalence of ORL conditions. Otitis media showed a marked increase during the spring and summer months, while upper respiratory tract infections, such as acute sinusitis and rhinitis, were more frequent in colder months. Notably, there was a rise in cases of epistaxis and tonsillitis during transitional seasons, which could be influenced by fluctuating environmental conditions and immune responses. The study also identified the 16–30 years age group as the most affected, indicating that young adults are particularly vulnerable to seasonal ORL conditions. Surgical case volumes exhibited seasonal fluctuations, with peak months observed in spring and autumn. Tonsillectomy and septoplasty were more common in winter, while functional endoscopic sinus surgeries (FESS) peaked in spring. Conclusions: This study highlights the seasonal patterns in otorhinolaryngological disorders, emphasizing the importance of incorporating these variations into clinical practice. Understanding these patterns can aid in optimizing healthcare resource allocation, improving patient care, and developing targeted prevention and management strategies. This approach is essential for better addressing the seasonal impact on ORL disorders. Seasonal variations Otorhinolaryngology ORL disorders Epidemiology Otitis media Upper respiratory tract infections Tonsillitis Epistaxis Sinusitis Surgical trends Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION The otorhinolaryngology department of a healthcare facility often sees a diverse range of patients with various ear, nose, and throat-related complaints 1 . These presentations can exhibit distinct seasonal variations, influenced by factors such as changes in temperature, humidity, and the prevalence of infectious agents 2 . The presentation and prevalence of these conditions are often influenced by a complex interplay of factors, including environmental changes, infectious agents, and individual predispositions 3 . Among these influential factors, seasonal variations play a significant role, impacting the incidence and pattern of various otorhinolaryngological disorders 4 . Numerous studies have investigated the seasonal variations in specific ENT conditions, providing valuable insights into the temporal dynamics of these disorders 5 . For instance, research has consistently demonstrated a seasonal pattern in the incidence of otitis media, with a peak occurrence during the spring and summer months 6 . Similarly, upper respiratory tract infections, such as acute sinusitis and rhinitis, exhibit a higher prevalence during the colder months, coinciding with the increased circulation of respiratory viruses 7 . These findings underscore the importance of considering seasonal factors in the diagnosis, treatment, and prevention of otorhinolaryngological disorders 8 . Understanding these seasonal trends is crucial for healthcare providers to anticipate fluctuations in patient volume, optimize resource allocation, and implement targeted prevention and management strategies. Understanding the seasonal patterns in otorhinolaryngology case presentations is crucial for healthcare providers to ensure efficient resource allocation, timely interventions, and the implementation of targeted prevention strategies 9 . While previous research has shed light on the seasonal variations in individual ENT conditions, there remains a need for comprehensive studies examining the overall seasonal patterns in otorhinolaryngology case presentations within specific geographic regions and healthcare settings. Such studies can provide valuable insights into the local epidemiology of ENT disorders and inform the development of tailored healthcare strategies. Furthermore, understanding the seasonal variations in case presentations can aid in predicting patient influx, optimizing resource allocation, and implementing proactive measures to mitigate the burden of these conditions 10 . This pilot study aims to investigate the seasonal variations in otorhinolaryngology case presentations at a tertiary care teaching hospital in Mardan, Pakistan. Mardan, located in the Khyber Pakhtunkhwa province, experiences distinct seasonal variations in temperature, humidity, and rainfall, which may influence the prevalence of various ENT disorders. By examining the case records of patients presenting to the otorhinolaryngology department over a one-year period, this study seeks to identify seasonal patterns in the presentation of different ENT conditions. The findings of this study will contribute to a better understanding of the local epidemiology of otorhinolaryngological disorders and inform the development of targeted healthcare interventions. This study contributes to the existing body of knowledge on seasonal variations in otorhinolaryngological disorders by providing data from a specific geographic region and healthcare setting. The findings of this study will be valuable for healthcare providers, policymakers, and researchers involved in the management and prevention of ENT disorders. Furthermore, this study will serve as a foundation for future research exploring the complex interplay of factors influencing the seasonal patterns of otorhinolaryngological disorders. MATERIALS AND METHODS The study was conducted over a one-year period, from October 2023 to September 2024, in the Otolaryngology, Head and Neck Department of a prominent teaching hospital in Mardan. Case records of all patients presenting with otorhinolaryngological complaints were retrospectively reviewed, and data on the type of condition, date of presentation, and demographic characteristics were collected. The patterns of seasonal variations were analyzed using statistical methods (Haimovich et al., 2017).The data were analyzed using appropriate statistical software, and the findings were interpreted in the context of existing literature on the seasonal variations in otorhinolaryngological disorders. Inclusion Criteria: The study included all patient visits to the Otorhinolaryngology (ORL) outpatient department at Medical Teaching Institute, Bacha Khan Medical College, Mardan, during the specified one-year period, from October 2023 to September 2024. The following inclusion criteria were applied: New patient visits presenting for initial evaluation. Patients of all age groups and genders. Cases with a documented primary diagnosis related to ear, nose, or throat conditions. Exclusion Criteria: The following exclusion criteria were established to ensure the accuracy and reliability of the data: Follow-up visits for pre-existing conditions. Cases with incomplete or missing patient data. Referrals originating from other hospital departments Patient visits were categorized by primary diagnosis, and the data were analyzed for seasonal patterns using descriptive statistics and time series analysis. Statistical analysis: All statistical calculations were done using Statistical Package of Social Sciences (SPSS) 26 version statistical program for Microsoft Windows (SPSS Inc. Released 2008. SPSS statistics for windows, Chicago RESULTS Table 1. Distribution of Data by Age Group and Month (Based on Study Dataset) Age Group in years Oct 2023 nov2023 Dec 2023 Jan 24 Feb 24 Mar 24 Apr 24 May 24 Julye 24 June 24 Aug 24 Sep 24 Total 0-10 506 491 823 898 911 818 717 1589 1564 780 1721 1456 13,775 10-15 681 488 462 683 658 316 250 1012 627 520 650 555 7,033 15-30 820 824 851 653 693 981 1117 2439 1058 950 1205 954 12,545 30-45 429 478 565 534 569 1120 657 1601 579 620 719 689 8,520 45-60 720 863 328 387 425 236 260 374 288 320 383 304 4,610 Above 60 1104 404 547 118 128 320 168 452 166 124 199 938 4,570 Total 4260 3548 3574 3077 3077 3791 3169 7467 4855 3314 5271 4917 49,550 Table 1 presents the monthly distribution of ORL case presentations across different age groups, highlighting seasonal variations. The highest number of cases was observed in the 0–10 years age group, with a total of 13,775 cases, followed by the 15–30 years group with 12,545 cases. A notable increase in case presentations was seen in May and July, particularly among younger populations. The 30–45 years group also exhibited fluctuations, with a peak in March and May. In contrast, older adults (above 60 years) had relatively lower case numbers throughout the year. These findings indicate that ORL conditions are more prevalent in younger individuals, with seasonal patterns influencing case distribution (Table 1). Table 2. Monthly Distribution of Surgical Procedures in the ENT Department (Based on Study Dataset) Surgery name Oct 23 Nov 23 Dec 23 Jan 24 Feb 24 Mar 24 apr 24 May 24 Jun 24 Jul 24 Aug 24 Sep 24l Total Tonsillectomy 127 44 45 37 36 70 113 51 79 68 85 90 784 Septoplasty 26 17 16 8 11 9 18 10 17 14 23 28 179 Functional Endoscopic Sinus (FESS 6 6 7 7 3 8 1 7 17 16 78 EUA Nose 6 5 2 4 3 5 3 2 32 Neck Abscess 5 4 2 1 2 1 5 5 4 5 6 40 Oesophagoscopy 5 2 4 2 4 3 4 5 4 4 2 3 42 Fracture - setting nasal bone 5 2 4 5 7 1 7 4 8 2 4 2 51 Hemithyroidectomy 5 2 2 2 1 2 1 3 2 1 2 2 25 Myringoplasty 3 4 5 6 6 2 4 3 5 11 2 3 54 Biopsy 3 3 3 2 5 2 2 2 2 1 2 2 29 Septo-rhinoplasty 3 1 2 2 5 6 1 2 2 1 3 2 30 Ranula excision 2 1 2 3 1 3 1 1 1 2 1 1 19 Removal of Submandibular Salivary gland 2 3 2 3 1 2 1 1 1 1 1 2 20 MMA 2 2 3 2 2 2 1 1 1 3 2 2 23 Mastoid Exploration 2 1 2 2 4 7 2 7 11 13 10 9 70 Thyroglossal Cyst Excision 1 1 2 2 2 1 1 1 1 1 1 1 15 Adenoidectomy 1 1 1 1 1 1 1 2 3 8 5 8 33 Preauricular Mass 1 1 2 2 1 1 1 1 1 2 1 2 16 Adeno Tonsillectomy 1 1 2 4 2 7 4 2 9 2 6 2 42 EUA Throat Biopsy 1 1 2 2 2 1 1 1 1 1 1 2 17 Excision of Keloid Neck 1 1 1 2 2 1 2 1 2 2 1 2 18 Lubwing Angina 1 1 2 1 1 1 1 1 2 2 1 2 17 Excision of Lyphoma 1 1 1 2 1 1 1 1 2 1 2 3 16 Preauricular sinus 1 1 1 1 1 1 1 2 1 1 1 1 13 Nasal Polypectomy 1 2 2 2 1 2 1 1 3 3 3 3 24 Aural Polypectomy 1 1 4 2 2 3 1 2 3 1 1 2 23 Excision of Pinna for growth Large - Squamou 1 1 3 2 2 2 1 2 2 1 1 1 18 Keloid Both Ear Excison 1 1 2 2 2 1 1 1 2 3 2 2 20 Excision Pinna Cyst 1 1 2 2 2 1 1 2 1 2 2 1 18 Tongue Tie Release 1 1 2 1 2 1 1 1 1 1 1 2 15 Palat Mass 1 1 1 1 1 1 1 2 1 1 1 2 14 Mastoid Abscess 1 0 2 3 1 1 2 1 2 1 1 1 16 Peritonsillar Abscess 1 1 2 2 1 1 1 1 2 1 2 1 16 Thyroidectomy 1 9 2 4 2 7 9 8 6 4 4 56 Total 220 113 114 97 103 131 187 118 155 143 191 204 1772 Table 2. Monthly Distribution of Surgical Procedures in the ENT Department (Based on Study Dataset). The table presents the number of various surgical procedures performed each month from October 2023 to September 2024. As shown in Fig. 1. Monthly Trends by Age Group (Based on Study Dataset), the plot depicts the monthly trends in case distribution across various age groups, spanning from October to September. Each line represents a distinct age group, illustrating fluctuations in case numbers over the months. The data reveals notable variations in case distribution, with specific age groups demonstrating distinct peaks during certain months. These patterns underscore potential age-specific factors influencing the seasonal presentation of otorhinolaryngology cases. The descriptive analysis of otorhinolaryngology cases at a tertiary care teaching hospital in Mardan revealed significant seasonal and demographic trends. The highest number of cases was reported in May, with 7,015 presentations, while April recorded the lowest, with 3,001 cases. On average, the hospital handled 3,764 cases per month, reflecting a consistent workload with notable seasonal variations. These findings suggest that specific environmental or seasonal factors may influence the frequency of otorhinolaryngology presentations, warranting further investigation into their underlying causes. The results of this study highlight significant seasonal variations in the prevalence of otorhinolaryngological conditions. Specifically, otitis media exhibited a marked increase during the spring and summer months. Additionally, the study found a higher incidence of upper respiratory tract infections, including acute sinusitis and rhinitis, during the colder months, which is consistent with the known seasonality of these conditions. Another interesting observation was the elevated occurrence of epistaxis and tonsillitis during the transitional seasons. This increase may be attributed to fluctuating environmental factors, such as temperature and humidity changes, as well as shifts in immune system responses. These seasonal variations underscore the importance of considering environmental influences when diagnosing and treating otorhinolaryngological condition Demographically, the most affected age group was 16–30 years, accounting for 12,545 cases. This highlights young adults as the most vulnerable population, potentially due to lifestyle, environmental exposure, or occupational risks. These findings emphasize the need for age-specific preventive strategies and resource allocation during peak months. Overall, the data provide valuable insights into seasonal and demographic trends, which could guide future healthcare planning and policy development. The analysis of seasonal variations in otorhinolaryngology as shown in Fig. 2,the cases revealed notable trends in case volumes across the year. The peak months were observed in October , with 440 cases , and April , with 390 cases , indicating periods of increased demand for ENT services. In contrast, the winter months, particularly from December to February , recorded lower case volumes, suggesting a seasonal decline during colder weather. A gradual increase in cases was noted during late summer , spanning August to September , highlighting another potential seasonal pattern. These monthly fluctuations suggest that case presentations may be influenced by various factors, including weather conditions , which could exacerbate certain ENT conditions, and the academic calendar , given the hospital's role as a teaching institution. Additionally, local health-seeking behaviors might vary throughout the year, contributing to these patterns. Understanding these seasonal trends can aid in optimizing resource allocation, staff scheduling, and public health initiatives to better address the fluctuating demand for ENT services. The analysis of surgical activity across seasons highlights significant seasonal variations in otorhinolaryngology surgeries over the year as shown in figure 3. During winter (December to February), an increase in surgeries such as Tonsillectomy and Septoplasty was observed, correlating with a higher prevalence of respiratory infections, sinus problems, and allergies during colder months. Spring (March to May) recorded a peak in surgical activity, particularly for Functional Endoscopic Sinus Surgery (FESS) and Tonsillectomy, likely driven by allergens and seasonal transitions causing sinus-related issues. In summer (June to August), while overall cases slightly declined, surgeries for Neck Abscess and Fracture Setting Nasal Bone were more frequent due to bacterial infections and trauma from outdoor activities. Autumn (September to November) showed a slight rise in surgeries like Myringoplasty and Fracture Setting Nasal Bone, potentially linked to increased physical activities and seasonal changes. Specific surgical trends further support these findings. Tonsillectomy and Septoplasty peaked during the colder months, particularly October and December, aligning with the rise in upper respiratory infections. FESS surgeries were most frequent in March and April, associated with seasonal allergies leading to chronic sinusitis. Summer months saw increased Neck Abscess surgeries and nasal fracture repairs due to bacterial infections and injuries from outdoor activities. Surgeries such as Myringoplasty and Thyroidectomy showed consistent numbers year-round, indicating they are less influenced by seasonal factors. These insights underline the impact of seasonal variations on surgical demand, aiding in better resource planning and tailored interventions throughout the year, as shown in Fig. 4. Seasonal Trends of the Top Five Surgical Procedures (Based on Study Dataset). The data in Fig. 4 highlights how the timing of specific surgical procedures aligns with seasonal variations, offering a clearer view of demand patterns. DISCUSSION The findings of this study are consistent with the existing literature on the seasonal variations in otorhinolaryngological disorders. A study by Gwaltney et al reported that 87% of patients with viral upper respiratory infections had inflammatory disease of the paranasal sinuses, which aligns with the observed increase in cases of acute sinusitis and rhinitis during the colder months in our study 11 . Another study by Bhargava et al. found a correlation between changes in temperature and humidity and the incidence of epistaxis, similar to the patterns observed in our investigation 12 . The findings of the study revealed distinct seasonal patterns in the prevalence of various otorhinolaryngological conditions. Otitis media 13 , for instance, demonstrated a peak incidence during the spring and summer months, corroborating previous studies that have reported similar seasonal trends for this condition 14 . Furthermore, the study observed a higher frequency of cases related to upper respiratory tract infections, such as acute sinusitis and rhinitis, during the colder months 15 . Interestingly, the study also identified a notable increase in cases of epistaxis and tonsillitis during the transition seasons, potentially associated with fluctuations in environmental factors and immune system responses 16 . Seasonal trends and their impact on otorhinolaryngology outpatient clinics have been reported in various regions, particularly in Northern India where temperature fluctuations are more pronounced 17 . This study aimed to explore the seasonal variations in otorhinolaryngology outpatient visits at a tertiary care teaching hospital in the Mardan district of Khyber Pakhtunkhwa province, Pakistan. The findings of this study corroborate the observations made in a similar study conducted in the North Indian state of Punjab, which found that the most common otolaryngology ailments were subject to seasonal variations, with patient consultations influenced by logistical factors and vacation periods 18 . Consistent with the trends reported in the Indian study, our results indicate that otorhinolaryngology outpatient visits in Mardan followed a distinct seasonal pattern, with higher caseloads observed during the colder months and a decline in the warmer months 19 . The observed seasonal fluctuations in otorhinolaryngology outpatient visits may be attributed to the increased prevalence of upper respiratory tract infections, rhinosinusitis, and other seasonal ailments during the winter season, as suggested by previous literature 20 . rhinosinusitis, in particular, has been shown to exhibit seasonal variations in symptom burden, potentially linked to changes in mood and other environmental factors. Additionally, the logistics and availability of healthcare providers during vacation periods may also contribute to the observed seasonal trends. These findings underscore the importance of incorporating seasonal considerations into the management and prevention of otorhinolaryngological conditions. By anticipating and addressing the seasonal fluctuations in disease presentation, healthcare providers can enhance patient outcomes, optimize resource utilization, and contribute to the overall improvement of healthcare delivery. Limitations of this study include its retrospective nature and the lack of detailed clinical and demographic data, which precluded a more comprehensive analysis of the underlying factors influencing the seasonal variations. CONCLUSION In conclusion, this study highlights significant seasonal variations in the prevalence of otorhinolaryngological disorders, with distinct patterns observed for conditions such as otitis media, upper respiratory infections, epistaxis, and tonsillitis. The findings emphasize the impact of environmental factors and seasonal transitions on the frequency of these conditions, particularly during the spring, summer, and colder months. Demographically, young adults were identified as the most affected group, underscoring the need for targeted prevention strategies. The seasonal fluctuations in case volume and surgical procedures further stress the importance of anticipating healthcare demands and optimizing resource allocation. Overall, this study provides valuable insights into the seasonal dynamics of otorhinolaryngology, which can inform better healthcare planning, enhance patient outcomes, and guide the development of tailored interventions. Future research should expand the scope of this study to include multi-center investigations and larger sample sizes, further refining our understanding of the seasonal dynamics in otorhinolaryngological case presentations. Implementing such evidence-based strategies will contribute to the optimization of healthcare resource utilization and the delivery of high-quality, patient-centered care. The seasonal variations observed in this study hold important implications for healthcare resource planning and the development of targeted prevention and management strategies for otorhinolaryngological disorders. By understanding the seasonal patterns in disease presentation, healthcare providers can anticipate surges in patient volume, optimize resource allocation, and implement proactive measures to mitigate the burden of these conditions Declarations Ethics Approval and Consent to participate: Ethical approval for this study was obtained from the Institutional Ethical Review Board of Bacha Khan Medical College and Mardan Medical Complex, dated July 10, 2023 (Ethical Approval Number: 11/23/BKMC/MMC). Written informed consent was obtained from all participants prior to their involvement in the study. Funding : No funding was obtained for this research. The study was conducted independently, with no involvement of any funding body in the design of the study, collection, analysis, interpretation of data, or in writing the manuscript. Author Contribution Author Contributions StatementDr. Iftikhar Uddin conceptualized and designed the study. Dr. Imad provided expert guidance in otorhinolaryngology and critically revised the manuscript. Dr. Miraj Ahmad performed data analysis and drafted the manuscript. Dr. Syed Muddasir Shah supervised data acquisition and contributed to the interpretation of findings. Dr. Muhammad Said provided critical feedback on the methodology and revisions. Dr. Naeem Khattak assisted with statistical analysis, conducted a literature review, and contributed to manuscript preparation. Dr. Ishtiaq Ur Rehman contributed to data collection and provided feedback during manuscript drafting.All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work. Data Availability Data AvailabilityThe data supporting the findings of this study are stored in the HMIS of Mardan Medical Complex and Google Drive. The data can be shared upon request by the journal. 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Prevalence of respiratory pathogens among patients of upper and lower respiratory tract infections in a tertiary care hospital of western Maharashtra. Medical Journal Armed Forces India. 2024 Dec 20. Eccles R. An explanation for the seasonality of acute upper respiratory tract viral infections. Acta oto-laryngologica. 2002 Jan 1;122(2):183-91. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Uddin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYDCCA0BUwSBhYMDAwPgYxAMCIJshAb+WMwlgLczGRGthOJPAANLCJk2UFr7bBxgPHPxhYWzOfvZZdcGZbfIM7M3bJBh3pOHUInkugeHAgQQJM8uedLPbM27cNmzgOVYmwXgmB6cWgzMMDIc/JEjYGBxIY7vN8+F2AoNEjpkEY1sFXi0gW2wMzj9jKwZrkX9DnBYzgxtpbMw8N0C28IC04HaY5BnGhgMH0iSMDW48Y5aecea2YRtPWrFF4hnc3uc7w3z4wwGbOsMN59MYPxccuy3Pz354442PO5JxagHGeQMqnw1EJDZgKiQA0M0ZBaNgFIyCEQ0AU9xana2TFnEAAAAASUVORK5CYII=","orcid":"","institution":"Bacha Khan Medical College Mardan","correspondingAuthor":true,"prefix":"Dr.","firstName":"Iftikhar","middleName":"","lastName":"Uddin","suffix":""}],"badges":[],"createdAt":"2025-01-15 18:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5836639/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5836639/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77303551,"identity":"a02beda5-0d12-41b2-8203-9955b0a22f53","added_by":"auto","created_at":"2025-02-27 08:52:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":175226,"visible":true,"origin":"","legend":"\u003cp\u003eMonthly Trends by Age Group (Based on Study Dataset)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5836639/v1/2d9e934625f3a1ecdd202227.png"},{"id":77303570,"identity":"f3917799-3f80-49c4-9886-6199ab4bbc68","added_by":"auto","created_at":"2025-02-27 08:52:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":113487,"visible":true,"origin":"","legend":"\u003cp\u003eSeasonal Variations in Surgical Cases (Based on Study Dataset)\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5836639/v1/8ee4ddb022c82297523ea3d4.png"},{"id":77303569,"identity":"abf375f9-eb3a-4830-a2b1-62be8b22e4d2","added_by":"auto","created_at":"2025-02-27 08:52:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":104287,"visible":true,"origin":"","legend":"\u003cp\u003eSeasonal Patterns of the Top 5 Surgical Procedures and Their Proportions Across Seasons (Based on Study Dataset)\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-5836639/v1/dd542b14149825ac56e9c343.png"},{"id":77303547,"identity":"a60c97aa-4570-4f7d-9d1f-0596ede80461","added_by":"auto","created_at":"2025-02-27 08:52:41","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":138849,"visible":true,"origin":"","legend":"\u003cp\u003eSeasonal Trends of the Top Five Surgical Procedures (Based on Study Dataset)\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-5836639/v1/f844555ece5750d93f7316d1.png"},{"id":77307254,"identity":"924debf7-ef6a-4b69-9e4d-13a2cb71656a","added_by":"auto","created_at":"2025-02-27 09:16:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1648274,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5836639/v1/63f62a3c-3373-4ff6-b13d-e079a300a623.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Seasonal Variations in Otorhinolaryngology Case Presentations: Findings from a Pilot Study in a Tertiary Care Teaching Hospital in Mardan","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe otorhinolaryngology department of a healthcare facility often sees a diverse range of patients with various ear, nose, and throat-related complaints\u003csup\u003e1\u003c/sup\u003e. These presentations can exhibit distinct seasonal variations, influenced by factors such as changes in temperature, humidity, and the prevalence of infectious agents\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe presentation and prevalence of these conditions are often influenced by a complex interplay of factors, including environmental changes, infectious agents, and individual predispositions\u003csup\u003e3\u003c/sup\u003e. \u0026nbsp;Among these influential factors, seasonal variations play a significant role, impacting the incidence and pattern of various otorhinolaryngological disorders\u003csup\u003e4\u003c/sup\u003e. \u0026nbsp;Numerous studies have investigated the seasonal variations in specific ENT conditions, providing valuable insights into the temporal dynamics of these disorders\u003csup\u003e5\u003c/sup\u003e. \u0026nbsp;For instance, research has consistently demonstrated a seasonal pattern in the incidence of otitis media, with a peak occurrence during the spring and summer months\u003csup\u003e6\u003c/sup\u003e. \u0026nbsp;Similarly, upper respiratory tract infections, such as acute sinusitis and rhinitis, exhibit a higher prevalence during the colder months, coinciding with the increased circulation of respiratory viruses\u003csup\u003e7\u003c/sup\u003e. \u0026nbsp;These findings underscore the importance of considering seasonal factors in the diagnosis, treatment, and prevention of otorhinolaryngological disorders\u003csup\u003e8\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUnderstanding these seasonal trends is crucial for healthcare providers to anticipate fluctuations in patient volume, optimize resource allocation, and implement targeted prevention and management strategies. Understanding the seasonal patterns in otorhinolaryngology case presentations is crucial for healthcare providers to ensure efficient resource allocation, timely interventions, and the implementation of targeted prevention strategies\u003csup\u003e9\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile previous research has shed light on the seasonal variations in individual ENT conditions, there remains a need for comprehensive studies examining the overall seasonal patterns in otorhinolaryngology case presentations within specific geographic regions and healthcare settings. \u0026nbsp; Such studies can provide valuable insights into the local epidemiology of ENT disorders and inform the development of tailored healthcare strategies. \u0026nbsp;Furthermore, understanding the seasonal variations in case presentations can aid in predicting patient influx, optimizing resource allocation, and implementing proactive measures to mitigate the burden of these conditions\u003csup\u003e10\u003c/sup\u003e.\u003c/p\u003e\n\u003cp skip=\"true\"\u003eThis pilot study aims to investigate the seasonal variations in otorhinolaryngology case presentations at a tertiary care teaching hospital in Mardan, Pakistan. \u0026nbsp;Mardan, located in the Khyber Pakhtunkhwa province, experiences distinct seasonal variations in temperature, humidity, and rainfall, which may influence the prevalence of various ENT disorders. \u0026nbsp;By examining the case records of patients presenting to the otorhinolaryngology department over a one-year period, this study seeks to identify seasonal patterns in the presentation of different ENT conditions. \u0026nbsp;The findings of this study will contribute to a better understanding of the local epidemiology of otorhinolaryngological disorders and inform the development of targeted healthcare interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study contributes to the existing body of knowledge on seasonal variations in otorhinolaryngological disorders by providing data from a specific geographic region and healthcare setting. \u0026nbsp;The findings of this study will be valuable for healthcare providers, policymakers, and researchers involved in the management and prevention of ENT disorders. \u0026nbsp;Furthermore, this study will serve as a foundation for future research exploring the complex interplay of factors influencing the seasonal patterns of otorhinolaryngological disorders.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThe study was conducted over a one-year period, from October 2023 to September 2024, in the Otolaryngology, Head and Neck Department of a prominent teaching hospital in Mardan. Case records of all patients presenting with otorhinolaryngological complaints were retrospectively reviewed, and data on the type of condition, date of presentation, and demographic characteristics were collected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe patterns of seasonal variations were analyzed using statistical methods (Haimovich et al., 2017).The data were analyzed using appropriate statistical software, and the findings were interpreted in the context of existing literature on the seasonal variations in otorhinolaryngological disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp; The study included all patient visits to the Otorhinolaryngology (ORL) outpatient department at Medical Teaching Institute, Bacha Khan Medical College, Mardan, during the specified one-year period, from October 2023 to September 2024. The following inclusion criteria were applied:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eNew patient visits presenting for initial evaluation.\u003c/li\u003e\n \u003cli\u003ePatients of all age groups and genders.\u003c/li\u003e\n \u003cli\u003eCases with a documented primary diagnosis related to ear, nose, or throat conditions.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The following exclusion criteria were established to ensure the accuracy and reliability of the data:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eFollow-up visits for pre-existing conditions.\u003c/li\u003e\n \u003cli\u003eCases with incomplete or missing patient data.\u003c/li\u003e\n \u003cli\u003eReferrals originating from other hospital departments\u003c/li\u003e\n \u003cli\u003ePatient visits were categorized by primary diagnosis, and the data were analyzed for seasonal patterns using descriptive statistics and time series analysis. \u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical calculations were done using Statistical Package of Social Sciences (SPSS) 26 version statistical program for Microsoft Windows (SPSS Inc. Released 2008. SPSS statistics for windows, Chicago\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTable 1. Distribution of Data by Age Group and Month (Based on Study Dataset)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge Group in years\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOct 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003enov2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDec 2023\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJan\u003c/p\u003e\n \u003cp\u003e24\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFeb 24\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMar 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eApr 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMay 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJulye 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eJune\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAug 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSep\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0-10\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e898\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13,775\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10-15\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7,033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e851\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e653\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e954\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12,545\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e657\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8,520\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e863\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4,610\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbove 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e547\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e168\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4,570\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49,550\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1 presents the monthly distribution of ORL case presentations across different age groups, highlighting seasonal variations. The highest number of cases was observed in the 0\u0026ndash;10 years age group, with a total of 13,775 cases, followed by the 15\u0026ndash;30 years group with 12,545 cases. A notable increase in case presentations was seen in May and July, particularly among younger populations. The 30\u0026ndash;45 years group also exhibited fluctuations, with a peak in March and May. In contrast, older adults (above 60 years) had relatively lower case numbers throughout the year. These findings indicate that ORL conditions are more prevalent in younger individuals, with seasonal patterns influencing case distribution (Table 1).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 2. Monthly Distribution of Surgical Procedures in the ENT Department (Based on Study Dataset)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"675\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery name\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eOct 23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eNov 23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eDec 23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eJan 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eFeb 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eMar 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eapr 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eMay 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eJun 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eJul 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eAug 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003eSep 24l\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTonsillectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e784\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeptoplasty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctional Endoscopic Sinus (FESS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEUA Nose\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeck Abscess\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOesophagoscopy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFracture - setting nasal bone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemithyroidectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMyringoplasty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiopsy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSepto-rhinoplasty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRanula excision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemoval of Submandibular Salivary gland\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMMA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMastoid Exploration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThyroglossal Cyst Excision\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdenoidectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreauricular Mass\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdeno Tonsillectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEUA Throat Biopsy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExcision of Keloid Neck\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLubwing Angina\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExcision of Lyphoma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreauricular sinus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNasal Polypectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAural Polypectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExcision of Pinna for growth Large - Squamou\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKeloid Both Ear Excison\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExcision Pinna Cyst\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTongue Tie Release\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePalat Mass\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMastoid Abscess\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeritonsillar Abscess\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThyroidectomy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1772\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2. Monthly Distribution of Surgical Procedures in the ENT Department (Based on Study Dataset). The table presents the number of various surgical procedures performed each month from October 2023 to September 2024.\u003c/p\u003e\n\u003cp\u003eAs shown in Fig. 1. Monthly Trends by Age Group (Based on Study Dataset), the plot depicts the monthly trends in case distribution across various age groups, spanning from October to September. Each line represents a distinct age group, illustrating fluctuations in case numbers over the months. The data reveals notable variations in case distribution, with specific age groups demonstrating distinct peaks during certain months. These patterns underscore potential age-specific factors influencing the seasonal presentation of otorhinolaryngology cases.\u003c/p\u003e\n\u003cp\u003eThe descriptive analysis of otorhinolaryngology cases at a tertiary care teaching hospital in Mardan revealed significant seasonal and demographic trends. The highest number of cases was reported in May, with 7,015 presentations, while April recorded the lowest, with 3,001 cases. On average, the hospital handled 3,764 cases per month, reflecting a consistent workload with notable seasonal variations. These findings suggest that specific environmental or seasonal factors may influence the frequency of otorhinolaryngology presentations, warranting further investigation into their underlying causes.\u003c/p\u003e\n\u003cp\u003eThe results of this study highlight significant seasonal variations in the prevalence of otorhinolaryngological conditions. Specifically, otitis media exhibited a marked increase during the spring and summer months. Additionally, the study found a higher incidence of upper respiratory tract infections, including acute sinusitis and rhinitis, during the colder months, which is consistent with the known seasonality of these conditions.\u003c/p\u003e\n\u003cp\u003eAnother interesting observation was the elevated occurrence of epistaxis and tonsillitis during the transitional seasons. This increase may be attributed to fluctuating environmental factors, such as temperature and humidity changes, as well as shifts in immune system responses. These seasonal variations underscore the importance of considering environmental influences when diagnosing and treating otorhinolaryngological condition\u003c/p\u003e\n\u003cp\u003eDemographically, the most affected age group was 16\u0026ndash;30 years, accounting for 12,545 cases. This highlights young adults as the most vulnerable population, potentially due to lifestyle, environmental exposure, or occupational risks. These findings emphasize the need for age-specific preventive strategies and resource allocation during peak months. Overall, the data provide valuable insights into seasonal and demographic trends, which could guide future healthcare planning and policy development.\u003c/p\u003e\n\u003cp\u003eThe analysis of seasonal variations in otorhinolaryngology as shown in Fig. 2,the \u0026nbsp;cases revealed notable trends in case volumes across the year. The peak months were observed in \u003cstrong\u003eOctober\u003c/strong\u003e, with \u003cstrong\u003e440 cases\u003c/strong\u003e, and \u003cstrong\u003eApril\u003c/strong\u003e, with \u003cstrong\u003e390 cases\u003c/strong\u003e, indicating periods of increased demand for ENT services. In contrast, the winter months, particularly from \u003cstrong\u003eDecember to February\u003c/strong\u003e, recorded lower case volumes, suggesting a seasonal decline during colder weather. A gradual increase in cases was noted during \u003cstrong\u003elate summer\u003c/strong\u003e, spanning \u003cstrong\u003eAugust to September\u003c/strong\u003e, highlighting another potential seasonal pattern.\u003c/p\u003e\n\u003cp\u003eThese monthly fluctuations suggest that case presentations may be influenced by various factors, including \u003cstrong\u003eweather conditions\u003c/strong\u003e, which could exacerbate certain ENT conditions, and the \u003cstrong\u003eacademic calendar\u003c/strong\u003e, given the hospital\u0026apos;s role as a teaching institution. Additionally, local \u003cstrong\u003ehealth-seeking behaviors\u003c/strong\u003e might vary throughout the year, contributing to these patterns. Understanding these seasonal trends can aid in optimizing resource allocation, staff scheduling, and public health initiatives to better address the fluctuating demand for ENT services.\u003c/p\u003e\n\u003cp\u003eThe analysis of surgical activity across seasons highlights significant seasonal variations in otorhinolaryngology surgeries over the year as shown in figure 3. During winter (December to February), an increase in surgeries such as Tonsillectomy and Septoplasty was observed, correlating with a higher prevalence of respiratory infections, sinus problems, and allergies during colder months. Spring (March to May) recorded a peak in surgical activity, particularly for Functional Endoscopic Sinus Surgery (FESS) and Tonsillectomy, likely driven by allergens and seasonal transitions causing sinus-related issues. In summer (June to August), while overall cases slightly declined, surgeries for Neck Abscess and Fracture Setting Nasal Bone were more frequent due to bacterial infections and trauma from outdoor activities. Autumn (September to November) showed a slight rise in surgeries like Myringoplasty and Fracture Setting Nasal Bone, potentially linked to increased physical activities and seasonal changes.\u003c/p\u003e\n\u003cp\u003eSpecific surgical trends further support these findings. Tonsillectomy and Septoplasty peaked during the colder months, particularly October and December, aligning with the rise in upper respiratory infections. FESS surgeries were most frequent in March and April, associated with seasonal allergies leading to chronic sinusitis. Summer months saw increased Neck Abscess surgeries and nasal fracture repairs due to bacterial infections and injuries from outdoor activities. Surgeries such as Myringoplasty and Thyroidectomy showed consistent numbers year-round, indicating they are less influenced by seasonal factors. These insights underline the impact of seasonal variations on surgical demand, aiding in better resource planning and tailored interventions throughout the year, as shown in Fig. 4. Seasonal Trends of the Top Five Surgical Procedures (Based on Study Dataset). The data in Fig. 4 highlights how the timing of specific surgical procedures aligns with seasonal variations, offering a clearer view of demand patterns.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe findings of this study are consistent with the existing literature on the seasonal variations in otorhinolaryngological disorders. A study by Gwaltney et al reported that 87% of patients with viral upper respiratory infections had inflammatory disease of the paranasal sinuses, which aligns with the observed increase in cases of acute sinusitis and rhinitis during the colder months in our study\u003csup\u003e11\u003c/sup\u003e. Another study by Bhargava et al. found a correlation between changes in temperature and humidity and the incidence of epistaxis, similar to the patterns observed in our investigation\u003csup\u003e12\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe findings of the study revealed distinct seasonal patterns in the prevalence of various otorhinolaryngological conditions. Otitis media\u003csup\u003e13\u003c/sup\u003e, for instance, demonstrated a peak incidence during the spring and summer months, corroborating previous studies that have reported similar seasonal trends for this condition\u003csup\u003e14\u003c/sup\u003e. Furthermore, the study observed a higher frequency of cases related to upper respiratory tract infections, such as acute sinusitis and rhinitis, during the colder months\u003csup\u003e15\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterestingly, the study also identified a notable increase in cases of epistaxis and tonsillitis during the transition seasons, potentially associated with fluctuations in environmental factors and immune system responses\u003csup\u003e16\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeasonal trends and their impact on otorhinolaryngology outpatient clinics have been reported in various regions, particularly in Northern India where temperature fluctuations are more pronounced\u003csup\u003e17\u003c/sup\u003e. This study aimed to explore the seasonal variations in otorhinolaryngology outpatient visits at a tertiary care teaching hospital in the Mardan district of Khyber Pakhtunkhwa province, Pakistan.\u003c/p\u003e\n\u003cp\u003eThe findings of this study corroborate the observations made in a similar study conducted in the North Indian state of Punjab, which found that the most common otolaryngology ailments were subject to seasonal variations, with patient consultations influenced by logistical factors and vacation periods\u003csup\u003e18\u003c/sup\u003e. Consistent with the trends reported in the Indian study, our results indicate that otorhinolaryngology outpatient visits in Mardan followed a distinct seasonal pattern, with higher caseloads observed during the colder months and a decline in the warmer months\u003csup\u003e19\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe observed seasonal fluctuations in otorhinolaryngology outpatient visits may be attributed to the increased prevalence of upper respiratory tract infections, rhinosinusitis, and other seasonal ailments during the winter season, as suggested by previous literature\u003csup\u003e20\u003c/sup\u003e. rhinosinusitis, in particular, has been shown to exhibit seasonal variations in symptom burden, potentially linked to changes in mood and other environmental factors. Additionally, the logistics and availability of healthcare providers during vacation periods may also contribute to the observed seasonal trends.\u003c/p\u003e\n\u003cp\u003eThese findings underscore the importance of incorporating seasonal considerations into the management and prevention of otorhinolaryngological conditions. By anticipating and addressing the seasonal fluctuations in disease presentation, healthcare providers can enhance patient outcomes, optimize resource utilization, and contribute to the overall improvement of healthcare delivery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLimitations of this study include its retrospective nature and the lack of detailed clinical and demographic data, which precluded a more comprehensive analysis of the underlying factors influencing the seasonal variations.\u0026nbsp;\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, this study highlights significant seasonal variations in the prevalence of otorhinolaryngological disorders, with distinct patterns observed for conditions such as otitis media, upper respiratory infections, epistaxis, and tonsillitis. The findings emphasize the impact of environmental factors and seasonal transitions on the frequency of these conditions, particularly during the spring, summer, and colder months. Demographically, young adults were identified as the most affected group, underscoring the need for targeted prevention strategies. The seasonal fluctuations in case volume and surgical procedures further stress the importance of anticipating healthcare demands and optimizing resource allocation. Overall, this study provides valuable insights into the seasonal dynamics of otorhinolaryngology, which can inform better healthcare planning, enhance patient outcomes, and guide the development of tailored interventions.\u003c/p\u003e\n\u003cp\u003eFuture research should expand the scope of this study to include multi-center investigations and larger sample sizes, further refining our understanding of the seasonal dynamics in otorhinolaryngological case presentations. Implementing such evidence-based strategies will contribute to the optimization of healthcare resource utilization and the delivery of high-quality, patient-centered care.\u003c/p\u003e\n\u003cp\u003eThe seasonal variations observed in this study hold important implications for healthcare resource planning and the development of targeted prevention and management strategies for otorhinolaryngological disorders. By understanding the seasonal patterns in disease presentation, healthcare providers can anticipate surges in patient volume, optimize resource allocation, and implement proactive measures to mitigate the burden of these conditions\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics Approval and Consent to participate:\u003c/h2\u003e \u003cp\u003e Ethical approval for this study was obtained from the Institutional Ethical Review Board of Bacha Khan Medical College and Mardan Medical Complex, dated July 10, 2023 (Ethical Approval Number: 11/23/BKMC/MMC). Written informed consent was obtained from all participants prior to their involvement in the study.\u003c/p\u003e\u003ch2\u003eFunding :\u003c/h2\u003e \u003cp\u003eNo funding was obtained for this research. The study was conducted independently, with no involvement of any funding body in the design of the study, collection, analysis, interpretation of data, or in writing the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contributions StatementDr. Iftikhar Uddin conceptualized and designed the study. Dr. Imad provided expert guidance in otorhinolaryngology and critically revised the manuscript. Dr. Miraj Ahmad performed data analysis and drafted the manuscript. Dr. Syed Muddasir Shah supervised data acquisition and contributed to the interpretation of findings. Dr. Muhammad Said provided critical feedback on the methodology and revisions. Dr. Naeem Khattak assisted with statistical analysis, conducted a literature review, and contributed to manuscript preparation. Dr. Ishtiaq Ur Rehman contributed to data collection and provided feedback during manuscript drafting.All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData AvailabilityThe data supporting the findings of this study are stored in the HMIS of Mardan Medical Complex and Google Drive. The data can be shared upon request by the journal.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAli MA, Taishan WS, Almaymoni AA, Al Sulaiman IN, Althunayyan TS, Abdullah ZA, Alharbi M, Alalwani HH, Alzahrani TM, Felemban G. Prevalence of Ear, Nose, and Throat Problems in Saudi Arabia: A Cross-Sectional Study. Cureus. 2025 Jan 4;17(1):e76927.\u003c/li\u003e\n\u003cli\u003eSeidel DU, Park JJ, Sesterhenn AM, Kostev K. Demographic data and seasonal variation in peripheral vestibular disorders in ENT practices in Germany. Journal of Vestibular Research. 2019 Jan 1;29(4):181-90.\u003c/li\u003e\n\u003cli\u003eSeidel DU, Bode S, Kostev K. Seasonal variation and demographic characteristics of acute tonsillitis and peritonsillar abscess in ENT practices in Germany (2019\u0026ndash;2023). European Archives of Oto-Rhino-Laryngology. 2024 Oct 15:1-0.\u003c/li\u003e\n\u003cli\u003eAlekri L, Alfayez FN. Incidence of Hemorrhage after ENT Procedures and Seasonal Variation: A Retrospective Study and Literature Review. International Journal of Otolaryngology and Head \u0026amp; Neck Surgery. 2021 May 25;10(3):173-83.\u003c/li\u003e\n\u003cli\u003eKoors PD, Thacker LR, Coelho DH. Investigation of seasonal variability of vestibular neuronitis. The Journal of Laryngology \u0026amp; Otology. 2013 Oct;127(10):968-71.\u003c/li\u003e\n\u003cli\u003eVesa S, Kleemola M, Blomqvist S, Takala A, Kilpi T, Hovi T. Epidemiology of documented viral respiratory infections and acute otitis media in a cohort of children followed from two to twenty-four months of age. The Pediatric infectious disease journal. 2001 Jun 1;20(6):574-81.\u003c/li\u003e\n\u003cli\u003evan Doorn HR, Yu H. Viral respiratory infections. InHunter\u0026apos;s tropical medicine and emerging infectious diseases 2020 Jan 1 (pp. 284-288). Elsevier.\u003c/li\u003e\n\u003cli\u003eKim MH, Cheon C. Epidemiology and seasonal variation of M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease: data from a population-based study. Audiology and Neurotology. 2020 Jul 17;25(4):224-30.\u003c/li\u003e\n\u003cli\u003eJiang W, Magit AE, Carvalho D. Equal access to telemedicine during COVID‐19 pandemic: a pediatric otolaryngology perspective. The Laryngoscope. 2021 May;131(5):1175-9.\u003c/li\u003e\n\u003cli\u003eKUMAR MILI MO, GHOSH T, GUPTA S, PHOOKAN J, SAIKIA N. Seasonal Variation in Epistaxis in Upper Assam Region: A Cross-sectional Study. Journal of Clinical \u0026amp; Diagnostic Research. 2021 Jun 1;15(6).\u003c/li\u003e\n\u003cli\u003eBachert C, H\u0026ouml;rmann K, M\u0026ouml;sges R, Rasp G, Riechelmann H, M\u0026uuml;ller R, Luckhaupt H, Stuck BA, Rudack C. An update on the diagnosis and treatment of sinusitis and nasal polyposis. Allergy. 2003 Mar;58(3):176-91.\u003c/li\u003e\n\u003cli\u003eSowerby LJ, DeSerres JJ, Rudmik L, Wright ED. Role of season, temperature and humidity on the incidence of epistaxis in Alberta, Canada. Journal of Otolaryngology-Head \u0026amp; Neck Surgery. 2014 Jan;43(1):10.\u003c/li\u003e\n\u003cli\u003eMasna K, Zwierz A, Domagalski K, Burduk P. The impact of the thermal seasons on adenoid size, its mucus coverage and otitis media with effusion: A cohort study. Journal of Clinical Medicine. 2021 Nov 28;10(23):5603.\u003c/li\u003e\n\u003cli\u003eGuo C, Pan L, Chen L, Xie J, Liang Z, Huang Y, He L. Investigating the epidemiological relevance of secretory otitis media and neighboring organ diseases through an Internet search. PeerJ. 2024 Mar 5;12:e16981.\u003c/li\u003e\n\u003cli\u003eLevy ML, Ericsson CD, Pickering LK. Infections of the upper respiratory tract. Medical Clinics of North America. 1983 Jan 1;67(1):153-71.\u003c/li\u003e\n\u003cli\u003eMori HR, Kucha A, Patelia MT, Shah SA. Incidence of Ear, Nose and Throat Disorders in Children: A Prospective Observational Study from Tertiary Care Teaching Hospital in Gujarat. Res. J. Med. Sci. 2023 Nov 30;17:186-93.\u003c/li\u003e\n\u003cli\u003eRegmi S, Chaudhary N, Shrestha S, Gupta BK, Swar R, Kurmi OP. Patterns of Pediatric ear, nose and Throat disorders in a Tertiary Care Hospital of Western Nepal: a cross-sectional study. Journal of Universal College of Medical Sciences. 2019 Dec 31;7(2):15-20.\u003c/li\u003e\n\u003cli\u003eSingh RR, Srivastava UK, Choudhary R, Yadav PK, Tripathi SK, Ttripathi SS. Impact of Overload on Emergency Medicine Department during Festive Season in a Tertiary Care Centre in North India: A Systematic Review. International Medicine ISSN: 2667-7008. 2023 Nov 23;9(3).\u003c/li\u003e\n\u003cli\u003eTandel K, Sondakar A, Kumar M, Yadav A, Acharya S, Vashisth R, Sharma P, Shinde V, Singh SP. Prevalence of respiratory pathogens among patients of upper and lower respiratory tract infections in a tertiary care hospital of western Maharashtra. Medical Journal Armed Forces India. 2024 Dec 20.\u003c/li\u003e\n\u003cli\u003eEccles R. An explanation for the seasonality of acute upper respiratory tract viral infections. Acta oto-laryngologica. 2002 Jan 1;122(2):183-91.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Seasonal variations, Otorhinolaryngology, ORL disorders, Epidemiology, Otitis media, Upper respiratory tract infections, Tonsillitis, Epistaxis, Sinusitis, Surgical trends","lastPublishedDoi":"10.21203/rs.3.rs-5836639/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5836639/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\nThis retrospective study aimed to examine the seasonal variations in the prevalence of otorhinolaryngological (ORL) disorders at a prominent teaching hospital in Mardan, spanning from October 2023 to September 2024. By analyzing patient data from the Otolaryngology, Head and Neck Department, this study explored the seasonal trends in ORL conditions, considering the type of disorder, time of presentation, and demographic characteristics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nThe study revealed significant seasonal variations in the prevalence of ORL conditions. Otitis media showed a marked increase during the spring and summer months, while upper respiratory tract infections, such as acute sinusitis and rhinitis, were more frequent in colder months. Notably, there was a rise in cases of epistaxis and tonsillitis during transitional seasons, which could be influenced by fluctuating environmental conditions and immune responses. The study also identified the 16–30 years age group as the most affected, indicating that young adults are particularly vulnerable to seasonal ORL conditions. Surgical case volumes exhibited seasonal fluctuations, with peak months observed in spring and autumn. Tonsillectomy and septoplasty were more common in winter, while functional endoscopic sinus surgeries (FESS) peaked in spring.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003cbr\u003e\nThis study highlights the seasonal patterns in otorhinolaryngological disorders, emphasizing the importance of incorporating these variations into clinical practice. Understanding these patterns can aid in optimizing healthcare resource allocation, improving patient care, and developing targeted prevention and management strategies. This approach is essential for better addressing the seasonal impact on ORL disorders.\u003c/p\u003e","manuscriptTitle":"Seasonal Variations in Otorhinolaryngology Case Presentations: Findings from a Pilot Study in a Tertiary Care Teaching Hospital in Mardan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-27 08:52:36","doi":"10.21203/rs.3.rs-5836639/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f0075955-4216-4b07-90bd-25085386b1db","owner":[],"postedDate":"February 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-27T08:52:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-27 08:52:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5836639","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5836639","identity":"rs-5836639","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}