Prevalence of Otolaryngology Diseases in an Urban Homeless Population

Abstract

Objective Otolaryngology diseases are common among people experiencing homelessness; however, they are seldom evaluated in a specialist setting, and investigations on their prevalence have rarely been conducted. The aim of this retrospective study was to evaluate the prevalence of otolaryngology conditions in an urban homeless population. Study Design Retrospective study. Setting Primary health care facility. Methods The clinical records of patients referred to the medical facilities of the Primary Care Services of the Eleemosynaria Apostolica, Vatican City, between October 1, 2019, and July 31, 2021, were retrospectively reviewed; those reporting at least 1 otolaryngology disease were included in the study. Results A total of 2516 records were retrospectively reviewed, and 484 (19.24%) were included in the study. The most common otolaryngology disease was pharyngotonsillitis (n = 118, 24.13%), followed by rhinitis with nasal obstruction (n = 107, 21.88%), hearing loss (n = 93, 19.01%), otitis (n = 81, 16.56%), abscess (n = 46, 9.40%), and sinusitis (n = 33, 6.74%). Head and neck cancer or precancerous lesions were reported in 34 subjects (7.02%). More than 1 simultaneous otolaryngology disorder was found in nearly 50% of our sample. A wide range of comorbidities was also reported. Conclusions Our results confirm an elevated otolaryngology demand in the homeless population and encourage the development of more efficient and effective strategies for a population-tailored diagnosis and treatment of these conditions.

Individuals Experiencing Homelessness: A Systematic Review of Otolaryngology‐Related Health Needs and Community‐Based Interventions

“…Among included studies, there were: 5 retrospective, 4 prospective, 1 descriptive analysis, 1 cross-sectional, and 1 case-control study (Supplemental Appendix B, available online). 13,14,[16][17][18]23,24,[29][30][31][32][33] Studies were published between 1998 and 2022. Studies reported on different otolaryngology needs within different subspecialties: general OHNS (16.7%, n = 2/12), otology (66.7%, n = 8/12), pediatrics (16.7%, n = 2/12), laryngology (25.0%, n = 3/ 12), head and neck (50.0%, n = 6/12), and rhinology (33.3%, n = 4/12).…”

“…Two studies reported on conditions related to general OHNS. 17,23 Gurgel et al 23 examined the prevalence of head and neck diseases in an urban homeless clinic in Utah and found that 15.2% (n = 8959/59,060) of all clinic visits were accounted for by OHNS diagnoses. Upper respiratory tract infections (URTI) accounted for the greatest proportion of OHNS diagnoses, which included nasopharyngitis, tonsillitis, acute sinusitis, and laryngitis (36%, n = 3208/11,690).…”

“…Other otology-related findings included ear eczema (2.5%, n = 12/484), cerumen plugs (6.6%, n = 32/ 484), acute vertigo (1.4%, n = 7/484), and tinnitus (1.2%, n = 6/484). 17,23…”

Challenges in Achieving Health Equity and Diversity in Otolaryngology

“…The need for basic otolaryngology care is particularly evident in vulnerable and marginalized groups, such as the diverse urban homeless population in Vatican City, which includes individuals from over 60 countries. 4 Hearing-related services for children, a particularly vulnerable group, face multiple challenges and barriers in providing access to these much-needed services. 5 Disparities in otolaryngology care outcomes are also seen in rural communities, especially related to head and neck cancers.…”

“…Disparities in access to general otolaryngology services—especially specialized care for head and neck cancers, hearing disorders, nasal and sinus diseases, and other disorders of the ears, nose, and throat—continue to persist nationally and internationally. The need for basic otolaryngology care is particularly evident in vulnerable and marginalized groups, such as the diverse urban homeless population in Vatican City, which includes individuals from over 60 countries 4 . Hearing‐related services for children, a particularly vulnerable group, face multiple challenges and barriers in providing access to these much‐needed services 5 .…”