Otolaryngologic aspects of tetanus.

Tetanus is considered a major health problem in the developing and under-developed countries, with approximately 1 million new cases occurring each year. We have evaluated the tetanus patients and their presenting complaints, the clinical findings and their relations to the head and neck region along with the frequency of otolaryngological findings and their correlation to the prognosis of this highly mortal disease. There were a total of 37 patients with generalized tetanus diagnosed and treated between 1991 and 2001. There were 25 women and 12 men with a mean age of 55+/-15.6 years. The most common presenting symptom was trismus, followed by neck pain, dysphagia, generalized pain and facial muscular contractions. Wound evaluation revealed that 72.9% of the patients had tetanus-prone wounds, and 27% had either no obvious wounds or a wound considered to be trivial by the patient. Only 62% percent of the patients had sought medical attention immediately after being injured. Three patients in our series were admitted to the otolaryngology clinic with upper aerodigestive tract symptoms. A comparison of complaints with clinical findings revealed a significant lack of correlation, emphasizing that complete physical examination must be performed when evaluating patients with trismus, dysphagia and neck pain. Tracheotomy was performed in 21 cases. There was a direct correlation between the clinical stage and the requirement of tracheotomy. Wound debridment was performed, and antibiotherapy, tetanus toxoid vaccine and immunoglobulin were administered. The mortality rate was 59.4% (22/37). Shorter incubation periods and periods of onset and a higher grade of disease were significantly related to high mortality rates ( P=0.001). It is important to realize the fact that instead of looking for tetanus-prone wounds, one should be on the lookout for tetanus-prone patients. Consequently, on the part of the otolaryngologist, there should always be a high index of suspicion, and concerning patients with trismus or subacute progressive dysphagia, the possibility of tetanus must be borne in mind.