Abdulazeez Ahmed

Indications for tonsillectomy and adenoidectomy: our experience.

BACKGROUND Infection and obstruction are the most common indications for performing tonsillectomy and adenoidectomy. In the past, infection was the main indication for these procedures; however, in the last few decades obstruction is said to be more prominent as an indication when compared to infection. OBJECTIVE The objective of this study was to report our observations of indications for tonsillectomy and adenoidectomy. MATERIALS AND METHODS This is a 2 year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy, adenoidectomy and adenotonsillectomy performed in a tertiary hospital. STATISTICAL ANALYSIS USED IBM SPSS (for windows, version 19) software was used to analyze this data. RESULTS A total of 115 patients records were reviewed. Moreover, 33.9% were children under 3 years, 60.0% were between 4 years and 10 years and 6.1% were between the ages of 11 years and 18 years. Obstruction accounted for a total of 68.7% while infection accounted for only 31.3% of the indication for these procedures. CONCLUSION Obstruction as an indication is proportionally higher in younger children while infection is proportionally higher in older children.

Inhaled foreign bodies in a paediatric population at AKTH Kano-Nigeria

Background: Inhaled foreign bodies are common paediatric emergencies and a major cause of accidental deaths at home among Nigerian children especially among children below the age of 5 years. Different types of foreign bodies have been reported from the ordinary to the most bizarre. We evaluated the types of foreign bodies and sites of possible impaction of these foreign bodies along the tracheobronchial tree. Materials and Methods: A 6-year case record of 35 patients with foreign body inhalation was reviewed from January 2005 to December 2010 at the Otorhinolaryngology Department of Bayero University/Aminu Kano Teaching Hospital, Kano — North-western Nigeria. Basic information such as date of birth, age groups, gender, indication for bronchoscopy, type of foreign bodies, sites of foreign body impaction and surgical outcome were extracted and analysed. Results: Thirty-five patients [18 (51.4%) males and 17 (48.6%) females, aged 6 months-10 years] with a mean age of 5.1 years and median of 5 years (+/- 3.0 Standard Deviation). The most affected age group with 31.4% is 3-5 years. Groundnuts and whistles were the most frequently inhaled foreign bodies with an equal frequency of 25.7%, respectively. Foreign bodies were preferentially lodged in the left main bronchus in 8 (22.9%) patients compared to the right main bronchus in 6 (17.1%) patients. Conclusion: Public enlightenment both in the news/print media on the risk of foreign body aspiration especially among the under-fives is highly advocated. The left main bronchus may be a common site for impaction as well.

Hearing screening techniques for referral purposes: Our experience from a rural setting

Background: Two thirds of the burden of hearing loss is predominantly in low- and middle-income countries. The World Health Organization estimated about 642 million (10.6%) of the worlds population has any level of hearing impairment in 2005. It becomes, therefore, imperative to gather data for the purpose of planning prevention strategies for hearing impairment and for monitoring and evaluation of these programs at primary and national levels. Aim: The aim of this study was to determine the prevalence of hearing impairment and report our findings on hearing screening in a rural setting. Materials and Methods: A total of 37 persons with hearing impairment were identified out of 650 seen with ages ranging from 3 to 60 years in a rural setting. They all had full clinical examination, tuning fork, and voice tests to assess hearing levels and otoscopy. Results: An overall hearing loss prevalence of 5.7% was observed, with commonest causes of hearing loss identified as febrile illness 48.6%, ear infections 32.4%, congenital and meningitis 8.1% each, and measles 2.7%. Conclusion: Prevalence studies and hearing screening programs are necessary to help formulate policies geared toward primary ear and hearing care. This will help reduce the burden of hearing loss as well as help to provide cheap and affordable hearing aids to the needy.

Outcome of treatment in patients with recurrent respiratory papilomatosis in Kano: A 10 years retrospective analysis

Background/Objectives: Respiratory papillomatosis (RP), which most often affects the larynx, is a relatively rare benign disease that can, however, have an aggressive clinical course. This study aimed to review the outcome of the patients treated for recurrent RP at Aminu Kano Teaching Hospital and the factors associated with the outcome. Materials and Methods: The records of patients managed for laryngeal papillomatosis at the Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria, over a period of 10 years between January 2004 and December 2013 were reviewed. Information obtained from the case files included demographic characteristics and clinical information. The data obtained were analysed using Statistical Package for Social Science version 16. Results: A total of 31 patients with recurrent RP were seen. Among these, 16 (51.6%) were males and 15 (48.4%) were females with sex ratio (M: F) of 1.1:1. The mean age was 11.7 years with standard deviation of ± 1.26. The main presenting symptoms were hoarseness in all patients and difficulty in breathing in 9 (29%). Patients who had the onset of symptoms between 6 and 10 years of age constituted the majority, 17 (54.8%). Only one patient had a solitary lesion on laryngoscopy, the majority had multiple papillomatous lesions, 30 (97.8%). Emergency tracheostomy was performed to relieve upper airway obstruction in 10 (32.3%). Twenty-seven of the patients constituting 87.1% had 1–3 surgical extirpations while 4 (12.9%) had surgery between 4 and 6 times. The voice outcome was mostly poor among the patients post-surgery, 27 (87.1%). Majority of the patients were lost to follow-up, 21 (67.7%), with 1 (3.2%) recorded death and 9 (29%) still on follow-up. Conclusion: There appears to be a limited success in the outcome of our patients managed for recurrent RP. However, early diagnosis and avoidance of tracheostomy where possible are factors that may improve the outcome.

Waardenburg syndrome type 1 in a Hausa/Fulani child: Implications for genetic counseling

Waardenburg syndrome (WS) is associated with hearing loss and is an autosomal inherited disorder with genetic heterogeneity. WS types 1 and 2 depict a high degree of inter- and intrafamilial variabilities, with type 1 being less common than type 2. In Northern Nigeria, due to cultural and religious inclinations, consanguineous marriages are quite common; thus, inheritable genes are easily passed on from one generation to the next. Following the paucity of reports of this syndrome in Northern Nigeria and its rarity worldwide, we report this case of WS type 1 with familial variability from a consanguineous marriage. We posit that with the availability of genetic counseling, it is possible to avoid the risk of passing on the Waardenburg gene to an unborn child and help to avoid untold hardship and societal stigma to both the child and the parent.

Hearing and audiometric estimates in a blind population in North-Western, Nigeria

Background: In our environment there is lack of awareness about the specific effects that hearing loss has on a blind person. The early identification of deafness and its early treatment have clearly been shown to lead to significant improvements in a child′s social and educational achievement. There is also evidence that comprehensive examination of students in boarding schools usually leads to rapid identification of conditions predisposing or associated with preventable ear diseases. Objective: This study aims to estimate prevalence of hearing impairment and other otological problems among blind students in Kaduna State special education school. Subjects and Methods: All consenting, consecutive students were recruited and assessed using the WHO Ear and Hearing disorders survey protocol. Otoscopy and audiometric air conduction thresholds were established separately for the left and right ear of each subject respectively, using frequencies of 500, 1000, 2000, and 4000Hz to estimate mean hearing thresholds. Results: A total of 58 students were recruited for this study with a prevalence of hearing impairment of 17.2%. The age of the students ranged from 10 to 25years with a mean age of 15.53years (SD: 3.3years). There were 22 (37.9%) females. Pure Tone Audiometry for the right ear revealed a minimum hearing threshold of 15dBHL and maximum of 83.75dBHL, with a mean hearing threshold of 22.03dBHL (SD: 1.20). Similarly, the left ear had a minimum threshold of 12.50dB and a maximum of 28.75dBHL, with a mean of 20.50dBHL (SD: 0.40). Five students (8.6%) had unilateral hearing impairment of variable severity. Cerumen auris (wax) was the commonest 18 (31%) otologic disorder. Conclusion: Efforts are needed toward strengthening hearing screening with provision of hearing aids for the institutionalized blind or persons with dual disabilities.

Tympanometric assessment among a select cohort of deaf students

Background: Children and young adults with profound hearing impairment and/or deafness are equally at risk of developing other ear diseases such as otitis media with effusion (OME) and/or middle ear infections. Otoscopic diagnosis of middle ear effusion is often problematic, and clinicians′ skills in that regard are notably variable. The objective of this study is to present the tympanometric findings among hearing-impaired students from a group of special schools for the hearing impaired in Kaduna metropolis. Participants and Methods: This was a prospective cross-sectional study conducted for 4 months between February and May, 2014. Students aged 7-18 years attending Kaduna State Special Education School for the deaf, Katsina road, and Demonstration School for the Deaf, Kawo, Kaduna, were recruited for the study. An interviewer-based questionnaire was developed to capture the student′s demographic characteristics and clinical information. This was followed by ear examination and tympanometric tests. The data were analyzed using Statistical Package for the Social Sciences software, version 16. Results: A total of 294 participants were recruited into the study group, and there were 173 males (58.8%) and 121 females (41.2%). The age of the participants ranged from 7 to 18 years. The mean age of the study group was 13.6 years with a standard deviation of ΁ 3.6 years. Forty-three (14.6%) of them had dull and retracted tympanic membranes while the rest had intact shiny tympanic membrane. Tympanometric test showed that 281 participants (89.5%) had type A tympanogram while types B and C accounted for 21 (7.1%) and 9 (3.1%), respectively. Among the 43 participants with dull and retracted tympanic membrane via otoscopic examination, 13 had type A tympanogram (normal) while the rest had middle ear disorders (type B and C tympanograms). Conclusion: Middle ear diseases such as OME and eustachian tube dysfunction were found among the study population. There is a need for the provision of regular awareness lecture and periodic ear examination to prevent, detect, and treat imminent otologic diseases.

Electrocardiographic characteristics of children with obstructive sleep apnea in a tertiary health center in Kano

Background: Obstructive sleep apnea in children may be associated with cardiovascular complications and these may be identifiable on the electrocardiogram. Some of those changes seen in adults include ventricular hypertrophy and arrhythmias; however the exact prevalence of these in children is not known. Therefore, this study seeks to characterize the electrocardiographic features in children with obstructive sleep apnea. Materials and Methods: This study reviewed 43 electrocardiograms (ECGs) of children clinically diagnosed with obstructive sleep apnea (OSAS) aged 4-14 years; their ECG parameters were compared with 43 apparently healthy controls matched for age and sex. Results: There were 21 males and 22 females with male to female ratio of 1:1. The PR interval and QRS duration were higher in the obstructive sleep apnea group in the 4-9-year age group except for the QRS and P-wave axes. While in the 10-14-year-old age group lower values in the QRS axis, PR interval, QRS duration, and T-wave axis were recorded in those with obstructive sleep apnea; however, these were not statistically significant. The mean R- and S-waves amplitude in V 4 R, V 2 , V 5 and V 6 though higher in the obstructive sleep apnea group, but were not statistically significant. Premature ventricular complex was identified in only one of the subjects, phasic sinus arrhythmia in three of the subjects, and two ECGs had premature junctional complexes. T-wave inversion involving precordial leads V 4 R to V 3 was most predominant in all the age groups Conclusion: The ECG characteristics of children with OSAS in this study were comparable to previous report in children and the prevalence of arrhythmia was also low.

Demographic and Hearing Related Variables Important for Prediction of Disabling Hearing Impairment: A Community Based Survey

Aim : The aim of this study was to estimate the prevalence of Disabling Hearing impairment and describe socio - demographic and hearing related risk factors as possible predictors of disabling hearing impairment. Study Design: This was a Cross - sec tional and descriptive study Place and Duration of Study : A semi - urban district called Kumbotso in Kano state, Northern Nigeria. 3 rd March 2013. Methodology : Data came from 58 participants, (39 females, 19 males; age range 5 - 50 years) who completed audiome tric testing during the Ear diseases/Hearing impairment survey. Audiometric testing was performed on the participants, air - conduction hearing thresholds in decibels hearing level (dB HL) were obtained for each ear at frequencies of 0.5 - 4 kHz. Disabling Hea ring loss was

Is the Trend in Indications for Tonsillectomy and Adenotonsillectomy Really Changing

Objectives: Infection and obstruction are the most common indications for performing tonsillectomy and adenotonsillectomy. In the past, infection was the main indication for these procedures; however, in the last few decades, obstruction is said to be more prominent as an indication when compared to infection. This study evaluates the changing trend in indications for tonsillectomy and adenotonsillectomies. Methods: This is a 2 year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy or adenoidectomy and tonsillectomy performed in Aminu Kano Teaching Hospital. IBM SPSS (for Windows, version 19) software was used to analyze these data. Results: A total of 115 patient case records were reviewed. 33.9% were children under 3 years old, 60.0% were between 4-10 years, and 6.1% were between 11-18 years. Obstruction accounted for a total of 68.7% while infection accounted for only 31.3% of the indications for these procedures. There was a significant association between age groups and indications for adenotonsillectomies (P = 0001, Phi and Cramer’s V = 0.363, respectively). Conclusions: Obstruction as an indication is proportionally higher in younger children, while infection is proportionally higher in older children.