Bs Alabi

Traumatic Tympanic Membrane perforation: An aetiological profile

BackgroundTraumatic perforation of the tympanic membrane may be due to direct or indirect source. The aim of the study is to profile the various aetiologies of traumatic tympanic membrane perforation in Ilorin, north central Nigeria.A retrospective review of 64 patients seen at the University of Ilorin Teaching hospital, Ilorin, Nigeria over a ten year period (January 1998 to Dec 2007) with history of traumatic tympanic membrane perforation from various causes, these also included multiply injured patients with bleeding from middle ear as part of their presentations. The data retrieved included the biodata, the clinical presentations, source of injury, the clinical findings and the treatment outcome. The data were entered into an SPSS version 11 computer soft ware and analyzed descriptively.FindingsSixty four (64) ears were analysed, Age range 6 months to 50 yrs, mean age of 29.2 yrs 7.9% of them were ≤5 years, 29.7% between 21-34 years, and 37.7% were 35 years and above. The male to female ratio was 2.5:1.0. Commonest aetiology was from slaps, then road traffic injury (RTI) in 35.9% and 23.5%, Majority of the slap injury were from fights (30.5%), security agents, senior students and cultists at schools (17.4% each). Sudden hearing loss was a typical presentation (95.3%), majority of the patient defaulted from follow up once the symptoms of bleeding and pain subsided. Only 7.8% had neomembrane formation on follow upConclusionTraumatic perforation of the tympanic membrane is an uncommon injury that is under-reported, there is the need to educate on alternative punitive measure among students and security agents, unskilled removal of foreign body, early identification, evaluation and referral of patients reduces the attendant morbidity.

Parental satisfaction with post-adenotonsillectomy in the developing world

AIM/BACKGROUND Tonsillectomy with or without adenoidectomy is one of the most commonly performed surgical procedures by the otolaryngologists in the pediatric population. The aim of this study is to evaluate parental expectation and satisfaction following tonsillectomy with or without adenoidectomy. MATERIALS AND METHODS Hospital-based prospective study of all consented parents whose children had tonsillectomy with or without adenoidectomy over a period of 13 months (February 2008 to February 2009) using a cross-sectional method. Pre- and post-surgical questionnaire-based Interview was conducted for them and information retrieved included biodata, pre- and post-surgical symptoms on follow-up in the clinic of obstructive sleep apnoea, snoring, mouth breathing and rhinorrhea, parental expectation and satisfaction after surgery. All data were entered into statistical data using SPSS version 11 and analyzed and the results are presented in tables and figures. RESULTS A total of 29 patients had adenotonsillar surgery, who were within the age range of 1.50-14 years with a mean age of 5.50 (SD=4.06+/-0.75). M:F ratio was found to be 3:1 (22 males and 7 females). Parents were satisfied with the expected outcome in terms of symptoms post-operatively in 96.6% while only one 3.4% were not satisfied. CONCLUSION Majority of the parents (96.6%) were satisfied with the expectation of immediate resolution of symptoms; however, obstructive adenotonsillar hypertrophy remains an important problem to be solved to achieve total parental satisfaction in adenotonsillar operations.

Prevalence of snoring and symptoms of sleep disordered breathing among primary school pupils in Ilorin, Nigeria.

BACKGROUND/AIM Snoring is the production of sound from the upper aero-digestive tract during sleep due to turbulent airflow This study is to determine the prevalence, pattern, night and daytime symptoms of snoring among nursery and primary school pupils in Ilorin, Nigeria due to its public health importance. MATERIALS AND METHODS This cross sectional survey was carried out among nursery /primary school pupils in Ilorin, Kwara state between April and September, 2010. Ten schools were selected randomly from 100 schools sited within the 3LGAs of Ilorin municipality. Also private and public schools with different parental social economic status were selected. The pupils were selected from nursery 2 to primary 6 in each school using the class registers with the aid of a table of random numbers with 1500 children assessed. The parents/guardians were made to fill the questionnaires and same returned with visitations to the schools twice weekly and reminders sent via phone calls. Data were analyzed using EPIINFO 2002 version 2 software. RESULTS 1500 questionnaires were given out but 909 were completely filled and returned (response rate of 61%.). There were 598(65.8%) non snorers (NSn) and 311(34.2%) snorers (Sn) at different scales with 153 male snorers to 158 female snorers. The ages of the children ranges from 3 to 16 years (mean ± SD, 8.3 ± 4.8 years. The mean age for the Sn was 8.2 and 8.3 for NSn (range 3-6 years). No statistical difference in age, gender or socio-economic status between Sn and NSn. 598(65.8%) were non snorers (NSn) and 311(34.2%) were snorers (Sn) especially in the age groups 3-6 years, 121(38.9%) and above 6 years of age 101(32.7%) and below 3 years were 89(28%). CONCLUSION Snoring is an important health problem among the pupils as a significant percentage snores and most of them are between third and sixth year of life.

Earwax Impaction: Symptoms, Predisposing Factors and Perception among Nigerians.

Background and Aim: Earwax impaction is a common ear disorder with presentation worldwide. This study aimed at determining the clinical presentation, patients’ perception of earwax, and its predisposing factors among Nigerians. Materials and Methods: This prospective study was conducted on consented patients with diagnosis of earwax impaction at the Ear, Nose, and Throat Clinic of the University Teaching Hospital, Ado Ekiti, Ekiti state, south west, Nigeria. The research was carried out over a period of one year (April 2008 and March 2009). All consented patients were told about the aim and scope of the study and their biodata were taken. Detailed history of the presenting complaints and otological complaints were taken and all data entered into structured questionnaires. Full-ear examination and otoscopy were performed and our findings were documented. From all these exercise, data obtained were collated and statistically analyzed. Results: A total of 437 patients were diagnosed with earwax impaction and prevalence of 20.1% was found. There was 52.2% male preponderance with male to female ratio of 1:1. Bimodal peak age distribution of patients was found at the extreme ages of life. Most common sources of our patients referrals were 39.6% general medical practitioners with least from 6.2% self-reporting. Common presentations were 277 (63.3%) hearing loss, 268 (61.3%) earache (otalgia), and 234 (53.5%) tiinitus. Unilateral earwax impaction, 75.1% was more common than bilateral earwax impaction. Right ear was more affected than left ear. Recurrent earwax impaction of 66.1% was found in our study. About 382 (87.4%) believed earwax was due to dirt or dust. Most common predisposing factors among our patients were self-ear cleaning. Conclusion: Common predisposing factor of this high recurrent earwax impaction were wrong perception and preventable self-ear cleaning with indiscriminate objects including cotton tip swab. This condition could be reduced by health education of the community.

A survey of facial nerve dissection techniques in benign parotid surgery among maxillofacial and ear, nose, and throat surgeons in Nigeria

OBJECTIVE The aim of the present study is to identify the facial nerve dissection technique routinely used during parotidectomy for benign parotid tumors by Nigerian Oral and Maxillofacial (OMF) and Ear, Nose, and Throat (ENT) Surgeons. MATERIALS AND METHODS A questionnaire-based study was conducted among Oral and Maxillofacial and Ear, Nose, and Throat Surgeons in Nigeria, on their experience with antegrade and retrograde facial nerve dissection techniques in parotid surgery. The respondents were asked to indicate their choice of dissection techniques in revision parotidectomy, limited superficial parotidectomy, and in obese patients with large tumors. They were also asked to indicate if they routinely used perioperative facial nerve monitoring devices in parotid surgery for benign tumors. RESULT About half (47.5%) of them routinely used the antegrade technique, while only a few (12.5%) used the retrograde technique. A large number of them (40%), however, used a combination of antegrade and retrograde routinely. Technical ease was the main reason for the choice of technique. The antegrade technique was the technique of choice by most respondents for revision parotidectomy (60%) and limited superficial parotidectomy (62%). However, the retrograde approach was the technique of choice by most of them (47%) in case of parotidectomy in obese patients with large tumors. The routine use of perioperative facial nerve monitoring devices is an uncommon practice among OMF and ENT surgeons in Nigeria. CONCLUSIONS The antegrade approach for facial nerve dissection is the most common technique used in parotid surgery by Nigerian OMF and ENT surgeons. Nigerian surgeons need to consider the retrograde approach in selected cases of parotid surgery especially for localized tumors that are amenable to limited superficial parotidectomy. Inclusion of perioperative facial nerve monitoring devices is also advocated.

Acute otitis media--a common diagnosis among febrile children in the tropics.

Acute otitis media is a common inflammation of acute onset in infants and older children worldwide. It is said to be the most frequent specific diagnosis in children who are febrile in the USA, and it is often overdiagnosed by physicians and emergency doctors. It is one of the most common reasons parents bring children into the primarycare physician’s office. Children with acute otitis media usually present with otalgia, otorrhoea, ear perforations and associated fever with hearing impairments. There is usually a preceding or accompanying upper respiratory tract infection. The diagnosis is usually based on clinical symptoms of otalgia, often fever with irritability, and by clinical otoscopy. Boys are more affected than girls. However, no specific causative factors have been found. Malaria is endemic in a tropical developing country like Nigeria, with the majority of children with pyrexia being diagnosed as such; hence, there is a need to have a high index of suspicion of acute otitis media as a cause of pyrexia in these children. This study is aimed at determining the prevalence of acute otitis media among febrile children.

Management and Outcome of Rhinosinusitis in Nigeria

Objective The aim of this study is to present the management and outcome of treatment of rhinosinusitis in Nigeria. Study Design A retrospective review of the case notes of patients with rhinosinusitis between January 2009 and December 2014. Setting Study at the University of Ilorin Teaching Hospital, Nigeria, using retrieved case notes after ethical approval was received. Subjects and Methods The information retrieved included sociodemographic data, clinical presentation, duration, endoscopic examination, and other clinical management protocols with follow-up. All information was entered into SPSS version 20 and analyzed descriptively, and results are presented in tables and figure. Results A total of 5618 patients were seen in the ear, nose, and throat clinic over the 6-year period. Of the patients, 445 had rhinosinusitis, and only 410 had complete data for analysis. Patient age ranged from 2 to 75 years (mean ± SD, 31.8 ± 1.2 years). The male to female ratio was 1.2:1. The duration of symptoms varied from 3 days to 10 years, with 78.7% having symptoms between 3 and 120 months. About 82.4% had nasal discharge, 51.3% had sneezing, 78.9% had alternating nasal obstruction, and 49.3% had nasal itch. Of the patients, 61.4% had a predisposition, of which 30.9% were allergic, 23.3% were infective, and 7.2% were vasomotor. Ethmoidal-maxillary sinuses were commonly affected radiologically. About 63% of patients had medical treatment, and only 28.7% had surgical intervention, of which 37% were scheduled for surgical treatment and 7.3% refused. Improved symptoms were noticed in 72.6% of patients, and 1.4% reported no improvement. Conclusion Rhinosinusitis is still common, affecting active males economically with more chronic cases and more allergic predisposition. Early medical management is still effective, and endoscopic sinus surgery is now a better surgical option with better outcome in 72.6%.

Omokanye-Adebola-Alabi (OAA) temporal bone holder

Cystometrography (CMG) is a means of studying bladder pressure. It is a very useful diagnostic tool in patients with lower urinary tract symptoms for which a simple cystoscopy will not offer sufficient information to form a diagnosis. Of the 8893 patients who underwent screening for urological conditions in rural northeast India during 2010–2014, 280 with lower urinary tract symptoms were investigated with a combination of cystoscopy and CMG. By corresponding CMG diagnosis and treatment, we could examine patients’ overall satisfaction with both the procedure and the treatment. We describe a low-cost method of CMG and our results using this method in rural areas of India.

Vagal reflex stimulation complicating retrieval of an unusual foreign body from the laryngotracheal lumen: Case report

Abstract Foreign body impaction in the aero digestive tract is a life-threatening emergency, particularly in the paediatric age group. Removal under general anaesthesia poses both surgical and anaesthetic challenges and this may rarely result in mortality. We report a case of a 4 year old boy with an unusual foreign body (FB) impacted in the laryngotracheal causing difficult intubation and precluding tracheostomy with attendant vasovagal reflex stimulation and cardiac arrest. Clinical presentation and radiological evaluation of the patient were highlighted with a review of pertinent literature. We conclude that dis-impacting a foreign body in the trachea could potentiate bradycardia and cardiac arrest; co-existing hypercarbia and/or sepsis increase the risk and worsen the prognosis.

Pharyngeal fibromatosis presenting as adenoid hypertrophy: A case report and review of literature

A 10-year-old girl presented with a noisy breathing noticed from birth and failure to thrive. Examination revealed a huge lobulated firm mass in the oropharynx (toward the left side). Plain radiography of the neck showed a huge circumscribed pharyngeal mass extending from the base of the tongue to the level of the fourth cervical vertebrae. The mass measuring 6 cm Χ 5 cm was excised through a left lateral pharyngotomy. Histological examination showed sections of highly cellular interlacing bundles of fibroblast with moderate hyalinization extending to the surrounding fibro-fatty tissue. The cells have spindle nuclei with tapering ends. Occasional mitosis and in some areas myxoid degeneration were seen. A diagnosis of pharyngeal fibroma was made. Patient had an uneventful post-operative recovery with complete resolution of symptoms for the past 6 years. This rare benign tumor has not previously been reported at this site and may thus give rise to difficulty in diagnosis or to a misdiagnosis.