Foluwasayo E. Ologe

Clinicopathological study of head and neck cancers in Ilorin, Nigeria

Eighty-nine cases of head and neck cancers were studied over a 5-year period (1997–2001) at the University of Ilorin Teaching Hospital, Nigeria. The most common cancer affecting the head and neck region was carcinoma which constituted 70.8% of all the cases studied. It was followed by the lymphomas and blastomas which accounted for 20.2% and 9%, respectively. The nose/paranasal sinuses were the most common site of primary cancer (18%) followed by thyroid (12.4%), nasopharynx (11.3%) and larynx (4.5%). Other sites include a hypopharynx (3.4%), eye (2.2%), palate (2.2%), tongue (2.2%), skin (1.1%), lip (1.1%), salivary gland (1.1%), oropharynx (1.1%). Cervical lymph node metastasis with unknown primary lesion was seen in 10.1%. The peak age incidence was in the fifth decade of life. The improvement in locoregional control of head and neck cancers over the last decades does not appear to modify the final survival of these patients. It is crucial to understand as accurately as possible the risk factors for these malignancies in order to improve primary prevention.

Deterioration of noise-induced hearing loss among bottling factory workers

BACKGROUND Repeated exposure to excessive noise will eventually lead to an irreversible increase in hearing thresholds. In theory, the damage reflects both the intensity of the noise and the duration of exposure. This is not linear with respect to duration of exposure; rather, the worker may experience a disproportionate loss in the early years of exposure. METHODS A prospective study surveying workers of the production section (i.e. most noise-exposed area) of a bottling factory was carried out in December 2003 and in December 2005. A self-administered questionnaire was used to extract information about workers demographic characteristics, drug intake, and medical and occupational history, as well as information on the use of hearing protection devices. Noise mapping of the various departments of the factory was carried out. Otological examination, tympanometry and audiometry were also carried out on selected subjects. RESULTS Eighty-four workers, 76 (90.5 per cent) men and eight (9.5 per cent) women, were studied. Their mean age was 33.0 +/- 7.6 years in 2003 and 35.0 +/- 7.6 years in 2005. The recorded noise levels in the factory production section ranged between 91.5 and 98.7 dBA. The prevalence of sensorineural hearing loss among workers was noted to be 64.9 and 86.9 per cent for test one (2003) and test two (2005), respectively. The degree of hearing deterioration within the two years of this study was 1.0-3.2 dB for the right ear and 1.6-3.4 dB for the left ear. This deterioration was at discrete frequencies. More than half (53.6 per cent) of the workers did not have a hearing protection device. Of the 46.4 per cent who did, only 38.5 per cent claimed to have used it regularly. INTERPRETATION These findings showed that there was a high prevalence of mild sensorineural hearing loss and significant hearing deterioration among workers, due to exposure to excessive noise over a two-year period. The study demonstrates the practical importance of serial audiometry for noise-exposed workers as a means of monitoring hearing deterioration. It is necessary to enforce existing occupational health laws in our industries in order to prevent noise-induced hearing loss, since it is eminently preventable.

Symptom Score for Allergic Rhinitis

Objectives To determine the prevalence of allergic rhinitis in our study population and the correlation between the Score for Allergic Rhinitis (SFAR) and nasal smear eosinophil count. Study Design Cross-sectional study. Setting Ear, nose, and throat clinic, University of Ilorin Teaching Hospital, Nigeria; a 450-bed tertiary health facility. Subjects Two hundred seventy-five consecutive, consenting patients who presented with nasal symptoms. Methods Information on the 8-parameter symptom score was collected using a semistructured questionnaire by interview. Nasal smear slides were air dried, fixed with 95% alcohol, stained using May-Grünwald-Giemsa stain, and examined under a light microscope. Results Of the 275 participants seen during the 1-year study, 116 (42.2%) were males. The mean ± SD age was 38.5 ± 16.3 (range, 14-75) years. Eighty-one (29.5%) were diagnosed with allergic rhinitis using a nasal smear eosinophil count. The most common symptom was excessive sneezing, involving 93% of patients with allergic rhinitis (P < .001). The prevalence of allergic rhinitis using SFAR was 31.6%. The SFAR cutoff was set at >8 (P < .001). The sensitivity and specificity for SFAR were 94.8% (confidence interval [CI], 90.5%-97.4%) and 95.1% (CI, 87.2%-98.4%), respectively. A high Spearman’s correlation (0.88) was obtained for SFAR when correlated with nasal smear eosinophil count. Conclusion The prevalence of allergic rhinitis using SFAR was 31.6%. The study shows that SFAR can be used as a simple, valid diagnostic tool in allergic rhinitis. This is important in rural settings where access to laboratory investigations might not be readily available.

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.

Health-Related Quality of Life and Its Contributory Factors in Allergic Rhinitis Patients in Nigeria

OBJECTIVES To determine the health-related quality of life (HRQoL) in allergic rhinitis patients as well as identify contributory factors to patients well-being. METHODS Cross-sectional study by multistage sampling. Four-month study duration (October 2013 to January 2014). The setting of the study was Kwara State, Nigeria, which has 16 local government areas with 3 senatorial districts, total land mass of 36,825km(2) with a population of 2,591,555. 132 consenting adults; 66 of them have allergic rhinitis (AR) using Score for Allergic Rhinitis (SFAR) instrument and 66 were age- and gender-matched controls (χ(2)=0, d.f.=1, P=1 and χ(2)=1.24, d.f.=2, P=0.54, respectively). Information on HRQoL was obtained using the 14-parameter mini-rhinoconjunctivitis quality of life questionnaire (mini-RQLQ). Socio-demographic variables possibly contributory to patients well-being were obtained. Kruskal-Wallis and Mann-Whitney U tests were used to compare means. RESULTS The overall Total Symptom Score (TSS) was 3.37±0.9, while male and female allergic patients and control TSS were 3.61±1.0; 3.16±0.8, and 0.98±0.2; 0.95±0.2, respectively. Effects of gender, marital status, senatorial districts, residential area and duration of symptoms had significant impact on the quality of life. The highest correlation with TSS and components of mini-RQOL questionnaire existed between nasal problems and other symptoms (r=0.866; 0.868). CONCLUSION AR had appreciable impact on HRQoL of the participants. Gender, number of dependents, marital status, senatorial districts, residential area and duration of symptoms were major identifiable contributory factors to the patients well-being.

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%.

Hazard of noise induced hearing loss (NIHL) among operators of music recording/retail centres in Nigeria

We studied the level of music loudness to which operators of music recording/retail centre were exposed in order to determine their risk of work-related hearing loss. A survey of consenting operators of music recording centres on six main streets selected by simple random sampling at different locations of the town was carried out using a structured questionnaire. The sound level of the music from the music player speakers in each centre was measured using a sound level meter (Testo 815) duly calibrated with a sound level meter calibrator (Testo 0554.0009). Results were analyzed by simple descriptive statistics. The study involved 79 mainly male young adults aged 27.7 ± 6.8 years (SD). The measured sound levels in the centres ranged from 86-104dBA; with a mean of 96 ± 2.5dBA(SD). Exposure to this music loudness was for an average of 9 hours daily for an employment period averaging about 5 years. Thirty percent of the study population reduced music loudness by turning down the volume; 6.3% sat at six or more metres from the speakers; 10% used ear plugs occasionally and 7.6% had hearing assessment at some stage prior to the present study. The level of noise exposure of this population of young males is in excess of the threshold associated with irreversible hearing loss, and protection measures were less than optimal.

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.

Screening audiometry in a private primary school in Ilorin, Nigeria

Potential development and verbal expression in childhood depend on hearing capability. Mild hearing loss, which in adults is socially adequate and may be ignored or even unnoticed, can have a severe social and educational impact on children who are in the process of learning to speak. Detection of hearing loss in children therefore should not be left to chance. Organised audiometry screening should be made available for every child so that appropriate interventions can be made early in life. The aim of this study was to determine the failure rate of hearing screening and the effect of hearing loss on the academic performance of Nigerian school pupils. Examining hearing levels in relation to academic achievement is of value from both a medical and an educational point of view. Two hundred and twenty-six pupils aged 5–14 years, 136 boys and 88 girls, were enrolled in the study. Over half (54%) failed the screening test done by the less than state-of-the-art technique of hand-held audiometry (SA 50, Entomed, Sweden) in a non-sound-proofed room. Pass was defined as responding correctly to stimuli at 30 dB HTL at frequencies 1 KHz, 2 KHz and 4 KHz, and at 50 dB HTL at 0.5 KHz in both ears. There was a correlation between deafness identified in this way and poor school performance, and parents were often not aware that their children had difficulties with hearing. This parental unawareness further strengthens the need for regular screening of hearing loss among school and pre-school children. Occlusion of the ear canal by wax was a significant cause of hearing loss (Table 1). Thus, simple, regular cleaning of the ear canals by qualified health personnel could significantly improve hearing and school performance in these children. It is interesting that no case of chronic suppurative otitis media (CSOM) was seen. CSOM is one of the commonest causes of hearing impairment in developing countries and it varies between socio-economic strata within a community. It is less prevalent at the higher socio-economic levels and in urban areas compared with rural areas. This is put down to better medical services. We conclude that screening for hearing impairment is an important component of school health programmes. Although routine screening of hearing in school children has long been established in developed countries, it is not routine in other parts of the world. TABLE 1. Otoscopic findings (n=452).*