Oa Afolabi

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.

Clinico-pathological profile of sinonasal masses: an experience in national ear care center Kaduna, Nigeria

BackgroundThe presence of a mass in the nose and paranasal sinuses may seem to be a simple problem; however it raises many questions about the differential diagnosis. The aim of this study is to evaluate the clinico-pathological profile of sinonasal masses in our environmentThis is a retrospective analytical review of all the patients with sinonasal masses that presented to the national ear care center, Kaduna over a six year (2003-2008) period. Their biodata, clinical profile and histological diagnoses were analyzed.FindingsA total of 76 patients were analyzed, age range 5 to 64 yrs with a mean age of 33.3 yr median and modal age of 35.00 (SD = 13.1 ± 1.5). Majority of the patients were in the age groups 21-50 yrs. There were 34 male and 42 female with M: F ratio of 1:1.2. The main presenting symptoms are nasal blockage 97.4% and rhinorrhea 94.7%. It was bilateral in 34 (44.7%), left side in 24(31.6%) and right side in 18(23.7%) patients. The commonest clinical diagnoses were simple nasal polyp 47(61.8%) and antrochoanal polyp 10(13.2%). About 59 (77.6%) were benign, 2 (2.6%) were malignant and 15 (19.7%) were lost to follow up. The commonest histological diagnosis is simple inflammatory nasal polyp in 28 (36.8%) patients and the least was nasal capillary hemangioma 2 (2.6%). About 55(72.4%) patients had surgical treatment.ConclusionsNasal obstruction and rhinorrhea are the commonest symptoms of presentation, simple inflammatory nasal polyp is still the commonest histological pattern seen in our environment, and surgery is still the best modality of treatment for benign tumor thus the need for advocacy for early recognition and referral to the ENT surgeon.

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.

Fish bone foreign body presenting with an acute fulminating retropharyngeal abscess in a resource-challenged center: a case report

IntroductionA retropharyngeal abscess is a potentially life-threatening infection in the deep space of the neck, which can compromise the airway. Its management requires highly specialized care, including surgery and intensive care, to reduce mortality. This is the first case of a gas-forming abscess reported from this region, but not the first such report in the literature.Case presentationWe present a case of a 16-month-old Yoruba baby girl with a gas-forming retropharyngeal abscess secondary to fish bone foreign body with laryngeal spasm that was managed in the recovery room. We highlight specific problems encountered in the management of this case in a resource-challenged center such as ours.ConclusionWe describe an unusual presentation of a gas-forming organism causing a retropharyngeal abscess in a child. The patients condition was treated despite the challenges of inadequate resources for its management. We recommend early recognition through adequate evaluation of any oropharyngeal injuries or infection and early referral to the specialist with prompt surgical intervention.

An audit of paediatric nasal foreign bodies in Ilorin, Nigeria

Background . Children with nasal foreign bodies are commonly seen in everyday practice. The aim of this study was to document the pattern of foreign bodies in the nose, their treatment and outcome. Methods . This was a prospective audit of all children seen in the ear, nose and throat clinic, accident and emergency unit and emergency paediatric unit at the University of Ilorin Teaching Hospital, Nigeria, from August 2005 to July 2006. Results . Of a total of 173 patients with ear, nose and throat foreign bodies seen during the study period, 71 patients had foreign bodies in the nose. The male/female ratio was 1.5:1 and the mean age was 2.5 years (range 1 - 15 years), under-5s comprising 72% of the patients. The most common foreign bodies were grains and seeds (35%). Presentation was within 24 hours in 45% of cases, between 1 and 5 days in 27%, and longer in the rest. Of the patients 51% had inserted the foreign body into the nose themselves, and in 39% of cases this had happened at school. In most cases (68%) the foreign body had been inserted into the right nostril. Most children had an offensive nasal discharge (45%) or were asymptomatic (27%). Parents were the first to make the diagnosis in 63% of cases, and in 32% of cases removal had been attempted before presentation. Most of the foreign bodies (89%) were mechanically extracted with a Jobson-Horne probe. In 61% of cases removal was done by a senior registrar. General anaesthesia was needed in a minority of cases. Minimal epistaxis after removal occurred in 50.7%, and only 1 patient had septal perforation. Conclusion . Nasal foreign bodies are still a challenge among under-5s. Public health education is needed to make parents and caregivers aware that it is hazardous for a child to insert a foreign body into the nose. Consistent with published guidelines, the majority of cases can be managed safely with direct extraction in the office setting. With adequate training, primary health care practitioners can manage most cases successfully and will know when to refer complicated ones.

Paediatric cochlear implantation in north-western Nigeria case report and review of our challenges.

OBJECTIVE To report the commencement of cochlear implantation (CI) in children in Northern Nigeria and review the challenges encountered with a view to establishing CI programme. CASES Two children with post-meningitic sensorineural hearing loss had standard pre-implantation assessment and cochlear implantation surgery in Nigeria in conjunction with surgeons from another developing country. Post-implantation meningitis was encountered and managed in one of the patients. Post-CI rehabilitation started in a foreign country and continued in our centre after training of our speech therapist. Both patients had improvement in their hearing. CONCLUSION These showcase successful CI in patients from Sub-Saharan Africa, the challenges included need for development of surgical and post-CI rehabilitation personnel and affordability of the cost of the implant. The support of all the stakeholders needed for commencement of a CI programme was noted.

Survey of ototopical self medication among patients attending ENT and family medicine departments in a Nigerian hospital

Abstract Background: Ototopical self-medication is a common practice in Nigeria. Objective: The aim of the study was to establish the proportion of patients with otological problems that practice ototopical self-medication. Methods: A 12-week cross-sectional study of all the new patients attending the general outpatient (also called family medicine (FM)) and ear, nose and throat (ENT) departments of a Nigerian specialist hospital was carried out. A semi-structured questionnaire was used to obtain information on bio data, practice of ototopical self medication among new patients with otological problems, the drugs used and the reasons for engaging in the practice. The results were analysed using SPSS version 11 and presented in Tables. Results: Out of 3276 patients that visited the hospital during the study period, 402 had otological problems. Of these, 125 (31%) used ototopical self-medication, giving a hospital incidence of 3.8%. 115 (92%) patients consented to fill in the questionnaire on the self-use of ototopical agents. Otalgia was the most common indication (27%) for ototopical self-medication. Gentamycin and Chloramphenicol topical agents were the most commonly used by the study participants. A total of 39 participants (34%) reported to have used non-prescribed self-medication because it was time saving. In 69 of the participants (60%), the drugs were self recommended while chemists and nurses recommended their use in 23 (20%) and 22 (19%) participants, respectively. Conclusion: In Nigeria, there is a need for public enlightenment and health education about the possible drawbacks of this practice.

Management of snake bite in resource-challenged setting: A review of 18 months experience in a Nigerian hospital

Snake bite is a worldwide environmental and occupational hazard with significant public health importance. The management of snake bites includes the use of specific anti-venom, use of clotting factors and tetanus prophylaxis. In many developing countries however, specific anti-venoms are not widely available and this might affect the outcome of patient management. The main objective of this work is to analyze the clinical presentation, management and outcome of snake bite patients a resource-challenged environment like ours. The study is a cross-sectional retrospective review of medical records of all patients admitted with snake bite to the male and female medical wards of the Specialist Hospital, Lokoja, Nigeria from 1

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%.

Combined turnover and deltopectoral flap in closure of persistent pharyngocutaneous fistula

Pharyngocutaneous fistula (PCF) is an infrequent complication of salvage total laryngectomy with associated increased morbidity. Chemoradiation for advanced laryngeal cancer is associated with increased incidence of PCF. In this case report, we present the first successful repair of a major PCF with prior chemoradiation therapy after multiple attempts at repair of the fistula in our health-care service.