Stephen Oluwatosin Adebola

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.

Pre-school hearing screening: Profile of children from Ogbomoso, Nigeria §

OBJECTIVES To carry out otoscopic and audiologic examinations amongst pre-school children in Ogbomoso, Nigeria in order to identify any cases of hearing loss and to intervene where possible. STUDY DESIGN AND SETTING Prospective audiologic evaluations of children in Nursery I and II (pre-kindergarten and kindergarten) in both private and public primary schools were carried out. METHODS One hundred and one children (202 ears) were screened using otoscopy and pure tone audiometry. RESULTS The age ranged from 3.5 to 6 years, mean age was 4.8 years (S.D. = 0.835), with a male population of 55 and 46 females (M:F ratio, 1.2:1). Otoscopic findings revealed normal findings (106) 52.4%, impacted cerumen auris, 44 (21.8%), otitis media with effusion, (28) 13.9%, perforated tympanic membrane, 24 (11.9%) and giving an otoscopic pass rate of 52.4%. Screening audiometry, on the other hand, recorded a pass rate of 78.7%. After 6-8 weeks of otolaryngologic intervention, the otoscopic pass rate improved to 88.6%, while the pass rate for screening audiometry also improved to 93.6%. CONCLUSION/SIGNIFICANCE From the study, an otoscopic pass rate of 52.9% and screening audiometry pass rate of 78.7% increased to 88.6% and 93.6%, respectively, through basic otolaryngologic interventions. The key roles played in identifying ear diseases with or without hearing impairments with the use of clinical examination (otoscopy) and audiologic evaluation in the pre-school age children has been highlighted in the study. Unfortunately, these evaluations are not performed routinely in children enrolled in both private and public primary schools in Ogbomoso, Nigeria. We advocate that the routine otoscopic examinations with screening audiometry be made available in all primary schools, in order to facilitate early detection and prompt rehabilitation of children with ear diseases and hearing impairment.

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.

Clinical predictors of aminoglycoside-induced ototoxicity in drug-resistant Tuberculosis patients on intensive therapy.

OBJECTIVE The study objectives were to determine the incidence of aminoglycoside-induced ototoxicity in institutionalized patients on intensive phase of therapy for drug-resistant Tuberculosis (DR Tb) and also to assess clinical factors which could predict the ototoxicity. METHODS The study was a prospective analytical study among consecutive DR Tb patients who were admitted for intensive phase of therapy (of 4 months) at the DR-Tb center over a 12-month period. Patients were diagnosed as DR Tb using the Gene Xpert machine to confirm Rifampicin resistance. All eligible 70 out of 87 consenting patients were consecutively recruited into the study. Patients had baseline (admission) and serial pure tone audiometries (PTAs) performed at 4 weekly intervals until discharge after 4 months of admission. Audiometric confirmation of aminoglycoside-induced ototoxicity was done by comparing serial with baseline PTA. RESULTS Among the 70 patients the male:female ratio was 1.7:1. Nine patients (12.9%) were retroviral-positive, and 16 patients (22.9%) were confirmed to have ototoxicity by audiometric criteria. The duration of treatment when ototoxicity was detected in the patients ranged 4-17 (Mean±SD; 9.4±3.4) weeks. Ototoxicity was detected in the audiometric low frequency ranges in 7 (43.8%) and at the high frequencies in 4 (25.0%) of the patients. Univariate analyses of clinical parameters found that age, underlying diabetes mellitus, deranged baseline PTAv >25dB HL, BMI on admission and retroviral status were significantly associated, while sex and previous drug regimen failure were not associated with ototoxicity. Multivariate adjusted logistic regression analyses, controlling for sex, revealed age (OR=1.068, p=0.018), BMI on admission (OR=0.673, p=0.012) and retroviral positivity (OR=8.822, p=0.014) of patients could significantly predict aminoglycoside-induced ototoxicity. CONCLUSION Incidence of aminoglycoside-induced ototoxicity in DR Tb patients was 22.9%. The clinical predictors for ototoxicity were age, BMI on admission, and co-existing retroviral infection in the patients. Clinicians should consider these factors in making choices of aminoglycosides to be used during intensive phase of treatment with second line anti-Tuberculous therapy.

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.

Otologic and audiologic characteristics of type 2 diabetics in a tertiary health institution in Nigeria

INTRODUCTION This cross-sectional comparative study was carried out at the Diabetes outpatient clinic of LAUTECH Teaching Hospital (LTH) Ogbomoso, Nigeria. OBJECTIVE This study assessed patterns of otologic diseases and auditory acuity among type 2 diabetics and determinants of these findings among diabetics. METHODS Ninety-seven consenting patients with clinical diagnosis of diabetes mellitus (194 ears) were matched for age and sex with ninety non-diabetic patients (180 ears). These patients were screened using otoscopy and pure tone audiometry over a 6-month period. RESULTS The study reported a crude prevalence rate of 21.6% hearing loss in T2DM patients. The most common type of otologic disease that showed significant association with T2DM patients was otitis media with effusion (p=0.027). T2DM was significantly associated with abnormal audiometric findings (p=0.022), particularly sensorineural hearing loss (p=0.022), of the moderate grade (p=0.057). There were no differences of the audilogical findings for any particular ear, and no differential affectation of frequency range was observed. Coexisting hypertension and poor glycaemic control were significantly associated with aggravation of the hearing of the T2DM patients (p< 0.001, and p=0.009 respectively). CONCLUSION T2DM had appreciable effects on hearing acuity. T2DM was significantly associated with the type and the degree of the hearing loss. The need for screening of hearing acuity of T2DM patients, in order to detect early changes, and promptly offer an adequate management and remedial measures was emphasized in this study.

Medication-Related Expenditures by Individuals with Allergic Rhinitis in Nigeria

Objective To assess the medication-related expenditures in individuals with allergic rhinitis (AR) and identify contributory factors that affect these expenditures. Study Design Cross-sectional study from August 2013 to January 2014. Setting Kwara state has 16 local government areas, a total land mass of 36,825 km2, and a population of 2,591,555. Subjects and Methods Of the 308 adult subjects, 66 had AR using the Score for Allergic Rhinitis (SFAR). Information on medication-related expenditure and associated factors in AR was obtained using a structured questionnaire. Descriptive and comparative analyses between AR and non-AR subjects were performed using an independent-sample t test and χ2 test. Factors associated with cost of care were assessed using logistic regression analysis. Results The AR crude prevalence rate was 21.4%. Of the subjects, the mean ± SD age was 37.6 ± 10.0 years, and 87.9% were married, 72.7% were self-employed, and 69.7% were in the low socioeconomic class. In total, 69.7% had intermittent symptoms, while 66.7% had a positive family history of allergy. Polypharmacy care was employed in 76.1%, and 30.3% had comorbidity with asthma. The mean monthly income was 842 US dollars (USD), while the mean monthly cost of care was 81 USD, constituting 9.6% of mean monthly income. All payments were through out-of-pocket-expenses. Factors associated with convenience of cost of care were positive family history (odds ratio [OR], 7.93; P = .021) and presence of intermittent symptoms (OR, 9.36; P = .013). Conclusion The medication-related expenditure of AR is burdensome with an average expenditure of almost 10% of monthly income.