Taiwo Olugbemiga Adedeji

Corrosive oesophageal injuries: a preventable menace.

Introduction Potentially catastrophic presentations and lifelong complications resulting from corrosive ingestions in humans is one of the most challenging situations encountered in clinical medical practice. This study reviewed pattern, mechanisms and associated socio-medical challenges with ingestion of corrosive agents as seen in a tertiary health institution in South-western Nigeria. Methods A retrospective review of all patients that were managed for corrosive ingestion at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over a seven year period. Results A total of 28 patients M:F: 1.6:1. There were 7 children and 21 adults. Majority (78.6%) of the patients ingested alkaline substances. Accidental ingestion occurred in 28.6% while 71.4% resulted from deliberate self harm especially among adults (66.7%). Almost two thirds (64.3%) of the patients presented after 48hrs of ingestion. Patients who presented early were managed conservatively. Most patients (64.3%) who presented late had nutritional and fluid rehabilitation. Two patients died from oesophageal perforation and resulting septicaemia. Psychiatric evaluation revealed that seven adults (25%) had psychotic illness while (42.9%) of the patients developed oesophageal strictures. Short segment strictures were managed with oesophageal dilatation with good outcome while long and multiple segment strictures were referred to cardiothoracic surgeons for management. Conclusion Corrosive oesophageal injuries remain a prevalent and preventable condition in the developing countries. Preventive strategies should include regulation and packaging of corrosive substances, organization of psychiatric services, and education of the population on corrosive ingestion.

Denture impaction in the oesophagus experience of a young ENT practice in Nigeria.

Introduction The effect of dental loss and associated desire to restore its function and aesthesis has led to an increase in the number of people wearing dentures. This study therefore reviews the cases of impacted acrylic dentures in the oesophagus. Methods A retrospective review of patients that were managed for oesophageal denture impaction at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over an eight year period from 2005 to 2012. Results A total of 14 patients (M: F 2.5: 1). The age ranged from 32 - 75 years. Majority 64.3%) were 51 years and above. Over 70% presented early. Major presenting symptoms were throat pain (100%), odynophageal (92.9%) and dysphageal (78.6%). The radiographic findings were air entrapment (64.3%) and increase in prevertebral soft tissue shadow (78.6%). Majority (87.5%) were impacted at the upper (cervical) oesophagus. Over 78% had successful extraction with rigid oesophagoscopy. Two (14.3%) had spontaneous expulsion of the denture and 1 (7.1%) discharged himself against medical advice. Complications were mucosa tear (28.6%), laryngeal spasm/ airway obstruction (14.3%), mucosa oedema/ erythema (57.1%), neck abscess (7.1%). Conclusion Impaction of esophageal dentures is relatively common in our locality; most patients present early for medical attention and associated with successful rigid oesophagoscopies and denture extraction under GA, and generally good outcome. Education of the wearers of dentures was emphasized as a way of preventing dentures impaction.

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.

Clinical spectrum of ear, nose and throat foreign bodies in North Western Nigeria.

BACKGROUND Ear, nose and throat foreign bodies (FBs) are common occurrences particularly among children. This study reviewed the clinical spectrum of ENT FBs, their treatment and outcomes as seen in a tertiary health center in North Western Nigeria. METHOD The study was a retrospective chart review of patients that were managed for FB impaction in a tertiary health institution in North Western Nigeria over a four year period. RESULT There were 239 patients; M: F: 1.2:1. Majority of FB impaction (46.4%) occurred in children. Majority (68.7%) were otic and FBs. 18.0% of the patients had had failed attempted removal by non ENT specialists. About 25% of these patients developed complications. Majority (62.0%) of these complications occurred in the hand of non-ENT medical personnel. CONCLUSION Ear, nose and throat foreign bodies are common in North-Western Nigeria with the highest incidence in children. Removal attempts by untrained health professionals and lack of experience in FB management predisposes to complications. Parental education on close monitoring of their children to avoid such incidences and the need to immediately seek an Otorhinolaryngologist to prevent complications are emphasized.

Management challenges of congenital & early onset childhood hearing loss in a sub-Saharan African country

BACKGROUND Hearing impairment is a hidden human disability with potentially catastrophic and age long consequences. This study highlighted the challenges associated with the management of congenital and early onset childhood hearing loss in a sub-Saharan African country. METHODS A retrospective descriptive study of children seen between January 2008 and December 2013 RESULT: A total of 223 children consisting of 124 (55.6%) males with (M:F) of 1.3:1. Age ranged 1-15 years (mean±SD; 6.39±4.37 years) and age group 1-5 years constituted the largest proportion (56.5%). Congenital causes, febrile illness and hypoxia were the leading causes of HI. Over 93% had moderately severe to profound hearing loss and 64.6% had delayed speech development. Majority (99.3%) with congenital/perinatal onset of HL had significantly delayed speech development and 99.3% of HL due to ototoxicity and infective causes had peri/post lingual speech impairment. Larger percentage of patients presented late; 16.6% of patients with congenital/perinatal onset of HL presented within the first year, >41% presented after the fifth year. Less than 5% had hearing aid fitted and patients with profound hearing impairment were referred for cochlear implant CONCLUSION The burden of congenital and early onset hearing impairment is high and management outcomes are unsatisfactory in our locality, Challenges associated with managing such children were discussed, and suggestions/strategies for better management and outcome were made.

Sub-clinical middle ear malfunctions in elderly patients; prevalence, pattern and predictors

Background Little is known about functioning of the middle ear with advancing age. Objectives To estimate the prevalence and describe tympanometric patterns of sub-clinical middle ear malfunctions,( S-MEM) in elderly patients. It also assessed clinical factors that could predict S-MEM. Methods Cross-sectional, analytical study of patients aged ≥ 60 years in a tertiary hospital in Nigeria between 2011–2014. Pure tone audiometry (PTA), tympanometry and acoustic reflexes were recorded. S-MEM was based on audiometric and tympanometric evident abnormalities. Descriptive, univariate and multivariate analyses performed to detect independent clinical predictors of S-MEM at p-value of <0.05. Results 121 patients , M: F of 1.1:1. Mean age was 70.1 ± 6.2 years, 77.7% were married. Prevalence of S-MEM was 21.5%. Abnormal tympanometric tracings were type AS>C>B>AD. The parameters that were statistically-significant on univariate analyses were subjected to logistic regression analysis which confirmed previous head injury, diabetes, osteoarthritis of knee joint, and absent acoustic reflex as clinical predictors for S-MEM. Conclusion 21.5% of elderly Africans had subclinical abnormalities in their middle ear functioning, mostly with type AS tympanogram. Independent clinical predictors of S-MEM included previous head injury, diabetes, history of osteoarthritis of knee joints, and absent acoustic reflex.

Indications and outcomes of tracheostomy: An experience in a resource-limited environment

Background: Tracheostomy remains one of the most important procedures for airway emergency management, especially in a developing country where patients will not present until they are in acute airway obstruction. This study reviews all the tracheostomies performed in a suburban tertiary health institution in a developing country. Materials and Methods: A retrospective review of patients who had tracheostomy over a 10-year period. Results: There were 52 tracheostomies performed on 36 males and 16 females with a male: Female ratio 2.3:1. Upper airway obstruction was the major indication (63.5%), with laryngeal tumor as the major cause (32.7%). Tracheostomy was performed as emergency in 76.9% and as elective in 23.1%. Majority (73.1%) of the emergency tracheostomies was done under general anesthesia and over 84% were temporary tracheostomies. There were 21.2% complications with tracheostomy dependence as the leading cause in 9.6%, followed by peri-stoma granulation in 5.8%. Conclusion: Upper airway obstruction remains the major indication for tracheostomy, with laryngeal tumor as the major cause. There is a need for increased awareness of the people through social campaigns and health education on the merits of early detection and improvement in health-seeking behaviors of the people.