Age-related hearing loss at Gwagwalada area council of federal capital territory, Abuja

Background

Presbyacusis is a cause of hearing loss in adults worldwide. It is a type of auditory dysfunction thought to be due to a series of insults over time including agerelated degeneration, noise exposure, and diseases of the ear. It usually affects the high frequencies of hearing. Presbyacusis has a tremendous impact on the quality of life of millions of the aged and is fast becoming an increasingly prevalent disorder as the population ages. Nigerian population is becoming progressively older making it imperative to focus on this area of research. It is worth noting that the Nigerian public health system does not have an effective and sustainable hearing loss screening strategy for lateonset hearing loss in adults.

Aim/Objective

This study evaluated the hearing threshold and pure tone audiometric pattern/s seen in participants with agerelated hearing loss (ARHL) in Gwagwalada Area Council of the Federal capital territoryAbuja.

Subjects and Methods

The study was a prospective communitybased crosssectional study, and a multistage sampling technique was adopted for this study, conducted at Gwagwalada, Abuja. Individuals from 55 years and above were recruited into the study after signing an informed consent. After a thorough and detailed clinical assessment, tympanometry and diagnostic puretone audiometry were carried out in all the participants.

Result

One hundred and fourteen participants were recruited into the study, out of which fourteen were excluded from the analysis on account of various exclusion criteria. The age range of the participants was 55 to 79 years, with a mean age of 65.8 ± 5.6 years.Twentyfive (25.0%) participants had normal hearing threshold, while seventyfive (75.0%) participants had sensorineural hearing loss (SNHL).

Conclusion

The study showed that the prevalence of ARHL from age 55 years and above at Gwagwalada Area Council, of FCT, Abuja was 75.0%.

Is there any relationship between hearing threshold levels and CD4 cell count of human immunodeficiency virus infected adults?

Background The role of viral load level and/or CD4 (Cluster of differentiation 4) cell count in the aetiopathogenesis of hearing loss in HIV infection is unclear. Therefore, we investigated the relationship between CD4 cell counts, viral load and hearing threshold of HIV (Human immunodeficiency virus) infected adults.

METHODS

This cohort audiometric study involved consecutive HIV-infected and HIV-uninfected adults as controls. Clinical data relating to hearing loss, HIV status, and highly -active antiretroviral therapy (HAART) were obtained. Audiornetric evaluation was performed. The most recent CD4 cell counts and RNA viral load-of HIV-infected participants were obtained from clinic records.

RESULTS

There were 299(66.7%) HIV-infected adults and 149(33.3%) controls with mean age of 39.64± 12.45 years and 39.60±12.45 years respectively (p=0.98). In both groups, there were more participants with left hearing loss. Mild to profound hearing loss was found in 65.9% HIV- infected participants and 53.7% controls. Majority (86.3%) of the HIV-infected participants were on HAART. The mean CD4 cell count was 654.58±289.15 in 41 HIV-infected participants not on HAART and 523.95±300.17 in 258 participants on HAART (p=0.01). Majority,- 197 (62%) HIV- infected participants with hearing loss had CD4 cell count ≤200 cells/mm3. Higher viral load significantly correlated with low CD4 cell counts (p<0.0 1; r=0. 18) and low CD4 cell count significantly correlated with high hearing threshold (p<O.01; r=0. 17).

CONCLUSION

There was a trend towards more hearing loss among the HIV-infected adults. The higher hearing threshold in those with low CD4 cell counts of <200 cells/mm3 suggests possible relationship between hearing status and severity of HIV disease.

Comparing Oxygen Saturation of Normal Children with that of Children with Adenotonsillar Hypertrophy

To compare the nocturnal oxygen saturation profiles of children with adenotonsillar enlargement with that of normal children. A 1 year comparative study. The study was carried out at the Otorhinolaryngology Ward of the University College Hospital Ibadan. These comprise of 60 children (1-9 years) with clinically confirmed adenotonsillar enlargement admitted for adenotonsillectomy and 60 normal children matched for age and sex. The biodata and common clinical presentations of the study group were acquired with a structured proforma. The severity of nasopharyngeal obstruction was determined by the adenoidal-nasopharyngeal ratio while the degree of tonsillar enlargement was graded by the Brodsky's classification. The nocturnal oxygen saturation of all the participants were recorded with a wrist worn pulse oximeter. Recording was for at least for 4 h. Oxygen saturation <92 % was regarded as desaturation. The oximetric values of the study and control group were compared. The mean nocturnal SPO2 (peripheral saturation of oxygen) profiles of children with adenotonsillar enlargement were as follows: basal = 96.86 %, minimum = 84.99 %; maximum = 99 % and average SPO2 <92 % = 87.74 % while the saturation profiles of the control group were as follows; basal = 97.88 %, minimum = 89.71 %; maximum = 99 %, average SPO2 <92 % = 90.82 %. Normal children have better nocturnal saturation profiles than children with adenotonsillar enlargement.

Sensorineural hearing loss in patients with chronic suppurative otitis media

Even though there are other complications of chronic suppurative otitis media, the aspect of hearing loss is often studied. Nevertheless, the occurrence of sensorineural hearing loss in patients with this disease is still controversial. This study aim (1) to assess the association between sensorineural hearing loss and chronic suppurative otitis media, (2) to investigate some clinical factors that might affect the sensorineural component in patients with this disease. This was a retrospective analysis of the clinical records and pure tone audiograms of patients with chronic suppurative otitis media in a Nigerian Tertiary Health Institution from January 2003 to December 2008. Sixty-nine patients with a mean age of 28.93 years; standard deviation of 18.593 were studied. They had an age range of 4-73 years. The duration of otorrhea ranged from 2 months to 20 years; with a mean of 6.11 years (standard deviation of 6.393). The mean bone conduction threshold in the diseased ear was 39.07 dB (standard deviation of 12.028), and 10.26 dB (standard deviation of 2.620) in the control ear (P < 0.05). The mean bone conduction threshold differences between the diseased and control ears range from 21.69 to 34.52 dB across the frequencies 0.5, 1.0, 2.0, and 4.0 kHz. These differences tended to increase with increasing frequency and were all significant (P < 0.05). In the diseased ears, there were no significant correlation between the age, duration of otorrhea, and the degree of SNHL (r = 0.186, P > 0.05; r = 0.190, P > 0.05 respectively). Patients with chronic suppurative otitis media had a significant degree of sensorineural hearing loss in this study. The higher frequencies were more affected; however, the patient's age and duration of otorrhea seem not to have any correlation with the degree of sensorineural hearing loss.

Swab and aspiration specimen collection methods and antibiogram in chronic suppurative otitis media at Jos University Teaching Hospital: Which is superior?

BACKGROUND

Chronic suppurative otitis media is a very common otologic problem in our environment. Appropriate methods for obtaining sample specimens for specific bacteria isolation has generated a lot of controversy. The simplest method available in our environment is the traditional swab method which, however, has been condemned on the basis of introducing contaminants. The objectives of this study were to compare the bacterial yield and the antibiogram of two specimen collection methods: the traditional swab method and aspiration method.

METHOD

This was a 3-month prospective study involving outpatients seen at both the emergency and outpatients' clinics of the Jos University Teaching Hospital in the period between May 2008 and July 2008. The biodata, duration of discharge and sites of samples were recorded in the study data form after obtaining consent from the patients or the parents of child.

RESULTS

Eighty patients were studied comprising 40 each for aspiration and swab technique. This consists of 30 males (37.5%) and 50 females (62.5%) with a male to female ratio of 1:1.7. There were 24 (30%) children (14 males, 10 females). Six (4 males, 2 females) and 74 (26 males, 48 females) patients had bilateral and unilateral ear discharges, respectively. A total of 86 specimens were obtained in all, consisting of 42 left and 44 right ears. There were 68 bacteria isolates comprising Pseudomonas (30), Staphylococcus (18), Proteus (12), and (8) Klebsiella species. Two were incidental fungal isolates of (Candida species), (8) cultures grew contaminants and (10) specimens had no growth at all. Each of the swab and aspiration techniques had (44) specimens.

CONCLUSIONS

Despite the controversy surrounding the sampling technique in literature, swab technique has been found to be as good as the aspiration technique in our study. The organisms isolated are the same as those obtained in other places. Contaminants found were few and occurred in equal amount in the same patients in the two methods.

Plain radiographic evaluation of children with obstructive adenoids

BACKGROUND

There are several methods of evaluating adenoidal size pre-operatively. Plain nasopharyngeal radiography is a common investigative modality: it has been advocated, and also condemned.

AIM

This study was intended to assess nasopharyngeal airway obstruction by the adenoids using plain X-rays; and also to find correlation if any, with the symptomatology.

METHODS

This is a retrospective study carried out between January and December 2008. The case notes and plain X-rays of the nasopharynx of 34 paediatric patients with clinical features of obstructive adenoids were analyzed.

RESULTS

A total of 34 children were studied, 22 (64.7%) were males and 12 (35.3%) were females. Their ages ranged between 7 months and 10 years: mean age was 3.55 years, standard deviation 2.723. Majority (67.6%) of the children were in the age group 0-4 years. The lowest symptomatology assessment score was 0 and the highest was 3. Children 4 years and below had the highest symptomatology scores. The minimum adenoidal-nasopharyngeal ratio was 0.35 and the maximum was 0.94. There was no significant difference in the mean adenoidal-nasopharyngeal ratio of males and females (t=0.407; p=0.692). Many (75.0%) of the children with moderate to severe nasopharyngeal airway obstruction by the adenoids were in the age bracket 0-4 years. The lowest adenoidal-nasopharyngeal ratio score was 0 and the highest was 3. Children 4 years and below had the highest adenoidal-nasopharyngeal ratio scores. There was a very weak nonsignificant correlation between the symptomatology assessment score and the radiological assessment score (r=0.168; p=0.375).

CONCLUSION

The adenoidal-nasopharyngeal ratio is reliable in assessing the nasopharyngeal airway in children with obstructive adenoids.

Experience with rigid esophagoscopy in Jos, north-central Nigeria

OBJECTIVE

Esophagoscopy which may be done for either a therapeutic or diagnostic reason has remained useful in the management of esophageal diseases. This study evaluates our experience with rigid esophagoscopy with special emphasis on esophageal foreign bodies in our unit.

METHOD

This is a six-year (January 2000-December 2005) retrospective review of cases of rigid esophagoscopy in the Ear, Nose and Throat Unit of our center.

RESULTS

Fifty-seven patients with ages ranging from 10 months 75 years were studied. There were 35 (61.4%) males and 22 (38.6%) females. Fifty-three of the patients (93%) had varying foreign bodies in the esophagus, 3 (5.2%) patients had carcinoma of the esophagus while 1 (1.8%) had pharyngeal pouch. The 0-10 year age group had the highest prevalence of esophageal foreign bodies (66.0%) with the middle third of the esophagus been the commonest site of impaction (58.5%). There was no fatality recorded.

CONCLUSION

Rigid esophagoscopy is a relatively safe procedure in trained hands and ideal environment with the necessary facilities in place.

Cervical necrotizing fasciitis: case series and review of literature

INTRODUCTION

Cervical necrotizing fasciitis is a fatal and rapid multi- bacteria infection causing extensive necrosis of the subcutaneous tissues and fascial planes with resultant skin gangrene and associated systemic manifestation. The aim of the present study is to report four cases of cervical necrotizing fascitis highlighting their source.

METHOD

The case notes of the patients were retrieved and reviewed, literature search was done using Medline, journals available and various texts.

RESULTS

Most often the cause of cervical necrotizing fascitis is of dental origin. The diagnosis depends mainly on clinical features and a high index of suspicion because the clinical features maybe innocuous at the early stage.

CONCLUSION

Despite aggressive management with liberal wound debridement, intravenous antibiotics, and nutritional support, the mortality was still high due to late presentation.

An unusual oronasal foreign body: report of a case

BACKGROUND

Foreign body removal in children is very common in the daily routine of an otolaryngologist but reports of oronasal foreign bodies and their management are rare.

METHOD

The case note of a 5-year-old female child presenting with an oronasal foreign body following a domestic accident was retrieved and studied and followed up.

RESULT

a 5-year-old female child with an oronasal foreign body which created an oronasal fistula that was closed with local palatal mucoperiosteal-lined flaps. The patient defaulted following treatment, a common practice by patients in our society.

CONCLUSION

This report highlights the occurrence of this rare condition, its management and the need to put measures in place to prevent domestic accidents especially for those most at risk.

Day case adenotonsiletomy: experience of two private clinics in Nigeria

BACKGROUND

adenoidectomy and tonsillectomy are among the common surgeries perform in children in otorhinoryngological practice. It was the aim of this study to evaluate the post operative mobility in patients undergoing day-case adenoidedtomy/tonsillectomy or adenotonsillectomy.

METHODOLOGY

All pediatrics cases requiring adenoidectomy, tonsillectomy or both who presented at HANSA clinics Enugu (January 1990 to June 2004) and GENIKS specialist clinics Ibadan (January 2000 to June 2004) were counseled for day case surgery. The inclusion criteria were: Patients certified fit for surgery-ASA grade I or II for general anaesthesia and had no intercurrent CVS disease or bleeding diathesis among others.

RESULTS

A total number of 144 patients requiring adenoidectomy Tonsillectomy or both were seen at the study centers with only sixty six (45.8%) meeting the inclusion criteria. Adenoidectomy constituted 47% of the surgeries with over 80 of the patient age less than 7 years reactionary haemorrhage was noted in 3 (4.5%) of the patient, the other complications were non-persistent vomiting 13 (19.7%), low grade fever 5 (7.6%) and pain at time of discharge 23 (34.8%). There were no fatalities.

CONCLUSION

The complication rates were low. Day-case Adenoidectomy/tonsillectomy or adenotonsillectomy is safe and the presence or closeness of the family members contributed greatly to patients/post recovery as this as this had a soothing/calming effect on the patient/s.

Surgical management of advanced hypopharyngeal carcinoma: a case report and literature review

BACKGROUND

Surgical resection of advanced primary head and neck cancers especially of the upper aerodigestive tract like hypopharyngeal cancer, usually leave a very big defect, which has to be reconstructed in order to maintain the gastropharyngeal continuity. This oncological surgery is best performed at the same sitting as a one staged procedure.

STUDY DESIGN

A clinical case of a 56-year-old female with advanced hypopharyngeal cancer who had a single stage total pharyngolaryngectomy and partial oesophagectomy with reconstruction of the upper aerodigestive tract using pectoralis major pedicled flap and post operative adjunct chemo-radiation therapy.

RESULT

Functionally, our patient had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. There was clinical evidence of weight gain. No evidence of flap complications post surgery.

CONCLUSION

The rarity of this procedure and its advantages in the management of an advanced hypopharyngeal cancer in this environment are discussed.

Chemo-radiation in advanced nasopharyngeal carcinoma, disease free after 6 years--a case report

This is a case report of a patient with advanced nasopharyngeal Carcinoma, (T4 N2 MO) who had chemo-radiation with Cisplatin based chemotherapy and total midplane dose of 60 Gray external beam radiation. Six years after treatment patient has remained disease free and the primary site histologically confirmed disease free with no clinical evidence of regional or distance metastases

Spectrum of otorhinolaryngology emergencies in the elderly in Ibadan, Nigeria

BACKGROUND

The elderly (65 years and above) are a special group of patients whose illnesses and management are modified by the process of aging. It is thus the aim of this study to evaluate the spectrum of ear, nose, throat, head and neck emergencies among the elderly in Ibadan, Nigeria.

METHOD

This is an eight-year (April 1996-March 2004) retrospective study of 87 geriatric patients who presented with otorhinolaryngological emergencies at our centre.

RESULTS

Eighty-seven emergency cases studied constituted about 20% of the total geriatric cases seen within this period. There were 55 (63.2 per cent) males and 32 (36.8 per cent) females. The pharyngolaryngeal emergencies with upper airway obstruction constituted 55 per cent of the cases, a majority being a result of malignant lesions of the larynx and pharynx. Others were nasal 20.7 per cent, otological 11.5 per cent, oesophageal 9.7 per cent and head and neck 3.1 per cent. Most of the patients had emergency tracheostomy (54 per cent), as a prelude to their definitive management while 24 per cent were managed medically.

CONCLUSION

Prevalence of emergency otorhinolaryngology cases among the elderly appears high. Most of the throat diseases with upper airway obstruction were due to malignancy. There is thus the need for increased awareness of the people through social campaigns and health education on the merits of early detection and seeking appropriate treatment for these tumours.

Retropharyngeal abscess: a clinical experience at the University College Hospital Ibadan

BACKGROUND

Infection within the retropharyngeal space could progress on to an abscess formation resulting into retropharyngeal abscess (RPA), which can either be acute or chronic. RPA can be a life-threatening emergency, with potential for airway compromise and other catastrophic complications. This review is aimed at highlighting our experience with patients with a diagnosis of retropharyngeal abscess.

METHODS

Retrospective review of thirty patients with a confirmed diagnosis of retropharyngeal abscess, who were admitted and managed within an eleven-year period (1993 to 2003) in the Otolaryngology department of the University College Hospital Ibadan.

RESULTS

There were fifteen males and females each with M:F ratio of 1:1, consisting of twenty-five children and five adults and their median age was 21 months and twenty three (77%) were younger than 5 years. It was observed that while the adult patients presented early for specialist treatment, the paediatric patients presented late. The major complaints were fever (87%), respiratory distress or stridor (57%), cough (53%), neck pain/swelling (43%), and refusal of feeds (30%). Other minor complaints were throat pain, difficulty in swallowing, anorexia, and weight loss. The commonest associated symptoms seen especially among the younger age group were nasal discharge, nasal blockage, tooth-ache, snoring and limitation of neck movement.

CONCLUSION

The treatment of retropharyngeal space infections in children and adults should include accurate clinical diagnosis, empirical usage of broad-spectrum antibiotics, and timely surgical drainage.

Non-operative management of benign intracranial hypertension presenting with complete visual loss and deafness

Benign intracranial hypertension (BIH) may lead to blindness and rarely deafness. We describe the case of a rapidly deteriorating 14-year-old African girl who presented with headaches associated with complete visual and hearing loss due to BIH. This was managed non-operatively with lumbar cerebrospinal fluid tap, weight reduction, nicotinic acid and acetazolamide. Response to treatment was quite dramatic with resolution of severe headaches and regaining of light perception 8 days after commencing treatment. By 3 months hearing recovered to normal and there was resolution of vision. This to the best of our knowledge is the first reported case of complete visual and hearing loss occurring in a patient with BIH, which was managed successfully non-operatively. When indicated, non-operative management is an effective treatment option even in malignant BIH.

Demographic factors in HIV infected patients seen at UCH, Ibadan, Nigeria

There is a rising rate of Human Immunodeficiency Virus (HIV) infection in Nigeria. Good knowledge of the demographic characteristics of the patients with HIV/AIDS may be of great importance in understanding its epidemiology in Nigeria and could facilitate efforts at curtailing the spread of the infection. The study was planned to determine the demographic factors in Nigerian patients with HIV infection. The study was conducted at the University College Hospital (U.C.H), Ibadan, located in the South West of Nigeria. It was a retrospective study of patients with HIV infection attending the U.C.H. from 1988 to 2002. The data collected from the clinical records of the patients with HIV infection included age, sex, marital status, number of spouses, tribe, occupation, education and their religious affiliation. A total of 460 patients aged 1-76 years with peak at 30-34 years were studied. The male/female ratio was 1.06 and the males were the older group. Traders accounted for 40% with female preponderance while the artisans (19.9%) and the military (2.9%) were mostly males. The patients were of Yoruba (70.6%), Igbo (20.0%) and Hausa (9.1%) races. Among the patients with marital status, majority (71.4%) were married while those separated and widowed accounted for 3.5% and 2.6% respectively. Also, a higher proportion of the female HIV patients were Christians whereas the majority of the males were of Islamic religion. Although, there was a low frequency of records on education, the males had better formal education. In conclusion, the study shows that HIV infection is presently an adult disease affecting the most productive segment of the Nigerian population regardless of the individual occupation, educational status, tribe and religious affiliation. Also, it shows that the infection could be associated with heterosexual intercourse.

An unusual rhino-pharyngeal foreign body

BACKGROUND

Foreign bodies of the upper aerodigestive tract are commonly seen in the paediatric population; however adult patients with nasal foreign bodies in particular are much less common and when sharp foreign bodies are present there is a great risk of developing complications.

STUDY DESIGN

This is a case report of a 20-year-old male magician with impacted rhino-pharyngeal foreign body. He intentionally inserted two long sewing needles into the right nasal cavity during a magical act.

RESULTS

The impacted foreign bodies were located in his nose/pharynx and removal was achieved per orally under general anaesthesia. Only a minimal evidence of retropharyngeal abscess was noted despite the prolonged stay of the foreign bodies.

CONCLUSION

This case highlights the fact that both a deliberate and an accidental foreign body in an adult nasal cavity can get impacted as well as the significance for its early removal.

Nasopharyngeal cancer at the University College Hospital Ibadan Cancer Registry: an update

BACKGROUND

Only two reports on nasopharyngeal cancer (NPC) are available from this large centre and both covered the years 1961--1966 and 1966--1980.

OBJECTIVE

This study describes the update of nasopharyngeal cancer at the Ibadan Cancer Registry from 1981 to 2000.

METHOD

This is a retrospective review of all histologically confirmed cases of nasopharyngeal cancer accumulated in the Ibadan Cancer Registry from 1981--2000.

RESULTS

Two hundred and twenty three cases were analysed consisting of 156 (70%) males and 67 (30%) females with a male: female of 2.3:1. There is a steady increase in the incidence of nasopharyngeal cancer over the last two decades. Overall, the mean age was 41.1years (age range 10 to 81 years). The females had a mean age of 36.1years (age range 11 to 80 years) and males 43.2 years (age range 10 to 81 years). The peak age group of incidence for the females was 20-29 and 50-59 for the males with an almost equal incidence in the preceding three (3) decades. The ratio of Regaud to Schmincke type cancer reversed with increasing age amongst the females with the Schmincke type more common in the first decade but this was not reproduced in the males.

CONCLUSION

There is a steady increase in the incidence of nasopharyngeal cancer over the last two decades. The two main histological types showed differential variation between the sexes suggesting a possible biological effect in the manifestation of this disease.

Ethical issues in HIV/AIDS infections

BACKGROUND

Human relationships are guided by codes of ethics, written or otherwise. The reality and the place of universal standards of ethics may be argued but local variations and interpretations of these universal standards do occur.

METHOD

A search of some relevant articles on ethical issues on HIV/AIDS was undertaken through the medline and standard texts.

RESULTS

Unlike any other disease HIV/AIDS infection has resulted in large amount of legal/ethical commentaries. For the most parts of the world HIV/AIDS issues have produced metamorphosing legal/ethical issues notably, the concern about confidentiality of medical information, informed consent for medical procedures/HIV testing, discrimination/stigmatisation of people living with HIV/AIDS, partner notification, the right of the patient to refuse treatment and the way counselling should be done. Clinicians in developing countries have had to rely on self-regulations in making ethical judgements or at least attempt to conform to poorly enforced ethical standards in clinical practice established by their institutions.

CONCLUSION

Universally, recognized human rights standard should guide policy makers in formulating the direction and content of HIV related policy and should form an integral part of all aspects of national and local responses to HIV/AIDS. This paper therefore discusses ethical/legal issues presented by HIV/AIDS and how a variety of state, and federal laws and various institutions have attempted to address them.

Recurrent respiratory papillomatosis in Ibadan, Nigeria

BACKGROUND

Recurrent respiratory papilomatosis (RRP), the most common benign neoplasm of the larynx, usually results in upper airway obstruction that is most often misdiagnosed as lower airway disease in children. The prevalence of RRP and various aspects of its clinical course are still unknown with a dearth of literature on this in Nigeria. This study aims at presenting the clinical profile of RRP as seen in the University College Hospital, Ibadan, Nigeria.

METHODOLOGY

A retrospective study of 43 cases of histologically confirmed RRP over a fifteen-year period in the Otorhinolaryngology Department of the University College Hospital Ibadan.

RESULTS

There were 28 (65.1%) males and 15 (34.9%) females with mean age of 8.7 years (range 2-23 years). Thirty-two patients (74.4%) were between 110 years with the highest incidence occurring at the 6-10 year age group (39.5%). Forty-one patients (95.3%) belonged to low social classes V and IV. Thirty-one patients (72%) presented within 1 year of onset of symptoms. All the patients were hoarse with 70% of those dyspnoeic at presentation having emergency tracheostomy. The lesions involved the vocal cords and anterior commissure mostly. There were no recurrences in 23 patients (53.5%) while twenty patients (46.5%) had 2 to 5 recurrences.

CONCLUSION

Sequelae of RRP in Children may be grave, thus a high index of suspicion is needed in a patient with progressive voice change exceeding six weeks and unresponsive to standard medical therapy.

Recurrent respiratory papillomatosis mimicking retropharyngeal abscess in a Nigerian child

Recurrent respiratory papillomatosis (RRP) is not an uncommon disease of the aero-digestive tract, usually involving points of narrowing. Involvement of the oropharynx, particularly when florid, may be easily confused with a retropharyngeal abscess.

STUDY DESIGN

Case report of a 1 1/2 year-old child with florid pharyngeal RRP.

RESULTS

The clinical presentation and features on radiography of this patient mimicked retropharyngeal abscess. The patient successfully had a preoperative tracheosomy and excision of the RRP.

CONCLUSION

There was a diagnostic dilemma in this patient because of the identical features of the two conditions. A high index of suspicion and painstaking, careful clinical and radiological evaluation is the key to diagnosis and prompt definitive management.

Hoarseness in adult Nigerians: a University College Hospital Ibadan experience

BACKGROUND

Hoarseness is a major symptom of laryngeal disease. Persistent hoarseness may be an early warning of such sinister lesions as cancer of the larynx and nasopharynx, hence the need for increased awareness of this symptom and its causes.

METHODS

This is a retrospective study of all hoarse adult patients seen in the Otorhinolaryngology clinics of the University College Hospital Ibadan over an 8-year period (1995-2002).

RESULTS

The total study population of 124 patients consisted of 72 (58.06%) males and 52 (41.94%) females with an overall mean age of 46.98 years and age range 16-84 years. The mean duration of hoarseness before presentation was 23.29 months; 56 (45.2%) patients presented within 6 months of onset of hoarseness. Chronic non-specific laryngitis including vocal cord nodules was the most common cause of hoarseness (55.6%). Chronic non-specific laryngitis patients had a mean age of 45.05 years. Fourteen point forty-nine percent (14.49%) of patients with chronic non-specific laryngitis smoked cigarette and drank alcohol, 60.88% were professional voice users. The other causes of hoarseness included laryngeal cancer (24.2%), recurrent laryngeal nerve palsy (8.1%) and laryngeal papilloma (6.5%). The patients with laryngeal cancer had a mean age of 57.63 years. The two male patients with laryngeal tuberculosis were all secondary to pulmonary phthisis.

CONCLUSION

The causes of hoarseness are varied and late presentation may worsen the prognosis. Persistent hoarseness of more than three weeks should have detailed Otolaryngological evaluation.

Hypopharyngeal paraganglioma: a case report

Paragangliomas are neuroendocrine neoplasms that primarily afflict patients during the fourth and fifth decades of life. The majority of extra-adrenal paragangliomas arise in the head and neck region, notably from the carotid and aortic bodies, jugular bulb and tympanic plexus. Although one-fifth of all parapharyngeal neoplasms are paragangliomas, primary hypopharyngeal paraganglioma is relatively uncommon, only one other case having previously been documented by Filippin et al. (1989). We report a second case of hypopharyngeal paraganglioma in an 18-year-old male as seen in our center.

Stomal recurrence post laryngectomy in University College Hospital, Ibadan

The outcome of laryngeal carcinoma is favourable and cure rate high if detected early. A major complication experienced post surgery for advanced laryngeal carcinoma is recurrence especially at the tracheostome. This study aimed at evaluating the incidence of stomal recurrence post total laryngectomy with respect to the risk factors. This is a retrospective review of eighteen patients (14 males and 4 females) that had total laryngectomy for histologically confirmed laryngeal carcinoma from 1990 - 2002. Seven patients (38.9%) had stomal recurrence. Seven patients (38.9%) had palpable deep cervical nodes at presentation. Fourteen (77.8%) and four (22.2%) patients had emergency and elective tracheostomy procedures respectively. Twelve patients (66.67%) had neck node dissection during surgery. Post-operatively, twelve patients (66.7%) had only radical radiotherapy; four (22.2%) had both radio-/ chemotherapy while two had preoperative and additional postoperative radiotherapy. The mean duration between the preoperative tracheostomy and total laryngectomy was 62.19 +/- 64.56 days while the mean duration between total laryngectomy and development of stomal recurrence was 7.79 +/- 8.57 months. Ten patients (55.6%) died, (seven with and three without stomal recurrence but who died of distant metastases to the lungs and thoracolumbar vertebral bodies). Stomal recurrence post laryngectomy has a grave prognosis. This present study also showed that advanced stage 3 and 4 tumour, transglottic involvement and the presence of preoperative tracheostomy are the likely risk factors that could be associated with recurrence in our environment. There is therefore the need to reevaluate these preventive measures in a prospective study in order to improve the final outcome in our environment.

Perceived susceptibility to noise induced hearing loss and attitude towards preventive care among metal workers at Gate, Ibadan: a pilot study

Audiometric assessment was carried out on 26 metal workers at the spare parts market, Gate Ibadan to corroborate their perceived susceptibility to noise induced hearing loss. Of the 26 studied, 13 (50.0%) indicated non-susceptibility, 11 (42.3%) indicated susceptibility while 2 (7.7%) did not know. Otology symptoms mentioned by those who indicate susceptibility were tinnitus (63.6%), hearing loss (36.4%), otalgia (18.2%), headache (9.1%), and post-aural pain (9.1%). Audiometric results showed 10 (76.9%) of non-susceptible subjects, 5 (45.5%) of susceptible subjects and 1 (50.0%) of undecided group had normal hearing bilaterally. Unilateral high frequency hearing loss was observed in 4 (36.4%) of the susceptible subjects. Implications of the findings for taking preventive action are discussed.

Complications of classical tracheostomy and management

Tracheostomy can prevent many deaths in otherwise fatal airway diseases and problems but has numerous complications that are mostly avoidable if the procedure is carefully performed together with strict postoperative management. This is a retrospective review of tracheostomy complications over a 10 year period (1991-2002) in the Department of Otorhinolaryngology (ORL), University College Hospital, Ibadan. A total of 179 tracheostomies performed on 168 patients with 69 complications (38.6%) were documented. There was a significantly greater number of complications in the 43 emergency cases (54%) than in the 26 elective cases 1(46%), P = 0.0002]. The overall mortality rate was 2.2%. The most common complications of tracheostomy were infective in origin, representing 43% of all complications. This study highlights the complications and mortality and gives details of management that will prevent or minimize their occurrences. Those who require long-term tracheostomy must be on regular follow-up and taught home-care of the tracheostomy before discharge from the hospital.

Primary extranodal non-Hodgkin's lymphoma of the upper aerodigestive tract--a descriptive analysis of the pattern seen in the University College Hospital, Ibadan

This retrospective review highlights primary extranodal non-Hodgkin's lymphoma (NHL), of the upper aerodigestive tract as seen in Ibadan over a ten-year period. There was a male preponderance (m:f ratio of 2:1), with a mean age of 42.5 years and a bimodal age presentation at the fourth and fifth decades. The Waldeyer's ring was the commonest affected site while the tonsil is the highest involved subsite. Sixty-eight percent of the patients had regional lymphadenopathy and thirty eight percent also 'B' symptom at presentation. The peculiar presentations of this NHL are the short duration (10 months) of symptoms, mainly intermediate/high grade diffuse large cell lymphoma especially in the Waldeyer's ring and sinonasal region with absence of low-grade small cell lymphoma. The majority of patients (64.3%) presented with Stage IV disease, which shows that the disease has an aggressive course with high mortality and generally poor outcome with 53.6% of the patients dead within one-year onset of symptoms. The overall mean survival period was 14 months. Comparison of the median survival of the patients that died when matched with the site, Ann Arbor staging, histological grade/subtype and treatment modality yielded no significant differences. These further confirm the aggressive nature of the disease in our environment.

Traumatic vertebral artery pseudoaneurysm: a case report

A case of traumatic vertebral artery pseudoaneurysm in a 16-year-old Nigerian male following a stab wound is described. Successful surgical treatment by proximal Subclavian artery control and excision of the lesion was achieved. The value of Doppler ultrasonography in the diagnosis is highlighted. This case illustrates and re-emphasises that this rare lesion should be considered in patients with neck mass following penetrating posteriorly located neck injuries.

Inverted papilloma of the nose and paranasal sinuses: a fifteen-year review

Inverted papilloma is a relatively rare epithelial neoplasm of the nose and paranasal sinuses accounting for 0.5-4% of all primary tumours of the nose. This is a retrospective study of fifteen patients with histologically confirmed I.P. of the nose and paranasal sinuses seen from 1986 to 2000 at the Department of Otorhinolaryngology, University College Hospital, Ibadan. The patients ages range from 14-65 years, with a median age of 39 years. There were twelve males and three females. Five patients had advanced lesions of which four were bilateral. There was associated synchronous and metachronous squamous cell carcinoma (SCC) in two patients respectively. The surgery offered was based on the clinical and radiological evaluations of these patients. Nine patients had conservative surgery (intranasal clearance/antrostomy and external fronto-ethmoidectomy) while the remaining six patients had radical surgery (lateral rhinotomy/medial maxillectomy) at various times. The two patients with SCC had adjunct radiotherapy/chemotherapy in addition. Recurrence was observed in those that had conservative surgery only. We therefore advocate radical surgery in our environment as the treatment of choice for effective limitation of recurrence.

Sensorineural hearing loss in adults with sickle cell anaemia

Sensorineural hearing loss (SNHL) is one of the known complications of sickle cell disease (SCD). However, there is paucity of information on SNHL as a complication of SCD, especially in sickle cell anaemia (SCA) in our environment, hence this study. This was a prospective study of pure tone audiological assessment of 167 adult SCA patients in stable condition attending the adult Sickle Cell Clinic and 100 apparently healthy Haemoglobin AA adults as control in the University College Hospital, Ibadan. Their ages ranged from 15 to 56 years for SCA and 15 to 65 years for the controls, with a mean age of 24.2 (+/- 8.2) and 28.7 (+/- 11.9) years respectively. There were 94 females (56.3%) and 73 males (43.7%), fifty-two females (52%) and forty-eight males (48%), with a M:F ratio of 1:1.3 and 1:1.1 for SCA and controls respectively. Sensorineural hearing loss (SNHL) was observed in a total of 178 ears in 110 SCA patients and 68 ears in 47 controls with a prevalence of 66% and 47%, respectively. Sixty-eight patients (62%) and twenty-one controls (44.7%) had bilateral impairment, although only 18 SCA patients (11%) perceived hearing impairment. High frequency loss (4000-8000 Hz) was commonly affected in both the SCA patients and controls as compared to other frequency ranges. Low frequency range was involved in ten ears (9%) especially the right ear of some SCA patients. Decibel hearing level (dBHL) loss was in the mild range (26-40 dBHL) in 103 (58%) and 53 (78%) ears in the SCA and controls, respectively. Five patients had severe and profound dBHL loss. The range of dBHL loss was 26-43 dBHL especially in the high frequency range bilaterally for both the SCA and controls. Mean binaural hearing of 13 dBHL was recorded in both the SCA and controls for each octave frequency bilaterally in those with normal hearing while 26 and 23 dBHL were for those with impaired hearing respectively. Also, the mean dBHL for both ears was observed to be progressively worse with increasing age groupings, more especially in SCA patients. There was no significant correlation between the severity of hearing loss and the frequency of vaso-occlusive crisis. It is hoped that this study would have increased the awareness that SNHL is a common complication of SCA in our patients. There is thus the need for periodic evaluation of the auditory function of SCA patients in our environment.