Adult Chronic Rhinosinusitis:Spectrum of Clinical Features and Management in aTertiary Health Institution and Literature Review

Background:Rhinosinusitis is defined as inflammation of the nasal and paranasal sinus mucosa.Chronic rhinosinusitis occurs when this inflammation and the symptoms persist for more than 3 months.The objective of this study was to evaluate the clinical features and management of adult chronic rhinosinusitis in a tertiary health institution and to review the literature for its current modalities of management.Methods:This is a 5-year retrospective study of all adult patients managed for clinically and radiologically diagnosed chronic rhinosinusitis at the study center.Their medical records were reviewed for essential data which included demographic data; clinical presentations; skin sensitivity test; radiologic reports and treatment offered.The data were collated and analyzed using simple descriptive statistics.Results: There were 228 patients; 97(42.54) males and 131(57.46) females with a male:female ratio of 1:1.35; age ranged between 18 - 67 years (mean =35.2).The five major presenting symptoms were nasal discharge 228(100.00); nasal obstruction 224 (98.25); equent throat hawking 189 (82.89); itching of eye; ear; nose or throat 138 (60.53) and excessive sneezing 136(59.65).About 6of the patients developed complications.Allergy accounted for the cause in 93 (40.79)patients. Maxillary antral mucosal thickening and engorged inferior turbinates were the commonest radiological features. About 51of the patients were treated with intranasal inferior meatal antrostomy with or thout inferior turbinectomy.There was recurrence of symptoms in about 18of these patients from 3 to 8months after surgery.Conclusions: Both subjective and objective measures should be employed in the diagnosis of chronic rhinosinusitis and intranasal inferior meatal antrostomy may rarely produce satisfactory clinical improvement

Tracheostomy Decannulation: Suprastomal Granulation Tissue in Perspective

Background: Suprastomal granulation tissue is a complication of tracheostomy which maymake decannulation difficult and presents a therapeutic challenge to the Otorhinolaryngologists. The aims of this study therefore were to evaluate tracheostomy in black African population; determine the prevalence of suprastomal granulation tissue and provide updated information on it that will enable the otorhinolaryngologists to better understand and manage the lesion. Methods: We reviewed case files of patients who had tracheostomy between 1993 and 2007 at University College Hospital; Ibadan; Nigeria for essential clinical data.Results: Of the 256 patients who had tracheostomy; 133(51.95) had prior orotracheal intubation for 10 21days. Suprastomal granulation tissue complicated 16 (6.25) cases; this accounted for 88.89of cases of failed decannulation. Indications for tracheostomy in these patients included severe head injury in 12 (75); tetanus in 3 (18.75)] and intubation granuloma in 1(6.25) of these cases. Sixteen (4.3) cases had stomal infection. Conclusion: This study showed that the prevalence of suprastomal granulation is high among our patients. There is a need for good surgical tracheostomy technique to prevent this complication and stomal infection should be promptly treated while cuffed orotracheal intubation for more than two weeks in unconscious and tetanus patients should be avoided

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 47of 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 denotonsillectomy 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