Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review

Background: The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria. Methods: A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively. Results: Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd­5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens'. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded. Conclusion: Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens'. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy

Challenges of Otolaryngologic Referral in a Nigerian Tertiary Hospital

Background: The referral system offers one strategy for making the best use of hospitals and tertiary healthcare services. The aim of this study was to analyze the referral system of patients to the otorhinolaryngologist and to examine the use of in-house referral system in the teaching hospital set up. Methods: This was a retrospective review of all patients referred to the ENT Department between January 2000 and December 2007. Data retrieved from all referral notes included the review of referral letter; demographic; referral status; clinical presentations and examination findings. These data were entered into the SPSS computer software version 11.0 and analysed Results: A total of 1402 cases were analyzed. The patients' ages ranged from 3weeks to 90yrs; with 70.4of cases being below 40yrs of age while 25.9were between 40-64yrs and 3.7were above 65yrs. The Male to female sex ratio was 1:1. The majority (70.4) of the patients had at least primary school education. The rest (29.6) had no formal education. Slight over half (51.5) of the patients were unemployed. The rest were either civil servants or self employed. Out of the 1402 patients that were referred to the hospital; in-house referral accounted for 74.1; 7.2of came from private health facility and 4.3were self referrals. Out of the 1038 in-house referrals; 42.8were from GOPD; 5.0from Staff clinic; 13.3from surgery; 4.7from medicine; 3.5from Obstetrics and Gynaecology; 10from paediatrics and 10.4from ophthalmology and 10.3from ENT staffs such as residents; ENT Nurse Practitioner and ENT supporting staffs such as speech therapist and audiologist. Conclusion: The challenges of referral to the otolaryngologists are enormous thus the need to organize continuous medical education for the family physician; to make patients have confidence in the primary care physician; early referral of patients and to allow the otorhinolaryngologist to focus on the cutting edge issues of the specialty

Aural foreign bodies in children.

OBJECTIVE: Foreign body in the ear is commonly encountered in children by primary care givers, emergency department Physicians, Pediatricians and Otolaryngologists worldwide. METHODS: We reviewed cases of aural foreign bodies in children seen in our centre over a five-year period with the aim of auditing our current practice and suggesting possible improvements suited for developing countries. RESULTS: Grains and seeds (27.9%), beads (19.7%), cotton wool (13.6%), paper (8.8%) and eraser (8.2%) formed the bulk of the aural foreign bodies. About 96% was removed without general anesthesia by using Jobson Horne's probe or aural dressing forceps (73.8%) under direct vision; or by syringing (22.1%). Some 4% had to be removed in the operating theatre under general anesthesia. The complications observed include bruise or laceration and bleeding from the external auditory canal (16.3%), otitis externa (6.5%) and traumatic perforation of the tympanic membrane (1.7%). CONCLUSION: Despite a high proportion of cases managed in the office setting, complication rates were within acceptable levels. There is need to develop practical criteria that will be beneficial to primary health care givers to determine which patients could be managed in the primary care setting with acceptable outcome.