Intra-antral application of an anti-fungal agent for recurrent maxillary fungal rhinosinusitis: a case report.

INTRODUCTION: Fungal infection of the paranasal sinuses is an increasingly recognized entity both in immunocompetent and immunocompromised individuals. Treatment has been via use of either surgical or medical modalities, or a combination of the two. Here, we present a case of utilization of intra-antral application of an anti-fungal agent in the management of recurrent fungal sinusitis in an indigent Nigerian patient. CASE PRESENTATION: We present the case of a 30-year-old West African Yoruba man, an indigent Nigerian clergyman, who presented to our facility with a history of recurrent nasal discharge (about one year), recurrent nasal blockage (about five months), and right facial swelling (about one week). After intra-nasal antrostomy for debulking with a systemic anti-fungal agent, our patient had a recurrence after four months. Our patient subsequently had an intra-antral application of flumetasone and clioquinol (Locacorten®-Vioform®) weekly for six weeks with improvement of symptoms and no recurrence after six months of follow-up. CONCLUSIONS: We conclude that topical intra-antral application of anti-fungal agents is effective in patients with recurrent fungal maxillary sinusitis after surgical debulking.

The burden of hearing loss in Kaduna, Nigeria: a 4-year study at the National Ear Care Centre.

Hearing loss among people in developing countries has been recognized as a major source of disability. Many of its causes are preventable, and others are curable. We reviewed the records of 5,485 patients who had presented during a 4-year period to the National Ear Care Centre in Kaduna, Nigeria. Of these, we identified 1,435 patients-812 males and 623 females, aged 9 months to 90 years (mean: 29.2 yr)-who had been diagnosed with hearing loss (26.2%). In addition to demographic data, we compiled information on each patient's type and degree of hearing loss, the affected side, and the predisposing factors. Sex and age cross-tabulations revealed that the greatest proportion of hearing loss according to sex occurred between the ages of 11 and 20 years for males and 21 and 30 years for females. The most common type of hearing loss was sensorineural, which was seen in 78.9% of patients; conductive hearing loss was seen in 17.7% and mixed in 3.4%. More than three-quarters of hearing losses were either moderate, moderately severe, or severe. Bilateral losses were far more common than unilateral losses; among the latter, the left side was affected slightly more often than the right. Predisposing factors were not documented in the vast majority of cases (87.6%), but when they were, the most common were chronic suppurative otitis media, meningitis, febrile convulsion, measles, and trauma. We present these findings to highlight the burden of hearing loss in our part of the world.

Fish bone foreign body presenting with an acute fulminating retropharyngeal abscess in a resource-challenged center: a case report.

INTRODUCTION: A retropharyngeal abscess is a potentially life-threatening infection in the deep space of the neck, which can compromise the airway. Its management requires highly specialized care, including surgery and intensive care, to reduce mortality. This is the first case of a gas-forming abscess reported from this region, but not the first such report in the literature. CASE PRESENTATION: We present a case of a 16-month-old Yoruba baby girl with a gas-forming retropharyngeal abscess secondary to fish bone foreign body with laryngeal spasm that was managed in the recovery room. We highlight specific problems encountered in the management of this case in a resource-challenged center such as ours. CONCLUSION: We describe an unusual presentation of a gas-forming organism causing a retropharyngeal abscess in a child. The patient's condition was treated despite the challenges of inadequate resources for its management. We recommend early recognition through adequate evaluation of any oropharyngeal injuries or infection and early referral to the specialist with prompt surgical intervention.

Survey of ototopical self medication among patients attending ENT and family medicine departments in a Nigerian hospital.

BACKGROUND: Ototopical self-medication is a common practice in Nigeria. OBJECTIVE: The aim of the study was to establish the proportion of patients with otological problems that practice ototopical self-medication. METHODS: A 12-week cross-sectional study of all the new patients attending the general outpatient (also called family medicine (FM)) and ear, nose and throat (ENT) departments of a Nigerian specialist hospital was carried out. A semi-structured questionnaire was used to obtain information on bio data, practice of ototopical self medication among new patients with otological problems, the drugs used and the reasons for engaging in the practice. The results were analysed using SPSS version 11 and presented in Tables. RESULTS: Out of 3276 patients that visited the hospital during the study period, 402 had otological problems. Of these, 125 (31%) used ototopical self-medication, giving a hospital incidence of 3.8%. 115 (92%) patients consented to fill in the questionnaire on the self-use of ototopical agents. Otalgia was the most common indication (27%) for ototopical self-medication. Gentamycin and Chloramphenicol topical agents were the most commonly used by the study participants. A total of 39 participants (34%) reported to have used non-prescribed self-medication because it was time saving. In 69 of the participants (60%), the drugs were self recommended while chemists and nurses recommended their use in 23 (20%) and 22 (19%) participants, respectively. CONCLUSION: In Nigeria, there is a need for public enlightenment and health education about the possible drawbacks of this practice.

Epidemilogical profile of speech and language disorder in north central Nigeria.

BACKGROUND: Speech-language pathologists/Otolaryngologists recognize high prevalence of speech and language disorder among children. The aim of the study is to find out the epidemiological profile of speech and language disorder in north central Nigeria. METHOD: A five year retrospective review of all referral to speech and language therapy unit ENT Department between January 2005 and December 2009. Information retrieved and analysed included bio-data, clinical presentation and diagnosis of the patients. Descriptive analysis of these data were done. RESULTS: A total of 146 patients were seen out of which 89 (61%) were under five, 32 (21.9%) were between 5-10 years, 20 (13.7%) in the range of 11-20 yrs and 2 (1.4%) were between 21-34 yrs. None was observed in the elderly. Male preponderance was noted with male to female ratio of 1.9:1.0. The commonest diagnosis was deaf-mutism in 84 (57.5%) followed by delayed speech development in 31(21.2%) patients. The least diagnosis was aphasia in 2 (1.4%) patients. CONCLUSION: Speech and language disorder was commonest among the under five's with non in the elderly, There was a higher prevalence amongst males and deaf-mutism was the commonest observed.

Clinico-pathological profile of sinonasal masses: an experience in national ear care center Kaduna, Nigeria.

BACKGROUND: The presence of a mass in the nose and paranasal sinuses may seem to be a simple problem; however it raises many questions about the differential diagnosis. The aim of this study is to evaluate the clinico-pathological profile of sinonasal masses in our environmentThis is a retrospective analytical review of all the patients with sinonasal masses that presented to the national ear care center, Kaduna over a six year (2003-2008) period. Their biodata, clinical profile and histological diagnoses were analyzed. FINDINGS: A total of 76 patients were analyzed, age range 5 to 64 yrs with a mean age of 33.3 yr median and modal age of 35.00 (SD = 13.1 +/- 1.5). Majority of the patients were in the age groups 21-50 yrs. There were 34 male and 42 female with M: F ratio of 1:1.2. The main presenting symptoms are nasal blockage 97.4% and rhinorrhea 94.7%. It was bilateral in 34 (44.7%), left side in 24(31.6%) and right side in 18(23.7%) patients. The commonest clinical diagnoses were simple nasal polyp 47(61.8%) and antrochoanal polyp 10(13.2%). About 59 (77.6%) were benign, 2 (2.6%) were malignant and 15 (19.7%) were lost to follow up. The commonest histological diagnosis is simple inflammatory nasal polyp in 28 (36.8%) patients and the least was nasal capillary hemangioma 2 (2.6%). About 55(72.4%) patients had surgical treatment. CONCLUSIONS: Nasal obstruction and rhinorrhea are the commonest symptoms of presentation, simple inflammatory nasal polyp is still the commonest histological pattern seen in our environment, and surgery is still the best modality of treatment for benign tumor thus the need for advocacy for early recognition and referral to the ENT surgeon.

Traumatic tympanic membrane perforation: an aetiological profile.

BACKGROUND: Traumatic perforation of the tympanic membrane may be due to direct or indirect source. The aim of the study is to profile the various aetiologies of traumatic tympanic membrane perforation in Ilorin, north central Nigeria.A retrospective review of 64 patients seen at the University of Ilorin Teaching hospital, Ilorin, Nigeria over a ten year period (January 1998 to Dec 2007) with history of traumatic tympanic membrane perforation from various causes, these also included multiply injured patients with bleeding from middle ear as part of their presentations. The data retrieved included the biodata, the clinical presentations, source of injury, the clinical findings and the treatment outcome. The data were entered into an SPSS version 11 computer soft ware and analyzed descriptively. FINDINGS: Sixty four (64) ears were analysed, Age range 6 months to 50 yrs, mean age of 29.2 yrs 7.9% of them were

Sinonasal paraganglioma: a case report.

OBJECTIVE: To highlight the importance of a high index of suspicion and meticulous evaluation of a patient with bleeding sinonasal mass in the diagnosis of sinonasal paraganglioma. METHOD: Case report of a 39-year-old female who presented with a bleeding lobulated left nasal mass necessitating multiple blood transfusions is presented. RESULT: Diagnostic investigations revealed that the patient was HIV-positive (ELISA and Western blot) and a tumour histology of paraganglioma. She had a CD4+ count of 487 cells/mm3. The urinary vanillylmandelic acid assay and echocardiography were normal. Subsequently, she had complete tumour excision through a medial maxillectomy and has remained without a recurrence 12 months after. CONCLUSION: To our knowledge, this is the first report in the world literature of sinonasal paraganglioma in a HIV-positive patient and the first reported case of sinonasal paraganglioma in Africa. It is, however, not clear from this report if the patient's HIV status preceded her development of the paraganglioma or not.

Socio-economic status and hearing loss in chronic suppurative otitis media in Nigeria.

BACKGROUND: Hearing loss is reported in about 50% of cases of chronic suppurative otitis media (CSOM). AIM: To report the prevalence, type and severity of hearing loss in CSOM and identify risk factors. METHODS: A prospective study of hearing loss in CSOM was undertaken in University College Hospital, Ibadan, two general hospitals and two primary health care centres, all in densely populated, semi-urban areas in south-west Nigeria. Controls were selected from school children, hospital workers' children and children whose parents were visiting the hospitals, all of whom claimed that there had been no episode of otitis media in the past. An oral questionnaire was administered to all, followed by audiometry and examination of the ear, nose and throat in study children. RESULTS: There were 189 CSOM subjects and 100 controls aged between 4 and 150 months [mean (SD) 59.25 (44.55), 173 girls and 116 boys, M:F 1.5:1]. The prevalence of hearing loss in CSOM was 89/189 (47%) and was conductive in 73/89 (82%) and sensorineural (SHL) in 16/89 (18%). Of the subjects with hearing loss, 72% had had otitis media during the 1st year of life. Of the 89, 61 (69%) were of low social class, 13/37 (35%) were middle class and 15/63 (24%) upper class. The duration of CSOM ranged from 4 weeks to 12 years [mean (SD) 4 yrs (2.04)] and from 5 to 12 years in those with SHL [mean (SD) 9 yrs (6.21)]. There was significant correlation between socio-economic status and hearing loss (r=0.138, p=0.02) while no correlation was found with upper respiratory infection (r=0.054, p=0.36), age of onset (r=0.037, p=0.62) or frequency of attacks (r=-0.068, p=0.35). CONCLUSION: About one fifth of patients with CSOM have SHL. Early diagnosis and management of CSOM is imperative to improve outcome. CSOM is strongly associated with low socio-economic status.