Pattern of indications for tracheostomy in a tertiary hospital in South Western Nigeria.

Introduction: Tracheostomy is a life-saving procedure; the benefits and frequency of procedures being performed have led to frequent reviews of indication in many regions of the world. The aim is to establish the indications, diagnosis and complications of tracheostomy performed in the past 10 years in a tertiary hospital in Lagos. Methods: This is a 10-year retrospective study of all patients who had tracheostomies for various indications from 2010 to 2019. Patient medical records were analysed for demographic profile, diagnosis, indication, elective or emergency tracheostomy, surgeon's rank, technique of decannulation and type of complications. All the variables in the data were imputed and analyzed using the IBM Statistical Package for the Social Sciences version 27. Continuous variables were presented as mean and standard deviation, whereas categorical variables were presented as frequency and percentage. Results: Four hundred and eighty-six tracheostomies were carried out during the period under review, and 440 patients had complete data retrieved. The age group of 0-9 years constituted the most common age for tracheostomy (18%). The most common indication for tracheostomy was for relief of upper airway obstruction in 53.4%. Neoplasms (40%) and trauma (30.7%) constituted primary diagnosis requiring tracheostomies. Amongst the paediatric age group with upper airway obstruction, infections (31.8%) and foreign body inhalation (24.3%) constituted the most common primary diagnosis. Stoma infection and peristomal granulation tissue were the most common early complication (21.8%) and late complication (43.4%), respectively. Conclusion: Relief of upper airway obstruction from neoplasm remains the most common indication for tracheostomy, and peristomal granulation infection was the most common complication.

Missense Variants Within GJB2 Gene Locus and the Risk of Hearing Defects in Nonsyndromic Cleft Lip and Palate.

AIM: The aim of the study was to investigate the role of variants in GJB2 gene in the etiology of hearing defects in nonsyndromic cleft lip/palate. METHOD: Saliva samples were obtained from cases (subjects with orofacial clefts) and control (subjects without orofacial clefts) who consented to the study. Deoxyribonucleic acid (DNA) was extracted using standardized protocol at Butali Lab (Iowa, IA). Primers for the coding region of GJB2 was designed using Primer 3 (http://bioinfo.ut.ee/primer3-0.4.0/) and optimized in the Butali lab using a gradient polymerase chain reaction to determine the annealing temperature for each primer set (forward and reverse). We measured the DNA concentration using Qubit and XY genotyping done for quality control. A concentration of 5 ng/µL of DNA was used for Sanger sequencing. RESULTS: A total of 150 subjects were sequenced (66 cases; 84 controls). Mutations in GJB2 gene were detected in 2 individuals with cleft palate. We found p.Arg165Trp variant in 1 case and p.Leu81Val variant in the second case. Although p.Arg165Trp was predicted to be either benign or tolerated by SIFT/POLYPHEN, the single nucleotide change from C>T, that is, CGG>TGG leads to a premature stop codon preventing the protein formation. The p.Leu81Val variant was predicted to be probably damaging/ deleterious. CONCLUSIONS: The present study implicates variants in the GJB2 gene in the etiology of hearing defects in nonsyndromic cleft lip and palate in the Nigerian population. Screening for variations in GJB2 gene is important for genetic counseling especially in high-risk families.

Permanent hearing loss among professional spice grinders in an urban community in southwest Nigeria.

This study set out to determine the pattern and predictors of noise-induced hearing loss (NIHL) among small-scale and self-employed chili pepper grinders in Lagos, Southwest Nigeria. Audiological evaluation was conducted for all participants after noise level measurement. Of 136 studied, 85 (62.5%) were confirmed with slight-to-moderate NIHL. Mean age was 40.2 years, mean years spent as grinders was 9.3 years and mean hours spent daily at work was 13.3 hours. The mean age of those with NIHL was significantly higher than those without. Spending over 10 years in commercial grinding and working ≤12 hours daily were predictive of NIHL. Questionnaire-based screening using symptoms of NIHL was associated with a sensitivity of 44.7%, specificity of 62.7%, and positive predictive value of 66.7%. In conclusion, pepper grinding is associated with high/excessive noise levels and NIHL. Hearing conservation program incorporating engineering modification of locally fabricated grinders is warranted in this and similar populations in developing countries.

The burden and management of infants with life-long and irreversible hearing impairment in Nigeria.

If left untreated or treated late and inappropriately, sensorineural hearing impairment has several adverse, irreversible and life-long health, psycho-social and economic consequences for the affected infants and their families. This seminar paper sets out to describe the burden, current practices and management options for sensorineural or permanent hearing impairment in early infancy for primary care physicians in Nigeria against the backdrop of their role as primary or first contact for all health consultations. Available studies suggest that up to 2.7% or 162,000 of the 6 million infants born annually may have permanent hearing impairment. The underlying aetiological factors may not be determined in the majority of the infants thus limiting the effectiveness of any primary prevention initiatives. However, the affected infants can be detected accurately with objective screening technologies such as otoacoustic emissions and auditory brainstem response in hospital or community settings. The ethical and scientific rationale for this intervention has been well established. Barring the challenge of parental follow-up default which is not insurmountable, affected infants and their families can be supported to establish appropriate auditory-based communication, avoid potentially harmful traditional therapies and child neglect commonly associated with childhood hearing impairment. Primary care providers in private and public practice have a crucial role in guiding parents to seek timely and appropriate services from ear care providers and child development specialists to ensure optimal child growth and developmental outcomes. On-going parental commitment to and active participation in the selected intervention programmes are essential to satisfactory long-term outcomes.

Is discordance in TEOAE and AABR outcomes predictable in newborns?

OBJECTIVE: To determine the perinatal predictors of discordant screening outcomes based on a two-stage screening protocol with transient-evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR). METHODS: A cross-sectional study of infants tested with TEOAE and AABR under a hospital-based universal newborn hearing screening program in Lagos, Nigeria. Maternal and infant factors associated with discordant TEOAE and AABR outcomes were determined with multivariable logistic regression analyses adjusting for potential confounding factors. RESULTS: Of the 4718 infants enrolled under the program 1745 (36.9%) completed both TEOAE and AABR. Of this group, 1060 (60.7%) passed both TEOAE and AABR ("true-negatives"); 92 (5.3%) failed both TEOAE and AABR ("true-positive"); 571 (32.7%) failed TEOAE but passed AABR ("false-positives") while 22 (1.3%) passed TEOAE but failed AABR ("false-negatives"). Infants with false-positives were likely to be admitted into well-baby nursery (p=0.001), belong to mothers who attended antenatal care (p=0.010) or who delivered vaginally (p<0.001) compared to infants with true-negatives while infants with true-positives were also more likely to be delivered vaginally (p=0.002) or admitted into well-baby nursery (p=0.035) compared to infants with false-negatives. Infants with true-positives were significantly more likely to be delivered vaginally (p<0.001) and have severe hyperbilirubinemia (p=0.045) compared with infants with true-negatives. No association was observed between false-negatives and true-negatives. Antenatal care status, mode of delivery and nursery type were useful predictors of discordant outcomes among all infants undergoing screening (c-statistic=0.73). CONCLUSIONS: Given the available screening technologies, discordant TEOAE and AABR may be inevitable for some categories of hearing loss among apparently healthy newborns whose mothers received prenatal care. The potential limitations of perinatal morbidities as basis of targeted screening for such cases therefore merit further consideration.