Update on first African clinical trial on earpopper for the treatment of otitis media with effusion [FCT/UATH/HREC/PR/330].

Background: Otitis media with effusion (OME) is a middle ear condition characterized by the accumulation of serous fluid. It is common, though not exclusive; among children with its attendant developmental consequence if missed or untreated in early life. OME could be managed surgically, pharmacologically, or physiologically. EarPopper is a medical device developed for physiologic management of OME, Eustachian tube dysfunction, and related problems. We aim to ascertain the suitability/efficiency of EarPopper® device for the treatment of OME in our setting. Methodology: This is a prospective interventional study of volunteers diagnosed with OME from four (4) medical centers in Abuja. Pneumatic otoscopy, video-otoscopy, tympanometry, and pure-tone audiometry were done to confirm the diagnosis. Serial EarPopper sessions were performed twice weekly for 2-12 weeks, and outcome was assessed using patients' reports. The reports include the EarPopper scoring system (ESS) and audiometric parameters (before and after therapy). Results: Forty-five patients (17 males and 28 females) aged between 3-56 years were enrolled. Thirty-five were diagnosed with bilateral OME and 10 unilateral. All patients had Type-B tympanometry tracing with mild-to-moderate conductive hearing losses and ESS of between 2.45% and 84%. Out of the 45 participants, 32 (71.1%) completed the treatment, whereas 13 (28.9%) were lost to follow-up. Duration of EarPopper treatment ranged from 2 to 12 weeks. The outcome revealed improvement in 26/32 (81.3%) with significant reduction in ESS (1% to 9.8%). Six patients 6/32 (18.9%) had persistence symptoms. These 18.9% had the propensity to progress to chronic OME. Conclusion: This study highly suggests good prospect in using EarPopper for the management of OME among Africans.

Résumé Contexte: L'otite séreuse est une affection de l'oreille moyenne caractérisée par l'accumulation de liquide séreux. Cette condition est courante chez les enfants (mais pas exclusivement) avec des conséquences développementales qui s'élabore si la diagnostique est manquées ou non traitées pendant les premières années de vie. L'otite séreuse peut être prise en charge chirurgicalement, pharmacologiquement ou physiologiquement. " EarPopper " est un appareil médical développé pour la gestion physiologique de l'otite séreuse, du dysfonctionnement de la trompe d'Eustache et des problèmes associés. Nous visons à déterminer la convenance/l'efficacité de l'appareil EarPopper® pour le traitement de l'otite séreuse dans notre environnement. Méthodologie: Il s'agit d'une étude interventionnelle prospective sur des volontaires ayant reçu un diagnostic de l'otite séreuse dans quatre (4) centres médicaux à Abuja. Une otoscopie pneumatique, une vidéo-otoscopie, une tympanométrie et une audiométrie tonale ont été réalisées pour confirmer le diagnostic. Des sessions EarPopper® en série ont été effectuées deux fois par semaine pendant 2 à 12 semaines, et les résultats ont été évalués à l'aide des rapports des patients. Les rapports incluent le système de notation EarPopper® (ESS) et les paramètres audiométriques (avant et après la thérapie). Résultats: Quarante-cinq patients (17 hommes et 28 femmes) âgés de 3 à 56 ans ont été inclus. Trente-cinq ont reçu un diagnostic de l'otite séreuse bilatérale et 10 unilatérales. Tous les patients avaient un tracé tympanométrique de type B avec des pertes auditives de transmission légères à modérées et une ESS comprise entre 2,45 % et 84 %. Sur les 45 participants, 32 (71,1 %) ont terminé le traitement, tandis que 13 (28,9 %) ont été perdus de vue. La durée du traitement EarPopper® variait de 2 à 12 semaines. Les résultats ont révélé une amélioration dans 26/32 patients (81,3%) avec une réduction significative de l'ESS (1% à 9,8%). Six patients (6/32 ; 18,9 %) on présentaient avec des symptômes persistants. Ces 18,9% avaient une propension à évoluer vers une otite séreuse chronique. Conclusion: Cette étude suggère fortement de bonnes perspectives d'utilisation d'EarPopper® pour la gestion de l'otite séreuse chez les Africains. Mots-clés: EarPopper®, l'otite séreuse, tympanométrie.

Hearing Thresholds among Individuals with Dependence on Psychoactive Substances: A Comparative Cross Sectional Pilot Study.

Background: Globally, the use of multiple psychoactive substances (MPS), either together or at different times, is on the rise. It is associated with a significant public health burden, including an increased risk for hearing impairment. This study aimed to determine the hearing thresholds among individuals with dependence on multiple psychoactive substances. Methodology: It was a comparative cross-sectional study of 41 subjects with dependence on multiple substances and an equal number of age and sex-matched comparison groups. The test group further had three subgroups, based on their predominant substances of dependence; Group I: Cigarettes, Cannabis, and Codeine; Group II: Group I substances and intravenous Pentazocine. Group III: Group II substances and intravenous Ketamine. Specific Substance Involvement scores for each of the psychoactive substances and their associated level of risk were determined, based on the ASSIST V3 questionnaire. All participants had tympanometry and pure tone audiometry. A Pure Tone Average (PTAv) was calculated. Data were analysed using SPSS 25 and statistical significance was set at a p-value 0.05. Results: There were 36 (87.8%) males and 5 (12.2%) females. The mean age of the test and comparison groups was 27.93 5.47 years and 27.98 5.70 years (p = 0.969). The mean PTAv of the test and comparison groups were 16.07 ± 5.53 dBHL and 11.01± 3.52 dBHL: (p 0.001). The p-value for the difference in the mean PTAv between sub-groups of the test group was 0.173, 0.037, and 0.719, respectively, between Group I and II, Group I and III, and Group II and III, respectively. Conclusion: Hearing thresholds were higher among individuals with dependence on MPS and statistically significant in those that were dependent on cigarettes, cannabis, and codeine. Further studies are needed on the relationship between PS and hearing loss.

Telemedicine in Otorhinolaryngological Practice during COVID-19 Pandemic.

Coronavirus-19 pandemic has impacted significantly on global social, economic, financial, and health institutions. Otolaryngologic (ORL) practice has also been affected by the scourge with the need for modification of practice. The risks of contracting COVID-19 with the regular "patient-doctor physical contact" method of management of cases in ORL practice are high, given the routine examination of nose and throat. The desirability of telemedicine in the handling of most patients is appealing despite the limitations in the technology, especially in the developing countries like Africa. Therefore, otorhinolaryngologists in Sub-Saharan Africa, within limits of applicability, should leverage on telemedicine in their clinical practice during this COVID-19 pandemic and beyond. COVID-19, being a disease of second chance, has provided us with the opportunity to harness this technologically driven method of supportive care in our clime.

Systematic Review and Meta-analysis of Smell and Taste Disorders in COVID-19.

OBJECTIVE: Loss of smell and taste are considered potential discriminatory symptoms indicating triaging for coronavirus disease 2019 (COVID-19) and early case identification. However, the estimated prevalence essential to guide public health policy varies in published literature. This meta-analysis aimed to estimate prevalence of smell and taste loss among COVID-19 patients. DATA SOURCES: We conducted systematic searches of PubMed, Embase, Web of Science, and Google Scholar databases for studies published on the prevalence of smell and taste loss in COVID-19 patients. REVIEW METHODS: Two authors extracted data on study characteristics and the prevalence of smell and taste loss. Random-effects modeling was used to estimate pooled prevalence. Subgroup analysis and meta-regression were conducted to explore potential heterogeneity sources. This study used PRISMA and MOOSE guidelines. RESULTS: Twenty-seven of 32 studies reported a prevalence of loss of smell, taste, or both from a combined sample of 20,451 COVID-19 patients. The estimated global pooled prevalence of loss of smell among 19,424 COVID-19 patients from 27 studies was 48.47% (95% CI, 33.78%-63.29%). Loss of taste was reported in 20 studies and 8001 patients with an estimated pooled prevalence of 41.47% (95% CI, 3.13%-31.03%), while 13 studies that reported combined loss of smell and taste in 5977 COVID-19 patients indicated a pooled prevalence of 35.04% (95% CI, 22.03%-49.26%). CONCLUSIONS: The prevalence of smell and taste loss among COVID-19 patients was high globally, and regional differences supported the relevance of these symptoms as important markers. Health workers must consider them as suspicion indices for empirical diagnosis of severe acute respiratory syndrome coronavirus 2 infection.

Migraine-associated vertigo: a review of the pathophysiology and differential diagnosis.

The clinical diagnosis of migraine-associated vertigo may be difficult because it shares features with some other clinical conditions. This communication presents a systematic review on the epidemiology and theories of pathophysiology of migraine-associated vertigo and its distinguishing features from peripheral vestibular disorders. We searched the Cochrane Library, MEDLINE, and Google scholar for all the studies on migraine-associated vertigo published in English language between 1966 and 2010. Their references were also reviewed for completion. Data from the studies were independently extracted and assessed by the three authors using standardized data forms. There was consensus between the authors on the studies in this review that met the criteria. Forty-five studies were identified and independently assessed based on the objectives of the study by the authors. All the studies discussed on the epidemiology of the migraine-associated vertigo, six discussed on the pathophysiology, while differential diagnosis were documented in thirty-two studies. In conclusion, migraine-associated vertigo is a global distinct disease entity that can be clinically distinguished from peripheral vestibular disorders. Abstinence from trigger factors remains imperative in the control, whereas some medications have been found useful in the management.