Knowledge and practices of epistaxis in Eastern Tanzania: A cross-sectional study of an emergency in otorhinolaryngology.

Introduction: It's approximated that 60% of the population globally experience epistaxis during lifetime. Despite epistaxis being prevalent in Tanzania, there are limited studies that have explored experience of participants on epistaxis. This study aims to determine knowledge on the causes, first aid management and practices of epistaxis among patients attending a health facility in Eastern Tanzania. Methods: A descriptive cross-sectional study was conducted where 371 participants aged 15 years and above were interviewed using structured questionnaires. Data was analyzed using Statistical Package of Social Sciences version 23. Chi-square tests were performed and a p-value <0.05 was considered to be statistically significant. Results: About two-thirds (60.9%) of the study participants had good knowledge of the causes of epistaxis. Majority of participants knew excessive nose manipulation (95.1%) to be the commonest cause of epistaxis and the least cause mentioned was chronic liver disease (24.8%). On the other hand, 77.6% of the participants had good knowledge while 22.4% had poor knowledge regarding first aid management of epistaxis. In this study, 328(88.4%) participants knew pressing the nose could stop epistaxis, while 164(44.2%) knew the best position to stop epistaxis and that is to tilt the head forward and those who had history of epistaxis, 150 (73.2%) out of 205 pinched the nose as the first aid. Similarly, 133(35.8%) participants thought cessation of smoking has effect on decreasing the occurrence of epistaxis. A significant association was noted between knowledge of first aid management of epistaxis and some socio-demographic characteristics such as age and educational level. There was also a significant association between knowledge of the causes of epistaxis and educational level. Conclusion: Majority of the participants had good knowledge of the causes and first aid management of epistaxis.

Synchronous nasal rhinosporidiosis and inverted papilloma in a paediatric patient in Dodoma, Tanzania: Case report.

INTRODUCTION: Nasal rhinosporidiosis refers to a rare chronic granulomatous disease caused by Rhinosporidium seeberi. It affects the mucous membrane of sites such as nasopharynx, conjunctiva and palate. Inverted papillomas are relatively rare and are benign epithelial tumors of the nasal cavity that are locally aggressive, exhibit recurrence tendency and malignant transformation. Both entities are very rare in our setting and this is perhaps the first documented case in Tanzania. CASE PRESENTATION: The patient was a 7-year old boy with a 1-year history of left-sided nasal obstruction and intermittent epistaxis for 6 months. He had no history of cheek swelling, pain or numbness, loss or loosening of teeth or alveolar ridge fullness. There were no ophthalmological, otological or neurological complaints reported. Endoscopic excision of the nasal mass was done and histopathological analysis confirmed co-existence of rhinosporidiosis and inverted papilloma. Postoperatively, the patient was kept on oral dapsone at a dose of 50 mg/day for 6-months and with no residual disease recurrence noted after 6-months follow up. CLINICAL DISCUSSION: The patient underwent endoscopic excision of the nasal mass and histopathological analysis confirmed co-existence of rhinosporidiosis and inverted papilloma. Postoperatively, the patient was kept on oral dapsone at a dose of 50 mg/day for 6-months and with no residual disease recurrence noted after 6-months of follow up. CONCLUSION: Nasal rhinosporidiosis and inverted papilloma lesions may resemble the routinely encountered nasal polyps thus important for both clinicians and pathologists to have a high index of suspicion when managing patients with nasal masses even from non-endemic areas.

Pulmonary manifestations masquerading a longstanding neglected metallic foreign body in the esophagus of a paediatric patient from Tanzania: Rare case report.

INTRODUCTION: Paediatric foreign body (FB) ingestion remains to be a common encounter in otorhinolaryngology and may manifest with pulmonary manifestations. Pulmonary manifestations masquerading chronic esophageal FBs in children is rare in clinical practice. This is perhaps the first documented case in Tanzania. CASE PRESENTATION: The patient was a 6-year old boy with a 6-month history of ingesting a metallic object. The child was reported to have presented with sudden onset of drooling of saliva and difficulty in swallowing that lasted for several hours. While preparing to visit a hospital, no more drooling of saliva was noted thus the visit was cancelled. A month later the patient presented with recurrent episodes of dry cough associated with wheezing and unresponsive to medical treatment. Upon attending other health facilities no chest X-ray was ordered but rather prescribed antibiotics, mucolytics, antihistamines and antileukotrienes without relief. Chest x-ray was indicated and revealed an esophageal metallic object. Rigid esophagoscopy under general anaesthesia yielded the rusted metallic object in piece meals. Postoperative antibiotic, analgesic and an oral corticosteroid were prescribed. Postoperative visits were uneventful. CLINICAL DISCUSSION: The patient underwent esophagoscopy and the rusted` metallic object was extracted in piece meals. Postoperative antibiotic, analgesic and oral corticosteroid were prescribed. Postoperative visits were uneventful. CONCLUSION: It is always important to suspect FB ingestion in a child with a history of sudden onset of drooling of saliva and difficulty in swallowing. Imaging should be advocated to avoid delayed diagnosis otherwise pulmonary manifestations can masquerade the diagnosis of chronic esophageal FBs.

Awareness of head and neck cancer among patients attended at a regional referral hospital in Tanzania.

BACKGROUND: Head and neck cancers (HNCs) are considered to be lethal and about 50% of the cases are diagnosed at advanced stages and are associated with poor prognosis. Despite the high disease burden globally, there are scarce studies on awareness of HNCs and this is the first study to explore such awareness in Tanzania. The study aimed at determining awareness of head and neck cancer among patients attended at a regional referral hospital in Tanzania. METHODS: A hospital based cross sectional study was conducted at Geita Regional Referral Hospital from April to May 2022 where 315 respondents were recruited. Simple random sampling technique was utilized and data was collected using structured questionnaires and analyzed using Statistical Package for Social Sciences (SPSS) version 23. Chi-square test was performed to establish the relationship between the selected independent and dependent variables. P-value < 0.05 was considered to be statistically significant. RESULTS: More than half (54.9%) of the respondents considered themselves to be somewhat knowledgeable on head neck cancer. In the same study, 56.2% of the respondents didn't know anatomical sites of head and neck cancer and over half (65.9%) of the respondents didn't know signs and symptoms of head and neck cancer. Cigarette smoking (73.7%) and alcohol consumption (65.1%) were the most correctly identified risk factors for HNCs. Regarding treatment options and preventive measures, 75.2% of the respondents knew cessation of cigarette smoking as a preventive measure for HNCs and surgery (91.7%) was the most known treatment option for head and neck. Similarly, a significant association was found between awareness on HNCs and some of the socio-demographic characteristics of the respondents. CONCLUSIONS: Although majority of respondents considered themselves to be somewhat knowledgeable on HNCs, awareness by patients on anatomical sites, clinical features, risk factors, preventive measures and curability of head and neck cancer at the Regional Referral Hospital was minimal.

The Time Preferred by Patients to Undergo Surgery: What Proportion Would Accept Day-Case Versus Overnight Tonsillectomy/Adenotonsillectomy?

Background: Day-case tonsillectomy is becoming popular with varying patients' satisfaction. Whether day-case or overnight tonsillectomy is safe and preferred by patients has been debatable among otorhinolaryngologists. To date, majority of otorhinolaryngologists in Tanzania are practicing overnight tonsillectomy unlike what is being practiced in other parts of the world. There is scarce literature regarding whether day-case or overnight surgical option is preferred by patients. Objective: To assess the time preferred by patients to undergo surgery by ascertaining the proportion of patients who would prefer day-case to overnight tonsillectomy or adenotonsillectomy. Methods: We conducted a hospital based cross sectional study at Ekenywa Specialised Hospital from January to December 2021. The study recruited 200 patients who underwent elective tonsillectomy or adenotonsillectomy. A structured questionnaire adopted from previously published studies and thereafter modified accordingly to fit the current study was used to collect relevant data. Data were analysed using Statistical Package for Social Sciences (SPSS) version 21. Results: The study had more male participants 104(52%) than females, 96 (48%) with a male to female ratio of 1.1:1. Majority of the study participants were aged below 5 years. Male participants aged below 5 years accounted for 50% while females aged <5 years accounted for 65.6%. Of the 200 (100%) patients who returned the questionnaires, 135(67.5%) preferred discharge on the 1st day post surgery while 65 (32.5%) preferred discharge on the 2nd postoperative day or later. Similarly, five (2.5%) would have wished day-case tonsillectomy/adenotonsillectomy while 195(97.5%) preferred an overnight surgery. Patients with postoperative pyrexia, older patients and those discharged on the 2nd day post surgery or later were more likely to prefer a longer postoperative hospital stay. Conclusion: Day-case surgery seems feasible due to less risk of postoperative complications such as haemorrhage and fever. Majority of the participants in this study preferred overnight tonsillectomy/adenotonsillectomy.

Clinical spectrum of ear, nose and throat foreign bodies at a tertiary hospital: a cross-sectional study.

Presence of foreign bodies (FBs) in the ears and upper aerodigestive tract is a common encounter in children unlike adults in otorhinolaryngology practice. FBs form a major part of emergencies in otorhinolaryngology. Studies on ear, nose and throat FBs in Tanzania are scarce. Objective: To determine the clinical spectrum of ear, nose and throat FBs at the largest tertiary hospital. Methods: A descriptive hospital based cross-sectional study was conducted where 95 patients were recruited at the Hospital from December 2019 to May 2020. Data were collected using semi-structured questionnaires and analyzed using Statistical Package for the Social Sciences (SPSSs) version 24. Results: In this study, there were more females, 56 (58.9%) than males, 39 (41.1%) with female to male ratio being 1.4:1. Children aged younger than 10 years predominated in this study, 69 (72.6%). The nose, 36 (37.9%) and ear, 29 (30.5%) were the commonest sites where FBs lodged followed by the pharynx, 22 (23.2%) and oesophagus, 10 (8.4%). Regarding types of FBs, inorganic types, 49 (51.6%) predominated and were mostly coins, 17 (17.9%). Majority of FBs were removed in less than 24 h (53.7%) and complications were found in 29 (30.5%) patients and being more pronounced with nasal FBs. Majority of those with complications presented to the hospital 24-72 h post lodging of FBs. Conclusion: FBs were encountered more commonly in children aged younger than 10 years. The nose was the commonly affected anatomical site followed by the ear, pharynx and oesophagus. The commonest FB was a coin. The inorganic FB type predominated and the most common inorganic type was a coin while the commonest organic type was a seed. Complications were encountered in those who presented between 24 and 72 h post FB lodgment.

Unsolicited ejection of an aspirated metallic foreign body in an adult male: Rare case report.

INTRODUCTION AND IMPORTANCE: Being an otorhinolaryngological emergency foreign body aspiration (FBA) has continued to be a great challenge to Otorhinolaryngologists. Foreign body inhalation poses life threatening challenges and its uncommon in adult unlike paediatric population. The recommended treatment for the aspirated foreign bodies is bronchoscopy. Unsolicited ejection of an aspirated foreign body is an uncommon encounter in clinical practice and few cases have been reported in the available literatures. CASE PRESENTATION: A man aged 38-years was attended at the clinic with a history of inhaling a metallic foreign body a day prior visiting our hospital underwent unsolicited ejection following several bouts of dry irritating cough while preparations were in progress to send the patient to an operating theatre for emergency bronchoscopy coupled with removal of the foreign body. CLINICAL DISCUSSION: The patient underwent unsolicited ejection of the metallic object following several episodes of dry cough and was then counseled to attend the scheduled follow up after 7-days and it was uneventful. CONCLUSION: Despite being unsafe and not recommended to wait for unsolicited ejection of an aspirated foreign body, meticulous attention should be kept to patients while waiting for bronchoscopy since there are rare chances for unsolicited ejection of such aspirated foreign bodies.

Unilateral choanal atresia and a co-existent long-standing medium-sized ipsilateral rhinolith in a 15-year old boy: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Unilateral choanal atresia is a congenital anomaly where a newborn baby is born with a unilateral imperforate posterior nare. In most of the time the diagnosis may be missed for years after birth. A rhinolith is an entity formed by gradual deposition and coating of different salts of calcium and magnesium over an endogenous or exogenous nidus in the nasal cavity. Coexistence of a rhinolith and choanal atresia is a very rare encounter in clinical practice and to the best of our knowledge this is perhaps the first documented case in Tanzania. CASE PRESENTATION: We present a 15-year old boy who was attended at our department with a longstanding history of left sided non-foul smelling nasal discharge which was noticed first when he was 5 years old but at the age of 13 years, he presented with ipsilateral nose bleeding and episodic foul smelling nasal discharge. He was attended at various peripheral health facilities without relief. CLINICAL DISCUSSION: The patient underwent left sided nasal endoscopy where unilateral choanal atresia and a rhinolith were found. Transnasal endoscopic choanal atresia release and rhinolith removal were done under general anaesthesia in operating room. Postoperatively, he was kept on a nasal decongestant, a broad-spectrum antibiotic, intranasal corticosteroid and an analgesic. CONCLUSION: Clinicians must have a high index of suspicion so as to establish the diagnosis of unilateral choanal atresia in patients with persistent unilateral non-foul smelling discharge and also nasal foreign bodies in those with foul smelling nasal discharge.

Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

Introduction: Middle ear effusion (MEE) is a common childhood disorder that causes hearing impairment due to the presence of fluid in the middle ear which reduces the middle ear's ability to conduct sound. Temporary or persistent hearing loss as a result of MEE causes speech, language and learning delays in children. There are few studies on MEE in Tanzania despite the huge burden of hearing loss among children with adenoid hypertrophy which is a known risk factor for MEE. Method: A cross-sectional study was conducted among 420 children aged nine years and below having adenoid hypertrophy with or without MEE. The diagnosis of adenoid hypertrophy was confirmed with a lateral view x-ray of the nasopharynx and tympanometry for cases with MEE. The primary objective of the study was to assess the prevalence of MEE among children with adenoid hypertrophy. Results: The prevalence of MEE among children with adenoid hypertrophy was 61.7%, with 218 (51.9%) males and 202 (48.1%) females. The most affected age group was 2-4 years with an incidence 193 (46%) and in this age group, males (53.9%) were more affected than females (46.1%). Generally, males, 134 (51.7%) were more affected by MEE than females, 125 (48.3%) of all 259 children with MEE. In terms of age group predominance by MEE, children aged 3-4 years, 107(41.3%) were more affected than all other age groups. Additionally, 4 (1.5%) children with MEE presented with hearing loss. Conclusion: There is a high prevalence of MEE among children with adenoid hypertrophy but no significant association with hearing loss.

An Audit of Endoscopic Sinus Surgery at a Tertiary Hospital in Tanzania.

Background: Being a frequently used approach by otorhinolaryngologists, Endoscopic sinus surgery (ESS) has been useful in the surgical management of different sinonasal conditions in this era. Although ESS is most commonly performed for inflammatory and infectious sinus diseases since its introduction in the 1960s by Prof. Messserklinger and Wigand, the current advancement in instrumentation has led to an increase in its indications. This study therefore aimed at auditing the ESS done at a tertiary hospital in our settings. Methodology: This was a retrospective descriptive cross-sectional study which was conducted at Muhimbili National Hospital. It involved all patients who underwent ESS in the department of otorhinolaryngology. Information was extracted from patients' files, ledger, and admission books. The obtained data were analyzed using a statistical package for social sciences (SPSS) version 22. Descriptive statistics were performed to present the frequency distribution of the demographic characteristics, indications for ESS, and mean for the length of hospital stay. Results: Out of 1261 surgeries done during the study period, 6.7% (84/1261) were endoscopic sinus surgeries. Of patients who underwent ESS, an almost equal proportion of males and females was found and ages ranged from 8 to 71 years with a mean age of 32 .2 ±16 .9 years. The commonest indication for ESS was sinonasal polyposis at 50.0% (42/84) followed by chronic rhinosinusitis at 20.4% (17/84). The majority of patients 52.4% (44/84) had a hospital stay of 1-3 days. The mean length of postoperative hospital stay following ESS in this study was found to be 2.8 days. Conclusion: Endoscopic sinus surgeries accounted for 6.7% of all surgeries with sinonasal polyposis being the commonest indication and the estimated mean length of postoperative hospital stay being 3 days.

Prevalence of frontal cells and their relation to frontal sinusitis among patients who underwent functional endoscopic sinus surgery: A prospective cross-sectional study in Tanzania.

Background: A narrow confine of frontal recess area and its variable anatomy has been a great surgical challenge to otorhinolaryngologists. There are several frontal cell types that have been described in frontal recess area. There is limited data in our setting on detailed description of frontal cells in patients who underwent functional endoscopic sinus surgery and their correlation to sinusitis. Objective: To determine the magnitude of frontal cells and their correlation to sinusitis involving frontal sinuses among patients who underwent functional endoscopic sinus surgery at a private health facility in Tanzania's largest populated city. Methods: A prospective cross sectional study was conducted where both coronal and axial computerized tomography (CT scans) views of paranasal sinuses of 45 patients admitted at a private hospital ready to undergo functional endoscopic sinus surgery were reviewed to identify agger nasi cells, frontal cells and frontal sinus disease. Data were collected for right and left sides. Results: Of the reviewed 90 sides, 75(83.3%) had agger nasi cells and 65(72.2%) had frontal cells. Similarly, 25(27.8%) were mucosal diseases free, 15 (16.7%) had partial opacification and 48(53.3%) had total opacification. Two frontal sinuses (2.2%) were not assessed for the presence of mucosal disease since they were aplastic or severely hypoplastic. There was no any statistically significant difference found in frontal sinus mucosal disease in presence or absence of frontal cells or agger nasi cells. Conclusion: The study has depicted frontal cells to be prevalent and higher than what has been reported in literature.

Role of Perioperative Intravenous Dexamethasone in Management of Post Adenotonsillectomy Morbidity: A Single Blinded Randomised Controlled Study.

Objective: To determine the role of perioperative intravenous dexamethasone in reducing post adenotonsillectomy morbidity in Dar es Salaam, Tanzania. Methods: A Prospective, randomised, placebo-controlled study was conducted at Ekenywa Specialized Hospital. Fifty patients were randomised to receive three doses of intravenous dexamethasone (13 males and 12 females) or placebo (13 males and 12 females) administered eight hourly for the first 24hours after surgery (1mg/kg). Data were analysed using statistical package for social sciences version 21 and P-value<.05 was considered to be statistically significant. Results: Intravenous dexamethasone was found to exert significant effects in terms of reducing the severity of some observed postoperative parameters such as pain scores, post-operative nausea and vomiting (PONV), tolerance to oral fluids, discharge from hospital, postoperative hemorrhage, postoperative pain, re-admission and wound healing between the two groups of patients. In this study, dexamethasone did not significantly exert any effect on fever in the first 24 hours after surgery. Conclusions: Intravenous dexamethasone is an effective and safe method for reducing post adenotonsillectomy morbidity.

A missed giant rhinolith retained for a decade in a paediatric patient at a zonal referral hospital in Central Tanzania: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Rhinolith is an entity formed by gradual deposition and coating of different salts of calcium and magnesium over an endogenous or exogenous nidus in the nasal cavity. The type, size and duration of the rhinolith lead to multiple types of presentation. Giant rhinoliths are very rare in paediatric patients owing the size of their nasal cavities. To the best of our knowledge this is the first reported case of a giant paediatric rhinolith in Tanzania. CASE PRESENTATION: We present a 12-year old male who presented with a history of left sided nasal obstruction accompanied with foul smelling nasal discharge for 11 years and was marked by being followed by house flies. Had history of occasional episodes of headache but no facial pain. He was managed at various remote health facilities without specialist consultation for eleven years as case of allergic rhinitis and rhinosinusitis and finally was referred with a provisional diagnosis of chronic granulomatous disease of the nose. The patient underwent anterior rhinoscopy and a left sided stony hard mass was removed under topical local anaesthesia. CLINICAL DISCUSSION: The patient underwent anterior rhinoscopy and a left sided stony hard mass was removed under topical local anaesthesia. Postoperatively he was kept on a nasal decongestant, a broad-spectrum antibiotic and an analgesic. CONCLUSION: Any child with unilateral foul smelling nasal discharge should be considered to have a nasal foreign body until proven otherwise. The treatment of choice remains to be nasal foreign body removal under local or general anaesthesia.

Advanced hypopharyngeal squamous cell carcinoma mimicking thyroid abscess in a young male: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Thyroid gland involvement by hypopharyngeal carcinoma is due to their close proximity. Initial presentation of such cancer as a thyroid abscess is rare in clinical practice thus risk of potential misdiagnosis. To the best of our knowledge, this is the first reported case in Tanzania. CASE PRESENTATION: We present a 17-year old male who presented with difficulty in swallowing, hot potato voice, difficulty in breathing and a wound at the anterior aspect of the neck. He was managed at peripheral health facilities as having thyroid abscess so had serial incision and drainage and prescribed antibiotics. He was referred to us where he undergone tracheostomy, direct laryngoscopy coupled with taking biopsy. CLINICAL DISCUSSION: Computerized tomography (CT scan) of the head and neck showed an ill-defined heterogeneously enhancing mass with calcifications seen at the hypopharynx extending to the larynx and thyroid gland causing destruction of cricoid cartilage. It measured approximately 7.6 × 6.5 × 4.4 cm. The submandibular and sublingual glands are slightly infiltrated. Multiple enlarged lymph nodes are seen at anterior upper jugular IIa and posterior upper jugular IIb with the largest having central necrosis and measures approximately 2.9 × 1.7 cm. Histopathology showed an ulcerated epithelium with an infiltrative tumor containing dense chromatin. Such features were consistent with invasive squamous cell carcinoma, Grade II.(TNM staging being T4bN2cM0). The patient undergone tracheostomy to relieve upper airway obstruction and sent to oncology center for chemoradiation. CONCLUSION: Clinicians should have a high index of suspicion of a possible underlying hypopharyngeal cancer whenever encountering patients with thyroid abscess.

Utility of reflux finding score and reflux symptom index in diagnosis of laryngopharyngeal reflux disease.

Objective: The study aimed to determine the utility of reflux finding score (RFS) and reflux symptom index (RSI) in the diagnosis of laryngopharyngeal reflux disease (LPRD) in Dar es Salaam, Tanzania. Methods: A prospective hospital-based cross-sectional study was conducted at a private hospital in Dar es Salaam, Tanzania. Data were analyzed using Statistical Package for Social Sciences version 21. Relationship between independent and dependent variables was established using chi-square test, a variable with p-value of equal or less than 0.05 was considered to be statistically significant. Results: In this study, a total of 2500 patients were recruited, out of which 800 (32.0%) were males and 1700 (68.0%) were female. Out of the 2500, 1520 (60.8%) patients were found to have a RSI of >13. Out of the 1520 patients subjected to 70-degree laryngoscopy, 1425 patients (95.0%) were found to have a RFS > 7. Of the 1425 patients with RFS > 7, 260 were males (18.2%) and 1165 were females (81.8%). Conclusion: RFS and RSI have demonstrated their role in establishing the diagnosis of LPRD. Level of Evidence: 4.

Nasal rhinosporidiosis masquerading as pyogenic granuloma in a pediatric patient at a Zonal Referral Hospital in Central Tanzania: Case report.

Being rare, rhinosporidiosis is a chronic granulomatous disease that is characterized by polypoidal lesions of the mucous membrane and is caused by Rhinosporidium seeberi. The disease commonly affects the mucous membrane of the nasopharynx, conjunctiva, and palate and its very rare in our geographical location.

Histocytopathological diagnosis of Rosai-Dorfman disease: Case report.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) being a rare benign proliferative self-limiting disease of the cells of macrophage-histiocyte family is of unknown etiology and presents with massive lymphadenopathy. We are hereby reporting a case of RDD presenting with massive bilateral cervical and submandibular lymphadenopathy, diagnosed by histocytopathology.

Characteristics of hearing loss in Dar es Salaam, Tanzania

Introduction: Hearing loss is a major public health problem in developed and developing countries. The objective of this study was to determine the causes and patterns of hearing loss at a private hospital that serves the largest number of patients with ear, nose and throat diseases in Tanzania's largest city. Method: This was a hospital based descriptive cross-sectional study that was conducted at a private hospital in Dar es Salaam. Data were collected from January to June 2021 and analysed using Statistical Package for Social Sciences (SPSS) version 20. P-value Results: Of the 250 patients recruited with hearing loss, there were 115 (46%) males and 135 (54%) females (F:M ratio of 1.2:1). The commonest cause of hearing loss was presbyacusis 132 (52.8%) followed by ototoxicity 26 (10.4%) and chronic suppurative otitis media 26(10.4%). Based on laterality, 73.2% of the patients had unilateral hearing loss whereas 26.8% had bilateral hearing loss. Regarding the type of hearing loss, 85.6% of the patients had sensorineural hearing loss followed by conductive type (13.2%) and mixed hearing loss (1.2%). Based on severity, 40.8% of the patients had moderate hearing loss followed by both moderately severe and severe hearing loss each accounting for 18% of cases Conclusion: Sensorineural hearing loss was the commonest type of hearing loss in this study. Both unilateral hearing loss according to laterality and moderate hearing loss upon classifying by severity predominated. Age related hearing loss was the most common cause of hearing loss followed by ototoxicity and chronic suppurative otitis media.

Jael's syndrome: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Jael's syndrome, an intentional injury caused by a knife in the face or skull is a rare encounter in clinical and forensic practice, rarely involving an impacted knife. Clinical and radiographic diagnosis is essential to identify severity of injury and location of the retained knife. To the best of our knowledge, this is the first reported novel case of Jael's syndrome in Tanzania. CASE PRESENTATION: We present the case of a 31-year old man admitted at Muhimbili National Hospital following an impacted knife. The stab wound extended to the medial wall of left orbit and ended just before the optic foramen associated with vitreous hemorrhage and the retained knife caused superoposterior displacement of the globe. Multidisciplinary management was instituted including prompt evaluation, imaging and surgical removal of the knife under general anesthesia. CLINICAL DISCUSSION: Plain skull X-ray revealed an extensive retained blade and computerized tomography (CT) showed the tip of the blade adjacent to the right styloid process with no neurovascular compromise. Initial concern was the left eye that was reported to be viable by ophthalmologists. Incredibly, the patient had no initial sequelae from such an extensive injury and had unremarkable recovery with no complications apart from the wound to left inferior rectus muscle that was conservatively managed. Simple withdrawal of the retained knife was successful. CONCLUSION: Craniofacial retained knives are rare. Thorough prompt initial evaluation and intervention is vital since improper management can be devastating.

Unusual longstanding intrabronchial foreign body masquerading as intractable bronchial asthma in an adult: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Tracheo-bronchial foreign body inhalation is a very common encounter in clinical practice among pediatric patients and rarely seen among adults. When inhalation of foreign bodies occurs in adults then it tends to lodge within the right bronchial tree but in children it lodges in the central airways. CASE PRESENTATION: We present a 58 year old woman, known asthmatic for 20 years and non-smoker who presented to our clinic which history of chronic cough, wheezing and pulmonary infections that did not respond to regular antibiotics and the usual antiasthmatic medications. She reported to have inhaled a foreign body about 18 years earlier. Extraction of the foreign body was performed without complications. CLINICAL DISCUSSION: A chest x-ray done was found to be normal and computerized tomography scan (CT scan) of the chest was ordered and revealed bronchial wall thickening with a calcified foreign body seen in the right intermediate bronchus. A combined rigid and flexible endoscopic bronchoscopy was performed and a chicken bone (measuring 2 cm × 1.5 cm) was extracted from the right intermediate bronchus with very minimal bleeding being encountered during and post bronchoscopy. Extraction of the foreign body was performed without complications. Post endoscopic intrabronchial foreign body removal, the patient recovered completely. CONCLUSION: An intrabronchial foreign body being masked for more than a decade by co-existent bronchial asthma is a rare encounter. Moreover, adult patients with chronic cough should be handled with caution to rule out the possibility of FB aspiration.