Paediatric paranasal sinus fibrous dysplasia.

Fibrous dysplasia in the bony walls of a paranasal sinus is a developmental tumour that is associated with a marked facial deformity. Delay in hospital presentation contributes to the destructive resection techniques employed and the management outcome. Our study looks at the factors for delay in hospital presentation and the management outcome by a retrospective review between January 1997 and December 2018. Of 43 children (M: F 1:1.2) with a mean age of 12 ± 1.75 years, the maxillary bones were mostly affected. All underwent surgical resection with good management outcomes except for maxillectomy. Tumour recurrence was noted in five and there was no mitotic cell at histology. The clinical symptoms of fibrous dysplasia vary in severity and age of onset, often with late hospital presentation already with complications. Health education is needed to reverse this trend.

Paediatric cochlear implantation in north-western Nigeria case report and review of our challenges.

OBJECTIVE: To report the commencement of cochlear implantation (CI) in children in Northern Nigeria and review the challenges encountered with a view to establishing CI programme. CASES: Two children with post-meningitic sensorineural hearing loss had standard pre-implantation assessment and cochlear implantation surgery in Nigeria in conjunction with surgeons from another developing country. Post-implantation meningitis was encountered and managed in one of the patients. Post-CI rehabilitation started in a foreign country and continued in our centre after training of our speech therapist. Both patients had improvement in their hearing. CONCLUSION: These showcase successful CI in patients from Sub-Saharan Africa, the challenges included need for development of surgical and post-CI rehabilitation personnel and affordability of the cost of the implant. The support of all the stakeholders needed for commencement of a CI programme was noted.

The role of plasma melatonin and vitamins C and B12 in the development of idiopathic tinnitus in the elderly.

BACKGROUND: To determine the correlation between plasma levels of melatonin, vitamin C and vitamin B12 and the presence of tinnitus among elderly subjects with unexplained subjective tinnitus. METHOD: Prospective involving apparently healthy elderly with subjective tinnitus and those without. Plasma levels of melatonin, vitamin C and vitamin B12 were determined using high performance liquid chromatography and correlation determined by comparing subjects with and without tinnitus. RESULT: There were 139 elderly subjects (78 females and 61males), the mean(SD) range of the age was 66.9years (0.77) 60-98 years. Of these 58.3% had tinnitus. The mean (SD) range of the plasma levels of melatoninn was 11.2 pg/mL(4.2) 5.1 pg/mL - 30.2 pg/mL while that of Vitamin C was 0.7 µmol/L (0.1) 0.3 µmol/L - 1.2 µmol/L, and vitamin B12 was 43.0pmol/L (3.1) 25.4 pmol/L - 71.6pmol/L. Comparing the plasma levels of the markers between elderly with and those without tinnitus, the plasma levels of melatonin (p=0.01) and vitamin B12 (p=0.03) were significantly lower among the elderly with tinnitus compared to those without, while the difference in the plasma level of vitamin C (p=0.6) was not. CONCLUSION: Low plasma melatonin and vitamin B12 have significant correlation with the development of subjective idiopathic tinnitus among the elderly. This finding suggests the need for the trial of correction of these markers in the reversal or control of tinnitus.

Disability and quality of life among community elderly with dizziness: report from the Ibadan study of ageing.

BACKGROUND: Dizziness is prevalent among the elderly. However, little is known about its impact on quality of life and disability, especially in developing countries, where the number of elderly people is increasing. AIM: This study aimed to determine the prevalence of disability, and the quality of life, among elderly persons with dizziness living in the community. SETTING AND DESIGN: Longitudinal cohort study of dizziness among elderly persons (i.e. aged 65 years and over) residing in Yoruba-speaking areas of Nigeria. METHOD: Face-to-face interviews with respondents selected using a multi-stage, stratified area probability sampling of households. Dizziness was based on self-reporting and health-related quality of life was measured using the brief version of the World Health Organization quality of life assessment. RESULT: Dizziness was reported and confirmed in 318/1281 elderly respondents, a prevalence of 24.8 per cent. Respondents comprised 197 (61.9 per cent) women and 121 (38.1 per cent) men. Thirty-nine respondents (12.3 per cent) were aged 65-69 years, 91 (28.6 per cent) 70-74 years, 66 (20.8 per cent) 75-79 years and 122 (38.4 per cent) > or =80 years. The prevalence of disability in activities of daily living was 29.56 per cent, and that of disability in instrumental activities of daily living 10.1 per cent. The influence of gender was not significant. The prevalence of disability in activities of daily living (p = 0.00) and in instrumental activities of daily living (p = 0.00) increased significantly with age. Univariate analysis revealed that disability in activities of daily living (p = 0.00), disability in instrumental activities of daily living (p = 0.01), poor family interaction (p = 0.00), poor community involvement (p = 0.00), overall poor health (p = 0.00), current depression (p = 0.01), and difficulty with sedentary (p = 0.00) and vigorous (p = 0.00) activities were significantly more common among elderly respondents with dizziness, compared with non-dizzy elderly respondents. In contrast, cognitive impairment (p = 0.05) was not significantly correlated. The probabilities of the occurrence of difficulty with vigorous or sedentary mobility in our elderly respondents were 2.6 and 1.9, respectively, compared with non-dizzy elderly respondents. Similarly, the probabilities of the occurrence of disability in activities of daily living, current depression and dementia were 1.6 each. Logistic regression analyses for age, sex, medical conditions and presence of disability confirmed that dizziness was significantly associated with worsened cognition. Similarly, dizziness was significantly associated with reduced total quality of life (p = 0.00), and also with reductions in the physical (p = 0.00), psychological (p = 0.00) and environmental (p = 0.00) domains of the research instrument. CONCLUSION: Among elderly people with dizziness, there was a high prevalence of significant disability requiring assistance. In addition, dizziness alone significantly reduced these individual's overall total quality of life, and their quality of life as regards physical, psychological and environmental parameters. This information will assist policy planning for the elderly.

Effect of Spinal Anaesthesia on Hearing Threshold

Background: Hearing loss following spinal anaesthesia is a known yet uncommonly reported complication. This study was aimed at determining the incidence and type of hearing loss (HL) following spinal anaesthesia (SA) and the relationship with the size of spinal needle. Methods: A prospective study of patients scheduled for spinal anaesthesia for surgery at the Operating room and Otorhinolaryngology department in a tertiary centre was undertaken. The audiometry was done and the pre- and post - anaesthesia results were compared.Results: Ninety - four ears of 47 patients; 16 males and 31 females; age range between 21 and 63 years (mean + SD= 41+5) were included. The duration of anaesthesia was between 90 and 150 minutes (mean + SD= 116+9). HL was seen in 9 ears of 7 patients (15) and tinnitus in 14 ears. The preoperative and postoperative BC PTA were 10 - 45dB (mean + SD= 26+ 5) and 25 - 65dB (mean + SD=38+5) respectively; (P= 0.02) while the preoperative and postoperative AC PTA in the early frequency range (0-100Hz) were between 5 - 45dB (mean + SD= 20+ 5) and 25 - 50dB (mean + SD=25+7) respectively; (P= 0.08). There was significant difference in the mean BC PTA between those who had procedure less than 1 hour; 37.2dB and those greater than 1 hour 38.4dB; (P=0.004). According to the Quincke needle sizes; the mean BC PTA among those who had 26G and 27G were 37.4dB and 38.1dB respectively (P=0.2). Conclusion: HL complicating SA is significant and associated with duration of procedure thus should be included in informed consent for medico-legal and ethical reasons and measures must be taken to avoid the leak of cerebrospinal fluid

Interferon-gamma in suppurative otitis media: significance of otorrhoea type and disease outcome.

BACKGROUND: Interferon-gamma has been reported to have an immunoregulatory role in otitis media with effusion. However, such a role remains to be determined in acute suppurative otitis media. AIM: To determine the levels of interferon-gamma in middle-ear secretion in children with acute suppurative otitis media, and to determine the significance of interferon-gamma to the nature of otorrhoea and the outcome of otitis media. SETTINGS AND DESIGN: Prospective, longitudinal follow up of patients selected from community and tertiary health centres. METHODS: We selected children with acute suppurative otitis media, diagnosed as otorrhoea of less than three months' duration. Middle-ear secretions were collected by pipetting and stored at -80 degrees C. Interferon-gamma was assayed using enzyme-linked immunosorbent assay. The patients were treated and followed up for nine to 12 months, to separate those with resolved acute suppurative otitis media from those with chronic suppurative otitis media. RESULT: The study initially included 358 cases of acute suppurative otitis media. Nine-month follow up was achieved in 304 patients (85 percent). Of these patients, acute suppurative otitis media resolved in 187 (61 percent), while chronic suppurative otitis media was evident in 117 (39 percent). The children with completed follow up comprised 173 boys and 131 girls, aged between four months and nine years (mean age 6.6 years; standard deviation 1.32). These children had purulent otorrhoea in 171 cases (56 percent) and mucoid otorrhoea in 133 cases (44 percent). The children's middle-ear secretion interferon-gamma concentrations ranged from 12 to 126 pg/ml. The mean middle-ear secretion interferon-gamma concentration was 27.2 pg/ml (standard deviation 8.8) in patients whose acute suppurative otitis media resolved, and 73.1 pg/ml (standard deviation 9.5) in those progressing to chronic suppurative otitis media. In children with purulent otitis media, the mean middle-ear secretion interferon-gamma concentration was 43.5 pg/ml (standard deviation 15.6); in those with mucoid otitis media, it was 74.3 pg/ml (standard deviation 19.1). Univariate analysis revealed significant differences in middle-ear secretion interferon-gamma concentration, comparing resolved acute suppurative otitis media and chronic suppurative otitis media cases (p = 0.00), and comparing purulent and mucoid otitis media cases (p = 0.00). Pearson correlation testing revealed significant inverse correlation between interferon-gamma concentration and middle-ear secretion immunoglobulin G concentration (p = 0.01), immunoglobulin E concentration (p = 0.03) and immunoglobulin A concentration (p = 0.00). CONCLUSION: A high concentration of interferon-gamma in middle-ear secretions promotes chronicity of suppurative otitis media. Further research in this area may lead to the development of agents which assist the control of suppurative otitis media chronicity.

Improvized laryngeal cautery forcep in microsurgical treatment of laryngotracheal stenosis--experience in Nigeria, sub-Saharan Africa.

Traumatic laryngotracheal stenosis is uncommon, however it seems to be increasing due to improvement in survival after trauma and detection of injury. Surgical options include dilatation and intralesional steroid, endolaryngeal microsurgery and laryngotracheal resection and anastomosis. We report our experience with management of traumatic laryngotracheal stenosis using improvised cauterization forcep in endolaryngeal microsurgery, in the absence of supportive facility for open laryngeal surgery in resource--poor sub-Saharan Africa. This is a retrospective analysis of the outcome of endolaryngeal microsurgery in patient with laryngotracheal stenosis using our improvised laryngeal cautery forceps. Traumatic A Lindholm laryngoscope suspended by a Riecher-Kleinsasser laryngoscope holder and chest support; and Carl-Zeiss operating microscope (Op Mi 1) was used for surgery. We improvised a laryngeal cauterization forcep by using an oesophageal foreign body forcep inserted in the measured length of fluid--giving set, exposing about 1 cm of the cutting end would insulate the forcep against the laryngotracheal wall. The diathermy handle is applied to the exposed end of the forceps. All the patients had endolaryngeal microsurgery and intralesional steroid. Thirteen endolaryngeal microsurgical procedures were done on 5 patients, 4 males and 1 female. The age ranged between 19 and 62 years. Functional voice and decannulation was achieved in 2/5 patients after each had had between 2-3 procedures. The indications in all was hoarseness while there was in addition, upper airway obstruction and dependence on tracheostomy in 3. The stenosis was supraglottic in 2, combined glottic and subglottic in 1 and laryngotracheal involvement in 2. Using the circumference of the laryngeal lumen as reference for severity of stenosis, 2 patients had a 50-70% lumen obstruction while 2 had a 71-99% and 1 had 100% lumen obstruction. We found the improvisation of the laryngeal cautery forcep useful for procedures in the larynx and recommend it to resource--poor centres where appropriate facilities are yet available. However this further shows that the role of endolaryngeal microsurgery is limited in laryngotracheal stenosis. The availability of other therapeutic modalities and training of personnel will give us the opportunity of a randomized treatment comparison in future.

Traditional Open Surgery for Advanced Benign Nasal Tumours in an Era of Endoscopy: Review of 38 Cases

During the past decade open nasal surgery has been overtaken by endoscopic resection in the management of benign sinonasal tumours in the advanced countries. However; due to limited availability of endoscopic surgical facilities and training in most parts of sub-Saharan Africa; open surgery still seems popular. This report determines the indications and outcome of open nasal surgery for benign tumours in a resource - poor tertiary centre in sub-Saharan Africa and compares with endoscopic resection. This is retrospective study of 38 open surgeries done by the authors for cases of benign sinonasal tumours. Seventeen (45) caldwel-luc procedures; 12 (31) external (lynch-howarth) fronto-ethmoidectomy and 9(24) lateral rhinotomy were carried out. The indications were simple nasal polyps 17(45); mucocoele 10(26); inverted paplloma 8(21); invasive fungal sinusitis 2(5) and ossifying fibroma 1(2). Postoperatively; recurrence was 1/17(6) caldwel-Luc surgery and 1/9 (11) lateral rhinotomy for inverted papilloma. Facial scar was seen in 21/38(55) but the cosmetic effect of the scars was acceptable to our patients. Postoperative stay was between 5 to 17 days. We conclude that open nasal surgery met the therapeutic expectations of our patients. The recurrence rate compared with that of endoscopic resection reported in the literature and cosmetic effect of facial scar was acceptable to the patients; however; postoperative stay in the hospital is longer. It is our hope that this will serve as a baseline to compare the result of endoscopic nasal surgery in future when it becomes a widespread procedure in the developing countries

Beliefs and perceptions of ear, nose and throat-related conditions among residents of a traditional community in Ibadan, Nigeria.

ENT-related conditions constitute a major burden of disease in Nigeria. The bulk of the available studies on these conditions are derived from hospital-based studies that underestimate the extent of the problem. Few studies have explored the perceptions of community residents on the causes and treatment of these conditions. This article describes findings of a qualitative study that explored the perception of residents of Foko, a traditional community in Ibadan, Nigeria. Five traditional healers were interviewed in-depth while four focus group discussions were conducted for men and women to determine perception of types, causation and treatment modalities for ENT-related conditions. The healers mentioned seven ENT-related conditions including ear discharge, deafness, epistaxis, nasal catarrh, sore throat, neck swelling and hoarseness. Informants and discussants attributed mainly spiritual attack as the cause of many of these conditions. Many of the treatment remedies used are topical, including use of effirin leaf (Occimum gratissium) for nose bleeding and using cold red oil or honey to treat ear discharge. These procedures are dangerous and could aggravate the conditions. We discuss the implications of these findings for further research and clinical practice.

Complications of sinusitis in Ibadan, Nigeria.

Nowadays the complications arising from sinusitis are rare since the introduction of antibiotics. However sinusitis and its complications are still life-threatening and if neglected may result in high morbidity and mortality. It is the purpose of this study to draw attention to the effects of the spread of infection beyond the sinus wall and thus to influence the clinician in his management in order to prevent the subsequent spread of the disease, and secondly make him aware of the sinogenic origin of these complications when he sees them. A retrospective study of 90 patients with sinusitis seen over a ten year period between 1988 and 1997 in the ENT Department, University College Hospital, Madan was (lone and those that had complications were further analysed to meet the objectives of this study. There were 90 patients seen with sinusitis over the ten years period, out of which 33 (37%) cases had complications, 17 males and 16 females (M.F.1:1). The average age of cases with complications was 28 years (age range 2.5 - 75 years). 66.6% of the complications cases occurred in age group under 30 years of age. Thus children and young adults were mostly affected. Twenty-six cases (79%) of chronic sinusitis developed complications while in acute sinusitis there were 7 cases (21%). The site affected most commonly by complications was the orbit (41%) followed by Sinus wall (32%), orophyarynx (18%), intracranial (5%); no car complications were seen. The type of complications seen at various sites and their incidence were also highlighted. Thus with this study it is hoped that clinicians would be reminded that complications of sinusitis still occur and hence be aware of the necessity to recognize and prevent them as rapidly as possible to avoid serious consequences.

Trends of sinusitis in Ibadan, Nigeria.

Sinusitis occurs frequently, complications are infrequent since the introduction of antibiotics and mortality has also decreased significantly for same reason. A retrospective study of 90 patients with sinusitis seen over a 10 year period between 1988 and 1997 in the E. N. T. Department, University College Hospital, Ibadan was done to highlight the general direction and tendency of sinusitis in our environment. There were 50 (56%) males and 40 (44%) females. The average age was 33 years and 70% were under the age 40 years, showed that sinusitis affects mostly children and young adults. 38% in social class V while 10% social Class I. Chronic sinusitis was 93%, acute sinusitis 7% (both types unisinusitis 56%, pansinusitis 29%, multisinusitis 16%). All the cases of unisinusitis were maxillary sinusitis. 85 (94%) had surgical treatment (antrostomy 64%, Fronto ethmoi-dectomy 15%, Caldwell-Luc's 13%, antral lavage 13%). 80 (94%) patients are alive and well after 2 years of follow up, 5 (6%) lost to follow up. Complications arising from sinusitis was seen affecting the orbit in 41%--the largest, followed by sinus wall 32%, no ear complications seen. Thirteen (14%) of the sinusitis cases associated with allergy only, 24 (27%) with polyps only, 6 (1%) with both allergy and polyps. It stresses the interwoveness of these entities (allergy, Polyps, sinusitis)--one predisposes to the other. Thus with these trends of sinusitis being highlighted, it is hoped that this would enhance our knowledge of the pathology, diagnosis and treatment of sinusitis.