Tympanometric findings among adult HIV patients undergoing a short-term treatment with high active antiretroviral therapy (HAART) in port harcourt.

Background: In our practice as ENT specialists, people living with Human immunodeficiency Virus/acquired immunodeficiency syndrome (HIV/AIDS) have presented at the clinics with symptoms suggestive of otitis media with effusion such as the sensation of fluid in the ear, aural fullness and hearing loss. Eustachian tube dysfunction which is often the beginning of middle ear pathology could be caused by nasal allergy, upper respiratory tract infection, or obstruction by a nasal pharyngeal lesion such as lymphoid hyperplasia which is a common feature in people living with HIV/AIDS. Tympanometric findings give a measure of the objective assessment of middle ear function. Aim and Objective: This study was designed to determine tympanometric findings among adult patients undergoing short-term treatment with HAART in Port Harcourt. Patients and Methods: A hospital-based study involving 150 HIV-positive patients that received the same HAART treatment over 6 months and a control group of 150 HIV-negative individuals in Port Harcourt. The data extracted includes; the patient's ear symptoms, otoscopic findings, and tympanogram. Data were analyzed using SPSS version 20 and statistical significance was set at P > 0.05. Results: There was a high proportion of type B-Typanogram at baseline (Rt ear 24[16.0%], left ear 23 [15.3%]) and at repeat (Rt ear 23 (15.3%), Lt ear 21 (14%) evaluations. Also, there was a relatively high proportion of type C- tympanogram at baseline {right ear 18 (12%), left ear 15 (10%)} and at repeat Rt ear 14 (9.3%), Lt ear 10 (6.7%)} evaluations. Conclusion: One out of every eight patients living with HIV infection may likely have Eustachian tube dysfunction while one out of every five may have developed otitis media with effusion already. There was no significant change in tympanometric findings after treatment with HAART.

Prevalence of hearing loss among newly diagnosed highly active antiretroviral therapy (Haart) naive adult patients in port harcourt.

Background: Numerous studies have reported a relationship between human immune deficiency virus (HIV)/acquired immune deficiency virus (AIDS) and auditory functions. There is a dearth of information on the prevalence of hearing loss among newly diagnosed HAART naïve adult patients. Aim: This study therefore provides baseline information on the prevalence of hearing loss among newly diagnosed HAART naïve adult patients in Port Harcourt and serves as a reference for the role of HAART in HIV related hearing loss and for future studies. Patients and Methods: This is a prospective cross-sectional study involving 260 participants; 130 newly diagnosed and 130 HIV-negative controls aged 18 to 50 years from two centers in Port Harcourt from July, 2018 to January, 2019. Participants were clerked and diagnostic pure tone audiometry was done. Results: The rate of hearing loss was observed with Pure Tone Audiometry to be higher (P-value = 0.001) among newly diagnosed HAART naive adult patients 37 (28.5%) in comparison to the control 8 (6.2%). The mean age of all the study participants was 31.80 ± 9.61 years (study group 32.18 ± 10.18 years, control group 31.42 ± 9.12 years). Gender characteristic of participants also showed that males were 46 (35.4%) and females 84 (64.6%) giving a male, female ratio of 1:1.83 among newly diagnosed HAART naive adults, while among the control group there were males 49 (37.7%) and female 81 (62.3%) giving male: female ratio of 1:1.65. The rate of hearing loss at baseline was significantly (P = 0.001) higher among 37 HIV-positive HAART naïve patients (28.5%) compared with 8 control patients (6.2%). Conclusion: There was significant proportion of hearing loss among newly diagnosed HAART naive adult patients in Port Harcourt.

Foreign Body Ingestion in a Neonate

Background: Foreign body ingestion is a very common event in the paediatric age group. There are however very few reports of foreign body ingestion in neonates. Aim: To report a case of ingestion of foreign body in a neonate. Case report: A neonate with thumb tack ingestion presented with respiratory distress. She had an emergency tracheostomy and subsequent extraction of the foreign body. She was extubated after four days and was discharged on the eighth day in good clinical condition. Conclusion: Foreign body ingestion in the neonate although very uncommon is possible. Paediatricians should therefore remember that an oesophageal foreign body may be a possible cause of respiratory distress in a neonate

Abscess of the deep cervical fascial space in adults: a report of 3 cases and review of anatomy.

Deep cervical space abscess is a disease with the potential for grave consequences if not managed properly. Even though since the antibiotic era it has been on the decline, it still occurs. Better imaging techniques have made the management of this disease better such that it is possible to treat the abscesses conservatively reserving surgical drainage for cases that fail to respond to treatment. We present 3 cases of deep cervical space abscess that were surgically drained and wide spectrum antibiotic administered. In one of the patients, there was coexisting pulmonary tuberculosis.

Traumatic perforation of the tympanic membrane in University of Port Harcourt Teaching Hospital, Port Harcourt. Nigeria.

OBJECTIVE: To evaluate the causes, clinical features and treatment of traumatic tympanic membrane perforation in University of Port Harcourt Teaching Hospital. PATIENTS AND METHODS: Patients with traumatic perforation of the tympanic membrane from August 2003 to February 2005 were evaluated clinically to determine the cause and the site of perforation. They had pure tone audiometry done. Treated by non- surgical means and followed up. RESULTS: Fifty- eight (8.6%) patients with traumatic perforation were seen among 676 patients with aural diseases. Average age was 27.56 years. Causes of traumatic perforation were, fights with spouse 27.6%, street fights 19%, instrumentation 17.2% and state security agents 15.5%. Hearing loss 94.8%, tinnitus 84.5% and otalgia 67.2% were common complaints. 63.8% had perforation in the lower half of pars tensa. 42.4% had mild conductive hearing impairment. 29.3% healed within 3 weeks. CONCLUSION: Physical blow to the ear was the commonest cause of tympanic perforation.

Surgery of parotid gland tumours in lagos: a 12 year review.

BACKGROUND/AIM: Tumours of the parotid gland are not common. Parotid tumours can pose a challenge both in diagnosis and treatment. Various factors contribute to the management difficulties of parotid tumours for the Head neck surgeon. The aim of the study is to determine the presentation and management of parotid tumours requiring surgery at the Burns and Plastic and Otolaryngology (ORL) units of the hospital. MATERIALS AND METHODS: This is a retrospective study carried out at the Lagos University Teaching Hospital from January 1994- December 2005. The medical case notes were reviewed for information on age, sex, clinical presentation, surgical management, histological diagnosis and outcome. RESULTS: A total of 58 patients with parotid tumours were seen with ages ranging from 25-65 years. Male to Female ratio was 1.4:1. Forty-two (72.4%) presented with firm preauricular swelling, 1.7% as dumb bell tumour and post surgical recurrence tumour respectively, 6.8% as tail of parotid tumour and 3.5% as bilateral disease. 93.13% had superficial parotidectomy. Histological diagnosis confirmed 65.5% as pleomorphic adenoma, 20.72% as carcinomas of which adenoidcystic and mucoepidermoid tumours were the commonest,3.45% as lymphoma and 1.7% as Sjogrens syndrome, oxyphil and Warthins tumour respectively. Immediate post surgical facial nerve palsy was seen in 69% and recovery was seen in 62% within 3-9months. Post surgical radiotherapy was given to 8.6%. CONCLUSION: The commonest parotid salivary gland tumour requiring surgery is pleomorphic adenoma, presenting as a pre-auricular mass and the commonest post- surgical complication was facial nerve palsy involving the mandibular branch. A good knowledge of the surgical anatomy of the gland, clinical behaviour and biologic nature of the tumours will ensure better surgical management.

Plain radiological profile of paranasal sinuses in chronic nasal diseases in University of Port Harcourt Teaching Hospital.

BACKGROUND: The paranasal sinuses can get affected by chronic diseases that maybe mitotic, bacterial, fungal and allergic. Plain x-rays, sinoscopy, tomograms, ultrasound scan, CT-scan and magnetic resonance imaging (MRI) technique are some of the means by which the sinus can be evaluated and a diagnosis made. The aim of this study is to evaluate the plain radiological findings of the paranasal Sinuses in-patient with chronic nasal diseases in the University of Port Harcourt Teaching hospital. METHODS: This is a prospective study of patients seen at the otorhinolaryngology out patient clinic of the university of Port Harcourt Teaching Hospital from August 2002 to November 2003. All patients with symptoms suggestive of nasal or paranasal sinus disease of more than 8 weeks duration were evaluated for the study. All the patients had plain radiographs in the occipito-mental, occipito-frontal and lateral views. A radiologist interpreted the x-rays. RESULTS: A total of 66 patients were seen with a male to female ratio of 1: 1.4. Ages of patients ranged from 17 years to 65 years. 72.7% had chronic infective sinusitis, 9.1% had vasomotor rhinitis and 6.1% had allergic rhinitis. Plain x-rays showed engorged turbinates due to allergy in 43.9% of patients, chronic sinusitis with engorged turbinates in 15.1%, engorged turbinates in 13.6%, chronic sinusitis in 10.6% and opaque nasal fossa in 6.1%. The maxillary sinus was most commonly involved site of disease as seen in (71.2%) of patients. The sphenoid sinus was the least involved (7.4%). Thirteen patients (19.7%) did not show any changes in the sinus x-rays. CONCLUSION: Chronic sinusitis is the commonest chronic nasal disease. Engorged nasal turbinate was the commonest plain x-ray finding. The maxillary sinus was the most commonly diseased sinus. In 19.7%, the plain radiograph was normal. Plain radiographs are a cheap and readily available tool for the investigation of diseases of the paranasal sinuses with good results in this environment.

Pattern of clinical features of chronic simple rhinosinusitis in Port Harcourt.

OBJECTIVE: To evaluate the symptoms, signs and types of chronic simple rhino-sinusitis. PATIENTS AND METHODS: This is prospective work done over a 2-year period. All the patients had symptoms of more than 8 weeks duration. Only patients with symptoms indicative of chronic rhino-sinusitis were included in the study. All the patients had plain x-rays of the paranasal sinuses done and a radiologist reported such. RESULTS: One hundred and fifteen patients were studied. The male to female ratio was 1:1.4 age range 15 years to 70 years. The mean duration of symptoms was 32.03 months. Rhinorrhoea 100%, stuffy nose 97.4%, sneezing 67.6%, anosmia 54.8% and headache 54.8% were the common symptoms while engorged inferior turbinates 79.1%, anterior nasal discharge 63.5% and postnasal discharge 39.1% were the common findings on examination. The clinical diagnosis was chronic infective sinusitis 72.7%, vasomotor rhinitis 17.4% and allergic rhinitis 10.4%. Engorged turbinate was the commonest radiological comment. CONCLUSION: Chronic infective rhino-sinusitis is the commonest type of chronic rhino-sinusitis seen in this study.

Day-case adenotonsillectomy: suitable in the tropics?

This study evaluates the outcome of offering day-case adenotonsillectomy in a hospital in the tropics. Seventy-seven patients with adenotonsillitis requiring surgery were admitted, operated upon and discharged within 12 h and were also evaluated for complications. There were no complications severe enough to warrant readmission. Day-case adenotonsillectomy is safe and acceptable in a developing country.

Malignant tumours of the nasopharynx at Jos University Teaching Hospital, Nigeria.

A retrospective epidemiological study of 55 patients who had been histologically diagnosed as having nasopharyngeal malignancy was undertaken at the Jos University Teaching Hospital in the period from December 1988 to November 1998. Jos is at the heart of the middle belt of Nigeria and is made up of peoples of various tribes and religions. The aim of this study was to evaluate the epidemiological factors, clinical presentation, histological pattern and treatment outcome in the patients during the study period. Fewer females were affected than males with a ratio of 1:1.6. Age range was 35-82 years with an average age of 42.19 years. Most of the well documented predisposing factors were absent in this series and the role of smoking and alcohol is unclear. Squamous cell carcinoma (72.7%) was the commonest epithelial malignancy with the incidence of the well differentiated type (WHO type 1) being as high as 34.5%. Rhabdomyosarcoma (14.8%) was the commonest sarcoma. Neck swelling 70.9%, Nasal stuffiness 41.8%, epistaxis 34.5% and pharyngeal mass 25.5% were the commonest symptoms. Treatment and follow-up were unsatisfactory as patients could not afford the cost of radiotherapy and anti-cancer drugs.

Cancer of the larynx in black Africans in Jos Nigeria.

OBJECTIVE: A clinico-pathological study of cancer of the larynx in Jos from 1983 to 1995. SETTING: Jos University Teaching University. SUBJECTS: 38 patients. RESULTS: 38 (100%) patients were seen. Thirty four (89.5%) were Black African males. Mean age was 47.7 years. Twenty nine (76.3%) smoked cigarettes and drank alcohol. Hoarseness (100%) was the commonest symptom. Mean duration of symptoms was 13.5% months. Transglottic (42.1%) was the commonest site and squamous cell carcinoma (97.4%) was the predominant histologic type. CONCLUSION: There was a male preponderance. The mean age was lower than in other series. Patients often presented late. Squamous cell carcinoma was the commonest cell type.

Rhinosporidiosis in the nasal cavity.

A case of nasal rhinosporidiosis in a 17-year-old patient from the Middle Belt area of Nigeria is described, the first such case seen in 16 years since this centre was established. The clinical features and the results of gross and microscopic examination of biopsy material are presented.