Hearing disorders in HIV positive adult patients not on anti-retroviral drugs at Kenyatta National Hospital.

OBJECTIVES: To determine the prevalence and type of hearing disorders in HIV positive patients not on anti - retroviral drugs (ARVs) and correlate this with the world health Organization (WHO) stage of HIV disease and CD4 positive cell counts. DESIGN: Case control study. SETTING: Comprehensive Care Clinic (CCC) and Voluntary Counseling and testing centre at Kenyatta National Hospital. SUBJECTS: One hundread and ninety four HIV positive patients attending CCC and 124 HIV negative subjects recruited from voluntary counseling and testing (VCT) centre. RESULTS: Hearing loss (HL) was present in 33.5% of HIV positive compared to 8.1% in negative subjects. No gender bias in HL Sensorineural hearing loss (SNHL) was the most common and the frequencies most 'affected were four-anti eight kHz CONCLUSION: Hearing loss is more prevalent in HIV positive individuals not on anti-retroviral drugs than negative normal subjects. Low CD4 cell count and advanced HIV diseases were associated with increased chance of having a hearing loss. Otological care should be part of the comprehensive care of HIV positive patients.

Hearing Disorders in HIV Positive Adult Patients

Background: This study was aimed at determining the prevalence and type of hearing disorders in HIV positive patients and any correlationship with the CD4 counts/stage of HIV/AIDS in patients attending the omprehensive care clinic (CCC). Methods: Case control study of 194 HIV positive patients attending CCC recruited into the study after informed consent. A thorough clinical examination and otoscopy done followed by tuning fork tests; Pure Tone Audiometry and tympanometric tests. This was compared with 124 HIV negative subjects matched for age and sex who were recruited from the voluntary counseling and testing centre. The world health organization staging of the HIV/AIDS disease and the CD4 positive lymphocyte cell count were carried out and correlated with any hearing disorder. Results were analyzed using statistical package for social sciences version 10.0. Results: Hearing loss (HL) was present in 33.5of HIV positive compared to 8.1in negative subjects. No gender bias in HL but HL worsened with advancement of age. SNHL was the most common and the higher frequencies were the most affected. Low CD4 cell count and advanced HIV disease were associated with increased chance of having a hearing loss. Conclusion: Hearing loss is more prevalent in HIV positive individuals than negative normal subjects and tends to worsen with the advancement of the HIV disease. This may negatively impact on the overall care and standard of living of HIV positive patients; hence otological care should be part of the comprehensive care

Hereditary haemorrhagic telangiectasia in a black adult male: case report.

Hereditary haemorrhagic telangiectasia, (HHT) or Rendu-Osler-Weber disease is a genetic autosomal dominant disorder that is characterised by telangiectasias, (small vascular malformations), in mucocutaneous tissues and arterial venous malformations, (AVMs), in various internal organs. Although HHT is relatively common in whites, the disorder has been reported to be rare in people of black African descent. Majority of HHT patients present with recurrent epistaxis, which in a significant proportion of patients is severe, warranting repeated blood transfusions and iron supplementation. Telangiectasias are most frequent on the tongue, hands, nose, lips and the gastrointestinal tract (GIT). AVMs occur in internal organs, particularly the lungs, brain, and the liver. Early and correct diagnosis of HHT is crucial as patients derive benefit from certain specific treatment modalities. Besides, AVMs which occur in various organs pose serious complications that may lead to death and therefore require early detection. We report a 55 year old black African male with HHT who presented with severe recurrent epistaxis and haematochezia leading to severe anaemia requiring repeated blood transfusions. His son, daughter and a maternal uncle experience milder recurrent epistaxis. The management of this patient and a brief review of the clinical features and management of HHT is presented. Our aim is to raise awareness of the occurrence of HHT in Kenya, in order to enhance early diagnosis and appropriate management.

[Otorhinolaryngology, head and neck surgery in Kenya--consequences of demographic parameters]. / Hals-Nasen-Ohrenheilkunde in Kenia - Auswirkungen demographischer Parameter.

BACKGROUND: In the time of evidence based medicine the analysis of the influence of demographic parameters and different environmental factors on the treatment concepts in a country is often neglected. This is also true for Otorhinolaryngology. METHOD: An evaluation of the situation concerning distribution of physicians, diagnostic procedures and epidemiology in Kenya has been performed. These factors are discussed in consideration of their effect on the incidence of different diseases and their treatment under the specific socio-economic conditions for the otolaryngological situation in Kenya. RESULTS: In Kenya 28 otolaryngologists are registered that concentrate on few urban regions. Chronic otitis media, malignant tumors in the head and neck region and AIDS associated diseases have meanwhile increased dramatically. Numerous instruments and equipment for diagnosis are missing. Bigger equipment for CT scans are nearly exclusively used by private hospitals. PERSPECTIVE: Beside a better provision with different equipment for diagnosis it is especially the organization of certain training programmes where local physicians are further educated that may lead to an optimised medical care in Kenya.

Frequency of adenotonsillectomy in some Nairobi hospitals.

OBJECTIVES: To determine the frequency of adenotonsillectomy in a sample of Kenyan hospitals and to review indications, timing and complications in 97 cases of adenotonsillectomy done by the authors. DESIGN: Retrospective, descriptive study. SETTING: Kenyatta National, Nairobi, Aga Khan, Gertrude and Mater Hospitals. RESULTS: Adenotonsillectomy is the most frequent otolaryngologic surgical operation. Indications for surgery were upper airway obstruction in 61.3%, recurrent tonsillitis in 28.7% and both in 7.5%. Surgery was indicated during the acute stage in 6.8% of cases. There was one case of post-operative acute airway obstruction. Post operative bleeding from the tonsillar bed was encountered in 2.1% of cases. CONCLUSION: Adenotonsillectomy is the most common otolaryngologic surgical operation in our set-up. The low frequency of complications and a short hospital stay puts up a case for routine adenotonsillectomy as a day surgery procedure.

Distant metastases from nasopharyngeal carcinoma at Kenyatta National Hospital, Nairobi.

OBJECTIVES: To determine the frequency and site of distant infraclavicular metastases of nasopharyngeal carcinoma (NPC), the stage of the primary tumour at presentation of metastasis and the histological trends. To determine if there is a correlation between the follow-up rate and different metastatic sites. DESIGN: A retrospective study. SETTING: Ear nose and throat surgical and radiotherapy clinics at Kenyatta National Hospital, Nairobi. SUBJECTS: Case notes, radiotherapeutic and laboratory records of patients presenting with NPC between January 1981 and December 1990. RESULTS: The frequency of distant NPC metastases was 14.6% and 92.3% manifested within 24 months of admission. It was most frequent in the males, a younger age group and early T1 disease. Bilaterality of the neck nodes had no relevance on metastatic rate. The bone (66.7%) was the most common distant metastatic destination followed by the liver (23.2%). Liver metastasis was associated with a shorter follow-up period. CONCLUSION: Apart from the late presentation of locoregional disease, the findings are similar to studies elsewhere. The preponderance of early primary disease in patients with distant metastasis need further appraisal as it preliminarily suggests existence of specific biological markers that favour metastases. This can only be done after recruiting more cases.

Causes of ear trauma in Kenyan patients.

Ear trauma is one of the most important epidemiological factors in causation of deafness. The causation of otologic trauma in eighty three patients is analysed. The triad of pain, hearing loss and tinnitus comprised the most frequent presenting complaints. Physical assault was the most common causation in 49.4% of the cases, road traffic accidents in 19.3% and self-inflicted injury in 15.6%. Law enforcement agencies constituted the most prominent factor in assault cases. Iatrogenic trauma was confined to 13.3% who were all below ten years of age. Road traffic accidents and violence from law enforcers were significant contributors to severe otologic damage as defined by dead ears and cerebrospinal otorrhoea.

Late presentation of laryngeal and nasopharyngeal cancer in Kenyatta National Hospital.

The clinical stage at presentation of laryngeal and pharyngeal cancer is an important determinant of survival. Fifty six patients admitted at Kenyatta National Hospital with nasopharyngeal and laryngeal carcinoma were reviewed to determine the period of delay from onset of illness to the first otolaryngologic appointment at the hospital, their clinical features and the tumour stage at presentation. All cases of nasopharyngeal carcinoma had cervical lymphadenopathy, 70.6% being N3 status while 57.8% of laryngeal carcinoma cases underwent emergency preoperative tracheostomy due to bulky obstructive tumour. On the whole, 96.4% of the patients presented with advanced (stage 3 or 4) head and neck carcinomas. The average period of delay between the first medical attention at a primary health care facility and the first appointment at the national hospital was 8.7 months. The study suggests that this long delay was due to inherent inefficiency in the referral system and was a major contributing factor to the advanced stage at presentation.

Complications following bilateral turbinectomy.

Thirty four patients undergoing bilateral inferior turbinectomy for obstruction of the upper airway are prospectively reviewed. The indication for the operation was persistent nasal obstruction interfering with sleep and speech. Their ages ranged from seven years to 50 years. The most common post operative complications were synaechiae (15%), atrophic rhinitis (15%), persistent obstruction (12%) and abnormal nasal sensation (9%).