Acute Otitis media, malaria and pyrexia in the under five age group.

BACKGROUND: Acute Otitis media is one of the most common childhood infections. It is responsible for every third visit to a pediatrician in a developed world. However, in Nigeria there is scanty knowledge about the incidence of Acute Otitis Media (AOM). OBJECTIVE: This study aimed at determining the incidence of AOM among under five year old children presenting with pyrexia, and to compare the incidence of AOM as a cause of pyrexia with the incidence of malaria in pyrexic children. DESIGN: It is a cohort study of 200 children of between the ages of 2 weeks and five years with a rectal temperature of 38 degrees C and above, seen over a period of 3 months. SETTING: The study was conducted at the Obafemi Awolowo University Teaching Hospital (OAUTHC) Comprehensive Health Centre, Eleiyele, and the children emergency room of the OAUTHC, Ile-Ife. PATIENTS AND METHODS: A questionnaire to collect information on the demographic data was administered to each mother/guardian of the patient. Otoscopic examination using a battery-operated hand held otoscope and magnifying lenses were done in addition to general systemic physical examination. Thin and thick blood smears were made for malaria parasite. The dried slides were examined under the microscope using the X 100 objective. Sixteen of the patients' slides were lost after processing. RESULTS: Out of the 200 patients that were studied, 58 (29%) had AOM. The highest incidence was recorded in the age group 12-24 months while the least age of occurrence was found to be the age group 4-5 years. Malaria parasitemia was found in 81 (43.5%) while 21 (25.9%) of those with parasitemia also had AOM. But 76 (36%) of the study population had neither AOM nor malaria parasitemia. CONCLUSION: Acute Otitis media was found in 29% of under five years old presenting with pyrexia. It was found to be highest in the first and second year of life, and was found to be least in the 5th year of life. Malaria was found in 81 (43.5%) of the children, and 21 (10.5%) of the children had malaria with a co-existing AOM.

Adult onset otitis media with effusion in Lagos.

BACKGROUND/AIM: The documented reports on adult onset OME is scanty world wide, this study was prompted by the increasing trend of OME in our adult patients with the aim of determining the prevalence, predisposing factors and treatment outcome of the disease. PATIENTS AND METHODS: A prospective study was carried out over a two year period at the Otolaryngology Clinic of Lagos University Teaching Hospital Lagos Nigeria, on 195 patients referred to the clinic with provisional diagnosis of OME. The patients had clinical evaluation, pure tone audiometry, tympanometry while a few had fibre optic nasopharyngoscopy and biopsy done. RESULTS: A hospital based prevalence of 2.6% was recorded in the Otolaryngology clinic during the study period, with infective and allergic sinusitis as the major predisposing factors to OME in adult patients. Majority 58 (92.06%) patients were treated conservatively and recurrence was seen in 8 (12.7%) of the patients without any untoward effects. OME, though recognised as a childhood disease may be as prevalent in adult as in childhood but with less complication. CONCLUSION: OME as a single clinical feature or in association with allergy or sinusitis is most unlikely to habour NPC therefore nasopharyngoscopy and biopsy are likely to give a low yield of positive biopsy in isolated OME in adult and the cost implication of this must be borne in mind.

Prognostic factors in the management outcome of carcinoma of the larynx in Lagos.

This is a retrospective analysis on the prognostic factors in the management outcome of clinically and histologically diagnosed carcinoma of larynx seen in Lagos University Teaching Hospital between 1996-1999. Various prognostic factors have been documented as determinants on the probable outcome of carcinoma of the larynx, such as duration of symptoms, smoking, medical status of the patient, degree of differentiation, size and site of tumour and presence of cervical lymph node. Thirty-six patients between 1996-1999 were reviewed, with a male to female ratio of 11:1, and peak age group of occurrence in 50-59 years, majority (86.12%) of which were non-smokers who presented in varied degrees of airway obstruction necessitating pre-treatment tracheostomy in 70% of the patients with more than 50% presenting within 3-6 months of onset of initial symptom. The tumours were staged clinically and histology revealed well differentiated T3 glottic tumour without any clinically palpable neck node in more than 50% of the patients which should predict a better outcome. But the interplay of many prognostic variables like pre-treatment tracheostomy and its attendant complications, supposed biological aggressive tumour in a non-smoker, coupled with treatment biased by patients, high costs of treatment, logistics and poor follow up compliance, resulted in poor outcome of our management.

Otorhinolaryngological manifestations of HIV/AIDS in Lagos.

A prospective study was carried out at the Lagos University Teaching Hospital in Lagos. The aims were to determine the prevalence of otorhinolaryngological disease among patients who were HIV+ and or had clinical AIDS and to correlate the presence of ORL disease with the clinical state of HIV infection. The study was done between October 1998 and September 1999. A total of ninety-eight patients were studied. The age range of the patients was between 15 and 69 years with 83% of them being in the age group of 20-49 years. The results showed that while only 17% of the patients were referred because of ORL diseases, 80% of them actually had O.R.L./head and neck conditions. This difference of proportion is highly significant P = 0.000037. 160.20% of the patients had oral/pharyngeal lesions and 24.5% had identifiable otological disease. Hearing impairment was noted in 30.6% of the patients on pure tone audiometric assessment of which 26.5% were sensorineural. The correlation between O.R.L./head and neck manifestation and the CDC classification of HIV/AIDS infection did not reveal a definite pattern.

Pattern of head and neck cancers among Nigerians in Lagos.

Three hundred and eight-one cases of head and neck cancers were studied over a 10 year period (1988 - 1998) at the Lagos University Teaching Hospital, Lagos. The aim was to assess the various sites of primary lesion, gender and age distribution and histopathological types. The International Classification of Diagnosis Oncology's (ICDO) 9TH version was used to categorize sites of primary lesion. A yearly incidence of 38 cases was noted with an overall male preponderance. Forty-five percent of the patients with head and neck cancers were in their forth and fifth decades of life. The nasopharynx was the commonest site of primary lesion (16.8%) followed by the nose, paranasal sinuses and middle ear (ICDO - 160) with 13.6%. Laryngeal cancer ranked third accounting for 12.1% of the cases. Other common sites of primary lesion were: the skin (9.2%), the salivary glands (7.6%), the mandible (7.3%) and the thyroid gland (7.3%). Metastatic cancer in the neck with unknown primary lesion was seen in 2.9% of the patients. Cancers associated with heavy tobacco use e.g. laryngeal cancers, lip and tongue cancers showed a very high male predilection with M:F ratios of 10.5:1, 8:1 and 6:1 respectively. 91% of the head and neck cancers were of epithelial tissue origin while sarcomas accounted for only 6.6% of the cases. The results show that head and neck cancers affect Nigerians especially males at the prime of their working life. The devastating psychosocial effects on the individual, the family and the society are enormous. Emphasis on cancer prevention is recommended.

The bacteriology of chronic suppurative otitis media.

Specimens obtained directly from the middle ear under direct vision from 40 patients with chronic suppurative otitis media (CSOM) were investigated quantitatively and qualitatively for aerobes and anaerobes. Twenty one of the 40 specimens yielded aerobes only, 17 yielded a mixed flora of anaerobes and aerobes while only one yielded anaerobes only and the remaining one was sterile. Bacteroides fragilis was the commonest anaerobe and the second single most common bacteria generally present in CSOM. Pseudomonas aeruginosa and Staphylococcus aureus were the dominant aerobic flora appearing in 17 and 14 out of 40 specimens respectively. All pathogens isolated were present in very high counts averaging 10(8) ml of the exudate. The use of systemic anti-anaerobic drug combined with an anti-aerobic drug is worthy of a clinical trial.

Randomised comparative efficacy of clindamycin, metronidazole, and lincomycin, plus gentamicin in chronic suppurative otitis media.

Chronic suppurative otitis media is major health problem seen frequently in the ENT clinics in Nigeria and the outcome of most medical management in the past have been disappointing. A comparative randomised clinical trial involving combination therapies with systemic clindamycin, metronidazole, lincomycin, each with gentamicin, was conducted on a total of 14 patients. At the end of one week, and three-week, follow-up end points the clinical response with bacteriological cure were, for clindamycin and gentamicin 21%, metronidazole and gentamicin 33%, lincomycin and gentamicin 22%, and the control (aural toilet alone) 14%. However, when the clinical response was measured only by the ceasation of discharge, the outcome was more impressive. By this assessment the clinical response with clindamycin and gentamicin was 52% of the 140 patients, metronidazole and gentamicin 69%, lincomycin and gentamicin 47%, and the control 24%. The metronidazole and gentamicin regime was significantly more effective than the other regimes and it is suggested for use in prophylactic treatment of CSOM patients undergoing surgical procedures.

The role of tracheostomy in otolaryngological practice in a developing country.

An analysis of 155 tracheostomies performed over a period of six years in a teaching hospital in a developing country is presented in this paper. It is a follow-up of an earlier analysis of such procedures performed in the same hospital. Tetanus has established itself as the main indication for tracheostomy while other conditions such as laryngotracheobronchitis, which was the leading indication a decade ago, have been treated more successfully as a result of other better and non-invasive management. A continuing analysis of the indication for and mortality attending tracheostomy is considered important as it gives an indication of the quality of health care delivery in developing countries.

Therapeutic acupuncture for sensori-neural deafness.

This article presents a case report of a 29 year-old Nigerian male with sensori-neural deafness since the age of 7 years managed by therapeutic acupuncture according to the classical Chinese technique. The patient was examined by radiological pictures in addition to biochemical and physical examinations. No medications were administered during the course of therapy. The study indicates that the impressive result obtained is due to the ability of therapeutic acupuncture to improve speech discrimination and hearing ability in our patient with sensori-neural deafness.

Management of conductive deafness of non-suppurative aetiology in Nigeria.

A review of 39 cases of deafness of non-suppurative aetiology seen in the Department of Otolaryngology of the University College Hospital, Ibadan between 1966 and 1971 is presented. Deafness of this type is not as common as deafness of suppurative origin but it presents problems of its own. First there is the inability of many patients to give accurate histories and describe actual sensation in the ear. Secondly, there is the problem created by patients not turning up for regular follow up. Thirdly, there is the problem of unavailability of necessary equipment such as that highlighted by the use of straight polythene tubes instead of the shaped grommet in the management of serous otitis media and the non-availability of prosthesis to replace the stapes when stapedectomy may have helped the patients. Suggestions are also offered on the ways of improving the treatment of the patients.