Otological manifestation of temporomandibular joint disorder in Ekiti, a sub-Saharan African country.

OBJECTIVE: To determine the prevalence, sociodemographic features, and clinical presentation of temporomandibular joint disorder in otorhinolaryngological practice. METHODS: This prospective hospital-based study involved patients diagnosed with temporomandibular joint disorder in our institution's ear, nose, and throat department. Data for this study were obtained from the patients using pretested interviewer-assisted questionnaires. RESULTS: The prevalence of temporomandibular joint disorder in this study was 1.3%. The study population included 17 (26.2%) male patients with a male:female ratio of 1.0:2.8. Joint disorder accounted for 75.4% of all disorders, while both mastication muscle and joint disorder accounted for 21.5%. A majority of the patients (47.7%) presented between weeks 1 and 13 of the illness. Unilateral temporomandibular joint disorder accounted for 98.5% of all disorders. The main otologic clinical features were earache and a dull tympanic membrane in 100% and 35.4% of patients, respectively. Middle ear assessment revealed type A in 73.8% of patients and type B in 20.0% according to Jerger's classification system of tympanometry. Most patients (81.5%) were referred by their family physician. All patients had undergone prehospital treatment prior to presentation. CONCLUSION: Temporomandibular joint disorder is a common presentation in medical practice. Common clinical features include ear, joint, and mastication muscle disorders.

Otorhinolaryngologic, head and neck presentations among patients with chronic renal disease in a developing country.

BACKGROUND: Data on otorhinolaryngology and head and neck diseases in patient with chronic renal disease are rare in developing African countries. This study was aimed to determine the epidemiology and management of otorhinolaryngology and head and neck diseases among chronic renal disease patient seen in our tertiary health-care facility. MATERIALS AND METHODS: This was a prospective, hospital-based study that was conducted in the ear, nose, and throat department in a Nigerian University Teaching Hospital. Informed consent was obtained, and pretested interviewers-assisted questionnaires were administered to each patient. Otoscopy, indirect laryngoscopy, and rhinoscopy were carried out. Renal functions were assessed by routine urine analysis and biochemical tests. Audiological tests were carried out for hearing assessment. Data collected were collated and analyzed using the SPSS software version 20.0. RESULTS: The prevalence of chronic renal disease in otorhinolaryngology practice was 1.1%. There were 67.9% male with a male-to-female ratio of 2.1:1. The duration of illness was more than 1 year in 39.6% of our patients. The most common presentation was 58.5% tinnitus, 34.0% neck pain, 28.3% nasal blockage, 28.3% sore throat, 26.4% rhinorrhea/epistaxis, 18.9%% pharyngeal wall nodularity, and 15.1% enlarged neck lymph node. The most common affected organ was the ear in 90.6%. Major diagnosis was sensorineural hearing loss, rhinosinusitis, pharyngitis, and cervical adenitis in 58.5%, 30.2%, 20.8%, and 7.5%, respectively. Hearing impairment occurred in 69.8% of the patients, out of which 43.4% were found to be mild hearing loss. Only 19 (35.8%) had dialysis, while 34 (64.2%) of them had conservatively treated. CONCLUSION: The prevalence of chronic renal disease in otorhinolaryngological practice was 1.1%, otological presentation was the most common in 90.6% of patients and 64.2% did well on conservative treatment. Avoidable otorhinolaryngologic complications among patients with chronic renal disease were noted. Periodic otorhinolaryngology referral for review and prompt management of this complication is advised.

Characteristics and Management of Childhood Tinnitus in a Developing Country.

OBJECTIVES: Tinnitus is a commonly neglected otologic symptom among children in developing country. This study aimed at determining the prevalence, clinical characteristics, diagnosis and management of childhood tinnitus in a developing country. METHOD: This prospective hospital based study of patients' age 18 years and below with complaints of tinnitus was conducted in Ear, Nose and Throat Department of Ekiti state UniversityTeaching Hospital,Ado Ekiti,Nigeria between April 2016 to March 2018. The parents/guardians/patients were briefed about the scope of the study. After getting oral consent, pretested interviewers assisted questionnaire was administered to collect data. Data obtained were collated and analyzed using SPSS software version 18.0 and was expressed in simple tables and charts. RESULTS: Prevalence of tinnitus in this study was 6.2%. There were 56.1% males and male to female ratio was 1.5:1. Majority 55.3% had single episode of tinnitus and long duration (>3 months) was commonest form of tinnitus in 59.1%. Bilateral tinnitus was recorded in 68.9% while subjective tinnitus constituted 93.9%. Discrete tinnitus was commoner in 67.4%. Major causes of tinnitus were febrile illnesses, otitis media, noise exposure, unknown (idiopathic), earwax impaction and ototoxicity in 19.7%, 16.7%, 15.9%, 14.4%, 12.9% and 9.8% respectively. A commonest tympanometric finding was type A in 72.7% of patients. Commonly affected quality of life were anxiety, depression and attention problem in 51.5%, 43.2% and 40.2% respectively. Associated comorbid illnesses in this study were 50.8% sleeping disorders, 42.4% concentration disorders and 31.1% headache. Referrals were mainly from paediatrician in 44.7%. Prehospital treatment was mainly medication in 62.1%. All the patients were counselled (assured). Other treatments given were conservative treatment, surgery, ear syringing and hearing aids in 56.1%, 15.9%, 12.9% and 9.1% patients respectively. CONCLUSION: Childhood tinnitus is caused by preventable diseases. At presentation there were associated hearing impairment, comorbid illnesses and affectation of quality of life.

Preschool Children Hearing Impairment: Prevalence, Diagnosis and Management in a Developing Country.

OBJECTIVES: Preschool children hearing impairment is a common otologic diseases worldwide. The burdens of this preventable condition can be reduced in developing country. This study was carried out to determine the prevalence, diagnosis and management of hearing impairment among children less than 5 years seen in our center. METHOD: This was a prospective hospital based study of preschool children with complaints of hearing impairment in Ekiti state university teaching hospital, Nigeria. This study was conducted over a period of two years (February 2016 to January 2018). Data was obtained from consented patients by using pretested interviewers assisted questionnaire. Data obtained was collated and analyzed by using SPSS software version 18.0. D escriptive statistics was used to present and expressed the data as simple tables and charts. RESULTS: The prevalence of hearing impairment in this study was 5.9% with peak value of 37.6% at preschool age 3 years. There were 42.6% males and 57.4% females. Majority (51.5%) of the patients were urban dwellers. The aetiologic factors of hearing impairment include; 15.8% neonatal jaundice, 13.9% febrile illness, 12.9% otitis media and 11.9% birth asphyxia. Prelingual presentation was commonest in 57.4%. Common clinical features includes yet to speak, restlessness/stubborn and not responding to command in 60.4%, 48.5% and 46.5% respectively. Commonest type of hearing impairment was sensorineural hearing loss is 61.4%. Type A tympanometry (normal) was the commonest findings in 82.2%. CONCLUSION: Preschool children hearing impairment with late presentation is a common otologic diseases burden to parent and otorhinolaryngologist in our center. The common causes were preventable with resulting permanent auditory damage.

Pattern of allergic rhinitis among children in Ekiti, Nigeria.

BACKGROUND: Allergic rhinitis is a chronic and recurrent nasal condition. It is often neglected in children with late presentation. This study aimed at determining the prevalence, sociodemographic features, comorbid illnesses, complications and quality of life in children with allergic rhinitis in the study institution. MATERIALS AND METHODS: This is a prospective hospital based study of children with allergic rhinitis in Ekiti state university teaching hospital, Ado Ekiti. The study was carried out in ENT department over a period of two years (between June 2015 to May 2017). Informed consent was obtained from the parents/guardian/patients and consented patients were enrolled into the study. Data were obtained by pretested interviewers assisted questionnaire. Details of their history, physical examination and investigations were carried out and findings were documented. All data obtained were descriptively analysed using SPSS version 18.0 and presented in simple tables and charts. Ethical clearance was sought for and obtained from the ethical committee of the hospital. RESULTS: A total of 4341 patients were seen out of which 265 were children with allergic rhinitis. Prevalence of allergic rhinitis in children in this study was 6.1%. There were 63.0% males with male to female ratio of 2:1. Allergic rhinitis was peaked at preschool age group (1-5 years) accounted for 47.9%. A total of 42.3% participants were living in urban setting while 57.7% were from rural setting. Majorities (40.4%) of the patients were in nursery and parent's major occupation was mainly farming in 27.2%. There was positive family history of allergy in 54.7% patients. Perennial allergic rhinitis were noted in 63.8% patients while seasonal allergic rhinitis were noted in 36.2% patients. Major form of allergens was inhalant 81.8% and the least form of allergen was ingestant 5.7%. The commonest identified trigger factors among the study population were as follows: dust, cold weather and smoke which were accounted for 59.6%, 37.4% and 18.9% of the study patients respectively. Other noted triggering factors were soap and perfume which accounted for 4.2% and 1.1% respectively. Major associated comorbid illnesses among the patients were tonsils hypertrophy, adenoid hypertrophy and inferior turbinate hypertrophy which accounted for 55.5%, 46.4% and 40.4% respectively. Clinical presentations of allergic rhinitis in this study were mainly 75.8% nasal blockage, 65.3% runny nose and 8.5% recurrent sneezing. Commonest complications of allergic rhinitis were 35.1% pharyngitis, 32.1% otitis media and 28.3% headache. Treatment of allergic rhinitis leads to improvement on the clinical features in 90.1% patients. No significant improvement in clinical features were noticed in 9.8% patients. None of the studied patients reported worse clinical condition after treatment of allergic rhinitis. No mortality was recorded from allergic rhinitis in this study. CONCLUSION: Allergic rhinitis affect all paediatric age group and there were delayed presentation in the participants. There were associated comorbid illnesses, complications and affectation of quality of life at presentation in majority of the patients.

The Role of Preoperative Evaluations in Otorhinolaryngological Procedures.

BACKGROUND: Routine laboratory investigations are important in preoperative preparation of otorhinolaryngological, head and neck patients to assess and to prevent operative risks. This study aimed at determining the American Society of Anesthesiologist (ASA) classification of the preoperative patients, causes of delayed surgery, associated comorbidity and abnormal laboratory investigation results in ear, nose, and throat surgical practice in a low-resource setting. MATERIALS AND METHODS: This is a prospective hospital-based study of patients being worked up for elective surgical procedures in Ekiti State University Teaching Hospital, Nigeria, from January 2014 to December 2016. Patients that gave consent were enrolled into the study. Interviewer-assisted questionnaires were used to obtained data from the patients. Data obtained were collated and statistically analyzed by using SPSS version 16. RESULTS: A total of 424 patients were enrolled into the study. Males constituted 61.8% and male to female ratio was 2:1. Majority, i.e. 69.8% of the patients belonged to the ASA Grade I. Preoperative findings leading to delayed surgery occurred in 17.9% of the patients. They were due to 2.4% arterial hypertension and 6.4% delayed routine laboratory investigations results. The overall comorbid illness was 21.2%. Major comorbid illnesses were 2.4% arterial hypertension and 6.8% diabetes mellitus. The types of surgery in the patients were 14.6% ear surgery, 12.3% nasal surgery, and 59.2% throat surgery. Delayed surgery occurred in 25.5% of the patients. The most common findings were 6.8% anemia, 6.3% abnormal prothrombin/international normalized ratio, and 5.7% blood electrolyte and urea. CONCLUSION: All surgical conditions are peculiar with different comorbid illnesses which can lead to untoward outcome. Adequate preoperative evaluation and preoperative laboratory investigation of ear, nose, and throat conditions are mandatory to detect subclinical illnesses in poor-resource setting.