Pattern of tympanic membrane perforation in a tertiary hospital in Nigeria.

BACKGROUND/OBJECTIVES: Tympanic membrane perforation is a common otological disorder with associated hearing impairment. This study aimed at determining the clinicoepidemiological pattern, etiological factors, clinical presentation, and management of tympanic membrane perforation in a tertiary hospital in Nigeria. MATERIALS AND METHODS: This was a prospective, hospital-based study of patients with the clinical finding of perforated tympanic membrane. The study was carried out over a period of 5 years (September 2012 to August 2017). Interviewer-assisted questionnaire was administered to obtain the detailed history and clinical findings from consenting patients. Data collected were collated and analyzed using SPSS version 16.0. RESULTS:: A total of 529 patients had tympanic membrane perforation, of which 368 (69.6%) were males and 161 (30.4%) were females with a male-to-female ratio of 2:1. The prevalence of tympanic membrane perforation in this study was 7.8%. The most common presenting symptom among the patients was otorrhea in 81.5%, otalgia in 72.8%, and tinnitus in 55.7%. Acute suppurative otitis media was a cause of tympanic membrane perforation in 28.4% of the patients while 55.7% of the patients proceed to chronic suppurative otitis media. Unilateral tympanic membrane perforation was 79.0%. The left ear tympanic membrane perforation was 43.9%. Grade 1 tympanic membrane perforation accounted for 39.3% while grade 2 accounted for 32.3%. The most common types of tympanic membrane perforation were central in 38.2%, anterior central in 32.3%, and posterior central in 19.3%. Conductive hearing impairment accounted for 61.6% while sensorineural hearing impairment 25.3%. The most common degrees of hearing impairment were mild and moderate and accounted for 47.1% and 25.1%, respectively. The most common complications of tympanic membrane perforation were hearing impairment in 52.6%. Majority of the patients (425) were treated conservatively, six had fat patches, while 98 were treated surgically. Tympanic membrane perforation healed at the end of 3 months in 81.5%, while 18.5% did not heal after 3 months. CONCLUSION: Tympanic membrane perforation arises mainly from middle ear infections and traumatic causes. At presentation, size and location of perforation vary which depend on duration of infection or the traumatic causes.

PAEDIATRIC OTORHINOLARYNGOLOGICAL PRESENTATION OF HALITOSIS IN A DEVELOPING COUNTRY.

BACKGROUND: Halitosis is a common medico social symptom among children. AIM: To determine the clinical, epidemiological patterns, aetiology and psycho-social issues of halitosis among children in a tertiary hospital in Nigeria. METHODOLOGY: This was a prospective hospital based study of children with complaints of halitosis. The study was carried out in Ear, Nose & throat Department, Ekiti State University Teaching Hospital, Ado Ekiti over a period of two years, (October 2015 to September 2017). Consent was obtained from the parents/guardian. Data was obtained by using pretested interviewer assisted questionnaire.All the data obtained were collated and analyzed by using SPSS version 16.0. Ethical clearance was obtained from the ethical committee of the institution. RESULTS: The prevalence of halitosis in this study was 6.8% and there were 58.5% males and 41.5% females with a male to female ratio of 1.5:1. Their age ranged from 1 year - 18 years with a mean of 9.48 ± 5.84 SD years.Sources of referral for the otorhinolaryngology, head and neck care were mainly from general practitioners (52.3%) and from pediatricians (24.6%). Halitosis was noticed by family members in 50.8% and from family friends in 23.1%. Nasal and throat diseases in 49.2% and 29.2% respectively were the commonest otorhinolaryngology, head and neck disorders that were responsible for halitosis. The major causes were rhinosinusitis in 24.6%, impacted nasal foreign body in 23.1% and adenotonsillar hypertrophy in 18.5%. Associated disabilities in children and family with halitosis include social withdrawal in 35.4%, low social interaction in 32.3% and depression in 29.2%. Acute halitosis (<3/12) accounted for 50.8% while chronic halitosis (>3/12) accounted for 49.2%. In all, fifty four (83.1%) of the patients were successfully treated. CONCLUSION: Bad breath is a common ear, nose and throat symptom in children it is commonly due to nasal and pharyngeal diseases which are amenable to treatment.

Open mastoidectomy and temporalis flap in the control of chronic otorrhoea.

Open mastoid surgery still remains a principal operative treatment for chronic discharging ear. The indications for this procedure still abound in the tropics although it is rarely done in the developed countries nowadays. This series re-emphasize the control of chronic otorrhoea and operative wound infection as benefiting from a combined open mastoidectomy and reconstruction with deep temporalis fascia flap in children. The operative technique is further discussed. It is our hope that repopularising this procedure will help in the control of highly prevalent chronic ear in the tropical environment.

Acute laryngeal obstruction in a Nigerian Hospital: Clinical presentation and management.

OBJECTIVES: To determine the clinical presentations and management of patients with acute laryngeal obstruction. PATIENTS AND METHODS: A retrospective study of 36 patients with acute laryngeal obstruction to the accident and emergency unit (A&E), emergency paediatric unit (EPU) and the Ear, Nose and Throat diseases clinic (ENT) of the University of Ilorin Teaching Hospital between January 1998 and the December 2002 are presented. RESULTS: The age ranges of the patient were between 1.5 years to 46 years (mean age 29.6 years with male/female ratio of 2:1 Breathlessness (83.3%), hoarseness (66.7%), and noisy breathing (50%) were the main symptoms at presentation. CONCLUSIONS: These 36 patients represented 4.9 % of the in-patients seen by the Otolaryngologists during the period under review and 75% of cases of acute upper airway obstruction managed during this period. The commonest cause of obstruction in this study was laryngeal tumours (47.2%)-laryngeal carcinoma (27.8%) in the adults and juvenile laryngeal papillomas (19.4%) in the paediatric age group; other causes were laryngeal infections (acute and chronic) represented 20% of aetiologic factors. Impacted laryngeal foreign bodies occurred in 5(13.9%) all in the paediatric age group. Eleven (30.6%) were managed conservatively with antibiotics and antikoch's therapy; 12(33.3%) had emergency tracheostomy prior to definitive treatment of direct laryngoscopy in 10 patients (27.8%) for biopsy, removal of foreign bodies and extirpations of juvenile laryngeal papillomas and 3(8.3%) were managed by endotracheal intubations. Health education of the public is recommended to ensure early presentation in hospital as soon as symptoms of laryngeal tumours are noticed and health care providers should refer such cases early.