Cross-over septal flap technique for choanal atresia surgery in two centres: how I do it.

BACKGROUND: Choanal atresia is a congenital obstruction of the posterior nasal aperture. Endoscopic endonasal surgery has led to successful choanal atresia repair. This paper describes our surgical technique using septal mucosal flaps without the need for stenting. METHODS: This study comprised a multicentre retrospective review of patient notes. A cross-over septal technique is described, whereby bilateral vertical mucosal incisions are made at the posterior third of the septum, and the atretic plate and posterior vomer are removed. One flap is pedicled superiorly and rotated over the bare skull base and sphenoid bone; the contralateral flap is pedicled inferiorly to cover the exposed vomer remnant and hard palate. RESULTS: There were 12 patients from 2013 to 2020, aged 0.07-50 years, with a male to female ratio of 1:5. Ten patients had unilateral and two had bilateral choanal atresia. Nine patients had bony choanal atresia, with the remainder mixed. CONCLUSION: The cross-over technique for choanal atresia has low morbidity and 100 per cent success in our series. The use of mucoperiosteal flaps to cover exposed bone and minimal instrumentation to the lateral nasal wall reduce post-operative stenosis.

ADENOTONSILLECTOMY: CARE GIVERS' RECALL OF INFORMATION ON RISKS PROVIDED DURING INFORMED CONSENT PROCESS.

BACKGROUND: "Informed consent" for surgery has been widely researched; however, there is no local data on surgical risk recall by care givers' (usually a parent) of children undergoing adenotonsillectomy (Ts &A). AIM AND OBJECTIVE: This study evaluated care givers' recall of the surgical risks for Ts&A after verbal explanation compared to combined verbal and written explanation in the informed consent process. DESIGN OF THE STUDY: This was a prospective randomized comparative study of fifty parents/guardians of patients undergoing tonsillectomy and adenoidectomy for obstructive sleep disorders. SETTING: The E.N. T. Unit, Korle Bu Teaching Hospital, Accra, Ghana. MATERIALS AND METHODS: Parents/guardians of children were randomized to only verbal explanation or combined verbal and written explanations prior to signing informed consent a day before their wards' operation. Recall of surgical risks explained in the informed consent procedure was evaluated two days postoperatively. The rates of surgical risk recall for the two groups were analysed and compared. RESULTS: There were no significant differences in the demographic characteristics of the parents/guardians. The overall recall rate for surgical risks for the whole group was 46.0%. The surgical risk recall rate for the verbal explanation group, 44.4% was not significantly different from that for the combined verbal and written explanation group, 47.2% (p=0.624). There was a weak but significant positive correlation between risk recall scores and parental level of education (Spearman rs=0.306; p = 0.015). CONCLUSION: Among parents/guardians whose children were undergoing adenotonsillectomy, combining written explanation with verbal explanation in the informed consent process did not significantly improve postoperative surgical risks recall rate when compared with only verbal explanation. The overall risk recall rate was 46.0%. A study with larger sample sizes is recommended to confirm these findings.

Aetiological agents of ear discharge: a two year review in a teaching hospital in Ghana.

BACKGROUND: The discharging ear is a common presentation in medical practice affecting all age groups but primarily children. This study shows the current aetiological causes of ear discharge and their antibiograms, data which would guide empirical treatment of ear infections, and also form a basis for further research. METHODOLOGY: This was a retrospective review of laboratory records of all ear swabs submitted for culture over a two year period in the Korle Bu Teaching Hospital Accra, Ghana. Data was obtained on demographic characteristics of patients, clinical diagnosis, isolated organisms and antibiotic susceptibility patterns of the isolated organisms. Data was analyzed by simple descriptive statistics. RESULTS: A total of 351 ear swabs were received by the laboratory for processing over the two year period. Of these 277(78.9%) had microorganisms isolated. A significant number127 (47%) was obtained from children under five years. Pseudomonas spp was the commonly isolated organism 121(46%) followed by Staphylococcus aureus 33(12.5%) and Proteus spp 32(12.2%). Candida was the commonest isolated fungi 9 (69.2%). Susceptibility of Pseudomonas spp to commonly used ototopics (ciprofloxacin & gentamicin) was 93% and 74% respectively. CONCLUSIONS: Most cases of the discharging ear were found in children under the age of five years. The most common bacteriologic cause of the discharging ear was Pseudomonas spp followed by Staphylococcus aureus. Candida species was the commonest fungal cause of ear discharge. Ciprofloxacin and gentamicin are effective ototopic antimicrobial agents for empirical treatment of the discharging ear.

Quality of life outcomes of adenotonsillectomy for obstructive sleep disorders: our experience in a Tertiary Care Centre in Ghana.

BACKGROUND AND OBJECTIVES: Obstructive Sleep Disorders (OSDs) impacts negatively on the quality of life of children. However the long term outcomes of adenoton-sillectomy remain unknown. The aims and objectives of this study was to assess the long term quality of life of Ghanaian children with OSDs undergoing adenotonsillectomy. METHODS: The subjects for this study were cohort of children who were part of a study named Study1 carried out at E.N.T. Unit, Korle Bu Teaching Hospital, Accra. These children had adenotonsillectomy for OSDs and their quality of life were evaluated preoperatively and again four to six weeks post operatively using Obstructive Sleep Apnoea 18 (OSA 18 ) questionnaire; a quality of life assessment tool. Thirty five children who were at least nine months post adenotonsillectomy were invited to a follow up E.N.T.clinic for the current study named Study 2 and their quality of life were again evaluated using OSA 18 questionnaire. RESULTS: Thirty-one children with a mean age of 5.08 ± 0.95 years were seen. The mean OSA-18 preoperative score for Study1 was 4.27 ± 0.27; the mean OSA 18 post operative scores for Study1 and Study 2 were 1.93 ± 0.25 and 1.78 ±0.31 respectively. There was a significant reduction in the mean post operative OSA 18 score for both studies compared to the corresponding preoperative mean score (p-value = 0.001). The mean postoperative overall quality of life scoresfor Study 1 and Study2 were 8.52 ± 0.53 and 7.68 ± 1.06 respectively. CONCLUSION: There was significant improvement in long term quality of life outcomes following adenotonsillectomy for OSDs.