Hearing dynamics in patients with traumatic tympanic membrane perforation.

BACKGROUND: Hearing distortions from trauma to the ear could occur by direct perforation of the tympanic membrane. AIM: To characterize hearing thresholds in patients with traumatic tympanic membrane perforation and changes in hearing occurring in the course of treatment. STUDY DESIGN: Prospective analytical study. SETTING: Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. METHODOLOGY: We prospectively entered in a proforma the demographics of 60 patients with traumatic tympanic membrane perforation at the teaching hospital in Sagamu, Nigeria over a period of five years as well as their hearing assessment with pure tone audiometry at initial contact and six weeks post-injury. The type of hearing loss, pure tone average and air-bone gaps were recorded. Hearing changes between initial and second audiometric assessments were analyzed and compared. RESULTS: The data obtained from 60 patients with 73 traumatized ears were analyzed. In all, 64 (87.7%) of the ears had hearing loss while 33(45.2%) had conductive hearing loss. Injured ears had significantly worse hearing and higher air-bone gaps ABGs compared with non-traumatized ears. There was notable improvement in hearing thresholds and closure of air-bone gaps in the course of treatment, which was significantly more at the low frequencies compared with the high frequencies. CONCLUSION: Patients with traumatic tympanic membrane perforation majorly had conductive hearing loss in the injured ears with audiometric confirmed air-bone gaps and increased hearing thresholds which were not frequency dependent. There was appreciable improvement in hearing parameters over time, significantly more at the low frequencies.

An audit of the Day-of-Surgery Cancellation of Scheduled Surgical Procedures in Sagamu, Nigeria

Background: Timely performance of scheduled surgical procedures may be an indirect method of assessing the quality of surgical services in a hospital.Objective: This study aimed to determine the rate and the reasons for day-of-surgery cancellation of elective surgical procedures.Methods: A prospective study was conducted at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria to audit the type of surgery and the reasons for the cancellation of procedure among patients scheduled for elective surgical procedures.Results: A total of 1,324 patients were scheduled for elective surgeries during the period of audit and 268 (20.2%) were cancelled on the day of surgery. One hundred and seventy-four of the 268 (65.0%) cancellations were avoidable while 94 (35.0%) cancellations were unavoidable. The reasons for the cancellation of surgeries included patient-related factors (35.0%), unfavourable pre-operative clinical evaluation (31.0%), facility-based factors (28.0%) and surgeon-related factors (6.7%).Conclusion: The day-of-surgery cancellation rate was 20.2%, and the three leading causes of cancellation of elective surgeries in Sagamu included patient-related factors, unfavourable pre-operative clinical evaluation and inadequacies of hospital resources

KNOWLEDGE OF CERUMEN AND EFFECT OF EAR SELF-CLEANING AMONG HEALTH WORKERS IN A TERTIARY HOSPITAL.

BACKGROUND: Ear wax lubricates, cleans and protects the external auditory canal while ear self-cleaning can lead to ear infections, trauma and perforation of the tympanic membrane. An erroneous understanding of these facts can lead to wrong practices with grievous consequences. OBJECTIVE: To assess the knowledge on ear wax and the effects of ear self-cleaning among health workers in Nigeria. MATERIALS AND METHODS: A cross-sectional study was done on health workers in a tertiary hospital in Nigeria with administration of structured questionnaire. Knowledge of the participants on the effect of ear self-cleaning were classified as poor, fair or good based on the calculation of their knowledge score. RESULTS: Out of 150 respondents, 10.7% of them had good knowledge of ear wax and the health effects of self-ear cleaning while 51.3% had poor knowledge. There was strong association between knowledge score and occupation (x2=24.113, P=0.007), while there was no association between knowledge score and practice of ear self-cleaning. CONCLUSION: Most respondents had poor knowledge of the function of ear wax and the damage to the auditory canal associated with ear self-cleaning. There is thus, the need for public enlightenment on the complications of the practice.

Trends in the clinical Pattern, diagnosis and management of rhinosinusitis in a sub-urban tertiary health centre

Background: Rhinosinusitis (RSS) is a common form of upper airway disease encountered by Otolaryngologists. Objectives: To describe the trends in the clinical presentation, diagnosis and management of RSS in a tertiary hospital.Methods:Retrospective analysis of clinical information retrieved from the hospital records of patients with RSS managed in the ENT department of OOUTH Sagamu over an 18-month period was done.Results: Out of 1814 patients, 143 had RRS with the prevalence rate of 7.9%. The male-to-female ratio was 1.1:1, the age ranged from 7 to 79 (median = 32.4) years. The presenting symptoms included mucoid nasal discharge (68.7%), nasal congestion (61.5%) and excessive sneezing (46.8%). Most (71.3%) of the patients presented after 3weeks of the onset of symptoms and the median duration was 3.2 months. The leading physical findings included engorged nasal turbinates (78.3%), ooedematous nasal mucosa (72.0%), mucopurulent anterior rhinorrhoea (28.6%) and pale nasal mucosa (25.9%). The investigations done included plain X-Rays of the sinuses (86.0%), full blood count (67.1%) and computerized tomographic (CT) scan of the sinuses (8.4%). Plain X-Ray abnormalities were most common in the maxillary sinuses (45.5%) while 30.1% had multi-sinusitis. The trend of diagnosis ranged from infective RSS in 51.7% to allergic RSS in 38.5%. About a quarter had different forms of non-endoscopic surgical intervention. Recorded complications included nasal polyps in 11.9%. Conclusion: The trend of RSS observed relative affectation of adults and mostly chronic infective types, and sometimes allergic types.Radiological assessment was by plain X-Rays in most cases, management was either medical or non-endoscopic surgical methods, frequently complicated by polyps

Awareness and attitudes to noise and its hazards in motor parks in a sub-urban Nigerian town.

AIMS AND OBJECTIVES: The study assessed awareness and attitudes of people working in the environment (users) of the motor parks (but not travelers), in a sub-urban town to environmental noise and its hazards. SUBJECTS AND METHODS: Regular users of major motor parks in Sagamu were administered with pretested structured questionnaire to obtain information on their awareness and attitudes concerning noise and NIHL at the parks. Descriptive and comparative analysis of the data obtained was performed by using SPSS version 15.0. RESULTS: Data from 387 subjects were analysed; 61.2% were males, mean age was 35.5 11.4 years, 56.8% had secondary school education, and 50.6% were vehicle drivers or conductors. 51.2% ascribed vehicular traffic the major source of noise generation at the parks, while average noise level was 84.1 ± 6.0 dBA. Among the subjects, 61.2% approved motor park was noisy, 47.8% (185/387) were aware of NIHL. Awareness did not change with age and sex, but increased significantly with level of education. 51.9% were concerned about the noisy environment, 12.7% (49/387) protected themselves from the effect of the noise, 6.1% used ear plugs. Attitudes of the users did not change with age, sex, and level of education. CONCLUSIONS: Noise level at the motor parks were marginally high, awareness of the users to noise and its hazards was relatively high but attitudes concerning protection from noise hazards was poor. Health education for the users and noise regulation at the parks were recommended.

An unusual foreign body in the ear of an elderly Nigerian patient.

This was a case of an incidental finding of an unusual foreign body in the right ear of an elderly Nigerian patient. The mode of presentation, the manner of discovery and how it was managed successfully were highlighted. We reported this case to create awareness, and encourage physicians to always observe effluents obtained from irrigation of body cavities for confirmation of diagnosis and documentation.

Profile of ear diseases among elderly patients in Sagamu, south-western Nigeria.

BACKGROUND: The elderly constitute a vulnerable group which other people often misunderstand, misrepresent and are potentially prone to abuses and suboptimal care. Ear diseases are important as they may affect the wellbeing of elderly patients and their quality of life. This study took an inventory of the pattern of ear diseases among elderly patients. METHODS: A five year descriptive retrospective analysis of the clinical information on the elderly patients who presented with Ear Diseases at the ENT Clinic of our hospital. RESULTS: Data was retrieved from 165 patients and analyzed. Average age was 70 years and females constituted 53.3% of the patients. The three leading symptoms experienced by the patients were tinnitus (84.2%), hearing loss (72.1%) and earache (32.7%) while 57.0% of the diseases affected both ears. The major clinical diagnoses were Presbycusis (38.2%), Otitis (25.5%), and wax impaction (18.8%). Majority (67.3%) of the patients had single pathology while most of the ear diseases affected the inner ear. CONCLUSION: There was a relatively high prevalence of ear diseases among our elderly patients. The need for proper clinical evaluation of patients with ear diseases was emphasized. The importance of screening for hearing impairment in the elderly patients was also stressed.

Clinical and audiometric features of presbycusis in Nigerians.

BACKGROUND: Presbycusis is the most common sensory impairment associated with ageing and it presents with variability of symptoms. Physicians need to recognize early clinical and audiometric signs of presbycusis in order to render adequate and quality care to patients and reduce associated morbidities. OBJECTIVE: To characterize the clinical modes of presentation and the typical audiometric tracings among patients with presbycusis. METHODS: This descriptive, prospective hospital-based study was conducted in the Ear, Nose and Throat (ENT) clinic of Olabisi Ona hing Hospital, (OOUTH) Sagamu, Nigeria. Patients with clinical diagnosis of presbycusis confirmed with bilateral sensorineural hearing loss (SNHL) on diagnostic audiometry were administered with questionnaires. Information obtained was analyzed using SPSS statistical package version 17.0 and presented in descriptive forms as percentages, means and graphs. RESULTS: Sixty-nine patients were diagnosed with presbycusis (M:F =1.6:1). Modal age group was 71-80 years. Hearing loss 88.4%, tinnitus 79.7% and vertigo 33.3% were the major symptoms on presentation. The average duration of symptoms before presentation was 2.6 years. There was positive history of ototoxic drugs usage in 24.6 %, family history in 11.6 %, hypertension in 34.8% and osteoarthritis in 13.0%. The most common type of audiometric pattern was strial. Hearing losses increased with age both at the speech and at the higher frequencies of sounds. CONCLUSIONS: We found hearing impairment affected both speech and higher frequencies and the strial type of audiometric pattern was most common. The need for screening for hearing impairment from early middle age in symptomatic individuals is emphasized.

Sleep disordered breathing (SDB) experiences associated with snoring in adult Nigerians.

BACKGROUND: Snorers often experience symptoms of sleep disordered breathing (SDB) which is largely undiagnosed in the population. Information on SDB experiences is needed to target high-risk individuals that may benefit from treatment of snoring. OBJECTIVE: This study compares the experience of the nighttime and daytime symptoms of SDB of habitual snorers with that of non-habitually snoring adult subjects in a tertiary health facility in Nigeria. METHODS: A cross-sectional, comparative, hospital based study was conducted. Berlin questionnaire was administered to consecutive adult patients (subjects) attending ENT Clinic of OOUTH, Sagamu, Nigeria. Based on the responses to their experience of snoring, the subjects were categorized as habitual snorers or non-habitual snorers. General physical examinations with emphases on the nose, throat and neck were performed on the subjects. The experiences of nighttime and daytime symptoms of SDB were recorded and those of habitual snorers compared to non-habitual snorers. RESULTS: One hundred and ninety- five subjects participated in the study. M:F =1.3:1. Overall prevalence of snoring was 37.9% and habitual snoring was 18.5%. Habitual snoring was significantly associated with age, marital status and obesity (BMI>=30.0). There were statistically significant increased odds of experiencing the nighttime and daytime symptoms of SDB in habitual snorers compared to non-habitual snorers. CONCLUSION: Adults that snore habitually had significantly more nighttime and daytime symptoms of SDB compared to those who do not snore habitually. Habitual snoring predisposes adult subjects to experiencing symptoms of SDB.

An unusual faciocerebellar arrow injury: successful surgical removal in a peasant Nigerian: a case report.

INTRODUCTION: Reports of penetrating injuries of the cranium have been mainly craniocerebral or faciocerebral, craniocerebellar projectiles are few. CASE: We present a case of a 23 year old Nigerian with a craniofacial penetrating injury by a hunting arrow. The trajectory of the arrow through the facial skeleton across the craniocervical junction into the posterior fossa makes this unique in the literature. Successful operative retrieval by a joint team of neurosurgeons and otorhinolaryngologists, problems of delayed presentation and inadequate diagnostic facilities are highlighted. CONCLUSION: The morbidity-free outcome of surgical removal despite the delay in presentation and management in our practice setting with limited facilities are the salient points of this presentation.

Nasal foreign bodies in the African children.

Nasal foreign bodies are very common in daily clinical practice. Their simplicity in pathology and diagnosis often gives the wrong impression of little or no risk of complications. A 5-year (1998 - 2002) prospective study of 106 patients with nasal foreign bodies was done to evaluate and present the patterns, possible challenges and complications or problems in the management of this condition in the Nigerian Africans. The male to female ratio was 1:1.26 (M 47; F 59) and with an average age of 3 years. The duration of symptoms ranged from degrees hour to 4 years with 74 (69.8%) presenting within 24 hours and 27 (25.5%) presenting after 24 hours. The most common nasal foreign bodies were seeds 34 (32.1%), polyurethane foams 12 (11.3%), stones 11 (10.4%), plastic 10 (9.4%), beads 6 (5.7%) and erasers 6 (5.7%). The objects were found in the right nasal cavity in 63 (59.4%) cases while 43 (40.6%) in the left nasal cavity. The various clinical presentations were history of insertion of foreign bodies 91 (85.8%), 15(14.2%) with no history of insertion, mucopurulent nasal discharge 25 (23.6%), foul nasal odour 10 (9.4%), epistaxis 6 (5.7%), nasal obstruction and mouth breathing 3 (2.8%) and 2 (1.9%) cases respectively. The main complications were nasal infections (23.6%), epistaxis (5.7%), and purulent maxillary sinusitis (1.9%) seen in this study. These are preventable complications if the patients present early to the hospital. The absence of enough E.N.T. specialists however still plagues developing countries like Nigeria. A call is therefore made for more specialists in this area for early detections and care of these cases.

Upper airway obstruction in Nigeria: an aetiological profile and review of the literature.

The early history of tracheostomy and intubation suggested that upper airway obstruction had been in existence for a long time. A study of 80 patients with upper airway obstructions treated over a 10-year period between 1990 and 1999 was carried out to determine the aetiology and incidence. There were 65 (81%) males and 15 (19%) females with a sex ratio of 4.3:1 (M:F). The age ranged from 6 months to 70 years; with mean age of 27 years. Ninety-nine per cent were acquired causes and 1% were congenital. The commonest site of obstruction was in the larynx 81%. In children, the most common causes were laryngeal papilloma (16%) and foreign body (14%), while in adults, laryngeal carcinoma (24%) and direct laryngeal injuries (15%). The study revealed a wide range of causes of upper respiratory tract obstruction encountered in a developing tropical country. Health education and community awareness programmes should be supported. This would encourage early presentation, prompt referral to experts and earlier treatment with improved outcome.