Audit of Adenotonsillar surgeries in a Tertiary Facility in Uyo, South-south Nigeria

Background:Adenoid and tonsils are lymphoid tissues that occupy the nasopharynx and tonsillar fossae and serve as the initial site of immunological contact for inhaled and ingested antigens. Adenoidectomy, tonsillectomy or adenotonsillectomy is a lifesaving surgical procedure and remains a leading reason of surgical admission in general otorhinolaryngological practice both in developed and developing countries.The study aims to audit adenotonsillar surgeries in the Department of Ear, Nose and Throat in University of Uyo Teaching Hospital, and compare findings with similar studies.Method:This is a retrospective study of patients who had adenoidectomy, tonsillectomy, or adenotonsillectomy over 5 years from January 2015 to December 2019 at the Department of Ear, Nose, and Throat, University of Uyo Teaching Hospital, Uyo, Akwa Ibom state, south-south Nigeria.Results:Atotal of 526 patients were recruited, and this accounted for 38.7% of the total ENTsurgeries performed within the study period. Ages ranged from 6 months to 72 years, with a mean age of 11.89+1.03. The majority of the patients were aged between 1-5 years and the commonest presenting symptom was snoring and mouth breathing (79.5%). Sleep-disordered breathing (55.7%) was the main indication for the surgeries. Adenotonsillectomy (61.0%) was the commonest surgery performed. About 1.0% of the patients had recurrent adenoids. Conclusion: The surgeries were of immense necessity to the patients as all presenting complaints and pre-operative diagnoses became completely resolved.

Combined transfacial and transcranial approach for tumours of the nose and paranasal sinuses with intracranial extension.

OBJECTIVES: To describe the importance of craniofacial approach in extensive tumours of the nose and paranasal sinuses with intracranial extension. MATERIALS AND METHODS: This is a retrospective study and descriptive analysis of craniofacial approaches to extensive tumors of the nose and paranasal sinuses that were carried at Usmanu Danfodiyo university teaching Hospital Sokoto Nigeria over a nine year period (July 1999 to June 2008). RESULTS: Out of 111 patients seen with tumours of the nose and paranasal sinuses during the period, 29(26.1%) were radiologically reported through computerised tomographic scan to have intracranial extension. Twenty-four (82.8%) were males while 5 (17.2%) were females. Twenty five (86.2%) patients underwent transfacial approach ( modified lateral rhinotomy). Intraoperative findings in these cases only warranted the repair of dural tear in 6 cases through the transfacial approach who had anterior skull base invovlement while 4 had combined transcranial and transfacial approaches (anterior craniofacial resection). Therefore only 10 (34.5%) patients of all the radiologically reported cases of intracranial extension were confirmed intraoperatively to have intracranial extension (5 males, 5 females) with an age range of 1 1/2 to 60 years and mean age of 34.1 years. One patient had orbital exenteration also carried out. Four out of 10 patients are alive after a minimum period of 2 years follow up due to extensive intracranial spread and late presentation of the patient. CONCLUSION: Extensive tumours of the nose and paranasal sinuses with suspected intracranial extension requires not only computerized tomographic scans to assess the extent of the tumour but also a combined transfacial and transcranial approach to successfully resect the tumour.

Combined transfacial and transcranial approach for tumours of the nose and paranasal sinuses with intracranial extension.

OBJECTIVES: To describe the importance of craniofacial approach in extensive tumours of the nose and paranasal sinuses with intracranial extension. MATERIALS AND METHODS: This is a retrospective study and descriptive analysis of craniofacial approaches to extensive tumors of the nose and paranasal sinuses that were carried at Usmanu Danfodiyo University Teaching Hospital, Sokoto Nigeria over a nine year period (July 1999 to June 2008). RESULTS: Out of 111 patients seen with tumours of the nose and paranasal sinuses during the period, 29(26.1%) were radiologically reported through computerised tomographic scan to have intracranial extension. Twenty-four (82.8%) were males while 5 (17.2%) were females. Twenty-five (86.2%) patients underwent transfacial approach (modified lateral rhinotomy). Intraoperative findings in these cases only warranted the repair of dural tear in 6 cases through the transfacial approach who had anterior skull base invovlement while 4 had combined transcranial and transfacial approaches (anterior craniofacial resection). Therefore only 10 (34.5%) patients of all the radiologically reported cases of intracranial extension were confirmed intraoperatively to have intracranial extension (5 males, 5 females) with an age range of 1 1/2 to 60 years and mean age of 34.1 years. One patient had orbital exenteration also carried out. Four out of 10 patients are alive after a minimum period of 2 years follow up due to extensive intracranial spread and late presentation of the patient. CONCLUSION: Extensive tumours of the nose and paranasal sinuses with suspected intracranial extension requires not only computerized tomographic scans to assess the extent of the tumour but also a combined transfacial and transcranial approach to successfully resect the tumour.

Laryngeal tumours: clinical pattern in Sokoto, Northwestern Nigeria.

BACKGROUND: Laryngeal tumours may be benign or malignant presenting with progressive voice hoarseness and upper airway obstruction which may be misdiagnosed. METHOD: Patients were prospectively recruited over 6years from July 1999 to July 2005 in a tertiary health centre. RESULTS: Thirty seven cases of laryngeal tumours were seen (30 males (81.1%), 7 females (18.9%). The incidence was 6.2 cases per year. Histological diagnosis was only obtained in 30 patients (25 (83.3%) males, 5 females (16.7%). The age range was 3 months to 75 years with the mean ages (benign 6.1 years, and malignant 47.9 years). Histology of the 30 patients showed 20 (66.7%) to be malignant (Squamous cell carcinoma) out of which 17 (85%) were males and 3 (15%) females with male to female sex ratio of 5.7:1. Ten (33.3%) of the 30 cases were benign out of which 8 were males (80%) and 2 females (20%) with male to female sex ratio of 4:1.Malignant cases who had total laryngectomy, selective neck dissection with radiotherapy lived longer (minimum of 4 years) than those who had only total laryngectomy (maximum of 2(1/2) years) or only radiotherapy (6 months - 1 year). There was recurrent nodal neck lesions in 6 (30%) patients, five of which did not go for radiotherapy after surgery while one had postoperative radiotherapy. Two of these died from carotid artery rupture. Two female patients with malignant tumor who had total laryngectomy had babies born through safe vaginal delivery but eventually succumbed to the disease. CONCLUSION: There were more malignant (66.7%) laryngeal tumors than benign (33.3%) lesions with a male preponderance and strong association with cigarette smoking but no alcohol consumption. The mean age for malignant lesions was 47.9 years which signifies a considerably younger population while that of benign lesion was 6.1 years.

Genetic studies in the Nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders.

BACKGROUND: Orofacial clefts are the most common malformations of the head and neck, with a worldwide prevalence of 1 in 700 births. They are commonly divided into CL(P) and CP based on anatomic, genetic, and embryologic findings. A Nigerian craniofacial anomalies study (NigeriaCRAN) was set up in 2006 to investigate the role of gene-environment interaction in the origin of orofacial clefts in Nigeria. SUBJECTS AND METHODS: DNA isolated from saliva from Nigerian probands was used for genotype association studies and direct sequencing of cleft candidate genes: MSX1 , IRF6 , FOXE1, FGFR1 , FGFR2 , BMP4 , MAFB, ABCA4 , PAX7, and VAX1 , and the chromosome 8q region. RESULTS: A missense mutation A34G in MSX1 was observed in nine cases and four HapMap controls. No other apparent causative variations were identified. Deviation from Hardy Weinberg equilibrium (HWE) was observed in these cases (p = .00002). A significant difference was noted between the affected side for unilateral CL (p = .03) and bilateral clefts and between clefts on either side (p = .02). A significant gender difference was also observed for CP (p = .008). CONCLUSIONS: Replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the development of CL(P).

Anterior neck injuries presenting as cut throat emergencies in a tertiary health institution in north western Nigeria.

BACKGROUND: Anterior neck injuries vary in pattern and aetiology and may pose management challenges ifnot fatal. AIMS AND OBJECTIVES: To describe patterns of anterior neck injuries in a tertiary hospital north western Nigeria. MATERIALS AND METHODS: This is a prospective study of all cases of anterior neck injuries presenting as cut throat emergencies that were referred from accident and emergency department to the department of otorhinolaryngology over a nine year period (September 1999 to August 2008). RESULTS: A total number of 19 cases were seen. All were males whose age range was from 5 years to 60 years with a mean age of 21.2 years. About 78.9% of the patients were within the 2nd to 4th decades of life with a peak at the 4th decade (31.6%). Ten (52.6%) patients were cases of attempted suicide with known background of psychiatric illness, Five (26.3%) were homicidal (3 under the influence of illicit drugs), two (10.5%) were from animal assault while one was as a result of road traffic accident and another one from fall on sharp object. Patients with attempted suicide had deep open wounds exposing the pharynx, larynx or both with horizontally positioned incision wounds while homicidal cases had obliquely positioned incision wounds. Restoration of normal neck, pharyngeal and laryngeal architecture was carried out through meticulous surgical repair of various tissue layers with nasogastric tube in situ for 7-9 days. Psychiatric evaluation and treatment were carried out concurrently with patients who attempted suicide and homicide. Two patients required tracheostomy to prevent upper airway obstruction from severe laryngeal trauma. CONCLUSION: Significant proportion of emergencies from anterior neck cut throat injuries in this study were from suicidal attempts (52.6%) by people with a background history of psychiatric illness, followed by attempted homicide (26.3%) and animal assault (10.5%). Prompt surgical repair and concurrent psychiatric evaluation in attempted suicide and homicide is required.

Rhinosinusitis: a retrospective analysis of clinical pattern and outcome in north western Nigeria.

BACKGROUND/OBJECTIVES: Rhinosinusitis is the commonest viral infection in man and the commonest inflammatory disorder encountered by general practitioners, chest physicians, and otorhinolaryngologists all over the world. The clinical pattern and outcome of conventional management measures were assessed. METHOD: All new patients with the diagnosis of rhinosinusitis over a 2-year period from July 1999 to July 2001 were analyzed for clinical features, conventional radiological findings, and treatment modalities over a period of 3 years follow up. RESULTS: There were 195 (11.7%) new cases of rhinosinusitis out of a total number of 1661 patients seen over the period under review. Only 146 case notes were accessible for the study. Eighty-four (57.5%) were males and 62 (42.5%) were females. Their ages ranged from 7 months to 70 years. The main clinical symptoms and signs were nasal discharge or rhinorrhea (84.9%), nasal obstruction (24.7%), epistaxis (22.0%), and sneezing (20.6%). The duration of symptoms ranged from few days to about 10 years with 24 (16.4%) being acute cases while 122 (83.6%) were chronic cases giving a prevalence of 1.4% and 7.3%, respectively. Maxillary sinus (58.9%) was the commonest sinus involved. More than one sinus involvement accounted for 37.7% of the cases. Infective causes accounted for 67.1% of cases followed by allergy (28.8%). There were complications in 21 (14.4%) cases with orbital involvement (33.3%) being the commonest complication. Mode of treatment were medical (86.3%), and conventional surgery was carried out in 13.7% of the cases for either failed medical treatment or associated complications. Facial paraesthesia along the sites of surgery was the commonest complications, otherwise the outcome of treatment was excellent. CONCLUSION: Rhinosinusitis in this region was more of chronic (83.6%) variety than acute (16.4%) variety. Infective causes (67.1%) and allergy (28.8%) were the commonest etiological factors. About (86.3%) were amendable to medical treatment while surgical treatment was carried out in 13.7% of the cases. Rhinosinusitis should be managed medically first before recourse to surgical measures in carefully selected cases. Endoscopic sinonasal surgery is most desirable in keeping with current global trends of treatment of rhinosinusitis but where facilities do not exist, conventional surgical measures may be used.

Smokeless tobacco use in adult Nigerian population.

OBJECTIVES: The study aim was to establish the prevalence and determinants of smokeless tobacco use in Nigerian adults' population. METHODS: Across-sectional survey of 1776 adults in Yola, North-East Nigeria was carried out in June 2007.A modified World Health Organization (WHO) tobacco survey questionnaire was used for interview and data collection. RESULTS: Out of 1776 interviewed respondents, 133 (7.49%) were user of smokeless tobacco. Snuffing of tobacco powder was the most common method of using smokeless tobacco (6.8%). Fifteen (0.9%) chewed tobacco while only 2(0.1%) both chewed and snuffed tobacco. Social acceptance (21.8%) was the major reason for using smokeless tobacco. Males, 5 th and 6 th decades of life, poor education, lower socioeconomic class, Margi, Hausa and Fulani tribes were the determinants of smokeless tobacco use. About 89.5% of the smokeless tobacco users believed that smokeless tobacco was not harmful to their health. CONCLUSION: Although the prevalence of smokeless tobacco use was low among Nigerian adult population in this study. Ignorance of the potential health dangers of smokeless tobacco was rampant therefore; concerted efforts should be made to discourage the use of all forms of tobacco rather than concentrating on cigarette smoking.

Endoscopic and external surgical approach to paranasal sinus mucocele.

Mucoceles of the paranasal sinuses are not common, but usually present as cystic lesions causing facial asymmetry requiring surgery. Hitherto surgical attempts at excision were external surgical approaches with the use of stents to drain the frontoethmoidal sinus, if they were the principal sinus involved, for a variable period. Recent advances in endoscopic sinus surgery have made the endoscopic approach to surgically manage paranasal sinus mucoceles the new trend. A total of 18 patients were seen over a ten-year period with paranasal sinus mucocele; 14 cases were managed through the external approach, while four were consecutively managed endoscopically. The endoscopic approach in the surgical management of mucoceles of the paranasal sinuses and the external approach are discussed in this article with the intent of showing the advantages of the two approaches, with more emphasis on the endoscopic approach and caution that should the endoscopic approach prove difficult, reversal to the external approach should be undertaken immediately, so as to avoid unnecessary complications.

Rhinosinusitis: A Retrospective Analysis of Clinical Pattern and Outcome in North Western Nigeria

Background/Objectives: Rhinosinusitis is the commonest viral infection in man and the commonest inflammatory disorder encountered by general practitioners; chest physicians; and otorhinolaryngologists all over the world. The clinical pattern and outcome of conventional management measures were assessed. Method: All new patients with the diagnosis of rhinosinusitis over a 2-year period from July 1999 to July 2001 were analyzed for clinical features; conventional radiological findings; and treatment modalities over a period of 3 years follow up. Results: There were 195 (11.7) new cases of rhinosinusitis out of a total number of 1661 patients seen over the period under review. Only 146 case notes were accessible for the study. Eighty-four (57.5) were males and 62 (42.5) were females. Their ages ranged from 7 months to 70 years. The main clinical symptoms and signs were nasal discharge or rhinorrhea (84.9); nasal obstruction (24.7); epistaxis (22.0); and sneezing (20.6). The duration of symptoms ranged from few days to about 10 years with 24 (16.4) being acute cases while 122 (83.6) were chronic cases giving a prevalence of 1.4and 7.3; respectively. Maxillary sinus (58.9) was the commonest sinus involved. More than one sinus involvement accounted for 37.7of the cases. Infective causes accounted for 67.1of cases followed by allergy (28.8). There were complications in 21 (14.4) cases with orbital involvement (33.3) being the commonest complication. Mode of treatment were medical (86.3); and conventional surgery was carried out in 13.7of the cases for either failed medical treatment or associated complications. Facial paraesthesia along the sites of surgery was the commonest complications; otherwise the outcome of treatment was excellent. Conclusion: Rhinosinusitis in this region was more of chronic (83.6) variety than acute (16.4) variety. Infective causes (67.1) and allergy (28.8) were the commonest etiological factors. About (86.3) were amendable to medical treatment while surgical treatment was carried out in 13.7of the cases. Rhinosinusitis should be managed medically first before recourse to surgical measures in carefully selected cases. Endoscopic sinonasal surgery is most desirable in keeping with current global trends of treatment of rhinosinusitis but where facilities do not exist; conventional surgical measures may be used

Surgical Considerations in the Management of Tumours of the Nose and Paranasal Sinuses in a Northern Nigerian Teaching Hospital

BACKGROUND: Tumours of the nose and paranasal sinuses in sub-Saharan Africa are generally characterised by late presentation posing management challenges to the otorhinolaryngologists in the sub-region. OBJECTIVES: To appraise surgical considerations in the management of tumours of the nose and paranasal sinuses in a developing nation from the experiences of an Ear; Nose; and Throat Department of a Nigerian Teaching Hospital. METHODS: This was a chart review of patients with tumours of the nose and paranasal sinuses who underwent various surgical operations over a period of four and a half years.The patients were referred by other physicians or health care workers. They were assessed clinically; backed by laboratory and radiological investigations. RESULTS: A total number of 55 patients underwent 64 surgical operations. There were 31 (56.4) males and 24 (43.6) females; giving a male to female ratio of 1.3:1. They were aged between four years and 70 years. In 46(83.6) patients the tumours had extended beyond the nasal cavity or one sinus cavity to contiguous structures. The surgical operations carried out were lateral rhinotomy in 37(57.8); intranasal clearance and intranasal antrostomy in 16(25); total maxillectomy in seven(11); and anterior craniofacial resection in two (3.1) patients.The histological examination showed that 43 (78.2) cases were benign; while 12 (21.8) cases were malignant. These malignant cases needed radiotherapy and chemotherapy. CONCLUSION: Majority of the cases were characterised by late presentation; requiring surgical approaches such as lateral rhinotomy; total maxillectomy or craniofacial resection depending on the extent of the tumour. Poverty; ignorance; inadequate funding and administration challenges of health resources are factors militating against proper clinical management of tumours of the nose and paranasal sinuses in developing nations. Provision of free medical care and modern facilities for early diagnosis; treatment; and health education are needed to reverse the trend

Smokeless Tobacco Use in Adult Nigerian Population

The study aim was to establish the prevalence and determinants of smokeless tobacco use in Nigerian adults' population. Across-sectional survey of 1776 adults inYola; North-East Nigeria was carried out in June 2007.A modified World Health Organization (WHO) tobacco survey questionnaire was used for interview and data collection. Out of 1776 interviewed respondents; 133 (7.49) were user of smokeless tobacco. Snuffing of tobacco powder was the most common method of using smokeless tobacco (6.8). Fifteen (0.9) chewed tobacco while only 2(0.1) both chewed and snuffed tobacco. Social acceptance (21.8) was the major reason for using smokeless tobacco. Males; 5th and 6th decades of life; poor education; lower socioeconomic class; Margi; Hausa and Fulani tribes were the determinants of smokeless tobacco use.About 89.5of the smokeless tobacco users believed that smokeless tobacco was not harmful to their health. : Although the prevalence of smokeless tobacco use was low among Nigerian adult population in this study. Ignorance of the potential health dangers of smokeless tobacco was rampant therefore; concerted efforts should be made to discourage the use of all forms of tobacco rather than concentrating on cigarette smoking

Prevalence of self reported allergic rhinitis and its relationship with asthma among adult Nigerians.

OBJECTIVES: The aims of the study were to establish the prevalence of self-reported allergic rhinitis in an adult Nigerian population and to examine the relationship between asthma and allergic rhinitis. METHODS: We conducted an epidemiological study of adults aged between 18 and 45 years in Ilorin, Nigeria from 2005 to 2006. An adaptation of the European Community Respiratory Health Survey questionnaire was administered by trained assistants to obtain information on demographics, history of nasal allergies, asthma symptoms, and smoking history. The participants also underwent spirometry. RESULTS: Of the 761 individuals screened, 733 were recruited, giving a participation rate of 96.3%; 441 (60.2%) were men and 292 (39.8%) were women. The prevalence of allergic rhinitis and asthma was 29.6% (n = 217) and 14.7% (n = 108), respectively. Of the individuals with allergic rhinitis, 31.8% (n = 69) had asthma and of those with asthma, 63.9% (n = 69) had allergic rhinitis. The mean (SD) age of those with allergic rhinitis was 31 (7.5) years and 65% (n = 141) were men. The determinants of asthma in individuals with allergic rhinitis were a family history of asthma (odds ratio [OR], 3.38), a history of smoking (OR, -2.58), high socioeconomic status (OR, 3.82) obesity (OR, 3.32), and wheezing (OR, 250). Lung volumes were reduced in those with both asthma and allergic rhinitis compared to those with allergic rhinitis alone. CONCLUSION: Our study revealed a high prevalence of allergic rhinitis in individuals with asthma. It is therefore important to increase awareness of the existence of allergic rhinitis and asthma as a common airway disease to ensure adequate management and control of both conditions.

Surgical management of chronic rhinosinusitis in north western Nigeria and challenges for the future.

BACKGROUND: Rhinosinusitis is usually treated medically. Surgical management is indicated when medical treatment fails or becomes complicated. Appraisal of various surgical methods employed in the treatment of chronic rhinosinusitis is the subject of this paper from a University teaching hospital in north western Nigeria. METHOD: This is a review of 75 patients who underwent various conventional surgical operations for rhinosinusitis over a 5.5 year period from September 1999 to February 2005 who were followed up for a minimum period of 2 years. RESULTS: A total number of 177 surgical operations were carried out of which 75 patients either had some surgical procedures unilaterally, bilaterally or in combinations. There were thirty nine males (52%) and thirty six females (48%) with a male to female ratio of 1:1. Their age ranges from 8 years to 70 years with a mean of 31.1 years. The ages 21-40 years range constituted majority (65.3%) of the patients. Ninety-two operations (52%) were caldwell luc (CWL) which was the commonest operation followed by forty-one (23.2%) cases of inferior meatal antrostomy (IMA), thirty two (18.1%) cases of partial inferior anterior turbinectomy (PIT), Ten (5.6%) cases of frontoethmoidectomy (FTE) and Two( 1.1%) cases of submucous resection of the septum (SMR). The indications for surgery were mainly persistent symptoms despite adequate medical treatment with radiologically confirmed evidence of ninety-seven nose or sinus pathologies in the seventy-five patients operated. These were: Chronic rhinosinusitis (CRS) with snus opacity in fifty four (55.7%) cases, CRS with polyps in eighteen (18.6%) cases, CRS with hypertrophic turbinates causing nasal obstruction in sixteen (16.8%) cases, CRS with frontoethmoidal mucoceles in five (5.2%) cases and CRS with sino-cutaneous fistula in two (2.1%) cases. Paraesthesia of the upper incissors was the commonest complaint after surgery for chronic maxillary sinusitis but at the fronto-ethmoidal region after frontoethmoidectomy which usually improved gradually and eventually disappeared between 3 to 6 months. Symptom relief after surgery justified surgery in all patients while one case needed a revision surgery after two and a half years for a recurrent symptom. There has not been any need for further surgery for the rest of the cases after a minimum period of 2 years follow up. CONCLUSION: Surgical management of rhinosinusitis in north western Nigeria was mainly for chronic rhinosinusitis and proved to be beneficial for relief of symptoms with minimal complications if patients are carefully selected either with failed medical treatment or with complications. The young population of twenty-one to forty years (65.3%) constituted the bulk of the patients with a peak at the 3rd decade anda mean age of 31.1 years.

Clinical and histological characteristics of nasopharyngeal cancer in Sokoto, north-western, Nigeria.

BACKGROUND: Cancer of the nasopharynx poses diagnostic and therapeutic difficulties because of the hidden nature of the nasopharyngeal space, which allows for significant spread of the disease before diagnosis and hence poor prognosis. OBJECTIVE: To describe the clinical and histological characteristics of nasopharyngeal cancer in a tertiarty health institution in Northern Nigeria. METHODS: Clinical features of patients with nasopharyngeal cancer presenting at the Ear, Nose and Throat clinic of a University Teaching Hospital in North western Nigeria seen over a five-year period were analysed. RESULT: A total number of 30 cases, [22 (73.3%) males and 8 (27.7%) females] with a male to female ratio of 2.8:1 were seen. The mean age was 39.1 years with the fourth decade of life recording the highest number of 16 cases (53.3%) and the least in the thirth decade. The commonest clinical features were neck swelling caused by cervical lymphadenopathy 28 (93.3%), epistaxis 25 (83.3%), nasal obstruction 20 (66.7%),and deafness 11 (36.7%). Others were otalgia 9 (30%), palatal swelling 8 (26.7%),cranial nerve involvement 7 (23.3%) and visual impairment 6 (20%). According to the UICC 1997 staging for nasopharyngeal carcinoma, 23 (76.7%) and 7 (23.3%) were T3 and T4 or stages III and IV respectively. The histological diagnoses were squamous cell carcinoma 23 (76.7%) cases, non-Hodgkins lymphoma 3 (10%) cases, plasmacytoma 2 (6.7%) cases, rhabdomyosarcoma one (3.3%) case, karposis sarcoma one (3.3%) cases. Seventeen (56.7%) patients though accepted in principle never went for radiotherapy. Only 2 (6.7%) were still alive three and six years respectively from the time of diagnosis after chemoradiation while all others (93.3%) had died within one year of diagnosis. CONCLUSION: Nasopharyngeal cancer in Northern Nigeria is characterised by presentation with advanced disease, high mortality and low 5-year survival rates. Free or highly subsidized medical programme for early detection and treatment will reduce the high mortality rate associated with nasopharyngeal cancer in this region.

Surgical considerations in the management of tumours of the nose and paranasal sinuses in a Northern Nigerian Teaching Hospital.

BACKGROUND: Tumours of the nose and paranasal sinuses in sub-Saharan Africa are generally characterised by late presentation posing management challenges to the otorhinolaryngologists in the sub-region. OBJECTIVES: To appraise surgical considerations in the management of tumours of the nose and paranasal sinuses in a developing nation from the experiences of an Ear, Nose, and Throat Department of a Nigerian Teaching Hospital. METHODS: This was a chart review of patients with tumours of the nose and paranasal sinuses who underwent various surgical operations over a period of four and a half years.The patients were referred by other physicians or health care workers. They were assessed clinically, backed by laboratory and radiological investigations. RESULTS: A total number of 55 patients underwent 64 surgical operations. There were 31 (56.4%) males and 24 (43.6%) females, giving a male to female ratio of 1.3:1. They were aged between four years and 70 years. In 46(83.6%) patients the tumours had extended beyond the nasal cavity or one sinus cavity to contiguous structures. The surgical operations carried out were lateral rhinotomy in 37(57.8%), intranasal clearance and intranasal antrostomy in 16(25%), total maxillectomy in seven(11%), and anterior craniofacial resection in two (3.1%) patients.The histological examination showed that 43 (78.2%) cases were benign, while 12 (21.8%) cases were malignant. These malignant cases needed radiotherapy and chemotherapy. CONCLUSION: Majority of the cases were characterised by late presentation, requiring surgical approaches such as lateral rhinotomy, total maxillectomy or craniofacial resection depending on the extent of the tumour. Poverty, ignorance, inadequate funding and administration challenges of health resources are factors militating against proper clinical management of tumours of the nose and paranasal sinuses in developing nations. Provision of free medical care and modern facilities for early diagnosis, treatment, and health education are needed to reverse the trend.

Ear foreign bodies: observations on the clinical profile in Sokoto, Nigeria.

BACKGROUND/OBJECTIVES: Ear foreign bodies are common otorhinolaryngological emergencies which must be removed otherwise they may present with various complications. This paper reviews cases of ear foreign bodies seen over a seven year period from January 1995 to December 2001 in the Ear, Nose and Throat (ENT) department of Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria. METHOD: This is a retrospective study of all case folders of patients who presented with ear foreign bodies whose clinical features and management modalities were analyzed. RESULTS: The total number of patients reviewed were 207. There were 126 males (60%) and 81 females (40%) with a male to female ratio of 1.5:1. Their ages ranged from 1 to 65 years with 61.8% being children under 10 years old. Agricultural seed was the commonest documented foreign body (15%). Deliberate insertion by patients accounted for 70% of the cases while accidental insertion accounted for 30%. Ear foreign bodies became complicated in 41 patients (19.8%) at presentation one of them requiring a major surgical operation (posterior tympanotomy) to remove the foreign body. About 99.5% of the foreign bodies were removed through the per meatal approach with 79.8% being carried out by the nurses and doctors who had received basic training to do so. CONCLUSION: Ear foreign bodies may become complicated and so needs to be removed using standard methods which should be carried out by those specially trained to do so.

Relationship between epistaxis and hypertension: a study of patients seen in the emergency units of two tertiary health institutions in Nigeria.

BACKGROUND: Both epistaxis and hypertension are common in the general population. OBJECTIVE: This study aimed at determining the prevalence of hypertension among epistaxics, and the relationship between epistaxis and hypertension. METHODS: Retrospective analysis of 62 adults comprising 31 each of males and females with a mean age of 41.4 +/- 16.6 years (range: 18-90 years) that presented in the emergency units of two tertiary health institutions seen over 11 years was done. Main outcome measure was the prevalence of hypertension amongst epistaxics. Seventy-six age and sex-matched patients with bleeding from sites other than the nostrils with no record of epistaxis were selected by simple random sampling as controls. RESULTS: Peak prevalence of epistaxis occurred during the months of January and March. Compared to the controls, the epistaxics had significantly higher blood pressures: (146.1 +/- 40.7 mmHg versus 123.2 +/- 16.3 mmHg systolic, P=0.001), and (91.3 +/- 24.8 mmHg versus 78.2 +/- 12.8 mmHg diastolic, P=0.001), and higher proportions of patients with previous history of hypertension (32.3% versus 7.9%; p<0.001) and family history of hypertension (12.9% versus 2.6%; p<0.02). The proportion of subjects with blood pressure elevation at presentation that remained sustained was significantly higher among the epistaxics than the nonepistaxics (87.5% versus 47.6%, chi2=8.1, P=0.005). The epistaxics had significantly higher prevalence of hypertension than the non-epistaxics (45.2% versus 13.2%, chi2=17.5, p=0.001). Univariate analysis demonstrated association between epistaxis and hypertension (OR=5.4, 95% CI=2.4-12.5, P=0.001), and between epistaxis and age (OR=0.9, 95% CI=1.3-12.5, P=0.02). On multivariate analysis using logistic regression the association between epistaxis and hypertension persisted, after adjusting for age, sex, season and causes of epistaxis (OR=5.6, 95% CI=1.7-15.6, P=0.01). CONCLUSIONS: Our findings support an association between epistaxis and hypertension in the study population.

Pattern of epistaxis in Sokoto, Nigeria: a review of 72 cases.

BACKGROUND: Epistaxis remains a common otorhinolaryngological emergency in most hospital emergency departments with varied manifestations. The pattern as seen in a tertiary health institution in Sokoto, Nigeria is the subject of this paper. METHOD: This is a 5 year retrospective study (January 1995-December 1999) of all cases of epistaxis presenting at or referred to the Ear, Nose and Throat (ENT) Department of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria whose data were analyzed. RESULTS: A total number of 72 cases were seen with epistaxis out of 3,706 new cases seen at the ENT clinic. The incidence of epistaxis amongst UDUTH ENT patients was 19/1000. There were 45 males (62.5%) and 27 Females (37.5%) with a male to female ratio of 1.7:1. Their ages ranged between land 70 years with the 0-10 age range recording the highest number (26.4%). The commonest cause of epistaxis was idiopathic (29.2%), followed by trauma (27.8%) and hypertension (18.0%). Non surgical methods (97.2%) such as observation alone (34.7%) without active intervention to arrest bleeding, and nasal packing (34.7%), being the commonest intervention measures used to actively arrest bleeding followed by cauterization of the bleeding points (11.1%) were the frequent treatment measures. Surgical extirpation was carried out in 2 cases (2.8%) to arrest the epistaxis. CONCLUSION: Although epistaxis is a common otorhinolaryngological emergency and varied in its manifestation, it affects mainly the young people (<30 years (62.5%)) in this environment with idiopathic, trauma, and hypertension being the common causes which are amendable to treatment with excellent results.