Pattern of indications for tracheostomy in a tertiary hospital in South Western Nigeria.

Introduction: Tracheostomy is a life-saving procedure; the benefits and frequency of procedures being performed have led to frequent reviews of indication in many regions of the world. The aim is to establish the indications, diagnosis and complications of tracheostomy performed in the past 10 years in a tertiary hospital in Lagos. Methods: This is a 10-year retrospective study of all patients who had tracheostomies for various indications from 2010 to 2019. Patient medical records were analysed for demographic profile, diagnosis, indication, elective or emergency tracheostomy, surgeon's rank, technique of decannulation and type of complications. All the variables in the data were imputed and analyzed using the IBM Statistical Package for the Social Sciences version 27. Continuous variables were presented as mean and standard deviation, whereas categorical variables were presented as frequency and percentage. Results: Four hundred and eighty-six tracheostomies were carried out during the period under review, and 440 patients had complete data retrieved. The age group of 0-9 years constituted the most common age for tracheostomy (18%). The most common indication for tracheostomy was for relief of upper airway obstruction in 53.4%. Neoplasms (40%) and trauma (30.7%) constituted primary diagnosis requiring tracheostomies. Amongst the paediatric age group with upper airway obstruction, infections (31.8%) and foreign body inhalation (24.3%) constituted the most common primary diagnosis. Stoma infection and peristomal granulation tissue were the most common early complication (21.8%) and late complication (43.4%), respectively. Conclusion: Relief of upper airway obstruction from neoplasm remains the most common indication for tracheostomy, and peristomal granulation infection was the most common complication.

Clinical and microbiological profile of otomycosis in Lagos, Nigeria.

Introduction: Otomycosis is a global disease, common in the world's tropical and subtropical regions. The diagnosis is clinical, but mycological examination is required for its confirmation. There is a paucity of published data on otomycosis particularly the aetiologic agents in Nigeria. This study aims to fill in this gap by assessing the clinical presentations, risk factors and aetiologic agents of otomycosis in our setting. Methods: This was a prospective study of 126 clinically diagnosed patients and 30 controls. Mycological analysis of debris and swab samples from their external auditory canal was carried out. Results: One hundred and twenty-six patients were recruited, with 162 ear samples collected. There was mycological confirmation of otomycosis in 100 (79.4%) patients (subjects) and 127 (78.4%) specimens. The subjects' age range was 1-80 years, 30.89 ± 21.15 mean age, and 29-year median age. The peak prevalent age of 1-10 years was statistically significant, P = 0.022. The common symptoms in the subjects were itching 86 (86%), ear blockage 84 (84%) and otalgia 73 (73%). Regular ear cleaning 67 (67.0%) was the most common risk factor. Noted aetiologic agents were Aspergillus species 81 (63.8%), Candida species 42 (33.1%) and Yeast 4 (3.1%). Aspergillus flavus (40/127; 31.5%) was the most common fungus isolated. Unilateral otomycosis 73 (73%) was more common than bilateral otomycosis 27 (27%). Conclusion: Otomycosis is common in all ages, and is a commonly unilateral disease. Regular ear cleaning is the most common risk factor. A. flavus was the most common aetiologic agent in this study.

Contemporary Management of Intracranial Subdural Empyema: An Institutional Experience.

Background: Intracranial subdural empyema (SDE) is a seemingly uncommon life-threatening ailment with varying presentations and outcomes. A variety of risk factors have been associated with predisposition to intracranial SDEs; however, they may be cryptogenic. There is an increased predilection for intracranial SDE in children and teenagers with paranasal sinusitis or middle ear infections. The clinical presentation is non-specific and thus a high index of suspicion is required. Neuroimaging is an invaluable diagnostic tool for early diagnosis and surgical intervention. There have been multiple proponents for either burr hole or craniotomy to treat intracranial SDEs; however, despite surgical intervention, adverse neurologic sequelae and even mortality still occur. Extended antibiotic therapy is mandatory and impacts significantly on patients' outcomes. Objectives: This study describes the demographics, clinical presentation, and surgical outcomes in patients with intracranial SDEs over the study period. Design: This is a retrospective single-centre case series. Setting: This study takes place in a tertiary referral centre, university hospital. Materials and Methods: This was a retrospective review of patients presenting with intracranial SDEs over a 10-year period in a tertiary neurosurgical unit serving south-western Nigeria. Demographic, clinical, and radiologic data were retrieved from patient records. Results: Forty-nine patients presented with intracranial SDEs during the review period. These patients aged between 16 months and 75 years, most of whom were 20 years of age and below. The mean age was 21.37 ± 19.29 years with a median age of 15 years. There were 35 males and 14 females giving a male-to-female ratio of 2.5:1. The most common presentations were headache (73.5%), altered sensorium (55.1%), and seizures (38.8%). Forty patients (81.6%) had evacuation of SDE by burr hole and subdural washout. There was a significant post-op residual SDE in six patients. There were eight (16.3%) mortalities in this series. Forty-seven (95.9%) patients had sterile cultures of the subdural pus collection. Conclusion: Intracranial SDE affects mostly children and teenagers. Early diagnosis, emergent surgery, extended antibiotic therapy, and concurrent source control employing a multidisciplinary approach are essential in managing this condition. Burr hole and subdural washout help control the disease process, reduce operation time, and may yield outcomes similar to craniotomies, which are more invasive.

Pediatric brain abscess - etiology, management challenges and outcome in Lagos Nigeria.

BACKGROUND: Brain abscess in children is a neurosurgical emergency with potentially catastrophic outcome despite the advances made in neuroimaging techniques and antibiotic therapy. Symptoms are nonspecific and may vary with the child's age, location, size, numbers and stage of abscess, and the primary source of infection. Treatment is usually with broad-spectrum antibiotics in combination and surgical evacuation in most cases or antibiotics alone in selected cases with clear-cut indications. This study was to document clinical characteristics, etiological factors, and spectrum of bacteriologic agents responsible for pediatric brain abscess in an African city, the challenges and management outcome over the study period. METHODS: This was a retrospective study over an 11-year period involving 89 children who presented with brain abscess. Information of interest was extracted from the medical records of each participant. The results from data analysis were presented in charts and tables. RESULTS: Eighty-nine children aged 0.85-15.7 years (median age of 6.4 years) met the inclusion criteria. The male-to-female ratio was 1.8:1. Headache (80%), fever (78%), and hemiparesis (78%) were the most common symptoms. Brain imaging deployed was CT scan in 56 (63%), MRI in 9 (10%), and transfontanel ultrasound scan in 24 (27%) children. Seventy-one (80%) children had antibiotics with surgical evacuation while 18 (20%) children received only antibiotics. In 19 (27%) children, the culture of the abscess was negative. In 53 (75%) children, Gram-positive aerobic organisms were isolated. A total of 75 patients (84%) had a favorable outcome. CONCLUSION: Pediatric brain abscess still poses significant public health challenge, especially in resource-limited regions. Successful management of brain abscess requires high index of suspicion for early diagnosis, referral, and intervention.

Audiologic Screening of People with Down Syndrome in Special Schools in Surulere Lagos, Nigeria.

Background: Down syndrome (DS) is associated with a high incidence of ear pathologies and hearing loss. There is a paucity of information on the audiology of people with DS particularly those in special schools in Nigeria. This study aimed to compare pneumatic otoscopy with tympanometry for middle ear screening and pure tone audiometry (PTA) with distortion product otoacoustic emission (DPOAE) for hearing screening in the different age groups of people with people DS. Methodology: People with DS in two special schools for people with intellectual disability in Surulere, Lagos state were selected based on the schools' record and their phenotype. Otoscopy, pneumatic otoscopy, tympanometry, screening PTA and screening DPOAE were performed on the subjects. Results: 52 subjects aged 6 to 36years and an M: F ratio of 1.5:1 were studied. 82.7% of subjects had wax impaction. The prevalence of otitis media with effusion (OME) by pneumatic otoscopy was 57.8% and 40.2% by tympanometry and the same number of subjects performed both tests successfully. Screening PTA and DPOAE were successfully performed on 32.7% and 94.2% of the subjects respectively. Fail rate of 29.4% by PTA and 65.3% by DPOAE were recorded. Conclusion: Regular ear check-up in people with DS is essential for the detection and treatment of ear wax, OME and hearing impairment which is highly prevalent in them. Pneumatic otoscopy is recommended for the detection of OME in all the age groups. Screening PTA and OAE are recommended for adults and children and non-cooperative adults hearing screening respectively.

Correlation of Nasal Endoscopy and Computed Tomography Scan Findings in Adult Patients With Chronic Rhinosinusitis.

Background: The diagnosis of chronic rhinosinusitis (CRS) is usually based on appropriate clinical features. However, confirmation is based on the evidence of features of inflammation on nasal endoscopy and/or computed tomography (CT) scan of the paranasal sinuses. Though CT scan is the gold standard, studies have found nasal endoscopy equally helpful and sometimes complementary to CT scan in the diagnosis of CRS. Aims and Objectives: The aim of this study is to assess and correlate the findings on nasal endoscopy and CT scan of adult patients with CRS. Materials and Methods: Consecutive adult patients clinically diagnosed with CRS were enrolled. Those who did both nasal endoscopy and CT scan of the paranasal sinuses within 3 months' interval were studied. The findings were correlated. Results: The commonest symptoms were rhinorrhea and nasal obstruction seen in 95% and 92.5% of the patients. Purulent discharge in the middle meatus was the commonest finding on nasal endoscopy seen in 56.7% of the patients. There was pathology of at least one paranasal sinus in 71.7% of the patients on CT scan. Maxillary sinus was most commonly affected. Obstruction of the osteomeatal complex was present in 51.7% of the patients. The sensitivity, specificity, positive, and negative predictive values of nasal endoscopy were 73.3%, 85.3%, 92.7%, and 55.8%, respectively. Conclusion: The presence of cream-coloured discharge in the middle meatus on nasal endoscopy is a good predictive index in the diagnosis of CRS, whereas sinus intraluminal lesions are better elucidated by CT scan.

Impact of emotional distress on caregivers burden among Nigerian children with Obstructive Adenotonsillar hypertrophy.

BACKGROUND: Despite the significance of the role of caregivers among children with Obstructive Adenotonsillar hypertrophy (OAT), their caregiving experience and emotional well-being are given poor attention in research, policy and service design. This study represents a novel effort sought to investigate the burden experienced by caregivers of children with OAT and the impact of emotional distress on their caregiving burden. METHODOLOGY: A total of one hundred consecutive caregivers of children with OAT were interviewed with designed socio-demographic questionnaire. This was subsequently followed by administration of General Health Questionnaire-12 (GHQ-12) to ascertain emotional distress using cut-off score ≥ 3 and Zarit Caregivers Burden of care scale was used to characterize the pattern of burden experienced by these caregivers. RESULTS: In this study, the mean ages of children with OAT and their caregivers were 36.7(± 21.8) months and 34.4(± 5.4) years, respectively. The affected children were mainly males (68%), while their caregivers were predominantly females (84%). Fifty-seven percent of children with OAT were schooling but 13% of them had academic delay. Majority of the caregivers (66%) had a tertiary level of education. Of the total participants, up to 43% reported various degrees of burden of care, with majority (34%) of them reporting mild to moderate burden of care. In the same vein, 48% were emotionally distressed. Following regression analyses, emotional distress was independently associated with burden of care among participants (Odds ratio [OR]=0.108; 95% Confidence Interval [95% CI]=0.043-0.272; p < 0.001). CONCLUSION: Caregivers of children with OAT reported the experience of various degrees of burden, and worse among caregivers with emotional distress. Overall, the level of distress and burden observed in this study were many-fold what has been reported among caregivers of other populations of children. The results of this study support the proposal of proactive measures to address the psychosocial needs of caregivers as integral to the care of children with OAT. Further research on the well-being of caregivers is also justified.

Correlation of Bacterial Isolates from Middle Ear and Nasopharynx in Patients with Chronic Suppurative Otitis Media in Ilorin, Nigeria.

PURPOSE: To determine the association between isolates in the middle ear (ME) and nasopharynx of patients with chronic otitis media in Ilorin, north-central Nigeria. METHODS: An ethically approved case control study was carried out in the Ear, Nose, and Throat clinic amongst consenting cases using normal subjects as controls. A microbiology investigation form giving the results for otoscopy, aspirate and swabs was filled out for both the ME and nasopharynx. The experimental procedure was carried out and bacteria were identified according to colony characteristics, morphological appearance, Gram-staining, and standard biochemical testing. Data obtained were analysed with SPSS version 16.0 and Epi Info 3.5.1 using the mean, standard deviation and chi-square results. RESULT: A total of 140 cases and 70 controls, were recruited. The Gram stain reaction of the ME aspirates were positive in 28.6% and negative in 71.4% of cases. Nasopharyngeal swabs revealed 64.3% Gram positive and 35.7% negative organisms. Overall, there was no relationship between the ME and nasopharyngeal isolates amongst cases, with a P value of 0.000. However, there was a relationship amongst the isolate from the nasopharynx of cases and controls, with the exception of Klebsiella pneumoniae, at P < 0.009. CONCLUSION: There was no relationship amongst the bacterial isolate from the ME and nasopharyngeal specimen of patients with otitis media.

The prevalence of hearing loss among schoolchildren with chronic suppurative otitis media in Nigeria, and its effect on academic performance.

We conducted a cross-sectional study to determine the prevalence of hearing loss among 1,500 Nigerian schoolchildren aged 9 to 15 years who had chronic suppurative otitis media (CSOM). We also attempted to ascertain the effect that this hearing loss had on their academic performance. The study population was drawn from three schools in different socioeconomic tiers-low (n = 300), medium (n = 400), and high (n = 800). Overall, CSOM was present in 35 of these children (2.3%)-12 from the low-status school (4.0%), 11 from the middle-status school (2.8%), and 12 from the high-status school (1.5%); the overall difference in prevalence among the three schools was statistically significant (chi(2) = 6.40; degrees of freedom [df] = 2; p = 0.04). In all, 52 ears were affected by CSOM; of these, 18 (34.6%) had a pure-tone average (PTA) within normal limits, 20 (38.5%) had a mild conductive hearing loss, and 14 (26.9%) had a moderate loss. All but 2 of 160 control ears (1.2%) had hearing thresholds within normal limits. The difference in PTAs across groups was statistically significant (chi(2) = 114.89; df = 2; p< 0.001). As for academic performance, cumulative average test scores were significantly lower in the CSOM patients than in the controls-chi(2) = 14.57; df = 3; p = 0.002. At the higher end of the academic scale, scores of 66% and higher were obtained by 40.0% of patients and 51.3% of controls, and scores of 50 to 65% were achieved by 20.0% of patients and 37.5% of controls. At the lower end, scores of 40 to 49% were obtained by 31.4% of patients and 6.3% of controls, and scores of 39% and lower were obtained by 8.6% and 5.0%, respectively. We conclude that hearing loss was a significant sequela of CSOM in our study population and that it had an adverse effect on their academic performance. Children in the low socioeconomic group appeared to be more vulnerable.

Surgical education at the West African College of Surgeons.

The West African College of Surgeons (WACS) was formed almost 50 years ago to foster friendship and greater interaction amongst the first crop of surgeons of West African origin freshly returning from overseas training. Under the College's umbrella, seven different surgical Faculties-Anaesthesiology, Dental Surgery, Obstetrics & Gynaecology, Ophthalmology, Otorhinolaryngology, Radiology/Radiotherapy, and Surgery-have been nurtured into viable entities. The WACS is a leading institution for surgical training, accreditation, and collaboration with international bodies in the subregion. With more than 3000 Fellows, the WACS' surgical training programs and diplomas have remained the standard format for a population of >140 million in the five Anglophone West African countries for decades. The College has assumed increasing roles in attracting donor agencies as well as West Africans in the Diaspora desirous of establishing training links with credible institutions in the subregion. This paper discusses the history of the WACS, its examination process and other functions, as well as its contributions toward and challenges in surgical manpower development in the West African subregion.

Comparing nasal secretion eosinophil count with skin sensitivity test in allergic rhinitis in Ibadan, Nigeria.

OBJECTIVES: The aim of this prospective study was to assess the usefulness of nasal smear eosinophilia compared with a skin sensitivity test for the diagnosis of allergic rhinitis and to determine the degree of correlation between the tests. MATERIAL AND METHODS: Fifty patients with a clinical history suggestive of nasal allergy and 20 controls were studied. A range of allergens were used for the skin sensitivity test in both groups. Nasal smears were examined by light microscopy. RESULTS: A positive skin test reaction was demonstrated in 90% of the study population and 25% of the controls, whereas 76% of the patients and 15% of the controls demonstrated significant nasal smear eosinophilia. There was 66% correlation between the skin test and nasal eosinophilia, although this was not statistically significant (correlation coefficient -0.187 p = 0.193). This study does, however, demonstrate that both tests are sensitive for the diagnosis of allergic rhinitis, with sensitivities of 0.90 (95% CI 0.82-0.98) for the skin test and 0.76 (95% CI 0.64-0.88) for nasal eosinophilia. CONCLUSION: Both the skin-prick test and the nasal smear eosinophilia showed correlation with the clinical history, although the skin-prick test was more sensitive. No statistically significant correlation was demonstrable between the two tests.