Fractured Metallic Tracheostomy Tube: A Rare Presentation of Bronchial Foreign Body.

BACKGROUND: Tracheostomy is an important life-saving surgical procedure that could be used to secure the lower airway. It can however serve as a source of airway compromise when fragments from it are deposited. This condition must be diagnosed early enough, and appropriate intervention should be done to forestall potential morbidity and mortality. CASE REPORT: A 56-year-old tracheostomized patient presented to the accident and emergency department with a 4-hour history of sudden onset choking cough and labored breathing. The shaft of his tracheostomy tube (TT) was fractured and subsequently aspirated while he was attempting to remove and clean the inner tube that morning. He has used the TT for about 6 years and lost to follow-up clinic visits. The chest radiograph showed the metallic foreign body lodged within the trachea. He had an emergency rigid bronchoscopy via the tracheostomy stoma, and the object was retrieved. All respiratory symptoms subsequently resolved, and a check radiograph showed normal findings. CONCLUSION: Tracheostomy tube fracture and aspiration should be ruled out in every tracheostomized patient with sudden onset acute respiratory symptoms. Otolaryngologists must always emphasize the need for proper handling of TT, regular follow-up, and tube replacement when due.

THE EFFECT OF CD4 COUNT LEVEL ON THE MIDDLE EAR DYNAMICS OF HIV INFECTED PATIENTS.

BACKGROUND: HIV infection, a multi systemic disease has been identified as one of the causes of hearing loss in man. OBJECTIVES: To compare the effect of HIV infection on the middle ear dynamics of HIV infected and non-HIV infected individuals using tympanometry. DESIGN: A prospective cross sectional study. SETTING: HIV Clinic at University of Benin Teaching Hospital (UBTH) in 2010. SUBJECTS: Tympanometry was done on adults (18-45 year old) patients with confirmed retroviral disease (RVD) infection and confirmed non-HIV infected adults (18-45 year old) as the control group. All the patients certified the inclusion and exclusion criteria. MAIN OUTCOME MEASURES: More women were found with HIV infection than men at a ratio of 1:3.7(men = 21% and females = 79%). There was preponderance of type "B" tympanogram among HIV-infected individuals. RESULT: There was a significant correlation between CD4 cell count and type "B" tympanogram (P = 0.03). The CD4 cell count measured severity of HIV infection while the type "B" tympanogram detected middle ear effusion. CONCLUSIONS: Middle ear effusion is the genesis of middle ear pathology in HIV infected population.

Suspected progeria in Nigeria: a case report.

BACKGROUND: Progeria is a rare fatal genetic condition characterized by an appearance of accelerated aging in children. It has an incidence of 1 in 8 million and results from a mutation of the LMNA gene causing nuclear instability. Clinical diagnosis is based on recognition of common clinical features and definitive diagnosis is by identifying the mutation in the LMNA gene. Affected children usually have a median life span of 13 years. There is no known cure but research is ongoing. Currently about 80 children have had a definitive diagnosis worldwide with the exclusion of Nigeria. There was however a case report of 3 siblings in the University of Benin Teaching Hospital, Benin City, Nigeria in 1990. OBJECTIVE: To present a rare case of suspected progeria in Nigeria. CASE REPORT: We report the case of baby IV, a 4-year old girl who presented with clinical and radiologic features consistent with progeria. CONCLUSION: Clinical and radiologic evidence give a high suspicion of progeria in the index patient. Efforts are ongoing to ensure a definitive diagnosis is made; which will be the first diagnosed case of progeria in Nigeria.

Tonsillectomy: vasoconstrictive hydrolytic cold dissection method

"Background: Tonsillectomy; a common paediatric otolaryngology procedure; has undergone several evolutionary trends in the surgical techniques aimed at minimizing complications and improving patients' satisfaction. Despite the technological advancements in this respect; search for an ideal method is still ongoing; and some authorities are reverting back to the conventional methods. We wish to introduce the ""Vasoconstrictive hydrolytic cold dissection"" (VHCD) method. Patients and Methods: The VHCD method was described; and the outcome measures in one hundred and thirty-five patients who had the procedures were presented in . Data entrance was done with SPSS 14. Results: A total 135 patients comprising of 107 children aged 1-12 years and 28 adolescents/adults aged 14-52 years were operated upon using the VHCD between March 2009 and July 2012 by the same teams of Surgeons and Anaesthetists. The average surgical time and blood volume losses were 15 minutes and 5 mls for children and 12 mins and 10 mls for adults/adolescents; respectively. There was a single case (0.7) of post-tonsillar bleed (reactionary haemorrhage). The rest (99.3) recorded nil haemorrhage within and beyond first 2 weeks post-surgery. Conclusions: Surgeons used to other techniques of tonsillectomies may not revert to the cold steel; however; those practicing CSM will benefit from VHCD. We hereby recommend this simple; cost-effective modification of the cold steel tonsillectomy; which appears to have made dissection easier and also minimizes haemorrhage; a common complication of tonsillectomy surgery. It is timely in the advent of increased advocacy towards reversal to the conventional method of tonsillectomy. A randomized control trial is required for further evaluation of this method."

Prevalence of ototoxicity in University of Benin Teaching Hospital, Benin city: a 5-year review.

BACKGROUND: Ototoxicity refers to damage of the cochlea and/or vestibular apparatus from exposure to chemical substances, resulting in hearing impairment and or disequilibrium. An earlier study carried out at University of Benin Teaching Hospital (UBTH) in 2000 implicated chloramphenicol as the commonest ototoxic drug, followed by antimalarials (Quinine). AIM: To identify the commonly implicated drugs in patients diagnosed with ototoxicity in Ear, Nose and Throat (ENT) Clinic of UBTH. MATERIALS AND METHODS: One-hundred and three patients' case notes, diagnosed as having ototoxicity, between June 2005 and July 2010 at the ENT Clinic of UBTH were reviewed. Seventy-nine cases met the criteria for diagnosis of ototoxicity in this study. RESULTS: Intravenous quinine (19.0%) was the commonest implicated drug, followed by oral chloroquine (6.3%), antihypertensive drugs (nifedipine, moduretics, artenolol [6.3%]), native herbal medicine (13.9%), chloramphenicol (1.3%), and unidentifiable drugs accounted for 53.2%. Most patients had severe to profound hearing loss at 4000 Hz and at 8000 Hz. Tinnitus was found in 84.8% of the patients. CONCLUSION: Quinine is still the commonest implicated ototoxic drug in this part of the country.

Blood transfusion, antibiotics use, and surgery outcome in thyroid surgery: experience from a suburban center in Nigeria.

BACKGROUND: Edo North, which is a known goiter belt in Nigeria, is within the catchment area of this hospital. Although thyroid disease is prevalent in the communities, the fear and cost of surgery have been limiting factors for sufferers who should otherwise seek expert care. AIM: To review all thyroid surgeries at Irrua Specialist Teaching Hospital, to determine pathological diagnosis of goiters, and to evaluate the outcome and necessity or otherwise of antibiotic therapy and routine cross-matching of blood. RESULTS: There were 80 patients in the study, with 75 (93.75%) females and 5 (6.25%) males, giving female-to-male ratio of 15:1. People in the 4 th and 5 th decade of life constituted a dominant 32.5% and 26.7%, respectively, while the 1 st and 2 nd decades combined constituted only 7.5% of the study population. Two patients (2.5%) had blood transfusion while a similar number had wound infection. CONCLUSION: Thyroidectomy is a safe surgery with minimal risk of complications. Grouping and cross-matching of blood in elective thyroidectomy is not an essential pre-operative preparation for all patients just as antibiotic therapy/prophylaxis made no difference in patient outcome. Simple multinodular goiter is the commonest histological diagnosis.