Automated ABR screening for hearing loss and its clinical determinants among newborns with hyperbilirubinemia in National Hospital, Abuja, Nigeria.

Background: Severe neonatal hyperbilirubinemia is a known risk factor for sensorineural hearing loss which is usually undiagnosed in our environment until school age due to a lack of routine screening programs. Materials and Methods: This cross-sectional study conducted between August 2020 and February 2021 employed a universal sampling of consecutive eligible participants after their mothers' consent. Hearing screening was conducted using an automated auditory brainstem response (AABR) device (Otoport OAE + ABR®). The proportion of AABR screening failure was assessed while associated clinical risk factors were determined using logistic regression. Statistical significance was set at 5% for all comparative analyses. Results: One hundred and sixty newborns below 28 days of age, delivered at 34 weeks gestation and above, who had jaundice were recruited. The prevalence of screening AABR failure in at least one ear was 26.2%. Significant risk factors for AABR screening failure in addition to extreme and hazardous hyperbilirubinemia were acute bilirubin encephalopathy (ABE) (Odds Ratio (OR) =4.44, 95% CI = 3.19-6.17), birth weight below 2500 g (OR = 3.16, 95% CI = 1.48-6.77), dull tympanic membrane (TM) (OR = 5.94, 95% CI = 2.36-14.92) and exchange blood transfusion (OR = 4.84, 95% CI = 1.87-12.58). Conclusion and Recommendations: The prevalence of AABR screening failure was high, and a dull TM was its strongest predictor among late preterm and term neonates with hyperbilirubinemia. Otoscopy should be included in the care of newborn with hyperbilirubinemia and screening programs established to mitigate hearing loss among high-risk neonates in Abuja.

Outcome and cost analysis of bilateral sequential same-day cartilage tympanoplasty compared with bilateral staged tympanoplasty.

BACKGROUND: Few studies have compared bilateral same-day with staged tympanoplasty using cartilage graft materials. METHODS: A prospective randomised observational study was performed of 38 chronic suppurative otitis media patients (76 ears) who were assigned to undergo bilateral sequential same-day tympanoplasty (18 patients, 36 ears) or bilateral sequential tympanoplasty performed 3 months apart (20 patients, 40 ears). Disease duration, intra-operative findings, combined duration of surgery, post-operative graft appearance at 6 weeks, post-operative complications, re-do rate and relative cost of surgery were recorded. RESULTS: Tympanic membrane perforations were predominantly subtotal (p = 0.36, odds ratio = 0.75). Most grafts were harvested from the conchal cartilage and fewer from the tragus (p = 0.59, odds ratio = 1.016). Types of complication, post-operative hearing gain and revision rates were similar in both patient groups. CONCLUSION: Surgical outcomes are not significantly different for same-day and bilateral cartilage tympanoplasty, but same-day surgery has the added benefit of a lower cost.

Chemical labyrinthectomy for the worse ear of adult Nigerians with bilateral Meniere's disease: preliminary report of treatment outcomes.

The objective of this study was to assess the effectiveness of variable titration, low-dose intratympanic gentamycin (ITG) into the worse affected ear of patients with bilateral Meniere's disease (MD). It is a prospective analytic case series conducted in a tertiary care referral hospital in a developing economy and a tertiary care otologic private ENT clinic. Patients with MD who failed or are intolerant to medical treatment were recruited based on the criteria of definite MD and bilateral ear involvement. 0.75 cc of low-dose (40 mg/ml) buffered gentamycin was injected into the worse affected ear and patients followed up every 2 months, and the regime repeated only if subjective vertigo persists. The patient's age, sex, duration of MD symptom, ear first affected, ear selected for ITG, pure tone threshold at each visit, duration of caloric response (in seconds) for the injected ear, status of tinnitus in both ipsilateral (injected) and contralateral ears, total number of injections before last follow-up, and time since last follow-up are entered into the study protocol and analyzed. Nine patients with a mean age of 45 years and mean duration of symptoms of 59 months were treated. The mean total number of injections was 2.8 with a mean follow-up period of 34 months. Three cases showed drop in pure tone average threshold (2.5-7.5 dB) while an increase in threshold was noted in six cases (2.5-5 dB). All cases demonstrated decrease in duration of response to iced water caloric stimulation in ipsilateral ear, and 4/9 of contralateral ear. The variable titration method using low-dose intratympanic gentamycin directed at worse ear of adult Nigerians with bilateral Meniere's disease appears to be highly effective. More studies are needed.

Tympanomastoidectomy for cholesteatoma among Nigerians.

The incidence of cholesteatoma among Nigerians is not well documented, as is the outcome of surgical treatment. A descriptive analysis of prospectively collected data of cases of cholesteatoma managed with tympanomastoidectomy at National Hospital Abuja between September 2005 and April 2012 is presented. Cases were analyzed for age, sex, type of cholesteatoma, intra-operative findings, and post-operative outcome after 6 months of follow up. A total of 28 ears from 25 cases of cholesteatoma had tympanomastoidectomy. Age range was 6-73 years (mean = 34.4, SD = 18.67). There were 13 females and 12 males. Primary acquired cholesteatoma was seen in 18 cases (20 ears), secondary acquired in 5 cases (six ears), and external auditory canal cholesteatoma was seen in 2 cases (two ears). The sites involved in middle ear cholesteatoma was attic, sinus and mesotympanum pars tensa (16/26), attic, sinus, antrum and mastoid cavity (5/26), attic, sinus, mesotympanum and mastoid antrum (4/26), and attic only (3/26).21/25 of cases (24 ears) managed had single stage intact canal wall (ICW) tympanomastoidectomy, while 4/25 (4 ears) had two-stage surgery with canal wall down tympanomastoidectomy in two of these, and revision surgery done within 12 months of first surgeries. 2/25 cases (in the two stage revision group) had postoperative persistent mastoid cutaneous fistula and were treated with post-auricular advancement flap. The commonest cholesteatoma type seen at National Hospital Abuja, Nigeria was primary acquired type, and involved the attic, sinus and mesotympanum pars tensa mainly, and most can be managed by single stage tympanomastoidectomy.

Combined approach branchial sinusectomy: a new technique for excision of second branchial cleft sinus.

OBJECTIVE: Branchial cleft anomalies are well described, with the second arch anomaly being the commonest. Following surgical excision, recurrence occurs in 2 to 22 per cent of cases, and is believed to be due largely to incomplete resection. This report aims to describe a simple surgical technique for treatment of second branchial cleft sinus in the older paediatric age group and adults. METHODOLOGY: An 11-year-old girl underwent surgical excision of a second branchial sinus. Prior to surgery, she was assessed by means of an imaging sonogram, and by direct methylene blue dye injection into the sinus on the operating table, followed by insertion of a metallic probe. Dissection was of the 'step ladder' incision type, but the incision was completed via an oropharyngeal approach. Histological examination of the lesion after excision established the diagnosis. No recurrence had been observed at the time of writing. CONCLUSIONS: Although they are congenital lesions, second branchial cleft abnormalities usually present in the older paediatric age group or even in adulthood. In the case reported, a simple combined approach ensured completeness of resection.

Otitis media as a cause of significant hearing loss among Nigerians.

UNLABELLED: Mild or worse hearing loss, defined as pure tone average >25 decibel, is seen commonly with preventable etiologies. SETTINGS: A tertiary care, urban referral hospital. METHODS: Retrospective analysis of prospectively collected data of individuals attending the hearing loss clinic of National Hospital, Abuja, between May 2005 and April 2007. Data matching the diagnosis of acute otitis media (AOM), otitis media with effusion (OME) and chronic suppurative otitis media (CSOM) were extracted from the database and analyzed. RESULT: A total of 298 cases with primary presenting complaints of hard of hearing were seen. A total of 77 cases had hearing loss due to otitis media. 44 (57.1%) had OME, 26 (33.8%) had CSOM, while 7 (9.1%) had AOM. The observed distribution of the OME was left OME (18.1%, n=14), right OME (9.1%, n=7) and bilateral OME (29.9%, n=23), while the CSOM is distributed into left CSOM (15.5%, n=12), bilateral CSOM (11.7%, n=9) and right CSOM (6.4%, n=5), and AOM is distributed into right AOM (2.6%, n=2), left AOM (3.9%, n=3), and bilateral AOM (2.6%, n=2). The mean pure tone averages for the three groups are AOM (30.5dB), OME (41.5dB) and CSOM (56.9dB). CONCLUSION: Otitis media is an important cause of preventable hearing loss in developing countries, and the predominance of unilateral otitis media in the left ear observed in this study deserves further studies.

A correlation of symptomatology with nasal smear eosinophilia in non-infectious chronic rhinitis preliminary report.

OBJECTIVE: To correlate subjective and objective clinical features with nasal smear cytology findings in noninfectious chronic rhinitis. DESIGN: An analysis of prospectively collected data of consecutive patients with non-infectious seasonal and perennial rhinosinusitis seen at a tertiary health institution. METHODOLOGY: Clinical assessments including Visual Analog Scale (VAS) scoring of presenting symptoms of 45 patients suffering from non-infectious chronic rhinosinusitis are measured. Subjects had a medical questionnaire regarding presence and duration of symptoms, family history of atopy or allergy, occupational exposure to allergens, provocative agents, and medication usages. Subjects had detail Ear, Nose, and Throat assessment, and nasal secretions were analyzed for eosinophils counts and statistically correlated with clinical parameter. RESULT: A total of 45 patients were recruited. Age range was 13 to 71 years (SD 11.516). 73% (n=33) were females while 27% (n=12) were males. The modal occupation was homemaking (24%, n=11). 38% (n=17) had family history of atopy, while 13% (n=6) had family history of allergy. Symptoms were perennial in 62% (n=28) and seasonal in 38% (n=17). 9% (n=4) of the subjects keep pets at home, while 40% (n=18) grow flowers or trees around the house. All subjects gave a history of identifiable provocative agents. There is positive correlation of itchy nose with total symptom score. There was negative history of occupational exposure to allergens in all subjects. The average subjective symptom score are Sneezing (6.3), Itchy nose (6.1), Nasal obstruction (6.2) and Runny nose (6.7). There is a high positive correlation of sneezing with runny nose (r = 0.51), but poor correlation with nasal obstruction (r = 0.15). There is negative correlation of total individual symptom score with keeping of pets (r = -0.24) or growing of flowers or trees around house (r = -0.039). There is also low correlation of total symptom score with family history of atopy (r = 0.06). There is positive correlation of total symptom score with number of provocative agents identified (r = 0.34). There is low positive correlation of nasal smear eosinophilia with total symptom score (r = 0.030) and itchy nose score (r = 0.038). Nasal smear eosinophilia show negative correlation with sneezing score (r= -0.076). CONCLUSION: The best predictors of nasal smear eosinophilia in non-infectious chronic rhinosinusitis are itchy nose score and Individual Total Symptom (ITS) score.

Controlled clinical study of the efficacy of loratadine in Nigerian patients with allergic rhinitis.

An observer blind clinical study was carried out among 64 Nigerian patients with allergic rhinitis to assess the efficacy and tolerance of loratadine a new generation H1 antihistamine. Patients were allotted randomly to receive treatment for 1 week with either loratadine + Vit. C (group A), chlorpheniramine + Vit. C (group B), or Vit. C alone (group C). Assessment was by subjective symptom scoring of three nasal symptoms namely; sneezing, rhinorrhoea and nasal blockage. Difference between pre treatment and post treatment mean symptom scores was used as degree of improvement for statistical analysis and this formed the primary efficacy parameter. Adverse effects namely; anticholinergic effects, gastrointestinal effects and drowsiness were assessed following treatment. The results showed that loratadine was significantly better than Vit. C. alone (P = 0.0002) and chlorpheniramine was also significantly better than Vit. C. alone (P = 0.039). However, loratadine was significantly better than chlorpheniramine P = 0.046. Drowsiness was noted in 19.2% of patients on loratadine compared with 57.1% of patients on chlorpheniramine. lt is concluded that though both loratadine and chlorpheniramine were effective in the relief of symptoms of allergic rhinitis in Nigerian patients, loratadine was significantly more effective with minimal sedating effect.