Observations on the current bacteriological profile of chronic suppurative otitis media in South eastern Nigeria.

BACKGROUND: Chronic suppurative otitis media (CSOM) is a disease well-known for its recurrence and persistence despite treatment. The situation is compounded by the increasing resistance to antimicrobial agents by bacteria these days. AIM: This study was carried out to examine the current local bacteriological profile of CSOM and to compare the profile of either ear in bilaterally discharging ears. MATERIALS AND METHODS: We carried out a retrospective analysis of ear swab cultures from 133 unilateral and 73 bilateral consecutive tubotympanic CSOM cases seen at the Ear-Nose-Throat clinics of a referral health institution during a 4 year period ending 2013. Sensitivities to eight locally available antibiotics were analyzed. Aerobic bacterial isolates were analyzed separately for the unilateral and bilateral cases. Comparison was made between the ears in the bilateral cases. RESULTS: We analyzed 279 ear swab culture results from 206 patients with age ranging from 5 months to 86 years and a mean of 21.3 (19.5) years. Pseudomonas aeruginosa was the most common isolated bacteria (44% [109/250]) followed by Staphylococcus aureus (17% [42/250]), and Proteus Mirabilis (15% [38/250]). The most and least sensitive bacteria were Klebsiella Spp and Escherichia Coli, respectively. The most effective antibiotics were gentamicin and ciprofloxacin. The two ears differ significantly in the rates of isolation of S. aureus and E. coli (P = 0.01 and P = 0.04, respectively). CONCLUSION: Pseudomonas is the most common bacteria involved in CSOM in this part of the country. Ciprofloxacin as ear drops is recommended as first-line drug in the management of active CSOM as it is cheap, less ototoxic, and locally available. Separate ear swab culture should be obtained in bilateral CSOM.

The role of adenoidal obstruction in the pathogenesis of otitis media with effusion in Nigerian children.

BACKGROUND: Although adenoidectomy is generally applied in the treatment of otitis media with effusion (OME), there is still much debate about the role of adenoid in the pathogenesis of OME. The purpose of this study is to determine the incidence of OME in children with obstructive adenoid disease in comparison with normal control, and the degree of nasopharyngeal obstruction by adenoid as it relates to the development of OME in Nigerian children. METHOD: Controlled, prospective clinical study was carried out. Diagnosis of OME was made with finding of type B tympanogram on tympanometry evaluation. The incidence of OME among adenoidal patients was compared with its incidence in normal control. The degree of nasopharyngeal obstruction among the adenoidal subjects was evaluated with an adenoidal-nasopharyngeal ratio parameter obtained from soft tissue radiograph of nasopharynx, and was related to the results of tympanometric evaluation of the adenoidal subjects. RESULTS: The incidence of OME was significantly higher in the adenoidal children than the normal control (p < 0.001). The risk of OME was more than 7 times as more among adenoidal group than among the non-adenoidal control. Gross nasopharyngeal obstruction was significantly associated with type B tympanogram (p = 0.002). The diagnosis of OME correlated significantly with the degree of nasopharyngeal obstruction (r = 0.32; p = 0.002). CONCLUSION: Our study found adenoid obstruction as a significant risk factor for OME in children. The risk of OME increases with the increasing degree of nasopharyngeal obstruction.

Tracheobronchial foreign body aspiration in children: how reliable are clinical and radiological signs in the diagnosis?

OBJECTIVES: To evaluate the yield of clinical and radiological features in the diagnosis of suspected foreign body aspiration in children and to assess factors associated with delayed diagnosis of foreign body aspiration. STUDY DESIGN AND SETTING: Retrospective review of 10 years of experience in tertiary referral centre. PARTICIPANTS: Data were extracted from clinical records of children who underwent rigid bronchoscopy for suspected foreign body aspiration at the University of Nigeria Teaching Hospital Enugu from 2000 to 2009. MAIN OUTCOME MEASURES: Clinical features and radiological findings were validated against bronchoscopic findings. RESULTS: Data of 103 children, (mean=2.7 years, range=months to 14 years; 64% boys and 36% girls, were analysed. Majority (73%) were under 3 years of age. Foreign body aspiration was proven bronchoscopically in 85 (83%) patients. The most common symptoms were sudden choking crisis (74%) and paroxysms of cough (73%). Independent predictors of proven foreign body aspiration were witnessed aspiration, choking crisis and unilateral decreased breath sounds in univariate (P=0.001, <0.001, and 0.001 respectively) and multivariable analyses (P=0.02, 0.001, and <0.001 respectively). The most sensitive and specific clinical features were choking (86%) and witnessed aspiration episode (89%), respectively. Available chest radiographs revealed radio-opaque objects in 27% of patients. Delayed diagnosis of foreign body aspiration (>72 h) was significantly more in younger children (t=3.29; P=0.001), as well as in children with no history of witnessed aspiration, negative chest examination and radiological signs (P<0.001, P=0.02 and P=0.04 respectively). CONCLUSION: To prevent the delayed diagnosis, witnessed aspiration, choking crisis, unilateral decreased breath sounds and radiopaque objects should be checked in all suspected cases. When history is doubtful, regardless of radiological findings, bronchoscopy can be strongly recommended in the presence of two factors.

The Role of Adenoidal Obstruction in the Pathogenesis of Otitis Media with Effusion in Nigerian Children

Background: Although adenoidectomy is generally applied in the treatment of otitis media with effusion (OME); there is still much debate about the role of adenoid in the pathogenesis of OME. The purpose of this study is to determine the incidence of OME in children with obstructive adenoid disease in comparison with normal control; and the degree of nasopharyngeal obstruction by adenoid as it relates to the development ofOMEin Nigerian children. Method: Controlled; prospective clinical study was carried out. Diagnosis of OME was made with finding of type B tympanogram on tympanometry evaluation. The incidence of OME among adenoidal patients was compared with its incidence in normal control. The degree of nasopharyngeal obstruction among the adenoidal subjects was evaluated with an adenoidal-nasopharyngeal ratio parameter obtained from soft tissue radiograph of nasopharynx; and was related to the results of tympanometric evaluation of the adenoidal subjects. Results: The incidence of OME was significantly higher in the adenoidal children than the normal control (p 0.001). The risk ofOMEwas more than 7 times as more among adenoidal group than among the non-adenoidal control. Gross nasopharyngeal obstruction was significantly associated with type B tympanogram (p

Non-explosive blast injury of the tympanic membrane in Umuahia, Nigeria.

BACKGROUND: To examine the clinical features and causes of non-explosive blast injury to the ear, as well as the frequency of the State police involvement. METHOD: Prospective clinical study of consecutive patients with traumatic tympanic membrane perforations resulting from non-explosive blast trauma to the ear without history of previous middle ear disease who attended ENT clinic of Federal Medical Center Umuahia. Clinical features and causes of non-explosive blast injury to ear; healing outcome at 2, 4, 8, and 12 weeks; perforation size versus healing outcome and cause of injury were the main outcomes measured. RESULTS: Five hundred and ninety three new patients with aural disease were analysed. Sixty-one patients, (38 males and 23 females), aged 10-56 years had tympanic membrane perforation from non-explosive blast injury to the ear. The commonest symptoms were hearing loss (64%), tinnitus (61%), and ear ache (57%). The causes of injury were: slap against the ear by State police (31%), spouse (28%), armed bandits (18%), school teachers (8%), parents (5%), and blow against the ear during street fight (10%). Ninety two percent of the perforations healed spontaneously Healing was associated with significant closure of air bone gap (t = 15.08; p < 0.01). Non-healing of perforation was significantly associated with the large perforations occupying estimated 50% or more of the entire tympanic membrane area (chi2 = 8.67; p = 0.003). CONCLUSION: The ear is very susceptible to injury from non-explosive blast trauma. There was a high spontaneous healing rate of the resulting tympanic membrane perforation, favoring conservative management in most of the case. Non-healing was associated with large-sized perforations. Abusive slap by the State police men was the commonest cause of non-explosive blast injury to the tympanic membrane. Our results are hoped to stimulate a change in the attitude of the culprits and lead to a reduction in the incidence of avoidable TM perforations from slap assaults.

Patterns of hearing loss in tympanic membrane perforation resulting from physical blow to the ear: a prospective controlled cohort study.

OBJECTIVES: To evaluate the incidence and pattern of hearing loss in non-explosive blast injury of the ear. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary referral centre. PARTICIPANTS: Consecutive patients who suffered physical blow to the ear resulting in tympanic membrane perforations without history of previous middle ear disease. MAIN OUTCOME MEASURES: Incidence of conductive and sensorineural hearing loss, extent of air-bone gap versus size and site of perforation, post-healing hearing loss recovery. RESULTS: Fifty-one patients, 31 males (61%) and 20 females (39%) aged 10-56 years, were recruited over a 30 month study period. The prevalence of hearing loss was significantly more in the injured ears than contralateral normal ears (chi(2) = 76.26; P = 0.000). Pure conductive hearing loss occurred in 39%, while 28% (14 patients) had mixed hearing loss. Three patterns of sensorineural loss were observed: dip involving several adjacent high frequencies, a dip in a single frequency, and two separate dips involving low and high frequencies. The extent of air-bone gap correlated with the size of perforation (r = 0.33; P = 0.01). Ears that sustained small tympanic membrane perforation showed significantly small average air-bone gap (t = 2.97; P = 0.005). The mean air-bone gap difference between the anterior and posterior perforations was not significant (t = 1.7; P = 0.09). Closure of air bone gap following healing was significant (t = 15.08; P < 0.01), while recovery of bone conduction abnormality was less favourable. CONCLUSION: Conductive hearing loss occurring in the speech frequencies was the most common form of hearing loss in this group of patients with non-explosive blast injury to the ear. The accompanying sensorineural loss mostly affected several adjacent high frequencies. Healing of perforation favoured significant recovery of the conductive loss, but recovery of sensorineural loss was less favourable.

Determinants of spontaneous healing in traumatic perforations of the tympanic membrane.

OBJECTIVES: To analyse the various factors influencing spontaneous healing of traumatic tympanic membrane perforation in West Africa. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary referral centre. PARTICIPANTS: Consecutive patients with traumatic tympanic membrane perforations without history of previous middle ear disease. MAIN OUTCOME MEASURES: Healing outcome at 4, 8, 12 weeks; effects of perforation size, location, and mode of injury, active intervention and ear discharge on healing outcome. RESULTS: Fifty-three patients, 32 (60%) men and 21 (40%) women, aged 2-86 years, with traumatic tympanic membrane perforation who met our inclusion criteria were analysed. Ninety-four percent of the perforations healed spontaneously. Spontaneous healing was significantly correlated with age (P < 0.05). It was significantly delayed by large perforations estimated at 50% or more of entire tympanic membrane, ear discharge, wrong intervention on acute perforation by ear syringing, and by penetrating injuries sustained through the ear canal (P < 0.05, P < 0.01, P < 0.01 and P < 0.01 respectively). Perforations in the anterior versus posterior quadrants showed no significant difference in the healing rate (P > 0.05). Non-healing of the traumatic perforation was significantly associated with the large perforations, ear discharge and wrong intervention by ear syringing in chi-square test (P = 0.01, P = 0.02 and P < 0.001 respectively), but only with penetrating injuries sustained through the ear canal and the ear syringing intervention in logistic regression test (P = 0.02 and P = 0.04 respectively). CONCLUSION: The rate of spontaneous healing of traumatic tympanic membrane perforation varied inversely with age of patient and size of perforation. It was delayed by middle-ear infection, as well as in ears that sustain direct injuries and in ears that had wrong interventions. However, it was not dependent on whether the perforation was in the anterior or posterior location. Logistic regression analysis revealed that penetrating injuries sustained through the ear canal and the ear syringing intervention were the only risk factors important in predicting the non-healing of traumatic tympanic membrane perforation.

Evaluation of adenoidal obstruction in children: clinical symptoms compared with roentgenographic assessment.

BACKGROUND: Obstructive adenoid enlargement is commonly implicated as the major cause of chronic nasal obstruction in children. Although clinical assessment is considered essential, there is little consensus over its reliability. This study was conducted to determine the correlation between graded symptomatology assessment and roentgenographic assessment of adenoidal obstruction. METHOD: Symptoms assessed included snoring, mouth-breathing and obstructive breathing during sleep. Each symptom was rated on a four-point scale (absent = zero, mild = one, moderate = two and severe = three). We summed the ratings for each child to obtain the symptomatology score. We used an adenoidal-nasopharyngeal ratio parameter to classify roentgenographic assessment into minimal, moderate or marked obstruction. RESULTS: Sixty-four children, 42 boys and 22 girls, aged one to 12 years were enrolled. The clinical symptomatology scores correlated significantly with the roentgenographic ratings of nasopharyngeal airway obstruction (r = 0.419; p = 0.001). The correlation was significant at roentgenographic ratings of minimal obstruction (p < 0.05) and gross obstruction (p < 0.001). Both the symptomatology score and the roentgenographic rating showed significant correlations with patient age (r = -0.657, p < 0.01 and r = -0.340, p < 0.01, respectively). CONCLUSION: Clinical rating of adenoidal symptoms in children provides a reasonably reliable assessment of the presence and severity of nasopharyngeal airway obstruction. This technique of assessment is easy to use and is particularly valid when obstruction is either minimal or gross.

Otoscopy compared with tympanometry: an evaluation of the accuracy of simple otoscopy.

BACKGROUND: Although otoscopy has been shown to compare favourably with results of tympanometry the actual diagnostic value of otoscopy for otitis media with effusion (OME) has not been evaluated in Nigeria. The study was aimed at evaluating the sensitivity, specificity and predictive value of otoscopy in the diagnosis of OME as compared with tympanometry. METHOD: It was a prospective hospital-based, descriptive cross-sectional study in which the results of simple otoscopy were compared with results of the tympanometry of 82 ears of children aged between 6 months and 12 years, who presented to the Otolaryngology clinics of the UNTH Enugu with symptoms of obstructive adenoid enlargement. RESULTS: Simple otoscopy produced 84.4% agreement with tympanometry in detecting OME. The agreement was better in older children than the younger ones (P < 0.05). Simple otoscopy was more specific in detecting ears considered normal than abnormal ears. Among the abnormal ears, otoscopy was more sensitive in its detection of OME than negative middle ear pressure. Retraction of the tympanic membrane was the most specific otologic finding in detection of OME. CONCLUSION: Simple otoscopy is comparable to the accuracy of tympanometry in the diagnosis of OME.

Otoscopy Compared with Tympanometry: An Evaluation of the Accuracy of Simple Otoscopy

Background: Although otoscopy has been shown to compare favourably with results of tympanometry; the actual diagnostic value of otoscopy for otitis media with effusion (OME) has not been evaluated in Nigeria. The study was aimed at evaluating the sensitivity; specificity and predictive value of otoscopy in the diagnosis of OME as compared with tympanometry. Method: It was a prospective hospital-based; descriptive cross-sectional study in which the results of simple otoscopy were compared with results of the tympanometry of 82 ears of children aged between 6 months and 12 years; who presented to the Otolaryngology clinics of the UNTH Enugu with symptoms of obstructive adenoid enlargement. Results: Simple otoscopy produced 84.4agreement with tympanometry in detecting OME. The agreement was better in older children than the younger ones (P

Otoscopy Compared With Tympanometry: An Evalluation of the Accuracy of Simple Otoscopy

Background:Although otoscopy has been shown to compare favourably with results of tympanometry; the actual diagnostic value of otoscopy for otitis media with effusion (OME) has not been evaluated in Nigeria. The study was aimed at evaluating the sensitivity; specificity and predictive value of otoscopy in the diagnosis of OME as compared with tympanometry. Method: It was a prospective hospital-based; descriptive cross-sectional study in which the results of simple otoscopy were compared with results of the tympanometry of 82 ears of children aged between 6 months and 12 years; who presented to the Otolaryngology clinics of the UNTH Enugu with symptoms of obstructive adenoid enlargement. Results: Simple otoscopy produced 84.4agreement with tympanometry in detecting OME. The agreement was better in older children than the younger ones (P