Predictors of Taste Dysfunction and Its Severity Among Patients With Chronic Kidney Disease

BACKGROUND

Patients with chronic kidney disease (CKD) often complain of taste dysfunction. The prevalent taste dysfunction among patients with CKD predisposes them to malnutrition, poor quality of life, and worsen disease prognoses. To appropriately treat the taste dysfunction in this group of patients, it's imperative that factors that predict taste dysfunction and its severity are identified for prompt treatment.

AIM

To identify factors associated with taste dysfunction and its severity among patients with CKD.

MATERIALS AND METHODS

This was a hospital-based case-control study of adult patients with CKD at the University College Hospital, Ibadan, Nigeria. The control group was made up of age- and gender-matched healthy volunteers with no clinical and laboratory evidence of CKD. Relevant clinical and social data obtained include demographics, symptoms, and signs of taste dysfunction and its risk factors. The 4 basic taste modalities namely sweet, sour, bitter, and salt taste senses of the participants were tested with validated "taste strips." Factors that predict taste dysfunction were identified among the spectrum of the disease.

RESULTS

There were 100 patients with CKD and 100 healthy controls, age ranges between 19 and 86 years (mean ± standard deviation [SD] = 46.3 ± 13.9 years) and 20 and 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (P = .57). Hypogeusia was found in 27.0% of patients with CKD, while total taste function score of all the control was within normal range. Increasing duration of CKD was identified as a predictor of taste dysfunction among patients with CKD (odds ratio: 4.889, P = .038). The stages of CKD had no statistically significant relationship with the severity of taste dysfunction (P = .629).

CONCLUSION

The prevalence of taste dysfunction among patients with CKD was high and this showed significant correlation with increasing duration of CKD; in contrast, the severity of CKD is not significant in the development of taste dysfunction.

Paediatric paranasal sinus fibrous dysplasia

Fibrous dysplasia in the bony walls of a paranasal sinus is a developmental tumour that is associated with a marked facial deformity. Delay in hospital presentation contributes to the destructive resection techniques employed and the management outcome. Our study looks at the factors for delay in hospital presentation and the management outcome by a retrospective review between January 1997 and December 2018. Of 43 children (M: F 1:1.2) with a mean age of 12 ± 1.75 years, the maxillary bones were mostly affected. All underwent surgical resection with good management outcomes except for maxillectomy. Tumour recurrence was noted in five and there was no mitotic cell at histology. The clinical symptoms of fibrous dysplasia vary in severity and age of onset, often with late hospital presentation already with complications. Health education is needed to reverse this trend.

Design and methods of the prevalence and pharmacogenomics of tenofovir nephrotoxicity in HIV-positive adults in south-western Nigeria study

BACKGROUND

Individuals of African descent are at higher risk of developing kidney disease than their European counterparts, and HIV infection is associated with increased risk of nephropathy. Despite a safe renal profile in the clinical trials, long-term use of tenofovir disoproxil fumarate (TDF) has been associated with proximal renal tubulopathy although the underlying mechanisms remain undetermined. We aim to establish the prevalence of and risk factors for TDF-induced kidney tubular dysfunction (KTD) among HIV-I and II individuals treated with TDF in south-west Nigeria. Association between TDF-induced KTD and genetic polymorphisms in renal drug transporter genes and the APOL1 (Apolipoprotein L1) gene will be examined.

METHODS

This study has two phases. An initial cross-sectional study will screen 3000 individuals attending the HIV clinics in south-west Nigeria for KTD to determine the prevalence and risk factors. This will be followed by a case-control study of 400 KTD cases and 400 matched controls to evaluate single nucleotide polymorphism (SNP) associations. Data on socio-demographics, risk factors for kidney dysfunction and HIV history will be collected by questionnaire. Blood and urine samples for measurements of severity of HIV disease (CD4 count, viral load) and renal function (creatinine, eGFR, phosphate, uric acid, glucose) will also be collected. Utility of urinary retinol binding protein (RBP) and N-acetyl-beta-D-glucosaminidase (NAG) levels as surrogate markers of KTD will be evaluated. Genomic DNA will be extracted from whole blood and SNP analyses performed using the rhAMP SNP genotyping assays. Statistical analysis including univariate and multivariate logistic regression analyses will be performed to identify factors associated with KTD.

DISCUSSION

In spite of TDF being the most commonly used antiretroviral agent and a key component of many HIV treatment regimens, it has potential detrimental effects on the kidneys. This study will establish the burden and risk factors for TDF-induced KTD in Nigerians, and explore associations between KTD and polymorphisms in renal transporter genes as well as APOL1 risk variants. This study may potentially engender an approach for prevention as well as stemming the burden of CKD in sub-Saharan Africa where GDP per capita is low and budgetary allocation for health is inadequate.

Spectrum of DNA variants for non-syndromic deafness in a large cohort from multiple continents

Hearing loss is the most common sensory deficit in humans with causative variants in over 140 genes. With few exceptions, however, the population-specific distribution for many of the identified variants/genes is unclear. Until recently, the extensive genetic and clinical heterogeneity of deafness precluded comprehensive genetic analysis. Here, using a custom capture panel (MiamiOtoGenes), we undertook a targeted sequencing of 180 genes in a multi-ethnic cohort of 342 GJB2 mutation-negative deaf probands from South Africa, Nigeria, Tunisia, Turkey, Iran, India, Guatemala, and the United States (South Florida). We detected causative DNA variants in 25 % of multiplex and 7 % of simplex families. The detection rate varied between 0 and 57 % based on ethnicity, with Guatemala and Iran at the lower and higher end of the spectrum, respectively. We detected causative variants within 27 genes without predominant recurring pathogenic variants. The most commonly implicated genes include MYO15A, SLC26A4, USH2A, MYO7A, MYO6, and TRIOBP. Overall, our study highlights the importance of family history and generation of databases for multiple ethnically discrete populations to improve our ability to detect and accurately interpret genetic variants for pathogenicity.

Neonatal hearing screening in a rural/sub-urban community in Nigeria, sub-Saharan Africa-a preliminary report

INTRODUCTION

The implementation of Neonatal Hearing Screening (NHS) program is still at the preliminary stage particularly in developing countries despite the burden of permanent congenital and early-onset hearing impairment. There has been an earlier report of NHS in a city in Nigeria, however, this is a report of a preliminary NHS carried in a rural/sub-urban area in Nigeria.

METHOD

This prospective study, which took place between October 2009 and April 2010, involved all newborns delivered at the University College Hospital, Ibadan and the Bilal Missionary Maternity, Agodi, Ibadan, a small maternity service located in Agodi community serving predominantly low socioeconomic class people. All the neonates delivered during the study period were included in the screening. The screening was performed within 72 h of delivery using automated auditory brainstem response (AABR) and repeated after 6 weeks among those with referral result. Subsequently the neonates were referred to diagnostic audiology.

RESULT

Among the 453 newborns (231 males and 222 female), AABR screening showed referral, in 43.7% of neonates. At first screening, 224 (49.4%) were referred while 229 (50.6%) passed, however, during the post-natal period 40/229 (17.5%) reported for second screening, out of these 26 showed pass to the screening. This gave a total pass of 255/453 (56.3%). The presence of maternal pre-ecclampsia (P = 0.05) was found to be a significant morbidity factor associated with referral in the screening, while parental socioepidemiological variables; and the neonates' birthweight, gestational age and APGAR score were not.

CONCLUSION

The proportion of referral on hearing screening encountered was far higher than previously reported, however, continuation of infant screening in future should be comprehensive with viral and genetic analysis in order to address the issue of aetiologic diagnosis; in addition, the implementation should factor the high drop out from the first stage screening in order to substantiate the findings in our region.

Prevalence and correlates of dizziness in the Ibadan Study of Ageing

Dizziness is common among older people, but little is known about its prevalence and risk factors in the sub-Saharan population. We conducted a cross-sectional study to determine the prevalence of dizziness and its sociodemographic, lifestyle, and clinical correlates in 1,299 subjects--551 men (42.4%) and 748 women (57.6%), aged 65 years and older (mean: 77.3 ± 6.3)--who lived in the Yoruba-speaking areas of Nigeria. Among this group, 318 persons reported dizziness, which represents a prevalence of 24.5%. Univariate analysis of sociodemographic and lifestyle variables revealed that low economic status (p = 0.05) and smoking (p = 0.01) were significantly correlated with dizziness; however, on logistic regression analysis, only smoking (p = 0.01) was found to be significant. Neither sex (p = 0.07), age (p = 0.71), area of residence (p = 0.34), education level (p = 0.74), nor alcohol consumption (p = 0.44) had a significant correlation with dizziness. On multivariate modeling, significant clinical correlates in patients with dizziness included self-reports of a history of suppurative otitis media (p = 0.01), head injury (p = 0.03), and recurrent rhinosinusitis (p = 0.01); no significant correlation was seen between dizziness and hypertension, transient ischemic attack, and diabetes. Finally, balance testing conducted in a subset of 1,006 subjects revealed poor balance in 93 of 250 persons with dizziness (37.2%) and in 189 of 756 subjects without dizziness (25.0%) (p = 0.01). Logistic regression analysis of sex and age revealed that the probability of poor balance was 1.5 times greater among those persons with dizziness. We conclude that the high incidence of dizziness among community-dwelling elderly and its significant correlations with remediable medical conditions suggest the need for policy formulation for the care of the elderly in Nigeria.

Paediatric cochlear implantation in north-western Nigeria case report and review of our challenges

OBJECTIVE

To report the commencement of cochlear implantation (CI) in children in Northern Nigeria and review the challenges encountered with a view to establishing CI programme.

CASES

Two children with post-meningitic sensorineural hearing loss had standard pre-implantation assessment and cochlear implantation surgery in Nigeria in conjunction with surgeons from another developing country. Post-implantation meningitis was encountered and managed in one of the patients. Post-CI rehabilitation started in a foreign country and continued in our centre after training of our speech therapist. Both patients had improvement in their hearing.

CONCLUSION

These showcase successful CI in patients from Sub-Saharan Africa, the challenges included need for development of surgical and post-CI rehabilitation personnel and affordability of the cost of the implant. The support of all the stakeholders needed for commencement of a CI programme was noted.

The role of plasma melatonin and vitamins C and B12 in the development of idiopathic tinnitus in the elderly

BACKGROUND

To determine the correlation between plasma levels of melatonin, vitamin C and vitamin B12 and the presence of tinnitus among elderly subjects with unexplained subjective tinnitus.

METHOD

Prospective involving apparently healthy elderly with subjective tinnitus and those without. Plasma levels of melatonin, vitamin C and vitamin B12 were determined using high performance liquid chromatography and correlation determined by comparing subjects with and without tinnitus.

RESULT

There were 139 elderly subjects (78 females and 61males), the mean(SD) range of the age was 66.9years (0.77) 60-98 years. Of these 58.3% had tinnitus. The mean (SD) range of the plasma levels of melatoninn was 11.2 pg/mL(4.2) 5.1 pg/mL - 30.2 pg/mL while that of Vitamin C was 0.7 µmol/L (0.1) 0.3 µmol/L - 1.2 µmol/L, and vitamin B12 was 43.0pmol/L (3.1) 25.4 pmol/L - 71.6pmol/L. Comparing the plasma levels of the markers between elderly with and those without tinnitus, the plasma levels of melatonin (p=0.01) and vitamin B12 (p=0.03) were significantly lower among the elderly with tinnitus compared to those without, while the difference in the plasma level of vitamin C (p=0.6) was not.

CONCLUSION

Low plasma melatonin and vitamin B12 have significant correlation with the development of subjective idiopathic tinnitus among the elderly. This finding suggests the need for the trial of correction of these markers in the reversal or control of tinnitus.

Prevalence of insomnia and impact on quality of life among community elderly subjects with tinnitus

OBJECTIVES

We sought to determine the prevalence of insomnia and its impact on the quality of life (QoL) among community elderly subjects (at least 65 years of age) with subjective tinnitus.

METHODS

After household selection with multistage stratified area probability sampling, face-to-face interviews were used to obtain self-reports of subjective tinnitus and insomnia, and QoL was assessed with the WHOQoL-Bref instrument.

RESULTS

Among 1302 elderly subjects, there were 183 subjects (109 female and 74 male) with tinnitus. Among those with tinnitus, insomnia was encountered in 95 (51.9%) and was found to be significantly more common among those with tinnitus than among those without (378 of 1119, or 33.8%; p = 0.002). The insomnia symptoms included difficulty in maintaining sleep in 73.4% of subjects, difficulty in falling asleep in 70.0%, early morning wakefulness in 64.3%, nonrestorative sleep in 35.1%, and daytime sleepiness in 34.7%. Univariate analysis revealed difficulty with falling asleep (p = 0.01) and early morning wakefulness (p = 0.05) to be significantly associated with tinnitus among the symptoms. Student's t-test and logistic regression analysis revealed significant deterioration in the total QoL and in the physical, psychological, social, and environmental QoL domains among elderly subjects who had tinnitus with insomnia as compared with those without insomnia.

CONCLUSIONS

We believe that insomnia is significantly more common among elderly subjects with tinnitus than among those without, and that its presence further depreciates the QoL in these elderly individuals.

Disability and quality of life among community elderly with dizziness: report from the Ibadan study of ageing

BACKGROUND

Dizziness is prevalent among the elderly. However, little is known about its impact on quality of life and disability, especially in developing countries, where the number of elderly people is increasing.

AIM

This study aimed to determine the prevalence of disability, and the quality of life, among elderly persons with dizziness living in the community.

SETTING AND DESIGN

Longitudinal cohort study of dizziness among elderly persons (i.e. aged 65 years and over) residing in Yoruba-speaking areas of Nigeria.

METHOD

Face-to-face interviews with respondents selected using a multi-stage, stratified area probability sampling of households. Dizziness was based on self-reporting and health-related quality of life was measured using the brief version of the World Health Organization quality of life assessment.

RESULT

Dizziness was reported and confirmed in 318/1281 elderly respondents, a prevalence of 24.8 per cent. Respondents comprised 197 (61.9 per cent) women and 121 (38.1 per cent) men. Thirty-nine respondents (12.3 per cent) were aged 65-69 years, 91 (28.6 per cent) 70-74 years, 66 (20.8 per cent) 75-79 years and 122 (38.4 per cent) > or =80 years. The prevalence of disability in activities of daily living was 29.56 per cent, and that of disability in instrumental activities of daily living 10.1 per cent. The influence of gender was not significant. The prevalence of disability in activities of daily living (p = 0.00) and in instrumental activities of daily living (p = 0.00) increased significantly with age. Univariate analysis revealed that disability in activities of daily living (p = 0.00), disability in instrumental activities of daily living (p = 0.01), poor family interaction (p = 0.00), poor community involvement (p = 0.00), overall poor health (p = 0.00), current depression (p = 0.01), and difficulty with sedentary (p = 0.00) and vigorous (p = 0.00) activities were significantly more common among elderly respondents with dizziness, compared with non-dizzy elderly respondents. In contrast, cognitive impairment (p = 0.05) was not significantly correlated. The probabilities of the occurrence of difficulty with vigorous or sedentary mobility in our elderly respondents were 2.6 and 1.9, respectively, compared with non-dizzy elderly respondents. Similarly, the probabilities of the occurrence of disability in activities of daily living, current depression and dementia were 1.6 each. Logistic regression analyses for age, sex, medical conditions and presence of disability confirmed that dizziness was significantly associated with worsened cognition. Similarly, dizziness was significantly associated with reduced total quality of life (p = 0.00), and also with reductions in the physical (p = 0.00), psychological (p = 0.00) and environmental (p = 0.00) domains of the research instrument.

CONCLUSION

Among elderly people with dizziness, there was a high prevalence of significant disability requiring assistance. In addition, dizziness alone significantly reduced these individual's overall total quality of life, and their quality of life as regards physical, psychological and environmental parameters. This information will assist policy planning for the elderly.

The prevalence and correlates of self-reported hearing impairment in the Ibadan study of ageing

This cohort study of 1302 persons aged >or=65 years, conducted in the Yoruba-speaking regions of Nigeria, determines the prevalence and correlates of hearing impairment (HI) in the elderly population. Self-reports of HI and its putative risk factors among several indices were obtained using face-to-face interviews, and confirmed by observer's evaluation. Hearing impairment was found in 79 respondents, giving a prevalence of 6.1%. Gender difference was not significant but increasing age was associated with higher prevalence. Logistic regression analysis, adjusted for age and sex, revealed that history of recurrent suppurative otitis media [odds ratio (OR)=4.6, 95% CI 2.34-8.99, P=0.01], head injury (OR=2.2, 95% CI 1.14-4.26, P=0.02) and current hypertension (OR=2.1, 95% CI 1.18-3.57, P=0.01) were significantly associated with HI. No identifiable risk factors were found in 32 (40.5%) of the 79 respondents with HI. We conclude that the prevalence of HI among the elderly in Nigeria is comparable to reports from other countries. Identified risk factors were preventable or controllable. The large proportion of elderly with no identifiable risk factors, presumably presbyacusis, suggests a need for further study. The strategies for control of these risk factors and hearing aid support should be integrated into health care policy initiatives for elderly persons in sub-Saharan Africa.

Comparative analysis of middle ear immune response and micronutrient level between mucoid and purulent otitis media

OBJECTIVE

To determine the differences in the outcome of treatment, the middle ear immune response, and micronutrient status between patients with purulent (POM) and mucoid (MOM) otitis media.

DESIGN

Children with acute otitis media were recruited, treated, and followed up for between 6 and 10 months. The sera and middle ear secretion (MES) were analyzed for immunoglobulins and zinc using enzyme-linked immunoassay and flame atomic absorption spectrophotometry, respectively. The parameters were compared with selected healthy controls.

SUBJECTS

There were 399 participants: 228 children with acute otitis media selected using the American Academy of Otolaryngology-Head and Neck Surgery criteria and 171 healthy controls, with ages ranging between 6 months and 9 years (mean 7 years; SD 2.32 years).

RESULT

POM accounted for 126 of 228 patients, and MOM accounted for 102. The chronicity of otitis media (using the 3-month duration cutoff) was seen in 87 subjects (46%): 31 of 126 POM subjects and 56 of 102 MOM subjects (p = .002). The serum IgA to IgG ratios were 0.03 and 0.07 among POM and MOM, respectively; however, the MES IgA to IgG ratios were higher, 0.3 and 0.2, for POM and MOM, respectively. This gives a MES to serum ratio of IgA to IgG value of 0.3 to 0.03 (10) for POM and 0.2 to 0.07 (2.67) for MOM, which showed a significant statistical difference (p = .001). The MES to serum ratios of IgE were 0.89 and 1.3 among POM and MOM, respectively (p = .03). There was a significant difference in the serum IgG (p = .019), serum zinc (p = .009), and MES IgA (p = .028) and IgG (p = .01).

CONCLUSION

Chronicity was greater in MOM than in POM; POM had a higher middle ear immune response (measured by the MES to serum ratio of IgA to IgG) and serum zinc than MOM but a lower MES IgE.

The role of maternal social factors and antenatal events in determination of the serum retinol in normal full term infant

BACKGROUND

The nutritional status of mothers affects their babies. However, the factors responsible for the control of fetal retinol levels are unknown. This study evaluates the role of maternal social factors in the determination of fetal serum retinol.

METHOD

Consecutive mothers with normal pregnancy as judged by obstetrician (excluding those with sepsis and medical illnesses) were recruited. The maternal social factors and antenatal history were determined using questionnaires and the retinol level of the cord blood of the neonates were estimated using the high performance liquid chromatography.

RESULTS

There were 106 mothers (ages between 21 and 39 years, mean of 26 years) and neonates, made up of 57 females and 49 males with gestational age 30-45 weeks, mean of 373 weeks). The range of the neonatal serum retinol level was 0.12 ig/L--1.57 ig/L, with a mean of 0.94 ig/L (SD = 0.17) and median value of 0.98 ig/L. The mean serum retinol in the females was 0.94 ig/L while males were 1.13 ig/L. Ihe mean serum retinol according to the socioeconomic classes were high (I and II) 1.2 ig/L, middle (III) 1.1 ig/L and low (IV and V) 0.9 ig/L. The mean fetal serum retinol among the mothers with fever in pregnancy (31/106), incomplete vaccination in pregnancy (17/106) and neonates with low birthweight (<2.5 Kg) was 0.9 ig/L. Bivariate analysis revealed significant correlation between the mean serum retinol and the socioeconomic class (P = 0.038), but there was no correlation with maternal age (P = 0.7), sex (P = 0.07), gestational age (P = 0.39), birth weight (P = 0.7), maternal tetanus vaccination (P = 0.28), fever (P = 0.64) and antenatal care (P = 0.97).

CONCLUSION

Socioeconomic status of the mothers was a significant factor in the determination of neonatal serum retinol level, suggesting that maternal retinol supplementation may help in control of neonatal hyporetinolaemia.

Serum and middle ear immunoglobulins in suppurative otitis media

BACKGROUND AND PURPOSE

Despite the increasing occurrence of suppurative otitis media (SOM), the content of immunoglobulin fractions in the middle ear secretion (MES) has still not been determined.

METHOD

The serum and MESwere analyzed for IgG and M using enzyme-linked immunoassay.

RESULT

The subjects and controls were 30 males and 22 females, between 6 months and 9 years old, with a mean age of 6 years (SD = 3.26). The patient group included 20 chronic SOM (CSOM) and 17 acute SOM (ASOM) cases, and sera of 15 subjects made the control group. The mean serum IgG levels were for controls 1,051 mg/dl, ASOM 666.1 mg/dl and CSOM 1,321.1 mg/dl; the MES levels were for ASOM 203.4 mg/dl and CSOM 511.5 mg/dl. The mean serum IgM levels were for controls 35 mg/dl, ASOM 64.1 mg/dl and CSOM 40 mg/dl; the MES levels were for ASOM 22.59 mg/dl and CSOM 3.44 mg/dl. The mean MES:serum ratios for IgG and IgM were between 0.1 and 0.4 in ASOM and CSOM. The ratio of serum IgG levels of controls to ASOM cases was 0.66 while that of controls to CSOM was 1.3. The corresponding ratios of IgM were 1.6 and 0.88. Multivariate analysis revealed a significant correlation between serum IgG levels of ASOM and CSOM (p = 0.043) and MES IgG (p = 0.02) in ASOM and CSOM but no correlation between serum IgG levels in controls and ASOM (p = 0.25), serum IgM levels in controls and CSOM (p = 0.62) and serum IgM levels in controls and ASOM (p = 0.73), ASOM and CSOM (p = 0.064) and MES IgM levels of ASOM and CSOM (p = 0.06).

CONCLUSIONS

Monitoring of the serum and MES IgG in ASOM may provide a useful index to assess the possibility of progression to chronicity. This forms a database for the immunological status of SOM patients.

The role of retinol in the etiology and outcome of suppurative otitis media

Vitamin A deficiency is still a serious public health problem affecting an estimated 127 million preschool children. The resulting immunological dysfunctions lead to increased risks of respiratory tract infections, diarrhoeal diseases and blindness, among others. The aim of this study is to determine the significance of the role of serum retinol in the etiology of acute suppurative otitis media (ASOM) and its chronicity (CSOM). In a prospective follow-up of patients with ASOM for 6-9 months, serum retinol determination was done using the high performance liquid chromatography. Participants comprised 358 ASOM and 52 control subjects. Six-month follow-up was achieved in 264 subjects (74%); of these, there was persistence of otorrhoea (CSOM) in 116, while 148 had resolved ASOM. Of the 264 subjects, 146 were males and 118 were females, between the ages of 6 months and 9 years and a mean of 7 years (SD = 2.32), whereas the control subjects comprised 29 males and 22 females, between the ages of 6 months and 11 years and a mean of 7.8 years (SD = 3.6). The range of serum retinol in the ASOM subjects was 1.63-2.64 microg/L, mean of 1.53 microg/L, median value of 2.61 microg/L and (SD = 0.16). Among control subjects, the range was 2.5-2.8 microg/L, mean of 2.58 microg/L and median value of 2.61 microg/L (SD = 0.14) (Table 1). The range of serum retinol in the resolved ASOM subjects was 1.61-2.63 microg/L, mean of 2.07 microg/L and median value of 2.09 microg/L (SD = 0.16) while the CSOM subjects ranged between 0.8-2.86 microg/L, mean of 1.58 microg/L and median value of 1.28 microg/L, (SD = 0.48) (Table 2). Univariate analysis using unpaired t test to compare the mean serum retinol revealed significant difference between ASOM and control (P = 0.0000) and between resolved ASOM and CSOM (P = 0.0000). In conclusion, hyporetinolaemia was a significant etiological factor in the etiology ASOM and CSOM, suggesting retinol supplementation as one strategy in control of SOM.

Sinonasal malignancies: a 10-year review in a tertiary health institution

Sinonasal malignancy is a cause of otorhinolaryngologic morbidity and mortality in West Africa. However, there is a dearth of information in the literature on its clinicopathologic presentation in West Africa. It is our aim to determine the prevalence of sinonasal malignancy and highlight the clinicopathologic features in our environment. A 10-year retrospective review of cases with histologically diagnosed malignant sinonasal tumors in University College Hospital, Ibadan, Oyo State, Nigeria was carried out. There were 82 cases-56 (68.29%) males and 26 (31.71%) females-whose ages ranged from 4-69 years. Epistaxis, rhinorrhea and nasal blockage were seen in all patients; other symptoms were facial [76 (93%)], oral cavity [48 (59%)], ophthalmic [33 (40%)] and [otologic 21 (25%)]. Squamous cell carcinoma accounted for 69/75 (92%) of epithelial tumors, and malignant lymphoma accounted for 4/7 (57%) of nonepithelial tumors. Advanced disease was the predominant presentation in our series, stage 3 in 59 (79%) and stage 4 in 12 (16%) cases. Therefore, health education on early presentation to hospitals and efforts at early detection of the disease are needed in order to achieve cure. Industrial workers should always wear face masks to protect their nasal cavity.

Clinical and demographic risk factors associated with chronic suppurative otitis media

BACKGROUND

The incidence of chronic suppurative otitis media (CSOM) is high worldwide but increasing occurrence of complications appear peculiar to West Africa. However, knowledge of associated risk factors is sparse, we report the sociodemographic risk factors of CSOM with the aim of control of the disease and complications; and possible preventive strategies.

METHOD

This is a survey of children with CSOM in five sites spread in two suburban cities in two states in Nigeria. Questionnaire was administered on the informants followed by examination of the children.

RESULT

Of the 189 children, 114 (60%) had developed ear suppuration before 6 months of age, the number of attacks within the previous 18 months ranged between 2-12 with average of 7. Sociodemographic risk factors included low socioeconomic class in 153 (81%), 136 (72%) live in congested houses with more than 10 people and 79 (42%) belonged to families with more than 5 children. Indoor-cooking and infant daycare attendance were 117 (62%) while supine bottlefeeding was 115 (61%) and 34 (18%) of subjects had smoking father. The clinical risk factors were upper respiratory tract infection (URI) 85 (45%), allergy 53 (28%), adenoid 54 (28%) and malnutrition 65 (34%). The univariate analysis revealed that low social class (OR=7.33, CI=4.18-12.83, P=0.0001), malnutrition (OR=3.57, CI=1.88-6.76, P=0.00001), bottlefeeding (OR=2.93, CI=1.63-5.28, P=0.0001), indoor-cooking (OR=1.35, CI=0.88-2.10, P=0.161) and high number of people in a household (OR=0.59, CI=0.34-0.98, P=0.04) are significant in development of OM; while multivariate logistic regression analysis showed malnutrition (OR=3.48, CI=1.633-7.425, P=0.001), low social status (OR=7.74, CI=4.15-14.43, P=0.0001) and indoor-cooking (OR=2.34, CI=1.18-4.66, P=0.014), second table. Parental smoking, daycare attendance, allergy, adenoiditis/adenoidal hypertrophy and upper respiratory tract infection were not found significant.

CONCLUSION

Low socioeconomic class, malnutrition, congestion from high number of children in the household and bottlefeeding constitute significant risk factor. The early onset of disease (<6 months) may suggest a prenatal predisposition. We need further research for the understanding of the biologic effect of these factors while this remains a database for prevention and control of disease.

Improvized laryngeal cautery forcep in microsurgical treatment of laryngotracheal stenosis--experience in Nigeria, sub-Saharan Africa

Traumatic laryngotracheal stenosis is uncommon, however it seems to be increasing due to improvement in survival after trauma and detection of injury. Surgical options include dilatation and intralesional steroid, endolaryngeal microsurgery and laryngotracheal resection and anastomosis. We report our experience with management of traumatic laryngotracheal stenosis using improvised cauterization forcep in endolaryngeal microsurgery, in the absence of supportive facility for open laryngeal surgery in resource--poor sub-Saharan Africa. This is a retrospective analysis of the outcome of endolaryngeal microsurgery in patient with laryngotracheal stenosis using our improvised laryngeal cautery forceps. Traumatic A Lindholm laryngoscope suspended by a Riecher-Kleinsasser laryngoscope holder and chest support; and Carl-Zeiss operating microscope (Op Mi 1) was used for surgery. We improvised a laryngeal cauterization forcep by using an oesophageal foreign body forcep inserted in the measured length of fluid--giving set, exposing about 1 cm of the cutting end would insulate the forcep against the laryngotracheal wall. The diathermy handle is applied to the exposed end of the forceps. All the patients had endolaryngeal microsurgery and intralesional steroid. Thirteen endolaryngeal microsurgical procedures were done on 5 patients, 4 males and 1 female. The age ranged between 19 and 62 years. Functional voice and decannulation was achieved in 2/5 patients after each had had between 2-3 procedures. The indications in all was hoarseness while there was in addition, upper airway obstruction and dependence on tracheostomy in 3. The stenosis was supraglottic in 2, combined glottic and subglottic in 1 and laryngotracheal involvement in 2. Using the circumference of the laryngeal lumen as reference for severity of stenosis, 2 patients had a 50-70% lumen obstruction while 2 had a 71-99% and 1 had 100% lumen obstruction. We found the improvisation of the laryngeal cautery forcep useful for procedures in the larynx and recommend it to resource--poor centres where appropriate facilities are yet available. However this further shows that the role of endolaryngeal microsurgery is limited in laryngotracheal stenosis. The availability of other therapeutic modalities and training of personnel will give us the opportunity of a randomized treatment comparison in future.

Hearing threshold in patients with chronic renal failure

OBJECTIVE

To determine the pattern of hearing loss among patients with chronic renal failure (CRF).

METHODS

This is a case control study carried out jointly by the Otorhinolaryngology and Nephrology Departments of the University College Hospital Ibadan, Nigeria between December 2004 and March 2006. Consecutive CRF patients who satisfied the inclusion criteria were recruited, the patients had not had hemodialysis prior to inception of the study. Parameters like age, gender, duration of illness and blood pressure were recorded and pure tone audiometry was carried out. The data was analyzed using the Statistical Package for Social Sciences.

RESULTS

Thirty-three CRF patients and 28 healthy controls (34 males and 27 females) were used. The age range was 16-72 years, mean of 45.30 (SD 16.20). Sensorineural hearing loss was found in 67% of CRF and 32% of controls. The mean hearing threshold of CRF was 47.42 (SD 18.55) while the controls was 35 db, unpaired t-test (value -5.155) and Pearson correlation p=0.0008, r=0.614 showed the difference was significant. There was a correlation between duration of renal disease and hearing threshold p=0.00387 (r=0.73). There was no correlation between the hearing threshold and the diastolic blood pressure p=0.056 dosage of diuretics p=-0.155 (r=0.12) and creatinine level of the patients p=0.35 (r=0.31).

CONCLUSION

Sensorineural hearing loss is common among patients with CRF and related to the duration of renal disease, we recommend periodic audiological assessment incorporated in the care of these patients.

Beliefs and perceptions of ear, nose and throat-related conditions among residents of a traditional community in Ibadan, Nigeria

ENT-related conditions constitute a major burden of disease in Nigeria. The bulk of the available studies on these conditions are derived from hospital-based studies that underestimate the extent of the problem. Few studies have explored the perceptions of community residents on the causes and treatment of these conditions. This article describes findings of a qualitative study that explored the perception of residents of Foko, a traditional community in Ibadan, Nigeria. Five traditional healers were interviewed in-depth while four focus group discussions were conducted for men and women to determine perception of types, causation and treatment modalities for ENT-related conditions. The healers mentioned seven ENT-related conditions including ear discharge, deafness, epistaxis, nasal catarrh, sore throat, neck swelling and hoarseness. Informants and discussants attributed mainly spiritual attack as the cause of many of these conditions. Many of the treatment remedies used are topical, including use of effirin leaf (Occimum gratissium) for nose bleeding and using cold red oil or honey to treat ear discharge. These procedures are dangerous and could aggravate the conditions. We discuss the implications of these findings for further research and clinical practice.

Complications of sinusitis in Ibadan, Nigeria

Nowadays the complications arising from sinusitis are rare since the introduction of antibiotics. However sinusitis and its complications are still life-threatening and if neglected may result in high morbidity and mortality. It is the purpose of this study to draw attention to the effects of the spread of infection beyond the sinus wall and thus to influence the clinician in his management in order to prevent the subsequent spread of the disease, and secondly make him aware of the sinogenic origin of these complications when he sees them. A retrospective study of 90 patients with sinusitis seen over a ten year period between 1988 and 1997 in the ENT Department, University College Hospital, Madan was (lone and those that had complications were further analysed to meet the objectives of this study. There were 90 patients seen with sinusitis over the ten years period, out of which 33 (37%) cases had complications, 17 males and 16 females (M.F.1:1). The average age of cases with complications was 28 years (age range 2.5 - 75 years). 66.6% of the complications cases occurred in age group under 30 years of age. Thus children and young adults were mostly affected. Twenty-six cases (79%) of chronic sinusitis developed complications while in acute sinusitis there were 7 cases (21%). The site affected most commonly by complications was the orbit (41%) followed by Sinus wall (32%), orophyarynx (18%), intracranial (5%); no car complications were seen. The type of complications seen at various sites and their incidence were also highlighted. Thus with this study it is hoped that clinicians would be reminded that complications of sinusitis still occur and hence be aware of the necessity to recognize and prevent them as rapidly as possible to avoid serious consequences.

Trends of sinusitis in Ibadan, Nigeria

Sinusitis occurs frequently, complications are infrequent since the introduction of antibiotics and mortality has also decreased significantly for same reason. A retrospective study of 90 patients with sinusitis seen over a 10 year period between 1988 and 1997 in the E. N. T. Department, University College Hospital, Ibadan was done to highlight the general direction and tendency of sinusitis in our environment. There were 50 (56%) males and 40 (44%) females. The average age was 33 years and 70% were under the age 40 years, showed that sinusitis affects mostly children and young adults. 38% in social class V while 10% social Class I. Chronic sinusitis was 93%, acute sinusitis 7% (both types unisinusitis 56%, pansinusitis 29%, multisinusitis 16%). All the cases of unisinusitis were maxillary sinusitis. 85 (94%) had surgical treatment (antrostomy 64%, Fronto ethmoi-dectomy 15%, Caldwell-Luc's 13%, antral lavage 13%). 80 (94%) patients are alive and well after 2 years of follow up, 5 (6%) lost to follow up. Complications arising from sinusitis was seen affecting the orbit in 41%--the largest, followed by sinus wall 32%, no ear complications seen. Thirteen (14%) of the sinusitis cases associated with allergy only, 24 (27%) with polyps only, 6 (1%) with both allergy and polyps. It stresses the interwoveness of these entities (allergy, Polyps, sinusitis)--one predisposes to the other. Thus with these trends of sinusitis being highlighted, it is hoped that this would enhance our knowledge of the pathology, diagnosis and treatment of sinusitis.