Hearing loss among inmates of a juvenile correctional facility in Nigeria

Background

Good hearing is essential to learning and rehabilitation of adolescent and young adults in juvenile correctional facilities. Hearing screening programme is not commonly in place for this incarcerated group.

Objective

To evaluate hearing threshold among inmates of a juvenile correctional facility in Nigeria and compare pattern of hearing loss with a control group.

Methods

A total of 135 inmates and equal number of age and sex matched control responded to interviewer-administered questionnaire followed by otoscopy and audiometry.

Results

Mean age of inmates was 19 years ±2.0, while that of control was 18yrs ± 2.5. (p-value 0.077). Four (3%) inmates had bleeding from the ear; otoscopy revealed traumatic tympanic membrane perforation in 2(1.5%) of them. Prevalence of hearing loss was 19.2% and for disabling hearing loss it was 1.4%. Conductive hearing loss was the most common 33(24.4%). Inmates had consistently worse mean hearing thresholds than controls across all frequencies tested in both ears (p-value <0.001).

Conclusion

Hearing loss is prevalent among inmates of juvenile correctional facility. Rehabilitation programme should be balanced with detail attention to health needs of inmates; including pre-admission and periodic hearing screening.

Foreign bodies in the aerodigestive tract: time for comprehensive preventive measures

Background

Foreign body (FB) in the aerodigestive tract presents more commonly in children and remains a surgical emergency with potential for fatal complications.

Objectives

To describe management and outcomes of aerodigestive FB managed at University of Ilorin Teaching Hospital (UITH) and proffer preventive measures.

Methods

A 9-year retrospective review of all patients with foreign body in the aerodigestive tract managed between March 2011 and July 2020.

Results

Sixty-six patients were studied. Median age was 9years with M:F ratio =1.6:1. FB was ingested in 38(57.6%) patients, aspiration occurred in 28(42.4%). Denture was most common FB 20(30.3%); plastic whistle/valve placed in dolls or football accounted for 4(6.1%). When ingested, FB was impacted in cervical 17(44.7%), upper thoracic 10(26.3%) and middle thoracic 2(5.3%) oesophagus. Oesophagoscopy was used in 30(8.9%) for retrieval. When aspirated, FB was located in the right bronchus 10(35.7%), left bronchus 7(25.0%), hypopharynx and trachea 2(7.1%) each, and cricopharynx 1(3.5%); no FB was found in 3(10.7%) patients. Direct Laryngoscopy was the method of retrieval in 3(10.1%) patients while others had rigid bronchoscopy. Mortality rate was 1.5%.

Conclusion

Children are most vulnerable group. Preventive effort should include public health education and close monitoring of children by parents and care givers during play.

Clinical evaluation and nasoendoscopic scores of patients with chronic rhinosinusitis in Ilorin, Nigeria

Introduction

chronic rhinosinusitis (CRS) is characterised by inflammation of the mucosal lining of the nose and paranasal sinuses for at least 12 weeks duration. Other than the diagnostic criteria that is based on clinical features; nasoendoscopy and/or computerized tomographic scan have been included in the diagnosis. This study seeks to outline the clinical evaluation and nasoendoscopic assessment of CRS patients.

Methods

a hospital-based analytical study carried out on 154 participants. Clinical assessment and nasoendoscopy were performed and scored according to the discharge, inflammation and polyps/oedema (DIP) scale. Statistical analysis was carried out and results were presented in charts and tables.

Results

of the 154 participants, 71 (46.1%) were males and 83 (53.9%) females with a male to female ratio of 1: 1.7. Nasal discharge and blockage were the commonest symptoms. Nasoendoscopy had higher yield in the examination of intranasal polyps (NPs) over anterior rhinoscopy. The prevalence of NPs was 26.6%. The result of DIP nasoendoscopic findings revealed more participants with moderate scores. There was a significant statistical difference between the presence of NPs on nasoendoscopy and DIP score.

Conclusion

nasoendoscopy is an important aspect in the diagnosis and evaluation of patients with CRS. It provides a better visualization of NPs; therefore, it should be made routine in the clinical assessment and treatment of patients with CRS. The nasal endoscopic scoring of CRS should be considered as a common practice in clinical setting as well.

Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review

Background:

The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria.

Methods:

A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively.

Results:

Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd–5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens’. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded.

Conclusion:

Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens’. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy.

Management and Outcome of Infantile Hydrocephalus in a Tertiary Health Institution in Nigeria

Background:

Hydrocephalus is a leading cause of disability among children worldwide. The outcome depends on morphology and whether insult is pre- or post-natal. There has been improvement in morbidity in developed countries due to improved surgical care. A paucity of trained personnel impacts negatively on care and outcome of infants with hydrocephalus in many low-income countries resulting poorer outcome. We conducted an audit of patients with hydrocephalus managed in our institution to determine common etiology and outcome.

Object:

The objective of this retrospective review was to conduct an audit of hydrocephalus care in our institution.

Materials and Methods:

Information was retrieved from case notes, ward records, imaging results, operation notes, and follow-up clinic charts. Type of hydrocephalus, onset, treatment offered, outcome, complications, and follow-up duration were documented.

Results:

Management of 58 infants with complete data was analyzed. Most hydrocephalus 40 (69%) were congenital with 14 (35%) occurring in association with myelomeningocele and 8 patients confirmed with aqueductal stenosis. Ventriculoperitoneal shunts insertion 53 (91%) was the most common treatment modality.

Conclusions:

There is need to improve surgical intervention in the form of endoscopic third ventriculostomy in suitable patients. Subsiding cost of care may be considered for indigent patients.

Management and Outcome of Rhinosinusitis in Nigeria

OBJECTIVE

The aim of this study is to present the management and outcome of treatment of rhinosinusitis in Nigeria.

STUDY DESIGN

A retrospective review of the case notes of patients with rhinosinusitis between January 2009 and December 2014.

SETTING

Study at the University of Ilorin Teaching Hospital, Nigeria, using retrieved case notes after ethical approval was received.

SUBJECTS AND METHODS

The information retrieved included sociodemographic data, clinical presentation, duration, endoscopic examination, and other clinical management protocols with follow-up. All information was entered into SPSS version 20 and analyzed descriptively, and results are presented in tables and figure.

RESULTS

A total of 5618 patients were seen in the ear, nose, and throat clinic over the 6-year period. Of the patients, 445 had rhinosinusitis, and only 410 had complete data for analysis. Patient age ranged from 2 to 75 years (mean ± SD, 31.8 ± 1.2 years). The male to female ratio was 1.2:1. The duration of symptoms varied from 3 days to 10 years, with 78.7% having symptoms between 3 and 120 months. About 82.4% had nasal discharge, 51.3% had sneezing, 78.9% had alternating nasal obstruction, and 49.3% had nasal itch. Of the patients, 61.4% had a predisposition, of which 30.9% were allergic, 23.3% were infective, and 7.2% were vasomotor. Ethmoidal-maxillary sinuses were commonly affected radiologically. About 63% of patients had medical treatment, and only 28.7% had surgical intervention, of which 37% were scheduled for surgical treatment and 7.3% refused. Improved symptoms were noticed in 72.6% of patients, and 1.4% reported no improvement.

CONCLUSION

Rhinosinusitis is still common, affecting active males economically with more chronic cases and more allergic predisposition. Early medical management is still effective, and endoscopic sinus surgery is now a better surgical option with better outcome in 72.6%.

Clinical Presentation and Outcome of Sinonasal Tumors in a Nigerian Tertiary Hospital - 6-year Review

Background:

Sinonasal tumor is an uncommon tumor in Nigeria, but the burden of the disease in terms of morbidity and mortality is on the increase. The aim of this study is to evaluate the pattern of presentation and outcome of sinonasal tumor in our center.

Methodology:

This was a retrospective review of all the patients with sinonasal cancer seen in Ear, Nose, and Throat Department of the hospital between January 2008 and December 2013. The patients' biodata, clinical presentation, stage of the disease at presentation, identifiable risk factors, histopathological findings, and outcome were presented.

Results:

A total of 22 patients were diagnosed with sinonasal cancer out of 71 patients (31%) with head/neck cancers during the period of study. There were 12 males (54.5%) and 10 females (45.5%) with a mean age of 51 ± 2.1 years. Epistaxis, nasal blockage, and discharge were seen in all patients though 41% of patients presented first to the ophthalmologist due to proptosis. Identifiable risk factors were exposure to wood dust (29%) and petrochemical products in (11%). Most patients presented first at advanced stages of the disease (82%). Histologically, well-differentiated squamous cell carcinoma was the most common (54.6%) followed by nonintestinal well-differentiated adenocarcinoma in 18.2% and plasmacytoma (9.1%). Chemoradiation was the mainstay of management in (38%) though 13.6% had total maxillectomy with postsurgical chemoradiation and 50.4% defaulted due to cost of management.

Conclusion:

Health education on early presentation and efforts at early detection of the disease are needed to achieve cure. Exposure to the identifiable risk factors should be reduced by protective measures. Easy access to radiotherapy at affordable price will surely improve the outcome of this disease.

Accidental Decannulation OF TRACHEOSTOMY TUBES - Case Series

Tracheostomy tube (TT) is usually removed in a planned manner once the patient ceases to have the condition that necessitated the procedure. Accidental decannulation or extubation refers to inadvertent removal of tracheostomy tube out of the stoma. It could prove fatal in an otherwise stable patient. We review a variety of unexpected and often-overlooked causes of accidental decannulation with suggestions on preventive measures. We therefore present three cases of accidental decannulation of tracheostomy tubes in order to report our experiences in the management of the condition.

CONCLUSION

Accidental decannulation occurs both in hospitalized and patient on home care of their tracheostomy tubes. Reduction in neck circumference due to weight loss predisposes to accidental decannulation, which could be prevented by suturing the flange to the skin.

INTRAMEDULLARY TUBERCULOMA OF THORACIC SPINAL CORD IN AN APPARENTLY HEALTHY NIGERIAN: CASE REPORT

Spinal intramedullary is an uncommon form of tuberculosis causing spinal cord injury in this environment. We report a case of thoracic intramedullary tuberculoma in an immunocompetent male Nigerian with negative screening for tuberculosis. He presented with 8 months history of back pain and 2 months history of progressive weakness in both lower limbs. Physical examination revealed a well-nourished man with spastic paraplegia. Chest radiograph and CT scan were normal but Magnetic resonance imaging (MRI) of the thoracolumbar region showed cord oedema and circumscribed intramedullary lesions at D12 and L1 levels with target sign. The patient was promptly prepared and had D12 and L1 laminectomy and posterior myelotomy with excision of the intramedullary lesion. Histology showed granulomatous lesion with central caseation in keeping with a tuberculoma. He was treated with a 4-drug antituberculous regimen with physiotherapy and he made complete neurological recovery 8 months post-operatively. Intramedullary tuberculoma should be considered in differential diagnosis of intramedullary tumors in this environment. Treatment with antituberculous drugs results in good outcome.

Prevalence of snoring and symptoms of sleep disordered breathing among primary school pupils in Ilorin, Nigeria

BACKGROUND/AIM

Snoring is the production of sound from the upper aero-digestive tract during sleep due to turbulent airflow This study is to determine the prevalence, pattern, night and daytime symptoms of snoring among nursery and primary school pupils in Ilorin, Nigeria due to its public health importance.

MATERIALS AND METHODS

This cross sectional survey was carried out among nursery /primary school pupils in Ilorin, Kwara state between April and September, 2010. Ten schools were selected randomly from 100 schools sited within the 3LGAs of Ilorin municipality. Also private and public schools with different parental social economic status were selected. The pupils were selected from nursery 2 to primary 6 in each school using the class registers with the aid of a table of random numbers with 1500 children assessed. The parents/guardians were made to fill the questionnaires and same returned with visitations to the schools twice weekly and reminders sent via phone calls. Data were analyzed using EPIINFO 2002 version 2 software.

RESULTS

1500 questionnaires were given out but 909 were completely filled and returned (response rate of 61%.). There were 598(65.8%) non snorers (NSn) and 311(34.2%) snorers (Sn) at different scales with 153 male snorers to 158 female snorers. The ages of the children ranges from 3 to 16 years (mean ± SD, 8.3 ± 4.8 years. The mean age for the Sn was 8.2 and 8.3 for NSn (range 3-6 years). No statistical difference in age, gender or socio-economic status between Sn and NSn. 598(65.8%) were non snorers (NSn) and 311(34.2%) were snorers (Sn) especially in the age groups 3-6 years, 121(38.9%) and above 6 years of age 101(32.7%) and below 3 years were 89(28%).

CONCLUSION

Snoring is an important health problem among the pupils as a significant percentage snores and most of them are between third and sixth year of life.