Sensorineural Hearing Loss among Hypertensives

BACKGROUND

The effect of hypertension on the vascular system leads to Target Organ Damage (TOD). The cochlea is one of the target organs affected by hypertension, giving rise to Sensorineural Hearing Loss (SNHL).

OBJECTIVE

To determine the prevalence and pattern of Sensorineural Hearing Loss (SNHL) among hypertensives.

DESIGN

Case-Control Study.

SETTING

Tertiary hospital.

SUBJECTS

Two hundred and twenty six hypertensives, aged 21 to 60 years and a corresponding number of age and sex matched control.

METHODOLOGY

Eligible participants were prospectively evaluated. Their blood pressures were verified, hearing thresholds assessed through Pure Tone Audiometry, Pure Tone Average were calculated and the types and degree of hearing loss were confirmed. Data was analyzed using SPSS 21 and statistical significance was set at p-value 0.05.

RESULTS

Each group had 127 (56.19% ) females and 99 ( 43.81 % ) males. The difference in the mean age between the cases (40.02 ± 0.70years) and the controls (37.42 ± 0.47years) was not statistically significant (p = 0.542).The difference in the mean Pure Tone Average in dBHL between the cases (15.53± 6.95) and the controls (13.98 ± 4.35) was significant (p = 0.005) with a 12.83% prevalence of SNHL among the hypertensives against 1.77% in the controls. Majority (96.6 %) of them demonstrated bilateral, symmetrical, mild SNHL with 51.7% of them being above 50 years. The odds ratio in this study was 8.17 (p = 0.0001).

CONCLUSION

This study demonstrated a SNHL prevalence of 12.83% with a mild, bilateral, symmetrical pattern among hypertensives; increasing with advanced age and an eight-fold risk of occurrence.

Pediatric Hearing Thresholds Post-bacterial Meningitis

Introduction: Disabling hearing loss as a sequela of bacterial meningitis results from damage to the auditory system. This study was designed to ascertain the hearing thresholds in survivors of bacterial meningitis and the risk factors of hearing loss in childhood bacterial meningitis.

Methodology: One hundred and two children admitted and treated for bacterial meningitis were recruited prospectively along with 102 age- and sex-matched controls who had auditory evaluation using otoacoustic emission and auditory brain stem response tests 48 h prior to hospital discharge. This was also repeated at the follow-up clinic at 1 month after hospital discharge, irrespective of the initial hearing assessment results.

Result: There were 57 (55.9%) males and 45 (44.1%) females among the cases (mean age, 5.34 ± 4.40 years) and 55 (53.9%) males and 47 (46.1%) females among the controls (mean age, 5.31 ± 3.15 years). The prevalence of hearing loss was 30.4% among the cases, while it was 6.9% among the controls. The risk factors of hearing impairment in this study were the presence of anemia, leukocytosis, and hypoglycorrhachia.

Conclusion: Hearing impairment with varying degrees of severity is a frequent complication of bacterial meningitis in children.

Long-term effects of Maternal HIV Infection and Anti-Retroviral Medications on the Hearing of HIV-Exposed Infants

BACKGROUND

The long-term effect of maternal HIV and antiretroviral medication on the hearing of HIV-exposed infants has not been well studied. We determined and compared the hearing thresholds of HIV-exposed infants with that of HIV-unexposed infants within the first month of life and at three, six and nine months of life.

MATERIALS AND METHODS

This was a Case control study of 126 HIV-exposed newborns and 121 HIV-unexposed newborns. Data collected included Socio-demographic, clinical characteristics and risk factors for hearing loss. Hearing was evaluated at newborn, 3, 6, and 9 months of life. Within and between groups analyses were done with appropriate statistics. Level of significance was P<0.05.

RESULTS

In both ears, the mean hearing thresholds of HIV-exposed infants were greater than those of the HIV-unexposed infants at baseline, 3, 6 and 9 months (P>0.05). In both groups, there was a decline in the mean hearing thresholds from baseline (new born) till 6 months of age. The highest mean threshold was recorded at 9 months. The mean hearing thresholds of infants at 3, 6, and 9 months were lower for HIV-exposed infants and higher for HIV-unexposed infants than the corresponding mean hearing thresholds measured at baseline. There was a significant strong correlation among hearing thresholds at 3, 6 and 9 months but weakly correlated with hearing thresholds at baseline.

CONCLUSION

There was a tendency towards higher hearing thresholds in HIV-exposed infants than the HIV-unexposed infants throughout the infancy period. This appears to have association with in-utero exposure to HIV.

Comparison between olfactory function of pregnant women and non-pregnant women in reproductive age group in Ibadan, Nigeria

BACKGROUND

Pregnant women require normal olfactory function in order to develop good appetite for healthy living and normal fetal development. This study was carried out to investigate and compare olfactory function of pregnant women with non-pregnant women.

METHODS

This was a case control study of women in reproductive age group at the University College Hospital, Ibadan, Nigeria from July 2014 to February 2015. Consecutive 70 pregnant women and 70 non-pregnant women (controls) without rhinologic symptoms were studied. A structured questionnaire was administered to obtain participants' information on socio-demographics, pregnancy history, and ability to perceive smell. They subjectively rated their olfactory function on a visual analogue scale of 0 - 100. Olfactory threshold (OT), discrimination (OD), identification (OI) scores and TDI of both groups were determined with"Sniffin' sticks"kits and compared. The level of significance was P<0.05.

RESULTS

The mean age of the pregnant women was 30.5±3.9years and control was 28.5±6.6years. There were more pregnant women (7.1%) with hyposmia than the non-pregnant women (2.9%). The subjective rating of olfactory function was 68.2±24.9 (median 70) and 72.3±21.6 (median 69) in pregnant women and controls respectively. The mean OT, OD, OI, TDI scores were higher in pregnant women than the controls. However, it was only in OI (P=0.000) and TDI (P=0.012) that the differences were significant.

CONCLUSIONS

Pregnant women have olfactory dysfunction more than the non-pregnant women of reproductive age group. Also, they have tendency to develop loss of cognitive olfactory information more than the non-pregnant women.

Evaluation of mobile smartphones app as a screening tool for environmental noise monitoring

Noise is a global occupational and environmental health hazard with considerable social and physiological impact and, therefore, there is a need for regular measurements to boost monitoring and regulations of environmental noise levels in our communities. This necessitates a readily available, inexpensive, and easy to use noise measuring device. We aimed to test the sensitivity and validity of mobile "smart" phones for this purpose. This was a comparative analysis of a cross sectional study done between January 2014 and February 2015. Noise levels were measured simultaneously at different locations within Abuja Nigeria at day and night hours in real time environments. A sound level meter (SLM) (Extech407730 Digital Soundmeter, serial no.: 2310135, calibration no: 91037) and three smartphones (Samsung Galaxy note3, Nokia S, and Techno Phantom Z running on Android "Apps" Androidboy1) were used. Statistical calculations were done with Pearson correlation, T-test and Consistency within American National Standards Institute acceptable standard errors. Noise level readings for both daytime and night with the SLM and the mobile phones showed equivalent values. All noise level meters measured were <100dB. The daytime readings were nearly identical in six locations and the maximum difference in values between the SLM and Smartphone instruments was 3db, noted in two locations. Readings in dBA showed strong correlation (r = 0.9) within acceptable error limits for Type 2 SLM devices and no significant difference in the values (p = 0.12 & 0.58) for both day and night. Sensitivity of the instrument yielded 92.9%. The androidboy1 "app" performance in this study showed a good correlation and comparative high sensitivity to the Standard SLM (type 2 SLM device). However there is the need for further studies.

Sensorineural Hearing Loss and Dyslipidemia: Is There Any Relationship?

BACKGROUND

The incidence of dyslipidemia is increasing worldwide due to changes in diet and lifestyle. The aetiological role of dyslipidemia in sensorineural hearing loss (SNHL) is unclear.

OBJECTIVE

To determine the association between SNHL and dyslipidemia in adult Nigerian population.

DESIGN OF THE STUDY

This prospective case control study was carried out at ENT Department of University College Hospital Ibadan from August 2013 to May 2014.

METHODS

The study involved consecutive adult patients (18-60 years) with SNHL. The controls were adults without SNHL matched for age, gender and socioeconomic status. Relevant clinical data were obtained. Hearing threshold was determined by standard method and fasting plasma lipid assayed for triglycerides (TG), total cholesterol (TC), high density and lipoprotein-cholesterol (HDL-C). The low density lipoprotein-cholesterol (LDL-C) was calculated from TG, TC and HDL-C using Freidewald's formulae. The values of <40mg/dl, >200mg/dl, >150mg/dl and >130mg/dl were considered abnormal for HDL-C, TC, TG and LDL-C respectively. Level of statistical significance was P<0.05.

RESULTS

There were 108 participants, consisting 57 (67.7%) cases and 51 (32.9%) controls with mean age of 37.911.3 years and 37.4 11.3-year respectively (p=0.708). Abnormalities in HDL-C values was the commonly observed in both cases (64.9%) and controls (76.5%).Thirty-six (63.2%) cases had severe to profound hearing loss. There was no significant correlation between lipid parameters and severity of SNHL.

CONCLUSION

The prevalence of dyslipidemia in adult patients with sensorineural hearing loss is similar to those with normal hearing. There appears to beno causal association between dyslipidemia and sensorineural hearing loss.

Effect of Strong Fragrance on Olfactory Detection Thresholds of Health Workers at UCH Ibadan, Nigeria

Objectives:

Assess the effect of perfume on olfactory detection thresholds of health workers at the University College Hospital, Ibadan.

Methods:

This was a quasi-experimental study on olfactory detection thresholds of one hundred healthy health workers in a tertiary health institution from September 2013-November 2013. A structured questionnaire was administered to participants to obtain information on sociodemographics, occupation, ability to perceive smell, use of perfume, effects of perfume on appetite and self-confidence, history of allergy, and previous nasal surgery. Participants subjectively rated their olfactory performance and thereafter had olfactory detection threshold testing done with varied concentrations of n-butanol in a forced triple response and staircase fashion. Olfactory detection thresholds at baseline and after exposure to Lynx perfume were determined and compared.

Results:

Thirty-seven males and 63 females were evaluated. Their ages ranged from 19-59 years with a mean age 31 years ± 8. Subjectively, 94% participants had excellent olfactory function. In the pre-exposure forced triple response, 88% participants were able to detect the odor at ≤0.25 mmol/L concentrations while in the post-exposure forced triple response, only 66% participants were able to detect the odor at ≤0.25 mmol/L concentrations. There was also a statistically significant difference in the olfactory detection threshold score between the pre-exposure and post-exposure period in the participants ( P < .05).

Conclusions:

Use of fragrance affects the olfactory detection threshold. Therefore, wearers should be aware of this and its implications on test of olfaction.

Comparison of Hearing Status of HIV-Exposed and -Unexposed Newborns and Immunovirologic Correlates in HIV-Exposed Newborns

Objectives:

(1) Compare hearing status of HIV-exposed newborns with HIV-unexposed newborns and (2) determine the association between their hearing threshold and maternal and newborn laboratory parameters.

Methods:

A cohort audiometric study of newborns in secondary and tertiary hospitals between October 2012 and September 2013. Subjects studied: Consecutive 126 HIV-exposed and 121 HIV-unexposed newborns. Interventions: Hearing screening and thresholds of the newborns were done with Auditory Brainstem Response and compared against maternal highly active antiretroviral therapy (HAART), CD4 cell counts, RNA viral loads, and newborn CD4 percentage. Outcome measurements: Hearing threshold levels of both groups were measured and analyzed using appropriate statistics.

Results:

A total of 9.5% of HIV-exposed and 5% of unexposed newborns had hearing impairment ( P = .1771; relative risk [RR] = 1.9206 [0.7445-4.9549]). A total of 6.4% of HIV-exposed and 2.5% HIV-unexposed newborns had hearing threshold >20 dBHL ( P = .1578). There was no significant association between the hearing threshold of HIV-exposed newborn and maternal CD4 cell counts ( P = .059) but there was a significant association with maternal viral load ( P = .034). Study showed a significant difference in the hearing of the 119 HAART-exposed newborns and 7 unexposed newborns ( P = .002; RR = 0.13 [0.05-0.32]).

Conclusions:

There was a trend toward more hearing loss in HIV-exposed newborns and a significant difference between the hearing thresholds of HIV-exposed newborns with CD4 % of ≤25 and >25. There is a significant association between newborn hearing threshold and mothers’ viral load. This background information supports the need for further study on the role of in-utero exposure to HIV and HAART in newborn hearing loss.

Comparative study of aerobic pathogenic bacteria isolates from patients with recurrent tonsillitis

BACKGROUND

To find out if isolated aerobic bacteria pathogens from surface tonsillar swab can correctly predict the infective pathogens within the core tonsillar tissues in recurrent tonsillitis.

METHODS

This was a prospective, hospital based study of 60 patients with recurrent tonsillitis at University College Hospital, Ibadan, Nigeria. Surface swabs of the infected-tonsils-biopsies-of the core tonsillar tissues were obtained. Microscopy, Culture and Sensitivity studies were performed on the specimens. The aerobic pathogens were isolated by standard microbiological methods. Data analysis was done by SPSS version 20.0.

RESULTS

Only 54 (90%) surface swab specimens yielded aerobic pathogens while 47 (78.3%) core tissue specimens yielded aerobic pathogens. The tonsil surface swab for identification of aerobic pathogenic bacteria has a sensitivity of 97.7%, specificity of 31.3%, positive predictive value or precision of 79.6%, negative predictive value of 83.3% and accuracy of 80%. Overall, there was no statistical significant difference in the aerobic pathogenic organisms isolated from surface tonsillar swab and core tonsillar tissue specimens (p=0.103).

CONCLUSION

Aerobic bacteria pathogens grown on tonsillar surface were not significantly different from those from core tonsillar specimenshence, the tonsillar surface swab can reliably be used to identify the pathogenic organisms in recurrent tonsillitis.

Correlating the site of tympanic membrane perforation with Hearing loss

Background

It is recognized that the size of tympanic membrane(TM) perforation is proportional to the magnitude of hearing loss, however, there is no clear consensus on the effect of the location (site) of the perforation on the hearing loss. Hence the study is set to investigate the relationship between the location of perforation on TM and hearing loss.

Methods

A cross-sectional prospective study of consecutive adult patients with perforated TM conducted in the ENT clinic of University College Hospital Ibadan between January 1st 2005 and July 31st 2006. Instruments used for data collection/processing include questionnaires, video and micro-otoscopy, Pure tone audiometer, image J and SPSS packages.

Results

Sixty-two patients (22-males, 40-females), aged 16–75 years (mean = 35.4 +/- 4) with 77 perforated ear drums were studied and 15(24.2%) had bilateral TM perforations, 21 (33.9%) right unilateral and 26(41.9%) left unilateral. The locations of the TM perforations were 60(77.9%) central, 6(9.6%) antero-inferior, 4(5.2%) postero-inferior, 4(5.2%) antero-superior and 3(3.9%) postero-superior respectively with sizes ranging from 1.51%–89.05%, and corresponding hearing levels 30 dB – 80 dB (59% conductive and 41% mixed). Fifty-nine percent had pure conductive hearing loss and the rest mixed. Hearing losses (dBHL) increased with the size of perforations (P = 0.01, r = 0.05). Correlation of location of perforations with magnitude of hearing loss in acute TM perorations was (P = 0.244, r = 0.273) and for chronic perforations (p = 0.047 & r = 0.31).

Conclusion

The location of perforation on the tympanic membrane (TM) has no effect on the magnitude of hearing loss in acute TM perforations while it is significant in chronic ones.

Assessments of the size of tympanic membrane perforations: a comparison of clinical estimations with video-otoscopic calculations

We conducted a study to determine how accurate various ENT specialists were in estimating the size of 100 tympanic membrane (TM) perforations with standard otoscopy. The specialists included, in descending order of rank, 2 Consultant Surgeons, 2 Senior Registrars, and 2 Registrars, all of whom had confirmed good vision. We compared their estimates, which were made independently and expressed as a percentage of the total area of the TM, with exact measurements calculated with computer-based video-otoscopy. We found that the video-otoscopic calculations were far superior to the estimates of the specialists, even the most experienced Consultants (p < 0.01). We recommend that video-otoscopy be used whenever possible.

Migraine and Meniere's disease: two different phenomena with frequently observed concomitant occurrences

BACKGROUND

Some variants of migraine could be indistinguishable from Meniere's disease, and this has prompted suggestions of possible association between the two disease entities.

AIM AND OBJECTIVES

This study aims at determining the prevalence of migraine among Meniere's patients and a possible linkage between the two diseases in our environment.

METHODOLOGY

A 10-year retrospective study of patients diagnosed with Meniere's disease using American Academy of Otorhinolaryngology criteria, including those that had associated migranous symptoms in accordance with the International Headache Society (IHS) diagnostic criteria for migraine, between 1996 and 2005. The prevalence of migraine in the Meniere's patients was also compared with lifetime prevalence recorded from a previous population-based study within the same setting. The statistical difference was tested with a Z nonparametric test (significance at P < 0.05). Epicalc2000 and SPSS 11 were used for the statistical analysis.

RESULT

A total of 25 patients representing 0.22% of the 11,463 ear, nose and throat outpatients seen within the study period met the diagnostic criteria for Meniere's disease. There were nine (36%) males and 16 (94%) females. Their ages ranged 27-65 years, mean 45.25 years +/- 11.05. Eight (32%) met IHS criteria for migraine. There is a statistically significant difference between the prevalence of migraine in Meniere's patients and migraine in the overall population (32% vs. 5.3%, P = 0.000).

CONCLUSION

The significant preponderance in the prevalence of migraine in Meniere's disease suggests a link between the two diseases. However, more molecular or genetic studies are needed to unveil this phenomenon.

Nasal septal teratoma in a child

Background

Teratoma is a rare developmental neoplasm that arises from totipotential tumor stem cells. Head and neck teratomas constitute about 10% of all cases. Only two cases of mature teratoma of the nasal septum have previously been documented in the world literature.

Case presentation

We present a case of histologically confirmed mature teratoma arising from the nasal septum in an eighteen month old Nigerian female who presented with a history of noisy breathing associated with recurrent rhinorrhea since birth. Physical examination revealed obstruction of the right nasal cavity by a pale fleshy mass. She underwent a total surgical excision and to date, after thirty one months follow-up, she is free from recurrence.

Conclusion

The prognosis for benign teratoma of the nasal septum is good following total surgical excision.

Quality of life in patients with head and neck cancers

OBJECTIVE

The aim was to assess the psychosocial effects on the quality of life (QOL) of adults with head and neck cancer (HNC) and any gender variations with predictive factors that may influence QOL.

PATIENTS AND METHODS

This was a three-month descriptive and prospective evaluation of QOL in 50 adult patients with HNC who were still on treatment but had spent a period of at least four weeks from commencement in a tertiary hospital.

MAIN OUTCOME RESULTS

There were 32 males and 18 females with a mean age of 47.74 years. Females had higher mean scores than males in all domains except pain domain, global and general questions. There was no significant difference in the mean score between the genders in all the domains: overall bother, overall satisfaction, response to treatment, site with QOL and health-related QOL (HRQOL). Pain domain correlated significantly with eating and emotion but weakly with stage of the disease. The predictive factor for overall bother was mainly emotion domain, while site of lesion with QOL was for overall satisfaction, response to treatment and HRQOL.

CONCLUSIONS

Pain, which is a major problem experienced by these patients with HNC, requires more attention by the caregiver in order to improve their QOL.

Esophageal impacted dentures

OBJECTIVES

This study aims to highlight the problems associated with impacted acrylic dentures and proffers advice to check them.

PATIENTS AND METHODS

Retrospective review of all cases of impacted acrylic dentures over a 16-year period.

RESULTS

Twenty-two adults had impacted esophageal acrylic dentures of which 16 (72.7%) and six (27.3%) were males and females, respectively (M:F ratio = 2.7:1) with age range 23-77 years. Fourteen patients (63.6%) had worn their dentures for more than 10 years without check-up, and 54.5% presented within 48 hours of impaction. The common symptoms in all the patients were difficulty with swallowing, throat pain and discomfort, followed by tenderness in the neck in 15 (68.2%). Dentures were extracted through esophagoscopy (17 cases) and cervical (three cases) esophagotomy, respectively. Observed complications included pulmonary edema in one and esophageal perforation in five patients.

CONCLUSION

Endoscopic extraction of dentures carries a high risk of perforation. Extraction of an impacted denture via esophagoscopy can be undertaken under direct vision and in an ideal situation with judicious use of the Shears forceps. In the absence of these, the safest option is an esophagotomy. Proper treatment planning in the fabrication of dentures with incorporation of radiopaque materials in the dental resins and adequate postdenture delivery instructions are necessary as preventive measures.

Cervical vertigo and cervical spondylosis--a need for adequate evaluation

BACKGROUND

Cervical spine spondylotic changes are known to cause vertigo. The mechanism by which cervical vertigo is induced is very debatable. This study was to highlight the prevalence of vertigo and other vestibulocochlear organ affectation in patients with cervical spondylosis and to serve as a template for further research in this area.

METHODOLOGY

A six-year retrospective review of vertiginous patients with radiological evidence of cervical spondylosis seen at the Otorhinolaryngology Clinic of University College Hospital (UCH), Ibadan.

RESULTS

Forty-three patients, 23 males (53.5%) and 20 females (46.5%) had vertigo as a symptom and radiological evaluation for cervical spondylosis. The radiological findings were normal in 11 patients (26%) and abnormal in 32 patients (74%). Of the twenty-five patients who had pure tone audiometry, 40% were normal and 60% abnormal. Out of 20 affected ears, seven patients (47%) had right, 3 patients (20%) left and 5 patients (33%) both ear involved respectively. High frequency range was affected in 8 (40%), low in 2 (10%) and all in 10 (50%) ears respectively. Decibel hearing level (dBHL) loss ranged from 30-90 dBHL with a mean binaural of 43 (+/- 8.5) dBHL.

CONCLUSION

We advocate early multidisciplinary approach in the management of all established cases of cervical vertigo.

Upper airway obstruction in Nigeria: an aetiological profile and review of the literature

The early history of tracheostomy and intubation suggested that upper airway obstruction had been in existence for a long time. A study of 80 patients with upper airway obstructions treated over a 10-year period between 1990 and 1999 was carried out to determine the aetiology and incidence. There were 65 (81%) males and 15 (19%) females with a sex ratio of 4.3:1 (M:F). The age ranged from 6 months to 70 years; with mean age of 27 years. Ninety-nine per cent were acquired causes and 1% were congenital. The commonest site of obstruction was in the larynx 81%. In children, the most common causes were laryngeal papilloma (16%) and foreign body (14%), while in adults, laryngeal carcinoma (24%) and direct laryngeal injuries (15%). The study revealed a wide range of causes of upper respiratory tract obstruction encountered in a developing tropical country. Health education and community awareness programmes should be supported. This would encourage early presentation, prompt referral to experts and earlier treatment with improved outcome.

Behavioural pattern of malignant otitis external: 10-year review in Ibadan

Malignant externa otitis is a rapidly progressive infection of the external ear canal, mastoid and the base of the skull caused by Pseudomonas aeruginosa in elderly diabetics and other immunosuppressive conditions. Thirteen cases of malignant externa otitis seen in the E.N.T. Dept University College Hospital, Ibadan between 1988 and 1997 were reviewed. The mean age was 62 years and the mean duration of diabetes was 14 years. The most frequent symptoms were otalgia 13 (100%) and otorrhoea 12 (92%). The complications include multiple cranial neuropathy 11 (85%), meningitis (31%), brain abscess (8%), and infratemporal abscess 1 (8%). There were 8 deaths (62%) showing that this is still a dangerous condition in our environment. The problems identified were late presentation of cases and inavailability of facilities for prompt control and monitoring of patients. It is hoped that the outlook of the disease can be improved if there are corrected.

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.

Bacterial agents of discharging ears and antimicrobial sensitivity patterns in children in Ibadan, Nigeria

Bacteriological studies were carried out on ear swabs from 361 cases of children with discharging ears at the Microbiology Department of the University College Hospital, Ibadan between March 1995 and February 1997. 308 (85.3%) had positive cultures. 78.6% of these yielded one isolate, 19.2% yielded two isolates while 2.2% had three isolates. Pseudomonas spp. Was the predominant agent of CSOM and ASOM. This was followed by Staphylococcus aureus. Other commonly isolated organisms were Proteus and Klebsiella species. Ofloxacin and ciprofloxacin showed the highest activity to all isolates, while two third of the isolates were sensitive to azithromycin, cefuroxime, ceftriazone and gentimicin.

Pyogenic granuloma, a cause of congenital nasal mass: case report

This is a case report of a 45-day-old Nigerian boy who presented with obstruction of the left nasal cavity since birth caused by a pyogenic granuloma which was successfully removed.

Ophthalmo-neurologic manifestation of nasopharyngeal carcinoma

Ophthalmo-neurologic manifestations may be the first and sole presenting feature of nasopharyngeal carcinoma. This may be mis-leading unless a high index of suspicion exists. A retrospective study with analysis of 79 patients with nasopharyngeal carcinoma seen in the 12 years between 1986 and 1997 is presented. Among the 79 cases seen and analysed 20 (25%) had ophthalmo-neurologic manifestations; showing that up to one quarter of nasopharyngeal carcinoma cases could have neuro-ophthalmic manifestations. The ages ranged between 11 years and 70 years with a male: female ratio 2.4:1. This is in consonance with previous reports that nasopharyngeal carcinoma mostly affects males. In this study, visual impairment and corresponding optic nerve lesions constituted 20% of the manifestations. Diplopia and ophthalmoplegia constituted 17% and 18% respectively of the manifestations; these are in consonance with previous reports as seen in literatures. However ptosis (15%) and Horner's syndrome (3%) were essential manifestations seen in this study that were not found or documented in other previous reports. It shows that these could be part of neuro-ophthalmic manifestations of malignant nasopharyngeal carcinoma prompting patients initial presentation to the ophthalmologist. This paper is thus to draw more attention to the significance of ophthalmo-neurologic signs and symptoms as an aid to early diagnosis of malignant nasopharyngeal carcinoma. This will no doubt improve prognosis.

Pharyngeal lipoma with cartilaginous metaplasia (chondrolipoma): a case report and literature review

The relative rarity of pharyngeal lipomas and paucity of clinical manifestations in the early stages of tumour growth conspire to task the diagnostic acumen of the clinician. A high index of suspicion and meticulous examination are essential in order to arrive at the diagnosis, which may be achieved pre-operatively by computerized axial tomography, revealing a mass lesion with a characteristic low attenuation value. A case of pharyngeal chondrolipoma in a 25-year-old male is reported. It is suggested that this conceptually intriguing and rarely encountered lesion can be explained on the basis of neoplastic transformation of the second to fourth pharyngeal cleft mesenchymal rests displaying both adipose and cartilaginous differentiation. Alternatively, the cartilage could represent vestigial remnants of non-neoplastic pharyngeal cleft tissue entrapped within a primarily lipomatous neoplasm. Slow growth may occur over a period of several years, prior to overt clinical manifestation.