Aetiologies of profound bilateral sensorineural hearing loss among children in Ekiti State, South Western Nigeria

Introduction

a strong need exists for the knowledge of aetiologies of diseases as this will guide the clinicians on the strategies for their treatment and prevention. In this study, we determined the aetiologies of profound bilateral sensorineural hearing loss (pbSNHL) with a view to provide the relevant data needed for preventive and therapeutic intervention among children in Ekiti State, South Western Nigeria.

Methods

medical records of children with pbSNHL seen over a ten-year period were analysed.

Results

in all, records of 142 children with pbSNHL were analysed. The results showed spectrum of aetiologies that were similar to those reported decades ago with the 'unknown' assuming a recurring decimal. Of the known (acquired) cases, measles takes up the largest 'chunk' with a prevalence of 45.8%. Twenty-eight (32.2%) of those with febrile illnesses had treated their fever with ototoxic antibiotics. Late diagnosis was characteristic of the pbSNHL.

Conclusion

this study shows that there hasn't been any significant shift in the common causes of pbSNHL. Of great concern is the persistence of the 'unknown' causes which assumes a recurring decimal in this and previous studies. Also worrisome is the high prevalence of measles-induced pbSNHL despite the availability of anti-measles vaccine. We therefore suggest effective immunization against measles and other vaccine-preventable causes of pbSNHL. The need for intensive research on the unknown causes of pbSNHL is hereby stressed. Also recommended is routine hearing assessment for survivors of febrile conditions so as to detect, if any, hearing loss promptly.

Teething Beliefs, Misconceptions, and Practices Among Mothers Attending a Tertiary Hospital in Nigeria: Implications for Child Health and Clinical Practice

Introduction: Teething is a physiologic process that begins during infancy. However, some mothers often attribute certain symptoms to teething. In this study, we assessed the opinions and practices of mothers attending a tertiary health facility in Nigeria on teething. Methods: This was a cross-sectional, descriptive study conducted among caregivers of children presenting to the out-patient department of a tertiary hospital, Southwestern Nigeria. Results: Five hundred and sixteen mothers were studied. The leading symptoms attributed to teething were fever 420 (81.4%), reduced food intake / appetite 320 (62.0%), diarrhoea 314 (60.9%) and vomiting 294 (57.0%). Some believed that teething is associated with convulsion 102 (19.8%), mouth ulcers 69 (13.4%), ear discharge 68 (13.2%), and no symptoms 41 (7.9%). Majority of the mothers 374 (72.5%) believed that teething requires treatment. Two hundred and four (39.5%) mothers had given their children oral analgesics for teething while 194 (37.6%) administered teething mixtures. These medications were more likely to be prescribed at the hospital or purchased over the counter (p < 0.05). Other treatments given included herbal concoction 46 (8.9%), local tooth extraction 22 (4.3%), enema 17 (3.3%), body scarifications 14 (2.7%), gum fomentation 14 (2.7%) and gum incision 12 (2.3%). Responders who attributed convulsion to teething were more likely to have incised their children’s gums (p < 0.05). Conclusions: This study revealed that sundry symptoms were attributed to teething and harmful home interventions were done for teething. There is a need to educate the society on teething and discourage harmful practices for teething by caregivers.

Pattern of tympanic membrane perforation in a tertiary hospital in Nigeria

Background/Objectives

Tympanic membrane perforation is a common otological disorder with associated hearing impairment. This study aimed at determining the clinicoepidemiological pattern, etiological factors, clinical presentation, and management of tympanic membrane perforation in a tertiary hospital in Nigeria.

Materials and Methods

This was a prospective, hospital-based study of patients with the clinical finding of perforated tympanic membrane. The study was carried out over a period of 5 years (September 2012 to August 2017). Interviewer-assisted questionnaire was administered to obtain the detailed history and clinical findings from consenting patients. Data collected were collated and analyzed using SPSS version 16.0.

Results:

A total of 529 patients had tympanic membrane perforation, of which 368 (69.6%) were males and 161 (30.4%) were females with a male-to-female ratio of 2:1. The prevalence of tympanic membrane perforation in this study was 7.8%. The most common presenting symptom among the patients was otorrhea in 81.5%, otalgia in 72.8%, and tinnitus in 55.7%. Acute suppurative otitis media was a cause of tympanic membrane perforation in 28.4% of the patients while 55.7% of the patients proceed to chronic suppurative otitis media. Unilateral tympanic membrane perforation was 79.0%. The left ear tympanic membrane perforation was 43.9%. Grade 1 tympanic membrane perforation accounted for 39.3% while grade 2 accounted for 32.3%. The most common types of tympanic membrane perforation were central in 38.2%, anterior central in 32.3%, and posterior central in 19.3%. Conductive hearing impairment accounted for 61.6% while sensorineural hearing impairment 25.3%. The most common degrees of hearing impairment were mild and moderate and accounted for 47.1% and 25.1%, respectively. The most common complications of tympanic membrane perforation were hearing impairment in 52.6%. Majority of the patients (425) were treated conservatively, six had fat patches, while 98 were treated surgically. Tympanic membrane perforation healed at the end of 3 months in 81.5%, while 18.5% did not heal after 3 months.

Conclusion

Tympanic membrane perforation arises mainly from middle ear infections and traumatic causes. At presentation, size and location of perforation vary which depend on duration of infection or the traumatic causes.

Otological burdens of Nigerian children with sickle cell disease

INTRODUCTION/OBJECTIVE

Sickle cell disease (SCD) is associated with episodic illnesses, multi-systemic affectations and end-organs damages. Otolaryngological related complications are not unexpected. Studies on the overall Otolaryngological pathologies in children with SCD relative to their non-SCD counterparts are scanty in Nigeria. We hypothesized that children with SCD are likely to have more otological burdens than their non-SCD counterparts. Thus, we embarked on this study to describe and compare the overall ear diseases burdens seen in children with sickle cell disease relative to their non-SCD counterparts.

METHODOLOGY

A cross-sectional study of otologic diseases among children with SCD and their non-SCD counterparts attending the paediatrics and otolaryngological clinics of a Nigerian tertiary institution was conducted.

RESULTS

Overall, 80 (47.62%) of the 168 ears of SCD patients compared to 37 (22.02%) of the 168 ears of their non-SCD counterparts were affected by diseases (p < 0.0001). The diseases were Wax, Otitis Media with Effusion, Suppurative Otitis Media, Otosclerosis and Sensorineural Hearing Loss (SNHL). There was a significant difference in the prevalence of SNHL and solitary otosclerosis between the SCD patients and their non-SCD counterparts (P < 0.05) respectively. Both the Haemoglobin concentration and HbF did not discriminate between the SCD participants with or without SNHL (P > 0.05).

CONCLUSION

This study showed that otological burdens are more prevalent in children with SCD than the non-SCD population. The microbiological peculiarity of suppurative otitis media (SOM) among participants stresses the need for concerted efforts at preventing SOM in SCD children. There is need for special Otolaryngological care for SCD children.

Patterns, Presentations and Prognosis of Nasal Polyps

Few studies have documented the characteristic features of nasal polyps in the developing countries. In this study, we described the patterns, presentations and prognosis of nasal polyps seen in clinical setting, with a view to improve our understanding of its clinical and epidemiological characteristics. The study was a 10-year retrospective analysis of histologically-confirmed nasal polyps seen between January 2006 and December 2015. Records of patients with intranasal masses were retrieved from our hospital's records department, clinics, wards and theatre suites. Those with nasal polyps were recruited into the study. The results were descriptively analyzed using SPSS statistical soft ware package version 10. There were 84 patients with intranasal masses seen within the reviewed period. Of this, 52 (61.9%) were histologically-confirmed nasal polyps. There were 22 males and 30 females. Their age ranges from 16 to 69 years. The most frequent symptom is nasal obstruction occurring in 76.9% of the cases. None of the patients had epistaxis. Thirty-one (59.6%) were associated with various complications either singly or multiple (Table 1). All (100%) were treated with conventional forceps excision. Eleven (21.2%) of them had recurrence between 3 and 5 years after surgery. None of the polyps or their recurrence exhibited malignant transformation. Nasal polyp is the most common intranasal mass seen in clinical practice. Its rarity in children and propensity for recurrence are reaffirmed. Although, recurrence is a major prognostic challenge, nasal polyp does not exhibit malignant transformation. [Table: see text].

Earwax Impaction: Symptoms, Predisposing Factors and Perception among Nigerians

Background and Aim:

Earwax impaction is a common ear disorder with presentation worldwide. This study aimed at determining the clinical presentation, patients’ perception of earwax, and its predisposing factors among Nigerians.

Materials and Methods:

This prospective study was conducted on consented patients with diagnosis of earwax impaction at the Ear, Nose, and Throat Clinic of the University Teaching Hospital, Ado Ekiti, Ekiti state, south west, Nigeria. The research was carried out over a period of one year (April 2008 and March 2009). All consented patients were told about the aim and scope of the study and their biodata were taken. Detailed history of the presenting complaints and otological complaints were taken and all data entered into structured questionnaires. Full-ear examination and otoscopy were performed and our findings were documented. From all these exercise, data obtained were collated and statistically analyzed.

Results:

A total of 437 patients were diagnosed with earwax impaction and prevalence of 20.1% was found. There was 52.2% male preponderance with male to female ratio of 1:1. Bimodal peak age distribution of patients was found at the extreme ages of life. Most common sources of our patients referrals were 39.6% general medical practitioners with least from 6.2% self-reporting. Common presentations were 277 (63.3%) hearing loss, 268 (61.3%) earache (otalgia), and 234 (53.5%) tiinitus. Unilateral earwax impaction, 75.1% was more common than bilateral earwax impaction. Right ear was more affected than left ear. Recurrent earwax impaction of 66.1% was found in our study. About 382 (87.4%) believed earwax was due to dirt or dust. Most common predisposing factors among our patients were self-ear cleaning.

Conclusion:

Common predisposing factor of this high recurrent earwax impaction were wrong perception and preventable self-ear cleaning with indiscriminate objects including cotton tip swab. This condition could be reduced by health education of the community.

Presentation of preauricular sinus and preauricular sinus abscess in southwest Nigeria

BACKGROUND AND AIM

Preauricular sinus abscess is a common congenital external ear disease. This abscess is usually misdiagnosed because it is commonly overlooked during physical examination. In Nigeria, the prevalence was 9.3% in Ilorin, north central Nigeria This study is to determine the distribution and clinical presentation of the preauricular sinus abscess in Ekiti, south west Nigeria.

MATERIALS AND METHODS

This is a prospective hospital based study of all patients with diagnosis of preauricular sinus abscess seen in our clinic carried out between April 2008 to March 2010. Detailed clinical history, administered interviewer's assisted questionnaires full examination and. Data obtained were collated and analysed.

RESULTS

Preauricular sinus were noticed in 184 (4.4%) out of 4170 patients seen during the study period. Preauricular sinus abscess were noticed in 21 (11.4%) of the preauricular sinuses especially in children. Unilateral preauricular sinus abscess accounted for 90.5%. Common presenting complaints were preauricular swelling (81.0%), 90.5% with recurrent earaches, 76.2% with ear discharges. All patients had antibiotic / analgesic while 17 out of 21 (81.0%) had surgical excisions.

CONCLUSION

Preauricular sinus abscess were noticed among 11.4% of the preauricular sinuses especially in children, unilateral preauricular sinus abscess accounted for 90.5%. Common complaints were otorrhoea, earaches, and swelling and they were mostly managed surgically.

Impacted stump of toothbrush in the throat following a fall: a case report

AIMS AND OBJECTIVES

The objective of this paper is to emphasise the importance of detailed history, thorough physical examination and the need to expose undergraduates to basic Otorhinolaryngological skills of clinical examination as a way of overcoming the diagnostic challenges of foreign body in the throat.

PATIENTS AND METHODS

The case was an 8-year old boy who presented with 1-year history of impacted stump of toothbrush in his throat following a fall. With a high index of suspicion, his throat was examined under bright illumination and a foreign body brought into view by tongue depression was found impacted in his left tonsillar fossa. He was subsequently taken to the operating room for removal under General Anaesthesia.

RESULTS

Intra-operatively, the stump of a toothbrush measuring 4.8cm in length was confirmed and removed (Figs 1 & 2). The procedure was uneventful.

CONCLUSION

Foreign body in the throat could pose diagnostic challenge. Detailed history and thorough physical examination are essential to clinch a diagnosis. Early referral in doubtful cases goes a long way to reduce morbidity and mortality associated with delayed removal.