Audit of Otorhinolaryngological, head and neck emergency in a tertiary health care centre in a sub Saharan Africa

Background: Ear, nose and throat, head and neck emergency are very common with low levels of awareness. Early diagnosis and treatment lead to good outcome with low morbidity and mortality. This study aimed at determining prevalence, socio-demographic features, types, Comorbid illnesses and management of otorhinolaryngological emergency in our centre. Materials and Methods: This was a retrospective study of the total number of ENT patients referred to Ear, Nose and throat department of Ekiti state university teaching hospital Ado Ekiti between July 2016 and June 2018. The clinical records of all the patients that have complete data were reviewed. All the data obtained were collated and analysed using SPSS version 18.0. Results: Prevalence of emergency Otorhinolaryngological cases in this study was 18.4%.There were 62.2% males with male to female ratio of 1.5:1. There were urban dwellers in 61.2%. The main type of otorhinolaryngology emergency was 55.8% foreign body (Ear, Nose and Throat), 19.0% infection/inflammation and 13.4% trauma/road traffic accident. The most common otorhinolaryngology foreign body distributions were ear, nose and throat in 28.8%, 23.4% and 3.6% respectively. Infection/inflammation occurred in the 6.4% ear, 5.9% nose and 7.5% throat. The anatomical distributions of otorhinolaryngology emergency were 49.9% in the ear, 31.9% in the nose and 15.9% in the throat. The most frequent clinical features of the otorhinolaryngology emergency in this study were pain in 60.7% followed by foreign body (ENT) in 54.5%. Major sources of referral were from self-reporting in 33.9% and casualty officers in 22.9%. Modes of otorhinolaryngological emergency patient’s presentation were ENT outpatient clinic in 77.6%, accident and emergency in 17.5% and hospital ward in 4.9%. Pre-hospital treatment occurred in 44.2% of the studied patients. 50.9% of the patients had conservative/medical treatment. Foreign body removal was done in 52.2% patients. Nasal packing were done in 6.9% while incision and drainage were performed in 5.4%. Conclusion: Otorhinolaryngological emergency is common in various forms in our practice. This is associated with complications at presentation. Early referral is advised

Pattern of Otalgia in Ekiti, Nigeria

Background: Otalgia is a discomforting otological symptom. The cause may be within or outside the ear. This study aimed at determining the clinico-epidemiological patterns, quality of life, type and aetiology of otalgia. Materials and Methods: It is a prospective hospital based study of patients with complaints of earache. The study was carried out in the ear, nose and throat department of Ekiti state university teaching hospital, Ado Ekiti over a period of one year, from May 2016 to April 2017. Data were obtained by using pretested interview assisted questionnaires from subjects that gave consent. Data obtained were collated, documented and analyzed by using SPSS version 16.0. Ethical clearance was sought for this study from the ethical committee of the institution. Results: Out of a total of 2,616 patients seen, 947 patients presented with complaints of earache. The prevalence of otalgia was 36.2%. There were 31.3% children (1-18 years) and 68.7% adults. The peaked age of otalgia occured at third decade (21-30 years), with a prevalence of 27.7%. There were 621(65.6%) males and 326 (34.4%) females with a male to female ratio of 2:1. Majority (89.1%) of the studied patients were Christian. About 26.6% of our patients were students/apprentice. Majority of the patients were referred to the department by general practitioners in 40.8% of the patients. In this study, main accompanied symptoms were otorrhea, hearing impairment, itching, ear fullness and feeling of movement in ear and these were 29.7%, 23.7%, 23.0%, 20.9% and 18.7% respectively. Other symptoms were toothache, sore throat, cough and hoarseness and these were 6.7%, 6.1%, 4.3% and 3.1% respectively. In this study, majority of the otalgia were secondary to 25.4% otitis externa, 13.6% impacted earwax, 11.9% otitis media and 7.7% tonsillitis. Otogenic otalgia accounted for 67.4% while referred otalgia accounted for 32.6%. Unilateral otalgia accounted for 80.6% while bilateral otalgia accounted for 19.4%. Right otalgia accounted for 47.4% and left otalgia accounted for 33.2% of the studied patients. Majority (65.7%) of the studied patients had noticed sleep disorder. Findings in this study revealed minority of the patients had 36.9% medical treatment while majority had 63.1% surgical treatment inform of ear lavage, aural toilet, aural dressing and foreign body removal. Prior to presentation in ENT department almost half (49.8%) of the patients had over the counter medication and 24.6% herbal treatment, 17.8% had prescribed medication while 7.7% had no treatment. Conclusions: Otalgia has high prevalence among complaints in otorhinolaryngological practice. The prevalence of otalgia was recorded in 36.2% of patients in this study. Majority of the patients presented to non specialist with otogenic and non otogenic aetiology effecting quality of life of sufferer

Clinicoepidemiological Survey of Tonsillitis in Ekiti State University Teaching Hospital, Nigeria

Background: Tonsillitis is a common throat infection with poor documentation in developing countries. In this study, we aimed to evaluate the prevalence, sociodemographic features, clinicoepidemiological survey, and bacteriology of tonsillitis among patients in our practice. Materials and Methods: This was a prospective study of all patients with a diagnosis of tonsillitis at Ekiti state university teaching hospital, Ado Ekiti, Nigeria. Data was collected using a pretested interviewer assisted questionnaire. Bacteriological investigations of tonsils were done and results were recorded. Data obtained were collated and analyzed using SPSS version 18.0. Results: Prevalence of tonsillitis was 12.7%. There were 55.5% males and male to female ratio was 1.2:1. A family history of tonsillitis occurred in 65.9%. The commonest type of tonsillitis in this study was 59.1% recurrent tonsillitis. The majority 38.4% of the patients were referred by a paediatrician. The majority 70.7% of the patients were seen in the ear, nose, and throat outpatient clinic. Most of the patients presented with fever, sore throat, and odynophagia in 72.6%, 71.3%, and 60.4% respectively. Frequent findings on clinical examination were 54.9% enlarged tonsils and 52.4% neck pain/cervical lymphadenopathy. No bacteria were isolated from 25.0% patients while common isolated bacteria were 11.6% Staphyloccocus aureus and 8.5% Streptococcus species. In this study, isolated Streptococcus species and Staphylococcus aureus showed 100% sensitivity to cefuroxime, gentamicin, azithromycin, and ceftazidime. Commonest associated complication was otitis media in 18.9%. Conclusion: Tonsillitis is quite a prevalent febrile illness with a sore throat and enlarged tonsils. Diagnosis is commonly omitted, poorly treated with associated complications at presentation to the specialist clinic

EPIDEMIOLOGICAL PATTERN OF TINNITUS IN EKITI

Objective: Tinnitus is common otological symptoms yet the aetiopathogenesis is poorly understand and poorly managed. This study aimed at determining the prevalence, sociodemographic features, aetiology, comorbidity and its impact upon quality of life in patients with tinnitus in the studied population. Methods: This prospective study of patients diagnosed of tinnitus was carried out in the Ear, Nose and Throat Department of Ekiti state university teaching hospital, Ado Ekiti between March 2012 and February 2017. Interviewer assisted questionnaire was used to document the biodata, history of tinnitus associated medical illnesses, sociodemographic profile and complete clinical examination including Hearing assessment, weight and blood pressure. Data obtained were collated and analyzed using SPSS version 16. The data were expressed in table, bar chart and pie chart. The study had ethical clearance from the Institution and informed consented was obtained from the subjects. Results: A total of 5,221 patients were seen in ear, nose and throat department of Ekiti state university teaching hospital. Total of 458 patients with tinnitus consented and were enrolled into the study. Prevalence of tinnitus in this study was 11.4%. The male were 64.7% and the male female ratio was 3:2. The peak age group was in the third decade. There were 41.8% married and 27.6% widow/widower with tinnitus. Majority of the studied population were Christian 408 (89.0%). Secondary level of education was 43.9% while post secondary education level was 33.2%. Civil servant accounted for 31.9% and farmer accounted for 23.5%. Smoking was noticed in 17.3% and alcohol consumption accounted for 34.8%. Major aetiological agent were ototoxicity, chronic suppurative otitis media and noise exposure as 24.3%, 17.6% and 14.3% respectively. Majority of the studied participants had 68.4% recurrent/persistent tinnitus, 31.6%, single episode of tinnitus, 53.8% short duration tinnitus, 41.7% unilateral tinnitus, 22.1% right ear tinnitus, 95.1% subjective tinnitus, 60.3% discrete tinnitus, 82.1% intermittent tinnitus and 81.1% non pulsatile tinnitus. Tinnitus caused majority of sleep disturbances, social functioning, headache and general health as follows 54.3%, 34.2%, 32.7% and 27.1% respectively. The otological symptoms associated with tinnitus were hearing loss, earache and ear discharge they were as follows 49.5%, 26.4% and 23.1% respectively. The order of comorbid illnesses were diabetes mellitus 12.9%, obesity 7.8% and hypertension 6.1%. Normal hearing was noticed in 26.4%.Referral were mainly from 56.2% general practitioners. Prior to presentation previous treatment received were 49.8% Nil treatment. Conclusion: Tinnitus is a common otological symptoms with prevalence of 11.4% Ekiti state university teaching hospital, Nigeria. There are various aetiological agent associated with comorbid illnesses and impact on quality of life of the suffer

REFERRED OTALGIA IN EKITI, NIGERIA

Background: Referred otalgia is defined as ear ache due to diseases in organs around the ear or other head and neck organs. This resulted from complex nervous connections in the ear, head and neck organs. This study aimed at determining the clinicoepidemiological patterns, impact on quality of life and aetiology of referred otalgia in Ekiti state university teaching hospital, Ado Ekiti, Nigeria. Materials and Methods: This is a prospective hospital based study of patients with diagnosis of referred otalgia in ear, nose and throat department of Ekiti state university teaching hospital, Ado Ekiti. The study was carried out over a period of one year; (May 2016 to April 2017). Consent was obtained from the patients. Data were obtained by using pretested interviews assisted questionnaire. Data obtained were collated and analyzed by using SPSS version 16.0. Results: A total of 2,616 patients were seen out of which a total of 116 patients had referred otalgia. The age group 21-30 year has the highest prevalence of 27.6%.There were 66.3% males and 33.7% females given a male to female ratio of 2:1. Majority (89.1%) of the studied patients were Christian. About 42.2% of our patients are secondary school leavers. Majority (61.2%) are married. About 26.7% were students/apprentice and 24.1% of them were civil servants. In this study, majority of the referred otalgia patients were secondary to tonsillitis in 28.4% of them. The findings in this study revealed higher proportion (58.6%) of our patient had single attack of referred otalgia while over 41.4% had recurrent referred otalgia. Unilateral referred otalgia accounted for 75.0% while bilateral otalgia accounted for 25.0%, with predominantly right ear involvement in 41.4% of our patients. Majority of the studied patients noticed 37.9% sleep disorder, 56.9% absenteeism and 44.8% social functioning. Prior to presentation in ENT department about 50% of the patients had over the counter medication. Conclusion: Referred otalgia is a common otological presenting complaint in otorhinolaryngological practice. The age group 21-30 year has the highest prevalence of 27.6% and tonsillitis is the commonest cause. Diagnosis requires thorough history and examination of head and neck organs

TRADITIONAL UVULECTOMY: ORIGIN, PERCEPTION, BURDEN AND STRATEGIES OF PREVENTION

Traditional uvulectomy is a procedure involving partial or total removal of uvula by traditional practitioners. Uvulectomy by traditional practitioners in Africa has been an age-long practice. The procedure persists in the developing countries probably because of low socioeconomic status and non-formal educational level. There are divergent views as to the reason for uvulectomy as well as its overall benefit. There have been reported cases of complications after the procedure with a subsequent increase in morbidity and mortality. The goal of this paper was to examine the origin of traditional uvulectomy, the perception of people, its burden and strategies of its prevention

Paediatric presentation of ear cleaning in a West African country

Background:Ear cleaning is very common medico-social habit among children worldwide. This study aimed at determining the prevalence, socio-demographic features, clinical presentation, associated complications and management of paediatric ear cleaning in a tertiary hospital in a West African country. Methods:This was a prospective cross-sectional hospital-based study which was carried out in Ear, Nose and Throat department of Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria, over a period of 6 months, between July and December 2017. Consent was obtained from the patients/parents/guardian. The instrument of data collection was a pretested interviewer-assisted questionnaire. Data obtained was collated and analysed using SPSS version 16.0. Results:Prevalence of ear cleaning in paediatric age group was 91.1%. Males were more affected and accounted for 53.4%. The most common reason for ear cleaning was due to personal hygiene. Ear cleaning was done in 57.1% of the children by their mother. Bilateral ear cleaning was noted in 45.3% of patients, 31.6% in the right ear and 23.1% in the left ear. Majority (65.5%) of patients believed that ear cleaning were beneficial. The commonly used object in ear cleaning were cotton bud, finger, sticks and writing material in 35.2%, 18.6%, 13.8% and 13.4%, respectively. Common clinical features among the patients were dirty/earwax, otalgia and itching in 33.6%, 30.8% and 25.9%, respectively. Short time (acute) ear cleaning in 57.9% was more common than long time (chronic) ear cleaning in 42.1%. The frequency of ear cleaning was done on a daily basis in 55.9% of patients, in 21.5% of patients weekly. In 12.6% of patients monthly while 10.1% of patients used to clean their ears occasionally. Major clinical diagnoses of ear cleaning in children were 26.3% personal hygiene, 19.4% allergy and 17.8% earwax. Common complications were external auditory canal injury in 32.4%, impacted foreign body in 21.5% and traumatic perforated tympanic membrane in 6.5%. About 42.9% of our patient obtained information about cleaning of ear from family, 29.6 % from neighbourhood while 27. 5% did not obtained information from anywhere. Treatment included conservative/medical treatment in 60.7%, foreign body removal in 21.5% and impacted earwax removal in 17.8%. Conclusions:Ear cleaning is a common otological habit among children. Personal hygiene was the most common reason for ear cleaning and with cotton bud been being the most common object used. The habit is associated with avoidable complications. Health education and treatment of underlying causes is paramount to reduce this habit

Clinical Profile and Management of Peritonsillar Abscess in a Sub Saharan Africa

Background: Peritonsillar abscess is a common pathology that presents to an otolaryngologist with poor documentation especially in developing countries. The aim of this study was to describe the clinical profile and management of peritonsillar abscess in our practice. Material and Method: This was a retrospective study of patients presenting to our Ear, Nose and Throat facility with diagnosis of peritonsillar abscess. Information obtained includes detailed demographic characteristics, clinical findings and management of the patients. All obtained data were collated, entered into computer system and analyzed using SPSS version 18.0. Results: Prevalence of peritonsillar abscess was 0.2%. There were 38.9% males and male to female ratio was 1:1.6. Duration of illness at presentation with more than 1 week was 75.9% and single episode occurred in 85.2%. Right peritonsillar abscess accounted for 66.7% and aspirated pus of more than 5 ml was recorded in 48.1%. Majority (87.0%) of the patients was referred and 42.6% of such referral is by family physician. Patients seen in ear, nose and throat outpatient clinic were 83.3%. Common symptoms at presentation were fever, sore throat, odynophagia and otalgia in 100%, 94.4%, 90.7% and 59.3% respectively. All the patients (100%) had enlarged tonsils and with deviated uvula on clinical examination followed by 98.1% exudate on the tonsils and 31.5% trismus. Test aspirate confirmed peritonsillar abscess in 68.5% and all revealed growth of bacteria. Common isolated bacteria were 35.2% Streptococcus species and 11.1% Staphyloccocus aureus. Isolated Streptococcus species and Staphylococcus aureus had 100% sensitivity to cefuroxime, gentamicin, azithromycin, ceftazidine, Amoxicillin and Streptomycin. Prior prehospital treatment was received by 81.5% patients. Hospital treatments were surgical intervention and medical treatment in 90.7% and 100% respectively. Recurrences occurred in 3.7% during followed up. Conclusion: Peritonsillar abscess are common disorder with female preponderance in this study. The prevalence recorded in this study was 0.2%. It usually mimic other causes of fever hence eye index of suspicion is essential. Surgical treatment remains the effective mode of management in our study

Patients Barrier to Ear, Nose and Throat Surgical Care in Nigeria

There is high prevalence of ear, nose and throat surgical conditions in our community. Ekiti state government funded facility is available and yet the rate of utilization is low. Therefore, there is need to study the barriers to and surgical uptake.The aim of the study is to identify barriers to both minor and major surgical uptake in Ekiti State, South-Western Nigeria.It is a prospective study of all patients who had attended our Ear,Nose and Throat clinics and scheduled for either minor or major surgery. The study was done between January and December 2016. The patients who consented to be included in the study were enrolled and interviewed. Relevant additional information from their case notes were coded and recorded in the software SPSS version 16. The data was collated and then analyzed.Seven hundred and two (702) consented respondents were enrolled into the study, this comprises of 368 females and 334 males. Majority of the respondents (61.6%) resided in Ado Ekiti while minority of our respondents 2.4% resided outside Ekiti state.Majority of our cases, 87.5% were booked for minor procedure. Only 44.9% of our study population was gainfully employed and 42.7% of the respondents were self-sponsored for the surgical cares.Only minority 13.2% of our studied population did not encountered any form of barrier and 19.2% were able to overcome their encountered barrier. Hospital based barrier, hospital staff based barrier and patient based barrier were found to be 53.8%, 43.6% and 33.8% respectively in the studied population

DANGER OF UNSKILLED HAND TREATMENT OF EAR WAX IMPACTION IN CHILDREN IN DEVELOPING SUB SAHARAN AFRICA

Objectives: Paediatric ear wax impaction is common worldwide with scarce hospital based study. This study aimed at determining the prevalence, sociodemographic features, clinical characteristics, clinical presentation, associated complications and management of ear wax impaction among children visiting our health facility. Materials and Methods: This was a prospective hospital based study of children with clinical diagnosis of earwax impaction reviewed and managed in Ear, Nose and Throat department of the Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria from March 2018 to February 2019. Pretested interviewer assisted questionnaires were administered to obtain data. Data analysis was done by using SPSS version 18. Results: Prevalence of paediatric ear wax impaction was 14.9%. Male is predominant in 56.6% with male to female ratio of 1.3:1. 62.2% were urban dwellers. Recurrent and acute (<3 months) ear wax impaction accounted for 44.1% and 29.4% respectively. Bilateral ear wax impaction was 17.5% while right ear wax impaction was 42.7%. Commonest predisposing factors was parental/self ear hygiene in 37.1%. Common clinical presentation were earache in 60.1%, ear blockage in 35.7% and hearing loss in 33.6%. Associated complications were foreign body impaction in 12.6% and otitis externa in 16.1%. Conclusion: Paediatric ear wax impaction is not an uncommon otologic diseases. At presentation majority were associated with complications from unskilled hand removal