Challenges of Otolaryngologic Referral in a Nigerian Tertiary Hospital

Background: The referral system offers one strategy for making the best use of hospitals and tertiary healthcare services. The aim of this study was to analyze the referral system of patients to the otorhinolaryngologist and to examine the use of in-house referral system in the teaching hospital set up.Methods: This was a retrospective review of all patients referred to the ENT Department between January 2000 and December 2007. Data retrieved from all referral notes included the review of referral letter, demographic, referral status, clinical presentations and examination findings. These data were entered into the SPSS computer software version 11.0 and analysedResults: A total of 1402 cases were analyzed. The patients’ ages ranged from 3weeks to 90yrs, with 70.4% of cases being below 40yrs of age while 25.9% were between 40-64yrs and 3.7% were above 65yrs. The Male to female sex ratio was 1:1. The majority (70.4%) of the patients had at least primary school education. The rest (29.6%) had no formal education. Slight over half (51.5%) of the patients were unemployed. The rest were either civil servants or self employed. Out of the 1402 patients that were referred to the hospital, in-house referral accounted for 74.1%, 7.2% of came from private health facility and 4.3% were self referrals. Out of the 1038 in-house referrals, 42.8% were from GOPD, 5.0% from Staff clinic, 13.3% from surgery, 4.7% from medicine, 3.5% from Obstetrics and Gynaecology, 10% from paediatrics and 10.4% from ophthalmology and 10.3% from ENT staffs such as residents, ENT Nurse Practitioner and ENT supporting staffs such as speech therapist and audiologist.Conclusion: The challenges of referral to the otolaryngologists are enormous thus the need to organize continuous medical education for the family physician, to make patients have confidence in the primary care physician, early referral of patients and to allow the otorhinolaryngologist to focus on the cutting edge issues of the specialt

Uncommon complications of Otitis media in a tertiary center: A Case Series

Background: The aim is to report cases of unusual and infrequent complication of otitis media in North-central Nigeria, as well as evaluate their outcome. We present 7 case reports of patients with unusual complications from otitis media in our setting.Case 1: A fifteen year old Yoruba girl presented at the Accident and emergency of our hospital with a 2 week history of left sided ear ache, 10 day history of left sided ear discharge and 3 day history of jaw and neck stiffness. There was a positive history of use of ‘Turari’ locally prepared perfume and application of an ear drop from a local chemist. Caregiver said patient was fully immunized. Examination revealed a young girl, conscious and alert, not pale, anicteric with stiff neck, positive and rigid joints on movement.Case 2: An 8 year old Yoruba girl presented first to the eye clinic with 2 days history of swelling of the right eye, associated pain, reduction in vision and eyelid swelling without eye discharge or itch. There was a of purulent ear discharge 8 days prior to eye symptoms. No history of trauma was obtained. Examination revealed proptosis with zygomatic abscess extending to the post-auricular. She had incision and drainage with systemic and topical antibiotics for ear dressing. Outcome was uneventful.Conclusion: The unusual complication of otitis media still occurs in our environment usually due to late presentation and contamination of wound. Prevention is still the best option.  Keywords: Otitis Media, Complications, Otogenic Tetanus, Ophthalmic, Proptosi

Comparison of start back screening tool and simmonds physical performance based tests battery in prediction of disability risks among patients with chronic low-back pain

Objectives: This study identified disability sub-groups of patients with chronic low back pain (LBP) using the Subgroup for Targeted Treatment (or STarT) Back Screening Tool (SBST) and Simmonds Physical Performance Tests Battery (SPPTB). In addition, the study investigated the divergent validity of SBST, and compared the predictive validity of SBST and SPPTB among the patients with the aim to enhance quick and accurate prediction of disability risks among patients with chronic LBP. Methods: This exploratory cross-sectional study involved 70 (52.0% female and 47.1% male) consenting patients with chronic non-specific LBP attending out-patient physiotherapy and Orthopedic Clinics at the Obafemi Awolowo University Teaching Hospitals, Ile-Ife and Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Disability risk subgrouping and prediction was carried out using the SBST and SPPTB (comprising six functional tasks of repeated trunk flexion, sit-to-stand, 360-degree rollover, Sorenson fatigue test, unloaded reach test, and 50 foot walk test). Pain intensity was assessed using the Quadruple Visual Analogue Scale. Data on age, sex, height, weight and BMI were also collected. Descriptive and inferential statistics were used to analyze data at p<0.05 Alpha level. Results: The mean age, weight, height and body mass index of the participants were 51.4±8.78 years, 1.61±0.76 m and 26.6±3.18 kg/m2 respectively. The mean pain intensity and duration were 5.37±1.37 and 21.2±6.68 respectively. The divergent validity of SBST with percentage overall pain intensity was r = 0.732; p = 0.001. Under SBST sub-grouping the majority of participants were rated as having medium disability risk (76%), whilst SPPTB sub-grouped the majority as having high disability risk (71.4%). There was a significant difference in disability risk subgrouping between SBST and SPPTB (χ²=12.334; p=0.015). SBST had no floor and ceiling effects, as less than 15% of the participants reached the lowest (2.9%) or highest (1.4%) possible score. Conversely, SPPBT showed both floor and ceiling effects, as it was unable to detect ‘1’ and ‘9’, the lowest and highest obtainable scores. The ‘Area Under Curve’ for sensitivity (0.83) and specificity (0.23) of the SBST to predict ‘high-disability risk’ was 0.51. The estimated prevalence for ‘high-disability risk’ prediction of SBST was 0.76. The estimate for true positive, false positive, true negative and false negative for prediction of ‘high-disability risk’ for SBST were 0.77, 0.23, 0.31, and 0.69 respectively

Translation and psychometric evaluation of the Yoruba version of the STarT Back tool among persons with longterm non-specific low-back pain

Background. Translating questionnaires into local languages is essential as it aids easy accessibility and understanding of such questionnaires by patients and their health caregivers. The STarT Back Tool (SBT), validated tool used to classify subgroups of persons with Low-Back Pain, has few translated versions. We translated the STarT Back Tool into the Yoruba language and established its psychometric properties among patients with long-term non-specific Low-Back Pain. Methods. Following the Lenz protocol, the SBT was successfully cross-culturally adapted into the Yoruba language. One hundred consenting patients (mean age = 57.0±11.43 years, 55% females) took part in the validation phase, while 53 of them participated in the test-retest phase. Psychometric indices of the Y-SBT assessed showed internal consistency, intraclass correlation coefficient (ICC), ceiling and floor effects and divergent validity. Results. The sub and total Cronbach’s α score for Y-SBT was 0.704 and 0.857, respectively. The test-retest reliability of the sub and total scores of the Y-SBT yielded an ICC of 0.82 (95% CI: 0.74 - 0.87) and 0.89 (95% CI: 0.84 - 0.93), respectively. The divergent validity for sub and total-scores of the Y-SBT based on Quadruple Visual Analogue Scale score for on-going pain was r = 0.374 (p = 0.001) and r = 0.432 (p = 0.001), respectively. The Y-SBT had no ceiling or floor effects. Conclusion. The Y-SBT have acceptable psychometric properties. It is recommended for use among Yorub speaking patients with LB

Foreign Bodies in the Upper Aerodigestive Tract of Nigerian Children

Aim/Background This is an audit of number, nature, sites of impaction and methods of removals and treatment outcome of upper aero-digestive foreign bodies among children in an urban University hospital in Nigeria. Patients and Methods This is an 8year retrospective review of foreign body in upper aero-dgestive tract of children (January 2001 to December 2007) was conducted at the ENT department of the University of Ilorin Teaching Hospital, Ilorin, Nigeria . Case notes of the patients were retrieved and the following were data extracted: demographic, clinical, operative and outpatient visits outcome. Results 81 children aged 9months to 16years were seen (mean 4.28, SD 2.95) with 49 males and 32 females and a male: female ratio of 1.5: 1.0.The commonest age group was 9months to 4years (76.5%). Most common of impaction sites were nasal cavity in 31 cases (38.3%), oesophagus in 23 cases (28.4%), oropharynx in 16 (19.8%) and larynx in 6 (7.4%)).The commonest FBs was coins in 33 (40.7 %) in the oesophagus and 37.5% of pharyngeal FBs .Inanimate FBs in the nose constituted 31(38.3%) [Non vegetative 27(87.1%), vegetative 4(12.9 %)]. Fish bones were seen in 11 cases (13.6%) [6 in the larynx and 5 around the tonsillar fauces] and miscellaneous objects in 6 cases. Conclusion Upper aero-digestive foreign bodies are common especially among the under fours', commonest sites being the nose and pharyngooesophageal region with coins and inanimate FBs constituting about four-fifth. There is the need for parental health education on object placements, and a high index of suspicion among practitioners to facilitate early referral and avoid preventable complications