Barriers to Adenoid and Tonsil Surgeries in Ekiti, Nigeria

Different form of barriers prevented or delayed patients from undergoing adenoid and tonsillar surgery in low-income countries. This study aimed at determining the prevalence of patients with barriers, types of barriers, identified affected individuals and possible way out to receive required adenotonsillar surgical care. Materials and Methods: This was a prospective hospital based study of patients scheduled for surgical procedures of adenoidectomy, tonsillectomy or both in the Ear, Nose and Throat department of Ekiti state university teaching hospital, Ado Ekiti, over a period of two years between July 2015 and June 2017. Results: A total of 172 patients were scheduled for adenotonsillectomy out of which 89 patients had surgery done over the study period. This represented 51.7% of patients that had surgery done. Majority (59.6%) with barriers were in the age group (1-10) years. There were 64.0% males and 36.0% females with a male: female ratio of 2:1. Majority (60.7%) of the study population were students/apprentice. Among the participants, 34.8% resided in Ado Ekiti, 55.1% live outside Ado Ekiti and within Ekiti state, while 10.1% were from outside Ekiti state. Major indications for the surgeries were obstructive adenotonsillar hypertrophy in 71.9% patients, recurrent tonsillitis in 19.5% while 4.5% were due to otitis media. About 43.8% patients accepted the surgical option. For one reason or the other 23.6% patients’ differed date for the adenotonsillectomy while 19.1% patients preferred to wait for patients to outgrowth the condition. 13.5% of the patients preferred alternative to surgery. In the findings 43.8% patients had both adenoidectomy and tonsillectomy (adenotonsillectomy) done, 24.7% patients had only adenoidectomy done while 31.5% patients had only tonsillectomy done. No barrier was experienced in 15.7% patients, 58.4% patient’s encountered hospital based barrier, 38.2% encountered patients based barrier, and 48.3% of the studied patients encountered barriers from the hospital staffs. High cost of surgical service and cumbersome preoperative surgical tests were barriers in all (100%) patients. Other major barriers to adenotonsillectomy were fear of bleeding in 94.4%, 88.8% are due to fear of complications and 86.5% were due to fear of surgery itself. Conclusions: Close to half of the patients with adenoid and tonsils disorder did not have the scheduled surgery. They were mainly due to patients based barriers, hospitals based barriers and hospital workers based barriers in these study patient

The Role of Preoperative Evaluations in Otorhinolayngological Procedures

Background: Routine laboratory investigations are important in preoperative preparation of otorhinolaryngological, head and neck patients to assess and to prevent operative risks. This study aimed at determining the American Society of Anesthesiologist (ASA) classification of the preoperative patients, causes of delayed surgery, associated comorbidity and abnormal laboratory investigation results in ear, nose, and throat surgical practice in a low‑resource setting. Materials and Methods: This is a prospective hospital‑based study of patients being worked up for elective surgical procedures in Ekiti State University Teaching Hospital, Nigeria, from January 2014 to December 2016. Patients that gave consent were enrolled into the study. Interviewer‑assisted questionnaires were used to obtained data from the patients. Data obtained were collated and statistically analyzed by using SPSS version 16. Results: A total of 424 patients were enrolled into the study. Males constituted 61.8% and male to female ratio was 2:1. Majority, i.e. 69.8% of the patients belonged to the ASA Grade I. Preoperative findings leading to delayed surgery occurred in 17.9% of the patients. They were due to 2.4% arterial hypertension and 6.4% delayed routine laboratory investigations results. The overall comorbid illness was 21.2%. Major comorbid illnesses were 2.4% arterial hypertension and 6.8% diabetes mellitus. The types of surgery in the patients were 14.6% ear surgery, 12.3% nasal surgery, and 59.2% throat surgery. Delayed surgery occurred in 25.5% of the patients. The most common findings were 6.8% anemia, 6.3% abnormal prothrombin/international normalized ratio, and 5.7% blood electrolyte and urea. Conclusion: All surgical conditions are peculiar with different comorbid illnesses which can lead to untoward outcome. Adequate preoperative evaluation and preoperative laboratory investigation of ear, nose, and throat conditions are mandatory to detect subclinical illnesses in poor‑resource setting

Palatal avulsion injury by a foreign body in a child

A 6-year-old girl who claimed to have fallen while playing with metal rod that resulted in palatal avulsion injuries was presented. Neither of the parents was around when the incidence happened. She was brought to the hospital because of pain, bleeding from the mouth, drooling of saliva mixed with blood and inability to feed or phonate appropriately. Examinations of the oral cavity revealed a triangular area of avulsion in the posterior aspect of the hard palate extending to the soft palate. She had examination under anaesthesia and wound repaired with 3-0 vicryl interrupted sutures after thorough wound debridement. She did well and was discharged from the clinic

Otologic and audiological evaluation among HIV patients in Ilorin, Nigeria

This study is to determine these manifestations among HIV/AIDS patients in Ilorin to update on previous study. Method: This was a prospective study of all consecutive new patients confirmed to be HIV positive attending the HIV clinic of the University of Ilorin Teaching Hospital, Ilorin, Kwara state, Nigeria between January and July, 2009. These patients were on HAART anti retroviral drug treatment. The information retrieved included the biodata, clinical presentation, otolaryngologic clinical findings, as well as their hearing assessment with Pure tone audiometry. Results: 74 out of the 89 HIV patients(82.8%) had otorhinolaryngological manifestations with the age range of 3 to 62 years (Mean of 36.4 yrs, SD=2.45±0.02). The modal age range was 21-40 years (59.6%) 51males (57.3%) and 38 females (42.7%) and a sex ratio of 1.3:1. Commonest otorhinolaryngological features included nasal in 45.6% (chronic rhinosinusitis), oral/oropharyngeal in 23.9% (oral candidiasis), otological in 21.5% (Serous otitis media) and cervical adenopathy in 9%. Conclusion: Otorhinolaryngological manifestations were found in 74 patients (82.8%) and commonest features included chronic sinusitis, oral/pharyngeal candidiasis, serous otitis media with cervical adeopathy in that order. It is important for otolaryngologists to be aware of otolaryngological manifestations, so early diagnosis and timely intervention alongside appropriate anti-retroviral therapy be instituted to improve survival rates. Keywords: sinusitis, otitis media with effusion, candidiasis oral, HIV

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

Pharyngeal fibromatosis presenting as adenoid hypertrophy: A case report and review of literature

A 10-year-old girl presented with a noisy breathing noticed from birth and failure to thrive. Examination revealed a huge lobulated firm mass in the oropharynx (toward the left side). Plain radiography of the neck showed a huge circumscribed pharyngeal mass extending from the base of the tongue to the level of the fourth cervical vertebrae. The mass measuring 6 cm Χ 5 cm was excised through a left lateral pharyngotomy. Histological examination showed sections of highly cellular interlacing bundles of fibroblast with moderate hyalinization extending to the surrounding fibro-fatty tissue. The cells have spindle nuclei with tapering ends. Occasional mitosis and in some areas myxoid degeneration were seen. A diagnosis of pharyngeal fibroma was made. Patient had an uneventful post-operative recovery with complete resolution of symptoms for the past 6 years. This rare benign tumor has not previously been reported at this site and may thus give rise to difficulty in diagnosis or to a misdiagnosis

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%

Paucity of HPV-Related Head and Neck Cancers (HNC) in Nigeria

Introduction: The burden of HPV-related Head and Neck Cancers (HNC) has been rising in the U.S. and other developed countries but this trend has not been reported in Africa. Objective of study was to evaluate the prevalence of HPV infection in HNC cancer cases seen between 1990 and 2011 at the tertiary health care institutions in Nigeria. Methods: We retrieved 149 head and neck cancer formalin fixed, paraffin embedded tumor specimens diagnosed between 1990 and 2011 from four teaching hospitals in Nigeria. One hundred and twenty-three blocks (83%) contained appropriate HNC for analysis while DNA extraction was successful in 60% (90/149). PCR amplification was successful in 33% (49/149) and Linear Array genotyping for HPV was successful in 11% (17/149) of these cases. These were in tumors from the larynx (6), cervical lymph nodes (3), nasal cavity (2), parotid (1), palate (1), maxillary sinus (1) and mandible (1). Two cases were non-specific and none were from the oropharynx. Histologically, 41% (7/17) of the successfully genotyped blocks were squamous cell carcinomas (larynx 6, maxillary sinus 1). Results and Conclusion We were unable to detect HPV in any of the HNC samples in our study. Our result may suggest that there is a low prevalence of HPV-related HNC among the adult population in Nigeria. Our results provide a benchmark to compare future incidence of HPV -related HNC in this community in future. We had significant analytical challenges from possible poor tissue processing and urge that future studies should prospectively collect samples and ensure high quality sample processing

sj-docx-1-smo-10.1177_20503121231152324 – Supplemental material for Medication adherence and blood pressure control: A preliminary assessment of the role of health insurance in Nigeria and Ghana

Supplemental material, sj-docx-1-smo-10.1177_20503121231152324 for Medication adherence and blood pressure control: A preliminary assessment of the role of health insurance in Nigeria and Ghana by Tijani Idris Ahmad Oseni, Paa-Kwesi Blankson, Bolade Folasade Dele-Ojo, Fiifi Duodu, Chidiebere Peter Echieh, Sulyman Biodun Alabi, Bamidele O Tayo, Daniel F Sarpong, Mary Amoakoh-Coleman, Vincent Boima and Gbenga Ogedegbe in SAGE Open Medicine</p

Distribution by Anatomical Site and Pathological Diagnosis of Final Sample (n = 17).

<p>Distribution by Anatomical Site and Pathological Diagnosis of Final Sample (n = 17).</p