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

Neuro-ophthalmic Manifestation Of Nasopharyngeal Carcinoma At Ilorin: A Five Year Review

Patients with Nasopharyngeal Carcinoma (NPC) may present with neuro-ophthalmic symptoms including visual loss. Involvement of the cranial nerves have been found to impact significantly on the individual\'s 5 year survival rate,whichmakes an early diagnosis of this condition of great importance in the management ofNPC. Aretrospective reviewof all patients with clinical and histological diagnosis of NPC over a five year period between 1999 and 2003was carried out. Information retrieved from the records include their age, symptoms and signs with emphases on neuro-ophthalmic at presentation. Data were analysed using SPSS statistical package. Twenty records out of the 23 patients with a diagnosis of NPC seen during this period were available for review.The age rangewas between 20 and 60years, theMeanwas 38.9years, SD11.62. Sixty percent of the patients had neuroophthalmic manifestation with symptoms such as ocular pain, double vision, loss of vision and eye protrusion and signs such as ophthalmoplegia, exposure keratopathy and proptosis in various combinations. Neuro-ophthalmic manifestations were commonly found among patients diagnosed as NPC at Ilorin. A high index of suspicion of NPC whenever a patient presents with neuro-ophthalmic signs and symptomis advocated. Keywords: Nasopharyngeal Carcinoma,Neuro-ophthalmic. Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 376-37

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

Intranasal Endoscopic Repair of Bilateral Choanal Atresia in a Male Newborn with Crouzon's Syndrome

No Abstract

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

Develop a cost model to evaluate the economic benefit of remanufacturing based on specific technique

Remanufacturing is a process of recovering used products to a like-new condition. It can potentially achieve considerable economic, environmental and social benefits in many applications. However, its economic benefit varies for different products and remanufacturing processes. This research aims to develop a framework and cost model to quantitatively evaluate the benefits of remanufacturing techniques to assist the decision making on end-of-life strategies. Additive manufacturing-based remanufacturing process has been modelled first, then cost breakdown structure for the process has been created, and the cost model has been developed. Validation of the cost model has been conducted based on expert judgement, and a case study has been carried out by using the developed cost model to compare the benefit of remanufacturing a specified component or making a new one

Day case adenoidectomy: Is it safe?

No Abstract

Aural myiasis mimicking foreign body in the ear: A case report

Despite the relatively common presentation of aural foreign body in the paediatric age group, other uncommon etiologies should be borne in mind. An uncommon presentation of an aural foreign body (myiasis) is presented in a female infant. The need for high index of suspicion and prompt management is emphasized. Keywords: Aural; myiasis; foreign body; ea

Whole fish as an unusual foreign body in the throat: a case report

Objectives: To draw attention to an unusual foreign body in the throat, while highlighting the weaknesses of our cash and carry health care delivery policy. Methods: Case report Report: A 17-year-old boy referred with history of accidental ingestion of a live fish. He was said to have caught a live fish, holding it between his teeth while attempting to catch another one. The fish between his teeth escaped into his throat and got stucked there. There was associated difficulty in breathing, pain in the throat and inability to speak. The patient's relatives absconded on the pretext of going to source for funds. Patient had spontaneous expulsion of the fish in the Accident and Emergency. Post expulsion x-ray soft tissues of the neck showed extensive subcutaneous emphysema. The patient absconded from admission afterwards. Conclusion: There is need for more rapid response in our emergency medical care, and our cash and carry health care policy needs to be modified to cater for the needs of the indigent, and those outside their usual place of domicile. Keywords: foreign body, throat, whole live fish, subcutaneous emphysema Nigerian Journal of Otorhinolaryngology Vol. 3(1) 2006: 30-3

Nasal haemangiopericytoma (hpc): A case report and literature review

No Abstract.Tropical Journal of Health Sciences Vol. 14 (2) 2007: pp.56-5