Lupus Vulgaris of the External Nose in a Paediatric Patient: A Case Report from Muhimbili National Hospital, Tanzania

Lupus vulgaris is the most common form of cutaneous tuberculosis which usually occurs in patients who have been previously sensitized to Mycobacterium tuberculosis.[1] We present a case of a 4-year-old girl who was diagnosed to have lupus vulgaris clinically and was then confirmed histopathologically. On local examination, the patient had irregularly  bordered, well demarcated, whitish to reddish lesion on her external nose. The histopathological examination showed many dermal stromal  granulomas of epithelioid cells, many multinucleated giant cells of Langhans type. This case report is therefore to emphasize on the importance of early diagnosis of lupus vulgaris of the external nose both clinically and on histopathological basis so as to avoid its destructive consequences which are mainly erosion of the external nose, nasal cavity and the face and in rare occasions, possible development of a carcinoma of squamous cell type.________________________________________________________________________Key words: Lupus vulgaris, external nose, Tanzani

Bilateral congenital choanal atresia in a 16-year old girl at Muhimbili National Hospital, Tanzania

Background: Bilateral choanal atresia refers to a congenital anomaly whereby a child is born with bilateral imperforate posterior nares. In most cases the diagnosis is established soon after birth. Establishment of the diagnosis requires a high index of suspicion by clinicians. The objective was thus to report an unusual case which went undiagnosed for many years and review the few available literatures.Case presentation: A 16-year old girl presented to the otorhinolaryngology clinic of Muhimbili National Hospital in Tanzania with a long standing history of bilateral nasal obstruction. The condition was reported to be present since birth and this was accompanied by mouth breathing and persistent bilateral nasal discharge. The patient also reported a history suggestive of respiratory distress after birth which necessitated oxygen therapy and difficulty in breastfeeding where she was kept on expressed breast milk during the first few weeks of life. Nasal endoscopy was done clinic and the diagnosis of bilateral congenital choanal atresia was made. Computerized tomography scan of the nose and paranasal sinuses revealed bilateral choanal atresia of mixed type. Surgical perforation of the atretic choanae without stenting was done endoscopically under general anaesthesia.Conclusion: Bilateral congenital choanal atresia is an otorhinolaryngological emergency and should be established promptly both in resource limited settings and in areas where advanced tools are in situ to prevent its morbidity and mortality if it goes unestablished

An unusual long standing tracheal foreign body in a paediatric patient removed via tracheostome: A case report

Aspirated foreign bodies are commonly reported in pediatric patients and accounts for emergencies. A long standing undiagnosed foreign body (FB) in the trachea is very rare and lethal and the diagnosis needs a high index of suspicion. Foreign bodies in the trachea are uncommon and usually present with acute respiratory symptoms sometimes mimicking bronchial asthma. A long standing tracheal FB is a rare presentation.We report a 4-year old female child who presented with a history suggestive of FB inhalation about 2 years’ prior admission. She was treated in several health facilities as a case of bronchial asthma/pneumonia with no clear relief. This case highlights the role of clinicians in having a high index of suspicion when encountering children with unresolving pneumonia so as to rule out the possibility of foreign body inhalation

Pattern and causes of tympanic membrane perforation at a private hospital in Dar es Salaam, Tanzania

Introduction: There is variation in the size, shape and position of tympanic membrane perforations; the degree of conductive hearing loss depends on the sizeand position of perforation.Objective: To determine the pattern and causes of tympanic membrane perforation at a private health facility in TanzaniaMethod: A hospital-based cross-sectional study in the ENT clinic at Ekenywa Specialised Hospital was conducted from January to May 2019. Ears were examined thoroughly by an Otorhinolaryngologist. Data were analysed using SPSS Version 21Results: Two hundred and fifty patients were examined and 50 (20%) were foundto have tympanic membrane perforations. Thirty (60%) were new patients while twenty (40%) were under review. Most 35(70%) were males. Central perforation predominated in 30 (60%), followed by subtotal in 10 (20%), total in 8 (16%) andmarginal perforations in 2 (4%). The left ear was more affected in (60%) than theright ear. Bilateral perforations accounted for 5 (10%) of cases. Chronic suppurative otitis media was found in 35 (70%); other causes were acute suppurative otitis media in 13 (26%) and trauma in 2 (4%) patientsConclusions: The clinical picture depicted in this study is similar to that found elsewhere. There is a need for prompt diagnosis of tympanic membrane perforation. Proper education on ear care in patients with perforated tympanic membrane is of paramount importance.Keywords: Pattern, Causes, tympanic membrane, perforation, Tanzani

Prevalence of chronic rhinosinusitis at Muhimbili National Hospital, Dar es Salaam

Introduction: Chronic rhinosinusitis (CRS) affects people of all ages worldwide and has significant socio-economic impact. Data on chronic rhinosinusitis are scarce.Objective: To determine the prevalence of CRS among patients attending the Otorhinolaryngology Department at Muhimbili National Hospital (MNH).Method: This was a hospital based descriptive cross-sectional study where 56 patients with CRS were recruited from July to December 2015 after meeting the criteria set by American Academy of Otorhinolaryngology Head and Neck Surgery (AAOHNS). Data were analysed using SPSS program version 21.Results: The prevalence of CRS among 5321 patients was 1.07%; 51.8% were female and the highest proportion was aged 11-20 years. Bilaterality of disease was found in 62%. The maxillary sinus (83.9%) was the most affected sinus whilst the sphenoid sinus was least affected. There was good correlation between computerized tomography (CT) and intraoperative findings, anatomical variations and pathological features.Conclusion: CRS appears to be less prevalent at MNH than elsewhere with a tendency to bilaterality and maxillary sinus predominance similar to other studies.Keywords: Prevalence, chronic rhinosinusitis, Muhimbili Hospital, TanzaniaSouth Sudan Medical Journal Vol 12 No 3 August 201

Clinical Profile of Paediatric Head and Neck Cancers at a Tertiary Hospital in Tanzania

Background Paediatric head and neck cancers represent an important group of childhood cancers that require maximum attention at large. They are often diagnosed at advanced clinical stages at Muhimbili National Hospital (MNH). Objective To describe the clinical profile of paediatric head and neck cancers at a tertiary hospital in Tanzania Method A hospital based descriptive cross-sectional study was conducted involving 180 paediatric patients. Data were analyzed using SPSS program version 21. Results A total of 180 paediatric patients were recruited where 61.1% were males and 38.9% were females. Majority belonged to the age group 0-5 years (53.9%). A total of 10 primary anatomical sites were found with the neck (cervical lymph node) predominating (36.1%), followed by the orbit/eye (34.4%) and the least anatomical sites were oral cavity (1.1%) and parapharyngeal space (0.5%). Leukocoria (93.9%), red eye (93.9%) and orbital cellulitis (77.6%) predominated in retinoblastoma but in patients with lymphomas, predominant features were night sweats (100%), weight loss (100%) and fevers (95.8%). Conclusion The clinical profile depicted in this study appears to correlate with advanced clinical stages. Keywords: Paediatric; Head; Neck Cancers; Muhimbili; Tanzani

Hoarseness of voice and accompanying symptoms among patients at a tertiary hospital, Tanzania

Introduction: Hoarseness of voice is a common complaint in otolaryngological practice and is an early manifestation of a large variety of conditions directly or indirectly affecting the larynx, ranging from inflammatory to malignant. Hoarseness has a prevalence of 6% in the general population, rising to 11% for professional voice users (30% of the patients whose work requires excessive voice use). Despite the high prevalence many people are unaware that persistent hoarseness may be a red flag indicating cancer. Any patient with hoarseness lasting longer than two weeks, in the absence of an apparent benign cause, requires a thorough evaluation of the larynx by direct or indirect laryngoscopy. The purpose of this study was to determine the prevalence of hoarseness among patients attending otorhinolaryngology services at a tertiary hospital in Tanzania. Method: A descriptive cross-sectional study was conducted. A total of 427 patients were recruited. Standard questionnaires were used to collect clinical and socio-demographic information. If hoarseness was identified, further evaluation was carried out including indirect and direct laryngoscopy. Biopsies were taken from the patients with laryngeal mass after direct laryngoscopy under general anaesthesia. Data were analysed using SPSS version 20.0. Confidentiality was maintained. Results: The prevalence of hoarseness was 65 (15.2%), which was more common in males 40 (17%) and the age group above 60 years. Common laryngoscopic findings among patients with hoarseness were laryngeal mass 47 (63%) and the leading accompanying symptom was difficulty in breathing 25(32%). Conclusion: Hoarseness of voice is a common complaint and accompanies various symptoms. It can also be a red flag for upper aero-digestive malignancies. Therefore, these patients should be evaluated with a high degree of suspicion

Prevalence of middle ear effusion among children with adenoid hypertrophy at a national referral hospital in Tanzania

Introduction: Middle ear effusion (MEE) is a common childhood disorder that causes hearing impairment due to the presence of fluid in the middle ear which reduces the middle ear’s ability to conduct sound. Temporary or persistent hearing loss as a result of MEE causes speech, language and learning delays in children. There are few studies on MEE in Tanzania despite the huge burden of hearing loss among children with adenoid hypertrophy which is a known risk factor for MEE. Method: A cross-sectional study was conducted among 420 children aged nine years and below having adenoid hypertrophy with or without MEE. The diagnosis of adenoid hypertrophy was confirmed with a lateral view x-ray of the nasopharynx and tympanometry for cases with MEE. The primary objective of the study was to assess the prevalence of MEE among children with adenoid hypertrophy. Results: The prevalence of MEE among children with adenoid hypertrophy was 61.7%, with 218 (51.9%) males and 202 (48.1%) females. The most affected age group was 2-4 years with an incidence 193 (46%) and in this age group, males (53.9%) were more affected than females (46.1%). Generally, males, 134 (51.7%) were more affected by MEE than females, 125 (48.3%) of all 259 children with MEE. In terms of age group predominance by MEE, children aged 3-4 years, 107(41.3%) were more affected than all other age groups. Additionally, 4 (1.5%) children with MEE presented with hearing loss. Conclusion: There is a high prevalence of MEE among children with adenoid hypertrophy but no significant association with hearing loss

Prevalence and aetiology of neck masses among patients receiving surgical services at Muhimbili National Hospital, Tanzania

Background: Neck masses are found in all age groups from many causes, ranging from congenital to acquired pathology. There is paucity of data on neck masses in Tanzania and at Muhimbili National Hospital, prevalence of neck masses is not yet known. The aim of this study was thus to address this gap.Methods: Descriptive cross sectional study was done from July to December 2016 involving patients who were admitted in surgical wards. Structured questionnaires were filled after thorough head and neck evaluation of patients. Data analys isby SPSS version 20 and p-value<0.05 was considered to be statistically significant.Results: The overall prevalence of neck masses was found to be 14.1% and proportion of neck masses was found to increase as the age increase. Anterior triangle was the commonest anatomical site (53.8%). Most of the neck masses (65.7%) were malignant and the age group most involved was >60 years (P-value 0.000). Among the malignant neck masses squamous cell carcinoma was the leading variant (54.1%) and most of themalignant neck masses were metastatic nodes from primary cancers in the upper aerodigestive tract (67.21%).Conclusion: This study has unveiled neck masses at MNH to be prevalent and the proportion of neck masses increase age increase. Anterior triangle was the leading anatomical site. Most of the neck masses were malignant and majority of them were metastatic nodes from upper aerodigestive tract.Any neck mass especially in adults needs thorough evaluation including upper aerodigestive assessment to rule out the possibility of malignancy.Keywords: Prevalence, Aetiology, Neck masses, Muhimbili, Tanzani

A rare incidental encounter of a foreign body in the nasopharynx during adenotonsillectomy: a case report from Tanzania

Foreign bodies may become lodged in various parts of the upper aerodigestive tract and establishing the presence of such foreign bodies is expected from health care practitioners. Foreign bodies may be classically organic or inorganic and their insertion into various parts of the aerodigestive tract may be deliberate or accidental. Majority of inhaled foreign bodies are reported in children and may even go unnoticed. There are scarce reported studies of foreign bodies in the nasopharynx. We are reporting an unusual case in which a foreign body in a child's nasopharynx went unnoticed for 9 months and was found incidentally during adenotonsillectomy