An audit of paediatric nasal foreign bodies in Ilorin, Nigeria

Children with nasal foreign bodies are commonly seen in everyday practice. The aim of this study was to document the pattern of foreign bodies in the nose, their treatment and outcome. Methods. This was a prospective audit of all children seen in the ear, nose and throat clinic, accident and emergency unit and emergency paediatric unit at the University of Ilorin Teaching Hospital, Nigeria, from August 2005 to July 2006. Results. Of a total of 173 patients with ear, nose and throat foreign bodies seen during the study period, 71 patients had foreign bodies in the nose. The male/female ratio was 1.5:1 and the mean age was 2.5 years (range 1 - 15 years), under-5s comprising 72% of the patients. The most common foreign bodies were grains and seeds (35%). Presentation was within 24 hours in 45% of cases, between 1 and 5 days in 27%, and longer in the rest. Of the patients 51% had inserted the foreign body into the nose themselves, and in 39% of cases this had happened at school. In most cases (68%) the foreign body had been inserted into the right nostril. Most children had an offensive nasal discharge (45%) or were asymptomatic (27%). Parents were the first to make the diagnosis in 63% of cases, and in 32% of cases removal had been attempted before presentation. Most of the foreign bodies (89%) were mechanically extracted with a Jobson-Horne probe. In 61% of cases removal was done by a senior registrar. General anaesthesia was needed in a minority of cases. Minimal epistaxis after removal occurred in 50.7%, and only 1 patient had septal perforation. Conclusion. Nasal foreign bodies are still a challenge among under-5s. Public health education is needed to make parents and caregivers aware that it is hazardous for a child to insert a foreign body into the nose. Consistent with published guidelines, the majority of cases can be managed safely with direct extraction in the office setting. With adequate training, primary health care practitioners can manage most cases successfully and will know when to refer complicated ones

Pathogenic agents of chronic suppurative otitis media in Ilorin, Nigeria

Objective: To determine the type and pattern of antibiotic susceptibility of the pathogenic micro-organisms causing chronic suppurative otitis media (CSOM) in our environment. Design: A retrospective study of ear discharges from patients presenting consecutively with chronic suppurative otitis media. Settings: University of Ilorin Teaching Hospital, a major referral centre in the Middle Belt region of Nigeria. Main outcome measures: Bacterial isolates and their sensitivity patterns. Subjects: Three hundred and seventy five patients aged between eight months and 70 years referred to the ear, nose, and throat clinic of The University of llorin Teaching Hospital were enrolled in the study. Results: About 95.5% and 4.5% of the specimens were culture positive and negative respectively. The commonest bacterial aetiologic agents were Pseudomonas aeruginosa (26.0%) and Proteus spp (21.8%). Peak prevalence of 30.5% occurred among the 0-5 years age group. Seventy five per cent of isolates were gram-negative bacteria. Ofloxacin produced 100% sensitivity in both gram positive and gram-negative organisms tested. Colistin, ceftazidime and cefuroxime were highly active ( _80%) against the gram-negative bacteria while erythromycin and cloxacillin were very effective ( _80%) against the gram-positive isolates. Conclusion: Chronic suppurative otitis media is still highly prevalent in our environment, affecting mainly children. The antibiotic susceptibility pattern of pathogenic isolates is different from those of other regions of Nigeria with increasing resistance recorded for some organisms. Hence, where possible and available, susceptibility tests should guide the management of CSOM in this environment, otherwise, ofloxacin if indicated and cloxacillin/ erythromycin may provide relief and delay emergence of resistant strains. (East African Medical Journal: 2002 79(4): 202-205