Pre-Operative Vocal Cord Palsy in Goitre Patient

Objectives: Determine the prevalence of vocal cord palsy and the relative prevalence of asymptomatic vocal cord palsy in pre-operative goitre patients using flexible fibreoptic laryngoscope (FFL) as a laryngeal  visualisation technique.Design: Hospital-based, cross-sectional study conducted throughout 2011 on consecutive, consenting pre-operative goitre patients referred to the E.N.T Department, University of Ilorin Teaching Hospital. Ilorin, Nigeria.Setting: University of Ilorin Teaching Hospital (U.I.T.H) Ilorin is a 600-bedded tertiary institution, serving primarily patients from Kwara State.Subjects: One hundred and ten consenting patients, age 16 and above- whose cooperation could easily be gained for an awake-laryngoscopy procedure.Results: Mean age, 42.98 ± 14.71. Female: Male = 4.5:1. Palsy rate was 2.9% and 25% in benign and malignant goitre respectively. Hoarseness was reported by 3(2.7%) patients with vocal cord palsy (p 0.001). Asymptomatic palsy was 40%.Conclusion: The prevalence of pre-operative vocal cord palsy was 4.5%; Relative prevalence was 2.9% and relative prevalence was 25% in benign and malignant goitre respectively

Fish bone foreign body presenting with an acute fulminating retropharyngeal abscess in a resource-challenged center: a case report

<p>Abstract</p> <p>Introduction</p> <p>A retropharyngeal abscess is a potentially life-threatening infection in the deep space of the neck, which can compromise the airway. Its management requires highly specialized care, including surgery and intensive care, to reduce mortality. This is the first case of a gas-forming abscess reported from this region, but not the first such report in the literature.</p> <p>Case presentation</p> <p>We present a case of a 16-month-old Yoruba baby girl with a gas-forming retropharyngeal abscess secondary to fish bone foreign body with laryngeal spasm that was managed in the recovery room. We highlight specific problems encountered in the management of this case in a resource-challenged center such as ours.</p> <p>Conclusion</p> <p>We describe an unusual presentation of a gas-forming organism causing a retropharyngeal abscess in a child. The patient's condition was treated despite the challenges of inadequate resources for its management. We recommend early recognition through adequate evaluation of any oropharyngeal injuries or infection and early referral to the specialist with prompt surgical intervention.</p

Knowledge and care seeking practices for ear infections among parents of under five children in Kigali, Rwanda : a cross-sectional study

Background: Infections affecting the middle ear are a common childhood occurrence. Some cases may present with ear discharge through a tympanic membrane perforation which may heal spontaneously. However, up to 5% or more cases of those affected have persistent ear discharge. A number of barriers contribute towards delayed presentation at health facilities for treatment of ear infections. We conducted a study to evaluate parents’ and caregivers’ knowledge and care seeking practices for ear infections in children under five in Gasabo district in Kigali, Rwanda. Methods: Parents/guardians (n = 810) were interviewed using a structured questionnaire to elicit their knowledge of ear infections in children under five and their attitude to seeking care for their children. Results: The mean age of the respondents was 31.27 years (SD = 7.88, range 17–83). Considering an average of knowledge parameters which included causes, symptoms, prevention, treatment and consequences of ear infections, we found that 76.6% (622) of respondents were knowledgeable about ear infections. We defined a positive practice as seeking medical treatment (community health workers or health facility) and this was found in 89.1% (722) respondents. Correlating knowledge with choice of seeking treatment, respondents were 33% less likely to practice medical pluralism (OR = 0.33, CI 0.11–0.97, P = 0.043) if they were familiar with infections. Moreover, urban dweller were 1.7 times more likely to know ear infections compared to rural dwellers (OR = 1.70, CI 1.22–2.38, P = 0.002). Conclusion: The majority of respondents had good knowledge and positive attitudes and practices about ear infection. However, medical pluralism was common. There is need to improve the community’s awareness and access to primary health care facilities for the care of ear infections especially in rural areas of Rwanda

Cervical spinal tuberculosis with tuberculous otitis media masquerading as otitis externa malignans in an elderly diabetic patient: case report

Extrapulmonary manifestation of tuberculosis (Tb), a medieval disease, occurs in every part of the body with varying degree of frequency but commonly in the pleural and lymph nodes. When it occurs in bones thoracolumbar vertebrae is the usual site of involvement. Other bones are less involved hence seldomly reported. This is true for other organs and parts of the body including larynx, pharynx nose and the middle ear. More importantly, isolated extrapulmonary tuberculosis without pulmonary involvement is uncommon. The case of a 65 year old Nigerian trader who presented with headache, chronic ear ache with otorrhoea, persistent neck pain and found to be diabetic on further evaluation is presented. She was hitherto managed as a case of otitis external malignans without any improvement but rather her clinical condition worsened with evidence of cervical vertebra destruction and multiple cranial nerve palsies without pulmonary tuberculosis. Prompt and effective response to anti tuberculosis drugs informed the diagnosis of tuberculosis of the cervical vertebra and tuberculous otitis media with multiple cranial nerve palsies. This case underscores the value of high index of suspicion, thorough and complete clinical evaluation in any patient with chronic symptoms and signs unresponsive to conventional treatment. East African Medical Journal Vol. 81 No. 5 May 2004: 267-27

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

Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in North central Nigeria

Background: Otitis media (OM) is a major health problem in both developed and developing countries.Objective: To determine the pattern of bacterial isolates in patients with chronic suppurative otitis media(CSOM) in Ilorin, Nigeria.Methods: A prospective study carried out in University of Ilorin Teaching Hospital, Nigeria among consenting patients with CSOM attending the ENT clinic over a period of 7months. Informed consent was obtained from the patients or caregivers and approval for the study obtained from ethical committee. Structured questionnaire was administered and microbiological analysis done, data obtained was entered into SPSS statistical software and results presented in tables and figures.Results: A total of 134 patients aged 5-64yrs with chronic suppurative otitis media were interviewed with a mean age of 17.0 (S.D. =15.1±1.30). About 55.2% of the respondents were under 10yrs. Seventy-two (53.7%) of the respondents were males with M:F=1.2:1. The gram stain showed predominantly gram negative organisms (71.6%). Pseudomonas aeruginosa was the commonest middle ear pathogenic organism identified and the sensitivity pattern highly favoured ciprofloxacin Conclusion: CSOM is still a childhood problem among the under tens’ more prevalent among males and the commonest agent is Pseudomonas aeruginosa. Ciprofloxacin is still the most sensitive antibiotics in vitro.Keywords: Otitis media, chronic, Bacterial isolates, antibiotic