The Values of ENT Medical Outreach in Suburb of Ekiti State, South-Western Nigeria

Objectives: To review the function of an otolaryngology (ENT) specialist outreach service in the various towns of Ekiti by the Federal Teaching Hospital Ido-Ekiti (FETHI) ENT team over a 5 year period(2013 to 2018).The purpose is to highlight the various ENT Problems and the difficulties being faced by the populace which discouraged them from attending the ENT tertiary facilities. Methods: The ENT and Community Medicine departments’ staff maintained a record of all outreach towns and patients profiles seen during each outreach. Data recorded for each visit included the number of patients, biometrics, occupations, ENT Problems with the patients, the procedure/operations done at the outreach site and at FETHI. All these data were analyzed using IBM SPSS version 23 in an attempt to qualitatively measure the impact of the visits. Results: From 2013 to 2018 a total of 8188 were seen in our outreach out of which 2394 had ENT related problems. From Table 1, it can be seen that most of the patients with ENT problems (N = 672, %age = 28.1) lies in the age group between 41 years to 50 years. There are22.6% patients in age group of 31— 40 years, 15.7% in age group of 21 – 30 years, 11.2% in age group of 51 – 61 years, 10.7% in age group of 11 – 20 years, and 6.9% in age group of 01 – 10 years. There are only 4.8% ENT patients (N = 115) having age of 61 or more years. It can be seen that most of the patients with ENT problem lies from age group of 11 -- 60 years. The patients having age less than 11 years or more than 60 years relatively have less ENT problem as compared to other age group. Conclusion: In developed countries, outreach by ENT surgeons is important in as much as addressing critical lack of access ENT care in developing countries. However, it should be done on shared values, mutual respect, aspirations, and desire to build a durable and sustainable impact, and best practice which is accepted inte rnationally

Hearing loss molecular analysis

In the past it was difficult to identify children with hearing loss, and many newborns remained undiagnosed, but since early 2000, when Universal Newborn Hearing Screening (UNHS) came into place and made successful strides in hearing loss research and have been able to provide screening of hearing loss at an early age of one month, hence they have been able to receive comprehensive treatment. UNHS also tracks infants for further follow up and wherever necessary. The two main methods used in newborn screening are otoacoustic emission and automated auditory brain stem response. Medical evaluation should begin as soon as possible when hearing loss is suspected, so as to complete prenatal, medical, and family history. Demands have been made to use DNA testing in detecting the molecular basis of hereditary hearing loss. The identification of genes and gene defects faces a lot of challenges due to the fact, there is tremendous genetic heterogeneity, but despite that, there has been successful genetic studies of hearing loss in isolated populations and consanguineous families. Hearing loss is common in patients with mitochondrialdisorders, affecting over half of all cases at some time in the course of the disease. Hearing loss has seen some research undertaken to the point now that deafness can be treated and this is through cochlea implantation

Morphology and Clinical Presentation of Duplicate External Auditory Canal-Literature Review

First branchial cleft anomalies (FBCA) such as duplication of the external auditory canal are due to failure to obliterate the ventral portion of the 1st cleft while external auditory canal stenosis and atresia are abnormalities of the dorsal portion.The annual incidence is 1:1000,000 and it’s been found to be commoner among females 69% than males 31% with the left ear most affected.FBCA can present as fistula, sinus or cysts located around/along the EAC, periauricular region and the neck above the hyoid bone. Keywords: Duplicate External auditory canal,First branchial anomaly,auditory canal stenosis DOI: 10.7176/JHMN/64-04 Publication date:July 31st 201

A Prospective Analysis of Otomycosis in a Tertiary Care Hospital

Background: Otomycosis is a fungal infection of the external auditory canal, commonly encountered in the general otolaryngology department. Otomycosis is more frequently observed in hot and humid climates and various individual, as well as environmental factors, predispose to this infection. This study aims to explore the prevalence of otomycosis in a tertiary care hospital in Ekiti state, Nigeria, along with a focus on patient demographics, predisposing risk factors, and pathogenic causes. Materials and methods: The study was conducted in the Ear, Nose, and Throat (ENT) department of Federal Teaching Hospital Ido-Ekiti, which is a tertiary care hospital in Ekiti state, Nigeria. The study involved 275 patients above the age of 10, who presented in the ENT department over 5 years period and were clinically diagnosed cases of otomycosis. Certain patient demographics such as age, gender, and clinical presentations were recorded along with possible risk factors and clinically observed findings. Microbiological causes were evaluated via the culture of samples collected from each individual. Results were statistically analysed and the results are presented in a tabulated manner. Results: The results obtained in our study revealed that the majority of the subjects were between the ages of 20 and 30 years, making a total of 38.2% of the study population. Males were observed more commonly then females accounting for 56% of the total study population. 267 patients reported unilateral ear involvement among which the right ear was involved in 82% of the cases. The most frequently observed risk factor was self-cleaning of ears with objects such as q-tips, wooden sticks, metal pickers, etc. seen in 71% of the study population, followed by the use of antibiotic ear drops observed in 57% and instillation of mustard oil in 52% of the study group. The most common presenting symptom in the study population was reported to be pruritus of the ear in 73% followed by otalgia in 66.5%, and sensation of blocked ear observed in 57%. Fungi were established to be the causative organism in 270 out of the total 275 samples and the most commonly isolated fungi were Aspergillus seen in 91% of the total population. The most common species of Aspergillus that was isolated from samples was Aspergillus Niger seen in 56%. The second most commonly isolated fungus was Candida in 13.8% of the group. Bacteria were isolated from 56.4% of the total samples as a concomitant organism, Staphylococcus aureus is the most commonly seen in 58% of the samples. The present study, apart from highlighting the patient population and causative agents of otomycosis, also places stringent focus on the need for education to eradicate the aforementioned predisposing risk factors to hinder the incidence of otomycosis

DRUGS UTILIZATION TRENDS IN ENT PRACTICE-A REVIEW OF LITERATURES

Objective: prescription in Ear, Nose and Throat, patients. Cochrane reviews and Web of Science was conducted for articles describing Pattern of Drug Prescription in ear, nose, and throat (ENT) Medical Practice. English with an English abstract that focused on Patter Review Methods: and outcome. articles were taken into consideration for the review. Most of the studies revealed prescribing more than one medication. Most commonly used antibiotic in most of the studies was Amoxicillin Clavulanate followed by Fluoroquinolones. Also along with the Antibiot analgesic and anti prescribed without culture and sensitivity reports. more than one drug was prescribed, times Antibiotics were prescribed before Culture and Sensitivity tests, which may be the core factor of growing antibiotic resistance. Creating awareness amongst physicians via Continuous Medical Educations (CME) may overcome this issue

Diagnosis and Management of Benign Paroxysmal Positional Vertigo in a West African Country

Objectives: Management of benign paroxysmal positional vertigo is inadequate in many developing countries. Also, there is a paucity of literature on benign paroxysmal positional vertigo in developing countries including West African countries. This study aimed at determining the pathological distribution, clinical presentation, comorbid illnesses, patients limitations, prehospital and Specialist treatment of benign paroxysmal positional vertigo in our center. It will also form the basis for further study on benign paroxysmal positional vertigo. Methods: This was a prospective hospital-based study of all patients with the diagnosis of benign paroxysmal positional vertigo. Pretested interviewer assisted questionnaire was administered to obtain data. Otoscopic examination, otoneurologic review, followed by mandatory Dix Hallpike manoeuvre and supine roll test was performed on all patients. All the patients were treated appropriately by Epley manoeuvre and Semont liberation manoeuvre. All the data obtained were collated and analysed by using SPSS version 18.0. Results: The mean age of the patients studied was 48.7. Males accounted for 46.1% with male to female ratio of 1:1.2. There was unilateral benign paroxysmal positional vertigo in 99.4% and right benign paroxysmal positional vertigo in 64.3%. 66.2% was posterior semicircular canal followed by 24.7% lateral semicircular canal. Majority 83.8% had more than 4 episodes before the presentation. Commonest clinical experience among our patients was vertigo, nystagmus, and loss of balance in 85.1%, 81.8%, and 80.5% respectively. Chronic cases (greater than 3 months) of benign paroxysmal positional vertigo occurred in 92.9%. 97.2% of the patients were reviewed ear, nose, and throat outpatient clinic. Associated comorbid illnesses were a visual disorder, hypertension, arthritis and diabetes mellitus in 27.9%, 23.4%, 22.1%, and 2.6% respectively. Patients major sources of referral was a general practitioner in 57.8%. The Commonest affected quality of life among patients was anxiety in 31.8%. It limits the daily activities of patients in 31.8% movement restrictions, 29.9% avoid turning on the bed, 24.7% indoor and 1.9% avoid driving a car. Majority 72.7% of the patients had one or more form of prehospital treatment. These were 46.1% pharmacy consultation, 30.5% over the counter drugs, 44.2% spiritual intervention, 23.4% herbal medication and 5.2% dietary approach. Majority 65.6% of the patients were on one or more form of medication(s) of which labyrinthine sedative was 63.0%. Conservative treatment was offered in 79.2%. Only 59.1% had canalith repositioning manoeuvres at presentation with two or more sessions in 50.6%. Comorbid illnesses were responsible for referral in 9.1% for experts review and management. Conclusion: Benign paroxysmal positional vertigo is a common otologic disorder with significant comorbid illnesses which limits patients daily activities and affect their quality of life. The illness was associated with late presentation and poorly treated by an unskilled hand, thus there is a need for public enlargement on vertigo and treatment

Immunotherapy for head and neck cancers

Head and neck squamous cell carcinoma (HNSCC) is a frequent tumour which arises from various anatomical areas in the head and neck region. HNSCC has multiple resistance mechanisms through which it evades the immune responses. It is particularly characterized by an immunosuppressive environment which includes the release of immunosuppressive factors, expansion, and expansion of immune cells which have inhibitory activity reduction of tumour immunogenicity. Human papillomavirus positive (HPV+) HNSCC tumours have one of the higher levels of T cells infiltration. Studies which explore this relationship to the prognosis of patients vary, with some showing benefit only with high CD8/Treg ratio as seen with HPV+ disease and others showing improved prognosis with a higher number of TIL Treg. High CD8+ TIL seen in HPV + disease has been shown in several studies to confer improved disease-free survival. The most successful vaccination strategy is preventive vaccination for HPV. Investigations using different approaches have been carried out on therapeutic vaccines for HPV-associated HNSCC. Despite immune responses being seen in a number of studies, these vaccines are still not effective for clinical use as of ye

Lateral Nasal Capillary Haemangioma a Rare Occurrence—Case Report and Literature Review

Nasal lobular capillary haemangioma (CH), also known as pyogenic granuloma, is a benign lesion of unknown etiology commonly associated with pregnancy, oral contraceptive pills, and trauma. Marked by epistaxis and nasal obstruction, the condition involves benign capillary proliferation with a microscopically distinctive lobular architecture, affecting the skin and mucous membranes of the oral cavity and nasal region. This aim of this article is to report a case of lateral nasal capillary haemangioma in a 39-year-old female, who presented in our facilities having experienced spontaneous epistaxis on the left side of the nose for the previous three months. Endoscopy revealed a protruding left intranasal mass arising from the lateral nasal wall in the region of the middle turbinate and osteo-meatal complex. The patient underwent endoscopic excision of the mass and did excellently well thereafter with no recurrence

Morphology and Clinical Presentation of Duplicate External Auditory Canal-Literature Review

First branchial cleft anomalies (FBCA) such as duplication of the external auditory canal are due to failure to obliterate the ventral portion of the 1st cleft while external auditory canal stenosis and atresia are abnormalities of the dorsal portion.The annual incidence is 1:1000,000 and it’s been found to be commoner among females 69% than males 31% with the left ear most affected.FBCA can present as fistula, sinus or cysts located around/along the EAC, periauricular region and the neck above the hyoid bone

Knowledge and awareness of nasal allergy among patients in a developing country

Background: Nasal allergy is a common public health disorder seen in clinical practice worldwide. This disorder affected activities such as sleep, education, trading, economy, and social life.This study aimed at determining the level of knowledge and awareness of nasal allergy among patients seen in the otorhinolaryngology clinical practice of a developing country. Methods and Materials: This was a descriptive cross‑sectional study, which was carried out among patients seen in Ekiti state university teaching hospital, Nigeria. Each patient completed a pretested interviewer assisted questionnaire on socio‑demographic features, awareness, and knowledge on nasal allergy.Data obtained were documented, collated, and analyzed by SPSS version 18.0. Results: There were 16.4% patient’s awareness and knowledge on nasal allergy, and 10.6% had allergic rhinitis.The patients included 59.2% males and male to female ratio was 1.5:1.Most common sources of information on nasal allergy were from ear, nose, and throat specialist/other doctors in 62.6%. Other sources were friends/relatives and media/Internet in 28.5% and 9.0%, respectively. Knowledge and awareness on if the nasal allergy was common in Nigeria and worldwide among the patients were 26.6% and 24.9%, respectively. However, 56.7% patients were aware that nasal allergy were commonly seen and diagnosed in the hospital.On the basis of knowledge and awareness of etiology of nasal allergy, majority 55.2% believed micro‑organisms caused nasal‑allergy. Minority 40.4% agreed nasal allergy was caused by parents genetic transmission from parents to offspring.On the awareness and knowledge of nasal allergy and its manifestations, the most common symptoms was 63.4% itching ear, throat, and eyes others were 63.2% catarrh and 56.3% bout of sneezing.There were 64.6% patients awareness of nasal allergy causes impairing concentration. However, 68.2% believed nasal allergy were curable diseases. On the awareness and knowledge, treatment was 52.7% prayer/spiritual intervention, 34.3% herbs, and 57.1% over‑the‑counter medication. However, 45.4% were aware and knowledgeable on the significance of avoidance of allergens. Conclusion: The level of awareness and knowledge on nasal allergy low with high levels of prevalence. Patients awareness and knowledge on etiology, clinical manifestations, effects, and management of nasal allergy is low