Classification and management challenges of otitis media in a resource-poor country

The clinical features and sequelae of otitis media (OM) vary depending on the duration, severity and progression of the disease. As a result, opinions on the modes of classification and management protocols have differed over the years. The need to critically appraise these opinions according to the peculiarities of each region is imperative. This work was aimed at reviewing the world literature on the subject and also highlights the limitations in management in our region. A wide literature search was conducted using the following search engines: PubMed, AJOL and University of Toronto Library. Also incorporated were essential materials obtained from the authors’ clinical practices. The search engines returned 22,903 related articles on OM. Further filtration yielded 88 articles on “classification and management” and these were obtained in full and thoroughly read. Extracted materials for review spanned between 1980 and 2008. OM is prevalent the world over with potentially severe complications if inadequately managed, especially in the developing countries. It is of note that in the developing countries, poverty, ignorance, dearth of specialists and limited access to medical care amongst others conspire to worsen the course and complications of OM

Tracheostomy Decannulation: Suprastomal Granulation Tissue in Perspective

Background: Suprastomal granulation tissue is a complication of tracheostomy which may make decannulation difficult and presents a therapeutic challenge to the Otorhinolaryngologists. The aims of this study therefore were to evaluate tracheostomy in black African population, determine the prevalence of suprastomal granulation tissue and provide updated information on it that will enable the otorhinolaryngologists to better understand and manage the lesion.Methods: We reviewed case files of patients who had tracheostomy between 1993 and 2007 at University College Hospital, Ibadan, Nigeria for essential clinical data.Results: Of the 256 patients who had tracheostomy, 133(51.95%) had prior orotracheal intubation for 10 – 21days. Suprastomal granulation tissue complicated 16 (6.25%) cases, this accounted for 88.89% of cases of failed decannulation. Indications for tracheostomy in these patients included severe head injury in 12 (75%), tetanus in 3 (18.75%)] and intubation granuloma in 1(6.25%) of these cases. Sixteen (4.3%) cases had stomal infection.Conclusion: This study showed that the prevalence of suprastomal granulation is high among our patients. There is a need for good surgical tracheostomy technique to prevent this complication and stomal infection should be promptly treated while cuffed orotracheal intubation for more than two weeks in unconscious and tetanus patients should be avoided

Rosai-Dorfman Disease: A Diagnostic Albatross in a Female Patient with Bilateral Persistent Neck Masses. A Case Report

RosaiDorfman disease (sinus histiocytosis with massive lymphadenopathy) is an uncommon benign and often self limiting lymphoproliferative disease of unknown aetiology which was first described by Rosai and Dorfman in 1969. It usually presents with a multiple progressive painless bilateral cervical lymphadenopathy, low grade fever, polyclonal hypergammaglobulinemia and raised erythrocyte sedimentation rate. Extranodal diseases are uncommon but have been documented. Due to the rarity of this condition, the diagnosis may not be suspected clinically and fine needle aspiration cytology of neck nodes may miss the diagnosis. In this study, we present a 24 year old female who presented with bilateral cervical lymphadenopathy and right breast lump since childhood

Experiences of Girls with Hearing Impairment in Accessing Reproductive Health Care Services in Ibadan, Nigeria

Delivery of health services to people with hearing impairment is poorly understood in Nigeria and limited research has been done to throw more light on the process involved. This study described experiences of 167 girls with hearing impairment in accessing reproductive health services in Ibadan using a validated questionnaire. Descriptive statistics and binary logistic regression were used to analyze the data. Almost 95.0% of respondents had ever visited health facility for reproductive health issues. Of these 6.2% and 4.6% went for treatment of STIs and pregnancy termination respectively; 36.7% were embarrassed to ask questions in the presence of an interpreter, communication (40.5%) and cost (10.8%) were key barriers to access and 85.6% would use facility if hearing impairment-friendly services are provided. Respondents who were currently working were 20 times more likely to receive services they wanted (OR=20.29, CI=1.05-392.16). Availability of certified interpreters and ensuring confidentiality are key to effective service delivery for the hearing impaired.RésuméLa prestation des services de santé aux personnes atteintes de déficience auditive est mal comprise au Nigéria et il n’y a pas eu assez de recherche faite pour jeter plus de lumière sur le processus impliqué. A l’aide d’un questionnaire validé, cette étude décrit les expériences de 167 filles atteintes de déficience auditive, face à l'accès aux services de santé de la reproduction, à Ibadan. Les statistiques descriptives et de régression logistique binaire ont été utilisées pour analyser les données. Près de 95,0% des interviewées avaient déjà visité un établissement de santé pour les questions de santé de la reproduction. Parmi elles, 6,2% et 4,6% sont allées pour le traitement des ISTs et l'interruption de grossesse, respectivement; 36,7% étaient gênées de poser des questions à la présence d'un interprète ; la communication (40,5%) et le coût (10,8%) étaient les principaux obstacles à l'accès et 85,6% se serviront des établissements de santé si les services adaptés à la déficience auditive sont assurés. Les interviewées qui travaillent actuellement étaient 20 fois plus susceptibles de recevoir des services qu'ils voulaient (OR = 20,29, IC = 1,05 à 392,16). La disponibilité des interprètes certifiés et l’assurance de la confidentialité sont essentielles à la prestation efficace des services pour les personnes atteintes de déficience auditive.Keywords: disability, reproductive health, health care access, hearing impaired girl

Epistaxis: An overview

No Abstract

Adult Chronic Rhinosinusitis: Spectrum of Clinical features and management in a Tertiary Health Institution and Literature Review

Background: Rhinosinusitis is defined as inflammation of the nasal and paranasal sinus mucosa. Chronic rhinosinusitis occurs when this inflammation and the symptoms persist for more than 3 months. The objective of this study was to evaluate the clinical features and management of adult chronic rhinosinusitis in a tertiary health institution and to review the literature for its current modalities of management. Methods: This is a 5-year retrospective study of all adult patients managed for clinically and radiologically diagnosed chronic rhinosinusitis at the study center. Their medical records were reviewed for essential data which included demographic data, clinical presentations, skin sensitivity test, radiologic reports and treatment offered. The data were collated and analyzed using simple descriptive statistics. Results: There were 228 patients, 97(42.54%) males and 131(57.46%) females with a male: female ratio of 1:1.35, age ranged between 18 - 67 years (mean =35.2). The five major presenting symptoms were nasal discharge 228(100.00%), nasal obstruction 224 (98.25%), frequent throat hawking 189 (82.89%), itching of eye, ear, nose or throat 138 (60.53%) and excessive sneezing 136(59.65%). About 6% of the patients developed complications. Allergy accounted for the cause in 93 (40.79%) patients. Maxillary antral mucosal thickening and engorged inferior turbinates were the commonest radiological features. About 51% of the patients were treated with intranasal inferior meatal antrostomy with or without inferior turbinectomy. There was recurrence of symptoms in about 18% of these patients from 3 to 8months after surgery. Conclusions: Both subjective and objective measures should be employed in the diagnosis of chronic rhinosinusitis and intranasal inferior meatal antrostomy may rarely produce satisfactory clinical improvement

Otorhinolaryngological HIV – related problems: a private practice experience

This is a retrospective review of six cases that presented with Otorhinolaryngological (ORL) problems associated with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) at GENIKS Specialist Clinics, Ibadan, Nigeria between January 2002 and June 2003. The patients all in the productive age group were either non responsive to conventional therapy for the presenting complaints or had features suggestive of immune depression prompting request for HIV screening, which was positive in all cases. Based on the findings, this paper proposes that all clinicians including otorhinolaryngologists especially should keep an eye for HIV infection hidden behind common ORL diseases and maintain a high level of suspicion for HIV infection in their day–to–day practice.Keywords: otorhinolaryngology HIV-related problems, private practice, NigeriaNigerian Journal of Otorhinolaryngology Vol. 2(2) 2005: 49-5

Paranasal sinusitis in the aetiology of orbital cellulitis

Aim: The purpose of this study was to assess the prevalence of paranasal sinusitis as a cause of orbital cellulitis and to identify the commonest sinus(es) involved in our setting.Methods: A retrospective review of the case notes of 47 patients with orbital cellulitis admitted into the ophthalmic ward of the University College Hospital, Ibadan within a ten-year period (1988-1987) was done.Results: Sinusitis 34.2%) was the most common cause of orbital cellulitis with the maxillary sinus being the most involved (38%). Patients in the second decade of life had the highest prevalence of 56%. More cases were seen during the dry season C November to February. Conclusion: Paranasal sinusitis is probably the most frequent cause of orbital cellulitis with the maxillary sinus being the most involved.Keywords: orbital cellulitis, paranasal sinusitis, Ibadan, NigeriaNigerian Journal of Ophthalmology Vol. 13 (1) 2005: 8-1

Chemo-radiation in advanced nasopharyngeal carcinoma, disease free 6 years-a case report

No Abstract. Nigrian Journal of Clinical Practice Vol.9 (1) 2006: pp.87-8