Denture impaction in the oesophagus: correlation of site and duration of impaction with sequelae

Background: Denture restores aesthesis and function of missing teeth. Accidentally swallowed denture is an otorhinolaryngology emergency. The types of denture base and oesophageal anatomy infuluence the site of impaction.Objective: To review site of denture impaction and factors associated with site of impaction. To correlate site and duration of denture impaction before removal with associated sequelae.Method: A retrospective study of 27 patients managed in Otorhinolaryngology Department of University College Hospital Ibadan, Nigeria for oesophageal partial denture impaction, between August 2006 and September 2016. The demographic and clinical data of the patients were extracted from the hospital records, and statistical tables were used to illustrate the data.Results: A total of 27 patients; 14(51.9%) males and 13(48.1%) females, (M: F, 1.1:1) were studied. The age ranged from 24 to 77 years (mean age 49.0 ± 14.2years). Dentures were worn for 3 to 30 years (mean 3.8 ± 2.3years) without follow-up visit to dentist and 85.2% were upper dentures. All patients had history of accidental ingestion of denture, and the mean site of impaction was 18.2 ± 3.2cm from upper incisor, typically at upper cervical oesophagus in elderly patients and in lower oesophagus in females. There was no association between site of denture impaction, duration of denture impaction and operative findings.Conclusion: Advanced age and female gender are associated with site of denture impaction. Late hospital presentation significantly promotes sequelae associated with management of impacted dentures. It is recommended that fundamental changes in denture designs, education on regular follow-ups and avoidance of ill-fitting dentures would reduce the prevalence of denture impaction.Keywords: Denture impaction, Health education, Oesophagus, Oesophagoscopy and Nigeri

Hearing loss among adolescents on antiretroviral therapy: a need for periodic hearing assessment

Background: Human immunodeficiency virus-infected adolescents have insufficient CD4 T cell count, and despite attaining viral suppression with HAART regimen, some experience significant hearing loss.Objective: To determine the association between the hearing thresholds in HIV positive adolescent on highly active antiretroviral therapy and CD4 T cell count.Method: In this cross-sectional study, 63 adolescents receiving highly active antiretroviral therapy had pure tone audiometry and hearing thresholds determined using standard method. Additional data collected using proforma include biodata type of HAART regimens, treatment duration, the nadir and current CD4-cell count (cells/ml) and viral load (copies/ml) levels. These clinical parameters were correlated with hearing thresholds. Statistical analysis done included univariate analysis and multivariate logistic regression using Statistical Product and Service Solutions (SPSS version 20) and level of statistical significance was determined at P < 0.05.Results: There were 63 participants comprising of 26 (41.3%) males and 37 (58.7%) females, age ranged from 13 – 17 years (mean age 14.7years ± 1.65). Hearing loss was found in 20.6% adolescents and was predominantly sensorineural hearing loss. There was asoociation between hearing threshold, nadir CD4 count and viral load, but not with gender, current CD4 count and viral load, HAART regimen, and treatment duration.Conclusion: The high prevalence of adolescents with hearing impairment showed that there might be an association with the disease and/its treatment hence the need for inclusion of periodic hearing evaluation in the routine clincal care of HIV-infected adolescent on HAART.Keywords: Adolescents, CD4 nadir, HIV, Sensorineural hearing loss, Nigeri

Pharyngo-cutaneous fistula post total-laryngectomy: A local experience

Background: Pharyngo-cutaneous fistula is a major complication of total laryngectomy. Despite its significant impact on the patients' nutrition and management outcome, there is lack of consensus for recognising high-risk patients and factors associated with fistula formation. Hence, this study was aimed at determining the incidence of pharyngocutaneous fistula and factors associated with fistula formation.Methods: A retrospective collection of data on all cases of laryngeal cancer diagnosed histologically and had total laryngectomy, in the  Otorhinolaryngology Department of a tertiary centre in Southwestern, Nigeria, from 2007 – 2016. The data collected includeage, gender, tumour stage, tracheostomy, adjuvant therapy extent of laryngectomy procedure and factors for pharyngo-cutaneous fistula.Results: Forty-two patients had total laryngectomy, male to female ratio was 7.4:1 and mean age was 52.3 ± 2.1 years. All patients had pathological diagnosis of stage 3 (83.3%) and stage 4 (16.7%) laryngeal cancer, respectively. The incidence of pharyngo-cutaneous fistula was11.9% and the factors related to fistula formation were prior radiotherapy treatment and diabetes. Age, gender, neck dissection procedures, site of primary tumor and emergency tracheostomy did not contribute to fistula formation. Spontaneous fistula closure was achieved in all cases except one patient who had surgical closure.Conclusion: Pharyngo-cutaneous fistula formation post-surgery is related to the presence of co-morbidities. The high percentage of spontaneous closure underscores the need for a conservative management approach. Keywords: Laryngeal Cancer, Laryngectomy, Neck dissection, Pharyngo-cutaneous fistula, Post-surgery, Radiotherap

Otogenic Tetanus: Continuing Clinical Challenge in the Developing Country

Background: Otogenic tetanus is a vaccine preventable disease which continues to be of public health significance.Objectives: To evaluate patients with otogenic tetanus and identify the factors that predisposes patients to it.Methodology: This is a 16-year retrospective review of all patients managed for otogenic tetanus at the Department of Otorhinolaryngology, University College Hospital, Ibadan. The essential clinical data collected include demographic data, clinical presentations, tetanus immunization history, duration of hospital admission, management and outcome.Results: There were 66 subjects made up of 45 (68.2%) males and 21 (31.8%) females. Their age ranged between 2 and 65years, mean of 7.7 years but the under 5years constituted the majority, 56.1%. All patients presented with ear discharge, lock jaw and spasms. The onset of symptoms ranged between 3 and 8 days with a mean of 4.3 ± 3.3days. Only 21.2% had history of completed childhood tetanus immunisation. No patient had booster shots. About 98% had history of use of herbs, charcoal, honey, cigarette, methylated spirit or deodorant in the discharging ear. All were managed with antibiotic ear dressing, tetanus toxoid, human tetanus immunoglobulin, antibiotic therapy and sedative but only 3% had airway management. The duration of hospital admission ranged from 18 days to 105 days and there were 12.1% death.Conclusion: Otogenic tetanus is still a major problem in developing countries and this can be prevented if recommended childhood tetanus vaccination and booster shots regimen are properly taken. Health education on ear hygiene and care of the ear may prevent this disease