Management of Peritonsillar Abscess in a Tertiary Hospital in Southwest Nigeria

Background: Peritonsillar abscess (PTA) occurs when pus accumulates in the peritonsillar space. There are controversies about the most adequate form of treatment. The objectives of this study were to describe the clinical profile of patients, PTA and bacteriological profile of aspirates, and management of PTA. Methods: This retrospective study included patients with PTA managed in a tertiary hospital. The clinico-demographic characteristics, oropharyngeal examination findings, including that of the tonsils, test aspiration of swelling, and culture results were documented. The treatment modalities, hospitalization period, and outcome were recorded. Results: Seventeen records of adults were available (mean age, 33.3±9.7 years; female, 58.8%). All patients presented with fever, odynophagia, and trismus within 3 days. Five (29.4%) had previous sore throat, 94.1% had previous medications, and 52.9% had the abscesses on the left side. Test aspirate yielded pus in 76.5% of patients, whereas 8 aspirates cultured micro-organisms; 70.6% of the patients had incision and drainage (I&D) of the abscess, and the average hospitalization period was 3 days. Most (94.1%) of the patients had favorable outcomes. Conclusion: PTA is common in adults, and they present early with classical symptoms. Purulent aspiration is usually positive, and patients are treated with I&D with antibiotic coverage, which leads to a generally good outcome

Management and Complications of Nasal Septal Collections

Background: Nasal septum collections (hematoma and abscess) can lead to structural and functional abnormalities. Our objective was to assess the clinical characteristics, management and complications of nasal septal collections, and document factors associated withtheir complications. Methods: This was a retrospective study of patients managed for nasal septal collections. Socio-demographic and clinical information was recorded, and the main investigations and results noted. Follow-up and complications of septal collections were documented and the clinical factors associated with the complications explored. Results: Twenty-four patients records were studied: male: female ratio=2:1, mean age 40.1±13.1years,62.5% presented with complaints of nasal obstruction, 66.7% had antecedent nasal trauma, presentation was from 2 to 13 days,25%had co-morbid disease(s). All patients had incision and drainage of the septal collection within 1–7 h; 41.2% of the aspirated collections cultured microorganisms, 20.8% developed complications. Increased age above 45 years, co-morbidity, delayed presentation, culture-positive aspirate was all significantly associated with development of complications. Conclusion: Nasal septal collections were more common in adult males with antecedent nasal trauma; 20% developedcomplications associated with the presence of culturepositive abscesses, increased age, and duration of septal collection. Keywords: Nasal trauma, Septal hematoma, Septal abscess, Complication

Vestibular disorders in elderly patients: characteristics, causes and consequences

Introduction: this study assessed vestibular disorders in elderly patients, describing the causes,  clinical characteristics, therapies and treatment outcomes. Methods: five-year hospital-based  prospective study, conducted at the ENT clinic of a tertiary referral center. Subjects were consecutive elderly patients with dizziness, treated and followed-up for a minimum of six months. Data was  generated using structured questionnaire and case record files. Analyzed results were presented in  simple descriptive forms as graphs and tables.Results: among the elderly patients, prevalence of vestibular disorders was 18.6%, 49.1% were retired, 71.9% were married, M:F was 1:1.1. Mean age ±SD were 69.4±1.1 and 69.0±0.8 years for males and females respectively. 56.9% of the patients presented early on experiencing the vestibular symptoms.  The symptoms were associated with nausea or vomiting in 26.3%, with an aura in 12.3%. While 50.9% of the patients experienced intermittent symptoms, laterality of the symptoms was not clear in 45.6%. Positional vertigo was diagnosed in 33.3% while in 17.5%, the symptoms could be attributable to  previous trauma or assaults. 31.6% of the elderly were referred to ENT surgeons by other specialties, 45.6% were managed with multidisciplinary approach, while 82.5% had the vestibular symptoms initially controlled with labyrinthine sedatives. At follow-up, 43.9% had intermittent periods of recurrence of symptoms. Conclusion: prevalence of vestibular disorders in elderly patients is high, most patients present early with intermittent, relatively innocuous symptoms which may be difficult to lateralize. Positional vertigo was the most common cause, it is frequently relieved with labyrinthine sedatives but tends to recur  intermittently.Key words: Dizziness, elderly, vertigo, causes, characteristics, Nigeri

Functional assessment of elderly patients with hearing impairment: A preliminary evaluation

AbstractBackgroundThe consequence of hearing impairment in elderly patients may affect daily living activities functions. This study assessed whether hearing impairment (HI) has an effect, and the extent of the effect, on the functionality of elderly patients. It also explored factors that may be associated with impaired functionality in hearing-impaired elderly patients.MethodsThis was a cross-sectional, comparative study of elderly patients (aged ≥ 60 years) with HI. The study was conducted in a specialist tertiary hospital in a suburban town in southwestern Nigeria. The study participants were administered a structured questionnaire to obtain information on sociodemographics, clinical and audiometric profiles, and functional capabilities relating to physical, cognitive, and emotional functioning. Differences in the functional capabilities between the test patients and the controls were explored using the Student t test and Chi-square test, based on the data generated by statistical software.ResultsOne hundred and thirty individuals (78 test patients, 52 controls), aged 60–94 years (mean ± standard deviation, 71.4 ± 7.4 years) completed the study. In the physical and cognitive domains, the prevalence of functional impairment was 52.6%. Functions were different between hearing-impaired patients and normal hearing elderly patients. The HI patients had associated significant impairment in two domains of functional assessment (χ2 = 10.5, p = 0.001). The factors associated with functional impairment included an age older than 70 years, unmarried status, the presence of combined distressing symptoms, the loss of right ear advantage, the presence of multiple comorbid systemic diseases, and the need for hearing aids.ConclusionElderly patients with HI have vital functional limitations in daily living activities in Nigeria. The factors associated with the limitations deserve urgent attention

Clinical spectrum of ear, nose and throat foreign bodies in North Western Nigeria.

Background: Ear, nose and throat foreign bodies (FBs) are common occurrences particularly among children. This study reviewed the clinical spectrum of ENT FBs, their treatment and outcomes as seen in a tertiary health center in North Western Nigeria. Method: The study was a retrospective chart review of patients that were managed for FB impaction in a tertiary health institution in North Western Nigeria over a four year period. Result: There were 239 patients; M: F: 1.2:1. Majority of FB impaction (46.4%) occurred in children. Majority (68.7%) were otic and FBs. 18.0% of the patients had had failed attempted removal by non ENT specialists. About 25% of these patients developed complications. Majority (62.0%) of these complications occurred in the hand of non-ENT medical personnel. Conclusion: Ear, nose and throat foreign bodies are common in North-Western Nigeria with the highest incidence in children. Removal attempts by untrained health professionals and lack of experience in FB management predisposes to complications. Parental education on close monitoring of their children to avoid such incidences and the need to immediately seek an Otorhinolaryngologist to prevent complications are emphasized

Sub-clinical middle ear malfunctions in elderly patients; prevalence, pattern and predictors

Background: Little is known about functioning of the middle ear with advancing age.Objectives: To estimate the prevalence and describe tympanometric patterns of sub-clinical middle ear malfunctions,( S-MEM) in elderly patients. It also assessed clinical factors that could predict S-MEM.Methods: Cross-sectional, analytical study of patients aged ≥ 60 years in a tertiary hospital in Nigeria between 2011-2014. Pure tone audiometry (PTA), tympanometry and acoustic reflexes were recorded. S-MEM was based on audiometric and tympanometric evident abnormalities. Descriptive, univariate and multivariate analyses performed to detect independent clinical predictors of S-MEM at p-value of <0.05.Results: 121 patients , M: F of 1.1:1. Mean age was 70.1 ± 6.2 years, 77.7% were married. Prevalence of S-MEM was 21.5%. Abnormal tympanometric tracings were type AS>C>B>AD. The parameters that were statistically-significant on univariate analyses were subjected to logistic regression analysis which confirmed previous head injury, diabetes, osteoarthritis of knee joint, and absent acoustic reflex as clinical predictors for S-MEM.Conclusion: 21.5% of elderly Africans had subclinical abnormalities in their middle ear functioning, mostly with type AS tympanogram. Independent clinical predictors of S-MEM included previous head injury, diabetes, history of osteoarthritis of knee joints, and absent acoustic reflex.Keywords: Middle ear malfunctions, elderly patients

Assessment of the risk factors for hearing loss in adult Nigerian population

Background: A reduction in hearing sensitivity is common in adults and was previously considered to be normal as age increases. However, other health variables may play a role in the sensory changes. This prospective, comparative, hospital-based study assessed the risk factors (RFs) associated with sensorineural hearing losses (SNHL) in adult patients in a specialized tertiary hospital clinic in South-western Nigeria. Materials and Methods: Patients with clinical diagnosis of hearing impairment (bilateral SNHL) were the test subjects and age and sex-matched comparable group without SNHL were the Controls. Using a structured questionnaire, variables assessed included current and past medical history, family and social history, use of medications including ototoxic drugs, and prolonged medications. Results: One hundred and twenty-seven patients participated in the study comprising of 76 test subjects with SNHL (including 14 with suspected ARHL) and 51 controls. 59.8% of the participants were males. Univariate analysis revealed statistically-significant differences in family history, alcohol consumption, smoking, exposure to noise, previous ear discharge, previous head injury, hypertension, diabetes, osteoarthritis, ototoxic drugs usage, prolonged medication and obesity between the two categories of subjects. Logistic regression analysis revealed family history, smoking, noise exposure, head injury, hypertension had significantly increased odds of developing SNHL. Conclusion: It was concluded that the RFs for SNHL in adult Nigerians were multifactorial while some of the RFs may be amenable to primary prevention. Legislation and public health education could facilitate reduction of SNHL in our community

Middle ear impedance studies in elderly patients implications on age-related hearing loss

INTRODUCTION: Controversies arise with respect to functioning of the middle ear over time.OBJECTIVE: To assess changes in middle ear impedance that may be related to aging, and/or if there was an association of these changes with those of the inner ear in the elderly patients.METHODS: Cross-sectional, comparative study of elderly patients managed in ear, nose and throat clinics. A structured questionnaire was administered to obtain clinical information. Pure tone audiometry, tympanometry, and acoustic reflexes were performed. Comparative analyses were performed to detect intergroup differences between clinico-audiometric findings and middle ear measures, viz. tympanograms and acoustic reflexes.RESULTS: One hundred and three elderly patients participated in the study; 52.4% were male, averagely 70.0 ± 6.3 years old, age-related hearing loss in 59.2%, abnormal tympanograms in 39.3%, absent acoustic reflex in 37.9%. There was no association between age and gender in patients with abnormal tympanograms and absent acoustic reflex. Significantly more patients with different forms and grades of age-related hearing loss had abnormal tympanometry and absent acoustic reflex.CONCLUSION: Some abnormalities were observed in the impedance audiometric measures of elderly patients, which were significantly associated with parameters connected to age-related hearing loss

Vestibular disorders in elderly patients: characteristics, causes and consequences

Abstract Introduction: this study assessed vestibular disorders in elderly patients, describing the causes, clinical characteristics, therapies and treatmen

Fatores de risco de apneia obstrutiva do sono entre pacientes ambulatoriais nigerianos Risk factors of obstructive sleep apnea among nigerian outpatients

Apneia obstrutiva do sono (SAOS) é uma condição médica com consequências adversas. OBJETIVOS: Descrever os fatores de risco associados com OSA em adultos atendidos em uma clínica especializada ambulatorial. Forma de estudo: Estudo clínico prospectivo, entre pacientes ambulatoriais adultos em uma clínica especializada. MÉTODO: Os dados foram coletados por meio de questionário incorporando o BQ e os pacientes foram divididos em riscos de baixa e alta da OSA. Os fatores de risco associados com OSA na análise univariada foram submetidas a um modelo multivariado de regressão logística binária. Odds ratio ajustados com intervalo de confiança de 95% foram calculados para as seguintes variáveis independentes. RESULTADOS: Cento e nove e cinco pacientes participaram do estudo (sexo masculino 56,4%; idade 43,5 ± 15,6 anos; não roncadores habituais 81,5%, risco de alta OSA 17,4%, IMC 24,1 ± 4,6 kg/m²; obesos 12,9%). Seis fatores, incluindo o estado civil e a pressão arterial, foram significativamente associados com SAOS usando análise bivariada, no entanto, idade, horas de trabalho, tabagismo e IMC permaneceu preditivo da OSA na análise de regressão logística. CONCLUSÕES: SAOS é comum entre pacientes nigerianos, pode ser sub-reconhecida e está associada a fatores de risco que são passíveis de estratégias preventivas.Obstructive sleep apnea (OSA) is a medical condition with adverse consequences. OSA is credited to be a sleep disorder that disproportionately affects blacks. The Berlin Questionnaire (BQ) is a screening questionnaire for OSA. OBJECTIVE: To describe the risk factors associated with OSA among adults attending an out-patient specialist clinic. Study design: Prospective, clinical study including adult outpatients attending a specialist clinic. METHOD: Data was collected using a questionnaire incorporating the BQ and patients were divided into low and high risks of OSA. The risk factors associated with OSA in the univariate analyses were subjected to a multivariate binary logistic regression model. Adjusted odds ratios with 95% confidence intervals were calculated for these independent variables. RESULTS: One hundred and ninety five patients participated in the study (Males 56.4%; Age 43.5 ± 15.6 years; Non-habitual snorers 81.5%; High risk OSA 17.4%; BMI 24.1 ± 4.6 kg/m²; Obese 12.9%). Six factors including marital status and blood pressure were significantly associated with OSA using bivariate analysis nevertheless age, hours at work, smoking status and BMI remained predictive of OSA on logistic regression analysis. CONCLUSIONS: OSA is common among Nigerian outpatients, may be under-recognized and is associated with risk factors that are amenable to preventive strategies