Profile of Ear Diseases among Elderly Patients in Sagamu, South-Western Nigeria

BACKGROUND: The elderly constitute a vulnerable group which other people often misunderstand, misrepresent and are potentially prone to abuses and suboptimal care. Ear diseases are important as they may affect the wellbeing of elderly patients and their quality of life.  This study took an inventory of the pattern of ear diseases among elderly patients. METHODS: A five year descriptive retrospective analysis of the clinical information on the elderly patients who presented with Ear Diseases at the ENT Clinic of our hospital. RESULTS: Data was retrieved from 165 patients and analyzed. Average age was 70 years and females constituted 53.3% of the patients. The three leading symptoms experienced by the patients were tinnitus (84.2%), hearing loss (72.1%) and earache (32.7%) while 57.0% of the diseases affected both ears. The major clinical diagnoses were Presbycusis (38.2%), Otitis (25.5%), and wax impaction (18.8%). Majority (67.3%) of the patients had single pathology while most of the ear diseases affected the inner ear.CONCLUSION: There was a relatively high prevalence of ear diseases among our elderly patients. The need for proper clinical evaluation of patients with ear diseases was emphasized. The importance of screening for hearing impairment in the elderly patients was also stressed. KEYWORDS:  Cerumen, Ear disease, Elderly, Otitis, PresbycusisErratum Note: Olusola AS on the article “Profile of Ear Diseases among Elderly Patients in Sagamu, South-Western Nigeria” on Page Nig. J. Med 2013. 143-147. Should read: Sogebi OA

Clinical and audiometric features of presbycusis in Nigerians

Background: Presbycusis is the most common sensory impairment associated with ageing and it presents with variability of symptoms. Physicians need to recognize early clinical and audiometric signs of presbycusis in order to render adequate and quality care to patients and reduce associated morbidities.Objective: To characterize the clinical modes of presentation and the typical audiometric tracings among patients with presbycusis.Methods: This descriptive, prospective hospital-based study was conducted in the Ear, Nose and Throat (ENT) clinic of Olabisi Onabanjo University Teaching Hospital, (OOUTH) Sagamu, Nigeria. Patients with clinical diagnosis of presbycusis confirmed with bilateral sensorineural hearing loss (SNHL) on diagnostic audiometry were administered with questionnaires. Information obtained was analyzed using SPSS statistical package version 17.0 and presented in descriptive forms as percentages, means and graphs.Results: Sixty-nine patients were diagnosed with presbycusis (M:F =1.6:1). Modal age group was 71-80 years. Hearing loss 88.4%, tinnitus 79.7% and vertigo 33.3% were the major symptoms on presentation. The average duration of symptoms before presentation was 2.6 years. There was positive history of ototoxic drugs usage in 24.6 %, family history in 11.6 %, hypertension in 34.8% and osteoarthritis in 13.0%. The most common type of audiometric pattern was strial. Hearing losses increased with age both at the speech and at the higher frequencies of sounds.Conclusions: We found hearing impairment affected both speech and higher frequencies and the strial type of audiometric pattern was most common. The need for screening for hearing impairment from early middle age in symptomatic individuals is emphasized.Keywords: Presbycusis, Nigerians, Audiometry, Clinical features, ElderlyAfrican Health Sciences 2013; 13(4): 886 - 89

An Unusual Foreign Body in the Ear of an Elderly Nigerian Patient

This was a case of an incidental finding of an unusual foreign body in the right ear of an elderly Nigerian patient. The mode of presentation, the manner of discovery and how it was managed successfully were highlighted. We reported this case to create awareness, and encourage physicians to always observe effluents obtained from irrigation of body cavities for confirmation of diagnosis and documentation. KEY WORDS: Ear syringing, elderly, foreign body, locust bea

Corrosive oesophageal injuries: a preventable menace

Introduction: Potentially catastrophic presentations and lifelong complications resulting from corrosive ingestions in humans is one of the most challenging situations encountered in clinical medical practice. This study reviewed pattern, mechanisms and associated socio-medical challenges with ingestion of corrosive agents as seen in a tertiary health institution in South-western Nigeria. Methods: A retrospective review of all patients that were managed for corrosive ingestion at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over a seven year period. Results: A total of 28 patients M:F: 1.6:1. There were 7 children and 21 adults. Majority (78.6%) of the patients ingested alkaline substances. Accidental ingestion occurred in 28.6% while 71.4% resulted from deliberate self harm especially among adults (66.7%). Almost two thirds (64.3%) of the patients presented after 48hrs of ingestion. Patients who presented early were managed conservatively. Most patients (64.3%) who presented late had nutritional and fluid rehabilitation. Two patients died from oesophageal perforation and resulting septicaemia. Psychiatric evaluation revealed that seven adults (25%) had psychotic illness while (42.9%) of the patients developed oesophageal strictures. Short segment strictures were managed with oesophageal dilatation with good outcome while long and multiple segment strictures were referred to cardiothoracic surgeons for management. Conclusion: Corrosive oesophageal injuries remain a prevalent and preventable condition in the developing countries. Preventive strategies should include regulation and packaging of corrosive substances, organization of psychiatric services, and education of the population on corrosive ingestion.Key words: Corrosive injuries, caustic ingestion, accidental ingestion, self harm, mechanisms, prevention, psychiatric disorders, esophageal stricture, Nigeri

Occupational noise exposure and hearing loss: A study on knowledge, attitude and practice among Tanzanian iron and steel workers

We assessed Knowledge Attitude and Practice (KAP) regarding occupational noise exposure, Noise-induced hearing loss, audiometry and use of hearing protection devices among iron and steel factory workers exposed to high noise level. A modified, validated, structured questionnaire was used to collect information from 253 male workers randomly selected from the four factories. The sum scores for each domain of KAP were computed. Scores above 75% were defined as good knowledge and positive attitude. For practice, scores of >50% were defined as good. Independent samples t-test and Chi-squared test were used to analyze association between KAP and continuous/categorical variables respectively. Majority of workers displayed poor knowledge and poor practice (94%), but 76% displayed a positive attitude. Most of the workers (86%) had never been provided with hearing protection devices. The mean scores for attitude and practice differed significantly between the four factories (one-way ANOVA, p < 0.001). Implementation of hearing conservation program with provision of hearing protection devices are suggested.publishedVersio

Ear, nose and throat injuries at Bugando Medical Centre in northwestern Tanzania: a five-year prospective review of 456 cases.

Injuries to the ear, nose and throat (ENT) regions are not uncommon in clinical practice and constitute a significant cause of morbidity and mortality in our setting. There is dearth of literature on this subject in our environment. This study was conducted to describe the causes, injury pattern and outcome of these injuries in our setting and proffer possible preventive measures. This was a descriptive prospective study of patients with ear, nose and throat injuries managed at Bugando Medical Centre between May 2007 and April 2012. Ethical approval to conduct the study was sought from relevant authorities. Statistical data analysis was performed using SPSS computer software version 17.0. A total of 456 patients were studied. The median age of patients at presentation was 18 years (range 1 to 72 years). The male to female ratio was 2:1. The commonest cause of injury was foreign bodies (61.8%) followed by road traffic accidents (22.4%). The ear was the most common body region injured accounting for 59.0% of cases. The majority of patients (324, 71.1%) were treated as an outpatient and only 132(28.9%) patients required admission to the ENT wards after definitive treatment. Foreign body removal and surgical wound debridement were the most common treatment modalities performed in 61.9% and 16.2% of cases respectively. Complication rate was 14.9%. Suppurative otitis media (30.9%) was the commonest complication in the ear while traumatic epistaxis (26.5%) and hoarseness of voice (11.8%) in the aero-digestive tract were commonest in the nose and throat. The overall median length of hospital stay for in-patients was 8 days (range 1 to 22 days). Patients who developed complications and those who had associated injuries stayed longer in the hospital (P < 0.001).Mortality rate related to isolated ENT injuries was 1.3% (6 deaths). The majority of patients (96.9%) were treated successfully and only 3.1% of cases were discharged with permanent disabilities. Injuries to the ENT regions are not uncommon in our environment and foreign bodies constitute a significant cause of injury. Majority of these injuries can be prevented through public enlightenment campaigns

Trends in the Clinical Pattern, Diagnosis and Management of Rhinosinusitis in a Sub-urban Tertiary Health Centre

Background: Rhinosinusitis (RSS) is a common form of upper airway disease encountered by Otolaryngologists. Objectives: To describe the trends in the clinical presentation, diagnosis and management of RSS in a tertiary hospital. Methods: Retrospective analysis of clinical information retrieved from the hospital records of patients with RSS managed in the ENT department of OOUTH Sagamu over an 18-month period was done. Results: Out of 1814 patients, 143 had RRS with the prevalence rate of 7.9%. The male-to-female ratio was 1.1:1, the age ranged from 7 to 79 (median = 32.4) years. The presenting symptoms included mucoid nasal discharge (68.7%), nasal congestion (61.5%) and excessive sneezing (46.8%). Most (71.3%) of the patients presented after 3weeks of the onset of symptoms and the median duration was 3.2 months. The leading physical findings included engorged nasal turbinates (78.3%), ooedematous nasal mucosa (72.0%), mucopurulent anterior rhinorrhoea (28.6%) and pale nasal mucosa (25.9%). The investigations done included plain X-Rays of the sinuses (86.0%), full blood count (67.1%) and computerized tomographic (CT) scan of the sinuses (8.4%). Plain X-Ray abnormalities were most common in the maxillary sinuses (45.5%) while 30.1% had multi-sinusitis. The trend of diagnosis ranged from infective RSS in 51.7% to allergic RSS in 38.5%. About a quarter had different forms of non-endoscopic surgical intervention. Recorded complications included nasal polyps in 11.9%. Conclusion: The trend of RSS observed relative affectation of adults and mostly chronic infective types, and sometimes allergic types. Radiological assessment was by plain X-Rays in most cases, management was either medical or non-endoscopic surgical methods, frequently complicated by polyps

Independent Predictors of Recurrence of Vertigo Among Nigerians

Background:&nbsp;Recurrence of vertigo indicates a morbidity to the patient and a dilemma for the managing physician. Objectives:&nbsp;To describe the characteristics of vertigo, document prevalence and explore the characteristics which could independently predict recurrence of vertigo. Methods:&nbsp;A cross-sectional study of patients managed for vertigo in a tertiary facility was retrospectively done. Patients’ demographic and clinical characteristics, associations of vertigo, audiological symptoms, comorbid illnesses, and duration to achieve control of vertigo were recorded. Recurrence of vertigo was used to categorize the patients. The factors that were associated with recurrence on univariate analyses were evaluated as independent predictors of recurrence of vertigo. Results:&nbsp;The 73 patients with a male-to-female ratio of 1:1.4 were aged 35 -78 (mean 56.6±9.9) years. The associated symptoms included body weakness (34.2%), audiological symptoms (38.4%), 27.4% had antecedent head and neck injury and vertigo was precipitated or aggravated by changes in the head and neck position in 63.0% Vertigo was controlled within 1 -7 (Median 2) days, 35.6% had a recurrence of vertigo. Age, the experience of nausea and vomiting, previous head and neck injury, presence of comorbidity, and long duration to achieve control of vertigo were significantly associated with recurrence of vertigo. All these factors except the presence of comorbidity could independently predict the recurrence of vertigo. Conclusion:&nbsp;Vertigo is common in adult females, and mostly positional in type. About a third of patients may have a recurrence of vertigo. Age, especially above 57 years, nausea and vomiting, head and neck injury and prolonged period to control vertigo may independently predict recurrence of vertigo

Laryngeal lesions in Ibadan, Nigeria

Background: There are few reports in the literature on the incidence of laryngeal lesions findings at direct laryngoscopy in our environment. The aim of this paper was to present the laryngeal lesions found at direct laryngoscopies done in a tertiary health institution in Nigeria over a ten-year period. Methodology: A retrospective study of patients who had direct laryngoscopy in the Ear, Nose and Throat Department of the University College Hospital Ibadan, Nigeria between January 1995 and December 2004 was done. All direct laryngoscopies were done under general anaesthesia and the larynx examined using Negus laryngoscopes. Some of the findings at direct laryngoscopies were corroborated with biopsies and histological diagnosis. Results: There were 101 patients. 23 (22.8%) of the patients were children while 78 (77.2%) were adults, giving childern: Adults ratio of 1: 3.4. In the paediatric population, there were 14 (60.9%) males and 9 (39.1%) females, while in the adults, 63 (80.8%) were males, while 15 (19.2%) were females making the male: female ratios 1.6: 1 and 4.2: 1 respectively. The main pathologies seen in the larynx of children in this study were laryngeal papillomatosis 17(51.5%), acute laryngitis 7(21.2%), laryngeal foreign body 4(12.1%) and laryngeal stenosis 4(12.1%). In the adult population in this study, the major findings at direct laryngoscopy were laryngeal tumours 43(53.1%), laryngeal stenosis 9(11.1%), and vocal cord nodules 7(8.6%). The laryngeal tumours were confirmed histologically to be carcinomas in 36(44.4%), dysplasias 3 (3.7%), papillomas 2 (2.5%) and sarcomas in 2 (2.5%) cases. Conclusion: In conclusion, the four most prevalent conditions diagnosed at direct laryngoscopy in children in this study were laryngeal papillomatosis, acute laryngitis, laryngeal foreign bodies, and laryngeal stenosis, while in the adults, laryngeal carcinomas, laryngeal stenosis, and vocal cord nodules constituted the major findings. Nigerian Journal of Otorhinolaryngology Vol. 3(1) 2006: 1-

A Facility-based Study of Preauricular Sinus Among Adults in Southwest Nigeria

Background:&nbsp;Preauricular sinus (PAS) is common among the blacks and it presents in different manners. The perceptions of adult patients with PAS may influence the management strategies deployed. Objectives:&nbsp;To determine the perceptions of adult patients who have PAS about the disorder and describe the modalities of presentation. Methods:&nbsp;A descriptive study was conducted at the ENT Clinics over nine months. Using a questionnaire, socio-demographic information, perception of patients on the cause, concerns, modality of treatment, inclination to surgery and perceived complications of surgery were explored. Examination findings of the sinuses, including results of audiological investigations were recorded. Results:&nbsp;The prevalence of PAS was 7.4% (56/754) and the mean age of the subjects was 43.9±10.6 years. Multiple causes of PAS were perceived by 58.5% of the patients, 13.2% were not concerned but intermittent symptom was experienced by 43.3% of the patients. More than half (52.8%) believed the sinus could be treated medically with drugs, 86.8% perceived complications from surgical excision while 73.6% abhorred surgical excision.&nbsp; Half of the PAS was in the left ear while 11.3% were bilateral. Audiological evaluation revealed 46.4% of patients had evidence of sensorineural hearing loss while 56.5% had abnormal middle ear functions. Conclusions:&nbsp;Some adult patients had wrong perceptions of PAS and most patients abhorred surgical excision. The clinical presentations were mostly of the classical type, with almost two-thirds violated. There may be a need for genetic studies on PAS in future research