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

Actualities of Management of Aural, Nasal, and Throat Foreign Bodies

Background: Foreign bodies (Fbs) in the ear, nose, and throat (ENT) are common presentations in healthcare settings worldwide.Aim: This study was carried out to review the modes of presentation, management, and outcome of inserted Fbs in our setting.Subjects and Methods: A 5‑year retrospective study of cases of ENT Fbs managed at two referral hospitals in Abuja Nigeria. The analysis was done with Chi‑square and Pearson correlation.Results: Five hundred and ninety‑four patients aged 0–75 years, M:F = 1.1 (295 vs. 299) were reviewed. Prevalence was predominantly among the under 5 s; 286/594 (P = 0.001). ENT Fbs were 356/594 (59.9%), 167/594 (28.1%) and 71/59 (12.0%), respectively. Cotton wool 133/356 (37.4%) and beads 75/356 (21.1%) constituted most aural Fbs. Beads 45/167 (27.0%) and grains/seed 37/167 (22.1%) were the most common nasal Fbs while fish bones 38/71 (53.5%) and piece of metals 12/71 (16.9%) were dominant in the throat. Most cases of aural and nasal Fbs were asymptomatic. Ear syringing was the most common method for removal of aural Fbs 216/594 (60.7%) and instrumentation under direct vision for nasal Fbs 153/167 (91.6%). Furthermore, 52/71 (73.2%) of throat Fbs were removed under general anesthesia. ENT complications observed included bruises, lacerations, perforations, Epistaxis, and a case of respiratory failure. Delayed presentation (beyond 24 h) was seen in 489/594 (82.3%) of cases while failed previous attempts by untrained hands constituted 353/594 (59.4%). A strong correlation between complications and duration of Fbs insertion (R2 = 0.8759) was established.Conclusions: Fbs in ENT are common especially among children below 5 years. Majority presented beyond 24 h, and there was a strong correlation between duration of Fbs insertion and associated complications. Repeated failed attempts and delayed referrals to otorhinolaryngologists from peripheral centers were also contributing factors to increased morbidity and hence the need for awareness. Keywords: Aural, Foreign bodies, Laryngeal, Nasal, Otorhinolaryngologist, Pharyngeal, Throa

Correlating the site of tympanic membrane perforation with Hearing loss

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Small Tympanic Membrane Perforations in the Inferior Quadrants Do Not Impact the Manubrium Vibration in Guinea Pigs

BACKGROUND: It has been believed that location of the perforation has a significant impact on hearing loss. However, recent studies have demonstrated that the perforation sites had no impact on hearing loss. We measured the velocity and pattern of the manubrium vibration in guinea pigs with intact and perforated eardrum using a laser Doppler vibrometer in order to determine the effects of different location perforations on the middle ear transfer functions. METHODS: Two bullas from 2 guinea pigs were used to determine stability of the umbo velocities, and 12 bullas from six guinea pigs to determine the effects of different location perforations on sound transmission. The manubrium velocity was measured at three points on the manubrium in the frequencies of 0.5-8 kHz before and after a perforation was made. The sites of perforations were in anterior-inferior (AI) quadrants of left ears and posterior-inferior (PI) quadrants of right ears. RESULTS: The manubrium vibration velocity losses were noticed in the perforated ears only below 1.5 kHz. The maximum velocity loss was about 7 dB at 500 Hz with the PI perforation. No significant difference in the velocity loss was found between AI and PI perforations. The average ratio of short process velocity to the umbo velocity was approximately 0.5 at all frequencies. No significant differences were found before and after perforation at all frequencies (p>0.05) except 7 kHz (p = 0.004) for both AI and PI perforations. CONCLUSIONS: The manubrium vibration velocity losses from eardrum perforation were frequency-dependent and the largest losses occur at low frequencies. Manubrium velocity losses caused by small acute inferior perforations in guinea pigs have no significant impact on middle ear sound transmission at any frequency tested. The manubrium vibration axis may be perpendicular to the manubrium below 8 kHz in guinea pigs

Mechanisms of Hearing Loss after Blast Injury to the Ear

Given the frequent use of improvised explosive devices (IEDs) around the world, the study of traumatic blast injuries is of increasing interest. The ear is the most common organ affected by blast injury because it is the bodyﾒs most sensitive pressure transducer. We fabricated a blast chamber to re-create blast profiles similar to that of IEDs and used it to develop a reproducible mouse model to study blast-induced hearing loss. The tympanic membrane was perforated in all mice after blast exposure and found to heal spontaneously. Micro-computed tomography demonstrated no evidence for middle ear or otic capsule injuries; however, the healed tympanic membrane was thickened. Auditory brainstem response and distortion product otoacoustic emission threshold shifts were found to be correlated with blast intensity. As well, these threshold shifts were larger than those found in control mice that underwent surgical perforation of their tympanic membranes, indicating cochlear trauma. Histological studies one week and three months after the blast demonstrated no disruption or damage to the intra-cochlear membranes. However, there was loss of outer hair cells (OHCs) within the basal turn of the cochlea and decreased spiral ganglion neurons (SGNs) and afferent nerve synapses. Using our mouse model that recapitulates human IED exposure, our results identify that the mechanisms underlying blast-induced hearing loss does not include gross membranous rupture as is commonly believed. Instead, there is both OHC and SGN loss that produce auditory dysfunction

Spectrum of otorhinolaryngology emergencies in the elderly in Ibadan, Nigeria

No Abstract. Nigerian Journal of Medicine Vol. 14(4) October-December 2005: 411-41

Otorhinolaryngology and Geriatrics in Ibadan, Nigeria

Background: Changing demographics trends in our country will have a profound influence on the future practice of otolaryngology. The geriatrics population has already become the fastest-growing segment of our society and it will continue to be so for decades to come and very soon a larger percentage of patients treated by Otolaryngologist will be in the over 65 age groups. The aim of this study is to present our observations on geriatrics ORL as seen in Ibadan, Nigeria. Methodology: A retrospective study analysis of 170 geriatrics patients that presented in the Ear, Nose and Throat Department of the University College Hospital, Ibadan, Nigeria between 2000 and 2004 was done. The diagnosis in each subject was based on history, clinical findings, and investigations done on each subject at the time of presentation. Results: 170 geriatrics patients were seen and treated over the 5-year studied period with 94 males (55.3%), 76 females (44.7%) (M:F 1.2:1) and with an average age of 70.9 years (age range 65-97 years). The geriatrics patients constituted 3.64% of the total new cases (4,675) seen during the studied period. Majority of the patients lived in the towns and cities 109 (64.1%) while 61 (35.9%) lived in the villages. 158 (92.9%) were married with 69 (40.6%) engaged in trading as an occupation while 54 (31.8%) and 23 (13.5%) were pensioners and housewife respectively. Only 16 (9.4%) still engaged in farming activities. The main presentations in these geriatrics patients were otological presentations 114 (67.1%) followed by rhinological 31(18.2%) and laryngeal presentations 22 (12.9%) respectively. Facio-plastic presentations were of 3 (1.8%) cases. Presbycusis 35 (30.7%) and cerumen auris 30 (26.3%) were the main otological problems encountered. Rhino-sinusitis 20 (58.8%) constituted the main rhinological problems seen. Laryngeal carcinoma 10 (41.7%) and pharyngo-laryngitis 6 (25%) constituted the main laryngeal problems found in this study. Majority of the patients were treated as outpatients 160 (94.1%), only 10 (5.9%) required admission for their treatments with an average hospital stays of 3-weeks. Conclusion: In conclusion, presbycusis, cerumen auris, rhino-sinusitis, and laryngeal carcinoma were the main otorhinolaryngological presentations seen among the geriatrics studied. With the explosive growth of the elderly population, this group will become a larger percentage of patients in the future and Otolaryngologist would need to be prepared to take care of these categories of patients adequately. Current and newly developed information relating to geriatrics in otolaryngology must be incorporated into present training of Otolaryngologist. Continuing education programs in geriatrics otolaryngology should be provided for all physicians in family practice to ensure early referral of such cases to ORL specialists. Key words: geriatrics, otolaryngology, presbycusis, sinusitis, laryngeal carcinoma. Nigerian Journal of Otorhinolaryngology Vol.2(1) 2005: 7-1

Patterns of tympanic membrane perforation in Ibadan: a retrospective study

Background: Tympanic membrane perforations vary in size, shape and position. The degree of conductive deafness varies with the size and position of the tympanic membrane perforation.Objective: This study is to determine the pattern and causes of tympanic membrane perforation.Method: Hospital based study at the ENT Clinic, UCH, Ibadan. Consecutive patients seen during the period of study with ear symptoms were interviewed and examined by ENT surgeons. This information was entered into computer and analyzed using SPSS v 11.Result: Thirty-three (13.5%) of the 244 patients were found to have tympanic membrane perforation. Fifteen (45.5%) patients were new while 18 (54.5%) were follow up patients. There were 13 (39.4%) males and 20 (60.6%) females. The type of perforation seen were central 57.6%, subtotal 33.3%, total 6.1%, marginal 3.0%. The sides affected were left ear 45.5%, right ear 15.2%, and both ears 39.4%. The causes found were chronic suppurative otitis media (CSOM) 90.9%, acute suppurative otitis media (ASOM) 6.1%, and trauma to the affected ear 3.0%. CSOM wasthe cause of tympanic membrane perforation seen in children. Conclusion: There is need for early diagnosis and treatment of all cases of tympanic membrane perforation and proper education of parents and guardians on proper method of ear care and early referral. There is also need to train all healthcare workers especially primary health care providers on how to manage these cases.Keywords: Pattern, tympanic membrane perforation, diseases of the ea

Tonsillectomy: Vasoconstrictive hydrolytic cold dissection method

Background: Tonsillectomy, a common paediatric otolaryngology  procedure, has undergone several evolutionary trends in the surgical  techniques aimed at minimizing complications and improving patients’ satisfaction. Despite the technological advancements in this respect, search for an ideal method is still ongoing, and some authorities are  reverting back to the conventional methods. We wish to introduce the “Vasoconstrictive hydrolytic cold dissection” (VHCD)method.Patients and Methods: The VHCD method was described, and the outcome measures in one hundred and thirty-fi ve patients who had the procedures were presented in tables. Data entrance was done with SPSS 14. Results: A total 135 patients comprising of 107 children aged 1-12 years and 28  adolescents/adults aged 14-52 years were operated upon using the VHCD between March 2009 and July 2012 by the same teams of Surgeons and Anaesthetists. The average surgical time and blood volume losses were 15  minutes and 5 mls for children and 12 mins and 10 mls for  adults/adolescents, respectively. There was a single case (0.7%) of posttonsillar bleed (reactionary haemorrhage). The rest (99.3%) recorded nil haemorrhage within and beyond first 2 weeks post-surgery.  Conclusions: Surgeons used to other techniques of tonsillectomies may not revert to the cold steel; however, those practicing CSM will benefi tfrom VHCD. We hereby recommend this simple, costeffective modification of the cold steel tonsillectomy, which appears to have made dissection easier and also minimizes haemorrhage, a common complication of tonsillectomy surgery. It is timely in the advent of increased advocacy towards reversal to the conventional method of tonsillectomy. A  randomized control trial is required for further evaluation of this method.Key words: Normal saline, tonsillectomy, vasoconstrictive hydrolytic  dissectio

Retropharyngeal abscess: A clinical experience at the University College Hospital, Ibadan

No Abstract. Nigerian Journal of Medicine Vol. 14(4) October-December 2005: 415-41