Risk Factors for Otitis Media with Effusion in Preschool and School Children in Calabar Municipality.

BACKGROUND: Predisposing factors for otitis media with effusion are multifactorial, ranging from genetic and anatomical abnormalities to environmental factors and inflammation of the nose and adjacent structures. AIM: The study determined the risk factors for otitis media with effusion (OME) among children in Calabar Municipality. METHODS: This was a descriptive, cross-sectional, community-based study including children aged 1-10 years randomly selected from government and privately owned daycares, nurseries (preschool), and primary schools. The risk factors assessed included upper respiratory tract infection, allergic rhinitis, adenoid enlargement, acute otitis media, recurrent acute otitis media parental educational level, overcrowding (four children sleeping in a room), duration of breastfeeding, cleft palate, and Down's syndrome. Allergic rhinitis was diagnosed when a child had at least two of the rhinological symptoms: nasal congestion, running nose, sneezing, itching of the eye or nose, and at least one of the following: history of allergy, family history of allergy, and positive history of asthma. The questionnaire was the research instrument used to assess the risk factors for OME. OME diagnosis was made with otoscopy and tympanometry. Data were collected and analyzed with IBM SPSS version 25, and a P value <0.05 was considered statistically significant. RESULTS: A total of 24 daycare pupils, 141 nursery pupils, and 155 primary pupils were recruited into the study. The prevalence of otitis media with effusion was more in younger children than in older children and the relationship was statistically significant (P < 0.001). Female children were more statistically affected than male children (P = 0.007). Children with allergic rhinitis accounted for a higher proportion of those with OME than those without allergic rhinitis (26.7% vs. 11.6%), and the difference was statistically significant (P = 0.007). The association between OME and upper respiratory tract infection, acute otitis media, and recurrent acute otitis media was not statistically significant (P > 0.05). Multivariate binary logistic regression was used to identify predictors for the otitis media with effusion. CONCLUSION: There are many endogenous and exogenous risk factors for OME, but notable risk factors in our study were age 1-2 years, female sex, and allergic rhinitis.

Prospective evaluation of the impact of daycare attendance on the prevalence of otitis media with effusion in 6 to 24 months old children in urban Nigeria.

BACKGROUND: The peak age prevalence of otitis media with effusion (OME) is in early childhood. Day care attendance has been established by various studies as a risk factor for the development of OME. OBJECTIVE: This study is aimed at evaluating the prevalence of OME among children aged 6 - 24 months, and the impact of day care center (DCCs) attendance on the OME occurrence. METHODS: A prospective cohort study conducted in children recruited from DCCs and immunization clinics in Surulere, Lagos state, Nigeria. They were matched mainly on their place of care, at home or at day care center and presence or absence of OME using pneumatic otoscopy and tympanometry. RESULTS: A total of 152 children were studied. Based on their place of care, they were divided into day care attendees 64 (42.1%), and non day care attendees 88 (57.9%). The prevalence of OME was 37.7% overall, 43.7% in the day care attendees and 33.4% in the non day care attendees. Factors found to positively influence the prevalence of OME in this study include: young age 6-12 months, female gender and day care attendance. CONCLUSION: OME is common in Nigerian children at young age. Day care facility attendance significantly increased OME prevalence.

Implementing the new WHO guidelines for the early detection of sensorineural hearing loss in newborns and infants in Nigeria.

This brief educational update examines the key recommendations in the new report of the World Health Organisation on newborn and infant hearing screening within the Nigerian context. While acknowledging the goal of universal newborn hearing screening as desirable, the authors highlight the need for all tertiary hospitals in the country to be appropriately equipped to provide at the minimum early hearing detection services for all high-risk newborns including those delivered by consanguineous parents, those with maternal hypertensive disorders, nonelective caesarean section and unskilled birth attendants. In addition to conventional risk factors for infant hearing loss, microcephalic and undernourished infants should be tested based on evidence from local pilot studies. Primary and secondary-level hospitals should maintain an active referral system to the tertiary centres within a multidisciplinary framework to assure the best of care for the affected infants.

Implementing the new WHO guidelines for the early detection of sensorineural hearing loss in newborns and infants in Nigeria.

This brief educational update examines the key recommendations in the new report of the World Health Organisation on newborn and infant hearing screening within the Nigerian context. While acknowledging the goal of universal newborn hearing screening as desirable, the authors highlight the need for all tertiary hospitals in the country to be appropriately equipped to provide at the minimum early hearing detection services for all high-risk newborns including those delivered by consanguineous parents, those with maternal hypertensive disorders, nonelective caesarean section and unskilled birth attendants. In addition to conventional risk factors for infant hearing loss, microcephalic and undernourished infants should be tested based on evidence from local pilot studies. Primary and secondary-level hospitals should maintain an active referral system to the tertiary centres within a multidisciplinary framework to assure the best of care for the affected infants.

Sensorineural hearing loss in infants with neonatal jaundice in Lagos: a community-based study.

AIM: To establish the incidence and predictors of sensorineural hearing loss (SNHL) in infants with neonatal jaundice (NNJ) in an inner-city setting with predominantly non-hospital births. METHODS: A community-based study in Lagos, Nigeria in which infants with SNHL attending well-child clinics for routine immunisation were detected by two-stage universal hearing screening with transient evoked oto-acoustic emissions and automated auditory brainstem response from July 2005 to December 2006. Predictors of SNHL among infants with a history of NNJ were determined with multivariate logistic regression based on adjusted odds ratio (OR) at 95% confidence intervals (CI). RESULTS: Of the 3676 infants enrolled, 52.4% were not born in hospital and 71 (2.1%) were confirmed to have SNHL. Fourteen (6.0%) of the 234 infants with NNJ had SNHL. Bilateral hearing loss was moderate (41-70 dB) in three (21.4%), severe (71-90 dB) in eight (57.1%) and profound (>90 dB) in two (14.3%) infants. One infant (7.1%) had unilateral SNHL. Six (42.9%) of the infants with SNHL had a profile suggestive of auditory neuropathy/dyssynchrony. Christianity (OR 0.15, CI 0.03-0.93), multiparity (OR 7.33, CI 1.17-45.99), low social class (OR 6.04, CI 1.33-27.48), infant's age (OR 10.17, CI 1.91-54.05), multiple gestations (OR 10.55, CI 1.98-56.11) and exchange blood transfusion (OR 7.74, CI 1.66-36.2) were predictive of SNHL. This model has a sensitivity of 85.7%, a specificity of 83.6%, a negative predictive value of 98.9% but a positive predictive value of only 25.0% for identifying SNHL among infants with severe NNJ. CONCLUSIONS: SNHL is prevalent among infants with NNJ and community-orientated early detection to curtail the associated long-term developmental consequences is feasible in resource-poor settings where facilities for clinical monitoring are limited. Hearing evaluation of infants treated for severe NNJ should be incorporated into the management and follow-up of these patients.

Universal infant hearing screening programme in a community with predominant non-hospital births: a three-year experience.

BACKGROUND: To evaluate three-year outcomes of a pilot community-based universal newborn/infant hearing screening programme (UNHS) and the associated factors in a low-income country where a high proportion of births occur outside hospitals. METHODS: A two-stage screening programme consisting of a first-stage transient evoked otoacoustic emissions and a second-stage automated auditory brainstem-response test was implemented in an inner-city community in Lagos, Nigeria from 2005 to 2008. Programme performance was measured by screening coverage, first-stage referral rate and second-stage screening results. The impact of infant's age-at-screening on otoacoustic emissions referral was assessed with survival analysis, while maternal/infant factors associated with screening results were explored by multinomial logistic regression analysis. RESULTS: About 96.7% (7175) of eligible infants were screened, 51.7% of whom were born outside hospitals. Overall referral rate after second-stage screening was 1.8%. Cumulative proportion of otoacoustic emissions failures was significantly higher (p = 0.045) among infants born outside hospital compared to those born in hospitals. Low social class, screening after one month of age, multiple gestation and severe neonatal jaundice were predictive of screen failure, while multiparity, screening after one month of age and severe jaundice were independently associated with programme drop-out. CONCLUSIONS: Community-based UNHS facilitates early detection of infants at risk of sensorineural hearing loss born outside hospitals and the overall performance is comparable to conventional hospital-based UNHS. Maternal education at antenatal clinics may be valuable in addressing the associated risk factors.

Traumatic perforation of the tympanic membrane in University of Port Harcourt Teaching Hospital, Port Harcourt. Nigeria.

OBJECTIVE: To evaluate the causes, clinical features and treatment of traumatic tympanic membrane perforation in University of Port Harcourt Teaching Hospital. PATIENTS AND METHODS: Patients with traumatic perforation of the tympanic membrane from August 2003 to February 2005 were evaluated clinically to determine the cause and the site of perforation. They had pure tone audiometry done. Treated by non- surgical means and followed up. RESULTS: Fifty- eight (8.6%) patients with traumatic perforation were seen among 676 patients with aural diseases. Average age was 27.56 years. Causes of traumatic perforation were, fights with spouse 27.6%, street fights 19%, instrumentation 17.2% and state security agents 15.5%. Hearing loss 94.8%, tinnitus 84.5% and otalgia 67.2% were common complaints. 63.8% had perforation in the lower half of pars tensa. 42.4% had mild conductive hearing impairment. 29.3% healed within 3 weeks. CONCLUSION: Physical blow to the ear was the commonest cause of tympanic perforation.

Ophthalmological complications of nasal, paranasal sinus diseases and head and neck tumours.

BACKGROUND: The proximity of the eye to the nose, paranasal sinuses and skull base makes it vulnerable to be involved in the diseases of this area. OBJECTIVE: To document the presenting diagnosis and ophthalmologic complications of nasal, paranasal sinus diseases and head/neck and skull base tumours. DESIGN: A prospective descriptive study. SETTING: Ophthalmology and otolaryngology units at Lagos University Teaching Hospital, Nigeria. SUBJECTS: Two hundred and twenty nine patients were reviewed between July 2003 and July 2005. RESULTS: Out of a total study population of two hundred and twenty nine patients, 88.2% patients presented primarily in the Otolaryngology unit. Otolaryngological diagnosis were as follows, sinusitis 170 (74.2%), nasal polyposis 27 (11.8%), nasopharyngeal carcinoma 23 (10%) and others were maxillary carcinoma six (2.3%), nasoethmoidal carcinoma two (0.9%) and frontoethmoidal mucocoele 0.4%. Ear, Nose and Throat (E.N.T) related ophthalmological complications was seen in 18 (7.9%) which included proptosis, proptosis /restrictive myopathy, visual loss, and enophthalmos while 39.3% had non ear, nose and throat related ophthalmological diseases. CONCLUSION: Ophthalmological complications of paranasal sinus diseases and head/neck tumours is still a significant health problem. Sinusitis though increasing in prevalence has resulted in less ophthalmological complications partly due to predominant allergic type with less complications and also to the availability and access to antibiotics and anti allergic drugs.

Adult onset otitis media with effusion in Lagos.

BACKGROUND/AIM: The documented reports on adult onset OME is scanty world wide, this study was prompted by the increasing trend of OME in our adult patients with the aim of determining the prevalence, predisposing factors and treatment outcome of the disease. PATIENTS AND METHODS: A prospective study was carried out over a two year period at the Otolaryngology Clinic of Lagos University Teaching Hospital Lagos Nigeria, on 195 patients referred to the clinic with provisional diagnosis of OME. The patients had clinical evaluation, pure tone audiometry, tympanometry while a few had fibre optic nasopharyngoscopy and biopsy done. RESULTS: A hospital based prevalence of 2.6% was recorded in the Otolaryngology clinic during the study period, with infective and allergic sinusitis as the major predisposing factors to OME in adult patients. Majority 58 (92.06%) patients were treated conservatively and recurrence was seen in 8 (12.7%) of the patients without any untoward effects. OME, though recognised as a childhood disease may be as prevalent in adult as in childhood but with less complication. CONCLUSION: OME as a single clinical feature or in association with allergy or sinusitis is most unlikely to habour NPC therefore nasopharyngoscopy and biopsy are likely to give a low yield of positive biopsy in isolated OME in adult and the cost implication of this must be borne in mind.

Malignant tumours of the nasopharynx at Jos University Teaching Hospital, Nigeria.

A retrospective epidemiological study of 55 patients who had been histologically diagnosed as having nasopharyngeal malignancy was undertaken at the Jos University Teaching Hospital in the period from December 1988 to November 1998. Jos is at the heart of the middle belt of Nigeria and is made up of peoples of various tribes and religions. The aim of this study was to evaluate the epidemiological factors, clinical presentation, histological pattern and treatment outcome in the patients during the study period. Fewer females were affected than males with a ratio of 1:1.6. Age range was 35-82 years with an average age of 42.19 years. Most of the well documented predisposing factors were absent in this series and the role of smoking and alcohol is unclear. Squamous cell carcinoma (72.7%) was the commonest epithelial malignancy with the incidence of the well differentiated type (WHO type 1) being as high as 34.5%. Rhabdomyosarcoma (14.8%) was the commonest sarcoma. Neck swelling 70.9%, Nasal stuffiness 41.8%, epistaxis 34.5% and pharyngeal mass 25.5% were the commonest symptoms. Treatment and follow-up were unsatisfactory as patients could not afford the cost of radiotherapy and anti-cancer drugs.