Foreign bodies in the aerodigestive tract: time for comprehensive preventive measures.

Background: Foreign body (FB) in the aerodigestive tract presents more commonly in children and remains a surgical emergency with potential for fatal complications. Objectives: To describe management and outcomes of aerodigestive FB managed at University of Ilorin Teaching Hospital (UITH) and proffer preventive measures. Methods: A 9-year retrospective review of all patients with foreign body in the aerodigestive tract managed between March 2011 and July 2020. Results: Sixty-six patients were studied. Median age was 9years with M:F ratio =1.6:1. FB was ingested in 38(57.6%) patients, aspiration occurred in 28(42.4%). Denture was most common FB 20(30.3%); plastic whistle/valve placed in dolls or football accounted for 4(6.1%). When ingested, FB was impacted in cervical 17(44.7%), upper thoracic 10(26.3%) and middle thoracic 2(5.3%) oesophagus. Oesophagoscopy was used in 30(8.9%) for retrieval. When aspirated, FB was located in the right bronchus 10(35.7%), left bronchus 7(25.0%), hypopharynx and trachea 2(7.1%) each, and cricopharynx 1(3.5%); no FB was found in 3(10.7%) patients. Direct Laryngoscopy was the method of retrieval in 3(10.1%) patients while others had rigid bronchoscopy. Mortality rate was 1.5%. Conclusion: Children are most vulnerable group. Preventive effort should include public health education and close monitoring of children by parents and care givers during play.

The role of informed consent in risks recall in otorhinolaryngology surgeries: verbal (nonintervention) vs written (intervention) summaries of risks.

BACKGROUND: Informed consent is a phrase often used in the law to indicate that the consent a person gives meets certain minimum standards. It relies on patients' ability to understand risk information. Evidence suggests that people may extract the gist of any risk information to make medical decisions. Existing evidence also suggests that there is an inverse relationship between the perception of risk and the perception of benefit. Informed consent is the method by which fully informed, rational persons may be involved in choices about their health care. AIM: The aims of this study were to study how much patients remember of the risks discussed with them about their otolaryngologic surgery and to evaluate whether a simple intervention, the addition of an information handout, improves their recall. METHODS: This was a prospective study carried out between January and December 2009 in the Department of Otorhinolaryngology, University of Ilorin teaching hospital. Fifty patients undergoing a variety of otorhinolaryngologic procedures, including mastoidectomy, tympanoplasty, nasal polypectomy, rhinotomy, maxillectomy, and laryngoscopy, were verbally consented by the operating surgeon with a standard checklist of potential surgical complications and adverse effects. Three surgeons participated in the study. Patients were stratified into 2 groups: a higher education group and a lower education group. Within each group, patients were randomized to either a control group, consisting of a verbal explanation only, or an intervention group, which added a written handout to the verbal explanation. A follow-up telephone interview was conducted at an average of 20.6 days (range, 14-53 days) to survey for recall of the complications discussed. The main outcome measure is risk recall. This was analyzed by education level and written sheet intervention. Other parameters examined were patient demographics and time elapsed from when the consent was obtained. RESULTS: Of the 50 patients involved in the study, 30 were men and 20 were women, with male/female ratio of 1.5:1.0. The average age was 43 years (range, 16-76 years). With respect to educational status, 26 patients had the equivalent of high school or less (group 1), and 24 had some degree of postsecondary training (group 2). Overall recall of potential complications was 56%. Those who received the handout recalled 67% of the complications overall, whereas those who did not receive the handout remembered 51% of the complications. The difference was significant recall of the specific risks varied considerably. For those with potential risk of facial nerve paralysis, 88% of them recalled, which was the highest in the study. This was followed by hearing loss (85%) and nasal adhesion (23%). The least were anesthetic reactions (4%) and hoarseness (2%). Those who received the handout recalled 62% of the complications overall, whereas those who did not receive the handout remembered 51% the complications. CONCLUSION: The addition of a handout significantly alters recall of potential complications of otorhinolaryngologic surgery with the recall of specific risk highest for facial nerve paralysis.

Clinical evaluation and nasoendoscopic scores of patients with chronic rhinosinusitis in Ilorin, Nigeria.

INTRODUCTION: chronic rhinosinusitis (CRS) is characterised by inflammation of the mucosal lining of the nose and paranasal sinuses for at least 12 weeks duration. Other than the diagnostic criteria that is based on clinical features; nasoendoscopy and/or computerized tomographic scan have been included in the diagnosis. This study seeks to outline the clinical evaluation and nasoendoscopic assessment of CRS patients. METHODS: a hospital-based analytical study carried out on 154 participants. Clinical assessment and nasoendoscopy were performed and scored according to the discharge, inflammation and polyps/oedema (DIP) scale. Statistical analysis was carried out and results were presented in charts and tables. RESULTS: of the 154 participants, 71 (46.1%) were males and 83 (53.9%) females with a male to female ratio of 1: 1.7. Nasal discharge and blockage were the commonest symptoms. Nasoendoscopy had higher yield in the examination of intranasal polyps (NPs) over anterior rhinoscopy. The prevalence of NPs was 26.6%. The result of DIP nasoendoscopic findings revealed more participants with moderate scores. There was a significant statistical difference between the presence of NPs on nasoendoscopy and DIP score. CONCLUSION: nasoendoscopy is an important aspect in the diagnosis and evaluation of patients with CRS. It provides a better visualization of NPs; therefore, it should be made routine in the clinical assessment and treatment of patients with CRS. The nasal endoscopic scoring of CRS should be considered as a common practice in clinical setting as well.

Management and Outcome of Rhinosinusitis in Nigeria.

OBJECTIVE: The aim of this study is to present the management and outcome of treatment of rhinosinusitis in Nigeria. STUDY DESIGN: A retrospective review of the case notes of patients with rhinosinusitis between January 2009 and December 2014. SETTING: Study at the University of Ilorin Teaching Hospital, Nigeria, using retrieved case notes after ethical approval was received. SUBJECTS AND METHODS: The information retrieved included sociodemographic data, clinical presentation, duration, endoscopic examination, and other clinical management protocols with follow-up. All information was entered into SPSS version 20 and analyzed descriptively, and results are presented in tables and figure. RESULTS: A total of 5618 patients were seen in the ear, nose, and throat clinic over the 6-year period. Of the patients, 445 had rhinosinusitis, and only 410 had complete data for analysis. Patient age ranged from 2 to 75 years (mean ± SD, 31.8 ± 1.2 years). The male to female ratio was 1.2:1. The duration of symptoms varied from 3 days to 10 years, with 78.7% having symptoms between 3 and 120 months. About 82.4% had nasal discharge, 51.3% had sneezing, 78.9% had alternating nasal obstruction, and 49.3% had nasal itch. Of the patients, 61.4% had a predisposition, of which 30.9% were allergic, 23.3% were infective, and 7.2% were vasomotor. Ethmoidal-maxillary sinuses were commonly affected radiologically. About 63% of patients had medical treatment, and only 28.7% had surgical intervention, of which 37% were scheduled for surgical treatment and 7.3% refused. Improved symptoms were noticed in 72.6% of patients, and 1.4% reported no improvement. CONCLUSION: Rhinosinusitis is still common, affecting active males economically with more chronic cases and more allergic predisposition. Early medical management is still effective, and endoscopic sinus surgery is now a better surgical option with better outcome in 72.6%.

Ear diseases in elderly hospital patients in Nigeria.

BACKGROUND: Little information is available about the pattern of ear diseases in the elderly population. Therefore, the present study aims to determine the pattern of ear diseases among elderly Nigerians, so as to provide an objective basis for cost-effective health care planning for the emerging geriatric population. METHODS: A retrospective study of 320 patients aged 60 years or older presenting with ear diseases at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between January 1996 and December 2001 was carried out. RESULTS: Impacted cerumen was the most common ear disease, occurring in 110 (34.4%) patients of the study population. Chronic suppurative otitis media (CSOM) was the most common infectious disease, affecting 28 (8.8%) patients. Of the 88 patients with hearing loss, 63 (71.6%) had sensorineural, 20 (22.7%) had presbycusis, 1 (1.1%) had conductive, and 4 (4.6%) had mixed hearing loss. CONCLUSION: Our data suggest that impacted cerumen, hearing loss, and infections (notably CSOM), are the common ear diseases among elderly Nigerians.

Intra-antral application of an anti-fungal agent for recurrent maxillary fungal rhinosinusitis: a case report.

INTRODUCTION: Fungal infection of the paranasal sinuses is an increasingly recognized entity both in immunocompetent and immunocompromised individuals. Treatment has been via use of either surgical or medical modalities, or a combination of the two. Here, we present a case of utilization of intra-antral application of an anti-fungal agent in the management of recurrent fungal sinusitis in an indigent Nigerian patient. CASE PRESENTATION: We present the case of a 30-year-old West African Yoruba man, an indigent Nigerian clergyman, who presented to our facility with a history of recurrent nasal discharge (about one year), recurrent nasal blockage (about five months), and right facial swelling (about one week). After intra-nasal antrostomy for debulking with a systemic anti-fungal agent, our patient had a recurrence after four months. Our patient subsequently had an intra-antral application of flumetasone and clioquinol (Locacorten®-Vioform®) weekly for six weeks with improvement of symptoms and no recurrence after six months of follow-up. CONCLUSIONS: We conclude that topical intra-antral application of anti-fungal agents is effective in patients with recurrent fungal maxillary sinusitis after surgical debulking.