Otosclerosis among South African indigenous blacks.

OBJECTIVE: To report cases of clinical otosclerosis histologically confirmed among indigenous South African blacks. DESIGN: A retrospective study. SETTING: Referral tertiary center, MEDUNSA, Garankuwa Hospital, South Africa. SUBJECTS: All fifteen indigenous South African blacks diagnosed with clinical otosclerosis at Garankuwa Hospital between January 1993 and January 2003 in the Ear, Nose and Throat Department. INTERVENTIONS: A retrospective study of the records of all patients seen at the Ear, Nose and Throat (ENT)outpatient clinic of GaRankuwa Hospital between January 1993 and January 2003 was undertaken. In addition, data was obtained from operating theatre records and histology reports. The files of these patients with a diagnosis of otosclerosis were reviewed for details on demographics, symptoms, audiometric test results, radiology, surgical and pathology reports. All of these patients were included in the study. RESULTS: From a weekly outpatient attendance of about 300 patients over a ten-year period, a total number of fifteen patients were identified with a definite diagnosis of clinical otosclerosis. Nine of them were confirmed surgically and histologically as having otosclerosis. These nine cases consisted of five females and four males, the mean age for females was thirty-five years and for males forty-seven years. They all presented with a progressive painless hearing loss with no ear discharge or previous surgery with negative family history. Audiometry confirmed a mixed hearing loss with a Carrhart notch at 2kHz typical for otosclerosis and all had normal tympanic membrane. All of these patients had a unilateral stapedectomy done. Schucknet wire prosthesis was used for surgical reconstruction. The outcome of surgery in all of these patients was satisfactory. The other six patients are still awaiting surgery. CONCLUSION: This study confirms the existence of otosclerosis among indigenous South African blacks. Otosclerosis should be included in the differentials of a conductive hearing loss in blacks.

A bedside system for clinical grading of parotid gland enlargement.

There are limited data on grading of parotid gland mass, and currently no bedside clinical grading system is available. Parotid enlargement is common in patients with HIV/AIDS, and the size of the gland can change depending on the progression of disease, with or without treatment. This needs to be recorded accurately and communicated properly. A novel system for bedside clinical grading of parotid gland enlargement using a soft tape measure is proposed.

Otolaryngological, head and neck manifestations in HIV-infected patients seen at Steve Biko Academic Hospital in Pretoria, South Africa.

BACKGROUND: Sub-Saharan Africa has the highest incidence of HIV infection. According to recent census statistics, 5.6 million people in South Africa (SA) are HIV-positive, the highest number of infected individuals worldwide. Over 80% of HIV-infected individuals will present with ear, nose and throat (ENT) manifestations. Previous studies show that oral diseases seem to be the most common ENT-related manifestation, reported in about 40 - 50% of HIV-infected patients. In SA, there is lack of local information regarding the otolaryngological and head and neck manifestations in HIV-infected individuals. OBJECTIVE: To ascertain our local trends of ENT and head and neck manifestations in HIV-infected patients seen at our specialised ENT-HIV Clinic, Steve Biko Academic Hospital, Pretoria, Gauteng Province, SA. METHODS: A 1-year prospective study involving 153 HIV-infected patients was conducted in the clinic from January to December 2011. Patient history was taken and examinations were performed based on the World Health Organization (WHO) HIV/AIDS classification system. Data analysis was performed using Epi Info 7 software. RESULTS: The most common manifestations were adenoid hypertrophy/hyperplasia followed by cervical lymphadenopathy, chronic suppurative otitis media, otitis media with effusion and sensory-neural hearing loss. CONCLUSION: Patients typically presented with early manifestations during symptomatic WHO stages I and II in contrast to results reported in similar developing world studies from Iran, Nigeria and India. A possible explanation may lie in the SA government HIV Counselling and Testing campaign and the antiretroviral rollout programme, the effectiveness of which is becoming evident.

Otosclerosis and TGF-beta 1 gene in black South Africans.

Limited literature is available on the epidemiology and genetics of otosclerosis in South African blacks, among whom it is extremely rare. We undertook this study because we had documented and surgically confirmed cases of clinical oval window otosclerosis in this population.

Resolution of nodular myocardial tuberculosis demonstrated by contrast-enhanced magnetic resonance imaging.

In sub-Saharan Africa, pericardial tuberculosis is frequently diagnosed in HIV sero-positive patients. Myocardial involvement has only rarely been reported. We present an HIV sero-positive patient in whom both pericardial and myocardial tuberculosis were diagnosed, and highlight the value of cardiac magnetic resonance imaging in the diagnosis and management of this condition.

Tuberculous effusive-constrictive pericarditis.

Infection with Mycobacterium tuberculosis and the human immunodeficiency virus has reached epidemic proportions in South Africa. Cardiac involvement occurs in approximately one per cent of patients suffering from active tuberculosis. This concerns predominantly pericardial involvement, resulting in chronic pericardial effusions, cardiac tamponade and constrictive pericarditis. Effusive-constrictive pericarditis is a clinical haemodynamic syndrome in which constriction by the visceral pericardium occurs in the presence of a tense effusion in a free pericardial space. We present a patient who was diagnosed with this condition, and highlight the value of contrast-enhanced magnetic resonance imaging in demonstrating the underlying structural and functional abnormalities.

Complications of inflammatory sinusitis in children: institutional review

Background: Complications of acute inflammatory sinusitis into orbital and intracranial sepsis is a common problem in paediatrics. A delay in making a diagnosis and early appropriate treatment has a high morbidity and mortality rate.The commonest presenting symptoms are throbbing headache and facial or periorbital swelling usually fallowing a two week history of upper respiratory tract infection. A high resolution Computed Tomography(CT) scan is very helpful in making a proper and accurate diagnosis. Appropiate early medical and surgical treatment has a good outcome.We are reporting our epidemiological study of complicated sinusitis of 59 cases treated at Dr George Mukhari Hospital; ENT Department a Tertiary referral centre; Medunsa Campus;University of Limpopo; RSA.Methods: A prospective case series of all patients admitted with complicate inflammatory confirmed on CT scan betweenApril 2004 to August 2005(Winter months).An interview data collection sheet was used to collect all clinical information.ResultsFifty-nine (59) inpatients (50 males and 9 females) admitted and treated at DGMH for complicated pan-sinusitis.The mean age of the patients was 13 years; with a male:female ratio of 7:1. All patients presented with a sporadic first episode of sinusitis; occurring within two weeks of upper airway infection. The affected age group was mainly paediatric of peripubertal age. In almost all the patients; headache and facial (peri-orbital) swelling were the main presenting symptoms. Most patients (85) were initially referred to other departments 59.3(35) to Ophthalmology; 18.6(11) to Neurosurgery; 6.7(4) to Paediatrics and only 15.2(9) directly to ENT (Otorhinolaryngology). Of these patients; 36 (61) had intracranial complications confirmed on CT scan and were managed in consultation with the neurosurgeons and ophthalmologists. No major surgical complications were reported. Staphylococcus species were the most common organisms isolated; however; 50of the pus swabs had a negative culture. Medical treatment based on culture and sensitivity; together with surgical drainage; achieved good results. Three females with severe complications died during the period of the study; but there were no male deaths reported in this study; even though more males than females were affected.ConclusionComplications of septic sinusitis are a common problem in the paediatrics; with males more commonly affected than females. Females; however; had a poorer prognosis than males in this study. Complicated sinusitis should be suspected in any adolescent with orbital; facial or frontal swelling associated with headache always during the winter (cold) months. To prevent morbidity and mortality; a high resolution contrasted CT scan is mandatory for the exclusion of complicated sinusitis; medical and surgical treatments are effective management of complicated sinusitis

Complications of Inflammatory Sinusitis in Children: Institutional Review

Background: Complications of acute inflammatory sinusitis into orbital and intracranial sepsis is a common problem in paediatrics. A delay in making a diagnosis and early appropriate treatment has a high morbidity and mortality rate. The commonest presenting symptoms are throbbing headache and facial or periorbital swelling usually fallowing a two week history of upper respiratory tract infection. A high resolution Computed Tomography(CT) scan is very helpful in making a proper and accurate diagnosis. Appropiate early medical and surgical treatment has a good outcome. We are reporting our epidemiological study of complicated sinusitis of 59 cases treated at Dr George Mukhari Hospital; ENT Department a Tertiary referral centre; Medunsa Campus; University of Limpopo; RSA.Methods: A prospective case series of all patients admitted with complicate inflammatory confirmed on CT scan between April 2004 to August 2005 (Winter months). An interview data collection sheet was used to collect all clinical informationResults: Fifty-nine (59) inpatients (50 males and 9 females) admitted and treated at DGMH for complicated pan-sinusitis. The mean age of the patients was 13 years; with a male:female ratio of 7:1. All patients presented with a sporadic first episode of sinusitis; occurring within two weeks of upper airway infection. The affected age group was mainly paediatric of peripubertal age. In almost all the patients; headache and facial (peri-orbital) swelling were the main presenting symptoms. Most patients (85) were initially referred to other departments 59.3 (35) to Ophthalmology; 18.6 (11) to Neurosurgery; 6.7 (4) to Paediatrics and only 15.2 (9) directly to ENT (Otorhinolaryngology). Of these patients; 36 (61) had intracranial complications confirmed on CT scan and were managed in consultation with the neurosurgeons and ophthalmologists. No major surgical complications were reported. Staphylococcus species were the most common organisms isolated; however; 50 of the pus swabs had a negative culture. Medical treatment based on culture and sensitivity; together with surgical drainage; achieved good results. Three females with severe complications died during the period of the study; but there were no male deaths reported in this study; even though more males than females were affected.Conclusions: Complications of septic sinusitis are a common problem in the paediatrics; with males more commonly affected than females. Females; however; had a poorer prognosis than males in this study. Complicated sinusitis should be suspected in any adolescent with orbital; facial or frontal swelling associated with headache always during the winter (cold) months. To prevent morbidity and mortality; a high resolution contrasted CT scan is mandatory for the exclusion of complicated sinusitis;medical and surgical treatments are effective management of complicated sinusitis