Protocol for a comparative cross-sectional study on characterisation of auditory impairment in sickle cell disease and sickle cell trait and its impact on health-related quality of life in Nigeria.

INTRODUCTION: Sickle cell disease (SCD) and sickle cell traits (SCT) are genetically inherited red blood cell disorders common among people of African descent. Nigeria has a high prevalence of SCD, with a prevalence of 2.28%-3% and SCT, 25%-30%. Poorly managed SCD and SCT can lead to sensorineural hearing loss and health-related quality of life (HRQoL) issues. This research aims to assess these possible complications of SCD and SCT in Nigeria. METHODS AND ANALYSIS: The study will use a comparative cross-sectional design at study power 80% to investigate the association between SCD/SCT, hearing impairment and HRQoL. Participants will be divided into two groups: a cohort and a control group. Hearing levels will be assessed through audiometric assessments and categorised by type and severity of hearing impairments using WHO classifications. HRQoL will also be assessed using WHO Disability Assessment Schedule 2.0. Statistical analyses will be performed using the SAS V.9.4, with parametric or non-parametric analysis depending on the distribution. Relationship between key variables will be determined via correlational tests, χ2, Fisher's exact test and multivariable logistic regression analyses. ETHICS AND DISSEMINATION: The proposal has been fully reviewed and registered by the University of Cape Town's Faculty of Health Sciences Human Research Ethics Committee (HREC REF 228/2022) and the University of Abuja Teaching Hospital Human Research Ethics Committee (HREC/PR/2020/08/007). Information dissemination will be through conferences, peer-review publication and personal communications. The Strengthening the Reporting of Observational Studies in Epidemiology statement will be followed in writing the manuscript.

The Global Otolaryngology-Head and Neck Surgery Workforce.

Importance: A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective: To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories. Design, Setting, and Participants: A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main Outcome: The OHNS workforce per capita, stratified by income and region. Results: Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and Relevance: This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.

ENT Outreach in Africa: Rules of Engagement.

To address inequality of access to ear, nose, and throat (ENT) care, there must be significant and sustained investment in education and training of surgeons, audiologists, speech therapists, clinical officers, anesthetists, and specialized nurses engaged in ENT in sub-Saharan Africa and other developing nations. Outreach by ENT surgeons from developed countries is essential if we are to address the critical lack of access to ENT care in SSA. However, it should be based on mutual respect, shared values, aspirations, a desire to create a durable and sustainable impact, and internationally accepted best practice. In this article, we propose rules of engagement for outreach projects in SSA and other developing countries to optimize their contributions by making them useful, sustainable, productive, and developmental. These proposed rules of engagement are based on our personal experiences and observations-good and bad-of outreach activities in our countries.

The post-Ebola virus disease scourge in Nigeria: Individual levels of preparedness among physicians in the Federal Capital Territory Abuja.

BACKGROUND: Ebola virus disease (EVD) is a viral hemorrhagic illness with great propensity for spread across international borders. The latest outbreak in the West African region, which involved Nigeria, was the worst among previously documented 25 outbreaks since discovery in 1976. The Nigerian response toward attaining Ebola free status was phenomenal and a case study for most nations. However, the persistence of EVD in West Africa is still a risk to recurrence, hence, the need to assess the level of consciousness of Nigerian physicians towards this. METHODOLOGY: A cross-sectional study utilizing the instrument of a pretested semi-structured questionnaire was conducted among physicians practicing within the federal capital city of Nigeria. General knowledge, treatment, prevention, and reporting of EVD were assessed and appropriate statistical analyses done using SPSS 20. RESULTS: Of the 101 respondents, 45% and 87% showed excellent level (>80% score) of "general knowledge" and "reporting" on EVD, respectively. However, only 51% respondents had good (60-80%) knowledge on EVD treatment. Three percent correctly identified the "EVD helpline" phone-numbers for reporting suspected cases. Furthermore, 43.6% admitted the availability of personal protective equipment (PPE) in their hospitals while 35.6% had witnessed a demonstration of the use. The distribution of the PPEs appeared skewed - 74.4% (teaching-hospitals), 16% (private-hospitals), and the primary health care centers (9.6%). CONCLUSION: A majority of the physicians showed good level of preparedness as it relates to general knowledge on EVD, knowledge on good clinical practice, use of protocols and standard precautions and PPE. The identification of deficits in knowledge on treatment of EVD and flow path for the notification of suspected cases requires urgent redress given the risk of re-occurrence in the country.

Evaluation of mobile smartphones app as a screening tool for environmental noise monitoring.

Noise is a global occupational and environmental health hazard with considerable social and physiological impact and, therefore, there is a need for regular measurements to boost monitoring and regulations of environmental noise levels in our communities. This necessitates a readily available, inexpensive, and easy to use noise measuring device. We aimed to test the sensitivity and validity of mobile "smart" phones for this purpose. This was a comparative analysis of a cross sectional study done between January 2014 and February 2015. Noise levels were measured simultaneously at different locations within Abuja Nigeria at day and night hours in real time environments. A sound level meter (SLM) (Extech407730 Digital Soundmeter, serial no.: 2310135, calibration no: 91037) and three smartphones (Samsung Galaxy note3, Nokia S, and Techno Phantom Z running on Android "Apps" Androidboy1) were used. Statistical calculations were done with Pearson correlation, T-test and Consistency within American National Standards Institute acceptable standard errors. Noise level readings for both daytime and night with the SLM and the mobile phones showed equivalent values. All noise level meters measured were <100dB. The daytime readings were nearly identical in six locations and the maximum difference in values between the SLM and Smartphone instruments was 3db, noted in two locations. Readings in dBA showed strong correlation (r = 0.9) within acceptable error limits for Type 2 SLM devices and no significant difference in the values (p = 0.12 & 0.58) for both day and night. Sensitivity of the instrument yielded 92.9%. The androidboy1 "app" performance in this study showed a good correlation and comparative high sensitivity to the Standard SLM (type 2 SLM device). However there is the need for further studies.

GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa.

HYPOTHESIS: Cochlear implantation and deaf education are cost effective in Sub-Saharan Africa. BACKGROUND: Cost effectiveness of pediatric cochlear implantation has been well established in developed countries but is unknown in low resource settings, where access to the technology has traditionally been limited. With incidence of severe-to-profound congenital sensorineural hearing loss 5 to 6 times higher in low/middle-income countries than the United States and Europe, developing cost-effective management strategies in these settings is critical. METHODS: Costs were obtained from experts in Nigeria, South Africa, Kenya, Rwanda, Uganda, and Malawi using known costs and published data, with estimation when necessary. A disability adjusted life years (DALY) model was applied using 3% discounting and 10-year length of analysis. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the WHO standard of cost-effectiveness ratio/gross domestic product per capita (CER/GDP) less than 3. RESULTS: Cochlear implantation was cost effective in South Africa and Nigeria, with CER/GDP of 1.03 and 2.05, respectively. Deaf education was cost effective in all countries investigated, with CER/GDP ranging from 0.55 to 1.56. The most influential factor in the sensitivity analysis was device cost, with the cost-effective threshold reached in all countries using discounted device costs that varied directly with GDP. CONCLUSION: Cochlear implantation and deaf education are equally cost effective in lower-middle and upper-middle income economies of Nigeria and South Africa. Device cost may have greater impact in the emerging economies of Kenya, Uganda, Rwanda, and Malawi.

A meta-analysis and systematic review of the prevalence of mitochondrially encoded 12S RNA in the general population: Is there a role for screening neonates requiring aminoglycosides?

BACKGROUND: This was a meta-analysis and systematic review to determine the global prevalence of the mitochondrially encoded 12S RNA (MT-RNR1) genetic mutation in order to assess the need for neonatal screening prior to aminoglycoside therapy. MATERIALS AND METHODS: A comprehensive search of MEDLINE, EMBASE, Ovid, Database of Abstracts of Reviews of Effect, Cochrane Library, Clinical Evidence and Cochrane Central Register of Trials was performed including cross-referencing independently by 2 assessors. Selections were restricted to human studies in English. Meta-analysis was done with MetaXL 2013. RESULTS: Forty-five papers out of 295 met the criteria. Pooled prevalence in the general population for MT-RNR1 gene mutations (A1555G, C1494T, A7445G) was 2% (1-4%) at 99%. CONCLUSION: Routine screening for MT-RNR1 mutations in the general population prior to treatment with aminoglycosides appear desirable but poorly supported by the weak level of evidence available in the literature. Routine screening in high-risk (Chinese and Spanish) populations appear justified.

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-five patients who had the procedures were presented in . 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 post-tonsillar 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 benefit from VHCD. We hereby recommend this simple, cost-effective 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.

Clinical evaluation of posterior canal benign paroxysmal positional vertigo.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a mechanical peripheral vestibular disorder which may involve any of the three semicircular canals but principally the posterior. In as much as the literature has described theories to explain the mechanism of BPPV and also contains scholarly works that elucidate BPPV; its management remains an enigma to most clinicians. To this end, this work was aimed at outlining an evidence-based best practice for most common form of BPPV. MATERIALS AND METHODS: A systematic review of the literature was conducted between 1948 and June 2011 in PubMed, Embase, Ovid, and Cochrane database through the online Library of the University of Cape Town. Seventy-nine worthy articles that addressed the study were selected on consensus of the two authors. CONCLUSION: There is consensus for the use of canalith repositioning procedures as the best form of treatment for posterior canal canalolithiasis. However, successful treatment is dependent on accurate identification of the implicated canal and the form of lithiasis. Furthermore, clinicians should note that there is no place for pharmacological treatment of BPPV; unless it is to facilitate repositioning.

Cochleo-vestibular clinical findings among drug resistant Tuberculosis Patients on therapy-a pilot study.

BACKGROUND: To investigate the Cochleo-vestibular clinical and audiometric findings in Multi and Extreme Drug Resistance(MDR and XDR) tuberculosis(TB) patients on treatment and make recommendations. METHODS: A cross-sectional study of adult MDR and XDR-TB patients was conducted in a general hospital in Cape-Town-South-Africa. Ethical approval was secured and all consenting patients administered with pretested and validated questionnaire under the guidance of International Classification of Functioning, Disability and Health(ICF) Checklist-version-2.1a. Audiometric evaluation included: Otoscopy, Diagnostic Audiometry and Tympanometry. The data analyses were done with SPSS version 16, Chi-square and StatCalc-7. RESULTS: Fifty-three adults, ages 18-60 (mean-33 years) comprising 26 males and 27 females participated in the study. Hospital stay duration varied from 1-18 months (mean-6 months) and all were on anti-Koch's second line drugs (regimen 2). MDR TB group were 45(85%) and XDR 8(15%). Vertigo was the most common vestibular symptoms, 24(45%) whereas, tinnitus 23(42%) and hearing loss 13(25%) were most frequent auditory complaints. Bilateral sensorineural hearing losses of varying degrees were confirmed in 23(47%).There was no association between gender and age with hearing loss [χ2 (P = 0.16, ά = 0.05) and (p = 0.13, ά = 0.05)]. Furthermore, MDR and XTR TB groups [20/42 Vs 3/8; Z = 0.46 and P = 0.64], showed no difference in pattern of the hearing losses. CONCLUSIONS: A multi-disciplinary close surveillance of MDR and XDR TB patients on therapy is imperative. Finally, researches into therapeutic trials on antidotes and potent safer substitutes for aminoglycosides in the management are recommended.

The sensitivity and specificity of Lassa virus IgM by ELISA as screening tool at early phase of Lassa fever infection.

BACKGROUND: Early diagnosis, prompt treatment, and disease containment are vital measures in the management of Lassa fever (LF), a lethal and contagious arenaviral hemorrhagic disease prevalent in West Africa. Lassa Virus (LAV)-specific Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test, the gold standard for diagnosis, is unavailable in most centers. Serologic detection of LAV IgM is a more accessible tool and this work was to investigate its adequacy as an early marker for LF. PATIENTS AND METHODS: A prospective case-control study conducted July 2007-March 2011 in a tertiary referral health center in Nigeria. Blood samples for test and control were evaluated for Lassa specific antigens and IgM using RT-PCR (primers S36+ and LVS 339) and indirect ELISA (Lassa Nucleo-protein (NP)-Antigen) respectively. RT-PCR outcome was used as standard to test for the sensitivity and specificity of IgM. RESULTS: Of the 37 confirmed cases of LF infection by RT-PCR, 21 (57%) were IgM positive. Amongst the 35 confirmed negative cases (control group), eight were IgM positive. The diagnostic sensitivity and specificity of the IgM assay were 57% and 77% respectively. The negative and positive predictive values of the IgM serological assay were 63% and 72%, respectively, while the efficiency of the test was 67%. CONCLUSION: The specificity and sensitivity of IgM as a screening tool for early detection of LF appear weak and, hence, the need for a reliable LF "rapid screening kit" since RT-PCR is unavailable in most centers. In the interim, "high clinical index of suspicion," irrespective of IgM status, requires urgent referral to confirmatory centers.

Neonatal hearing screening in Benin City.

OBJECTIVE: Congenital hearing loss is a major health care problem that tends to retard the developmental milestones of children. It takes early detection and intervention to avoid a permanent loss in acquisition of speech and cognitive functions. Hence, the importance of hearing screening in all newborns especially in the developing world for accurate statistics and early intervention. Therefore, this work was aimed at detecting the crude prevalence of congenital hearing loss among the newborns in Benin City. METHODOLOGY: Consecutive neonates at designated immunization centers in Benin City metropolis were screened for hearing loss via the detection and analysis of distortion product otoacoustic emissions from both ears. The handheld otoacoustic machine model MAICO 8172 was employed and the outcome results presented in tables. Statistical analysis was performed using SPSS 11. RESULTS: A total of 400 neonates (218 males and 182 females) were screened for the presence of otoacoustic emission in both ears. Ninety neonates (22.5%) p<0.05 were referred. Bilateral hearing loss was seen in 26 (6.5%) whereas 64 (16%) had unilateral loss. CONCLUSIONS: The screening tests suggest a high crude prevalence (6.5%) of bilateral neonatal hearing impairment in Benin City necessitating confirmation and intervention. The study fortifies the need for hearing screening among all new born in developing countries.

Correlating the site of tympanic membrane perforation with Hearing loss.

BACKGROUND: It is recognized that the size of tympanic membrane perforation is proportional to the magnitude of hearing loss, however, there is no clear consensus on the effect of the location (site) of the perforation on the hearing loss. Hence the study is set to investigate the relationship between the location of perforation on TM and hearing loss. METHODS: A cross-sectional prospective study of consecutive adult patients with perforated TM conducted in the ENT clinic of University College Hospital Ibadan between January 1st 2005 and July 31st 2006. Instruments used for data collection/processing include questionnaires, video and micro-otoscopy, Pure tone audiometer, image J and SPSS packages. RESULTS: Sixty-two patients (22-males, 40-females), aged 16-75 years (mean = 35.4 +/- 4) with 77 perforated ear drums were studied and 15(24.2%) had bilateral TM perforations, 21 (33.9%) right unilateral and 26(41.9%) left unilateral. The locations of the TM perforations were 60(77.9%) central, 6(9.6%) antero-inferior, 4(5.2%) postero-inferior, 4(5.2%) antero-superior and 3(3.9%) postero-superior respectively with sizes ranging from 1.51%-89.05%, and corresponding hearing levels 30 dB - 80 dB (59% conductive and 41% mixed). Fifty-nine percent had pure conductive hearing loss and the rest mixed. Hearing losses (dBHL) increased with the size of perforations (P = 0.01, r = 0.05). Correlation of location of perforations with magnitude of hearing loss in acute TM perorations was (P = 0.244, r = 0.273) and for chronic perforations (p = 0.047 & r = 0.31). CONCLUSION: The location of perforation on the tympanic membrane (TM) has no effect on the magnitude of hearing loss in acute TM perforations while it is significant in chronic ones.

Sensorineural hearing loss in Lassa fever: two case reports.

INTRODUCTION: Lassa fever is an acute arena viral haemorrhagic fever with varied neurological sequelae. Sensorineural hearing loss is one of the rare complications which occur usually during the convalescent stage of the infection. CASE PRESENTATION: The cases of two female patients aged 19 and 43 years old, respectively, with clinical features suggestive of Lassa fever and confirmed by immunoserological/Lassa-virus-specific reverse transcriptase polymerase chain reaction are presented. Both patients developed severe sensorineural hearing loss at acute phases of the infections. CONCLUSION: Sensorineural hearing loss from Lassa fever infections can occur in both acute and convalescent stages and is probably induced by an immune response.

Assessments of the size of tympanic membrane perforations: a comparison of clinical estimations with video-otoscopic calculations.

We conducted a study to determine how accurate various ENT specialists were in estimating the size of 100 tympanic membrane (TM) perforations with standard otoscopy. The specialists included, in descending order of rank, 2 Consultant Surgeons, 2 Senior Registrars, and 2 Registrars, all of whom had confirmed good vision. We compared their estimates, which were made independently and expressed as a percentage of the total area of the TM, with exact measurements calculated with computer-based video-otoscopy. We found that the video-otoscopic calculations were far superior to the estimates of the specialists, even the most experienced Consultants (p < 0.01). We recommend that video-otoscopy be used whenever possible.

Sinonasal paraganglioma: a case report.

OBJECTIVE: To highlight the importance of a high index of suspicion and meticulous evaluation of a patient with bleeding sinonasal mass in the diagnosis of sinonasal paraganglioma. METHOD: Case report of a 39-year-old female who presented with a bleeding lobulated left nasal mass necessitating multiple blood transfusions is presented. RESULT: Diagnostic investigations revealed that the patient was HIV-positive (ELISA and Western blot) and a tumour histology of paraganglioma. She had a CD4+ count of 487 cells/mm3. The urinary vanillylmandelic acid assay and echocardiography were normal. Subsequently, she had complete tumour excision through a medial maxillectomy and has remained without a recurrence 12 months after. CONCLUSION: To our knowledge, this is the first report in the world literature of sinonasal paraganglioma in a HIV-positive patient and the first reported case of sinonasal paraganglioma in Africa. It is, however, not clear from this report if the patient's HIV status preceded her development of the paraganglioma or not.

Migraine and Meniere's disease: two different phenomena with frequently observed concomitant occurrences.

BACKGROUND: Some variants of migraine could be indistinguishable from Meniere's disease, and this has prompted suggestions of possible association between the two disease entities. AIM AND OBJECTIVES: This study aims at determining the prevalence of migraine among Meniere's patients and a possible linkage between the two diseases in our environment. METHODOLOGY: A 10-year retrospective study of patients diagnosed with Meniere's disease using American Academy of Otorhinolaryngology criteria, including those that had associated migranous symptoms in accordance with the International Headache Society (IHS) diagnostic criteria for migraine, between 1996 and 2005. The prevalence of migraine in the Meniere's patients was also compared with lifetime prevalence recorded from a previous population-based study within the same setting. The statistical difference was tested with a Z nonparametric test (significance at P < 0.05). Epicalc2000 and SPSS 11 were used for the statistical analysis. RESULT: A total of 25 patients representing 0.22% of the 11,463 ear, nose and throat outpatients seen within the study period met the diagnostic criteria for Meniere's disease. There were nine (36%) males and 16 (94%) females. Their ages ranged 27-65 years, mean 45.25 years +/- 11.05. Eight (32%) met IHS criteria for migraine. There is a statistically significant difference between the prevalence of migraine in Meniere's patients and migraine in the overall population (32% vs. 5.3%, P = 0.000). CONCLUSION: The significant preponderance in the prevalence of migraine in Meniere's disease suggests a link between the two diseases. However, more molecular or genetic studies are needed to unveil this phenomenon.

Impacted radio-opaque glass in the oesophagus of a child.

Most ingested foreign bodies in the aero-digestive tracts in both children and adults are not radio-opaque, and as a result, a preoperative plain radiograph may not be helpful. However, incorporating radio-opaque markers into such potential foreign bodies like toys, beads, and dentures during manufacture (as illustrated in this case of a 6-year-old boy who ingested a piece of glass mirror which was easily seen on X-ray) would obviate this problem. While this may constitute some financial burden on manufacturers, the cost effectiveness on health management is non-negotiable. We suggest that appropriate authorities and regulatory bodies should enforce this through legislation.

Amyloid angiopathy of the floor of the mouth: a case report and review of the literature.

Amyloidosis is a rare disease characterised by the deposition of insoluble extracellular fibrillar proteins in various tissues of the body. The pattern of manifestation is organ dependent and also on whether the disease is localised or systemic, primary or secondary.Though the disease is usually fatal with a 5-year survival rate of 20%, there is still paucity of literature on this disease entity worldwide. Diagnosis has remained mostly at autopsy.A case of amyloid angiopathy involving the submandibular gland and floor of the mouth with an associated fatal bleed is reported. The purpose of this case report is to reiterate the importance of a high index of suspicion in the approach to the management of head and neck swellings.