Childhood hearing loss; a need for primary health care.

INTRODUCTION: Essential health care for children is the care of the ear. METHODS: A cross-sectional descriptive study of 155 children with hearing loss. RESULTS: A total of 155 pupils with hearing impairment and their parents were interviewed; 77(49.7%) males and 78(50.3%) females, age ranged from 6 to 15years (mean 9.11 ± 2.5 years). None of the participants had neonatal hearing screening. Parents detected the hearing loss at a mean age of 2.3 ± 1.1years. Initial care was given by community health workers and general medical practitioners, only 21 participants had otolaryngological consultation and none had audiological rehabilitation. Barriers to accessing services were financial constraints, poor awareness and non-availability of otolaryngological service for the hearing impaired in the communities. CONCLUSION: Hearing impaired children in Nigeria have poor access to ear care. There is a need to create awareness of otological services and incorporate ear-care into the primary health care.

Clinical predictors of aminoglycoside-induced ototoxicity in drug-resistant Tuberculosis patients on intensive therapy.

OBJECTIVE: The study objectives were to determine the incidence of aminoglycoside-induced ototoxicity in institutionalized patients on intensive phase of therapy for drug-resistant Tuberculosis (DR Tb) and also to assess clinical factors which could predict the ototoxicity. METHODS: The study was a prospective analytical study among consecutive DR Tb patients who were admitted for intensive phase of therapy (of 4 months) at the DR-Tb center over a 12-month period. Patients were diagnosed as DR Tb using the Gene Xpert machine to confirm Rifampicin resistance. All eligible 70 out of 87 consenting patients were consecutively recruited into the study. Patients had baseline (admission) and serial pure tone audiometries (PTAs) performed at 4 weekly intervals until discharge after 4 months of admission. Audiometric confirmation of aminoglycoside-induced ototoxicity was done by comparing serial with baseline PTA. RESULTS: Among the 70 patients the male:female ratio was 1.7:1. Nine patients (12.9%) were retroviral-positive, and 16 patients (22.9%) were confirmed to have ototoxicity by audiometric criteria. The duration of treatment when ototoxicity was detected in the patients ranged 4-17 (Mean±SD; 9.4±3.4) weeks. Ototoxicity was detected in the audiometric low frequency ranges in 7 (43.8%) and at the high frequencies in 4 (25.0%) of the patients. Univariate analyses of clinical parameters found that age, underlying diabetes mellitus, deranged baseline PTAv >25dB HL, BMI on admission and retroviral status were significantly associated, while sex and previous drug regimen failure were not associated with ototoxicity. Multivariate adjusted logistic regression analyses, controlling for sex, revealed age (OR=1.068, p=0.018), BMI on admission (OR=0.673, p=0.012) and retroviral positivity (OR=8.822, p=0.014) of patients could significantly predict aminoglycoside-induced ototoxicity. CONCLUSION: Incidence of aminoglycoside-induced ototoxicity in DR Tb patients was 22.9%. The clinical predictors for ototoxicity were age, BMI on admission, and co-existing retroviral infection in the patients. Clinicians should consider these factors in making choices of aminoglycosides to be used during intensive phase of treatment with second line anti-Tuberculous therapy.

Otologic and audiologic characteristics of type 2 diabetics in a tertiary health institution in Nigeria / Características audiológicas e otológicas de diabéticos tipo 2 em uma instituição de saúde terciária na Nigéria

ABSTRACT INTRODUCTION: This cross-sectional comparative study was carried out at the Diabetes outpatient clinic of LAUTECH Teaching Hospital (LTH) Ogbomoso, Nigeria. OBJECTIVE: This study assessed patterns of otologic diseases and auditory acuity among type 2 diabetics and determinants of these findings among diabetics. METHODS: Ninety-seven consenting patients with clinical diagnosis of diabetes mellitus (194 ears) were matched for age and sex with ninety non-diabetic patients (180 ears). These patients were screened using otoscopy and pure tone audiometry over a 6-month period. RESULTS: The study reported a crude prevalence rate of 21.6% hearing loss in T2DM patients. The most common type of otologic disease that showed significant association with T2DM patients was otitis media with effusion (p = 0.027). T2DM was significantly associated with abnormal audiometric findings (p = 0.022), particularly sensorineural hearing loss (p = 0.022), of the moderate grade (p = 0.057). There were no differences of the audilogical findings for any particular ear, and no differential affectation of frequency range was observed. Coexisting hypertension and poor glycaemic control were significantly associated with aggravation of the hearing of the T2DM patients (p < 0.001, and p = 0.009 respectively). CONCLUSION: T2DM had appreciable effects on hearing acuity. T2DM was significantly associated with the type and the degree of the hearing loss. The need for screening of hearing acuity of T2DM patients, in order to detect early changes, and promptly offer an adequate management and remedial measures was emphasized in this study.

Resumo Introdução: Este estudo de caso-controle foi realizado no Ambulatório de Diabetes do LAUTECH Teaching Hospital (LTH), em Ogbomoso, Nigéria. Objetivos: Este estudo avaliou os padrões de doenças otológicas e acuidade auditiva entre os diabéticos tipo 2 e os fatores determinantes desses achados entre os diabéticos. Método: Ao todo, 97 pacientes com diagnóstico clínico de diabetes melito (194 orelhas) deram seu consentimento e foram pareados por idade e sexo, com 90 pacientes não diabéticos (180 orelhas). Eles foram avaliados por otoscopia e audiometria tonal liminar por um períodode seis meses. Resultados: O estudo relatou uma taxa de prevalência bruta de 21,6% de perda auditiva em pacientes com DM2. O tipo mais comum de doença otológica, afetando significativamente pacientes com DM2, foi otite média com efusão (p = 0,027). A DM2 foi associada com achados audiométricos alterados (p = 0,022), principalmente perda auditiva neurossensorial (p = 0,012), de grau moderado (p = 0,057). Não houve predileção dos efeitos da DM2 para uma das orelhas em particular, e também não houve efeito diferencial da faixa de frequência. A coexistência de hipertensão e controle glicêmico inadequado associou-se significativamente à piora da audição dos pacientes com DM2 (p < 0,001 e p = 0,009, respectivamente). Conclusão: A DM2 mostrou apresentar efeitos significantes na acuidade auditiva afetando significativamente o tipo e o grau da disacusia. Este estudo mostrou a necessidade de avaliação da acuidade auditiva de pacientes com DM2, a fim de detectar as alterações iniciais, e poder rapidamente oferecer medidas corretivas adequadas.

Profile of pediatric traditional uvulectomy in North-West Nigeria: The need for caution and education.

OBJECTIVES: The study assessed the prevalence of complications associated with traditional uvulectomy and identified factors associated with favorable outcome after management in a pediatric population in North-Western Nigeria. STUDY DESIGN AND SETTING: This cross-sectional descriptive study was carried out at the accident and emergency section as well as at the otolaryngology out-patient clinic of the Federal Medical Centre, Birnin-Kebbi, Nigeria. METHODS: Patients with traditional uvulectomy complications were recruited on consecutive basis and sample size was dependent on the patients seen over the study period. This was done over a 6 month study period (January 2014-June 2014). RESULTS: A total of forty one participants, all within the paediatric age group (<15 years) participated in this study. The age of the participants ranged from 2 to 13 years while the mean age was 6.17 years ± 2.47. The ≤5 year age group constituted about 44% of the children studied. Gender distribution noted a slight male preponderance (Male: Female ratio = 1.05: 1). A total of 58.8% of the participants were fully immunized, while the Haemoglobin concentration status (packed cell volume) at hospital presentation of <10 g/dl (<30%) occurred in 34.1% of the participants of the study. The duration of hospital stay in pediatric patients with post-traditional uvulectomy complications was significantly associated with the maternal immunization status (p = 0.007). Also, subjects with completed maternal immunization status had about 0.1 times odds (CI = 0.19-0.64) likelihood to have a prolonged hospital stay when compared with subjects whose mothers were partially immunized or not immunized at all. CONCLUSION/SIGNIFICANCE: In conclusion, this study found that favorable outcome post-traditional uvulectomy is related to early presentation and maternal immunization status, but adversely affected by anemia. Traditional uvulectomy remains a cultural practice that should be discouraged using both advocacy and legislative measures.

Otologic and audiologic characteristics of type 2 diabetics in a tertiary health institution in Nigeria.

INTRODUCTION: This cross-sectional comparative study was carried out at the Diabetes outpatient clinic of LAUTECH Teaching Hospital (LTH) Ogbomoso, Nigeria. OBJECTIVE: This study assessed patterns of otologic diseases and auditory acuity among type 2 diabetics and determinants of these findings among diabetics. METHODS: Ninety-seven consenting patients with clinical diagnosis of diabetes mellitus (194 ears) were matched for age and sex with ninety non-diabetic patients (180 ears). These patients were screened using otoscopy and pure tone audiometry over a 6-month period. RESULTS: The study reported a crude prevalence rate of 21.6% hearing loss in T2DM patients. The most common type of otologic disease that showed significant association with T2DM patients was otitis media with effusion (p=0.027). T2DM was significantly associated with abnormal audiometric findings (p=0.022), particularly sensorineural hearing loss (p=0.022), of the moderate grade (p=0.057). There were no differences of the audilogical findings for any particular ear, and no differential affectation of frequency range was observed. Coexisting hypertension and poor glycaemic control were significantly associated with aggravation of the hearing of the T2DM patients (p< 0.001, and p=0.009 respectively). CONCLUSION: T2DM had appreciable effects on hearing acuity. T2DM was significantly associated with the type and the degree of the hearing loss. The need for screening of hearing acuity of T2DM patients, in order to detect early changes, and promptly offer an adequate management and remedial measures was emphasized in this study.

Health-related quality of life and its contributory factors in allergic rhinitis patients in Nigeria.

OBJECTIVES: To determine the health-related quality of life (HRQoL) in allergic rhinitis patients as well as identify contributory factors to patient's well-being. METHODS: Cross-sectional study by multistage sampling. Four-month study duration (October 2013 to January 2014). The setting of the study was Kwara State, Nigeria, which has 16 local government areas with 3 senatorial districts, total land mass of 36,825km(2) with a population of 2,591,555. 132 consenting adults; 66 of them have allergic rhinitis (AR) using Score for Allergic Rhinitis (SFAR) instrument and 66 were age- and gender-matched controls (χ(2)=0, d.f.=1, P=1 and χ(2)=1.24, d.f.=2, P=0.54, respectively). Information on HRQoL was obtained using the 14-parameter mini-rhinoconjunctivitis quality of life questionnaire (mini-RQLQ). Socio-demographic variables possibly contributory to patient's well-being were obtained. Kruskal-Wallis and Mann-Whitney U tests were used to compare means. RESULTS: The overall Total Symptom Score (TSS) was 3.37±0.9, while male and female allergic patients and control TSS were 3.61±1.0; 3.16±0.8, and 0.98±0.2; 0.95±0.2, respectively. Effects of gender, marital status, senatorial districts, residential area and duration of symptoms had significant impact on the quality of life. The highest correlation with TSS and components of mini-RQOL questionnaire existed between nasal problems and other symptoms (r=0.866; 0.868). CONCLUSION: AR had appreciable impact on HRQoL of the participants. Gender, number of dependents, marital status, senatorial districts, residential area and duration of symptoms were major identifiable contributory factors to the patient's well-being.

Medication-related expenditures by individuals with allergic rhinitis in Nigeria.

OBJECTIVE: To assess the medication-related expenditures in individuals with allergic rhinitis (AR) and identify contributory factors that affect these expenditures. STUDY DESIGN: Cross-sectional study from August 2013 to January 2014. SETTING: Kwara state has 16 local government areas, a total land mass of 36,825 km(2), and a population of 2,591,555. SUBJECTS AND METHODS: Of the 308 adult subjects, 66 had AR using the Score for Allergic Rhinitis (SFAR). Information on medication-related expenditure and associated factors in AR was obtained using a structured questionnaire. Descriptive and comparative analyses between AR and non-AR subjects were performed using an independent-sample t test and χ(2) test. Factors associated with cost of care were assessed using logistic regression analysis. RESULTS: The AR crude prevalence rate was 21.4%. Of the subjects, the mean ± SD age was 37.6 ± 10.0 years, and 87.9% were married, 72.7% were self-employed, and 69.7% were in the low socioeconomic class. In total, 69.7% had intermittent symptoms, while 66.7% had a positive family history of allergy. Polypharmacy care was employed in 76.1%, and 30.3% had comorbidity with asthma. The mean monthly income was 842 US dollars (USD), while the mean monthly cost of care was 81 USD, constituting 9.6% of mean monthly income. All payments were through out-of-pocket-expenses. Factors associated with convenience of cost of care were positive family history (odds ratio [OR], 7.93; P = .021) and presence of intermittent symptoms (OR, 9.36; P = .013). CONCLUSION: The medication-related expenditure of AR is burdensome with an average expenditure of almost 10% of monthly income.

Profile of anaerobic bacteriology of middle ear aspirates in a developing country: does immunocompromise play a role?

OBJECTIVES: The study intends to report the profiles of anaerobic bacteria isolated and attempts to evaluate the impact of immunocompromised status of patients on the disease. STUDY DESIGN: A cross-sectional prospective study. SETTING: ENT clinic, University of Ilorin Teaching Hospital, Nigeria; a 450-bed tertiary health facility. SUBJECTS: 104 consecutive consenting participants with clinical evidence of CSOM ≥12 weeks. METHODS: A hospital-based study conducted over a seven (7) month period. The middle ear aspirate was obtained with the aid of a micropipette and sent immediately for Microscopy, Culture and Sensitivity of both anaerobic and aerobic bacterial isolates. RESULTS: A total of 11 patients with chronically discharging ears, of the 104 studied had anaerobic bacteria cultured from their middle ear aspirates. Age ranged from 4 to 50 years with a male:female ratio of 1:1.8. A total of 32 isolates (11 anaerobic and 21 aerobic) were recovered. All anaerobic organisms were mixed and included both Peptostreptococcus and Bacteroides. Metronidazole had 100% sensitivity to gram negative and 62.5% to gram positive anaerobic organisms tested. Five (5) patients had immunocompromised states of 11 patients with anaerobic bacteria isolated in middle ear aspirates (group I), while 13 immunocompromised patients of the remaining 93 patients with no anaerobic bacteria isolated (group II). The proportion of anaerobic isolates in group I is higher (p < 0.05) than in group II. CONCLUSION: Immunocompromised state and age appear to play key role in presence of the anaerobic organisms recovered from the middle ear of the patients studied.

Pre-school hearing screening: profile of children from Ogbomoso, Nigeria.

OBJECTIVES: To carry out otoscopic and audiologic examinations amongst pre-school children in Ogbomoso, Nigeria in order to identify any cases of hearing loss and to intervene where possible. STUDY DESIGN AND SETTING: Prospective audiologic evaluations of children in Nursery I and II (pre-kindergarten and kindergarten) in both private and public primary schools were carried out. METHODS: One hundred and one children (202 ears) were screened using otoscopy and pure tone audiometry. RESULTS: The age ranged from 3.5 to 6 years, mean age was 4.8 years (S.D. = 0.835), with a male population of 55 and 46 females (M:F ratio, 1.2:1). Otoscopic findings revealed normal findings (106) 52.4%, impacted cerumen auris, 44 (21.8%), otitis media with effusion, (28) 13.9%, perforated tympanic membrane, 24 (11.9%) and giving an otoscopic pass rate of 52.4%. Screening audiometry, on the other hand, recorded a pass rate of 78.7%. After 6-8 weeks of otolaryngologic intervention, the otoscopic pass rate improved to 88.6%, while the pass rate for screening audiometry also improved to 93.6%. CONCLUSION/SIGNIFICANCE: From the study, an otoscopic pass rate of 52.9% and screening audiometry pass rate of 78.7% increased to 88.6% and 93.6%, respectively, through basic otolaryngologic interventions. The key roles played in identifying ear diseases with or without hearing impairments with the use of clinical examination (otoscopy) and audiologic evaluation in the pre-school age children has been highlighted in the study. Unfortunately, these evaluations are not performed routinely in children enrolled in both private and public primary schools in Ogbomoso, Nigeria. We advocate that the routine otoscopic examinations with screening audiometry be made available in all primary schools, in order to facilitate early detection and prompt rehabilitation of children with ear diseases and hearing impairment.

Symptom score for allergic rhinitis.

OBJECTIVES: To determine the prevalence of allergic rhinitis in our study population and the correlation between the Score for Allergic Rhinitis (SFAR) and nasal smear eosinophil count. STUDY DESIGN: Cross-sectional study. SETTING: Ear, nose, and throat clinic, University of Ilorin Teaching Hospital, Nigeria; a 450-bed tertiary health facility. SUBJECTS: Two hundred seventy-five consecutive, consenting patients who presented with nasal symptoms. METHODS: Information on the 8-parameter symptom score was collected using a semistructured questionnaire by interview. Nasal smear slides were air dried, fixed with 95% alcohol, stained using May-Grünwald-Giemsa stain, and examined under a light microscope. RESULTS: Of the 275 participants seen during the 1-year study, 116 (42.2%) were males. The mean ± SD age was 38.5 ± 16.3 (range, 14-75) years. Eighty-one (29.5%) were diagnosed with allergic rhinitis using a nasal smear eosinophil count. The most common symptom was excessive sneezing, involving 93% of patients with allergic rhinitis (P < .001). The prevalence of allergic rhinitis using SFAR was 31.6%. The SFAR cutoff was set at >8 (P < .001). The sensitivity and specificity for SFAR were 94.8% (confidence interval [CI], 90.5%-97.4%) and 95.1% (CI, 87.2%-98.4%), respectively. A high Spearman's correlation (0.88) was obtained for SFAR when correlated with nasal smear eosinophil count. CONCLUSION: The prevalence of allergic rhinitis using SFAR was 31.6%. The study shows that SFAR can be used as a simple, valid diagnostic tool in allergic rhinitis. This is important in rural settings where access to laboratory investigations might not be readily available.