Comparing Oxygen Saturation of Normal Children with that of Children with Adenotonsillar Hypertrophy.

To compare the nocturnal oxygen saturation profiles of children with adenotonsillar enlargement with that of normal children. A 1 year comparative study. The study was carried out at the Otorhinolaryngology Ward of the University College Hospital Ibadan. These comprise of 60 children (1-9 years) with clinically confirmed adenotonsillar enlargement admitted for adenotonsillectomy and 60 normal children matched for age and sex. The biodata and common clinical presentations of the study group were acquired with a structured proforma. The severity of nasopharyngeal obstruction was determined by the adenoidal-nasopharyngeal ratio while the degree of tonsillar enlargement was graded by the Brodsky's classification. The nocturnal oxygen saturation of all the participants were recorded with a wrist worn pulse oximeter. Recording was for at least for 4 h. Oxygen saturation <92 % was regarded as desaturation. The oximetric values of the study and control group were compared. The mean nocturnal SPO2 (peripheral saturation of oxygen) profiles of children with adenotonsillar enlargement were as follows: basal = 96.86 %, minimum = 84.99 %; maximum = 99 % and average SPO2 <92 % = 87.74 % while the saturation profiles of the control group were as follows; basal = 97.88 %, minimum = 89.71 %; maximum = 99 %, average SPO2 <92 % = 90.82 %. Normal children have better nocturnal saturation profiles than children with adenotonsillar enlargement.

Novel management of cervical necrotising fasciitis in a developing country: case report.

OBJECTIVE: We report a rare case of cervical necrotising fasciitis arising from poorly managed acute tonsillitis. CASE REPORT: A 23-year-old woman presented with a two-week history of fever and an eight-day history of painful neck swelling. Nine days before presentation, she had received digital manipulation of her throat by a neighbour, which had worsened her throat pain. There was associated progressive generalised neck swelling, odynophagia, dysphagia and dyspnoea. An X-ray of the neck soft tissue showed multiple gas collections. CONCLUSION: Cervical necrotising fasciitis is rare and usually odontogenic in origin. It is associated with a high mortality rate. Our patient responded to aggressive daily bedside wound debridements and dressings, appropriate intravenous antibiotics and high-protein nutritional support. In this way, exploration under general anaesthesia was avoided, in a developing country with limited facilities.

Prevalence of otomycosis in Ibadan: a review of laboratory reports.

Otomycosis has typically been described as fungal infection of the external auditory canal with infrequent complications involving the middle ear. Because of the dearth of data on the prevalence of Otomycosis in this environment and increased rate of immunosuppression, this study was aimed at finding the prevalence and fungal etiological agents responsible for this condition. Aretrospective review of the laboratory reports of ear swabs of patients that presented with signs and symptoms suggestive of fungal infections of the ear like otorrhoea, otalgia and aural fullness were done. The diagnosis of otomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae and fruiting bodies under microscopy. The swabs were cultured on the Sabouraud Dextrose agar kept at room temperature (27-30 degrees C). Fungi growth occurred within 48 hours to 3 weeks. The data collected were analyzed with the aid of SPSS version 12.0 computer software. Level of significance was set at p<0.05. A total of 53 patients with documented diagnosis of otomycosis were included in the analysis and consisted of 31 (58.5%) females and 22 (41.5%) males. The ages at diagnosis ranged from 2 to 68 years (Mean: 28.9 yrs; Median: 30.0 yrs). Otalgia and otorrhoea were the most common symptoms, followed by hearing loss and aural fullness. The prevalence of otomycosis among the patients in this hospital was 39.6%. Candida albicans was the most common fungal isolate in these patients as it occurred in 28.3% (15/53). Other isolates in order of frequency were Aspergillus fumigatus (5.7%), A. niger (1.9%), Penicillium spp. (1.9%) and Mucor spp.(1.9%). Candida albicans was also the most common fungus identified in all age group. There was no statistical significance associated between age of presentation and types of fungi isolated (p = 0.054). Even though, there was no statistical significance between sex and fungi isolated (p > 0.05), it was noted that all the fungi were commonly isolated from female gender irrespective of their age. Candida albicans and Aspergillus species were the most commonly identified fungal pathogens of otomycosis in U.C. H., Ibadan, Nigeria. High index of suspicion should be demonstrated by General practitioners and Otorhinolaryngologists. Patients' specimens should be sent to the laboratory as early as possible for prompt diagnosis.

Quantitative analysis of tympanic membrane perforation: a simple and reliable method.

BACKGROUND: Accurate assessment of the features of tympanic membrane perforation, especially size, site, duration and aetiology, is important, as it enables optimum management. AIM AND OBJECTIVES: To describe a simple, cheap and effective method of quantitatively analysing tympanic membrane perforations. MATERIALS AND METHODS: The system described comprises a video-otoscope (capable of generating still and video images of the tympanic membrane), adapted via a universal serial bus box to a computer screen, with images analysed using the Image J geometrical analysis software package. The reproducibility of results and their correlation with conventional otoscopic methods of estimation were tested statistically with the paired t-test and correlational tests, using the Statistical Package for the Social Sciences version 11 software. RESULTS: The following equation was generated: P/T x 100 per cent = percentage perforation, where P is the area (in pixels2) of the tympanic membrane perforation and T is the total area (in pixels2) for the entire tympanic membrane (including the perforation). Illustrations are shown. Comparison of blinded data on tympanic membrane perforation area obtained independently from assessments by two trained otologists, of comparative years of experience, using the video-otoscopy system described, showed similar findings, with strong correlations devoid of inter-observer error (p = 0.000, r = 1). Comparison with conventional otoscopic assessment also indicated significant correlation, comparing results for two trained otologists, but some inter-observer variation was present (p = 0.000, r = 0.896). Correlation between the two methods for each of the otologists was also highly significant (p = 0.000). CONCLUSION: A computer-adapted video-otoscope, with images analysed by Image J software, represents a cheap, reliable, technology-driven, clinical method of quantitative analysis of tympanic membrane perforations and injuries.

Pattern of tympanic membrane perforation in ibadan: a retrospective study.

BACKGROUND: Tympanic membrane perforations vary in size, shape and position. The degree of conductive deafness varies with the size and position of the tympanic membrane perforation. OBJECTIVE: This study is to determine the pattern and causes of tympanic membrane perforation. METHOD: Hospital based study at the ENT Clinic, UCH, Ibadan. Consecutive patients seen during the period of study with ear symptoms were interviewed and examined by ENT surgeons. This information was entered into computer and analyzed using SPSS v 11. RESULT: Thirty-three (13.5%) of the 244 patients were found to have tympanic membrane perforation. Fifteen (45.5%) patients were new while 18 (54.5%) were follow up patients. There were 13 (39.4%) males and 20 (60.6%) females. The type of perforation seen were central 57.6%, subtotal 33.3%, total 6.1%, marginal 3.0%. The sides affected were left ear 45.5%, right ear 15.2%, and both ears 39.4%. The causes found were chronic suppurative otitis media (CSOM) 90.9%, acute suppurative otitis media (ASOM) 6.1%, and trauma to the affected ear 3.0%. CSOM was the cause of tympanic membrane perforation seen in children. CONCLUSION: There is need for early diagnosis and treatment of all cases of tympanic membrane perforation and proper education of parents and guardians on proper method of ear care and early referral. There is also need to train all healthcare workers especially primary health care providers on how to manage these cases.

Hearing impairment among mill workers in small scale enterprises in southwest Nigeria.

This cross-sectional study was conducted among mill workers in a large market in Ibadan, southwest Nigeria. These workers are engaged in small scale businesses with little or no regulation of work exposures. Questionnaires administered to mill workers sought information on personal characteristics, length of time engaged in the job, type of milling done and symptoms of hearing impairment. Noise exposure and hearing impairment were assessed among 85 mill workers. Audiometry was done on mill workers and 45 controls with no known exposure to noise and no history of aural disease. Noise levels at work stations ranged from 88-90dB for small mills and 101-105 for larger mills. None of the workers used hearing protection. Analysis based on total number of ears showed that 56% of the workers had hearing impairment ranging from mild (49%) moderate (6.4%) to severe (0.6%) whilst 33% of the controls had hearing impairment which was mild (26%), moderate (7%) and no severe losses, P = 0.001. There was no association between age and hearing impairment but prevalence of hearing impairment was highest among those who had been engaged in the trade for more than 20 years. There is a need for regulation of small scale enterprises to protect the health of workers. Health education and provision of low cost ear plugs will reduce the occurrence and severity of hearing impairment among these low income workers.

Traditional Open Surgery for Advanced Benign Nasal Tumours in an Era of Endoscopy: Review of 38 Cases

During the past decade open nasal surgery has been overtaken by endoscopic resection in the management of benign sinonasal tumours in the advanced countries. However; due to limited availability of endoscopic surgical facilities and training in most parts of sub-Saharan Africa; open surgery still seems popular. This report determines the indications and outcome of open nasal surgery for benign tumours in a resource - poor tertiary centre in sub-Saharan Africa and compares with endoscopic resection. This is retrospective study of 38 open surgeries done by the authors for cases of benign sinonasal tumours. Seventeen (45) caldwel-luc procedures; 12 (31) external (lynch-howarth) fronto-ethmoidectomy and 9(24) lateral rhinotomy were carried out. The indications were simple nasal polyps 17(45); mucocoele 10(26); inverted paplloma 8(21); invasive fungal sinusitis 2(5) and ossifying fibroma 1(2). Postoperatively; recurrence was 1/17(6) caldwel-Luc surgery and 1/9 (11) lateral rhinotomy for inverted papilloma. Facial scar was seen in 21/38(55) but the cosmetic effect of the scars was acceptable to our patients. Postoperative stay was between 5 to 17 days. We conclude that open nasal surgery met the therapeutic expectations of our patients. The recurrence rate compared with that of endoscopic resection reported in the literature and cosmetic effect of facial scar was acceptable to the patients; however; postoperative stay in the hospital is longer. It is our hope that this will serve as a baseline to compare the result of endoscopic nasal surgery in future when it becomes a widespread procedure in the developing countries

Stomal recurrence post laryngectomy in University College Hospital, Ibadan.

The outcome of laryngeal carcinoma is favourable and cure rate high if detected early. A major complication experienced post surgery for advanced laryngeal carcinoma is recurrence especially at the tracheostome. This study aimed at evaluating the incidence of stomal recurrence post total laryngectomy with respect to the risk factors. This is a retrospective review of eighteen patients (14 males and 4 females) that had total laryngectomy for histologically confirmed laryngeal carcinoma from 1990 - 2002. Seven patients (38.9%) had stomal recurrence. Seven patients (38.9%) had palpable deep cervical nodes at presentation. Fourteen (77.8%) and four (22.2%) patients had emergency and elective tracheostomy procedures respectively. Twelve patients (66.67%) had neck node dissection during surgery. Post-operatively, twelve patients (66.7%) had only radical radiotherapy; four (22.2%) had both radio-/ chemotherapy while two had preoperative and additional postoperative radiotherapy. The mean duration between the preoperative tracheostomy and total laryngectomy was 62.19 +/- 64.56 days while the mean duration between total laryngectomy and development of stomal recurrence was 7.79 +/- 8.57 months. Ten patients (55.6%) died, (seven with and three without stomal recurrence but who died of distant metastases to the lungs and thoracolumbar vertebral bodies). Stomal recurrence post laryngectomy has a grave prognosis. This present study also showed that advanced stage 3 and 4 tumour, transglottic involvement and the presence of preoperative tracheostomy are the likely risk factors that could be associated with recurrence in our environment. There is therefore the need to reevaluate these preventive measures in a prospective study in order to improve the final outcome in our environment.