ABSTRACT
The University of Cape Town Karl Storz Head and Neck Surgery Fellowship is the only head and neck surgery fellowship in Sub-Saharan Africa. This article briefly describes this fellowship and outlines the experience and ongoing collaborative efforts of members of the American Academy of otolaryngology-head and neck surgery with graduates of this program who are now building head and neck surgery programs in East Africa. This educational collaboration avoids many common pitfalls associated with short-term humanitarian outreach and represents a successful model for international collaborative educational efforts with head and neck surgeons in developing countries in Africa.
ABSTRACT
BACKGROUND: Chronic suppurative otitis media (CSOM) is still a significant health problem in developing countries. Therefore, it was pertinent to determine the local Malawian microbiology in order to guide adequate treatment, avoid complications, and provide records for future reference. AIM: The study sought to determine the CSOM-causing microorganisms at Queen Elizabeth Central Hospital in Blantyre, Malawi, and establish their relationship signs and symptoms, and with the demographic pattern of the study. METHODS: This was a hospital-based cross-sectional descriptive study carried out at the ENT outpatient clinic and the Microbiology Department of Queen Elizabeth Central Hospital.The sample comprised 104 patients with unilateral or bilateral active CSOM, who met the inclusion criteria. All patients were evaluated through a detailed history and clinical examination. Pus samples from draining ears were collected by aspiration with a sterile pipette. The specimens were immediately sent for microbiological analysis. Data were analyzed using SPSS.version 20. RESULTS: The study found that Proteus mirabilis, Pseudomonas aeruginosa, and Staphylococcus aureus were the most prevalent aerobic bacteria, while Bacteroides spp. and Peptostreptococcus spp. were the commonest anaerobic bacteria causing CSOM. These CSOM-causing microorganisms were predominant among males aged 18 years and below. Some CSOM-causing microorganisms were-significantly more so than the others-characteristically associated with each of the following clinical features: quantity of pus drainage, mode of onset, otalgia, hearing loss, location of tympanic membrane perforation, and mucosal appearance.
Subject(s)
Bacteria, Aerobic/isolation & purification , Bacteria, Anaerobic/isolation & purification , Bacterial Infections/microbiology , Otitis Media, Suppurative/microbiology , Adolescent , Adult , Aged , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacteria, Aerobic/classification , Bacteria, Aerobic/drug effects , Bacteria, Anaerobic/classification , Bacteria, Anaerobic/drug effects , Bacterial Infections/diagnosis , Bacterial Infections/epidemiology , Child , Child, Preschool , Chronic Disease , Cross-Sectional Studies , Female , Humans , Malawi/epidemiology , Male , Microbial Sensitivity Tests , Middle Aged , Prevalence , Young AdultABSTRACT
Background.Chronic suppurative otitis media (CSOM) is still a significant health problem in developing countries. Therefore; it was pertinent to determine the local Malawian microbiology in order to guide adequate treatment; avoid complications; and provide records for future reference. Aim. The study sought to determine the CSOM-causing microorganisms at Queen Elizabeth Central Hospital in Blantyre; Malawi; and establish their relationship signs and symptoms; and with the demographic pattern of the study.Methods.This was a hospital-based cross-sectional descriptive study carried out at the ENT outpatient clinic and the Microbiology Department of Queen Elizabeth Central Hospital.The sample comprised 104 patients with unilateral or bilateral active CSOM; who met the inclusion criteria. All patients were evaluated through a detailed history and clinical examination. Pus samples from draining ears were collected by aspiration with a sterile pipette. The specimens were immediately sent for microbiological analysis. Data were analyzed using SPSS version 20.The study found that Proteus mirabilis; Pseudomonas aeruginosa; and Staphylococcus aureus were the most prevalent aerobic bacteria; while Bacteroides spp. and Peptostreptococcus spp. were the commonest anaerobic bacteria causing CSOM. These CSOM-causing microorganisms were predominant among males aged 18 years and below. Some CSOM-causing microorganisms were-significantly more so than the others-characteristically associated with each of the following clinical features: quantity of pus drainage; mode of onset; otalgia; hearing loss; location of tympanic membrane perforation; and mucosal appearance
Subject(s)
Cross-Sectional Studies , Otitis Media , Otitis Media/diagnosis , Otitis Media/microbiologyABSTRACT
Head and neck cancers pose an especially serious problem in developing countries due to late presentation requiring complex surgical intervention. These countries are faced with many challenges, ranging from insufficient health care staff to problems with peri-operative requirements, diagnostic facilities, chemoradiation services and research funding.These challenges can be addressed through the training of head and neck surgeons and support personnel, the improvement of cancer awareness in local communities, and the establishment of dedicated head and neck institutes which focus on the special needs of head and neck cancer patients.All these changes can best be achieved through collaborative efforts with external partners. The Karl Storz Fellowship in Advanced Head and Neck Cancer, enabling training at the University of Cape Town, South Africa, has served as a springboard towards establishing head and neck services in developing sub-Saharan African countries.
Subject(s)
Developing Countries , Head and Neck Neoplasms/surgery , Health Workforce , Hospital Units , Otolaryngology/organization & administration , Academies and Institutes/organization & administration , Africa South of the Sahara/epidemiology , Fellowships and Scholarships , Head and Neck Neoplasms/epidemiology , Humans , International Cooperation , Interprofessional Relations , Medically Underserved Area , Otolaryngology/education , Patient Care Team/organization & administrationABSTRACT
OBJECTIVES: To determine whether, in a developing world context, early oral feeding after laryngectomy is safe, cost-effective and appropriate. STUDY DESIGN: A prospective study of early oral feeding after laryngectomy, compared with retrospective, historical delayed feeding controls. METHOD: Forty patients underwent total laryngectomy for advanced carcinoma of the larynx with or without hypopharyngeal involvement, not requiring tongue base resection or myocutaneous flaps, and were commenced on oral feeding on the second post-operative day. Thirty-nine laryngectomy patients previously managed in the same unit who had received conventional, delayed oral feeding served as controls. RESULTS: Pharyngocutaneous fistulae developed in 20 per cent of the early feeding patients, compared with 15.4 per cent of the delayed oral feeding controls (p = 0.592). For patients who did not develop fistulae, hospitalisation was shorter in the early oral feeding group (p = 0.007). CONCLUSION: Early oral feeding for laryngectomy patients is recommended, both in developed and developing countries.
