Fractured Metallic Tracheostomy Tube: A Rare Presentation of Bronchial Foreign Body.

BACKGROUND: Tracheostomy is an important life-saving surgical procedure that could be used to secure the lower airway. It can however serve as a source of airway compromise when fragments from it are deposited. This condition must be diagnosed early enough, and appropriate intervention should be done to forestall potential morbidity and mortality. CASE REPORT: A 56-year-old tracheostomized patient presented to the accident and emergency department with a 4-hour history of sudden onset choking cough and labored breathing. The shaft of his tracheostomy tube (TT) was fractured and subsequently aspirated while he was attempting to remove and clean the inner tube that morning. He has used the TT for about 6 years and lost to follow-up clinic visits. The chest radiograph showed the metallic foreign body lodged within the trachea. He had an emergency rigid bronchoscopy via the tracheostomy stoma, and the object was retrieved. All respiratory symptoms subsequently resolved, and a check radiograph showed normal findings. CONCLUSION: Tracheostomy tube fracture and aspiration should be ruled out in every tracheostomized patient with sudden onset acute respiratory symptoms. Otolaryngologists must always emphasize the need for proper handling of TT, regular follow-up, and tube replacement when due.

Primary minor salivary gland tumors: A retrospective review of cases seen in a tertiary institution in South East Nigeria.

Background: Tumors of the minor salivary glands (MSGs) are rare. They constitute a wide range of histologic types despite their low frequency. Aim: The aim of this study is to evaluate the clinical and pathological features of 11 different tumors of MSGs presented at the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu and to compare them with similar studies done elsewhere. Patients and Method: This is a retrospective study of patients with tumors involving the MSGs seen at the OMFS and ORL clinics, UNTH. Information regarding demographic characteristics, duration at first presentation, types of tumors, site and side affected, and treatment given were recorded in patients' medical records. Data were analyzed using SPSS version 23; qualitative variables were compared using Chi-square test. Result: One hundred and thirty three cases of various lesions involving the salivary gland were seen within the study period. Fifty three (39.8%) patients met the inclusion criteria and are reported further. Twenty eight (28) cases occurred in males. The mean age of the patients was 39.8 years STD 16.5, while the mean duration of the swellings at presentation was 45.5 months STD 35.4. Pleomorphic adenoma was the most common of the 29 (54.7%) benign histopathologic type seen. The soft palate was the commonest site affected 37 (69.8%). Local excision with wide margin was adequate in treating majority of the swellings 40 (75.5%), while 1 (1.9%) case of recurrence was seen within the study period. Conclusion: Tumors involving the MSGs are uncommon; males are mostly affected in our environment.

Ear-related problems among children attending the paediatric and otorhinolaryngology out-patients clinics of the University of Nigeria Teaching Hospital, Enugu.

BACKGROUND: Ear related diseases are commonly seen in clinics worldwide especially among children. They are associated with significant morbidity and frequent hospital visits. Limited data exists regarding the burden of ear disease among Nigerian children. OBJECTIVE: To determine the prevalence of ear-related problems among children presenting at the Paediatric and Otorhinolaryngology clinics of the University of Nigeria Teaching Hospital, Enugu. MATERIALS AND METHODS: This was a cross-sectional study conducted at the Paediatric and Otorhinolaryngology Clinics of the University of Nigeria Teaching Hospital Enugu. All children aged 0 and 17 years presenting between 1(st) June and 31(st) August 2006 with ear-related problems were enrolled consecutively into the study. Data analysis was by SPSS version 11. RESULTS: Three thousand and twenty-one children were seen during the study period. Out of these, 248 children (8.2%) presented with ear-related problems. Chronic otitis media (30.5%), acute otitis media (29.9%), cerumen auris (11.3%), otitis externa (10.1%), hearing impairment (7.3%) and foreign body in the ear (5.7%) were the most commonly diagnosed ear-related problems. CONCLUSION: Ear-related problems among children presenting at the UNTH Enugu were not uncommon. However, otitis media was the most commonly diagnosed ailment affecting the ears in children.

THE EFFECT OF CD4 COUNT LEVEL ON THE MIDDLE EAR DYNAMICS OF HIV INFECTED PATIENTS.

BACKGROUND: HIV infection, a multi systemic disease has been identified as one of the causes of hearing loss in man. OBJECTIVES: To compare the effect of HIV infection on the middle ear dynamics of HIV infected and non-HIV infected individuals using tympanometry. DESIGN: A prospective cross sectional study. SETTING: HIV Clinic at University of Benin Teaching Hospital (UBTH) in 2010. SUBJECTS: Tympanometry was done on adults (18-45 year old) patients with confirmed retroviral disease (RVD) infection and confirmed non-HIV infected adults (18-45 year old) as the control group. All the patients certified the inclusion and exclusion criteria. MAIN OUTCOME MEASURES: More women were found with HIV infection than men at a ratio of 1:3.7(men = 21% and females = 79%). There was preponderance of type "B" tympanogram among HIV-infected individuals. RESULT: There was a significant correlation between CD4 cell count and type "B" tympanogram (P = 0.03). The CD4 cell count measured severity of HIV infection while the type "B" tympanogram detected middle ear effusion. CONCLUSIONS: Middle ear effusion is the genesis of middle ear pathology in HIV infected population.

The role of adenoidal obstruction in the pathogenesis of otitis media with effusion in Nigerian children.

BACKGROUND: Although adenoidectomy is generally applied in the treatment of otitis media with effusion (OME), there is still much debate about the role of adenoid in the pathogenesis of OME. The purpose of this study is to determine the incidence of OME in children with obstructive adenoid disease in comparison with normal control, and the degree of nasopharyngeal obstruction by adenoid as it relates to the development of OME in Nigerian children. METHOD: Controlled, prospective clinical study was carried out. Diagnosis of OME was made with finding of type B tympanogram on tympanometry evaluation. The incidence of OME among adenoidal patients was compared with its incidence in normal control. The degree of nasopharyngeal obstruction among the adenoidal subjects was evaluated with an adenoidal-nasopharyngeal ratio parameter obtained from soft tissue radiograph of nasopharynx, and was related to the results of tympanometric evaluation of the adenoidal subjects. RESULTS: The incidence of OME was significantly higher in the adenoidal children than the normal control (p < 0.001). The risk of OME was more than 7 times as more among adenoidal group than among the non-adenoidal control. Gross nasopharyngeal obstruction was significantly associated with type B tympanogram (p = 0.002). The diagnosis of OME correlated significantly with the degree of nasopharyngeal obstruction (r = 0.32; p = 0.002). CONCLUSION: Our study found adenoid obstruction as a significant risk factor for OME in children. The risk of OME increases with the increasing degree of nasopharyngeal obstruction.

The Role of Adenoidal Obstruction in the Pathogenesis of Otitis Media with Effusion in Nigerian Children

Background: Although adenoidectomy is generally applied in the treatment of otitis media with effusion (OME); there is still much debate about the role of adenoid in the pathogenesis of OME. The purpose of this study is to determine the incidence of OME in children with obstructive adenoid disease in comparison with normal control; and the degree of nasopharyngeal obstruction by adenoid as it relates to the development ofOMEin Nigerian children. Method: Controlled; prospective clinical study was carried out. Diagnosis of OME was made with finding of type B tympanogram on tympanometry evaluation. The incidence of OME among adenoidal patients was compared with its incidence in normal control. The degree of nasopharyngeal obstruction among the adenoidal subjects was evaluated with an adenoidal-nasopharyngeal ratio parameter obtained from soft tissue radiograph of nasopharynx; and was related to the results of tympanometric evaluation of the adenoidal subjects. Results: The incidence of OME was significantly higher in the adenoidal children than the normal control (p 0.001). The risk ofOMEwas more than 7 times as more among adenoidal group than among the non-adenoidal control. Gross nasopharyngeal obstruction was significantly associated with type B tympanogram (p

Evaluation of adenoidal obstruction in children: clinical symptoms compared with roentgenographic assessment.

BACKGROUND: Obstructive adenoid enlargement is commonly implicated as the major cause of chronic nasal obstruction in children. Although clinical assessment is considered essential, there is little consensus over its reliability. This study was conducted to determine the correlation between graded symptomatology assessment and roentgenographic assessment of adenoidal obstruction. METHOD: Symptoms assessed included snoring, mouth-breathing and obstructive breathing during sleep. Each symptom was rated on a four-point scale (absent = zero, mild = one, moderate = two and severe = three). We summed the ratings for each child to obtain the symptomatology score. We used an adenoidal-nasopharyngeal ratio parameter to classify roentgenographic assessment into minimal, moderate or marked obstruction. RESULTS: Sixty-four children, 42 boys and 22 girls, aged one to 12 years were enrolled. The clinical symptomatology scores correlated significantly with the roentgenographic ratings of nasopharyngeal airway obstruction (r = 0.419; p = 0.001). The correlation was significant at roentgenographic ratings of minimal obstruction (p < 0.05) and gross obstruction (p < 0.001). Both the symptomatology score and the roentgenographic rating showed significant correlations with patient age (r = -0.657, p < 0.01 and r = -0.340, p < 0.01, respectively). CONCLUSION: Clinical rating of adenoidal symptoms in children provides a reasonably reliable assessment of the presence and severity of nasopharyngeal airway obstruction. This technique of assessment is easy to use and is particularly valid when obstruction is either minimal or gross.

Profile of aerobic bacteria isolated in chronic maxillary sinusitis patients.

OBJECTIVES: To determine the pattern of aerobic bacteria isolated in patients with chronic maxillary sinusitis at the Ear, Nose and Throat Clinic of the University of Nigeria Teaching Hospital, Enugu, and the antibiotics sensitivity pattern of these organisms. METHODS: A prospective hospital-based clinical study. RESULTS: Fifty - four patients with clinical diagnosis of chronic maxillary sinusitis were evaluated. Out of 54 maxillary sinus aspirate specimens studied, 31 yielded bacterial growths and 32 no bacterial growth. The common aerobic bacteria isolated were Staphylococcus aureus (32.3% ), Pseudomonas aeruginosa and Escherichia coli were 16.1% each. Staphylococcus aureus was sensitive to Erythromycin, and the gram-negative organisms to Gentamicin. CONCLUSION: Bacteria isolated in chronic maxillary sinusitis and their sensitivity patterns varied. Bacteriologic study of the antral washings / aspirates should be done in every patient with chronic maxillary sinusitis. Combination chemotherapy that included Erythromycin and Gentamicin was recommended.

Clinical profile of acute otitis media among Nigerian children.

A one-year prospective clinical study to assess principal clinical symptoms, signs and bacteriological isolates in Nigerian children with acute otitis media. This is a multicentre study conducted from January-December, 1998 in three University Teaching Hospitals. A strict recruitment protocol was followed. Patient symptoms had to be less than one week before enrollment. Eighty-one children were recruited into the study. The major findings indicative of acute otitis media were ear pain (92.6%), fever (88.9%), redness of the tympanic membrane (89.9%) and loss of light reflex (84%). Rupture of the tympanic membrane occurred in 15 patients (18.5%) Staphylococcus aureus was the most common pathogen (50%) isolated from the ear swabs. A high index of suspicion is necessary to diagnose acute otitis media early in children especially those who may have fever as the main symptom. This will minimise the frequency of tympanic membrane perforations.

Management of the upper airway in severe cut-throat injuries.

Four patients treated for cut-throat injuries are the subjects of this paper. Two were self-inflicted suicide attempts while one each was for ritual killing and over disputed farmland. Tracheostomy was deplored at the early period in all cases to ensure safe and patent airway. Significant laryngo-tracheal stenosis was a long-term morbidity suffered by two of the patients. Management of the airway in the early and late periods following the cut-throat injuries is discussed.

Correlation of plain radiological diagnostic features with antral lavage results in chronic maxillary sinusitis.

To justify the continued relevance of plain radiography of maxillary sinus in establishing diagnosis and planning treatment of chronic maxillary sinusitis, its specificity and predictive values must have a high degree of confidence. The objective of this study was to examine different plain radiographic features and correlate them with antral lavage results in patients suffering from chronic maxillary sinusitis. Air-fluid level and antral opacity have specificity of 92.3% each and positive predictive value of 87.5% and 96.0% respectively. Gross mucosal thickening and haziness showed low specificity and predictive values of 36.7% and 29.4% respectively. Normality of radiographs was reliable in predicting clear antral lavage effluent. Plain radiograph of the maxillary sinus is still relevant in establishing diagnosis and planning treatment in chronic maxillary sinusitis.

Salivary gland neoplasms: a descriptive analysis of the pattern seen in Enugu.

The objective of this study is to describe the pattern of salivary gland neoplasms as experienced in Enugu-Nigeria. Patients are selected from those attending the Otorhinolaryngology units of the author at the University of Nigeria Teaching Hospital and Balsam Clinics both in Enugu from January 1992 to December 1997, with tumours of salivary gland origin. Non-neoplastic lesions were excluded. There were forty-one (41) patients with salivary gland neoplastic growths in the following sites: parotids (25) submandibular gland (SMG) (10) and minor (6). There were 15 males, 26 females; age range 10-74 year, with mean of 41 years. Seven of the parotid tumours were recurrent/residual. Salivary gland neoplasms are important surgical disease in this region with clinical manifestations similar to what obtains in other parts of the world. Surgical excision of salivary neoplasms is beneficial, but misadventure is still rampant.

Fluconazole in the therapy of tropical deep mycoses.

A clinical study was conducted to test the efficacy of fluconazole in the treatment of tropical deep mycoses. Two out of four patients with zygomycosis due to Conidiobolus coronatus who were treated with the drug were completely cured; the other two patients exhibited considerable improvement but could not be followed up. Two patients with eumycetoma, one due to an Acremonium sp. and one due to Pseudallescheria boydii, were treated successfully, whereas another patient with a eumycetoma caused by an unidentified fungus could not be followed up. A complete cure was achieved with one patient with African histoplasmosis and one with candiduria. A case of cerebral phaeohyphomycosis due to Cladosporium sp. showed some improvement but the patient later developed meningitis and died.

Nasopharyngeal carcinoma in the differential diagnosis of intracranial subtemporal masses.

Six cases of nasopharyngeal carcinoma presenting primarily to the neurosurgical service of the University of Nigeria Teaching Hospital as intracranial subtemporal masses are discussed. This mode of initial presentation is very rare. The clinical features are described and the need to examine and biopsy the nasopharynx in cases of intracranial space occupying lesions in the subtemporal or posterior fossa regions is emphasised.