Effect of Chronic Kidney Disease on Olfactory Function: A Case-Control Study.

BACKGROUND: Olfactory function of patients with chronic kidney disease (CKD) has been found to be defective, and patients are often unaware of it. This predisposes them to malnutrition with consequence on health recovery and quality of life. AIM: To assess the olfactory function and determine the pattern of olfactory dysfunction in patients with CKD attending the University College Hospital, Ibadan. MATERIALS AND METHODS: This was a prospective, hospital-based case-control study of adult patients with CKD. The control group were age- and sex-matched individuals without CKD. Olfactory threshold (OT), odor discrimination (OD), and odor identification (OI) tests were carried out in participants using the "Sniffin Sticks." RESULTS: There were 100 patients with CKD and 100 healthy controls, age ranges between 19 to 86 years (mean ± SD = 46.3 ± 13.9 years) and 20 to 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (P = .57). The mean olfactory scores were significantly lower among the cases than control, OI 11.2 ± 2.3 and 13.1 ± 1.2 (P < .001), OD 8.5 ± 2.4 and 10.9 ± 1.5 (P < .001), OT 6.4 ± 2.5 and 9.6 ± 1.9 (P < .001), and threshold discrimination and identification 26.0 ± 5.7 and 33.6 ± 3.3 (P < .001), respectively. Prevalent olfactory dysfunction among patients with CKD was 77% (hyposmia 72%, anosmia 5%), and the control was 16% (all hyposmia; P < .001). CONCLUSION: There was high prevalence of olfactory dysfunction among patients with CKD, and the affectation is more at the central olfactory pathway.

Effect of Chronic Kidney Disease on Taste Function: A Case Control Study among Nigerian.

Taste dysfunction has been associated with chronic kidney disease (CKD) especially end stage kidney disease (ESKD) and also implicated as one of the predisposing factors for the prevalent malnutrition, muscle wasting and impaired quality of life among patients with CKD. To assess the taste function and determine the pattern of taste dysfunction in patients with CKD attending the University College Hospital, Ibadan. This was a cross sectional, hospital-based case-control study of adult patients with CKD. The control group were age and sex matched without CKD. Interviewer-assisted questionnaires were administered on all participants to obtain clinical information concerning demographics, clinical data on kidney disease and taste dysfunction. The four basic taste modalities namely; sweet, sour, bitter and salt taste senses of the participants were tested with validated "taste strips". There were 100 patients with CKD and 100 healthy controls, age ranges between 19 and 86 years (mean ± SD = 46.3 ± 13.9 years) and 20 and 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (p = 0.57). Hypogeusia was found in 27.0% of CKD patients with specific taste modalities dysfunction for salt, sour, sweet and bitter taste of 13.0, 24.0, 13.0 and 17.0%, respectively. The controls only had specific taste modalities dysfunction for salt, sour and bitter taste of 1.0% for each of the taste modalities. The mean total taste scores in the cases and controls were - 9.8 ± 3.2 and 13.4 ± 1.5 (p = 0.001), respectively. The mean taste scores were significantly lower among the cases than controls, salt taste-2.82 ± 1.1 and 3.7 ± 0.7 (p = 0.001), sour taste - 2.2 ± 1.0 and 3.2 ± 0.7 (p = 0.001), sweet taste-, 2.9 ± 1.8 and 3.8 ± 0.5 (p = 0.001), bitter taste - 1.9 ± 1.2 and 2.8 ± 0.9 (p = 0.001). Taste dysfunction is prevalent among patients with CKD and the affectation involves all taste modalities.

SELF-REPORTED OLFACTORY, GUSTATORY AND OTOLOGIC DYSFUNCTIONS AMONG COVID-19 POSITIVE ADULTS IN NIGERIA- A PRELIMINARY REPORT.

INTRODUCTION: The pathophysiology of COVID-19 is evolving. We investigated self-reported sudden loss of sense of smell and taste, and otologic disorders among COVID-19 patients. METHODS: This was a case-control olfaction, gustation and otology study of COVID-19 RT-PCR tested adults. The study took place at the isolation centres for COVID-19 positive individuals in Abuja and Ibadan, among the epicentres of the disease in Nigeria. The participants were 46 COVID-19 positive adults and 46 COVID-19 negative adults. They responded to a validated online questionnaire-based on olfactory, gustatory and auditory loss. Chi-square tests and correlation analysis was done. Level of significance was at P<0.05. RESULTS: Among cases, sudden loss of smell, taste and hearing were reported by 14 (30.4%), 8 (17.4%) and 5 (10.9%) cases respectively during the COVID- 19 infection. First symptom was loss of smell in 7 (15.2%) and loss of taste in 2 (4.3%) cases. The controls did not present with any of the symptoms. There was no significant correlation between loss of smell and age (r = 0.023, p=0.879); sex (r = -0.132, p=0.382) and co-morbidities (r = -0.028, p = 0.857). Similarly, there was no significant correlation between loss of taste and age (r = 0.052, p = 0.732); sex (0.040, p = 0.792) and co-morbidities (r = -0.014, p = 0.925). CONCLUSION: Sudden loss of smell and taste are commoner among COVID - 19 positive adults than those without the infection in Nigeria. There is evidence of associated reduction in hearing acuity but further study with objective audiometric testing is recommended.

HEARING LOSS AMONG ADOLESCENTS ON ANTIRETROVIRAL THERAPY: A NEED FOR PERIODIC HEARING ASSESSMENT.

AIM: Background: Human immunodeficiency virus-infected adolescents have insufficient CD4 T cell count, and despite attaining viral suppression with HAART regimen, some experience significant hearing loss. OBJECTIVE: To determine the association between the hearing thresholds in HIV-positive adolescent on highly active antiretroviral therapy and CD4 T cell count. METHODS: In this cross-sectional study, 63 adolescents receiving highly active antiretroviral therapy had pure tone audiometry and hearing thresholds determined using standard method. Additional data collected using proforma include biodata type of HAART regimens, treatment duration, the nadir and current CD4-cell count (cells/ml) and viral load (copies/ml) levels. These clinical parameters were correlated with hearing thresholds. Statistical analysis done included univariate analysis and multivariate logistic regression using Statistical Product and Service Solutions (SPSS version 20) and level of statistical significance was determined at P < 0.05. RESULTS: There were 63 participants comprising of 26 (41.3%) males and 37 (58.7%) females, age ranged from 13 - 17 years (mean age 14.7years ± 1.65). Hearing loss was found in 20.6% adolescents and was predominantly sensorineural hearing loss. There was asoociation between hearing threshold, nadir CD4 count and viral load, but not with gender, current CD4 count and viral load, HAART regimen, and treatment duration. CONCLUSION: The high prevalence of adolescents with hearing impairment showed that there might be an association with the disease and/its treatment hence the need for inclusion of periodic hearing evaluation in the routine clincal care of HIV-infected adolescent on HAART.

Long-term effects of Maternal HIV Infection and Anti-Retroviral Medications on the Hearing of HIV-Exposed Infants.

BACKGROUND: The long-term effect of maternal HIV and antiretroviral medication on the hearing of HIV-exposed infants has not been well studied. We determined and compared the hearing thresholds of HIV-exposed infants with that of HIV-unexposed infants within the first month of life and at three, six and nine months of life. MATERIALS AND METHODS: This was a Case control study of 126 HIV-exposed newborns and 121 HIV-unexposed newborns. Data collected included Socio-demographic, clinical characteristics and risk factors for hearing loss. Hearing was evaluated at newborn, 3, 6, and 9 months of life. Within and between groups analyses were done with appropriate statistics. Level of significance was P<0.05. RESULTS: In both ears, the mean hearing thresholds of HIV-exposed infants were greater than those of the HIV-unexposed infants at baseline, 3, 6 and 9 months (P>0.05). In both groups, there was a decline in the mean hearing thresholds from baseline (new born) till 6 months of age. The highest mean threshold was recorded at 9 months. The mean hearing thresholds of infants at 3, 6, and 9 months were lower for HIV-exposed infants and higher for HIV-unexposed infants than the corresponding mean hearing thresholds measured at baseline. There was a significant strong correlation among hearing thresholds at 3, 6 and 9 months but weakly correlated with hearing thresholds at baseline. CONCLUSION: There was a tendency towards higher hearing thresholds in HIV-exposed infants than the HIV-unexposed infants throughout the infancy period. This appears to have association with in-utero exposure to HIV.

Comparison between olfactory function of pregnant women and non-pregnant women in reproductive age group in Ibadan, Nigeria.

BACKGROUND: Pregnant women require normal olfactory function in order to develop good appetite for healthy living and normal fetal development. This study was carried out to investigate and compare olfactory function of pregnant women with non-pregnant women. METHODS: This was a case control study of women in reproductive age group at the University College Hospital, Ibadan, Nigeria from July 2014 to February 2015. Consecutive 70 pregnant women and 70 non-pregnant women (controls) without rhinologic symptoms were studied. A structured questionnaire was administered to obtain participants' information on socio-demographics, pregnancy history, and ability to perceive smell. They subjectively rated their olfactory function on a visual analogue scale of 0 - 100. Olfactory threshold (OT), discrimination (OD), identification (OI) scores and TDI of both groups were determined with"Sniffin' sticks"kits and compared. The level of significance was P<0.05. RESULTS: The mean age of the pregnant women was 30.5±3.9years and control was 28.5±6.6years. There were more pregnant women (7.1%) with hyposmia than the non-pregnant women (2.9%). The subjective rating of olfactory function was 68.2±24.9 (median 70) and 72.3±21.6 (median 69) in pregnant women and controls respectively. The mean OT, OD, OI, TDI scores were higher in pregnant women than the controls. However, it was only in OI (P=0.000) and TDI (P=0.012) that the differences were significant. CONCLUSIONS: Pregnant women have olfactory dysfunction more than the non-pregnant women of reproductive age group. Also, they have tendency to develop loss of cognitive olfactory information more than the non-pregnant women.

Comparison between olfactory function of pregnant women and non-pregnant women in reproductive age group in Ibadan, Nigeria

Background: Pregnant women require normal olfactory function in order to develop good appetite for healthy living and normal fetal development. This study was carried out to investigate and compare olfactory function of pregnant women with non-pregnant women. Methods: This was a case control study of women in reproductive age group at the University College Hospital, Ibadan, Nigeria from July 2014 to February 2015. Consecutive 70 pregnant women and 70 non-pregnant women (controls) without rhinologic symptoms were studied. A structured questionnaire was administered to obtain participants' information on socio-demographics, pregnancy history, and ability to perceive smell. They subjectively rated their olfactory function on a visual analogue scale of 0 ­ 100. Olfactory threshold (OT), discrimination (OD), identification (OI) scores and TDI of both groups were determined with"Sniffin' sticks"kits and compared. The level of significance was P<0.05. Results: The mean age of the pregnant women was 30.5±3.9years and control was 28.5±6.6years. There were more pregnant women (7.1%) with hyposmia than the non-pregnant women (2.9%). The subjective rating of olfactory function was 68.2±24.9 (median 70) and 72.3±21.6 (median 69) in pregnant women and controls respectively. The mean OT, OD, OI, TDI scores were higher in pregnant women than the controls. However, it was only in OI (P=0.000) and TDI (P=0.012) that the differences were significant. Conclusions: Pregnant women have olfactory dysfunction more than the non-pregnant women of reproductive age group. Also, they have tendency to develop loss of cognitive olfactory information more than the non-pregnant women

Is there any relationship between hearing threshold levels and CD4 cell count of human immunodeficiency virus infected adults?

Background The role of viral load level and/or CD4 (Cluster of differentiation 4) cell count in the aetiopathogenesis of hearing loss in HIV infection is unclear. Therefore, we investigated the relationship between CD4 cell counts, viral load and hearing threshold of HIV (Human immunodeficiency virus) infected adults. METHODS: This cohort audiometric study involved consecutive HIV-infected and HIV-uninfected adults as controls. Clinical data relating to hearing loss, HIV status, and highly -active antiretroviral therapy (HAART) were obtained. Audiornetric evaluation was performed. The most recent CD4 cell counts and RNA viral load-of HIV-infected participants were obtained from clinic records. RESULTS: There were 299(66.7%) HIV-infected adults and 149(33.3%) controls with mean age of 39.64± 12.45 years and 39.60±12.45 years respectively (p=0.98). In both groups, there were more participants with left hearing loss. Mild to profound hearing loss was found in 65.9% HIV- infected participants and 53.7% controls. Majority (86.3%) of the HIV-infected participants were on HAART. The mean CD4 cell count was 654.58±289.15 in 41 HIV-infected participants not on HAART and 523.95±300.17 in 258 participants on HAART (p=0.01). Majority,- 197 (62%) HIV- infected participants with hearing loss had CD4 cell count ≤200 cells/mm3. Higher viral load significantly correlated with low CD4 cell counts (p<0.0 1; r=0. 18) and low CD4 cell count significantly correlated with high hearing threshold (p

Bacteriology of middle meatal aspirate of adult patients with chronic rhinosinusitis in Lagos. University Teaching Hospital, Lagos.

BACKGROUND: Chronic rhinosinusitis (CRS) significantly lowers the quality of life of patients. The common use of broad spectrum antibiotics for its treatment may alter the pathogens that promote the persistence of this condition. However, the data concerning the distribution of bacteria species. in patients with CRS are not consistent. OBJECTIVE: To isolate the common aerobic and anaerobic bacteria from the middle meatal aspirates of adult patients with CRS and determine their antibiotic sensitivity patterns Methods: This was a case-control study of adults with diagnosis of CRS. Middle meatal aspirate and swab were obtained from cases and control respectively for bacteriological studies. Data analysis was done using Statistical package for social sciences (SPSS) version 17 Result: Forty one aerobic bacteria were cultured. Sixty one percent of the aerobic bacteria isolated were gram positive (staphlylococcus.aureus was the most frequently found) organisms while the remaining 39% was gram negative. Fifteen peicent of the cultured isolates yielded mixed growth of both aerobes (Gram positive and gram negative).3(6%) isolates of Bacteroides species were cultured Conclusion: The present study found that Staphylococcus aureus, streptococcus pneumoniae, Proteus mirabilis, Klebsiella spp, Escherichia coli and Bacteroides spp) were the common bacterial flora in the paranasal sinuses of patients with CRS.

Sensorineural Hearing Loss and Dyslipidemia: Is There Any Relationship?

BACKGROUND: The incidence of dyslipidemia is increasing worldwide due to changes in diet and lifestyle. The aetiological role of dyslipidemia in sensorineural hearing loss (SNHL) is unclear. OBJECTIVE: To determine the association between SNHL and dyslipidemia in adult Nigerian population. DESIGN OF THE STUDY: This prospective case control study was carried out at ENT Department of University College Hospital Ibadan from August 2013 to May 2014. METHODS: The study involved consecutive adult patients (18-60 years) with SNHL. The controls were adults without SNHL matched for age, gender and socioeconomic status. Relevant clinical data were obtained. Hearing threshold was determined by standard method and fasting plasma lipid assayed for triglycerides (TG), total cholesterol (TC), high density and lipoprotein-cholesterol (HDL-C). The low density lipoprotein-cholesterol (LDL-C) was calculated from TG, TC and HDL-C using Freidewald's formulae. The values of <40mg/dl, >200mg/dl, >150mg/dl and >130mg/dl were considered abnormal for HDL-C, TC, TG and LDL-C respectively. Level of statistical significance was P<0.05. RESULTS: There were 108 participants, consisting 57 (67.7%) cases and 51 (32.9%) controls with mean age of 37.911.3 years and 37.4 11.3-year respectively (p=0.708). Abnormalities in HDL-C values was the commonly observed in both cases (64.9%) and controls (76.5%).Thirty-six (63.2%) cases had severe to profound hearing loss. There was no significant correlation between lipid parameters and severity of SNHL. CONCLUSION: The prevalence of dyslipidemia in adult patients with sensorineural hearing loss is similar to those with normal hearing. There appears to beno causal association between dyslipidemia and sensorineural hearing loss.

Comparative study of aerobic pathogenic bacteria isolates from patients with recurrent tonsillitis.

BACKGROUND: To find out if isolated aerobic bacteria pathogens from surface tonsillar swab can correctly predict the infective pathogens within the core tonsillar tissues in recurrent tonsillitis. METHODS: This was a prospective, hospital based study of 60 patients with recurrent tonsillitis at University College Hospital, Ibadan, Nigeria. Surface swabs of the infected-tonsils-biopsies-of the core tonsillar tissues were obtained. Microscopy, Culture and Sensitivity studies were performed on the specimens. The aerobic pathogens were isolated by standard microbiological methods. Data analysis was done by SPSS version 20.0. RESULTS: Only 54 (90%) surface swab specimens yielded aerobic pathogens while 47 (78.3%) core tissue specimens yielded aerobic pathogens. The tonsil surface swab for identification of aerobic pathogenic bacteria has a sensitivity of 97.7%, specificity of 31.3%, positive predictive value or precision of 79.6%, negative predictive value of 83.3% and accuracy of 80%. Overall, there was no statistical significant difference in the aerobic pathogenic organisms isolated from surface tonsillar swab and core tonsillar tissue specimens (p=0.103). CONCLUSION: Aerobic bacteria pathogens grown on tonsillar surface were not significantly different from those from core tonsillar specimenshence, the tonsillar surface swab can reliably be used to identify the pathogenic organisms in recurrent tonsillitis.

Pattern of skin sensitivity to various aeroallergens in bronchial asthmatic patients in Lagos, Nigeria.

UNLABELLED: Background: Skin prick testing is an established way of investigating respiratory allergic diseases to determine the allergen or allergens responsible for clinical symptoms as well as degree of reactivity in the individual cases. OBJECTIVE: To study the skin sensitivity to various aeroallergens by skin prick test in selected asthmatic patients (with and without concurrent Allergic Rhinitis). DESIGN: A prospective case-control study. SETTING: Tertiary Health Institution. SUBJECTS: Cases were 160 adult patients with confirmed bronchial asthma and controls were 160 subjects without bronchial asthma. METHODS: Skin prick test was performed with a panel of allergens which included house dust mites, cockroach, cat, dog, moulds, and aspergillus fumigatus on all subjects. RESULTS: Amongst the asthmatic patients 148 (92%) had positive skin tests to the allergens, this is higher than findings from previous studies carried out on asthmatics in Lagos. The house dust mite (Dermatophagoides pteronyssimus) had the highest proportion of reactions among the study group. There is a higher incidence of severe reactions to other allergens (grass mix, dog skin, cat skin, aspergillus, cockroach) in the asthmatics than the control. CONCLUSION: The skin test is a valuable diagnostic tool in detecting the presence and degree of allergy in asthmatics in our environment. However, the house dust mite was allergen that most of the subjects reacted to.

Factors contributing to poor management outcome of sinonasal malignancies in South-west Nigeria.

OBJECTIVE: To describe the clinico-pathologic manifestations of sinonasal malignancies, identify the contributing factors to delay in presentation and recommend ways of preventing them in a resource challenged environment. DESIGN: A questionnaire based cross sectional descriptive study of patients with sinonasal malignancies between 2006 and 2011. SETTING: Hospital based study at the Otorhinolaryngology Department, University College Hospital, Ibadan. PARTICIPANTS: 61 patients diagnosed with sinonasal malignancies. MAIN OUTCOME MEASURES: Patients demographic and essential medical data were collected with a structured, interviewer assisted questionnaire and results analysed using descriptive statistics. RESULTS: There were 28(45.9%) males and 33(54.I %) females; mean age 37years. The common presentations were epistaxis, nasal obstruction and facial asymmetry and 96.7% patients with squamous cell carcinoma presented in advanced disease stage (Stage 3 & 4). Over 47% patients presented a year after onset of symptoms. Factors which included self-medication, wrong advice from relations/friends to consult traditional herbalist or quacks for treatment and traditional & religious beliefs contributed to delay in presentation to hospitals. High cost of medical treatment, unwelcoming attitudes of some hospital staff, lack of confidence in orthodox medicine and proximity to health facilities were reasons given for not considering hospital as the first place to seek medical treatment. CONCLUSION: Health education to create awareness of sinonasal malignancies and provision of affordable and accessible health facilities especially in rural areas are recommended ways to encourage patients to present early in hospitals. This will improve the management outcome and quality of life of patients with sinonasal malignancies.

Phleboliths from venous malformations of the head and neck.

OBJECTIVES/HYPOTHESIS: Phleboliths in venous malformations (VM) of the head and neck are often observed and may cause significant symptoms. Only a few articles refer to the morphology and composition of the phleboliths in VM. The objective of this study was to analyse and to demonstrate their composition and morphology. METHODS: Patients with VM presenting to a vascular anomalies centre during a three-year period were identified. The incidence of phleboliths was analysed followed by morphological and structural analysis with cone beam tomography and X-ray diffraction. RESULTS: Phleboliths were identified in 28/98 patients with VM of the head and neck. Seven patients underwent conventional surgery to reduce the volume of the VM or to remove the phleboliths, which were localized in the cheek (3 cases), submandibular region (2 cases), infrahyoidal neck or upper eyelid (1 case each). The structural analysis showed that more advanced lamination and an increasing radiopacity of the cortex was observed in larger phleboliths. X-ray powder diffraction analysis revealed that the main constituent in the pulverized phleboliths was carbonate-fluorohydroxylapatite. CONCLUSION: This study shows in a vivid way that phleboliths from VM of the head and neck area show a laminar structure and consist of apatite, without any indication of differences in their chemical composition. Treatment of localized intravascular coagulopathy in VM might be able to prevent the formation and the progression of phleboliths. Hypothetically, another option might be lithotripsy.

Routine Electrocardiography Request in Adenoidectomy: Is it necessary?

To evaluate the relevance of routine electrocardiographic request in pre-operative work-up of children undergoing adenoidectomy. This is a two year prospective study of children with obstructive adenoid that had adenoidectomy. This is a tertiary hospital based study at the Otorhinolaryngology Department of University College Hospital, Ibadan. Children (≤12 years) with clinical and radiological evidence of an obstructive adenoid were investigated. Information obtained with an interviewer assisted questionnaire included the biodata, clinical presentation of the patients, ECG findings, echocardiographic findings, cardiothoracic ratio, palatal airway and ratio of adenoid diameter to the nasopharyngeal diameter. The adenoid volume was measured after adenoidectomy. The results were analyzed using SPSS version 14 and level of statistical significance was P < 0.05. There were seventy four patients; 45 (60.8%) males and 29 (39.2%) females with a mean age of 38.35 months, S.D ± 30.32 (range 5-144 months). All the patients presented with mouth breathing and recurrent mucopurulent rhinorrhea. Mild snoring was detected in 18 (25%) patients, moderate snoring in 39 (54.17%) patients and severe snoring in 15 (20.83%) patients. Mild apnea was observed in 55 (74.32%) patients and moderate in 19 (25.68%) patients. Only seven (9.46%) patients had abnormal electrocardiographic findings but their ejection fraction on echocardiography ranged from 63 to 72% with a mean value of 68.17%, S.D ± 3.22. Cardiac complications of enlarged obstructive adenoid appear not to be common. Routine preoperative electrocardiography should therefore be restricted to only the high risk patients.

Radiological changes and complications associated with nasal polyposis.

BACKGROUND: Nasal polyps are pedunculated portion of oedematous mucosa of the nose or paranasal sinuses. Simple mucous or benign nasal polyps are an early recognizable clinical entity. METHODOLOGY: A 5-year (1998--2002) study of 63 nasal polyposis patients seen at the department of Otorhinolaryngology of University College Hospital Ibadan, Nigeria with radiological changes and complications was done. RESULTS: Out of these 63 patients, 55 (87 %) had associated radiological changes of which 34 (62 %) were males and 21(38%) females with M:F of 1.6:1 and with an average age of 34 years. The duration of symptoms ranged from 2 months-14 years. The radiological changes were mainly seen in the maxillary sinus (40:33%), nasal cavity (37:30%) and ethmoidal air cells (21:17%), Sinus opacifications (90-100%) constituted the most common features seen followed by nasal cavity loss of radio-translucency (97 %). 50(79 %) had complications with sinusitis (98 %) being the most common complication seen. CONCLUSION: The nasal polyposis has been found in this study to cause the radiological changes mainly in the maxillary sinus. The plain radiographs of the paranasal sinuses demonstrated by at least the occipito-frontal, occipito-mental and lateral views would show the extent of the disease in the nose and paranasal sinuses to certain good extent.