Comparing Hearing Loss in Children with Adults Living with Sickle Cell Disease and Sickle Cell Traits.

BACKGROUND: Hearing loss is a neurological sequelae associated with sickle cell disease (SCD) and probably sickle cell trait (SCT) in children and adults but remains understudied. AIM: This study aimed to compare the hearing impairment among children and adults living with SCD or SCT. METHODS: A comparative cross-sectional study conducted in four departments with SCD outpatient clinic in a tertiary hospital in Nigeria. Participants with Sickle cell disease (HbSS) and Sickle cell trait (HbAS) (cohort) and HbAA (control) had comprehensive ear and hearing assessments for sensorineural hearing loss. Audiometric results were categorized according to WHO classifications and data analysed with Statistical Analysis System (SAS 9.4). RESULTS: A total of 212 participants (106 cohort and control, respectively), aged 6 months to 55 years, were enrolled. Of these, 35% of children with SCD and 25% with SCT had hearing impairment, while 30% of adults with SCD, 36.1% with SCT, and 11% with HbAA had hearing impairment. There was asymmetry in the hearing impairment, with the left ear more affected in children and the right ear in adults. The odds ratio (OD) of hearing impairment was higher in HbSS (2.48 (95% confidence interval (CI):1.51-4.14); P = 0.0004) and HbAS (2.28 (95% CI: 1.1-4.58); P = 0.02) participants compared with HbAA but was not statistically significant when adjusted for frequency of hospitalization, crises, blood transfusion and routine drugs in HbAS (P = 0.49) unlike HbSS (P = 0.03). CONCLUSION: The prevalence of hearing loss among children and adults with SCD is higher than in those with HbA genotype. The frequency of hospitalization, crises, blood transfusion and taking routine drugs may influence hearing impairment in SCT but may not in SCD.

Sensorineural Hearing Loss among Hypertensives.

BACKGROUND: The effect of hypertension on the vascular system leads to Target Organ Damage (TOD). The cochlea is one of the target organs affected by hypertension, giving rise to Sensorineural Hearing Loss (SNHL). OBJECTIVE: To determine the prevalence and pattern of Sensorineural Hearing Loss (SNHL) among hypertensives. DESIGN: Case-Control Study. SETTING: Tertiary hospital. SUBJECTS: Two hundred and twenty six hypertensives, aged 21 to 60 years and a corresponding number of age and sex matched control. METHODOLOGY: Eligible participants were prospectively evaluated. Their blood pressures were verified, hearing thresholds assessed through Pure Tone Audiometry, Pure Tone Average were calculated and the types and degree of hearing loss were confirmed. Data was analyzed using SPSS 21 and statistical significance was set at p-value 0.05. RESULTS: Each group had 127 (56.19% ) females and 99 ( 43.81 % ) males. The difference in the mean age between the cases (40.02 ± 0.70years) and the controls (37.42 ± 0.47years) was not statistically significant (p = 0.542).The difference in the mean Pure Tone Average in dBHL between the cases (15.53± 6.95) and the controls (13.98 ± 4.35) was significant (p = 0.005) with a 12.83% prevalence of SNHL among the hypertensives against 1.77% in the controls. Majority (96.6 %) of them demonstrated bilateral, symmetrical, mild SNHL with 51.7% of them being above 50 years. The odds ratio in this study was 8.17 (p = 0.0001). CONCLUSION: This study demonstrated a SNHL prevalence of 12.83% with a mild, bilateral, symmetrical pattern among hypertensives; increasing with advanced age and an eight-fold risk of occurrence.

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.

Age-related hearing loss at Gwagwalada area council of federal capital territory, Abuja.

BACKGROUND: Presbyacusis is a cause of hearing loss in adults worldwide. It is a type of auditory dysfunction thought to be due to a series of insults over time including agerelated degeneration, noise exposure, and diseases of the ear. It usually affects the high frequencies of hearing. Presbyacusis has a tremendous impact on the quality of life of millions of the aged and is fast becoming an increasingly prevalent disorder as the population ages. Nigerian population is becoming progressively older making it imperative to focus on this area of research. It is worth noting that the Nigerian public health system does not have an effective and sustainable hearing loss screening strategy for lateonset hearing loss in adults. AIM/OBJECTIVE: This study evaluated the hearing threshold and pure tone audiometric pattern/s seen in participants with agerelated hearing loss (ARHL) in Gwagwalada Area Council of the Federal capital territoryAbuja. SUBJECTS AND METHODS: The study was a prospective communitybased crosssectional study, and a multistage sampling technique was adopted for this study, conducted at Gwagwalada, Abuja. Individuals from 55 years and above were recruited into the study after signing an informed consent. After a thorough and detailed clinical assessment, tympanometry and diagnostic puretone audiometry were carried out in all the participants. RESULT: One hundred and fourteen participants were recruited into the study, out of which fourteen were excluded from the analysis on account of various exclusion criteria. The age range of the participants was 55 to 79 years, with a mean age of 65.8 ± 5.6 years.Twentyfive (25.0%) participants had normal hearing threshold, while seventyfive (75.0%) participants had sensorineural hearing loss (SNHL). CONCLUSION: The study showed that the prevalence of ARHL from age 55 years and above at Gwagwalada Area Council, of FCT, Abuja was 75.0%.

Skin Prick Test Analysis in Allergic Rhinitis Patients: A Preliminary Study in Abuja, Nigeria.

Allergic rhinitis (AR) is prevalent in Nigeria, though little information exists on the allergen. We assessed the clinical features of AR patients in our environment based on the allergic rhinitis impact on asthma (ARIA) classification. Only patients with positive skin prick test (SPT) were recruited. Seventy-four patients participated in the study. AR and asthma comorbidity were observed in 13.5%. The proportion of "sneezers-runners" was higher than "blockers" with significantly more "sneezers-runners" having persistent AR (P = 0.007). No relationship was established between these predominant symptoms and the aeroallergens used in this study. Intermittent mild and moderate/severe AR were evident in 13.5% and 31.1%, while persistent mild and moderate/severe were seen in 20.3% and 35.1%, respectively. House dust mites allergen yielded the highest number of positive responses (22.6%) followed by tree pollen (16.8%). No relationship was observed between the allergens tested and AR severity. Majority of patients were oligosensitive (33.8%) and polysensitive (35.1%) and were not significantly associated with AR severity (P = 0.07). Most AR patients presenting for treatment in Abuja, Nigeria, had moderate-severe persistent AR and showed similar SPT sensitization pattern with countries having similar climatic conditions. Sensitization patterns were not related to ARIA classification or predominant AR symptoms.

Actualities of management of aural, nasal, and throat foreign bodies.

BACKGROUND: Foreign bodies (Fbs) in the ear, nose, and throat (ENT) are common presentations in healthcare settings worldwide. AIM: This study was carried out to review the modes of presentation, management, and outcome of inserted Fbs in our setting. SUBJECTS AND METHODS: A 5-year retrospective study of cases of ENT Fbs managed at two referral hospitals in Abuja Nigeria. The analysis was done with Chi-square and Pearson correlation. RESULTS: Five hundred and ninety-four patients aged 0-75 years, M:F = 1.1 (295 vs. 299) were reviewed. Prevalence was predominantly among the under 5 s; 286/594 (P = 0.001). ENT Fbs were 356/594 (59.9%), 167/594 (28.1%) and 71/59 (12.0%), respectively. Cotton wool 133/356 (37.4%) and beads 75/356 (21.1%) constituted most aural Fbs. Beads 45/167 (27.0%) and grains/seed 37/167 (22.1%) were the most common nasal Fbs while fish bones 38/71 (53.5%) and piece of metals 12/71 (16.9%) were dominant in the throat. Most cases of aural and nasal Fbs were asymptomatic. Ear syringing was the most common method for removal of aural Fbs 216/594 (60.7%) and instrumentation under direct vision for nasal Fbs 153/167 (91.6%). Furthermore, 52/71 (73.2%) of throat Fbs were removed under general anesthesia. ENT complications observed included bruises, lacerations, perforations, Epistaxis, and a case of respiratory failure. Delayed presentation (beyond 24 h) was seen in 489/594 (82.3%) of cases while failed previous attempts by untrained hands constituted 353/594 (59.4%). A strong correlation between complications and duration of Fbs insertion (R (2) = 0.8759) was established. CONCLUSIONS: Fbs in ENT are common especially among children below 5 years. Majority presented beyond 24 h, and there was a strong correlation between duration of Fbs insertion and associated complications. Repeated failed attempts and delayed referrals to otorhinolaryngologists from peripheral centers were also contributing factors to increased morbidity and hence the need for awareness.

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.

Potential roles of stem cells in the management of sensorineural hearing loss.

BACKGROUND: In the management of sensorineural hearing loss, effective therapy for degenerated hair cells, third order neurons, ganglions, dendrites and synaptic areas of the vestibulo-cochleo-cerebral pathway remains an enigma. Transplantation of stem and progenitor cells appears to be an emerging potential solution, and is the focus of this review. AIM: To review recent developments in the management of sensorineural hearing loss in the field of stem cell research. MATERIALS AND METHOD: A systematic review of the English language literature included all experimental and non-experimental studies with a Jadad score of three or more, published between 2000 and 2010 and included in the following databases: Cochrane Library Ear, Nose and Throat Disorders; Medline; Google Scholar; Hinari; and the Online Library of Toronto University. RESULTS: Of the 455 and 29 600 articles identified from Medline and Google Scholar, respectively, 48 met the inclusion criteria. These were independently reviewed and jointly analysed. CONCLUSION: Although there is not yet any evidence from successful human studies, stem cell and 'alternative stem cell' technology seems to represent the future of sensorineural hearing loss management.

Classification and management challenges of otitis media in a resource-poor country.

The clinical features and sequelae of otitis media (OM) vary depending on the duration, severity and progression of the disease. As a result, opinions on the modes of classification and management protocols have differed over the years. The need to critically appraise these opinions according to the peculiarities of each region is imperative. This work was aimed at reviewing the world literature on the subject and also highlights the limitations in management in our region. A wide literature search was conducted using the following search engines: PubMed, AJOL and University of Toronto Library. Also incorporated were essential materials obtained from the authors' clinical practices. The search engines returned 22,903 related articles on OM. Further filtration yielded 88 articles on "classification and management" and these were obtained in full and thoroughly read. Extracted materials for review spanned between 1980 and 2008. OM is prevalent the world over with potentially severe complications if inadequately managed, especially in the developing countries. It is of note that in the developing countries, poverty, ignorance, dearth of specialists and limited access to medical care amongst others conspire to worsen the course and complications of OM.

Early-onset sensorineural hearing loss in Lassa fever.

Lassa fever (LF) is a viral hemorrhagic disease which affects one-fourth to two million people annually with the fatality rate of about 10,000. It is associated with sensorineural hearing loss (SNHL) usually at the convalescent stage. Recently, cases of SNHL at the acute phase have been reported. This study was done to further investigate the incidence and features of SNHL in acute phase of LF. It is a prospective case-control study of LF patients seen with acute SNHL conducted between July 2007 and April 2009 at Irrua Specialist Teaching Hospital Nigeria. The diagnosis of acute LF was based on the clinical features and detection of IgM antibodies and/or positive Lassa virus-specific reverse transcriptase-polymerase chain reaction using primers S36+ and LVS 339 while SNHL was diagnosed clinically and confirmed with PTA and speech discrimination tests. Patients with other acute febrile illnesses were used as control. Statistical analysis was done using SPSS version 11 and Fisher's exact test while level of significance was set at p < 0.05. Out of the 37 confirmed cases of LF, 5 (13.5%) and none (0%) of the control developed early-onset SNHL (p = 0.03). Forty percent of the cases studied had negative IgM. The audiograms showed involvement at all frequency groups with pure tone average 65-85 dB and the speech discrimination 20-40%. The overall case fatality rate was 27.0%, and for early SNHL cases 60.0% (p > 0.05). The incidence of SNHL in LF infection is about 13.5% and could be a reflection of a worse disease process. There is possibility of direct viral invasion aside immunological reaction as a causative mechanism.

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.

Meniere's disease: rare or underdiagnosed among Africans.

Meniere's disease can easily be misdiagnosed because several otological disorders mimic the disease. Conflicting reports on the incidence of this disease among the Africans had been documented. The goal of our study was to verify the prevalence and clinical features of Meniere's disease in WA sub-region. A 10 year (1996-2005) retrospective study carried out in our hospital. The diagnostic criteria for the disease were outlined and Oyedeji's social classification instrument was adapted for socio-economic stratification of patients. The method of treatment and prognostic out-come were discussed. Out of 11,463 patients seen within the period, 25 (16 females and 9 males) met the diagnostic criteria for Meniere's disease. The age ranged from 27 to 75 years (mean=47.2 SD13.2) and the most predominant age group was 41-50 years. Sixty-eight percent were of low socio-economic class and the rest high. About 84% had unilateral and 16% bilateral Meniere's disease. All the patients presented with tinnitus, vertigo and audiologically confirmed sensorineural hearing loss. CT-scan and MRI were used to rule out some differentials, while caloric and recruitment tests were used to strengthen the diagnosis. Treatment regimen (conservative) outcome: 72% had good improvement, 8% fair, while 20% absconded from follow-up. The prevalence of Meniere's disease in West African sub-region is 0.22%. This prevalence among Africans may not differ from the Caucasians. Under- or over-diagnosis of the disease previously must have been responsible for the contrasting results. Appropriate diagnostic tools are necessary for accurate diagnosis of the disease.

Spectrum of otorhinolaryngology emergencies in the elderly in Ibadan, Nigeria.

BACKGROUND: The elderly (65 years and above) are a special group of patients whose illnesses and management are modified by the process of aging. It is thus the aim of this study to evaluate the spectrum of ear, nose, throat, head and neck emergencies among the elderly in Ibadan, Nigeria. METHOD: This is an eight-year (April 1996-March 2004) retrospective study of 87 geriatric patients who presented with otorhinolaryngological emergencies at our centre. RESULTS: Eighty-seven emergency cases studied constituted about 20% of the total geriatric cases seen within this period. There were 55 (63.2 per cent) males and 32 (36.8 per cent) females. The pharyngolaryngeal emergencies with upper airway obstruction constituted 55 per cent of the cases, a majority being a result of malignant lesions of the larynx and pharynx. Others were nasal 20.7 per cent, otological 11.5 per cent, oesophageal 9.7 per cent and head and neck 3.1 per cent. Most of the patients had emergency tracheostomy (54 per cent), as a prelude to their definitive management while 24 per cent were managed medically. CONCLUSION: Prevalence of emergency otorhinolaryngology cases among the elderly appears high. Most of the throat diseases with upper airway obstruction were due to malignancy. There is thus the need for increased awareness of the people through social campaigns and health education on the merits of early detection and seeking appropriate treatment for these tumours.

Retropharyngeal abscess: a clinical experience at the University College Hospital Ibadan.

BACKGROUND: Infection within the retropharyngeal space could progress on to an abscess formation resulting into retropharyngeal abscess (RPA), which can either be acute or chronic. RPA can be a life-threatening emergency, with potential for airway compromise and other catastrophic complications. This review is aimed at highlighting our experience with patients with a diagnosis of retropharyngeal abscess. METHODS: Retrospective review of thirty patients with a confirmed diagnosis of retropharyngeal abscess, who were admitted and managed within an eleven-year period (1993 to 2003) in the Otolaryngology department of the University College Hospital Ibadan. RESULTS: There were fifteen males and females each with M:F ratio of 1:1, consisting of twenty-five children and five adults and their median age was 21 months and twenty three (77%) were younger than 5 years. It was observed that while the adult patients presented early for specialist treatment, the paediatric patients presented late. The major complaints were fever (87%), respiratory distress or stridor (57%), cough (53%), neck pain/swelling (43%), and refusal of feeds (30%). Other minor complaints were throat pain, difficulty in swallowing, anorexia, and weight loss. The commonest associated symptoms seen especially among the younger age group were nasal discharge, nasal blockage, tooth-ache, snoring and limitation of neck movement. CONCLUSION: The treatment of retropharyngeal space infections in children and adults should include accurate clinical diagnosis, empirical usage of broad-spectrum antibiotics, and timely surgical drainage.

Hoarseness in adult Nigerians: a University College Hospital Ibadan experience.

BACKGROUND: Hoarseness is a major symptom of laryngeal disease. Persistent hoarseness may be an early warning of such sinister lesions as cancer of the larynx and nasopharynx, hence the need for increased awareness of this symptom and its causes. METHODS: This is a retrospective study of all hoarse adult patients seen in the Otorhinolaryngology clinics of the University College Hospital Ibadan over an 8-year period (1995-2002). RESULTS: The total study population of 124 patients consisted of 72 (58.06%) males and 52 (41.94%) females with an overall mean age of 46.98 years and age range 16-84 years. The mean duration of hoarseness before presentation was 23.29 months; 56 (45.2%) patients presented within 6 months of onset of hoarseness. Chronic non-specific laryngitis including vocal cord nodules was the most common cause of hoarseness (55.6%). Chronic non-specific laryngitis patients had a mean age of 45.05 years. Fourteen point forty-nine percent (14.49%) of patients with chronic non-specific laryngitis smoked cigarette and drank alcohol, 60.88% were professional voice users. The other causes of hoarseness included laryngeal cancer (24.2%), recurrent laryngeal nerve palsy (8.1%) and laryngeal papilloma (6.5%). The patients with laryngeal cancer had a mean age of 57.63 years. The two male patients with laryngeal tuberculosis were all secondary to pulmonary phthisis. CONCLUSION: The causes of hoarseness are varied and late presentation may worsen the prognosis. Persistent hoarseness of more than three weeks should have detailed Otolaryngological evaluation.