Audiologic Evaluation of Patients with Head and Neck Cancers Treated with Cisplatin Based Chemotherapy: A Longitudinal Study.

Background: Recently, the incidence of head and neck cancers are on the increase globally and particularly in our environment. In addition, concurrent platinum-based chemoradiotherapy has become widely used in the treatment of head and neck malignancies. The objective of this study was to determine the effect of cisplatin-based chemotherapy on hearing in patients with head and neck cancers at our University Teaching Hospital. Methodology: This was a hospital-based longitudinal case-control study that involved 54 participants attending the oncology treatment centre of the University Teaching Hospital Zaria. The study investigated the hearing threshold and degree of hearing loss pre and post cisplatin-based chemotherapy at intervals of 3 months and 6 months. The data obtained were analyzed using Statistical Product and Service Solutions (SPSS)version 20. Results: Seventy-two participants were recruited into the study, but 54 (75%) participants met the inclusion criteria and were enrolled and as well as same age and sex match controls. Thirty-one31(57.4%) of the participants had a nasopharyngeal tumour, 14(25.9%) had Sinonasal tumour and 9(16.7%) had Laryngeal tumour. Among the study group, there were 39 males (72.2%) and 15 females (27.8%) with an M: F ratio of 2.6:1. The age of the participants ranged from 13-68 years. (Mean =40.3years. SD=13.6). Assessment of hearing in the better ear showed 22 (40.7%) of subjects and 6 (11.1%) of controls had hearing loss before the onset of the study. The majority of these patients had mild hearing loss either mixed or SNHL. In the study group, 32(29.6%) ears showed changes in hearing threshold after 3 months of cisplatin therapy while68(62.9%) ears showed changes at 6 months of therapy. The overall incidence of ototoxicity after 6 months of therapy was 62.9%. Conclusion: This study found a significant number of head and neck cancers patients with hearing impairment pre-chemotherapy. Cisplatin treatment-based chemotherapy was associated with significant short term hearing impairment in patients with head and neck cancers.

Intraoperative Dye Test in Total Laryngectomy: A Technique to Reduce the Incidence of Pharyngocutaneous Fistula.

BACKGROUND: Pharyngocutaneous fistula (PCF) could complicate laryngectomy in advanced disease. The cause is multifactorial, and this may include poor technique in pharyngeal repair. Intraoperative assessment of the repaired mucosa integrity for adequate closure may reduce PCF, but this is not routinely done. OBJECTIVE: The objective of this study is to describe a novel technique that has been successfully used to ascertain intraoperative pharyngeal repair integrity. METHODS: Thirty-one patients who had total laryngectomy and pharyngeal reconstruction for locally advanced laryngeal squamous cell carcinoma were studied. Connell extramucosal suturing technique was used for the mucosal repair. Thereafter, a small feeding tube was introduced through the oral cavity to the site of the pharyngeal repair, and diluted methylene-blue dye was injected through it while digitally occluding the cervical esophagus. Whenever leakage of the dye was seen, the leakage site (s) was repaired. Thereafter, the dye test would be repeated to confirm the integrity of the repair. RESULTS: Their mean age was 53.4 ± 10.9 years. Seven (22.6%) patients had Stage 3 disease and 24 (77.4%) had Stage 4 disease. All the patients had neck dissection, whereas 3 (9.7%) patients had salvage laryngectomy postradiotherapy. Dye test was performed intraoperatively for all the patients and leakages were seen in 4 (12.9%) patients which were successfully repaired. Oral feeding was commenced on the fifth postoperative day, and none of the patients had PCF. CONCLUSION: Performing a dye test intraoperatively helps detect the point of leakage and immediate repair will prevent PCF.

Comparison of auditory brainstem response in HIV-1 exposed and unexposed newborns and correlation with the maternal viral load and CD4+ cell counts.

OBJECTIVE: The effects of maternal HIV infection and antiretroviral therapy on hearing of HIV-exposed newborns in sub-Saharan Africa have not been investigated. We determined the prevalence of sensorineural hearing loss among HIV-exposed newborns and the association between the hearing threshold and maternal and newborn parameters. DESIGN: A cohort audiometric study of newborns between October 2012 and April 2013. SETTINGS: A secondary and tertiary hospital-based study. PARTICIPANTS: Consecutive 126 HIV-exposed and 121 HIV-unexposed newborns. INTERVENTION: Hearing screening of the newborns was done with Auditory Brainstem Response and compared with maternal HAART, CD4 cell counts, RNA viral loads and newborn CD4 cell count percentage. MAIN OUTCOME MEASURE: Hearing threshold levels of both groups were measured and analysed. RESULTS: Around 11.1% of HIV-exposed and 6.6% of unexposed newborns had hearing impairment (P = 0.2214). About 6.4% of HIV-exposed and 2.5% HIV-unexposed newborns had hearing threshold of more than 20 dBHL (P = 0.1578). There was no significant association between the hearing thresholds of HIV-exposed newborns and maternal CD4 cell counts (P = 0.059) but there was with maternal viral load (P = 0.034). There was significant difference between the hearing thresholds of HIV-exposed newborns with CD4% of 25 or less and more than 25. This study showed significant difference in the hearing of the 119 HAART-exposed newborns and seven unexposed newborns [P = 0.002; risk ratio, 0.13 (0.05-0.32)]. CONCLUSION: There was a trend towards more hearing loss in HIV-exposed newborns. However, hearing thresholds increase with increasing mothers' viral load. The background information supports the need for further studies on the role of in-utero exposure to HIV and HAART in newborn hearing loss.

Effect of strong fragrance on olfactory detection threshold.

OBJECTIVE: To assess the olfactory threshold of healthy volunteers at the University College Hospital, Ibadan and to investigate the effect of perfume on their olfactory detection thresholds. STUDY DESIGN: A quasi-experimental study on olfactory detection thresholds of healthy volunteers from September 2013 to November 2013. SETTING: Tertiary health institution. SUBJECTS AND METHODS: A structured questionniare was administered to the participants in order to obtain information on sociodemographics, occupation, ability to perceive smell, use of perfume, effects of perfume on appetite and self-confidence, history of allergy, and previous nasal surgery. Participants subjectively rated their olfactory performance. Subsequently, they had olfactory detection threshold testing done at baseline and after exposure to perfume with varied concentrations of n-butanol in a forced triple response and staircase fashion. RESULTS: Healthy volunteers, 37 males and 63 females, were evaluated. Their ages ranged from 19 to 59 years with a mean of 31 years ± 8. Subjectively, 94% of the participants had excellent olfactory function. In the pre-exposure forced triple response, 88% were able to detect the odor at ≤.25 mmol/l concentration while in the post-exposure forced triple response, only 66% were able to detect the odor at ≤.25 mmol/l concentration. There is also a statistical significant difference in the olfactory detection threshold score between the pre-exposure and post-exposure period in the participants (P < .05). CONCLUSION: Use of strong fragrances affects the olfactory detection threshold. Therefore patients and clinicians should be aware of this and its effects on the outcome of test of olfaction.