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.

Hearing loss due to wax impaction.

BACKGROUND: Deafness and hearing impairment are major causes of disability in developing countries. The World Health Organization (WHO) has pointed out that much deafness and hearing impairment is avoidable or remediable. A good proportion of patients presenting in the Ear, Nose, Throat, Head and Neck (E,N,T,H &N) Surgery Clinic of the University of Benin Teaching Hospital (UBTH),Benin City, have ear wax impaction causing hearing loss. OBJECTIVE: This study was therefore carried out to determine the prevalence of wax impaction among the aetiological factors for hearing loss, the type and severity of hearing loss due to wax impaction in our hospital. METHODS: Patients who met the inclusion criteria for the study were enrolled and Pure Tone Audiometry (PTA) threshold for each ear with wax impaction was determined at 250Hz, 500Hz, 1KHz, 2KHz, 4KHz and 8KHz by air conduction, Also bone conduction measurements were obtained at 500Hz, 1KHz, 2KHz and 4KHz. RESULTS: Forty-two out of 471 ears with hearing loss had wax impaction in this study; giving a prevalence of 8.9% for wax impaction among the aetiological factors for hearing loss. The result showed that mild hearing loss was the average and predominant type of hearing loss in terms of severity. Pure tone audiograms showed conductive hearing loss in all the patients, while 8 out of the 42 ears had a super-imposed sensorineural component, which gave a mixed hearing loss forthe ears. CONCLUSION: Wax impaction is a relatively common cause of hearing loss, usually of the mild conductive type. Appropriate strategies should be put in place for its management.

Type 1 Tympanoplasty in Benin: a 10- year review.

A review of type 1 Tympanoplasty operations (myringoplasty) done on thirty (30) ears in the University of Benin Teachinhg Hospital, Benin City, (UBTH) during a ten - year period was carried out. The patients were aged 21 to 69 years, and consisted of 21 males and 9 females. 15 (50% ) of the ears had medium to large sized central perforations whilst 13 (43.3 % ) were subtotal perforations. Two cases (6.6% ) had marginal perforations. The overall success rate in terms of full graft take was 66.6%, whilst 32.3 % had partial take of the graft. Post operative audiograms showed improvement in hearing in 77% of those cases for which records were available. However long term outcome both for graft take and hearing improvement was impossible to establish due to poor follow-up compliance in the majority of patients. Although there are many cases of chronic suppurative otitis media (CSOM) with resultant persistent tympanic (TM) perforation and concomitant hearing defect in the community, the relutance or inability of patients to have reconstructive ear surgery, relative lack of the facilities for the operation in our hospitals and poor follow-up compliance amongst our patients are some of the identificable problems related to this otherwise worthwhile procedure.

Nasal symptoms in bronchial asthma.

In a review of 160 consecutive cases of bronchial asthma, 127 (79%) had nasal symptoms indicative of chronic rhinitis or rhinosinusitis. There was a higher incidence of positive family history of asthma in this group (34%) than in those patients without nasal symptoms (15%). In the majority of the cases (69%) the nasal symptoms started before or at the same time as the onset of asthma; the most common symptoms being rhinorrhoea in 105 (82%) and sneezing in 101 (79%) of the patients. In 59 (46%) of the cases where a definite relationship could be established, nasal symptoms immediately preceded, precipitated or accompanied acute asthmatic episodes. Such cases improve significantly, in the severity of the asthmatic symptoms, with treatment directed at the nasal condition, and it is therefore suggested that the presence of persistent nasal symptoms be looked for as aggravating factors in asthmatics, and their underlying cause treated.

Screening audiometry in Nigerian school children

Audiometric screening tests done on 292 six-year old primary school children in Benin; shows that 9.2of the children had significant hearing impairment with elevation of hearing thresholds (HTL) above recommended screening levels at all or most of the frequencies tested; a total of 31of all subjects had some threshold elevation although in the majority of cases only one or two frequencies were affected. Otoscopic abnormalities were evident in a higher proportion of children who had hearing impairment than in those with normal hearing. The need for routine audiometric screening of school children is emphasized

Impedance screening for otitis media with effusion in Nigerian children.

Tympanometry and acoustic reflex tests performed on 431 school children aged five to six years showed that eight per cent of the ears screened had type B or type C tympanograms suggestive of otitis media with effusion (1.2 per cent type B, and 6.8 per cent type C). Preliminary otoscopy revealed tympanic membrane appearances consistent with middle ear effusion in a correspondingly low proportion of ears (7.6 per cent), whilst acoustic reflex screening at 105 dB for three frequencies (0.5, 1 and 2 kHz) showed absent reflexes at one or more frequencies in 8.1 per cent of the ears. The findings indicate a relatively low prevalence of otitis media with effusion in children in Nigeria. Possible contributory factors are discussed.

A comparison of skin test reactions in allergic rhinitis and patients with asthma/rhinitis.

A comparison of skin test reactions in allergic rhinitis patients and cases of combined allergic rhinitis and asthma shows a significantly higher proportion of positive reactions to all allergens tested in the asthma/rhinitis patients. Both groups of patients exhibited as expected more positive reactions than a group of controls with house dust mite, and house dust eliciting the highest proportion of reactions. The asthma/rhinitis patients also showed a higher ratio of strong (grades III and IV) to weak (grades I and II) reactions than the allergic rhinitis group. This indicates a stronger allergic sensitivity state in the former group and may be of relevance in deciding the modalities of management.

Assessment of auditory function in sickle cell anaemia patients in Nigeria.

The auditory function of 30 patients with homozygous sickle cell disease (sicklers) was compared to a control group of 20 patients with a normal haemoglobin AA (non-sicklers). The sicklers exhibited a relatively higher mean pure tone hearing threshold at most frequencies than the control group, the difference at 4000 cps being statistically significant. The sicklers and non-sicklers (control group) did not show any significant differences in the pattern of tympanograms, static middle ear compliance and mean acoustic reflex thresholds, suggesting essentially normal middle ear mechanisms in both groups. The higher mean pure tone hearing threshold in sicklers may be due to inner ear sensori-neural deafness due to lifelong vaso-occlusion of some of the micro-vasculature supplying the inner ear apparatus in sicklers. Clinical implications are discussed and the need for periodic assessment of auditory function in Nigeria sicklers for preventive management of auditory problems is emphasized.

Pneumatisation of the maxillary sinus in normal and symptomatic children.

The pattern of pneumatisation and normal width of the maxillary sinus in 191 Nigerian infants and children whose age range was 6 months to 14 years was determined. Fifty-four percent of children with no respiratory tract or sinus infection had an opaque maxillary sinus. A figure of 44.5% was obtained amongst children with suspected bronchopneumonia. Only 41.5% of suspected cases of sinusitis, acute and chronic middle ear disease had opaque sinuses. The highest rate of sinus opacity was seen in children under 2 years who were asymptomatic. The mean maximal width of the normally aerated sinus was 8.74 mm for children under 2 years, 16.5 mm for 3-6 years, 21.5 mm for 7-11 years and 25 mm for children 12 years and above. We conclude that maxillary sinus opacity in our experience is an unreliable index for the diagnosis of sinusitis in children.