Tympanometric findings among adult HIV patients undergoing a short-term treatment with high active antiretroviral therapy (HAART) in port harcourt.

Background: In our practice as ENT specialists, people living with Human immunodeficiency Virus/acquired immunodeficiency syndrome (HIV/AIDS) have presented at the clinics with symptoms suggestive of otitis media with effusion such as the sensation of fluid in the ear, aural fullness and hearing loss. Eustachian tube dysfunction which is often the beginning of middle ear pathology could be caused by nasal allergy, upper respiratory tract infection, or obstruction by a nasal pharyngeal lesion such as lymphoid hyperplasia which is a common feature in people living with HIV/AIDS. Tympanometric findings give a measure of the objective assessment of middle ear function. Aim and Objective: This study was designed to determine tympanometric findings among adult patients undergoing short-term treatment with HAART in Port Harcourt. Patients and Methods: A hospital-based study involving 150 HIV-positive patients that received the same HAART treatment over 6 months and a control group of 150 HIV-negative individuals in Port Harcourt. The data extracted includes; the patient's ear symptoms, otoscopic findings, and tympanogram. Data were analyzed using SPSS version 20 and statistical significance was set at P > 0.05. Results: There was a high proportion of type B-Typanogram at baseline (Rt ear 24[16.0%], left ear 23 [15.3%]) and at repeat (Rt ear 23 (15.3%), Lt ear 21 (14%) evaluations. Also, there was a relatively high proportion of type C- tympanogram at baseline {right ear 18 (12%), left ear 15 (10%)} and at repeat Rt ear 14 (9.3%), Lt ear 10 (6.7%)} evaluations. Conclusion: One out of every eight patients living with HIV infection may likely have Eustachian tube dysfunction while one out of every five may have developed otitis media with effusion already. There was no significant change in tympanometric findings after treatment with HAART.

Prevalence of hearing loss among newly diagnosed highly active antiretroviral therapy (Haart) naive adult patients in port harcourt.

Background: Numerous studies have reported a relationship between human immune deficiency virus (HIV)/acquired immune deficiency virus (AIDS) and auditory functions. There is a dearth of information on the prevalence of hearing loss among newly diagnosed HAART naïve adult patients. Aim: This study therefore provides baseline information on the prevalence of hearing loss among newly diagnosed HAART naïve adult patients in Port Harcourt and serves as a reference for the role of HAART in HIV related hearing loss and for future studies. Patients and Methods: This is a prospective cross-sectional study involving 260 participants; 130 newly diagnosed and 130 HIV-negative controls aged 18 to 50 years from two centers in Port Harcourt from July, 2018 to January, 2019. Participants were clerked and diagnostic pure tone audiometry was done. Results: The rate of hearing loss was observed with Pure Tone Audiometry to be higher (P-value = 0.001) among newly diagnosed HAART naive adult patients 37 (28.5%) in comparison to the control 8 (6.2%). The mean age of all the study participants was 31.80 ± 9.61 years (study group 32.18 ± 10.18 years, control group 31.42 ± 9.12 years). Gender characteristic of participants also showed that males were 46 (35.4%) and females 84 (64.6%) giving a male, female ratio of 1:1.83 among newly diagnosed HAART naive adults, while among the control group there were males 49 (37.7%) and female 81 (62.3%) giving male: female ratio of 1:1.65. The rate of hearing loss at baseline was significantly (P = 0.001) higher among 37 HIV-positive HAART naïve patients (28.5%) compared with 8 control patients (6.2%). Conclusion: There was significant proportion of hearing loss among newly diagnosed HAART naive adult patients in Port Harcourt.

The Pattern of Foreign Body Impactions in the Tracheobronchial Tree in University of Port Harcourt Teaching Hospital

Background: Foreign body aspiration in the tracheobronchial tree usually presents as emergency. The diagnosis is often delayed. Aim: To determine the pattern of foreign body aspiration in the tracheobronchial tree in the University of Port Harcourt Teaching Hospital (UPTH) and to highlight the factors responsible for the morbidity and the unusually high mortality associated with this accident especially in the paediatric age group. Methods: This was a retrospective study of patients from the ENT Surgery department of UPTH over a ten-year period from January 1995 to December 2004. The Clinics record of attendance; augmented by ward and theatre records formed the material resource for this study. Extracted data was analysed using descriptive statistics. Results: Twenty-eight patients presented with foreign body aspirated in the tracheobronchial tree. Only 11 case notes were retrieved. There were 5 males (45.5) and 6 females (54.5) with a M: F ratio of 1:1.3. The age range was 1 to 45 years with a median age of 6 years. Children below 10 years made up the bulk (63.3). Groundnut was the commonest foreign body inhaled (45.5) while the right main bronchus was the site of lodgment in 9 patients (81.8). The outcome of treatment by the specialists showed a success rate of 63.3and mortality of 36.4. Conclusion: Foreign body in the tracheobronchial tree could be managed with better prognosis in the pediatric age group if the clinicians of first contact had a high index of suspicion and referred cases promptly

The perception of Patients of Doctor-Patient Relationship in Otorhinolaryngology Clinics of the University of Port Harcourt Teaching Hospital (UPTH) Nigeria

Background: The doctor-patient relationship is central to the practice of medicine and is essential for the delivery of high quality healthcare in the diagnosis and treatment of diseases. Recently; patient participation has gained increasing prominence in healthcare delivery. Aim: To explore the perceptions of Nigerian adult patients who attend the University of Port-Harcourt Teaching Hospital (UPTH) Otorhinolaryngology clinics with regard to relation with their doctors during consultations. Methods: This is a descriptive cross-sectional study; the duration of the field work was two weeks. The study population consisted of adult patients who attended the otorhinolaryngology clinics. Data collection was carried out using interviewer-administered semi-structured questionnaires that explored the perception of patients of doctor-patient relationship. Forty patients were selected for the study and the sampling was purposeful. An average of twenty interviews was conducted per clinic day. Each interview took approximately 15 minutes. Results: The majority (95) of patients' treatment was decided by the doctors. The majority of the patients (87.5) welcomed the opportunity to have more involvement in making treatment decisions. Most of the patients (67.5) were not satisfied with the services received from their doctors. Conclusion: This study established paternalistic model as the dominant pattern of doctor-patient relationship in UPTH otorhinolaryngology clinics. The patients preferred a more cordial relationship

The pattern of cut throat injuries in the University of Port-Harcourt Teaching Hospital, Portharcourt.

BACKGROUND: The incidence of cut throat injuries irrespective of the cause is on the increase worldwide but they are underreported in Nigeria. The neck contains a lot of vital organs and great vessels which make the patients with injuries to the neck to present most times as emergency. The management of cut throat injuries is bedeviled with complications which can be reduced to the barest minimum if managed by the specialists. Our aim and objectives are to determine the pattern of cut throat injuries as seen in University of Port-Harcourt Teaching Hospital (UPTH) and to highlight the factors responsible for the morbidity and the mortality associated with this condition. METHODOLOGY: The study is a retrospective review of cut throat injuries that presented to the Ear Nose and Throat (E.N.T.) department of University of Port-Harcourt Teaching Hospital (U.P.T.H.) over a 10 yr period (1995 to 2010). The accident and emergency department records; ward records and theatre registers were the main source of the information. Twenty four cases were recorded and analyzed. The data extracted for analysis were age, sex, occupation, clinical presentation, treatment, duration of stay and complications. RESULTS: All the patients were males; age range was 26-45 years. The commonest age group affected was 31-35 years, suicide accounted for 60% of cases. Majority (62.5%) of patients were unemployed. Lacerations of the anterior aspect of the neck, aphonia with exposure of the thyroid cartilage were the commonest clinical features. Majority (58.3%) of the patients had complications following treatment while two patients had mortality. CONCLUSION: Cut throat injuries require a multidisciplinary approach and could be managed with better prognosis if the patients present early to the hospital and are given prompt attention. Poor socioeconomic status and poverty have been associated with a high incidence of cut throat injuries.

Does the Nigeria Health Care System Need a Primary Gate-Keeper?

Background: The World Health Organization (WHO) is presently focusing more attention on how health systems will become more effective and efficient. Introduction of primary gate-keepers into healthcare systems by some countries has revolutionized their healthcare system. It clearly alters the channels by which patients receive care particularly in countries where specialists are in short supply. Aim: To discuss the role of primary gate-keeping in healthcare systems and to use the experience of some countries with and without a primary gate-keeper function to evaluate the Nigerian healthcare system. Methods: A search of some standard books and relevant articles on primary 'gate-keeping' and healthcare systems using the Google and Yahoo search engine facilities helped to gain access to general information on the title. We also searched the EMBASE and OVIDMEDLINE data bases using the HMIC search strategy template. Results: Healthcare services are delivered within three distinct but increasingly overlapping and fluid subsystems namely; primary; secondary and tertiary care. In the UK and Netherlands healthcare systems; the general practitioner (GP) serves as the primary gate-keeper to other professionals. On the contrary; France; Germany and Nigeria don't have effective primary gate-keeping system. However; in Nigeria family physicians run the general out-patient clinics and serve as a point of first contact and referrals. Conclusion: Gate-keepers are mainly geared towards helping a healthcare system to achieve better health levels. Unlike in the UK and Netherlands; there is no effective primary gate-keeping in the Nigerian healthcare system. Government should make efforts to address this anomaly to allow every person have effective and efficient healthcare services

Pattern of geriatric otolaryngological diseases in Port Harcourt.

BACKGROUND: There is an emerging population of senior citizens with improving standard of living and health facilities. The aim of this to document the pattern of Geriatric Otorhinolaryngological diseases in Port Harcourt. PATIENTS AND METHOD: This is a ten-year retrospective review of patients aged 60 years and above seen between January 1994 and December 2003 at the ENT Surgery Department of the University of Port Harcourt Teaching Hospital. RESULTS: Nine hundred and seventy two patients out of a total patient population of 20,600 were found to be 60 years and above. The geriatric population was thus 4.7% of our total patients. Otological disease predominated with 537 (55.2%), followed by Rhinological disease with 180 (18.5%) before Laryngological pathologies with 154 (16.4%). 65(6.7%) had unspecified diseases. CSOM was the commonest otological (25%) and Otorhinolaryngological (13.78%) problem, followed by Otomycosis Externa 94 (17.5%) and Cerumen Auris 82 (15.3%). Allergic Rhinitis was the commonest Rhinological pathology with 110 (58%) of Rhinological cases, while Chronic Pharyngitis topped the list of diseases of the throat with 62 (34.4%). CONCLUSION: This report does not differ significantly from what is reported elsewhere. The only outstanding difference is the emergence of CSOM as the most common ear disease.

Abscess of the deep cervical fascial space in adults: a report of 3 cases and review of anatomy.

Deep cervical space abscess is a disease with the potential for grave consequences if not managed properly. Even though since the antibiotic era it has been on the decline, it still occurs. Better imaging techniques have made the management of this disease better such that it is possible to treat the abscesses conservatively reserving surgical drainage for cases that fail to respond to treatment. We present 3 cases of deep cervical space abscess that were surgically drained and wide spectrum antibiotic administered. In one of the patients, there was coexisting pulmonary tuberculosis.

Epistaxis in Port Harcourt.

BACKGROUND: Epistaxis often causes significant anxiety in both patients and clinicians. Various methods of treatment have been advocated. The aim of this paper is to document the pattern of epistaxis in Port Harcourt, determine the etiologies and advocate the best treatment option. METHODS: This is a 6-year retrospective study of patients that were managed for epistaxis in the department of Otorhinolaryngology of the University of Port Harcourt Teaching Hospital, Port Harcourt, from January 2000 to December, 2005. The material resources were the records of the Otorhinolaryngology outpatient clinic and Accident & Emergency department of the hospital. These were updated with records from the ward admissions and theatre. The diagnosis of epistaxis was based on clinical history, physical findings, laboratory and radiological investigations with examination under anaestheasia of the nose, nasopharynx and biopsy. RESULTS: There were 30 patients, 16 males and 14 females with a mean age of 30.48 years +/- 15.14 [range 1-70 years]. The most commonly affected age group was 31-40 years. Idiopathic causes accounted for 66.67%, trauma 13.33%, nasopharyngeal carcinoma 10%, chronic maxillary sinusitis 6.67%, and vicarious menstruation 3.33%. The right nasal cavity was more affected than the left. The most commonly used method of treatment was anterior nasal packing (50%). Posterior nasal packing accounted for 26.67% while chemical cauterization was done in 13.3% of cases. CONCLUSION: The pattern of epistaxis in our study agrees with the pattern found elsewhere. Anterior and posterior nasal packing were cost effective methods of treatment.

Foreign bodies in the nose.

BACKGROUND: Nasal foreign bodies occur most frequently in children and most times first present to the emergency physicians. It poses a challenge to the Otorhinolaryngologist when tampered with. The objective of this paper is to determine the pattern of foreign bodies lodged in the nasal passages in Port Harcourt with a view to documenting the types and highlighting the results of management. METHODS: A retrospective study was done using 134 patients who presented with foreign bodies in the nose to the Ear, Nose and Throat clinic of the University of Port Harcourt Teaching Hospital (UPTH) and Benok Consultants Clinic both in Port Harcourt over an eight-year period from January 1993 to December 2000. RESULTS: One hundred and thirty four patients were seen with a male female ratio of approximately 1:1. Age range was 1-21 years with a mean of 3.23 years +/- 2.48 [SD] and mode of 2-years. The children within the age group 2-4 years had the highest incidence. The right side of the nose was more involved than the left with only one bilateral case noted. The foam was the commonest foreign body found. Most patients presented within the 1st day with only 15 presenting late. Most were removed in the clinic under good illumination, only 6 had to undergo examination under anaesthesia (EUA) in the theatre and these were the uncooperative patients. CONCLUSION: Foreign body in the nose is an emergency only as far as it concerns anxiety to the relations. It presents no problems in management to the Otorhinolaryngologist