Determinants of hearing loss in children with cerebral palsy in Kano, Nigeria.

BACKGROUND: Cerebral palsy (CP) is a commonly occurring disorder of movement and posture that starts in early childhood. It is accompanied by other disturbances including hearing loss which has been shown to worsen the quality of life of the patients due to problems associated with speech and language acquisition. Several factors are responsible for developing hearing loss in CP. AIMS: To determine the factors that can help in early diagnosis and treatment of hearing loss in children with cerebral palsy. METHODOLOGY: This was a hospital based cross-sectional study conducted among 165 randomly selected children with CP. An interviewer-administered questionnaire was used to obtain relevant sociodemographic and clinical information. The data collected was analyzed using Statistical Product and Services Solution (SPSS) version 21. RESULTS: The age range of the participants was 1-12 years, with a mean age and standard deviation (SD) of 4.49 ± 2.85. The male to female ratio was 2:1. The commonest type of CP encountered was of spastic variety seen in 47.3%, while the least encountered variety was of the ataxic type, seen in only 4.2%;46.7% of the children were reported to have hearing impairment by their guardian. Other comorbidities reported included epilepsy (33.9%), speech impairment (27.3%), mental retardation (17.0%) and visual impairment (8.5%). A statistically significant association was found between the presence of comorbidities (P = 0.05) and hearing loss among children with CP. CONCLUSION: Hearing impairment is common among children with CP. Several factors are associated with the development of hearing loss among children with CP. However, only presence of comorbidities was found to be a significant determinant of hearing loss among children with CP.

Microbiome of the Middle Meatus in HIV.

BACKGROUND: Infection with Human Immunodeficiency Virus (HIV) leads to immune dysfunction with increased risk of developing varied infections including opportunistic infections. It may be that a change in the microbial community of HIV patients could be contributory to their development of rhinosinusitis. However, the normal sinonasal microbiome in HIV is yet to be thoroughly studied. OBJECTIVE: To determine the bacteria in the middle meatus of HIV infected adults without features of rhinosinusitis. METHODS: Middle meatal swab specimens were collected under endoscopic guidance from 141 HIV infected patients with no sign and symptoms of rhinosinusitis. Specimen were sent for microscopy and culture. 141 HIV negative individuals were used as controls. RESULTS: Fourty eight point nine (48.9%) of swab specimen had bacteria isolated in the patients. Thirty-nine (56.5%) specimen yielded aerobes consisting of Staphylococcus epidermidis, Staphylococcocus aureus and Streptococcus; while thirty (43.5%) specimen yielded anaerobes consisting of Bacteroids and Peptostreptococcus. Staphylococcus epidermidis was the most frequently isolated bacteria. In the control group, forty-two (29.8%) of cultures were positive for bacteria. There was statistically significant difference in the bacteria isoltes (P=0.001) CONCLUSION: Bacteria isolated were similar to those isolated from the HIV negative control however there were greater number of isolates in the subjects.

A correlation of symptomatology with lung function in patients with allergic rhinosinusitis.

BACKGROUND: Allergic rhinosinusitis is clinically defined as a symptomatic disorder of the nose induced by an IgE-mediated inflammation following allergen exposure to the membrane lining of the nose. It constitutes a global health problem. Both allergic rhinosinusitis and bronchial asthma are systemic inflammatory conditions that often coexist. OBJECTIVE: The objectives of the study are to assess the pattern of allergic rhinosinusitis and to correlate nasal symptom score with lung volumes of patients with allergic rhinosinusitis. METHODS: This is a prospective study of all the adult patients with clinically diagnosed allergic rhinosinusitis at the study center. Patients' biodata, symptoms, and signs were obtained using a specially designed form. The symptoms were scored using nasal symptom scoring protocol and the lung volumes determined using spirometry. The data were collated and analyzed using SPSS Version 15 statistical software. RESULTS: There were 300 patients and another 300 nonallergic individuals as control. The most common presenting symptom was nasal congestion (98%), whereas the most common sign was engorged turbinates (91%). The most common trigger of allergic symptoms was dust (72.3%). Spirometric test results were below 90% on average in both sexes and significantly (P < 0.05) below those of the participants in the control group. A large number of patients with abnormal spirometry results have total nasal symptom scores of above 5 (n = 119), whereas few (n = 7) had symptom scores of 5 and below. There was a statistically significant correlation between high total nasal symptom score and abnormal spirometry (χ2 = 72, P = 0.0001). CONCLUSION: There is a significant correlation between nasal symptom score and reduced lung volumes in patients with allergic rhinosinusitis even in the absence of asthma.

Sensorineural hearing loss in patients with chronic suppurative otitis media.

Even though there are other complications of chronic suppurative otitis media, the aspect of hearing loss is often studied. Nevertheless, the occurrence of sensorineural hearing loss in patients with this disease is still controversial. This study aim (1) to assess the association between sensorineural hearing loss and chronic suppurative otitis media, (2) to investigate some clinical factors that might affect the sensorineural component in patients with this disease. This was a retrospective analysis of the clinical records and pure tone audiograms of patients with chronic suppurative otitis media in a Nigerian Tertiary Health Institution from January 2003 to December 2008. Sixty-nine patients with a mean age of 28.93 years; standard deviation of 18.593 were studied. They had an age range of 4-73 years. The duration of otorrhea ranged from 2 months to 20 years; with a mean of 6.11 years (standard deviation of 6.393). The mean bone conduction threshold in the diseased ear was 39.07 dB (standard deviation of 12.028), and 10.26 dB (standard deviation of 2.620) in the control ear (P < 0.05). The mean bone conduction threshold differences between the diseased and control ears range from 21.69 to 34.52 dB across the frequencies 0.5, 1.0, 2.0, and 4.0 kHz. These differences tended to increase with increasing frequency and were all significant (P < 0.05). In the diseased ears, there were no significant correlation between the age, duration of otorrhea, and the degree of SNHL (r = 0.186, P > 0.05; r = 0.190, P > 0.05 respectively). Patients with chronic suppurative otitis media had a significant degree of sensorineural hearing loss in this study. The higher frequencies were more affected; however, the patient's age and duration of otorrhea seem not to have any correlation with the degree of sensorineural hearing loss.

Otology practice in a Nigerian tertiary health institution: A 10-year review.

BACKGROUND: The practice of otology in developing countries has remained unsatisfactory. The aim of this study is to describe the practice in a tertiary health institution with a view to articulate strategies for improvement. MATERIALS AND METHOD: This a retrospective study of patients with otology problems, who attended Ear, Nose and Throat clinic of Aminu Kano Teaching Hospital, Kano, over a 10-year period (1997-2007). Case notes were retrieved and studied. RESULTS: Otologic conditions accounted for 56.3% of the 8070 clinic visits. The most frequent condition seen was chronic otitis media (25.4%). Sensorineural hearing loss (mostly preventable) accounted for 16%. Other cases included wax impaction (7.5%) and foreign body in ear (7.3%). Modern diagnostic and operative equipment were lacking. Operative surgery was offered to 4% of cases of chronic suppurative otitis media and 72% of patients needing hearing aid could not afford one. There was no middle ear reconstructive or inner ear operation in the 10-year period. CONCLUSION: A significant number of patients are in need of otology services. These services are inadequate presently. Concerted effort should be geared toward strengthening preventive ear health, training and re-training, procurement of relevant diagnostic and operative equipment.

Pattern of ototoxicity in a Nigerian teaching hospital.

INTRODUCTION: Ototoxicity is a preventable cause of irreversible sensorineural hearing loss. This paper aims to highlight the pattern of ototoxicity seen in a tertiary health institution. METHOD: A retrospective study of patients with ototoxicity seen over a seven year period at ENT department of Aminu Kano Teaching Hospital, Kano. Case notes were retrieved and studied. RESULTS: Fifty nine patients made up 37 males and 22 females were seen with 86% in the age group 20-60 years. The commonest ototoxic drugs were aminoglycosides (37.3%), loop diuretics (27.1%), antimalarials (23.7%) and traditional concoctions (11.9%). The commonest presentation from most drugs was permanent sensorineural hearing loss (50-85%). Associated comorbid conditions included "febrile illness" (475%), hypertension (30.5%), diabetes mellitus (13.6%), renal disease (5%). Follow-up was poor. Only 18 patients presented for review beyond a second hospital visit, only those with ototoxicity from antimalarials recovered hearing. There were no effective audiometric and serum drug monitoring mechanism in place before, during or after therapy with ototoxic medications. CONCLUSION: Ototoxicity is not uncommon and attempts at prevention are feeble. Increased awareness of this condition is advised. High frequency audiometric assessment, otoacoustic emission and serum drug monitoring facilities should be provided at health institutions. Caution should be exercised when prescribing ototoxic drugs in the presence of other risk factors.

Plain radiographic evaluation of the nasopharynx: do raters agree?

BACKGROUND: Subjective plain radiographic evaluation of the nasopharynx has been a widely adopted technique. Although it has its own limitations, its ease of interpretation and simplicity are some of its advantages. AIM: To investigate the reliability, using kappa, in subjectively reporting plain nasopharyngeal radiographs in children with symptoms suggestive of enlarged adenoids. METHODS: This was a retrospective study of the clinical records, and plain X-rays of the nasopharynx of paediatric patients with clinical features of adenoid hypertrophy in a Nigerian Tertiary Health Institution from January 2008 to December 2008. RESULTS: Fifty-one children with a mean age of 3.4 years; standard deviation of 2.772 was studied. They had an age range of 2 months to 12 years. Most (66.6%) of the children studied were in the age bracket 0-4 years. The inter-rater reliability between the two Otolaryngologists, and that between an Otolaryngologist and a Radiologist using kappa statistics were 0.6696, 95% CI (0.5035-0.8357; p<0.05) and 0.8182, 95% CI (0.7073-0.9291; p<0.05) respectively. While the kappa intra-rater reliabilities for the two Otolaryngologists were 0.6931, 95% CI (0.5473-0.8389) and 0.9591, 95% CI (0.9033-1.000). CONCLUSION: There was a high level of agreement among trained raters, in subjectively interpreting plain nasopharyngeal radiographs in children with suspected adenoidal obstruction.

Otology Practice in a Nigerian Tertiary Health Institution: A 10-Year Review

Background : The practice of otology in developing countries has remained unsatisfactory. The aim of this study is to describe the practice in a tertiary health institution with a view to articulate strategies for improvement. Materials and Method : This a retrospective study of patients with otology problems; who attended Ear; Nose and Throat clinic of Aminu Kano Teaching Hospital; Kano; over a 10-year period (1997-2007). Case notes were retrieved and studied. Results : Otologic conditions accounted for 56.3of the 8070 clinic visits. The most frequent condition seen was chronic otitis media (25.4). Sensorineural hearing loss (mostly preventable) accounted for 16. Other cases included wax impaction (7.5) and foreign body in ear (7.3). Modern diagnostic and operative equipment were lacking. Operative surgery was offered to 4of cases of chronic suppurative otitis media and 72of patients needing hearing aid could not afford one. There was no middle ear reconstructive or inner ear operation in the 10-year period. Conclusion : A significant number of patients are in need of otology services. These services are inadequate presently. Concerted effort should be geared toward strengthening preventive ear health; training and re-training; procurement of relevant diagnostic and operative equipment