Early hearing threshold changes and peculiarities of audiometric assessments among patients in a drug-resistant tuberculosis treatment center.

BACKGROUND: Hearing threshold changes occurred relative to baseline at both one and two weeks after onset of aminoglycoside therapy. OBJECTIVES: To assess changes in audiometric hearing thresholds between pre-treatment values and two weeks into therapy. To document observed changes, and occurrence of ototoxicity within the period. METHODS: Prospective analytical cohort study on drug-resistant tuberculosis patients. Basic demographic parameters were taken. Three-point audiometric assessments within two weeks into therapy were done. Percentage of patients with ototoxicity were calculated. Pure tone threshold changes between the three audiometric values were compared. RESULTS: Audiograms of 53 patients comprising 56.6% males; age range was 13 to 91 years. Both air and bone conduction hearing thresholds significantly worsened between baseline and one week into therapy (p=0.011, and 0.015 respectively), and between baseline and two weeks into therapy (p=0.003 and 0.042 respectively). Minimal insignificant reduction occurred between both air and bone conduction hearing values of week 1 and week 2 of therapy (p= 1.000 and 0.856 respectively). By audiometric criteria, 4 patients (7.5%) developed ototoxicity within two weeks of treatment. CONCLUSION: Audiometric assessments within two weeks into therapy with anti-tuberculous therapy may not represent baseline audiometry. 7.5% of the patients developed ototoxicity within two weeks of therapy.

Traumatic tympanic membrane perforations: characteristics and factors affecting outcome.

OBJECTIVE: To characterize traumatic tympanic membrane perforation (TTMP) in terms of distribution, mechanisms, and outcome of treatment. To assess the factors influencing such outcome. STUDY DESIGN: Prospective analytical study, assessing outcomes post-injuries. SETTING: Clinical department of a tertiary referral hospital. PARTICIPANTS: Patients with TTMP based on history of trauma to the ear, and otoscopic examination confirming tympanic membrane (TM) perforation. INTERVENTIONS: Conservative, inactive treatment. MAIN OUTCOME MEASURES: Distribution and healing of perforations. RESULTS: There were 53 patients, Male: Female ratio =1.5:1, age 8-71years (Mean ±SD= 33.8 ±12.9). Median duration of injury before presentation was 3 days. 11 patients had both ears traumatized. 46.9% of perforations were in the antero-inferior part of the TM. Median size of perforations was 33.0%; Patients main complaints were blockage of the ears/ hearing loss and tinnitus. Common causes of perforations were domestic assault (28.3%), self-inflicted/ accidental injuries (20.8%), and road traffic accidents (18.9%). There was a significant difference in the mechanism/cause of injuries between the sexes (X2 =15.607, p=0.005). Traumatic perforation was caused by penetrating injuries in 22 (34.4%) ears. The outcome of TTMP was poor in 18.7%. Big sized perforations (t=2.630; p=0.011), penetrating injuries (X2 =9.263; p=0.005), and postero-superior location (X2=6.326;p=0.009) had negative impacts on the healing. CONCLUSIONS: TTMP was common in young adult males, caused often by assaults, presented with ear hearing loss and tinnitus, perforations were located in antero-inferior part of TM and most healed well. Factors associated with poor healing were postero-superior location, large size and penetrating injuries to the TM. FUNDING: Not indicated.

Otologic and audiologic characteristics of type 2 diabetics in a tertiary health institution in Nigeria / Características audiológicas e otológicas de diabéticos tipo 2 em uma instituição de saúde terciária na Nigéria

ABSTRACT INTRODUCTION: This cross-sectional comparative study was carried out at the Diabetes outpatient clinic of LAUTECH Teaching Hospital (LTH) Ogbomoso, Nigeria. OBJECTIVE: This study assessed patterns of otologic diseases and auditory acuity among type 2 diabetics and determinants of these findings among diabetics. METHODS: Ninety-seven consenting patients with clinical diagnosis of diabetes mellitus (194 ears) were matched for age and sex with ninety non-diabetic patients (180 ears). These patients were screened using otoscopy and pure tone audiometry over a 6-month period. RESULTS: The study reported a crude prevalence rate of 21.6% hearing loss in T2DM patients. The most common type of otologic disease that showed significant association with T2DM patients was otitis media with effusion (p = 0.027). T2DM was significantly associated with abnormal audiometric findings (p = 0.022), particularly sensorineural hearing loss (p = 0.022), of the moderate grade (p = 0.057). There were no differences of the audilogical findings for any particular ear, and no differential affectation of frequency range was observed. Coexisting hypertension and poor glycaemic control were significantly associated with aggravation of the hearing of the T2DM patients (p < 0.001, and p = 0.009 respectively). CONCLUSION: T2DM had appreciable effects on hearing acuity. T2DM was significantly associated with the type and the degree of the hearing loss. The need for screening of hearing acuity of T2DM patients, in order to detect early changes, and promptly offer an adequate management and remedial measures was emphasized in this study.

Resumo Introdução: Este estudo de caso-controle foi realizado no Ambulatório de Diabetes do LAUTECH Teaching Hospital (LTH), em Ogbomoso, Nigéria. Objetivos: Este estudo avaliou os padrões de doenças otológicas e acuidade auditiva entre os diabéticos tipo 2 e os fatores determinantes desses achados entre os diabéticos. Método: Ao todo, 97 pacientes com diagnóstico clínico de diabetes melito (194 orelhas) deram seu consentimento e foram pareados por idade e sexo, com 90 pacientes não diabéticos (180 orelhas). Eles foram avaliados por otoscopia e audiometria tonal liminar por um períodode seis meses. Resultados: O estudo relatou uma taxa de prevalência bruta de 21,6% de perda auditiva em pacientes com DM2. O tipo mais comum de doença otológica, afetando significativamente pacientes com DM2, foi otite média com efusão (p = 0,027). A DM2 foi associada com achados audiométricos alterados (p = 0,022), principalmente perda auditiva neurossensorial (p = 0,012), de grau moderado (p = 0,057). Não houve predileção dos efeitos da DM2 para uma das orelhas em particular, e também não houve efeito diferencial da faixa de frequência. A coexistência de hipertensão e controle glicêmico inadequado associou-se significativamente à piora da audição dos pacientes com DM2 (p < 0,001 e p = 0,009, respectivamente). Conclusão: A DM2 mostrou apresentar efeitos significantes na acuidade auditiva afetando significativamente o tipo e o grau da disacusia. Este estudo mostrou a necessidade de avaliação da acuidade auditiva de pacientes com DM2, a fim de detectar as alterações iniciais, e poder rapidamente oferecer medidas corretivas adequadas.

Otologic and audiologic characteristics of type 2 diabetics in a tertiary health institution in Nigeria.

INTRODUCTION: This cross-sectional comparative study was carried out at the Diabetes outpatient clinic of LAUTECH Teaching Hospital (LTH) Ogbomoso, Nigeria. OBJECTIVE: This study assessed patterns of otologic diseases and auditory acuity among type 2 diabetics and determinants of these findings among diabetics. METHODS: Ninety-seven consenting patients with clinical diagnosis of diabetes mellitus (194 ears) were matched for age and sex with ninety non-diabetic patients (180 ears). These patients were screened using otoscopy and pure tone audiometry over a 6-month period. RESULTS: The study reported a crude prevalence rate of 21.6% hearing loss in T2DM patients. The most common type of otologic disease that showed significant association with T2DM patients was otitis media with effusion (p=0.027). T2DM was significantly associated with abnormal audiometric findings (p=0.022), particularly sensorineural hearing loss (p=0.022), of the moderate grade (p=0.057). There were no differences of the audilogical findings for any particular ear, and no differential affectation of frequency range was observed. Coexisting hypertension and poor glycaemic control were significantly associated with aggravation of the hearing of the T2DM patients (p< 0.001, and p=0.009 respectively). CONCLUSION: T2DM had appreciable effects on hearing acuity. T2DM was significantly associated with the type and the degree of the hearing loss. The need for screening of hearing acuity of T2DM patients, in order to detect early changes, and promptly offer an adequate management and remedial measures was emphasized in this study.

Pattern of Otorhinolaryngological Admissions via Emergency Unit in a Suburban Tertiary Center.

BACKGROUND: Patients with ORL lesions sometimes present to the general emergency room. This study reviews the common ENT admissions via emergency room in a sub-urban town in Nigeria. METHODS: A retrospective study spanning five years from January 2009 to December 2013. RESULTS: A total of 211 cases consisting of 131 (62.1%) males with male: female ratio 1.6: 1 and a mean age of 32.8 ± 22.4 years. About a quarter of the patients were children, the peak age was 21-40 years (in 37%). The common indications for emergency otorhinolaryngological admissions were Epistaxis (16.1%), Nasal/facial trauma (14.7%), pharyngo-esophageal foreign bodies (13.3%) and upper airway obstruction (8.1%). Majority 16 (57.1%) of the Pharyngo-esophageal FBs occurred in children. Most of the airway obstructions in children were due to juvenile recurrent respiratory papillomatosis while laryngeal cancer was the major cause among the adult. Sixty percent had surgical procedures, 86.7% had satisfactory outcome and mortalities were recorded in 1.4%. CONCLUSION: Majority of causes for ORL admissions via emergency unit are of pharyngo-esophageal origin. There is apparent reversal of the otological origin trend in ENT admissions via A&E unit.

Management challenges of congenital & early onset childhood hearing loss in a sub-Saharan African country.

BACKGROUND: Hearing impairment is a hidden human disability with potentially catastrophic and age long consequences. This study highlighted the challenges associated with the management of congenital and early onset childhood hearing loss in a sub-Saharan African country. METHODS: A retrospective descriptive study of children seen between January 2008 and December 2013 RESULT: A total of 223 children consisting of 124 (55.6%) males with (M:F) of 1.3:1. Age ranged 1-15 years (mean±SD; 6.39±4.37 years) and age group 1-5 years constituted the largest proportion (56.5%). Congenital causes, febrile illness and hypoxia were the leading causes of HI. Over 93% had moderately severe to profound hearing loss and 64.6% had delayed speech development. Majority (99.3%) with congenital/perinatal onset of HL had significantly delayed speech development and 99.3% of HL due to ototoxicity and infective causes had peri/post lingual speech impairment. Larger percentage of patients presented late; 16.6% of patients with congenital/perinatal onset of HL presented within the first year, >41% presented after the fifth year. Less than 5% had hearing aid fitted and patients with profound hearing impairment were referred for cochlear implant CONCLUSION: The burden of congenital and early onset hearing impairment is high and management outcomes are unsatisfactory in our locality, Challenges associated with managing such children were discussed, and suggestions/strategies for better management and outcome were made.

Esophageal impacted dentures.

OBJECTIVES: This study aims to highlight the problems associated with impacted acrylic dentures and proffers advice to check them. PATIENTS AND METHODS: Retrospective review of all cases of impacted acrylic dentures over a 16-year period. RESULTS: Twenty-two adults had impacted esophageal acrylic dentures of which 16 (72.7%) and six (27.3%) were males and females, respectively (M:F ratio = 2.7:1) with age range 23-77 years. Fourteen patients (63.6%) had worn their dentures for more than 10 years without check-up, and 54.5% presented within 48 hours of impaction. The common symptoms in all the patients were difficulty with swallowing, throat pain and discomfort, followed by tenderness in the neck in 15 (68.2%). Dentures were extracted through esophagoscopy (17 cases) and cervical (three cases) esophagotomy, respectively. Observed complications included pulmonary edema in one and esophageal perforation in five patients. CONCLUSION: Endoscopic extraction of dentures carries a high risk of perforation. Extraction of an impacted denture via esophagoscopy can be undertaken under direct vision and in an ideal situation with judicious use of the Shears forceps. In the absence of these, the safest option is an esophagotomy. Proper treatment planning in the fabrication of dentures with incorporation of radiopaque materials in the dental resins and adequate postdenture delivery instructions are necessary as preventive measures.