Malignant schwannoma of the nasal cavity and paranasal sinuses in a Nigerian.

An unusual case of malignant schwannoma with involvement of the forehead, external nose, right nasal cavity, paranasal sinus system (bilateral frontal sinus, right ethmoidal sinus), right orbit and anterior cranial fossa is reported in a Nigerian. Malignant schwannomas of the paranasal sinus are extremely rare, as only 20 well-documented cases have been previously published in English literature. No report in black Africans has been found in extant literature. The clinical features of this tumour are presented with detailed management. The patient had a wide surgical resection of the lesion with reconstruction of the resultant fronto-nasal defect using forehead musculofascial flap plus full thickness skin graft and adjuvant radiotherapy with satisfactory outcome. The good result of combined surgery and radiation regimens in this case demonstrates the usefulness of adjuvant radiation therapy in this condition.

Presbycusis in Nigerians at the University College Hospital, Ibadan.

Presbycusis refers to sensori-neural hearing impairment in elderly individuals resulting from the degenerative changes of aging. Characteristically, it involves bilateral sensorineural hearing loss, worse at high frequencies, which is associated with difficulty in speech discrimination and central auditory processing of information. The aim of this study is to present our observations on presbycusis as seen in Nigerians. A 41/2-year prospective study of 67 patients that presented with features of presbycusis in the Ear, Nose and Throat Department of the University College Hospital, Ibadan, Nigeria between January 2000 and June 2004 was done. The diagnosis of presbycusis in each subject was based on history, clinical findings, and pure tone audiometry. 67 patients with features of presbycusis were seen and treated over the studied period with 37 males (55.2%), 30 females (44.8%) (M:F 1.2:1) and with an average age of 69.3 years (age range 46-90 years). Presbycusis constituted 2.4% of the 2817 otological cases seen during the studied period. Majority (64.1%) of the cases were of 6th to 8th decades of life. The symptoms were mainly of hearing loss 34 (50.7%), tinnitus 19 (28.4%), hearing loss and tinnitus together in 14 (20.9%) cases. Stria (metabolic) presbycusis 20 (29.9%) constituted the most common type of presbycusis seen in this study followed by mechanical presbycusis 15 (22.4%), neural presbycusis 14 (20.9%) and sensory presbycusis 7 (10.4%) respectively. Presbycusis has been found in this study to affect both males and females subjects almost equally, has an insidious onset as from fourth decades of life in our environment, of stria (metabolic) type mostly, presents with moderate to severe sensori-neural hearing loss (SNHL), and constitute an important problem in the society as it occurs in an elderly population that relies on their special senses (especially auditory) to compensate for other age-associated disabilities.

Childhood Septicaemia Due To Salmonella Species in Ibadan, Nigeria

A cross sectional study to assess the incidence and antibiotic sensitivity patterns of Salmonella isolates in septicaemic children who were presented at the children's emergency unit and children out-patient clinic, University College Hospital, Ibadan was undertaken. A total of 442 samples from children (6months and 11 years) with the history of fever were investigated, using blood culture method. The frequency of 151 bacteria isolated, were as follows: Staphylococcus aureus 50 (33.1%), Escherichia coli 29 (19.2%), Salmonella typhi 19 (12.6%), Staphylococcus albus 14(9.3%), Klebsiella species 12(7.9%), Pseudomonas aeruginosa 10(6.6%), Enterococcus faecalis 9(5.9%), Salmonella paratyphi 6(3.9%) and Haemophilus species 2(1.3%). Septicaemia due to Salmonella speciesshowed the highestamongchildren aged5-11years bracket (56%), followed by 1-5 years group (36%); while those within 0-1 year group showed the lowest frequency of (8%). Inthe antibiotic sensitivity patterns of Salmonella typhi and Salmonella paratyphi, only Ceftriaxone showed 100% sensitivity in-vitro.While Gentamicin, Ofloxacin,Cefrazidime; Augmentin, Pefloxacin, Chloramphenicol, Amoxycillin, Cotrimoxazole showed varied sensitivity/resistance in descending order. These findings suggest an increasing resistance to the antibiotics commonly used for salmonellosis and the rate at which bacteria become resistant to antimicrobial agents is of public health concern. This calls for routine bacteriological culture and sensitivity test in the management of bacterial infections. Furthermore, the provision of adequate health care, wholesome water for drinking and domestic use by governments cannot be overemphasized

Trends of ear syringing at Ibadan, Nigeria.

Ear syringing is a procedure by which the external auditory canal is irrigated with a normal saline at body temperature. It is a procedure which every doctor or nurse should be able to perform proficiently. A study of 622 patients that needed ear syringing was done between December 1999 and June 2001 to determine its trend. There were 341(55%) males and 281(45%) females with age ranged from 3.5months to 89 years: 44.4% were in the first decade of life. Cerumen auris 99% remained the commonest indication for syringing in this study with bilateral cerumen auris constituting 53.1% while right and left cerumen auris constituted 24.4% and 21.5% respectively. Cerumen auris constituted 66% of total 933 Otologic cases seen during the study period. Other indications were otitis externa 0.7% (otomycosis 0.5%; bacterial 0.2%) and foreign body 0.3%. The majority of patients (86%) required between 500mls and 1000mls of fluid for irrigation and 94.9% required not more than one attempt at syringing. The complications recorded were mainly vertigo 0.2% and tympanic membrane perforation 0.2% respectively. Thus ear syringing, though simple and sometimes taken for granted may be fraught with dangers; it is a very safe procedure in trained hands and that after at least three attempts of ear syringing for cerumen auris and if it persists despite effective applications of cerumenolytic agents prior to irrigation, the procedure should be discontinued and other methods of imparted cerumen auris removal should be employed.

Radiological changes and complications associated with nasal polyposis.

BACKGROUND: Nasal polyps are pedunculated portion of oedematous mucosa of the nose or paranasal sinuses. Simple mucous or benign nasal polyps are an early recognizable clinical entity. METHODOLOGY: A 5-year (1998--2002) study of 63 nasal polyposis patients seen at the department of Otorhinolaryngology of University College Hospital Ibadan, Nigeria with radiological changes and complications was done. RESULTS: Out of these 63 patients, 55 (87 %) had associated radiological changes of which 34 (62 %) were males and 21(38%) females with M:F of 1.6:1 and with an average age of 34 years. The duration of symptoms ranged from 2 months-14 years. The radiological changes were mainly seen in the maxillary sinus (40:33%), nasal cavity (37:30%) and ethmoidal air cells (21:17%), Sinus opacifications (90-100%) constituted the most common features seen followed by nasal cavity loss of radio-translucency (97 %). 50(79 %) had complications with sinusitis (98 %) being the most common complication seen. CONCLUSION: The nasal polyposis has been found in this study to cause the radiological changes mainly in the maxillary sinus. The plain radiographs of the paranasal sinuses demonstrated by at least the occipito-frontal, occipito-mental and lateral views would show the extent of the disease in the nose and paranasal sinuses to certain good extent.

Arrow injury to the skull base.

An unsual case of penetrating nasal injury with middle skull base involvement, from fired arrow is reported. The arrow was surgically removed and the patient remains well with no sequelae. We therefore present this case because of its rarity. The anatomical principles underlying the surgical management of the lesions are discussed.

Nasal foreign bodies in the African children.

Nasal foreign bodies are very common in daily clinical practice. Their simplicity in pathology and diagnosis often gives the wrong impression of little or no risk of complications. A 5-year (1998 - 2002) prospective study of 106 patients with nasal foreign bodies was done to evaluate and present the patterns, possible challenges and complications or problems in the management of this condition in the Nigerian Africans. The male to female ratio was 1:1.26 (M 47; F 59) and with an average age of 3 years. The duration of symptoms ranged from degrees hour to 4 years with 74 (69.8%) presenting within 24 hours and 27 (25.5%) presenting after 24 hours. The most common nasal foreign bodies were seeds 34 (32.1%), polyurethane foams 12 (11.3%), stones 11 (10.4%), plastic 10 (9.4%), beads 6 (5.7%) and erasers 6 (5.7%). The objects were found in the right nasal cavity in 63 (59.4%) cases while 43 (40.6%) in the left nasal cavity. The various clinical presentations were history of insertion of foreign bodies 91 (85.8%), 15(14.2%) with no history of insertion, mucopurulent nasal discharge 25 (23.6%), foul nasal odour 10 (9.4%), epistaxis 6 (5.7%), nasal obstruction and mouth breathing 3 (2.8%) and 2 (1.9%) cases respectively. The main complications were nasal infections (23.6%), epistaxis (5.7%), and purulent maxillary sinusitis (1.9%) seen in this study. These are preventable complications if the patients present early to the hospital. The absence of enough E.N.T. specialists however still plagues developing countries like Nigeria. A call is therefore made for more specialists in this area for early detections and care of these cases.

Cyanoacrylate (superglue) presenting as an otic foreign body.

This is a case report of a 55 years-old Nigerian woman who presented an unusual left ear foreign body consisting of cyanoacrylate (super glue) which was successfully removed after application of acetone.

Corrosive oesophagitis in Nigeria: clinical spectrums and implications.

Ingested corrosive agents produce oropharyngeal and gastro-oesophageal injuries ranging from minor burns to severe necrosis, depending on the agent, amount, concentration and duration of exposure. A 10-year (1990-1999) study of 23 corrosive oesophagitis patients depicting the clinical spectrums and implications was done. There were 17 (74%) males and 6 (26%) females, with an average age of 16 years: 35% were in the first decade of life and 39% in the second, with an average occurrence of three new cases a year. The main corrosive agents were alkali (NaOH) 48% and sulphuric acid 39%. The factors that predisposed to corrosive ingestion included: accidental 43%; suicidal 35%; homicidal 13% and 'therapy' 9%. Of the accidental cases 60% were seen in children; 75% of suicide attempts were in the second decade of life. Eleven (48%) patients developed complications, namely laryngeal stenosis 4% and oesophageal strictures 44%. The hospital stay ranged from 2-4 weeks. Awareness of the dangers of corrosive ingestion should be extensively publicized. Government regulations permitting the sales and procurement of corrosive substances should be strictly enforced and, if not yet in place, should be enacted without further delay.

Upper airway obstruction in Nigeria: an aetiological profile and review of the literature.

The early history of tracheostomy and intubation suggested that upper airway obstruction had been in existence for a long time. A study of 80 patients with upper airway obstructions treated over a 10-year period between 1990 and 1999 was carried out to determine the aetiology and incidence. There were 65 (81%) males and 15 (19%) females with a sex ratio of 4.3:1 (M:F). The age ranged from 6 months to 70 years; with mean age of 27 years. Ninety-nine per cent were acquired causes and 1% were congenital. The commonest site of obstruction was in the larynx 81%. In children, the most common causes were laryngeal papilloma (16%) and foreign body (14%), while in adults, laryngeal carcinoma (24%) and direct laryngeal injuries (15%). The study revealed a wide range of causes of upper respiratory tract obstruction encountered in a developing tropical country. Health education and community awareness programmes should be supported. This would encourage early presentation, prompt referral to experts and earlier treatment with improved outcome.

Complications of sinusitis in Ibadan, Nigeria.

Nowadays the complications arising from sinusitis are rare since the introduction of antibiotics. However sinusitis and its complications are still life-threatening and if neglected may result in high morbidity and mortality. It is the purpose of this study to draw attention to the effects of the spread of infection beyond the sinus wall and thus to influence the clinician in his management in order to prevent the subsequent spread of the disease, and secondly make him aware of the sinogenic origin of these complications when he sees them. A retrospective study of 90 patients with sinusitis seen over a ten year period between 1988 and 1997 in the ENT Department, University College Hospital, Madan was (lone and those that had complications were further analysed to meet the objectives of this study. There were 90 patients seen with sinusitis over the ten years period, out of which 33 (37%) cases had complications, 17 males and 16 females (M.F.1:1). The average age of cases with complications was 28 years (age range 2.5 - 75 years). 66.6% of the complications cases occurred in age group under 30 years of age. Thus children and young adults were mostly affected. Twenty-six cases (79%) of chronic sinusitis developed complications while in acute sinusitis there were 7 cases (21%). The site affected most commonly by complications was the orbit (41%) followed by Sinus wall (32%), orophyarynx (18%), intracranial (5%); no car complications were seen. The type of complications seen at various sites and their incidence were also highlighted. Thus with this study it is hoped that clinicians would be reminded that complications of sinusitis still occur and hence be aware of the necessity to recognize and prevent them as rapidly as possible to avoid serious consequences.

Immunoglobulin classes, complement factors and circulating immune complexes in chronic sinusitis patients.

Serum concentrations of immunoglobulin classes (IgG, IgA and IgM), complement factor B (FB), 4th complement factor (C4) and circulating immune complexes (CIC) were determined in 34 Nigerians with chronic sinusitis and 37 apparently healthy age and sex matched controls by single radial immunodiffusion and polyethylene glycol precipitation methods, respectively. The mean serum IgG, IgA, C4, FB and CIC were significantly reduced in chronic sinusitis patients compared with the controls. The mean serum levels of IgG, IgM, C4 and FB were higher in male chronic sinusitis patients compared with female patients. In contrast the mean serum level of IgA was significantly reduced in chronic sinusitis patients. Only IgG and IgA showed significant correlation with the duration of chronic sinusitis. These findings in Nigerian patients suggest immuno-deficiency as one of the causes of chronic sinusitis in Nigerians, therefore routine serum immunoglobulin evaluation is recommended and if found deficient immunoglobulin replacement therapy is advocated for the treatment of such chronic sinusitis.

Pyogenic granuloma, a cause of congenital nasal mass: case report.

This is a case report of a 45-day-old Nigerian boy who presented with obstruction of the left nasal cavity since birth caused by a pyogenic granuloma which was successfully removed.

Ophthalmo-neurologic manifestation of nasopharyngeal carcinoma.

Ophthalmo-neurologic manifestations may be the first and sole presenting feature of nasopharyngeal carcinoma. This may be mis-leading unless a high index of suspicion exists. A retrospective study with analysis of 79 patients with nasopharyngeal carcinoma seen in the 12 years between 1986 and 1997 is presented. Among the 79 cases seen and analysed 20 (25%) had ophthalmo-neurologic manifestations; showing that up to one quarter of nasopharyngeal carcinoma cases could have neuro-ophthalmic manifestations. The ages ranged between 11 years and 70 years with a male: female ratio 2.4:1. This is in consonance with previous reports that nasopharyngeal carcinoma mostly affects males. In this study, visual impairment and corresponding optic nerve lesions constituted 20% of the manifestations. Diplopia and ophthalmoplegia constituted 17% and 18% respectively of the manifestations; these are in consonance with previous reports as seen in literatures. However ptosis (15%) and Horner's syndrome (3%) were essential manifestations seen in this study that were not found or documented in other previous reports. It shows that these could be part of neuro-ophthalmic manifestations of malignant nasopharyngeal carcinoma prompting patients initial presentation to the ophthalmologist. This paper is thus to draw more attention to the significance of ophthalmo-neurologic signs and symptoms as an aid to early diagnosis of malignant nasopharyngeal carcinoma. This will no doubt improve prognosis.

Trends of sinusitis in Ibadan, Nigeria.

Sinusitis occurs frequently, complications are infrequent since the introduction of antibiotics and mortality has also decreased significantly for same reason. A retrospective study of 90 patients with sinusitis seen over a 10 year period between 1988 and 1997 in the E. N. T. Department, University College Hospital, Ibadan was done to highlight the general direction and tendency of sinusitis in our environment. There were 50 (56%) males and 40 (44%) females. The average age was 33 years and 70% were under the age 40 years, showed that sinusitis affects mostly children and young adults. 38% in social class V while 10% social Class I. Chronic sinusitis was 93%, acute sinusitis 7% (both types unisinusitis 56%, pansinusitis 29%, multisinusitis 16%). All the cases of unisinusitis were maxillary sinusitis. 85 (94%) had surgical treatment (antrostomy 64%, Fronto ethmoi-dectomy 15%, Caldwell-Luc's 13%, antral lavage 13%). 80 (94%) patients are alive and well after 2 years of follow up, 5 (6%) lost to follow up. Complications arising from sinusitis was seen affecting the orbit in 41%--the largest, followed by sinus wall 32%, no ear complications seen. Thirteen (14%) of the sinusitis cases associated with allergy only, 24 (27%) with polyps only, 6 (1%) with both allergy and polyps. It stresses the interwoveness of these entities (allergy, Polyps, sinusitis)--one predisposes to the other. Thus with these trends of sinusitis being highlighted, it is hoped that this would enhance our knowledge of the pathology, diagnosis and treatment of sinusitis.