Utilization and Findings of Flexible Naso-Pharyngo-Laryngoscopy in Upper Airway Disorders: A Clinic Audit.

Background: Flexible naso-pharyngo-laryngoscopy (NPL) has become an essential clinic tool for evaluating patients with upper airway disorders in otorhinolaryngology. It has been established to be a simple, cost-effective, and minimally invasive technique with good diagnostic yields. This study aimed to audit the procedure of flexible NPL done in our clinic over 2 years and analyse the technique, indications, and findings of the procedure. Methodology: A retrospective cross-sectional study among all the patients who presented to our ENT clinic in ABUTH Zaria, from July 2021 to June 2023 with upper airway symptoms or neck swelling who had flexible NPL done in the clinic. The records of these patients were reviewed, and information extracted including age, sex, use of anaesthesia, indications and findings of the procedure were entered in SPSS and analysed. Results: Flexible NPL was done in 266 patients aged 4 months to 85 years. Only 3% of the patients required local anaesthesia. The commonest indications were for preoperative evaluation of goitre (26.7%), suspected adenoid hypertrophy (18.4%), complaints of hoarseness (18.8%), and foreign body sensation (12%). The commonest diagnoses made were adenoid hypertrophy (19.9%), laryngeal tumour (5.3%), nasopharyngeal tumour (4.9%), vocal cord palsy (4.9%), rhinitis (4.5%) and pharyngitis (4.1%), laryngitis (3.0%), laryngopharyngeal reflux disease (3.0%) and vocal cord nodule (2.3%). Conclusions: Office flexible NPL was done commonly for preoperative evaluation of goitre, suspected adenoid hypertrophy, hoarseness, and foreign body sensation. The commonest pathologies were adenoid hypertrophy, laryngeal tumour, nasopharyngeal tumour, vocal cord palsy, rhinitis, pharyngitis, and laryngitis.

Adenoid and Tonsil Hypertrophy in Zaria, North Western Nigeria: Review of Clinical Presentation and Surgical Outcome.

Background: Adenotonsillar hypertrophy is one of the most common childhood disorder that necessitates presentation to the ear nose and throat specialist. The disorder may be managed conservatively or by surgery. Aim: To highlight the clinical presentation and surgical treatment outcome of patients managed for adenoid and tonsillar hypertrophy at Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Materials and Methods: The case records of patients managed for adenoid and tonsil hypertrophy were reviewed from January 2013 to December 2017 at the Division of Otorhinolaryngology, Department of Surgery Ahmadu Bello University Teaching hospital Zaria, - Northwestern Nigeria. Case notes with incomplete information and /or missing pages were excluded. The data were analyzed using IBM SPSS (for windows, version 23). Results: There were 56 (55.4%) males and 45 (44.6%) females with male to female ratio of 1.2:1. Their ages ranged from 2-16 years with a mean and standard deviation of 4.0 and 3.2 respectively. The most common symptom at presentation was snoring 85 (84.2%) followed by rhinorrhea 81(80.2%). Findings from the radiologic investigations revealed that majority of the patients had severely narrowed nasopharyngeal air column 83(82,2%) Adenotonsillectomy was the most common surgery performed on most of the patients 63(62.4%) who presented with adenotonsillar hypertrophy. Majority of the patients 95(94.1%) had resolution of symptoms within the period of follow up. Four (4.0%) of them had recurrent adenoidal growth. Conclusion: Snoring, rhinorrhea and mouth breathing were the most common symptoms of adenotonsillar hypertrophy. The outcome of adenotonsillar surgeries in our patients is good, with the majority having resolution of symptoms.

Fibreoptic Laryngoscopic Assessment of Patients with Hoarseness: A Cross-sectional Analysis.

Background: Hoarseness is a common clinical manifestation of laryngeal diseases. The cause of hoarseness may not always be a simple inflammatory disease, but it can be from other serious life-threatening conditions such as laryngeal cancer, for which a delay in diagnosis of such condition may compromise treatment, resulting in poor prognosis and a decreased survival rate. Against this background, we evaluated the causes of hoarseness using fibreoptic laryngoscopy in our environment. Materials and Methods: This was a cross-sectional study of patients with hoarseness attending ENT clinic of our institution. Ethical clearance and consent were obtained. A questionnaire was used to collect relevant clinical data, fibreoptic laryngoscopy was carried out, and the data was analysed using the Statistical Products and Service Solution version 20.0. Results: The study recruited 90 patients with hoarseness. The age of the patients ranged between 18 and 70 years with a mean of 40.1 ± 14.8 years. There were 51 (56.7%) males and 39 (43.3%) females. About 46 (51.2%) of the patients had intermittent hoarseness, whereas 44 (48.8%) had persistent hoarseness. Most of the patients, 49 (54.4%), had hoarseness for less than 6 months before presentation. The fibreoptic laryngoscopic findings were non-specific laryngitis 49 (54.5%), laryngeal tumor 20 (22.2%), vocal cord polyp 7 (7.7%), laryngeal papilloma 6 (6.7%), vocal cord palsy 5 (5.6%), and others 3 (3.3%). Conclusion: Laryngeal tumour constituted a significant percentage of fibreoptic laryngoscopic findings in patients with hoarseness after nonspecific laryngitis. Therefore, fibreoptic laryngoscopy is recommended for all patients with hoarseness in order to detect sinister pathology early.

Advance oropharyngeal mucoepidermoid carcinoma in a 9-year-old boy: A case report and review of literature.

Primary malignant salivary gland tumours are uncommon among the paediatric population, accounting for <10% of all head-and-neck tumours in childhood. Less than 5% of all salivary gland cancers occur during childhood, most of them are diagnosed over the age of 10 years and are histologically low or intermediate grade. Mucoepidermoid carcinoma (MEC) occurring in the oropharynx of children and arising from the posterior pharyngeal wall is rare and probably never reported. We hereby report a case of advanced MEC arising from the posterior wall of the oropharynx in a 9-year-old boy, managed via a transcervical excision in a resource-poor setting.

Clinical profile and treatment outcome of laryngeal cancer in a Nigerian Tertiary hospital.

BACKGROUND: Laryngeal cancer is one of the most common malignancies of the upper aerodigestive tract worldwide, and its management may sometimes be challenging, especially in developing countries due to late presentation, poverty and limited resources. AIM: This study aims to highlight the clinical profile and treatment outcome of laryngeal cancer in our centre. PATIENTS AND METHODS: This was a retrospective review of patients who were managed for laryngeal cancer between January 2011 and December 2020. RESULTS: There were 90 (89.1%) males and 11 (10.9%) females, with a male-to-female ratio of 8.2:1. The age ranged from 22 to 82 years, with a mean age of 57.2 ± 12.7 years. Fifty patients (49.5%) presented more than 1 year after the onset of the symptoms. Squamous cell carcinoma (SCCA) was the only histological diagnosis observed in our patients. The laryngeal cancer was transglottic in location in 45 (44.6%) patients, while 50 (49.5%) patients presented with Stage III disease. Twenty-one (20.8%) patients had total laryngectomy. Amongst the patients managed, 17 (17.0%) were still on follow-up. Up to 37 (37.0%) were referred for radiotherapy elsewhere after chemotherapy. Forty-one of the patients (40.0%) died during the course of their management. There was a statistically significant association between having definitive surgical management and survival beyond 5 years (Chi-square test = 8.635, P = 0.003). CONCLUSION: Majority of the patients presented late with transglottic SCCA. Surgical extirpation of the lesion was associated with better prognosis in our patients.

Paediatric neck masses in Zaria: A review of clinical profile and treatment outcome.

BACKGROUND: A neck mass is any abnormal lesion in the neck that can be seen, palpated, or identified on imaging. It is one of the most common reasons for presentation to the surgical clinics. AIM: the aim is to analyse the clinical presentation and treatment outcome in children who were diagnosed and managed for neck masses in a tertiary centre in Northwestern Nigeria. MATERIALS AND METHODS: The records of patients managed for neck masses over 7 years between January 2013 and December 2019 were reviewed. Demographic and clinical data were retrieved and analysed using Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA). RESULTS: A total of 99 cases were reviewed and there were 52 (52.5%) males and 47 (47.5%) females with male-to-female ratio of 1.1:1, and mean age ± standard deviation of 4.4 ± 3.9 years, the primary complaints of all the patients were neck swellings. The anterior triangle was the most common region involved in 86 (86.9%) patients. The majority of the neck masses were congenital, accounting for 71 (71.8%) patients. Ultrasound scanning was the most commonly requested radiological investigation done in 87 (87.8%) patients. .: Thyroglossal duct cyst was the most common paediatric neck mass seen in 41 (41.4%) patients. The majority of the patients 68 (68.7%) had an excisional biopsy of the lesion. Surgical site infection was the most common complication noted in 7.1% of the study population. CONCLUSION: Most of the neck masses were congenital and were managed surgically. Prompt diagnosis with appropriate treatment may result in a good outcome.

An Audit of Surgical Neck Explorations for Penetrating Neck Injuries in Northwestern Nigeria: Experience from a Teaching Hospital.

BACKGROUND: Penetrating neck injury is a major trauma mechanism present in about 5%-10% of trauma patients with an estimated mortality of 3%-10%. The management of these injuries is dependent on the anatomical level of injury. OBJECTIVES: The objective of the study was to document the clinical and operative findings as well as the treatment outcome among our patients who underwent neck exploration for penetrating neck injuries. MATERIALS AND METHODS: A retrospective review of patients who had neck exploration for penetrating neck injury between January 2012 and December 2018 was done. RESULTS: Thirty-five patients all of whom had surgical neck exploration were included. The age ranged from 15 to 62 years with a male: female of 7.8:1. The mean age was 30.7 years with standard deviation of ± 12.5 years and the peak age of occurrence of 20-29 years. The mechanism of injury was commonly arrow injury in 9 (25.7%) and suicidal cutthroat in 7 (20%) patients. Thirty-two (91.4%) patients presented with stable vital signs. Zone II neck injuries were most prevalent, seen in 23 (65.7%) patients. Laryngeal injury in 7 (20%) and soft-tissue injury in 7 (20%) of the patients were the most common intraoperative findings. The complication rate of 17.1% with a mortality rate of 2.9% was recorded. There was a statistically significant association between the presence of vascular injury and the development of complications after exploration (Chi-square = 5.666, P = 0.017). It was also a significant positive predictor of complication following neck exploration (odds ratio = 0.017, P = 0.048). CONCLUSION: Male young adults were most involved, commonly from arrow and stab injuries. Although laryngeal and soft-tissue injuries were predominant, vascular injuries were most associated with postoperative complications.

An audit of parotid gland surgeries in Kano, Nigeria: A review of 34 cases.

BACKGROUND: Neoplasms both benign and malignant are the most common indications for parotidectomy. About 70%-80% of all salivary gland tumours are located in the parotid gland with up to 80% being benign. Parotidectomy is a common surgical procedure performed by the otorhinolaryngologist and oral and maxillofacial surgeons. AIMS: This study aimed to document our experience on parotid gland surgeries, and occurrence of facial nerve palsy. MATERIALS AND METHODS: The records of all patients that had parotidectomy between January 2014 and December 2018 were evaluated. Demographic, clinical and operative data were retrieved and analysed using Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA). RESULTS: A total of 34 cases were reviewed and there were 12 (35.3%) males and 22 (64.7%) females with a male-to-female ratio of 1:1.8 and mean age ± standard deviation of 39.3 ± 18.4 years. Patients with primary disease constituted the majority 29 (85.3%) in this series. Most of them (26, 76.5%) had superficial parotidectomy. Cervicomastoidfacial incision was the most preferred incision employed among 33 (97.1%) of our patients. Complication following surgery was observed in 12 (35.3%) patients. Majority, 7 (63.6%), had temporary facial nerve paresis. Pleomorphic adenoma was the most common histological diagnosis noted in 19 (55.9%) patients postoperatively. There is a statistically significant association between fine-needle aspiration cytology (FNAC) findings and final histological diagnosis. CONCLUSION: Pre-operative FNAC could be a reliable tool in the evaluation of our patients being prepared for parotidectomy even in our resource-poor setting.

Endsocopic Internal Maxillary Artery Cauterization in a Patient with Severe Posterior Epistaxis: A Case Report.

Epistaxis from the posterior superior region of the nasal cavity might be fatal in some cases. It is particularly severe in an individual with hypertension, arterial aneurysm of traumatic origin, and bleeding from posterior lateral nasal artery, which is frequently difficult to reach and ligate directly on a bleeding area. Certain cases have been reported in which the bleeding could be stopped only by ligating/embolization of the external carotid artery or the internal maxillary artery at its branching off from the external carotid artery. Despite the multiple anastomoses, the effect of such ligation or cauterization is effective if properly done. We present a case of a 25-year-old young man with a 3-month history of recurrent epistaxis resulting from an internal maxillary artery aneurysm following trauma. The clinical presentation, diagnosis, and successful endoscopy treatment of posterior epistaxis are presented.

Audiologic Evaluation of Patients with Head and Neck Cancers Treated with Cisplatin Based Chemotherapy: A Longitudinal Study.

Background: Recently, the incidence of head and neck cancers are on the increase globally and particularly in our environment. In addition, concurrent platinum-based chemoradiotherapy has become widely used in the treatment of head and neck malignancies. The objective of this study was to determine the effect of cisplatin-based chemotherapy on hearing in patients with head and neck cancers at our University Teaching Hospital. Methodology: This was a hospital-based longitudinal case-control study that involved 54 participants attending the oncology treatment centre of the University Teaching Hospital Zaria. The study investigated the hearing threshold and degree of hearing loss pre and post cisplatin-based chemotherapy at intervals of 3 months and 6 months. The data obtained were analyzed using Statistical Product and Service Solutions (SPSS)version 20. Results: Seventy-two participants were recruited into the study, but 54 (75%) participants met the inclusion criteria and were enrolled and as well as same age and sex match controls. Thirty-one31(57.4%) of the participants had a nasopharyngeal tumour, 14(25.9%) had Sinonasal tumour and 9(16.7%) had Laryngeal tumour. Among the study group, there were 39 males (72.2%) and 15 females (27.8%) with an M: F ratio of 2.6:1. The age of the participants ranged from 13-68 years. (Mean =40.3years. SD=13.6). Assessment of hearing in the better ear showed 22 (40.7%) of subjects and 6 (11.1%) of controls had hearing loss before the onset of the study. The majority of these patients had mild hearing loss either mixed or SNHL. In the study group, 32(29.6%) ears showed changes in hearing threshold after 3 months of cisplatin therapy while68(62.9%) ears showed changes at 6 months of therapy. The overall incidence of ototoxicity after 6 months of therapy was 62.9%. Conclusion: This study found a significant number of head and neck cancers patients with hearing impairment pre-chemotherapy. Cisplatin treatment-based chemotherapy was associated with significant short term hearing impairment in patients with head and neck cancers.

Clinicopathologic profile of sinonasal neoplasia in Kano, Northwestern Nigeria: A 10-year single-institution experience.

Background: Sinonasal neoplasia comprises approximately 3% of all head-and-neck tumors. However, the incidence of these tumors may be greater in some parts of the world including Asia and Africa. Aim and Objective: The study aimed to review the clinical and histopathological pattern of sinonasal neoplasms in Kano, Nigeria. Materials and Methods: The records of patients managed for sinonasal neoplasia at the Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria, over a period of 10 years were reviewed. Information obtained from the case files included demographic characteristics, tumor characteristics, and clinical information. The data obtained were analyzed using SPSS version 23. Results: A total of 245 patients were reviewed with sinonasal neoplasms. Among these, 168 (68.57%) were males, with a sex ratio (M:F) of 2.18:1. The mean age was 40.2 ± 18.9 years. Malignant sinonasal neoplasm constituted 55.92%% of the sinonasal neoplasia, with peak age at the fifth decade. Squamous cell carcinoma was the most common histological subtypes seen in 50.36% of the patients. Inverted papilloma was the most common benign sinonasal neoplasia (42.59%). The most common symptom presented by the patients was nasal obstruction (77.55%), mostly presented within 6 months of onset of symptoms (63.67%), and farmers were the predominant (27.76%). The most common treatment modality was surgical extirpation (54%), and most of the patients presented with Stage IV disease (88%). The site of tumor was found to statistically correlate with the type of tumor among the patients (P ≤ 0.0001), whereas the type of tumor and site of tumor correlated significantly with the duration of symptoms before the presentation. Conclusion: Malignant sinonasal disease is the predominant sinonasal neoplasm in this environment, and most of the patients presented with advanced disease.

RésuméContexte: La néoplasie des muqueuses nasales représente environ 3% de toutes les tumeurs de la tête et du cou. Cependant, l'incidence de ces tumeurs peut être plus importante dans certaines régions du monde, notamment en Asie et en Afrique. But et Objectif: L'étude visait à examiner le schéma clinique et histopathologique des néoplasmes sinonasaux à Kano, au Nigéria. Matériels et Méthodes: Les dossiers des patients pris en charge pour une néoplasie sinon nasale au département d'otorhinolaryngologie de l'hôpital universitaire Aminu Kano de Kano, au Nigéria, ont été examinés pendant 10 ans. Les informations obtenues à partir des dossiers incluent les caractéristiques démographiques, les caractéristiques de la tumeur et les informations cliniques. Les données obtenues ont été analysées avec SPSS version 18. Résultats: Un total de 245 patients ont été examinés avec des néoplasmes sinonasasaux. Parmi eux, 168 (68,57%) étaient des hommes avec un sex-ratio (M: F) de 2,18: 1. L'âge moyen était de 40.2 ± 18.9 ans. La tumeur maligne nasale est la plus fréquente avec 55,92%, un âge maximum à la 5ème décennie et le carcinome épidermoïde étant le sous-type histologique le plus commun (50,36%). Le symptôme le plus souvent présenté par les patients était une obstruction nasale (77,55%), présentée le plus souvent dans les six mois suivant l'apparition des symptômes (63,67%) et les agriculteurs prédominants (27,76%). La modalité de traitement la plus courante était la disparition chirurgicale (54%) et la plupart des patients présentaient une maladie de stade IV (88%). Il a été constaté que le site de la tumeur était statistiquement corrélé avec le type de tumeur chez les patients (valeur P ≤ 0,0001), tandis que le type de tumeur et le site de la tumeur étaient en corrélation significative avec la durée des symptômes avant la présentation. Conclusion: la néoplasie maligne nasale prédominante était prédominante dans cet environnement et, même si nos patients présentaient relativement tôt une maladie, la maladie avancée était la principale constatation.

Unilateral Sinonasal Masses: Review of Clinical Presentation and Outcome in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

BACKGROUND: Unilateral persistent nasal obstruction may indicate the presence of sinonasal lesion, which could be inflammatory or neoplastic. It is a common practice to assume that unilateral nasal mass in adults is either inverted papilloma or a malignant lesion. OBJECTIVES: The objective is to study the pattern of clinical presentation and outcome of treatment of patients managed for unilateral nasal masses at Ahmadu Bello University Teaching Hospital, Zaria. MATERIALS AND METHODS: The record of patients managed for unilateral nasal masses over 5 years between January 2013 and December 2017 was reviewed. Data obtained for this study included demographic characteristics such as age, sex, occupation, main presenting symptoms, duration of symptoms, histological type, type of treatment given, and current status of patients. The data were analyzed using the Statistical Package for the Social Science version 23.0. RESULTS: A total of 38 cases were reviewed for this study and there were 25 (65.8%) males and 13 (34.2%) females with a sex ratio (male: female) of 1.9:1. The mean age was 50.8 years, with the standard deviation of ± 13.7. Rhinorrhea, nasal blockage and the presence of nasal growth were the most common symptoms at presentation seen nearly in all the patients. Inflammatory polyp 16 (42.1%) was the most common histological type observed in this study. The majority of patients with malignant sinonasal masses had well-differentiated squamous cell carcinoma 5 (13.2%). Most of our patients 29 (76.3%) presented to the hospital within 1-3 years of the onset of the symptoms. The majority of our patients 26 (68.4%) did very well and were discharged from the clinic following resolution of their symptoms. Three (7.9%) had recurrent nasal mass. We recorded three cases of mortality from the 38 patients managed. CONCLUSION: Inflammatory polyp was the most common unilateral sinonasal mass followed by inverted papilloma. A thorough clinical evaluation of any patients with prolonged nasal symptoms will go a long way in the early detection of these lesions.

Management of Deep Neck Space Infections in a Tertiary Center in North West Nigeria.

BACKGROUND: Deep neck space infection (DNSI) is a potentially fatal condition that more commonly results from dental and tonsillar infections. Timely intervention is, therefore, crucial when such patients present to the managing physician. OBJECTIVE: The objective of this study is to review the etiology, clinical presentation, and treatment outcome of patients managed for DNSIs over a period of 7 years at National Ear Care Centre, Kaduna. METHODOLOGY: The record of patients managed for DNSIs over a 7-year period between January 2010 and December 2016 was reviewed. Data obtained included demographic characteristics such as age, sex, occupation, level of education, main presenting symptoms, duration of symptoms, etiology of the DNSI, location of the infection, comorbidity, bacteriology, duration of hospital stay, and type of treatment given. The data were analyzed using the Statistical Package of the Social Sciences version 23.0. RESULTS: A total of 55 patients presented with DNSIs, and there were 34 (61.8%) females and 21 (38.2%) males, with a sex ratio of 1.6:1. The age range of the patients was 1-71 years, with a mean age of 30.7 years (standard deviation of 18.1). The most common etiologic factor among these patients was tonsillar-related infection which accounted for 24 (43.6%). The most common symptom at presentation was fever (96.4%), followed by odynophagia (60%). Peritonsillar space infection as seen in 25 (45.5%) patients was the most common region affected, followed by submandibular space infection. Of the 35 (64%) patients who had incision and drainage, Staphylococcus aureus was the most common organism isolated in 16 (45.7%), followed by Streptococcus pneumoniae (11, 31.4%). Majority (38, 69.1%) of the patients spent <5 days on admission. CONCLUSION: This study shows that oropharyngeal and orodental infections are the most common causes of DNSIs. Educating the populace about orodental health may help in reducing cases of DNSIs in Nigeria.