Prevalence and Co-Morbidities of Adult-Onset Otitis Media With Effusion.

Background: Adult-onset otitis media with effusion (AO-OME) is relatively difficult to characterize, because of its associated co-morbidities. Objectives: To quantify the burden, assess co-existing diseases, and management of patients with AO-OME. Design of the Study: A descriptive observational prospective study. Setting: Clinical department in a tertiary hospital. Materials and Methods: Adult patients with conductive hearing impairment without ear discharge (excluding other pathologies) nor external ear pathology were eligible. The patients also had tympanometry with type B tracings (tympanograms). Interventions: Clinico-demographic characteristics, history of otologic symptoms, affected ear, and hearing impairment were obtained. Pure-tone audiometry (PTA), tympanometry, and radiological investigations were performed. Other existing diseases (co-morbidities) were noted. The main outcome measure was audiologically confirmed AO-OME. Results: Prevalence of AO-OME was (110/3452) 3.2%. Young adults (age group 18-30 years) constituted 33.7% (28/83), mean age was 37.3 ± 11.5 years, and 46/83 (55.4%) were males and 37/83 (44.6%) were females. The common otologic symptoms were feeling of fullness in the ear in 27.7% (23/83), hearing loss in 24.1% (20/83), and bilateral ear involvement in 32.5% (27/83). PTA revealed 8.2% (9/110) had normal hearing, whereas 62.7% (69/110) ears had conductive hearing loss. Patients had radiological investigations, namely plain X rays in 67.5% (56/83) and computerized tomography scan of sinuses in 10.8% (9/83). Three (3/83) patients (3.6%) each had nasoendoscopy, and nasal and nasopharyngeal examination under anaesthesia and biopsy. The major associated diseases (co-morbidities) were allergy in 38.6% (32/83), infective rhinosinusitis in 24.1% (20/83), and upper respiratory tract infection in 14.5% (12/83). Conclusion: Prevalence of AO-OME was 3.2%. AO-OME co-existed commonly with allergy and other inflammatory diseases of the upper respiratory tract. The management was conservative medical management.

Asymptomatic Otitis Media With Effusion in Children With Adenoid Enlargement.

OBJECTIVES: To estimate the burden, and clinical factors associated with development of Otitis media with effusion (OME) in children with enlarged adenoids. METHODS: Consecutive eligible patients with adenoid (sometimes with tonsillar) enlargement managed operatively in a period of five years. Patients had no complaints suggestive of hearing impairment. Age, sex, clinical diagnosis, and weight of patients were recorded. Otoscopic, audiometric, and radiological examinations findings were recorded. Tympanometry patterns were classified according to Jerger's classification; type B and C tympanograms represented OME. Some patients had Pure Tone Audiometry (PTA). Plain nasopharyngeal X-ray assessed the adenoid: nasopharyngeal (AN) ratio with >0.5 regarded as obstructive adenoid. RESULTS: 216 ears of 108 children were assessed. 49.1% of children were in age range 1-3 years, mean 3.6 ± 2.6 years. 62.0% were males, weight ranged from 7.8 to 31.0 kg, mean was 14.3 ± 5.2 kg. 63.9% had associated tonsillar enlargement. Mean AN ratio was 0.69 ± 0.07. Tympanometric findings showed prevalence of OME in all ears was 63/216 = 29.2%, consisting of 30.5% with unilateral (Right ear 19.4%, Left ear 11.1%), and 13.9% with bilateral OME. Acoustic reflexes were absent in both ears in 32 (29.6%) of the patients. There was normal hearing in 16/38 ears (42.1%), while others had different types of hearing loss. Two factors namely increased age and weight were significantly associated with OME in patients with Adenoid enlargement. CONCLUSIONS: 29.2% of children with adenoid enlargement had a co-morbidity of asymptomatic OME. The factors associated with OME were increased age and weight of the patients.

Audiological characteristics of the contralateral ear in patients with unilateral physical non-explosive ear trauma.

OBJECTIVES: To document the frequency of occurrence and types of symptoms experienced in the contralateral ear in patients with unilateral physical non-explosive (UPN) ear trauma and to compare the audiometric and tympanometric parameters between asymptomatic and symptomatic contralateral ears. DESIGN: Prospective analytical clinical study Setting: Specialized (Ear, Nose, and Throat) clinic of a tertiary health institution. Participants: Patients with UPN ear trauma who presented within the first week of the incident. Main outcome measures: Otologic symptoms in the contralateral ear in UPN ear trauma. RESULTS: Eighteen out of 53 patients (34.0%) experienced symptoms in the contralateral ear. The symptoms were tinnitus in 77.8% (14/18), hearing loss in 66.7% (12/18), and ear blockage in 27.8% (5/18). There was hearing loss in 38/53 (71.7%) of contralateral ears. Hearing loss type and PTAv at the low frequencies were not significantly different (p=0.142), but other audiometric parameters were significantly different between asymptomatic and symptomatic contralateral ears (p<0.05 in all). Type C tympanogram was more prominent in the symptomatic contralateral ear. There was a statistically-significant difference in the type of tympanogram between the two categories of patients (p=0.018). There was no difference in acoustic reflex between the two categories of patients (p=0.095). CONCLUSIONS: The contralateral ear may be affected in up to one-third of patients with UPN ear trauma, and experience otologic symptoms similar to those of the traumatized ears. Audiologic and audiometric parameters were abnormal in most of the contralateral ears. The two ears must be assessed thoroughly in cases of UPN ear trauma.

Hearing thresholds in patients with drug-resistant tuberculosis: baseline audiogram configurations and associations.

OBJECTIVE:: To use baseline audiogram parameters in order to ascertain whether drug-resistant tuberculosis (DR-TB) has effects on hearing, as well as to describe the configurations of the audiograms and to determine whether there are parameters that can be associated with those configurations. METHODS:: This was a prospective study involving patients diagnosed with DR-TB at a tuberculosis treatment center in the state of Ogun, in Nigeria. The patients included in the study were submitted to pure tone audiometry at baseline (within two weeks after treatment initiation). For comparative analyses, data regarding demographic and clinical characteristics were collected from the medical records of the patients. RESULTS:: The final sample comprised 132 patients. The mean age of the patients was 34.5 ± 12.6 years (range, 8-82 years), and the male:female ratio was 2:1. Of the 132 patients, 103 (78.0%) resided in neighboring states, 125 (94.7%) had previously experienced antituberculosis treatment failure, and 18 (13.6%) were retroviral-positive. Normal audiograms were found in 12 patients (9.1%), whereas sensorineural hearing loss was identified in 104 (78.8%), the two most common configurations being ascending, in 54 (40.9%), and sloping, in 26 (19.7%). Pure-tone averages at low frequencies (0.25-1.0 kHz) and high frequencies (2.0-8.0 kHz) were 33.0 dB and 40.0 dB, respectively. Regarding the degree of hearing loss in the better ear, 36 patients (27.3%) were classified as having normal hearing and 67 (50.8%) were classified as having mild hearing loss (26-40 dB), whereas 29 (21.9%) showed moderate or severe hearing loss. Among the variables studied (age, gender, retroviral status, previous treatment outcome, and weight at admission), only male gender was associated with audiometric configurations. CONCLUSIONS:: In this sample of patients with DR-TB, most presented with bilateral, mild, suboptimal sensorineural hearing loss, and ascending/sloping audiometric configurations were associated with male gender. OBJETIVO:: Utilizar parâmetros do audiograma basal para verificar se a tuberculose resistente (TB-R) tem efeitos na audição, descrever as configurações dos audiogramas e determinar se há parâmetros que possam ser associados a essas configurações. MÉTODOS:: Estudo prospectivo com pacientes diagnosticados com TB-R em um centro de tratamento de tuberculose no estado de Ogun, Nigéria. Os pacientes incluídos no estudo foram submetidos à audiometria de tons puros em até duas semanas após o início do tratamento (audiometria basal). Características demográficas e clínicas foram coletadas dos prontuários médicos dos pacientes para análises comparativas. RESULTADOS:: A amostra final envolveu 132 pacientes. A média de idade dos pacientes foi de 34,5 ± 12,6 anos (variação, 8-82 anos), e a razão homem:mulher foi de 2:1. A maioria dos pacientes (n = 103; 78,0%) residia nos estados vizinhos e tinha história de falha de tratamento antituberculose (n = 125; 94.7%); 18 (13.6%) apresentavam status retroviral positivo. Doze pacientes (9,1%) apresentaram audiogramas normais, e 104 (78,8%) apresentaram perda auditiva neurossensorial, sendo as configurações mais comuns do tipo ascendente, em 54 (40,9%), e descendente, em 26 (19,7%). As médias de tons puros em frequências baixas (0,25-1,0 kHz) e altas (2,0-8,0 kHz) foram de 33,0 dB e 40,0 dB, respectivamente. Quanto ao grau de perda auditiva no melhor ouvido, 36 pacientes (27,3%) apresentaram audição normal, e 67 (50,8%) apresentaram perda auditiva leve (26-40 dB), enquanto 29 (21,9%) mostraram perda auditiva moderada ou grave. Entre as variáveis estudadas (idade, gênero, status retroviral, desfecho de tratamento anterior e peso na admissão), somente o gênero masculino foi associado às configurações audiométricas. CONCLUSÕES:: Nesta amostra de pacientes com TB-R, a maioria apresentou perda auditiva neurossensorial leve e subótima bilateralmente, com configurações audiométricas ascendentes/descendentes associadas ao gênero masculino.

Hearing thresholds in patients with drug-resistant tuberculosis: baseline audiogram configurations and associations / Limiares auditivos em pacientes com tuberculose resistente: configurações do audiograma basal e associações

ABSTRACT Objective: To use baseline audiogram parameters in order to ascertain whether drug-resistant tuberculosis (DR-TB) has effects on hearing, as well as to describe the configurations of the audiograms and to determine whether there are parameters that can be associated with those configurations. Methods: This was a prospective study involving patients diagnosed with DR-TB at a tuberculosis treatment center in the state of Ogun, in Nigeria. The patients included in the study were submitted to pure tone audiometry at baseline (within two weeks after treatment initiation). For comparative analyses, data regarding demographic and clinical characteristics were collected from the medical records of the patients. Results: The final sample comprised 132 patients. The mean age of the patients was 34.5 ± 12.6 years (range, 8-82 years), and the male:female ratio was 2:1. Of the 132 patients, 103 (78.0%) resided in neighboring states, 125 (94.7%) had previously experienced antituberculosis treatment failure, and 18 (13.6%) were retroviral-positive. Normal audiograms were found in 12 patients (9.1%), whereas sensorineural hearing loss was identified in 104 (78.8%), the two most common configurations being ascending, in 54 (40.9%), and sloping, in 26 (19.7%). Pure-tone averages at low frequencies (0.25-1.0 kHz) and high frequencies (2.0-8.0 kHz) were 33.0 dB and 40.0 dB, respectively. Regarding the degree of hearing loss in the better ear, 36 patients (27.3%) were classified as having normal hearing and 67 (50.8%) were classified as having mild hearing loss (26-40 dB), whereas 29 (21.9%) showed moderate or severe hearing loss. Among the variables studied (age, gender, retroviral status, previous treatment outcome, and weight at admission), only male gender was associated with audiometric configurations. Conclusions: In this sample of patients with DR-TB, most presented with bilateral, mild, suboptimal sensorineural hearing loss, and ascending/sloping audiometric configurations were associated with male gender.

RESUMO Objetivo: Utilizar parâmetros do audiograma basal para verificar se a tuberculose resistente (TB-R) tem efeitos na audição, descrever as configurações dos audiogramas e determinar se há parâmetros que possam ser associados a essas configurações. Métodos: Estudo prospectivo com pacientes diagnosticados com TB-R em um centro de tratamento de tuberculose no estado de Ogun, Nigéria. Os pacientes incluídos no estudo foram submetidos à audiometria de tons puros em até duas semanas após o início do tratamento (audiometria basal). Características demográficas e clínicas foram coletadas dos prontuários médicos dos pacientes para análises comparativas. Resultados: A amostra final envolveu 132 pacientes. A média de idade dos pacientes foi de 34,5 ± 12,6 anos (variação, 8-82 anos), e a razão homem:mulher foi de 2:1. A maioria dos pacientes (n = 103; 78,0%) residia nos estados vizinhos e tinha história de falha de tratamento antituberculose (n = 125; 94.7%); 18 (13.6%) apresentavam status retroviral positivo. Doze pacientes (9,1%) apresentaram audiogramas normais, e 104 (78,8%) apresentaram perda auditiva neurossensorial, sendo as configurações mais comuns do tipo ascendente, em 54 (40,9%), e descendente, em 26 (19,7%). As médias de tons puros em frequências baixas (0,25-1,0 kHz) e altas (2,0-8,0 kHz) foram de 33,0 dB e 40,0 dB, respectivamente. Quanto ao grau de perda auditiva no melhor ouvido, 36 pacientes (27,3%) apresentaram audição normal, e 67 (50,8%) apresentaram perda auditiva leve (26-40 dB), enquanto 29 (21,9%) mostraram perda auditiva moderada ou grave. Entre as variáveis estudadas (idade, gênero, status retroviral, desfecho de tratamento anterior e peso na admissão), somente o gênero masculino foi associado às configurações audiométricas. Conclusões: Nesta amostra de pacientes com TB-R, a maioria apresentou perda auditiva neurossensorial leve e subótima bilateralmente, com configurações audiométricas ascendentes/descendentes associadas ao gênero masculino.

Sub-clinical middle ear malfunctions in elderly patients; prevalence, pattern and predictors.

BACKGROUND: Little is known about functioning of the middle ear with advancing age. OBJECTIVES: To estimate the prevalence and describe tympanometric patterns of sub-clinical middle ear malfunctions,( S-MEM) in elderly patients. It also assessed clinical factors that could predict S-MEM. METHODS: Cross-sectional, analytical study of patients aged ≥ 60 years in a tertiary hospital in Nigeria between 2011-2014. Pure tone audiometry (PTA), tympanometry and acoustic reflexes were recorded. S-MEM was based on audiometric and tympanometric evident abnormalities. Descriptive, univariate and multivariate analyses performed to detect independent clinical predictors of S-MEM at p-value of <0.05. RESULTS: 121 patients , M: F of 1.1:1. Mean age was 70.1 ± 6.2 years, 77.7% were married. Prevalence of S-MEM was 21.5%. Abnormal tympanometric tracings were type AS>C>B>AD. The parameters that were statistically-significant on univariate analyses were subjected to logistic regression analysis which confirmed previous head injury, diabetes, osteoarthritis of knee joint, and absent acoustic reflex as clinical predictors for S-MEM. CONCLUSION: 21.5% of elderly Africans had subclinical abnormalities in their middle ear functioning, mostly with type AS tympanogram. Independent clinical predictors of S-MEM included previous head injury, diabetes, history of osteoarthritis of knee joints, and absent acoustic reflex.

Clinical predictors of aminoglycoside-induced ototoxicity in drug-resistant Tuberculosis patients on intensive therapy.

OBJECTIVE: The study objectives were to determine the incidence of aminoglycoside-induced ototoxicity in institutionalized patients on intensive phase of therapy for drug-resistant Tuberculosis (DR Tb) and also to assess clinical factors which could predict the ototoxicity. METHODS: The study was a prospective analytical study among consecutive DR Tb patients who were admitted for intensive phase of therapy (of 4 months) at the DR-Tb center over a 12-month period. Patients were diagnosed as DR Tb using the Gene Xpert machine to confirm Rifampicin resistance. All eligible 70 out of 87 consenting patients were consecutively recruited into the study. Patients had baseline (admission) and serial pure tone audiometries (PTAs) performed at 4 weekly intervals until discharge after 4 months of admission. Audiometric confirmation of aminoglycoside-induced ototoxicity was done by comparing serial with baseline PTA. RESULTS: Among the 70 patients the male:female ratio was 1.7:1. Nine patients (12.9%) were retroviral-positive, and 16 patients (22.9%) were confirmed to have ototoxicity by audiometric criteria. The duration of treatment when ototoxicity was detected in the patients ranged 4-17 (Mean±SD; 9.4±3.4) weeks. Ototoxicity was detected in the audiometric low frequency ranges in 7 (43.8%) and at the high frequencies in 4 (25.0%) of the patients. Univariate analyses of clinical parameters found that age, underlying diabetes mellitus, deranged baseline PTAv >25dB HL, BMI on admission and retroviral status were significantly associated, while sex and previous drug regimen failure were not associated with ototoxicity. Multivariate adjusted logistic regression analyses, controlling for sex, revealed age (OR=1.068, p=0.018), BMI on admission (OR=0.673, p=0.012) and retroviral positivity (OR=8.822, p=0.014) of patients could significantly predict aminoglycoside-induced ototoxicity. CONCLUSION: Incidence of aminoglycoside-induced ototoxicity in DR Tb patients was 22.9%. The clinical predictors for ototoxicity were age, BMI on admission, and co-existing retroviral infection in the patients. Clinicians should consider these factors in making choices of aminoglycosides to be used during intensive phase of treatment with second line anti-Tuberculous therapy.

Clinical spectrum of ear, nose and throat foreign bodies in North Western Nigeria.

BACKGROUND: Ear, nose and throat foreign bodies (FBs) are common occurrences particularly among children. This study reviewed the clinical spectrum of ENT FBs, their treatment and outcomes as seen in a tertiary health center in North Western Nigeria. METHOD: The study was a retrospective chart review of patients that were managed for FB impaction in a tertiary health institution in North Western Nigeria over a four year period. RESULT: There were 239 patients; M: F: 1.2:1. Majority of FB impaction (46.4%) occurred in children. Majority (68.7%) were otic and FBs. 18.0% of the patients had had failed attempted removal by non ENT specialists. About 25% of these patients developed complications. Majority (62.0%) of these complications occurred in the hand of non-ENT medical personnel. CONCLUSION: Ear, nose and throat foreign bodies are common in North-Western Nigeria with the highest incidence in children. Removal attempts by untrained health professionals and lack of experience in FB management predisposes to complications. Parental education on close monitoring of their children to avoid such incidences and the need to immediately seek an Otorhinolaryngologist to prevent complications are emphasized.

Medication-related expenditures by individuals with allergic rhinitis in Nigeria.

OBJECTIVE: To assess the medication-related expenditures in individuals with allergic rhinitis (AR) and identify contributory factors that affect these expenditures. STUDY DESIGN: Cross-sectional study from August 2013 to January 2014. SETTING: Kwara state has 16 local government areas, a total land mass of 36,825 km(2), and a population of 2,591,555. SUBJECTS AND METHODS: Of the 308 adult subjects, 66 had AR using the Score for Allergic Rhinitis (SFAR). Information on medication-related expenditure and associated factors in AR was obtained using a structured questionnaire. Descriptive and comparative analyses between AR and non-AR subjects were performed using an independent-sample t test and χ(2) test. Factors associated with cost of care were assessed using logistic regression analysis. RESULTS: The AR crude prevalence rate was 21.4%. Of the subjects, the mean ± SD age was 37.6 ± 10.0 years, and 87.9% were married, 72.7% were self-employed, and 69.7% were in the low socioeconomic class. In total, 69.7% had intermittent symptoms, while 66.7% had a positive family history of allergy. Polypharmacy care was employed in 76.1%, and 30.3% had comorbidity with asthma. The mean monthly income was 842 US dollars (USD), while the mean monthly cost of care was 81 USD, constituting 9.6% of mean monthly income. All payments were through out-of-pocket-expenses. Factors associated with convenience of cost of care were positive family history (odds ratio [OR], 7.93; P = .021) and presence of intermittent symptoms (OR, 9.36; P = .013). CONCLUSION: The medication-related expenditure of AR is burdensome with an average expenditure of almost 10% of monthly income.

Middle ear impedance studies in elderly patients implications on age-related hearing loss / Estudos de impedância da orelha média em pacientes idosos: implicações na perda auditiva relacionada à idade

INTRODUCTION: Controversies arise with respect to functioning of the middle ear over time. OBJECTIVE: To assess changes in middle ear impedance that may be related to aging, and/or if there was an association of these changes with those of the inner ear in the elderly patients. METHODS: Cross-sectional, comparative study of elderly patients managed in ear, nose and throat clinics. A structured questionnaire was administered to obtain clinical information. Pure tone audiometry, tympanometry, and acoustic reflexes were performed. Comparative analyses were performed to detect intergroup differences between clinico-audiometric findings and middle ear measures, viz. tympanograms and acoustic reflexes. RESULTS: One hundred and three elderly patients participated in the study; 52.4% were male, averagely 70.0 ± 6.3 years old, age-related hearing loss in 59.2%, abnormal tympanograms in 39.3%, absent acoustic reflex in 37.9%. There was no association between age and gender in patients with abnormal tympanograms and absent acoustic reflex. Significantly more patients with different forms and grades of age-related hearing loss had abnormal tympanometry and absent acoustic reflex. CONCLUSION: Some abnormalities were observed in the impedance audiometric measures of elderly patients, which were significantly associated with parameters connected to age-related hearing loss. .

INTRODUÇÃO: Existem controvérsias no que se refere às alterações funcionais da orelha média com o passar dos anos. OBJETIVO: Avaliar as mudanças na impedância da orelha média que podem estar relacionadas ao envelhecimento, bem como qualquer associação dessas alterações com as que ocorrem na orelha interna. MÉTODO: Estudo prospectivo comparativo de pacientes idosos atendidos em ambulatórios espe-cializados em otorrinolaringologia e aplicação de questionário estruturado para obtenção de informações clínicas. Foram realizadas audiometria de tons puros, timpanometria e reflexos acústicos e análise comparativa para detectar as diferenças intergrupos entre os achados clínico-audiométricos. RESULTADOS: Participaram do estudo 103 pacientes idosos: 52,4% do gênero masculino; idade de70 ± 63 anos; perda auditiva relacionada à idade detectada em 59,2%; timpanograma anormal em 39,3%; e reflexo acústico ausente em 37,9%. Não foi encontrada associação entre idade e gênero em pacientes com timpanograma anormal e reflexo acústico ausente. Um número significantemente maior de pacientes com diferentes graus e configurações de perda auditiva relacionada à idade apresentou timpanometria anormal e reflexo acústico ausente. CONCLUSÃO: Algumas anormalidades foram observadas em medidas de impedância audiométrica em pacientes idosos, que foram significantemente associados com os parâmetros ligados à perda auditiva relacionada à idade. .

Middle ear impedance studies in elderly patients implications on age-related hearing loss.

INTRODUCTION: Controversies arise with respect to functioning of the middle ear over time. OBJECTIVE: To assess changes in middle ear impedance that may be related to aging, and/or if there was an association of these changes with those of the inner ear in the elderly patients. METHODS: Cross-sectional, comparative study of elderly patients managed in ear, nose and throat clinics. A structured questionnaire was administered to obtain clinical information. Pure tone audiometry, tympanometry, and acoustic reflexes were performed. Comparative analyses were performed to detect intergroup differences between clinico-audiometric findings and middle ear measures, viz. tympanograms and acoustic reflexes. RESULTS: One hundred and three elderly patients participated in the study; 52.4% were male, averagely 70.0±6.3 years old, age-related hearing loss in 59.2%, abnormal tympanograms in 39.3%, absent acoustic reflex in 37.9%. There was no association between age and gender in patients with abnormal tympanograms and absent acoustic reflex. Significantly more patients with different forms and grades of age-related hearing loss had abnormal tympanometry and absent acoustic reflex. CONCLUSION: Some abnormalities were observed in the impedance audiometric measures of elderly patients, which were significantly associated with parameters connected to age-related hearing loss.

Validation of hearing handicap inventory for the elderly questionnaire among elderly subjects in Sagamu, Nigeria.

BACKGROUND: Use of hearing impairment (HI) questionnaires has been an alternative to formal audiometry. OBJECTIVE: To validate hearing handicap inventory for the elderly (HHIE) questionnaire and verify its suitability or otherwise as a screening instrument in low-resource clinical settings. SUBJECTS AND METHODS: A cross-sectional analytical study deployed the HHIE questionnaire to detect emotional and situational hearing handicaps (HHs) and assigned scores. Total scores were categorised as no, mild to moderate or significant HH. Pure tone audiometries (PTAs) were performed and PT average (PTAv) was calculated. HHIE scores were compared with the PTAvs. Validity of HHIE scores compared with PTAvs was explored with sensitivity, specificity and predictive values, while correlation coefficients combined age, HHIE scores and PTAv. Level of statistical significance was taken as P < 0.05 for all analyses. RESULTS: One hundred and three subjects with mean age ± standard deviation, 71.3 ± 7.2 years were studied. Over 70% (71.8%, 74/103) were married, 63.1% (65/103) attended secondary school, 35.0% (36/103) were professionals and 45.6% (47/103) were retired. HHIE questionnaire revealed 59.2% (61/103) had handicap and PTA confirmed 47.6% (49/103) had HI. Comparing HHIE scores with PTAv, overall sensitivity was 79.6%, specificity was 59.3%, positive predictive value was 63.9% and negative predictive value was 76.2%. HHIE scores correlated significantly with PTAv (r = 0.527, P < 0.001) and there was no correlation between age and PTAv (r = 0.145, P = 0.143) and between age and HHIE scores (r = 0.187, P = 0.059). CONCLUSION: HHIE scores obtained from questionnaire can adequately quantify HI. HHIE questionnaire is a valid screening instrument to identify HH among elderly subjects.

Denture impaction in the oesophagus experience of a young ENT practice in Nigeria.

INTRODUCTION: The effect of dental loss and associated desire to restore its function and aesthesis has led to an increase in the number of people wearing dentures. This study therefore reviews the cases of impacted acrylic dentures in the oesophagus. METHODS: A retrospective review of patients that were managed for oesophageal denture impaction at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over an eight year period from 2005 to 2012. RESULTS: A total of 14 patients (M:F 2.5:1). The age ranged from 32-75 years. Majority 64.3%) were 51 years and above. Over 70% presented early. Major presenting symptoms were throat pain (100%), odynophageal (92.9%) and dysphageal (78.6%). The radiographic findings were air entrapment (64.3%) and increase in prevertebral soft tissue shadow (78.6%). Majority (87.5%) were impacted at the upper (cervical) oesophagus. Over 78% had successful extraction with rigid oesophagoscopy. Two (14.3%) had spontaneous expulsion of the denture and 1 (7.1%) discharged himself against medical advice. Complications were mucosa tear (28.6%), laryngeal spasm/ airway obstruction (14.3%), mucosa oedema/ erythema (57.1%), neck abscess (7.1%). CONCLUSION: Impaction of esophageal dentures is relatively common in our locality; most patients present early for medical attention and associated with successful rigid oesophagoscopies and denture extraction under GA, and generally good outcome. Education of the wearers of dentures was emphasized as a way of preventing dentures impaction.

Vestibular disorders in elderly patients: characteristics, causes and consequences.

INTRODUCTION: This study assessed vestibular disorders in elderly patients, describing the causes, clinical characteristics, therapies and treatment outcomes. METHODS: Five-year hospital-based prospective study, conducted at the ENT clinic of a tertiary referral center. Subjects were consecutive elderly patients with dizziness, treated and followed-up for a minimum of six months. Data was generated using structured questionnaire and case record files. Analyzed results were presented in simple descriptive forms as graphs and tables. RESULTS: Among the elderly patients, prevalence of vestibular disorders was 18.6%, 49.1% were retired, 71.9% were married, M:F was 1:1.1. Mean age±SD were 69.4±1.1 and 69.0±0.8 years for males and females respectively. 56.9% of the patients presented early on experiencing the vestibular symptoms. The symptoms were associated with nausea or vomiting in 26.3%, with an aura in 12.3%. While 50.9% of the patients experienced intermittent symptoms, laterality of the symptoms was not clear in 45.6%. Positional vertigo was diagnosed in 33.3% while in 17.5%, the symptoms could be attributable to previous trauma or assaults. 31.6% of the elderly were referred to ENT surgeons by other specialties, 45.6% were managed with multidisciplinary approach, while 82.5% had the vestibular symptoms initially controlled with labyrinthine sedatives. At follow-up, 43.9% had intermittent periods of recurrence of symptoms. CONCLUSION: Prevalence of vestibular disorders in elderly patients is high, most patients present early with intermittent, relatively innocuous symptoms which may be difficult to lateralize. Positional vertigo was the most common cause, it is frequently relieved with labyrinthine sedatives but tends to recur intermittently.

Assessment of the risk factors for hearing loss in adult Nigerian population.

BACKGROUND: A reduction in hearing sensitivity is common in adults and was previously considered to be normal as age increases. However, other health variables may play a role in the sensory changes. This prospective, comparative, hospital-based study assessed the risk factors (RFs) associated with sensorineural hearing losses (SNHL) in adult patients in a specialized tertiary hospital clinic in South-western Nigeria. MATERIALS AND METHODS: Patients with clinical diagnosis of hearing impairment (bilateral SNHL) were the test subjects and age and sex-matched comparable group without SNHL were the Controls. Using a structured questionnaire, variables assessed included current and past medical history, family and social history, use of medications including ototoxic drugs, and prolonged medications. RESULTS: One hundred and twenty-seven patients participated in the study comprising of 76 test subjects with SNHL (including 14 with suspected ARHL) and 51 controls. 59.8% of the participants were males. Univariate analysis revealed statistically-significant differences in family history, alcohol consumption, smoking, exposure to noise, previous ear discharge, previous head injury, hypertension, diabetes, osteoarthritis, ototoxic drugs usage, prolonged medication and obesity between the two categories of subjects. Logistic regression analysis revealed family history, smoking, noise exposure, head injury, hypertension had significantly increased odds of developing SNHL. CONCLUSION: It was concluded that the RFs for SNHL in adult Nigerians were multifactorial while some of the RFs may be amenable to primary prevention. Legislation and public health education could facilitate reduction of SNHL in our community.

Corrosive oesophageal injuries: a preventable menace.

INTRODUCTION: Potentially catastrophic presentations and lifelong complications resulting from corrosive ingestions in humans is one of the most challenging situations encountered in clinical medical practice. This study reviewed pattern, mechanisms and associated socio-medical challenges with ingestion of corrosive agents as seen in a tertiary health institution in South-western Nigeria. METHODS: A retrospective review of all patients that were managed for corrosive ingestion at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over a seven year period. RESULTS: A total of 28 patients M:F: 1.6:1. There were 7 children and 21 adults. Majority (78.6%) of the patients ingested alkaline substances. Accidental ingestion occurred in 28.6% while 71.4% resulted from deliberate self harm especially among adults (66.7%). Almost two thirds (64.3%) of the patients presented after 48hrs of ingestion. Patients who presented early were managed conservatively. Most patients (64.3%) who presented late had nutritional and fluid rehabilitation. Two patients died from oesophageal perforation and resulting septicaemia. Psychiatric evaluation revealed that seven adults (25%) had psychotic illness while (42.9%) of the patients developed oesophageal strictures. Short segment strictures were managed with oesophageal dilatation with good outcome while long and multiple segment strictures were referred to cardiothoracic surgeons for management. CONCLUSION: Corrosive oesophageal injuries remain a prevalent and preventable condition in the developing countries. Preventive strategies should include regulation and packaging of corrosive substances, organization of psychiatric services, and education of the population on corrosive ingestion.

Characterization of tinnitus in Nigeria.

OBJECTIVE: This study aimed to characterize tinnitus in middle aged and elderly out-patients attending a specialized clinic in a developing country. METHODS: A cross sectional study of patients attending the ear, nose and throat (ENT) clinic of Olabisi Onabanjo University Teaching Hospital, OOUTH Sagamu, Nigeria. Data was collected with the use of a structured questionnaire. Data collected included socio demographics, medical history including experience of tinnitus, PTAs, BMI and BP. Data was analyzed using SPSS version 17.0. RESULTS: 79 patients had complaints of tinnitus thus making a crude prevalence of 14.5%, the prevalence increased steadily along the age groups. 51.9% of patients experienced tinnitus for a short period. 53.2% of the patients had symptoms referable to only one ear, while 54.4% had discrete as opposed to multiple types of tinnitus. Occurrence of intermittent symptoms was experienced by 75.9% of the patients and 70.9% were non-pulsatile in nature. Tinnitus was significantly associated with abnormal audiographic pattern, global increased hearing thresholds, high tone hearing loss, vertigo, hypertension and obesity. CONCLUSION: Tinnitus character was majorly short term, unilateral, discrete, intermittent, and non-pulsatile in nature, and it is associated with otological, audiological, anthropometric and cardiovascular anomalies. The characteristics of tinnitus in Nigerian patients were similar to those described in developed countries, but the major risk factors for tinnitus except hearing impairment, may be different from the latter.

Fatores de risco de apneia obstrutiva do sono entre pacientes ambulatoriais nigerianos / Risk factors of obstructive sleep apnea among nigerian outpatients

Apneia obstrutiva do sono (SAOS) é uma condição médica com consequências adversas. OBJETIVOS: Descrever os fatores de risco associados com OSA em adultos atendidos em uma clínica especializada ambulatorial. Forma de estudo: Estudo clínico prospectivo, entre pacientes ambulatoriais adultos em uma clínica especializada. MÉTODO: Os dados foram coletados por meio de questionário incorporando o BQ e os pacientes foram divididos em riscos de baixa e alta da OSA. Os fatores de risco associados com OSA na análise univariada foram submetidas a um modelo multivariado de regressão logística binária. Odds ratio ajustados com intervalo de confiança de 95% foram calculados para as seguintes variáveis independentes. RESULTADOS: Cento e nove e cinco pacientes participaram do estudo (sexo masculino 56,4%; idade 43,5 ± 15,6 anos; não roncadores habituais 81,5%, risco de alta OSA 17,4%, IMC 24,1 ± 4,6 kg/m²; obesos 12,9%). Seis fatores, incluindo o estado civil e a pressão arterial, foram significativamente associados com SAOS usando análise bivariada, no entanto, idade, horas de trabalho, tabagismo e IMC permaneceu preditivo da OSA na análise de regressão logística. CONCLUSÕES: SAOS é comum entre pacientes nigerianos, pode ser sub-reconhecida e está associada a fatores de risco que são passíveis de estratégias preventivas.

Obstructive sleep apnea (OSA) is a medical condition with adverse consequences. OSA is credited to be a sleep disorder that disproportionately affects blacks. The Berlin Questionnaire (BQ) is a screening questionnaire for OSA. OBJECTIVE: To describe the risk factors associated with OSA among adults attending an out-patient specialist clinic. Study design: Prospective, clinical study including adult outpatients attending a specialist clinic. METHOD: Data was collected using a questionnaire incorporating the BQ and patients were divided into low and high risks of OSA. The risk factors associated with OSA in the univariate analyses were subjected to a multivariate binary logistic regression model. Adjusted odds ratios with 95% confidence intervals were calculated for these independent variables. RESULTS: One hundred and ninety five patients participated in the study (Males 56.4%; Age 43.5 ± 15.6 years; Non-habitual snorers 81.5%; High risk OSA 17.4%; BMI 24.1 ± 4.6 kg/m²; Obese 12.9%). Six factors including marital status and blood pressure were significantly associated with OSA using bivariate analysis nevertheless age, hours at work, smoking status and BMI remained predictive of OSA on logistic regression analysis. CONCLUSIONS: OSA is common among Nigerian outpatients, may be under-recognized and is associated with risk factors that are amenable to preventive strategies.

Risk factors of obstructive sleep apnea among Nigerian outpatients.

UNLABELLED: Obstructive sleep apnea (OSA) is a medical condition with adverse consequences. OSA is credited to be a sleep disorder that disproportionately affects blacks. The Berlin Questionnaire (BQ) is a screening questionnaire for OSA. OBJECTIVE: To describe the risk factors associated with OSA among adults attending an out-patient specialist clinic. STUDY DESIGN: Prospective, clinical study including adult outpatients attending a specialist clinic. METHOD: Data was collected using a questionnaire incorporating the BQ and patients were divided into low and high risks of OSA. The risk factors associated with OSA in the univariate analyses were subjected to a multivariate binary logistic regression model. Adjusted odds ratios with 95% confidence intervals were calculated for these independent variables. RESULTS: One hundred and ninety five patients participated in the study (Males 56.4%; Age 43.5 ± 15.6 years; Non-habitual snorers 81.5%; High risk OSA 17.4%; BMI 24.1 ± 4.6 kg/m²; Obese 12.9%). Six factors including marital status and blood pressure were significantly associated with OSA using bivariate analysis nevertheless age, hours at work, smoking status and BMI remained predictive of OSA on logistic regression analysis. CONCLUSIONS: OSA is common among Nigerian outpatients, may be under-recognized and is associated with risk factors that are amenable to preventive strategies.