Urgences ORL de l'enfant au CHU de Yopougon (Côte d'Ivoire)

Objectif : Décrire les caractéristiques épidémiologiques, cliniques et thérapeutiques des urgences ORL de l'enfant dans le service d'ORL-CCF du CHU de Yopougon.Patients et méthodes : Il s'agissait d'une étude prospective transversale portant sur les patients âgés de moins de quinze ans reçus en urgence sur une période de dix mois. Résultats : Cent-vingt-six (126) enfants sur 239 patients ont été reçus en urgence (52,72%). Le sexe masculin représentait 57,94% d'enfants avec un sex-ratio de 1,37. L'âge moyen était de 4,26 ans ± 3,59 (extrêmes 1 jour et 15 ans). Dans cet échantillon, 73,81% des patients ont été reçus pendant la garde en dehors des heures de consultation dont 30,95% les week-ends. Les urgences absolues représentaient 14,30% des cas. Les corps étrangers, les traumatismes externes et les tuméfactions cervicales fébriles ont été observés dans respectivement 50%, 15,08% et 7,14% des cas. La prise en charge était multi-disciplinaire dans 11,12% des cas. Elle concernait en plus de l'ORL, la pédiatrie, la neurochirurgie et la réanimation. Le traitement était médical dans 50% des cas parfois associé aux méthodes physiques (9,52%) ou médico-chirurgicales dans 26,98% des cas. Les méthodes physiques seules ont été suffisantes dans 18 cas (14,29%). Cinq abstentions thérapeutiques (3,97%) ont été répertoriées. L'évolution était favorable dans 90 cas (71,43%). Il a été noté 1 cas de décès. Conclusion : La prévention des accidents de la voie publique et la surveillance des enfants sont des mesures à prendre pour réduire la prévalence des urgences ORL dans notre pratique quotidienne

[Hearing disorders at the candidates of the National Gendarmerie's competition, Ivory Coast].

Objective: Detect the hearing deficiencies of the candi­da­tes of the gendarmerie's competition. Material and method: Pros­pec­tive study realized over 3 years (2008-2010), in the ENT service of the Gendarmerie to Agban (Abidjan). Examination included an otoscopy and a pure tone audiometry. Results: On 23121 candidates, 1245 had a plug of earwax (5.4%). They were aged from 18 to 25 years old (average age: 22.85 years). Eardrum was pathological in 0.5 % of the cases. Prevalence of hearing loss was 1.5%. Hearing loss included sensorineural hearing loss (56.7%), deafness of transmission (29.4%) and mixed deafness (13.9%). Deafness was unilateral in 79.8% and bilateral in 20.2%. Conclusion: Result of audio­gram will be useful for tracking or assessing cases of noise-induced hearing loss attributable to military service.

[Tympanoplasty: Experience of the ENT department in Yopougon hospital (Ivory Cost)]. / La tympanoplastie: expérience du service ORL du CHU de Yopougon (Côte d'Ivoire).

PURPOSE: Perform an analysis of epidemiological, diagnostic and therapeutic aspects of tympanoplasty in Ivory Coast. MATERIALS AND METHODS: Retro and prospective study over 13 years conducted in the ENT department of Yopougon Teaching Hospital. Our study concerned 104 patients. RESULTS: The study population was dominated by young adults with an average age of 30.61 years. Chronic otitis media accounted for 80.76% of past medical history, a condition that was also the main indication (74.04%). Otoscopy pre- and intraoperative found essentially a non-marginal tympanic perforation (74.03%) and preoperative hearing assessment noted a conductive hearing loss in 72% of cases. The retroauricular surgical incision was performed in all patients. Surgical treatment consisted of a tympanoplasty type I in 76.3% of cases. The anatomical results were good in 81% of cases and functionally, 75% of our patients had interaural intensity difference of less than 20 decibels. CONCLUSION: The tympanoplasty performed in our hospital apparently gives results that are similar to those of western countries to the patients who got a post operative control.

[A specific plain X-ray in the diagnosis of elongated styloid apophysis in the Ivory Cost]. / Intérêt du profil oblique menton dégagé dans le diagnostic des apophyses styloïdes allongées en Côte d'Ivoire.

OBJECTIVES: To appreciate the value of a simple radiographic incidence and its effectiveness for the search and the measurement of elongated styloid apophysis (ESA) and to recommend it in the routine search of ESA in practice. PATIENTS AND METHOD: This prospective study was realized over a period of 3 years. It involved the study of ESA from conventional radiographic imaging; the face low incidence in comparison with an experimental incidence, the oblique profile chin lift (OPCL). 101 patients presenting with stylalgia were investigated. RESULTS: Out of the 101 patients, the low face cliché found 49 ESA having an average length of 5 cm. The OPCL allowed to identify 63 ESA, 54 of which were bilateral and 9 unilateral. It also helped identify other associated abnormalities: otitis media (5 cases), dental pathologies (4 cases), dental condensing osteitis (2 cases). The comparative analysis demonstrated a better efficiency of the OPCL in comparison to the standard incidence: the LOW FACE (Roc curve). The OPCL allowed the exposure in one incidence the styloid process and to better appreciate the lower and superior borders of the styloid process giving a better estimate of its measurements. CONCLUSION: It appears from this study that the experimental incidence, the OPCL presents a real interest in the investigation of the ESA but also in the study of the soft tissues of the pharynx, the cervical spine, and the temporo-mastoid region. It also allows the detection of other.

[A case of nasal foreign bodies by tooth migration]. / Un cas de corps étranger des fosses nasales par migration dentaire.

Foreign bodies are a frequent reason for ENT consultation especially in children. Although the nature of the foreign body can be variable, the discovery of a tooth in a nasal cavity is a rare occurrence. The authors report a case of foreign body inside the nasal cavity caused by tooth migration and discuss its pathologic, diagnostic and therapeutic aspects.

A case of middle-ear angiosarcoma.

INTRODUCTION: Middle-ear angiosarcoma is a rare malignant tumor that requires early diagnosis to allow satisfactory removal. The objective of the present study was to describe and discuss the diagnosis and treatment of this rare malignant middle-ear tumor. CASE REPORT: A 12-year-old girl was admitted for a left retroauricular mass and a budding left external auditory canal tumor without associated peripheral facial nerve palsy. CT scan showed a mastoid-region tumor extending to the external auditory canal with mastoid and occipital bone-loss. Tumor removal used a retroauricular approach. Postoperative diagnosis was of angiosarcoma. At 12 months' regular follow-up, there were no signs of local recurrence. DISCUSSION AND CONCLUSION: Middle-ear angiosarcoma is a rare tumor, in which diagnosis is late because early symptoms are not specific. A multidisciplinary approach is essential for efficient management.

[Extraction of the esophageal foreign bodies by cervicotomy: our experience about 9 cases]. / Extraction de corps étrangers oesophagiens par voie de cervicotomie: à propos de 9 cas.

OBJECTIVE: To present our experience of the extraction of the esophageal foreign bodies by cervicotomy route. PATIENTS AND METHOD: Descriptive retrospective study from 2006 to 2010 realized in the ENT Departments of Yopougon and Treichville's Teaching Hospital. RESULTS: 9 (3.3%) of 270 patients underwent surgery to remove esophageal foreign bodies. The average age of the patients was of 14.6 years (extremes: 8 months and 49 years). The foreign bodies were fish bone, hook of clothes peg, medallion, denture and weld. Cervicotomy was performed at once in 4 cases and after failure of esophagoscopy in 5 cases. There were 2 complications (pharyngostoma and suppuration of the operating site). CONCLUSION: The cervicotomy must be quickly performed in case of perforation with or without neck abscess, sharp or voluminous bodies.

[A case of nasal NK/T cell lymphoma in Africa]. / Un cas de lymphome nasal T/NK en Afrique noire.

INTRODUCTION: Nasal NK/T cell lymphoma is an aggressive, locally destructive and necrotizing lesions. It is exceptional rare in Africa. CASE REPORT: We report a 73 year-old patient's case presenting a nasal obstruction with a chronic purulent nasal discharge. The physical examination showed a chronic nasal lesion involving the nose and infiltrating the pyramid. The histopathological examination performed in a french laboratory diagnosed a nasal T cell lymphoma. Chemotherapy was initiated; radiotherapy being unavailable. CONCLUSION: The difficulties in management of nasal NK/T lymphoma cases are due to diagnostic difficulties and therapeutic problems related to the absence of radiotherapy in our work environment.

[Thyroid localization of myxofibrosarcoma: first case in Africa]. / Myxofibrosarcome à localisation thyroïdienne: première observation en Afrique.

This case report describes a 45-year-old woman who was treated for a bulky ulcerated thyroid tumor with an offensive odor. The tumor had been ongoing for approximately 20 years. The patient had familial medical history of goiter. Histopathological diagnosis of the surgical specimen demonstrated myxofibrosarcoma associated with a classic thyroid tumor (vesicular adenoma). Based on this case, the author reviews the literature describing this rare soft-tissue tumor that is usually located on the extremities. Surgical treatment consists of radical tumor excision. A multidisciplinary therapeutic approach is necessary for efficient management by ensuring proper coordination of adjunctive treatment.

Newborn hearing screening in a developing country: results of a pilot study in Abidjan, Côte d'ivoire.

OBJECTIVE: To investigate the feasibility of neonatal hearing impairment in newborn babies in Abidjan, Côte d'Ivoire. METHODS: It is a cross-sectional study in which all infants aged from 3 to 28 days, attending for Bacille Calmette-Guerin (BCG) immunization in primary care centers or hospitalized in neonatal intensive care units (NICU), between July 2007 and March 2008, were included. Screening followed a two-stage strategy with transient evoked otoacoustic emissions (TEOAE). Infants referred after the second-stage screening were scheduled for diagnostic evaluation by diagnostic auditory brainstem response (ABR). The variables analyzed were: screening coverage, referral rates; return rates for second-stage screening and diagnostic evaluation, incidence of permanent hearing loss and age at diagnosis. RESULTS: 1306 newborns, of a total of 1495, were successfully screened, giving a screening coverage of 87.4%. The average age was 4.5 days (S.D.: 2.7), with 5.85 days (S.D.: 3.17) for the immunization group and 3.20 days (S.D.: 0.40) for the neonatal unit group. In total, 286 out of the 1306 infants (21.9%) were referred after the first-stage screening; out of which 193 (67.5%) return for the second stage. After the second-stage screening, 48 (16.8%) were scheduled for diagnostic evaluation (45 from NICU and 3 from primary care centers). The overall referral rate for diagnostic evaluation was 3.7% (48/1306). Only 18.75% of those referred (9/48) returned for evaluation, and seven of them (77.8%) were confirmed with hearing loss (2 from immunization group and 5 from neonatal unit group). The prevalence of permanent hearing loss in this screened population was 5.96 per 1000 (7/1174 babies who completed the screening) [95% I.C.: 5.62-6.30 per 1000]. The mean age at diagnosis was 22 weeks (S.D.: 8.3). The reasons for non-completed screening were, according to 62 mothers: no financial means, absence of hearing loss, fear of spouse reactions, lack of information about this test and deafness. CONCLUSION: The incidence of permanent and early hearing impairment identified by this screening program was about 6 per 1000. Routine hearing screening of infants for the early detection of hearing loss is necessary in Côte d'Ivoire. It is possible to implement such a hearing screening, targeting all newborns, in primary health care centers and neonatal intensive care units.

[Cephalometric characteristics of black African children 3-6 years of age with nasal obstruction]. / Caractéristiques céphalométriques chez l'enfant mélano-africain âgé de 3 à 6 ans avec obstruction du cavum.

OBJECTIVE: To determine the cephalometric craniofacial characteristic of the child with chronic rhinopharyngeal obstruction. MATERIAL AND METHODS: It is about a comparative cross-sectional study with etiologic aiming including children of the 2 sexes, old from 3 to 6 years. The pathological subjects are represented by those presenting a chronic rhinopharyngeal obstruction due to the presence of hypertrophied tonsils (n = 29) and the "normal" subjects, those without any rhinopharyngeal obstruction (n = 30). Lateral cephalometric radiographs were obtained for each subject. The conventional landmarks were determined with the subject's head in neutral position. The two groups underwent cephalometric measurements. The cephalometric analysis was made starting from conventional landmarks resulting from soft tissues and osseous structures. Various statistical tests (test t of student, test of Kruskal Wallis, test of Mann-Whitney) were used for the exploitation of the cephalometric data. RESULTS: On the skeletal level, the length of the posterior cranial base was shorter at the pathological subjects than at the healthy subjects. Concerning the mandible, the height of the ramus and the length of the mandibular corpus are also weaker at the pathological subjects than at the witnesses. The hyoid bone is further away from the 3rd cervical vertebra and the craniocervical angle is more open at the pathological subjects, representing a modification of the slope of the cervical column. On the level of the rhinopharyngeal space, the average distances from the posterior nasal spine at the posterior edge of the rhinopharyngeal space and between the posterior nasal spine and the posterior base of the base of cranium are respectively of 19,43 +/- 4,78 mm and 37,56 +/- 2,95 mm. These measurements are not significantly different from those described in the literature. CONCLUSION: Our study highlighted skeletal modifications in children presenting a rhinopharyngeal obstruction. Even if they do not justify all the symptoms met, these modifications can represent a readjustment of the pharyngeal corridor aiming at facilitating the flow of airflow.

Particularities of bacterial ecology of acute otitis media in an African subtropical country (Cote d'Ivoire).

BACKGROUND: Acute otitis media (AOM) is the commonest infectious disease of childhood. Its treatment is based on a probabilistic antibiotic therapy. OBJECTIVE: To determine the prevalence of different bacteria responsible for AOM in children in Abidjan (Côte d'Ivoire). MATERIALS AND METHODS: This is a prospective study, between November 2002 and August 2003. To identify bacterial isolates, 60 children under 15 years old with AOM were enrolled. In 52 cases, the sample was recovered by aspiration of a spontaneous otorrhea and in eight cases, it was taken by paracentesis. Nasopharyngeal swabs were cultured. Antibiotic susceptibility tests were performed on isolates. RESULTS: 75% of children were under 24 months of age. Pseudomonas aeruginosa was recovered in 31.8% of cases followed by Streptococcus pneumoniae (21%), Proteus (7.4%) and Staphylococcus (6.2%). The rate of penicillin-nonsusceptible S. pneumoniae (NSSP) was 11.8%. Resistance to erythromycin was 6%. For Pseudomonas, resistances to antibiotics were 35.5% to ceftazidim and 16% to pefloxacin, respectively, but all the strains were sensible to colistin, iminepem and ciprofloxacin. CONCLUSION: These data can modify therapeutic approaches for treatment of AOM in our country. This study should encourage surveillance of AOM microbiology.

[Benign lymphoid pseudotumors of the nasal cavity and HIV infections]. / Les pseudotumeurs lymphocytaires benignes du cavum et infections a VIH.

OBJECTIVE: To return particular aspects of the benign lymphoid pseudotumor of the cavum. MATERIAL AND METHOD: It is about a prospective survey on 7 years achieved in the ENT services of university hospital of Treichville (1994-1995) and of Bouaké (1996-2001). Five cases have been kept. RESULTS: There were 4 women and 1 man aged between 26 years and 47 years. The main reason of consultation was the hypoacousia and the nasal obstruction. A cavum tumor was founded will all the patients during cavoscopy. The tympanometry confirmed the diagnosis of otitis media with effusion. The histological operative piece exam noted a lymphoid hyperplasia. HIV serology was positive in 4 cases and negative in 1 case. The treatment consisted in surgical removal of the tumor in 1 case and in 4 cases it was associated with the grommet insertion. Three of the 4 HIV-positive patients received antiviral treatment. The evolution was good with all the patients. CONCLUSION: The lymphoid pseudotumors of the cavum must make search for a VIH infection at the young.

[Hearing evaluation on young children (less than five years old) in an under-equipped center. An adaptation of the Delaroche protocol]. / Evaluation de l'audition chez l'enfant de moins de cinq ans en milieu sous équipé. Une adaptation du protocole Delaroche.

The authors report their experience of audiometric test in childhood (less than fifty years old). It's an adaptation of Delaroche protocol which was first described by the Bordeaux's team. This prospective study has been realized in their works conditions in Abidjan (Ivory Coast) on 75 children under five years of age (average 2,64 years). This protocol is essentially based on: at first, hearing evaluation with acoustic toys; secondly, bone conduction on the vibrator; at the end, air conduction on the head set. The analysis of the results on 75 children shows that there were 35 normal examinations, 5 conductive deafness, 32 sensorineural hearing loss among which 9 partial failures (hearing threshold non evaluated), 3 complete failures (refuse the test). The authors insist on the utility of audiometric tests in early management of hearing loss in young children.

[Surgical management of laryngeal stenosis in children]. / Traitement chirurgical des sténoses laryngées de l'enfant.

Surgical management of children with laryngotracheal stenosis changed recently because of the procedure of single-stage approach. Between January 1992 and April 1997, 101 children underwent surgery for laryngotracheal stenosis in our department: 47 of them had a single stage procedure, and 54 a classic laryngotracheoplasty with stenting with an Aboulker's tube or silastic sheets. The majority of the cases were acquired stenosis (64%) and the others congenital. The degree of stenosis was graded into four categories according to Cotton's classification. Thirty six cases were grade 2, 44 cases were grade 3, 21 cases were grade 4. Subglottic localization of the stenosis was found in 64% of the cases and the mobility of the vocal folds was normal in 60% of the cases. The surgery was considered successful after one procedure when there was a permanent and permeable laryngotracheal lumen (no more than grade 1) not requiring a tracheotomy. Of the 47 single-stage procedures, 38 were successful (81%); of the 54 cases managed with classic methods, 30 were successful (55%). These results and the indications of the different surgical procedures are discussed.