Hoarseness in a nigerian tertiary health facility: Prevalence, aetiology and predisposing factors.

Objectives: To determine the prevalence, aetiology and predisposing factors in patients presenting with hoarseness to Usmanu Danfodiyo University Teaching Hospital, Sokoto. Methods: The study was a prospective, hospital-based study involving patients with hoarseness ≥7 years. Demographic characteristics and information on voice abuse, smoking, alcohol ingestion and gastroesophageal reflux disease (GERD) were taken. Participants had laryngeal endoscopy using a flexible nasopharyngolaryngoscopy to determine the cause of hoarseness. Results: A prevalence of 2.97% was obtained in the study, and the age range of participants was 7 to 78 years, with a male:female ratio of 1.3:1. The most common cause of hoarseness was laryngeal inflammation 38 (40.0%), followed by benign neoplasm 24 (25.3%) , malignancy 20 (21.1%) and trauma 10 (10.5%). Voice abuse, GERD and smoking were significant predisposing factors for benign neoplasm (χ2 = 8.73; P = 0.0031), inflammation (χ2 = 19.79; P < 0.0001) and malignancy of the larynx (χ2 = 10.66; P = 0.0011), respectively. Conclusion: The study showed that acute and chronic laryngeal infection and neoplasms (benign and malignant) of the larynx were the most common causes of hoarseness. Voice abuse, smoking and GERD were the commonest predisposing factors.

Heterogeneity in head and neck cancer incidence among black populations from Africa, the Caribbean and the USA: Analysis of cancer registry data by the AC3.

BACKGROUND: Africa and the Caribbean are projected to have greater increases in Head and neck cancer (HNC) burden in comparison to North America and Europe. The knowledge needed to reinforce prevention in these populations is limited. We compared for the first time, incidence rates of HNC in black populations from African, the Caribbean and USA. METHODS: Annual age-standardized incidence rates (IR) and 95% confidence intervals (95%CI) per 100,000 were calculated for 2013-2015 using population-based cancer registry data for 14,911 HNC cases from the Caribbean (Barbados, Guadeloupe, Trinidad & Tobago, N = 443), Africa (Kenya, Nigeria, N = 772) and the United States (SEER, Florida, N = 13,696). We compared rates by sub-sites and sex among countries using data from registries with high quality and completeness. RESULTS: In 2013-2015, compared to other countries, HNC incidence was highest among SEER states (IR: 18.2, 95%CI = 17.6-18.8) among men, and highest in Kenya (IR: 7.5, 95%CI = 6.3-8.7) among women. Nasopharyngeal cancer IR was higher in Kenya for men (IR: 3.1, 95%CI = 2.5-3.7) and women (IR: 1.5, 95%CI = 1.0-1.9). Female oral cavity cancer was also notably higher in Kenya (IR = 3.9, 95%CI = 3.0-4.9). Blacks from SEER states had higher incidence of laryngeal cancer (IR: 5.5, 95%CI = 5.2-5.8) compared to other countries and even Florida blacks (IR: 4.4, 95%CI = 3.9-5.0). CONCLUSION: We found heterogeneity in IRs for HNC among these diverse black populations; notably, Kenya which had distinctively higher incidence of nasopharyngeal and female oral cavity cancer. Targeted etiological investigations are warranted considering the low consumption of tobacco and alcohol among Kenyan women. Overall, our findings suggest that behavioral and environmental factors are more important determinants of HNC than race.

Relationship between Sinonasal Anatomical Variations and Symptom Severity in Patients with Chronic Rhinosinusitis.

Background: Anatomical variations are subtle structural abnormalities around the osteomeatal complex that might obstruct paranasal sinus drainage and ventilation. The role of these anatomical variants in chronic rhinosinusitis is still controversial and unclear. The aim of this study was to determine the prevalence of anatomical variations and their relationship with the severity of symptoms in patients with chronic rhinosinusitis. Materials and Methods: This was a cross-sectional study conducted among randomly selected patients with chronic rhinosinusitis. Sinonasal Outcome Test-20 (SNOT-20) was used to assess the patient's severity of symptoms. Computed tomographic scan was used to determine the presence of anatomical variations. The relationship between anatomical variations and symptom severity was determined using the Statistical Products and Service Solution (SPSS) version 20.0. Results: There were 70(58.3%) males and 50(41.7%) females within the age range of 17-60 years. SNOT-20 scoring showed 6(5.0%) of the patients with mild symptoms, 69(57.5%) with moderate, 37(30.8%) with severe, and 8(6.7%) with profound symptoms. The prevalence of sinonasal anatomical variants was 26.7%, which comprised of septal deviation (10.8%), agger nasi (6.7%), concha bullosa (4.2%), Haller cells (3.3%), and Onodi cells (1.7%). There was a statistically significant relationship between the anatomical variations and symptom severity (P = 0.000). Conclusion: This study found a significant relationship between anatomical variations and severity of chronic rhinosinusitis. The prevalence of anatomical variants was found to be 26.7%.

Contexte: Les variations anatomiques sont des anomalies structurelles subtiles autour du complexe ostéoméatal qui peuvent obstruer le drainage et la ventilation des sinus paranasaux. Le rôle de ces variantes anatomiques dans la rhinosinusite chronique est encore controversé et peu clair. Le but de cette étude était de déterminer la prévalence des variations anatomiques et leur relation avec la sévérité des symptômes chez les patients atteints de rhinosinusite chronique. Méthodologie: Il s'agissait d'une étude transversale menée auprès de patients sélectionnés au hasard et atteints de rhinosinusite chronique. Sinonasal Outcome Test-20 (SNOT-20) a été utilisé pour évaluer la gravité des symptômes du patient. La tomodensitométrie a été utilisée pour déterminer la présence de variations anatomiques. La relation entre les variations anatomiques et la gravité des symptômes a été déterminée à l'aide de la version 20 de la solution SPSS. Résultats: Il y avait 70 (58,3%) hommes et 50 (41,7%) femmes dans la tranche d'âge de 17 à 60 ans. Le score SNOT-20 a montré que 6 (5,0%) des patients présentaient des symptômes légers, 69 (57,5%) des symptômes modérés, 37 (30,8%) des symptômes graves et 8 (6,7%) des symptômes profonds. La prévalence des variantes anatomiques naso-sinusiennes était de 26,7%, comprenant la déviation septale (10,8%), l'agger nasi (6,7%), la concha bullosa (4,2%), les cellules de Haller (3,3%) et les cellules d'Onodi (1,7%). Il y avait une relation statistiquement significative entre les variations anatomiques et la sévérité des symptômes (P = 0,000). Conclusion: Cette étude a trouvé une relation significative entre les variations anatomiques et la sévérité de la rhinosinusite chronique. La prévalence des variantes anatomiques était de 26,7%.

Cardiovascular risk factors and hearing loss among adults in a tertiary center of Northwestern Nigeria.

OBJECTIVE: To assess the effect of cardiovascular risk factors on hearing impairment. METHODS: This was a cross sectional study conducted in Usmanu Danfodiyo University Teaching Hospital, Sokoto. A pretested questionnaire was used to obtain information about the biodata and medical history of participants after which, they were examined and had their hearing thresholds measured. RESULTS: In this study, total of 220 participants were recruited. Within these participants, 112 (55.5%) were females, while 98 (44.5%) were males. The average age of the participants was (45.24 ± 12.21) years. The mean of pure tone average among the participants was (19.15 ± 9.28) dB HL. Thirty-six (16.4%) of the participants had some degree of hearing loss. Besides, 30 of them (13.6%) had hypertension, while 23 (10.5%) presented with diabetes mellitus. In addition, 43 participants (19.5%) had BMI (body mass index) that was ≥25 kg/m2. Also, 9 out of the 220 participants (4.1%) had a history of cigarette smoking. Our studies indicated that hypertension, diabetes mellitus, BMI of ≥25 kg/m2, and aging were significantly associated with the risk of hearing loss. In contrast, cigarette smoking and sex were not associated with the hearing loss. CONCLUSION: This study showed that hypertension, diabetes mellitus, aging, and higher BMI were associated with increase risk of hearing loss.

Total laryngectomy for laryngeal cancer in a nigerian tertiary health center: prognosis and outcome.

BACKGROUND: Advanced laryngeal cancers presenting with upper airway obstruction are a common scenario in Sub-Saharan Africa, requiring operative intervention as a priority. OBJECTIVE: To assess outcome of total laryngectomy as a treatment option in the surgical management of advanced laryngeal cancers in a tertiary health institution in northwestern Nigeria. MATERIALS AND METHODS: A retrospective analysis of total laryngectomies for laryngeal cancers carried out by one surgeon from December 2000 to August 2009. RESULTS: Out of 30 patients with histologically diagnosed laryngeal cancer, 18 were treated with total laryngectomy Fourteen (77.8%) were males, while 4 (22.2%) were females, with a male-to-female ratio of 3.5:1. The age range was 20-70 years with a mean age of 47years for males and 33.8 years for females. Total laryngectomy was carried out on T4 lesions (100%), with preoperative tracheostomy (100%) carried out as an emergency measure to relieve upper airway obstruction. Two female patients had safe vaginal deliveries after their surgeries. Although all patients were referred for radiotherapy, only 6 (33.3%) patients could afford postoperative radiotherapy, with a 5-year survival rate of 33.3%; while all others could not afford the cost of radiotherapy treatment, which was to be carried out at a center about 5 hours drive away from our center. Seven (38.9%) patients presented with recurrent neck nodal disease, while 3 (16.7%) had carotid blow-out hemorrhage that was fatal. CONCLUSION: Total laryngectomy remains an important surgical modality of treatment for advanced laryngeal cancers, as it affords the patient an opportunity of longer survival when combined with postoperative radiotherapy. It is superior to 'radiotherapy only' or 'surgery only' or nothing.

Asthma in Nigeria: are the facilities and resources available to support internationally endorsed standards of care?

OBJECTIVE: The objective of this study was to assess the facilities and resources available to support internationally endorsed standards of asthma care at tertiary hospitals (University teaching, Federal Medical Centre and State specialist Hospitals) in Nigeria. METHODS: This cross sectional study was conducted among 68 tertiary hospitals (TH) in Nigeria from June 2009 to December 2009. Structured standards of care questionnaires on asthma based on the Global initiative for asthma (GINA) guideline were completed by physician working in each of the TH. RESULTS: Most TH lacked the services of respiratory physicians, internists, and pediatricians. Available basic infrastructures were asthma clinics (0%), clinic registers (20.6%), and hospital protocol (17.6%), doctor's attendance of asthma CME (8.8%) and nurse educator with a bias for asthma (14.7%). Thirty eight percent of TH had peak flow meter, 29.4% had spirometer, skin allergy test kits (15.6%), pulse oximeter (38.2%) while 17.6% had arterial blood gases analyser. Nebuliser and spacer were available in 41.2% and 20.6% of TH respectively. Oral short acting beta 2 agonist (SABA) was available in 79.4% of the hospitals, glucocorticosteroid (79.4%), theophyllines (76.5%), and SABA (metered-dose inhaler MDI: 76.5%, Nebules: 35.3%). Long acting beta 2 agonist (LABA) and steroid fixed dose combination inhaler (50%) was available in 50% of TH. Glucocorticosteroid nasal spray was available in 33.3% of TH and <10% reported the availability of anti-cholinergic and chromoglycate inhaler and oral leukotriene antagonist. Standard oxygen delivery system and self-educational support materials were available in 52.9% of TH. CONCLUSION: The available facilities and human resources for asthma management in Nigerian tertiary hospitals were not enough to support the standard internationally endorsed for asthma care. Provisions of deficient infrastructures and continuous training of health care personnel in asthma management are imperative to enhance the quality of care.