Effect of HIV Infection and Highly Active Antiretroviral Therapy on Hearing Function: A Prospective Case-Control Study From Cameroon.

IMPORTANCE: Human immunodeficiency virus (HIV) infection remains a major cause of morbidity and mortality worldwide. Many studies have found a higher prevalence of hearing impairment among HIV-positive individuals. OBJECTIVE: To investigate the effect of HIV and highly active antiretroviral treatment (HAART) on the hearing function in a Cameroonian population. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective case-control study from March 1, 2012, through January 31, 2013. The study took place at the National Social Insurance Fund Hospital in Yaoundé, Cameroon, a public health facility. We included 90 HIV-positive case patients and 90 HIV-negative control patients aged 15 to 49 years without any history of hearing loss or treatment with a known ototoxic drug. The case group was further divided into 3 subgroups: 30 HAART-naive patients, 30 patients receiving first-line HAART, and 30 patients receiving second-line HAART. INTERVENTIONS: Hearing function was assessed by pure-tone audiometry and classified according to the criteria of the Bureau International d'Audio-Phonologie. MAIN OUTCOMES AND MEASURES: Hearing loss due to HIV and HAART. RESULTS: The HIV-positive patients had more otologic symptoms (hearing loss, dizziness, tinnitus, and otalgia) than HIV-negative patients (41 vs 13, P = .04). There were 49 cases (27.2%) of hearing loss in the HIV-positive group vs 10 (5.6%) in the HIV-negative group (P = .04). Compared with HIV-negative individuals, the odds of hearing loss were higher among HIV-infected HAART-naive patients (right ear: odds ratio [OR], 6.7; 95% CI, 4.3-9.7; P = .004; left ear: OR, 6.2; 95% CI, 3.5-8.3; P = .006), patients receiving first-line HAART (right ear: OR, 5.6; 95% CI, 1.9-10.5; P = .01; left ear: OR, 12.5; 95% CI, 8.5-15.4; P < .001), and patients receiving second-line HAART (right ear: OR, 6.7; 95% CI, 3.3-9.6; P = .004; left ear: OR, 3.7; 95% CI, 3.0-5.0; P = .08). CONCLUSIONS AND RELEVANCE: Hearing loss is more frequent in HIV-infected patients compared with uninfected patients. Therefore, HIV-infected patients need special audiologic care. Further studies are needed because controversy remains regarding the factors that lead to ear damage.

[Facial entomophtoromycosis: à propos of a case]. / Entomophtoromycose rhinofaciale à propos d'un cas.

We report one case of rare facial entomophtoromycosis which occured in a young male patient of 16 years of age, in Cameroon. The clinical presentation was a central mass of the face. We show the interest of the diagnosis of this rare fungal infection through biopsy and its medical treatment.

[Management of laryngeal cancer in an ENT Service in subSaharan Africa]. / Prise en charge des cancers du larynx: expérience d'un service ORL en Afrique noire.

INTRODUCTION: The management of cancers of the larynx remains a challenge to most ENT specialists in Cameroon due to a multitude of factors linked to their management. The aim of this study is to identify the important factors that militate against the proper management of these cancers and to propose solutions. MATERIALS AND METHODS: A retrospective study was carried out in the ENT service of the General Hospital of Douala over six years (April 1998 to June 2006). Eighteen cases of epidermoid cancers of the larynx were identified. Only 10 of the clinical records could be reviewed because the remaining patients refused to be treated in our unit immediately after they were informed of the diagnosis. RESULTS: All the cases were males with a mean age of 53. Most of the cases diagnosed were at the advanced stage of the disease (7T4, 2T3, 1T2). Six patients were treated with radiotherapy only, one with chemo-radiotherapy. Three patients had a full laryngectomy followed by radiation therapy in two cases. One of the cases operated developed a pharyngeal fistula. By the end of the third year only 30% of our patients still continued their follow-up. DISCUSSION: The therapeutic protocols used took into consideration the socio-economic status of the patients, the experience of the personnel in the management of laryngeal cancers and the treatment techniques and modes available in our hospital. Because of these factors, standard European and American recommendations for the management of laryngeal cancers could not be used. CONCLUSION: Government intervention to offer subventions for the high cost of work-up and treatment of these patients is a must for better results to be obtained. There is also a need for the creation of training, prevention and treatment centres for cancers of the larynx.