Effect of Chronic Kidney Disease on Olfactory Function: A Case-Control Study.

BACKGROUND: Olfactory function of patients with chronic kidney disease (CKD) has been found to be defective, and patients are often unaware of it. This predisposes them to malnutrition with consequence on health recovery and quality of life. AIM: To assess the olfactory function and determine the pattern of olfactory dysfunction in patients with CKD attending the University College Hospital, Ibadan. MATERIALS AND METHODS: This was a prospective, hospital-based case-control study of adult patients with CKD. The control group were age- and sex-matched individuals without CKD. Olfactory threshold (OT), odor discrimination (OD), and odor identification (OI) tests were carried out in participants using the "Sniffin Sticks." RESULTS: There were 100 patients with CKD and 100 healthy controls, age ranges between 19 to 86 years (mean ± SD = 46.3 ± 13.9 years) and 20 to 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (P = .57). The mean olfactory scores were significantly lower among the cases than control, OI 11.2 ± 2.3 and 13.1 ± 1.2 (P < .001), OD 8.5 ± 2.4 and 10.9 ± 1.5 (P < .001), OT 6.4 ± 2.5 and 9.6 ± 1.9 (P < .001), and threshold discrimination and identification 26.0 ± 5.7 and 33.6 ± 3.3 (P < .001), respectively. Prevalent olfactory dysfunction among patients with CKD was 77% (hyposmia 72%, anosmia 5%), and the control was 16% (all hyposmia; P < .001). CONCLUSION: There was high prevalence of olfactory dysfunction among patients with CKD, and the affectation is more at the central olfactory pathway.

Effect of Chronic Kidney Disease on Taste Function: A Case Control Study among Nigerian.

Taste dysfunction has been associated with chronic kidney disease (CKD) especially end stage kidney disease (ESKD) and also implicated as one of the predisposing factors for the prevalent malnutrition, muscle wasting and impaired quality of life among patients with CKD. To assess the taste function and determine the pattern of taste dysfunction in patients with CKD attending the University College Hospital, Ibadan. This was a cross sectional, hospital-based case-control study of adult patients with CKD. The control group were age and sex matched without CKD. Interviewer-assisted questionnaires were administered on all participants to obtain clinical information concerning demographics, clinical data on kidney disease and taste dysfunction. The four basic taste modalities namely; sweet, sour, bitter and salt taste senses of the participants were tested with validated "taste strips". There were 100 patients with CKD and 100 healthy controls, age ranges between 19 and 86 years (mean ± SD = 46.3 ± 13.9 years) and 20 and 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (p = 0.57). Hypogeusia was found in 27.0% of CKD patients with specific taste modalities dysfunction for salt, sour, sweet and bitter taste of 13.0, 24.0, 13.0 and 17.0%, respectively. The controls only had specific taste modalities dysfunction for salt, sour and bitter taste of 1.0% for each of the taste modalities. The mean total taste scores in the cases and controls were - 9.8 ± 3.2 and 13.4 ± 1.5 (p = 0.001), respectively. The mean taste scores were significantly lower among the cases than controls, salt taste-2.82 ± 1.1 and 3.7 ± 0.7 (p = 0.001), sour taste - 2.2 ± 1.0 and 3.2 ± 0.7 (p = 0.001), sweet taste-, 2.9 ± 1.8 and 3.8 ± 0.5 (p = 0.001), bitter taste - 1.9 ± 1.2 and 2.8 ± 0.9 (p = 0.001). Taste dysfunction is prevalent among patients with CKD and the affectation involves all taste modalities.

Oro-facial squamous cell carcinoma--a twenty-year retrospective clinicopathological study.

BACKGROUND: Squamous cell carcinoma of the orofacial region is a potentially life-threatening malignant epithelial neoplasm. There have been few studies on the relationship between clinical variables and histological grade among patients with oro-facial carcinoma. We sought to find correlation (if any) between clinical profile, anatomical location and histological grade of these tumours. METHODOLOGY: A retrospective study of all histologically diagnosed oro-facial squamous cell carcinoma cases seen at the University College Hospital, Ibadan between 1990 and 2009. RESULTS: Squamous cell carcinomas constituted 176 (38%) of all oro-facial malignancies. They comprised 91 males and 85 females with mean age of 57 (+/- 16.4) years. The maxillary region was most frequently affected (25%) while the lip was least involved (3.4%). Well-differentiated squamous cell carcinomas constituted 49%, moderately differentiated carcinoma accounted for 36.8% while poorly-differentiated squamous cell carcinomas constituted 14.2%. Well-differentiated and moderately differentiated tumours were relatively more common among subjects older than 50 years of age and poorly-differentiated tumours were more common before 50 years of age (p= 0.001). Degree of tumour differentiation was not correlated with gender (p = 0.88), and anatomical location (p = 0.17). CONCLUSION: Further clinical studies may be required to determine whether oro-facial carcinoma in patients less than 50 years of age has a more aggressive behaviour than in older patients.

Open mastoidectomy and temporalis flap in the control of chronic otorrhoea.

Open mastoid surgery still remains a principal operative treatment for chronic discharging ear. The indications for this procedure still abound in the tropics although it is rarely done in the developed countries nowadays. This series re-emphasize the control of chronic otorrhoea and operative wound infection as benefiting from a combined open mastoidectomy and reconstruction with deep temporalis fascia flap in children. The operative technique is further discussed. It is our hope that repopularising this procedure will help in the control of highly prevalent chronic ear in the tropical environment.

General and regional anaesthesia for thyroidectomy in rural/semi-urban Nigerian centres.

OBJECTIVE: To evaluate the feasibility and benefits of regional anaesthesia (RA) for thyroidectomy in rural/semi-urban centres. DESIGN: A prospective study. SETTINGS: Missionary Hospital Saki, Nigeria and Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. SUBJECTS: One hundred and seventy five patients with goitre. RESULTS: The average time for the anaesthetists to put patients to sleep was 4.06 +/- 1.02 minutes, while it took 17.8 +/- 2.9 minutes to give the regional block. Post operative laryngeal complications in RA group were very minimal, while in general anaesthesia (GA) group, there were significant complications in 32 (36%) patients laryngeal oedema 15 (17%), erosions in 10 (11%) and ulcer in seven (8%). Cost of surgery in GA was thrice as much as in RA group. Thirty one (35%) with GA had steam inhalation for sore throat. It was possible to converse (laryngeal nerve monitoring) with the patient during operation but not possible with GA group. There was early discharge of patients in RA group. CONCLUSION: Regional/local anaesthesia is feasible for some cases of thyroidectomy with a lot of advantages and specifically allows surgeons to converse with the patients during operation-direct laryngeal and other nerve monitoring. Despite advancement in cuff design a lot of lesions still occur from endotracheal intubations.

An unusual case of total maxillary sequestration in a diabetic patient.

Osteomyelitis of the jaw is of relatively low incidence. Maxillary Osteomyelitis is however rare compared with mandibular osteomyelitis. The extensive blood supply and the strut-like bones of the maxilla make it less prone to chronic infections. Systemic conditions that alter the host's resistance such as diabetes mellitus, autoimmune disorders, agranulocytosis, anaemia, especially sickle cell anaemia are predisposing factors for the development of this condition. An unusual case of chronic maxillary osteomyelitis induced by trauma in a diabetic, with subsequent atypical necrotising ulceration of palatal mucosa resulting in total maxillary sequestration is presented.

Deep temporalis fascia in tympanomastoid reconstruction.

Various techniques have been described in the reconstruction of mastoidectomy cavity in an attempt to minimize or control the problems of persistent postoperative otorrhoea. We report the efficacy of deep temporalis fascia and its pedicled flap in 34 cases. Retrospective study method was used. There were 34 cases, 19 males and 13 females, the age ranged between 5 and 64 years, mean of 28 years. The clinical pathology included mastoiditis which was common to all the patients, others are middle ear polyp in 7, mastoid abscess 6, meningitis 4, lateral sinus thrombosis 3 and cholesteatoma 2. Comorbidity factors included diabetes mellitus in 2, moderate anaemia in 3 and septicaemia in 7. The procedures comprised of 18 modified radical mastoidectomy (MRM) and 8 atticoantrostomy (AA) with lining of the resulting cavity and tympanoplasty using a pedicled temporalis fascia flap; and 8 cortical mastoidectomy (CM) and tympanoplasty using a graft. The success rate in terms of control of otorrhoea was 55% and there was no case of postoperative wound infection, an improvement compared to an earlier report. In addition there was a reduction in terms of postoperative hospital stay to an average of 9 days. We found the technique simple to learn and needing minimal equipment, hence relevant to otolaryngologic practice in a resource--poor environment. In addition the deep temporalis fascia is an autologous tissue with no risk of immune rejection. We recommend that mastoid reconstruction with the temporalis fascia becomes a routine in mastoidectomy so as to achieve control of chronic discharging ear, particularly in the sub-Saharan Africa where this is still predominant.

Challenges in management of childhood sensorineural hearing loss in sub-Saharan Africa, Nigeria.

The evaluation of a hearing-impaired child attempts to determine the aetiology, the degree of hearing loss and intervention to aid speech and language. This remains a challenge to practising otolaryngologists, especially in the developing countries as 85-90% of causes of hearing losses were never discovered leading to delayed intervention and irreversible effects. In a review of children presenting at the otolaryngology outpatient in the University College Hospital, Ibadan, Nigeria, sensorineural hearing loss was found in 103, giving a hospital prevalence rate of 14%, we still perceived this figure to be unrepresentatively and low, probably due to poor access to medicare, poverty and other factors. Genetic factor accounted for 25%, followed by measles infections 13% and meningitis 8%. About 60% of them had educationally significant hearing loss at presentation. Access to hearing aid was poor as only 12.5% of the patients could afford it and the rest were managed by deaf training. We conclude by suggesting an audiologic programme which has the comprehensive function of neonatal and infant hearing screening, subsidized hearing aid services and hearing rehabilitation surgery.

Trans-frontal extracranial approach in repair of cerebrospinal fluid fistula.

A 35 year old African woman presented with a 2 year history of unilateral watery left anterior rhinorrhoea, the only other significant feature being a history of severe head injury during childhood. Clinical and radiological evaluation confirmed a cerebrospinal fluid fistula, localized in the inferior portion of the posterior wall of the frontal sinus and ethmoid, no intracranial pathology. Repair was done successfully with a deep temporalis fascial graft through an external transfrontal approach. We report this to buttress the current trend in which less invasive external and endoscopic techniques are replacing intracranial methods. Reduction in morbidity and mortality which are the merits of this technique are emphasized and the management is discussed.

An unusual faciocerebellar arrow injury: successful surgical removal in a peasant Nigerian: a case report.

INTRODUCTION: Reports of penetrating injuries of the cranium have been mainly craniocerebral or faciocerebral, craniocerebellar projectiles are few. CASE: We present a case of a 23 year old Nigerian with a craniofacial penetrating injury by a hunting arrow. The trajectory of the arrow through the facial skeleton across the craniocervical junction into the posterior fossa makes this unique in the literature. Successful operative retrieval by a joint team of neurosurgeons and otorhinolaryngologists, problems of delayed presentation and inadequate diagnostic facilities are highlighted. CONCLUSION: The morbidity-free outcome of surgical removal despite the delay in presentation and management in our practice setting with limited facilities are the salient points of this presentation.

Human immunodeficiency virus and invasive external otitis--a case report.

Acute invasive external otitis is an uncommon life-threatening infection of the external auditory canal (EAC), most often affecting the elderly diabetic patients. Although few reports have been made in HIV-positive/Aids patients among the caucasians. We present here a 25 year old nursing mother with a month history of fever, persistent otalgia with acutely inflammed EAC, gross facial cellulitis, mastoid abscess and facial paresis, following a minor left ear trauma with a matchstick. This unusual course of ear infection in an otherwise healthy young adult prompts a search for an immunodepressing factor which was confirmed to be Human Immunodeficiency Virus (HIV). This article highlights the clinical peculiarities and the management of invasive external otitis in an HIV-positive patient.

Behavioural pattern of malignant otitis external: 10-year review in Ibadan.

Malignant externa otitis is a rapidly progressive infection of the external ear canal, mastoid and the base of the skull caused by Pseudomonas aeruginosa in elderly diabetics and other immunosuppressive conditions. Thirteen cases of malignant externa otitis seen in the E.N.T. Dept University College Hospital, Ibadan between 1988 and 1997 were reviewed. The mean age was 62 years and the mean duration of diabetes was 14 years. The most frequent symptoms were otalgia 13 (100%) and otorrhoea 12 (92%). The complications include multiple cranial neuropathy 11 (85%), meningitis (31%), brain abscess (8%), and infratemporal abscess 1 (8%). There were 8 deaths (62%) showing that this is still a dangerous condition in our environment. The problems identified were late presentation of cases and inavailability of facilities for prompt control and monitoring of patients. It is hoped that the outlook of the disease can be improved if there are corrected.