Tympanometry and endoscopic diagnosis of eustachian tube dysfunction in patients with chronic rhinosinusitis.

Background: This study assessed the eustachian tube (ET) function in adult patients with chronic rhinosinusitis (CRS) using tympanometry and nasal endoscope. Materials and Methods: This was a hospital-based cross-sectional study conducted for 9 months. All participants underwent endoscopic evaluation of the pharyngeal end of their ETs, and the middle ear function was assessed using tympanometry. Endoscopic findings were graded based on a validated mucosal inflammatory endoscopic grading scale. Statistical analysis was carried out using SPSS version 24. Results: A total of 102 CRS patients and age- and sex-matched controls were recruited. Tympanograms suggestive of eustachian tube dysfunction (ETD) types B and C were found among 7.8% and 12.8% of the right and left ears of the CRS groups, respectively. Mucosal inflammatory endoscopic grade that is diagnostic of ETD Grades 3 and 4 was found among 24.5% and 38.2% of the right and left ET of CRS cases, respectively. Conclusion: CRS predisposes patients to anatomical and functional impairment of ET. The relationship between tympanometry and mucosal inflammatory endoscopic grading scale in detecting ETD among CRS patients showed a strong relationship. However, a combination of the two will improve the diagnosis of ETD by evaluating the ET function directly and indirectly.

Hearing loss among inmates of a juvenile correctional facility in Nigeria.

Background: Good hearing is essential to learning and rehabilitation of adolescent and young adults in juvenile correctional facilities. Hearing screening programme is not commonly in place for this incarcerated group. Objective: To evaluate hearing threshold among inmates of a juvenile correctional facility in Nigeria and compare pattern of hearing loss with a control group. Methods: A total of 135 inmates and equal number of age and sex matched control responded to interviewer-administered questionnaire followed by otoscopy and audiometry. Results: Mean age of inmates was 19 years ±2.0, while that of control was 18yrs ± 2.5. (p-value 0.077). Four (3%) inmates had bleeding from the ear; otoscopy revealed traumatic tympanic membrane perforation in 2(1.5%) of them. Prevalence of hearing loss was 19.2% and for disabling hearing loss it was 1.4%. Conductive hearing loss was the most common 33(24.4%). Inmates had consistently worse mean hearing thresholds than controls across all frequencies tested in both ears (p-value <0.001). Conclusion: Hearing loss is prevalent among inmates of juvenile correctional facility. Rehabilitation programme should be balanced with detail attention to health needs of inmates; including pre-admission and periodic hearing screening.

Clinical evaluation and nasoendoscopic scores of patients with chronic rhinosinusitis in Ilorin, Nigeria.

INTRODUCTION: chronic rhinosinusitis (CRS) is characterised by inflammation of the mucosal lining of the nose and paranasal sinuses for at least 12 weeks duration. Other than the diagnostic criteria that is based on clinical features; nasoendoscopy and/or computerized tomographic scan have been included in the diagnosis. This study seeks to outline the clinical evaluation and nasoendoscopic assessment of CRS patients. METHODS: a hospital-based analytical study carried out on 154 participants. Clinical assessment and nasoendoscopy were performed and scored according to the discharge, inflammation and polyps/oedema (DIP) scale. Statistical analysis was carried out and results were presented in charts and tables. RESULTS: of the 154 participants, 71 (46.1%) were males and 83 (53.9%) females with a male to female ratio of 1: 1.7. Nasal discharge and blockage were the commonest symptoms. Nasoendoscopy had higher yield in the examination of intranasal polyps (NPs) over anterior rhinoscopy. The prevalence of NPs was 26.6%. The result of DIP nasoendoscopic findings revealed more participants with moderate scores. There was a significant statistical difference between the presence of NPs on nasoendoscopy and DIP score. CONCLUSION: nasoendoscopy is an important aspect in the diagnosis and evaluation of patients with CRS. It provides a better visualization of NPs; therefore, it should be made routine in the clinical assessment and treatment of patients with CRS. The nasal endoscopic scoring of CRS should be considered as a common practice in clinical setting as well.

Management and Outcome of Rhinosinusitis in Nigeria.

OBJECTIVE: The aim of this study is to present the management and outcome of treatment of rhinosinusitis in Nigeria. STUDY DESIGN: A retrospective review of the case notes of patients with rhinosinusitis between January 2009 and December 2014. SETTING: Study at the University of Ilorin Teaching Hospital, Nigeria, using retrieved case notes after ethical approval was received. SUBJECTS AND METHODS: The information retrieved included sociodemographic data, clinical presentation, duration, endoscopic examination, and other clinical management protocols with follow-up. All information was entered into SPSS version 20 and analyzed descriptively, and results are presented in tables and figure. RESULTS: A total of 5618 patients were seen in the ear, nose, and throat clinic over the 6-year period. Of the patients, 445 had rhinosinusitis, and only 410 had complete data for analysis. Patient age ranged from 2 to 75 years (mean ± SD, 31.8 ± 1.2 years). The male to female ratio was 1.2:1. The duration of symptoms varied from 3 days to 10 years, with 78.7% having symptoms between 3 and 120 months. About 82.4% had nasal discharge, 51.3% had sneezing, 78.9% had alternating nasal obstruction, and 49.3% had nasal itch. Of the patients, 61.4% had a predisposition, of which 30.9% were allergic, 23.3% were infective, and 7.2% were vasomotor. Ethmoidal-maxillary sinuses were commonly affected radiologically. About 63% of patients had medical treatment, and only 28.7% had surgical intervention, of which 37% were scheduled for surgical treatment and 7.3% refused. Improved symptoms were noticed in 72.6% of patients, and 1.4% reported no improvement. CONCLUSION: Rhinosinusitis is still common, affecting active males economically with more chronic cases and more allergic predisposition. Early medical management is still effective, and endoscopic sinus surgery is now a better surgical option with better outcome in 72.6%.

Health-related quality of life and its contributory factors in allergic rhinitis patients in Nigeria.

OBJECTIVES: To determine the health-related quality of life (HRQoL) in allergic rhinitis patients as well as identify contributory factors to patient's well-being. METHODS: Cross-sectional study by multistage sampling. Four-month study duration (October 2013 to January 2014). The setting of the study was Kwara State, Nigeria, which has 16 local government areas with 3 senatorial districts, total land mass of 36,825km(2) with a population of 2,591,555. 132 consenting adults; 66 of them have allergic rhinitis (AR) using Score for Allergic Rhinitis (SFAR) instrument and 66 were age- and gender-matched controls (χ(2)=0, d.f.=1, P=1 and χ(2)=1.24, d.f.=2, P=0.54, respectively). Information on HRQoL was obtained using the 14-parameter mini-rhinoconjunctivitis quality of life questionnaire (mini-RQLQ). Socio-demographic variables possibly contributory to patient's well-being were obtained. Kruskal-Wallis and Mann-Whitney U tests were used to compare means. RESULTS: The overall Total Symptom Score (TSS) was 3.37±0.9, while male and female allergic patients and control TSS were 3.61±1.0; 3.16±0.8, and 0.98±0.2; 0.95±0.2, respectively. Effects of gender, marital status, senatorial districts, residential area and duration of symptoms had significant impact on the quality of life. The highest correlation with TSS and components of mini-RQOL questionnaire existed between nasal problems and other symptoms (r=0.866; 0.868). CONCLUSION: AR had appreciable impact on HRQoL of the participants. Gender, number of dependents, marital status, senatorial districts, residential area and duration of symptoms were major identifiable contributory factors to the patient's well-being.

Correlation of Bacterial Isolates from Middle Ear and Nasopharynx in Patients with Chronic Suppurative Otitis Media in Ilorin, Nigeria.

PURPOSE: To determine the association between isolates in the middle ear (ME) and nasopharynx of patients with chronic otitis media in Ilorin, north-central Nigeria. METHODS: An ethically approved case control study was carried out in the Ear, Nose, and Throat clinic amongst consenting cases using normal subjects as controls. A microbiology investigation form giving the results for otoscopy, aspirate and swabs was filled out for both the ME and nasopharynx. The experimental procedure was carried out and bacteria were identified according to colony characteristics, morphological appearance, Gram-staining, and standard biochemical testing. Data obtained were analysed with SPSS version 16.0 and Epi Info 3.5.1 using the mean, standard deviation and chi-square results. RESULT: A total of 140 cases and 70 controls, were recruited. The Gram stain reaction of the ME aspirates were positive in 28.6% and negative in 71.4% of cases. Nasopharyngeal swabs revealed 64.3% Gram positive and 35.7% negative organisms. Overall, there was no relationship between the ME and nasopharyngeal isolates amongst cases, with a P value of 0.000. However, there was a relationship amongst the isolate from the nasopharynx of cases and controls, with the exception of Klebsiella pneumoniae, at P < 0.009. CONCLUSION: There was no relationship amongst the bacterial isolate from the ME and nasopharyngeal specimen of patients with otitis media.

Profile of anaerobic bacteriology of middle ear aspirates in a developing country: does immunocompromise play a role?

OBJECTIVES: The study intends to report the profiles of anaerobic bacteria isolated and attempts to evaluate the impact of immunocompromised status of patients on the disease. STUDY DESIGN: A cross-sectional prospective study. SETTING: ENT clinic, University of Ilorin Teaching Hospital, Nigeria; a 450-bed tertiary health facility. SUBJECTS: 104 consecutive consenting participants with clinical evidence of CSOM ≥12 weeks. METHODS: A hospital-based study conducted over a seven (7) month period. The middle ear aspirate was obtained with the aid of a micropipette and sent immediately for Microscopy, Culture and Sensitivity of both anaerobic and aerobic bacterial isolates. RESULTS: A total of 11 patients with chronically discharging ears, of the 104 studied had anaerobic bacteria cultured from their middle ear aspirates. Age ranged from 4 to 50 years with a male:female ratio of 1:1.8. A total of 32 isolates (11 anaerobic and 21 aerobic) were recovered. All anaerobic organisms were mixed and included both Peptostreptococcus and Bacteroides. Metronidazole had 100% sensitivity to gram negative and 62.5% to gram positive anaerobic organisms tested. Five (5) patients had immunocompromised states of 11 patients with anaerobic bacteria isolated in middle ear aspirates (group I), while 13 immunocompromised patients of the remaining 93 patients with no anaerobic bacteria isolated (group II). The proportion of anaerobic isolates in group I is higher (p < 0.05) than in group II. CONCLUSION: Immunocompromised state and age appear to play key role in presence of the anaerobic organisms recovered from the middle ear of the patients studied.

Symptom score for allergic rhinitis.

OBJECTIVES: To determine the prevalence of allergic rhinitis in our study population and the correlation between the Score for Allergic Rhinitis (SFAR) and nasal smear eosinophil count. STUDY DESIGN: Cross-sectional study. SETTING: Ear, nose, and throat clinic, University of Ilorin Teaching Hospital, Nigeria; a 450-bed tertiary health facility. SUBJECTS: Two hundred seventy-five consecutive, consenting patients who presented with nasal symptoms. METHODS: Information on the 8-parameter symptom score was collected using a semistructured questionnaire by interview. Nasal smear slides were air dried, fixed with 95% alcohol, stained using May-Grünwald-Giemsa stain, and examined under a light microscope. RESULTS: Of the 275 participants seen during the 1-year study, 116 (42.2%) were males. The mean ± SD age was 38.5 ± 16.3 (range, 14-75) years. Eighty-one (29.5%) were diagnosed with allergic rhinitis using a nasal smear eosinophil count. The most common symptom was excessive sneezing, involving 93% of patients with allergic rhinitis (P < .001). The prevalence of allergic rhinitis using SFAR was 31.6%. The SFAR cutoff was set at >8 (P < .001). The sensitivity and specificity for SFAR were 94.8% (confidence interval [CI], 90.5%-97.4%) and 95.1% (CI, 87.2%-98.4%), respectively. A high Spearman's correlation (0.88) was obtained for SFAR when correlated with nasal smear eosinophil count. CONCLUSION: The prevalence of allergic rhinitis using SFAR was 31.6%. The study shows that SFAR can be used as a simple, valid diagnostic tool in allergic rhinitis. This is important in rural settings where access to laboratory investigations might not be readily available.

The prevalence of hearing loss among schoolchildren with chronic suppurative otitis media in Nigeria, and its effect on academic performance.

We conducted a cross-sectional study to determine the prevalence of hearing loss among 1,500 Nigerian schoolchildren aged 9 to 15 years who had chronic suppurative otitis media (CSOM). We also attempted to ascertain the effect that this hearing loss had on their academic performance. The study population was drawn from three schools in different socioeconomic tiers-low (n = 300), medium (n = 400), and high (n = 800). Overall, CSOM was present in 35 of these children (2.3%)-12 from the low-status school (4.0%), 11 from the middle-status school (2.8%), and 12 from the high-status school (1.5%); the overall difference in prevalence among the three schools was statistically significant (chi(2) = 6.40; degrees of freedom [df] = 2; p = 0.04). In all, 52 ears were affected by CSOM; of these, 18 (34.6%) had a pure-tone average (PTA) within normal limits, 20 (38.5%) had a mild conductive hearing loss, and 14 (26.9%) had a moderate loss. All but 2 of 160 control ears (1.2%) had hearing thresholds within normal limits. The difference in PTAs across groups was statistically significant (chi(2) = 114.89; df = 2; p< 0.001). As for academic performance, cumulative average test scores were significantly lower in the CSOM patients than in the controls-chi(2) = 14.57; df = 3; p = 0.002. At the higher end of the academic scale, scores of 66% and higher were obtained by 40.0% of patients and 51.3% of controls, and scores of 50 to 65% were achieved by 20.0% of patients and 37.5% of controls. At the lower end, scores of 40 to 49% were obtained by 31.4% of patients and 6.3% of controls, and scores of 39% and lower were obtained by 8.6% and 5.0%, respectively. We conclude that hearing loss was a significant sequela of CSOM in our study population and that it had an adverse effect on their academic performance. Children in the low socioeconomic group appeared to be more vulnerable.