Naso-mucociliary Clearance Time among Patients with Chronic Rhinosinusitis in Ilorin, North-central Nigeria.

CONTEXT: The mucociliary clearance system is an important component in the prevention of chronic inflammation of the nasal and paranasal sinus. AIM: The study aims to establish the normal values of mucociliary clearance in our region and to study the variation in mucociliary activity in patients with chronic rhinosinusitis in Ilorin, North-central Nigeria. SETTINGS AND DESIGN: This was a prospective, cross-sectional study using consecutive consenting participants in both the control and study groups carried out at both family medicine and otorhinolaryngology clinics among patients attending the clinics. SUBJECTS AND METHODS: After ethical approval was sought, informed consent was obtained from patients, a modified version of the validated health questionnaire was filled, semi-structured questionnaires were also filled after which patient undergo anterior rhinoscopy, nasal patency test and spirometry was done. The saccharine test has been used to measure nasal-mucociliary clearance time in the past. STATISTICAL ANALYSIS: All information were entered into SPSS version 20 and analysed descriptively, and results were presented in tables and figures. RESULTS: Consecutive consenting 125 patients with rhinosinusitis (study group) and those without rhinosinusitis (control group) underwent naso-mucociliary clearance test. There were 34 males and 91 females with a male:female ratio of 1:2.6 among the study group and 55 males and 70 females with a male:female ratio of 1:1.3 for the control group. The age range was from 18 to 68 years with 18-40 years constituting the modal age group. The mean age for the studied group was 35.7 years while that of the control group was 33.1 years. The mean naso-mucociliary clearance time among the study group was 35.1 min standard deviation (SD = 12.32 ± 1.63), while among the control group, it was 14.8 min (SD = 5.59 ± 0.43). CONCLUSION: Compared to the control group, there was a roughly 200% prolonged increase in the duration of naso-mucociliary clearance time among patients with rhinosinusitis. There was also a positive correlation with increasing age. Future studies comparing the pre-operative and post-operative treatment of rhinosinusitis will contribute to knowledge.

Management of Foreign Bodies in the Ear: A Retrospective Review of 123 Cases in Nigeria.

Foreign bodies in the ear are relatively common in emergency medicine. However, attempts at removal made outside the healthcare setting by untrained persons can result in complications of varying degrees. We conducted a 3-year retrospective review of 123 cases of aural foreign bodies at our hospital in Nigeria. Our patient population was made up of 80 males and 43 females, aged 2 to 67 years (mean: 13.2); almost three-fourths of these patients were aged 15 years or younger. Only 40 of them (32.5%) presented to an otolaryngologist within 12 hours of foreign-body insertion. A total of 30 patients (24.4%) had initially undergone removal attempts by a non-otolaryngologist prior to receiving trained ENT care, and 23 of them experienced a total of 41 complications: 17 cases of canal abrasion, laceration, and/or bleeding, 8 cases of otitis externa, 6 cases of tympanic membrane perforation, 5 cases of impaired hearing, 3 cases of chronic suppurative otitis media, and 2 cases of middle ear involvement. Of the 93 patients who were seen by an otolaryngologist initially, only 6 (6.5%) developed a complication: 4 cases of canal abrasion, laceration, and/or bleeding and 2 cases of otitis externa. The difference in overall complication rates between patients treated by otolaryngologists and non-otolaryngologists was statistically significant (p < 0.001). We conclude that attempts at removal by non-otolaryngologists can result in a high incidence of preventable complications.

Ear diseases in elderly hospital patients in Nigeria.

BACKGROUND: Little information is available about the pattern of ear diseases in the elderly population. Therefore, the present study aims to determine the pattern of ear diseases among elderly Nigerians, so as to provide an objective basis for cost-effective health care planning for the emerging geriatric population. METHODS: A retrospective study of 320 patients aged 60 years or older presenting with ear diseases at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between January 1996 and December 2001 was carried out. RESULTS: Impacted cerumen was the most common ear disease, occurring in 110 (34.4%) patients of the study population. Chronic suppurative otitis media (CSOM) was the most common infectious disease, affecting 28 (8.8%) patients. Of the 88 patients with hearing loss, 63 (71.6%) had sensorineural, 20 (22.7%) had presbycusis, 1 (1.1%) had conductive, and 4 (4.6%) had mixed hearing loss. CONCLUSION: Our data suggest that impacted cerumen, hearing loss, and infections (notably CSOM), are the common ear diseases among elderly Nigerians.

Hearing thresholds in sickle cell anemia patients: emerging new trends?

PURPOSE OF STUDY: Advances in medicine resulting in better understanding of sickle cell disease and general improvement of the well-being of the sufferers even in the developing countries have positively affected the dreadful outlook of this disease with resultant increase in the population of sickle cell disease patients reaching adulthood, and less severe complications. We therefore set out to evaluate the presence and severity of sensorineural hearing loss in sickle cell anemia (SCA) patients in the light of the overall improvement in the morbidity and mortality. METHODS: A prospective case control study of SCA patients attending our adult SCA clinic and control subjects from homozygous hemoglobin AA patients attending the staff clinic of the hospital for routine medical tests. Tympanometry and diagnostic audiometry were performed on each patient. MAIN FINDINGS: Forty-six SCA patients (21 males, 45.7%) aged 16-48 years with a mean age of 22.9 years +/- 6.45 and 42 controls (24 males, 57.1%) aged 15-39 years with a mean age of 23.7 years +/- 5.69 were included in this study. The average hearing thresholds of SCA patients were consistently higher than controls in all frequencies tested in both right and left ears. Of the 92 ears of SCA patients tested, 95.7% exhibited hearing thresholds within normal limits, and 4.3% had mild hearing loss. The controls had thresholds within normal limits. CONCLUSION: The incidence of significant sensorineural hearing loss in SCA seems to have reduced in line with the general improvement and survival of SCA patients. The hearing loss is worse in the right ear and has a female preponderance. We hope that more aggressive primary and secondary prevention and adequate treatment of sickle cell crisis would reduce if not eliminate the hearing loss found in SCA.

Hearing function in Nigerian children with a family history of type 2 diabetes.

OBJECTIVE: Consequent on our previous observations [F.E. Ologe, E.O. Okoro, Type 2 diabetes and hearing loss in black Africans, Diabetic Med. (in press).], we investigated whether abnormality in auditory function can precede overt diabetes in individuals with a genetic predisposition to type 2 diabetes. METHOD: Frequency specific pure tone audiograms (125, 250, 500, 1000, 2000, 3000, 4000, 8000 Hz) and fasting blood glucose (FBG) and 2h post prandial blood glucose (2hrPBG) levels were measured in Nigerian children aged 9-19 years with at least a biologic parent with type 2 diabetes and compared with controls (contemporaries with non-diabetic parents). RESULTS: : Both groups were similar in gender mix, age, body sizes, FBS, 2PPhr BG, SBP; the values being (chi(2) = 0.04, d.f. = 1, p = 0.84); 14.32 +/- 2.29 years versus 14.77 +/- 3.10 years, 19.47 +/- 1.82 kg/m(2) versus 18.66 +/- 3.12 kg/m(2); 4.26 +/- 0.68 mmol versus 4.04 +/- 0.61 mmol; 5.07 +/- 0.95 mmol versus 5.16 +/- 1.04 mmol; 103.73 +/- 9.62 mmHg versus 100.07 +/- 13.77 mmHg for control and offspring of diabetic individuals, respectively. Similarly, pure-tone air-conduction audiograms were comparable (p > 0.5) in both groups. CONCLUSION: The data shows normal glucose metabolism in teenage offspring of type 2 diabetes and a pattern of audiogram not different from those observed in their counterparts without a genetic predisposition to type 2 diabetes.

Management of foreign bodies in the ear: a retrospective review of 123 cases in Nigeria.

Foreign bodies in the ear are relatively common in emergency medicine. However, attempts at removal made outside the healthcare setting by untrained persons can result in complications of varying degrees. We conducted a 3-year retrospective review of 123 cases of aural foreign bodies at our hospital in Nigeria. Our patient population was made up of 80 males and 43 females, aged 2 to 67 years (mean: 13.2); almost three-fourths of these patients were aged 15 years or younger. Only 40 of them (32.5%) presented to an otolaryngologist within 12 hours of foreign-body insertion. A total of 30 patients (24.4%) had initially undergone removal attempts by a non-otolaryngologist prior to receiving trained ENT care, and 23 of them experienced a total of 41 complications: 17 cases of canal abrasion, laceration, and/or bleeding, 8 cases of otitis externa, 6 cases of tympanic membrane perforation, 5 cases of impaired hearing, 3 cases of chronic suppurative otitis media, and 2 cases of middle ear involvement. Of the 93 patients who were seen by an otolaryngologist initially, only 6 (6.5%) developed a complication: 4 cases of canal abrasion, laceration, and/or bleeding and 2 cases of otitis externa. The difference in overall complication rates between patients treated by otolaryngologists and non-otolaryngologists was statistically significant (p < 0.001). We conclude that attempts at removal by non-otolaryngologists can result in a high incidence of preventable complications.

Facial nerve palsy after head injury: Case incidence, causes, clinical profile and outcome.

BACKGROUND: To investigate the case incidence, causes, clinical profile, and outcome of facial nerve palsy complicating head trauma. METHOD: A 10-year (1991-2000) retrospective study of head injured patients at the University Teaching Hospital, Ilorin, Nigeria. Age, gender, and neurologic findings were analyzed. RESULTS: Of 794 patients, facial nerve palsy occurred in 40 (5.04%). Facial nerve was the most frequently injured cranial nerve, followed by vestibulo-cochlear (12 [1.5%]) and abducens (8 [1.0%]). Majority (70%) of the seventh nerve palsies were of the lower motor neurone type. The left nerve was more frequently affected (60%). Facial nerve palsy was more common in male patients and adults with a peak incidence at the 4th decade. Spontaneous functional recovery occurring within 6 to 24 months of injury was total in 12 (30%), partial in 5 (12.3%), and none in 3 (7.5%) subjects. Thirteen patients died giving a mortality rate of 32.5%. The patients were aged 5 to 85 years (mean, 34 years). Causes of head trauma were traffic injuries (82.5%), fall from height (7.5%), assault (5%), and gunshot (2.5%). Though patient mortality rate was higher among patients with facial nerve palsy (32.5%) than those without (23.04%), facial nerve palsy was not a strong predictor of fatality (p = 0.2950). CONCLUSION: The case incidence of facial nerve palsy in head injured patients in our center is 5.04%. The lower motor neurone type predominates. It is commoner in men and on the left side with spontaneous recovery occurring in 30% of cases.

Occupational noise exposure and sensorineural hearing loss among workers of a steel rolling mill.

Hearing loss is one of the most common chronic health conditions and has important implications for the patient's quality of life. However, hearing loss is substantially underestimated and under treated. The purpose of this study was to determine the prevalence of sensorineural hearing loss among the workers in a steel rolling mill in Nigeria. Each of the 150 randomly selected subjects had a structured questionnaire administered to them, followed by a full otological examination. Of these, 116 had tympanometry and pure-tone audiometry. Also a noise mapping of their respective work units was done. The workers were exposed to noise levels varying from 49 to 93 dBA. About 28.2% of the 103 who had their audiogram analysed had mild to moderate sensorineural hearing loss in their better ear and 56.8% of them had mild to moderate sensorineural hearing loss in their worse ear. The pure-tone average and the average hearing thresholds at 4 kHz for the groups significantly increased with an increasing noise exposure level. The prevalence of sensorineural hearing loss among the study population is high; and noise exposure is at least contributory. Pre-employment and regular audiometry while on the job is highly recommended.

Noise exposure, awareness, attitudes and use of hearing protection in a steel rolling mill in Nigeria.

OBJECTIVES: To study exposure to noise, the attitudes and knowledge towards noise-induced hearing loss and the actual use of hearing protection in a steel rolling mill in Nigeria. METHODS: A structured questionnaire was administered to 116 randomly selected workers to collect information relating to their knowledge and attitudes towards hazardous occupational noise and preventative measures. Noise mapping of the factory was also carried out. RESULTS: Time weighted average noise levels were: administrative area 49 dBA, mechanic/maintenance workshop 72 dBA, mill floor 86 dBA and finishing stage 93 dBA. There was high awareness of the hazard of noise to hearing (93%) and of methods of prevention (92%) but only 27% possessed hearing protectors and only 28% of these stated that they used them all the time. CONCLUSION: While noise is recognized as a hazard, initiatives are required to increase use of effective preventative measures.