International Journal of Health Sciences & Medical Research , 2024
Background: Hypertension is an important public-health problem, and it has been identified as the... more Background: Hypertension is an important public-health problem, and it has been identified as the leading cause of morbidity and
mortality due to the high incidence of end-organ damages. Unlike other complications of hypertension, cochlear dysfunction in
hypertensive patients is a hidden and progressive damage that remains undetected (subclinical) for a long time. The aim of this study
was to assess the prevalence of subclinical hearing impairment, as well as the type and degree of hearing loss among hypertensive
patients in our environment.
Methods: This was a cross-sectional cohort study conducted among adults diagnosed with hypertension previously. Ethical
clearance and informed consent were obtained. Previous history of related exposure event (hypertension) and outcome (hearing
loss) was assessed. Each participant was then subjected to conventional Pure Tone Audiometry (c-PTA) and Extended High
frequency Audiometry (EHA) tests, and findings were analyzed.
Results: One hundred and ninety (190) hypertensive patients were enrolled, among which 107 (56.3%) were females and 83 (43.7%)
males. Hypertension was more common in the age group of 51-60 years (26.8%) and 61-70 years (30.5%). The overall prevalence
of hearing loss was 41.6%, of which 18.4% had subclinical hearing impairment. The most common type of hearing loss was
sensorineural 68 (86.1%), and found to be in varying degrees of 33.8%, 26.5%, 23.5%, and 16.2% for mild, moderate, severe, and
profound hearing loss, respectively.
Conclusion: The overall prevalence of hearing loss among hypertensive patients was 41.6%, with a significant proportion (18.4%)
having subclinical hearing loss, which is not noticed by the patients. Therefore, routine pure tone audiometric hearing screening for
all hypertensives is recommended to enable early detection and treatment of this hearing loss.
Keywords: Hearing loss, Hypertension, Extended High Frequency Audiometry, Pure tone Audiometry, Prevalence, Subclinical
hearing loss
International Journal of Medical Science and Clinical Research Studies, 2024
Diarrhea is a complication in critically ill patients, contributing to increased morbidity and he... more Diarrhea is a complication in critically ill patients, contributing to increased morbidity and healthcare costs. It is often multifactorial in origin, arising from infections, enteral nutrition, medications (especially antibiotics), and altered immunity and gastrointestinal function due to critical illness. Diarrhea in these patients can exacerbate fluid and electrolyte imbalances, increase the risk of skin breakdown, and contribute to malnutrition. Identifying the underlying etiology is essential for targeted management. Diagnostic approaches typically include stool cultures, assessments for Clostridium difficile infection, and evaluation of medication-related causes. Treatment involves supportive care, such as fluid and electrolyte replacement, modifying enteral nutrition, and judicious use of anti-diarrheal agents when appropriate. Preventative strategies, such as the careful use of antibiotics and probiotics, may reduce the incidence of diarrhea in critically ill patients. Addressing diarrhea effectively requires a multidisciplinary approach to reduce complications and improve patient outcomes in the critical care setting.
Nigerian Journal of Basic and Clinical Sciences , 2024
Context: Eustachian tube dysfunction (ETD) results from failure of the Eustachian tube (ET) to ve... more Context: Eustachian tube dysfunction (ETD) results from failure of the Eustachian tube (ET) to ventilate the middle ear adequately. It is responsible for most cases of persistent middle ear disease. Management of ETD is classically conservative and limited to medical therapy. Surgery is usually reserved for cases that fail medical treatment. Recently, endoscopic balloon dilation of the cartilaginous ET has shown encouraging results and appears effective, safe, well tolerated, and affordable. Aims: To present a preliminary report of Endoscopic balloon dilatation of Chronic ETD in a tertiary hospital. Settings and Design: A retrospective study involving 5 patients with chronic ETD who had endoscopic-assisted balloon dilatation of the ET in a tertiary hospital. Materials and Methods: The patients' records were retrieved, and relevant data were extracted. All patients had completed an otorhinolaryngological examination and tympanometry. Statistical Analysis: The data were analyzed using SPSS version 25.0. Results: There was a symptomatic improvement in four patients (7 ETs) at 2 weeks post-operative review. No improvement was seen in one patient (2 ETs). Similarly, the result of tympanometry at 6 weeks follow-up showed a change in tympanogram from type-C to type-A in two patients and from type-B to type-C in one patient. There was persistence of type-C in one patient and type-B in one patient. Conclusion: Although findings from our experience showed mixed results, endoscopic-assisted balloon dilatation of ET is feasible and can be used as an option in managing patients with ETD in our environment.
International Journal of Medical Science and Clinical Research Studies , 2024
Background: The prevalence of diabetes mellitus (DM) and the burden of its complications have bee... more Background: The prevalence of diabetes mellitus (DM) and the burden of its complications have been increasing, particularly in low-and middle-income countries. These complications include blindness, chronic kidney disease, heart attacks, stroke, diabetic foot disease, and hearing loss. Of these complications, hearing loss is a hidden disability; it usually goes undetected for a long time until it is too late. Once the diagnosis is late, the hearing loss is irreversible. This emphasizes the importance of early screening and prevention of hearing loss among diabetic patients. The aim of this study was to evaluate the prevalence, severity, and type of hearing loss among diabetic patients attending the medical outpatient clinic of our institution. Methods: This was a prospective observational study among adults diagnosed with DM. Ethical clearance and informed consent were obtained. Each participant had fasting blood sugar and pure tone audiometric tests performed. The severity of hearing loss was categorized according to WHO grading. The data was analyzed using Statistical Products and Service Solution (SPSS) version 26. Results: There were 240 participants, with 131(54.6%) being males. The majority of the participants had type 2 DM 232(96.7%) with uncontrolled blood sugar levels of 176 (73.3%). The overall prevalence of hearing loss was 67.5%, of which 51.7% had asymptomatic hearing loss. The severity of hearing loss was 102(42.5%), 34(14.2%), 14(5.8%), and 4(1.7%) for mild, moderate, severe, and profound sensory neural hearing loss respectively. The most common type of hearing loss was sensorineural 154(64.2), other types were conductive hearing loss 6(2.5%), and mixed hearing loss 2(0.8%). Conclusion: This study revealed high prevalence of hearing impairment among diabetic patients, of whom most had asymptomatic hearing impairment and were not aware of their hearing impairment. This emphasized the importance of routine pure tone audiometry for early detection of hearing loss among diabetic patients, a practice that could significantly improve the quality of life of the DM patient.
International Journal of Otolaryngology and Head & Neck Surgery, 2024
Background: Cut-throat injury is a potentially fatal condition that may be associated with seriou... more Background: Cut-throat injury is a potentially fatal condition that may be associated with serious morbidity and mortality. The neck region is particularly at risk of serious injuries due to the location of vital structures, including nerves, viscera, and major vessels. Although cut-throat injury is said to be rare in children, its occurrence has been reported in some series. Management of this condition requires a multidisciplinary approach for a better outcome. Aim: The aim of this report is to highlight the successful management of an alarming case of severe cut-throat injury with associated laryngeal injury in a child. Case presentation: A 12-year-old boy presented with a cut-throat following an assault by an unknown person. Examination revealed an acutely ill child, conscious but pale. He sustained a deep transverse laceration that transected the thyroid cartilage, exposing the laryngeal cavity. An assessment of Zone II penetrating neck injury was made. He was resuscitated, and had emergency neck exploration, tracheostomy, and repair of the injuries. The patient was followed up for 6 months, and had a good voice outcome, with no significant complication. Conclusion: Cut-throat injury is rare in children. But it is a potentially life-threatening condition. It is therefore important to recognize this entity and develop effective protocol of management in our environment.
International Journal of Medical Science and Clinical Research Studies , 2024
Cardiovascular disease and its risk factors are no longer only problems in developed countries, t... more Cardiovascular disease and its risk factors are no longer only problems in developed countries, they are equally prevalent in developing countries. Cardiovascular risk factors have been hypothesized to play a role in the pathogenesis of hearing loss. Specifically, hypertension and diabetes mellitus can affect the cochlear microvasculature, leading to cochlear atherosclerosis. These atherosclerotic changes may result in impairment of local micro-cochlear circulation, causing ischemia and necrosis of the stria vascularis, hair cells, and the entire organ of Corti, and this may lead to hearing loss. The effect of cardiovascular risk factors on hearing is still under investigation. The aim of this study is to review the relationship between cardiovascular risk factors (hypertension and diabetes) and hearing loss.
International Journal of Otolaryngology and Head & Neck Surgery , 2024
Background: Ethmoidal polyposis coexisting with adenoid enlargement and tympanic membrane perfora... more Background: Ethmoidal polyposis coexisting with adenoid enlargement and tympanic membrane perforation is a rare condition in otolaryngological practice. Evidences have shown that antrochoanal polyp often times coexists with adenoid enlargement especially in the young which was in sharp contrast to ethmoidal polyposis occurring in the presence of adenoid enlargement. Moreover, the hidden location of nasopharynx housing the adenoids, coupled with the masking effect of bilateral sinonasal polyps, leads to inadvertent misdiagnosis of this complex pathology with subsequent difficulty in providing effective management. Case Presentation: A 24 year-old lady presented with recurrent bilateral nasal obstruction that became persistent associated with nasal discharge and anosmia. She also had recurrent right otorrhoea with associated hearing loss. Diagnostic rigid nasal endoscopy revealed mucoid discharge with bilateral polypoid masses filling both nasal cavities. Otoendoscopic finding revealed a small (about 5%) central tympanic membrane perforation. A clinical assessment of chronic rhinosinusitis with nasal polyposis complicated by chronic suppurative otitis media (CSOM) was made. A non-contrast CT scan of the paranasal sinuses showed isodense lesions in the nasal cavities, all paranasal sinuses and the entire nasopharynx. She had endoscopic sinus surgery and a nasopharyngeal clearance biopsy. The nasal, paranasal and nasopharyngeal masses had histologic confirmation of inflammatory nasal polyps and lymphoid (adenoid) hyperplasia respectively. Her condition
Background: Obstructive adenoid enlargement is common in our environmentit, it manifests with nas... more Background: Obstructive adenoid enlargement is common in our environmentit, it manifests with nasal obstruction, persistent mouth breathing, snoring, sleep apnea, and daytime somnolence, which results in poor school performance. Fibreoptic nasopharyngoscopy has recently been recommended for the diagnosis of adenoid enlargement. It is, however, expensive and not readily available in a resource-constrained setting. Clinical symptomatology is invaluable to the physician, as it may be the only assessment tool available to a healthcare provider in a rural setting. However, some workers considered it unreliable and insufficient for the diagnosis of adenoid enlargement. Objectives: The research's aim was to find out how reliable clinical symptoms are for diagnosing obstructive adenoid enlargement compared to fiberoptic nasopharyngoscopy. Materials and methods: This was a cross-sectional study among children with obstructive adenoid enlargement. Ethical approval and informed consent were given. A structured questionnaire was utelized to assess clinical symptomatology. A fiberoptic nasopharyngoscopic examination was carried out, and the data were analyzed. Results: This study recruited 79 (56.4%) men and 61 (43.6%) women within the age range of 2-10 years with a mean of 4.5 ± 2.5 years. The clinical symptomatology score correctly predicted 60% of endoscopic grade 1, 67.5% of endoscopic grade 2, and 78.9% of endoscopic grade 3 adenoid enlargement. There was a statistically significant association between clinical symptomatology score and fiberoptic endoscopic findings (χ 2 = 96.9, P-value = 0.000). Conclusion: This study found that the clinical symptomatology score is reliable in diagnosing obstructive adenoid enlargement.
Background: Endoscopic sinus surgery (ESS) has recorded an excellent success rate, ranging from 8... more Background: Endoscopic sinus surgery (ESS) has recorded an excellent success rate, ranging from 80%–98% in the developed countries. However, the outcome in a resource-constraint setting may not be the same due to several factors associated with the patient, the clinical course, and the management of the disease. Objective: The aim of this study was to examine the factors that affect the outcome of ESS in a resource-constraint setting. Materials and Methods: Clinical, radiological, surgical, and outcome data of patients who had ESS at a newly established tertiary hospital from January 2018 to June 2022 were reviewed. Patients with complete resolution of symptoms and absence of disease on postoperative endoscopy were considered to have “satisfactory outcome.” Those with either recurrence or residual disease were considered to have “unsatisfactory outcome.” Chi-square and logistic regression analyses were carried out to determine the factors and predictors of outcome. Results: Fifty-three patients were evaluated, comprised of 29 (54.7%) males and 24 (45.3%) females. The age of the patients ranged between 11 and 67 years with a median of 33 years. The majority of the patients (67.9%) had satisfactory outcome, but 32.1% had unsatisfactory outcome. The complication rate was 26.4%, although the majority (24.5%) had minor complications. Factors associated with outcome were nasal allergy (P = 0.000), nasal polyps (P = 0.000), and anatomical variation (P = 0.045). However, only nasal allergy (P = 0.046) and nasal polyps (P = 0.004) were significant predictors of unsatisfactory outcome on logistic regression analysis. Conclusion: The outcome of ESS is also good in resource-constraint setting. However, a significant unsatisfactory outcome was recorded, factors such as the presence of allergy and nasal polyps may predict the unsatisfactory outcome. Therefore, allergy and nasal polyps should be evaluated thoroughly while preparing patient for ESS. Keywords: Allergy, chronic rhinosinusitis, endoscopic sinus surgery, factors, nasal polyps
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The a... more Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...
Background: Dysphonia impairs verbal communication of the sufferer, which can lead to social isol... more Background: Dysphonia impairs verbal communication of the sufferer, which can lead to social isolation, depression, and reduced quality of life. Evaluation of voice handicap and emotional impact of dysphonia are not routinely consider in our laryngology and voice clinics, despite the fact that about 50% to 60% of patients with dysphonia have social and psychological problems. Aims: The aim of this study is to investigate the voice handicap and emotional status among dysphonic and non-dysphonic individuals in our environment. Materials and Methods: It was a cross-sectional study that included dysphonic patients and non-dysphonic individuals matched for age and gender. A detailed clinical history was obtained, and the Voice Handicap Index (VHI) questionnaire was used to assess the voice handicap and emotional status of the participants. The mean VHI score of dysphonic and non-dysphonic participants was compared. Results: Ninety dysphonic patients and equal number of non-dysphonic controls completed the study. The mean VHI score dysphonic patients was higher (46.8 ± 17.7) than that of the controls (5.2 ± 3.9), and there was a statistical significant difference between the two groups (P = 0.000). Most of the dysphonic patients 69(77.8%) had poor emotional status, while most of the controls had good emotional status 83(92.3%). Conclusion: This study found high Voice Handicap Index and poor emotional status among dysphonic patients compared to controls. Therefore, patients with dysphonia should be reviewed by a psychologist in order to address the emotional aspect of their problem.
International Journal of Health Sciences & Medical Research , 2024
Background: Hypertension is an important public-health problem, and it has been identified as the... more Background: Hypertension is an important public-health problem, and it has been identified as the leading cause of morbidity and
mortality due to the high incidence of end-organ damages. Unlike other complications of hypertension, cochlear dysfunction in
hypertensive patients is a hidden and progressive damage that remains undetected (subclinical) for a long time. The aim of this study
was to assess the prevalence of subclinical hearing impairment, as well as the type and degree of hearing loss among hypertensive
patients in our environment.
Methods: This was a cross-sectional cohort study conducted among adults diagnosed with hypertension previously. Ethical
clearance and informed consent were obtained. Previous history of related exposure event (hypertension) and outcome (hearing
loss) was assessed. Each participant was then subjected to conventional Pure Tone Audiometry (c-PTA) and Extended High
frequency Audiometry (EHA) tests, and findings were analyzed.
Results: One hundred and ninety (190) hypertensive patients were enrolled, among which 107 (56.3%) were females and 83 (43.7%)
males. Hypertension was more common in the age group of 51-60 years (26.8%) and 61-70 years (30.5%). The overall prevalence
of hearing loss was 41.6%, of which 18.4% had subclinical hearing impairment. The most common type of hearing loss was
sensorineural 68 (86.1%), and found to be in varying degrees of 33.8%, 26.5%, 23.5%, and 16.2% for mild, moderate, severe, and
profound hearing loss, respectively.
Conclusion: The overall prevalence of hearing loss among hypertensive patients was 41.6%, with a significant proportion (18.4%)
having subclinical hearing loss, which is not noticed by the patients. Therefore, routine pure tone audiometric hearing screening for
all hypertensives is recommended to enable early detection and treatment of this hearing loss.
Keywords: Hearing loss, Hypertension, Extended High Frequency Audiometry, Pure tone Audiometry, Prevalence, Subclinical
hearing loss
International Journal of Medical Science and Clinical Research Studies, 2024
Diarrhea is a complication in critically ill patients, contributing to increased morbidity and he... more Diarrhea is a complication in critically ill patients, contributing to increased morbidity and healthcare costs. It is often multifactorial in origin, arising from infections, enteral nutrition, medications (especially antibiotics), and altered immunity and gastrointestinal function due to critical illness. Diarrhea in these patients can exacerbate fluid and electrolyte imbalances, increase the risk of skin breakdown, and contribute to malnutrition. Identifying the underlying etiology is essential for targeted management. Diagnostic approaches typically include stool cultures, assessments for Clostridium difficile infection, and evaluation of medication-related causes. Treatment involves supportive care, such as fluid and electrolyte replacement, modifying enteral nutrition, and judicious use of anti-diarrheal agents when appropriate. Preventative strategies, such as the careful use of antibiotics and probiotics, may reduce the incidence of diarrhea in critically ill patients. Addressing diarrhea effectively requires a multidisciplinary approach to reduce complications and improve patient outcomes in the critical care setting.
Nigerian Journal of Basic and Clinical Sciences , 2024
Context: Eustachian tube dysfunction (ETD) results from failure of the Eustachian tube (ET) to ve... more Context: Eustachian tube dysfunction (ETD) results from failure of the Eustachian tube (ET) to ventilate the middle ear adequately. It is responsible for most cases of persistent middle ear disease. Management of ETD is classically conservative and limited to medical therapy. Surgery is usually reserved for cases that fail medical treatment. Recently, endoscopic balloon dilation of the cartilaginous ET has shown encouraging results and appears effective, safe, well tolerated, and affordable. Aims: To present a preliminary report of Endoscopic balloon dilatation of Chronic ETD in a tertiary hospital. Settings and Design: A retrospective study involving 5 patients with chronic ETD who had endoscopic-assisted balloon dilatation of the ET in a tertiary hospital. Materials and Methods: The patients' records were retrieved, and relevant data were extracted. All patients had completed an otorhinolaryngological examination and tympanometry. Statistical Analysis: The data were analyzed using SPSS version 25.0. Results: There was a symptomatic improvement in four patients (7 ETs) at 2 weeks post-operative review. No improvement was seen in one patient (2 ETs). Similarly, the result of tympanometry at 6 weeks follow-up showed a change in tympanogram from type-C to type-A in two patients and from type-B to type-C in one patient. There was persistence of type-C in one patient and type-B in one patient. Conclusion: Although findings from our experience showed mixed results, endoscopic-assisted balloon dilatation of ET is feasible and can be used as an option in managing patients with ETD in our environment.
International Journal of Medical Science and Clinical Research Studies , 2024
Background: The prevalence of diabetes mellitus (DM) and the burden of its complications have bee... more Background: The prevalence of diabetes mellitus (DM) and the burden of its complications have been increasing, particularly in low-and middle-income countries. These complications include blindness, chronic kidney disease, heart attacks, stroke, diabetic foot disease, and hearing loss. Of these complications, hearing loss is a hidden disability; it usually goes undetected for a long time until it is too late. Once the diagnosis is late, the hearing loss is irreversible. This emphasizes the importance of early screening and prevention of hearing loss among diabetic patients. The aim of this study was to evaluate the prevalence, severity, and type of hearing loss among diabetic patients attending the medical outpatient clinic of our institution. Methods: This was a prospective observational study among adults diagnosed with DM. Ethical clearance and informed consent were obtained. Each participant had fasting blood sugar and pure tone audiometric tests performed. The severity of hearing loss was categorized according to WHO grading. The data was analyzed using Statistical Products and Service Solution (SPSS) version 26. Results: There were 240 participants, with 131(54.6%) being males. The majority of the participants had type 2 DM 232(96.7%) with uncontrolled blood sugar levels of 176 (73.3%). The overall prevalence of hearing loss was 67.5%, of which 51.7% had asymptomatic hearing loss. The severity of hearing loss was 102(42.5%), 34(14.2%), 14(5.8%), and 4(1.7%) for mild, moderate, severe, and profound sensory neural hearing loss respectively. The most common type of hearing loss was sensorineural 154(64.2), other types were conductive hearing loss 6(2.5%), and mixed hearing loss 2(0.8%). Conclusion: This study revealed high prevalence of hearing impairment among diabetic patients, of whom most had asymptomatic hearing impairment and were not aware of their hearing impairment. This emphasized the importance of routine pure tone audiometry for early detection of hearing loss among diabetic patients, a practice that could significantly improve the quality of life of the DM patient.
International Journal of Otolaryngology and Head & Neck Surgery, 2024
Background: Cut-throat injury is a potentially fatal condition that may be associated with seriou... more Background: Cut-throat injury is a potentially fatal condition that may be associated with serious morbidity and mortality. The neck region is particularly at risk of serious injuries due to the location of vital structures, including nerves, viscera, and major vessels. Although cut-throat injury is said to be rare in children, its occurrence has been reported in some series. Management of this condition requires a multidisciplinary approach for a better outcome. Aim: The aim of this report is to highlight the successful management of an alarming case of severe cut-throat injury with associated laryngeal injury in a child. Case presentation: A 12-year-old boy presented with a cut-throat following an assault by an unknown person. Examination revealed an acutely ill child, conscious but pale. He sustained a deep transverse laceration that transected the thyroid cartilage, exposing the laryngeal cavity. An assessment of Zone II penetrating neck injury was made. He was resuscitated, and had emergency neck exploration, tracheostomy, and repair of the injuries. The patient was followed up for 6 months, and had a good voice outcome, with no significant complication. Conclusion: Cut-throat injury is rare in children. But it is a potentially life-threatening condition. It is therefore important to recognize this entity and develop effective protocol of management in our environment.
International Journal of Medical Science and Clinical Research Studies , 2024
Cardiovascular disease and its risk factors are no longer only problems in developed countries, t... more Cardiovascular disease and its risk factors are no longer only problems in developed countries, they are equally prevalent in developing countries. Cardiovascular risk factors have been hypothesized to play a role in the pathogenesis of hearing loss. Specifically, hypertension and diabetes mellitus can affect the cochlear microvasculature, leading to cochlear atherosclerosis. These atherosclerotic changes may result in impairment of local micro-cochlear circulation, causing ischemia and necrosis of the stria vascularis, hair cells, and the entire organ of Corti, and this may lead to hearing loss. The effect of cardiovascular risk factors on hearing is still under investigation. The aim of this study is to review the relationship between cardiovascular risk factors (hypertension and diabetes) and hearing loss.
International Journal of Otolaryngology and Head & Neck Surgery , 2024
Background: Ethmoidal polyposis coexisting with adenoid enlargement and tympanic membrane perfora... more Background: Ethmoidal polyposis coexisting with adenoid enlargement and tympanic membrane perforation is a rare condition in otolaryngological practice. Evidences have shown that antrochoanal polyp often times coexists with adenoid enlargement especially in the young which was in sharp contrast to ethmoidal polyposis occurring in the presence of adenoid enlargement. Moreover, the hidden location of nasopharynx housing the adenoids, coupled with the masking effect of bilateral sinonasal polyps, leads to inadvertent misdiagnosis of this complex pathology with subsequent difficulty in providing effective management. Case Presentation: A 24 year-old lady presented with recurrent bilateral nasal obstruction that became persistent associated with nasal discharge and anosmia. She also had recurrent right otorrhoea with associated hearing loss. Diagnostic rigid nasal endoscopy revealed mucoid discharge with bilateral polypoid masses filling both nasal cavities. Otoendoscopic finding revealed a small (about 5%) central tympanic membrane perforation. A clinical assessment of chronic rhinosinusitis with nasal polyposis complicated by chronic suppurative otitis media (CSOM) was made. A non-contrast CT scan of the paranasal sinuses showed isodense lesions in the nasal cavities, all paranasal sinuses and the entire nasopharynx. She had endoscopic sinus surgery and a nasopharyngeal clearance biopsy. The nasal, paranasal and nasopharyngeal masses had histologic confirmation of inflammatory nasal polyps and lymphoid (adenoid) hyperplasia respectively. Her condition
Background: Obstructive adenoid enlargement is common in our environmentit, it manifests with nas... more Background: Obstructive adenoid enlargement is common in our environmentit, it manifests with nasal obstruction, persistent mouth breathing, snoring, sleep apnea, and daytime somnolence, which results in poor school performance. Fibreoptic nasopharyngoscopy has recently been recommended for the diagnosis of adenoid enlargement. It is, however, expensive and not readily available in a resource-constrained setting. Clinical symptomatology is invaluable to the physician, as it may be the only assessment tool available to a healthcare provider in a rural setting. However, some workers considered it unreliable and insufficient for the diagnosis of adenoid enlargement. Objectives: The research's aim was to find out how reliable clinical symptoms are for diagnosing obstructive adenoid enlargement compared to fiberoptic nasopharyngoscopy. Materials and methods: This was a cross-sectional study among children with obstructive adenoid enlargement. Ethical approval and informed consent were given. A structured questionnaire was utelized to assess clinical symptomatology. A fiberoptic nasopharyngoscopic examination was carried out, and the data were analyzed. Results: This study recruited 79 (56.4%) men and 61 (43.6%) women within the age range of 2-10 years with a mean of 4.5 ± 2.5 years. The clinical symptomatology score correctly predicted 60% of endoscopic grade 1, 67.5% of endoscopic grade 2, and 78.9% of endoscopic grade 3 adenoid enlargement. There was a statistically significant association between clinical symptomatology score and fiberoptic endoscopic findings (χ 2 = 96.9, P-value = 0.000). Conclusion: This study found that the clinical symptomatology score is reliable in diagnosing obstructive adenoid enlargement.
Background: Endoscopic sinus surgery (ESS) has recorded an excellent success rate, ranging from 8... more Background: Endoscopic sinus surgery (ESS) has recorded an excellent success rate, ranging from 80%–98% in the developed countries. However, the outcome in a resource-constraint setting may not be the same due to several factors associated with the patient, the clinical course, and the management of the disease. Objective: The aim of this study was to examine the factors that affect the outcome of ESS in a resource-constraint setting. Materials and Methods: Clinical, radiological, surgical, and outcome data of patients who had ESS at a newly established tertiary hospital from January 2018 to June 2022 were reviewed. Patients with complete resolution of symptoms and absence of disease on postoperative endoscopy were considered to have “satisfactory outcome.” Those with either recurrence or residual disease were considered to have “unsatisfactory outcome.” Chi-square and logistic regression analyses were carried out to determine the factors and predictors of outcome. Results: Fifty-three patients were evaluated, comprised of 29 (54.7%) males and 24 (45.3%) females. The age of the patients ranged between 11 and 67 years with a median of 33 years. The majority of the patients (67.9%) had satisfactory outcome, but 32.1% had unsatisfactory outcome. The complication rate was 26.4%, although the majority (24.5%) had minor complications. Factors associated with outcome were nasal allergy (P = 0.000), nasal polyps (P = 0.000), and anatomical variation (P = 0.045). However, only nasal allergy (P = 0.046) and nasal polyps (P = 0.004) were significant predictors of unsatisfactory outcome on logistic regression analysis. Conclusion: The outcome of ESS is also good in resource-constraint setting. However, a significant unsatisfactory outcome was recorded, factors such as the presence of allergy and nasal polyps may predict the unsatisfactory outcome. Therefore, allergy and nasal polyps should be evaluated thoroughly while preparing patient for ESS. Keywords: Allergy, chronic rhinosinusitis, endoscopic sinus surgery, factors, nasal polyps
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The a... more Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains...
Background: Dysphonia impairs verbal communication of the sufferer, which can lead to social isol... more Background: Dysphonia impairs verbal communication of the sufferer, which can lead to social isolation, depression, and reduced quality of life. Evaluation of voice handicap and emotional impact of dysphonia are not routinely consider in our laryngology and voice clinics, despite the fact that about 50% to 60% of patients with dysphonia have social and psychological problems. Aims: The aim of this study is to investigate the voice handicap and emotional status among dysphonic and non-dysphonic individuals in our environment. Materials and Methods: It was a cross-sectional study that included dysphonic patients and non-dysphonic individuals matched for age and gender. A detailed clinical history was obtained, and the Voice Handicap Index (VHI) questionnaire was used to assess the voice handicap and emotional status of the participants. The mean VHI score of dysphonic and non-dysphonic participants was compared. Results: Ninety dysphonic patients and equal number of non-dysphonic controls completed the study. The mean VHI score dysphonic patients was higher (46.8 ± 17.7) than that of the controls (5.2 ± 3.9), and there was a statistical significant difference between the two groups (P = 0.000). Most of the dysphonic patients 69(77.8%) had poor emotional status, while most of the controls had good emotional status 83(92.3%). Conclusion: This study found high Voice Handicap Index and poor emotional status among dysphonic patients compared to controls. Therefore, patients with dysphonia should be reviewed by a psychologist in order to address the emotional aspect of their problem.
Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as ind... more Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45•6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84•5 (95% CI 84•1-84•9), which varied between HIC (88•5 [89•0-88•0]), MIC (81•8 [82•5-81•1]), and LIC (66•8 [64•9-68•7]) settings. In the third phase, 1217 (74•6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51•4%) were from HIC, 538 (44•2%) from MIC, and 54 (4•4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3•6% (95% CI 3•0-4•1; p<0•0001) increase in SVR. This was consistent in HIC (4•8% [4•1-5•5]; p<0•0001), MIC (2•8 [2•0-3•7]; p<0•0001), and LIC (3•8 [1•3-6•7%]; p<0•0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.
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Papers by Auwal Adamu
mortality due to the high incidence of end-organ damages. Unlike other complications of hypertension, cochlear dysfunction in
hypertensive patients is a hidden and progressive damage that remains undetected (subclinical) for a long time. The aim of this study
was to assess the prevalence of subclinical hearing impairment, as well as the type and degree of hearing loss among hypertensive
patients in our environment.
Methods: This was a cross-sectional cohort study conducted among adults diagnosed with hypertension previously. Ethical
clearance and informed consent were obtained. Previous history of related exposure event (hypertension) and outcome (hearing
loss) was assessed. Each participant was then subjected to conventional Pure Tone Audiometry (c-PTA) and Extended High
frequency Audiometry (EHA) tests, and findings were analyzed.
Results: One hundred and ninety (190) hypertensive patients were enrolled, among which 107 (56.3%) were females and 83 (43.7%)
males. Hypertension was more common in the age group of 51-60 years (26.8%) and 61-70 years (30.5%). The overall prevalence
of hearing loss was 41.6%, of which 18.4% had subclinical hearing impairment. The most common type of hearing loss was
sensorineural 68 (86.1%), and found to be in varying degrees of 33.8%, 26.5%, 23.5%, and 16.2% for mild, moderate, severe, and
profound hearing loss, respectively.
Conclusion: The overall prevalence of hearing loss among hypertensive patients was 41.6%, with a significant proportion (18.4%)
having subclinical hearing loss, which is not noticed by the patients. Therefore, routine pure tone audiometric hearing screening for
all hypertensives is recommended to enable early detection and treatment of this hearing loss.
Keywords: Hearing loss, Hypertension, Extended High Frequency Audiometry, Pure tone Audiometry, Prevalence, Subclinical
hearing loss
Methods: This was a prospective observational study among adults diagnosed with DM. Ethical clearance and informed consent were obtained. Each participant had fasting blood sugar and pure tone audiometric tests performed. The severity of hearing loss was categorized according to WHO grading. The data was analyzed using Statistical Products and Service Solution (SPSS) version 26.
Results: There were 240 participants, with 131(54.6%) being males. The majority of the participants had type 2 DM 232(96.7%) with uncontrolled blood sugar levels of 176 (73.3%). The overall prevalence of hearing loss was 67.5%, of which 51.7% had asymptomatic hearing loss. The severity of hearing loss was 102(42.5%), 34(14.2%), 14(5.8%), and 4(1.7%) for mild, moderate, severe, and profound sensory neural hearing loss respectively. The most common type of hearing loss was sensorineural 154(64.2), other types were conductive hearing loss 6(2.5%), and mixed hearing loss 2(0.8%).
Conclusion: This study revealed high prevalence of hearing impairment among diabetic patients, of whom most had asymptomatic hearing impairment and were not aware of their hearing impairment. This emphasized the importance of routine pure tone audiometry for early detection of hearing loss among diabetic patients, a practice that could significantly improve the quality of life of the DM patient.
Case presentation: A 12-year-old boy presented with a cut-throat following an assault by an unknown person. Examination revealed an acutely ill child, conscious but pale. He sustained a deep transverse laceration that transected the thyroid cartilage, exposing the laryngeal cavity. An assessment of Zone II penetrating neck injury was made. He was resuscitated, and had emergency neck exploration, tracheostomy, and repair of the injuries. The patient was followed up for 6 months, and had a good voice outcome, with no significant complication. Conclusion: Cut-throat injury is rare in children. But it is a potentially life-threatening condition. It is therefore important to recognize this entity and develop effective protocol of management in our environment.
mortality due to the high incidence of end-organ damages. Unlike other complications of hypertension, cochlear dysfunction in
hypertensive patients is a hidden and progressive damage that remains undetected (subclinical) for a long time. The aim of this study
was to assess the prevalence of subclinical hearing impairment, as well as the type and degree of hearing loss among hypertensive
patients in our environment.
Methods: This was a cross-sectional cohort study conducted among adults diagnosed with hypertension previously. Ethical
clearance and informed consent were obtained. Previous history of related exposure event (hypertension) and outcome (hearing
loss) was assessed. Each participant was then subjected to conventional Pure Tone Audiometry (c-PTA) and Extended High
frequency Audiometry (EHA) tests, and findings were analyzed.
Results: One hundred and ninety (190) hypertensive patients were enrolled, among which 107 (56.3%) were females and 83 (43.7%)
males. Hypertension was more common in the age group of 51-60 years (26.8%) and 61-70 years (30.5%). The overall prevalence
of hearing loss was 41.6%, of which 18.4% had subclinical hearing impairment. The most common type of hearing loss was
sensorineural 68 (86.1%), and found to be in varying degrees of 33.8%, 26.5%, 23.5%, and 16.2% for mild, moderate, severe, and
profound hearing loss, respectively.
Conclusion: The overall prevalence of hearing loss among hypertensive patients was 41.6%, with a significant proportion (18.4%)
having subclinical hearing loss, which is not noticed by the patients. Therefore, routine pure tone audiometric hearing screening for
all hypertensives is recommended to enable early detection and treatment of this hearing loss.
Keywords: Hearing loss, Hypertension, Extended High Frequency Audiometry, Pure tone Audiometry, Prevalence, Subclinical
hearing loss
Methods: This was a prospective observational study among adults diagnosed with DM. Ethical clearance and informed consent were obtained. Each participant had fasting blood sugar and pure tone audiometric tests performed. The severity of hearing loss was categorized according to WHO grading. The data was analyzed using Statistical Products and Service Solution (SPSS) version 26.
Results: There were 240 participants, with 131(54.6%) being males. The majority of the participants had type 2 DM 232(96.7%) with uncontrolled blood sugar levels of 176 (73.3%). The overall prevalence of hearing loss was 67.5%, of which 51.7% had asymptomatic hearing loss. The severity of hearing loss was 102(42.5%), 34(14.2%), 14(5.8%), and 4(1.7%) for mild, moderate, severe, and profound sensory neural hearing loss respectively. The most common type of hearing loss was sensorineural 154(64.2), other types were conductive hearing loss 6(2.5%), and mixed hearing loss 2(0.8%).
Conclusion: This study revealed high prevalence of hearing impairment among diabetic patients, of whom most had asymptomatic hearing impairment and were not aware of their hearing impairment. This emphasized the importance of routine pure tone audiometry for early detection of hearing loss among diabetic patients, a practice that could significantly improve the quality of life of the DM patient.
Case presentation: A 12-year-old boy presented with a cut-throat following an assault by an unknown person. Examination revealed an acutely ill child, conscious but pale. He sustained a deep transverse laceration that transected the thyroid cartilage, exposing the laryngeal cavity. An assessment of Zone II penetrating neck injury was made. He was resuscitated, and had emergency neck exploration, tracheostomy, and repair of the injuries. The patient was followed up for 6 months, and had a good voice outcome, with no significant complication. Conclusion: Cut-throat injury is rare in children. But it is a potentially life-threatening condition. It is therefore important to recognize this entity and develop effective protocol of management in our environment.