[Show abstract][Hide abstract] ABSTRACT: Epistaxis is a common otolaryngological emergency and is often due to lesions within or around the nose and systemic conditions. Controlling epistaxis presents a challenge in the underdeveloped, resource-poor centres where there are limited facilities.
To describe the aetiopatogenesis of epistaxis in our hospitals.
This was a retrospective review of the cases of epistaxis managed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile Ife, over a three-year period: January 2003 - through December, 2005. Information on sociodemographic characteristics, clinical presentation and management of epistaxis was obtained from the hospital records both in the accident and emergency units and the ENT outpatient clinic.
A total of 106 cases were managed during the period. The peak age incidence was in the 21-40-year group. There was a significant male preponderance, ratio 3.4:1. Trauma contributed to 75 (70.9%) of the cases managed. Maxillofacial injuries were the most common injury encountered (50.7%). This was mainly secondary to the road traffic accident (RTA). Malignant neoplasms were the second most common aetiological factor seen in this study while idiopathic causes were the third most common. There were two cases with systemic problems associated with renal failure. Nasal packing was adequate to control the epistaxis in most cases. Nasal packing was done with gloved finger cots and vasellinated gauze. Two patients (1.9%) had external carotid artery ligation. Eleven patients (10.4%) received blood transfusion.
Epistaxis is a common presentation of head and neck trauma. Non-surgical control of epistaxis (nasal packing) is adequate in many cases. Reducing the incidence of trauma from RTA will reduce the incidence of emergency epistaxis in our centers.
West African journal of medicine 05/2009; 28(3):165-8. DOI:10.4314/wajm.v28i3.48443
[Show abstract][Hide abstract] ABSTRACT: Repeated exposure to excessive noise will eventually lead to an irreversible increase in hearing thresholds. In theory, the damage reflects both the intensity of the noise and the duration of exposure. This is not linear with respect to duration of exposure; rather, the worker may experience a disproportionate loss in the early years of exposure.
A prospective study surveying workers of the production section (i.e. most noise-exposed area) of a bottling factory was carried out in December 2003 and in December 2005. A self-administered questionnaire was used to extract information about worker's demographic characteristics, drug intake, and medical and occupational history, as well as information on the use of hearing protection devices. Noise mapping of the various departments of the factory was carried out. Otological examination, tympanometry and audiometry were also carried out on selected subjects.
Eighty-four workers, 76 (90.5 per cent) men and eight (9.5 per cent) women, were studied. Their mean age was 33.0 +/- 7.6 years in 2003 and 35.0 +/- 7.6 years in 2005. The recorded noise levels in the factory production section ranged between 91.5 and 98.7 dBA. The prevalence of sensorineural hearing loss among workers was noted to be 64.9 and 86.9 per cent for test one (2003) and test two (2005), respectively. The degree of hearing deterioration within the two years of this study was 1.0-3.2 dB for the right ear and 1.6-3.4 dB for the left ear. This deterioration was at discrete frequencies. More than half (53.6 per cent) of the workers did not have a hearing protection device. Of the 46.4 per cent who did, only 38.5 per cent claimed to have used it regularly.
These findings showed that there was a high prevalence of mild sensorineural hearing loss and significant hearing deterioration among workers, due to exposure to excessive noise over a two-year period. The study demonstrates the practical importance of serial audiometry for noise-exposed workers as a means of monitoring hearing deterioration. It is necessary to enforce existing occupational health laws in our industries in order to prevent noise-induced hearing loss, since it is eminently preventable.
The Journal of Laryngology & Otology 09/2008; 122(8):786-94. DOI:10.1017/S0022215107000242 · 0.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To analyse general differences in age, gender, anatomic location of the various histological types of malignant neoplasm involving the oral and maxillofacial region at a tertiary referral centre in Nigeria and to compare this with reports in the literature.
A tertiary referral centre in Lagos, Nigeria.
All patients with a histological diagnosis of malignancy were included provided the final surgical histology reports as well as the biopsy reports were available for review.
Squamous cell carcinoma (SCCA) with a peak age incidence in the 6th decade of life and a male to female ratio of 1.65 to 1 was the most common cancer (42.8%). Males with SCCA (mean = 48.7 years) were relatively younger than females (mean = 58.8 years). Eighteen percent of patients with SCCA were below 40 years at presentation and males were predominantly affected at a ratio of 5.2:1. Majority of the SCCA (75%) were well/moderately well differentiated. However, in patients below 40 years, 45.9% had poorly differentiated SCCA. The Most commonly affected sites for SCCA were the maxillary antrum (36.7%), mandibular gingiva/ alveolus (23.0%) and tongue (12.04%). Patients who presented with antral SCCA were relatively younger (mean = 48.9 years) than those who had SCCA involving the mandibular gingiva/ alveolus (mean = 57.1 years) as well as floor of mouth (mean = 56.3 years). Furthermore, males with antral SCCA were younger than their female counterparts. Similarly, males who had mandibular gingiva/ alveolus SCCA (mean = 48.4 years) were younger than their female counterparts (mean = 62.8 years). Majority of the glandular carcinomas (GLDCAs) arose from minor salivary glands (63.0%). Thirty seven per cent of these patients were below 40 years at presentation. Females who had antral GLDCA (mean = 32.4 years) were relatively younger than their male counterparts (mean = 49 years). Most of the patients who presented with sarcoma were below 40 years (77.4%) and males were younger (22. 8 years) than females (mean = 35.4 years).
The proportion of orofacial cancers that is SCCA in Nigerians is relatively low because of a relatively high proportion of GLDCA and Burkitt's lymphoma. A relatively high proportion of patients with SCCA were below 40 years at presentation. They were predominantly males who presented with poorly differentiated tumours.
East African medical journal 04/2006; 83(3):62-8. DOI:10.4314/eamj.v83i3.9399
[Show abstract][Hide abstract] ABSTRACT: This is a retrospective analysis on the prognostic factors in the management outcome of clinically and histologically diagnosed carcinoma of larynx seen in Lagos University Teaching Hospital between 1996-1999. Various prognostic factors have been documented as determinants on the probable outcome of carcinoma of the larynx, such as duration of symptoms, smoking, medical status of the patient, degree of differentiation, size and site of tumour and presence of cervical lymph node. Thirty-six patients between 1996-1999 were reviewed, with a male to female ratio of 11:1, and peak age group of occurrence in 50-59 years, majority (86.12%) of which were non-smokers who presented in varied degrees of airway obstruction necessitating pre-treatment tracheostomy in 70% of the patients with more than 50% presenting within 3-6 months of onset of initial symptom. The tumours were staged clinically and histology revealed well differentiated T3 glottic tumour without any clinically palpable neck node in more than 50% of the patients which should predict a better outcome. But the interplay of many prognostic variables like pre-treatment tracheostomy and its attendant complications, supposed biological aggressive tumour in a non-smoker, coupled with treatment biased by patients, high costs of treatment, logistics and poor follow up compliance, resulted in poor outcome of our management.
The Nigerian postgraduate medical journal 07/2003; 10(2):103-6.
[Show abstract][Hide abstract] ABSTRACT: To compare the prevalence of chronic supperative otitis media (CSOM) among two populations of school children.
A survey-demographic data collection and otoscopy was carried out among the two populations of school children.
A rural government primary school and an urban private primary school
Six hundred and ninety nine school pupils in the rural school and two hundred and seventy pupils in the urban school.
Six per cent of the pupils in the rural schools had CSOM as evidenced by persistent perforation of tympanic membrane of more than three months duration. No tympanic membrane perforations were observed in the children in the urban school at the time of this study. The difference in the prevalence of CSOM between the two populations is statistically significant (P < 0.001). The difference in socio-economic status between the two populations is statistically significant in relation to the prevalence of CSOM in the two populations. The poorer rural population had a significantly higher prevalence of CSOM (P < 0.001).
The two study populations are just seven kilometres apart geographically but there is a world of difference in their socio-economic status, availability of social infrastructure and health facilities. This presumably had reflected in the marked difference in the prevalence of CSOM between the two study populations. A collective effort of government and well meaning indigenes of rural communities in Nigeria can help promote the socio-economic status and enhance the availability of social infrastructure and health facilities of rural areas. This we hope will lead to a decline in the prevalence of CSOM in the rural areas.
East African medical journal 03/2003; 80(3):130-4. DOI:10.4314/eamj.v80i3.8681
[Show abstract][Hide abstract] ABSTRACT: One thousand, one hundred and thirty-five pupils were examined for CSOM in a rural community of Kwara State of Nigeria. The prevalence of CSOM was 73 per 1000 pupils. The highest is seen among the age group of 2-5 years. Unilateral disease was most prevalent (79.5%); 99% of the pupils had tubotympanic disease. Active disease was observed in 27.7% of the cases of CSOM.
The Nigerian postgraduate medical journal 07/2002; 9(2):63-6.
[Show abstract][Hide abstract] ABSTRACT: A prospective study was carried out at the Lagos University Teaching Hospital in Lagos. The aims were to determine the prevalence of otorhinolaryngological disease among patients who were HIV+ and or had clinical AIDS and to correlate the presence of ORL disease with the clinical state of HIV infection. The study was done between October 1998 and September 1999. A total of ninety-eight patients were studied. The age range of the patients was between 15 and 69 years with 83% of them being in the age group of 20-49 years. The results showed that while only 17% of the patients were referred because of ORL diseases, 80% of them actually had O.R.L./head and neck conditions. This difference of proportion is highly significant P = 0.000037. 160.20% of the patients had oral/pharyngeal lesions and 24.5% had identifiable otological disease. Hearing impairment was noted in 30.6% of the patients on pure tone audiometric assessment of which 26.5% were sensorineural. The correlation between O.R.L./head and neck manifestation and the CDC classification of HIV/AIDS infection did not reveal a definite pattern.
The Nigerian postgraduate medical journal 01/2002; 8(4):170-4.
[Show abstract][Hide abstract] ABSTRACT: An observer blind clinical study was carried out among 64 Nigerian patients with allergic rhinitis to assess the efficacy and tolerance of loratadine a new generation H1 antihistamine. Patients were allotted randomly to receive treatment for 1 week with either loratadine + Vit. C (group A), chlorpheniramine + Vit. C (group B), or Vit. C alone (group C). Assessment was by subjective symptom scoring of three nasal symptoms namely; sneezing, rhinorrhoea and nasal blockage. Difference between pre treatment and post treatment mean symptom scores was used as degree of improvement for statistical analysis and this formed the primary efficacy parameter. Adverse effects namely; anticholinergic effects, gastrointestinal effects and drowsiness were assessed following treatment. The results showed that loratadine was significantly better than Vit. C. alone (P = 0.0002) and chlorpheniramine was also significantly better than Vit. C. alone (P = 0.039). However, loratadine was significantly better than chlorpheniramine P = 0.046. Drowsiness was noted in 19.2% of patients on loratadine compared with 57.1% of patients on chlorpheniramine. lt is concluded that though both loratadine and chlorpheniramine were effective in the relief of symptoms of allergic rhinitis in Nigerian patients, loratadine was significantly more effective with minimal sedating effect.
The Nigerian postgraduate medical journal 10/2001; 8(3):127-32.
[Show abstract][Hide abstract] ABSTRACT: To identify the career aspirations of interns (house officers) working in two hospitals in Lagos, Nigeria.
All house officers working in the Lagos University Teaching Hospital and the General Hospital, Ikeja were invited to participate in a cross sectional survey. A self-administered questionnaire was used to collect data.
Specialization choice was evident in 97.1% of the interns while they were undergraduates but this declined to 82.9% on qualifying, though chosen specialties did not vary much between both periods. The preferred specialties were surgery (18.1%), obstetrics and gynaecology (18.1%), paediatrics (9.5%) and dental sciences (10.5%). Doctors who were below the age of 26 years were significantly more likely to want to specialize than others (P=0.017). Furthermore, respondents who had no regrets about selecting medicine as a career were significantly more willing to specialize than others (P=0.013). The major reasons for wanting to specialize were interest in specialty (72.4%), job satisfaction (67.6%) and bright prospects in selected field (54.3%). However, 14.4% no longer wanted to practise medicine while 69% would have liked to leave Nigeria, mainly for the United States of America. Financial considerations were a major reason for both groups.
Surgery, obstetrics and gynaecology continue to attract young doctors to the detriment of other specialties. Financial considerations are also a key determinant of with regard to place of future practice.
Medical Education 06/2001; 35(5):482-7. DOI:10.1046/j.1365-2923.2001.00896.x · 3.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Three hundred and eight-one cases of head and neck cancers were studied over a 10 year period (1988 - 1998) at the Lagos University Teaching Hospital, Lagos. The aim was to assess the various sites of primary lesion, gender and age distribution and histopathological types. The International Classification of Diagnosis Oncology's (ICDO) 9TH version was used to categorize sites of primary lesion. A yearly incidence of 38 cases was noted with an overall male preponderance. Forty-five percent of the patients with head and neck cancers were in their forth and fifth decades of life. The nasopharynx was the commonest site of primary lesion (16.8%) followed by the nose, paranasal sinuses and middle ear (ICDO - 160) with 13.6%. Laryngeal cancer ranked third accounting for 12.1% of the cases. Other common sites of primary lesion were: the skin (9.2%), the salivary glands (7.6%), the mandible (7.3%) and the thyroid gland (7.3%). Metastatic cancer in the neck with unknown primary lesion was seen in 2.9% of the patients. Cancers associated with heavy tobacco use e.g. laryngeal cancers, lip and tongue cancers showed a very high male predilection with M:F ratios of 10.5:1, 8:1 and 6:1 respectively. 91% of the head and neck cancers were of epithelial tissue origin while sarcomas accounted for only 6.6% of the cases. The results show that head and neck cancers affect Nigerians especially males at the prime of their working life. The devastating psychosocial effects on the individual, the family and the society are enormous. Emphasis on cancer prevention is recommended.
West African journal of medicine 01/2001; 20(2):111-6.
[Show abstract][Hide abstract] ABSTRACT: A one-year prospective clinical study to assess principal clinical symptoms, signs and bacteriological isolates in Nigerian children with acute otitis media. This is a multicentre study conducted from January-December, 1998 in three University Teaching Hospitals. A strict recruitment protocol was followed. Patient symptoms had to be less than one week before enrollment. Eighty-one children were recruited into the study. The major findings indicative of acute otitis media were ear pain (92.6%), fever (88.9%), redness of the tympanic membrane (89.9%) and loss of light reflex (84%). Rupture of the tympanic membrane occurred in 15 patients (18.5%) Staphylococcus aureus was the most common pathogen (50%) isolated from the ear swabs. A high index of suspicion is necessary to diagnose acute otitis media early in children especially those who may have fever as the main symptom. This will minimise the frequency of tympanic membrane perforations.