Pattern of Salivary Gland Tumour in Sokoto, North-Western Nigeria

Background: Salivary gland tumours though rare but constitute a heterogeneous group of tumours accounting for 5% of head and neck tumours with a high incidence reported in other part of the world compared with studies in Sub-saharan Africa. Aim: To describe the dermographic and histopathological patterns of salivary gland tumuors in a tertiary health institution Sokoto. Materials and Method: This was a five-year descriptive and retrospective analysis of all patients diagnosed and managed with salivary gland tumour in the department of ear, nose and throat, Usmanu Danfodiyo University Teaching Hospital Sokoto between January 2010 and December 2014. Clinical records and histopathological slides of these patients were retrieved and data extracted from the case files included patients demography, site of the tumour, and histopathological diagnosis. Data obtained were analysed using IBM-SPSS version 22. Results: A total of 103 salivary gland tumours (SGTs) during the study period. Age ranged from 1 year to 75 years with a mean age of 41.66 (±17.80) years. There was a male preponderance of 53.4% and 46.6% female with a M:F of 1.2:1. Histologically, 35 (34.0%) were benign and 68 (66.0%) were malignant lesion. Minor salivary gland 63 (61.2%) was the commonest gland involved followed by the parotid 27 (26.2%) gland. Squamous cell carcinoma (SCC) was most frequent malignant lesion and pleomorphic adenoma was the commonest benign tumour. Conclusion: Minor salivary glands of the palate are the principal site for salivary gland malignancy with male preponderance and SCC being the most frequent malignant lesion. Therefore any SGTs should raise a high index of suspicion.

Laryngeal Stenosis from Trapped Overflowed Head Scarf in the Wheel of a Moving Motor Cycle: A Case Report

Introduction: Laryngeal stenosis is partial or circumferential narrowing of the endolaryngeal airway from congenital or acquired causes. It can present with life threatening upper airway obstruction, and the goal of treatment is restoration of good quality voice, respiration and laryngeal competence. We report a case of laryngeal stenosis following strangulation by a trapped overflowed head scarf, whilst being transported on a motor cycle and highlighted the treatment challenges. Methodology: A case of laryngeal stenosis studied, clinical findings, investigation results and treatment analysed. Results: A 70-year-old Nigerian elderly woman presented with three weeks’ history of hoarseness and progressive difficulty in breathing, following pulling of her long head scarf into the back wheel of the motor cycle taking her home. She had immediate loss of consciousness, which lasted for about 60 minutes. There was associated bout of cough while eating. Examination revealed life threatening upper airway obstruction. X-ray soft tissue neck showed soft tissue mass obliterating larygotracheal air column. Flexible nasopharyngolaryngoscopy showed grossly distorted laryngeal inlet with invisible vocal cords. CT scan of the larynx showed multiple and displaced fractures of the laryngeal cartilages. Microlaryngoscopy findings were pin-hole laryngeal lumen with firm collapsed mucosa. Emergency tracheostomy was done to relieve the upper airway obstruction. Attempts were made to excise the collapse mucosa and insert a stent proved difficult. Referral for endoscopic laser excision was caution because of the potential risk of aspiration. She was counselled and coping well with the tracheostomy.

Aural Toileting and Dressing—Important Intervention Measures in the Management of Acute Suppurative Otitis Media

Background: Otitis media is one of the most common childhood infections, the leading cause of doctor’s visit by children in ENT clinic. The acute form if not recognized early is commonly characterized by suppuration from the middle ear following perforation of the tympanic membrane otherwise referred to as acute suppurative otitis media (ASOM). If not adequately treated, it progresses to chronic suppurative otitis media with attendant challenges in management. Ceasation of ear discharge is an indication of resolution of disease. The objective of this study is to appraise the value of local ear suction toileting and dressing in the ceasation of ear discharge in acute suppurative otitis media. Materials and Method: Consecutive new cases of acute suppurative otitis media seen at the Ear, Nose and Throat clinic of a tertiary health centre in north western Nigeria were assessed for efficacy of aural toileting and dressing with antibioctic impregnated guaze in the treatment of acute suppurative otitis media and compared with patients with similar disease without aural toileting and dressing or dressing with normal saline soaked guaze in addition to systemic antibiotic and antihistamine medications. Ear toileting was done by suctioning the discharge with suction machine, and cleaning the external auditory canal with hydrogen peroxide and methylated spirit. They were then dressed with gauze impregnated with antibiotic ear drops daily until there was no more ear discharge. The period of ceasation of ear discharge in each group was assessed. Results: There were 39 patients with acute suppurative otitis media (ASOM). Eighteen were females (46.2%) while 21 were males (53.8%), giving M:F ratio 1:2.1. Their ages ranged between 1 month and 45 years. About 36 (92.3%) were children and out of this, 28 (77.8%) were less than 5 years old. The average period of ceasation of discharge was 24 - 48 hours with those undergoing ear toileting and dressing but varied between 7 and 10 days with those without ear dressing or dressing with normal saline soaked guaze. This finding compelled us to stop the study on ethical grounds when this was carried out in the first 5 patients on each side of the study groups necessitating reversals of other groups to aural toileting and dressing with antibiotic impregnated guaze. Conclusion: Local ear toileting and dressing appear to show significant contribution to the early ceasation of ear discharge and are highly recommended not only for acute suppurative otitis media but also for all suppurative ear diseases.

Giant Retropharyngeal Abscess in a Nigerian Adult Following Fish Bone Throat Injury

Retropharyngeal abscess (RPA) is an uncommon disease entity that typically occurs in children under 5 years of age, which has the potential to cause upper airway obstruction. Upper respiratory tract infection is the most common predisposing factor to RPA in children while cervical spine tuberculosis and trauma are the major aetiological factors in the adult. We report a case of a 21-year-old Nigerian farmer with giant retropharyngeal abscess following fish bone throat injury causing life-threatening upper airway obstruction. The patient responded well to emergency tracheostomy, intraoral surgical drainage and empirical antibiotic therapy. We highlight the diagnostic and therapeutic challenges of managing such a patient.

Nasal Rhinosporidiosis in a Nigerian Child: A Rare Clinical Entity

Background: Rhinosporidiosis is a rare chronic granulomatous disease characterized by polypous lesion of the mucous membrane caused by rhinosporidium seeberi which predominantly affects the mucous membrane of the Naso-pharynx, conjuctiva and palate. Rhinosporidiosis can be easily misdiagnosed as a neoplastic disease, and hence, it is necessary to educate the public and medical community about this emerging disease entity in our region. Aim: To report a rare case of nasal rhinosporidiosis in a 13-year-old male patient from Sokoto, North Western Nigeria. Case Report: A 13-year-old male Quranic child from gwadabawa village in Sokoto State, North Western Nigeria, whose parents are rice farmers, presented in the ENT clinic of Usmanu Danfodiyo University Teaching Hospital with 15-month history of intermittent epistaxis and left nasal mass noticed one month before presenting. He was examined clinically and a pinkish polypoidal mass arising from the septum and filling the left nasal cavity was seen. He subsequently had a biopsy of the mass and histopathological examination with special histochemical staining, which confirmed rhinosporidiosis. Conclusion: Rhinospridiosis is an unusual cause of nasal masses in our region and is probably a fungal disease. To the best of our knowledge, this is the first reported case in this region. This lesion largely mimics ordinary nasal polyp;therefore, it is an important possible differential diagnosis to be considered in our region when evaluating patients with nasal masses.

Nasal Response from Formaldehyde Exposure Used as Cadaver Preservative among Pre-Clinical Medical Students in a Nigerian Medical College

Background: Formaldehyde is commonly used for cadaver preservation in most anatomy laboratories with medical students at risk of acute toxic reactions involving the mucosal surface of the upper respiratory tract. Aim: To assess the nasal induced physical reactions from formaldehyde exposure among pre-clinical medical students. Materials and Method: This is a cross sectional, anonymous questionnaire-based study that included 119 preclinical medical students who took human anatomy laboratory course in the year 2012 at the College of Health Science of the Usman Danfodiyo University, Sokoto, Nigeria. Results: One hundred and nineteen students responded to the questionnaires. There were 82 males and 37 females with a ratio of 2.2:1. Fifty nine (49.6%) of the respondents had watery rhinorrhea, nose itching 41 (34.5%), excessive sneezing 34 (28.6%), nasal obstruction 32 (26.9%), hyposmia 23 (19.3%) and 6 (5%) epistaxis. Thirty (29.2%) respondents had persistent nasal symptoms throughout the dissection session and nasal obstruction accounted for 40% of those affected. Majority of the respondents 113 (95%) had no knowledge of health hazards and precautions against formaldehyde exposure. Conclusion: Watery rhinorrhea, followed by nasal obstruction were the most common nasal symptoms which were persistent in 36.7% and 40% of the respondents respectively throughout the anatomy dissection sessions. Ninety five percent of the respondents had no knowledge of health hazards and precautions against formaldehyde exposure, therefore we recommend creation of awareness and precautionary measures against formaldehyde exposure in our Nigerian medical schools.

Sociodemographic Characteristics and Prevalence of Self Ear Cleaning in Sokoto Metropolis

Background: Self ear cleaning with cotton buds and other objects is a common practice. Objective: To determine the sociodemographic characteristics and the prevalence of self ear cleaning habit among patients attending a family medicine clinic in a teaching hospital in Sokoto metropolis. Materials and Methods: This was a 4 weeks prospective study carried out between May and June, 2013 at Usmanu Danfodiyo University Teaching Hospital and Specialist Hospital Sokoto. A structured self response questionnaire containing items on sociodemographic characteristics, frequency of administering objects into the ear and complications of self ear cleaning was administered to the respondents after institutional research ethical clearance. The data were analysed using SPSS for windows version 16.0. P-value was considered significantly if less than 0.05. Results: A total of 200 subjects were included in this study, comprising of 93 (46.5%) males and 107 (53.5%) females. Their ages ranged from 18-57 years with the mean age being 30.29 years (±8.70). Eighty percent (160) of the respondents practise self ear cleaning. Types of objects included writing objects and cotton buds. For many of the subjects, the frequency of insertion was once daily and both ears were frequently cleaned. Complications that have arisen due to the practice included otitis externa. Conclusion: Self ear cleaning was prevalent in the subjects. Considering the complications that may arise, ear cleaning is better done by trained health personnel.