Ethmoidal Polyposis, Adenoid Hypertrophy and Tympanic Membrane Perforation—A Case Report

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 improved remarkably with subsequent medical treatment. She was followed up for 8 months and no recurrence was observed. Conclusion: Sinonasal polyposis can coexist with adenoid hypertrophy and middle ear disease as a single pathological condition. Hence, a high index of suspicion and thorough evaluation become necessary for making timely diagnoses and instituting effective management.

A Comparative Study of Ear Diseases in School Children from Lower versus Higher Socioeconomic Status

Background: Preventable otologic conditions have been found to be important health issues among paediatric age group. Poor socioeconomic status and inappropriate management services in developing countries lead to various complications despite the fact that most of these diseases are self-limiting. The aim of this study was to determine the prevalence and pattern of ear diseases in school children of high and low socioeconomic status in Yola, Nigeria. Methods: This study was conducted in March 2017 in two primary schools (private and public) in Yola among 6 - 8 years old pupils. Approval for the study was obtained from Federal Medical Centre, Yola and consent was obtained from the parents/guardians and the school authorities. Using a health questionnaire, a brief ENT history was obtained from children in years 1 and 2 of each school. Otoscopic examination, audiometry and tympanometry were then carried out. Data collected was analysed using SPSS version 20. Results: One hundred and three children were studied. The age range was 6 - 8 with mean age of 6.8 ± 0.9 and 53 (51.5%) boys. Fifty-two (50.5%) were from public school (low socio-economic class) and 51 (49.5%) from private (high social class). Wax was the most common ear condition encountered affecting 37 (35.9%) children, and the number was similar in both groups. Otitis media with effusion (OME) was encountered in seven children evenly split between the two groups showing a point incidence of 6.8%. There was hearing loss in 13 (12.6%) children, and this was also similar in the two groups. Conclusion: Wax impaction was the commonest otologic disease encountered. Our study also showed a point incidence of 6.8% for OME, but there was no statistical difference between the two groups, and neither was there any statistically significant difference between the two groups in any of the other diseases encountered.

Impact of COVID-19 on the Practice of Otorhinolaryngology in Nigeria

Background: The 2019 novel corona virus disease (COVID-19) pandemic broke out in Wuhan, Hubei province in China in December 2019. Available research so far showed that Otolaryngologists had an elevated risk of exposure to SARS-CoV-2 due to the high viral load in the respiratory tract, which is the primary area of examination and instrumentation. We aimed to present our findings on the impact of this pandemic on Otolaryngology practice in Nigeria. Materials and Methods: This study was conducted online in September, 2020 amongst otolaryngologists in secondary and tertiary health centers across Nigeria using the survey monkey. Analysis was done using SPSS version 20. Results: A total of 102 ORL practitioners in Nigeria were assessed in this study. The mean age of the respondents was 42.4 ± 7.9 years;majority (54.9%) were Consultants and their duration of ORL practice ranged between 1 - 37 years. All the respondents felt being an ENT Surgeon exposes them to higher risk of contracting COVID-19 in their practice while 93% of them felt unsafe to perform throat examination during COVID-19 pandemic. Similarly, 74.5% feel unsafe to perform rhinoscopy while 67.7% of the respondents feel unsafe to do anterior rhinoscopy, posterior rhinoscopy and rigid nasal endoscopy. Conclusion: Otolaryngologist is at high risk of being infected with SARS COV-2 as they cope with upper respiratory tract during diagnosis, clinical review, sampling and surgery. The pandemic has affected almost all aspects of Otolaryngologic practice in Nigeria.