Preliminary Results of Cochlear Implantation in Underdeveloped Countries: The Experience of Cameroon

Introduction: Deafness, is the most common neurosensory deficit in humans. The origins can be diverse: congenital or acquired and sometimes of an etiology that is difficult to specify. The main risk is social exclusion. The advent of cochlear implants is a solution of choice for severe to profound sensorineural hearing loss. This innovative therapeutic modality is new to Cameroon, so we proposed to evaluate the preliminary results of cochlear implantation at the General Hospitals of Yaoundé and Douala, by addressing the epidemiological, clinical and paraclinical, surgical, and prosthetic aspects. Methodology: We conducted a descriptive and prospective cross-sectional study over a period of two years and eight months, from January 2019 to 31 August 2021. The study sites were: the general hospitals of Yaounde and Douala, as well as the private practices of speech therapists in the said cities. We collected socio-demographic, clinical, paraclinical variables and data on surgical, prosthetic and speech therapy management which were processed. Results: We recruited 15 cochlear implant patients, one adult and 14 children. The sex ratio was 1.14 in favour of girls, the average age of the child population was 4.9 years and one subject was 57 years old. These children were mostly in school (85.7%) and mostly (86.7%) living in urban areas. The average period of sound deprivation was 3.9 years. The deafness of the children was 100% prelingual and the acquired cause was evoked in front of the risk factors (prematurity, low birth weight, neonatal asphyxia, jaundice, meningitis, neuromalaria) for 57.7% of them. The adult deafness was postlingual and post-traumatic. The associated clinical conditions found in 4 (26.8%) of the patients were an ocular refraction disorder, a chronic otitis media sequelae, cerebral palsy and minor head trauma injuries. There was no syndromic or malformative picture. The deafness was bilateral in all cases, asymmetric in 22.2% of cases and severe to profound sensorineural. The threshold of the deafness was deep in 78.6% of cases, with a more marked involvement on the right. Imaging studies (MRI and CT scans of the cranium, brain and rock) carried out in our series showed abnormalities in 4 (26.7%) of the children, but none of these abnormalities were an absolute contraindication to implantation. The surgical management was done with oticon® Neuro ZTI implants. Implantations were unilateral and mostly right, with one case of stenosis of the round window recess observed. The postoperative course was simple for 92.8% of patients. One case of superinfection of the surgical wound. The activations were performed within four to five weeks after surgery and the implant was functional in fourteen patients and dysfunction was observed in one patient. Conclusion: The cochlear implant is an effective solution in the fight against severe to profound sensorineural deafness. The diffusion of this therapeutic tool in our environment is still hampered by the youth of the teams, the lack of equipment and the insufficient financial means.

Predictive Factors for the Occurrence of Pharyngostoma after Laryngectomy and Total Pharyngo-Laryngectomy in Yaounde and Douala

Introduction and Aims: Pharyngostoma or pharyngo-cutaneous fistula is a frequent complication of totals laryngectomies and pharyngo-laryngectomies. Its incidence varies from one series to another from 13% to 58%. Multiple risk factors are known. The data from our environment concerning this condition are few. Thus, in order to contribute to the study of this complication in our environment, we proposed to carry out this study, whose objective was to determine the predictive factors for the occurrence of pharyngo-cutaneous fistula or pharyngostoma after total laryngectomy and total pharyngo-laryngectomy in Yaounde and Douala. Patients and Methods: This was a retrospective, cross-sectional, descriptive study conducted in the 5 Ear-Nose-Throat (ENT) department of hospital in the city of Yaounde and Douala. The study took place between January 2009 and December 2020. All patients who underwent total laryngectomy or total pharyngo-laryngectomy with a follow-up of at least one month were included in the study. Incomplete records were excluded, as well as those of patients who died before one month of postoperative follow-up. Results: We selected 48 cases of total laryngectomies (TL) and total pharyngo-laryngectomies (TPL), and identified 37 cases of pharyngostoma. 45 men (93.8%) and 3 women (6.3%). The mean age was 56.4 years with extremes ranging from 37 to 86 years. Smoking and alcoholism were noted in 75% and 79.2% of our patients respectively. A tracheotomy before TL and TPL was found in 41.7%. 100% of the tumours found were T3 or T4. The surgery was in 34 cases (70.8%) TL and in 14 cases (29.2%) TPL. Pharyngostomas were observed in 37 cases among 48 patients operated on, i.e. a frequency of 77.1%. The average delay of appearance was 7 to 14 days. We had spontaneous healing with pressure dressing and nasogastric tube feeding in 35 patients (77.8%) and two patients benefited from pectoralis major flap treatment;the healing time was 21 to 30 days. We did not find any correlation between gender, age, tumour site of origin and locoregional extension and the occurrence of pharyngostoma. Preoperative tracheotomy and radiotherapy were not significant risk factors for the occurrence of pharyngostoma. However, preoperative anaemia (p = 0.02), LTP (p = 0.02), early complications (p 0.001) and lack of continuous saliva aspiration postoperatively (p = 0.03) were statistically significant predictors of pharyngostoma in univariate analysis. Conclusion: Pharyngostoma is the most common postoperative complication after TL and TPL. In our setting, the main associated risk factors identified were: preoperative anaemia, LTP, early complications and failure to continuously aspirate saliva postoperatively.

Endoscopic Endonasal Surgery at the Yaounde General Hospital-Cameroon: Case Study of 30 Operated Patients

Introduction: Endoscopic endonasal surgery is currently a validated therapeutic modality in most nasal sinus disorders. In developed countries, this practice is common and sees the indications constantly reviewed;In sub-Saharan Africa, this surgical technique is popularized. The external pathways are morbid and not very functional. In our daily practice at the Yaounde General Hospital (YGH), this technique is still in its infancy. Gradually it’s entering our habits and sees its indications increases. Through this study, we are reporting readily available data from our experience. Objectives: The objective was to study the practice of endoscopic endonasal surgery in our setting. Patients and Method: This was a cross-sectional, descriptive, retrospective study. The site of study was the ear-nose and throat service of Yaounde General Hospital. The study was conducted from January 2013 to December 2020, for an 8 years basis. The sampling was consecutive. We included in this study all patients operated on for a nasal sinus disease by the endoscopic endonasal modality. We excluded patients with incomplete files, as well as those who had a complementary transfacial approach during the same operation. The data were collected on prepared questionnaire. Data analysis is done with ssps 23.0 software. Results: We recruited 30 cases, out of a total of 330 interventions carried out in our department. The prevalence of this surgery in our activity was 9%. Male and female had equal ratio of 50%. The most represented age group was 30 - 40 years (33.3%). All the patients had a facial sinus CT scan, we did not note any anatomical variant as risk. Two patients of our sample size had a history of sinus surgery, treated externally. Chronic maxillary sinusitis was the surgical indication in 36.7%, followed by Killian antro-choanal polyps in 13.3%, nasosinus polyposis in 13.3% and all performed under general anesthesia. The most performed procedure was unilateral mean meatotomy with 43.33% followed by bilateral mean meatotomy with 20%, ethmoidectomy 13.3%, bimeatotomy 10%. The admission lasted for 2 days. 100% of patients had a previous nasal tamponade at the end of the intervention. The tamponade was removed on the second postoperative day in 100% of patients. 16.7% of patients presented with complications of low abundance postoperative bleeding. All patients noted clinical improvement over the initial symptoms postoperatively. Conclusion: Endoscopic endonasal surgery is experiencing slow but certain progress in our daily practice. The operated patients are young, chronic maxillary sinusitis is the main indication, the most performed procedure is the unilateral mean meatotomy. The operation goes uneventful with satisfactory prognosis. A study with a larger sample is necessary in order to refine our results. The practice remains limited by the technical platform, which needs to be strengthened, in order to optimize the practice.