Otolaryngology In Africa

Clinical Audiogram of the Week: vol5, no10

2007-04-16T07:09:00.000-07:00

This case was presented in a recent (vol5,no10) issue of otorhinolaryngology news:

A 37-year old female presented with 1 year history of right aural tinnitus, hearing loss, and initial vertigo which had since resolve. The only significant medical history is allergic rhinitis which is seasonal. Clinical examination including Otoscopy was negative. Pure Tone Audiometry revealed the audiogram demonstrated here:

Diagnosis: Right Meniere's Syndrome. 'Syndrome' and not 'Disease' because the underlying aetiology suspected here is allergy. Hearing loss in Meniere's disease is thought to be caused by distortion of the basilar membrane by fluid pressure an effect maximized at its widest point. This point is at the apical turn, hence the low frequency character of the typical hearing loss. In our experience, this hearing loss is the most difficult to correct of the triad that characterize this syndrom

RE: Case of The Week - Vol6, No2

2007-04-15T10:14:00.000-07:00

This case was presented in a recent edition of the otorhinolaryngology news:

A 27-year-old female presented with hoarseness of 5 months duration. Symptom dated to last delivery that was complicated, necessitated prolonged intubation and nasogatric tube feeding for over a week. Hoarseness has been persistent since then. No associated cough or breathlessness. Indirect Laryngoscopy revealed the features shown here.

Post intubation laryngeal polyp of the type seen here is presumably rare. At direct micro-laryngo-bronchoscopy, supraglottic polypoidal masses, on either side, and with ball-valve effects were seen and excised. Immediate post op disappearance of hoarseness was noted.

Clinical Photo of The Week: Vol3,No9

2006-07-30T07:31:00.000-07:00

The following case was presented in vol3,No9 of otorhinolaryngology newsletter:
A 41-year old male presented with recurrent epistaxis and persistent sero-sanguinous rhinorrhoea following radiotherapy treatment for a lesion biopsied from his right gingivo-buccal sulcus, and histologically diagnosed as squamous cell carcinoma. Examination revealed the sign demonstrated in this picture and negative orbital or neurological signs. CT-Sinuses showed soft tissue opacity completely filling right maxillary sinus with extension to right ethmoidal air cells, nasopharynx, right nasal cavity and erosion of anterior wall of right maxilla. An opaque ipsilateral sphenoid sinus was also found. No orbital extension was found and ipsilateral pterygoid plate was free. Vision was good in both eyes.

The Best Management Option? Well, On account of nasopharyngeal involvement, some authorities advocate irresectability. However, on account of the young age of this patient, and the fact that vision was excellent both eyes, we offered him right extended Denker's approach combined with right infrastructure maxillectomy. Cheeck flap margin was free, nasal septal margin was involved. We have followed him up for 4 months now with good healing and no reccurence so far.

Clinical Photo of The Week: Vol3, No8

2006-07-01T05:16:00.000-07:00

This case waspresented in the recent edition (Vol3,N08) of the otorhinolaryngology news :
A 65-year old male presented with insidious onset of dysphagia, especially to saliva and solids of 3 months duration, and inability to properly open the left eye of one week duration. His medical history revealed well controlled hypertension. He had no nasal symptoms and denied preceding cervico-facial or cranial trauma. Examination revealed the sign shown in this picture. MRI brain was negative. CT-Sinuses showed isolated right maxillary polyp. A follow-up visit a week later revealed bilateral ptosis with additional complaints of muscle weakness and easy fatigability.
Diagnosis: Myasthenia gravis. It wasn't until weakness, proximal myopathy and ptosis involving the second eye appeared that the diagnosis became obvious. In the abscence of these, a strong differential will be extraocular mithochondrial myopathies.

Clinical Photo of The Week: Vol3,No6

2006-07-01T04:59:00.000-07:00

This case was presented in the recent edition (Vol3No6) of otorhinolaryngology news :
A 48-year old male presented with a year history of diminished hearing on the left. He gave a history of left ear canal surgery 10 years earlier. The surgery was to correct post traumatic closure of left ear canal observed following a vehicular accident. Examination revealed the sign shown in this picture. CT-Scan showed normal distal 1/3rd bony canal, normal middle and inner ear, and soft tissue density in the outer 2/3rd ear canal. Audiometry revealed air-bone gap of 15-20dB across speech frequencies.
Diagnosis: Restenosis following initial surgically repaired acquired canal atresia

Clinical Audiogram of The Week - Vol3,No4

2006-05-27T07:18:00.000-07:00

This case was presented in the recent (vol3No4) edition of otorhinolaryngology news: An 46-year old male presented with difficulty in hearing conversation speech of 12 years duration. He often resorted to carrying out 'Toynbee's maneuvre" - swallow against pinched nose, closed mouth in order to be able to hear in the right ear. He gave a history of unsuccessful ossiculoplasty both ears ten years previously. Examination revealed bilaterally normal EACs and Tympanic membranes. Tuning fork assessment revealed bilateral conductive hearing loss. Pure tone audiometry revealed the audiogram displayed here. You may click on the audiogram to view a larger picture of the audiogram.
Diagnosis: Bilateral Conductive Hearing Loss with wide air-bone gap. Otosclerosis was the initial diagnosis, but exploratory tympanotomy revealed loose PORP in the right middle ear. The patient demonstrated significant amplification gains and is doing well on binaural ITC Hearing aids.

Clinical Photo of The Week: Vol3, No3

2006-05-20T03:46:00.000-07:00

The following case was presented in a recent (Vol3,No3) edition of otorhinolaryngology news:
An 11-year old female was referred on account of 3 weeks history of progressive right sided neck swelling not responsive to conventional antibiotics. she had associated fever, odynophagia and dysphagia, but no preceding dental or throat symptoms. Examination revealed high fever, (T=39.80Celsius), pallor, tinge of jaundice, dry coated tongue with thick adherent whitish plaque on the dorsum, trismus and the neck sign demonstrated in this picture. Her ESR was markedly elevated, Her PCV was 20, Only anomaly on E/U/Cr was hypokalemia (K+ = 2.5 mEq/L). Her retroviral screen was negative.
Diagnosis: Deep Neck Infection (DNI). This patient had an initial parapharyngeal space infection which subsequently spread to the submandibular and masseteric spaces. Click Here for factors affecting the bacteriology in DNI.

Clinical Photo of The Week - Vol3, No2

2006-05-01T08:48:00.000-07:00

This case was presented in the recent edition of the otorhinolaryngology news:
A 30-year old male was referred on account of 11 months history of right sided epistaxis, 3 months history of twisting of the face to the left side, and drooping of upper right eyelid. He had always done clerical jobs. Examination revealed right ptosis, right complete lower motor neuron facial nerve palsy, right soft palatal paralysis and the tongue sign demonstrated in this picture. EUA postnasal space revealed scanty soft tissue mass admixed with old blood clots. You may want to view his MRI of sinuses / brain findings for more detail.
Diagnosis: Parapharyngeal Tumour involving the skull bas with multiple cranial neuropathy

Clinical Photo of The Week - Vol3, No1

2006-04-20T09:46:00.000-07:00

The following case was present in a recent (vol3, N01) edition of otorhinolaryngology news:
A 36-year old female presented with painless anterior lower neck swelling of 8 months duration. She had no laryngeal, tracheal or pharyngo-oesophageal symptoms.

Clinical examination was negative except for the structure revealed in this picture. Her thyroid function tests were normal. FNA yielded chocolate-colored aspirate from the neck mass. Cytology of the aspirate was negative (acellular).

Diagnosis: Benign Thyroid Cyst. See this abstract on biochemical composition of thyroid cyst. A recommendation on management approach to cystic thyroid disease could be found here

Clinical Radiograph of The Week: Vol2, No10

2006-04-05T08:57:00.000-07:00

The following case was presented in the recent edition (vol2No10) of otorhinolaryngology news:
A 55-year old male presented with reccurent excruciating right hemicranial headache worse in the right periorbital region of 4 months duration. The onset was preceded by an attack of flu. There was little response to analgesia. Clinical and opthalmological examinations were negative.MRI brain was negative. CT Scan of sinuses revealed the feature shown (red outline). You may want to see other views for clarity.

Diagnosis: Isolated Sphenoid Sinusitis. This patient was found to, at sphenoidotomy have a polyp-filled right sphenoid sinus, with complete resolution of symptoms following surgery.

Clinical Photo of The Week - Vol2, No9

2006-04-05T08:24:00.000-07:00

This case was presented in the recent (Vol2No9) edition of otolaryngology news:
A 34-year old female presented with recurrent painful sublingual swelling of 3 years. The pain is occasionally felt on the adjoining lower gum. She has had several analgesia to no avail. She has no history of autoimmune disorders, trauma or drug allergy. Examination revealed the structure demonstrated in this picture.
Diagnosis: Infected ranula

Clinical Audiogram of The Week - Vol2No8

2006-03-17T07:17:00.000-08:00

This case was presented in the recent edition (vol2no8) of otolaryngology newsletter:
A 23-year old female presented with progressive bilateral hearing impairment of . 3 months duration. She denied any previous head/ear trauma, otorrhoea exposure to loud noise, or preceding ingestion of known ototoxic drugs. There was negative family history of hearing impairment. Clinical examination including otoscopy was not remarkable. Her left ear pure tone audiogram is shown in this picture. You may want to View audiogram for both ears for clarity.

Diagnosis: Binaural mid-frequency sensorineural hearing loss. This type of audiogram has been reported in (1) some cases of hereditary hearing loss, (2) acoustic trauma, (3) idiopathic as well as vestibular schwanomas, as well as (4) in ethyl benzene-induced ototoxicity in rats. This particular case showed no obvious etiological predisposing factor, and there were no amplification gains on hearing aid trials.

Clinical Radiograph of The Week - Vol2No6

2006-02-26T23:48:00.000-08:00

This case was presented in the recent edition (vol2no6) of otolaryngology newsletter :
A 53-year old male presented with sudden onset of dysphagia following accidental ingestion of his denture of 24 hours duration. He initially presented to a secondary health care service where radiological investigation revealed an irregular-shaped silhouette under right diaphragm and the feature demonstrated on this C-spine radiograph. He was noticed sipping soft drink while in the waiting room. Clinical examination was not remarkable.
Diagnosis: Air entrapment sign. This sign said to be common with dentures was, in this particular case noted to be due to oedema of the endoluminal oesophageal mucosa at oesophagoscopy

Clinical Photo of the Week - Vol2No5

2006-02-18T04:03:00.000-08:00

This case was presented in the recent (vol2No5) edition of otorhinolaryngology news:
A 30-year old male presented with recurrent painful swelling on the left side of his face. He occasionally experiences left rhinorrhoea associated with intermittent relieve of anterior facial swelling and pain. The clinical examination revelaed the finding (white arrows) seen on this picture.

Diagnosis: Infected Nasolabial Cyst

Clinical Radiograph of the Week: Vol2N04

2006-02-11T03:25:00.000-08:00

The following case was presented in the recent edition (vol2no4) of otorhinolaryngology news: A 51-year old female presented with 3-year history of recurrent right tinnitus and otalgia. She also experiences slight hearing loss on the right, but no other local or systemic symptoms. Otoscopy revealed a reddish spot on the Right TM which appeared to fluctuate in size according to previous follow up case note documentations. The MRI brain revealed the feature arrowed on this picture

Diagnosis: Jugulotympanic paraganglioma (Glomus tumour). In this case, patient declined surgical excision because of the mild nature of hearing loss and the fluctuating nature of the symptoms.

Clinical Photo of The Week: Vol2, No3

2006-01-28T04:18:00.000-08:00

This case was presented in the current edition (vol2No3) of otorhinolaryngology news:
An 11-year old male presented with 3-week history of persistent fever, nasal obstruction with mouth breathing, and swelling of the nose. The symptoms were preceded by history of blunt injury to the nose while trying to separate his classmates who were fighting. There was little response to antibiotic therapy given by the GP before referral. Examination revealed the nasal feature displayed on this radiograph.
Diagnosis: Septal Abscess. About 12mls of pus was drained in this particular case. The pus was believed to have resulted from a possible septal haematoma following the blunt injury to nasal pyramid.

Clincal Radiograph of The Week: vol2, No2

2006-01-22T05:56:00.000-08:00

The following case was presented in the recent edition (vol2no2) of the otorhinolaryngology news: A 40-year old male presented with progressive painless right cheek swelling of 6 months duration. The swelling was associated with systemic symptoms of tiredness, easy fatigability and recurrent fever. There was no associated oral or pharyngeal thrush. Examination revealed firm swelling over the right parotid area. CT-Scan showed the feature displayed on this radiograph. You may want to see other views of the CT for clarity

Diagnosis: HIV-related lymphoepithelial cyst of the parotid. You can view a medline abstract on this topic here. You can also view a full publication on case report from 5 patients here

Clinical Photo of The Week: Vol2, No1

2006-01-14T05:19:00.000-08:00

This case was presented in the recent edition of the otorhinolaryngology news (vol2n01):
A 66-year old male presented with recurrent painful swelling right upper neck of 2 months duration. The painful swelling was worse during feeding. He had no dental or pharyngo-laryngeal symptoms. Examination revealed the feature (white arrow) on this picture. CT-Scan showed a well encapsulated mass with solitary extra capsular node about 0.75 cm diameter.

Diagnosis: Submandibular swelling, which on excision was histologically was diagnosed monomorphic adenoma, and the solitary node overlying the capsule reactive inflammatory. We refrained from FNAC of this mas because of its appearance on CT - the fear of seedling tumour cells into extracapsular space.

Clinical Radiograph of The Week: Vol1,No7

2006-01-04T05:28:00.000-08:00

The following case was presented in the recent (vol1no7) issue of otorhinolaryngology news:
A 30-year old female was referred from the neurology clinic where she had presented with insomnia of 3 months duration following a near-fatal accident involving a car she was travelling in. She sustained no injury during the near-fatal accident. Examination was essentially normal. MRI brain revealed the feature (red arrow) on this picture. You way want to see the axial view of contrast-enhanced MRI

Differential diagnosis here include (1) isolated ethmoidal polyp (incidental finding) and (2) mucocoele of ethmoidal sinus.

Clinical Radiograph of The Week: Vol1, No.6

2005-12-28T07:34:00.000-08:00

This case was presented in the recent (vol1No6) edition of otolaryngology news.
A 60-year old male presented with annoying clicking sound heard in right ear during eating or opening / closure of the jaw. He also experiences discomfort right ear during chewing. He had no other symptoms, Otoscopy was not remarkable Examination showed tenderness on deep palpation over right TMJ area. Plain TMJ x-ray revealed the features seen (white thin arrow) on this picture. You way want to compare the appearance of left TMJ for clarity

Diagnosis: TMJ Arthritis. The best recommended modality for imaging patients with suspected TMJ arthritis is the TMJ MRI and disc displacement, joint effusion as well as bone marrow abnormalities are commonest MRI findings. However, MRI where available is still considered expensive and not affordable to most African patients with this disorder.

Clinical Photo of The Week: Vol1No5

2005-12-18T01:19:00.000-08:00

This case was presented in the otolaryngology news (Vol1No5):
An 11-year old male presented with persistent discharge of clear fluid from the point arrowed in this picture during eating. The only significant history was that of I&D of a 'boil' on the cheek by a GP at age of 6 years. Examination showed an oblique puckered scar above the angle of right mandible (displayed on this picture). Radiological contrast injected through the discharging focus ended blindly in a pouch. Right parotid sialogram was abandoned because of difficulty in visualizing right Stenson's duct
Diagnosis: Sialo-cutaneous Fistula, resulting from iatrogenic I&D. The initial 'boil' might have been parotid sialoadenitis. If this patient had no history of trauma, then first branchial cleft might be the likely diagnosis

Clinical Photo of the Week: Vol1, No.4

2005-12-10T02:26:00.000-08:00

This case was presented in the last edition (Vol1No4) of otolaryngology news: A 31-year old male presented with progressive neck swelling, bleeding gum, loosening of the teeth and a history of treatment for basal cell carcinoma of the forehead 2 years prior to presentation. The symptoms were associated with bilateral nasal obstruction, and patient was unable to chew because of the painful bleeding gum. Examination revealed bilateral submandibular neck swelling displayed on this picture,dental anarchy, trismus with persistent drooling of blood-stained saliva and gingival hypertrophy. Diagnosis: African type of Burkitt's lymphoma.

Clinical Photo of The Week: Vol.1 No.3

2005-11-28T03:47:00.000-08:00

This case was presented in otolaryngology news(Vol.1, No.3)
A 12-year old male presented with swelling involving the left half of the face since birth and recent bilateral otalgia on chewing, and right nasal obstruction. He has no other symptoms. Examination revealed the facial features displayed on this picture, fullness of right shoulder, and upper and lower limbs length inequality with the left side slightly longer and larger than the right.

Diagnosis: Hemifacial microsomia. It is the second most common facial birth defect after clefts.
Biodun

Clinical Photo of The Week: Vol1, No2

2005-11-19T06:03:00.000-08:00

This case was presented in the recent edition (Vol1N02) of otolaryngology newsletter:
48-year old male with 3-year history of "something salty/sour trickling down the cheek into the mouth on the right side". Has long-standing history of 'sinusitis'. Had history of a couple of dental extractions. O/E findings include slightly swollen and tender anterior cheek on the right, and the sign displayed in this picture. Sinus x-ray showed opacity of right maxillary sinus. Proof right maxillary antral aspiration yielded 40 mls of frank pus. On antral lavage, effluent noted from this point .
Diagnosis: Anaerobic osteomyelitis complicating chronic infective right maxillary sinusistis. For anaerobic osteomyelitis, see this Medline Abstract

Clinical Photo of The Week: Vol1No1

2005-11-12T06:08:00.000-08:00

This Case was presented in the latest edition of otolaryngology news:
30-year old female with long-standing history of right muco-purulent Otorrhoea since childhood. No previous ear surgery, but had I&D of post-auricular swelling done by a GP at about age 10 years. O/E findings include right complete LMN facial palsy, large mastoid cavity with mucopurulent Otorrhoea and the finding seen on this picture

Diagnosis: Automastoidectomy complicating chronic otomastoiditis.

The only case of automastoidectomy reported in literature was in 1986 and was due to keratosis obturans (Medline Abstract)

Biodun.

Welcome to the Blogsite of ORL in Africa...

2005-11-09T07:11:00.000-08:00

It is common to google a search topic and one is often overwhelmed with returns from several webpages matching the information being searched. However I curiously searched the phrase "Otolaryngology In Africa" and came up with almost a blank! There are a couple of sites of that match the words, but not the phrase, and most of these contain resumes of Otolaryngologist in the southern part of the continent.
So what exaclty is the problem? With hundreds of otolaryngologists scattered all over the continent, why is there no online forum addressing their views? I hate to believe that we are all technophobes
This blogsite should serve as a forum for otolaryngologist in Africa to air their views, discuss cases, learn about upcoming conferences, and advance opinions on several topical issues relating to the sciences and arts of otolaryngology. It will also enable the non-otolaryngologist searching for information on Otolaryngology in Africa to have his/her fills.
Feel free to contribute topics, challenge any view posted on this site as well as suggest ways that this blogsite could be improved.
You are Welcome!
Biodun Olusesi, FWACS, FMCORL
National Hospital, Abuja, Nigeria
Blogsite Coordinator.