Search

The article offers information on a medical research conducted at a primary school in Nigeria related to the diagnosis and treatment of cerumen impaction, an ear disease which causes pain and otitis externa. As mentioned, the otoscopy research indicates a major problem of impaction of earwax in primary school children. There is lack of knowledge about the symptoms and diagnosis of the diseases which leads delay in disease management and causes hearing impairment in children.

Background: Brain abscess in children is a neurosurgical emergency with potentially catastrophic outcome despite the advances made in neuroimaging techniques and antibiotic therapy. Symptoms are nonspecific and may vary with the child's age, location, size, numbers and stage of abscess, and the primary source of infection. Treatment is usually with broad-spectrum antibiotics in combination and surgical evacuation in most cases or antibiotics alone in selected cases with clear-cut indications. This study was to document clinical characteristics, etiological factors, and spectrum of bacteriologic agents responsible for pediatric brain abscess in an African city, the challenges and management outcome over the study period., Methods: This was a retrospective study over an 11-year period involving 89 children who presented with brain abscess. Information of interest was extracted from the medical records of each participant. The results from data analysis were presented in charts and tables., Results: Eighty-nine children aged 0.85-15.7 years (median age of 6.4 years) met the inclusion criteria. The male-to-female ratio was 1.8:1. Headache (80%), fever (78%), and hemiparesis (78%) were the most common symptoms. Brain imaging deployed was CT scan in 56 (63%), MRI in 9 (10%), and transfontanel ultrasound scan in 24 (27%) children. Seventy-one (80%) children had antibiotics with surgical evacuation while 18 (20%) children received only antibiotics. In 19 (27%) children, the culture of the abscess was negative. In 53 (75%) children, Gram-positive aerobic organisms were isolated. A total of 75 patients (84%) had a favorable outcome., Conclusion: Pediatric brain abscess still poses significant public health challenge, especially in resource-limited regions. Successful management of brain abscess requires high index of suspicion for early diagnosis, referral, and intervention., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Surgical Neurology International.)

Background: Diabetic foot ulcer is an associated and an increasing problem among individuals with diabetes. The aim of the present study was to evaluate the risk factors for amputation in patients with diabetic foot ulcer as well as common causes of increasing mortality in these patients., Methods: The design was an observational prospective study carried out between July 2015 and June 2018. The Demographic data of all patients with diabetic foot ulcer seen at Lagos University Teaching Hospital and Nigerian Navy Reference Hospital Lagos with their clinical signs and symptoms as well as basic laboratory results were documented. The ankle brachial index (ABI), history of neuropathy, nephropathy and the relationship between these and lower limb amputation and mortality were collected and analyzed., Results: There were 539 patients with diabetic foot ulcer seen during the 3-year period. The mean age was 62 + 13.7. There was male preponderance with a ratio of 1.7:1. Patient with amputation more often had ABI <0.9. Male sex is a risk factor for amputation. Over 40.5% of the patients had grade I ulcer, 19.5% had grade II, while 22.3%, 12.3% and 5.4% had grade III, IV and V respectively. Amputations were performed in 144(26.7%) patients (48 minor, 96 major). Compared with patients without amputation, patients with amputation differed significantly concerning diabetes and its complications. Mortality rate was 11.8%., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2021 by West African Journal of Medicine.)

Background: Halitosis is a common medico social symptom among children., Aim: To determine the clinical, epidemiological patterns, aetiology and psycho-social issues of halitosis among children in a tertiary hospital in Nigeria., Methodology: This was a prospective hospital based study of children with complaints of halitosis. The study was carried out in Ear, Nose & throat Department, Ekiti State University Teaching Hospital, Ado Ekiti over a period of two years, (October 2015 to September 2017). Consent was obtained from the parents/guardian. Data was obtained by using pretested interviewer assisted questionnaire.All the data obtained were collated and analyzed by using SPSS version 16.0. Ethical clearance was obtained from the ethical committee of the institution., Results: The prevalence of halitosis in this study was 6.8% and there were 58.5% males and 41.5% females with a male to female ratio of 1.5:1. Their age ranged from 1 year - 18 years with a mean of 9.48 ± 5.84 SD years.Sources of referral for the otorhinolaryngology, head and neck care were mainly from general practitioners (52.3%) and from pediatricians (24.6%). Halitosis was noticed by family members in 50.8% and from family friends in 23.1%. Nasal and throat diseases in 49.2% and 29.2% respectively were the commonest otorhinolaryngology, head and neck disorders that were responsible for halitosis. The major causes were rhinosinusitis in 24.6%, impacted nasal foreign body in 23.1% and adenotonsillar hypertrophy in 18.5%. Associated disabilities in children and family with halitosis include social withdrawal in 35.4%, low social interaction in 32.3% and depression in 29.2%. Acute halitosis (<3/12) accounted for 50.8% while chronic halitosis (>3/12) accounted for 49.2%. In all, fifty four (83.1%) of the patients were successfully treated., Conclusion: Bad breath is a common ear, nose and throat symptom in children it is commonly due to nasal and pharyngeal diseases which are amenable to treatment.

Background: Penetrating anterior neck injuries are potentially life threatening and the causes vary across countries of the world. Studies in Nigeria have been mainly isolated case reports and few retrospective studies., Aim: The aim of this study was to assess the causes, severity and management outcome of patients treated in our centre., Methodology: This is a retrospective study of penetrating anterior neck injuries treated at the Lagos University Teaching Hospital over a 25-year period. The case records were retrieved and demographic data as well as the causes, site, extent of injuries and treatment outcome were analyzed., Results: The mean age of the 39 patients in this study was 30.5yrs ± 7.9 SD with a male: female ratio of 6.8:1. Inflicted cut throat injuries accounted for 46% followed by vehicular accidents in 21%. Zone II site of the neck was the commonest site of injury 61.6% of the patients; while 71.8% of the patients presented within 24hrs of the injury, 46% of them had immediate blood transfusion. Tracheostomy was the main method of securing the airway. Primary soft tissue repair was performed on all the patients. Laryngopharyngeal repair was done in 61.5%. Peri-operative mortality was 7.7% and 83.3% had prolonged hospital admission with wound infection in 27.8% and laryngotracheal stenosis in 22.2% as the commonest complications., Conclusion: This study has shown that penetrating anterior neck injuries is not uncommon in Nigeria and commonly due to cut throat and vehicular accidents. Proper documentation and following established management protocols will improve outcome.

Background: Assessment of clinical skills is essential in medical education. Ideally marks should be based on the student's competence alone. The limitations of the traditional long case examinations such as the patient and examiner variability are well known. The objective structured clinical examination (OSCE) was designed to overcome these limitations. Studies comparing the OSCE and the traditional long case examination in the same group of students are very sparse., Aim: To compare the objective structured clinical examination (OSCE) and the traditional long case examination by determining their correlations with other forms of assessment in undergraduate surgery., Setting: This study was carried out at the College of Medicine, University of Lagos, Nigeria., Methodology: The results of 612 undergraduate students in our medical school of the University of Lagos, Nigeria over a period of 4 years (2012-2015) were analysed. The scores in the long case examination , objective structured clinical examination (OSCE) , multiple choice questions and Essays were analysed and compared using the Pearson's Correlation co-efficient. SPSS version 17 software was used and a P-value < 0.01 was regarded as statistically significant., Results: Overall, there was a statistical significant positive correlation among most forms of assessment. The OSCE and the long case examination had a correlation of 0.374. Compared with the long case examination, the OSCE had a higher correlation with all other forms of assessment. The total clinical score (the sum of all long case examination and OSCE) however performed better than the OSCE or the long case examination alone as it had the highest correlation with all other forms of assessment., Conclusion: The OSCE has been shown to be better than the long case examination as an indicator of the student overall knowledge of surgery as it had a superior correlation with other forms of assessments. The total clinical score was however the best indicator of the student overall knowledge in Surgery as it had the best correlation with other forms of assessment. We recommend and encourage institutions that presently combine the OSCE and the long case examination to carry out similar analysis such as ours to determine the desirability of combining LCE and OSCE rather than outright replacement of LCE with OSCE.

Background: Chronic rhinosinusitis (CRS) significantly lowers the quality of life of patients. The common use of broad spectrum antibiotics for its treatment may alter the pathogens that promote the persistence of this condition. However, the data concerning the distribution of bacteria species. in patients with CRS are not consistent., Objective: To isolate the common aerobic and anaerobic bacteria from the middle meatal aspirates of adult patients with CRS and determine their antibiotic sensitivity patterns Methods: This was a case-control study of adults with diagnosis of CRS. Middle meatal aspirate and swab were obtained from cases and control respectively for bacteriological studies. Data analysis was done using Statistical package for social sciences (SPSS) version 17 Result: Forty one aerobic bacteria were cultured. Sixty one percent of the aerobic bacteria isolated were gram positive (staphlylococcus.aureus was the most frequently found) organisms while the remaining 39% was gram negative. Fifteen peicent of the cultured isolates yielded mixed growth of both aerobes (Gram positive and gram negative).3(6%) isolates of Bacteroides species were cultured Conclusion: The present study found that Staphylococcus aureus, streptococcus pneumoniae, Proteus mirabilis, Klebsiella spp, Escherichia coli and Bacteroides spp) were the common bacterial flora in the paranasal sinuses of patients with CRS.

Background and Aim: Earwax impaction is a common ear disorder with presentation worldwide. This study aimed at determining the clinical presentation, patients' perception of earwax, and its predisposing factors among Nigerians., Materials and Methods: This prospective study was conducted on consented patients with diagnosis of earwax impaction at the Ear, Nose, and Throat Clinic of the University Teaching Hospital, Ado Ekiti, Ekiti state, south west, Nigeria. The research was carried out over a period of one year (April 2008 and March 2009). All consented patients were told about the aim and scope of the study and their biodata were taken. Detailed history of the presenting complaints and otological complaints were taken and all data entered into structured questionnaires. Full-ear examination and otoscopy were performed and our findings were documented. From all these exercise, data obtained were collated and statistically analyzed., Results: A total of 437 patients were diagnosed with earwax impaction and prevalence of 20.1% was found. There was 52.2% male preponderance with male to female ratio of 1:1. Bimodal peak age distribution of patients was found at the extreme ages of life. Most common sources of our patients referrals were 39.6% general medical practitioners with least from 6.2% self-reporting. Common presentations were 277 (63.3%) hearing loss, 268 (61.3%) earache (otalgia), and 234 (53.5%) tiinitus. Unilateral earwax impaction, 75.1% was more common than bilateral earwax impaction. Right ear was more affected than left ear. Recurrent earwax impaction of 66.1% was found in our study. About 382 (87.4%) believed earwax was due to dirt or dust. Most common predisposing factors among our patients were self-ear cleaning., Conclusion: Common predisposing factor of this high recurrent earwax impaction were wrong perception and preventable self-ear cleaning with indiscriminate objects including cotton tip swab. This condition could be reduced by health education of the community.

Background: Allergic rhinitis (AR) and asthma are different manifestations of allergic disease of the airway. Both can exist together or as separate disease entity in an individual. However, it is not known if the coexistence of the two diseases can make asthmatic control difficult or not in the black population., Objective: To determine the prevalence of allergic rhinitis in asthmatics and its effects on bronchial asthmatic control among adult Nigerians.., Design: A prospective case-control study., Setting: Lagos University Teaching Hospital, Lagos, Nigeria., Subjects: Cases were 160 adult patients with confirmed bronchial asthma and controls were 160 subjects without bronchial asthma., Methods: Structured questionnaire adapted from the European Community Respiratory Health Survey was applied. Allergic rhinitis was clinically diagnosed if watery rhinorrhea, nasal blockage, and excessive bout of sneezing, itching of eye, ear, nose or throat were present., Results: Amongst the asthmatics, 133 (83%) had concomitant allergic rhinitis while 30 (19%) controls had allergic rhinitis(x(2)=137.81, p<0.001). Seventy eight (59%) cases with allergic rhinitis had uncontrolled asthma while 9 (33%) cases without allergic rhinitis had uncontrolled asthma (x(2) = 8.8731, p=0.012)., Conclusion: The prevalence of allergic rhinitis among adult asthmatics was high and the co-existence of allergic rhinitis was significantly associated with poor asthmatic control.

Background: The peak age prevalence of otitis media with effusion (OME) is in early childhood. Day care attendance has been established by various studies as a risk factor for the development of OME., Objective: This study is aimed at evaluating the prevalence of OME among children aged 6 - 24 months, and the impact of day care center (DCCs) attendance on the OME occurrence., Methods: A prospective cohort study conducted in children recruited from DCCs and immunization clinics in Surulere, Lagos state, Nigeria. They were matched mainly on their place of care, at home or at day care center and presence or absence of OME using pneumatic otoscopy and tympanometry., Results: A total of 152 children were studied. Based on their place of care, they were divided into day care attendees 64 (42.1%), and non day care attendees 88 (57.9%). The prevalence of OME was 37.7% overall, 43.7% in the day care attendees and 33.4% in the non day care attendees. Factors found to positively influence the prevalence of OME in this study include: young age 6-12 months, female gender and day care attendance., Conclusion: OME is common in Nigerian children at young age. Day care facility attendance significantly increased OME prevalence.

Background: Otitis media (OM) is a major health problem in both developed and developing countries., Objective: To determine the pattern of bacterial isolates in patients with chronic suppurative otitis media(CSOM) in Ilorin, Nigeria., Methods: A prospective study carried out in University of Ilorin Teaching Hospital, Nigeria among consenting patients with CSOM attending the ENT clinic over a period of 7months. Informed consent was obtained from the patients or caregivers and approval for the study obtained from ethical committee. Structured questionnaire was administered and microbiological analysis done, data obtained was entered into SPSS statistical software and results presented in tables and figures., Results: A total of 134 patients aged 5-64yrs with chronic suppurative otitis media were interviewed with a mean age of 17.0 (S.D. =15.1±1.30). About 55.2% of the respondents were under 10yrs. Seventy-two (53.7%) of the respondents were males with M:F=1.2:1. The gram stain showed predominantly gram negative organisms (71.6%). Pseudomonas aeruginosa was the commonest middle ear pathogenic organism identified and the sensitivity pattern highly favoured ciprofloxacin, Conclusion: CSOM is still a childhood problem among the under tens' more prevalent among males and the commonest agent is Pseudomonas aeruginosa. Ciprofloxacin is still the most sensitive antibiotics in vitro.

Background: 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., Methods: 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., Results: 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., Interpretation: 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.

Objectives: 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., Design: Retrospective analysis., Setting: A tertiary referral centre in Lagos, Nigeria., Subjects: 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., Results: 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)., Conclusions: 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.

Objectives: The aim of this prospective study was to assess the usefulness of nasal smear eosinophilia compared with a skin sensitivity test for the diagnosis of allergic rhinitis and to determine the degree of correlation between the tests., Material and Methods: Fifty patients with a clinical history suggestive of nasal allergy and 20 controls were studied. A range of allergens were used for the skin sensitivity test in both groups. Nasal smears were examined by light microscopy., Results: A positive skin test reaction was demonstrated in 90% of the study population and 25% of the controls, whereas 76% of the patients and 15% of the controls demonstrated significant nasal smear eosinophilia. There was 66% correlation between the skin test and nasal eosinophilia, although this was not statistically significant (correlation coefficient -0.187 p = 0.193). This study does, however, demonstrate that both tests are sensitive for the diagnosis of allergic rhinitis, with sensitivities of 0.90 (95% CI 0.82-0.98) for the skin test and 0.76 (95% CI 0.64-0.88) for nasal eosinophilia., Conclusion: Both the skin-prick test and the nasal smear eosinophilia showed correlation with the clinical history, although the skin-prick test was more sensitive. No statistically significant correlation was demonstrable between the two tests.

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.

Objective: To compare the prevalence of chronic supperative otitis media (CSOM) among two populations of school children., Design: A survey-demographic data collection and otoscopy was carried out among the two populations of school children., Setting: A rural government primary school and an urban private primary school, Subjects: Six hundred and ninety nine school pupils in the rural school and two hundred and seventy pupils in the urban school., Results: 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)., Conclusion: 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.

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.

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.

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.

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.

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.

A total of one hundred and two cases of otitis media were screened for the isolation of bacterial flora of ears. Out of this, Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae accounting for 41.2%, 25.5% and 13.3% respectively were isolated. A further two hundred and four sputum samples from cases of lower respiratory tract infections were screened. Moraxella catarrhalis, S. aureus, S. pneumoniae and H. influenzae constituting 20.9%, 37%, 30% and 21% were isolated in that order. Thirty-one point seven percent of the Moraxella catarrhalis isolates were beta-lactamase positive. Beta-lactamase M. catarrhalis were resistant to penicillin and ampicillin while the non-beta-lactamase producers were sensitive to these antimicrobial agents. However, both beta-lactamase producers and non-producers were resistant to trimethoprim but sensitive to erythromycin, tetracycline and amoxycillin. Staphylococcus aureus, S. pneumoniae and H. influenzae was also sensitive to penicillin while S. pneumoniae was also sensitive to erythromycin and H. influenzae to chloramphenicol.