BACKGROUND:OME is an accumulation of serous or mucoid fluid in the middle ear cavity with an intact tympanic membrane and without any sign of acute infection. AIMS:This study aimed to determine the prevalence of otitis media with effusion among preschool and school-age children aged 1-10 years in private and public schools in Calabar municipality and the correlations between otoscopic findings and Jerger's diagnostic criteria among study participants. METHODS:This school-based descriptive cross-sectional study used a multistage sampling technique to recruit participants. The Institutional Ethical Committee approved the study. Consent and assent were obtained from parents/guardians of children aged < 6 years and >7 years, respectively. A structured questionnaire was used to obtain sociodemographic characteristics, symptoms, and possible risk factors for otitis media with effusion. In addition, ear, nose, and throat (ENT) examinations and tympanometry were performed for each participant. Jerger's type B and C tympanograms were the diagnostic criteria for otitis media with effusion. The data were analyzed using IBM SPSS version 25, and the threshold for statistical significance was set at P < 0.05. RESULTS:The overall prevalence of OME was 13.8%, with P values ≤ 0.001, P = 0.597, and P = 0.007 for daycare (45.85%), public schools (14.7%), and females, respectively. Jerger type B tympanograms had a strong positive correlation with middle ear fluid (r = 0.777) on otoscopy, Jerger type C tympanograms with dull TM (r = 0.687), and retracted TM (r = 0.774). CONCLUSION:Otitis media with effusion was more prevalent among preschool children aged 1-2 years in public schools and among female children in Calabar municipalit. The otoscopic results of otitis media with effusion were consistent with Jerger's diagnostic criteria in our study.

BACKGROUND:Predisposing factors for otitis media with effusion are multifactorial, ranging from genetic and anatomical abnormalities to environmental factors and inflammation of the nose and adjacent structures. AIM:The study determined the risk factors for otitis media with effusion (OME) among children in Calabar Municipality. METHODS:This was a descriptive, cross-sectional, community-based study including children aged 1-10 years randomly selected from government and privately owned daycares, nurseries (preschool), and primary schools. The risk factors assessed included upper respiratory tract infection, allergic rhinitis, adenoid enlargement, acute otitis media, recurrent acute otitis media parental educational level, overcrowding (four children sleeping in a room), duration of breastfeeding, cleft palate, and Down's syndrome. Allergic rhinitis was diagnosed when a child had at least two of the rhinological symptoms: nasal congestion, running nose, sneezing, itching of the eye or nose, and at least one of the following: history of allergy, family history of allergy, and positive history of asthma. The questionnaire was the research instrument used to assess the risk factors for OME. OME diagnosis was made with otoscopy and tympanometry. Data were collected and analyzed with IBM SPSS version 25, and a P value <0.05 was considered statistically significant. RESULTS:A total of 24 daycare pupils, 141 nursery pupils, and 155 primary pupils were recruited into the study. The prevalence of otitis media with effusion was more in younger children than in older children and the relationship was statistically significant (P < 0.001). Female children were more statistically affected than male children (P = 0.007). Children with allergic rhinitis accounted for a higher proportion of those with OME than those without allergic rhinitis (26.7% vs. 11.6%), and the difference was statistically significant (P = 0.007). The association between OME and upper respiratory tract infection, acute otitis media, and recurrent acute otitis media was not statistically significant (P > 0.05). Multivariate binary logistic regression was used to identify predictors for the otitis media with effusion. CONCLUSION:There are many endogenous and exogenous risk factors for OME, but notable risk factors in our study were age 1-2 years, female sex, and allergic rhinitis.

Background: Sickle cell disease (SCD) is the most common genetic disorder, with Africa bearing the highest burden. In this cohort study, sickle cell subjects are immunocompromised and predisposed to recurrent infections and tonsillar hypertrophy, especially in children. Subsequently, tonsillar hypertrophy leads to sleep-disordered breathing (SDB) with resulting hypoxemia, hypercapnia, and acidosis, raising the risk of HbS polymerization and, consequently, vaso-occlusive phenomena and other complications. Aims: This study aimed to compare tonsillar hypertrophy between sickle cell patients and controls. Materials and Methods: A cross-sectional descriptive study was conducted at, University of Calabar Teaching Hospital, Calabar from September 2019 to September 2021. The cohort of the study was an SCD patient confirmed using hemoglobin electrophoresis at the hematology laboratory of University of Calaabr teaching hospital and recruited via the adult and pediatric hematology unit of University of Calabar teaching hospital, and Calabar sickle cell club. The data were analyzed using Microsoft Excel and IBM Statistical Package and Service Solution (SPSS) version 22. Results: Using Brodsky's grading, the prevalence of grade 3 and 4 hypertrophic tonsils in sickle cell subjects was 41.6% but 17.3% in control. The age range of 0-25 years was the most frequently affected with the peak at 0-5 years. The males among the sickle cell subjects were slightly more affected than the females (M: F =1.2:1), while the females were slightly more in the control (M: F =1:1.1). Conclusions: Hypertrophic tonsils affect control and SCD, but the obstructive grades are commoner in genotypes SCD- Sickle cell disease Haemoglobin SS, SC and AA.

Objectives: Nasal polyps are the commonest intranasal masses. It has a worldwide distribution and significantly reduces the productivity of affected individuals. Early diagnosis and treatment can lead to better treatment outcomes. The aim of the study were: To study the occurrence, types, associated co-morbidities, and management of polyps in Calabar, Nigeria. Materials and Methods: A retrospective study of all nasal polyps seen between January 2009 and January 2019. Records of all intranasal masses seen during the period including age, sex, aetiopathological profile, and histopathology results were obtained from the records department, theater, and the wards. Patients who had nasal polyps either had nasal polypectomy with/without antral lavage, or Caldwell Luc operation. Results: One hundred and eighty-two intranasal masses were seen during the study period. One hundred and thirty-four of them (73.625%) were nasal polyps; 62.6% were inflammatory polyps, 14.7% had chronic rhinitis, 9.7% inverted papilloma, and 2.24% squamous cell carcinoma. About 31.3% of the polyps were right-sided, 31.3% bilateral, 26.9% left-sided, and 10.44% antrochoanal polyps. About 97% of the patients presented with nasal blockage, 53.23% with rhinorrhoea, 41.79% signs of anosmia, and 29.85% sneezing. Comorbidities seen include diabetes mellitus 1.6%, hypertension 4.5%, allergy 70%, and asthma 25%.Squamous cell carcinoma was the most common malignancy found and inverted papilloma was the most common benign tumor present. Conclusion: Nasal polyps occur globally. They are the most common intranasal masses. They seem to occur more in males and occurrence increases with age. Not all nasal polyps turn out as polyps histologically as this study shows; we had chronic rhinitis, inverted papillomas, squamous cell carcinomas, etc. The comorbidities found were diabetes mellitus, hypertension, allergy, and asthma. Diabetes and hypertension may have been incidental but the number of patients with asthma and allergy shows a definite link between these two and allergy. Treatment for nasal polyps may be medical or surgical and the best form of surgery is endoscopic sinus surgery. However, financial constraints could prevent patients access to FESS.

Eagle’s syndrome is a condition caused by elongation of the styloid process or ossification of the styloid ligament resulting in non-specific symptoms related to pressure on vital blood vessels of the neck, the internal carotid artery, internal jugular vein, and nerves; the glossopharyngeal and vagus nerves. Eagle’s syndrome may have varied presentations with numerous symptoms: Pain in the throat/neck radiating to the ear and pharynx, foreign body sensation in the throat, dysphagia, otalgia, trismus, and intense facial pain. A high index of suspicion with a prompt resort to a three-dimensional CT skull could be helpful to give a quick diagnosis of Eagle’s syndrome amid numerous differential diagnoses. We present a 59-year-old male with an 18-month history of left-sided neck pain, cheek pain, and the feeling of a foreign body in the throat. He had pain relievers and other drugs to no avail. A three-dimensional CT scan of his skull revealed features of Eagle’s syndrome. The excision of the styloid process through the extraoral route relieves his symptoms. The second patient is a 42-year-old female with symptoms of peptic ulcer disease, dysphagia, pain in the throat, and sometimes fainting attacks when she moves her neck swiftly to the left side. A three-dimensional CT skull scan confirmed features of an elongated styloid process bilaterally suggestive of Eagle’s syndrome. Treatment offered to her was conservative, with a diclofenac suppository only because she refused surgery. Restricted and limited neck movement relieved her of syncope attacks.

Background: Exposure to Sound Pressure Levels (SPL) above 85 dB over 8 hours is potentially damaging to the ears. Unfortunately, many people may be unaware of the adverse effects of such SPL on the ear and quality of life. The level of awareness of hearing test has not been adequately determined in our region, a developing world. Some even seek ear care from unauthorized facilities and persons who often recommended inappropriate medications and treatment. The objectives of this study were to assess specifically the respondents' level of awareness of sound levels that could cause hearing loss, determine the number of respondents who have had a hearing test, and the sources of ear healthcare among residents in an urban city in South-South, Nigeria. Participants and Methods: An interviewee-administered questionnaire under three sections: socio-demographics; awareness of damaging sound levels and their sources; hearing testing and ear health care was used to collect data from 274 consenting respondents. Data were analyzed using IBM Statistical Product and Service Solution version 26.0. Results were presented on frequencies, percentages, tables, and figures. A P ≤ 0.05% was considered statistically significant at a 5% level of significance. Results: The respondents were aged between 10 and 74 years, and a median age of 24 years. Most 202 (73.7%) were males, while 72 (26.3%) were females, with male: female = 2.8:1. The greater proportion 223 (81.4%) were single; 177 (64.6%) were students; 16 (5.8%) were unemployed and 21 (7.7%) civil servants. Of the 274 consenting participants, only 79 (28.8%) were aware that the numerical value of noise level above 85 dB could cause damage to hearing. Only a small proportion with tertiary education 28 (10.2%) reported having had a hearing test. All the respondents in occupations prone to high levels of noise never had a hearing test. There was a statistically significant association between the types of ear drop/substance used by respondents and the attendant health personnel (P = 0.0001). Conclusion/Recommendation: There is poor awareness of ear health care among urban city dwellers in Calabar, South-South, Nigeria. Most young adults aged 20–29 years were aware that loud noise is hazardous to hearing. Generally, there was ignorance on objective numerical noise levels for hazard; the importance of hearing testing; and utilization of appropriate ear care facilities for treatment of ear diseases. Public health education on appropriate ear healthcare is highly recommended.

Case Report Lymphomas are malignant neoplasms of the lymphocytic cell lines, involving mainly lymph nodes and also extra nodal sites. They are generally classified as either Hodgkin’s lymphoma, or Non-Hodgkin’s lymphoma; which may be of either B – lymphocyte or T – lymphocyte in origin. Oropharyngeal lymphomas are relatively rare and diagnosis is a challenge. Most frequently arising from the Waldeyer’s ring after gastrointestinal tract is the second most common site for extra nodal lymphomas. We report a case of primary Non –Hodgkin’s lymphoma arising from the soft palate in a 71yearold male who presented with progressive difficulty in swallowing, slurred speech and choking on lying supine. There was no other lymphomatous lesion detected elsewhere in the body. Postnasal Xray revealed a pedunculated mass arising from the soft palate down the laryngeal inlet. Excisional biopsy of the lesion showed sections of lymphoid tissue with partial effacement of the architecture replaced by illdefined follicles and diffused pattern in some areas. Follicles are of various sizes and shapes, containing varying proportions of centrocytes and centroblasts suggestive of follicular mixed type of primary extra nodal lymphoma. Immunohistochemistry confirmed the diagnosis. Our patient has been followed up for 15months and currently doing well.

Background: Exposure to loud noise and its attendant health and social effects is a public health problem. Its significance has not been adequately determined in developing countries. Noise-induced hearing loss is permanent and can be acquired at home, schools, concerts, churches, mosques, sporting events, and at workplaces. The objective of this study is to assess respondents' awareness of noise-induced hearing loss, experiential symptoms and sources of noise pollution in a Metropolitan City in South-South, Nigeria. Methods: A cross-sectional descriptive study using interviewee questionnaire was employed. The respondents comprising of secondary school pupils, undergraduates, tricycle riders, and staff of the tertiary institution who participated at awareness campaign programs on World Hearing Day, World Family Day, and at a religious crusade ground in a tertiary institutions. Data were analyzed using IBM statistical product and service solution version 26.0. Results: There were 274 respondents, age range from 10 to 74 years, 73.7% (n = 202) were male and 26.3% (n = 72) female, male:female = 2.8:1. The overall level of noise-induced hearing loss (NIHL) awareness was 69.34% (n = 190). The greater proportion of respondents 236 (86.13%) knew that excessive noise could cause hearing loss. The common symptoms experienced by the respondents were 147 (53.6%) hyperacusis and tinnitus 142 (51.8%). Conclusion/Recommendation: Awareness it NIHL was greater among male, undergraduates between the ages of 20 and 29 years. Children's toys were poorly reported as a source of noise. There was poor awareness of the incurable nature of NIHL. A continuous public health education on sources and prevention of NIHL is advocated for early evaluation and intervention.

BACKGROUND: Nasal foreign bodies are common domestic accidents in children. They can constitute a great challenge and management may require great skill. However, seldom does the Otolaryngologist keep track of the number and kinds of the foreign bodies he encounters. OBJECTIVE: To evaluate cases of nasal foreign bodies among children managed in Otorhinolaryngology Department of the University of Calabar Teaching Hospital, Nigeria. MATERIALS AND METHODS: A retrospective study of 215 Cases of paediatric nasal foreign bodies seen and managed in the Otorhinolaryngology Department of the University of Calabar Teaching Hospital from January 2015 to December 2018. Maximum age was 14years.The case notes of all children diagnosed with nasal foreign bodies within the period under review, from ENT Clinic, Ward and Children emergency Room were reviewed as related to age, gender, and type of foreign bodies, category of doctors, methods of removal and complications. Data were analysed and presented in descriptive, tabular and chart forms. RESULTS: Of the 215 children, 43.7% were males and 56.3% females. The age range was 0 - 14 years, with a male: female ratio of 1:1.35.The peak age range at which nasal foreign bodies were found was 0 - 4 years (87%) and the least frequent age bracket was 10 - 14years (1.4%). Most of the children were asymptomatic (60%), and others had unilateral foul-smelling nasal discharge (40%). The most common foreign body were beads (34.9%), followed by seeds (23.2%). Most presentations were within one day (90%), followed by one week (7%). Most foreign bodies (59.5%) were inserted into the right nostril, and 40.5% into the left. No bilateral insertion was observed. Most of the foreign bodies (80%) were mechanically extracted with Jobson-Horne’s probes without general anaesthesia. Mainly Registrars did most removals 65% while 25% were by Senior Registrars. Mild epistaxis was a complication in 5% of cases. CONCLUSION: Nasal foreign bodies are common in Calabar. The most frequently observed foreign bodies were beads and seeds. Therefore, public health education is needed for parents and caregivers.

Background: Pediatric aural foreign bodies (FB) are relative medical emergencies. Primary care physicians, pediatricians, and otorhinolaryngologists commonly encounter them. Objective: The objective was to carry out a retrospective analysis of pediatric aural FB managed in otorhinolaryngology department of the University of Calabar Teaching Hospital, Nigeria. Materials and Methods: A total of 157 children with aural FB managed at the Department of Otorhinolaryngology, University of Calabar Teaching Hospital, Nigeria, from January 2015 to December 2018 were reviewed with regard to the type of FB, location, in the ear, methods of removal, complications, age, and sex. Results: Of the 157 children, 54.1% were males and 45.9% females. Male: female ratio was 1.2:1. Ninety-five (60.5%) were below the age of 5 years, 46 (29.3%) were 6–10 years of age, and 16 (10.2%) were in the age group of 11–15 years. The most common objects were beads, papers, and cotton. Most presentations (86%) were within 24 h. Seven patients (4.5%) required surgical removal under general anesthesia. Most of the patients (92.4%) had no complications. Morbidities include bleeding from the ear canal 6 (3.8%), canal abrasions/lacerations 4 (2.5%), and tympanic membrane perforations 2 (1.3%). Conclusion: Aural FBs are common conditions in children in our environment. Most of these can be successfully removed by skillful personnel, adequate immobilization, and proper instrumentation. Pediatricians, family physicians, and other health workers should not hesitate to refer to otorhinolaryngologists, uncooperative/apprehensive children, those with a history of attempted removal by their parents or caregivers, or FB whose contour, composition and position in the canal cannot be fully assessed.

Subcutaneous emphysema after adeno-tonsillectomy is rarely encountered. One of such cases following adenotonsilectomy was seen in our institution.We report the case of a 5-year-old girl who developed cervicofacial emphysema and pneumomediastinum following retching and vomiting 6 hours after a routine adenotonsillectomy. Radiograph of the jaws and chest revealed subcutaneous emphysema. Previously published cases showed that the cause was most likely due to air passing into subcutaneous tissue through the tonsillar fossa and superior constrictor muscle into the facial layers of the neck following a bout of coughing and straining (crying), or the use of positive pressure ventilation. The emphysema can then spread to parapharyngeal and retropharyngeal spaces with associated morbidities. Further complications may include pneumothorax and pneumomediastinum and this should be excluded.

Noise above a certain acceptable level or sustained noise may cause damage to the ears. The aim of this study is to determine the prevalence and level of awareness of noise induced hearing loss in Calabar. Seventy-five workers from two noise producing companies, in Calabar- Flour mill and Wartsilla were chosen for this study. An author administered questionnaire was used to record sociodermographic data, occupation, access to ear protection, number of working years, etc; Rhine’s test, Webers test, otoscopy and pure tone audiometry were done for each of the participants. Workers in the generator house, loading bay and production plant were regarded as noise exposed workers while others were non-noise exposed. Forty-one of the noise exposed workers in flour mill (66.83%) had mild hearing loss and ten (16.66%) had moderate loss. In Wartsilla, twenty six workers (50.98%) of the noise exposed workers had mild hearing loss and six(11.76%) had moderate loss. Three non- noise exposed workers in each of the companies also had mild hearing loss. 40% of the participants never heard about ear protection devices; 60%, knew about them. 50% had seen them and 30% felt better using them.Keywords: Awareness, hearing loss, prevalence, Calabar

This paper studies changes observed in pregnant women at the 3 stages of pregnancy in Calabar. Eighty pregnant women and eighty non-pregnant women were used. Most signs and symptoms occurred more in the first trimester while others occurred more in the third trimester. Vomiting, loss of appetite, excess salivation, Nausea gastro – esophageal reflux, fever, headaches otomycosis were predominant in our study.

Necrotizing fasciitis of the head and neck is a rare and potentially fatal disease. It is a bacterial infection characterized by spreading along fascia planes and subcutaneous tissue resulting in tissue necrosis and likely death. It is commonly of dental or pharyngeal origin. Factors affecting the success of the treatment are early diagnosis, appropriate antibiotics and surgical debridement. Our study showed eight patients, five males and three females with mean age of 49.25 years (range 20–71 years). Clinical presentations were a rapidly progressing painful neck swelling, fever, dysphagia and trismus. The aetiology varied from idiopathic, pharyngeal/tonsillar infection, trauma and nasal malignancy. There were associated variable comorbidities (diabetes mellitus, HIV infection, hypertension and congestive cardiac failure). All the patients received early and aggressive medical treatment. The earliest time of surgery was 12 h after admission because of the poor financial status of patients. Three cases came in with complications of the disease and were not fit for extensive debridement under general anaesthesia. For them limited and reasonable bed side debridement was done. Mortality was 50 % from multiple organ failure, HIV encephalopathy, aspiration pneumonitis and septicemia. The duration of hospital stay for the patients that died ranged from 1 to 16 days and 4 to 34 days for the survivor. Our study heightens awareness and outlines the management challenges of necrotizing fasciitis of the head and neck in a poor resource setting.

To review the management challenges and outcome of advanced carcinoma of the larynx associated with patient treatment preference regardless of available or clinically appropriate treatment modality. This was a retrospective review of the records of patients with laryngeal cancer managed in the Otorhinolaryngology department of the University of Calabar Teaching Hospital, Calabar South eastern Nigeria. The period under review was April 2001 to march 2011. The age, sex, presentation, history of cigarette smoking and alcohol consumption, histopathological diagnosis, patient treatment preference and outcome of management, were analysed. There were 10 patients, all males in the age range 42 to 75 years. Hoarseness was the initial symptom in all the patients (100%) with stridor and difficulty in breathing in 8(80%) at presentation. There was history of recent or past cigarette smoking in all but 2 (20%) of the patients. Tumour was transglottic in 7 (70%) patients, glottic in 2 (20%) and supraglottic in 1 (10%). Emergency tracheostomy was the first line of treatment to relieve upper airway obstruction in 8 (80%) cases. The histological diagnosis was exclusively squamous cell carcinoma of variable degrees of differentiation in 9 (90%) cases and carcinoma in situ in a case (10%) patient. Clinical staging was T 3 No in 8(80%) of cancer. Nodal staging was not confirmed by CT or MRI scans. There was biased to any form of laryngeal surgery as treatment option because of societal believes and ignorance. Chemoradiation therapy without surgery was preferred by all the patients regardless of advanced stage of disease. There was high morbidity including disease recurrence within 1 year in 7(70%) patients and dependence on tracheotomy in 8(80%), feeding gastrostomy, intractable pain and pharyngocutaneus fistula. Voice optimisation was achieved only in the 2 patient with early glottic tumours. Mortality within 1 year was recorded in 5 patients despite Chemoradiation therapy (CRT). Mortality was attributable to liquid morphine overdose/toxicity in 1 patient. Prognosis was abysmally poor. Treatment of Ca larynx in Calabar South eastern Nigeria is a management challenge with considerable morbidity and mortality. Cure rate and prognosis are very poor because of late presentation and patient's preference for inappropriate treatment modality in advanced disease. Refusal of laryngeal surgery as treatment option even when conservative non-surgical options have failed was because of societal beliefs and ignorance. There is need for public enlightenment on the possibility of high cure rates and voice preservation in early laryngeal cancer. Cost of oncology care should be subsidized by government while an oncology centre should be established in each of the six geopolitical zones in Nigeria.

Disk Battery ingestion is a medical emergency often seen children under the age of 6 years with a peak incidence in the 1 to 3 year old. In most cases ingestion is not witnessed however in some cases especially in the older children, there is a history or suspicion of ingestion of the foreign body by the child or caregiver. Of all dangerous oesophageal FB, disk battery is the most dangerous. Occasionally, referral for endoscopic removal of ingested DB body is delayed because transition through the GIT is expected. Disk Battery ingestion seems to be an emerging pediatric emergency associated with clinically significant outcomes in our region. We report a case of a three year old baby who ingested a disk battery and immediately informed the parents. A chest x-ray taken within 2 hours of ingestion revealed a coin like opacity but was misdiagnosed as a 50Kobo coin. The 50Kobo coin hitherto was the commonest circular metallic foreign body in the esophagus in our region. Referral for endoscopic assessment was delayed because transit through the gastrointestinal tract expected. The child seemed comfortable and asymptomatic but suffered significant injury resulting in esophageal pleural fistula within 4 days of ingestion. Battery type was CR2025 and lodgment was at the gastro esophageal sphincter. The need for early presentation to the hospital, correct diagnosis, undelayed endoscopic evaluation and removal of Disk Battery foreign body is reemphasized. The importance of careful history taking, examination and simple plain radiograph of the neck and chest and abdomen in a seeming comfortable and well child with suspicion of foreign body ingestion is highlighted. A review of relevant literature is also done.

Otomycosis is a common clinical problem in our region of sub Saharan African because of the hot, humid, dusty and wet climate of this region. The infection can be diagnosed clinically on the basis of symptoms like pruritus, otalgia, discharge, blockage, hearing loss and presence of murky debris resembling wet newspaper in the external auditory meatus. It is commoner in females and occurs more in the 21-30 year age range. The most common symptoms in our review were pruritus followed by hearing loss, Murky otorrhoea and blockage. Otomycosis was predominantly unilateral with both ears almost equally affected. Our study highlights a management challenge in the treatment of otomycosis in Calabar, South-South Nigeria. The species of fungus causing the disease in our center could not be established because of poor access to mycological facilities. However, cure rates following antifungal treatment was high (86%) even in the absence of mycological identification of causative fungal agent. Drugs like Clioquinone/flumethasone (eardrops/cream), Beclomethasone dipropionate/clotrimazole/lidocaine hydrochloride (eardrops) or Gentian violet are indespensible topical agents in the management of otomycosis in the Third World. Gentian violet should only be used as treatment of last resort because it discolors the external auditory canal giving a poor cosmetic appearance during treatment. Although confirmatory test to identify causative fugal agent is important, in the absence of adequate mycological diagnostic facilities, presumptive clinical diagnosis and treatment based on signs and symptoms has a high (86%) cure rate.