|Year : 2015 | Volume
| Issue : 3 | Page : 190-193
Otologic surgeries in National Ear Care Centre, Kaduna, Nigeria: A 5 years review
Grema Umar Sambo, Aminu Bakari, Musa Thomas Samdi, Garba Mohammed Mainasara, Joseph Yohanna, Abdullahi Musa Kirfi
Department Clinical Services, National Ear Care Centre, Kaduna, India
|Date of Web Publication||17-Jul-2015|
Grema Umar Sambo
Department Clinical Services, National Ear Care Centre, Kaduna
Source of Support: None, Conflict of Interest: None
Background: Otologic surgeries that endure are based on a detailed knowledge of anatomy, physiology, and pathology of the temporal bone. Ear surgeries are challenging to most otolaryngologists practicing in Nigeria. The aim was to present a 5 years review of indications, types, complications, success, and limitations of the ear surgeries at the study center. Materials and Methods: A 5 years retrospective review of all the otologic surgeries are done under general and local anesthesia from July, 2009 to July, 2014. Results: There were 1067 patients who had ear, nose, and throat surgeries within the period under review, out of which 68 were ear surgeries. Prevalence was 6.37%, there were 25 (37%) males and 43 (63%) females, male: female 1:1.7. Age ranged from 1 to 58 years, mean age 21 ± 6 years. Chronic suppurative otitis media was the most common diagnosis 39 (57.4%) and indication for tympanoplasty 31 (46.6%). Meatocanaloplasty was the least with 2 (2.9%), mastoidectomy 7 (10.3%), myringotomy and grommet insertion 11 (16.2%), excisional biopsy 7 (10.3%), foreign body removal 4 (5.90%), tympanomastoidectomy 3 (4.40%), and pinnaplasty 3 (4.40%). Forty-one (60.3%) achieved resolution of symptoms while 8 (11.8%) had persistence of symptoms. One (1.5%) had revision surgery. The success rate is about 60.3% within the period under review. Postoperative complications (facial nerve paralysis, persistence discharge from the mastoid cavity, worsened deafness, postauricular fistula) were seen in 14 (20.6%). While 4 (5.9%) were lost to follow-up. Conclusion: Ear surgeries are still underdeveloped when compared to nose and throat surgeries in our center. Complication (chronic suppurative otitis media) was the most common indication for ear surgery. Provision of adequate training facilities, especially in the field of otology and review of the training curriculum for otorhinolaryngology residency in Nigeria is indispensable.
Keywords: Indications, Kaduna, Otologic surgeries, Outcome
|How to cite this article:|
Sambo GU, Bakari A, Samdi MT, Mainasara GM, Yohanna J, Kirfi AM. Otologic surgeries in National Ear Care Centre, Kaduna, Nigeria: A 5 years review. Indian J Otol 2015;21:190-3
|How to cite this URL:|
Sambo GU, Bakari A, Samdi MT, Mainasara GM, Yohanna J, Kirfi AM. Otologic surgeries in National Ear Care Centre, Kaduna, Nigeria: A 5 years review. Indian J Otol [serial online] 2015 [cited 2020 Feb 26];21:190-3. Available from: http://www.indianjotol.org/text.asp?2015/21/3/190/159703
| Introduction|| |
A sound knowledge of the anatomy and physiology of the ear is necessary for the management of ear diseases.  The most difficult ear to manage is the chronic draining ear, which has lost its tympanic membrane, ossicles, and middle ear mucosa.  The primary goal of surgery for chronic otitis media is to eradicate disease and obtain a dry and safe ear. Restoration of hearing is by necessity a secondary consideration. Absolute indications for surgical intervention include impending or established intratemporal or intracranial complications, which can cause grave morbidity and even mortality. , Complication of chronic suppurative otitis media such as mastoiditis, mastoid abscess are common indicators for ear surgery in our practice.  It is the past experience, present knowledge and technical dexterity that determine the success of the otological surgery.  The choice of the prosthesis and the particular reconstructive technique also depend heavily on the skills and preferences of the operating surgeon.  The aim of this paper was to present an overview of the ear surgeries did over the last 5 years, the indications, types, complications, successes, and limitations in our center.
| Materials and Methods|| |
This is a 5 years retrospective study of all patients who had ear surgeries through July 2009 to July 2014 from the record department of National Ear Care Centre, Kaduna, Nigeria. Ethical approval was obtained from the Institution's Health Research Ethics Committee. The data retrieved from clinical files includes; biodata (age, gender), clinical presentation (otorrhea, hearing loss, tinnitus, ear blockage, preauricular swelling, postauricular swelling, ear trauma etc.), diagnosis (chronic suppurative otitis media, otitis media with effusion, mastoiditis, preauricular sinus infection, meatal atresia, postauricular cyst, keloid, foreign body in the ear etc.), indication for surgery, type of surgery, follow-up/outcome of all the cases operated on. The data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 16.0 (Chicago Ilinois USA) and results were presented in tables and descriptive chart.
| Results|| |
One thousand and sixty-seven ear nose and throat surgeries were performed, during the period under review, out of which 68 were ear surgeries. There were 25 (37%) males and 43 (63%) females, (male:female 1:1.7). Age ranged between 1 and 58 years, mean age was 21 ± 6 years. The clinical presentation was mostly otorrhea associated with hearing loss 22 (32.4%) as shown in [Table 1]. The side of ear operated on showed the right ear 26 (38.2%), left ear 27 (39.7%) and 15 (22.1%) were on both ears. The most frequent clinical diagnosis was chronic suppurative otitis media 39 (57.4%) as the highest indication for ear surgery (tympanoplasty 31 [46.6%]) while meatocanaloplasty formed the least 2 (2.9%) as shown in [Table 2] and [Table 3], respectively. Ear swab cultured Pseudomonas aeruginosa in 13 (31.1%) patients, Staphylococcus aureus in 11 (25.8%) patients, Streptococcus pyogenes in 5 (11.6%) patients, Proteus spp. in 2 (3%) patients, Escherichia More Details coli 1 (1.7%), Klebseilla spp. 1 (1.7%), and Candida in 2 (3%) patients. In 9 (21.5%) patients, no organism grew after 72 h of aerobic culture. Most of the surgeries were done under general anesthesia via orotracheal intubation, including mastoidectomy 7 (10.3%), tympanoplasty 31 (45.6%), meatocanaloplasty 2 (2.9%); these were the one mostly, performed by consultants 60 (94%) while only 4 (6%) done by senior registrars. Foreign body removal 4 (5.9%) were done as day cases under face mask and all performed by resident doctors except, one case that has to be through postauricular approach under general anesthesia that was performed by a consultant. Most cases of excisional biopsy 7 (10.3) were done under local anesthesia with the exception of preauricular sinus infection 2 (2.90%) as shown in [Table 2] and [Table 3], respectively. The most frequent postoperative complication recorded in this study, was persistence of discharge from mastoid cavity 4 (28.5%) followed by facial nerve paralysis and worsened deafness 3 (21.4%) each as shown in [Figure 1]. Forty-one (60.3%) patients achieved resolution of the symptoms while 1 (1.5%) patient had revision surgery. The success rate is about 60.3% within the period under review. Detailed information is as presented in [Table 4].
| Discussion|| |
From this study, it can be deduced that, the majority of patients present with otorrhea and hearing loss as reported by Lasisi and Afolabi,  Kurien,  and mills.  Chronic suppurative otitis media is a common indication for ear surgery in our center, which is similar to the study done by Okafor  and Brobby.  The most common infective organism isolated was P. aeruginosa 13 (31.1%), this is similar to the study of Rotimi et al.,  Kumar et al.,  Nwabuisi and Ologe,  and Afolabi et al.,  but contradicts the finding of Ahmad and Kudi in which S. aureus was the most common.  The majority of patients were within school age group 0-10 years. This is the age group where disability of hearing impairment hampers child's performance in school. This is contrary to the findings of Adobamen and Ogisi where they found the majority of their patients were young adults aged 20-39 years.  Although, they did their study basically on middle ear surgery only. We recorded persistence discharge from the mastoid cavity as the most common complication. A similar study was reported by Kamath et al.  In our case, may be attributed to the following; incomplete exenteration of the diseased mucosa from the mastoid cavity, patients defaulting regular follow-up and use of herbs at home as confessed by one of the patients. The revision surgery was done on patient with extensive cholesteatoma combined with tympanoplasty. Another worrisome complication was facial nerve paralysis 3 (21.4%), one of them was found to have dehiscence facial canal intraoperatively, and the similar incidence reported by Lin et al.  Two of them 2 (66.6%) recovered with physiotherapy. Seven (63.6%) out of eleven patients who had myringotomy and grommet insertion, had adenoidectomy at the same time. Eight had spontaneous extrusion of grommet while the remaining 3 developed purulent discharge, which were managed with aural toileting and topical antibiotic. All cases of meato/canaloplasty were done by the consultants. Foreign body removal constituting 4 (5.90%) of ear surgeries of which 3 (75%) were done permeatal and 1 (25%) through postauricular approach (due to foreign body impaction) as a result of prior failed attempts at removal by the caregiver before referral. The intraoperative findings were that of damaged tympanic membrane and ossicular dislocation; similar to the findings of Fasunla et al.  From our study, it can be depicted that, despite our limited exposure and inadequate facilities for ear surgeries, we were able to achieve up to 60.3% success rate.
However, it is still worth mentioning that, out of 1067 patients who had ear, nose, and throat surgeries only 68 (6.37%) were ear surgeries within the period under review, despite the increasing number of patients with chronic discharging ear attending our clinic. The study proves beyond reasonable doubt that, there is the inadequate exposure of trainees and the trainers to ear surgeries. That will explain the reasons why some other middle ear surgeries such as stapedectomy and other forms of middle ear reconstructions are not in our operation records.
| Conclusion|| |
This study shows ear surgeries are still underdeveloped. This may be due to low expertise, and hence the inadequate exposure of the trainee to sufficient temporal bone dissection or the lack of essential facilities for ear surgeries that characterize the otolaryngology residency training in Nigeria.
More females opt for ear surgeries. Complications of a middle ear infection are the most common indications for surgery. It is highly recommended that there is an urgent need for provision of adequate training facilities, more hands-on dissection of temporal bone, adequate exposure in ear surgeries, and review of the training curricula for otorhinolaryngology residency in Nigeria. These can be achieved only if our institutions would have an elaborate and standard temporal bone laboratory and enforcement of post fellowship training/attachment in otologic surgery. With these in place, there will be a lot of benefits to patients and decrease in progression of ear diseases and hearing loss
| Acknoowledgments|| |
We wish to acknowledge the medical record officers particularly, the head of medical record, the theatre staffs and the registrars who help in extracting data from the hospital's database.
| References|| |
Ibekwe TS, Nwaorgu OG. Classification and management challenges of otitis media in a resource-poor country. Niger J Clin Pract 2011;14:262-9.
McGee TM. Management of totally disabled middle ear: Symposium on otologic surgery reassessment after 25 years. Laryngoscope 1979;89:730-4.
Steven A, Telian MD, Cecelia E, Schmalbach MD. Chronic otitis media. In: Snow JB, Ballenger JJ editor. Otorhinolaryngology Head and Neck Surgery. 16 th
ed. Hamilton, Ontario: BC Decker Inc.; 2003. p. 261-93.
Lee A, Harker MD. Cranial and intracranial complication of acute and chronic otitis media. In: Snow JB, Ballenger JJ. editor. Otorhinolaryngology Head and Neck Surgery. 16 th
ed. Hamilton, Ontario: BC Decker Inc.; 2003. p. 294-316.
Lasisi OA, Nwoargu OG, Garandawa HI, Isa A. A 15 fifteen year review of otological surgery in Ibadan, Nigeria. Problems and prospects. Niger J Surg Res 2002;4:45-9.
Alejandro IT, Douglas DB. Clinical assessment and surgical treatment of conductive hearing loss. In: Cummings CW, editor. Otolaryngology-Head and Neck Surgery. 5 th
ed., Vol. 2. Philadelphia, PA 19103 - 2899: Mosby; 2010. p. 2017-27.
Lasisi OA, Afolabi O. Mastoid surgery for the chronic ear: A ten year review. Internet J Head Neck Surg 2007;2:. Available from: www.ispub.com/ijhns/2/2/11806
(Last cited on 2015 Feb 25)
Kurien M. Otorrhoea: A management protocol for a tropical doctor. Trop Doct 1999;29:232-5.
Mills PR. Management of chronic suppurative otitis media. In: Kerr AG, Booth JB, editors. Scott-Brown′s Otolaryngology Otology. 6 th
ed. Oxford: Butterworth-Heinemann; 1997. 3/10/1-3/10/11.
Okafor BC. The chronic discharging ear in Nigeria. J Laryngol Otol 1984;98:113-9.
Brobby GW. The discharging ear in the tropics: A guide to diagnosis and management in the district hospital. Trop Doct 1992;22:10-3.
Rotimi VO, Okeowo PA, Olabiyi DA, Banjo TO. The bacteriology of chronic suppurative otitis media. East Afr Med J 1992;69:394-7.
Kumar R, Srivastara P, Sharma M, Rishi S, Nirwan PS, Hemwani K, et al
. Isolation and Antimicrobial sensitivity profile of bacterial agent in chronic suppurative otitis media patients at NIM Hospital, Jaipur. Int J Pharm Biol Sci 2013;3:265-9.
Nwabuisi C, Ologe FE. Pathogenic agents of chronic suppurative otitis media in Ilorin, Nigeria. East Afr Med J 2002;79:202-5.
Afolabi OA, Salaudeen AG, Ologe FE, Nwabuisi C, Nwawolo CC. Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in North central Nigeria. Afr Health Sci 2012;12:362-7.
Ahmad BM, Kudi MT. Chronic suppurative otitis media in Gombe, Nigeria. Niger J Surg Res 2003;5:120-3.
Adobamen P, Ogisi FO. The use of surgicel in middle ear surgery. Niger J Otorhinolaryngol 2004;1:19-21.
Kamath MP, Sreedharan S, Rao AR, Raj V, Raju K. Success of myringoplasty: Our experience. Indian J Otolaryngol Head Neck Surg 2013;65:358-62.
Lin JC, Ho KY, Kuo WR, Wang LF, Chai CY, Tsai SM. Incidence of dehiscence of the facial nerve at surgery for middle ear cholesteatoma. Otolaryngol Head Neck Surg 2004;131:452-6.
Fasunla J, Ibekwe T, Adeosun A. Preventable risks in the management of aural foreign bodies in Western Nigeria. Internet J Otorhinolaryngol 2006;7:1-4.
[Table 1], [Table 2], [Table 3], [Table 4]