|Year : 2012 | Volume
| Issue : 3 | Page : 153-156
An appraisal of common otologic disorders as seen in a deaf population in North-Western Nigeria
Abdulazeez O Ahmed1, Emmanuel S Kolo1, Emmanuel R Abah2, Kehinde K Oladigbolu2
1 Department of Otorhinolaryngology, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Ophthalmology, Ahmadu Bello University, Zaria-Shika, Nigeria
|Date of Web Publication||5-Jun-2012|
Abdulazeez O Ahmed
P.O. Box 14529, Kano Main Post Office, Kano
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background/Objective: Deaf persons are equally susceptible to other otologic diseases as the rest of the population; however, there may be increased morbidity among the deaf population. The aim of the study is to determine common otologic problems and their prevalence among the deaf and to offer treatment where appropriate.
Materials and Methods: Six hundred and twenty students aged between 5 and 38 years with profound hearing loss were recruited from a special school for the deaf. Hearing level was assessed and full ENT examination including otoscopy was done.
Results: 22.4%  of the deaf students had otologic diseases, with 69.1% of them having wax impaction and chronic suppurative otitis media and otitis media with effusion accounting for 21.6 and 7.2% respectively.
Conclusion: The study showed that wax impaction is a common problem and this can be quite uncomfortable for some of the students. A routine general and otologic screening program targeted at the deaf and deaf-blind is recommended.
| Abstract in French|| |
Contexte/objectif: Les personnes sourdes sont également sensibles à d'autres maladies provoquerait comme le reste de la population; toutefois, il peut y avoir une augmentation de la morbidité parmi la population sourde. L'objectif de l'étude est de déterminer les problèmes provoquerait communs et leur prévalence chez les personnes sourdes et d'offrir le traitement le cas échéant.
Matériaux et procédés: Six cent vingt étudiants âgés de 5 à 38 ans, avec une surdité profonde ont été recrutés dans une école spéciale pour les sourds. Audition de niveau a été évaluée et examen ENT complet, y compris otoscopie a été fait.
Résultats: 22,4%  les étudiants sourds avait maladies provoquerait, avec 69,1% d'entre eux ayant cire impaction et suppurée otite moyenne chronique et otite moyenne avec la comptabilité de l'épanchement de 21,6 et 7,2% respectivement.
Conclusion: L'étude a montré qu'impaction de cire est un problème fréquent et cela peut être très mal à l'aise pour certains des étudiants. Une programme de dépistage de généraux et provoquerait ciblé aux personnes sourdes et sourdes-aveugles est recommandé la routine.
Mots clés: La morbidité, otite, trouble provoquerait, prévalence, cire
Keywords: Morbidity, otitis media, otologic disorder, prevalence, wax
|How to cite this article:|
Ahmed AO, Kolo ES, Abah ER, Oladigbolu KK. An appraisal of common otologic disorders as seen in a deaf population in North-Western Nigeria. Ann Afr Med 2012;11:153-6
|How to cite this URL:|
Ahmed AO, Kolo ES, Abah ER, Oladigbolu KK. An appraisal of common otologic disorders as seen in a deaf population in North-Western Nigeria. Ann Afr Med [serial online] 2012 [cited 2020 Nov 24];11:153-6. Available from: https://www.annalsafrmed.org/text.asp?2012/11/3/153/96875
| Introduction|| |
Ear disorders amongst the deaf are often neglected because of the assumption that these disorders cannot make the hearing loss worse. However, deaf people in the same way like the rest of the population are prone to having common ear disorders such as ear wax, ear infections and middle ear effusion. Neglecting these disorders can be a major source of morbidity and rarely mortality in a few. A comprehensive examination of the ear, nose and throat of students in boarding schools led to rapid identification of conditions predisposing or associated with preventable ear disease.  Chronic suppurative otitis media is prevalent in overcrowded houses, among people maintaining poor personal hygiene, areas that lack access to proper health facilities, most especially in developing nations such as Nigeria. This condition is quite common in school children as several studies have shown. ,, Studies depicting prevalence of otologic diseases among the hearing impaired and/or deaf subjects are variable; they can be as high as 75.7% in Kathmandu valley  and as low as 24.2% in Turkey.  This study was therefore undertaken to determine some common otologic problems, in addition to hearing loss, among deaf students at the Kaduna State Special Education School, Kaduna-Northwestern Nigeria, with the aim of identifying and providing appropriate interventions where possible and referring more difficult cases to secondary or tertiary health facilities for effective management.
| Materials and Methods|| |
A cross-sectional survey was carried out in a special education school for the deaf in Kaduna by a group of otolaryngologists and ophthalmologists, in North Western Nigeria, between May and June 2009. A total of 620 students who are deaf/blind or deaf were recruited in to the study. The study was carried out after obtaining consent from the Ministry of Education, the Parents and Teachers Association and from the students.
Exclusion criteria were children under five years of age. Two students declined to be included in the study.
Several of the teachers with sign language proficiency were on hand to interpret questionnaires and help to relate with the students. All students had a general physical examination, otoscopic and audiometric evaluation [using a Heine mini 3000 Otoscope and portable screening audiometer- Earscan 3]. Students with wax obstructing the ear canal were de-waxed prior to otoscopy. Even though it was a deaf school, audiometry was carried to ascertain the level of hearing impairment; however, all the students examined had hearing losses from profound to deaf mutism.
For the purpose of this survey, students with intact but thickened, dull/opalescent drumheads or drumheads with increased vascularity with or without fluid levels were tentatively labeled as otitis media with effusion, then later subjected to pneumatic otoscopy for confirmation. Tympanometry was not available due to limited resources; while those with perforated drumheads with or without aural discharge of greater than 12 weeks duration were labeled as chronic suppurative otitis media. Deaf students with discharge up to or less than 2 weeks are labeled as acute suppurative otitis media and those with discharge in the range of 2-12 weeks as subacute otitis media.
| Results|| |
A total of 620 deaf students were examined. Their ages range from 5 years to 38 years with a mean of 15.7 years (+ 3.9 SD). 60% (372) were males and 40% (248) females, with a male: female ratio of 1.5: 1.
Twenty two point four percent (139) of the total students examined had otologic problems, while 77.6% (481) had apparently normal otoscopic findings. Wax was the most common otologic disorder (69.1%), followed by otitis media with effusion (21.6%) and chronic suppurative otitis media (CSOM) (7.2%), and foreign bodies in the ear canal (2.1 %) was the least [Table 1].
The most affected age group for otologic diseases was 5 to 24 years with a total of 135 students (21.8% of total student population [Table 2]. No significant sex difference with regard to otologic diseases was noted.
About 142 [22.9%] of the deaf student population received some kind of treatment or intervention, out of which 15.5% were de-waxed, while 6.3% (39) were promptly referred, four students were treated successfully (0.6%) while about three students (0.5%) had foreign bodies removed instantly [Table 3].
| Discussion|| |
In our study of this deaf population, a prevalence of 22.4% was noted which is much lower than 75.7% as alluded to by Adhikari et al.  This may be due to our smaller sample size or the fact that being a deaf school some attention is focused on students' ears. The prevalence of total deaf population of the country may be higher as a large number are on the streets as beggars or destitutes, and often do not have any means or access to good healthcare [Table 1].
Impacted Cerumen auris was the most common otologic problem in our survey accounting for 15.5% of the total population. It is usually a cause of treatable hearing impairment. But in an already deaf ear, it can be a source of discomfort and itching predisposing to external otitis. These were the concerns expressed by majority of the students who had obstructing Cerumen auris; however, no frank case of otitis externa was observed. Wax is reasonably a common otologic problem as alluded to by Adhikari et al.  & Sharma et al.  with 60.6 and 50% respectively. Wax impaction is said to be more common in blacks and Indian children than in Caucasians. 
This study shows that young age may play a role in wax impaction as students between the ages of 5 to19 years were the most affected, totaling 79% of the wax affected group and this began to drop beyond this age [Table 2]. The above-mentioned age group may be higher compared to the observations by Baisakhiya et al. 
Acute otitis media (AOM) with or without suppuration was not observed during the course of this survey. However, otitis media with effusion (OME) had a prevalence of 4.8% and it compares favorably with other studies of 3.7 and 5.3% in Kathmandu valley  and Nigeria  respectively. It could occur on its own and commonly presents with some degree of hearing impairment. Since these students are already deaf, much attention is not paid on other complaints such as aural fullness or tinnitus which are the common symptoms as well. In our study, the most affected age group was 10 to 14 years (12) followed by the age group 20 to 24 years (10), more accurate rates may perhaps be better appreciated with larger sample size and via impedance studies.  On occasions, certain people with this ailment have been labeled as deaf mutes and inadvertently placed in special schools for the deaf!
Chronic suppurative otitis media (CSOM) is a major health concern in developing countries including Nigeria.  It accounted for the 3 rd commonest otologic disease with 1.6% in this deaf population. This prevalence is less compared to other studies by Adhikari et al.,  Ologe et al.,  Rupa et al.,  which showed 5.7, 6.0 and 6.0% respectively in the normal population. Similarly, our study shows 1.6% which is much lesser than those reported by Biswas et al.,  Akinpelu et al.,  and Morris et al.,  with 33.9, 12.4 and 15.4% respectively. The exclusion of pupils under the age of five years could account for a lower incidence of CSOM in our study, as children in that age group tend to have a higher incidence of ear discharge. This is a highly selective group who maintains better personal hygiene and receives better health care than their "normal population" counterparts.
The least common otologic disorder was foreign body in the ear canal (0.5%) which is also the least as seen in Nigeria by Akinpelu  and Okafor.  External otitis and otomycosis were not observed in our survey, in contrast to other studies  [Table 2].
Furthermore, it was observed that the prevalence of otologic disorders in this deaf population was 22.4% and compares favorably with the reports from Turkey (24.2%)  and South Western Nigeria (24.8%).  This study highlights the fact that common ear disorders are prevalent in the deaf population as the rest of the normal population. About 22.9% of the total student population received one form of intervention or another. Ninety-six deaf students with impacted wax got it removed either by syringing or instillation of ceruminolytic agents to soften it [Table 3].
Finally, other deaf students with some residual hearing and middle ear effusion about 39 (6.3%) were promptly referred for further care at the tertiary center.
| Conclusion|| |
Most of these observed otologic disorders are readily preventable and treatable [Table 1]; indeed, the need for government and non-governmental support for these group of vulnerable individuals cannot be over-emphasized. With the provision of dedicated health facilities for the school, inclusive of a minimum of an ENT trained nurse practitioner, better boarding facilities, health education and routine bi-annual general screening program for the deaf and deaf-blind, will go a long way in enhancing their social wellbeing.
| Acknowledgement|| |
We sincerely appreciate the efforts of all the teachers of this school, who have made possible ease communication with these deaf students. We also sincerely thank Professor E. Samaila for conceiving this work and also Hassan Merali, our Canadian visiting scholar, for participating in the survey and finally Mallam Abubakar T.H. especially for his constant support throughout the study period.
| References|| |
|1.||Adhikari P, Kharel DB, Ma J, Baral DR, Pandey T, Rijal R, et al. Pattern of otological diseases in school going children of Kathmandu valley. Arq Int Otorhinolaringol 2008;12:502-5. |
|2.||Adhikari P. Chronic suppurative otitis media in school children of Kathmandu valley. Int Arch Otorhinolaryngol 2007;11:175-8. |
|3.||Biswas AC, Joarder AH, Siddiquee BH. Prevalence of CSOM among rural school going children. Mymensingh Med J 2005;14:152-5. |
|4.||Prevention of Hearing impairment from chronic otitis media, WHO/CIBA foundation workshop report. London; 1996. p. 19-21. |
|5.||Ozturk O, Silan F, Oghan F, Egeli E, Belli S, Tokmak A, et al. Evaluation of deaf children in a large series in Turkey. Int J Pediatr Otorhinolaryngol 2005;69:367-73. |
|6.||Sharma H, Bhusan V, Dayal D, Mishra SC. Preliminary study of hearing handicap in school-going children. Indian J Otolaryngol Head Neck Surg 1992;30:119-24. |
|7.||Bhoola D, Hugo R. Excess cerumen: Failure rate of Black and Indian preschool children from Durban on the Middle Ear Screening Protocol (MESP). S Afr J Commun Disord 1997;44:43-52. |
|8.||Baisakhiya N, Golher S, Prashant M. Wax: An overview. Internet J Otorhinolaryngol 2009;9:1 |
|9.||Akinpelu OV, Amusa YB. Otological diseases in Nigerian children. Internet J Otorhinolaryngol 2007;7:1. |
|10.||Ahmad BM, Nwaorgu OG, Nwawolo CC. Otologic findings in children from a deaf school in Ibadan, Nigeria. Sahel Med J 1999;2:49-52. |
|11.||Ologe FE, Nwawolo CC. Prevalence of chronic suppurative otitis media (CSOM) among children in a rural community in Nigeria. Niger Postgrad Med J 2002;9:63-6. |
|12.||Rupa V, Jacob A, Joseph A. Chronic suppurative otitis media: Prevalence and practices among rural south Indian children. Int J Pediatr Otorhinol 1999;48:217-21. |
|13.||Morris PS, Leach AJ, Silberberg P, Mellon G, Wilson C, Hamilton E, et al. Otitis media in young Aboriginal children from remote communities in Northern and central Australia: A cross sectional survey. BMC Pediatr 2005;5:27. |
|14.||Okafor BC. Otolaryngology in Southeastern Nigeria: Pattern of diseases of the ear. Niger Med J 1983;13:11-9. |
[Table 1], [Table 2], [Table 3]