RESUMEN
OBJECTIVES: To determine the prevalence of chronic ear disease in HIV+, highly active anti-retroviral therapy (HAART)-treated children and compare this to the prevalence in healthy children of similar age living in a similar setting. INTRODUCTION: From previous clinical work in Ethiopia, we suspected that chronic middle ear disease was common both in the general pediatric population and especially among children with HIV/AIDS. Few studies have examined the prevalence of chronic ear disease in HIV + children, particularly in those treated with HAART. METHODS: Full examination of the head and neck was performed by otolaryngologists. This including cleaning of cerumen, otoscopy and microscopic otoscopy when needed. Patient's medical records were reviewed. Presence or absence of tympanic membrane (TM) perforation (unilateral or bilateral), tympanosclerosis, TM atrophy, otorrhea and/or cholesteatoma was documented. RESULTS: 112 HIV+ and 162 healthy (HIVU) children were included. Prevalence of TM perforations was 17% in the HIV + infected versus 3% in the HIVU (Fisher's-Exact-Test; OR: 7.2, 95% CI 2.5-20, p-value <0.0001). Presence of unilateral TM perforations was 12% in the HIV + population and 2% in the HIVU population (Fisher's-Exact-Test; OR: 6.8, 95% CI 2.0-22, p-value 0.002). The presence of bilateral perforations was 4% in the HIV + population and 1% in the HIVU population (Fisher's-Exact-Test; OR: 6.8, 95% CI 1.1-42, p-value 0.088). In the HIV + cohort, 2% were diagnosed with cholesteatoma compared to 0% in the HIVU population (95% CI HIV+ 0.002-0.06; HIVU 0.0-0.02) and 8% of HIV + subjects had active middle ear discharge, compared to 0% in the HIVU population (95% CI HIV+ 0.04-0.1; HIVU 0.0-0.02). Neither tympanosclerosis nor tympanic membrane atrophy was more frequent in the HIV + population compared to the HIVU population. Persistent or recurrent TM perforation was not more frequent in children with prior tympanoplasty in the HIV + population compared to the HIVU population. CONCLUSION: TM perforations are significantly more common in HAART-treated HIV + children than in healthy, age-matched HIVU population. Otorrhea and cholesteatoma were found only in the HIV + cohort.
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Terapia Antirretroviral Altamente Activa/efectos adversos , Enfermedades del Oído/epidemiología , Infecciones por VIH/complicaciones , Adolescente , África del Sur del Sahara/epidemiología , Terapia Antirretroviral Altamente Activa/métodos , Cerumen , Niño , Preescolar , Enfermedad Crónica , Enfermedades del Oído/complicaciones , Enfermedades del Oído/cirugía , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Otoscopía , Prevalencia , Membrana TimpánicaRESUMEN
OBJECTIVES: The prevalence of hearing loss (HL) in children infected with HIV/AIDS is not well studied. Even fewer studies focus on stable HIV-infected children treated with high-effective antiretroviral therapy (HAART). We aim to compare the prevalence of ear disease and HL in HAART-treated, HIV + children in Addis Ababa, Ethiopia with a well, similarly-aged elementary school population with unknown HIV status (HIVU). METHODS: Children underwent standard head and neck examination and cerumen removal by board certified otolaryngologists. Next, certified audiologists performed hearing screening with pure-tone audiometry using a circumaural headset but without an ambient noise reducing environment. Children failing audiometric screening underwent full behavioral audiometry including air and bone testing. The primary outcome parameter was HL > 25 dB with the audiologist accounting for background noise. A second endpoint was PTA >40 dB (500, 1000, 2000 Hz) without assessment of background noise. RESULTS: 107 HIV+ and 147 HIVU children met inclusion criteria. In the HIV + cohort 17.8% had evidence of TM perforations and 8.4% had otorrhea. In the HIVU group 2.7% had a TM perforation and 0% had otorrhea. Hearing was significantly worse in HIV + children. (Audiologist determination: 38.3% HL HIV+, 12.2% HIVU, Fisher's-Exact-Test OR: 4.5, 95% CI 2.4-8.3, p-value <0.0001; Worse-hearing-ear PTA > 40 dB: 19.6% HL HIV+, 6.1% HIVU, OR: 3.7, 95% CI 1.7-8.4, p-value <0.001). CONCLUSIONS: Chronic OM, conductive and mixed hearing losses are significantly more common in HAART-treated HIV + children than in well, similarly-aged controls. Rates of SNHL are similar.
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Terapia Antirretroviral Altamente Activa/efectos adversos , Enfermedades del Oído/epidemiología , Infecciones por VIH/tratamiento farmacológico , Pérdida Auditiva/epidemiología , Adolescente , Audiometría de Tonos Puros , Niño , Enfermedades del Oído/etiología , Etiopía/epidemiología , Femenino , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/etiología , Humanos , Masculino , Prevalencia , Adulto JovenRESUMEN
OBJECTIVES/HYPOTHESIS: To determine the safety and effectiveness of pediatric tympanoplasty performed on short-term international medical missions. STUDY DESIGN: Prospective observational study. METHODS: Ethiopian children who had dry or nearly dry tympanic perforations and bilateral conductive hearing losses underwent postauricular tympanoplasties with underlain temporalis fascia grafts. Pre- and postoperative air and bone audiometry was performed. Complications, graft success, hearing improvement, and dry ear at 6-month follow-up were evaluated. RESULTS: Patients were 7 to 25 years old (24 female ears, 20 male ears). The majority had subtotal perforations. Operative findings included ossicular erosions and fixation by hypertrophic mucosa. There were no major medical complications or deaths in this series. Of 44 ears, 27 had complete pre- and postoperative audiometric data. Twenty-four of 44 surgeries resulted in an intact tympanic membrane. Twelve of 44 markedly reduced the perforation. Eight of 44 grafts failed. The mean improvement in PTA was 14 dB (range = -6-45 dB). Human immunodeficiency virus (HIV)+ patients had a high rate of graft failure (3/4) and comprised 38% (3/8) of complete graft failures (P = .015). Among the 20 ears with residual perforations, 14 were dry at 6-month follow-up. Of the six ears with drainage, three were HIV+ (P = .019). CONCLUSIONS: Pediatric tympanoplasty is a safe procedure in a short-term surgical mission setting when high anesthetic and surgical standards are maintained. Surgical results were similar to those found in developing-world university hospitals, but were worse than in United States or European series. HIV+ children did worse than their HIV-/unknown peers, with a high rate of graft failure and persistent otorrhea. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1464-1469, 2016.
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Fascia/trasplante , Misiones Médicas , Músculo Temporal/trasplante , Perforación de la Membrana Timpánica/cirugía , Timpanoplastia/métodos , Adolescente , Adulto , Audiometría/métodos , Conducción Ósea , Niño , Etiopía , Femenino , Estudios de Seguimiento , Pérdida Auditiva Bilateral/etiología , Pérdida Auditiva Bilateral/cirugía , Pérdida Auditiva Conductiva/etiología , Pérdida Auditiva Conductiva/cirugía , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento , Perforación de la Membrana Timpánica/complicaciones , Adulto JovenRESUMEN
BACKGROUND: Respiratory Tract infections continue to be a major cause of morbidity and mortality world wide. There is a failure to treat respiratory infections due to the emergence of antibiotic resistant strains among the most common respiratory pathogens. OBJECTIVES: To evaluate the in vitro antibacterial activities of two traditionally used plants: Albizia gummifera (Ambabesa-Muka, Oromifa, Sessa-Amharic.) and Ferula communis (Doge-Oromifa, Dog-Amharic) against clinical isolates of S. pyogenes and S. pneumoniae. METHODS: The study involving the antibacterial susceptibility test of traditionally used plant species against Gram-positive bacterial pathogens was conducted over a period of 5 months (January - August, 2004) at the Ethiopian Health, and Nutrition Research Institute. The in vitro antibacterial activities of 80% methanol crude extracts prepared from the seeds of Ablizia gummifera and, roots of Ferula communis as well as their respective hydro alcoholic solvent fractionates of both plant species were tested for inhibitory activity against the clinical isolates of six S. pneumonae and twenty two S. pyogenes using agar dilution method. RESULTS: Eighty percent ethanol solubilized fractions of both plants were found to have antibacterial effects to all assayed bacteria while aqueous solubilized fractions did not exhibit any effect. Minimum inhibitory concentration (MIC) of the 80% ethanol solubilized fractions was determined and the MIC of the fractions ranged from 500 mg/ ml to 1000 mg/ml for both plants showing the extracts may contain bioactive compounds of therapeutic interest. CONCLUSION: All extracts showed antibacterial activities against clinical isolates of S. pyogenes and S. pneumoniae. The extracts may contain compounds with potential therapeutic activity. Further purification and identification are needed to be tested using animal models.
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Antibacterianos/farmacología , Fitoterapia , Extractos Vegetales/farmacología , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pyogenes/efectos de los fármacos , Albizzia/química , Ferula/química , Pruebas de Sensibilidad Microbiana , Raíces de Plantas , Plantas Medicinales/efectos adversos , Plantas Medicinales/química , SemillasRESUMEN
There are several reports on epidemic meningococcal meningitis in some areas of Ethiopia, which lie in the meningococcal meningitis belt of Africa. Very little is known about the neurological sequel of epidemic meningococcal meningitis, especially that of hearing loss. This hospital-based study was conducted prospectively at the Ear Nose Throat clinic of the Pediatric Outpatient Department of the Tikur Anbessa Hospital during the meningococcal meningitis epidemic from May to October 2000 in order to assess the hearing status of patients after completion of their course of treatment. Demographic, clinical, microbiologic, audiometric data were collected using a preformed questionnaire. One hundred forty one cases of pyogenic meningitis were examined at discharge and on subsequent visits. Most of the patients (73.5%) were between 5 and 12 years of age. The major bacteriological isolate from the cerebrospinal fluid in 48 cases (35.3%) of the specimens was meningococci. Hearing loss was the commonest neurological sequel at discharge constituting 25% of the cases. At least 12.5% of the patients had severe to profound sensorineural hearing loss. This level of hearing loss would affect communication abilities and impair studies in school if left without rehabilitative measures including hearing aids or other means. Large scale community based studies are required to determine the magnitude of hearing loss associated with epidemic meningococcal meningitis.