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Research Dissertation Title: the Pattern of Hearing Loss As Seen at the University of Benin Teaching Hospital, Benin City

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Research Dissertation Title: the Pattern of Hearing Loss As Seen at the University of Benin Teaching Hospital, Benin City RESEARCH DISSERTATION TITLE: THE PATTERN OF HEARING LOSS AS SEEN AT THE UNIVERSITY OF BENIN TEACHING HOSPITAL, BENIN CITY. BY DR. PAUL R O C ADOBAMEN ADDRESS: ENT UNIT, DEPARTMENT OF SURGERY, UBTH, BENIN CITY. A RESEARCH DISSERTATION, SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF FMCORL OF THE NATIONAL POST GRADUATE MEDICAL COLLEGE OF NIGERIA. MAY 2006. 1 CANDIDATE’S DECLARATION I, Dr. Adobamen P R O C hereby declare that: “The pattern of hearing loss as seen at the University of Benin Teaching Hospital, Benin City”; - Is an original prospective work done by me as the sole author and assistance received is duly acknowledged. - This work has not been previously submitted either in part or in full to any other College for a Fellowship nor has it been submitted elsewhere for publication. SIGNATURE------------------------ DATE------------------------------- 2 CERTIFICATION This study titled: “The pattern of hearing loss as seen at the University of Benin Teaching Hospital (UBTH), Benin City” was done by Dr. Adobamen P R O C under our supervision. We also supervised the writing of this dissertation. 1. NAME: Prof. F O Ogisi. FRCS, FICS, FWACS, FMCORL, DLO. STATUS: CONSULTANT OTORHINOLARYNGOLOGIST, HEAD AND NECK SURGEON, PROFESSOR. ADDRESS: DEPARTMENT OF SURGERY, U. B. T. H., BENIN CITY, NIGERIA. SIGNATURE:------------------------------------------------------ DATE:------------------------------------------------------------ 2. NAME: PROF B C EZEANOLUE. FMCORL, FWACS, FICS STATUS: CONSULTANT OTORHINOLARYNGOLOGIST, HEAD AND NECK SURGEON, ASSOCIATE. PROFESSOR. ADDRESS: DEPARTMENT OF OTOLARYNGOLOGY, U.N.T.H., ENUGU, NIGERIA. SIGNATURE:------------------------------------------------------ DATE:------------------------------------------------------------ 3 DEDICATION This book is dedicated to the bride of Jesus Christ; for their gallant stand for the Word of God. 4 5 6 ACKNOWLEDGEMENT I express my profound gratitude to Jesus Christ; Who directed me during this project. I also thank Him for giving me the grace to successfully complete the project against all odds, especially at the data analysis stage, which was so burdensome and painstaking. I express my sincere thanks to the dynamic, indefatigable and charismatic Prof. FO Ogisi and the energetic, prudent and meticulous Prof. BC Ezeanolue for the materials and hints they gave to me, that helped in this work. I also appreciate their patience in reading through and correcting the manuscript several times despite their hectic daily schedule. I also thank them for their constructive criticisms and encouragement throughout the period of this work. I express my sincere gratitude to my wife; Oluchukwu and my children who had to be alone during my long stay on outside postings. I thank Miss Jennifer Ehizibue for the secretarial assistance of this project. I also express my deep respect and thanks to Mr. Clifford Ogiugo, the audiology 7 technician who did the pure tone audiometry for the patients in this study. Lastly, I express my sincere appreciation to Professor B A Oyejola of Statistics Department, University of Ilorin, for the statistical analysis of the data of this project. 8 TABLE OF CONTENTS Contents Page Candidate’s declaration i Certification ii Formative assessment of dissertation proposal iii Ethical clearance certificate iv Dedication v Acknowledgement vi Table of contents vii Summary ix CHAPTER ONE Introduction 1 Research problem 3 Scope and limitations of the study 4 Justification/significance of the study 5 CHAPTER TWO Aims and objectives of the study 6 CHAPTER THREE Review of literature 7 3.1 Normal ear anatomy and conduction of sound waves 7 9 3.2 Measurement of hearing 11 3.3 Diagnosis of hearing loss 14 3.4 Types of hearing loss 17 3.5 Causes of hearing loss 18 3.6 Prevalence of hearing loss in Nigeria 21 3.7 Hearing loss in specific conditions 24 CHAPTER FOUR Patients and method 36 4.1 Patients 36 4.2 Study method 37 4.3 Data analysis 39 CHAPTER FIVE Results 40 CHAPTER SIX Discussion 62 Conclusion 85 Recommendation 87 References 89 Appendix I (Consent form) 103 Appendix II (Questionnaire) 104 Appendix III (Registration of title of dissertation) 106 10 SUMMARY Background- Deafness and hearing impairment are major causes of disability in developing countries. In Nigeria the magnitude of the problem of hearing impairment is enormous. Aims and objectives- The aim of the study was to determine the pattern of hearing loss, the types of hearing loss and the clinical profile of patients presenting with hearing loss, at the University of Benin Teaching Hospital (UBTH), Benin City. Methodology- This study was a 12-month prospective clinical and audiological, hospital based study. Patients who presented with hearing loss at the Ear. Nose and Throat (ENT) clinic of University of Benin Teaching Hospital, Benin City, between September 2004 and August 2005 were recruited into the study. Pure tone air conduction thresholds of these patients were measured for the frequencies 250Hz, 500Hz, 1000Hz, 2000Hz, 4000Hz and 8000Hz. Bone conduction thresholds were measured at 500Hz, 1000Hz, 2000Hz and 4,000Hz. 11 Results- There were 257 patients, aged between 10years and 100 years in this study. There were 139 males and 118 females. Eighty-two patients had unilateral hearing loss while 175 patients had bilateral hearing loss; giving a total of 432 ears with hearing loss that were studied. The main causes of hearing loss were ototoxicity (15.7%), chronic suppurative otitis media (14.9%), presbyacusis (13.2%), wax impaction (8.9%) and rhinosinusitis (7.4%). In 10.6% of cases, the cause of the hearing loss was unknown. Multiple aetiological factors were identified for some ears. Different pure tone thresholds and types of hearing loss were encountered in this study, depending on the aetiological factor responsible for the hearing loss. Tinnitus was the commonest symptom that was complained of by patients with hearing loss. Hypertension was the commonest co- morbid medical condition associated with hearing loss in this study. The mean duration of hearing loss before presentation at ENT clinic was 5.1years 9.2SD in the right ear and 5.4years 9.5SD in the left ear. Conclusion: The pattern of hearing loss as seen in UBTH, Benin City, is not significantly different from that obtained 12 in other parts of Nigeria. The need for prophylactic measures to be put in place to prevent these aetiological factors, the provision of modern facilities for early detection, treatment and rehabilitation of patients with hearing loss were highlighted. Keywords- Hearing loss, Benin City, Ototoxicity, Chronic suppurative otitis media, Presbyacusis, Pattern. 13 CHAPTER ONE INTRODUCTION The World Health Organization (WHO) applies the term “deaf” to persons whose hearing impairment is so severe that they cannot benefit from amplification1. It will be difficult for this definition to find relevance in the context of a developing country, like Nigeria; where hearing aid facilities are not widely available and the few available ones cannot be adequately maintained2,3. Those persons who are “deaf,” according to the above definition, are either totally without hearing or have profound hearing impairment (>90dB). It was projected that there would be 562 million people with hearing impairment in the world by 2005 by the World Health Organization4. A 1985 World Health Organization (WHO) resolution in relation to the prevention of deafness and hearing impairment, pointed out that much deafness and hearing impairment is avoidable or remediable and that developing countries had the greatest need for the prevention and remediation of hearing problems5. A 1995 WHO resolution estimated that there were 120 million 14 people with ‘disabling hearing difficulties’ worldwide and urged member states to set up national programmes for the prevention of deafness and hearing impairment5. It was envisaged that technical assistance to such countries would be provided by the WHO. Deafness and hearing impairment are major causes of disability in developing countries. Unfortunately, they are generally neglected in comparison with other disabling conditions. The reasons for this neglect are many. Principally, this is because deafness and hearing impairment produce unseen disability. There is also ignorance of the true size and nature of the problems and a conspicuous lack of resources to tackle these problems, particularly in developing countries. Lastly, lack of awareness of the possibilities for prevention as well as uncertainty about the most appropriate methods for treatment and rehabilitation especially in developing countries is another reason for this neglect. Although many countries do not have the wherewithal to mount their own national studies of hearing impairment, 15 they can rely on data from other countries. However, the extrapolations from such data are usually filled with uncertainties. Each country should therefore continue to aspire for the epidemiological studies that are required to provide the accurate, population-based data on which the extent of the problem can be determined. Accurate data are needed for governments to determine priorities within health programmes, to select and monitor preventive strategies and to predict treatment and rehabilitation needs. Accurate data is also needed to determine the individual and societal costs of hearing impairment as well as the benefits of prevention. Accordingly, the significance of the challenge of deafness is made more painful when we realize that the deaf have
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