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Dr. Musa Emmanuel

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Dr. Musa Emmanuel PURE TONE HEARING THRESHOLD AND MIDDLE EAR FUNCTION OF PATIENTS WITH CLEFT PALATE ANOMALY AT SMILE TRAIN CENTRE KADUNA BY DR. MUSA EMMANUEL NATIONAL EAR CARE CENTRE KADUNA NIGERIA NOVEMBER 2014 i PURE TONE HEARING THRESHOLD AND MIDDLE EAR FUNCTION OF PATIENTS WITH CLEFT PALATE ANOMALY AT SMILE TRAIN CENTRE KADUNA BY DR. MUSA EMMANUEL NATIONAL EAR CARE CENTRE KADUNA NIGERIA A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FUFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE FELLOWSHIP (FMCORL) IN THE FACULTY OF OTORHINOLARYNGOLOGY NOVEMBER 2014 ii DECLARATION I hereby declare that: a. I am the sole author of this dissertation b. I conducted the work reported herein and all assistance received was duly acknowledged. c. This dissertation has never been previously submitted for a higher degree or publication in part or in full to any institution/journal. …………………………………… DR MUSA EMMANUEL iii CERTIFICATION This is to certify that the project titled: “Pure tone hearing threshold and middle ear function of patients with cleft palate anomaly at Smile Train Centre Kaduna” by DR MUSA EMMANUEL was conducted under our supervision. _________________________________________ ___________________ Dr Kodiya, AM, MBBS (Unimaid), FMCORL(Nig) Date Consultant ENT Surgeon/Senior Lecturer Department Of Otorhinolaryngology, University of Maiduguri Teaching Hospital, Maiduguri _________________________________________ ___________________ Professor O.G.B Nwaorgu, MBBS (Ib), FMCORL, Date Consultant ENT Surgeon & Professor of ORL Department of ORL, University College Hospital, Ibadan _________________________________________ ___________________ Professor E. Adekeye , Date B.DS.(Edin)FDS RCS (Eng FWACS;FMCDS (Nig) F.IC.S Consultant Oral and Maxillofacial Surgeon Etomie Smile Train Centre Kaduna iv ACKNOWLEDGEMENT I shall ever be grateful to my supervisors Dr. A.M Kodiya, Professor O.G.B Nwaorgu and Professor E. Adekeye for guiding me throughout this work. I appreciate my teachers’ Professor B.M Ahmad, Dr. A. Bakari, Dr. A.S Labaran, Dr. A.D Salisu, Dr. E.S Kolo, Dr. M.T Samdi, Dr. U Grema and other consultants for their tireless efforts in training me. My friends and colleagues at the National Ear Care Centre, Kaduna are too numerous to mention but I appreciate them all for their support for me throughout this work. May God bless Dr. A Kirfi for dedicating his time to assist me with data management. Special thanks to the Head of Audiology Mr A. Babangida, Mr S. Aliyu, and Mr M.Tanko for assisting me during the audiological tests. I am short of words to appreciate the Management and Staff of Etomie Hospital/ Smile Train Centre, Kaduna and indeed their patients who participated in this study. Special thanks to Mrs. E Adekeye, Matron P.Gideon and Mr. D. Philip. I am greatly indebted to my family. My parents, brothers and Sister have continued to be a blessing to me. My wife, Patience and daughters, Joanna & Jessica were a constant support and inspiration throughout this work. v DEDICATION I dedicate this work to the LORD. He is my rock, my fortress, my deliverer, my God, my strength, my buckler, the horn of my salvation and my high tower. vi TABLE OF CONTENTS Pages Cover Page- - - - - - - - - - - i Title Page - - - - - - - - - - ii Declaration - - - - - - - - - - iii Certification - - - - - - - - - - iv Acknowledgement - - - - - - - - - v Dedication - - - - - - - - - - vi Table of content - - - - - - - - - vii Summary - - - - - - - - - x CHAPTER ONE: Introduction 1.1 Introduction- - - - - - - - - - 1 1.2 Statement of Problem - - - - - - - - 3 1.3 Research question - - - - - - 3 1.4 Hypotheses - -- - - - - - - - 3 1.5 Justification for the study - - - - - - - - 4 1.6 Scope of the study - - - - - - - - - - 4 1.7 Limitations of the study - - - - - - - - 5 CHAPTER TWO: Aim and Objectives 2.1 General Objective - - - - - - - - 6 2.2 Specific Objectives - - - - - - - - 6 CHAPTER THREE: Review of Literature 3.1 Introduction - - - - - - - - - 7 3.1.2 Incidence: - - - - - - - - - 7 3.1.3 Aetiology: - - - - - - - - - 8 3.1.4 Classification: - - - - - - - - 8 3.2 Anatomy and Physiology - - - - - - - 10 3.2.1 The lip and Palate - - - - - - - - 10 vii 3.2.2 The Eustachian Tube - - - - - - - - 12 3.2.3 The Auditory System - - - - - - - - 13 3.3 Pathogenesis of Eustachian tube Dysfunction and Otitis Media with Effusion in Cleft Palate - - - - - - - - - 14 3.3.1 Mechanical - - - - - - - - - 14 3.3.2 Infection - - - - - - - - - 14 3.3.3 Eustachian Tube Dynamics - - - - - - - 15 3.4 Association between cleft lip and / or palate with middle ear diseases and Hearing Loss - - - - - - - - - 16 3.5 Assessment of Middle Ear Function and Hearing - - - - 17 3.5.1 Otoscopy - - - - - - - - - 17 3.5.2 Tuning Fork Tests - - - - - - - - 18 3.5.3 Pure Tone Audiometry - - - - - - - 19 3.5.4 Tympanometry - - - - - - - - 20 3.6 Management - - - - - - - - - 21 CHAPTER FOUR: Methodology 4.1 Study Centre/Location - - - - - - - 23 4.2 Study Design - - - - - - - - - 23 4.3 Study Population - - - - - - - - 23 4.4 Sample Size Determination - - - - - - - 24 4.4.1 Sampling Technique - - - - - - - - 24 4.4.2 Inclusion Criteria- - - - - - - - - 25 4.4.3 Exclusion Criteria- - - - - - - - - 25 4.5 Study Protocol - - - - - - - - 25 4.5.1 Study Materials/Equipment - - - - - - - 25 4.5.2 Data Collection - - - - - - - - 26 4.5.3 Data Management - - - - - - - - 27 4.5.4 Statistical Analysis - - - - - - - - 27 4.6 Ethical Consideration- - - - - - - - 28 4.6.1 Informed Consent - - - - - - - - 28 viii 4.6.2 Financial Implications - - - - - - - - 28 4.6.3 Confidentiality of Data - - - - - - - 28 4.6.4 Benefits to the Participants - - - - - - - 28 4.6.5 Right to Decline - - - - - - - - 28 4.7 Challenges - - - - - - - - - - - 29 CHAPTER FIVE: Results 5.1 Results - - - - - - - - - - 30 CHAPTER SIX 6.1 Discussion - - - - - - - - - - - 44 6.2 Conclusion - - - - - - - 48 CHAPTER SEVEN: Recommendations 7.1 Recommendations - - - - - - - - - - 49 References - - - - - - - - - 50 Appendix I: Questionnaire- - - - - - - - 56 Appendix II: Informed Consent- - - - - - - 59 Appendix III: College Approval Letter - - - - - - 62 ix SUMMARY Background: Hearing loss and middle ear dysfunction are common in people with isolated cleft palate (ICP) or cleft lip and palate (CLP). They are susceptible to otitis media with effusion from poor middle ear function predisposing them to hearing loss and poor speech development leading to poor school performance for the cleft child and significant morbidity in the adult cleft population. Aim: The aim of this study was to assess the pure tone hearing threshold and middle ear function of patients with cleft palate anomaly at Smile Train Centre Kaduna. Participants and Method: This was a prospective cross-sectional descriptive study designed to assess the pure tone hearing threshold and middle ear function of 160 consecutive adults and children not less than 5 years of age with repaired or unrepaired cleft palate attending Etomie Smile Train Centre in Kaduna, Nigeria compared with a control group of 160 non cleft volunteers matched for age and sex. After obtaining ethical clearance, informed consent and history, ear examination with careful otoscopy, tympanometry and pure tone audiometry were performed in a sound proof booth. Data collected were analyzed using statistical package (SPSS) version 16. Simple statistical parameters, Chi - Square and paired-samples T-test were used as appropriate. The level of statistical significance was set at p value < 0.05 Results: Abnormal tympanic membrane findings on otoscopy was seen in 62.5% of ears of patients with CLP and ICP while 19.7% among the control group had abnormal findings. The prevalence of hearing loss was 59.4% in patients with CLP and ICP and 12% among the control group. About 66% of ears had type B and 8.1% type C tympanograms among patients with CLP and ICP while 10.6% and 2.5% for types B and C respectively were seen among the control group ( P value = 0.000). x Conclusion: There is high prevalence of otitis media with effusion, Eustachian tube dysfunction and conductive hearing loss among patients with cleft palate anomaly at Etomie Smile Train Centre Kaduna Key words: Cleft palate, middle ear function, pure tone threshold, Smile Train Centre. xi CHAPTER ONE INTRODUCTION 1.1 Introduction Cleft lip and palate are the most common congenital malformations of the head and neck.1-4 Patients with these deformities often may have associated problems including otologic diseases, speech and language problems, dental deformities, facial growth deficiencies, and psychosocial issues.5 There is renewed hope for surgical repair for people with cleft deformity in Nigeria today due to serious commitment in offering them free surgeries by Smile Train, Christian Broadcasting Network (CBN), Cleft Care Nigeria Foundation, Cleft Correction & Care Foundation (CC&CF), Health, Education, Work and Shelter (HEWS) Foundation and other non-governmental organizations. While effort at corrective surgery is very commendable, the need for proper diagnosis and management of middle ear disease and hearing loss among the cleft population cannot be overemphasized. It is well established that middle ear dysfunction and hearing loss are common in people with cleft palate though the incidence of hearing loss in people with cleft lip alone is the same as in the controlled population.6-8 Globally, the incidences of hearing loss among cleft population vary greatly ranging from 3% to 90% but their hearing loss and middle ear conditions are
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