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Tropical ENT MD thesis
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Tropical ENT MD thesis

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Communication MD Tropical ENT: Sub-Saharan Practice

Communication MD Tropical ENT: Sub-Saharan Practice

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  • 1. TROPICAL OTO-RHINO-LARYNGOLOGY: PRACTICE IN SUB-SAHARAN AFRICA ABBAS A1, TALL A2, DIOUF R 2, NDIAYE IC2, DIOP EM 2 1 ENT Resident of Marseille – CHU Timone - (France) aliabbas07@yahoo.fr 2 Clinique ORL – CHU A. Le Dantec – Dakar (Senegal)• BACKGROUND: Ear, nose and throat practice in sub-saharan Africa exposes one to a variety of ENT diseases consistent with a tropical area. It is also interesting to note that many West physicians are totally unfamiliar with them. The aim of this study is to describe the ENT practice in a sub- saharan area.• MATERIAL AND METHODS : Personal practice during one resident semester of training in hospitals of Senegal and meta-analysis of studies of ENT tropical diseases.• RESULTS: Rhinoscleroma: is a chronic, progressive, granulomatous infection of the upper airways with a preference for the nose, caused by Fig 1: Rhinoscleroma the bacteria Klebsiella rhinoscleromatis (Fig 1). It is classified into 3 clinical stages: the catarrhal-atrophic stage (atrophy and crusting of the (EM Diop collection) nasal mucosa), the granulomatous stage (rubbery granulomatous lesion evolving into a pale and indurated granulomatous mass) and the sclerotic stage (increased deformity and stenosis).It is difficult to threat, and the relapse rate is high: treatment by prolonged antimicrobial therapy and surgical debridement [1].• Noma: (cancrum oris) is a devastating gangrenous disease (Fig 2) that leads to severe tissue destruction in the face and is associated with high morbidity and mortality (acute necrotizing gingivitis). It is seen almost exclusively in young children living in remote areas of less developed countries, particularly in Africa. The cause remains unknown, but a combination of several elements of a plausible etiology has been Fig 2: noma (cancrum oris) identified: malnutrition, a compromised immune system, poor oral hygiene and a lesion of the gingival mucosal barrier, and an unidentified bacterial factor acting as a trigger for the disease. The correction of deformities after noma is one of the most challenging problems for surgeons [2].• Burkitt’s lymphoma: has the highest incidence of any childhood cancer in sub-saharan Africa (Fig 3), with a predominated maxillary localization. EBV is contained in all endemic Burkitt’s lymphoma cells. The diagnosis is easy among a child presenting a tumoral mass on the maxillary bone. The treatment consist of chemotherapy [3]. Fig 3: Burkitt’s lymphoma
  • 2. • Tubercular cervical lymphadenitis : frequency increasing because of HIV epidemic; third extrapulmonary localization, first peripheral node localization, 20% of fistulization (Fig 4), presenting as a unilateral painless neck mass among young adults. The role of surgery in the treatment of isolated peripheral tuberculous lymphadenitis should be limited [4]. Fig 4: fistulized tubercular cervical lymphadenitis• Otologic disorders: chronic otitis media: is very common ABSTRACT and characterized in sub-saharan Africa by a high rate of Background: Ear, nose and throat practice in complications affecting children: acute mastoiditis (Fig 5a &5b), meningitis, hearing impairment. Surgical treatment is accessible sub-saharan Africa exposes one to a variety of with difficulties because of lack of surgical instruments and ENT diseases consistent with a tropical region. It otologist personnel [5,6]. is also interesting to note that many West physicians are totally unfamiliar with them. Material and Methods: Personal practice during one resident semester of training in hospitals of Senegal and meta-analysis of studies of ENT tropical diseases.• CONCLUSION: Tropical diseases should be kept in mind Results: In this presentation, special emphasis by the ENT surgeon when considering patients under two will be given to rhinoscleroma, noma, Burkitt’s different sets of circumstances: one (the commonest) when lymphoma, some common otologic disorders the patient is an immigrant, and the other when he has and infectious and granulomatous lesions returned from a journey overseas. Due to the rapidity and involving the ear, nose and cervical area, ease of world travel today, knowledge, diagnosis and Conclusion: Due to the rapidity and ease of treatment of ENT tropical diseases are important for the world travel today, knowledge, diagnosis and West otolaryngologist. treatment of ENT tropical diseases are important for the West otolaryngologist. Key words: otorhinolaryngology, tropical, noma, rhinoscleroma, Burkitt’s lymphoma. REFERENCES [1]Ouoba K, Sangare L, Dao M, Sakande B, Sanou A. Le rhinosclérome: épidémiologie, clinique et thérapeutique à propos de 51 cas observés au C.H.N de Ouagadougou. Les Cah ORL1995;31:514-8 [2] Baratti-Mayer D et al. Noma: an "infectious" disease of unknown aetiology. Lancet Infectious 2003;3;419-31 [3]Segbena AY, Kueviakue M, Vovor A, Tatagan-Agbi K, Assimadi K, Napo-Koura GA, Kpodzro K. Le lymphome de Burkitt au Togo. Aspects épidémiologique, clinique, thérapeutique et évolutif. Méd Afr Noire 1997;44:141-5 [4]Kinde-Gazard D, Anagonou YS, Gninafon M, Tawo L, Josse R. Les adénopathies cervicales dorigine tuberculeuse: aspects épidémiologique, diagnostique et thérapeutique au centre national hospitalier de pneumophtisiologie Fig 5a & 5b: cholesteatomatous chronic otitis complicated de Cotonou. Méd Afr Noire 1997;44:90-94 by mastoitidis [5] Diop EM, Diouf R, Ndiaye IC, Tending G, Faye M, Tall A. Traitement des otites moyennes chroniques cholestéatomateuses: quelle stratégie pour un service dORL dAfrique? JFORL 1996;45:145 [6] Kangsanarak J, Navacharoen N, Fooanant S, Ruckphaopunt K. Intracranial complications of suppurative otitis media: 13 years experience. Am J Otol 1995;16:104-9

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