Communication MD Tropical ENT: Sub-Saharan Practice

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.
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