Congress of the Tanzanian ENT Society (TENTS)

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Congress of the Tanzanian ENT Society (TENTS)

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In November 2015 team of the World Hearing Center was conducting hearing screening in Kigali in Rwanda and in Kilimanjaro in Tanzania and took part in the Congress of the Tanzanian ENT Society. Specialists participating in the Congress – otorhinolaryngologists, head and neck surgeons, and otoneurologists – represented the largest ORL centers in Tanzania, including the Muhimbili National Hospital and Kilimanjaro Christian Medical Centre.

Honorary guests of the conference were Prof. Henryk Skarżyński, Ass. Prof. Piotr Skarżyński, Prof. Gayle E. Woodson (USA), Dr. Niels Van Heerbeek (the Netherlands) and Dr. Robbins (USA). Among the participants the World Hearing Center represented also Adam Piłka, MSc Eng., Marta Zwolińska, MA, Kamila Osińska, MD and Aymen Mohamed Najjar, Eng.

Conference had been organized on the initiative of dr. Edwin Liyombo, head of the ORL Clinic of the Muhimbili National Hospital in Dar es Salaam and president of the Tanzanian RNT Society, organization dedicating its activities to raising knowledge and qualifications of medical professionals in Tanzania.

The conference addressed all major problems of present ORL. One of the most important was considered to be the topic of partial deafness. Ass. Prof. Piotr H. Skarżyński in his presentation has spoken about its surgical treatment method using a six step procedure develop by Prof. Henryk Skarżyński and hearing results obtained in different groups of patients after cochlear implantation. In his second presentation Ass. Prof. P.H. Skarżyński has introduced a concept of hearing screening with application of the Sense Examination Platform presenting the results of these examinations conducted by a team of experts from the Institute of Physiology and Pathology of Hearing in 12 countries in Europe, Asia and Africa.

The Institute of Physiology and Pathology of Hearing is one of the dynamic centers specializing in cochlear implants. Tanzanian experts were very interested in presentation of Marta Zwolińska and Aymen Mohamed Najjar about teleaudiology, telefitting and remote rehabilitation of hearing, crucial for access for an effective treatment of hearing disorders.  These innovative methods can find application also in Tanzania, where internet availability and bandwidth are consistently growing. Thanks to telemedical applications in Africa it could be possible to provide consultations for local patients with complex ORL disorders from Kajetany and to provide remote training courses and workshops for doctors organized by experts from the Institute.

Dr. Kamila Osińska from the Institute has presented a problem of perinatal causes of hearing loss. According to the newest report of the World Health Organization, profound hearing loss occurs in 1-3 in thousand births. In a group of newborns treated in neonatology clinic this rate is higher – severe hearing disorder have 2-4 in thousand children.  Statistical analyses performed in the Institute show that among pediatric patients the largest group of cochlear implant recipients constitute children born prematurely in 24-28 week. Most frequently occurring risk factors of profound hearing loss are perinatal asphyxia, ototoxic drugs, ventilation though a respirator, intrauterine infections or hyperbilirubinemia. Dr. Osińska has underlined that qualification of the youngest patients for cochlear implantation must be performed with utmost caution. Immaturity of other systems may be a contraindication for a procedure performed under general anesthesia.

Other presentations at the Congress of the Tanzanian ENT Society included also information about the newest developments in treatment of hearing disorders with a bone conduction device Baha Attract. It is an efficient method of treatment of different types of hearing loss: conductive, mixed moderate and single sided deafness. Very often it is the definitive method of treatment in advanced ear lesions such as chronic otitis media with cholesteatoma. This system allows achieving a significant improvement in speech understanding is easy to use and – as it has been observed in an extended follow-up period – allows patients achieving better and better hearing benefits. Follow-up on a large group of patients suggests that it is an effective method of treatment of hearing loss in cases of very advanced post-inflammatory or postoperative lesions as well as in congenital external and middle ear malformations.

Lectures presented on the Tanzanian Congress included also presentations about the possibilities of treatment of head and neck neoplasms. Particular attention had been given to surgical techniques and steps allowing avoiding the most common complications after oncological operations. Prof. Mark Zafereo from the University of Texas has presented information about the chief types of salivary gland lesions and possibilities of treatment of laryngeal and laryngopharyngeal cancer. Prof. Gayle E. Woodson from the Southern Illinois University School of Medicine in Springfield has spoken about one of the most frequent complications in thyroid surgery – vocal fold paresis, its causes and treatment possibilities.

During their stay in Africa the team of the World Hearing Center had been conducting for two days, hearing screening tests among school children. Such screenings will enable comparing the scale of hearing loss incidence in Tanzania and Rwanda with populations of other countries in Africa, Asia or Europe. Activities of our specialists have met with a very positive reception of local communities. Often they have spoken about a need for screening examinations being conducted on a regular basis by local specialists. Detailed questions have been asked about the equipment, testing technique and diagnostic follow-up in detection of hearing loss and later its treatment.

First hearing screening examinations have been conducted in Kigali in Rwanda in two schools maintained by pallottine missionary sisters. Screening examinations have included 195 patients aged 4-20 years, in which the largest group was children 6-11 years old. Examinations were performed using video otoscope, pure-tone audiometry, Sense Examination Platform and otoacoustic emissions. There are 40% of incorrect results of OAEs or pure-tone audiometry and 44% of incorrect results of otoscopy. The most frequent ear problems included excessive cerumen, adhesions, tympanosclerosis, retraction pockets and tympanic membrane perforations. One patient had been diagnosed with a bilateral chronic suppurative otitis media requiring an immediate medical attention.

Nest hearing screening examinations have been conducted in a primary school in Moshi in Tanzania. They have encompassed 200 children aged 5-11 years, the largest age group were children aged 6-8 years. The range of examinations performed was the same as in Kigali. Results have shown 42% of incorrect results of hearing for at least one ear and 59% incorrect results of video otoscopy. Most frequently observed problems included excessive cerumen, adhesions, tympanosclerosis, atelectasis of different degrees, otitis media with effusion, abnormal anatomy of outer and middle ear. Two cases of acute otitis media have been diagnosed and one case of chronic otitis media. That child had been referred for treatment in the local health center. According to the specialists from Moshi, acute otitis is one of the most common diseases of Tanzanian children. This was supported by post inflammatory lesions frequently observed in video otoscopy. Scarce cases of acute otitis or effusion observed in screening examinations were related to season – screenings were conducted at the beginning of short rains season, before the period of the maximum incidence of upper respiratory infections.

Analysis of the results of screening examinations in Rwanda and Tanzania suggests significant difficulties with regard to detection and treatment of hearing loss in children. Positive attitudes of local experts and observed large need and openness for audiology and otology training give hope for establishing wide and long term cooperation between specialists from Kajetany and Africa.