ENT in Africa

It would be fascinating to figure out how to capture the excessive noise generated in the universe, especially the developing countries, and use same to generate electricity, enough to supply the energy needs of these countries. Just exactly how this could be achieved shouldn't be rocket science, as nature, in form of delicate transduction mechanism of the inner ear already provided us with the blueprint.
Virtually all current sources of electricity used in developing countries - hydro-dam, Thermal plants, gas turbines, Coal generating plants - as well as other artificial alternatives (generators) and social contraptions (lorries, cars, diesel engines, caterpillars, discotheques, social and political gatherings generate tremendous amount of sound.
What is so exciting about this form of energy is that it is infinitely renewable, as sound generated can be captured, stored, and reuse. It is also likely to have the best green credential among alternative energy sources. Imagine the scenario where you are short of electricity, and all you need to do is power on your stereo to highest volume (with ear muff and bolted doors of course!) for few minutes, and pronto, you have enough "suel" for your local electric supply for days.
To be realistic, an equally green alternative to amplify the energy generated, and transport it over a long distance would need to be invented.
Subsequent aspect of this blog will examine in detail technical feasibility of the Sonar Electricity generation

Hearing loss, despite advances in technology is known to affect over 200 millions worldwide, with sensorineural hearing loss presenting clinicians with most challenges to treatment. This is because the major cause of sensorineural deafness - loss of hair cells and spiral ganglion neurons due to aging, antibiotic use, noise exposure, and genetic defects [Lin J et al, 2007], and once lost, there is no regeneration of such hair cells in human [Lowenheim H et al, 2008]. After moderate cochlear trauma, hair cells degenerate and their places are taken by phalangeal scars formed by differentiated supporting cells [Rapheal, Kim, Ozumi & Izumikawa, 2007].
With hearing aids and cochlear implants offering limited improvement in hearing loss restoration, attention of clinicians and researchers is turned towards regenerative medicine especially stem cells therapy. A key goal in developing therapy for sensorineural deafness is the identification of strategies to replace lost hair cells [ Breuskin, Bodson, Thelen, et al, 2007].
One approach to hair cell regeneration targets cochlear stem cells /progenitors which are known to be quiescent in the Organ of Corti, and the genes they expressed, with the purpose of inducing such cells to differentiate into hair cells (inducible stem cells therapy), while other approach (Molecular therapy) borrows from the knowledge of spontaneous regeneration of avian organ of Corti, by targeting the supporting cells that are known to lose their differentiated features after severe insults or prolonged hearing loss and become a simple, flat epithelium. Gene disruption of the cell cycle inhibitor p27(Kip1) allows supporting cell proliferation in the organ of Corti in vivo. Furthermore, in vitro studies indicate that newly generated cells may differentiate into hair cells after p27(Kip1) disruption [Lowenheim H et al, 2008].
In either of these strategies, hair cell specific genes known to be essential for hair cell differentiation or maintenance such as ATOH1, POU4F3, GFI1, and miRNA-183 will be utilized with the hope of completely restoring hearing to all patients with hearing loss [Pauley, Kopecky, Beiel et al, 2008].
Finally, the issue of best route to introduce stem cells into the cochlea for deafness theapy is also being addressed. Injection via lateral wall cochleostomy was recently described [Bogaets S et al, 2008].

The just concluded XXV Barany Society Meeting that took place in Kyoto, Japan, March 31 - April 3, 2008 was a great opportunity for specialists in all areas of vestibular care and research t mix and compares notes as well as provides insight into the progress of research in balance and dizziness disorders.
Being the first Barany Meeting to feature didactic teaching session, the first day featured lectures on basic physics, neurophysiology, neurology, otology, ophthalomology, multi-sensory interactions, and audiology that a neuro-otologist is expected to fathom.
Distinguished speakers at this session include Herman Kingma, Straussman D, Lloyd Minor, M. Magnusson, Zee D, Adolfo Bronstein and a representative on Linda Luxon.
A warm welcome dinner at International Conference Centre, Kyoto, followed.
the next three days featured 2 plenary sessions ((1)Self motion and Perception; and (2) Oculomotor System and adaptive plasticity); 2 lunchtime lectures (speakers were Cohen b (US A) and Brandt T (Germany), multiple oral, podium and poster sessions, as well as 14 symposiums on topics like Meniere's disease and related disorders, Posture and locomotion, Genetics, development and regenration; Clinical testing for vestibular function; Pursuit vestibular interaction, Neural mechanism of self motion perception, Positional and Positioning vertigo, Visual-vestibular interaction, Vertical eye movements, Autonomic functions and Migraine, Visual backup mechanism to the VOR, and Vestibular compensation.


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This week, I choose to play deaf advocate in order to further highlight the plight of the hearing impaired in Africa, especially in the aspect of hearing rehabilitation.
It is worrisome that due to conspicuous abscence of central hearing aid distribution and regulation in most parts of Africa, a large number of hearing-impaired are left to deal directly with hearing aid dispensers, most of whom are profit driven.
Now the paradox of letting someone largely un-informed about technology as complex as hearing aid loose to a profit-driven private hearing-aid dispenser is best imagined. The result might be the increasing report of non-user (personal observation) among paediatric patients fitted with hearing aid.
The point is we do know that the hearing aid prescription procedure for infants and young children should be based on real-ear aided gain rather than insertion gain(Seward R, 1995; Dillon H, 2001). Children, unlike adults cannot voice their complaints if the HA is uncomfortably loud or produces irritating noise. The outcome might be the child's rejection of the HA anytime it is switched on.
The paradox is the poorly regulated field of hearing aid distribution system in Africa produces more non-users (in theory) which in turn worsen the statistics on hearing impaired.
But how can we regulate hearing aids fitting if we do not possess means of assessing that the hearing aid meets minimum criteria of standard expected for hearing aids? We have witnessed situations where greedy but hearless traders imported tinnitus maskers and sell them as hearing aids! We have also witnessed situation where low quality hearing aids, not recommended for use in countries they emanated from, get imported to Africa - all in the name of 'Africans are poor people' But a child carrying poor hearing aid is worse off than a child not aided at all.
One solution is to establish regional acoustic laboratories (if individual countries of Africa cannot afford one) to regulate (See hyperlink ) and oversee regional dispensation and fitting of hearing aids in Africa.
Biodun

This passing week is bit event-filled for me.
First, I lost a friend and a mentor-of-sort - Dr Eribo - A retired pediatrician, who was like a non-biogical dad to me over the past one-and-half decade.
Secondly, tried as much as I could, I was unable to secure a flight to Sierra Leone for the WACS meeting, where I was scheduled to give two papers. This is due to over-booking of the only airliner that flies that route from Nigeria. Attempts to break down the flight was futile. as Ghana airways, the other option cannot be reached and booked from Nigeria - was told Ghana airways no longer have operational base in Nigeria.
Thirdly, I read this interesting article (Elshaug, Moss, Hiller & Madden, 2008) published in January 5 edition of BMJ providing evendence base from published literature tothe effect that upper airway surgery should not be the first line treatment for OSAS - wait a minute! that refrain is familiar!! - and that even where CPAP (the recommended first line treatment by this paper) and even the adjunctive weight reduction have failed, mandibular advancement devices may be considered as second line, with the surgical option considered as last option, and patient informed of inconsistent result of surgery!
The lead authors of this paper were all public health specialists. I am not sure whether otolaryngologists, writing on same subject could have arrived at same conclusion.
As for otolaryngologists practicing in Africa, even the issue of extensive sleep centre investigations prior to upper airway surgery for OSAS is a luxury as many centres lack such specialized sleep centers, and surgery is oftened offered on the conviction of the surgeon of possible benefits to such patients who are more likely to have explored every other alternative therapy before presenting to otorhinolaryngologists
Biodun

I spent this weekend doing a web search on certain issues partaining to cellphone and remote health care. Then it dawn on me that the otological effects due to cell phone use need to be highlighted in this week's blog.
A quick medline search for the term 'cellphone and the ear' returned 46 references
This is hardly suprising. After all, you don't hold your cellphone over your eyes, nose, leg or abdomen when making or taking a call, but over your pinna, temporal region including the mastoid area
Otological effects of cell phone use, like other medical effects, could be theoretically classified into thermal, non-thermal, and the so-called geno-toxic effects.
In general, the reported otologic effects of cell phone use could be visualized as relating to three issues:
1. Heat generated by cellphone battery
2. Radiofrequency emmsion from the cell phone,and from the base stations
3. Noise generated from cell phone applications - radios, MP3 players, etc

With respect to the first, Tahvanainen K et al (2007) studied the effect of cellular phone use on ear canal temperature using thermistors, and observed that RF exposure to a cellular phone, either using 900 or 1800 MHz with their maximal allowed antenna powers, increases the temperature in the ear canal.
Effects of cellphone use resulting directly from RF emmision reported ranges from insiginificant (McIntosh RL et al, 2008), Paglialonga A et al, 2007, Parazzini M et al, 2007, to anecdoctal report of tinnitus, and vertigo, to even development of vestibular schwannoma

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