Browsing by Author "Peer, Shazia"
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- ItemOpen AccessClinical correlations to distinguish from milder forms of obstructive sleep apnoea syndrome using overnight oximetry to prioritize adenotonsillectomy in a low resource setting(2022) Mlauzi, Raphael; Peer, ShaziaBackground: In resource-poor settings with limited surgical services, it is essential to identify and prioritise children with severe and very severe obstructive sleep apnoea syndrome (OSAS) to expedite surgery. McGill's Oximetry Score (MOS) has been validated against polysomnography for OSAS and is affordable and easy to use. Aims: The aim of this study was to assess the correlation of tonsillar size and clinical symptoms with MOS grade 3 or 4, to identify who requires overnight oximetry and who to prioritise for adenotonsillectomy. Methods: Children with suspected OSAS were recruited from the otolaryngology clinic at the Red Cross War Memorial Children‟s Hospital. Demographics, symptom screening scores (SSS), patient characteristics, overnight oximetry (OO), echocardiography and MOS scores (graded 1- 4) were recorded. Multivariate modified-Poisson regression models were used to examine correlations of patient characteristics „with grade 3 or 4 MOS. Results: One-hundred-and-three children were analysed, 38% were female, and median (IQR) age was 3.8 (2.5-5.3) years. Increased tonsil size was associated with a 60% increased risk of grade 3 or 4 MOS, risk ratio (RR) 1.59, 95% CI 1.10-2.29 (p=0.014). Children with witnessed apnoeic events during sleep had 1.3 times increased risk of MOS Grade 3 or 4, RR 1.31, 95% CI (p=0.033). A significant correlation was shown with grade 3 or 4 MOS, RR 1.15, 95% CI 1.03-1.27 (p=0.010) by combining tonsillar size with the following symptoms: apnoeic events; struggling to breathe during sleep and; needing to stimulate the child to breathe. Conclusion: Identifying children with suspected OSAS who require overnight oximetry can be performed using a simple 3-question screening tool: witnessed apnoeic events, struggling to breathe and the need to shake them awake to breathe. This is more precise with an additional clinical finding of grade 3 or 4 tonsils. These children should have surgery expedited. Any child with a MOS 3 or 4 score on OO needs to have expedited surgery.
- ItemOpen AccessDeep Neck Space Infections In Infants At A Tertiary Referral Centre: A Case Review(2023) Moyo, Charles; Peer, ShaziaBackground: Persistent upper respiratory tract infections in infants can lead to retropharyngeal lymphadenitis. If untreated, they can progress to deep neck space infections (DNSI). Objective: To review surgical management of DNSI in infants, and to determine optimum timing of surgical drainage, and sequelae thereof. Methods: A retrospective study of infants presenting with DNSI, was conducted at Red Cross War Memorial Children's Hospital, Cape Town, between May 2018 to March 2022. Medical folders were reviewed, data collected included demographics, clinical presentation, investigations, management, and post-operative course. Ethics approval was obtained prior to commencement. Results: Six children with DNSI were identified, aged between 3-12 (average 6.7) months. None had any preceding comorbidities; 2/6 (33%) children incidentally tested positive for Covid-19; 4/6 (67%) had preceding URTI, 3/4 (75%) having commenced antibiotics prior to presentation. Common clinical findings were neck swelling in 5/6 (83%) and fever in 6/6 (100%); stridor in 4/6 (67%) and dysphagia in 3/6 (50%). The average white cell count (WCC) was 21.5 (range 12.6-34.3) *109 /L. 3/6 infants had measured procalcitonin levels between 0.23-2.74 (average 1.10) ng/ml. DNSI was identified on CT imaging in all cases in the following deep spaces: retropharyngeal 6/6 (100%); parapharyngeal 4/6 (67%); superior mediastinum 5/6 (83%); anterior cervical 2/6 (33%); posterior mediastinum 1/6 (17%) and paratracheal 1/6(17%). Abscess size of more than 3cm with airway displacement was seen in all cases. 5/6 (83%) infants underwent surgical intervention within 24hours of presentation. Delayed surgical intervention in 1/6 (17%) resulted in “antibioma” formation and delayed surgical drainage. Methicillin sensitive staphylococcus aureus (MSSA) was cultured in 5/6 (83%) cases; no organisms were identified in the remaining case. 5/6 (83%) were managed post-operatively in the ICU for 3-9 (average 5.8) days. Empiric intravenous therapy was commenced in all cases, namely, Co-Amoxiclav (4/6) and Piperacillin/Tazobactam (2/6). Amikacin was additionally administered in 1 case for presumed nosocomial respiratory infection prior to DNSI management. Culture-directed therapy modified treatment to Cephalexin/Flucloxacillin in 2/6 cases. Neck drains were removed after an average of 2.8 (range 1-6) days when output was minimal. Duration of hospital stay was 13 (range 5-19) days. There were no mortalities. Conclusion: DNSI is a rare but serious complication of progressive retropharyngeal lymphadenitis resulting from non-resolving or worsening URTIs in infants. This was observed in all six cases. Typical presentation includes neck swelling, fever, and airway compromise often requiring prompt airway management with source control. Recommended management includes CT imagining of head, neck and chest to determine extent of spread, appropriate intravenous antibiotics, and prompt surgical drainage. Medical therapy alone can risk antibioma formation, with inevitable surgical clearance of sepsis.
- ItemOpen AccessHearing loss in the developing world : evaluating the i-Phone mobile device as a screening tool(2014) Peer, ShaziaBackground: Hearing loss is a global health burden affecting 360 million people. The highest prevalence is in the Developing World where hearing screening programmes are scarce, and failure to address growing high-risk populations will result in new deaf communities. In resource stretched communities such as these, new strategies to alleviate this burden are necessary. Advances in technology have led to innovative mobile digital devices like smartphones and tablets with the potential to test hearing through audiometric applications. Given the recent upsurge of mobile technology in Africa, it is befitting to determine whether the implementation of science can translate to health service delivery. Objectives: To validate the Apple iPhone mobile device using the uHearâ„¢ application "app" as a possible hearing screening tool in the Developing World.
- ItemOpen AccessHow accurate is translaryngeal ultrasound when compared to flexible nasal endoscopy in viewing vocal cord mobility in children?(2025) Ramyead, Divya Pallavi; Peer, ShaziaObjectives: Flexible fibreoptic laryngoscopy (FFL) is currently the gold standard for assessment of true vocal cord (TVC) mobility but is invasive and not without risk. The COVID-19 pandemic has led to growing interest in assessment tools that avoid aerosol generation and risk for transmission of disease. Transcutaneous laryngeal ultrasonography (TLUS) is a potentially useful, non-invasive alternative diagnostic tool for assessing true vocal cord (TVC) mobility.The aim was to determine the accuracy of an application-based TLUS as a screening tool for mobility of the true vocal cords (TVC), and to assess the feasibility of its use by an otolaryngologist not formally trained in ultrasonography. Methods: This was a prospective cohort study conducted after approval by human research ethics committee (HREC 202/2021). Forty children attending the ENT clinic at Red Cross War Memorial Children's Hospital (RCWMCH) for an upper airway assessment with FFL were recruited. Exclusion criteria were children on oxygen; with airway instability, and with behavioural disorders. The first author (DR), an ENT registrar without prior knowledge of ultrasonography, was trained by a consultant radiologist to use the Lumify® handheld ultrasound probe and application tool to assess the larynx and true vocal cord mobility. Combined TLUS and FFLs, short, looped and anonymised videos were formulated. Two qualified ENT specialists (neither trained in ultrasonography) consented to evaluate videos for true vocal cord mobility. Results: In total, 135 videos were obtained from 40 participants. Ages ranged from10 days to 9 years, and the genders were equally represented. On FFL, 92.5% (n=37/40) had normal TVC mobility and 7.5% (n=3/40) had unilateral TVC palsy. The overall accuracy of TLUS evaluation was 95.5% (sensitivity of 100%, specificity of 60%). Although the proportion of cases where normal mobility was correctly identified was 93.3% (n=120/135), the proportion of cases in which abnormal mobility (unilateral vocal cord mobility) was present and correctly identified was 100% (n=135/135). The reliability of TLUS when compared to FFL showed a p value <0.001 and a 100% agreement between ENT specialists evaluating the shared videos. Conclusions: Our study shows TLUS to be a reliable method of assessing TVC mobility. It is also portable, non–invasive and easy-to-use, making it a potentially useful screening tool especially in resource-limited settings, where FFL might not be readily available. Furthermore, it has potential benefit as a screening tool for TVC assessment for practitioners other than radiologists, e.g., otolaryngologists, who have a good understanding of laryngeal anatomy. More studies are needed to fully elucidate use of diagnostic and therapeutic ultrasound in children with airway conditions.
- ItemRestrictedJuvenile onset Recurrent Respiratory Papillomatosis (JoRRP) at Red Cross War Memorial Children’s Hospital, Cape Town: A 2-year review(2019) Pretorius, Vincent; Peer, Shazia; Fagan, JohanIntroduction: Juvenile onset recurrent respiratory papillomatosis (JoRRP) is the commonest benign paediatric neoplasm. There is no curative treatment, but the condition is self-limiting. Current primary treatment is aimed at symptomatic relief, comprising of serial surgical debulking of obstructive papillomas along the respiratory tract, with voice preservation. Adjuvant therapy is indicated in severe cases. Objective: A review of children with JoRRP presenting to the ENT Department at Red Cross War Memorial Children’s Hospital (RCWMCH) over 2 years. Evaluation of the pattern of disease and factors that may contribute to disease severity were reviewed. Method: Retrospective folder review of children with histologically confirmed laryngeal papillomatosis over above the time period. Results: Twenty children were included. Nine were male, 11 were female. The median age at diagnosis was 2.4 years (11 - 109 months). Presentation at < 3 years was noted in 5/7 of the most severe cases. Nine of 20 were HPV serotyped; 5 were type 11, and 4 were type 6. Eighty percent (16/20) were HIV negative; 10% (2/20) HIV positive; and 10% (2/20) were unknown. A total of 90 surgical procedures were performed; the highest number of surgeries per child was 13. Inter-surgical time was 1 to 164 weeks (median 9 weeks). Four received Gardasil vaccination as adjuvant therapy, 3 of who showed a reduction in disease severity. Conclusion: JoRRP commonly presents around the first 3 years of life. Severe cases can be life-threatening, often with multiple hospital admissions for clearance of surgical papillomata. Severe cases presented before 3 years. Gardasil vaccination as adjuvant therapy has promise. No identifiable risk factors in our review were noted. HIV co-infection and HPV type were not risk factors for severity.
- ItemOpen AccessPerioperative antibiotic practices amongst Otorhinolaryngologists (Ear, Nose & Throat Surgeons) in South Africa(2023) White, Matthew; Peer, ShaziaBackground: The primary goal of perioperative antibiotics is to reduce the rate of surgical site infections (SSI); however, in certain surgical procedures, the use of perioperative antibiotics has been shown to have no impact on the rate of SSI. Inappropriate use of antimicrobials not only comes at increased cost and risk of side effects to the patient, but also promotes antibiotic resistance. Antibiotic resistance is arguably one of the greatest current and future threats the health sector faces globally; accounting for approximately 700 000 deaths in 2016, which is projected to rise to 10 million by 2050. In otorhinolaryngology, multiple evidence-based guidelines have been developed to guide decision-making regarding antibiotic prophylaxis in ear, nose and throat (ENT), and head and neck surgery. This study aims to provide insight into the adherence of South African ENT surgeons to available evidence-based international guidelines. Methods: An electronic survey was sent to practising ENT Surgeons in South Africa. Surgeons were asked to indicate their personal antibiotic prescribing practise for general and subspecialty procedures. Results: A total of 92 members of the South African ENT society completed the survey. Respondents indicated that they utilize the following resources to guide their decisions regarding perioperative antibiotic prescribing: anecdotal evidence 27 % (25/92), practices of the surgeon's postgraduate training unit 28% (26/92), published international guidelines 28% (26/92), recommendation of their local hospital's microbiologists 14% (13/92), attending anaesthetists discretion 0 % (0/92). Respondents indicated they take the following factors into consideration to guide decisions regarding perioperative antimicrobial use: 48% (35/92) duration of surgery, 85% (78/92) degree of contamination of the surgical field, 8% (7/92) patient's age, 8% (7/92) degree of blood loss, 22% (20/92) HIV status of patient, 32% (20/92) patient's access to hospital. 35% (32/92) of respondents indicated they audit their own rate of wound complications. For paediatric tonsillectomies, 35% (32/92) routinely prescribe perioperative antibiotics. For insertion of tympanostomy tubes, 50% (46/92) prescribe systemic perioperative antibiotics and 77 % (61/92) use ototopicals. Conclusion: There is significant heterogeneity in the use of perioperative antibiotic prescribing practices and variable adherence to international consensus guidelines amongst ENT surgeons in South Africa. In light of the global increase in antibiotic resistance, this study highlights the need for increased awareness regarding the principles of antibiotic stewardship, pre-existing evidence-based guidelines and the need for a locally-generated South African Otorhinolaryngology consensus guideline that promotes safe and rational use of perioperative antibiotic prophylaxis.
- ItemMetadata onlyPrimary Ear and Hearing Care Training Manual for Health Workers(University of Cape Town, 2022-01) McGuire, Jessica; Doyle, Gregory; McNamee, Lakshini; Prinsloo, Lene; Peer, Shazia; McGuire, JessicaThis resource is on a site that has been designed for medical students and primary healthcare providers to improve knowledge on ear and hearing health.
- ItemOpen AccessSurgical outcomes of Endoscopic Anterior Cricoid Split and Balloon dilation as treatment for paediatric subglottic stenosis: a retrospective case series(2025) Brownell, Louisa; Peer, Shazia; McGuire, Jessica; Wright, KateObjective: Subglottic stenosis (SGS), congenital or acquired, can present as life-threatening airway emergencies or ongoing respiratory symptoms in paediatric patients. In resource-limited settings, identifying a first-line surgical option to definitively manage SGS, as opposed to permanent tracheostomy, is the ideal. The aim of this study is to review endoscopic anterior cricoid split with balloon dilation (EACSBD) as the first-line definitive treatment option for selective SGS cases, in a resource-limited setting, and to retrospectively compare outcomes with published literature. Study design: Retrospective Case Series Setting: Tertiary Paediatric State Hospital in Cape Town, South Africa. Methods: Medical records of children with SGS managed with EACSBD from Jan 2020 to July 2021 were reviewed. Data collected included preoperative characteristics, intraoperative findings, postoperative course, and clinical outcomes. Successful treatment was defined as resolution of symptoms with no baseline respiratory distress. Institutional ethical approval was obtained prior to commencement. Results: Eight patients aged between 3-17 months (mean age of 6,8 months) were identified. Cotton-Myer grades ranged between 1-3. The aetiology of the subglottic stenoses were: 4 acquired, 3 congenital, 1 mixed. Five patients did well with no further intervention necessary. One patient required a single follow-up laryngoscopy and balloon dilation. Overall, 6 patients (75%) had successful treatment and remained symptom-free. All congenital SGS (3/8) patients were successfully treated. Two patients failed EACSBD for reasons unrelated to the procedure. One patient (1/8) remained intubated for 41 days post-operatively and required a tracheostomy for respiratory failure secondary to severe pulmonary tuberculosis. Three children had post-operative aspiration, two resolved with speech therapy. One child went home on nasogastric feeding. No procedural complications were reported. Conclusion: This is the first study from sub-Saharan Africa to describe a series of EACSBD in selective paediatric SGS. All congenital cases in our cohort were successfully treated, contributing to an overall success rate of 75%. EACSBD is therefore a safe and effective surgical option for selected paediatric subglottic stenosis. It is well-suited for resource-limited settings by offering a definitive solution that may avert a tracheostomy. However, it should be used with caution in patients with additional laryngeal pathology, those with higher risk of aspiration, and in cases of co-existing lung disease. Careful patient selection is therefore essential to achieve optimal outcomes.
- ItemOpen AccessThe Assessment of quality of life in children with Tracheostomies and their families in a Low to Middle Income Country (LMIC)(2021) Din, Taseer Feroze; Peer, ShaziaIntroduction The Breatheasy© Tracheostomy Program based at the Red Cross War Memorial Children's Hospital, Cape Town, manages children mostly from poor socio-economic backgrounds. In our resource-limited setting, it is unclear how these families cope with the demands of a tracheostomised child. We aim to assess the quality of life (QOL) of tracheostomised children and their families as the first study of its kind in a low-resource setting. Methods A descriptive, observational study was done to assess the QOL of tracheostomised children managed by the Breatheasy© Program over 10 months. Children with tracheostomies for longer than 6 months, complex syndromic children, and home ventilated children were included. The validated Paediatric Tracheotomy Health Status Instrument (PTHSI) was utilised, where a higher score, implied a better outcome. Results A total of 68 families were recruited. In 57 (85.1%) of the carers, the highest level of education achieved was primary or high school. Twenty-seven (42%) families reported having an annual household income of less than $675 US Dollars (ZAR10,000). Sixteen (24%) resided within informal housing. The mean scores for the 4 PTHSI domains were: physical symptoms 24.8/35 (70.9%), frequency/financial impact of medical visits 14.2/15 (94.7%), QOL of child 8.8/15 (58.7%), QOL of carer 62.3/85 (73.3%); the overall score was 110.2/150 (73.5%). There was no significant correlation between total PTHSI and annual household income, carer's educational status or type of housing. Children with a concomitant major medical condition had a significantly poorer total PTHSI scores (p-value 0.024). Conclusion Tracheostomy care compounds challenging socio-economic circumstances. In our experience, with adequate training, home-care nursing is not necessary. Despite difficult living conditions, the Breatheasy© Program empowers children and their families to live independently of the hospital system and appear to be thriving. The decision to perform a paediatric tracheostomy should not be influenced by the carer's education level, socioeconomic status, or on the basis of formal or informal housing. Children with major medical comorbidities represent a group that requires more support.