Health experts have uttered divergent views on the medical trip of President Muhammadu Buhari to the United Kingdom.
Head, Department of Ear Nose and Throat (ENT) Lagos University State Teaching Hospital (LASUTH), Dr Vincent Adekoya said there was nothing wrong with a patient seeking second opinion, especially if the facilities for treating such ailment was not available in the country.
According to Adekoya, there are various ear diseases that may demand second opinion.
Besides, one or two patients who visit ENT clinic often experience dizziness due to endolymphatic hydrops – a Meniere’s disease.
Why this? He said the ear has two functions – hearing and maintaining balance.
He said something can be blocking the inner ear’s channel where the order of balance is, and as such, the patient may experience dizziness, among other conditions.
“But a lot people blame this on stress, alcoholism, sodium potassium imbalance and infective process somewhere in the ear; although the cause of fluid accumulation is unknown. What is known is that through tests we can see whether a tumor is growing in the ear or not,” he said.
Endolymphatic hydrops, he said, can recur in some patients and it may not in the others, but the good news is that the disease can be treated.
He described Endolymphatic hydrops as a disorder of the inner ear that causes episodes, in which patients feel as if they are spinning (vertigo).
He continued: “They also have fluctuating hearing loss with a progressive, ultimately permanent loss of hearing, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear. In most cases, Meniere’s disease affects only one ear”.
The disease, he said, was a common one that patients brought to the ENT on clinic days.
He said a lot of things can cause dizziness but it depends on the symptoms the patients present for experts to identify, which of them is it.
“Those who have endolymphatic hydrops feel dizzy; others diseases may come with vomiting, ear making noise and hearing loss,” he said.
He said Benign Paroxysmal Positional Vertigo (or BPPV) is the most common cause of vertigo, a false sensation of spinning.
Explaining this, he said, the ear has two functions, which is hearing and maintaining balance.
“In this case, something may be blocking the organ for balancing. This may be due to a metabolic condition, among others. When the material blocks the canal the patient can be dizzy. This shows that he or she is suffering from Benign Paroxysmal Positional Vertigo.
He said those diseases mention earlier are inner ear problems.
According to him, there is a vertigo vesila insufficiency.
This, he said, occurs when somebody is ageing, adding that the blood supply to the inner ear passes through the neck bone to supply to the ear organ may malfunction.
“This is when the bone is getting degenerated then there is esophyx and cervical spondylosis. It shows that the blood to the ear is affected. There will be lack of oxygen and blood flow and the patient can experience dizziness.
“Also, from the inner ear to the brain there is a nerve bone and something can be pressing on the nerve. From the inner ear to the brain there is a kind of small canal there. When something is pressed on it, the patient can begin to feel dizzy. This takes time to manifest. But it often progresses to a hearing loss,” he said.
Bad catarrh, he said, can also affect hearing.
He said people can take drugs that can affect the organ for the balance, and as such be feeling dizzy. Some viral infections can affect the organ. “So quite a number of things can affect inner hear,” he said.
Adekoya said: “When patients present with ear problems, we may actually be dealing with one of the three parts of the ear. The ear is divided into three – outer ear, inner ear or middle ear”.
Classification of ear problems, he said, are infections, trauma cases, neoplastic condition which involve cancer cases, metabolic conditions and neurological problems. These conditions can affect outer, middle and inner ear.
“When a patient complains to an ENT, he has investigated which part of the ear is affected,” he said.
He identified are six symptoms of ear diseases, stressing: “A patient can have pain in the ear (otalgia). Patients can feel noise in the ear or have hearing loss. He may also suffer discharge in the ear and pain in the ear. Many also have dizziness and speech problem”.
As experts, he said: “Our task is to determine where the problem is coming from”, adding: “We have to investigate whether inner, middle or outer ear problem is what we are dealing with”.
Adekoya said his centre see about 60 cases every clinic day.
He said ENT or other medical field cannot diagnose a patient in absential, adding that experts require about 30 minutes to do proper diagnosis on a patient.
“We need to get the history of the patient and this takes some time. ENT is a very wide area of medicine. And there are varying degrees of ear problems. This ranges from cancer, lymphatic and neurological cases to mention a few.”
He said although it is very rare that ENT experts refer patients but some patients may require it for second opinion, especially if there is not equipment. “Also, a patient can be referred if the hospitals in Nigeria do not do a particular surgery often. Those who have cancer may have surgery abroad and come back to continue the treatment,” he said.
Advising patients, he said, they should be properly evaluated before treatment and then follow up.
He said getting second opinion is very good to corroborate earlier diagnoses but most times, the investigations usually come out as the same thing.
Medical doctors, he said, are trained the same way across the world.
An expert at the department, Dr Adesegun Adeyinka said a younger person suffering from balance problem will get over the problem faster than an older person. There is what is called central correction. This would be faster recovery in a 30 year-old than somebody in his 60s. This allows the ear of a younger person to get better within a short time.
For him, any age group can have ear problems because it does not have to do with age.
He said ear problem can be congenital or acquired. “A child may be snoring as a result of ear problem. Some parents may think their child is stubborn but it may be due to the ear problem.
Some diseases are peculiar with age.
He said conditions, such as snoring and stubbornness due to benign are seen in children from two to three years than in adults.
Diabetes and its complication, he said, can also affect the ear.
Adeyinka said frequent changes in atmospheric whether condition can affect the ear, especially when a patient is on a plane or diving.
He said there is a tube which connects the nose to the ear, adding that the work of the tube is to balance the air pressure in the outside and the middle ear.
It balances the pressure between the atmosphere and the middle ear.
Traveling can affect resistance dysfunction secondary to pressure (barrow) trauma. Barrow means pressure.
This gives injury to the ear.
When somebody has a balancing problem when he is swimming he may be going down when actually he was supposed to be coming up.
Vice President, Commonwealth Medical Association, Dr Osahon Enabulele, has described President Buhari’s oversea medical vacation as a “great shock, sadness, and disappointment”.
He commended Mr. President for the medical disclosure, but condemned the trip.
His reasons: “I am very constrained to state that this foreign medical trip flies in the face of the Federal Government’s earlier declaration of her resolve to halt the embarrassing phenomenon of outward medical tourism, which as at the end of the year 2013 had led to a humongous capital flight of about $1billion dollars, particularly from expenses incurred by political and public office holders (and their accompanying aides), whose foreign medical trips (most of which are unnecessary) were financed with tax payers’ resources”.
He said President Buhari has lost an opportunity to assert his change mantra through a clear demonstration of leadership by example, by staying back to receive medical treatment in Nigeria.
“Without prejudice to the expert recommendation of Mr. President’s Personal Physician and the ENT specialist said to have examined and treated Mr. President in Abuja, I consider it a national shame of immense proportions that Mr. President had to be recommended for foreign medical care/re-evaluation despite the presence of over 250 ENT specialists (and professors) in Nigeria, as well as a National Ear Centre located in Kaduna state,” he said.
His recommendations: “If I were in their shoes I would have advised Mr. President to stay back in Nigeria.”
He urged that a consortium of Nigerian trained ENT specialists in Nigeria to Abuja to re-evaluate and treat Mr. President.
He said if it was determined that the medical expertise was (and I doubt this), any identified Nigerian trained ENT specialist practicing anywhere in the world should be invited to Abuja to re-evaluate and treat Mr. President.
“If it is a case where the health facilities/equipment are unavailable (and this is a possibility) then Mr. President should have used his current medical situation, though unfortunate, to commence the Federal Government’s plan to re-equip Nigerian hospitals with modern state-of-the art health facilities, by ordering for the needed medical equipment to enable the locally available Nigerian trained ENT specialists to attend to him, and thereafter use same facilities to attend to other Nigerians with similar conditions,” Enabule said.
Enabule advised Mr. President to return to the country to receive medical attention to lead by example.
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