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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 27  |  Issue : 4  |  Page : 365-370

Tympanometric findings among Nigerian prison inmates: A cross-sectional survey


1 Department of Otorhinolaryngology, Head and Neck Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
2 Department of Otorhinolaryngology, Head and Neck Surgery, Federal Medical Center, Yola, Nigeria
3 Department of Otorhinolaryngology, Gombe State University, Gombe, Nigeria
4 Department of Otorhinolaryngology, Head and Neck Surgery, University of Maiduguri Teaching Hospital, University of Maiduguri, Maiduguri, Nigeria
5 Department of Otorhinolaryngology, Head and Neck Surgery, University College Hospital, Ibadan and College of Medicine, University of Ibadan, Ibadan, Nigeria

Date of Submission23-Apr-2020
Date of Decision13-May-2020
Date of Acceptance12-Jul-2020
Date of Web Publication04-Nov-2020

Correspondence Address:
Dr. Abdullahi Musa Kirfi
Department of Otorhinolaryngology, Head and Neck Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_96_20

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  Abstract 


Background: Prisoners, due to confinement, are isolated from contact with society and access to many of the facilities, including medical care. There is paucity of data on the middle ear function of prison inmates in the English literature globally. We aimed to assess the middle ear function of prison inmates in Kaduna, Nigeria. Participants and Methods: This was a cross-sectional comparative study of prison inmates at the Kaduna convict prison. Ethical approval was obtained from the Kaduna State Ministry of Health and the Nigerian Prison Service. Prison inmates aged 18–55 years in the Kaduna convict prison with an equal number of age and sex-matched controls from the community were enrolled. Consent was obtained from the participants. Data were collected using a structured pre-tested questionnaire. Participants had a thorough physical examination of the ears. Tympanometry was conducted on suitable participants to assess the middle ear function. Statistical Product and Service Solutions version 20.0 was used to analyse the data. Results: Four hundred and thirty inmates with an equal number of controls were enrolled for the study. The mean age for the inmates and controls was 30.2 ± 7.51 and 30.4 ± 8.02 years, respectively. There were 47 female and 383 males, with a female: male of 1:8.1. Forty-six (46/397, 11.6%) of the inmates and 15 (15/423, 3.5%) of the controls had abnormal tympanograms on the right while on the left, it was 12.4% and 3.8%, respectively. The difference between the two groups was statistically significant (χ2 = 40.071, P = 0.0001). Conclusion: Middle ear abnormalities are more prevalent among prison inmates than the general population. Middle ear effusion and ossicular chain disruption were the most common middle ear abnormalities affecting the prison inmates.

Keywords: Kaduna, middle ear function, Nigeria, prison inmates


How to cite this article:
Kirfi AM, Fufore MB, Quadri OR, Kodiya AM, Benjamin Nwaorgu OG. Tympanometric findings among Nigerian prison inmates: A cross-sectional survey. Niger Postgrad Med J 2020;27:365-70

How to cite this URL:
Kirfi AM, Fufore MB, Quadri OR, Kodiya AM, Benjamin Nwaorgu OG. Tympanometric findings among Nigerian prison inmates: A cross-sectional survey. Niger Postgrad Med J [serial online] 2020 [cited 2020 Nov 24];27:365-70. Available from: https://www.npmj.org/text.asp?2020/27/4/365/299920




  Introduction Top


Major studies on the health of prison inmates were undertaken in developed countries, but there is paucity of data on the health of prisoners in the developing world.[1] Imprisonment serves the functions of; protection of society, prevention of crime, retribution against criminals, rehabilitation and training of convicted offenders, the assurance of justice and the re-integration of the imprisoned back into the society.[2],[3] Globally, the health conditions of inmates within the prisons are usually suboptimal. Overcrowding, undernutrition and deteriorating environmental conditions, pre-dispose the prisoners to develop tuberculosis,[4],[5],[6] contagious diseases[7],[8] and other communicable diseases.[9],[10],[11],[12],[13] In the Carolina United States, Rosen et al.[14] found that alcohol or drug use accounted for about 80% of deaths of Coloured inmates in the prison population, while in Brazil, Mendes dos Santos et al.[15] concludes that the use of drugs and alcohol among female prison inmates was associated with increased health-care problems as well as violent crimes.

Prison inmates are prone to otologic diseases prevalent than the general population. They are also prone to such diseases that are thought to be associated with over-crowding, because almost all prisons in Nigeria are over-crowded.[5],[16],[17],[18] Otologic diseases such as acute and chronic otitis media, acute and chronic suppurative otitis media, otitis media with effusion, otitis externa including malignant otitis externa, especially among diabetic inmates, traumatic tympanic membrane perforations from assault and bullying among the inmates could be seen. All these conditions could lead to middle ear dysfunction resulting in abnormal tympanogram. The ear is divided into three; the external, middle and inner ear.[19] The middle ear cavity also called the tympanic cavity, is filled with air. It also has some tiny bones (ossicles) responsible for the conduction of sound into the inner ear. Any condition that disrupts the aeration of the middle ear cavity, including those earlier stated, is capable of resulting in an abnormal middle ear function, which can be appropriately assessed by tympanometry. There is, however, paucity of data on the middle ear function of prison inmates in the English literature globally, hence the need for this study. This study assessed the middle ear function of prison inmates in Kaduna, Nigeria.


  Participants and Methods Top


This was a cross-sectional comparative study of prison Inmates at the Kaduna Convict Prison carried out over a period of 23 months (April 2017 to February 2019). Ethical approval was obtained from Kaduna State Ministry of Health, Independence Way Kaduna Nigeria (Protocol number: MOH/ADM/744/Vol. 1/461) on 17th August 2016 and from the National Headquarters of the Nigerian Prison Service, Airport Road, Abuja Nigeria (Protocol number: NPS.536/5.3/T2/67) on 26th September 2016. The sample size for the study was calculated using the Fischer formula for cross-sectional studies: n = Z2pq/D2, where n = minimum sample size, z = normal standard deviate which is 1.96 (at 95% confidence interval). P = prevalence of middle ear abnormalities among prison inmates. No such study has been conducted in Nigeria. Hence, the prevalence of 50% was used for calculating the minimum sample size. Therefore: P = 0.5,Q = 1 − p, Q = 1 − 0.5 = 0.5, D = Degree of precision, set at 5% = 0.05,n= 1.962 × 0.5 × 0.5/0.052 = 3.8416 × 0.25/0.0025 = 0.9604/0.0025.N= s384.16 = 384.

Prison inmates aged 18–55 years in the Kaduna convict prison with an equal number of age and sex-matched controls from the community were enrolled. Informed consent was obtained from the participants before enrolment. Data were collected using a structured questionnaire. Participants had a thorough physical examination of the ears, including inspection of the pinna and periauricular area, palpation for tragal tenderness, tenderness over the mastoid bone. Otoscopy was performed to assess the external ear canal for the presence of ear wax, any obstruction in the external auditory canal-like foreign bodies or bony projections and also assess the tympanic membrane for fluid level, infection, retraction or perforation. Those with ear wax or foreign body had it removed before continuing with the tympanometry and those with ear discharge or tympanic membrane perforation were excluded from the procedure (tympanometry). Tympanometry was conducted on suitable participants in sitting position after explaining the procedure to them to assess the middle ear function, and this was done with appropriate size probe tip by fitting the clean tip of suitable size and shape to the probe and straightening the ear canal by gently pulling the pinna. The probe was then pointed in the direction of the tympanic membrane to avoid the risk of occluding the probe aperture.[20] A continuous pure tones were then presented into the test ear using an American Audiometrics Ear Scan Tympanometer calibrated to the International Organisatio for Standardisation standard. The tympanometer automatically varies the air pressure in the canal and graphically displays the relative changes in the immittance at the plane of the tympanic membrane in response to changes in relative air pressure in the external auditory canal. The participants were instructed to pay attention, avoid abnormal movement, swallowing or yawning while performing the tympanometry. The same procedure was then carried out on the contralateral ear. Antiseptics were used to appropriately clean the tip of the probe before and after use. Tympanometric findings were categorised based on Jegher's classification (types A, As, Ad, B and C).[20] Type A (normal), Type As (otosclerosis), Ad (ossicular discontinuity), Type B (middle ear fluid) and Type C (Eustachian tube dysfunction).[20] Statistical Products and Service Solutions (SPSS) software IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, NY, USA) was used to analyse the data. Chi-square test was used to determine the possible association, and the level of statistical significance was set at P < 0.05.

Inclusion criteria for the subjects were consented prison convicts aged 18–55 years who have stayed for >6 months, while consented adults aged 18–55 years were enrolled in the control group.

Exclusion criteria for the subjects were inmates who did not consent, inmates >55 years of age and inmates who cannot be accessed for safety reasons (Hardened criminals and condemned criminals on death row) while in the control arm, all unconsented adults, those >55 years of age as well as consented adults who were imprisoned within the last 6 months were excluded.


  Results Top


Four hundred and thirty inmates with an equal number of controls were enrolled for this study. The mean age for the inmates and the controls was 30.2 ± 7.51 and 30.4 ± 8.02 years, respectively. In both groups, 47 females and 383 males were enrolled, with a female: male of 1:8.1. Age distribution among the participants is shown in [Table 1].
Table 1: Age distribution of the participants

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Fortysix (46/397, 11.6%) of the inmates and 15 (15/423, 3.5%) of the controls had abnormal tympanograms on the right as shown in [Table 2]. The difference between the two groups was statistically significant (χ2 = 40.071, P = 0.0001). Similarly, abnormal tympanograms among the inmates and controls on the left accounted for 51 (51/412, 12.4%) and 16 (16/426, 3.8%), respectively. Ears with tympanic membrane perforation and those with external auditory canal stenosis had no tympanometry done hence excluded. Thirty-two (7.4%) of the inmates had tympanic membrane perforation in the right ear, whereas 18 (4.2%) inmates had it in their left ears. The tympanic membrane of the right ears of 7 (1.8%) and left ears of 4 (0.9%) among the control group was also found to be perforated. One (0.23%) inmate had stenosis of the right external auditory canal, precluding tympanometry.
Table 2: Tympanometric findings among the inmates and controls

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Most of those with abnormal tympanogram in both the inmates and the controls had Type 'B' tympanogram (suggestive of middle ear effusion), followed by Type 'Ad' (suggestive of an ossicular discontinuity). Among the inmates, 327 (76.0%) had bilaterally normal ears, 55 (12.8%) had bilateral disease not precluding tympanometry, 29 (6.7%) of them had unilateral disease, while 19 (4.4%) inmates had bilateral tympanic membrane perforation precluding tympanometry. [Table 3] gives details of the tympanometric parameters among both the inmates and the controls.
Table 3: Tympanometric parameters among participants

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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6] show the different types of tympanograms seen among the participants.
Figure 1: Bilateral Type A Tympanogram among the participants

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Figure 2: Right Type A and left Type B Tympanogram among the participants

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Figure 3: Bilateral Type B Tympanogram among the participants

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Figure 4: Bilateral Type C Tympanogram among the participants

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Figure 5: Bilateral Type As Tympanogram among the participants

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Figure 6: Bilateral Type Ad Tympanogram among the participants

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  Discussion Top


In this study, 430 prison inmates in the Kaduna convict prison had an evaluation with history, physical examination and tympanometric tests. The mean age of the inmates was 30.2 ± 7.51 years, with the majority (370/430, 86.1%) been within the age range of 18–39 years. This corresponds to the agile members of most communities. However, in a study by Thomas and Job[1] in an Indian prison, the majority of the inmates were within the age range of 41–60 years, followed most closely by those in the range of 20–40 years. This difference in the age group of the studied inmates might stem from the fact that they assessed inmates with documented otologic complaints at the prison infirmary.

Most of the inmates in this study gave histories of being slapped on both ears at the same time from behind; most of them dated their complaints to such incidences as they noticed sudden loss of hearing immediately after such slap. Tympanic membrane appearance can infer the possibility of pathology in the middle ear. According to Thomas and Job[1] in India, 18.75% of the prison inmates studied had an abnormal middle ear function evidenced by tympanic membrane perforation. This was higher than what was obtained in the current study, which revealed that 46 (11.6%) and 51 (12.4%) inmates studied had abnormal middle ear function on the right and left ears, respectively. The higher percentage of middle ear dysfunction evidenced by tympanic membrane perforation reported in their study may be explained by the variation in sample size, possibly due to the small sample size used in the Indian study.

Of those that had tympanometry among the inmates in the present study, 351/397 (88.4%) and 361/412 (87.6%) had normal tympanograms on the right and left ears, respectively. Nineteen (19/397, 4.8%) of the inmates had Type B tympanogram on the right, whereas 29/412 (7.0%) of the inmates had Type B tympanogram on their left ears. The higher number of Type B tympanogram among the inmates can be explained by the higher number of fluid levels and otitis media with effusion in the middle ears of the inmates seen during otoscopy which can be explained historically by the relatively high frequency of upper respiratory tract infection among the inmates as a result of overcrowding. In this study, (6/397, 1.5%) of the inmates had type C tympanogram (Eustachian tube dysfunction) on the right, and none of the inmates had type C on the left.

Type As tympanogram (suggestive of otosclerosis) was observed in 5/397 (1.3%) and 6/412 (1.5%) in the right and left ears of the inmates, respectively. In this study, the rate of type As tympanogram was observed to be higher among inmates compared to the controls [Table 3]. The use of nicotine as a risk factor for the development of otosclerosis was observed more among the inmates than the control population. Most of the inmates started smoking cigarettes while in detention as a coping strategy to forget the circumstances surrounding their incarceration. Type Ad tympanogram (usually signifies ossicular chain disruption) accounted for 16/397 (4.0%) of the inmates on the right and 16/412 (3.9%) on the left. The reason for its relatively high prevalence is not very clear, but maybe due to repeated trauma (slap) during interrogation. This was attested to by the inmates.


  Conclusion Top


The study revealed that middle ear dysfunction is more prevalent among prison inmates compared to the general population. Based on the tympanometric findings in this study, middle ear effusion and ossicular chain disruption were the most common middle ear abnormalities affecting the prison inmates. While middle ear effusion and eustachian tube dysfunction may be attributable to overcrowding and poor living conditions in the correctional facility, ossicular chain disruption may be evidence of the physical assaults that these inmates are recurrently exposed to, from the dirty slap.

Recommendations

There is a need for a holistic adoption and implementation of a healthy prison concept by decongesting the Nigerian prisons and improve the living condition of the prison inmates. There is also the need to make laws that can prohibit prison authorities and other security agents from assaulting inmates or suspects on the ear during interrogation.

Acknowledgment

We would like to acknowledge Dr. Umaru Sambo Grema of Department of Clinical Services, National Ear Care Centre Kaduna-Nigeria, for his support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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