Otorhinolaryngology

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The management of acquired cervical tracheal stenosis.
(1993) Grundlingh, Theodore, Daniel.; Fernandes, Carlos M. C.
Abstract available in PDF.
The management of peritonsillar abscess.
(1999) Nwe, Thin Thin.
Over a four month period from 1 st November 1998 to 28th February 1999 a randomised prospective study was undertaken in 75 patients with peritonsiller abscess (PTA) to determine the treatment modality that is most effective in alleviating the excruiating pain and discomfort associated with the condition. The patients were divided into three treatment groups. There were 25 patients in each group. Group A patients were treated with intravenous antibiotics and intra muscular opiates, Group B aspiration and oral antibiotics and Group C incision and drainage and oral antibiotics. Pain relief was objectively assessed with each treatment modality by measuring the upper to lower incisor distance, 15 mins, 24 hours and 48 hours and oral intake at 2 hours, 24 hours and 48 hours after the initial treatment. The improvement of the mean upper to lower incisor distance 15 minutes after the initial treatment was 5% in Group A, 38% in Group B and 100% in Group C. Twenty four hours later the improvement was 30% in Group A, 111 % in Group B and 125% in Group C. None of the patients in Group A were able to take fluid orally at 2 hours. Only 2 patients (8%) could in Group B and 23 patients (92%) in Group C. 24 hours later, 15 patients (60%) could take fluid orally in group A, 19 (76%) in group B and 25 (100%) in group C. Treatment failures were those patients in whom the trismus, odynophagia and pyrexia failed to subside after 48 hours. There were 8 patients (30 per cent) in group A, 6 (24%) in group B and none in Group C. The 14 failures were successfully treated with incision and drainage. The conclusion derived from this study is that incision and drainage is superior to intravenous antibiotic and aspiration in alleviating the pain and discomfort associated with peritonsillar abscess.
Salivary gland tumours in the era of antiretroviral treatment.
(2018) Moodley, Kerusha.; Saman, Yougan.
HIV is a global pandemic with an estimated 36.7 million people infected worldwide with HIV in 2015. Sub Saharan Africa remains the region most heavily affected with South Africa being home to the world’s largest population living with HIV – which in 2016 was estimated at 7.1 million people. Data released in 2018 by Stats SA placed HIV prevalence rates in South Africa at 13.1% and 19 % for adults aged 15 – 49 years. Anti retroviral therapy has changed the face of the HIV pandemic with people infected with HIV now presenting with a wide variety of conditions including Non – AIDS defining cancers in the Head and Neck region. There are various Head and Neck sites that have been investigated but little data exists regarding the impact of HIV on the Salivary Gland subset of Head and Neck Tumours. In particular there is no data on the topic from South Africa. Kwazulu Natal’s high rates of infection make it an excellent region in which to conduct the study. The study will further explore epidemiology and the spectrum pathology of Epithelial Salivary Gland Neoplasms, in HIV positive and negative patients, presenting to our institution and whether our data compares to our local and international counterparts. This study/ project was conducted by performing a retrospective chart review to determine any differences between patients with HIV presenting with Epithelial Salivary Gland Tumours and their HIV negative counterparts. It further gathers information regarding patient presentation and outcomes between HIV positive patients on ARV’s and those not on treatments. It is hoped that this study will enlighten us to the trends in epidemiology of Salivary Gland Neoplasms at our institution and aspects of Epithelial Salivary Gland Tumours in HIV positive individuals, particularly in those on treatment and in doing so will enable us in future to faster recognize, diagnose and better manage affected individuals.
Indications for tracheostomy in paediatric patients at a tertiary referral centre, Inkosi Albert Luthuli Hospital (IALCH).
(2018) Kissi, Phumelele Bongiwe Nokwazi.; Naidu, Tesuven Krishna.
The paediatric tracheostomy is an uncommon procedure, with higher mortality and morbidity rates than the adult tracheostomy. The procedure itself is technically more demanding than in adults due to the smaller more pliable trachea and the limited operatingfield. The paediatric tracheostomy is performed with a different technique than that of an adult tracheostomy, with a formal stoma is fashioned by suturing the tracheal wall to the skin with maturation sutures in addition to safety stay sutures placed in the tracheal wall. The considerations include the growing anatomy of a child and attention is placed on preventing accidental decannulation and preventing long term damage to the growing anatomy of a child. With the increased availability of Paediatric intensive Care Units (PICU), and high trauma burden in children in Durban, South Africa, we plan to determine what the most common indication for performing a tracheostomy in a paediatric population. This will be done by a retrospective chart review of all cases requiring tracheostomy at IALCH between the period of 2004 to 2016. An in-depth analysis of the charts will provide insight in to the most common pathology requiring a tracheostomy and with that knowledge we can add value to the existing Paediatric tracheostomy Care programme at IALCH. This information gathered will further assist in establishing a support system for the parents of a child with a tracheostomy.
Exploring the influence of professional interactions within school environments on levels of teacher job satisfaction : a comparative study across different school types.
(2018) Moodley, Pregasen Koogathassan.; Ramrathan, Prevanand.
Since the end of apartheid school education in South Africa has been constantly reviewed, undergone transformation and critiqued with a view to influencing school reforms that would produce a quality driven school education system. Given the changes of the education system since the advent of democracy, teachers have been subject to numerous demands in terms of curricula, assessments, policies, work contexts, the types of management and peer relationships, and the way they need to view such changes. All of these impinge upon the level of job satisfaction teachers feel, which influence motivation to teach and ultimately filter to the quality of teaching and learning that occurs in the classroom. This study, located within the Kranskloof ward of the Pinetown district, Durban, South Africa, focused on teacher job satisfaction across public, private and Ex-Model C schools, sought to answer the following research questions: 1) What are the current levels of teacher job satisfaction within each of the different school types and how do these levels differ across school types? 2) What is the nature and frequency of professionnal interactions occurring within each of the different school types? 3) How do these professional interactions in the different school types influence levels of teacher job satisfaction? and 4) Why do these professional interactions in the different school types influence teacher job satisfaction in the way they do? In answering these research questions, this study explored how teachers feel about their role as professionals and how this contribute to their levels of job satisfaction. In the context of this study, professional interactions encompassed the principal’s leadership style, teacher involvement in matters concerning their work and the level of teacher collegiality and collaboration. These three themes focusing on the level of professional interactions between the principal and teachers and between the teachers themselves, contributed to the body of literature on teacher job satisfaction by identifying the school context as a professional field, a concept that will be elaborated on later in the study, and its influence on levels of teacher job satisfaction. This study was mainly underpinned by the needs-based approach, arising from the seminal theories of Fredrick Herzberg (1966) and Abraham Maslow (1959). According to these theories, the level of job satisfaction is influenced by the extent to which teachers’ needs within the school environment are met.These theories categorize factors influencing teachers’ levels of job satisfaction as being extrinsic and intrinsic and the extent to which these needs are satisfied is measured through the nature and frequency of professional interaction v activities occurring within the school environment. Whilst acknowledging that these two theories are the dominant theories in this study, other theories were mentioned as a means of supplementing the discussion. These additional theories highlighted the influence of teacher’s needs being satisfied as a factor influencing job satisfaction. These theories included The Discrepancy Theory of Porter and Lawler (1968), the Affect/Expectancy Theory of Locke (1976) which explained job satisfaction as the difference between expectation and outcome and The Three Factor Theory of David Sirota (2005) which highlighted the significance of inter-personal relationships as a factor within school environments influencing job satisfaction. A mixed method sequential explanatory design was used and involved a first phase quantitative survey of a total of fifty level one teacher participants from the three different school types, and a second phase of semi-structured interviews with nine teachers, three from each school type. The survey research aimed to provide information on the current status of teachers’ job satisfaction levels and to identify the nature and frequency of professional interaction activities occurring within the different school environments and to identify possible relationships between aspects of professional interactions and levels of teacher job satisfaction, whilst the qualitative data sought to explain the relationships between these variables. The overall finding of this study showed that both extrinsic factors which shape the school context and identity through professional interactions (principal’s leadership style, teacher involvement and teacher collegiality and collaboration), and intrinsic factors (achievement and recognition, teacher involvement and engagement in matters concerning their work, and professional advancement and growth) influenced levels of teacher job satisfaction. The main concepts dealing with professional interactions as identified in the literature correlate with the constructs of the theoretical framework underpinning this study. A significant finding of this study was that job satisfaction amongst teachers ranked according to the school type in which they taught. Significant relationships between professional interactions and levels of teacher job satisfaction existed across all school types, but individual schools presented varying results, showing that the school context does influence levels of teacher job satisfaction. vi Based on the findings of this study, it is recommended that school management and education policymakers pay attention to the importance of school contexts, through its professional interactions, in influencing levels of job satisfaction of teachers.
Development of an assessement tool that measures change of knowledge, attitude and practice of mothers towards universal newborn hearing screening programme.
(2020) Graham, Christine John.; Saman, Yougan.; Seeley, Janet.
Hearing loss is a common cause of disability and has increasingly become a global burden. Although Universal Newborn Hearing Screening Programme (UNHSP), as a public health initiative, provides detection and management services for childhood hearing loss, the loss to follow-up remains a challenge. For the optimal prevention of long-term speech-language, cognitive and social disability working with the communities concerned is important. Accordingly, this thesis reports on the process of developing a knowledge, attitude and practice (KAP) tool that captures mothers’ understanding of childhood hearing loss and newborn hearing screening in Amajuba District, KwaZulu-Natal, South Africa. This research pursued an exploratory sequential, mixed method design which combines both qualitative and quantitative methodological approaches. For the qualitative approach, focus group interviews, using an interview guide, were conducted with the aim of identifying content area for the development of the tool. Inductive thematic analysis was used to analyse data. The themes identified were used to develop a tool which was then validated by face and content validity and which was analysed using descriptive statistics and content validity index respectively. A test-retest repeatability study was undertaken to assess stability then analysed with Cohen’s kappa coefficient. Thereafter, a KAP survey was conducted to obtain a baseline. Nine themes were obtained for the qualitative study: Perception of deafness; causes of deafness; identification of deafness; detection and treatment; beliefs; feelings; health seeking behaviours; further examination and support. A validated KAP tool was developed with twenty-nine items: 6 – demography; 6 – knowledge; 6 – attitude; 6 – practice and 5 – awareness. Both scale content validity index and item content validity index scored 1 for comprehensiveness and relevancy and 97% of participants stated that the tool was appropriate for face validity. Test-retest repeatability study results showed a Cohen’s Kappa Coefficient of 0.87 (95% CI: 0.87, 0.87) for stability. The baseline KAP showed limited knowledge regarding childhood hearing loss amongst mothers in terms of a newborn hearing loss, causes, detection and treatment. Cultural factors such as birth and ancestral rituals were identified amongst the causes of hearing loss. However, the attitude towards early detection of hearing loss was positive and most mothers would accept screening if offered, although acceptance could be impeded by lack of finance, fear of equipment and the time required. Nonetheless, a health facility was mentioned as the first point of consultation and treatment. These research outcomes have demonstrated the feasibility of developing a validated KAP tool regarding childhood hearing loss and newborn hearing screening. The reported inadequate knowledge of mothers’ KAP has informed practitioners and policy makers of the existing needs of this community. The outcomes will also allow for tailor-made awareness strategies comprised of health education and promotion of newborn and childhood hearing.

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