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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 34 | Issue 3
Page Nos. 165-211

Online since Thursday, August 16, 2018

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LETTER TO THE EDITOR  

Safety in ENT surgery p. 165
Mahmoud H.M Hasan
DOI:10.4103/ejo.ejo_22_18  
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ORIGINAL ARTICLES Top

Pulmonary function of patients with chronic rhinosinusitis and the impact of endoscopic sinus surgery p. 167
Ahmed M Youssef, Osama G Abdel-Naby Awad, Mohamed Taha
DOI:10.4103/ejo.ejo_99_16  
Background There is growing evidence that chronic rhinosinusitis (CRS) may be associated with lower airway manifestations. The difference in pulmonary function between normal individuals and patients with CRS and whether endoscopic sinus surgery (ESS) has a positive effect on the lower airway still remains controversial. The aim of this study was to compare pulmonary function tests (PFTs) in normal individuals and CRS patients and to investigate the outcomes of ESS on PFTs in patients with CRS. Patients and methods A prospective study was carried out on 25 normal adults (group I) and 25 adult CRS patients (group II). PFTs were used to compare the lower airway condition between the two groups. Another comparison in PFTs was made in patients with CRS to evaluate the effectiveness of ESS at 1 week preoperatively and 1 month, postoperatively. Results In group I, all participants had forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) of at least 80%, with a mean of 0.84±0.07, compared with the preoperative FEV1/FVC values of group II, which ranged from 61 to 70% in five (20%) patients, from 71 to 79% in 10 (40%) patients, and were equal to or higher than 80% in 10 (20%) patients. FEV1/FVC was significantly lower in group II patients than in group I participants (P=0.04). At 1 month postoperatively, the FEV1/FVC values of group II ranged from 61 to 70% in two (8%) patients, from 71 to 79% in 13 (52%) patients, and were equal to or higher than 80% in 12 (48%) patients; the mean FEV1/FVC was 0.9±0.50. These values were significantly higher (P=0.02) compared with the preoperative values. Conclusion This study provides corroborative objective evidence that patients with CRS may have nonmanifest lower airway infection compared with normal individuals and ESS is efficacious in the improvement of such infection.
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I-shaped incision with mucosal flap preserving technique in endoscopic dacrocystorhinostomy p. 173
Mahmoud A Hassan, Mohamed H Badreldin, Tarek El-Nahriry, Mohamed T El-Tabbakh
DOI:10.4103/ejo.ejo_42_17  
Introduction Epiphora due to nasolacrimal duct obstruction accounts for ∼3% of all general ophthalmology visits. Endoscopic dacryocystorhinostomy (DCR) has become accepted as a suitable treatment for patients with obstructions of the lacrimal system at the level of the sac or below it. Modification of endoscopic DCR is realized by using the overlapping flaps between the lacrimal sac and nasal mucosa with the creation of a wide bony ostium by drilling out the bony borders of the lacrimal sac. Aim To assess the rate of patency of rhinostome after endoscopic DCR with mucosal flap preservation technique in the treatment of nasolacrimal duct obstruction. Patients and methods The study population was 30 patients suffering from epiphora due to obstructive lacrimal drainage disorders attending the ORL clinic who were referred from the Ophthalmology Clinic in Suez Canal University Hospital. Patients included in the study had been subjected to the following procedures: full history taking, eye and ORL examinations, diagnostic procedures (dye disappearance test − Jones test I and II), routine preoperative investigations, and endoscopic DCR with mucosal preservation flap technique surgery. Results Most of the patients were women (70%). The patients’ age ranged from 18 to 65 years old. All patients complained of epiphora, 50% had punctual discharge, and 26.6% had lacrimal sac swelling before the operation. The success rate of the operation was 90%. Conclusion We conclude that the low complication and high success rate indicate that EN-DCR with a large bony ostium and large nasal mucosal flap opposed with lacrimal sac flaps can be considered as a better technique in the treatment of lacrimal system obstructions.
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Comparative study between microdebrider, radiofrequency and classic microlaryngosurgical in the treatment of benign vocal cord lesions p. 179
Mahmoud Ashraf Ragab, Elham A Shahin, Ahmed M Atef, Hany Samir, Mohammed A Hussein
DOI:10.4103/ejo.ejo_76_16  
Background Benign vocal fold lesions are a common cause for hoarseness of voice. Aim The aim of this work was to investigate the efficacy and safety of microdebrider and radiofrequency in excision of benign vocal fold lesions compared with the classic microlaryngosurgical (MLS). Patients and methods This study included 30 patients, 22 male and eight female, diagnosed to have benign vocal fold lesions, who were divided into three groups: They were assessed preoperatively and 2 weeks postoperatively using the GRB scale for auditory perceptual assessment and computerized speech lab. Results Marked improvement of vocal functions with no statistically significant differences between the three groups was observed. Conclusion Radiofrequency and microdebrider could be used in the treatment of benign vocal fold lesions with nearly the same results of MLS.
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Increased intracranial tension and cochleovestibular symptoms: an observational clinical study p. 191
Badr E Mostafa, Hesham A.A El-Sersy, Tarek A Hamid
DOI:10.4103/ejo.ejo_5_18  
Objectives Meniere’s disease is thought to be pathophysiologically due to increased pressure in the endolymphatic spaces leading to distortion of the sensory elements. As the inner ear fluids are in direct and indirect contact with cerebrospinal fluid (CSF), it was hypothesized that changes in CSF hydrodynamics could affect inner ear fluid pressures. Patients and methods This study was conducted on 150 patients presenting with benign increased intracranial tension diagnosed by Dandy’s criteria and by radiological data. All patients were subjected to a detailed vertigo questionnaire and underwent comprehensive clinical, audiological, and vestibular testing to detect any vestibular abnormalities. Results Of the studied patients, 38 (25.3%) (34 females and four males) presented with audiovestibular symptoms: ear fullness and/or hearing loss, tinnitus, attacks of vertigo, and instability. Some patients reported atypical positional or motion-induced vertigo. A total of 13 patients presented with sensorineural hearing loss (SNHL). Clinical head impulse test (HIT) was positive in 30 patients, abnormal caloric test results in 24 patients, and 12 had positive Dix–Hallpike test results. All patients with audiovestibular symptoms were previously treated with betahistine (24 mg, three times a day) with poor response. Patients with abnormal test results were shifted to acetazolamide+betahistine. Thirty patients had a dramatic response on both audiological and vestibular manifestations. Conclusion Changes in CSF pressure significantly affect inner ear fluids in some patients. Symptoms and tests may mimic Meniere’s disease, and we recommend evaluating patients with atypical Meniere’s disease (MD), especially early bilateral affection and/or poor response to conventional therapy, for increased intracranial tension (ICT). Further testing of other cochlea-vestibular functions in these patients is under way.
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Underlay cartilage tympanoplasty: different ways of application of the graft p. 194
Ahmed Abdel Rahman Abdel Aziz
DOI:10.4103/ejo.ejo_21_17  
Introduction The objective of this study was to evaluate underlay tympanoplasty technique of perichondrium cartilage graft according to the position of the graft with respect to the handle of malleus and remnant of tympanic membrane. Patients and methods In all, 150 patients with chronic suppurative otitis media (safe type) underwent tympanoplasty with or without mastoidectomy. The patients were divided into three groups (50 patients in each group). Group I graft was placed medial to the handle of malleus, group II graft was placed at the plane of malleus, group III graft was placed lateral to the malleus between it and remnant of tympanic membrane. Results Success rate (graft taken with no residual perforation) in all cases is 98% (147 cases). Success rate in groups I–III is 98% (49 cases), 100% (50 cases) and 96% (48 cases), respectively. There is significant statistical improvement of postoperative pure tone audiogram. Conclusion Underlay cartilage tympanoplasty was associated with a high rate of graft taken and good hearing results despite the position of the graft in relation to the handle of malleus.
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Study of telemetry changes over time in children with a cochlear implant p. 198
Samir I Asal, Osama A Sobhy, Najla D Massad
DOI:10.4103/ejo.ejo_56_17  
Background Cochlear implant (CI) is an electronic device that provides direct electrical stimulation to the auditory division of the eighth cranial nerve. The integrity of the internal CI part after implantation can be assessed through objective measures, which are a widely used and valuable tool in the field of CIs. Impedance measurement and electrically evoked compound action potential (ECAP) are the most frequently used tests to facilitate programming of the implants especially in young children. Aim This study was carried out to compare ECAP thresholds and electrode impedance at the time of surgery, at the first stimulation session, and monthly for the next 2 months to assess whether a significant change take places with time. Patients and methods Fifteen deaf children implanted unilaterally with a MED-EL Sonata Implant System with an Opus 2 speech processor were included in this study. All patients received the implant if they fulfilled the Alexandria main hospital criteria for receiving CIs. The group studied included seven males and eight females; they ranged in age from 2 to 6 years. Two of the patients had received implantation in the left ear, whereas the rest of the patients had received a CI in the right ear. Results Intraoperative impedance was the lowest among all postoperative readings in all electrodes. The highest value was that measured 1 month after surgery, after which impedance values continued to decrease significantly, but not to the intraoperative values. The ECAP threshold showed no significant P values between the ECAP threshold measured in the intraoperative and the postsurgery follow-up period. Conclusion The measured impedance showed significant changes in the form of increasing values postoperatively relative to the intraoperative time. The ECAP threshold did not change significantly intraoperatively and postoperatively, showing that intraoperative ECAP can be useful in mapping as it shows no changes.
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The effect of memory training on children with learning difficulty p. 203
Yehia A Abo-Ras, Nesrine H Hamouda, Rana A El-Shafaei
DOI:10.4103/ejo.ejo_4_18  
Background Learning is a step by step process that relies on successful completion of individual learning activities for accumulation of knowledge. Failure of working memory (auditory and visual memory) can lead to inattentive behavior. The end result is frequently lost learning opportunities and so slow rates of educational progress. Objective The aim of this study is to adapt and apply the ‘no-glamour memory’ training program to suit the Egyptian learning disabled children to outline a program for training and test its effectiveness. Patients and methods This study was conducted on 20 school-age children complaining of learning difficulty and memory problems who were attending the Unit of Phoniatrics, Department of Otorhinolaryngology, Alexandria Main University Hospitals. All children were assessed using the protocol of assessment of learning difficulties and memory deficits and were reevaluated after a period of 3–6 months of training. Results In the present study, there was significant improvement of the studied group in the different tests such as Stanford Binet Intelligence Scale, childhood attention and adjustment survey, Arabic dyslexia assessment test, and test of memory and learning 2nd ed., after therapy. Conclusion Memory training can have an effect on domain-general cognitive mechanisms; thus, these results benefit multiple areas of cognition and learning.
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