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   Table of Contents - Current issue
January-March 2018
Volume 34 | Issue 1
Page Nos. 1-103

Online since Monday, February 12, 2018

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Role of vitamin D in chronic rhinosinusitis: a systematic review and meta-analysis study Highly accessed article p. 1
Hassan A Al-Ebiary, Amr G Shafik, Mohammed A Hassan, Mohammed S Taha, Yahya M El-Naggar
Background Chronic rhinosinusitis (CRS) is one of the most common diseases with no specific long-term treatment. CRS can present in two phenotypes: chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP). Vitamin D (VD) is considered to have an immunomodulatory role, especially in allergic diseases. Recent studies have found that patients with CRS have VD level lower than normal, especially patients with CRSwNP. Aim The aim of this study was to systematically evaluate and find out whether there is a relationship between serum VD level and CRS and its phenotypes. Materials and methods Using Medline database, we conducted a systematic search to find all related articles published up to 31 August 2016 using the keywords Vitamin D, allergic rhinitis, CRSwNP, and CRSsNP and applying certain inclusion and exclusion criteria. Results Six articles were included with a total number of participants of 309 with serum VD level. Four comparisons were made. The first comparison showed no statistically significant difference in VD level between the CRSsNP and the control group. The second comparison showed a statistically significantly lower VD level in the CRSwNP group than in the control group. The third comparison showed a statistically significantly lower VD level in the CRSwNP than in the CRSsNP group. The last comparison showed no statistically significant difference in VD level between CRS with or without nasal polyps and controls. Conclusion VD level was significantly low in patients with CRSwNP, which might have a causative relationship. However, there was no relation between VD level and CRSsNP.
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Endoscopic endonasal bony landmarks of vertical petrous internal carotid: anatomic study p. 9
Sameh M Amin, Hesham Fathy
Background Endoscopic endonasal direct exposure or vascular control of basal internal carotid artery (ICA) is difficult among soft tissue of infratemporal fossa. Objective The aim of this work was to develop surgical instructional model for direct exposure of vertical petrous (Vp) ICA relatively dependent on bony fixed landmarks. Materials and methods Endoscopic endonasal drilling of 14 sides of dry skull models was presented. Different bony landmarks and measurements of Vp ICA canal were obtained. Results Endoscopic endonasal transpterygoid approach was performed. The medial pterygoid process and base were drilled to expose the vidian canal and foramen rotundum. The lateral pterygoid process was drilled following the slope of skull base to medial and lateral ends of foramen oval (FO). The spine of the sphenoid was drilled to obscure the tensor tympani canal and the bony Eustachian tube (ET). The bony end of ET was identified lateral to FO. The Vp ICA was exposed retrogradely by drilling the tubal process of tympanic bone (bone between FO and bony ET) downward, backward, and medially toward carotid foramen, forming an acute angle with horizontal petrous (Hp) ICA. The carotid foramen lies medial to styloid process. Three processes are identified sequentially from endonasal perspective; spine of sphenoid, tubal process of tympanic bone, and vaginal process of tympanic bone enclosing the styloid process laterally. The mean length of Vp ICA canal was 12.93±2.23 mm, mean width of FO was 5.04±0.8 mm, and distance between FO and bony ET was 6.68±1.42 mm, representing surgical width of Vp ICA ∼10 mm. The surgical corridor was ∼10 mm wide and 15 mm long. Conclusion Endoscopic endonasal systematic orientation of bony fixed landmarks of Vp ICA exposure is described. The proposed endonasal bony pathway relatively bypasses the muscular compartment of infratemporal fossa. This model can help to obtain vascular control of basal ICA and retrograde identification of parapharyngeal ICA.
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Efficacy of voriconazole in nonsurgical treatment of allergic and chronic granulomatous fungal rhinosinusitis: a preliminary study Highly accessed article p. 15
Hesham M El-Adl, Mohamed Abd El-Badee Awad, Shawky Mahmoud El-Morsy, Yasser W Khafagy
Objective Evaluate the effectiveness and safety of voriconazole in the non surgical treatment of allergic fungal rhinosinustis (AFRS) and chronic granulomatous fungal rhinosinusitis (CGFRS). Also, we present our conservative approach for cases of chronic granulomatous fungal rhinosinusitis with skull base involvement. Patients and Methods 26 Patients with the diagnosis of AFRS (17 patients) and CGFRS (9 patients) have been treated with voriconazole for a period of 3 weeks in AFRS to three months in CGFRS. Results All patients with AFRS have shown marked improvement both clinically and radiologically, recurrence occur in 6 cases, two patients improved medically, and 4 patient required endoscopic sinus surgery. From 9 patients with CGFRS, 6 patients improved completely and did not require surgery, three patients had persistent or residual disease and required surgical interference. Conclusions Voriconazole is effective, and safe in treatment of AFRS as well as CGFRS. This is a preliminary study; further long-term studies are required for proper understanding of the strategies of this new treatment in fungal rhinosinusitis management.
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Endoscopic detection of fast mucociliary pathways in endoscopic sinus surgery: a marker for local mucociliary function p. 21
Sameh M Amin, Amr A Baky, Tamer O Fawzy, Mohamed Hussein
Introduction The mucociliary transport velocity is heterogenous showing areas of slow and fast pathways. The aim of this study was to assess fast mucociliary pathways (FMP) in the maxillary sinus in chronic rhinosinusitis. Patients and methods Endoscopic recording of mucociliary clearance (MCC) and FMP was performed on the posterior wall of the maxillary sinus in 22 chronic rhinosinusitis patients subjected to endoscopic sinus surgery and 12 normal volunteers undergoing septal or turbinate surgery. MCC was assessed intraoperatively using methylene blue over 20 min. MCC was designated as complete, incomplete, or absent. For all patients and controls, the preoperative and postoperative sinonasal outcome scores (SNOT 20) were determined, and the transnasal and transmaxillary saccharin test, and preoperative computed tomography radiological staging were performed. Results FMP were more frequent in the controls (75%) than the patients (40%), with no statistical significance. Delay, direction, site, and duration of FMP were not statistically different in both groups. Six patients with no FMP (absent MMC in five and partial in one) had extremely prolonged transmaxillary saccharin times, with no postoperative improvement. Otherwise, SNOT 20, transnasal, and transmaxillary saccharin times improved significantly in the patients. Controls showed a significant improvement in the SNOT 20 and transmaxillary sacchrin time. FMP correlated significantly with MCC (r=0.636; P<0.01), transnasal (r=−0.7, P<0.05), and transmaxillary (r=−0.553; P<0.05) saccharin times. In a discriminant model, the only predictive variables of FMP detection were MCC (positive) and transnasal saccharin time (negative) with total correction classification (91.2%). This study describes the different characteristics of FMP. Our results suggest that FMP can be used as a marker of local MCC.
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Incus buttress approach as an alternative safe technique for cochlear implantation; preliminary results with review of literature p. 29
Mahmoud F Mandour, Mohammed A Khalifa, Hossam M Adel Khalifa
Aim Report our preliminary experience with an alternative technique for cochlear implantation. Setting Tertiary referral cochlear implant center. Study design Retrospective case series. Subjects and method Fifteen patients have been operated using incus buttress approach. The procedure involves classical cortical mastoidectomy and identification of short process of the incus. Bony incus buttress was removed moving inferiorly toward facial recess. Round window was identified then marginal cochleostmy was performed and finally insertion of the electrode into the cochlea via the widened aditus. Results Fifteen implants were performed on 15 patients. All were children (mean age of 3.2 years). All the children were pre-lingual. A Med-el SONATA implant (MED-EL, Innsbruck, Austria) was used in all patients. Mean duration of surgery was 12015 minutes. The minimum follow-up was 6 months. No complications were observed during the procedure or during postoperative follow-up. Conclusion Here, we describe a new alternative technique for cochlear implantation and report our preliminary results. The procedure has advantages over the existing alternatives techniques and avoids the potential complications of posterior tympanotomy.
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Surgical complications and morbidity in cochlear implantation p. 33
Ihab K Sefein
Introduction Cochlear implantation (CI) has been established worldwide as the surgical treatment for individuals with bilateral severe-to-profound hearing loss. This is a safe and standard procedure in the hands of experienced implant surgeons. Complications due to surgery are minimal and are often encountered in cases of congenital anomalies of the temporal bone and inner ear. Patients and methods All patients receiving CI at our institution between 2014 and 2015 were included in the study. Aim The aim of this study was to report the frequency of surgical complications following 112 consecutive CIs in 102 children and 10 adults in the National Hearing and Speech Institute (HIS), Cairo, Egypt. The international consensus on the reporting of CI complications proposed by Hansen and colleagues was used and evaluated. Results In all, 112 implantations were performed in 102 pediatric and 10 adult patients. Overall, complications occurred in 21 (18.75%) patients, including minor complications in nine (8.03%) and major complications in 12 (10.71%) cases. Complications were delayed in nine (8.03%) cases. No death was attributed to device implantation. Major complications occurred in 12 cases, which included misplaced electrodes in two cases, cerebrospinal fluid leak (gusher) in four cases, labyrinthitis ossificans in one patient, magnet displacement in one case (chronic suppurative otitis media), central perforation in one case, seroma and hematoma (severe cutaneous infections) in one case, wound infection in one case, and persistent pain/discomfort (migration) in one case. Conclusion Complications of CI are more common in children than in adults with trauma as a major factor. Inner ear malformations should prompt specific preventive management. CI in young children did not appear to be a risk factor in this study.
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Cartilage versus partial ossicular replacement prosthesis in ossiculoplasty during cholesteatoma surgery p. 42
Mohammad K Mobashir, Yasser A Fouad, Mohamed A Alshawadfy, Mohammad R Hassaan, Ahmed M Anany
Objective This study aims at comparing cartilage ossiculoplasty by lever method with ossiculoplasty by partial ossicular replacement prosthesis during cholesteatoma surgery. Patients and methods This is a prospective study that was conducted on 36 cases having cholesteatoma; they were randomly divided into two groups of 18 in each group. In the first group (cartilage group), ossiculoplasty was performed with cartilage. In the second group (prosthetic group), ossiculoplasty was performed by partial ossicular replacement prosthesis. In both groups, eradication of the cholesteatoma was performed first at the same sitting of the ossiculoplasty by canal wall down tympanomastoidectomy with reconstruction of the posterior meatal wall at the same sitting. Results Within the follow-up period (1 year at least), the total rate of reported complications was relatively, but not significant, higher in the prosthesis group (50%) in comparison with the cartilage group (27.7%). There was a significant postoperative improvement in the air-bone gap in both groups; however, there was no significant difference between the two groups regarding improvement of the air-bone gap either 6 or 12 months after surgery. Conclusion Cartilage ossiculoplasty by lever method is an easy procedure for using an autogenous material in ossiculoplasty with no reaction, no extrusion, and also with acceptable hearing outcome.
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Large oroantral fistula repair using combined buccal and palatal flaps: a case series p. 48
Ahmed N Abdelhamid, Tamer Youssef
Aim The aim was to detect the efficacy of combined buccal advancement and palatal rotational flaps in closure of large oroantral fistulas (OAFs) after dental extraction. Materials and methods A 3-year prospective study was conducted between February 2014 and May 2017. A total of 11 patients with large OAF after dental extraction were included in the study. Seven patients developed OAF after dental extraction of the maxillary first molar teeth, whereas two patients developed an OAF after dental extraction of the second maxillary premolars. The last two patients developed an OAF after dental extraction of the second maxillary molars. Results Closure of the defect was achieved in 10 cases, whereas only one case had failure. In addition to postoperative pain, swelling, and reduction of the vestibular sulcus, one patient experienced postoperative nasal adhesions between the nasal septum and inferior turbinate. Conclusion A combined buccal and palatal flap is efficient in closure of large delayed OAF secondary to dental extraction. Further study is required to assess new bone formation after repair of large OAF using this technique.
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Endoscopic partial epiglottectom using diathermy for chronic epiglottitis from khat chewing p. 55
Ali O Muthanna, Arif Fadhl Eryani
Objective The aim of this study was to determine the effect of endoscopic partial epiglottectomy on airway obstruction. Patients and methods A prospective study was conducted in the ENT Department, Al-Thawra Teaching Hospital, Sana’a, Yemen. A total of 58 patients underwent partial epiglottectomy using standard laryngeal instruments and monopolar microdissection scissors and hook diathermy, during the period January 2005–July 2011. Results A total of 58 patients were included in this study, 47 male and 11 female. Their ages ranged from 21–60 years, with a mean age of 32.39 years. A total of 58 (100%) patients presented with change of voice, 58 (100%) patients presented with difficulty in breathing on exertion, 20 (34.5%) patients presented with foreign body sensation, 58 (100%) with stridor on exertion, 20 (34.5%) with stridor at rest, 20 (34.5%) with dysphagia, and four cases with tracheostomy in situ. Postsurgical results All (100%) patients showed improvement in voice, breathing, and disappearance of stridor. An overall 90% (18/20) of patients had disappearance of foreign body sensation. Recurrence occurred in 25.9% of patients. Postoperative aspiration occurred in 11 (19%) patients for short time. Conclusion Using diathermy to perform endoscopic partial epiglottectomy is simple, effective, and safe in the treatment of hypertrophic epiglottis using laryngeal instruments and diathermy. It did not need special preparation and could be performed in hospitals that have no laser facilities.
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Assessment of audiovestibular system in patients with vitiligo: a case–control study p. 60
Rabab Ahmed Koura, Iman Mostafa Basiouny, Reham William Doss, Alshimaa Mohamed Abbas Mostafa, Ahmed EmadEldin Arafa
Background Vitiligo is characterized by loss of epidermal melanocytes. Alterations in melanocytes in extracutaneous sites have been reported in vitiligo and sometimes implied for the inner ear along with an associated compromise in function. Aim The aim of this study was to map the auditory and vestibular functions in patients with vitiligo. Materials and methods A total of 30 patients with vitiligo vulgaris and 30 age-matched and sex-matched healthy controls were enrolled in this study. Pure tone audiometry and measurements of auditory brainstem responses, cervical vestibular-evoked myogenic potential (cVEMP), and videonystagmography (VNG) were carried out in all participants. Results Mean hearing thresholds of patients with vitiligo were highly statistically significantly lowered at 4 and 8 kHz than the controls. Analysis of brainstem auditory-evoked potentials (BAEP) revealed statistically significantly prolonged wave III, wave V, and interpeaks of I–III and I–V latencies in both ears of 18 (60%) patients and in the left ear of two (6.6%) patients in the vitiligo group than the controls. VNG findings showed canal paresis in nine (30%) patients. There was a negative statistically significant correlation between disease duration and pure tone audiometry, BAEP, and latency of N23 of cVEMP. Conclusion This study sheds light on the importance of melanocytes for proper functioning of the auditory and vestibular system. The presence of high-frequency hearing loss, BAEP abnormalities, and cVEMP changes are valuable findings in patients with vitiligo. This highlights the importance of follow-up along the disease course for early detection of auditory abnormality. cVEMP testing can be used for the evaluation of the vestibulocolic reflex in patients with vitiligo. Moreover, VNG testing can be an important tool for assessment of the vestibular system in patients with vitiligo.
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Effect of auditory temporal processing training on behavioral and electrophysiological functions in central presbycusis p. 68
Samir I Asal, Ossama A Sobhy, Hebatollah M Morsy
Objective Age-related changes in the central auditory system, particularly auditory temporal processing abilities, were considered among most important factors affecting speech understanding performance in older adults. Once these factors are identified, clinical management procedures could be developed for prevention and treatment. The aim of this study was to determine the effects of short-term auditory training on the behavioral and electrophysiological measurements of auditory function in individuals with age-related temporal processing deficit. Participants and methods A prospective study of 20 individuals aged 60–67 years with either normal or bilateral symmetric high-frequency hearing loss was conducted. Evaluations of auditory temporal processing using behavioral tests (Pitch Discrimination Test, Pitch Pattern Sequence Test, Auditory Fusion Test-Revised, and Time Compressed Speech Test), P300 potential, and the administration of ‘Amsterdam inventory for auditory disability and handicap’ were performed before and after short-term auditory training. Results All participants demonstrated poor pretraining Pitch Pattern Sequence Test results which were significantly improved after remediation. All patients showed normal pretraining performance on Pitch Discrimination Test, Auditory Fusion Test-Revised, and Time Compressed Speech Test tests. There was a statistically significant increase in P300 amplitude and shortening in latency after remediation. Conclusion Short-term auditory training in older adults with auditory temporal processing deficit led to improvements in temporal sequencing skills and communication in noisy environments. P300 potential has been proved to be an objective indicator of neurophysiologic changes in the central auditory system resulting from auditory experience. Recommendation Short-term auditory training is an efficient rehabilitative tool for elderly people with auditory temporal processing deficit. However, maintenance of treatment effects over time should be evaluated.
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Hearing profile in Egyptian children with attention-deficit hyperactivity disorders p. 76
Mohamed Salama, Khaled A Elbeh, Emad M Hammad, Eman Abdel-Fattah Said, Ahmed Nashaat
Background Attention-deficit hyperactivity disorder (ADHD) is a common neuropsychiatric syndrome with onset in childhood, most commonly becoming more apparent during the first few years of grade school. The aim of this study is to assess peripheral hearing and central auditory processing as well as cognitive function in 30 children diagnosed with ADHD. Their age ranged from 6 to 16 years (16 males and 14 females) and their IQ of at least 70. All of them were subjected to a basic audiological evaluation, and assessment of auditory brainstem responses, slow vertex response, and P300 waves using the oddball paradigm. Results No significant differences were found between pure tone thresholds and speech audiometry between the study and the control groups. There was a statistically significant increase in auditory brainstem response (ABR) absolute latencies (III and V) and interpeak latencies (I–III and I–V) at both low repetition rate and high repetition rate. Also, an increase in latencies of N1, P2, N2, and P300 latencies was observed with decreased P300 amplitude of the study group compared with the control groups. A significant mild positive correlation was found between P300 and both wave V latency and I–V interpeak latency. Conclusion The results of this study provide more evidence of central auditory processing involvement in children with ADHD and show the role of ABR and P300 in the management of these children.
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Postural stability in patients with Parkinson’s disease versus patients with type 2 diabetes mellitus p. 84
Soha M Hamada
Background Postural control is defined as the control of body’s position in space for balance purpose. Postural control in static conditions is known as postural steadiness, whereas in the dynamic volitional perturbations, it is noted as postural stability. Postural stability can be affected owing to central or peripheral lesions; one of the central lesions with postural instability is Parkinson’s disease (PD). However, peripheral neuropathies that affect stability are one of the most common complications of diabetes mellitus. Aim The aim was to assess postural stability in patients with PD and those with type 2 diabetes as examples of central and peripheral lesions, respectively, and to compare the results with the findings obtained from the normal control group. Patients and methods The patient group in the study was divided into two subgroups: subgroup 1 consisted of 15 patients diagnosed as having PD and subgroup 2 included 15 patients with type 2 diabetes mellitus. Control group consisted of 15 normal age-matched participants. Postural assessment was performed using computerized dynamic posturography. This included the automatic motor assessments tests, including motor control test and adaptation test, and functional limitation tests such as tandem walk. Results This research showed that there is a statistically significant difference between control group and subgroup with PD in all tested parameters. A statistically significant difference was found between control group and subgroup with diabetes in all parameters of adaptation test and speed test. Moreover, there is a statistically significant difference between the two subgroups in most of tested parameters, with the highest value in PD group. Conclusion The findings reflect that postural stability is more affected with central lesion than peripheral lesion.
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Video head impulse test in different age groups p. 90
Samir I Asal, Ossama A Sobhy, Diana M.E Abdel Raof
Background and objective The head impulse test is a well-known clinical test that uses video-oculography to quantify vestibulo-ocular reflex (VOR). Normative data for VOR gain are accessible, but most studies just report horizontal-plane VOR characteristics, overlooking variations in vertical-plane VOR gains. The aim of this study is to supply normative data for different age groups to permit future comparison of results to the matching norms. Patients and methods The study was accomplished on 50 individuals who have normal peripheral hearing sensitivity, no otological disorder, and have no history of vestibular disorder, and were divided according to age into five groups, each one comprising 10 participants: individuals in the first group were aged 10–25 years, individuals in the second group were aged 25–35 years, individuals in the third group were aged 35–45 years, individuals in the fourth group were aged 45–55 years, and individuals in the fifth group were aged more than 55 years. Video head impulse test was done using GN Otometrics ICS Impulse in the lateral, left anterior right posterior, and right anterior left posterior semicircular canal planes. Results This study demonstrated that age has no impact on VOR gain, and it can be applied indifferently to all ages. Conclusion These normative values permit the correlation between the results of any specific patient and the values of healthy people of the same age range.
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Public awareness of delayed language development in Upper Egypt p. 94
Eman Mostafa, Mona El-Rabie Ahmed
Aim The aim of this study was to investigate public awareness and the attitude of delayed language development (DLD) in children in Sohag, Upper Egypt. Patients and methods The Phoniatric Unit at Sohag University Hospital receives a considerable number of belated cases of children with DLD. No Egyptian surveys were found collecting information about public awareness and knowledge of DLD and speech–language pathology services. A cross-sectional survey was done of both male and female participants who were asked to fill in a questionnaire. The questionnaire contains participant’s demographic information, eight closed-ended questions, and one open-ended question, addressing their knowledge and attitudes toward DLD. Results The questionnaire was introduced to 1500 questionnaires (1380 have returned; 92% response). Good awareness of DLD in children was recognized in 74.49% of the study group. The age of 2 years was thought to be the most suitable age to seek medical advice for children with DLD in 48.84% of the study group. Some occupations such as teachers did not value early intervention of language delay. Language therapy was thought to be the best way to treat DLD in 68.7% of the study group. Conclusion There is limited awareness of the value of early language learning and the best treatment of DLD. Awareness should be raised and changing the attitude of individuals in some occupations, especially teachers, toward DLD should be addressed.
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Erratum: Safety and efficacy of pediatric functional endoscopic sinus surgery for the treatment of pediatric chronic rhinosinusitis p. 103

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