Tonsillectomy is the most common surgical procedure in otorhinolaryngology and hence efforts are being constantly directed toward improving its various aspects, such as indications for the procedure, duration of surgery, techniques, safety measures, and postoperative care. One of the major concerns of this procedure is determination of the most suitable age for surgery. This issue is under a lot of controversy particularly with respect to extreme age groups of younger than 3 years and older than 60 years. Although the extremely old age groups are considered to be at risk for any surgical procedure, they are considered to be especially at risk for tonsillectomy because of lack of proper body tissue tolerance and response to post-tonsillectomy bleeding and upper airway edema and obstruction. However, individuals belonging to these age groups are still at lower risk for morbidity and mortality compared with infants, and hence a large part of ENT research is focused on this extremely young age group.
Therefore, this study was conducted prospectively to confirm whether tonsillectomy can be performed safely in children younger than 3 years with nonsignificant difference with respect to postoperative morbidity and mortality as compared with the other age groups of 3 years or older.
A total of 648 children aged from 8 months to 8 years presented at the ENT Department, Al-Thawra Central Teaching Hospital (Elbyda City, Libya), from 2005 to 2012 with chronic adenotonsillitis with variable patterns of indications for tonsillectomy, such as snoring and apnea attacks, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, and malocclusive dental deformity. Of these 648 children, 241 were under the age of 3 years and represented group A, whereas the remaining 407 were aged 3 years and above and constituted group B. As a prospective analytical study, both groups were compared with respect to intraoperative time and the incidence of serious postoperative complications such as post-tonsillectomy bleeding, aspiration, airway obstruction, dehydration, postadenotonsillectomy negative-pressure pulmonary edema, metabolic changes, and nutritional deficiencies. In addition, both groups were compared with respect to the period of postoperative hospitalization, which can be used as an objective indicator of postoperative morbidity rate.
This study confirmed that tonsillectomy is an easy and safe procedure among children younger than 3 years as it is in older children as indicated by the appearance of a nonsignificant difference between the two groups with respect to intraoperative time and occurrence of serious suspected post-tonsillectomy complications such as post-tonsillectomy hemorrhage, aspiration, airway obstruction, negative-pressure pulmonary edema, dehydration, metabolic changes, and nutritional deficiencies.
Generally speaking, tonsillectomy is a safe procedure that can be performed successfully among children belonging to different age groups with a low incidence of post-tonsillectomy complications compared with adults.
Children with hearing impairment may have a potential risk for vestibular dysfunctions. They may undergo a sensory redistribution process whereby visual and somatosensory information becomes more essential for postural control. The aim of the study was to assess the balance ability in children with sensorineural hearing loss (SNHL) compared with normal-hearing controls using clinical balance subset tests. A second aim was to determine the prognostic value of some etiological, audiological, and demographic (age and sex) factors in predicting a possibility for vestibular impairment for the early identification of children with vestibular deficits.
Thirty children with normal hearing (17 girls and 13 boys) and 50 children with bilateral SNHL of varying degree, aged between 5 and 15 years, were recruited from the Audiology Unit of Assiut University Hospital. All of them were subjected to the following: basic audiological evaluation (pure tone, speech audiometry), immittancemetry and auditory brainstem responses, clinical balance subset tests of the standardized Bruininks-Oseretsky Test of motor proficiency (BOT-2), modified Clinical Test of Sensory Interaction for Balance (mCTSIB), one-leg stand (OLS), and tandem stand.
Hearing-impaired (HI) children showed bilateral SNHL of varying degree, ranging from moderate to profound hearing loss (moderately–severe 32%, severe 18%, and profound 50%) and of different etiologies (heredofamilial 46%, acquired 38%, not known 16%).
Balance abilities as measured in this study were significantly poorer in HI children compared with normal-hearing children. HI children with acquired cause and profound degree of SNHL had the highest abnormal score in these clinical tests compared children with other etiologies and degrees of SNHL (although this difference did not reach statistical significance).
In most clinical balance tests that were done in this study, the youngest children in the HI group achieved scores that were almost lower than the scores obtained by the older age groups; the most significant difference was observed for tests performed with eyes closed.
Balance dysfunction occurs in a significant percentage of HI children and may have significant detrimental effects on motor development mainly in very young children. Therefore, information on the identification and treatment of these balance dysfunctions is crucial.
Superior canal dehiscence syndrome is a rare medical condition with many variants. In this case report, we present a 35-year-old patient who presented with atypical presentation of superior canal dehiscence syndrome. We discuss his audiological, vestibular, and radiological findings before and after surgery. We present a protocol to establish the diagnosis of a similar condition, especially those presenting atypically.
Speech intelligibility is usually expressed as a percentage of spoken words, sentences, or phonemes correctly identified by a listener or a group of listeners when spoken by a talker or a number of talkers. Communicative disorders could have a deleterious effect on speech intelligibility. To date, there are no Arabic tests measuring speech intelligibility.
It is necessary to develop and standardize an objective Arabic speech intelligibility test that can be used to estimate the degree of deterioration of speech intelligibility in communicative disorders as an attempt to develop a valid and a reliable tool to assess the efficacy of different therapy programs for different communicative disorders.
This study was carried out on 200 children with an age range of 4–12 years whose language skills were either fully developed or equivalent for age. All children were selected randomly from the outpatient clinic of phoniatrics and had any of five selected speech disorders affecting speech intelligibility. Each child included in the study was subjected to two evaluations: a subjective rating of the child’s speech intelligibility and the developed Arabic speech intelligibility test, which is meant to be an objective measure.
The results showed a highly significant correlation between the scores of the Arabic speech intelligibility test and the average scores given by raters, the average scores for words, and the average scores for sentences (0.92, 0.98, and 0.84, respectively).
The developed test is proven to be valid and reliable for measuring speech intelligibility in children and could be categorically classified according to ranges of severity.
The repair of skull base defects after skull base surgeries is a major problem. Postoperative cerebrospinal fluid leak in reconstruction of the anterior skull base defect using a nasal septal flap was minimal when compared with other techniques.
The nasal septal flap should be considered as the first line of treatment after transnasal endoscopic skull base surgery.
Evaluation of the usefulness and reliability of endoscopic endonasal skull base reconstruction using a nasal septal flap.
This study was carried out on 10 paediatric patients with skull base defects because of different pathologies. These patients were admitted in El-Kasr El-Ainy Hospital, Otorhinolaryngology Department. These patients included one patient with a germ cell tumour, five patients with a congenital encephalocele and four patients with skull base defects because of trauma to the skull base.
Various endoscopic techniques have been described to separate the cranial cavity from the sinonasal cavity to prevent infection, pneumocephalus and cerebrospinal fluid leak. Different techniques were used to close the anterior skull base defects such as multilayer free graft, suturing the dural defect combined with free graft and reconstruction based on a vascularized graft. The nasal septal flap should be considered as the first line of treatment after transnasal endoscopic skull base resections.
This study aimed to evaluate the efficacy of palonosetron, the 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, in preventing postoperative nausea and vomiting (PONV) after middle ear surgery.
Sixty-two ASA I and II patients who had undergone middle ear surgery under general anesthesia were included in a double-blind, placebo-controlled study and were enrolled into two groups: palonosetron group (P) and placebo control group (C). Patients were administered 0.075 mg of palonosetron or isotonic saline, respectively. The incidence of PONV and requirement of rescue antiemetics were assessed. The severity of nausea was evaluated according to the visual analogue scale. Patients who had not experienced any attack of vomiting or received rescue drug were considered to have a complete response.
The incidence of PONV was significantly lower in group P than that in the control group C during (0–4 h) P-value less than 0.001 and (4–24 h) 0.05 periods, and the incidence of complete response was 83.7% in group P and 6.5% in group C (P<0.001).
Palonosetron could provide effective prophylactic antiemetic control to prevent PONV after middle ear surgery under general anesthesia.
The activities of swallowing and speaking depend upon the ability to achieve adequate closure of the velopharyngeal (VP) port. Swallowing and speaking are complex motor skills that involve the coordination of diverse groups of muscles between the nasopharynx and oropharynx. Various conditions can affect VP closure function including an adenoidectomy operation. Defects in the VP sphincter can affect the patient’s speech in many ways – for example, induction of hypernasality, decreased speech intelligibility, and nasal emissions. Three main surgical approaches to VP corrective surgery can be used – namely, pharyngoplasty, pharyngeal flap, and posterior pharyngeal wall augmentation. The author of this study designed a new procedure called cerclage sphincter pharyngoplasty to be added for correction of VP insufficiency. Maximum benefit can be achieved when the surgical technique takes advantage of the remaining native VP closure. As pharyngeal flaps are not functional and have multiple drawbacks and because posterior pharyngeal wall augmentation is successful only in case of minor defects, the author focuses on functional techniques used for correction of different closure patterns and grades – namely, cerclage and sphincter pharyngoplasty.
The nephron in the kidney and the stria vascularis in the inner ear have many anatomical, physiological, and pathological similarities. Several studies have reported sensorineural hearing loss in adult chronic renal failure (CRF). However, there are only a few reported surveys on audiological affection in children with CRF.
The aim of this study was to determine the presence, type, and severity of hearing loss (HL) and to evaluate the relationship of reported HL with the duration of hemodialysis and biochemical and hematological data of children with CRF on regular hemodialysis.
This study included 30 patients with CRF on regular hemodialysis and 20 healthy children as a control group. All children were subjected to standard and extended high-frequency pure-tone audiometry, tympanometry, and otoacoustic emissions.
Among 60 ears examined, 50 ears showed sensorineural hearing loss (83.3%), mainly at high frequencies (64%) and of mild and moderate severity, with a highly statistically significant difference between pure-tone thresholds in the patients and the control groups across frequencies 500–8000 Hz. High-frequency thresholds were significantly higher for the patients with CRF. No significant relation was found with the duration of hemodialysis or biochemical and hematological parameters. Transient-evoked otoacoustic emissions testing showed absent emission in 20 ears and those with preserved transient-evoked otoacoustic emissions had significantly lower amplitudes in all frequencies.
A high incidence of HL among children with CRF on regular hemodialysis was found in this study. Duration of hemodialysis treatment and biochemical and hematological parameters did not have a significant impact on HL. Thus, audiological evaluation must be considered in these children.
To identify the correlation between obstructive sleep apnea (OSA) and motor nerve conduction study of hypoglossal nerve in terms of amplitude and terminal latency.
The present study included 16 adult OSA patients who presented to the Otolaryngology outpatient clinic of the Suez Canal University Hospital. Exclusion criteria included previous significant facial trauma, head or neck cancer, previous surgery (including tonsillectomy or adenoidectomy), previous radiation therapy to head or neck, known diagnosis of peripheral neuropathy, any implanted device (nerve stimulator, implanted pump, pacemaker, and defibrillator), and known pregnancy. All patients were subjected to an assessment protocol that included thorough assessment of history (age, sex, snoring, nasal obstruction, and excessive daytime sleepiness), clinical examinations [BMI, apnea/hypopnea index (AHI), Friedman tongue position (FTP), and Mallampati grading], and electrophysiological studies of hypoglossal nerve.
87.5% of the patients had moderate to severe AHI (15 to >30). The degree of excessive daytime sleepiness was slight in 18.8% of the patients, mild in 50% of the patients, and moderate in 31.3% of the patients. FTP grades ranged from grade II (FTP II) (37.5%) to grade III (FTP III) (62.5%). Mallampati grading of tonsils also ranged from grade 2 (T2) (43.8%) to grade 3 (T3) (56.2%). Seventy-five percent of the patients had delayed distal latency of hypoglossal nerve. The mean distal latency of the patients was 3.24±123 ms, with the range of 2.5–7.7 ms. All the patients had low motor amplitude of the hypoglossal nerve. There were significant positive correlations between excessive daytime sleepiness and BMI, snoring, FTP, Mallampati grading, and decreased hypoglossal nerve distal latency.
Most patients with OSA had significantly impaired hypoglossal nerve conduction in the form of delayed distal latency and low motor amplitude.
In this study, we present our experience with correction of prominent ears by posterior scoring only without elevation of the anterior perichondrium of the auricle.
By avoiding an anterior subperichondrial flap, we managed to reduce operative time, convalescence, and complications, with no effect on postoperative outcome.
The standard treatment for nasolacrimal duct obstruction has been dacryocystorhinostomy (DCR) surgery. Endoscopic endonasal dacryocystorhinostomy (EnDCR) has been gaining popularity, largely because of technological advances in endoscopes and other modern instruments used for rhinologic surgery. EnDCR can be performed under locoregional anaesthesia in elderly and medically unfit patients for general anaesthesia. The EnDCR often requires septal or turbinate surgery to optimize access to the lacrimal area. Here, we report a revision EnDCR using cold steel tools with powered drills under locoregional anaesthesia in an unfit elderly patient with chronic excessive tearing because of chronic dacryocystitis.
Intranasal corticosteroids offer effective treatment for allergic rhinitis. The action of interleukin 5 (IL-5) (Th2-type cytokine) and its response to intranasal steroids has not been thoroughly studied in the deep compartment of the nasal mucosa. The aim of this study was to determine the influence of prolonged topical glucocorticosteroid on the allergic inflammatory responses in the deep compartment of the nasal mucosa in patients with allergic rhinitis.
Fluticasone furoate spray was used once daily. Biopsies were obtained from 22 patients with perennial allergic rhinitis at different intervals: before treatment with nasal corticosteroids, and after 1, 6, and 12 months. Biopsies were taken from 18 individuals serving as a control group. All biopsies were examined by light microscopy and immunohistochemisty.
The results showed the efficacy of fluticasone in reducing the number of eosinophils in both epithelial and subepithelial layers, which suppresses the allergic manifestations. The maximum reduction occurred after 12 months. This is achieved by reducing the number of eosinophils and IL-5 in both epithelial and subepithelial compartments.
Intranasal corticosteroids effectively reduce both the number of eosinophils and IL-5 expression inside activated eosinophils. They influence both the epithelium and the deep compartment of the nasal mucosa.
We report a 60-year-old nonsmoker woman with laryngeal squamous cell carcinoma for which total laryngectomy and right conservative neck dissection was decided. Right hemithyroidectomy is usually a part of this procedure, but in this case, because of inadvertent ligation of the left inferior thyroid artery, total thyroidectomy was performed. A small nodule 0.5 cm of papillary microcarcinoma in the left lobe that was not diagnosed preoperatively was discovered in the final pathological examination. Therefore, ultrasound evaluation of the thyroid gland should be added to the work-up of all cases undergoing total laryngectomy and there is a need for new guidelines to treat incidental thyroid lesions in the context of laryngeal cancer.