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2012| January | Volume 28 | Issue 1
Online since
June 13, 2014
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REVIEW ARTICLES
Endonasal neuroendoscopy: New horizons
Ahmed El-Guindy
January 2012, 28(1):1-7
DOI
:10.7123/01.EJO.0000411077.98347.c1
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ORIGINAL ARTICLES
Newborn hearing screening: Importance and characteristics of a high-risk register in a neonatal intensive care unit
Ahmed Sameh Farid, Iman Abd El Salam Seoud, Tarek Mohamed El Dessouky, Marwa Mohamed El Shabrawy, Zeinab Mohamed Mounir
January 2012, 28(1):17-21
DOI
:10.7123/01.EJO.0000411083.36466.f9
Background
Hearing loss is one of the most common congenital anomalies, occurring in approximately two to four infants per 1000. Children whose hearing loss is identified, and who receive appropriate intervention before 6 months of age, develop significantly better language ability than those who are identified later.
Objectives
To assess the failure rate of neonatal hearing screening in a high-risk register group of neonates and the relative importance of these risk factors in hearing impairment in the neonatal ICU (NICU) of the El-Mounira Children Hospital and identify the incidence of hearing loss.
Patients and methods
The study was carried out on 100 neonates in El-Mounira Children Hospital (NICU) and on 30 control neonates (15 boys and 15girls) chosen from Kasr El-Eini Maternity Hospital. All control cases aged 1–4 days had normal birth weight (2000–4000 g) and gestational age (35–40 weeks) and were delivered normally or by cesarean section without complications. The children in the study group were 3–23 days old (53 boys and 47 girls) and had birth weight ranging from 900 to 4000 g and gestational age ranging from 28 to 41 weeks. All the cases were screened for hearing loss using the transient evoked otoacoustic emission device (Echo-Screen), followed by a second-stage screening for those who failed the test with the transient evoked otoacoustic emission device. Those cases given a Refer were then made to undergo an Automated Auditory Brainstem Response test after 3–4 weeks.
Results
In the NICU group, 55% had hyperbilirubinemia, requiring exchange transfusion, 13% were of low birth weight (<1500 g), and 13% were on mechanical ventilation. Other risk factors such as cranio-facial anomalies showed a combined effect. In the first screening phase, 71% were given a Pass response and 29% were given a Refer response. In the second screening phase, 28% were given a Pass, 31% were given a Refer, and 41% were dropouts, as they had passed their critical stage and had been discharged. The highest referral rates were in neonates with multiple risk factors.
Conclusion
A comprehensive intervention and management program must be an integral part of the screening program in the postnatal period. Public awareness about the value of hearing screening is important for follow-up to be more effective. Monitoring of ototoxic drug administration and further assessment of the high prevalence of hyperbilirubinemia are needed. A team of obstetricians, pediatricians, and audiologists is needed to identify and assess risk factors.
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Prosodic assessment in Egyptian children with specific language impairment
Elham A. Shaheen, Sahar S. Shohdi, Nader N. Ahmed, Heba Ashour
January 2012, 28(1):56-63
DOI
:10.7123/01.EJO.0000411076.60229.ab
Background
Prosody is the aspect of language that conveys emotion by changes in tone, rhythm, and emphasis during speech. Prosody includes aspects such as intonation and tone of voice. Specific language impairment (SLI) is a developmental disorder in which language development is below the chronological age despite normal nonverbal intelligence and no obvious neurological or physiological impairments or emotional and/or social difficulties that could impact language use. Most of these children experience considerable difficulty in language comprehension and/or production and experience specific problems in learning syntactic rules. In the speech stream, boundaries of major syntactic constituents are reliably marked by prosodic cues. Although deficits in related aspects of prosody have been hypothesized to underlie SLI, prosody has been little studied in Egyptian children having SLIs.
Objective
The objective of this work was to assess prosody in Egyptian children with an SLI in order to correlate the results with the clinical profile of the patients so as to choose the proper rehabilitation training program.
Participants and method
This study included 30 Egyptian children with SLIs and 30 normal children as a control group; their ages ranged between 4 and 6 years. Assessment included language assessment using the Arabic language test and prosodic assessment using the protocol of prosodic assessment, which was especially designed to assess prosodic abilities in Arabic-speaking children.
Results
Results revealed a significant difference in most of the individual and total subjective scores of prosodic skills between the control group and children with SLIs. Although the difference in the average of the total objective scores of prosodic assessment, which included pitch and energy, was highly significant, the average of total sentence duration was insignificant. There was significant correlation between the total language age and all subjective scores and an insignificant correlation with the total objective scores of prosodic assessment skills in SLI children.
Conclusion
SLI children have defective receptive, expressive, subjective, and objective scores of prosodic assessment skills that should be considered during the rehabilitation program for language stimulation for these children.
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Arabic psycholinguistic screening tool: A preliminary study
Azza Adel Aziz, Elham Ahmed Shaheen, Dalia Mostafa Osman, Ahmad El Sabagh
January 2012, 28(1):64-73
DOI
:10.7123/01.EJO.0000411080.90712.1c
Background
Psycholinguistics or the psychology of language refers to the study of the psychological and neurobiological factors that enable humans to acquire, use, and understand language.
Objectives
This work aimed at designing and applying an Arabic Psycholinguistic Screening Tool on a group of native Egyptian students aged 7 through 9, 11 years old, enrolled in primary grade 1 through primary grade 4, and analyzing the obtained results in order to attain a better understanding of psycholinguistic skills in the studied age range and preliminarily study the constituent items of the tool.
Participants and methods
The sample in this study included 45 healthy native Arabic-speaking Egyptian children: 25 boys and 20 girls. The groups were as follows: group I (from 7 to 7; 11 years old), group II (from 8 to 8; 11 years old), and group III (from 9 to 9; 11 years old). They were attending regular classes in schools following the Egyptian Arabic National curriculum. The participants were enrolled in primary grade 1 through primary grade 4. Children were randomly selected from a cluster of children reported to be subjectively free from any hearing difficulties, delayed language development, medical problems, and intellectual, social, psychiatric, psychological, or serious academic difficulties. Psycholinguistic abilities for each child were evaluated using the Arabic Psycholinguistic Screening Tool designed in the current study. Tested parameters included oral similarity, morphological closure, proper word and nonsense word repetition, phonological deletion, phonological rhyming awareness and production, spoken and written vocabulary, sequencing events, sight and sound decoding, in addition to sight and sound spelling. The results obtained were then analyzed using descriptive, comparative, correlation, reliability, and validity studies.
Results
The results reflected internal consistency as well as the content, construct, and convergent validity of the Psycholinguistic Screening Tool for children aged 7 through 9; 11 years for those items covering oral similarity, morphological closure, proper word repetition, spoken and written vocabulary, proper word repetition, spoken and written vocabulary, sequencing of events, sight and sound decoding, and sound spelling. Although nonsense word repetition, sight spelling, phonological rhyming awareness, and production subtests were found to have convergent validity as well as internal consistency, statistical studies did not quite prove their construct validity.
Conclusion and recommendations
(a) The phonological rhyming awareness and production as well as nonsense word repetition and sight spelling subtests should be revised taking into consideration the Arabic educational curriculum applied in Egyptian schools. (b) Further studies should be carried out on the Arabic Screening Tool to study predictive validity on a larger group of children. (c) Studies should be carried out using the Arabic Psycholinguistic Screening Tool on a group of children with learning disabilities to examine its diagnostic sensitivity.
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TMC: A new staging system for tympanomastoid cholesteatoma
Aziz Belal, Mahmoud Reda, Ahmed Mehanna, Yousef Belal
January 2012, 28(1):12-16
DOI
:10.7123/01.EJO.0000411081.90723.55
Objective
To present a new staging system for tympanomastoid cholesteatoma that is based on the primary site of pathology in the middle ear (T), its spread to the mastoid (M), and to the surrounding structures, either cranial, intracranial, or extracranial, and presence of complications (C).
Setting
Tertiary Care Center (ENT Department, Faculty of Medicine, University of Alexandria, Egypt).
Study design
Clinical Prospective Study.
Methods
The TMC staging system is based on the correlation of preoperative otoscopy findings with computed tomography examination of the temporal bone. Preoperative findings have also been correlated with intraoperative findings.
Patients
We included 120 patients with tympanomastoid cholesteatoma diagnosed preoperatively.
Results
In 87% of the patients, preoperative and intraoperative staging were well correlated.
Conclusion
The TMC staging system of cholesteatoma paves the way to a logical roadmap for functional surgery of the middle ear and mastoid; in addition, it makes the comparison of clinical studies about cholesteatoma meaningful.
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Sinus involvement in cases of rhinoscleroma: A cause of antibiotic resistance and early recurrence after medical treatment
Ahmed Atef, Nassim Talaat, Ahmed El Farouk, Mohamed Qotb, Hesham Fathi, Shady Ilia
January 2012, 28(1):8-11
DOI
:10.7123/01.EJO.0000411079.83100.c1
Theory
To investigate the true incidence of sinus infection in cases of rhinoscleroma, and the possible role of reinfection from the sinuses to explain recurrence and resistant to treatment in cases of scleroma.
Materials and methods
Twenty-five patients with histologically proved granular rhinoscleroma were included in this cohort prospective study.
Results and conclusion
More than one-third of the cases of rhinoscleroma in our series were associated with histologically proved sinus lesions, and these sinus-positive lesions were associated with resistance to standard medical treatment and with early recurrence.
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Electrophysiological differences in sensorineural hearing loss patients with and without problem-tinnitus
Eman A Said
January 2012, 28(1):22-34
DOI
:10.7123/01.EJO.0000411078.05971.d1
Objects
Problem-tinnitus refers to tinnitus that is sufficiently severe to produce a major disruption in the patient’s life; tinnitus of such severity involves a number of regions of the auditory system and other brain systems may also play an essential role. Auditory brainstem responses (ABR) and event-related potentials (ERP) were recorded from sensorineural hearing loss (SNHL) patients with problem-tinnitus and were then compared with responses from normal hearing and hearing loss tinnitus-free patients.
Aim
To study whether differences exist in ABR and/or ERP parameters in SNHL patients with and without problem-tinnitus when matched as closely as possible for hearing loss, age, and sex to investigate the mechanism responsible for tinnitus.
Materials and Methods
Ninety participants were included in this study. They were divided into two groups: the study group included 66 participants with bilateral symmetrical SNHL that did not exceed a moderate degree. The study group was divided into two subgroups: 36 patients had problem-tinnitus and 30 patients were tinnitus-free (SNHL, age, and sex matched). Participants in each of these subgroups were compared with each other and were also compared with 24 healthy individuals in the control group (age and sex matched with the study group). All participants were subjected to a basic audiological evaluation and electrophysiological tests (ABR and ERP).
Results
This work had shown a higher prevalence of ABR abnormalities in tinnitus patients in comparison with either the control group or the SNHL tinnitus-free group. Statistically significant differences were found in III–V and I–V interpeak latencies and in the V\I amplitude ratio in problem-tinnitus female patients compared with tinnitus-free female patients. Meanwhile, in problem tinnitus male patients when compared with tinnitus-free male patients at III–V interpeak latencies and at V\I amplitude ratio. As regards the results of ERP in this work, an increase in latency and amplitude reduction were found. Statistically significant differences were observed regarding both the mean latency values of waves N1, P2, and P300 and the amplitude mean values of P2 and P300 when we compared the problem-tinnitus subgroup with either the tinnitus-free subgroup or the control group (both female and male patients.
Conclusion
A variety of ABR and ERP components are altered in tinnitus patients; this would indicate impairment in both the central auditory pathway and central auditory processing. Thus, it is suggested that this form of ABR, ERP testing could be considered as an objective measure to complement behavioral, audiologic, and other physiologic methods of assessing tinnitus, rather than a single definitive tinnitus measure in an attempt to supplement and thereby extend knowledge of the nature and origins of tinnitus. Furthermore, these results provide the basis for future neurofeedback-based tinnitus therapies aiming at maximizing the ability to shift attention away from the tinnitus.
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Assessing speech intelligibility in a group of Egyptian dysarthric patients
Mohamed Sadek Refai, Azza Adel Aziz, Dalia Mostafa Osman, Shahinaz Farag El-Shafee
January 2012, 28(1):49-55
DOI
:10.7123/01.EJO.0000411075.95445.ea
Background
Improving speech intelligibility in dysarthric patients is considered the primary goal of therapeutic intervention.
Aim
This study aimed at examining factors affecting speech intelligibility in four Arabic-speaking dysarthric groups using perceptual and instrumental techniques in order to gain a better understanding of the important factors contributing to reduced speech clarity in these patients.
Methods and procedures
Participants included 30 male Egyptian dysarthric patients (patient group) and 30 male age-matched healthy individuals (control group). The patient group was subdivided – on the basis of the neurological examination and investigation that had been carried out previously at the Neurology Department, Kasr el Aini Hospital – into four subgroups; spastic, ataxic, flaccid, and hypokinetic (having Parkinsonism). Speech samples consisting of spontaneous speech and a standard reading passage (that the participants were asked to repeat after the assessor) were used to obtain the following variables: speech rate (number of words per minute), Speech Intelligibility Score, number of nonintelligible words per minute, dysphonia grade, percent of consonants correct, percent of vowels correct, Nasalance Score, fundamental frequency, jitter, shimmer, harmonic-to-noise ratio, duration of /a/, first and second formant frequency values for three corner vowels /a/, /i/, and /u/, voice onset time of /b/, /t/, /k/, stop gap of /t/, /t/, /d/, /d/, and duration of /s/ and /∫/. The study examined the differences between the healthy control group and the different dysarthric groups for each variable as well as the correlation between speech intelligibility and each variable within each dysarthric subgroup.
Outcomes and results
The Speech Intelligibility Score was the highest for flaccid dysarthria and the lowest for ataxic. Results revealed significant differences between the control group and each of the patient groups studied for all subjective measures as well as most of the instrumental measures that were included in the study. A significant positive correlation was found between speech rate and speech intelligibility in patients with ataxic and flaccid dysarthria. However, a negative correlation was found between speech rate and speech intelligibility in patients with hypokinetic dysarthria. A significant negative correlation was found between speech intelligibility and jitter, F1 and F2 of /u/, stop gap of /t/, /t/, /d/, and /d/, and /s/ duration in spastic, ataxic, and flaccid groups. In addition, a significant negative correlation was found between shimmer and speech intelligibility in the ataxic group and between Nasalance Score and speech intelligibility in the flaccid group.
Conclusion and implications
Factors contributing to reduced speech intelligibility vary from one type of dysarthria to the other.
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Genetic study of autosomal recessive nonsyndromic sensorineural hearing loss in Kuwaiti children
Ahmed S. Farid, Mohammed I. Shabana, Mona H. Selim, Khalid H. Al Sebeih, Maryam M. Abdulla
January 2012, 28(1):35-43
DOI
:10.7123/01.EJO.0000411085.21218.f5
Background
The prevalence of congenital hearing loss was found to be one in 1000 of live births. Fifty percent of the cause is genetic and autosomal recessive nonsyndromic sensorineural hearing loss (ARNSNHL) is responsible for 80% of the genetic causes.
Study design
Descriptive cross-sectional study.
Objectives
To study the genetic causes of ARNSNHL, mainly mutation in the gene encoding
connexin26 (Cx26)
, and to correlate the identified gene and mutation with the degree and configuration of hearing loss, the progressiveness of hearing loss, as well as its relation to language development.
Patients and methods
One hundred children, age ranging from 6 months to 18 years, presenting with congenital ARNSNHL were chosen. Behavioral observation audiometry or pure tone audiometry to identify the hearing threshold level of the children was performed. Imittancemetry, otoacoustic emissions, auditory brainstem response, and computed tomography scan study were also undertaken. In addition, genetic tests to detect
Cx26
mutations using a PCR and primers, as well as sequencing using different primers were also undertaken.
Results
Out of the total of 100 cases, 15 children were shown to have positive results for
Cx26
; nine of these were heterozygous and six were homozygous. Twelve participants (80%) among the
Cx26
cases were due to 35delG. Out of the nine children who were heterozygous, six showed positive results for D1 (35delG), whereas three children were found to have positive results for D2 (G2A at location base 71). All the six homozygous cases were shown to be positive for D1 (35delG). Thus, the results revealed that 80% of the positive genetic results cases had 35delG.
Conclusion
Eighty percent of the cause of ARNSNHL in a Kuwaiti population was the 35delG mutation and 20% was due to G2A at location base 71. Of all the cases, 57% showed a positive family history of hearing loss. The homozygous cases presented with more severe clinical pictures compared with the heterozygous cases.
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Assessment of postural control system in autistic patients
Mohamed Ibrahim Shabana, Amira Mohamed El Shennawy, Tarek Mohamed El Dessouky, Shiama Ahmed Sabry
January 2012, 28(1):44-48
DOI
:10.7123/01.EJO.0000411082.28842.4c
Introduction
Studies using clinical tests have reported abnormal postural balance in children with autism generally but it was only clinically significant when somatosensory input was disrupted alone or in combination with other sensory challenges.
Objective
To assess the postural control system in autistic children and correlate their age and Child Autism Rating Scale (CARS) score with their postural control.
Methods
Computerized dynamic posturography was performed in 20 autistic children with (IQ>70) between the ages of 5 and 15 years and 15 age-matched healthy children.
Results
There was a statistically significant positive correlation between age in both the study and the control groups and the Sensory Organization Test (SOT) results in all SOT conditions. As regards the degree of autism, this study included 20 autistic children diagnosed by CARS and their CARS values ranged from 30 to 46, with a mean (33.7±3.22). In our study, we found that there was a statistically significant negative correlation between the CARS score in the study group and SOT results in all conditions, except in SOT condition 1.
Conclusion
The evidence from this study suggests the more general involvement of neural circuitry beyond the neural systems for social behavior, communication, and reasoning, all of which share a high demand on neural integration of information.
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CASE REPORT
Pemphigus vulgaris of the larynx
Mohammed Ibrahim Eladl
January 2012, 28(1):74-74
DOI
:10.7123/01.EJO.0000411084.13595.52
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