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   2014| April-June  | Volume 30 | Issue 2  
    Online since May 27, 2014

 
 
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AUDIOLOGY FOR OTOLARYNGOLOGIST
The role of videonystagmography (VNG) in assessment of dizzy patient
Soha Mekki
April-June 2014, 30(2):69-72
DOI:10.4103/1012-5574.133167  
Videonystagmography (VNG) is a complete diagnostic system for recording, analyzing, and reporting eye movements using video imaging technology, in which hi-tech video goggles with infrared cameras are used. VNG includes a series of tests used to determine whether a vestibular disease may be causing a balance or dizziness problem; VNG can differentiate between a central and a peripheral vestibular lesion, and, if peripheral, it can decipher between unilateral and bilateral vestibular loss. VNG addresses the functionality of each ear.
  33,731 2,230 2
CASE REPORTS
Autoimmune inner ear disease associated with ankylosing spondylitis
Kazuma Sugahara, Makoto Hashimoto, Yoshinobu Hirose, Hiroaki Shimogori, Hiroshi Yamashita
April-June 2014, 30(2):176-179
DOI:10.4103/1012-5574.133224  
We report here a case study of a 24-year-old man suffering from autoimmune inner ear disease who also suffered from ankylosing spondylitis (AS). Although he was previously diagnosed with AS, he has now presented with sensorineural hearing loss and vertigo. It is the first case that a patient with AS displays symptoms of autoimmune inner ear disease. His symptoms responded well to prednisolone treatment. However, because weight gain is a common side effect of steroid treatment and may exacerbate the lower back pain, which is symptomatic of AS, he has so far been treated with a minimum dosage of prednisolone. In addition, intratympanic administration of dexamethasone was effective to suppress the exacerbation of deafness.
  15,281 392 -
ORIGINAL ARTICLES
Recurrent epistaxis in children: When should we suspect coagulopathy?
Magy S Abdel Wahab, Hesham Fathy, Rania Ismail, Nancy Mahmoud
April-June 2014, 30(2):106-111
DOI:10.4103/1012-5574.133207  
Objective The objective of this study was to evaluate children and adolescents with recurrent epistaxis and to spot variables that may predict underlying bleeding disorder. Study design This was a prospective study. Materials and methods Thirty-six children with recurrent epistaxis were recruited from ENT outpatient clinic as well as emergency room of Cairo University children hospital. Patients with systemic causes for epistaxis were not included. All patients were subjected to basic workup to differentiate between ENT and hematological causes of epistaxis. Accordingly, extended ENT investigations or coagulation studies were performed. Results Results showed 47.6% incidence for bleeding disorders, 39.7% incidence for ENT causes, and 12.7% incidence for idiopathic causes. Reported coagulopathies included idiopathic thrombocytopenic purpura with an incidence of 26.7%, platelet functions disorders such as Glanzmann's thrombasthenia (13.3%) and Bernard-Soulier syndrome (10%), aplastic anemia (3.3%), hemophilia A (3.3%), Von Willebrand disease (3.3%), and unclassified (40%). Reported local ENT causes included bacterial rhinitis (88%) (lodged foreign body was found in 1/3 of these patients, digital trauma by habitual nose picking was detected in another 1/3, and the remaining 1/3 represented cases of complicated previous viral rhinitis), nasal allergy (8%), and adenoid (4%). Conclusion The study recommended some statistically significant predictors for bleeding disorders such as positive consanguinity, high epistaxis bleeding score, presence of other bleeding sites, low hemoglobin level and platelet count, and elevated activated partial thromboplastin time.
  11,879 567 1
A comparative study on effectiveness of the rolling-over maneuver in rehabilitation of patients with posterior semicircular canal benign paroxysmal positional vertigo
Hesham A Abdel Kader, Fathy N Abdel Halim, Tayseer T Abdel Rahman
April-June 2014, 30(2):88-93
DOI:10.4103/1012-5574.133193  
Hypothesis Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder. The canalith repositioning procedure (CRP) is known to be an effective therapy for the treatment of BPPV. However, because of its various movements of the head and body, it is impossible to perform in BPPV patients with orthopedic impairments or in the elderly. The rolling-over maneuver (ROM) involves easy movements, with only a small load. This therapy is suitable for most BPPV patients, especially for those without an indication for CRP. Hence, we propose that ROM is as effective as CRP for the treatment of BPPV. Purpose In this study, we compared among the ROM, Epley, and Brandt-Daroff maneuvers in the management of patients with posterior semicircular canal-type BPPV. Patients and methods The study included 60 patients with BPPV who were randomized and divided into the following three groups: (i) those treated by Epley maneuver as CRP; (ii) those treated by ROM; and (iii) those treated by the Brandt-Daroff maneuver. Results The findings of this study demonstrated that the success rate was the best in patients who were treated with Epley maneuver (90%), then in patients treated with ROM (85%) followed by those treated with the Brandt-Daroff maneuver (80%). The recurrence rate after management was high in patients treated with the Brandt-Daroff maneuver (31.25%), with no statistically significant difference. Conclusion We recommend either Epley maneuver in the office or ROM at home, according to the general condition of the patient.
  8,216 316 -
CASE REPORTS
Post-traumatic auriculotemporal neuralgia: A previously unreported complication of endaural incision
Kamal G Effat
April-June 2014, 30(2):180-181
DOI:10.4103/1012-5574.133225  
Auriculotemporal neuralgia is a rare form of facial pain. In this report, the author presents a case of auriculotemporal neuralgia following an endaural incision. This condition has not been previously documented in the literature.
  5,430 209 -
ORIGINAL ARTICLES
Effectiveness of modified cautery-assisted palatal stiffening operation in controlling snoring
Ussama A. Naseer, Badawy Khalifa, Ahmed Nassar
April-June 2014, 30(2):147-150
DOI:10.4103/1012-5574.133219  
Objective The aim of the study was to assess the effectiveness of modified cautery-assisted palatal stiffening operation (CAPSO) to treat snoring. Patients and methods Fifty patients with simple snoring underwent the modified CAPSO; patients underwent polysomnography, preoperatively and at 3 months postoperatively. Results All patients had improvement in their snoring, and the patients and their sleep partners were satisfied with the result at 3 months postoperatively. Conclusion The modified CAPSO technique has shown promising and encouraging results in a small cohort of patients with simple snoring.
  4,223 233 -
Serial histopathological tracheal changes from prolonged intubations
Mohamed H Badr El Din, Mohamed R. Ahmed, Adel R. Hinnis, Moustafa S Abd El Baky
April-June 2014, 30(2):142-146
DOI:10.4103/1012-5574.133218  
Introduction Prolonged tracheal intubations are usually complicated by subglottic stenosis. The aim of this study was to identify the pathological changes in the trachea due to prolonged endotracheal intubations. Materials and methods A prospective study was conducted on 35 patients who were admitted to the ICUs for different periods of time and tracheostomy operation was planned for them. The part of the trachea that was removed during tracheostomy was examined histopathologically. Results The most common histopathological finding was inflammation and ulceration. Fibrosis was also found with evidence of cartilage necrosis. All histopathological findings were more prevalent among patients who were intubated for 1 week. Conclusion Prolonged endotracheal intubations are associated with various histopathological changes ranging from erosion of the epithelium to necrosis of the cartilage and fibrosis. Level of evidence Level 2b.
  3,946 256 -
Parental attitudes and knowledge of stuttering
Rasha F Safwat, Aya Sheikhany
April-June 2014, 30(2):151-156
DOI:10.4103/1012-5574.133220  
Background To date, very little research has been carried out on the knowledge and awareness of stuttering in an Arab population. Parents' attitudes toward stuttering play a critical role in helping the child develop healthy communication attitudes. Objective The aim of this study was to collect information on the attitude and knowledge of parents on stuttering in order to gain a better understanding of their level of awareness of the nature of the disorder. Patients and methods This study included 100 parents of preschool-aged and school-aged stutterers. They were attendants to the Phoniatric Unit at Kasr Al Aini Hospital; of these, 56 (56%) were women and 44 (44%) were men, age range 26.8-44.3 years, mean 34.7 years. A questionnaire was designed to determine the knowledge and attitudes of parents toward stuttering. Results Most parents were familiar with stuttering, but their general knowledge of the disorder was limited. Negative beliefs and attitudes toward stuttering and people who stutter were also held by some parents. The results showed a significant association between the education level and to a lesser extent sex and parental knowledge of and attitudes toward stuttering. Conclusion The importance of increasing public awareness of stuttering is evident.
  3,293 369 2
Allergic Rhinitis and its Impact on Asthma scores in asthmatic patients with and without allergic rhinitis
Mohamed Shehata Taha, Tamer Youssef, Hanaa Fathey Abd-Alsamee, Azza Omran, Waleed Farag Ezzat
April-June 2014, 30(2):112-121
DOI:10.4103/1012-5574.133210  
Background Allergic rhinitis and allergic asthma are chronic inflammatory conditions that frequently coexist, both with hallmark eosinophilia. Immunotherapy is an established treatment for allergic diseases. Noninjective routes for immunotherapy, such as the sublingual route, are thought to be valuable therapeutic options for respiratory allergy. Aim of the study In the present study, sublingual immunotherapy (SLIT) using multiple allergens was administered to allergic asthmatic patients with and without allergic rhinitis aiming to evaluate the clinical efficacy of and changes in allergen-specific antibodies during SLIT and its effect on control of asthma severity and nasal allergy scores. Patients and methods The study included 40 patients in two groups: group I included 20 asthmatic patients and group II included 20 patients with both proven bronchial asthma and allergic rhinitis. All patients were subjected to assessment of the status of asthma and hence its degree of control using the Global Initiative for Asthma (GINA) guidelines; patients received SLIT according to the results over a period of 1 year and were clinically reassessed monthly. In addition, for the recruited candidates, the initial total immunoglobulin E (IgE) levels were measured and pulmonary function tests were performed at the time of recruitment and repeated after 6 months and 1 year of the initiation of the course of SLIT. SLIT was stopped for asthmatic patients during acute exacerbation and resumed after complete asthma control. Results There was a statistically significant decrease in blood eosinophils but a statistically insignificant decrease in total IgE 1 year after SLIT in both groups. Results of specific IgE to food and inhalants revealed that there was statistically significant reduction in the number of allergens in both groups 1 year after SLIT. Results of the skin prick test revealed similar results. Our results revealed that the scores of, both Allergic Rhinitis and its Impact on Asthma and GINA had improved in all patients after 1 year of continuous therapy. Conclusion SLIT is a safe treatment strategy that significantly reduces symptoms and medication requirements and improves asthma control in both asthmatic patients with and without allergic rhinitis. SLIT using multiple allergens lowered the allergen burden in both asthmatic patients with and those without allergic rhinitis. Level of evidence 1b (Clinical Decision Rule tested within one clinical center).
  3,362 229 1
HOW I DO IT
Starplasty: A new design for pediatric tracheostomy
Mostafa I. Ammar, Amr I. Elkawa, Ahmed S. Elhamshary, Kamal Ebeid
April-June 2014, 30(2):183-187
DOI:10.4103/1012-5574.133227  
We are describing a new design of pediatric tracheostomy planned for long periods of time. The procedure entails creating a mature tracheo-cutaneous track through three dimensions Z-plasty design. This technique showed superiority to other currently available techniques in reducing the incidence of teacheostomy complications, specially serious hypoxemia after accidental deacannulation. However, this is on the expense of persistence of tracheo-cutaneous fistula after decanuulation.
  3,108 241 -
ORIGINAL ARTICLES
Removal of adenoid remnants after curettage adenoidectomy: Do we need powered instruments?
Ahmed Hesham, Mahmoud Attia, Hatem Badran, Ahmed Hussien, Sherif Safwat
April-June 2014, 30(2):102-105
DOI:10.4103/1012-5574.133204  
Aim To compare powered to cold instruments for removing adenoid remnants after conventional curettage adenoidectomy. Methods 110 patients (4 to 12 years old) scheduled for adenoidectomy with or without other surgeries (tonsillectomy, myringotomy and ventilation tube insertion) were enrolled in this prospective controlled study. We included patients with endoscopically detected adenoid remnants after curettage adenoidectomy including revision cases. Adenoidectomy was done using the adenoid curette, adenoid remnants detected endoscopically were removed by blakesley forceps (Group A) or by the microdebrider (Group B). Both groups were compared in terms of operative time, operative bleeding, post operative complications and adenoid recurrence. Results 20 patients were excluded due to absence of adenoid remnants after curettage and 10 more were lost for follow up, so we were left with 80 patients (42 in group A and 38 in group B). The mean age was 4.5 years for group A and 5 years for group B. The mean operative time was 10 minutes in group A and 9.5 minutes in group B, the difference was not statistically significant (p>0.05). Excessive intra operative bleeding was encountered in 1 patient of group B, which was controlled with suction cauetry. We didn't encounter any postoperative bleeding in either group. Also, there were no other post operative complications like nasopharyngeal stenosis and velopharyngeal insufficiency, no adenoid recurrence was detected in both groups. Conclusions Both the powered instruments (microdebrider) and the traditional instruments (blakesley forceps) under endoscopic control were characterized by a high level of precision, complete resection of residual adenoid with a very low incidence of post-operative bleeding and no recurrence, but we feel that powered instruments didn't add any advantage over the traditional ones especially if the cost of the disposable blades is taken in consideration
  2,916 162 -
Parotid sialometry: A standard technique in the diagnosis of parotid sialadenosis
Magdy A. Riad, Hussain T. Salma, Reda M. I. Sabra, Tarek A. Hamdy
April-June 2014, 30(2):138-141
DOI:10.4103/1012-5574.133217  
Background Sialadenosis is a clinical condition characterized by bilateral, painless, diffuse and recurrent parotid gland swelling. Histologically, the only feature of note is acinar cell hypertrophy, with no apparent change in the duct structure or cellular infiltrate. The functional changes in the parotid parenchyma in this condition are ill understood. The association between malnutrition and parotid gland swelling was first reported in Egypt. The pathogenesis of the condition remains unclear.The aim of this study is to explain the development of parotomegaly by analysing the parotid secretory pattern in parotomegaly patients Subjects and Methods Patients with malnutrition were studied at Ain Shams University Hospitals. 47 patients, 19 male patients and 28 female patients, were studied, of these eight patients (three male patients and five female patients) suffered parotomegaly.Thirty-one patients with morbid obesity were recruited. 23 patients were female and eight were male. Six patients in this group had parotomegaly. Results were compared with those of 30 healthy volunteers recruited from medical and nursing staff, medical students and patients attending the ENT clinic for minor procedures.Parotid saliva was collected by the standard technique Results The results of salivary analysis in 47 patients suggested a pattern of inhibitory proteodyschylia, with increased salivary flow rate and reduced total protein level and amylase activity compared with 30 healthy volunteers. This inhibitory proteodyschylia pattern is identical to the secretory pattern induced experimentally by blocking B-adrenergic receptors in the parotid Conclusion A possible explanation for the development of parotomegaly in malnutrition is a degenerative neuropathy affecting the B-adrenergic innervation of the parotid that cause acinar cell congestion by zymogen granules, which is manifested clinically as parotomegaly.
  2,800 183 -
Detection of gastric pepsin in middle ear fluid of children with chronic otitis media with effusion
Yasser Shewel, Mokhtar Bassiouny, Mohamed M. Rizk
April-June 2014, 30(2):78-81
DOI:10.4103/1012-5574.133176  
Objectives To study the possible relationship between gastroesophageal reflux and chronic middle ear effusion by (i) evaluating the presence of pepsin/pepsinogen in middle ear fluid of children with chronic otitis media with effusion (OME) and to (ii) differentiate between pepsin from gastric juice and pepsin derived from plasma pepsinogen. Patients and methods This was a prospective study carried out in the Departments of Otorhinolaryngology and Clinical Pathology, Alexandria University. Middle ear effusions and blood samples were collected from 25 patients undergoing bilateral myringotomy with tube placement for chronic OME. These samples were prepared for pepsin assay. The total pepsin/pepsinogen concentrations of effusions and serum samples were measured with an enzyme-linked immunosorbent assay using human pepsin-specific antibody. Results Pepsin was detected in 22 of 25 (88%) patients and in 42 of 50 (84%) of the ears, and it was detected in all serum samples. A total of seven of 25 (28%) patients and nine of 50 (18%) ears were found to have higher pepsin levels in their middle ear effusion samples than the cut-off value of serum. The average pepsin level in all effusion samples was 109.99 ng/ml, whereas it was 55.72 ng/ml in serum samples. Conclusion The gastroesophageal reflux is one of the contributing factors in the etiopathogenesis of middle ear effusion as gastric pepsin reaches the middle ear through the nasopharynx and Eustachian tube to cause OME.
  2,561 183 -
Auditory neural encoding of speech in adults with persistent developmental stuttering
Ola A. Ibraheem, Amal S. Quriba
April-June 2014, 30(2):157-165
DOI:10.4103/1012-5574.133221  
Background Stuttering is a speech disorder with frequent and protracted prolongations, repetitions, and silent blocks that hamper proper speech production. It develops during the preschool years with a prevalence of 5%, decreasing to 1% in adulthood to be referred to as persistent developmental stuttering. Auditory processing deficit is proposed to be one of the contributing factors to developmental stuttering. Objective This study aimed to determine the pattern of auditory processing affection if any in stuttering disorder. This might be helpful for improving management approaches in the future. Patients and methods Eleven adults with persistent developmental stuttering and 11 comparative age-matched normally fluent participants were examined with auditory brainstem response (ABR) and mismatch negativity to evaluate the brainstem and cortical processing of speech syllables, respectively. Results All participants exhibited normal brainstem processing of nonspeech (click) stimuli, whereas 72.7% of stutterers revealed prolongation of peak latency of all waves of speech-evoked ABR. An additional peak latency delay of mismatch negativity response was found in 81.8% of stutterers. Conclusion Auditory processing abnormality is proposed to be the underlying deficit in a subset of stutterers.
  2,511 208 1
Limits of conventional temporal bone computed tomography in the management of cholesteatoma otitis media: Report of 96 cases
Mardassi Ali, Mathlouthi Nabil, Kdous Safa, Mezri Sameh, Zgolli Cyrine, Chebbi Ghassen, Ben M. Rania, Akkari Khemaies, Benzarti Sonia
April-June 2014, 30(2):73-77
DOI:10.4103/1012-5574.133174  
Introduction Cholesteatoma is a dangerous chronic otitis media, with keratine accumulation causing bone erosion and invasive damages. Computed tomography (CT) is commonly indicated to evaluate the extension and the complications of cholesteatoma. Materials and methods In 96 patients with cholesteatoma otitis, preoperative CT data were compared with surgical findings using the sensitivity, specificity, and the predictive value of a CT-scan for anatomical structures. Results A CT scan offers an adequate anatomical conformation of the tympanomastoid cavities. The lysis of the tegmen (Se = 61%, Sp = 79%) and the erosion of the scutum (Se = 100%, Sp = 51%) are well visualized on coronal sections. CT is very sensitive to objective ossicular chain lysis (Se = 90%) but with a low specificity (Sp = 71%). The performance of CT in the facial canal erosion (Se = 45%, Sp = 78%) and in the labyrinthine fistulae (Se = 46%, Sp = 98%) was insufficient with the conventional scanning machine used. Conclusion A CT-scan should be a routine exam before cholesteatoma surgery, but with improved resolution, and therefore sensitivity, to characterize all middle ear structures and complications of the disease.
  2,380 238 -
Could recurrent otitis media predict primary antibody deficiencies in Egyptian children?
Shereen M. Reda, Tamer A. Yousef, Reem A. Elfeky, Mohamed T. Sallam, Reham A. Gaafar
April-June 2014, 30(2):82-87
DOI:10.4103/1012-5574.133179  
Background Recurrent ear infection is a significant warning sign of primary immunodeficiency diseases. Objective To estimate the frequency of IgA deficiency among children presenting to the outpatient clinic with recurrent otitis media (ROM > 4 times/year) and identify other possible risk factors of ROM in our community. Materials and methods Three hundred children (154 males and 146 females), who presented to the outpatient clinic of Children's Hospital, Ain Shams University with ROM, were consecutively enrolled in the study over a 1-year period. According to the age of enrollment, children were classified into two groups: group A (1-6 years) and group B (>6-12 years). The demographic features of both groups were evaluated together with assessment of serum IgA level. Results Of all patients studied, only two (0.7%) had a low serum IgA level for normal age-reference values. None of the patients had neutropenia or lymphopenia. Iron-deficiency anemia was diagnosed in 76 cases, with higher rates among the patients in group A than group B. All patients received several courses of various empirical broad-spectrum antibiotics, but with either an incomplete course (n = 192) or a poor response (n = 49). Conclusion The current study showed a relatively low incidence of IgA deficiency among children with ROM and indicated other environmental risk factors that participated in the occurrence of OM in our community.
  2,452 159 -
CASE REPORTS
Myoepithelial carcinoma of the ear: A rare case report and review of the literature
Vedula P. Saha, Sudipta Pal, Somnath Saha, Sarbani Chattopadhyay
April-June 2014, 30(2):171-175
DOI:10.4103/1012-5574.133223  
The aim of this study was to present a unique case report of myoepithelial carcinoma arising from the external auditory canal and presenting as a huge tympanomastoid mass along with a review of the literature. A 52-year-old woman presented with a large periauricular swelling of a 3-year duration with a recent increase in size over the last 3 months along with pain and bleeding from the mass. The patient was evaluated by clinical examination, haematological and biochemical tests, and computed tomographic and MRI scan of the tympanomastoid region. An incision biopsy was performed before definitive management was initiated. Computed tomographic scan and MRI were suggestive of a large tympanomastoid mass without any intracranial extension. The incisional biopsy report was suggestive of invasive adenocarcinoma. En-bloc excision of the mass including lateral temporal bone resection along with ipsilateral selective (levels I, II and III) neck dissection was performed under general anaesthesia. The resultant defect was reconstructed by a rotational scalp flap. Immunohistochemistry and histopathology of the excised specimen proved the diagnosis of myoepithelial carcinoma. After surgery, the patient was treated with adjuvant radiotherapy. At 1΍ years of follow-up, the patient was doing fine, without any recurrence of disease. Myoepithelial carcinoma of the ear has rarely been reported in the literature. Histopathology along with immunohistochemistry is the mainstay of diagnosing of this unusual lesion. Meticulous planning and proper execution of optimum surgical excision is the primary treatment modality, which should be supplemented with radiation therapy. Long-term disease-free survival, although rare, can be achieved as in the present case report.
  2,348 170 -
INTERNATIONAL EDITORIAL LETTER
Angiofibroma Group-Southeast Asia: Concept, research and outcome
Hemant Ahluwalia, Vandana Verma
April-June 2014, 30(2):63-66
DOI:10.4103/1012-5574.133149  
The Angiofibroma Group, Southeast Asia, is a global research group dedicated to innovations in angiofibroma. It was founded in 1994 with an inspiration from an angiofibroma patient. A major boost to the group came in 2008. The headquarters and secretariat of the angiofibroma group is in Agra, India. The aim of the group is to provide a platform to conduct, present, publish and promote research, exclusively in the field of angiofibroma.
  2,307 146 -
PHONIATRICS FOR OTOLARYNGOLOGIST
Office-based laryngeal procedures: An integrated approach
Aya Sheikhany
April-June 2014, 30(2):67-68
DOI:10.4103/1012-5574.133156  
The surgical management of superficial epithelial diseases of the vocal folds was primarily performed in the surgeon's office in the 19th century and in the operating room in the 20th century. In 2001, the office-based treatment for routine management of laryngeal papillomatosis and dysplasia under local anesthesia was used by Zeitels and colleagues. Office-based procedures were revisited once again and the scope was widened as the years passed This technique is relatively new, but it holds distinct advantages over the traditional operating room-based approach. In this editorial article we are describing office based laryngeal procedures as an integrated approvals between phoneticians and diagnosis with special emphasis on our experience in office based laryngeal procedure in Cairo university.
  2,250 203 -
ORIGINAL ARTICLES
The role of fine needle aspiration in pediatric head and neck masses: does the yield justify the pain?
Zeinab AlQudehy, Zainab Al-Khars
April-June 2014, 30(2):132-137
DOI:10.4103/1012-5574.133216  
Objective The aim of our study was to report our own experience with utilizing fine needle aspiration (FNA) as a primary diagnostic procedure in adolescent patients with head and neck masses, examining the utility, feasibility, and appropriateness of this technique. Study design This is a retrospective, single-institute study that was conducted at Dammam Medical Complex from January 2004 to December 2006. All adolescent patients aged between 10 and 18 years with neck masses who underwent FNA as the primary diagnostic modality were included in our study. We excluded patients with neck masses of thyroid origin and those who were lost to follow-up. Result A total of 26 patients between 10 and 18 years of age were studied. All patients presented with nonthyroidal neck masses and underwent FNA. The study population was divided into three groups depending on the tissue of origin of the mass: lymph node origin (18 patients), salivary gland origin (five patients), and miscellaneous origin (three patients). FNA from lymph-node-related masses revealed lymphadenitis in about two third of the cases, whereas of the patients with masses of salivary gland origin, 60% had a diagnosis of pleomorphic adenoma. In the third group, the masses were of variable origin. There were no reported complications. The overall sensitivity and specificity were calculated and found to be more than 90%. Conclusion We believe that FNA as an office-based procedure is well tolerated and has a high diagnostic potential in head and neck masses. FNA in the adolescent age group has not been studied separately in the literature. FNA, apart from reassuring benignity, helps in confirming malignancy and thus in initiating early treatment.
  2,241 160 -
Advanced laryngeal cancer with skin infiltration: Survival analysis
Mohamed Mosleh, Hesham Fathy
April-June 2014, 30(2):122-125
DOI:10.4103/1012-5574.133213  
Objective The objective of this study was to investigate T4 laryngeal cancer patients with skin infiltration regarding survival and different variables that may influence the survival. Study design This was a retrospective analytic study. Materials and methods This study included 14 patients suffering from laryngeal carcinoma, with tumor extending to involve the skin of the front of the neck. Total laryngectomy was performed for all patients together with excision of the overlying skin, and pectoralis major myocutaneous flap was used for reconstruction of the skin defect in all patients. Analysis of the preoperative, operative, postoperative, and follow-up patients' data was performed. The 1-, 2-, 3-, and 5-year survival rates were estimated. Results The overall mean survival time for all patients was 51.1 ΁ 8.3 months. The mean survival time for patients with recurrent disease was 16.4 ΁ 3.5 months and for patients without recurrent disease was 70.7 ΁ 6 months. The 1-, 2-, 3-, and 5-year survival rates were 92.9, 71.4, 64.3, and 50%, respectively. The univariate analysis revealed that previous treatment before definitive surgery was the only variable that had a statistical influence on the overall 5-year survival rate (P = 0.046). Conclusion Extended laryngectomy with skin removal offers reasonable 5-year survival rate for T4 laryngeal cancer patients with skin invasion, and reconstruction of the neck skin defect with a pectoralis major myocutaneous flap is a reliable method of repair.
  2,098 135 -
Effect of chitosan on bone restoration in nasal bone defect: An experimental study
Mosaad Elsisy, Ashraf Elhamshary, Yasser M. Haroon, Samira Sallam
April-June 2014, 30(2):94-101
DOI:10.4103/1012-5574.133202  
Objective The aim of this work was to study the effect of chitosan in restoration of bone defect (an experimental study). Materials and methods The study included 54 male guinea pigs. Nasal bone defect was done. The experimental animals were divided into a control group (group A), calcium sulfate group (group B), and chitosan-coated calcium sulfate group (group C). Three-dimensional computed tomography and histological examination were carried out at intervals of 1, 2, and 3 months for measuring the change in the size of the bone defect and confirmation of bone formation, respectively. Results The decrease in the size of the bone defect was significant in group C than in groups A and B. Also, histological results showed formation of woven bone after 1 month in groups B and C and formation of lamellar bone in group C in the second month, whereas the lamellar bone was formed in group B in the third month. Conclusion Radiological and histological studies showed that the new bone formation on defected nasal bone was more in group C. These findings suggest that chitosan is very effective in early bone formation.
  1,976 147 -
BOOK REVIEW
Pediatric airway surgery: Management of laryngotracheal stenosis in infants and children

April-June 2014, 30(2):188-190
  1,921 195 -
ORIGINAL ARTICLES
Effect of age on ocular vestibular-evoked myogenic potentials using air-conducted sound
Samir Asal
April-June 2014, 30(2):166-170
DOI:10.4103/1012-5574.133222  
Rationale/purpose Diagnostic testing of the vestibular system is an essential component for the correct treatment and rehabilitation of patients with balance dysfunction. Stimulus-related electromyogenic changes can be recorded from the extraocular muscles and is termed ocular vestibular-evoked myogenic potential (oVEMP). These changes are a reflection of the otolith organ functionality. The purpose of this study was to investigate the effect of age on the amplitude, threshold, and latency of the oVEMP, to establish age-appropriate norms that will help in the correct diagnosis of balance dysfunction accordingly. Participants and methods This study was carried out in the Audiology Unit of Alexandria Petrol Hospital (Egypt). Participants with no medical history, normal hearing, and who were neurologically free participated in this study. The study was carried out on 50 ears (50 individuals) divided into five groups according to age: the first group from 10 to 25 years, the second group from 25 to 35 years, the third group from 35 to 45 years, the fourth group from 45 to 55 years, and the fifth group over 55 years of age. Each group contained 10 participants. Results and conclusion The main outcome measures are amplitude, latency, and threshold of the oVEMP. In this study, oVEMP was present contralaterally in 88% of healthy participants (44 of 50 ears), and the percentage of the presence of oVEMP decreased with age stratification to 60% in the oldest age group (>55 years). When we examined the younger groups in this study, we found 100% response rate for participants under the age of 45 years, whereas the response rate was only 80% in the fourth group (age range, 45-55 years) and 60% in the fifth group (age > 55 years). In the current study, an age effect on oVEMP N1-P1 amplitude and threshold was observed. Significantly reduced amplitude and a significantly increased threshold were observed in the two oldest age groups (>45 years) compared with other age groups. However, oVEMP N1 latency was stable for all age groups less than 55 years but significantly increased in the oldest age group above 55 years. The well-documented neuroanatomic age-related changes that occur in the peripheral vestibular system may explain the commonly reported decrease in the response rate and a decrease in the amplitude with age. However, oVEMP N1 latency represents the function of the time required for the afferent limb of reflex, central transmission and the efferent limb of reflex, and muscle activation. Therefore, the age-dependent increase in N1 latency may occur as a result of degradation of central vestibular system processing, rather than as a result of diminished peripheral vestibular system function.
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Morphological and electron microscopic effects of mitomycin C inhalation in experimentally induced laryngeal fibrosis in dogs
Mohamed T El Tabbakh, Mohsen Mohamed Hassan Mostafa Zagholol, Adel R. Hinnis, Zinab Abdel-Hady
April-June 2014, 30(2):126-131
DOI:10.4103/1012-5574.133214  
Purpose This study was carried out to investigate the morphological and ultrastructural effects of mitomycin C in the inhalational form on induced laryngeal tissue injuries and fibrosis. Materials and methods This study was carried out on 17 cross-breed clinically healthy dogs. Three dogs were included in a normal control group. The rest of the 14 dogs were subjected to induction of laryngeal fibrosis and assigned randomly to two equal groups: one treated with inhalational mitomycin C and the other was an untreated control group. Tissue biopsies were studied after H&E and Masson's trichrome stains, whereas other pieces were examined by electron microscopy. Results Epithelial ulceration with marked inflammatory infiltration, edema, and congestion was evident in all experimented dogs. There was a significant difference in epithelial hyperplasia between the treated and the untreated groups; it was markedly reduced in the treated group. The untreated group showed extensive well-organized fibrosis that was significantly increased compared with the other groups. Results were confirmed by electron microscopy. Conclusion Inhalation of mitomycin C has a potent antifibrotic effect through decreasing the activity of fibroblast evident by the decrease in both the size of fibroblast and the density of the intrafibroblast endoplasmic reticulum.
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RESIDENT PAGE
The making of an endoscopic sinus surgeon: Place yourself at the feet of the greats
Ahmed H Monib
April-June 2014, 30(2):182-182
DOI:10.4103/1012-5574.133226  
If you wish to be an an endoscopic sinus surgeon, search for the greats, whose papers you have read, and place yourself at their feet. You may face a lot of bureaucracy, and you may leave your family, staying away of your home, but nothing should change your decision, if you are insisting to learn.
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