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  Citation statistics : Table of Contents
   2014| July-September  | Volume 30 | Issue 3  
    Online since August 12, 2014

 
 
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ORIGINAL ARTICLES
Effect of nasal obstruction surgery on middle ear ventilation
Osama G Abdel-Naby Awad, Yehia M Salama, Mohammed El-Badry
July-September 2014, 30(3):191-195
DOI:10.4103/1012-5574.138462  
Aim The purpose of this study was to reveal the role of nasal surgeries in changing Eustachian tube function (ETF) and middle ear ventilation. Methods This prospective study involved 30 patients with diffrent nasal pathologies causing nasal obstruction. The patients were subjected to diffrent nasal surgeries for treating their nasal obstruction. ETF tests in the form of (Valsalva and Toynbee manuvers) together with tympanometery were performed the day before the operation, and then repeated 30 days after removal of the nasal packs. Pre and postoperative Valsalva and Toynbee tubal function tests, tympanometery and ear fullness sensation were evaluated for both ears of each patient. Results Preoperatively, 47 (78.3%) ears were type A, 24 ears of them had poor ETF and 23 ears had good ETF. Thirteen (21.6%) ears were type C, all of them had poor ETF. The postoperative results of ETF tests were significantly better than preoperative results (P < 0.002).Significant improvement in tympanometeric values was also found (P < 0.05).Preoperatively, 28 patients (93.3%) had sensation of ear fullness. At 30 days after removal of nasal packs, 20 patients (66.7%) still had sensation of ear fullness, with significant improvement (P < 0.001). Conclusion We suggest that nasal obstruction has a definite relationship with EFT. Surgery for nasal obstruction has a favorable effect on the middle ear pressure and EFT. Type A tympanogram not always means a good EFT but the patient may have poor EFT with Eustachian tybe dysfunction inspite of type (A) tympanogram.
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Role of surgical septal correction in subjective improvement of chronic rhinosinusitis
Osama G Abdel-Naby Awad, Abd El-Rehim A Abd El-Karim, Mostafa S Hamad
July-September 2014, 30(3):196-200
DOI:10.4103/1012-5574.138465  
Aim The purpose of this study was to reveal the role of septoplasty in improving the subjective outcome of chronic rhinosinusitis (CRS) in patients with significant septal deviation. Methods This prospective study involved 24 patients with CRS and septal deviation. The patients were randomly divided into two groups according to the applied surgical proceures. In the first and second groups, septoplasty and septoplasty plus endoscopic sinus surgery were applied, respectively. Subjective questionnaire of success rates were used to analyze the results. Results At 6 months follow-up period, the subjective score in group 1 dropped significantly from 57.6 to 23.1 (P <0.05). In group 2 the score also dropped significantly from 64.1 to 28.4 (P <0.05) , with no significant difference between the 2 groups regarding the improvement of their scores. Conclusion We suggest that septoplasty alone can be adequate for the treatment of CRS with septal deviation.
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Effect of Epstein-Barr virus infection on predisposition and postradiotherapeutic prognostic value among Libyan patients with nasopharyngeal cancer
Khaled M Bofares
July-September 2014, 30(3):201-207
DOI:10.4103/1012-5574.138466  
Background and objective Libya is one of the North African countries with an endemic of nasopharyngeal carcinoma, particularly in the northern part of Libya as compared with its southern part. The clinical and histopathological presentation reveals no uniquely specific pattern of appearance; however, there is high deficiency in the data that confirm the possible predisposing factors that may play a role in the development of this common variety of head and neck cancer in this country, and whether these factors affect the patients' response to treatment. This study was conducted to determine the role of the Epstein-Barr virus (EBV) in the risk for nasopharyngeal cancer in the Libyan population; the results were correlated with radiotherapy response and improvement in the post-therapeutic prognostic value. Patients and methods Sixteen patients aged 9-80 years presented at the ENT Department, Althowra Central Teaching Hospital, Albyda, Libya, from September 2005 to January 2014 with variable patterns of clinical presentation suggestive of nasopharyngeal carcinoma. All patients were evaluated radiologically and endoscopically. The diagnosis was confirmed by biopsy and further histopathological assessment. For all patients, serological elucidation for IgG and IgM anti-EBV antibodies was carried out, and the results were correlated with age at incidence, sex of the patient, pattern of clinical presentation, pattern of histopathological presentation, response to radiotherapy, rate of recurrence, and 5-year survival. Results In all, 88% of patients showed a significant increase in serum IgG against viral capsid antigen of EBV; 83% of the cases presented with cervical masses and unilateral otitis media with effusion; 86% of cases showed lymphoepithelioma as histopathological pattern. All patients with lymphoepithelioma showed significant response to concomitant radiochemotherapy (100%) with high survival rate exceeding 5 years. Conclusion The EBV infection can be considered one of the main predisposing factors to nasopharyngeal carcinoma in the Libyan population. It was noted from this study that the induction of cancer by EBV is mainly by chronic infection rather than by acute infection; this was confirmed by significant elevation in serum IgG rather than IgM. In addition, it was postulated that the EBV infection is most likely associated with the lymphoepithelioma variety of histopathology rather than with the well-differentiated type, and as it was elucidated through this study that the association of the cancer with EBV infection increased the sensitivity of the tumor to concomitant radiochemotherpy, thus improving the 5-year survival after treatment.
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Study of the epidemiology and management of laryngeal cancer in Kasr Al-Aini Hospital
Hazem M Abdel Tawab, Mikhail W Abd ElMessih, Nasser AA AlNaggar, Louay S El Sharkawy
July-September 2014, 30(3):208-214
DOI:10.4103/1012-5574.138468  
Objectives Epidemiological study of laryngeal cancer and modalities of treatment according to TNM classification. Methods Retrospective study was conducted on 295 patients who were admitted at the Otolaryngology-Head and Neck surgery department, Kasr-Al Aini hospital, Cairo University during the period from Jan 2009 till Dec 2011. It was done on cases of laryngeal cancers and included study of the epidemiology (age, gender, residence and smoking) and modalities of treatment according to TNM classification. Results The mean age was (57.6 ± 10.5) ranging from (22 to 87) years old. Males were 93.9% while females were 6.1%, smokers were (254) 86.1% of 295 patient. In this study, the treatment modalities for primary tumor were: surgery alone, chemo-radiotherapy, surgery and postoperative radiotherapy and radiotherapy alone as well as neck dissection for lymph node control. The surgeries performed included 160 total laryngectomies, 47 partial (39 supracricoid, 4 supraglottic and 4 vertical) laryngectomies and 18 transoral endoscopic laser surgery selected according to the site and stage of the primary tumor. For lymph node control: 84 selective neck dissection, 8 radical or modified radical neck dissection and 13 combined. Conclusion Total laryngectomy was the most common modality of treatment for primary tumors as the majority of cases presented at late stages. For lymph node control, the selective neck dissection was the commonest treatment as most of the patients had N0 and N1 lymph node.
  - 3,163 248
Systemic steroids and intratympanic steroids perfusion as an initial therapy for idiopathic sudden sensorineural hearing loss, a comparative study
Hazem A Oyoun, Maha Abou-Elew, Mohamed Mosleh, Hesham Fathy, Wael Wageeh, Mahmoud A El Hassan
July-September 2014, 30(3):215-219
DOI:10.4103/1012-5574.138472  
Objective The objective of this study is to compare the efficacy of systemic steroids (SS) and the intratympanic steroids (ITS) in the treatment of idiopathic sudden sensorineural hearing loss (SSNHL). Study design This is a prospective study. Material and methods This study included 21 patients suffering from idiopathic SSNHL. They were divided into 2 groups according to the modality of treatment. Group A included 10 patients who were treated with SS and group B included 11 patients who were treated with ITS due to their refusal or contraindication to take SS. A pre-treatment pure tone audiometry (PTA) was performed for all patients at their first presentation for establishment of the diagnosis and assessment of the degree of the hearing loss. A post-treatment PTA was done at the follow up visit 2 weeks later for the assessment of the degree of hearing loss and hearing improvement. The data of both groups were compared together. Results For group A the pre-treatment PTA average ranged from 37.5 to 113.3 db with a mean of 72.3 ± 25.11 db and the post-treatment PTA average ranged from 13.3 to 113.3 db with a mean of 49.24 ± 33.72 db. On comparing the means of the pre-treatment and the post-treatment PTA averages the difference was found to be statistically significant (P = 0.03). The overall hearing improvement rate using SS was 60%. For group B the pre-treatment PTA average ranged from 50 to 115 db with a mean of 77 ± 18.98 db and the post-treatment PTA average ranged from 26.6 to 101.8 db with a mean of 50.05 ± 23.3 db. On comparing the means of the pre-treatment and the post-treatment PTA averages the difference was found to be statistically highly significant (P = 0.001). The overall hearing improvement rate using ITS was 72.7%. Conclusion Both SS and ITS have proven to be effective in the treatment of idiopathic SSNHL, however SS seems to have a better effect in terms of cure with complete recovery to normal hearing, while ITS exerts most of its effect in partial recovery.
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Microdebrider intracapsular tonsillotomy versus conventional extracapsular tonsillectomy
Sherif I Gabr, Khaled A Harhash, Mahmoud S El Fouly, Ahmed A Kamel, Mostafa M Eldwebes
July-September 2014, 30(3):220-224
DOI:10.4103/1012-5574.138476  
Objective The aim of the study was to evaluate the efficiency of microdebrider intracapsular tonsillotomy compared with conventional extracapsular tonsillectomy. Patients and methods The study included 40 patients assigned to undergo tonsillectomy. Patients were divided randomly into two equal groups: group A included 20 patients who underwent microdebrider intracapsular tonsillotomy and group B included 20 patients who underwent conventional extracapsular tonsillectomy. Items of comparison between the two groups included time of operation, estimated blood loss, postoperative pain, rate of postoperative hemorrhage, tonsillar fossa healing, swallowing, and complications rate. Results Regarding intraoperative blood loss, the conventional group had significantly lower blood loss (P < 0.05). The microdebrider group showed significantly less pain and better swallowing function (P < 0.05) than the conventional group. There were no significant differences in operative time or wound healing. No postoperative complications such as recurrence or hemorrhage were detected in either group. Conclusion Microdebrider intracapsular tonsillotomy is an effective method to remove tonsillar tissue. There was significantly less pain and better swallowing function compared with the conventional extracapsular tonsillectomy group.
  - 2,706 263
Preoperative gabapentin decreases the incidence of postoperative vomiting and analgesic requirements after pediatric adenotonsillectomy
Mahmoud H Mohamed, Hesham Al-Sersy
July-September 2014, 30(3):225-228
DOI:10.4103/1012-5574.138478  
Objective The aim of the study was to evaluate the effect of preoperative gabapentin on the incidence of postoperative vomiting (POV) and on analgesic requirements after adenotonsillectomy in pediatrics. Patients and methods A total of 144 pediatric patients (4-8 years) scheduled for elective adenotonsillectomy were randomly assigned to either the gabapentin (G) group (20 mg/kg, 2 h before surgery) or the placebo (P) group. A standard technique was used for anesthesia. Ondansetron (0.1 mg/kg) was used as a rescue antiemetic and ketorolac (1 mg/kg) was used as a rescue analgesic postoperatively. The prevalence of POV and number of patients who required ketorolac as a rescue analgesic were assessed in the first 6 h after surgery. Results Of the 72 patients, 15 patients (20.8%) in the G group and 21 patients (43%) in the P group developed POV; the difference was statistically significant (P = 0.007). The number of patients who required analgesics in the G group was 14 (19.4%) and in the P group was 35 (48.6%), and the difference was statistically significant (P = 0.0004). Conclusion Our data show that preoperative gabapentin reduces the incidence of POV and the analgesic requirements after pediatric adenotonsillectomy.
  - 2,211 240
Comparison of three techniques for tonsillectomy during free medical camps in Yemen
Mohamed Y Al-Mahbashi, Shehab Q Saeed, Abdulrahman A Al-Attab, Yahia A Raja'a
July-September 2014, 30(3):229-233
DOI:10.4103/1012-5574.138479  
Objective The aim of the study was to compare four different surgical techniques for tonsillectomy during free medical camps in Yemen, regarding type of anesthesia, complication rates, operative time, and cost of the operation. Patients and methods This prospective study was conducted from April 2006 to December 2011. There were 12 280 patients who underwent tonsillectomy in 26 hospitals in different Yemeni governorates, and operations were performed in 46 free medical camps. Under general anesthesia, we performed traditional dissection techniques (TDTs) and bipolar diathermy technique. Under local anesthesia, tonsillectomies were performed using TDT and guillotine excision technique. Results Of the 12 280 tonsillectomies patients, 53.7% were male patients and 46.3% were female patients. The median age of the patients was 11.5 years (range 3-30 years). Under general anesthesia, 6639 (54.1%) tonsillectomies were performed; of these, 86.1% were performed by TDT, whereas 13.9% were performed by bipolar diathermy technique. Under local anesthesia, 5641 (45.9%) tonsillectomies were performed; of these, 81% were performed by TDT, whereas 19% were performed by guillotine excision technique. Post-tonsillectomy hemorrhage was low in patients operated by TDT as compared with the other techniques. No significant differences were found in operative time between the four surgical techniques. The costs of tonsillectomy ranged between 30 and 37$. Conclusion The TDT is the most common method performed in the free medical camps, is handy, favorite, less costly, and comfortable for our patients, and is suitable for our work environments, experiences, and equipments. We recommend this technique for the same circumstances as a day-case tonsillectomy. Although less postoperative hemorrhage was observed in traditional surgery under general anesthesia, surgery under local anesthesia is safer and less costly.
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Vestibular evoked myogenic potentials results of dizzy patients with normal videonystagmography
Ihab Nada, Tarek El Dessouky
July-September 2014, 30(3):234-236
DOI:10.4103/1012-5574.138480  
Aim The aim of this study is to detect saccular dysfunction tests using vestibular evoked myogenic potentials (VEMPs) in dizzy patients with normal videonystagmography (VNG) findings. Patients and methods Thirty patients complaining of dizziness with normal VNG findings were studied. They were subjected to full assessment of history, basic audiological evaluation, VNG, and VEMPs. VEMPs were evaluated in both ears of all cases through absolute latencies of p13 and n23. Results VEMPs showed abnormalities in 19 patients (66.3%). Ten patients (33.3%) showed unilateral absent, six patients (20%) showed bilateral absent, and three patients (20%) showed shifted latencies. Conclusion VEMP appears to be a valuable tool in the detection of initial saccular abnormalities initially in dizzy patients with normal VNG findings.
  - 4,274 185
Value of early intervention for hearing impairment on language and speech acquisition
Ebtessam Nada, Ahmad Khater, Amal Saeed
July-September 2014, 30(3):237-242
DOI:10.4103/1012-5574.138483  
Background It is well known that early diagnosis and intervention for hearing impairment is crucial for normal development of language and speech and for a normal life in the future. This study was carried out on 58 patients suffering from sensory-neural hearing loss. They were divided into four groups: Group A (n = 16) Group B (n = 22) Group C (n = 14) Group D (n = 6). The first three groups had severe sensory-neural hearing loss and were bilaterally amplified with hearing aids at the time of diagnosis. They were classified according to the age of amplification into group A, which included children amplified before 6 months of age, group B, which included children amplified between 6 and 12 months of age, and group C, comprising children amplified at 12-24 months of age. The last group (group D) included six children with severe to profound sensory-neural hearing loss. This group had undergone unilateral cochlear implantation. Children of this group were implanted at the age of 4 ± 1.2 years. For all children language and speech assessment was performed at school age. The results were compared among all groups. Conclusion Hearing intervention at the age of 6 months had the best outcome in terms of language development, even when compared with the group with late cochlear implantation.
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Noise-induced hearing loss among workers in textile factory
Ebtessam Nada, Waleed M Ebraheem, Samah Sheta
July-September 2014, 30(3):243-248
DOI:10.4103/1012-5574.138484  
Introduction Noise-induced hearing loss (NIHL) is one of the most common chronic health problems, which produces gradual progressive impairment and disturbs the patient's quality of life. Industries in general and especially textile ones produce noise levels that, if intensified, can cause damage to worker's hearing. Hence, premature hearing loss is a well-known outcome of noise exposure at work in industrial workers. Aims of the work The aim of the study was to assess hearing threshold levels among exposed patients and to compare them with the nonexposed control group and to evaluate other variables such as outer hair cell and medial olivocochlear bundle function represented with transient evoked otoacoustic emissions (TEOAEs) testing with and without suppression and to find the relationship with duration of exposure if any. Patients and methods The study included 145 patients and same number of controls who were exposed to hazardous levels of noise for variable durations. All participants were subjected to audiological examination including basic audiological evaluation, otoacoustic emissions, and otoacoustic emissions with contralateral suppression (CAS). Results Of the 145 patients (290 ears), 214 ears showed sensorineural hearing loss (73.8%). Sensorineural hearing loss was mild in 63 (43.44%) ears, moderate in 82 (56.55%) ears, and severe in 69 (47.58%) ears. TEOAEs were found in those with mild hearing loss with significantly lower amplitudes. Intact suppression (CAS) was significantly lower for the study group than for the control group. However, there was no significant difference in level of suppression for different duration of exposure. Conclusion A high incidence for NIHL is present among workers in textile factories, which indicate the mandatory use of different protective measures. CAS can be used as a predictor for the susceptibility to NIHL.
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Single monotic auditory steady-state response in children with severe to profound sensorineural hearing loss
Nagwa Hazzaa, Elham El Saiid, Dalia M Hassan, Mohamed Moneer
July-September 2014, 30(3):249-254
DOI:10.4103/1012-5574.138486  
Aim The aim of the study was to find out the predictive value of single monotic auditory steady-state response (ASSR) in hearing threshold estimation in children with severe to profound sensorineural hearing loss (SNHL). Materials and methods Forty-eight children (96 ears) with severe to profound SNHL were included. They were subjected to age-based audiological evaluation. Single monotic ASSR was obtained and analyzed for all children using test signals of 250, 500, 1000, 2000, and 4000 Hz, modulated in either ears at high rates of 67, 74, 81, 88, and 95 Hz, respectively, using GSI Audera evoked potential system. Results The number and percentage of ASSR detected were highest at 1000, 500, and 2000 Hz, respectively in all children. The ASSR thresholds obtained were statistically correlated with the behavioral audiometric thresholds at the corresponding frequencies. A considerable number of ears with no sound field thresholds or click auditory brainstem response responses showed ASSR. Conclusion Single monotic ASSR, with high modulation frequencies, has shown to be a reasonable method for estimating hearing sensitivity in the mid-conventional audiometric frequencies in children with severe to profound SNHL.
  - 1,674 109
Effect of parent interaction on language development in children
Rasha Farouk Safwat, Aya R Sheikhany
July-September 2014, 30(3):255-263
DOI:10.4103/1012-5574.138488  
Background Positive quality of parent-child interactions is essential for shaping a child's language development. Many individual factors have been found to be associated with language development, but their interaction with each other and their relation with language development is still less clear. Objective The aim of the study was to evaluate whether the quantity and quality of parent-child interactions contribute to language development and to detect the factors that would influence this interaction in different socioeconomic standards to consider them while planning the therapy program. Patients and methods This study included 100 parents and their children; they were attendants at the Phoniatric Unit of Kasr Al Aini Hospital, complaining of delayed language development in their children. Parents included 60 women and 40 men; their ages ranged between 21 and 43 years, with a mean age of 32.7 ± 5.5 years. The age range of the children was 27-49 months, with a mean of 38 ± 5.7 months. The parents were asked to fill in a questionnaire, which was divided into two sections (A and B). Section A described the parents' communicative behavior and section B included basic information on the parents and their beliefs about causes and management of delayed language development. Socioeconomic status of the parents was assessed. Children included in the study were subjected to the protocol of language assessment. Results Results indicate that the majority of the included parents did not use effective methods to foster their child's language acquisition, although their knowledge about language development and intervention was adequate. There was a significant positive association between the parent's interaction score and the child's total language age. Socioeconomic status has been shown to be a significant predictor of a child's language outcomes. Conclusion Parent-child interaction is an important variable in the development of a child's language. Future research and intervention services should focus on increasing the quality of these interactions.
  - 22,847 1,932
Acoustic comparison between two different techniques of endoscopic resection of benign laryngeal lesions
MH Abdel-Monam, AH Gaafar, RM Maghraby, SS Abdel Gawad
July-September 2014, 30(3):264-267
DOI:10.4103/1012-5574.138491  
Introduction Microdebrider as a new technology in the management of laryngeal lesions is a powered rotatory dissection device with suction assistance; it was used before in orthopedic surgery and sinus surgery. The aim of this work was to assess the microdebrider as a tool for excision of benign laryngeal lesions and compare its results (intraoperative and postoperative) with those of microlaryngeal surgery by cold instruments. Patients and methods Forty patients with benign vocal fold lesions were included (25 women and 15 men), with age ranging from 24 to 51 years. Group I was subjected to excision of lesions by the conventional instruments. Group II was subjected to excision of lesions by the microdebrider. Each patient was subjected to the protocol of voice assessment preoperatively and 3 weeks postoperatively. The patients were assessed subjectively by Voice Problem Self-Assessment Scale and objectively by laryngoscopy, stroboscopy, and acoustic analysis. Results No significant difference in the acoustic parameters between the two groups was observed, but there was significant difference between the preoperative and the postoperative acoustic parameters for each group. Postoperative parameters satisfactorily improved with resolution of the lesions in both groups. Conclusion The microdebrider was determined to be a safe, accurate, and reliable method in removal of benign vocal fold lesions but does not offer major advantages compared with the standard instruments.
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Management of cut-throat injuries
Zafarullah Beigh, Rauf Ahmad
July-September 2014, 30(3):268-271
DOI:10.4103/1012-5574.138493  
Introduction Cut-throat injuries (CTIs) are defined as incised injuries or those resembling incised injuries in the neck inflicted by sharp objects. This may result from accident, homicide, or suicide. CTIs are potentially life threatening because of the many vital structures in this area. These patients need emergency and multispecialty care. In this part of the world, suicide is the major cause of CTIs. Exposed hypopharynx and/or larynx following a cut throat, hemorrhage, shock, and asphyxia from aspirated blood are the most common causes of death following a CTI. Materials and methods This retrospective study was carried out in the Department of Otorhinolaryngology and Head Neck Surgery, Government Medical College, Srinagar, J&K, India, and included 26 CTI patients who were brought to our department for treatment. The demographics of the patients, site, cause, and nature of the CTI, and the type and outcome of treatment received were recorded and analyzed. Results This study showed that young men from rural areas were most susceptible to CTIs. The leading cause of a CTI was a suicide attempt. Among patients who attempted suicide, the reason was psychiatric illness most of the times. The majority of the patients in our study had a cut in the center of the neck, with injury to skin, soft tissue, and the larynx/pharynx. Of 26 patients, 24 recovered completely, whereas two patients died. In our study, 15 out of 26 patients were managed without tracheostomy. Conclusion All patients with a CTI should be referred immediately to hospital; early management of patients by a team of specialists can save the life of the patient most of the time. All patients who have attempted suicide should undergo a psychiatric evaluation. This is because the act of suicide is a sign of an underlying mental illness and there may be a possibility of a second attempt. Not all patients with CTIs require tracheostomy. The majority of patients with CTIs can be managed without tracheostomy.
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Dysphonia in teachers: is it only a matter of voice misuse?
Asmaa Ahmed Abdel Hamid, Hossam Mohammed Eldessouky, Nagy Micheal Iskender, Elham Mo'men Hassan
July-September 2014, 30(3):272-278
DOI:10.4103/1012-5574.138494  
Background Teaching is considered among the most demanding tasks for voice; Aim This study investigated dysphonia in a sample of Egyptian teachers and determined the prevalence of dysphonia in the sample under study. Patients and methods The study was carried out by applying a questionnaire to 250 primary school teachers in Fayed city. The questionnaire included three main groups of questions that indicate the presence or absence of dysphonia, gastric reflux, and allergy, in addition to questions about personal and teaching data. The participants who reported that they suffer from dysphonia were transmitted to the second step of the study, which is acoustic analysis for their voices and laryngoscopic examination for their larynges. Results The present study revealed that the prevalence of dysphonia in the study sample is 23.2%. The dysphonia was based on the participants self-impression and was emphasized by the acoustic analysis; in addition, this study showed a significant correlation between dysphonia and both allergy and reflux. Conclusion The study revealed that prevalence of dysphonia in the sample under study which contains primary school teachers is 23.2%. A positive correlation between teaching hours/week, allergy and reflux with dysphonia with presence of pathological lesions and subclinical finding detected by acoustic analysis changes.
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