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Table of Contents
January-April 2014
Volume 30 | Issue 1
Page Nos. -
Online since Monday, February 17, 2014
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ORIGINAL ARTICLES
A comparative study of audiological and surgical results in partial versus complete strip cartilage reinforcement tympanoplasty
p. 1
Hesham A AbdelKader, Ahmed G Khafagy, Tayseer T Abdel Rahman
DOI
:10.4103/1012-5574.127183
Hypothesis
Different techniques used in cartilage tympanoplasty are palisade technique, shield graft, in-lay butterfly graft, and island flap cartilage.
Purpose
The aim of the study was to compare audiological and graft take results in partial versus complete strip cartilage reinforcement tympanoplasty.
Materials and methods
A total of 60 patients with central perforation of the tympanic membrane and age ranging from 18 to 40 years were selected. They were divided into two equal study groups of 30 patients each. The first group underwent complete strip cartilage reinforcement tympanoplasty and the second group underwent partial strip cartilage reinforcement tympanoplasty.
Results
The overall success rate was 83.3% in the complete strip technique and 86.66% in the partial strip technique. In both study groups, there was statistically significant difference between the audiological results before and after operation. Furthermore, audiological and graft take results were better in the partial strip technique but with no statistically significant difference.
Conclusion
The overall results of partial strip tympanoplasty are better than complete strip tympanoplasty regarding graft take and audiological results.
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Affection of the middle ear after radiotherapy for head and neck tumors
p. 5
Hesham Negm, Mohamed Mosleh, Noha Hosni, Hesham A Fathy, Nora Fahmy
DOI
:10.4103/1012-5574.127184
Aim
The aim of this study is to evaluate the effect of radiotherapy (RT) as one of the modalities of treatment in patients with head and neck tumors on the Eustachian tube and middle ear.
Study design
This is a prospective study.
Material and methods
This study included 20 patients suffering from squamous cell carcinoma of the head and neck other than nasopharynx and parotid. They were treated either by surgery and postoperative radiotherapy or by primary radiotherapy alone or by concomitant chemoradiotherapy. Audiological evaluation was performed both pre-treatment and post- treatment in the form of pure tone threshold audiometry (PTA), tympanometry, stapedius acoustic reflex and eustachian tube (ET) function test.
Results
The 20 patients corresponded to 40 ears which were analyzed. Post RT tympanometry done revealed 16 (40%) ears with normal type A tympanogram and 24 (60%) ears with abnormal tympanometry findings, Post RT ET function test done revealed 7 (17.5%) ears with good ET function and 33 (82.5%) with abnormal ET function, acoustic reflex done post RT revealed 36 (90%) ears with absent acoustic reflex bilaterally and 4 (10%) ears with preserved acoustic reflex and Post RT PTA done revealed 16 (40%) ears with normal PTA, 13 (32.5%) ears with conductive hearing loss (CHL), 8 (20%) ears with sensori neural hearing loss (SNHL) and 3 (7.5%) ears with mixed hearing loss.
Conclusion
Patients with head and neck tumors given RT as one of the modalities of treatment have a high incidence of affection of middle ear function and ET dysfunction as well as development of CHL.
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Orbital complications of sinus origin: diagnosis, differential diagnosis, and management
p. 10
Nassim Talaat, Sherif Safwat, Nader Naguib, Fady Ghareb
DOI
:10.4103/1012-5574.127185
Objective
The aim of this study was to propose a proper and standardized protocol for the management of patients diagnosed with orbital complications of sinus origin. This depends on the original clinical diagnosis, or as the patient sent from the ophthalmology department, after computerized tomography, and sometimes pathology, some cases proved to be of nonsinus origin.
Materials and methods
This is a retrospective study that included 62 patients diagnosed with orbital complications of sinus origin and treated in the last 8 years; the data collected included medical history, detailed examination including endoscopic findings, radiological results, and finding at surgical intervention if performed. Follow-up data were collected for at least 6 months after management.
Results
Sinusitis of different etiologies can affect the orbit, affection is not always by direct extension, and the orbit may also be affected by noninfectious lesions from the sinuses.
Conclusion
Proper management of orbital complications of sinusitis requires meticulous assessment of history, examination, and radiology for a proper diagnosis without delay that may adversely affect vision.
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Demonstration of aeroallergenicity of fungal hyphae and hyphal fragments among allergic rhinitis patients using a novel immunostaining technique
p. 17
Hany Samir, Wael Wageh, Marwa M Abd-Elaziz Emam
DOI
:10.4103/1012-5574.127186
Background
More than 80 species of fungi are suspected of inducing immunoglobulin E (IgE)-mediated hypersensitivity. Exposure to airborne fungal conidia has been linked to the respiratory symptoms in individuals with fungal allergy; however, the contribution of airborne fungal hyphae and hyphal fragments to allergic diseases is poorly understood.
Objective
We sought to investigate the expression of allergens from airborne fungal hyphae and hyphal fragments using the halogen immunoassay, which uses patients' serum IgE to immunostain immobilized allergens extracted from individual fungal particles.
Materials and methods
Airborne fungi were collected from the nasal cavities of 25 patients and 10 controls using the refined nasal wash technique, fixed on mixed cellulose ester protein-binding membranes, incubated overnight in a humid chamber to promote the germination of conidia, and immunostained with the participants own serum IgE. The samples were examined by means of light microscopy, and positively immunostained fungal particles were classified and counted.
Results
All samples contained fungal particles that expressed soluble allergens and were significantly higher in concentration than counts of conidia of individual well-characterized allergenic genera (
P
< 0.05). Resultant immunostaining of fungal hyphae was heterogeneous, and ∼27% of all hyphae expressed detectable allergens compared with nonstained hyphae (
P
< 0.05).
Conclusion
This study conclusively demonstrates that fungal hyphae and fragments are underestimated sources of aeroallergens because positively immunostained hyphal fragments were detected in all samples and the number of the detected fungal hyphae in any of the individual protein-binding membranes was significantly higher than the conidial counts in any of the commonly recognized aeroallergenic species.
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Histopathological study of hypertrophic inferior turbinate
p. 23
Mohamed A Hegazy, Ahmed S Mohamed, Ahmed Y El-Hennawy, Mahmoud S El-Fouly
DOI
:10.4103/1012-5574.127189
Aim of Work
In the present study, indications, outcomes, and complications of partial inferior turbinectomy were studied, along with histopathological analysis of the resected turbinate.
Methods
A total of 20 patients with inferior turbinate hypertrophy were evaluated before and after surgery.
Results
Clinical evaluation of partial turbinectomy showed that 100% of patients were relieved of their symptoms either completely or partially. None of the patients experienced a worsening of their symptoms after surgery. Complications of this surgery are also fewer and patients can be managed conservatively either by regular follow-up or through proper postoperative instructions. Histopathological evaluation of the turbinate specimens revealed both mucosa and bone as being contributors toward hypertrophy in allergic rhinitis patients more than in patients with inferior turbinate hypertrophy with a deviated nasal septum.
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Management of patients with cancer of the larynx in Suez Canal University Teaching Hospital: 5 years' experience
p. 30
Mohamed T El Tabbakh, Mohamed R Ahmed, Doaa F Sedik, Diaa El Hennawi
DOI
:10.4103/1012-5574.127196
Background
Suez Canal University Hospital, which is the only tertiary care facility in the Suez Canal and Sinai area, is estimated to service more than 5 million patients. Cancer of the larynx, which is the most common head and neck cancer, is also the most common tumor presented to the otolaryngology departments.
Aim
To evaluate the results of interventional protocols for patients with cancer of the larynx treated in Suez Canal University Hospital.
Patients and methods
This was a retrospective study carried out on 53 patients with cancer of the larynx reviewed from 1 January 2007 to 1 January 2012 according to demographic, clinical, radiological, operative, pathological data, and possible complications.
Results
Fifty-three patients, mean age 58 years (71.1% were from urban areas), were studied. The main presenting symptom was hoarseness of voice (66%). Glottis carcinoma was the most common type of cancer found in 41.1% patients. Stage IVa was the most common presenting stage in 39.6% of the patients. Emergent tracheostomy was performed for 39.6% of the patients. According to the treatment protocol, single treatment modality was recommended for 38 (71.6%) patients: 17 (32%) patients were recommended total laryngectomy, followed by radiotherapy in 11 (20.7%) patients, chemotherapy was recommended for eight (15.1%) patients, concurrent chemoradiotherapy was offered to one (1.9%) patient, and partial laryngectomy with preservation of both arytenoids was offered to one (1.9%) patient. In addition, 15 (28.4%) patients were subjected to combined therapy: total laryngectomy combined with radiotherapy in nine (17%) patients and total laryngectomy with chemoradiotherapy in six (11.4%) patients.
Conclusion
Although the standards of management of laryngeal carcinoma in Suez Canal University hospital are almost in compliance with regional and international standards, we need to deal with the time delay between the diagnosis and definitive treatment to revise the items in the medical records and its registration.
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Evaluation of the efficacy of recurrent laryngeal nerve identification utilizing the Zuckerkandl tubercle
p. 34
Sherif K Mohamed, Tamer S Sobhy
DOI
:10.4103/1012-5574.127197
Introduction
Recurrent laryngeal nerve identification is an essential step in thyroid surgery for preserving the patients' voice and thus their quality of life. Methods of dissection and identification are adopted according to the surgeon's preference.
Objective
The aim of the study was to demonstrate the efficacy of recurrent laryngeal nerve identification using the Zuckerkandl tubercle as an anatomical landmark in comparison with the usual inferosuperior dissection of the tracheoesophageal groove.
Patients and methods
Four-hundred patients undergoing thyroidectomy were enrolled in a prospective comparative study. They were divided into two equal groups, each group being subjected to a specific technique.
Results and conclusion
There was a nonsignificant statistical difference between the two techniques, thus validating the efficacy of Zuckerkandl tubercle as an anatomical landmark for identification of the recurrent laryngeal nerve.
Level of evidence
Ib.
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Assessing the applications of cortical auditory evoked potentials as a biomarker in children with hearing aids
p. 38
Ismail Zohdi Mostafa, Mohamed Ibrahim Shabana, Amira Maged El Shennawy, Hoda Mahmoud Weheiba
DOI
:10.4103/1012-5574.127200
Background
Cortical auditory evoked potentials (CAEPs) are noninvasive measures used to quantify central auditory system function in humans. More specifically, the P1-N1-P2 CAEP has a unique role in identifying a central auditory system that has benefited from amplification or implantation. P1 reflects the maturation of the auditory system in general as it has developed over time.
Objective
The objective of this study was to assess the CAEP in children with hearing aids versus age-matched controls, and to compare the pattern of P1 CAEP in patients with hearing aids versus those with cochlear implants.
Materials and methods
Twenty hearing-impaired children (using their own binaural digital hearing aids) were compared with 20 age-matched and sex-matched children with normal hearing. In both groups, P1 CAEP latency and waveform morphology were recorded by free-field auditory stimulation using tone bursts at 500 and 2000 Hz at 100 dB sound pressure level. Finally, P1 CAEP was compared between patients using hearing aids and 20 children with cochlear implants.
Results
We have assessed the use of P1 latency and CAEP waveform morphology in a total of 20 children with hearing aids as a biomarker for the development of the central auditory pathway in patients with hearing loss. Children using hearing aids exhibited an exponential decay in P1 latencies, indicating an overall delay in maturation when compared with that in children with normal hearing. There was no statistically significant difference as regards P1 latencies and amplitudes between cochlear implant and hearing aid users, who showed statistically significantly higher mean values compared with the normal group.
Conclusion
Children's auditory systems develop comparatively as long as they are receiving appropriate amplification, whether this is through a cochlear implant or through the use of hearing aids. The P1 CAEP test can be applied as a tool in the diagnosis of central processing disorders in children with hearing impairments fitted with cochlear implants or hearing aids. This information will be useful when monitoring a child's progress with his hearing device and in auditory training.
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Vestibular assessment in children with sensorineural hearing loss using both electronystagmography and vestibular-evoked myogenic potential
p. 43
Eman Abdel-Fattah Said
DOI
:10.4103/1012-5574.127203
Background
The clinical course and prognosis in sensorineural hearing loss (SNHL) may be even worse if the vestibular system is also involved, especially because of near location of the anatomic structures in the inner ear. However, vestibular function in children with SNHL appears to be under-reported. The aim of the study was to assess the vestibular function and to determine the prognostic value of some etiological, audiological, and demographic (age, sex) factors in predicting a possibility of vestibular impairment for very early identification of children with vestibular deficits.
Materials and methods
The control group consisted of 30 children with normal hearing (17 girls and 13 boys) and the study group consisted of 50 children with varying degrees of bilateral SNHL, aged between 5 and 15 years. All of them were subjected to the following: basic audiological evaluation (pure-tone, speech audiometry), immittancemetry and auditory brainstem responses, electronystagmography (ENG), and vestibular-evoked myogenic potential (VEMP).
Results
Hearing impaired (HI) children showed bilateral SNHL of various degrees ranging from moderate to profound hearing loss (HL) [moderate-severe (32%), severe (18%), and profound (50%)] and of different etiologies [heredofamilial (46%), acquired (38%), not known (16%)]. Abnormal ENG findings were recorded in 64% of HI children. Abnormal caloric test findings were found in 56% of the HI children with heredofamilial cause of HL, in 84.2% with acquired HL, and in 37.5% with unknown cause. These results according to the degree of HL were 37.5, 55.5, and 76% for moderate, severe, and profound HL, respectively. It was noticed that HI children with profound degree and acquired etiology of HL had the highest abnormal caloric findings. Abnormal VEMP was found in 72% of HI children, but this percentage varied according to the different etiologies, 56.5, 84, and 75% for heredofamilial, acquired, and unknown, respectively. Bilateral saccular affections were more common than unilateral. HI children with profound HL had the highest percentage of both bilateral and unilateral saccular affections in the absence of VEMP.
Conclusion
Vestibular deficits occur in a significant percentage of HI children. Abnormal ENG and VEMP findings in HI children varied according to the etiology and or the degree of HL; those with acquired etiology and/or profound degree of HL had the highest abnormal scores.
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Effect of chronic renal failure on voice: an acoustic and aerodynamic analysis
p. 53
Eman S Hassan
DOI
:10.4103/1012-5574.127207
Objective
This study was conducted to investigate the effect of chronic renal failure (CRF) on acoustic and aerodynamic parameters of voice and to compare the results with a group of individuals with normal renal function.
Design
The participants in this study were divided into two groups. A clinical group (the patient group) consisted of 66 adults diagnosed as having CRF (26 male patients and 40 female patients), with their age ranging from 19 to 68 years. The control group consisted of 66 healthy adults (36 male individuals and 30 female individuals). Their age ranged from 20 to 60 years and they did not have any impairment in renal function or any complaints concerning their voice. All participants underwent evaluation of their voice acoustically and aerodynamically. Acoustic analysis was performed using computerized speech lab. The acoustic parameters studied include average pitch, jitter, shimmer, and noise-to-harmonic ratio. Aerodynamic analysis was performed using Aerophone II Model 6800. The aerodynamic parameters studied include vital capacity, maximum phonation time, phonation quotient, mean flow rate, subglottic pressure, and glottal efficiency. The data were analyzed using the independent
t
-test to compare the significance of difference between means across the two groups.
Results
In acoustic analysis, there was a significant increase in pitch in male patients with CRF and an increase in shimmer with borderline significance in the total group with CRF. The total group as well as the female subgroup with CRF showed a significant increase in noise-to-harmonic ratio. With respect to the aerodynamic analysis, the total group as well as the male and female subgroups with CRF showed a significant decrease in the vital capacity. There was also a significant decrease in the maximum phonation time in the total and female subgroup with CRF.
Conclusion
Participants with CRF exhibit clinical evidence of voice disorders both acoustically and aerodynamically. Hence, the present study sheds light on the interplay of different body systems and laryngeal muscles.
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Spontaneous drainage of a Bezold neck abscess into the middle-ear cleft: a rare incident
p. 58
Kamal G Effat
DOI
:10.4103/1012-5574.127209
Bezold's abscess is a neck abscess, arising as a complication of acute mastoiditis or active chronic otitis media and cholesteatoma. This condition is rarely reported in the recent literature. A very rare case is presented of spontaneous drainage of Bezold's neck abscess into the middle ear. Pertinent review of the literature is illustrated.
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© The Egyptian Journal of Otolaryngology | Published by Wolters Kluwer -
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Online since 31 Jan, 2014