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The role of videonystagmography (VNG) in assessment of dizzy patient
Soha Mekki
April-June 2014, 30(2):69-72
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.
  33,403 2,219 2
Effect of parent interaction on language development in children
Rasha Farouk Safwat, Aya R Sheikhany
July-September 2014, 30(3):255-263
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.
  22,539 1,923 -
Magnetic resonance imaging criteria in vascular compression syndrome
Sherif Elaini, Jaques Magnan, Arnaud Deveze, Nadine Girard
January 2013, 29(1):10-15

The aim of this work is to show the imaging criteria of the offending vessel in neurovascular compression syndrome in the cerebellopontine angle using MRI. This will increase the acceptance of the concept of vascular compression syndrome of the cranial nerves as an etiology of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and some cases of disabling vertigo and tinnitus.

Materials and methods

Between 1994 and 2008, MRI radiographs of 782 cases of vasculoneural compression were reviewed to analyze the imaging criteria of the offending vascular loop and were correlated with intraoperative vascular decompression findings in various pathologies such as hemifacial spasm, trigeminal neuralgia, glossopharyngeal neuralgia, vertigo, and tinnitus.


The specificity and high sensitivity of the T2 constructive interference in steady state or fast spin eco sequence MRI allowed us to precisely define the vasculoneural conflict in almost all cases and to highlight certain radiological criteria required for a vasculoneural conflict diagnosis in general. These criteria are mainly the presence of a vascular loop that is perpendicular to the course of the nerve and the presence of distortion of the neural structures.


MRI in the T2 sequence is the key assessment in neurovascular compression syndrome.

  21,422 1,864 -
Use of local anesthesia in ear surgery: technique, modifications, advantages, and limitations over 30 years’ experience
Mohamed A El-Begermy, Marwa M El-Begermy, Amr N Rabie, Abdelrahman E.M Ezzat, Ahmed A Kader Sheesh
July-September 2016, 32(3):161-169
Background Local anesthesia (LA) is safe and well established for a variety of ear operations. It has many advantages compared with general anesthesia (GA). Objective This article is intended to be a comprehensive reference for those who use this art, in which we have more than 30 years of experience. We also aimed to find out the effect of LA on blood pressure (BP) and heart rate (HR), operative time, time of anesthesia with different adrenaline concentrations, and patient satisfaction with LA. Patients and methods This was a retrospective study of our experience in the technique of LA in more than 2600 patients spanning more than 30 years, along with modifications introduced. Additional prospective trials were also conducted. BP and HR were monitored during LA injection in 200 patients. The calculated operative time was compared between two groups of 21 patients each: the first group was operated upon under LA and the other under GA. Anesthesia time was calculated for LA with different adrenaline concentrations (1 : 20 000–1 : 200 000 and 0% or no adrenaline) by means of injections over both the mastoid and the forearm on five volunteers. Patient satisfaction was measured using postoperative questionnaire in 200 patients. Results Patients showed initial increase in BP due to apprehension, which was abolished with diazepam; a second increase in BP and HR occurred after LA injection by 3–10 min. LA statistically significantly shortened the operative time compared with GA. Time of anesthesia was longer using anesthetic solution with higher adrenaline concentration and was longer on the mastoid as compared with the forearm. Finally, 92% of the patients showed satisfaction from the procedure. Conclusion LA is a safe and effective way of anesthesia in ear surgery, allowing intraoperative testing of hearing, facial nerve action, and eustachian tube patency. With high adrenaline concentration, it allows excellent hemostasis, shortens the operative time, and increases the time of anesthesia, allowing probable prolonged postoperative analgesia and is well tolerated by the patients.
  19,272 952 2
Diagnosis and management of benign tumors of nasal and paranasal cavities: 31 cases
Mardassi Ali, Mathlouthi Nabil, Nefzaoui Safa, Dimassi Hela, Mezri Sameh, Zgolli Cyrine, Chebbi Ghassen, Ben Mhamed Rania, Akkari Khemaies, Benzarti Sonia
January-March 2015, 31(1):4-9
Aim To precise the clinical, paraclinical and therapeutic features of the benign tumors of nasal and paranasal cavities. Methods We report a retrospective study carried out in the ENT Department of the Military Hospital of Tunis, Tunisia over a period of 10 years (2003-2012). Results we report 31 patients operated for benign tumors of the nasal and paranasal cavities. The mean age was 38 years (2 months to 73 years), and the sex ratio was 2.4 (22 male and nine female). The diagnosis was assessed through endoscopic and radiological findings. Surgery was underwent by an endonasal approach in 84% and an external approach in 16% of the cases. The evolution after surgery was different according to the histological type of the tumor. Discussion Benign tumors of the nasal and paranasal cavities are characterized by their histological diversity. Thus, clinical presentation is variable and nonspecific. Their diagnosis has been improved by modern imaging techniques and is definitely confirmed after histological examinations. Actually, endoscopic surgery of the paranasal sinuses has become the procedure of choice for treatment.
  15,918 759 -
Tonsillectomy under the age of 3 years: is it recommended or not?
Khalid M Bofares
October-December 2014, 30(4):337-342
Background and objectives Tonsillectomy is the most common surgical procedure in specialty of otorhinolaryngology. Therefore, there are frequent premises regarding this procedure to be improved from different aspects, indications, time of surgery, techniques, safety measures, and postoperative care. One of the major issues regarding this procedure is the most suitable age for the surgery. This point is creating a lot of controversies particularly at extreme age groups - that is, less than 3 years and more than 60 years. Although the extreme old age groups are considered as risky for any surgical procedures specially for tonsillectomy due to lack of proper body tissues tolerance and response to post-tonsillectomy bleeding as well as upper airway edema and obstruction, those age groups are still at lesser incidence of morbidity and mortality as compared to the infantile age groups who take the wider spectrum of ENT surgeons' concentration, discussions, and studies regarding this issue. Therefore, this study was conducted prospectively to confirm whether tonsillectomy can be performed safely before 3 years of age with nonsignificant difference regarding postoperative morbidity and mortality as compared to the other age group of 3 years or above. Patients and methods A total of 648 children aged from 8 months to 8 years presented at ENT department, Al-Thowra central teaching hospital and Altarahom private center, Elbyda city, Libya during the period between September 2005 and October 2012 as cases of chronic adenotonsillitis with variable patterns of indications for tonsillectomy, namely snoring and apnea attacks, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, and malocclusive dental deformity. In all, 241 patients were under age of 3 years who represented group A, whereas remaining 407 patients at age of 3 years and above constituted group B. As prospective analytic study, both groups were compared with respect to intraoperative time consumption and whether there is any significant difference between the two groups regarding the incidence of serious postoperative complications occurrence, namely post-tonsillectomy bleeding, aspiration, airway obstruction, dehydration, postadenotonsillectomy negative pressure pulmonary edema, and metabolic as well as nutritional deficiencies. In addition, both groups were compared for any significant difference regarding the period of postoperative hospitalization, which can be used as objective indicator to measure the postoperative morbidity rate. Results This presenting study confirmed that the tonsillectomy procedure is an easy procedure among children younger than 3 years of age as in older children; this can be indicated by the appearance of nonsignificant difference between both groups regarding the intraoperative time consumption. In contrast, this procedure approved to be a safe procedure among children with age below 3 years as in older children; this was illustrated by the presence of nonsignificant difference between group A and group B regarding the serious suspected post-tonsillectomy complications, namely post-tonsillectomy hemorrhage, aspiration, airway obstruction, negative pressure pulmonary edema, dehydration, and metabolic as well as nutritional deficiencies. Conclusion In general, tonsillectomy is a safe procedure that can be performed successfully among children at different age groups with low incidence of post-tonsillectomy complications as compared with adults.
  15,945 321 -
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
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.
  15,127 387 -
Approach to diagnosis of vocal fold immobility: a literature review
Omayma E Afsah
April-June 2015, 31(2):78-91
Vocal fold immobility (VFI) is a sign of disease and not a final diagnosis. VFI can have a profound impact on a patient's quality of life. The most important objective in evaluating a patient with VFI is to exclude the existence of a treatable and potentially life-threatening primary disease as the cause of VFI. Thorough evaluation of these cases is mandatory for proper decision-making and planning of therapy. This paper addresses the established diagnostic workup for VFI and critically evaluates the contribution of different modalities to VFI diagnosis. To achieve this goal, a comprehensive review of the available literature regarding the diagnostic approaches to VFI was conducted. Eligible studies were identified by searching PubMed, Google Scholar, Springer, and ScienceDirect databases for relevant articles by combining the MESH heading term 'vocal fold immobility' with the words 'diagnosis, evaluation, paralysis, electromyography, imaging'.
  14,092 1,113 1
Spontaneous rupture of hemorrhagic thyroid nodules causing extensive laryngopharyngeal, neck, and chest hematoma
Timothy L.W Wong, Rohaizam Jaafar
January-March 2017, 33(1):128-130
We report a rare case of spontaneous rupture of a thyroid nodule causing extensive soft tissue hematoma involving the laryngopharyngeal, neck, and chest regions in a 41-year-old healthy woman. Spontaneous hematoma secondary to a thyroid nodule is a rare occurrence. Hematoma usually tends to be secondary to blunt cervical trauma, fine needle aspiration for cytology, and usage of anticoagulants such as heparin or warfarin. It is crucial to assess the patient’s condition and airway in managing a case of spontaneous hematoma secondary to a ruptured thyroid nodule as this would determine the subsequent management. In this case, the patient presented with no obstructive signs or symptoms, and thus was managed conservatively. The hematoma subsequently resolved spontaneously.
  13,665 272 -
Factors affecting secondary post-tonsillectomy hemorrhage: a case–control study
Hesham Negm, Ahmed Atef, Hesham Lasheen, Ahmed A Kamel, Khaled Azooz, Osama Elhoussainy
January-March 2017, 33(1):50-55
Background: Tonsillectomy is one of the commonest otolaryngological procedures performed. Multiple reports have demonstrated the safety of ambulatory (outpatient) pediatric Tonsillectomy, however Post-tonsillectomy hemorrhage remains the most serious complication of tonsillectomy. Patients and methods: In this work, we analyzed different parameters including patient’s age, gender, type of surgery “Tonsillectomy or Adenotonsillectomy”, technique “Cold dissection or Bipolar”, evidence of tonsillar bed infection and pre-operative hemoglobin level in two groups of patients indicated for tonsillectomy. One group of 80 patients didn’t suffer from posttonsillectomy bleeding as a control group; the other of 20 patients having secondary post-tonsillectomy bleeding. Results: According to our statistical analysis and data, no significant difference between the two groups regarding the occurrence of secondary post-tonsillectomy in the following parameters: patient’s age, gender, type of surgery “Tonsillectomy or Adenotonsillectomy” and preoperative hemoglobin level. Conclusion: However there was higher incidence of secondary post tonsillectomy bleeding in patients operated by bipolar scissors. Also evidence of tonsillar bed infection raises the possibility of secondary post-tonsillectomy bleeding occurrenc.
  13,261 414 -
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
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.
  11,685 563 1
Management of cut-throat injuries
Zafarullah Beigh, Rauf Ahmad
July-September 2014, 30(3):268-271
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.
  11,560 482 1
Bilateral vestibulopathy treatment: Update and future directions
Mohamed Fawzy, Ahmed Khater
April-June 2016, 32(2):83-92
Bilateral vestibulopathy or BVH is a disorder of both labyrinths and/or vestibular nerves which have various etiologies. BVH is most often a chronic condition in which patients can suffer from blurred vision (oscillopsia), impaired spatial orientation and postural instability. Moreover, there is no continuing distressing vertigo, spontaneous nystagmus, or postural falls, which are typical signs of a vestibular tone imbalance caused by acute unilateral lesions. Those symptoms lead to an important decrease in physical activity, social functioning and vitality that dramatically impact the patients' quality of life. The treatment options for various forms of BVH could be one of the following four lines of treatment: (a) Preventive treatment through prevention of ototoxicity, (b) therapeutic treatment through medical treatment of the causative underlying disease, (c) rehabilitative treatment through the vestibular rehabilitation therapy, (d) future directions through sensory substitution devices (balance prostheses technology). The prognosis of BVH is poor and more than 80% of the patients do not improve. The aim of this study was to discuss the update and the future directions in the treatment of the bilateral vestibular hypofunction (BVH).
  11,149 724 1
The effect of L-thyroxine hormone therapy on hearing loss in hypothyroid patients
Mohammed M Hussein, Samir I Asal, Tarek M Salem, Ahmed M Mohammed
October-December 2017, 33(4):637-644
Objective The aim of this work was to study whether or not the hearing loss encountered in some hypothyroid patients can be improved with L-thyroxine hormone therapy, as other symptoms of hypothyroidism. Study design The study design was a prospective cohort one. Patients and methods This study included 30 patients of either sex who were proved to be in a hypothyroid state with an additional symptom of hearing impairment. The study was carried out in Alexandria Main University Hospital and was conducted in a prospective manner. All selected patients were proved to be in a hypothyroid state in the Endocrinology Department. Moreover, their symptom of hearing impairment was confirmed by thorough audiological examination supplemented by pure-tone audiometry plus tympanometry that was carried out in the ENT Department and the associate Audiology Unit. L-thyroxine treatment for hypothyroidism was initiated in all cases for 6 months to maintain a state of euthyroidism. At the end of 6 months, a repeat audiogram and tympanometry were performed in all patients in order to evaluate the efficacy of the said treatment protocol on the hearing in these patients. Cases proved to have hearing impairment irrelevant to the hypothyroid condition were excluded. Informed consent was compulsory for recruitment in this study. Results Post-treatment assessment revealed that variable improvement was achieved in 48% of ears, whereas 52% did not respond to the given treatment, with the impairment remaining nearly the same as it was before. Of the improved ears, in 15% of ears hearing levels were restored to normal hearing levels. Thereby, adherence to replacement therapy may reverse the hearing deficits in a few number of hypothyroid patients. Conclusion There is a definitive improvement in hearing with the use of L-thyroxine treatment of hypothyroid patients with hearing impairment.
  11,306 348 2
Successful management of functional aphonia using a modified voice therapy technique: a case series
Aboloyoun I Ali, Marglani Osama, Elmorsy A Soha, El Kholy M Rasha, Farooq U Mian
October-December 2017, 33(4):679-684
Objective The aim of the present study was to report the experience of a tertiary-care center in Makkah, Saudi Arabia in managing cases of functional aphonia. Study settings and design A case series study was conducted at the Phoniatrics Outpatient Clinics of King Abdullah Medical City in Holy Makkah, Saudi Arabia. Materials and methods Cases with functional aphonia managed by modified voice therapy technique in the period from March 2011 to January 2016 at the Phoniatrics Outpatient Clinics were recruited. Management consisted of auditory perceptual assessment, acoustic analysis, laryngeal examination, and voice handicap index measurement. All these parameters were recorded for each case before and after management. Statistical analysis Data were analyzed using statistical package for the social sciences version 16, and data were subjected to descriptive as well as inferential analyses. Results A total of 15 patients with functional aphonia were managed. One female patient had an exceptionally long period of aphonia, and her case is presented separately. The success rate of the procedure used for management was 100%. Conclusion Using the nonphonatory function of vocal folds in a modified manner by experienced therapists leads to recovery of voice regardless of the period of aphonia.
  11,048 457 -
Endoscopic approaches to the sphenoid ( How I do it?)
Tamer A. Youssef
October 2013, 29(4):284-289

Sphenoid sinus disease is recognized as an unusual clinical entity. It is likely that it is under-reported because of its lack of recognition as it has an insidious onset with nonspecific symptoms. Further, optimal physical examination is difficult because of the relative inaccessibility of the sinus. During the past decades, endoscopic sphenoid surgery has been the standard approach worldwide. There are many variables to be considered while selecting the best endoscopic approach to the sphenoid. In this work, the author describes different endoscopic approaches to the sphenoid with their clinical application.

  10,413 722 -
Empty nose syndrome: etiopathogenesis and management
Magdy Eisa Saafan, Hassan Moustafa Hegazy, Osama A Albirmawy
July-September 2016, 32(3):119-129
Empty nose syndrome (ENS) is an iatrogenic disorder most often recognized by the presence of paradoxical nasal obstruction despite an objectively wide patent nasal cavity. It occurs after inferior and/or middle turbinate resection; however, individuals with normal turbinates and intranasal volume may also complain of ENS. Its pathophysiology remains unclear, but it is probably caused by wide nasal cavities affecting the neurosensitive receptors and inhaled air humidification. Neuropsychological involvement is also suspected. Not every patient undergoing radical turbinate resection experiences the symptoms of ENS. ENS can affect the normal breathing function of the nasal cavity, with subsequent deterioration in patients’ quality of life. The diagnosis is made on the basis of the patients’ history, endoscopic examination of the nasal cavity, imaging (computed tomography imaging and functional MRI), and rhinomanometry. Prevention is the most important strategy; thus, the inferior and middle turbinate should not be resected without adequate justification. Management is problematic including nasal cavity hygiene and humidification, with surgery reserved for the most severe cases. The surgery aims at partial filling of the nasal cavity using different techniques and implant materials. In this paper, we review both the etiology and the clinical presentation of ENS, and its conservative and surgical management. Core tip Empty nose syndrome (ENS) is encountered after inferior and/or middle turbinate resection; however, it can occur in patients with seemingly normal turbinates. Rhinologists should avoid routine resection of the inferior and middle turbinates. It is not certain why some patients develop ENS, whereas others do not. The frequent association with psychiatric disorders and possibly psychosomatic pathologies indicate the possible role of psychological stress in some patients. Its diagnosis relies on clinical suspicion and physical examination. Nasal augmentation surgery can improve the quality of life of patients by restoring nasal anatomy toward the premorbid state.
  10,241 578 -
Audiologic evaluation and communication disorders in a group of Egyptian children with autistic features
Kamal Labib Samy, Mona Hassan Selim, Dalia Mostafa Osman, Reham Ahmed Mohamed
May 2012, 28(2):108-116

The aim of this work was to perform an audiological evaluation on a group of children with autistic features and to correlate the results with the intelligent quotient, communication skills, and sensory integration function of these children.

Study design

Descriptive cross-sectional study.

Patients and methods

The study was carried out on 25 Egyptian children with autistic features and 25 age-matched and sex-matched typically developing children. All the children’s age ranged from 4 to 9 years. All the children were subjected to the following: history taking, basic audiological evaluation, transient evoked otoacoustic emissions, N100, and P300. The children were also subjected to communication assessment, sensory integration dysfunction questionnaire, psychometric evaluation, and the Childhood Autism Rating Scale. The results obtained from the two groups were then compared. In addition, correlation studies were carried out for all the results obtained.


Autistic children presented with normal hearing sensitivities and cochlear function, and delayed N100 and P300 latencies and small P300 amplitudes compared with the control group. There was a significant negative correlation between N100 latency and verbal and nonverbal communication abilities. In addition, there was a significant correlation between P300 latency and amplitude and each of the following: intelligent quotient, the Childhood Autism Rating Scale, and dynamic assessment of verbal and nonverbal communication. The auditory and visual modalities of the sensory integration dysfunction score correlated positively with P300 latency but not amplitude.


The auditory deficits in autism involve controlled attention processes, speed of perceptual classification, and allocation of attention. N100 is a correlate of the level of communication and language development rather than a marker of autism. P300 abnormalities affect verbal and nonverbal communication, mental development, autistic features, and sensory integration function in autism and may be used as a tool to assess the prognosis of autism.

  10,172 229 -
Predictors of central vestibular disorders from videonystagmography tests
Enass S Mohamed
July-September 2016, 32(3):202-209
Background The diagnosis of central vestibular lesion is challenging and sometimes there is an overlap in symptoms and signs with a peripheral vestibular lesion. In some selected cases, dizziness is the only presenting symptom and in other patients, mild neurological symptoms as numbness are ignored. Videonystagmography (VNG) is considered a useful method for diagnosing vertigo of peripheral origin; however, not all the patients with central vertigo can be diagnosed easily. Benign paroxysmal positional vertigo and central positional vertigo share common criteria. The aim of the present study is to assess the usefulness of different VNG tests as predictors of central vestibular disorders, to determine the criteria that differentiate central positional nystagmus from the peripheral type, and to attempt to relate the abnormality in different VNG tests to certain central nervous system (CNS) levels. Materials and methods A retrospective study was carried out on 51 patients with possible central vestibular disorders from VNG tests battery and were referred for an MRI for further assessment. According to MRI results, the patients were divided into group A (31 patients), the group with manifest MRI findings, and group B, the group with free MRI (20 patients). Different VNG tests were compared between both groups. Results Three predictors of CNS lesion by VNG were determined: fixation index (FI), oculomotor tests, and central positional nystagmus; there was a statistically significant difference between both groups in FI, oculomotor tests, and central positional nystagmus, and apogeotropic criteria or nystagmus in multiple plains. There was no relation between any of those predictors and specific levels in the CNS. Conclusion VNG tests are a good diagnostic tool to differentiate between peripheral and central vestibular lesions. The inclusion of FI and positional tests to the oculomotor tests increases the sensitivity of the VNG. In some cases, it is difficult to distinguish between benign paroxysmal positional vertigo and central positional vertigo; apogeotropic nystagmus and nystagmus in multiple plains should raise the suspicion of CNS lesion. Anterior circulation ischemia may lead to chronic vertigo symptoms. Central vestibular vertigo could be caused by dysfunction or excitation of various structures in the CNS including the vestibular cortex.
  8,916 742 2
Comparison between frequency transposition and frequency compression hearing aids
Mohammed Alnahwi, Zeinab A AlQudehy
January-March 2015, 31(1):10-18
Background High-frequency hearing loss is one of the challenges for accurate hearing. One method of amplification toward improved detection and discrimination of high frequencies is through lowering of high frequencies to a lower-frequency hearing region. Frequency compression (FC) or frequency transposition (FT) can be used for individuals with different configurations of hearing impairment, such as steeply sloping and high-frequency hearing loss (containing high-frequency dead regions). Objective The purpose of this review was to compare the effects of FC and FT on the speech recognition abilities of people with hearing impairment. Patients and methods This study is a systematic review of previous investigations carried out to test the efficacy of frequency-lowering algorithms (i.e. FC or FT) in improving the detection of high frequencies. The concept of FC and FT depends on enhancement of speech recognition in patients suffering from high-frequency hearing loss. In this review, compression shifting and frequency transposition were compared on the basis of improvements in the audibility of high frequency sound to improve the outstanding and acceptance level of speech. Conclusion It can be concluded from this review that both FC and FT are useful in people with high-frequency hearing loss. FC has a potential role in recognition of monosyllabic words, consonants, and sentences in the presence of background noise. In contrast, FT facilitates detection of fricatives that ultimately leads to improvement in the discrimination of consonants. Throughout the literature, only one study has compared both FT and FC using various speech tests to evaluate the performance of different hearing instruments. Therefore, further studies addressing the benefits of both modalities of hearing aids with a more standardized outcome measure for both adult and pediatric patients are required.
  8,312 627 2
Laryngeal ultrasound as effective as CT scans for the diagnosis of various laryngeal lesions
Wail F. Nasr, Hazem S. Amer, Sherif M. Askar, Moanes M. Enaba
April 2013, 29(2):93-98

Different methods have been used in the past for the diagnosis of many laryngeal diseases. Ultrasound has become a very important, widely used diagnostic tool for head and neck diseases.


The aim of this study was to evaluate laryngeal ultrasound as an alternative to computed tomography (CT) scans in the diagnosis of different laryngeal diseases.

Study design and methods

This was a comparative cross-sectional study that was carried out between April 2010 and December 2011 in the Department of Otorhinolaryngology, Zagazig University Hospitals, Egypt. The study comprised two groups of patients: the control group (12 patients) and the study group (54 patients). Individuals of the control group who were undergoing neck ultrasound for thyroid swelling were subjected to laryngeal ultrasound only, whereas patients of the study group were subjected to both laryngeal ultrasound and CT scans of the neck.


Laryngeal ultrasound was found to be effective in detecting vocal cord nodules in 27.3% of patients, polyps and cysts in all patients, Reinke’s oedema in 60% of patients and laryngeal masses in 78.6% of patients. These results were comparable with those of the CT scans.


Laryngeal ultrasound is considered of great value in diagnosing different laryngeal lesions and can be used as an alternative to or complementary to CT scans.

Level of evidence

The level of evidence is 3a.

  7,920 575 -
Brainstem encoding of speech in normal-hearing individuals with absent acoustic reflex
Rajkishor Mishra, Himanshu Kumar Sanju, Preeti Sahu
July-September 2015, 31(3):156-161
The acoustic reflex test is an important tool for identifying auditory disorder from the middle ear to the superior olivary complex. Absence of acoustic reflexes is the early sign of many auditory disorders. Absence of acoustic reflex with normal hearing sensitivity may be an early sign of auditory neuropathy with poor encoding of speech at initial stage. Speech auditory brainstem response was recorded with /da/ (40 ms) stimuli in two groups of patients. The control group contained normal-hearing participants with presence of acoustic reflex, whereas the experimental group contained normal-hearing participants with absent acoustic reflexes. The peak latency, amplitude, and F0 and F1 mean amplitude were analyzed in both groups. MANOVA showed no significant difference in any parameter between the control and experimental group. Results of the current study showed that absence of acoustic reflexes in normal-hearing patients without auditory complaint is not sufficient by itself to diagnose the existence of auditory neuropathy. This study also highlighted that normal-hearing patients with absence of acoustic reflex have similar brainstem encoding of speech as that of patients with acoustic reflex.
  7,584 875 -
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
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.
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Postauricular epidermoid and dermoid cysts in adults
Abdullahi Mohammed, Kabir Abdullahi
October-December 2018, 34(4):213-216
Background Compared with other cutaneous cysts of the head and neck region, postauricular epidermoid and dermoid cysts are rare, asymptomatic benign swellings. Aim To describe the clinical profile of postauricular dermoid and epidermoid cysts in adults. Patients and methods A descriptive retrospective study was conducted on patients older than 16 years, diagnosed histologically with postauricular epidermoid and dermoid cysts who presented to the Ear, Nose and Throat Clinic of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January 2005 to December 2017. Results A total of eight patients were reviewed: two (25%) males and six (75%) females. The age ranged from 22 to 55 years (mean age, 30.1±11.2 years). Most cases (seven, 87.5%) were epidermoid cysts. The mean duration of cystic swellings was 9.8±5.7 years. All the patients presented with asymptomatic postauricular extracranial cysts mostly at the left postauricular side (five, 62.5%). Complete surgical excision was carried out for all the lesions, and no recurrence was observed in the two (25%) patients who came for follow-up; the rest were lost to follow-up. Conclusion Postauricular cysts, mostly epidermoid cyst, are rare unilateral asymptomatic, extracranial swellings that are associated with a delay in seeking medical intervention.
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Endonasal neuroendoscopy: New horizons
Ahmed El-Guindy
January 2012, 28(1):1-7
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