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  Citation statistics : Table of Contents
   2015| July-September  | Volume 31 | Issue 3  
    Online since July 28, 2015

 
 
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CASE REPORTS
Tuberculosis of the parotid gland and the middle ear: a rare case report
Praveer K Banerjee, Abhineet Jain, D Manjunath
July-September 2015, 31(3):196-198
DOI:10.4103/1012-5574.161618  
Aim Tuberculosis of parotid gland is a rare entity only about a hundred cases have been reported till date. An associated tubercular otitis media is very rare. The present case was diagnosed by montoux test and treated successfully by ATT. Case report A 26-year old lady attended our OPD with complaints of swelling over rt. parotid area and discharge from rt. ear since 5 and 3 months respectively. clinical examination, revealed a, non tender, soft, fluctuant parotid swelling of 4×2 cm, with rt. level 1b lymphadenopathy and granulations at annulus and dull, lustureless retracted TM with discharge. FNAC of parotid and granulation biopsy revealed epitheloid and giant cells with no caseation. Z-N stain for AFB, chest radiograph, serum ACE levels were unremarkable. Montoux test was positive (20*20mm) and ESR was 42 mm/hr. A CT scan showed isodense mass with hypodesne centre and rim enhancement in the rt. parotid gland and MRI on T2W images had mastoiditis and middle ear mucosal disease. The patient was advised ATT and had remarkable improvement. Conclusion Parotid gland and middle ear tuberculosis is rare. FNAC and Z-N staining of the aspirate, should be routinely done. Further an AFB negative presumptive diagnosis by this method may prompt a trial of ATT which can be rewarding.
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Malignant laryngeal fibrous histiocytoma: a new concept of management
Amin Alherabi, Ali I Aboloyoun, Tahira Hamid, Mian U Farooq
July-September 2015, 31(3):199-201
DOI:10.4103/1012-5574.159790  
A 75-year-old male patient presented to the Speech and Language Disorder Outpatient Clinic of King Abdullah Medical City, Makkah, Saudi Arabia, on February, 2010, with a complaint of gradual onset and progressive course of dysphonia for 2 years. Nasofibrolaryngoscopic examination indicated a polipoidal mass of about 1.5 × 1 cm masking the entire glottic inlet. The mass was removed by direct laryngoscopy and diagnosed as a malignant fibrous histiocytoma. The patient developed recurrence of the tumor on the same site postoperatively and underwent the same procedure of excision, followed by a second recurrence. Direct laryngoscopic excision of the tumor was performed for a third time, but with a safety margin of 2 mm. Monthly follow-up examination indicated no postoperative recurrence till 10 months.
  - 1,923 139
Tracheolith: a case report of a new disease entity
Hussain Albaharna, Aqeel Ahmad
July-September 2015, 31(3):202-203
DOI:10.4103/1012-5574.161622  
This case reports a stone in the trachea of a patient with tracheostomy. The presence of stone in the airway is uncommon condition. Broncholithiasis is characterized by formation of the stone due to erosion of calcified lymph node in the bronchus. There is no reported case of a stone in the trachea in the literature. The pathophysiology of this condition is still unknown, but we think that it is related to prolong tracheostomy. We recommend performing chest radiography in all cases of tracheostomy obstruction. More investigation and data collection of same cases are needed to have a more clear picture regarding the pathophysiology and the underlying cause.
  - 1,721 155
Severe esophageal damage caused by button battery ingestion in a 10-month-old infant
Savita Lasrado, Kuldeep Moras, George J.O. Pinto, Anita Aramani, Ayshwarya Vijayan
July-September 2015, 31(3):204-206
DOI:10.4103/1012-5574.161624  
Foreign body ingestion is commonly encountered in infants and young children. Button batteries represent a special category of pediatric ingested foreign bodies because of the serious possibility of complications when impacted in the esophagus. Herein we report a case of emergency medicine in a 10-month-old infant who accidentally ingested a button battery, causing severe esophageal damage. He presented with excessive crying and decreased oral intake. A chest radiograph revealed a coin shadow at the mid-esophagus, which subsequently led to the diagnosis and removal of the object. Postoperative treatment options such as antireflux therapy, antibiotic therapy, steroids, and esophageal stenting, which are still controversial, have been discussed in this paper. With increasing accessibility to electronic toys and gadgets, accidental ingestion is on the rise in infants and young children. Judicious management should be tailored in every case.
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ERRATUM
Endoscopic approaches to the sphenoid: How I do it? : Erratum

July-September 2015, 31(3):207-207
DOI:10.4103/1012-5574.158321  
  - 1,189 115
ORIGINAL ARTICLES
Value of hyperbaric oxygen therapy in the management of malignant otitis externa patients
Reda M Sabra, Mohamed S Taha, Ahmed G Khafagy, Talat Elsamny
July-September 2015, 31(3):143-148
DOI:10.4103/1012-5574.161598  
Background Malignant external otitis is a rapidly spreading bacterial infection that is aggressive in nature and may be fatal if left untreated. Hyperbaric oxygen therapy (HBOT) is a medical treatment in which the entire body is placed in an airtight chamber at increased atmospheric pressure and has been proven to be effective for a number of different medical conditions. Objective The aim of this study was to assess the usefulness of HBOT as an adjunctive treatment in patients with malignant otitis externa. Patients and methods Forty-three diabetic patients, who had malignant otitis externa, underwent control of diabetes mellitus and were treated with ciprofloxacin. HBOT was administered to 15 patients as an adjunctive treatment. All the patients were evaluated clinically (in terms of ear discharge, granulations, and pain severity) and radiologically by a temporal bone computed tomography scan. The minimum follow-up duration in both groups was 2 months. HBOT was administered in one session every other day for 2 months, resulting in a total of 30 sessions. Patient factors analyzed included age, sex, ear discharge, and pain severity. Results A total of 43 patients (28 men, 15 women) were divided into two groups: group A (28 patients) only received the antibiotic ciprofloxacin and group B (15 patients) was treated with ciprofloxacin and hyperbaric oxygen. The severity of pain improved considerably and the pain score decreased markedly from score 3 (severe) to score 0 (no pain) after 1 month in 46.7 and 93.3% of the patients by the end of the second month in comparison with patients treated only with the antibiotic: 0% after 1 month and 28.5% after 2 months. On clinical and microscopic examination, both ear discharge and granulations in the external canal had improved considerably. There was no ear discharge in 80% of patients in group B after one month treathent, 93.3% after 2 months, in comparison with 0% after 1 month, 28.5% after 2 months treatment in group A, highly statistically significant (P<0.001). Conclusion The addition of HBOT to medical treatment is highly effective and has facilitated considerable improvement in patients.
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Difficult cochleostomy in the normal cochlea
Hamad S Al-Muhaimeed, Hazem Y Abdelwahed
July-September 2015, 31(3):149-155
DOI:10.4103/1012-5574.159791  
Background The concept that the morphological and the spatial orientation of the labyrinth does not change postnatally is undergoing a worldwide discussion by cochlear implant surgeons. The main objective of this study was to examine the basal turn angulation of the cochlea relative to the midsagittal line to find a possible relationship with the difficulty in implanting the normal cochlea. Participants and methods A retroprospective descriptive study was conducted on two equal groups, each consisting of six cochlear implantees. All patients of both groups were having bilateral profound sensorineural hearing loss with normal patent cochlea. The basal turn angle (BTA) of the cochlea relative to the midsagittal plane was measured using the preoperative axial view of the computed tomography (CT) imaging. Results A retrospective study was performed on the first group of six cochlea implantees without difficult cochleostomy as noted in the operative notes and correlated with the postoperative BTAs (range = 55-60°) measured later, using patients' preoperative CT images, which were within the normal range. A blind prospective study was performed on the second group of six patients undergoing cochlear implantation in which difficult cochleostomy was faced intraoperatively in one patient (number 2), whose preoperatively measured BTA was 65° (i.e. more obtuse than the normal range), predicting a rotated cochlea with difficult cochleostomy, which was actually faced intraoperatively. BTAs of other five implantees in this group (55, 62, 50, 56, and 57°, respectively) were within the same range as our first group, predicting no difficulty, and this was also found intraoperatively. Conclusion Our results were comparable to those of the three pediatric cochlear implantees reported with difficult cochleostomy in whom the BTAs were more obtuse than normal, indicating a rotated cochlea. The possibility of a rotated cochlea should be borne in mind when difficult cochleostomy is encountered. Measuring the BTA of the cochlea relative to the midsagittal plane in all preoperative CT scans is advised to identify cases in which the basal turn of the cochlea may have an unusual orientation. Scala vestibuli insertion or a combined approach technique in case of encountered difficult cochleostomy is highly recommended.
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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
DOI:10.4103/1012-5574.161599  
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.
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Auditory dysfunction in patients with type 2 diabetes mellitus with poor versus good glycemic control
Noha M Abo-Elfetoh, Enass Sayed Mohamed, Lubna M Tag, Mona A El-Baz, Manal E Ez Eldeen
July-September 2015, 31(3):162-169
DOI:10.4103/1012-5574.161603  
Background Auditory functions among patients with type 2 diabetes mellitus (DM) are controversial regarding cochlear or neural changes and the relationship between these changes and serum level of glycosylated hemoglobin (HbA 1c %). Aim of the study The aim of the study was to investigate auditory dysfunctions in type 2 DM patients with poor versus good glycemic control. Materials and methods The present study was conducted on three groups: two diabetic groups with poor and good glycemic control (n = 18 and 14, respectively) based on serum HbA 1c % and one healthy control group (n = 30) matched with age, sex, and BMI. All participants were subjected to clinical assessment, audiometry, brainstem auditory evoked potential (BAEP), and evoked acoustic emissions transient evoked otoacoustic emissions and distortion product otoacoustic emissions (TEOAEs and DPOAEs). Results Diabetic patients with poor glycemic control had significantly elevated hearing thresholds compared with other groups at low and high frequencies in audiometry (P < 0.01 and P < 0.001). They showed significantly prolonged absolute latency in wave I and interpeak latency (III-V) in the BAEP test compared with other groups (P < 0.001). DM patients with poor glycemic control had significantly low amplitudes at all frequencies in the TEOAE test, as well as at high frequencies (4 and 6 kHz) on the DPOAE test, compared with other groups (P < 0.001 and P < 0.05, respectively). There were significant correlations between HbA 1c % and interpeak latency III-V (r = 0.340, P = 0.004) on the one hand and overall response of TEOAE amplitude (r = −0.471; P = 0.000) on the other. Conclusion Diabetic patients with poor glycemic control had worse auditory dysfunctions on both cochlear and neural findings.
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Predictors of language and auditory skills in Egyptian children with a cochlear implant
Asmaa Abdel Hamid, Mohammed Elshazly, Tarek Eldessouky, Hosam Abdel Ghaffar, Ahmed Radwan, Ahmed Abdel Monem
July-September 2015, 31(3):170-175
DOI:10.4103/1012-5574.161605  
Aim The aim of this study was to investigate the prognostic factors contributing toward the comprehension and production of Arabic language as well as auditory abilities after cochlear implantation of Egyptian children. Participants and methods A total of 150 children with severe to profound sensory neural congenital hearing loss were implanted with multichannel cochlear implants. Children had received their implants 3 months to 2 years before the onset of the study. They had received their implants between the age range of 3 and 6 years. Tests of receptive, expressive language, and sets of auditory abilities were administered. Characteristics of the child and the family (age before implant and duration of implant use, preimplant use of hearing aids and language therapy, parents' involvement in therapy, mode of communication at home, type of the implant, and geographic distribution) were considered the predictors. Predictors of total language and auditory abilities were determined using statistical analysis by univariate and multivariate analyses. Results Some significant predictors of language and auditory skills in this study included duration of implant use, use of auditory mode of communication and parent interaction. There is a positive correlation between language age and both individual and total auditory abilities scores. Conclusion Prognostic factors for language and auditory abilities are useful in a rehabilitation program after cochlear implantation.
  - 2,093 199
Grammatical comprehension in developmental semantic-pragmatic disorder
Sally T Kheir El-Din, Yossra Sallam
July-September 2015, 31(3):176-179
DOI:10.4103/1012-5574.161607  
This is a clinical case study of 105 children; 35 children demonstrated 'semantic-pragmatic' type of specific language impairment, 35 children presented with delayed language development due to mental retardation, and 35 children with normal language development. In contrast to the disturbances of linguistic form that characterize the most frequently reported type of specific language impairment, the semantic-pragmatic disorder is characterized mostly by 'inappropriate' language use. A cognitive explanation has been proposed, which accounts for all instances of inappropriate language thus far studied in this population. An expressive linguistic explanation has also been proposed, which accounts for some instances of inappropriate language. This study investigates the possibility that a receptive linguistic explanation can account for inappropriate responses to questions. A linguistic explanation with receptive and expressive components could account for some of the semantic-pragmatic behaviors previously accounted for by the cognitive explanation. To test this proposal, the linguistic profiles of all children were examined using the Arabic language test. The results indicate that grammatical comprehension was impaired in about 45.7% of the children examined. Therefore, instances of inappropriate language use that appear to express disordered concepts may reflect receptive linguistic deficits instead.
  - 1,913 160
Assessment of Egyptian children who stutter using the standardized Arabic form of the Test of Childhood Stuttering
Rania Abdou
July-September 2015, 31(3):180-187
DOI:10.4103/1012-5574.159789  
Introduction Stuttering is one of the most common speech disorders affecting children. The proper assessment of stuttering has been a point of interest for researchers over the years. The aim of this study was to adapt the Test of Childhood Stuttering (TOCS) to suit the Egyptian culture and to test the validity and reliability of application of this test for the assessment of Egyptian children who stutter, for proper management of this ailment. Patients This study included 130 children. The ages ranged between 4 years and 12 years 11 months among both boys and girls. The children were divided into two groups: group 1 included 30 children who stuttered; group 2 included 100 typically developing children as the control group, who did not suffer from any language or speech disorder. Methods A pilot study was conducted on eight children who stuttered, after Arabic translation of the TOCS, and a few modifications were made to the pictures of the picture book of the TOCS to suit the Egyptian culture. Reliability was assessed by the test-retest method, and test validity was established on the basis of content description validity, internal consistency validity, convergent validity, and known group comparisons. Results The Arabic version of the TOCS is a valid and reliable test for the evaluation of Arabic speaking children who stutter and to determine the severity of a child's stuttering. The results were highly significant and were capable of discriminating between children with normal disfluency and those who stutter.
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Outcome of stuttering therapy on Egyptian school-aged children using the speak freely program
YA Abo Ras, RM El-Maghraby, WM Madkour
July-September 2015, 31(3):188-195
DOI:10.4103/1012-5574.161614  
Background The training program presented depends on improving the physical dimension for stutters by teaching both stuttering modification and fluency-shaping techniques based on the Speak Freely Program. Aim of the work This study is designed to adapt and apply the 'Speak Freely Program' of stuttering intervention for Arabic-speaking school-aged stuttering children and to explore its effectiveness as a therapeutic tool. Subjects and methods The present work was carried out on 25 stuttering children of both sexes in the age range of 7-18 years. The participants were divided into two age groups: group I (7-12 years) and group II (12.1-18 years). Each participant was subjected to the protocol of stuttering evaluation as follows: (a) assessment of history and analysis of complaints; (b) observation of features of stuttered speech (core behavior, secondary reactions, devices to cancel stuttering, escape, antiexpectancy) and overt behaviors; (c) Stuttering Severity Instrument (SSI-3) was used to assess moments of stuttering in a speech sample and reading aloud; (d) psychometric battery was used to compare between pretherapeutic and post-therapeutic anxiety and depression scale; (d) two objective evaluations were used: first, spectral analysis to measure the voice onset time, formant transition, and vowel duration for all participants' fluent productions of monosyllabic words with initial /t/ and /d/, and second, Visipitch to measure fundamental frequency, relative average perturbation, amplitude, shimmer, voiced percent (voiced%), voiceless%, and pause% in an automatic, reading, and spontaneous. Results The study showed that the younger stutterers achieved better outcome with the therapeutic program. The results of the SSI-3 and the anxiety and the depressive state of the studied children, respectively, showed a highly significant difference between the pretherapeutic and the post-therapeutic values of the two groups studied. Formant transition of the (voiced and voiceless) and the vowel duration of (voiceless) monosyllabic words showed a difference after therapy. Both groups showed higher post-therapeutic values for the voiced%, voiceless%, and the amplitude measurements. Conclusion To conclude, stuttering therapy alters the acoustic properties of stutterers' fluent speech concomitant with reducing stuttering frequency speech samples.
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