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   2016| October-December  | Volume 32 | Issue 4  
    Online since October 19, 2016

 
 
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ORIGINAL ARTICLES
Registry on assessing the quality of life improvement with triamcinolone in the treatment of moderate-to-severe persistent allergic rhinitis in egyptian patients
Mahmoud Elsammaa
October-December 2016, 32(4):243-247
DOI:10.4103/1012-5574.192547  
Background Allergic rhinitis is a common disorder that can significantly impact the quality of life of patient. It is strongly linked to asthma and conjunctivitis. The classic symptoms of the disorder are nasal congestion and itching, rhinorrhea, and sneezing. Currently, steroids have played a role in the management of allergic rhinitis. The aim of the study was to assess the efficacy and safety of triamcinolone in the treatment of allergic rhinitis in Egypt. Patients and methods A total of 308 Egyptian patients who were suffering from moderate-to-severe allergic rhinitis and were prescribed triamcinolone were enrolled. The improvement in the quality of life of patients receiving triamcinolone after 4 weeks of treatment was assessed using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). All adverse events were recorded during the study duration. Results The RQLQ showed a significant improvement in the quality of life of patients after using triamcinolone. The mean RQLQ score before triamcinolone administration was 2.99±1.015 versus 0.68±0.706 after 4 weeks of treatment (P<0.001), with a mean percent reduction of −76.78±23.62%. The individual domain scores of the RQLQ after 4 weeks of treatment showed a significant improvement in the level of all domains. No adverse events were reported and the drug showed a high tolerability profile. Conclusion Triamcinolone is considered an efficient and safe drug in the management of allergic rhinitis. It has a positive impact on the quality of life of patients with moderate-to-severe persistent allergic rhinitis under conditions of daily practice in patients receiving triamcinolone after 4 weeks of treatment.
  2,095 3,550 -
Potentiation of physiotherapy by low-level laser or kinesio taping for treatment of cervicogenic headache: a randomized controlled study
Hazem Mohamed Saleh, Marina Onsy Fahim Edward, Ahmed Al Farouk Abdel Fattah, Mohamed Farouk Ali
October-December 2016, 32(4):248-254
DOI:10.4103/1012-5574.192549  
Background Cervicogenic headache (CGH) is a referred pain originating from the neck and perceived in the head and/or face. Its morbidity and cost of treatment hugely affect the society. Classical management is by physiotherapy (PT) and analgesics. Patients and methods A total of 45 patients with CGH were treated either by PT alone or by PT and low-level laser or by PT and kinesio taping (KT). Results Three outcome measures were obtained: the pain pressure threshold, the neck disability index, and the forward head posture improved significantly in all groups. Compared with PT alone, adding KT gave better results in all three parameters. Adding low-level laser gave better scores in both pain pressure threshold and neck disability index. Adding KT to PT gave better results in all parameters than adding low-level laser. Conclusion In the short term, KT improves the outcome of PT for CGH to a greater extent compared with the low-level laser therapy.
  3,347 1,847 -
Voice outcome following electrical stimulation-supported voice therapy in cases of unilateral vocal fold paralysis
Yehia A Ras, Mohamed Imam, Manal M El-Banna, Nesrine H Hamouda
October-December 2016, 32(4):322-334
DOI:10.4103/1012-5574.192543  
Introduction The current lack of knowledge on the effects of transcutaneous electrical stimulation-supported voice therapy (TESVT) on voice production, coupled with increasing anecdotal reports of TESVT use with voice disorders, prompted this research. Aim The aim of this study was to compare the therapeutic value of conventional voice therapy (CVT) and TESVT on voice outcome in patients with unilateral vocal fold paralysis. Patients and methods The study was conducted on randomly selected 29 patients with unilateral vocal fold paralysis who were candidates for voice therapy attending to the Unit of Phoniatrics, Department of Otorhinolaryngology, Faculty of Medicine, University of Alexandria. The patients were divided into two groups: group I, which included 14 patients who were assigned to CVT, and group II, which included 15 patients who were assigned to TESVT. Each patient was subjected to the following procedures before and after therapy to document glottis closure and voice quality changes: auditory perceptual assessment using the GRBAS scale, the Voice Problem Self-assessment Scale, videostroboscopic examination, and acoustic and aerodynamic analysis of a sample of phonation in addition to electroglottography. TESVT was applied for all participants. Results Statistically significant changes have been obtained for all measurers. No significant statistical difference was found between CVT and TESVT in patients with vocal fold immobility except for frequency perturbation and some electroglottographic parameters. Conclusion Transcutaneous electrical stimulation-supported voice therapy is as effective as CVT in improving voice parameters in cases of unilateral vocal fold immobility. Further research is warranted with a larger number of patients to assess the efficacy of electrical stimulation-supported voice therapy in cases of vocal fold immobility and to determine selective criteria for this TESVT approach.
  3,530 316 3
Risk factors associated with aspiration after partial laryngectomies
MA Riad, MM Samir, OH Abdul Latif, HM Rabie, SE Bassiouny, AN Abdel-Hamid
October-December 2016, 32(4):271-278
DOI:10.4103/1012-5574.192545  
Hypothesis Aspiration and dysphagia still remain the most common drawbacks limiting conservation partial laryngeal surgery. Videofluoroscopic swallowing study (VFSS) has became the gold standard examination that guides the surgeon about important risk factors, helping him in technique selection and anatomical structure preservation, in balance with radical removal of laryngeal neoplasms. Objectives The purpose of this study was to determine the major risk factors for postoperative aspiration using VFSS and how to overcome it following different types of partial laryngectomies. Study design The authors conducted a prospective evaluation comparative study. Patients and methods This study was conducted on patients with laryngeal carcinoma who underwent partial laryngectomy between October 2009 and May 2012. VFSS was carried out to evaluate postoperative swallowing and aspiration. Statistical analyses were performed using Pearson’s χ2 and Spearman’s rank correlation test to detect the major risk factors associated with aspiration. Results Thirty-two patients were enrolled in the present study. Six different types of partial laryngeal surgeries were carried out according to the size and extent of the primary tumor. Twenty-five (78.12%) patients suffered from various degrees of aspiration. Age, smoking, site of tumor, resection of valleculae, epiglottis, hyoid bone, ventricular folds, and true vocal folds were significantly associated with aspiration (P<0.05). Conclusion Aspiration is common after partial laryngeal surgeries but is rarely severe or permanent. VFSS should be used before and after any partial laryngectomy to exclude silent aspiration and the risk for aspiration pneumonia. Aspiration can be minimized with careful patient selection and precise surgical technique selection and perfection.
  2,498 153 -
Value of vitamin D assessment in patients with head and neck squamous cell cancer before treatment
Badr El-Din Mostafa, Heba M Abdelmageed, Marwa M El-Begermy, Mohamed S Taha, Tarek Abd-Elhamid Hamdy, Azza Omran, Neama Lotfy
October-December 2016, 32(4):279-286
DOI:10.4103/1012-5574.192550  
Introduction The 5-year survival of patients with head and neck squamous cell carcinoma (HNSCC) has not changed dramatically over the last decades despite the use of various therapeutic modalities, including surgery and/or chemoradiation. Thus, new approaches remain necessary to prevent cancer, reduce recurrence, and improve treatment with reduction of its side effects. There is recent evidence that vitamin D promotes cell differentiation and decreases cell proliferation, invasion, angiogenesis, and metastasis. Thus, it has been hypothesized that vitamin D may protect against cancer at multiple sites. Objective The aim of this study was to evaluate serum level of vitamin D (VD), calcium, and phosphate in patients with HNSCC before treatment as a step in studying its impact on HNSCC development and progression. Type of the study This prospective study was conducted between March 2013 and October 2014 at Ain Shams University Hospitals, Cairo, Egypt. Patients and methods The study included 80 participants categorized into two groups. Group A included 50 (36 males and 14 females) patients with various HNSCC sites; their median age was 54.8 ± 12.7 years. Group B included 30 (20 males and 10 females) sex-matched and age-matched healthy volunteers as controls; their mean age was 50.5 ± 12.0 years. Results The median VD level in group A was 40.35 (31.9–55) and for group B it was 118.75 (55.0–175) (P < 0.001), indicating a significant decrease of VD in group A than in group B. VD deficiency (<37.5 nmol/ml) in group A was 42%, which was significantly more than that in group B, which was only 3%. Conclusion This study showed that vitamin D deficiency is prominent in patients with head and neck squamous cell carcinoma before treatment than in controls. Although it may expose the patients to increased risk of therapy-related morbidity and poor outcome, it may constitute an inexpensive prophylactic and cost-effective option in the therapeutic armamentarium as a synergistic agent to traditional treatment options.
  2,407 177 1
Efficacy of the Arabic Modified Fluency Shaping Program in the treatment of stuttering
Nahla A.A. Rifaie, Amal S Saber, Sally T Kheir El-Din, Yossra A.N.M. Sallam, Asmaa M.A.S. Algamal
October-December 2016, 32(4):306-321
DOI:10.4103/1012-5574.192546  
Background The goal of fluency-shaping approaches is not to modify stuttering but rather to completely replace it with fluent speech. This is achieved by applying a range of fluency-controlling techniques, usually implemented within a slow-speech framework, which fundamentally changes the way that respiration, phonation, and articulation are coordinated for speech. Aim The present study aimed at evaluating the efficacy of the Arabic Modified Fluency Shaping Program as a valuable treatment approach for Egyptian stutterers. Patients and methods The study design was a prospective longitudinal experimental controlled one. The present work was carried out on 100 stutterers of both sexes in the age range of 8–20 years. The participants were divided into two groups: the study group and the control group. A multidimensional assessment protocol was used for all participants. It included elementary diagnostic procedures (personal interview, visual perceptual assessment, and auditory perceptual assessment), clinical diagnostic aids (Stuttering Severity Instrument for Children and Adults-Arabic version, speech rate, psychometric evaluation, and assessment of feelings and attitudes using speech performance self-reported questionnaire), and additional instrumental measures (spectrographic assessment and Visi Pitch). Therapy program: Participants in the study group were trained using the Arabic Modified Fluency Shaping Program. Results The study group achieved better outcome with the therapeutic program regardless of the age of the patient at the time of therapy. There was marked reduction in mean total score of Stuttering Severity Instrument for Children and Adults-Arabic version in the study group and was 1.48, 1.66, and 2.12, respectively, during post-therapy, first follow-up, and second follow-up evaluations compared with 25.36 during the pretherapy evaluation. As regards spectral analysis, there were higher post-therapeutic values for voice onset time, vowel duration, syllable duration, and shorter sentence duration. As regards Visi Pitch, there were lower post-therapeutic values for percent voiced and percent pause and a higher value for the percent unvoiced, which denotes improvement. The results of speech performance self-reported questionnaire showed an increase in patient’s satisfaction with speech and trust in their abilities as a speaker; there was also a decrease in avoidance of speaking situations and speaking on the phone after therapy. Conclusion The results of this study indicated the efficacy of the Arabic Modified Fluency Shaping Program in rehabilitation of stuttering. The presented program provides participants with strategies that significantly improve their speech behavior and their attitudes toward speech.
  2,323 215 -
The impact of electrode type on intraoperative and postoperative telemetry measures in cochlear implant using different surgical technique
Soha Hamada, Abir Omara, Ihab K Sefein, Amr Younes
October-December 2016, 32(4):264-270
DOI:10.4103/1012-5574.192548  
Background Cochlear implantation (CI) is largely considered successful based on the device’s ability to reliably send electrical signals to the auditory nerve fibers. Telemetry (electrode impedance) is a bidirectional communication system. The telemetry system allows us to test the basic functions of a CI and to detect the electrical problems in each electrode. Aim The aims of this study were to monitor electrode telemetry at the intraoperative and initial-activation postoperative periods and to correlate the telemetry measures with the type of inserted electrode and surgical technique. Patients and methods A retrospective analysis of impedance data from 69 CI surgeries occurring at the Hearing and Speech Institute was conducted. Intraoperative and postoperative impedance values were available in 69 pediatric and adult patients during the first fitting 3 weeks to 1 month postoperatively. The data obtained in this study were divided into four groups depending on the type of implanted electrode and device used. In this research, four types of electrodes (Mid Scala, 1J, Flex 28, and Standard) and two surgical techniques (cochleostomy and round window) were used. Results Findings showed that there is a statistically significant difference between intraoperative and postoperative mean average of telemetry measure for 1J and Flex 28 electrodes that increased postoperatively. There was no statistically significant difference between intraoperative and postoperative mean±SD of each of the two electrodes (Mid Scala, 1J, Flex 28, and Standard). Comparison between intraoperative and postoperative average of the four electrodes shows statistically significant difference in intraoperative average. The study also showed that there is no statistical difference between telemetry results when either cochleostomy or round-window approaches were used. Conclusion Findings of this research showed increase in postoperative impedance with all types of electrodes, which can be referred to the absence of electrical stimulation prior to initial activation of the device. There is statistically significant difference in intra-operative telemetry average between four types of used electrode.
  2,106 219 -
Effect of the type of surgery, use of intraoperative topical mitomycin C or stenting on the outcome of choanal atresia repair: a systematic review and meta-analysis
Marwa M El-Begermy, Mohamed Magdy Samir, Samia A Fawaz, Wael G Elkelany
October-December 2016, 32(4):255-263
DOI:10.4103/1012-5574.192552  
Background Restenosis and recurrence of symptoms after posterior choanal atresia (CA) repair is a major concern for surgeons, which leads to the use of a variety of surgical approaches and adjuvant treatment modalities to avoid restenosis. Aim The study was designed to compare the outcome of transnasal endoscopic and transpalatal repair of CA as regards restenosis, and also to compare the effect of using topical mitomycin C (MMC) or nasal stenting with not using these modalities on the outcome of repair as regards restenosis. Methods A systematic search was conducted on the PubMed/MEDLINE to locate and select relevant studies without applying any limits. Studies included in meta-analysis were tested for heterogeneity of the estimates. Results As regards comparing the transnasal endoscopic and transpalatal approaches, eight studies, involving 410 cases, met our criteria; 197cases were repaired endoscopically with 37.5% restenosed and 188 through transpalatal approach with 28.2% restenosed. Using the estimated odds ratio, no statistically significant difference was found as regards restenosis. For the use of MMC, five articles fulfilled our criteria; they involved 155 cases; MMC was used in 70 cases where 24.2% restenosed, and was not used in 85 cases where 35.2% restenosed. By estimated odds ratio, there was no statistically significant difference between the two groups as regards restenosis. For the use of stenting, four articles fulfilled our criteria; they involved 165 cases, out of which 93 cases used nasal stent after repair of CA (21.5% restenosed), whereas in 72 cases stent was not used (18% restenosed). By estimated odds ratio there was no statistically significant difference between the two groups. Conclusion The available evidence suggests that there is no statistically significant difference between transnasal endoscopic and transpalatal approach in the repair of CA as regards restenosis; furthermore, there is no statistically significant difference between using intraoperative topical MMC and nasal stent and not using such modalities on the outcome of CA repair.
  1,904 389 -
Performance of children with mild or moderate sensory hearing loss on central auditory tests
Mona Mourad, Mohammed Talaat, Rania Abdou, Ghada Abdelkader
October-December 2016, 32(4):298-305
DOI:10.4103/1012-5574.192544  
Hearing is fundamental to the development of successful language skills. Deficits in hearing acuity and auditory processing (AP) can profoundly obstruct effective communication. Our study aimed to evaluate the performance of children with mild and moderate sensory hearing loss (HL) on central AP tests. The study included 50 children: 10 children with normal hearing who were used as controls; 20 children with mild sensory HL; and 20 children with moderate sensory HL. Both male and female children were equally represented. All children underwent otoscopic examination, pure tone audiometry, tympanometry, and acoustic reflex measurements. Questionnaires on central AP disorders, dyslexia, and attention deficit hyperactivity disorder were answered by the parents. Screening tests for AP abilities [pitch pattern sequence test, speech perception in noise (SPIN) right SPIN, left SPIN, dichotic digit test] were conducted. All children were then examined with the full versions of the previous tests in addition to auditory fusion test − revised, masking level difference test, binaural fusion test, competing sentence test, and low pass-filtered test. Arabic-version dyslexia assessment was carried out for those who failed the tests. The study revealed that children with mild and moderate HL who failed the screening tests also failed the full version tests, and when tested by the Arabic-version dyslexia assessment test, dyslexia was found as a comorbid condition.
  1,860 120 -
CASE REPORT
Paediatric Boerhaave's syndrome: a rare but crucial diagnosis
Abdul W Mohammed, Sajjad Saneeq, Kasim Kolakkadan, Koruvachukandiyil K Amrutha
October-December 2016, 32(4):335-338
DOI:10.4103/1012-5574.192551  
Boerhaave's syndrome is typically seen in middle-aged male population. We report a case of a child who presented with sudden onset of left-sided oedema of the face and periorbital region. The child had a history of fever and throat pain, which started a day prior to the onset of swelling. On examination, the child had crepitus over the swelling on the left side of the face. Radiology showed pneumomediastinum and pneumothorax, and were treated with chest tube insertion. We present this case because of its rarity, unique presentation and need for prompt diagnosis, and discuss the literature.
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ORIGINAL ARTICLES
Indices for the determination of the degree of communication skills improvement in prelingual children with cochlear implantation
Manal El-Banna, Gamal Youssef
October-December 2016, 32(4):287-297
DOI:10.4103/1012-5574.192553  
Introduction Monitoring and documenting the progress in communication skills of cochlear implanted (CI) children is important for intervention planning, conduction of evidence-based studies, and reporting parents about their children’s progress. Aim The aim of the present study was to provide reliable indices that may be used to monitor a child’s communication skills progress after CI and to grade his or her performance. Patients The study was carried out on 53 prelingual CI children (28 boys and 25 girls). Their ages ranged from 2.5 to 6 years. They were all of average intelligence and showed no associated disorders. They were all enrolled for verbal auditory training at the Unit of Phoniatrics. Methodology The CI children were evaluated postoperatively using the quasi-objective description of communicative ability, following scaling by transformation from the lower stages to the higher stages in communicative performance. This entailed the determination of the levels for auditory performance, receptive and expressive language, speech intelligibility, mode of communication, approximate language age, vocabulary size, and speech sounds perception. After 1 year of implantation, the children were re-evaluated and the levels achieved in each item and on the therapy program were recorded. The subjective impression of improvement was marked as poor, fair, or good, which was determined by the phoniatrician, therapist, and the parents for each child. Conclusion Expressive language development and speech intelligibility in the presence of marked speech perception are significant indicators for communication skills progress. The indices provided for various degrees of improvement are helpful to conduct evidence-based research, especially in the absence of reliable formal testing.
  1,523 98 -