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   Table of Contents - Current issue
April-June 2018
Volume 34 | Issue 2
Page Nos. 105-164

Online since Wednesday, May 9, 2018

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External endoscopic multiportal frontal sinus obliteration for laterally pneumatized frontal sinus: a feasibility study p. 105
Sameh M Amin
Introduction Osteoplastic flap procedure is a standard method used for frontal sinus obliteration. Endoscopic external frontal sinus obliteration is a minimally invasive new technique confined to small-sized and medium-sized pneumatized frontal sinuses. Objective The aim of this study was assess the feasibility and surgical application of this technique for far-lateral pneumatized frontal sinuses. Materials and methods Ten sides of adult dry skull were assessed for frontal sinus pneumatization and supraorbital cells by computerized tomography. Three sides were selected with frontal sinus pneumatization extending beyond midorbital line. Feasibility of obliteration of frontal sinus was tested. Endoscopic external multiportal frontal sinus approach was done using angled endoscopy and standard instrumentation. Classic frontal sinus trephine port was performed initially to safely locate the frontal sinus. In-situ nondisplaced superiorly based miniosteoplastic flap reaching to midorbital plane was performed providing another port. Additional lateral trephine port beyond midorbital plane was performed. Angled endoscopy and standard instrumentation were used reciprocally through different ports to reach different areas of frontal sinus. Outcome parameters were ability to reach corners of frontal sinus, remove sinus septae and nasofrontal duct, and maintain integrity of anterior wall of frontal sinus. Surgical application was done in two cases of frontal sinus mucocele and meningoencephalocele. Results In three laterally pneumatized frontal sinuses of dry skulls, corners, septae, and nasofrontal ducts could be handled using external multiportal endoscopic approach without disruption of anterior frontal wall. Three ports allowed two-hand surgical technique. Surgical application in two cases with follow-up over 6 months revealed no significant complication. Subcutaneous collection developed in one case after 2 weeks and resolved with medical treatment. Conclusion External endoscopic multiportal obliteration is feasible for frontal sinuses with lateral pneumatization beyond midorbital line. This technique is minimally invasive with less morbidity. Long-term follow-up in a larger series is needed.
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Correlation between dyslipidemia and severity of allergic rhinitis p. 111
Mohamed R Ahmed, Yasser T Madian, Mohammed T El-Tabbakh, Ahmed T El-Serafi, Gamela M Nasr, Waheed F Hessam
Background Allergic rhinitis is a common problem affecting between 20 and 25% of the population lowering the quality of life (QOL) more than any other disease. Dyslipidemia is known to impact potently the development of atopy as it promotes proatopic Th2 immunity and allergic inflammation. Objective The aim was to test the correlation between severity of allergic rhinitis and dyslipidemia. Materials and methods A comparative study carried out on 350 allergic rhinitis patients were subjected to full serum lipid assays, visual analog scale assessing their nasal symptoms, and QOL assessment using a seven-point scale. Results Patients were divided into two groups (according to their lipid profile): abnormal dyslipidemia group (33%) and normal lipid profile group (67%). The abnormal dyslipidemia group showed a more intense allergic rhinitis symptoms compared with the normal lipid profile with poor QOL score (1.97). Conclusion Dyslipidemia might play an important role in increasing the severity of allergic rhinitis symptoms with impaired patients’ QOL; therefore, its control could achieve better treatment outcomes.
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Comparative immunohistochemical study of acquired cholesteatoma in children and adults Highly accessed article p. 116
Mohammed Bassiouny, Nahed Badour, Yasser Shewel
Objective To compare the histopathological structure and immunohistochemical characteristics of acquired cholesteatoma in children and adults. Patients and methods This study was carried out on 40 patients presenting with cholesteatomatous middle-ear disease. Twenty patients were of a pediatric age group (<18 years) and the rest were adults (>18 years). Patients were admitted to the ENT Department of Alexandria University Hospital. All cholesteatoma specimens were collected intraoperatively and preserved for histopathological examination and immunohistochemical technique using the epidermal growth factor (EGF) monoclonal antibody. Results Histopathological examination of the submitted specimens showed that strips of stratified squamous epithelium with the underlying tissues were fibrous in adults, whereas cellular inflammatory infiltrates were observed in children. The degree of fibrosis was significantly higher in the adult group, whereas the pediatric group had higher inflammatory infiltrate. Immunohistochemical examination indicated significantly higher expression of EGF in children compared with adults both in the matrix and in the perimatrix of acquired cholesteatoma. Conclusion Children with acquired cholesteatoma had higher inflammatory infiltration and significant expression of EGF in both the matrix and the perimatrix with less fibrosis compared with adults, explaining the possible pathogenesis of aggressive behavior of cholesteatoma in children.
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C-arm-assisted internal fixation of pediatric mandibular fracture p. 122
Mohammad W El-Anwar, Mohamed Salah, Ghada Abdulmonaem
Introduction Dentition is one of the main concerns while managing pediatric mandibular fractures. The aim of this study was to assess the results of the usage of intraoperative images with C-arm to identify and protect the roots of nonerupted teeth during open reduction and internal fixation (OR/IF) of pediatric mandibular fractures. Patients and methods This prospective study was conducted on children who had mandibular fractures with unerupted mandibular teeth appearing on panoramic examination. All patients were managed by OR/IF by titanium miniplates using manual maxillomandibular fixation treated under general anesthesia. Titanium miniplate was positioned according to preoperative radiology. Then C-arm images were taken to confirm the screws position away from the nonerupted teeth. Lastly, the screws were inserted at C-arm-confirmed safe position. Then the results were assessed such as reliability, difficulties of the procedures, operative time, dental occlusion, average intrinsic vertical mouth opening, and complication. Results A total of 20 children with parasymphyseal fractures, with mean age of 6.5 (range: 4–9) years, were included. No difficulties were detected during application of the C-arm during surgery regarding position or projection, and the registered views were clearly seen and easily interpreted. Thus, added duration for C-arm use did not significantly elongate the operative time. Postoperative radiology confirmed proper position of all fixed screws away for the teeth root or unerupted teeth. Conclusion Operative C-arm-guided plate screws positioning and fixation can effectively obviate the risk of injury to tooth root or bud during OR/IF of mandibular.
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Does early tracheostomy affect the duration of mechanical ventilation in patients with severe traumatic head injuries? p. 127
MM Roushdy, HS Abdel-Ghaffar, AE Saleh
Background and purpose Tracheostomy is a surgical procedure performed frequently in intensive care units (ICUs). Prolonged mechanical ventilation (MV) is the main indication for tracheostomy in ICUs. This study was conducted to investigate if early tracheostomy affects the duration of mechanical ventilation in patients with severe traumatic head injuries. Patients and methods It is a prospective, randomized study in which patients with severe post-traumatic head injuries, with a Glasgow Coma Scale of less than 8, were included. Patients were randomized into two groups; group of early tracheostomy (ET) included 53 patients subjected to tracheostomy before the seventh day of intubation and group of late tracheostomy (LT) included 34 patients subjected to tracheostomy on or after the seventh day of intubation. The total duration of mechanical ventilation, the complications of tracheostomy, and mortality were recorded. Results The mean duration of mechanical ventilation of ET group (ET=10.97±6.82) was statistically significantly shorter than the LT group (LT=16.28±8.65) (P=0.002). Complications were minor and not life threating. No mortalities were detected because of tracheostomy. Conclusion Tracheostomy is a safe procedure with acceptable rate of minor complications. Early tracheostomy, before the seventh day of intubation, significantly shortens the duration of mechanical ventilation in patients with severe traumatic head injuries.
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Partial laryngotracheal resection and anastomosis, institutional 10 years’ experience p. 132
Mohamed Mobashir, Abd Elraof S Mohamed, Ahmed Anani, Ashraf El-Malt, Yasser A Fouad, Ahmed I El-Sayed
Objective This study aimed to evaluate the results of partial laryngotracheal resection and anastomosis in the management of iatrogenic laryngotracheal stenosis. Patients and methods This retrospective analytical study was conducted on all patients who had been operated by means of partial laryngotracheal resection and anastomosis in our institute, from 2004 to 2014. The period of follow-up was at least 1 year. The total number of the patients included was 22. Results Successful decanulation was achieved in 20 (90.9%) cases. The number of complicated cases in our study (with one or more complication) was eight (36.3%). Two cases complained of dyspnea with documented restenosis of the trachea, and one case died from severe hemoptysis at 12 days postoperatively, most probably from trauma of the innominate. Two cases were complicated by surgical emphysema and one case was complicated by hematoma; all of them were managed successfully. Conclusion Partial laryngotracheal resection and anastomosis is a safe and reliable surgical method for the management of grade III and IV iatrogenic laryngotracheal stenosis. This technique achieves best results in male patients when the stenosis is short segment, and not involving the cricoid cartilage.
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The use of the LittlEARS Auditory Questionnaire in assessing children before and after cochlear implantation p. 138
Hatem Ezzeldin, Fatma El-Zahraa A Kaddah, Ahmed Abd Al Hameed
Background The age of cochlear implant (CI) is a crucial factor that affects auditory skills and speech outcome in children after CI. Speech and auditory skills outcome using the Arabic form of the LittlEARS Auditory Questionnaire (LEAQ) on Arabic-speaking cochlear-implanted children is not sufficiently studied. Objective The aim of the present study was to assess. the use of the Arabic form of the LEAQ to determine the effect of age of CI on the outcome of auditory skills in children with CIs, to enhance better intervention protocols for children in need of CI and to achieve the best communicative skills for those children. Patients and methods A total of 45 children with CI were classified into three groups according to their ages, and they were assessed using the Arabic version of LEAQ preoperatively as well as 6 and 18 months after mapping. Results Significant improvement in auditory skills and speech was reported in the three groups. The improvement was highly significant in the youngest group in comparison with the other two groups 6 and 18 months after mapping. In addition, speech and auditory skills were highly significant in each group after CI. Conclusion The age of the child at which CI is placed is a crucial factor in speech and auditory skills development. The earlier the age of CI, the better the result.
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Vestibular-evoked myogenic potential: an easy neurophysiological tool for evaluating brain stem involvement in multiple sclerosis p. 144
Rabab Koura, Mona Hussein
Background Vestibular-evoked myogenic potentials (VEMPs) are an applicable neurophysiological technique that can be used for diagnosis of brain stem involvement in patients with multiple sclerosis (MS). Aim The aim was to evaluate the relationship between VEMP parameters, clinical characteristics, and brain stem lesions in patients with MS. Patients and methods The study was a case–control study done on 20 patients with MS and 10 normal controls. The disability level of the patients was assessed by the expanded disability status scale and brain stem functional system score (FSS). Location of demyelinating lesions was determined from brain and spinal cord MRI scans. VEMP was done for all patients and controls. Results Overall, 60% (n=12) of patients with MS were found to have absent VEMP latency (P13–N23) in both right and left side. Patients with preserved VEMP latency were found to have significantly delayed latency (P13–N23) in both right and left sides than controls. Comparison between patients with delayed VEMP latency and those with absent VEMP latency in disease characteristics revealed that there was a statistically significant difference between them in disease duration (P=0.001), expanded disability status scale score (P=0.01), and functional system score (P=0.04). The group of patients with vestibular symptoms or brain stem lesions was found to have significantly more absent VEMP latency than those without. Conclusion Patients with MS may have abnormal VEMP, especially those with long disease duration, vestibular symptoms, greater disability, and brain stem lesions.
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Comparison of three different frequency-lowering technologies in Arabic speaking hearing loss children p. 149
Naema M Ismael, Ebtessam H Nada, Amani M El-Gharib
Introduction Frequency-lowering is the generic term that refers to current technologies that take high-frequency input signals, typically considered speech sounds, and deliver them to a lower frequency region for improved speech understanding. Manufacturers of hearing aids (HAs) introduced frequency-lowering techniques to compensate in part for the perceptual effects of high-frequency hearing impairments, which include linear frequency transposition scheme, nonlinear frequency compression, and spectral IQ. Objectives To find which of the three frequency-lowering technologies is more beneficial in amplifying high-frequency sounds in children with high-frequency hearing. We also aimed to find which technology gives the best aided Arabic speech score in our Egyptian children patients. Patients and methods A total of 10 children with moderately severe to profound high-frequency sensory neural hearing loss using conventional methods of amplification were included. Aided threshold and word discrimination score were done four times using conventional HA once and other three trails using HAs with different frequency-lowering technology. Results Significant differences were found between conventional amplification and the three frequency-lowering technologies, where the spectral IQ was considered the best regarding functional gain and speech discrimination abilities. Conclusion Spectral IQ is better for children as a fitting strategy, giving more gain in the high frequencies and better speech identification.
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Social anxiety disorders among stutterers: effects of different variants p. 155
Hanan H Ahmed, Hassnaa O Mohammed
Context Development of social anxiety disorders (SADs) among stutterers was and is still poorly understood. Despite the absence of clear factors responsible for the emergence of such a disorder among the stuttering population, age, sex, and severity of stuttering remained among the major contributing factors. Aims The aims of this study were to (a) determine the prevalence of SADs among stutterers and (b) discuss the relation between the age of stutterers, their sex, and the degree of stuttering severity and the presence of SAD. Settings and design This study was carried out among the stuttering population attending the phoniatrics outpatient clinic. The data were collected retrospectively. Materials and methods A total of 120 stutterers who underwent both phoniatrics and psychiatric assessments between January 2015 and January 2017 were included in this study. Assessment was performed utilizing the protocol of assessment of stuttering (including assessment of stuttering severity using Stuttering Severity Instrument for Children and Adults-3) as well as a structured psychiatric interview using Mini International Neuropsychiatric Interview and Mini International Neuropsychiatric Interview for children and adolescents and Structured Clinical Interview for DMS-IV (SCID) for the assessment of SAD. Results A total of 120 patients (92 males and 28 females) underwent phoniatrics and psychiatric assessments. A total of 70 patients (46 males and 24 females) were assessed as a child group and 50 patients (46 males and four females) were assessed as an adolescents and adults group. SADs were obviously present in the adolescents and adults group rather than the child group. Its development is related to the older age of the stutterers and stuttering severity score. Conclusion The co-morbidity of stuttering with SAD could be considered a specific sub-type of stuttering. Accordingly, this co-morbidity should be determined during the assessment and management of stuttering. Otherwise, it could markedly affect the course and prognosis of the stuttering condition.
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