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   Table of Contents - Current issue
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April-June 2019
Volume 35 | Issue 2
Page Nos. 135-240

Online since Friday, April 12, 2019

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ORIGINAL ARTICLES  

Selenium supplement for treatment of geriatric rhinitis Highly accessed article p. 135
Esin Yalcinkaya, Hasmet Yazici, Hakan Kayir, Fatih K Soy, Hesham Negm
DOI:10.4103/ejo.ejo_102_18  
With the aging of population, the incidence of geriatric problems is increasing. However, the diagnosis and treatment of geriatric problems are usually ignored. This study investigated the efficacy of supplemental selenium in patients with geriatric rhinitis (GR). The study was conducted at an academic secondary referral center in a prospective design. Patients were divided into two groups, and they were compared with healthy volunteers. The treatment group, including patients with GR, was given nasal saline wash four times daily and 100 µg of seleno-6 dietary supplements twice daily. The patient control group and the healthy volunteers were given only the nasal saline wash four times daily. Glutathione peroxidase, superoxide dismutase, and catalase levels were measured in all participants before and after treatment. In addition, the sino-nasal outcome test-20 and visual analog scale were applied before and after treatment. In the selenium supplement group, the visual analog scale, sino-nasal outcome test-20 scores, and enzyme levels were significantly improved compared with the untreated group. No adverse effects occurred in the selenium supplement group during the study. Supplemental selenium might be effective in the treatment of GR in terms of aging physiology and the oxidative system. However, large-scale randomized studies are needed to determine the optimal treatment.
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Safety and efficacy of extraturbinal microdebrider-assisted inferior turbinoplasty in children Highly accessed article p. 140
Osama Galal Abdelnaby Awad
DOI:10.4103/ejo.ejo_36_18  
Background Nasal obstruction is commonly seen in children and can be caused by a variety of factors. Turbinate hypertrophy has become a more frequent entity in pediatric patients presenting with nasal obstruction. Aim This study aims to assess the effectiveness and safety of extraturbinal microdebrider-assisted inferior turbinoplasty (MAIT) in relieving inferior turbinate hypertrophy in children. Patients and methods This prospective study was conducted from May 2016 to May 2017 in a tertiary referral hospital. Fifty pediatric patients with chronic hypertrophic rhinitis were enrolled in the study. We tried the extraturbinal MAIT technique to reduce inferior turbinate size. The degree of nasal obstruction was assessed using subjective, clinical symptom grading tools, visual analogue scale, and saccharin clearance test at 1 and 6 months postoperatively. Any postoperative complications were also noted. Results Mean age of patients were 12.7±9.5 years (range: 6–18 years). Significant postoperative improvement (P<0.001) was noted in the degree of nasal obstruction in 1 month and was maintained after a follow-up period of 6 months. Majority of patients had minimal crusting with good tissue healing with no adhesions or atrophic changes and with significant improvement of saccharin clearance time at 6 months postoperatively. Conclusion Extraturbinal MAIT is an effective and safe procedure in children compared with other reported procedures.
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Endoscopic endonasal prelacrimal recess approach for antrochoanal polyp Highly accessed article p. 147
Wael F Ismaeil, Mohamed H Abdelazim
DOI:10.4103/ejo.ejo_101_18  
Background The purpose of this study was to assess the effectiveness of endoscopic transnasal prelacrimal recess approach (ETPRA) in preventing the recurrence of antrochoanal polyps. Patients and methods A total of 32 patients with antrochoanal polyp were divided into two equal groups: group 1 included 16 patients who underwent endoscopic middle meatal antrostomy (EMMA), and group 2 included 16 patients who underwent a combined surgical technique using EMMA together with ETPRA. They were followed up from 24 to 36 months. Success rates for visualization of the origin of the polyps, surgical complications, and recurrence were evaluated. Results The most common symptoms were nasal obstruction (100%), snoring (75%), rhinorrhea (59.38%), headache (96.88%), and hyposmia (53.13%). The study found that postoperative complications varied between both groups. Recurrence was found in 18.75% in EMMA group and 0% in ETPRA group. They were statistically significant (P<0.05). However, nasolacrimal duct injury was found in two patients in ETPRA group, and postoperative lacrimation presented in only one (6.25%) patient of the same group. They were statistically insignificant (P>0.05). Conclusion Recurrence rate of antrochoanal polyp has been reduced with the usage of ETPRA in comparison with EMMA alone.
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The relation between chronic rhinosinusitis and sleep-disordered breathing p. 155
Yasser F El-Beltagy, Alaa F Ghita, Ossama M Mady, Ahmed M Ibrahim
DOI:10.4103/ejo.ejo_60_18  
Background Chronic sinusitis is one of the most prevalent chronic illnesses affecting persons of all age groups. It is an inflammatory process that involves the paranasal sinuses and persists for 12 weeks or longer. Purpose The aim of this study was to investigate the effect of chronic rhinosinusitis (CRS) on sleep-disordered breathing. Patients and methods This study was conducted prospectively during the period spanning from June 2017 to June 2018 on 100 patients with CRS who attended to the ENT Departments of El-Maadi Armed Forces Medical Complex, Kobry El-Kobba Armed Forces Medical Complex, and El-Demerdash Hospitals. An additional 10 control patients were included in the study. All these patients gave informed consent to participate in this study. Results As regards apnea–hypopnea index, a comparative study between preoperative and postoperative measurements revealed a nonsignificant difference (P>0.05). As regards snore index and snore episodic measurements, the comparative study between preoperative and postoperative measurements revealed a highly significant decrease (P<0.01). As regards sleep efficiency and minimal and basal oxygen saturation measurements, the comparative study between preoperative and postoperative measurements revealed a highly significant increase (P<0.05). Conclusion Surgery decreased snoring and Epworth Sleepiness Scale scores, increased sleep efficiency and minimal and basal oxygen saturation measurements without changes in the apnea–hypopnea index, and improved sleep quality.
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Vitamin D levels in children diagnosed with acute otitis media p. 162
Mohamed A. M Salem, Mohamed Abdullah M., Zakria A Mohamed, Mohamed O. A Gad, Walla G Gadalla
DOI:10.4103/ejo.ejo_59_18  
Objective To investigate the relationship between acute otitis media (AOM) and vitamin D level in children. Patients and methods This prospective study was conducted at Assiut University Hospital between December 2016 and March 2017. The study group comprised ambulatory children who were diagnosed with AOM and healthy controls. The blood sample (5 cm) was taken immediately after the diagnosis of AOM in the laboratory for measuring serum 25-hydroxyvitamin D. Abnormal value=deficiency+insufficiency. Results Of the 40 children included in this study, 30 were the cases and 10 were controls. The mean age of the cases was 4.92±3.08 and 5.92±4.04 years for the controls besides 18 (60%) of the AOM group were boys and 12 (40%) were girls, compared with five (50%) boys and five (50%) were girls in the control group. Otalgia and congested tympanic membrane were present in all children of the diseased group. Also 70% had upper respiratory tract infection preceding the attack of AOM and 33.3% had previous attack of AOM. Twenty-two (73.3%) out of 30 children of the AOM group have an abnormal value of vitamin D and it was statistically significant than the control group. Conclusion Both vitamin D deficiency and insufficiency were significant in children suffering from AOM than normal children.
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Impact of mastoidectomy on tympanoplasty for recurrent suppurative otitis media p. 168
Sayed Mohammed Said Kadah, Sayed Mohammed Mokhemar, Hoda. Ali Ibrahim, Hanem Elsayed Ibrahim
DOI:10.4103/ejo.ejo_34_18  
Background There are still many questions about the pathogenesis of chronic suppurative otitis media (CSOM) and consequently about the optimal management medical or surgical interventions. Many otolaryngologists continue to routinely perform mastoidectomy with tympanoplasty, arguing that surgical aeration of the mastoid will improve outcomes by providing a reservoir of air that can buffer pressure changes in the middle ear according to Boyle’s law. Patients and methods During the period from December 2013 to October 2017, the mean age was ranging from 20 to 50 years; 25 (62.5%) patients were females, whereas 15 (37.5%) patients were male who were attending the Otorhinolaryngology Department, Al Zahraa University Hospital, with recurrent suppurative otitis media refractory to medical treatment. The 20 patients selected for this study were randomly assigned to undergo tympanoplasty with cortical mastoidectomy (n=20) and tympanoplasty alone (n=20). Results The factors that may influence surgery success rates are age, perforation location and size, Eustachian tube conditions, status of the middle-ear mucosa, the type of graft used, and surgeon experience. The primary argument in favor of mastoidectomy has been an improvement in the middle ear and mastoid environment through clearance of the diseased mucosa and through the ventilatory mechanisms of an open mastoid system, as a buffer to the changes in pressure within the middle ear. Conclusion There was no additional benefit to performing mastoidectomy with tympanoplasty for uncomplicated perforations. Mastoidectomies were generally performed with a worst disease, as suggested by the presence of extensive inflammation, or a sclerotic middle ear or mastoid.
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Effect on postoperative pain after topical application of local anesthetics in the tonsillar fossa after tonsillectomy p. 173
Ahmed El Daly, Moustafa Abd El Naby, Pola Emad
DOI:10.4103/ejo.ejo_74_18  
Background Tonsillectomy is one of the most commonly performed surgeries in ENT practice. Despite improvements in anesthetic and surgical techniques, post-tonsillectomy morbidities continue to be a significant clinical concern. Pain is the cause of most of the postoperative morbidity after tonsillectomy. An effective pain therapy to block or modify the physiological responses to stress has become an essential component of modern pediatric anesthesia and surgical practice. Aim The present study compares the results between the effect of lidocaine 2% infiltration, lidocaine 10 % spray, and bupivacaine 0.5% spray in the tonsillar bed after tonsillectomy on postoperative pain. Materials and methods The study included a total of 120 patients aged 5–18 years who were candidates for tonsillectomy at the Otorhinolaryngology Department of Alexandria Main University Hospital. The patients were randomly divided into three groups of 40 patients each. Group A received lidocaine 2% (Xylocaine) peritonsillar infiltration 2 ml in one tonsillar bed and posterior pillar; group B received lidocaine 10% (Xylocaine) spray 2 puff in one tonsillar bed; group C received bupivacaine 0.5% (Marcaine) solution 2 ml in one tonsillar bed spray by syringe and the other tonsillar bed in each group receives pack with similar amounts of normal saline for 5 min as a control group after tonsillectomy before recovery from anesthesia. Results There was no statistical difference between the three studied groups as regards age and sex. There is significant statistical difference according to the frequency of throat pain and ear pain by comparing cases and controls of each group within the first 24 h after surgery. It appears that increased frequency of postoperative throat pain and ear pain is present with the control side (saline). Conclusion Topical application of the tonsillar bed with a local anesthetic after tonsillectomy results in significant reduction of postoperative throat pain and referred otalgia and should be used during surgery for tonsillectomy.
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Impact of voice disorders and microlaryngeal surgery on psychological profiles of Arabic-speaking professional and nonprofessional voice users p. 182
Ayatallah Sheikhany, Ahmed Atef, Osama Refaat, Ahmad Al Ali
DOI:10.4103/ejo.ejo_107_18  
Introduction Voice disorders that impair normal social communication may cause subsequent emotional distress and are significantly associated with greater risk of anxiety and depression. The occurrence of vocal symptoms and voice disorders in professions where voice is an essential tool may cause stress and anxiety to the professionals suffering from them. Voice disorders in professionals have a major psychoemotional and social impact because they can threaten, shorten, or even end teachers’ and singers’ careers. Aim of the work Psychological impact of various voice disorders of professional and nonprofessional voice users has not yet been adequately studied according to the authors’ knowledge in the Egyptian population. It is therefore of great importance to shed light on the psychological impact of voice disorders on patients in an attempt to improve the quality of life of those patients. Patients and methods During the period of 6 months from June 2014 to December 2014, 40 patients were included prospectively in this work. Results and conclusion Professional voice users are more susceptible to psychological diseases than nonprofessional voice users. The degree of improvement postoperatively in professional voice users was statistically significant in all assessments of this study when compared with the nonprofessional voice users except in self-confidence and worth (Rosenberg self-esteem test). The best degree of improvement postoperatively was detected in the professional voice physically according to Jacobson scoring guidelines. There was a moderate relation between dysphonia and anxiety and depression according to the Voice Handicap Index and Kessler psychological distress scale results in this study.
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Formulation of a program for treatment of childhood dysphonia p. 189
Riham M Elmaghraby, Yehia A.A Ras, Maha M Elkaraksy
DOI:10.4103/ejo.ejo_7_18  
Background Dysphonia is a disorder characterized by change in voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life. Childhood dysphonia has several adverse educational and psychosocial implications. Dysphonic children are not aware or not bothered by their voice disorder. Although dysphonia might, in some cases, improve by itself in adulthood, it can be of important value to treat the dysphonic voice already during childhood. Aim The aim of this study was to adapt and formulate a program of voice intervention for childhood dysphonia and apply it on Egyptian children to explore its effectiveness as a therapeutic tool. Patients and methods This study was conducted on 20 children of both sexes attending the Phoniatrics Unit in Alexandria Main University Hospital complaining of dysphonia. The remediation program aims to improve dysphonia in children using a combination of indirect and direct treatment techniques. It is a modification of The Boone Voice Program for Children combined with new technologies such as the voice games by Kay Elementrics. It is designed to provide the clinician with step-by-step procedures and materials to remediate voice disorders in school-aged children. The program was translated to Arabic and a number of modifications were done in order to adapt it to the Egyptian children. Results The study showed effectiveness of the remediation program for childhood dysphonia regarding some of the auditory perceptual assessment and acoustic analysis values. Some of the laryngeal examination findings also showed improvement post-therapy. The study showed significant relation between the children’s age, sex, diagnosis, and some pretherapy and post-therapy findings. Conclusion Data from the current study suggests that voice therapy may prove to be a valid alternative to just planned follow-up.
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A preliminary study on the composition of the early expressive lexicon in Egyptian infants and toddlers p. 195
Aisha F Abdel Hady, Heba M Farag, Ayatallah R Sheikhany
DOI:10.4103/ejo.ejo_96_18  
Objective The aim of this study was to gain insight into early vocabulary size in Egyptian children aged between 12 and 30 months and to study the children’s lexicon composition at that young age while studying some demographic factors that might affect early vocabulary development. Participants and methods Parents of 150 children joining day care nurseries in Cairo were asked to fill in the Arabic vocabulary checklist designed in this study. The children were divided according to their age into three groups and then further subdivided according to their vocabulary size into low-vocabulary and high-vocabulary groups. Results Range and median and vocabulary percentages were estimated. Vocabulary size in older children is larger than younger children. More word types developed in the high-vocabulary group in younger age than in low-vocabulary group. All types of vocabulary continued to grow in older children in both low-vocabulary and high-vocabulary groups. There are differences between high-vocabulary and low-vocabulary groups in some demographic factors. Conclusion In this study, the vocabulary size for Arabic infants and toddlers is less than some languages. There are delays and differences between low-vocabulary and high-vocabulary groups regarding the linguistic composition and some demographic factors.
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Hearing loss-related knowledge and attitude toward neonatal hearing screening among Egyptian parents p. 207
Reem Elbeltagy, Huny M Bakry, Eman H Waly
DOI:10.4103/ejo.ejo_112_18  
Background Hearing loss is considered one of the most prevalent global health concerns. In Egypt, the accurate estimation of hearing loss among children is difficult to be determined owing to the absence of a national hearing screening program until now. The parents play an important role in the process of hearing screening and intervention. Their knowledge and attitude certainly influence their decisions. Their decisions toward early identification and intervention of hearing loss may have lifelong effects on the infant’s life. Aim To assess the knowledge and attitude of Egyptian parents toward risk factors of infant hearing loss and its neonatal screening and treatment. Methods A cross-sectional study was conducted among 384 Egyptian parents through convenience sampling technique using an online questionnaire over a period of 3 months (from August 2018 to November 2018). Results Overall, 51.6% of the parents who participated in the study had a good knowledge about hearing loss, and 99.5% had a good attitude toward neonatal hearing screening. There was no significant association between knowledge, attitude, and sociodemographic characteristics except between the attitude toward child wearing of hearing aid and age of the parents. Conclusion and recommendation In spite of good positive attitude toward neonatal hearing screening and infant wearing of hearing aids among the studied parents only half of them showed a good level of knowledge about hearing loss. Accordingly, the application of a national newborn hearing screening program is highly recommended.
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The role of rigid bronchoscopy in pediatric foreign body aspiration p. 213
Mohamed Zahran, Ahmed Youssef
DOI:10.4103/ejo.ejo_61_18  
Introduction Foreign bodies (FBs) in the airway continue to be a diagnostic and therapeutic challenge. In the present study, we present our experience in the evaluation and management of children with suspected FB aspiration. Aim The aim was to study children with suspected FB aspiration regarding clinical presentation, evaluation, and management. Patients and methods Fifty patients were included in the study during the period from January 2016 to April 2017. Our study was a retrospective analytical study including analysis of the preoperative, operative, postoperative, and follow-up patients’ data. Results Most of the studied patients (66%) were between one and less than 3 years. FB was found in right (RT) bronchus in 25 patients (50%). Seeds were found in most of the studied patients (62.5%). Conclusions History and clinical suspicion are crucial for the diagnosis of pediatric FB aspiration.
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CASE REPORTS Top

Ectopic third molar in maxillary sinus: an asymptomatic accidental finding p. 219
Mitra Karbasi Kheir, Mahnaz Sheikhi
DOI:10.4103/ejo.ejo_80_18  
Ectopic tooth eruption in maxillary sinus is rare. Ectopic eruption in maxillary sinus usually causes sinonasal or ophthalmic symptoms, but asymptomatic cases are less reported. A 26-year-old man was referred to take a presurgical implant cone beam computed tomography of his anterior part of maxilla. The cone beam computed tomography projections showed an accidental finding of ectopic maxillary third molar in the posterior portion of left maxillary sinus. The patient did not report any history of swelling or pain. Although the patient was asymptomatic, the impacted tooth was removed because of the tendency of untreated impacted teeth to form cyst or tumor. The tooth was removed through Caldwell-Luc procedure.
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Nasopharyngeal cavernous hemangioma: an approach to remove p. 222
Mohammad W El-Anwar, Ismail Elnashar, Ezzeddin Elsheikh
DOI:10.4103/ejo.ejo_76_18  
Introduction Few nasal cavernous haemangiomas have been previously reported, only nasopharyngeal cavernous hemangiomas have been reported; both arise from the lateral wall of the nasopharynx. We reported the case of a 27-year-old woman who had repeated severe epistaxis and nasal obstruction of 6 months duration. Computed tomography showed a large vascular nasopharyngeal mass. Complete endoscopic removal of the mass that was found to arise from the posterior end of the nasal septum was achieved without complications. Histopathology showed a cavernous heamangioma. Epistaxis completely stopped throughout the 12-month follow-up. This is the first work to describe the management of nasopharyngeal cavernous heamangiomas originating from the posterior end of the nasal septum. Transnasal endoscopic approach permits adequate exposure of the lesion, control of bleeding, and complete hemangioma removal.
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Tracheobronchial foreign body in an extremely preterm infant complicated with pulmonary hemorrhage p. 227
Jasmine P.Y Kho, Ann Cheng Wong, Shu Ching Teo, Ing Ping Tang
DOI:10.4103/ejo.ejo_71_17  
Tracheobronchial foreign bodies in preterm neonates are extremely rare. They are usually iatrogenic and associated with dislodgement of medical devices. The narrow airways of neonates pose a challenge in removal of foreign bodies. The obstructing object or attempt of removal in itself may cause significant morbidity or mortality. We report a rare case of pulmonary hemorrhage secondary to a tracheobronchial foreign body in an extremely preterm infant and its successful removal. Literature reviews show atelectasis, pneumonia, and respiratory distress being the most common complications from a tracheobronchial foreign body. Removal of tracheobronchial foreign bodies in the narrow airways of neonates can be a grueling task with multiple risks. A high index of suspicion is needed for early detection of foreign body in the airways to avoid morbid complications.
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Unicentric Castleman disease in the paediatric neck: an unusual case of a rare diagnosis p. 230
Simon P Leckenby, Nicholas Dawe, Mario Abinun, Steven M Powell
DOI:10.4103/ejo.ejo_105_18  
We present a rare case of unicentric Castleman disease (CD) in the paediatric neck. A 12-year-old Caucasian girl was referred to us due to a slowly enlarging, painless right-sided neck mass. Our thorough investigative approach identified unicentric CD, with previously undocumented CD-like features occurring simultaneously in a separate lesion from the lymph node group involved in unicentric CD. Recognition of CD in the paediatric patient is essential, despite the condition’s rarity, to ensure adequate diagnostic work-up and management. We discuss features of unicentric CD, current concepts surrounding histology of the two separate variants of unicentric and multicentric CD, and the implications for management.
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Congenital nasal stenosis: a report of two cases p. 234
Samy El-Wany, Diaa M El-Hennawi, Mohamed R Ahmed, Ashraf S Abou-Halawa, Yasser T Madian, Ibrahim H Ibrahim
DOI:10.4103/ejo.ejo_106_18  
The human neonate is an obligate nasal breather for a variable period of time after birth. Congenital nasal airway anomalies are potentially dangerous if they are not immediately recognized at birth and if appropriate intervention is not instituted. Here, we report two clinical cases of congenital nasal stenosis seen in the Suez Canal University Hospital in Ismailia in 2016. Approval from our institutional ethics committee and consent from parents of the patients to publish the cases and their photos were obtained. Level of Evidence: 3b.
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ERRATUM Top

Erratum: The impact of high intensity versus low intensity behavioral therapy in establishment of functional routines in Egyptian autistic children p. 239

DOI:10.4103/1012-5574.255970  
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Erratum: Oropharyngeal dysphagia profile in early versus late stage dementia p. 240

DOI:10.4103/1012-5574.255971  
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