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   Table of Contents - Current issue
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July-September 2017
Volume 33 | Issue 3
Page Nos. 557-609

Online since Monday, July 10, 2017

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ORIGINAL ARTICLES  

Effect of topical use of platelet-rich fibrin in repairing central tympanic membrane perforation using the endoscopic inlay butterfly cartilage myringoplasty technique Highly accessed article p. 557
Mohamed Hosam, Mohamed Shaker, Ahmed Aboulwafa
DOI:10.4103/ejo.ejo_7_17  
Objective The aim of this study was to determine the effectiveness of inlay butterfly cartilage myringoplasty and to assess the importance of topical use of autologous platelet-rich fibrin (PRF) in this technique. Patients and methods Fifty patients with dry central perforation were classified into two groups: group A included 25 patients who had undergone endoscopic inlay butterfly myringoplasty with the use of autologous PRF, and group B consisted of 25 patients who had undergone the same technique but without the use of autologous PRF. The study was performed during the period between 2013 and 2016. The follow-up period ranged from 1 to 14 months. All patients were assessed clinically to evaluate healing of tympanic membrane, postoperative air-bone gap, and complications. Results The overall graft take rate was 96% (24 cases) in group A, whereas the graft take rate in group B was 76% (19 cases) with a statistically significant difference between the two groups. The hearing results were satisfactory and compatible with previous studies in the literature. No postoperative complications were reported. Conclusion Inlay butterfly cartilage myringoplasty is a simple technique for repairing small-to-medium-sized tympanic membrane perforation. The success rate of this technique has improved with topical application of PRF. The autologous PRF not only enhances healing of the graft but also protects it from infection.
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Intratympanic methylprednisolone acetate versus intratympanic lidocaine in the treatment of idiopathic subjective unilateral tinnitus of less than 1-year duration: a randomized, double-blind, clinical trial p. 564
Diaa El Din M El Hennawi, Mohamed R Ahmed, Wael Abdelkafy, Ahmed Geneid, Ibrahim H Ibrahim
DOI:10.4103/ejo.ejo_4_17  
Background Tinnitus, which can persist for many years, usually affects the quality of life. Tinnitus is challenging to manage with a variety of options including psychotherapy and pharmacological treatment. Intratympanic (IT) injections of steroids or lidocaine (LD) are two of the pharmacological treatment options used in the treatment of idiopathic tinnitus. Objective The aim of the study was to evaluate the efficacy and safety of IT-methylprednisolone acetate (MPA) versus IT-LD in the treatment of idiopathic subjective unilateral tinnitus of less than 1-year duration. Participants and methods In this randomized, double-blind, clinical study, 46 people who had been diagnosed with idiopathic subjective unilateral tinnitus were randomly divided into two groups and treated with IT-MPA acetate or IT-LD, accordingly. Improvement was evaluated in both groups 3 months after the injections and then again after 1 year. Safety was evaluated by recording the side effects of the injections. Results At 3 months after the injections, the mean improvement rates (using visual analog scale) were 56.5% in the MPA group and 47.8% in the LD group. After 1 year, this declined to 30.4 and 26.1%, respectively. The difference in improvement was not statistically significant. The side effects were all minor, and were primarily reported after LD injection. Conclusion IT injections of MPA and LD result in moderate improvement in tinnitus, but no statistically significant differences between these treatments were found.
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The role of preoperative computerized tomography in a safe posterior tympanotomy for cochlear implant surgery p. 569
Saad Elzayat, Mahmoud Mandour, Rasha Lotfi
DOI:10.4103/ejo.ejo_97_16  
A posterior tympanotomy is a technique performed to access round window area to insert cochlear implant electrode into round window membrane or through cochleostomy. In this study, we aimed to classify and evaluate the anatomical relationships between the facial nerve (FN) (vertical segment), chorda tympani nerve, and facial recess (FR) pneumatization in an axial temporal bone computerized tomography (CT) to be safe when performing a posterior tympanotomy. We performed a retrospective analytic study of temporal bone CT scans. A cohort of 51 patients who underwent cochlear implantation with classical mastoidectomy with posterior tympanotomy were included. All patients had preoperative diagnostic CT of the temporal bone from January 2014 to November 2015. Anatomical correlations were classified according to several parameters including protrusion of the FN into the antrum, FR pneumatization, and status of the facial canal. Anatomical relationships between the vertical segment and posterior tympanotomy were classified into three types: type 1, the FN has no protrusion with a regular facial canal with pneumatized FR; type 2, the FN has protrusion into the antrum with a regular facial canal and/or poorly pneumatized FR; and type 3, the FN has sclerotic mastoid with no FR pneumatization. These results enable preoperative evaluation of the FN’s status and difficulty while performing posterior tympanotomy, providing basic knowledge to prevent injury of the FN while performing a posterior tympanotomy.
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Endoscopic and transcaruncular medial wall decompression in unilateral graves’ orbitopathy: a multicenter randomized study p. 573
Mahmoud A El-Samkary, Hesham A El-Sersy
DOI:10.4103/ejo.ejo_27_17  
Background Thyroid eye disease is the most common orbital inflammatory disorder causing unilateral or bilateral proptosis in an adult. Infiltrative orbitopathy thyroid disease characterized by the deposition of immune complexes and inflammatory cells with subsequent fibrosis can severely affect vision and damage the optic nerve. In this study, we compare the safety and efficacy of transcaruncular versus endoscopic orbital decompression in the management of patients with unilateral Graves’ orbitopathy. Patients and methods This is a retrospective comparative, center-based randomization which included 36 eyes of 36 different patients with Graves’ orbitopathy and axial proptosis ranging between 20 and 26 mm. Complete ophthalmic examination included visual acuity, color vision, intraocular pressure, fundus examination and visual field assessment. Proptosis was measured by Hertel exophthalmometry and computed tomography orbit for all the cases preoperatively and 1.6 months postoperatively. There were follow-ups at day 1 postoperative, and at 1, 3, 6 months. All patients were photographed by the same camera. Patients were divided and were randomized on center based, distributed into two groups: the endoscopic group (18 eyes) were operated on through nasal endoscopic approach and the transcaruncular group (18 eyes) were operated on through the transcaruncular approach. Result There was significant reduction in proptosis in each group after surgery (P<0.001). The mean reduction of proptosis was more pronounced and statistically significant in the transcaruncular group (4.78±0.17 mm) as compared with the endoscopic group (3.61±0.18 mm) (P<0.001). The bony decompressed volume estimated by the serial computed tomography image was 0.75±0.23 cm3 in the transcaruncular group and 0.80±0.29 cm3 in the endoscopic group. There significant improvement in vision from 20/45 to 20/30 in both groups (P<0.001). Visual field defects have improved in 14 (77.8%) cases of the transcaruncular group, as compared with 15 (83.3%) cases of the endoscopic group with complete resolution of corneal staining in both groups within 1 month, postoperatively. Conclusion The transcaruncular technique showed better results because it has significantly better proptosis reduction, has 50% less residual proptosis, higher expanded compressed volume area and better improvement of visual acuity, although statistically nonsignificant.
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Temporal bone resection for patients with head and neck cancer: surgical modalities and techniques of reconstruction p. 579
Ayman Amin, Sherif Zayed, Ibrahim El-Dessouky, Abdel-Raouf Said, Mohammed Shams El-Din, Mohammad W El-Anwar, Mahmoud Bassiouny
DOI:10.4103/ejo.ejo_80_16  
Objective The aim of this article is to present authors’ experience of using different modalities of temporal bone resection (TBR) and methods of reconstruction in malignant tumor involving temporal bone. Patients and methods For 27 patients scheduled for TBR, computed tomography was done for all patients, whereas complementary MRI for 13 patients. Different indications, TBR types, reconstruction technique, complications, and outcome were documented and analyzed. Results This study included 27 patients who had malignancy of or extend to temporal bone, including 11 (40.7%) external auditory canal, eight (29.6%) parotid gland, seven (26%) middle ears, and one (3.7%) lateral skull base tumors. The mean age of the patients was 57±10.4 years. Final histopathology was proved to be squamous cell carcinoma in 15 patients, adenoid cystic carcinoma in eight patients, and adenocarcinoma in four patients. Types of TBR were Lewis en-block technique in seven (26%) cases, lateral TBR in eight (29.6%) cases, modified lateral TBR in eight (29.6%) cases, and subtotal TBR in four cases (14.8%). Neck dissection (ND) was performed in all patients in the form of modified radical neck dissection (13 cases), radical neck dissection (five cases), supraomohyoid (three cases), and upper neck dissection (six cases). All preoperative clinicoradiological staging was upstaged postoperatively. Reconstruction of resulting defects was done using temporalis muscle flap (55.5%), pectoralis major myocutaneous flap (26%), latissimus dorsi myocutaneous flap (3.7%), trapezius myocutaneous flap (3.7%), and free flaps (14.8%). Reported complications were dural tears (22.2%), internal jugular vein injury (3.7%), transient vertigo (55.5%), complete facial nerve paralysis (33.3%), and hearing loss (14.8%). Postoperative adjuvant radiotherapy was given to 17 (62.9%) patients. The overall 3-year survival was 73%. Conclusion Commonest temporal bone involving malignancy was squamous cell carcinoma. TBR is integral part of radical resection for certain cancers involving temporal bone. Postoperative radiotherapy is usually needed. Operative tumor staging is more advanced than preoperative.
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Study of the effect of different body positions on ocular vestibular-evoked myogenic potentials using air-conducted sound p. 588
Samir Asal, Ossama Sobhy, Nervana Salem
DOI:10.4103/ejo.ejo_20_17  
Objective The tested hypothesis states that by manipulating body position, a differentiation in the optimum body position for ocular vestibular-evoked myogenic potential (oVEMP) testing could be obtained. Patients and methods The present study was conducted on 33 ears (33 healthy adult volunteers) with no age or sex limit or any ontological complaint in the audiology unit of Alexandria Main University Hospital. Pure-tone audiometry, tympanometry, and oVEMP testing were performed. Ocular VEMP was performed in four different positions − sitting, supine, right decubitus, and left decubitus positions. Ocular VEMP waveforms were analyzed regarding morphology, latency, amplitude, and threshold. Results (a) oVEMP was present in 90% of the studied cases. (b) The sitting position produced the shortest latencies. (c) The independent position provided the largest amplitude. (d) The dependent position elicited the highest thresholds. Conclusion Although the best position for oVEMP test could not be determined by the present study, the trends found support that the sitting position may be preferred for future oVEMP testing based on the short latencies produced in this position. On the other hand, high thresholds were obtained in the dependent (left decubitus) position, which indicates that it is the least favorable position.
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Auditory system dysfunction in patients with vitiligo: is it a part of a systemic autoimmune process? p. 594
Enass S Mohamed, Eman A Said, Doaa S Sayed, Sara M Awad, Marwa H Ahmed
DOI:10.4103/ejo.ejo_6_17  
Background and aim Association of vitiligo with ocular and auditory abnormalities and other autoimmune disorders suggests its systemic autoimmune origin. Therefore, this study was carried out in an attempt to evaluate the effect of melanin deficiency in patients with vitiligo, as regards the extent and duration of the disease on the auditory pathway and to study the associated other ocular and systemic abnormalities in them. Patients and methods Forty patients with vitiligo and 20 normal volunteers were examined. Audiological evaluation including pure-tone audiometry, extended high-frequency audiometry, transient evoked otoacoustic emissions, and auditory brainstem response was carried out. Ophthalmic evaluation including visual acuity, intraocular tension, and fundus examination was carried out. Laboratory investigations including hemoglobin level, random blood sugar, liver, kidney, and thyroid function tests, and autoimmune testing (antistreptolysin O titer, erythrocyte sedimentation rate, rheumatoid factor, and antinuclear antibodies) were carried out. Results Sensorineural hearing loss was found in 15 (37.5%) patients; 10 (66.67%) of them had bilateral hearing loss and at high frequencies (2–8 kHz) sensorineural hearing loss. Transient evoked otoacoustic emissions were absent or decreased in 67.5%. There were no statistically significant differences in all auditory brainstem response parameters in vitiligo patients compared with the control group. One-fourth (25%) of them had decreased visual acuity, 22.5% had anemia, 12.5% had thyroid dysfunction, 10% had raised random blood sugar, 2.5% had raised liver enzymes, 32.5% had raised rheumatoid factor, 20% had raised antinuclear antibody, and 15% had raised erythrocyte sedimentation rate.
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Concurrent language disorders in children with idiopathic epilepsy p. 603
Hamdy M Bedair, Mona K Mohamed, Rania M Abdou, Faten I El Kafrawy
DOI:10.4103/ejo.ejo_2_17  
Objectives The relationship between language and epilepsy remains complex. Language disorder and epilepsy can be concomitant but unrelated phenomena. They can also be separate consequences of the same underlying brain pathology. Epilepsy can also be the direct cause of the language disorder. The aim of this study was to study concurrent language disorders in children with idiopathic epilepsy. Study design This cross-sectional study was conducted on 50 children attending the Neurology Clinic at Alexandria University Children Hospital at El-Shatby with the diagnosis of idiopathic epilepsy. Their ages ranged from 3 to 6 years, and 29 were male and 21 were female. These children were divided into two groups: group 1 included 25 cases with idiopathic generalized epilepsy, and group 2 included 25 cases with idiopathic focal epilepsy. All cases were subjected to thorough history taking, assessment of epilepsy severity using the National Hospital Seizure Severity Scale, and comprehensive neurological examination. They were also subjected to digital electroencephalographic recording. The studied cases had undergone psychometric assessment using the Stanford–Binet Test and language assessment using the Comprehensive Arabic Language Test. The study was approved by the Ethics Committee at the Faculty of Medicine, Alexandria University. Consent was taken from all cases to participate in the study. Results Thirty-two (64%) children with idiopathic epilepsy presented with developmental language disorders. As regards the observed disorders, 30 (93.7%) cases presented with phonological disorder, 29 (90.6%) presented with semantic disorders, 29 (90.6%) presented with syntax disorders, 20 (62.5%) presented with morphological disorders, and 28 (87.5%) cases presented with pragmatic disorders. Male sex, age (54.48±9 months), and uncontrolled epilepsy demonstrated to have a higher risk for developmental language disorders. Conclusion Male sex, age, and uncontrolled epilepsy are risk factors.
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