The aim of this work is to show the imaging criteria of the offending vessel in neurovascular compression syndrome in the cerebellopontine angle using MRI. This will increase the acceptance of the concept of vascular compression syndrome of the cranial nerves as an etiology of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and some cases of disabling vertigo and tinnitus.
Between 1994 and 2008, MRI radiographs of 782 cases of vasculoneural compression were reviewed to analyze the imaging criteria of the offending vascular loop and were correlated with intraoperative vascular decompression findings in various pathologies such as hemifacial spasm, trigeminal neuralgia, glossopharyngeal neuralgia, vertigo, and tinnitus.
The specificity and high sensitivity of the T2 constructive interference in steady state or fast spin eco sequence MRI allowed us to precisely define the vasculoneural conflict in almost all cases and to highlight certain radiological criteria required for a vasculoneural conflict diagnosis in general. These criteria are mainly the presence of a vascular loop that is perpendicular to the course of the nerve and the presence of distortion of the neural structures.
MRI in the T2 sequence is the key assessment in neurovascular compression syndrome.
The aim of this work was to perform an audiological evaluation on a group of children with autistic features and to correlate the results with the intelligent quotient, communication skills, and sensory integration function of these children.
Descriptive cross-sectional study.
The study was carried out on 25 Egyptian children with autistic features and 25 age-matched and sex-matched typically developing children. All the children’s age ranged from 4 to 9 years. All the children were subjected to the following: history taking, basic audiological evaluation, transient evoked otoacoustic emissions, N100, and P300. The children were also subjected to communication assessment, sensory integration dysfunction questionnaire, psychometric evaluation, and the Childhood Autism Rating Scale. The results obtained from the two groups were then compared. In addition, correlation studies were carried out for all the results obtained.
Autistic children presented with normal hearing sensitivities and cochlear function, and delayed N100 and P300 latencies and small P300 amplitudes compared with the control group. There was a significant negative correlation between N100 latency and verbal and nonverbal communication abilities. In addition, there was a significant correlation between P300 latency and amplitude and each of the following: intelligent quotient, the Childhood Autism Rating Scale, and dynamic assessment of verbal and nonverbal communication. The auditory and visual modalities of the sensory integration dysfunction score correlated positively with P300 latency but not amplitude.
The auditory deficits in autism involve controlled attention processes, speed of perceptual classification, and allocation of attention. N100 is a correlate of the level of communication and language development rather than a marker of autism. P300 abnormalities affect verbal and nonverbal communication, mental development, autistic features, and sensory integration function in autism and may be used as a tool to assess the prognosis of autism.
Different methods have been used in the past for the diagnosis of many laryngeal diseases. Ultrasound has become a very important, widely used diagnostic tool for head and neck diseases.
The aim of this study was to evaluate laryngeal ultrasound as an alternative to computed tomography (CT) scans in the diagnosis of different laryngeal diseases.
This was a comparative cross-sectional study that was carried out between April 2010 and December 2011 in the Department of Otorhinolaryngology, Zagazig University Hospitals, Egypt. The study comprised two groups of patients: the control group (12 patients) and the study group (54 patients). Individuals of the control group who were undergoing neck ultrasound for thyroid swelling were subjected to laryngeal ultrasound only, whereas patients of the study group were subjected to both laryngeal ultrasound and CT scans of the neck.
Laryngeal ultrasound was found to be effective in detecting vocal cord nodules in 27.3% of patients, polyps and cysts in all patients, Reinke’s oedema in 60% of patients and laryngeal masses in 78.6% of patients. These results were comparable with those of the CT scans.
Laryngeal ultrasound is considered of great value in diagnosing different laryngeal lesions and can be used as an alternative to or complementary to CT scans.
The level of evidence is 3a.
Sphenoid sinus disease is recognized as an unusual clinical entity. It is likely that it is under-reported because of its lack of recognition as it has an insidious onset with nonspecific symptoms. Further, optimal physical examination is difficult because of the relative inaccessibility of the sinus. During the past decades, endoscopic sphenoid surgery has been the standard approach worldwide. There are many variables to be considered while selecting the best endoscopic approach to the sphenoid. In this work, the author describes different endoscopic approaches to the sphenoid with their clinical application.
Children with hearing impairment may have a potential risk for vestibular dysfunctions. They may undergo a sensory redistribution process whereby visual and somatosensory information becomes more essential for postural control. The aim of the study was to assess the balance ability in children with sensorineural hearing loss (SNHL) compared with normal-hearing controls using clinical balance subset tests. A second aim was to determine the prognostic value of some etiological, audiological, and demographic (age and sex) factors in predicting a possibility for vestibular impairment for the early identification of children with vestibular deficits.
Thirty children with normal hearing (17 girls and 13 boys) and 50 children with bilateral SNHL of varying degree, aged between 5 and 15 years, were recruited from the Audiology Unit of Assiut University Hospital. All of them were subjected to the following: basic audiological evaluation (pure tone, speech audiometry), immittancemetry and auditory brainstem responses, clinical balance subset tests of the standardized Bruininks-Oseretsky Test of motor proficiency (BOT-2), modified Clinical Test of Sensory Interaction for Balance (mCTSIB), one-leg stand (OLS), and tandem stand.
Hearing-impaired (HI) children showed bilateral SNHL of varying degree, ranging from moderate to profound hearing loss (moderately–severe 32%, severe 18%, and profound 50%) and of different etiologies (heredofamilial 46%, acquired 38%, not known 16%).
Balance abilities as measured in this study were significantly poorer in HI children compared with normal-hearing children. HI children with acquired cause and profound degree of SNHL had the highest abnormal score in these clinical tests compared children with other etiologies and degrees of SNHL (although this difference did not reach statistical significance).
In most clinical balance tests that were done in this study, the youngest children in the HI group achieved scores that were almost lower than the scores obtained by the older age groups; the most significant difference was observed for tests performed with eyes closed.
Balance dysfunction occurs in a significant percentage of HI children and may have significant detrimental effects on motor development mainly in very young children. Therefore, information on the identification and treatment of these balance dysfunctions is crucial.
Dizziness is a common symptom that may be caused by diverse pathologies. It requires a multidisciplinary approach and comprehensive workup to diagnose and treat the cause. A practical and simplified approach is presented.
After reading this article you should be able to: (1) Remember the basics of balance control; (2) Assess a dizzy patient in the office; (3) Be familiar with available vestibular tests and the clinical yield of each; (4) Plan a practical workup algorithm; (5) Differentiate between the common causes of dizziness; (6) Know the current management strategies; (7) Understand the concepts of vestibular rehab.
Tonsillectomy is the most common surgical procedure in otorhinolaryngology and hence efforts are being constantly directed toward improving its various aspects, such as indications for the procedure, duration of surgery, techniques, safety measures, and postoperative care. One of the major concerns of this procedure is determination of the most suitable age for surgery. This issue is under a lot of controversy particularly with respect to extreme age groups of younger than 3 years and older than 60 years. Although the extremely old age groups are considered to be at risk for any surgical procedure, they are considered to be especially at risk for tonsillectomy because of lack of proper body tissue tolerance and response to post-tonsillectomy bleeding and upper airway edema and obstruction. However, individuals belonging to these age groups are still at lower risk for morbidity and mortality compared with infants, and hence a large part of ENT research is focused on this extremely young age group.
Therefore, this study was conducted prospectively to confirm whether tonsillectomy can be performed safely in children younger than 3 years with nonsignificant difference with respect to postoperative morbidity and mortality as compared with the other age groups of 3 years or older.
A total of 648 children aged from 8 months to 8 years presented at the ENT Department, Al-Thawra Central Teaching Hospital (Elbyda City, Libya), from 2005 to 2012 with chronic adenotonsillitis with variable patterns of indications for tonsillectomy, such as snoring and apnea attacks, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, and malocclusive dental deformity. Of these 648 children, 241 were under the age of 3 years and represented group A, whereas the remaining 407 were aged 3 years and above and constituted group B. As a prospective analytical study, both groups were compared with respect to intraoperative time and the incidence of serious postoperative complications such as post-tonsillectomy bleeding, aspiration, airway obstruction, dehydration, postadenotonsillectomy negative-pressure pulmonary edema, metabolic changes, and nutritional deficiencies. In addition, both groups were compared with respect to the period of postoperative hospitalization, which can be used as an objective indicator of postoperative morbidity rate.
This study confirmed that tonsillectomy is an easy and safe procedure among children younger than 3 years as it is in older children as indicated by the appearance of a nonsignificant difference between the two groups with respect to intraoperative time and occurrence of serious suspected post-tonsillectomy complications such as post-tonsillectomy hemorrhage, aspiration, airway obstruction, negative-pressure pulmonary edema, dehydration, metabolic changes, and nutritional deficiencies.
Generally speaking, tonsillectomy is a safe procedure that can be performed successfully among children belonging to different age groups with a low incidence of post-tonsillectomy complications compared with adults.
To conduct a prospective study investigating the causes of repeated recurrences of antrochoanal polyps (ACPs) in an attempt to minimize recurrence.
Twenty-two patients, with an established diagnosis of a recurrent ACP, were included in the study. A subjective visual analogue scale, endoscopic examination, and computed tomography, both coronal and axial, were performed preoperatively. Endoscopic sinus surgery was performed in all cases, combined with transcanine antrostomy in some cases, aiming at the complete removal of the polyp. Postoperatively, improvements in clinical symptoms and endoscopic findings were evaluated using visual analogue scale and endoscopic examination.
The study included 22 patients with recurrence of an ACP one to five times (a total of 38 previous surgeries). The endoscopic transnasal approach was used in 14 cases, whereas a combined endoscopic transcanine approach was used in eight cases. The success rate was 85.7% in the endoscopic transnasal approach and 100% in the combined endoscopic transcanine approach. All patients showed a subjective improvement after surgery but endoscopic recurrence was detected only in two cases after 18–24 months of follow-up.
The main cause of recurrence of ACPs is incomplete removal. Every effort should be made to completely remove the polyp (especially antral part) to avoid recurrence. Endoscopically, this can be performed using 30–45 and 70π telescopes, angled forceps, and performing a very wide middle meatal antrostomy and may be assisted with a canine fossa puncture. The operation preserves healthy antral mucosa and promotes epithelization and mucociliary clearance of the antrum.
Falls and unstable balance are multifactorial problems and rank high among serious clinical problems faced by the elderly. They are a cause of substantial rates of mortality and morbidity as unintentional injuries.
The aim of the study was to explore the most common risk factors for falls in the elderly and to construct the most specific test battery including clinical and laboratory tests capable of determining risk for falls in the elderly.
A 6-month prospective study was carried out on a sample of 30 elderly persons of age at least 60 years, reporting more than one fall within last 6 months. Detailed history on neuro-otological symptoms, previous falls, dizziness episodes, and symptoms of systemic disease or osteoarthritis was taken. Visual acuity, musculoskeletal examination, complete neurological examination, and a complete vestibular test battery in the form of the videonystagmography (VNG) test battery, vestibular-evoked myogenic potentials, and computerized dynamic posturography was performed. All participants underwent radiological diagnosis and grading of the osteoarthritic knee and hip. The mobility and gait screening protocol was used, which includes the timed up and go test (TUG), fall risk assessment screening tool (FRAST), and Dynamic Gait Index (DGI).
Most patients suffered from peripheral vestibular dysfunction and the most frequent VNG abnormality was unilateral vestibular lesion. Radiological assessment of knee and hip osteoarthritis revealed 36.76% with grades II and III. Significant impairment of vision was found in 40% of the elderly. TUG test revealed high risk of falls in those elderly. In total, 20 participants revealed moderate or high risk for falls by FRAST. There was significant correlation between the number of falls and SOT tests (C5 and C6) together with adaptation tests reflecting vestibular pattern of dysfunction. Functional test of dynamic posturography revealed a highly significant correlation between limits of stability reaction time, movement velocity, and tandem of gait step and the number of falls. TUG showed a highly significant correlation in elderly people who experienced falls, whereas DGI showed only significant correlation and FRAST showed nonsignificant correlation. A highly significant correlation was found between SOT C5 and C6 scores and TUG and DGI with a weak correlation with FRAST. Vestibular-evoked myogenic potential asymmetry and unilateral canal paresis revealed nonsignificant results with all functional tests except DGI, which revealed a weak correlation with them. Analysis of variance test revealed that the vestibular dysfunction group is more vulnerable to falls than other groups.
The VNG test battery and computerized dynamic posturography in conjunction with stance tests in the elderly who complain of dizziness can identify those with high risk of a fall.