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.
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.
The aim of this study was to evaluate the tongue base suspension suture technique using a repose bone screw system with respect to efficiency in relieving obstructive sleep apnea, safety, and postoperative morbidity.
This was a prospective study carried out on 10 patients with a complaint of moderate or severe obstructive sleep apnea because of retrolingual hypopharyngeal obstruction.
Demographic data were determined and preoperative investigations (flexible nasopharyngoscopy, polysomnography, and lateral cephalometry) were carried out; in addition, operative technique and postoperative assessment of patients’ complaints and postoperative data of polysomnography and lateral cephalometry were carried out.
Improvement in the main complaints of patients, a significant reduction in the mean apnea hypopnea index in postoperative polysomnography, and an increase in the mean posterior airway space at the level of the tongue base in postoperative lateral cephalometry were recorded.
The tongue base suspension technique using a repose bone screw system is an easy and efficient procedure for the treatment of retrolingual obstruction, with minimal postoperative morbidity.
Myringoplasty is a common otologic procedure that results in successful closure of the perforation in most cases; however, the theoretical risk of iatrogenic sensorineural hearing loss during surgery has induced a reluctance among otosurgeons to perform bilateral myringoplasty.
The aim of this study was to evaluate simultaneous bilateral myringoplasty as a single-stage operation.
A prospective study was carried out between December 2009 and March 2012 on 30 patients (60 ears) with bilateral tympanic membrane perforations. Bilateral myringoplasty was performed in the same sitting using an underlay technique.
Of the 60 ears operated upon, perforation closure was achieved in 56 (93.3%) ears and 51 (80%) ears gained hearing. No worsening of hearing was observed in any ear.
Simultaneous bilateral myringoplasty is safe and effective as a single-stage operation, with a high success rate.
In recent times major advances have been made in the field of early detection of autism in infants, and validated screening tools now exist to facilitate the early and accurate screening of infants before further referral for specialized autism diagnostic testing.
The aim of this study was to screen low-birth-weight (LBW) toddlers for early autistic features compared with normal controls and identify the associated risk factors.
This cross-sectional study included 100 toddlers (24–30 months old) with a history of LBW. They were screened for autism using the Modified Checklist for Autism in Toddlers (M-CHAT). Further assessment was made using the Childhood Autism Rating Scale (CARS), Vineland Social Maturity Scale, and Arabic Language Test. One hundred age-matched and sex-matched full-term toddlers with a history of average birth weight and uneventful natal, perinatal, and postnatal history were included as the control group.
The toddlers with LBW had a significantly higher frequency of positive M-CHAT screening than did the controls (11% of LBW children vs. 2% of controls). Positively screened LBW toddlers had significantly higher parental age at conception, lower birth weight, higher frequency of small-for-gestational-age preterms as well as higher incidence of gestational bleeding when compared with negatively screened LBW. They also had lower language and social ages than the negatively screened LBW. M-CHAT scores of positively screened LBW children correlated positively with maternal age at conception and negatively with birth weight, social age, and language age. Five of the 11 positively screened LBW children and one of the two positively screened controls were confirmed to have autism on the basis of CARS.
LBW is probably an independent risk factor associated with the development of autism. Early screening for autism is recommended for the LBW population especially if associated with risk factor(s) or if showing early impairment of social and language abilities, to be followed by definitive autism testing in those with positive screening results.
Chronic otitis media with effusion (OME) is a worldwide major health problem for both children and adults. The aim of this study is to test the effectiveness of intratympanic injection of corticosteroid in the treatment of chronic OME.
The study was applied on 14 patients (24 ears) who had failed medical treatment and had recurrence after surgery or patients who refused surgical treatment.
These patients received 4 intratympanic injections of dexamethasone. Approximately 0.5 ml of dexamethasone was injected in each time. Subjective assessment for symptomatic improvement was done and objective assessment was done by pure tone audiometry and tympanometry 3 months after the last injection.
At the end of follow up period, no patient had noticeable improvement in hearing, aural fullness nor tinnitus. Also, pure tone audiometry and tympanometry revealed no noticeable improvement in any patient.
It was found that intratympanic injection of dexamethasone is not effective in management of chronic OME.
Lingual thyroid is a rare developmental congenital anomaly. Symptoms may not develop unless the gland enlarges because of gland hypertrophy or malignancy. When removal is advocated, most proposed techniques are invasive and associated with substantial morbidity.
The approval of the Otolaryngology Department Research and Ethics Committee, Mansoura University, to perform an analysis of a new minimally invasive surgical technique for the management of a case of obstructive lingual thyroid gland was obtained before study commencement. Careful preoperative assessment of the diagnosis of the lingual thyroid gland included an 131I scan and an MRI of the head and neck with and without gadolinium.
A transoral, minimally invasive, video-assisted thyroidectomy, using Harmonic shears, was performed on a 22-year-old man with a longstanding lingual thyroid that had begun to cause dysphagia and upper airway obstruction. The procedural time was 85 min, and the estimated blood loss was 20 cm3. The patient tolerated a regular diet with minimal discomfort and was discharged home within 24 h.
The combination of the transoral endoscope-guided technique with Harmonic vascular control is considered a surgically minimally invasive satisfactory option in well-trained hands familiar with such tools.
Scleroma is a chronic-specific granuloma of the nose and it may involve other parts of the respiratory tract. The condition is endemic in Egypt. Neurofibromatosis type 1 (NF-1) is one of the most common genetic conditions of the nervous system. Before this report, no case had been published documenting scleroma in a patient with NF-1.
To describe a case of rhinolaryngoscleroma in a patient with NF-1.
Case report and literature review.
Presentation of clinical, imaging and pathological findings, as well as management considerations.
This is the first case to be reported in the literature documenting the coexistence of rhinolaryngoscleroma and NF-1. The biological events in the immune system await further studies.
Intraoperative use of nerve integrity monitors has been advocated to enhance nerve identification. We evaluate the impact of two controversial procedures used in surgical management of parotid tumors on postoperative facial nerve morbidity in University Kebangsaan Medical Centre, Malaysia: fine needle aspiration cytology and continuous facial monitoring using a nerve integrity monitor (NIM). This is a retrospective study on 15 cases of superficial parotidectomy performed during a 2-year period (2008–2010). In our opinion, using an NIM is optional for parotid tumors of the superficial lobe; however, performing preoperative fine needle aspiration cytology and using an NIM may help operative planning and improve medical education in a teaching hospital.
Acute suppurative otitis media is a very common health problem associated with emerging resistant organisms that require special attention.
The aim of this study was to determine the most common infecting microorganism causing acute suppurative otitis media in Ismailia city and to determine the organism’s sensitivity to antibiotics.
This investigation was a cross-sectional study carried out in multiple hospitals and primary care clinics in Ismailia city targeting patients below 18 years of age. Each patient underwent history taking and a clinical examination. An ear swab and a nasopharyngeal specimen were taken and sent for culture and sensitivity testing.
A total of 2003 patients with a mean age of 2.5 years were included in the study, 53.7% of whom were boys and 46.6% were girls. Haemophilus influenzae was the most prevalent organism in both the ear swab and nasopharyngeal aspirate culture and was mostly sensitive to amoxicillin–clavulanic acid, followed by azithromycin.
H. influenzae is the most common infecting organism causing acute suppurative otitis media and is highly sensitive to amoxicillin–clavulanic acid.