Tonsillitis is widespread among children and has serious poststreptococcal complications, and both the patients and the otolaryngology surgeon have to face the question on what is the role and benefit of using long-acting penicillin and whether it is an alternative method of treatment to surgery? This study was carried out to evaluate the effectiveness of tonsillectomy compared with long-acting penicillin in the treatment of recurrent tonsillitis, comparing their effects on the levels of the antistreptolysin O titer (ASOT) and erythrocyte sedimentation rate (ESR).
A total of 200 patients aged 4–15 years with recurrent tonsillitis and signs of chronic tonsillitis, after exclusion of patients with bleeding diathesis, anemia, chronic illness, and criteria of rheumatic fever, who were attending the Ismailia General Hospital were included in this study; they were divided to two groups comprising 100 patients each. The first group was treated by tonsillectomy, whereas the second group was treated using long-acting penicillin monthly for 6 months. They were clinically evaluated; ESR and ASOT levels were recorded for all patients before management, after 3 months, and after 6 months.
The mean ESR readings before management, after 3 months, and after 6 months for the first group treated by tonsillectomy were 45.28, 22.36, and 7.4 ml/h, respectively (P-value<0.0021); for the second group treated with penicillin, they were 45.39, 14.98, and 6.48 ml/h, respectively (P-value<0.020). The mean ASOT readings for the tonsillectomy group were 518.29, 253.28, and 117.13 IU/ml, respectively (P-value<0.004), whereas for the penicillin group, they were 526.70, 413.39, and 262.98 IU/ml, respectively (P-value<0.072).
This study demonstrates that the first line of treatment of recurrent chronic tonsillitis is tonsillectomy, as it is both clinically effective and cost-effective for children and that the second line of treatment is long-acting penicillin with a long-term follow-up, and in patients, have contraindications for surgery such as bleeding diathesis.
Patients undergoing salvage surgery are more prone to developing pharyngocutaneous fistulas, the fistula rates reported are as high as 70%.
The aim of this study was to present our experiences with patients undergoing reconstruction with a pectoralis major flap.
We describe the surgical steps we employed during the reconstruction after salvage laryngectomy in 14 consecutive patients.
This flap will give the patient the advantages of early oral feeding, good tracheostomy care, short hospital stay, and protection against catastrophic vascular blowouts.
The purpose of this study was to evaluate the role of middle-ear endoscopy in the effective control over cholesteatoma through visualizing hidden areas of the middle-ear cleft.
A total of 60 ears with retraction pocket cholesteatoma were operated upon. They were subdivided into 40 cases operated upon using the canal wall up technique and another 20 cases operated upon using transcanal atticotomy. Endoscopically guided ear surgery was incorporated complementary to the microscope as a principal part in the procedure.
The incidence of cholesteatoma in the facial recess that was visualized by the endoscope was 25% compared with 20% by the microscope, whereas the incidence of detection of cholesteatoma in the sinus tympani by the endoscope was 35% compared with 5% by the microscope. Cholesteatoma in the anterior epitympanic recess was detected by the endoscope in 10% of ears compared with 0% by the microscope. In this series, no morbidity or complication was encountered secondary to the use of endoscopes in the mastoid or the middle ear.
Endoscope-assisted ear surgery has many benefits in cholesteatoma surgery as endoscopy helps explore hidden areas of the middle-ear cavity with a much lesser requirement for surgical exposure and the need to drill healthy bone; therefore, effective control over the disease can be achieved, thus establishing the concept of functional endoscopic ear surgery.
To improve the control of bleeding during functional endoscopic sinus surgery (FESS) by means of positional changes, controlled hypotensive anesthesia, and an intraoperative (IO) intravenous injection of tranexamic acid.
The study included 45 patients assigned to undergo FESS. Patients were divided randomly into three equal groups: group A received an IO injection of tranexamic acid 10 mg/kg as a bolus injection after induction of anesthesia. Group B included patients placed on a table inclined by ∼30π in the anti-Trendelenburg position and received an IO injection of tranexamic acid 10 mg/kg after induction of anesthesia. Group C included patients maintained supine who did not receive an IO injection of tranexamic acid. All patients received a maintenance anesthetic regimen that used combined intravenous/inhalational anesthesia. Operative field visibility was evaluated using the Fromme scale. The total amount of bleeding as judged by the amount evacuated was recorded.
The anesthetic maneuver used reduced blood pressure and heart rate significantly at the end of surgery compared with the measures estimated at the time of induction of anesthesia. Groups A and C showed significantly higher blood pressure and heart rate estimated at the end of surgery compared with group B. All surgeries were conducted completely without IO complications. No extensive bleeding was recorded and no patient had a visibility score of 0 or 5. Four patients had a visibility score of 1, nine patients had a visibility score of 2, 15 patients had a visibility score of 3, and 17 patients had a visibility score of 4. The frequency of patients who had higher field visibility was significantly higher in group B compared with groups A and C, with a significantly higher frequency in group A compared with group C. Manipulations applied for group B significantly reduced the amount of IO bleeding, with a subsequent significant improvement in the mean field visibility score compared with groups A and C. Tranexamic acid significantly reduced the amount of bleeding and improved field visibility in group A compared with group C.
A combination of maintaining patients in the anti-Trendelenburg position, anesthetic manipulation using combined intravenous and inhalational anesthesia, and an IO intravenous injection of tranexamic acid could minimize bleeding and improve field visibility during FESS and this combination of manipulations could be recommended as strategy for this type of surgery.
Adenoidectomy is a safe and straightforward surgical procedure with clear indications. Traditionally, adenoidectomy is performed using a curette. The main disadvantage of this method is that it is a relatively blind technique. The aim of this study was to assess the efficacy of endoscopic nasopharyngeal examination at the end of curettage adenoidectomy in terms of both subjective and objective relief of nasal symptoms. A total of 110 patients were included is this study and divided randomly into two equal groups during the operation. Patients in group A underwent conventional curettage adenoidectomy and those in group B were further subjected to nasopharyngeal endoscopic examination at the end of the operation. After 18 months, 21.1% of patients in group A and 14% in group B complained of nasal obstruction. Moreover, on endoscopy, 13.4% of patients in group A and 8% in group B showed remaining adenoid tissue. Hence, nasopharyngeal endoscopic examination at the end of conventional curettage adenoidectomy is an easy method to detect and remove remnant adenoid tissue with minimal extra cost and operative time.
This article aims at addressing some inflammatory markers obtained from patients who underwent a functional endoscopic sinus surgery for refractory chronic rhinosinusitis (CRS) to predict the outcome of such surgeries according to the inflammatory load and to determine whether certain immune markers can predict a poor prognosis in these patients.
Fourteen patients (eight women and six men) with diffuse rhinosinusitis as evident from a computed tomography scan but without nasal polyposis underwent ethmoidectomy. All patients had undergone biopsies of the ethmoid sinuses at the time of surgery. All tissue samples were subjected to immunohistochemical staining using CD3, CD4, CD8, and interleukin (IL)-5 antibodies, and the number of lymphocyte subsets (CD3, CD4, and CD8) and IL-5-expressing cells at the time of surgery were compared with the clinical response and nasal endoscopic findings 6 months after surgery.
Only six patients showed an improvement with a decrease in nasal symptoms and a decrease in the need for medications. Eight patients had an unchanged status or worsened, with disabling rhinorrhea and repeated sinusitis.
Almost more than half of the patients with CRS and a diffuse mucosal disease do not respond to surgery. T lymphocytes play an important role in the pathophysiology of CRS. An increased number of IL-5-expressing cells in the ethmoid sinuses at the time of surgery could predict a poor prognosis. It may eventually be possible to classify patients with CRS into different groups with different prognoses.
Squamous cell carcinomas of the head and neck are known for their aggressive growth and propensity to metastasize. The invasion is facilitated by matrix metalloproteinases (MMPs). The overexpression of many MMPs is positively associated with tumour metastasis. The nm23H1 gene has been implicated as a suppressor gene and reduced expression of its gene product has been observed in patients with positive lymph node metastasis.
The aim of this study was to examine the degree of expression of both MMP2 and nm23H1 proteins in 24 patients with primary laryngeal carcinoma using immunohistochemical technique and also to correlate the results with the clinical, radiological and histopathological data, in order to evaluate their role in predicting the local spread and lymph node metastasis.
This study included 24 patients with primary laryngeal carcinoma involving various regions of the larynx and was carried out at the Department of Otolaryngology, Ain Shams University Hospitals.
The laryngeal and nodal specimens were examined histopathologically and immunohistochemical analysis was carried out for the nm23H1 and MMP2 proteins.
There was a significant correlation between MMP2 expression and the site of the tumour, as a drastic reduction in MMP2 expression was mainly associated with glottic carcinoma (P<0.05). The tumour stages were associated with an increase in MMP2 expression, but this was not statistically significant (P=0.07). However, the presence of lymph node metastasis was significantly related to the overexpression of MMP2 (P<0.05). As regards nm23H1, a statistically significant correlation was found between nm23H1 expression and the tumour stage (P<0.05). Moreover, the presence of lymph node metastasis was significantly correlated to the loss of nm23H1 expression and vice versa (P<0.05). However, the correlation between the expression levels of MMP2 and nm23H1 was found to be statistically insignificant (P>0.05).
The increased expression of MMP2 was related to the occurrence of nodal metastasis of the tumour and also to the tumour sites characterized by frequent metastasis (supraglottic and transglottic). In contrast, nm23H1 expression was inversely related to the advancement of the tumour stage and the nodal metastatic state.
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.
Hearing rehabilitation using nonlinear hearing aid (HA) fitting formulae provides hearing-impaired individuals with the audibility, comfort, and speech intelligibility for a better life.
To compare three nonlinear HA fitting formulae in adults in a Channel Free artificial intelligence parallel processing HA.
The study included 19 adults with bilateral moderate to severe sensorineural hearing loss, monaurally fitted with nonlinear HA. Comparisons were made on the basis of aided speech intelligibility in quiet and in noise, aided sound field thresholds, and functional performance in real life using APHAB, COSI, and GHABP questionnaires.
The three formulae have significantly improved speech discrimination in adults, with no significant difference among the formulae for speech intelligibility in quiet or in noise, with no sex or HA experience differences. The three formulae have significantly improved functional performance in real-life speech communication, with the NAL-NL1-based formula showing the greatest degree of benefit and improvement in listening needs, followed by NAL-NL1 and then DSL [I/O]. However, amplification with the three formulae increased aversiveness to environmental sounds. Participants reported significant benefits using NAL and NAL-NL1-based formulae. Experienced HA users, using the NAL-NL1-based formula, showed significantly less difficulty in listening quality in large spaces and greater capacity to recognize speech within competitive noise and better tolerance to environmental sounds than nonexperienced users. The SPIN test correlated well with real-life speech communication.
The three fitting rationales have equally improved intelligibility, with variable degrees of improvement in real-life speech communication with preferences for NAL-NL1 and the manufacture-specific NAL-NL1-based formula.
Enlarged vestibular aqueduct (EVA), the most common radiological finding in children with sensorineural hearing loss, is associated with variable auditory and vestibular symptoms.
The aim of this study was to determine vestibular findings in patients with EVA.
Twenty patients diagnosed with sensorineural hearing loss and EVA were included in the study group and 20 healthy individuals matched for age and sex were included in the control group. Both groups were subjected to the following: complete history taking, general and neurological examination, full ENT examination, pure tone audiometry, tymanometry, high-resolution computed tomography, vestibular evoked myogenic potentials (VEMP), caloric test, and computerized dynamic posturography.
EVA was bilateral in 14 patients and unilateral in six patients. The VEMP amplitude of wave p13–n23 was higher in ears with EVA and it correlated positively with its size. p13–n23 latencies did not differ significantly from the control group. The caloric test showed an absent response in four patients, unilateral weakness in six patients, and normal results in 10 patients. There was no statistically significant difference in the results of computerized dynamic posturography.
The results showed a larger VEMP amplitude, which is indicative of a third window lesion. Some patients showed abnormalities in the caloric test, which indicates a peripheral vestibular lesion. VEMP, caloric test, and computerized dynamic posturography testing were effective in the evaluation of patients with EVA.
Pediatric voice disorders have typically been blamed on vocal abuse. Changes in the pitch, loudness, and overall vocal quality tend to interfere with communicative abilities. Recently, research has focused on pediatric voice disorders and the effects of a voice disorder on a child’s life. It has been reported that children felt that their voice disorders resulted in negative attention and limited their participation in activities.
The aim of this study was to examine the relationship between the pediatric voice handicap index (p-VHI) and both the auditory perceptual assessment (APA) and acoustic analysis of voice in patients with hyperfunctional childhood dysphonia.
This study included 32 children diagnosed with hyperfunctional childhood dysphonia within the age range of 4.7–11.8 years, with a mean of age of 8.4 years; 22 (68.75%) were boys and 10 (31.25%) were girls. All patients were subjected to an APA of their voice after a modified GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and the domains were graded on a scale of 0–3, in which 0 is normal and 3 is severe. Acoustic voice analysis was carried out using Kay Elemetrics’ Computerized Speech Laboratory to obtain the following perturbation measures: jitter (%), shimmer (%), and harmonic to noise ratio. All patients were examined by videolaryngoscopy using fiberoptic nasofibrolaryngoscopes. Parents of all patients were given an Arabic p-VHI form that consists of 23 items divided among three subscales: functional, physical, and emotional. Scoring of the Arabic p-VHI is on the basis of an ordinal scale: the parents rate each statement between ‘0’ and ‘4’, in which ‘0’ represents a response of ‘never’, ‘1’ represents ‘almost never’, ‘2’ represents ‘sometimes’, ‘3’ represents ‘almost always’, and ‘4’ represents ‘always’. From these responses, a total score was obtained by adding the values of all responses ranging from 0 to 92.
The mean scores on the different domains of the Arabic p-VHI among the study groups were 18.6±3.75 in the functional domain (range 4–31), 20.91±8.36 in the physical domain (range 6–34), 13.11±4.86 in the emotional domain (range 3–28), and 52.77±18.15 (range 13–80) in the total score. Correlation between the domains of the APA and those of the Arabic p-VHI showed a significant correlation between both the functional and physical domains of the Arabic p-VHI, namely roughness, breathiness, and strain quality, and pitch, and overall severity, whereas the emotional domain was not correlated with any of the APA domains. The p-VHI total score showed a significant correlation with the overall severity of dysphonia and breathiness. Correlation between the Arabic p-VHI domains and perturbation measures showed a significant correlation between all the domains and all acoustic perturbation measures, namely jitter (r=0.83; P=0.42), shimmer (r=0.81; P=0.39), and harmonic to noise ratio (r=0.76; P=0.36).
The Arabic p-VHI seems to be a useful tool in children with dysphonia. Although it could help in assessment of the degree of disability that a voice disorder is causing, it should not be used as a sole clinical tool. Other clinical evaluation procedures such as APA and acoustic analysis of voice are strongly recommended in the evaluation of voice disorders and defining the amount of voice handicap.
Narrative skills are a form of discourse that describes real or fictional events. In recent years, the study of communicative competence has extended to examining longer discourse units, including narratives in many languages. Unfortunately, few studies have been carried out to assess narrative skills in Arabic-speaking children.
The aim of this study was to design an assessment protocol for narrative skills in Arabic-speaking children in order to reach a better understanding of their developmental pattern.
The study was carried out on 60 Arabic-speaking normal Egyptian children aged between 2 and 6 years. The children were divided into four groups according to their age. An assessment tool was designed to assess their narrative skills on three aspects, namely, story structure, language structure, and narrative productivity.
The results revealed significant differences between the groups in all studied aspects. Narrative skills were found to develop with age. However, the age at which narrative skills are acquired varies from one skill to the other.
Children start to acquire narrative skills at the age of 2 years and these skills become well developed around the age of 6. Some narrative skills are acquired at an earlier age compared with others.