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.
The aim of the study was to evaluate diode laser myringotomy (DLM) in children for the management of Eustachian tube and middle-ear disorders that require myringotomy for short-term treatment.
This is a prospective clinical study.
The study comprised 20 children selected to undergo DLM for middle-ear ventilation as a mode of treatment for recurrent acute serous otitis media; these children suffered from persistent middle-ear effusion and had experienced failure of medical treatment for at least 8 weeks. Postoperative weekly visits to evaluate the myringotomy opening (MO) were carried out until healing was recorded. The Eustachian tube and hearing ability were evaluated preoperatively and postoperatively 4 weeks after healing of the tympanic membrane. Cases were deemed to be failed when the MO closed early within the second week postoperatively without improvement in hearing, or the myringotomy persisted until the end of the third month postoperatively. Outcome measures were the state of the MO and of the ear drum, the patency time of the myringotomy, improvement in hearing and Eustachian tube function and incidence of operative and postoperative complications.
The mean operative time was 5 min. No operative complications occurred. Procedural success was achieved in 16/20 ears (80%). Two ears showed postoperative persistent perforations, and two recorded early closure of the MO. The mean improvement in the air/bone gap was 12 dB for the successful cases. Twelve ears with healed MOs showed type A curve (75%). Four ears showed type C curve (25%) and needed further management.
DLM is useful in children for the management of Eustachian tube and middle-ear disorders needing myringotomy for short-term treatment.
We report a rare tumor of the nasopharynx with an unusual presentation in a 15-year-old female: the teratoid or hairy polyp. Hairy polyps are rare benign congenital tumors that present at birth or shortly after. Usually, they arise from the ectoderm and endoderm. Their presence in older individuals is unusual. Their clinical presentation depends on the site and size. Our patient presented late with nasal obstruction, snoring, and mouth breathing, and the clinical examination indicated a nasopharyngeal mass. The tumor was removed without complications and the histopathology was consistent with hairy polyp. In this short communication, we raised awareness of such a rarity of nasopharyngeal mass that has to be suspected in pediatric age group. A review of this unusual malformation will be included. We believe, after a computerized literature search, that this is the first report of its kind from the Arabian Peninsula.
Improved articulatory placement through speech therapy may eliminate compensatory errors, improve velopharyngeal function, minimize perception of hypernasality, and improve speech intelligibility.
The aim of this work was to study the effect of preoperative speech therapy on the speech intelligibility in patients with residual velopharyngeal insufficiency in order to provide a better speech outcome in such patients.
This study included 41 patients diagnosed with residual velopharyngeal insufficiency after cleft palate repair. Patients were divided into two groups: group I included 22 patients scheduled to undergo speech therapy 6 months preoperatively, and group II included 19 patients who did not receive preoperative speech therapy. Both groups underwent speech therapy for 6 months postoperatively. Evaluation was carried out through auditory perceptual assessment (APA) including the type and degree of open nasality, consonant precision, compensatory articulatory mechanisms (glottal articulation and pharyngealization of fricatives), audible nasal emission of air, and overall intelligibility of speech. All these elements are graded along a five-point scale in which 0 is normal and 4 is severe affection. Documentation of APA is performed by high fidelity speech and voice audio recording and endoscopy. Formal speech intelligibility testing was carried out using the Arabic Speech Intelligibility test, which is designed to provide an estimation of the overall speech intelligibility of children by providing a total score in percentage. Nasometry was performed for all patients using a Kay nasometer, which provides the ‘nasalance score’.
On comparing the APA assessment of group I after 6 months of speech therapy postoperatively with the preoperative data, a highly significant decrease with regard to all parameters was revealed; however, in group II, the same comparison revealed a highly significant decrease as regards the degree of open nasality and nasal emission of air and a significant difference in terms of glottal articulation, pharyngealization of fricatives, and overall speech intelligibility. On comparing the two groups postoperatively, a significant difference in glottal articulation, pharyngealization of fricatives, and overall speech intelligibility, being more improved in group I, was revealed. Nasometry showed a significant difference between the postoperative results after speech therapy compared with the preoperative results, with a nonsignificant difference between the two groups postoperatively. In group I, the results of the Arabic Speech Intelligibility test showed a highly significant decrease in the number of patients with unintelligible speech and poor speech intelligibility, a significant decrease in number of patients with fair speech intelligibility, and a highly significant increase in the number of patients with good and excellent speech intelligibility. In group II, there was a significant decrease in the number of patients with unintelligible speech and poor speech intelligibility and a significant increase in the number of patients with fair, good, and excellent speech intelligibility.
Speech therapy before surgery for residual velopharyngeal insufficiency can improve the results of postoperative therapy, with a better speech intelligibility outcome. Therefore, it is recommended to schedule a speech therapy program before secondary repair of the velopharyngeal valve in order to attain better speech intelligibility.
To investigate the usefulness of three-dimensional images on the basis of multidetector computer tomography (MDCT) in the evaluation of suspected foreign body (FB) aspiration in children.
A total of 28 children presented to Ain Shams University hospital with suspected FB inhalation. All patients underwent chest radiographs. Of the patients, eight with inconclusive history, physical examination, and negative radiograph findings for FB inhalation underwent MDCT. All patients underwent rigid bronchoscopy (RB) and the results were compared with the findings of chest radiographs and virtual bronchoscopy images.
Four patients were negative by radiography and MDCT scan, and were subjected to RB, with no FB found. The other four patients who were negative by radiography turned out to be positive by MDCT and were subjected to RB, which was positive for FB in only 3 patients. MDCT had a negative predictive value of 100%, whereas its positive predictive value was 75%.
RB should always be performed as a first-line procedure in the presence of a combination of characteristic clinical and radiographic signs. In the other patients, the presence of FB can be confirmed by MDCT in order to reduce the negative RB rate.
Temporal bone fracture (TBF) following head trauma is a well-known cause of facial nerve paralysis (FNP) and almost 22% of all skull fractures are TBF. It has been estimated that 25–70% of TBF are associated with FNP and otic capsule-violating fracture of the petrous portion of the temporal bone is more commonly associated with FNP, although otic capsule-sparing fracture is more common. (a) The incidence of FNP is reported to be 10–25% of otic capsule-sparing fracture. (b) With otic capsule-sparing fractures, FNP is often delayed 2–3 days, and is incomplete and temporary, with good recovery during a period of 6–8 weeks. Most clinicians seldom consider a surgical intervention in delayed FNP; however, surgical exploration may be required for complete recovery. The optimal timing for surgical exploration of traumatic FNP to best preserve facial function is currently controversial. Decompression surgery still has a beneficial effect if performed within 14 days of injury. However, late exploratory surgery is recommended in patients who do not experience recovery of facial nerve function, patients who cannot be operated on early, and who present 1–3 months after TBF with more than 95% denervation on electroneurography. Here, we report a case of delayed-onset FNP of otic capsule-sparing fracture with an excellent outcome after late surgical decompression at 6 months after trauma.
Cortical auditory evoked potentials (CAEPs) are noninvasive measures used to quantify central auditory system function in humans. More specifically, the P1–N1–P2 cortical auditory evoked potential has a unique role in identifying the central auditory system that has benefited from amplification or implantation. P1 reflects the maturation of the auditory system in general as it has developed over time.
The aims of this study were to assess the CAEP in children with cochlear implants compared with age-matched controls, to study the different variables affecting the results, and to compare the pattern of P1 CAEP in cochlear implant patients compared with that in those with hearing aids.
Thirty-five hearing-impaired children (using cochlear implants) were compared with 20 age-matched and sex-matched children with normal hearing. In both groups, P1 CAEP latency and waveform morphology were recorded using free-field auditory stimulation with tone bursts at 500 and 2000 Hz at 100 dB sound pressure level in two sessions that were 6 months apart.
Children using cochlear implants exhibited prolongation of P1 latencies, indicating an overall delay in maturation when compared with that in children who could hear normally. P1 CAEP latency and amplitude improved significantly after 6 months of device use.
Standardized age-appropriate normative data on P1 CAEPs in the pediatric Egyptian population could be used to determine implantation or amplification results.
The objective of this study is to evaluate the efficacy of image-guided systems in nasal and skull base surgeries.
This is a prospective case–control study.
A total number of 24 patients were included in this study. The relevant preoperative, operative, and postoperative records were collected and analyzed.
The mean total operative time was greater for the image-guided surgery group (130 min; range 95–160 min) than for the control group (119 min; range 85–150 min). However, the mean actual operative time was less for the image-guided surgery group (93 min; range 65–120 min) than the control group (99 min; range 70–130 min). The image-guided surgery group had no major complications. However, the control group had three major complications (25%). The average estimated blood loss was higher for the image-guided surgery group (395 ml; range 130–1100 ml) than the control group (380 ml; range 100–950 ml).
Image-guided system may reduce the complications associated with endoscopic sinus surgery and allow for a more thorough operation.
The aim of this study was to assess whether total immunoglobulin E (IgE) levels and peripheral eosinophilia correlate with the extent of sinus mucosal disease on computed tomography (CT) of paranasal sinuses.
CT scans were performed; total IgE and peripheral eosinophil levels were measured for all patients. The relationships between peripheral eosinophilia, total IgE levels, and the presence of mucosal disease on sinus CT imaging were also determined.
The total IgE did not correlate with CT stage of the disease, whereas there was a significant moderate positive correlation between CT stage and peripheral eosinophil levels.
The data suggest that eosinophil levels contribute toward mucosal inflammation in paranasal sinuses and the presence of peripheral eosinophilia in patients with sinusitis indicates a high likelihood of extensive disease. However, IgE levels did not correlate with CT scan findings. Calculation of the percentage of peripheral eosinophils by measurement of the differential leukocyte count is a simple, easy, and rapid technique for assessment of the severity of chronic rhinosinusitis.
Supracricoid laryngectomy (SCL) is largely affected by invasion of the tumor into the paraglottic space.
The aim of this study was to histopathologically examine whether SCL provides adequate safety margins in terms of the paraglottic space or not.
A prospective study was carried out on 20 patients with advanced cancer larynx staged as T2b, T3 and cases with failed radiotherapy where SCL was performed, followed by whole-organ transverse sections of the specimens to evaluate the relation of the tumor to the paraglottic space.
The local success rate in this study was 90%; one case showed infiltrated surgical margins and the other showed local recurrence 6 months after the operation.
SCL allows for a safe enbloc resection of a malignant tumor in the larynx with complete resection of the paraglottic space. A safety margin of at least 4 mm is needed to eradicate the tumor as revealed by the whole-organ section technique.
Elderly individuals often have more difficulty in understanding speech than younger adults, particularly in noisy environments. Three models that attempt to explain this are as follows: (a) deterioration in peripheral hearing; (b) structural changes to the central auditory system; and (c) changes in normal cognitive processes. The aim of this study was to assess the central auditory functions in an elderly population and compare them with those of an adult population.
The study group included 60 elderly individuals; they were older than 60 years of age and were divided into two subgroups: the first subgroup A included 24 elderly individuals with normal peripheral hearing and the second subgroup B included 36 elderly individuals with presbycusis with a mild degree of hearing loss. The control group included 30 individuals ranging in age from 18 to 30 years. Both the study and the control group were subjected to an otological examination, immittancemetry, pure tone audiometry, speech audiometry, and central auditory processing assessment using the following selected few behavioral central auditory tests: synthetic sentence identification test with ipsilateral competing message (SSI-ICM), dichotic digits test (DDT), auditory fusion test-revised (AFT-R), and pitch pattern sequences test (PPT).
There were elevated hearing thresholds at mostly all frequencies with statistically significant differences on comparing both study subgroups A and B with the control group.
On using SSI-ICM, in the competition ratio (−15 dB), there were statistically significantly low scores in subgroups A and B compared with the control group. Results of DDT showed statistically significantly low scores on comparing the results between the left ear and the right ear in both subgroups A and B. There was a statistically significant elevated gap threshold for tonal stimuli in the AFT-R test on comparing both subgroups A and B with the control group. The results of PPT showed that subgroup B obtained a statistically significantly lower score compared with the control group.
There was a statistically significant negative correlation between age and the results of SSI-ICM in the competition ratio 0 dB when presented to the left ear, DDT, and PPT. There was a statistically significant positive correlation between age and the results of AFT-R when presented at 4000 Hz.
Age-related changes to auditory processing will occur in most adults 60 years of age and older that may or may not be concomitant with peripheral hearing loss. Aging decreases the capacity of digit recognition and also increases interaural asymmetries. Many older listeners show reduced temporal resolution even when potential influences of hearing loss are absent. Temporal ordering abilities decrease with age.
It is important to include central auditory tests in the audiologic assessment protocol of the elderly. The utilization of these tests in assessment of the elderly enables us to improve the quality of therapeutic-rehabilitative interventions.