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ORIGINAL ARTICLES
Vestibular assessment in children with sensorineural hearing loss using both electronystagmography and vestibular-evoked myogenic potential
Eman Abdel-Fattah Said
January-April 2014, 30(1):43-52
DOI:10.4103/1012-5574.127203  
Background The clinical course and prognosis in sensorineural hearing loss (SNHL) may be even worse if the vestibular system is also involved, especially because of near location of the anatomic structures in the inner ear. However, vestibular function in children with SNHL appears to be under-reported. The aim of the study was to assess the vestibular function and to determine the prognostic value of some etiological, audiological, and demographic (age, sex) factors in predicting a possibility of vestibular impairment for very early identification of children with vestibular deficits. Materials and methods The control group consisted of 30 children with normal hearing (17 girls and 13 boys) and the study group consisted of 50 children with varying degrees of bilateral SNHL, aged between 5 and 15 years. All of them were subjected to the following: basic audiological evaluation (pure-tone, speech audiometry), immittancemetry and auditory brainstem responses, electronystagmography (ENG), and vestibular-evoked myogenic potential (VEMP). Results Hearing impaired (HI) children showed bilateral SNHL of various degrees ranging from moderate to profound hearing loss (HL) [moderate-severe (32%), severe (18%), and profound (50%)] and of different etiologies [heredofamilial (46%), acquired (38%), not known (16%)]. Abnormal ENG findings were recorded in 64% of HI children. Abnormal caloric test findings were found in 56% of the HI children with heredofamilial cause of HL, in 84.2% with acquired HL, and in 37.5% with unknown cause. These results according to the degree of HL were 37.5, 55.5, and 76% for moderate, severe, and profound HL, respectively. It was noticed that HI children with profound degree and acquired etiology of HL had the highest abnormal caloric findings. Abnormal VEMP was found in 72% of HI children, but this percentage varied according to the different etiologies, 56.5, 84, and 75% for heredofamilial, acquired, and unknown, respectively. Bilateral saccular affections were more common than unilateral. HI children with profound HL had the highest percentage of both bilateral and unilateral saccular affections in the absence of VEMP. Conclusion Vestibular deficits occur in a significant percentage of HI children. Abnormal ENG and VEMP findings in HI children varied according to the etiology and or the degree of HL; those with acquired etiology and/or profound degree of HL had the highest abnormal scores.
  4 2,711 299
Preoperative gabapentin decreases the incidence of postoperative vomiting and analgesic requirements after pediatric adenotonsillectomy
Mahmoud H Mohamed, Hesham Al-Sersy
July-September 2014, 30(3):225-228
DOI:10.4103/1012-5574.138478  
Objective The aim of the study was to evaluate the effect of preoperative gabapentin on the incidence of postoperative vomiting (POV) and on analgesic requirements after adenotonsillectomy in pediatrics. Patients and methods A total of 144 pediatric patients (4-8 years) scheduled for elective adenotonsillectomy were randomly assigned to either the gabapentin (G) group (20 mg/kg, 2 h before surgery) or the placebo (P) group. A standard technique was used for anesthesia. Ondansetron (0.1 mg/kg) was used as a rescue antiemetic and ketorolac (1 mg/kg) was used as a rescue analgesic postoperatively. The prevalence of POV and number of patients who required ketorolac as a rescue analgesic were assessed in the first 6 h after surgery. Results Of the 72 patients, 15 patients (20.8%) in the G group and 21 patients (43%) in the P group developed POV; the difference was statistically significant (P = 0.007). The number of patients who required analgesics in the G group was 14 (19.4%) and in the P group was 35 (48.6%), and the difference was statistically significant (P = 0.0004). Conclusion Our data show that preoperative gabapentin reduces the incidence of POV and the analgesic requirements after pediatric adenotonsillectomy.
  4 1,698 199
Acute-phase reactants in children with recurrent tonsillitis treated by tonsillectomy versus long-acting penicillin
Azza Mohamed, Mohamed El Tabbakh, Alaa Zeitoun, Diaa El Hennawi
April 2013, 29(2):99-103
DOI:10.4103/1357-6283.134339  
Introduction

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).

Patients and methods

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.

Results

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).

Conclusion

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.

  3 3,025 265
Microdebrider intracapsular tonsillotomy versus conventional extracapsular tonsillectomy
Sherif I Gabr, Khaled A Harhash, Mahmoud S El Fouly, Ahmed A Kamel, Mostafa M Eldwebes
July-September 2014, 30(3):220-224
DOI:10.4103/1012-5574.138476  
Objective The aim of the study was to evaluate the efficiency of microdebrider intracapsular tonsillotomy compared with conventional extracapsular tonsillectomy. Patients and methods The study included 40 patients assigned to undergo tonsillectomy. Patients were divided randomly into two equal groups: group A included 20 patients who underwent microdebrider intracapsular tonsillotomy and group B included 20 patients who underwent conventional extracapsular tonsillectomy. Items of comparison between the two groups included time of operation, estimated blood loss, postoperative pain, rate of postoperative hemorrhage, tonsillar fossa healing, swallowing, and complications rate. Results Regarding intraoperative blood loss, the conventional group had significantly lower blood loss (P < 0.05). The microdebrider group showed significantly less pain and better swallowing function (P < 0.05) than the conventional group. There were no significant differences in operative time or wound healing. No postoperative complications such as recurrence or hemorrhage were detected in either group. Conclusion Microdebrider intracapsular tonsillotomy is an effective method to remove tonsillar tissue. There was significantly less pain and better swallowing function compared with the conventional extracapsular tonsillectomy group.
  3 2,117 215
Topical tranexamic acid versus hot saline for field quality during endoscopic sinus surgery
Ahmed Shehata, Mohammed Sabra Ibrahim, Mohammed Hamed Abd-El-Fattah
October-December 2014, 30(4):327-331
DOI:10.4103/1012-5574.144965  
Objectives This study conducted to evaluate and compare between topical tranexamic acid (TA) and hot saline as an alternative to local vasoconstrictors on bleeding and surgery site quality during endoscopic sinus surgery (FESS). Patients and methods This study was performed on 75 patients with class I and II American society of anesthesiologists (A.S.A.), scheduled for elective FESS under general anesthesia. Patients divided into three groups, each (25 patients), group A: topical tranexamic acid (1000mg diluted in 20ml normal saline) was used during surgery for packing and irrigation, group B: hot saline up to 50°C was used and group C :(control group) normal saline was used. Results The use of local (TA) was associated with significant decrease in estimated blood loss 214.2 ml more than local hot saline which was 216.75 and both is much better than the normal saline which was 272.66. Also (TA) and hot saline showed decrease in the duration of surgery, improve the surgical field quality and blinded surgeon satisfaction as compared with the control group. Conclusion The use of local TA and local hot saline up to 50°C achieved reduction in blood loss, duration of surgery and improved surgical field quality during FESS.
  3 2,333 278
Voice outcome following electrical stimulation-supported voice therapy in cases of unilateral vocal fold paralysis
Yehia A Ras, Mohamed Imam, Manal M El-Banna, Nesrine H Hamouda
October-December 2016, 32(4):322-334
DOI:10.4103/1012-5574.192543  
Introduction The current lack of knowledge on the effects of transcutaneous electrical stimulation-supported voice therapy (TESVT) on voice production, coupled with increasing anecdotal reports of TESVT use with voice disorders, prompted this research. Aim The aim of this study was to compare the therapeutic value of conventional voice therapy (CVT) and TESVT on voice outcome in patients with unilateral vocal fold paralysis. Patients and methods The study was conducted on randomly selected 29 patients with unilateral vocal fold paralysis who were candidates for voice therapy attending to the Unit of Phoniatrics, Department of Otorhinolaryngology, Faculty of Medicine, University of Alexandria. The patients were divided into two groups: group I, which included 14 patients who were assigned to CVT, and group II, which included 15 patients who were assigned to TESVT. Each patient was subjected to the following procedures before and after therapy to document glottis closure and voice quality changes: auditory perceptual assessment using the GRBAS scale, the Voice Problem Self-assessment Scale, videostroboscopic examination, and acoustic and aerodynamic analysis of a sample of phonation in addition to electroglottography. TESVT was applied for all participants. Results Statistically significant changes have been obtained for all measurers. No significant statistical difference was found between CVT and TESVT in patients with vocal fold immobility except for frequency perturbation and some electroglottographic parameters. Conclusion Transcutaneous electrical stimulation-supported voice therapy is as effective as CVT in improving voice parameters in cases of unilateral vocal fold immobility. Further research is warranted with a larger number of patients to assess the efficacy of electrical stimulation-supported voice therapy in cases of vocal fold immobility and to determine selective criteria for this TESVT approach.
  3 2,542 250
AUDIOLOGY FOR OTOLARYNGOLOGIST
The role of videonystagmography (VNG) in assessment of dizzy patient
Soha Mekki
April-June 2014, 30(2):69-72
DOI:10.4103/1012-5574.133167  
Videonystagmography (VNG) is a complete diagnostic system for recording, analyzing, and reporting eye movements using video imaging technology, in which hi-tech video goggles with infrared cameras are used. VNG includes a series of tests used to determine whether a vestibular disease may be causing a balance or dizziness problem; VNG can differentiate between a central and a peripheral vestibular lesion, and, if peripheral, it can decipher between unilateral and bilateral vestibular loss. VNG addresses the functionality of each ear.
  2 28,102 1,957
ORIGINAL ARTICLES
Evaluation of facial nerve course, posterior tympanotomy width and visibility of round window in patients with cochlear implantation by performing oblique sagittal cut computed tomographic scan temporal bone
Mohamed S Hasaballah, Tarek A Hamdy
October-December 2014, 30(4):317-321
DOI:10.4103/1012-5574.144963  
Background Posterior tympanotomy is a well-known otologic procedure that allows surgeons access to the middle ear cavity. During posterior tympanotomy the surgeon can approach the round window niche and promontory, where a cochleostomy is carried out for cochlear implant electrode array insertion. The mastoid segment of the facial nerve and the chorda tympani nerve could be injured in cases of narrow facial recess or inadequate posterior tympanotomy. With the image reconstruction in an oblique sagittal plane and curve reconstructions, the whole tympanic and mastoid segments of the facial nerve can be visualized in just one image. It is necessary to preoperatively estimate both the facial nerve status and the anatomical relationships between the facial recess and the round window, this may reduce the risk of facial nerve injury and influence the decision on which side to implant, which approach to use and whether to enter the cochlea via cochleostomy or round window membrane route. Objectives The aim of our study is to evaluate the facial nerve (course and anomalies), visibility of the round window membrane and the width of posterior tympanotomy before cochlear implantation by using oblique sagittal cuts CT scan temporal bone. Methods A prospective study; done on 18 consecutive patients with severe to profound sensorineural hearing loss who are candidates for cochlear implantation in Ain Shams University Hospitals during years 2011 & 2012. We focused on oblique sagittal cut CT scan & its role to evaluate the course of facial nerve, posterior tympanotomy width and visibility of the round window. Results We tried to make a statistical correlation between CT scan and intraoperative findings. Statistically significant positive correlation between posterior tympanotomy width and 2nd genu angle, distance from facial bony canal to round window and distance from facial nerve to round window. The mean distance from facial bony canal to round window was longer in operatively viewed round window than non-viewed window (4.7 and 4.4 mm respectively) (P < 0.05). The mean distance from facial nerve to round window was longer in operatively viewed round window membrane than non-viewed window (5.9 and 5.5 mm respectively) (P < 0.05). The mean width of posterior tympanotomy was wider in operatively viewed round window niche than non-viewed window niche (3.1 and 3.0 mm respectively) (P < 0.01). Conclusion Oblique sagittal cuts CT scan temporal bone is very helpful preoperative radiological tool for evaluation of the facial nerve course and anatomical factors that may determine the field of view or the accessibility of the posterior tympanotomy for either cochleostomy or round window membrane approach. Other approaches can be used with more safety when the position of the facial nerve prevents an adequate posterior tympanotomy.
  2 4,205 387
Dysphonia in teachers: is it only a matter of voice misuse?
Asmaa Ahmed Abdel Hamid, Hossam Mohammed Eldessouky, Nagy Micheal Iskender, Elham Mo'men Hassan
July-September 2014, 30(3):272-278
DOI:10.4103/1012-5574.138494  
Background Teaching is considered among the most demanding tasks for voice; Aim This study investigated dysphonia in a sample of Egyptian teachers and determined the prevalence of dysphonia in the sample under study. Patients and methods The study was carried out by applying a questionnaire to 250 primary school teachers in Fayed city. The questionnaire included three main groups of questions that indicate the presence or absence of dysphonia, gastric reflux, and allergy, in addition to questions about personal and teaching data. The participants who reported that they suffer from dysphonia were transmitted to the second step of the study, which is acoustic analysis for their voices and laryngoscopic examination for their larynges. Results The present study revealed that the prevalence of dysphonia in the study sample is 23.2%. The dysphonia was based on the participants self-impression and was emphasized by the acoustic analysis; in addition, this study showed a significant correlation between dysphonia and both allergy and reflux. Conclusion The study revealed that prevalence of dysphonia in the sample under study which contains primary school teachers is 23.2%. A positive correlation between teaching hours/week, allergy and reflux with dysphonia with presence of pathological lesions and subclinical finding detected by acoustic analysis changes.
  2 2,556 285
The study of central auditory processing in stuttering children
Samir Asal, Rania M Abdou
October-December 2014, 30(4):357-361
DOI:10.4103/1012-5574.144976  
Background There are evidences that indicate a relationship between auditory processing disorders and stuttering. Aim The aim of the study was to evaluate central auditory processing in stuttering children and to compare the findings with those of normal fluent children. Patients and methods Twenty stuttering school-age children of both sexes were included in the study. A control group included 20 age-matched and sex-matched nonstuttering children. Full informed consent from all participants was taken before initiating the study. All participants were subjected to the following central auditory processing tests: pitch pattern sequence test (PPST), dichotic digit test (DDT), speech in noise test (children version) (SPIN), auditory fusion test revised (AFT-R), and binaural masking level difference (MLD) test. All patients were subjected to stuttering severity instrument III to assess their stuttering and its severity. Results The stuttering group scored significantly poorer in the PPST, DDT, and SPIN, whereas they scored similar to the control group in MLD and AFT-R. There was no correlation between the severity of stuttering and the performance on the central auditory processing tests. Conclusion Stuttering children have an intact brain stem integrity shown by the normal MLD and an intact right hemisphere as signified by the normal right and left ear difference in the DDT and by the improvement in the PPST on humming. Left hemisphere deficit appears in more complicated tasks such as PPST, DDT, and SPIN, but not in simple tasks such as AFT-R. We can conclude that the deficit is within the left cerebral hemisphere. Recommendation The effect of the usage of central auditory processing disorder rehabilitation programs on those children should further be assessed.
  2 2,274 235
Comparison between frequency transposition and frequency compression hearing aids
Mohammed Alnahwi, Zeinab A AlQudehy
January-March 2015, 31(1):10-18
DOI:10.4103/1012-5574.152703  
Background High-frequency hearing loss is one of the challenges for accurate hearing. One method of amplification toward improved detection and discrimination of high frequencies is through lowering of high frequencies to a lower-frequency hearing region. Frequency compression (FC) or frequency transposition (FT) can be used for individuals with different configurations of hearing impairment, such as steeply sloping and high-frequency hearing loss (containing high-frequency dead regions). Objective The purpose of this review was to compare the effects of FC and FT on the speech recognition abilities of people with hearing impairment. Patients and methods This study is a systematic review of previous investigations carried out to test the efficacy of frequency-lowering algorithms (i.e. FC or FT) in improving the detection of high frequencies. The concept of FC and FT depends on enhancement of speech recognition in patients suffering from high-frequency hearing loss. In this review, compression shifting and frequency transposition were compared on the basis of improvements in the audibility of high frequency sound to improve the outstanding and acceptance level of speech. Conclusion It can be concluded from this review that both FC and FT are useful in people with high-frequency hearing loss. FC has a potential role in recognition of monosyllabic words, consonants, and sentences in the presence of background noise. In contrast, FT facilitates detection of fricatives that ultimately leads to improvement in the discrimination of consonants. Throughout the literature, only one study has compared both FT and FC using various speech tests to evaluate the performance of different hearing instruments. Therefore, further studies addressing the benefits of both modalities of hearing aids with a more standardized outcome measure for both adult and pediatric patients are required.
  2 6,353 555
Sensorineural hearing loss following tympanoplasty surgery: A prospective cohort study
Fatma H Al Anazy, Fahad A Alobaid, Wala S Alshiha
April-June 2016, 32(2):93-97
DOI:10.4103/1012-5574.181083  
Objectives Sensorineural hearing loss (SNHL) subsequent to middle-ear surgery is an important yet under-reported complication. Our aim is to assess the prevalence of this complication and to identify the risk factors for SNHL after type 1 tympanoplasties. Materials and methods In this prospective cohort study, a total of 312 patients with tubotympanic chronic suppurative otitis media and pure conductive hearing loss were included. The patients were evaluated using case histories, clinical examinations, preoperative and postoperative (3, 6, and 12 months) audiograms, and laboratory investigations. All patients underwent type 1 tympanoplasties, the surgical details were noted, and the prevalence of SNHL as a consequence of the surgical procedure was recorded. Results Sixteen patients (5.1%) developed SNHL. Fifteen operations were performed by residents, and one was performed by a consultant. Conclusion We concluded that the most important factor in the development of SNHL after a type 1 tympanoplasty is the surgeon's experience.
  2 3,997 343
Use of local anesthesia in ear surgery: technique, modifications, advantages, and limitations over 30 years’ experience
Mohamed A El-Begermy, Marwa M El-Begermy, Amr N Rabie, Abdelrahman E.M Ezzat, Ahmed A Kader Sheesh
July-September 2016, 32(3):161-169
DOI:10.4103/1012-5574.186541  
Background Local anesthesia (LA) is safe and well established for a variety of ear operations. It has many advantages compared with general anesthesia (GA). Objective This article is intended to be a comprehensive reference for those who use this art, in which we have more than 30 years of experience. We also aimed to find out the effect of LA on blood pressure (BP) and heart rate (HR), operative time, time of anesthesia with different adrenaline concentrations, and patient satisfaction with LA. Patients and methods This was a retrospective study of our experience in the technique of LA in more than 2600 patients spanning more than 30 years, along with modifications introduced. Additional prospective trials were also conducted. BP and HR were monitored during LA injection in 200 patients. The calculated operative time was compared between two groups of 21 patients each: the first group was operated upon under LA and the other under GA. Anesthesia time was calculated for LA with different adrenaline concentrations (1 : 20 000–1 : 200 000 and 0% or no adrenaline) by means of injections over both the mastoid and the forearm on five volunteers. Patient satisfaction was measured using postoperative questionnaire in 200 patients. Results Patients showed initial increase in BP due to apprehension, which was abolished with diazepam; a second increase in BP and HR occurred after LA injection by 3–10 min. LA statistically significantly shortened the operative time compared with GA. Time of anesthesia was longer using anesthetic solution with higher adrenaline concentration and was longer on the mastoid as compared with the forearm. Finally, 92% of the patients showed satisfaction from the procedure. Conclusion LA is a safe and effective way of anesthesia in ear surgery, allowing intraoperative testing of hearing, facial nerve action, and eustachian tube patency. With high adrenaline concentration, it allows excellent hemostasis, shortens the operative time, and increases the time of anesthesia, allowing probable prolonged postoperative analgesia and is well tolerated by the patients.
  2 14,436 807
Predictors of central vestibular disorders from videonystagmography tests
Enass S Mohamed
July-September 2016, 32(3):202-209
DOI:10.4103/1012-5574.186534  
Background The diagnosis of central vestibular lesion is challenging and sometimes there is an overlap in symptoms and signs with a peripheral vestibular lesion. In some selected cases, dizziness is the only presenting symptom and in other patients, mild neurological symptoms as numbness are ignored. Videonystagmography (VNG) is considered a useful method for diagnosing vertigo of peripheral origin; however, not all the patients with central vertigo can be diagnosed easily. Benign paroxysmal positional vertigo and central positional vertigo share common criteria. The aim of the present study is to assess the usefulness of different VNG tests as predictors of central vestibular disorders, to determine the criteria that differentiate central positional nystagmus from the peripheral type, and to attempt to relate the abnormality in different VNG tests to certain central nervous system (CNS) levels. Materials and methods A retrospective study was carried out on 51 patients with possible central vestibular disorders from VNG tests battery and were referred for an MRI for further assessment. According to MRI results, the patients were divided into group A (31 patients), the group with manifest MRI findings, and group B, the group with free MRI (20 patients). Different VNG tests were compared between both groups. Results Three predictors of CNS lesion by VNG were determined: fixation index (FI), oculomotor tests, and central positional nystagmus; there was a statistically significant difference between both groups in FI, oculomotor tests, and central positional nystagmus, and apogeotropic criteria or nystagmus in multiple plains. There was no relation between any of those predictors and specific levels in the CNS. Conclusion VNG tests are a good diagnostic tool to differentiate between peripheral and central vestibular lesions. The inclusion of FI and positional tests to the oculomotor tests increases the sensitivity of the VNG. In some cases, it is difficult to distinguish between benign paroxysmal positional vertigo and central positional vertigo; apogeotropic nystagmus and nystagmus in multiple plains should raise the suspicion of CNS lesion. Anterior circulation ischemia may lead to chronic vertigo symptoms. Central vestibular vertigo could be caused by dysfunction or excitation of various structures in the CNS including the vestibular cortex.
  2 6,653 586
Application of the GUSS test on adult Egyptian dysphagic patients
Ahmed AbdelHamid, Ahmed Abo-Hasseba
January-March 2017, 33(1):103-110
DOI:10.4103/1012-5574.199419  
Background The evaluation of swallowing disorders and their rehabilitative modalities is an important topic. The benefit to the patient, in terms of improvement in quality of life, cannot be underestimated. Bedside tests might be used to identify patients with oropharyngeal dysphagia and to identify those who are at a risk for aspiration. Aim The aim of the present study was to evaluate the validity and reliability of the Gugging Swallowing Screening (GUSS) test for the detection of aspiration and swallowing abnormalities in dysphagic Egyptian patients. This helps in better management. Study design The present study was a comparative, cross-sectional study. Patients and methods A total of 42 patients were referred from the outpatient clinics with a complaint of dysphagia. All patients were evaluated using flexible endoscopic examination of swallowing (FEES) and the GUSS test. The results of these two methods were compared to assess validity. Reliability was approved by the assessment of the Cohen's κ agreement between the two independent raters. Results The mean age of the patients was 51.6 ± 12.2 years. According to the results of FEES, 28 (66.7%) patients were at a risk for aspiration, whereas 30 (71.4%) patients were rated to be at a risk according to the GUSS test results. According to the cutoff of 14 points, GUSS reached 93.3% sensitivity and 83.3% specificity when compared with FEES. Positive predictive value was 93.3% and negative predictive value was 83.3%. The results of reliability (by comparing the scores of the two raters as regards the degree of severity) showed excellent agreement between the two raters (κ = 0.84, Ρ > 0.05, PO = 91%). Conclusion GUSS test proved to be an easy, valid, and reliable test to predict the risk for aspiration among the adult Egyptian patients.
  2 1,640 154
The effect of L-thyroxine hormone therapy on hearing loss in hypothyroid patients
Mohammed M Hussein, Samir I Asal, Tarek M Salem, Ahmed M Mohammed
October-December 2017, 33(4):637-644
DOI:10.4103/ejo.ejo_25_17  
Objective The aim of this work was to study whether or not the hearing loss encountered in some hypothyroid patients can be improved with L-thyroxine hormone therapy, as other symptoms of hypothyroidism. Study design The study design was a prospective cohort one. Patients and methods This study included 30 patients of either sex who were proved to be in a hypothyroid state with an additional symptom of hearing impairment. The study was carried out in Alexandria Main University Hospital and was conducted in a prospective manner. All selected patients were proved to be in a hypothyroid state in the Endocrinology Department. Moreover, their symptom of hearing impairment was confirmed by thorough audiological examination supplemented by pure-tone audiometry plus tympanometry that was carried out in the ENT Department and the associate Audiology Unit. L-thyroxine treatment for hypothyroidism was initiated in all cases for 6 months to maintain a state of euthyroidism. At the end of 6 months, a repeat audiogram and tympanometry were performed in all patients in order to evaluate the efficacy of the said treatment protocol on the hearing in these patients. Cases proved to have hearing impairment irrelevant to the hypothyroid condition were excluded. Informed consent was compulsory for recruitment in this study. Results Post-treatment assessment revealed that variable improvement was achieved in 48% of ears, whereas 52% did not respond to the given treatment, with the impairment remaining nearly the same as it was before. Of the improved ears, in 15% of ears hearing levels were restored to normal hearing levels. Thereby, adherence to replacement therapy may reverse the hearing deficits in a few number of hypothyroid patients. Conclusion There is a definitive improvement in hearing with the use of L-thyroxine treatment of hypothyroid patients with hearing impairment.
  2 7,810 261
Visual vestibular mismatch: is it a vestibular disorder?
Nadia Kamal, Hesham Taha, Rasha H El-Kabarity, Dina Housni
October-December 2017, 33(4):645-649
DOI:10.4103/ejo.ejo_69_17  
Background Visual vestibular mismatch (VVM) is a group of symptoms rather than a disease. All are exaggerated by introducing any visual conflict. For such reason, there is no adequate tools to investigate or to diagnose and limited research studies were done to explore such group of people. Aim To identify VVM disorder among dizzy patients and to study the vestibular function in them. Patients and methods This study was conducted on 30 patients suffering from VVM (out of 153 patients) who were selected by a questionnaire modified by the authors based on the original questionnaire. All patients were subjected to objective testing including: full neuro-otological history, office vestibular tests including dynamic visual test (DVA), modified clinical test of sensory integration of balance (MCTSIB), Fukuda stepping test, functional reach test, videonystagmography and vestibular evoked myogenic potentials (VEMPs). Results VVM symptomatology was found in 19 patients (subjectively by Mallison questionnaire) and reached 30 patients using a modified questionnaire. 23.33% patients had abnormal Fukuda test, 26.6% had abnormal functional reach test, while 97.6% of patients had abnormal MCTSIB test scores and 50% had abnormal DVA test scores. Abnormal cervical VEMP test results were present in 50% of cases, while only 10% suffered from videonystagmography abnormalities reflecting minor affection of semicircular canals as compared with the saccule. Conclusion This study showed that VVM is a fairly common complain among the dizzy population and it can be easily picked up using a simple questionnaire. Office tests as DVA and MCTSIB were highly sensitive tests for VVM patients but more research is needed to find the correlations between these tests and VVM. The study pointed out to the importance of cervical VEMP test to be routinely enrolled in testing of patients with suggestive symptoms of VVM. Further researches should be conducted for knowing the underlying cause and the exact role of saccule in VVM.
  2 4,147 193
Parental attitudes and knowledge of stuttering
Rasha F Safwat, Aya Sheikhany
April-June 2014, 30(2):151-156
DOI:10.4103/1012-5574.133220  
Background To date, very little research has been carried out on the knowledge and awareness of stuttering in an Arab population. Parents' attitudes toward stuttering play a critical role in helping the child develop healthy communication attitudes. Objective The aim of this study was to collect information on the attitude and knowledge of parents on stuttering in order to gain a better understanding of their level of awareness of the nature of the disorder. Patients and methods This study included 100 parents of preschool-aged and school-aged stutterers. They were attendants to the Phoniatric Unit at Kasr Al Aini Hospital; of these, 56 (56%) were women and 44 (44%) were men, age range 26.8-44.3 years, mean 34.7 years. A questionnaire was designed to determine the knowledge and attitudes of parents toward stuttering. Results Most parents were familiar with stuttering, but their general knowledge of the disorder was limited. Negative beliefs and attitudes toward stuttering and people who stutter were also held by some parents. The results showed a significant association between the education level and to a lesser extent sex and parental knowledge of and attitudes toward stuttering. Conclusion The importance of increasing public awareness of stuttering is evident.
  2 2,585 310
Phonological awareness deficits in Arabic-speaking children with learning disabilities
Mohamed Ali Saad Barakah, Alia Mahmoud Elshobary, Noran Nagdy El-Assal, Ihab Shehad Habil, Sally Taher Kheir Eldin, Dina Ahmed El-Refaie
April-June 2015, 31(2):140-142
DOI:10.4103/1012-5574.156103  
Background Phonological awareness refers to the language ability to perceive and manipulate the sounds of spoken words. It is an understanding of the structure of spoken language - that it is made up of words, and that words consist of syllables, rhymes, and sounds. The presence of a relationship between performance in phonological awareness tasks and reading ability is undisputed. Materials and methods 100 normal children together with 30 learning -disabled children were evaluated with the Arabic phonological awareness test to detect their performance on phonological awareness. Results A large amount of evidence has been accumulated to show that the more knowledge children have about the constituent sounds of words, the better they tend to be at reading. Aim Many studies have been conducted to detect phonological awareness deficits in English-speaking children, but very few studies have been conducted on Arabic-speaking children.
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Intratympanic dexamethasone injection in Meniere's disease
Adel A Maksoud, Dalia Mohamed Hassan, Yasser Nafie, Ahmed Saadb
April-June 2015, 31(2):128-134
DOI:10.4103/1012-5574.156098  
Aim The aim of the study was to investigate the role of intratympanic (IT) dexamethasone in the treatment of medically refractory Meniere's disease (MD) using two different concentrations. Patients and methods Twenty-four adults with unilateral MD received a single IT injection of dexamethasone at 4 or 10 mg/ml concentration. Partial or no improvement over the next 1 month following injection necessitated a second injection. Before and after injection, all patients underwent detailed history taking, were evaluated with the Dizziness Handicap Inventory scale, and underwent basic audiological evaluation and assessment of cervical-vestibular evoked myogenic potential. The presence or absence of spontaneous, post-head-shaking, and positional nystagmus was assessed using a video-nystagmography system. Twelve patients served as the control group and were followed up subjectively for 1 month. Results Both 4 and 10 mg/ml IT dexamethasone improved all subjective symptoms and pure-tone audiometry thresholds. The cervical-vestibular evoked myogenic potential asymmetry ratio dropped after injection. However, the 10 mg/ml concentration was superior to the 5 mg/ml concentration in improving the signs of disease activity, Dizziness Handicap Inventory scores, and the duration of vertigo attacks. No change was reported by the controls. Conclusion IT dexamethasone injection might be helpful in controlling MD in some patients. The 10 mg/ml dexamethasone concentration controls vertigo at both the subjective and objective level. Especially if used early in the course of the disease
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Improvement of cochlear implant performance: changes in dynamic range
Ahmed Khater, Amira El Shennaway, Ahmed Anany
January-March 2015, 31(1):36-41
DOI:10.4103/1012-5574.152706  
Context Theoretically, a wide input dynamic range (IDR) will capture more of the incoming acoustic signal than a narrow IDR, allowing the cochlear implant (CI) user to hear soft, medium, and loud sound. A narrow IDR may restrict the CI user's ability to hear soft speech and sound because less of the incoming acoustic signal is being mapped into the CI user's electrical dynamic range. Aim The overall goal of the study is to provide guidelines for audiologists to efficiently and effectively optimize performance of CI recipients for two difficult listening situations: understanding soft speech and speech in noise. Settings and design Two variables were studied; the independent variables were IDR and the electric dynamic range of the channels. The dependent variables were six Ling sounds, monosyllabic word test, and speech in noise test. Materials and methods Fourteen patients participated in the study. For each patient, seven programs were created. In each program, dependent variables were assessed in different independent ones. Results A restricted IDR resulted in poor speech recognition compared with the relatively wide IDR. Subjectively determined T level and most comfortable level (MCL) at the most, not the maximum, comfortable level appears to have a positive effect on both soft sound recognition and speech discrimination. Conclusion Dynamic range is an important factor -among others- to improve the ability of CI users to understand soft speech as well as speech in noise.
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The side of cochlear implantation and speech intelligibility in pediatric and adult cochlear implantees
Abdelhamid A Mohammed, Sally A Sarwat
October-December 2014, 30(4):362-366
DOI:10.4103/1012-5574.144977  
Background A cochlear implant (CI) is an auditory prosthesis that stimulates the primary auditory nerve fibers electrically to elicit sound perception in individuals with severe-to-profound sensorineural hearing impairments. Speech intelligibility is a joint product of a speaker and a listener and can provide a close approximation of an individual's everyday communication status, and cochlear implants can facilitate the development of speech and language skills in prelingually deaf patients. Aim The aim of this work was to study whether there is an advantage of one ear in the improvement of speech intelligibility in pediatric and adult cochlear-implanted patients. Study design A cross-sectional study to assess the speech intelligibility of right and left cochlear-implanted patients. Patients and methods The study included 50 cochlear-implanted patients (24 male and 26 female): 25 of the patients were prelingual and 25 were postlingual. Twenty-six of the patients were implanted on the right ear and 24 were implanted on the left ear. Speech intelligibility assessment was conducted using the Arabic Speech Intelligibility test. This Arabic Speech Intelligibility test is meant to be an objective measure as the examiner does not have to evaluate how a word was said. Results The results revealed that there was no significant difference between the speech intelligibility percentage regarding the onset of deafness (prelingual or postlingual), the sex and the duration of therapy, but there was a significant difference between the speech intelligibility percentage in right-ear-implanted and left-ear-implanted patients, with marked advantage for the implanted right ear. Conclusion and recommendation Right-ear cochlear implantation has an advantage over left-ear implantation regarding the speech intelligibility. Hence, in case of bilateral profound deafness of the same degree with no anatomical complications in either of the ears, it is recommended to choose the right ear for cochlear implantation.
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Management of cut-throat injuries
Zafarullah Beigh, Rauf Ahmad
July-September 2014, 30(3):268-271
DOI:10.4103/1012-5574.138493  
Introduction Cut-throat injuries (CTIs) are defined as incised injuries or those resembling incised injuries in the neck inflicted by sharp objects. This may result from accident, homicide, or suicide. CTIs are potentially life threatening because of the many vital structures in this area. These patients need emergency and multispecialty care. In this part of the world, suicide is the major cause of CTIs. Exposed hypopharynx and/or larynx following a cut throat, hemorrhage, shock, and asphyxia from aspirated blood are the most common causes of death following a CTI. Materials and methods This retrospective study was carried out in the Department of Otorhinolaryngology and Head Neck Surgery, Government Medical College, Srinagar, J&K, India, and included 26 CTI patients who were brought to our department for treatment. The demographics of the patients, site, cause, and nature of the CTI, and the type and outcome of treatment received were recorded and analyzed. Results This study showed that young men from rural areas were most susceptible to CTIs. The leading cause of a CTI was a suicide attempt. Among patients who attempted suicide, the reason was psychiatric illness most of the times. The majority of the patients in our study had a cut in the center of the neck, with injury to skin, soft tissue, and the larynx/pharynx. Of 26 patients, 24 recovered completely, whereas two patients died. In our study, 15 out of 26 patients were managed without tracheostomy. Conclusion All patients with a CTI should be referred immediately to hospital; early management of patients by a team of specialists can save the life of the patient most of the time. All patients who have attempted suicide should undergo a psychiatric evaluation. This is because the act of suicide is a sign of an underlying mental illness and there may be a possibility of a second attempt. Not all patients with CTIs require tracheostomy. The majority of patients with CTIs can be managed without tracheostomy.
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Noise-induced hearing loss among workers in textile factory
Ebtessam Nada, Waleed M Ebraheem, Samah Sheta
July-September 2014, 30(3):243-248
DOI:10.4103/1012-5574.138484  
Introduction Noise-induced hearing loss (NIHL) is one of the most common chronic health problems, which produces gradual progressive impairment and disturbs the patient's quality of life. Industries in general and especially textile ones produce noise levels that, if intensified, can cause damage to worker's hearing. Hence, premature hearing loss is a well-known outcome of noise exposure at work in industrial workers. Aims of the work The aim of the study was to assess hearing threshold levels among exposed patients and to compare them with the nonexposed control group and to evaluate other variables such as outer hair cell and medial olivocochlear bundle function represented with transient evoked otoacoustic emissions (TEOAEs) testing with and without suppression and to find the relationship with duration of exposure if any. Patients and methods The study included 145 patients and same number of controls who were exposed to hazardous levels of noise for variable durations. All participants were subjected to audiological examination including basic audiological evaluation, otoacoustic emissions, and otoacoustic emissions with contralateral suppression (CAS). Results Of the 145 patients (290 ears), 214 ears showed sensorineural hearing loss (73.8%). Sensorineural hearing loss was mild in 63 (43.44%) ears, moderate in 82 (56.55%) ears, and severe in 69 (47.58%) ears. TEOAEs were found in those with mild hearing loss with significantly lower amplitudes. Intact suppression (CAS) was significantly lower for the study group than for the control group. However, there was no significant difference in level of suppression for different duration of exposure. Conclusion A high incidence for NIHL is present among workers in textile factories, which indicate the mandatory use of different protective measures. CAS can be used as a predictor for the susceptibility to NIHL.
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Systemic steroids and intratympanic steroids perfusion as an initial therapy for idiopathic sudden sensorineural hearing loss, a comparative study
Hazem A Oyoun, Maha Abou-Elew, Mohamed Mosleh, Hesham Fathy, Wael Wageeh, Mahmoud A El Hassan
July-September 2014, 30(3):215-219
DOI:10.4103/1012-5574.138472  
Objective The objective of this study is to compare the efficacy of systemic steroids (SS) and the intratympanic steroids (ITS) in the treatment of idiopathic sudden sensorineural hearing loss (SSNHL). Study design This is a prospective study. Material and methods This study included 21 patients suffering from idiopathic SSNHL. They were divided into 2 groups according to the modality of treatment. Group A included 10 patients who were treated with SS and group B included 11 patients who were treated with ITS due to their refusal or contraindication to take SS. A pre-treatment pure tone audiometry (PTA) was performed for all patients at their first presentation for establishment of the diagnosis and assessment of the degree of the hearing loss. A post-treatment PTA was done at the follow up visit 2 weeks later for the assessment of the degree of hearing loss and hearing improvement. The data of both groups were compared together. Results For group A the pre-treatment PTA average ranged from 37.5 to 113.3 db with a mean of 72.3 ± 25.11 db and the post-treatment PTA average ranged from 13.3 to 113.3 db with a mean of 49.24 ± 33.72 db. On comparing the means of the pre-treatment and the post-treatment PTA averages the difference was found to be statistically significant (P = 0.03). The overall hearing improvement rate using SS was 60%. For group B the pre-treatment PTA average ranged from 50 to 115 db with a mean of 77 ± 18.98 db and the post-treatment PTA average ranged from 26.6 to 101.8 db with a mean of 50.05 ± 23.3 db. On comparing the means of the pre-treatment and the post-treatment PTA averages the difference was found to be statistically highly significant (P = 0.001). The overall hearing improvement rate using ITS was 72.7%. Conclusion Both SS and ITS have proven to be effective in the treatment of idiopathic SSNHL, however SS seems to have a better effect in terms of cure with complete recovery to normal hearing, while ITS exerts most of its effect in partial recovery.
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* Source: CrossRef