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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.
  12,027 922 1
ORIGINAL ARTICLES
Magnetic resonance imaging criteria in vascular compression syndrome
Sherif Elaini, Jaques Magnan, Arnaud Deveze, Nadine Girard
January 2013, 29(1):10-15
DOI:10.7123/01.EJO.0000423132.45878.f4   
Objectives

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.

Materials and methods

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.

Results

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.

Conclusion

MRI in the T2 sequence is the key assessment in neurovascular compression syndrome.

  10,775 1,016 -
Audiologic evaluation and communication disorders in a group of Egyptian children with autistic features
Kamal Labib Samy, Mona Hassan Selim, Dalia Mostafa Osman, Reham Ahmed Mohamed
May 2012, 28(2):108-116
DOI:10.7123/01.EJO.0000413588.51884.02   
Objectives

The aim of this work was to perform an audiological evaluation on a group of children with autistic features and to correlate the results with the intelligent quotient, communication skills, and sensory integration function of these children.

Study design

Descriptive cross-sectional study.

Patients and methods

The study was carried out on 25 Egyptian children with autistic features and 25 age-matched and sex-matched typically developing children. All the children’s age ranged from 4 to 9 years. All the children were subjected to the following: history taking, basic audiological evaluation, transient evoked otoacoustic emissions, N100, and P300. The children were also subjected to communication assessment, sensory integration dysfunction questionnaire, psychometric evaluation, and the Childhood Autism Rating Scale. The results obtained from the two groups were then compared. In addition, correlation studies were carried out for all the results obtained.

Results

Autistic children presented with normal hearing sensitivities and cochlear function, and delayed N100 and P300 latencies and small P300 amplitudes compared with the control group. There was a significant negative correlation between N100 latency and verbal and nonverbal communication abilities. In addition, there was a significant correlation between P300 latency and amplitude and each of the following: intelligent quotient, the Childhood Autism Rating Scale, and dynamic assessment of verbal and nonverbal communication. The auditory and visual modalities of the sensory integration dysfunction score correlated positively with P300 latency but not amplitude.

Conclusion

The auditory deficits in autism involve controlled attention processes, speed of perceptual classification, and allocation of attention. N100 is a correlate of the level of communication and language development rather than a marker of autism. P300 abnormalities affect verbal and nonverbal communication, mental development, autistic features, and sensory integration function in autism and may be used as a tool to assess the prognosis of autism.

  8,137 63 -
CASE REPORTS
Autoimmune inner ear disease associated with ankylosing spondylitis
Kazuma Sugahara, Makoto Hashimoto, Yoshinobu Hirose, Hiroaki Shimogori, Hiroshi Yamashita
April-June 2014, 30(2):176-179
DOI:10.4103/1012-5574.133224  
We report here a case study of a 24-year-old man suffering from autoimmune inner ear disease who also suffered from ankylosing spondylitis (AS). Although he was previously diagnosed with AS, he has now presented with sensorineural hearing loss and vertigo. It is the first case that a patient with AS displays symptoms of autoimmune inner ear disease. His symptoms responded well to prednisolone treatment. However, because weight gain is a common side effect of steroid treatment and may exacerbate the lower back pain, which is symptomatic of AS, he has so far been treated with a minimum dosage of prednisolone. In addition, intratympanic administration of dexamethasone was effective to suppress the exacerbation of deafness.
  4,542 150 -
ORIGINAL ARTICLES
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.
  4,410 235 1
REVIEW ARTICLE
Approach to diagnosis of vocal fold immobility: a literature review
Omayma E Afsah
April-June 2015, 31(2):78-91
DOI:10.4103/1012-5574.156088  
Vocal fold immobility (VFI) is a sign of disease and not a final diagnosis. VFI can have a profound impact on a patient's quality of life. The most important objective in evaluating a patient with VFI is to exclude the existence of a treatable and potentially life-threatening primary disease as the cause of VFI. Thorough evaluation of these cases is mandatory for proper decision-making and planning of therapy. This paper addresses the established diagnostic workup for VFI and critically evaluates the contribution of different modalities to VFI diagnosis. To achieve this goal, a comprehensive review of the available literature regarding the diagnostic approaches to VFI was conducted. Eligible studies were identified by searching PubMed, Google Scholar, Springer, and ScienceDirect databases for relevant articles by combining the MESH heading term 'vocal fold immobility' with the words 'diagnosis, evaluation, paralysis, electromyography, imaging'.
  3,770 406 -
ORIGINAL ARTICLES
Effect of parent interaction on language development in children
Rasha Farouk Safwat, Aya R Sheikhany
July-September 2014, 30(3):255-263
DOI:10.4103/1012-5574.138488  
Background Positive quality of parent-child interactions is essential for shaping a child's language development. Many individual factors have been found to be associated with language development, but their interaction with each other and their relation with language development is still less clear. Objective The aim of the study was to evaluate whether the quantity and quality of parent-child interactions contribute to language development and to detect the factors that would influence this interaction in different socioeconomic standards to consider them while planning the therapy program. Patients and methods This study included 100 parents and their children; they were attendants at the Phoniatric Unit of Kasr Al Aini Hospital, complaining of delayed language development in their children. Parents included 60 women and 40 men; their ages ranged between 21 and 43 years, with a mean age of 32.7 ± 5.5 years. The age range of the children was 27-49 months, with a mean of 38 ± 5.7 months. The parents were asked to fill in a questionnaire, which was divided into two sections (A and B). Section A described the parents' communicative behavior and section B included basic information on the parents and their beliefs about causes and management of delayed language development. Socioeconomic status of the parents was assessed. Children included in the study were subjected to the protocol of language assessment. Results Results indicate that the majority of the included parents did not use effective methods to foster their child's language acquisition, although their knowledge about language development and intervention was adequate. There was a significant positive association between the parent's interaction score and the child's total language age. Socioeconomic status has been shown to be a significant predictor of a child's language outcomes. Conclusion Parent-child interaction is an important variable in the development of a child's language. Future research and intervention services should focus on increasing the quality of these interactions.
  3,482 468 -
Diagnosis and management of benign tumors of nasal and paranasal cavities: 31 cases
Mardassi Ali, Mathlouthi Nabil, Nefzaoui Safa, Dimassi Hela, Mezri Sameh, Zgolli Cyrine, Chebbi Ghassen, Ben Mhamed Rania, Akkari Khemaies, Benzarti Sonia
January-March 2015, 31(1):4-9
DOI:10.4103/1012-5574.152702  
Aim To precise the clinical, paraclinical and therapeutic features of the benign tumors of nasal and paranasal cavities. Methods We report a retrospective study carried out in the ENT Department of the Military Hospital of Tunis, Tunisia over a period of 10 years (2003-2012). Results we report 31 patients operated for benign tumors of the nasal and paranasal cavities. The mean age was 38 years (2 months to 73 years), and the sex ratio was 2.4 (22 male and nine female). The diagnosis was assessed through endoscopic and radiological findings. Surgery was underwent by an endonasal approach in 84% and an external approach in 16% of the cases. The evolution after surgery was different according to the histological type of the tumor. Discussion Benign tumors of the nasal and paranasal cavities are characterized by their histological diversity. Thus, clinical presentation is variable and nonspecific. Their diagnosis has been improved by modern imaging techniques and is definitely confirmed after histological examinations. Actually, endoscopic surgery of the paranasal sinuses has become the procedure of choice for treatment.
  3,637 265 -
REVIEW ARTICLES
Endonasal neuroendoscopy: New horizons
Ahmed El-Guindy
January 2012, 28(1):1-7
DOI:10.7123/01.EJO.0000411077.98347.c1   
  2,859 255 -
ORIGINAL ARTICLES
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.
  2,740 290 1
Laryngeal ultrasound as effective as CT scans for the diagnosis of various laryngeal lesions
Wail F. Nasr, Hazem S. Amer, Sherif M. Askar, Moanes M. Enaba
April 2013, 29(2):93-98
DOI:10.7123/01.EJO.0000426360.69695.f1   
Background

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.

Objectives

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.

Study design and methods

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.

Results

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.

Conclusion

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.

Level of evidence

The level of evidence is 3a.

  2,695 263 -
BOOK REVIEW
Endoscopic approaches to the sphenoid ( How I do it?)
Tamer A. Youssef
October 2013, 29(4):284-289
DOI:10.7123/01.EJO.0000434902.23128.3c   

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.

  2,629 234 -
ORIGINAL ARTICLES
Clinical balance tests for evaluation of balance dysfunction in children with sensorineural hearing loss
Eman A.F. Said
July 2013, 29(3):189-201
DOI:10.7123/01.EJO.0000431452.76343.3d   
Aim

Children with hearing impairment may have a potential risk for vestibular dysfunctions. They may undergo a sensory redistribution process whereby visual and somatosensory information becomes more essential for postural control. The aim of the study was to assess the balance ability in children with sensorineural hearing loss (SNHL) compared with normal-hearing controls using clinical balance subset tests. A second aim was to determine the prognostic value of some etiological, audiological, and demographic (age and sex) factors in predicting a possibility for vestibular impairment for the early identification of children with vestibular deficits.

Participants and methods

Thirty children with normal hearing (17 girls and 13 boys) and 50 children with bilateral SNHL of varying degree, aged between 5 and 15 years, were recruited from the Audiology Unit of Assiut University Hospital. All of them were subjected to the following: basic audiological evaluation (pure tone, speech audiometry), immittancemetry and auditory brainstem responses, clinical balance subset tests of the standardized Bruininks-Oseretsky Test of motor proficiency (BOT-2), modified Clinical Test of Sensory Interaction for Balance (mCTSIB), one-leg stand (OLS), and tandem stand.

Results

Hearing-impaired (HI) children showed bilateral SNHL of varying degree, ranging from moderate to profound hearing loss (moderately–severe 32%, severe 18%, and profound 50%) and of different etiologies (heredofamilial 46%, acquired 38%, not known 16%).

Balance abilities as measured in this study were significantly poorer in HI children compared with normal-hearing children. HI children with acquired cause and profound degree of SNHL had the highest abnormal score in these clinical tests compared children with other etiologies and degrees of SNHL (although this difference did not reach statistical significance).

In most clinical balance tests that were done in this study, the youngest children in the HI group achieved scores that were almost lower than the scores obtained by the older age groups; the most significant difference was observed for tests performed with eyes closed.

Conclusion

Balance dysfunction occurs in a significant percentage of HI children and may have significant detrimental effects on motor development mainly in very young children. Therefore, information on the identification and treatment of these balance dysfunctions is crucial.

  2,338 203 -
Endoscopic criteria of offending vessel in neurovascular compression syndrome
Sherif Elaini, Jaques Magnan, Arnaud Deveze
October-December 2014, 30(4):305-310
DOI:10.4103/1012-5574.144960  
Objectives The aim of this work was to detect the anatomical relationship criteria of the offending vessel with respect to the cranial nerve in neurovascular compression syndrome using the endoscopic-assisted minimally invasive retrosigmoid approach for microvascular decompression (MVD); these criteria help the surgeon to define the actual conflicting vessel during surgery for better results. Materials and method Between 1994 and 2009, we have performed 782 cases of MVD surgeries using endoscopic-assisted minimally invasive retrosigmoid approach (453 MVD surgeries for hemifacial spasm, 269 for trigeminal neuralgia, 56 for tinnitus and vertigo, and four decompressions for glossopharyngeal neuralgia). During these surgeries we recorded the anatomical relationships between the offending vessel and the affected cranial nerve to detect the endoscopic criteria of the offending vessel. Results There are certain criteria for the anatomical relationship between the offending vessel and affected cranial nerve; these criteria include common features such as a perpendicular contact between the vascular loop and the cranial nerve along two different perpendicular planes at its root exit zone, distortion of the nerve course, and distortion or compression of adjacent neural structures mainly brain stem. Other criteria include the vascular loop causing impression of the nerve or encircling the nerve causing reduction of its diameter. Conclusion Certain criteria for the anatomical relationship between the offending vessel and the affected cranial nerve should be fulfilled to diagnose the actual conflicting vessel during MVD surgery in vascular compression syndrome using endoscopic-assisted minimally invasive retrosigmoid approach.
  2,215 229 -
CASE REPORTS
Post-traumatic auriculotemporal neuralgia: A previously unreported complication of endaural incision
Kamal G Effat
April-June 2014, 30(2):180-181
DOI:10.4103/1012-5574.133225  
Auriculotemporal neuralgia is a rare form of facial pain. In this report, the author presents a case of auriculotemporal neuralgia following an endaural incision. This condition has not been previously documented in the literature.
  2,274 120 -
ORIGINAL ARTICLES
Brainstem encoding of speech in normal-hearing individuals with absent acoustic reflex
Rajkishor Mishra, Himanshu Kumar Sanju, Preeti Sahu
July-September 2015, 31(3):156-161
DOI:10.4103/1012-5574.161599  
The acoustic reflex test is an important tool for identifying auditory disorder from the middle ear to the superior olivary complex. Absence of acoustic reflexes is the early sign of many auditory disorders. Absence of acoustic reflex with normal hearing sensitivity may be an early sign of auditory neuropathy with poor encoding of speech at initial stage. Speech auditory brainstem response was recorded with /da/ (40 ms) stimuli in two groups of patients. The control group contained normal-hearing participants with presence of acoustic reflex, whereas the experimental group contained normal-hearing participants with absent acoustic reflexes. The peak latency, amplitude, and F0 and F1 mean amplitude were analyzed in both groups. MANOVA showed no significant difference in any parameter between the control and experimental group. Results of the current study showed that absence of acoustic reflexes in normal-hearing patients without auditory complaint is not sufficient by itself to diagnose the existence of auditory neuropathy. This study also highlighted that normal-hearing patients with absence of acoustic reflex have similar brainstem encoding of speech as that of patients with acoustic reflex.
  1,721 672 -
HOW I DO IT
Practical approach to the management of dizzy patients
Ossama I. Mansour
January 2013, 29(1):49-55
DOI:10.7123/01.EJO.0000422795.12899.35   
Introduction

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.

Objectives

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.

  2,128 229 -
ORIGINAL ARTICLES
Tonsillectomy under the age of 3 years: is it recommended or not?
Khalid M Bofares
October-December 2014, 30(4):337-342
DOI:10.4103/1012-5574.144967  
Background and objectives Tonsillectomy is the most common surgical procedure in specialty of otorhinolaryngology. Therefore, there are frequent premises regarding this procedure to be improved from different aspects, indications, time of surgery, techniques, safety measures, and postoperative care. One of the major issues regarding this procedure is the most suitable age for the surgery. This point is creating a lot of controversies particularly at extreme age groups - that is, less than 3 years and more than 60 years. Although the extreme old age groups are considered as risky for any surgical procedures specially for tonsillectomy due to lack of proper body tissues tolerance and response to post-tonsillectomy bleeding as well as upper airway edema and obstruction, those age groups are still at lesser incidence of morbidity and mortality as compared to the infantile age groups who take the wider spectrum of ENT surgeons' concentration, discussions, and studies regarding this issue. Therefore, this study was conducted prospectively to confirm whether tonsillectomy can be performed safely before 3 years of age with nonsignificant difference regarding postoperative morbidity and mortality as compared to the other age group of 3 years or above. Patients and methods A total of 648 children aged from 8 months to 8 years presented at ENT department, Al-Thowra central teaching hospital and Altarahom private center, Elbyda city, Libya during the period between September 2005 and October 2012 as cases of chronic adenotonsillitis with variable patterns of indications for tonsillectomy, namely snoring and apnea attacks, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, and malocclusive dental deformity. In all, 241 patients were under age of 3 years who represented group A, whereas remaining 407 patients at age of 3 years and above constituted group B. As prospective analytic study, both groups were compared with respect to intraoperative time consumption and whether there is any significant difference between the two groups regarding the incidence of serious postoperative complications occurrence, namely post-tonsillectomy bleeding, aspiration, airway obstruction, dehydration, postadenotonsillectomy negative pressure pulmonary edema, and metabolic as well as nutritional deficiencies. In addition, both groups were compared for any significant difference regarding the period of postoperative hospitalization, which can be used as objective indicator to measure the postoperative morbidity rate. Results This presenting study confirmed that the tonsillectomy procedure is an easy procedure among children younger than 3 years of age as in older children; this can be indicated by the appearance of nonsignificant difference between both groups regarding the intraoperative time consumption. In contrast, this procedure approved to be a safe procedure among children with age below 3 years as in older children; this was illustrated by the presence of nonsignificant difference between group A and group B regarding the serious suspected post-tonsillectomy complications, namely post-tonsillectomy hemorrhage, aspiration, airway obstruction, negative pressure pulmonary edema, dehydration, and metabolic as well as nutritional deficiencies. Conclusion In general, tonsillectomy is a safe procedure that can be performed successfully among children at different age groups with low incidence of post-tonsillectomy complications as compared with adults.
  2,161 95 -
Recurrent epistaxis in children: When should we suspect coagulopathy?
Magy S Abdel Wahab, Hesham Fathy, Rania Ismail, Nancy Mahmoud
April-June 2014, 30(2):106-111
DOI:10.4103/1012-5574.133207  
Objective The objective of this study was to evaluate children and adolescents with recurrent epistaxis and to spot variables that may predict underlying bleeding disorder. Study design This was a prospective study. Materials and methods Thirty-six children with recurrent epistaxis were recruited from ENT outpatient clinic as well as emergency room of Cairo University children hospital. Patients with systemic causes for epistaxis were not included. All patients were subjected to basic workup to differentiate between ENT and hematological causes of epistaxis. Accordingly, extended ENT investigations or coagulation studies were performed. Results Results showed 47.6% incidence for bleeding disorders, 39.7% incidence for ENT causes, and 12.7% incidence for idiopathic causes. Reported coagulopathies included idiopathic thrombocytopenic purpura with an incidence of 26.7%, platelet functions disorders such as Glanzmann's thrombasthenia (13.3%) and Bernard-Soulier syndrome (10%), aplastic anemia (3.3%), hemophilia A (3.3%), Von Willebrand disease (3.3%), and unclassified (40%). Reported local ENT causes included bacterial rhinitis (88%) (lodged foreign body was found in 1/3 of these patients, digital trauma by habitual nose picking was detected in another 1/3, and the remaining 1/3 represented cases of complicated previous viral rhinitis), nasal allergy (8%), and adenoid (4%). Conclusion The study recommended some statistically significant predictors for bleeding disorders such as positive consanguinity, high epistaxis bleeding score, presence of other bleeding sites, low hemoglobin level and platelet count, and elevated activated partial thromboplastin time.
  2,006 231 -
Tonsillectomy at age below 3 years ( is it recommended?)
Khalid M. Bofares
July 2013, 29(3):170-175
DOI:10.7123/01.EJO.0000430964.51015.8f   
Back ground and objectives

Tonsillectomy is the most common surgical procedure in otorhinolaryngology and hence efforts are being constantly directed toward improving its various aspects, such as indications for the procedure, duration of surgery, techniques, safety measures, and postoperative care. One of the major concerns of this procedure is determination of the most suitable age for surgery. This issue is under a lot of controversy particularly with respect to extreme age groups of younger than 3 years and older than 60 years. Although the extremely old age groups are considered to be at risk for any surgical procedure, they are considered to be especially at risk for tonsillectomy because of lack of proper body tissue tolerance and response to post-tonsillectomy bleeding and upper airway edema and obstruction. However, individuals belonging to these age groups are still at lower risk for morbidity and mortality compared with infants, and hence a large part of ENT research is focused on this extremely young age group.

Therefore, this study was conducted prospectively to confirm whether tonsillectomy can be performed safely in children younger than 3 years with nonsignificant difference with respect to postoperative morbidity and mortality as compared with the other age groups of 3 years or older.

Patients and methods

A total of 648 children aged from 8 months to 8 years presented at the ENT Department, Al-Thawra Central Teaching Hospital (Elbyda City, Libya), from 2005 to 2012 with chronic adenotonsillitis with variable patterns of indications for tonsillectomy, such as snoring and apnea attacks, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, and malocclusive dental deformity. Of these 648 children, 241 were under the age of 3 years and represented group A, whereas the remaining 407 were aged 3 years and above and constituted group B. As a prospective analytical study, both groups were compared with respect to intraoperative time and the incidence of serious postoperative complications such as post-tonsillectomy bleeding, aspiration, airway obstruction, dehydration, postadenotonsillectomy negative-pressure pulmonary edema, metabolic changes, and nutritional deficiencies. In addition, both groups were compared with respect to the period of postoperative hospitalization, which can be used as an objective indicator of postoperative morbidity rate.

Results

This study confirmed that tonsillectomy is an easy and safe procedure among children younger than 3 years as it is in older children as indicated by the appearance of a nonsignificant difference between the two groups with respect to intraoperative time and occurrence of serious suspected post-tonsillectomy complications such as post-tonsillectomy hemorrhage, aspiration, airway obstruction, negative-pressure pulmonary edema, dehydration, metabolic changes, and nutritional deficiencies.

Conclusion

Generally speaking, tonsillectomy is a safe procedure that can be performed successfully among children belonging to different age groups with a low incidence of post-tonsillectomy complications compared with adults.

  2,059 86 -
Study of recurrent antrochoanal polyps ( causes and how to minimize recurrence)
Magdy Eisa Saafan, Mohamed Osama Tomoum
May 2012, 28(2):75-79
DOI:10.7123/01.EJO.0000413106.07357.c9   
Objectives

To conduct a prospective study investigating the causes of repeated recurrences of antrochoanal polyps (ACPs) in an attempt to minimize recurrence.

Materials and methods

Twenty-two patients, with an established diagnosis of a recurrent ACP, were included in the study. A subjective visual analogue scale, endoscopic examination, and computed tomography, both coronal and axial, were performed preoperatively. Endoscopic sinus surgery was performed in all cases, combined with transcanine antrostomy in some cases, aiming at the complete removal of the polyp. Postoperatively, improvements in clinical symptoms and endoscopic findings were evaluated using visual analogue scale and endoscopic examination.

Results

The study included 22 patients with recurrence of an ACP one to five times (a total of 38 previous surgeries). The endoscopic transnasal approach was used in 14 cases, whereas a combined endoscopic transcanine approach was used in eight cases. The success rate was 85.7% in the endoscopic transnasal approach and 100% in the combined endoscopic transcanine approach. All patients showed a subjective improvement after surgery but endoscopic recurrence was detected only in two cases after 18–24 months of follow-up.

Conclusion

The main cause of recurrence of ACPs is incomplete removal. Every effort should be made to completely remove the polyp (especially antral part) to avoid recurrence. Endoscopically, this can be performed using 30–45 and 70π telescopes, angled forceps, and performing a very wide middle meatal antrostomy and may be assisted with a canine fossa puncture. The operation preserves healthy antral mucosa and promotes epithelization and mucociliary clearance of the antrum.

  1,966 143 -
REVIEW ARTICLE
Bilateral vestibulopathy treatment: Update and future directions
Mohamed Fawzy, Ahmed Khater
April-June 2016, 32(2):83-92
DOI:10.4103/1012-5574.181082  
Bilateral vestibulopathy or BVH is a disorder of both labyrinths and/or vestibular nerves which have various etiologies. BVH is most often a chronic condition in which patients can suffer from blurred vision (oscillopsia), impaired spatial orientation and postural instability. Moreover, there is no continuing distressing vertigo, spontaneous nystagmus, or postural falls, which are typical signs of a vestibular tone imbalance caused by acute unilateral lesions. Those symptoms lead to an important decrease in physical activity, social functioning and vitality that dramatically impact the patients' quality of life. The treatment options for various forms of BVH could be one of the following four lines of treatment: (a) Preventive treatment through prevention of ototoxicity, (b) therapeutic treatment through medical treatment of the causative underlying disease, (c) rehabilitative treatment through the vestibular rehabilitation therapy, (d) future directions through sensory substitution devices (balance prostheses technology). The prognosis of BVH is poor and more than 80% of the patients do not improve. The aim of this study was to discuss the update and the future directions in the treatment of the bilateral vestibular hypofunction (BVH).
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EDITORIAL LETTER
Egyptian curriculum and assessment protocol for postgraduate study in otorhinolaryngology, head and neck surgery advanced training
Zoheir El Hoshy, Ihab K Sefein, Mohamed M El Sheikh, Abdulrahman Younes
October-December 2014, 30(4):279-304
DOI:10.4103/1012-5574.144958  
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REVIEW ARTICLE
Empty nose syndrome: etiopathogenesis and management
Magdy Eisa Saafan, Hassan Moustafa Hegazy, Osama A Albirmawy
July-September 2016, 32(3):119-129
DOI:10.4103/1012-5574.186540  
Empty nose syndrome (ENS) is an iatrogenic disorder most often recognized by the presence of paradoxical nasal obstruction despite an objectively wide patent nasal cavity. It occurs after inferior and/or middle turbinate resection; however, individuals with normal turbinates and intranasal volume may also complain of ENS. Its pathophysiology remains unclear, but it is probably caused by wide nasal cavities affecting the neurosensitive receptors and inhaled air humidification. Neuropsychological involvement is also suspected. Not every patient undergoing radical turbinate resection experiences the symptoms of ENS. ENS can affect the normal breathing function of the nasal cavity, with subsequent deterioration in patients’ quality of life. The diagnosis is made on the basis of the patients’ history, endoscopic examination of the nasal cavity, imaging (computed tomography imaging and functional MRI), and rhinomanometry. Prevention is the most important strategy; thus, the inferior and middle turbinate should not be resected without adequate justification. Management is problematic including nasal cavity hygiene and humidification, with surgery reserved for the most severe cases. The surgery aims at partial filling of the nasal cavity using different techniques and implant materials. In this paper, we review both the etiology and the clinical presentation of ENS, and its conservative and surgical management. Core tip Empty nose syndrome (ENS) is encountered after inferior and/or middle turbinate resection; however, it can occur in patients with seemingly normal turbinates. Rhinologists should avoid routine resection of the inferior and middle turbinates. It is not certain why some patients develop ENS, whereas others do not. The frequent association with psychiatric disorders and possibly psychosomatic pathologies indicate the possible role of psychological stress in some patients. Its diagnosis relies on clinical suspicion and physical examination. Nasal augmentation surgery can improve the quality of life of patients by restoring nasal anatomy toward the premorbid state.
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ORIGINAL ARTICLES
Serial histopathological tracheal changes from prolonged intubations
Mohamed H Badr El Din, Mohamed R. Ahmed, Adel R. Hinnis, Moustafa S Abd El Baky
April-June 2014, 30(2):142-146
DOI:10.4103/1012-5574.133218  
Introduction Prolonged tracheal intubations are usually complicated by subglottic stenosis. The aim of this study was to identify the pathological changes in the trachea due to prolonged endotracheal intubations. Materials and methods A prospective study was conducted on 35 patients who were admitted to the ICUs for different periods of time and tracheostomy operation was planned for them. The part of the trachea that was removed during tracheostomy was examined histopathologically. Results The most common histopathological finding was inflammation and ulceration. Fibrosis was also found with evidence of cartilage necrosis. All histopathological findings were more prevalent among patients who were intubated for 1 week. Conclusion Prolonged endotracheal intubations are associated with various histopathological changes ranging from erosion of the epithelium to necrosis of the cartilage and fibrosis. Level of evidence Level 2b.
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