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  Citation statistics : Table of Contents
   2015| January-March  | Volume 31 | Issue 1  
    Online since March 17, 2015

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Comparison between frequency transposition and frequency compression hearing aids
Mohammed Alnahwi, Zeinab A AlQudehy
January-March 2015, 31(1):10-18
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.
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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
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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Seven-block pyramid model to build up an endoscopic sinus surgeon
Ahmed H Monib, Mahamed M Alhussainia, Ahmed A Saleh
January-March 2015, 31(1):76-77
Surgeons spend most of their professional life acquiring new surgical skills and learning new surgical procedures. On the way of building up an endoscopic sinus surgeon, some may get cofused; what should we do first to be professional endoscopic sinus surgeons. This suggested seven-block pyramid model is just our own limited personal experience to help other junior physicians to arrange their priorties while being on their way in endoscopic sinus surgery.
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Kimura's disease of head and neck: a rare case presentation
Talha A Qureshi, Moghira I Siddiqui, Mohammad U Tariq
January-March 2015, 31(1):73-75
Kimura's disease (KD) is a rare, unusual occurrence, predominantly seen in Asian men, and poses a diagnostic challenge, often manifesting with allergic, eosinophilic hyperplasia, and nonspecific lymphadenitis. A 39-year-old man presented with mobile, well circumscribed, facial and neck swelling. His earlier biopsy showed a reactive lymph node hyperplasia on ultrasound neck and was suggestive of lipomatosis. As definitive diagnosis could not be made, the patient was planned for excision and biopsy. Subsequent histopathology demonstrated eosinophilic infiltration of lymphoid follicles and expansion of interfollicular area with interfollicular eosinophilic abscess formation and capillary venule proliferation. This was quite interesting as the previously diagnosed case of nonspecific lymphadenitis based on biopsy later turned out to be a rare occurrence of KD. Furthermore, because of other systemic symptoms (pedal edema and eye irritation), which probably reflected generalized manifestations of KD, the patient was referred to a rheumatologist after diagnosis, where he was effectively managed with immunotherapy and steroids.
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An analysis of causes behind missed scheduled appointments at outpatient ENT clinics
Ashraf Amin Kasem, Talal Saud Althobaiti, Dhaif Allah S Al-Jeaid, Saleh Mayoof Al-Osaimi
January-March 2015, 31(1):1-3
Objectives To investigate missed appointments in Alhada Armed Forces hospitals (Prince Mansour hospital). Study Design Prospective, descriptive series. Setting ENT out-patients clinics. Method Analysis of the clinic attendance statistics to identify patients who missed appointments. Results Of 1275 patient booking over the duration of study, (60.30%) of patients kept their appointments at the clinics, while 40.70% missed appointments, and of the 519 patients, 16(3%) had no response to telephone calls or coming back to clinics. The youngest age group, 10 to 20 years, showed the highest rate of missed appointments, being 26.2%. Afternoon appointments had higher rate of no-show (63.5%) than morning (36.5%). Reasons given by no-show patients for missing their appointments are presented in figure (1). Unavailability of transportation constituted the highest proportion of reasons of no-show (26.4%) followed by forgetting the appointments (13.7%). The third frequently cited reason was work commitments (13.3 %). These three reasons represented of the (53.6%) of the total reasons of the no-show. Conclusion The 40.70% missed appointment rate is largely due to transport constraints. The authors seek to identify patients at risk of missed appointments and suggest interventions to decrease this incidence.
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A stepwise algorithm for the management of cerebrospinal fluid gusher during cochlear implantation
Ahmed Mohamed Ahmed Mehanna, Mohamed Fawzi Fathala, Mohamed Samy Elwany
January-March 2015, 31(1):19-29
Objectives The aim of this study was to assess the incidence of CSF gusher during cochlear implantation in children with and without congenital inner-ear malformation and to establish a simple stepwise algorithm for managing CSF gusher at the time of cochleostomy. Materials and methods A total of 54 congenitally deaf children were included in a retrospective study between January 2011 and December 2012. All cases underwent classical cochlear implantation surgeries via mastoidectomy and posterior tympanostomy approach. Results Nine patients developed gusher at the time of the cochleostomy. Among the nine cases, only one child did not show any preoperative radiologic evidence of any bony cochleovestibular malformation, whereas the remaining eight cases had different congenital inner-ear malformations with known risk for intraoperative gusher during surgery. Conclusion We concluded that the CSF gusher is a surgical difficulty or an intraoperative challenge rather than a bad prognostic determinate for the postoperative audiologic performance, and in cases of congenital cochleovestibular malformation that develop gusher, a high degree of congenital anomaly of the cochlea, and not the degree or the amount of gusher, is correlated to the poor patient performance. Finally, we were able to achieve a simple stepwise algorithm for the management of gusher during cochlear implantation.
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Could fungi be detected in the fluid of persistent otitis media with effusion?
Mohamed E Farag, Waleed R Jabri, Wael N Wageh, Mostafa M Ezzat
January-March 2015, 31(1):30-35
Background Otitis media with effusion (OME) often is considered a direct extension of the inflammatory process that occurs during long-lasting or recurrent episodes of acute otitis media. The observations above suggest that OME has an infectious etiology. Most bacterial and viral cultures of middle ear fluid that had been performed were often negative suggesting that other infectious agents may be involved such as fungi. Materials and methods Thirty patients (group A) suffering from chronic secretory otitis media (OME) were enrolled in this study. Three samples were collected and investigated using PCR assay with universal fungal primers and Sabouraud agar. The first sample was obtained from the fluid of the middle ear before insertion of the ventilation tube; the second sample was obtained from nasal secretions; and the third sample was obtained from the ipsilateral peritubal area of the nasopharynx. Thirty patients (group B) with comparable age group without history of ear diseases scheduled for tonsillectomy or adenotonsillectomy were added as a control group. Samples from peritubal area of the nasopharynx of patients and nasal secretion were tested using PCR assay with universal fungal primers and Sabouraud agar. Results PCR examination of the middle ear aspirate in group (A) cases was positive in 7 cases (23.3%), in nasal secretions samples 2 cases only (13.3%) were positive and no positive cases were detected in nasopharyngeal swab samples. In group (A), Sabouraud agar culture was positive for fungal culture of middle ear aspirates in 5 cases (16.6%) but in no cases for nasal secretion samples. Group A showed also negative (N 0 ) growth in 30 (100%) patients for nasopharyngeal swab on Sabouraud agar. In group B, the findings of nasopharyngeal swab were negative (N 0 ) growth in all examined samples on Sabouraud agar, and nasal secretions were also negative for fungal DNA detection using PCR assay. Conclusion In this study, fungal DNA could be detected in the middle ear fluid in seven (23.3%) of 30 patients with persistent OME using PCR assay, and fungi could be detected in five (16.6%) patients on Sabouraud agar. A significant relationship was found between detection of fungi in the middle ear fluid and the duration of the disease, associated adenoid, and history of asthma.
  - 1,191 121
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
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.
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Detection of 35delG, 167delT mutations in the connexin 26 gene among Egyptian patients with nonsyndromic sensorineural hearing loss
Nehal E El Barbary, Mervat F El Belbesy, Samir I Asal, Soha F Kholeif
January-March 2015, 31(1):42-46
Aim The aim of this study was to detect 35delG and 167delT mutations in the connexin 26 gene among Egyptian patients with nonsyndromic sensorineural hearing loss, allowing accurate diagnosis, proper genetic counseling, and carrier detection. Patients and methods Fifty-one patients were subjected to 35delG and 167delT mutations detection using PCR-based techniques. Results Seven patients had the 35delG mutation. Four patients were homozygous and four patients were heterozygous for this deletion. Two homozygotes were sibs and two heterozygotes were sibs as well. The allelic frequency for 35delG was 10.8%. The 167delT was not detected in any of the patients studied. Conclusion The 35delG is a common pathogenic mutation and an important contributor toward autosomal recessive nonsyndromic hearing loss in the Egyptian population.
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Voice changes and laryngo-video-stroboscopic findings in patients with vocal fold polyps and cysts
Aml S Quriba, Mohamed E Darweesh
January-March 2015, 31(1):47-53
Background Vocal fold polyps and cysts are two disorders of the minimal associated pathological lesions of the vocal folds. These disorders may be misdiagnosed by a simple laryngoscopic examination. Laryngo-video-stroboscopic (LVS) assessment is required for proper differentiation. Objectives This study aimed to examine the voice changes and LVS findings of vocal fold polyps and cysts and differentiate between them clearly, and also to determine which stroboscopic signs are correlated to the severity of dysphonia. Patients and methods This study was carried out on 47 patients; 21 of these patients (45%) were diagnosed with vocal fold cysts (group 1) and 26 patients (55%) were diagnosed with vocal fold polyps (group 2). The results of auditory perceptual assessment, LVS evaluation, and acoustic analysis of the voice were compared in both groups. The correlation between the different parameters of LVS and the grade of dysphonia was tested. Results Vocal fold polyps lead to more severe dysphonia than vocal fold cysts, proved by significant differences between both groups in the grade of dysphonia and in acoustic analysis. LVS findings differed significantly between both groups. Irregularity of the edge of the affected vocal fold, phase closure characteristics, and phase symmetry were found to be the most useful parameters for the assessment of the severity of dysphonia in these voice disorders than the amplitude of vibration. Conclusion The results of assessment of voice in vocal fold cysts and polyps are related to the nature and the pathology of the disorder. Irregular vocal fold edges in cases of vocal fold polyps and absent mucosal wave over the lesion in cases of vocal fold cysts enabled clear differentiation between them. Irregularity of the vocal fold edges and symmetry between vocal folds were stroboscopic signs correlated to the severity of dysphonia in cases of vocal fold polyps and cysts.
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Variables affecting speech intelligibility in prelingual Arabic speaking cochlear-implanted children
Jilan F Nassar, Fatma-Alzahraa A Kaddah, Ahmed Abdelhamid, Hesham M Taha
January-March 2015, 31(1):54-60
Background Speech intelligibility (SI) is usually expressed as the degree to which a speaker's intended message can be recovered by other listeners. It is determined by many factors that may be affected by the degree of hearing loss. The use of cochlear implants (CIs) can facilitate the development of speech and language skills of prelingually deaf children. Thus, improvements in SI after CI fitting can provide indirect evidence of sensory aid benefits. Aim This cross-sectional study aimed to explore the different variables that affect SI in prelingual CI children in order to achieve the maximum benefit for improving SI in such candidates. Participants and methods This study included 30 prelingually hearing-impaired participants, with ages ranging from 6 to 10 years. They used bilateral hearing aids for a duration of 2.6 ΁ 1.7 years before undergoing CI, which was performed at ages ranging from 4 to 9 years. They were enrolled in specific language intervention programs after implantation for a duration ranging from 1 to 3.8 years. Then, the Arabic Speech Intelligibility test was used to assess their SI. The effect of different variables on their SI was assessed through both comparative and correlative analysis. Results SI scores showed highly significant differences in patients at younger age at implantation (aged ≤5years) and in those who had received language therapy for more than 2 years after implantation. Meanwhile, preimplantation therapy for more than 1 year and usage of hearing aids for more than 1 year before CI had significant effects on the SI scores. SI was highly significantly negatively correlated with age at CI and highly significantly positively correlated with the duration of postimplantation therapy. The SI scores were also affected by the three groups of the SI test. The front consonants had higher significant scores compared with both back consonants and sentences, and back consonants had significantly higher scores compared with sentences. Conclusion The SI of prelingual cochlear-implanted children was affected by all of the studied variants. However, for best SI, age at implantation and postimplantation therapy duration should be considered to enable better SI in these children.
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Lifestyle profile of school-aged children suffering from pathological stuttering
Rahma S Bhgat, Mohamed E Darweesh, Mervat A Ahmed
January-March 2015, 31(1):61-70
Background Stuttering is a speech disorder that involves intraphonemic disruption, part-word repetitions, monosyllabic whole-word repetitions, prolongation, and silent fixations (blocks). Objective The aim of the study was to investigate the lifestyle profile of children suffering from pathological stuttering and identify the factors that worsen or improve the condition of the child with pathological stuttering. Participants and methods The study sample consisted of 60 children suffering from pathological stuttering as well as their mothers or caregivers who attended the previous setting. Data were collected using two tools. The first tool was a structured questionnaire that included biosocial characteristics of the children and biosocial data of mothers. The second tool was an observation checklist developed by the researcher to observe children suffering from pathological stuttering as well as their mothers during speech therapy. Results It was found that 63.3% of children with stuttering were of a mean age of 8.17 ± 1.66 years. Significant difference was found between the mean age of stuttering children and their socialization skills. Significant difference was found between the mean age of stuttering children and response to treatment. Conclusion From the present study it can be concluded that pathological stuttering as a disease is easy to diagnose, difficult to treat, and has many negative impacts on the physical, psychological, social, and spiritual aspect of the child.
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Cutaneous leishmaniasis: an unusual cause of nasal obstruction
Loknath Ghoshal, Suchibrata Das, Joyeeta Chowdhury, Sudip Das
January-March 2015, 31(1):71-72
Nasal and sinus-related illnesses are among the most common reasons for appointments to otolaryngologists and allergists. The usual causes include septal deviation, allergic rhinitis, polyps and so on. Apart from the common cold, allergic rhinitis is probably the most common cause of nasal obstruction. Allergic rhinitis is most common during adolescence and improves significantly during middle age and wanes during old age. The anatomical causes including septal deviation and adenoids constitute other common causes of nasal obstruction. The unusual causes include middle turbinate osteoma, concha bullosa of the inferior turbinate, congenital nasal pyriform aperture stenosis, and congenital inferior turbinate hypertrophy. We describe the case of a 44-year-old man with localized cutaneous leishmaniasis, a hitherto unobserved cause of nasal obstruction, cured with intravenous sodium stibogluconate.
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