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   2015| April-June  | Volume 31 | Issue 2  
    Online since April 30, 2015

 
 
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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'.
  13,386 1,091 1
ORIGINAL ARTICLES
Assessment of nasal tip projection
Mahmoud F ElBestar, AbdAllah Y AlMahdy, Fadi M Gharib
April-June 2015, 31(2):105-110
DOI:10.4103/1012-5574.156093  
Introduction The aim of this study was to compare Goode's and Byrd's method in objectively assessing nasal tip projection. Materials and methods This study included 20 patients from the ENT outpatient clinic, Cairo university hospital, who underwent augmentation tip rhinoplasty, closed technique, using Sheen graft, during the period from January 2008 until December 2011. Two objective methods, Goode's method and Byrd's method, were used to assess nasal tip projection preoperatively and postoperatively. Results There was statistically significant difference between the gain in projection by Goode's method compared with Byrd's method. The mean gain in projection was 11.6 using Goode's method, whereas it was only 9.55 when measured by Byrd's method. Goode's method correlated more with patients' and surgeon's subjective assessment and satisfaction. Conclusion In our study, Goode's method proved to be more accurate in representing the final outcome compared with Byrd's method in the Egyptian population.
  3,208 259 -
Rotational chair testing in patients with unilateral peripheral vestibular disorders
Mohamed F. M. Ahmed
April-June 2015, 31(2):115-121
DOI:10.4103/1012-5574.156095  
Objective The aim of the study was to evaluate the rotational chair (RC) sinusoidal harmonic acceleration (SHA) test and the rotational velocity step (RVS) test in patients with unilateral peripheral vestibular disorders. Study design This study was retrospective in nature. Setting It was conducted in a clinical tertiary care vestibular function test center. Patients A total of 119 patients (63 men and 56 women) with documented unilateral peripheral vestibular lesions were evaluated with bithermal binaural caloric and sinusoidal and step velocity RC tests. Intervention Clinical, caloric, and RC tests were carried out. Patients and methods The study group was selected by including patients with a clinical diagnosis suggestive of peripheral vestibular lesions and with documented unilateral caloric weakness matching the clinical diagnosis, and by excluding patients with a clinical diagnosis suggestive of a peripheral vestibular lesion but not documented by unilateral caloric weakness, as well as patients with incomplete tests or uninterpretable data (due to poor recordings or eye movement artifacts). Caloric testing was performed using an infrared video-oculographic system and a Brookler-Grams closed-loop irrigation unit with standard bithermal irrigations of 30 and 44°C for 45 s each in the following order: L30°C, R30°C, R44°C, and L44°C. The RC testing paradigms used in this study were the rotational SHA test and the RVS test. Results When patients were classified on the basis of etiology, the most common cause of dizziness in the study group was found to be Mιniθre's disease (34.9%), followed by vestibular neuritis (31.1%). Seventy-two patients in the study group demonstrated right caloric weakness and 47 patients demonstrated left caloric weakness, whereas only 18 of 119 patients demonstrated directional preponderance. When the RC SHA test parameters (gain, phase, and symmetry) in the study group were compared with the manufacturer's normal values, statistically significant difference was seen in vestibulo-ocular reflex (VOR) gain at low frequencies (0.01-0.08 Hz), in VOR phase at all frequencies, and in VOR symmetry at low frequencies (0.01-0.04 Hz). Conclusion In summary, despite the encouraging results of the discriminating power of caloric testing, it should be emphasized that RC testing has its own unique capabilities, such as the following: (i) it is a physiologic stimulus whose frequency and amplitude can be varied precisely; (ii) the stimulus is unrelated to physical features of the external ear or temporal bone; (iii) it is useful in children who may not tolerate caloric testing; and (iv) it is very useful in assessing patients receiving vestibulotoxic drugs. Multiple stimuli of varying intensities can be applied to the vestibular system within a relatively short period of time.
  3,068 246 -
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
  2,978 222 1
A clinicopathological study of masses arising from sinonasal tract and nasopharynx in north Bengal population with special reference to neoplasms
J Bhattacharya, BK Goswami, A Banerjee, Ranjan Bhattacharyya, I Chakrabarti, A Giri
April-June 2015, 31(2):98-104
DOI:10.4103/1012-5574.156091  
Introduction Various masses arise from sinonasal tract and nasopharynx, which are embryologically distinct. Aims and objectives A cross-sectional study for 1 year in a tertiary care hospital was carried out. Materials and methods Either incisional biopsy or surgical excision sample with proper history and imaging was collaborated. Results The total percentage of these tumors during the 1-year period was 3.52%. A total of four nonspecific lesions, 49 non-neoplastic masses, 17 benign neoplastic masses, and 24 malignant neoplastic masses were found. Conclusion Non-neoplastic masses were the majority in number (52.12%). Among the neoplastic masses (43.61%), malignant neoplasms constituted 25.53%, a vast majority being nasopharyngeal carcinomas. Immunohistochemistry further helped to differentiate undifferentiated carcinomas into epithelial and lymphoid malignancies.
  2,462 290 1
Sex as a source of variance affecting auditory evoked potential
Jayesh Dalpatbhai Solanki, Hemant Biharilal Mehta
April-June 2015, 31(2):111-114
DOI:10.4103/1012-5574.156094  
As a noninvasive measure of physiological integrity of auditory pathway, auditory evoked potential (AEP) has gained popularity globally. Baseline reference values specific for each setup demand normative AEP study, in which sex is one of the confounding factors affecting it. We tried to review studies conducted to correlate sex and AEP among various age groups with exploration of various explanations for it and the extent to which they are significant.
  2,309 150 -
The role of auditory perceptual analysis of speech in predicting velopharyngeal gap size in children with velopharyngeal insufficiency
Gamal Youssef, Anwar Alkhaja
April-June 2015, 31(2):122-127
DOI:10.4103/1012-5574.156097  
Context Assessment of velopharyngeal (VP) function starts with careful perceptual speech analysis, because it is the degree of speech impairment that dictates the need for intervention. Aim The aim of this study was to evaluate the role of auditory perceptual analysis of speech in predicting VP gap size in children with VP insufficiency. Design and setting This was a prospective correlation study conducted in a hospital-based setting. Materials and methods Referred sample of 38 participants with VP insufficiency and age ranging from 4 to 16 years were included in the study. The subjective evaluation of patients' speech was carried out using four-point severity scales. This included degree of hypernasality, audible nasal emission of air, the compensatory articulations (glottal and pharyngeal articulation), and the overall intelligibility of speech. Nasalance scores for oral and nasal sentences were measured. A combination of nasopharyngoscopy and multiview videofluoroscopy was used to measure VP gap size, which was rated using the scale proposed by Golding-Kushner and colleagues. The studied patients were classified into three groups on the basis of the estimated gap size (small, moderate, and large VP gap groups). Statistical analysis Statistical analysis was carried out using analysis of variance and post-hoc tests. Results There was a positive correlation between all studied auditory perceptual analysis variables and VP gap size. The degree of hypernasality and overall speech intelligibility had the strongest predictive values, followed by glottal articulation, nasal emission, pharyngeal articulation, and oral sentence nasalance score. Conclusion The study finding suggests that the size of the VP opening can be predicted on the basis of perceptual assessment of speech, which helps to anticipate the appropriate line of intervention without the need for invasive procedures.
  1,948 169 -
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.
  1,719 205 1
Evaluation of the effect of intratympanic injection of gentamicin for resistant cases of Meniere's disease on hearing and vestibular functions
Fatthi Baki, Samir Asal, Yasser Shewel, Ahmed Galal
April-June 2015, 31(2):135-139
DOI:10.4103/1012-5574.156099  
Objectives This study was performed to investigate the effect of a single minimal dose of intratympanic injection (IT) gentamicin on hearing and otolithic function, mainly on the utricle and saccule independently. Patients and methods Our study was performed on 10 patients with definite Meniere's disease diagnosed according to AAO-HNS criteria and who had been showing resistance to medical treatment for more than 6 months with persistent vertigo affecting their lifestyle. IT of gentamicin was given under local anesthesia through direct perfusion in a single dose of 12 mg (0.3 ml of 40 mg/ml) unilaterally on the lesion side. Preinjection evaluation included history, otoscopy, formal pure tone audiometry (PTA), and tympanometry. In addition, cervical vestibular-evoked myogenic potential (cVEMP) and oVEMP were tested. One month after injection, PTA and both VEMP tests were again carried out. Data before and after injection were analyzed and correlated. Results No overall significant effect on hearing was found. IT gentamicin had significant effect on cVEMPs with 100% abolition, as well as a statistically significant effect on oVEMP with 70% abolition and distortion of the remaining 30%. In these remaining 30% latencies and amplitudes, there was no significant difference in values before and after injection. Conclusion A 12 mg single dose of gentamicin can abolish otolithic function without affecting hearing.
  1,457 180 -
Does angiogenesis have a prognostic value in squamous cell carcinoma of the larynx?
Osama M Ibrahim, Hassan A El-Ebiary, Nedal A Hegazy, Samia A Fawaz, Mohamed M El-Sharnouby, Ahmed G Khafagy
April-June 2015, 31(2):92-97
DOI:10.4103/1012-5574.156090  
Introduction Angiogenesis marks a tumour's transition to a systemic disease. It is a useful prognostic and predictive factor; yet, its relationship to prognosis in squamous cell carcinoma of the larynx is controversial. Aim of this study was to evaluate the significance of angiogenesis in laryngeal squamous cell carcinoma. Patients and methods A prospective study was conducted in the Otorhinolaryngology Department of Ain Shams University. Patients with laryngeal cancer, between 2006 and 2012, were enrolled. After surgery, histopathological examination with grading of tumours and immunostaining with CD34 antibody was carried out. Patients were followed up for 2 years and reassessment with immunostaining was carried out for recurrent tumours. Results Eighty cases were included. Results showed that tumours associated with a higher mean microvessel count had a highly significant association with nodal metastasis, recurrence and subsites, with poorer prognosis. Conclusion Results suggest that angiogenesis can be used as a prognostic factor in patients with laryngeal squamous cell carcinoma.
  1,451 147 -