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   2016| July-September  | Volume 32 | Issue 3  
    Online since July 20, 2016

 
 
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ORIGINAL ARTICLES
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.
  9,890 576 2
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.
  5,154 436 2
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.
  4,721 384 -
ORIGINAL ARTICLES
Adenoidectomy: comparison between the conventional curettage technique and the coblation technique in pediatric patients
Abd El Rahman El Tahan, Saad Elzayat, Hassan Hegazy
July-September 2016, 32(3):152-155
DOI:10.4103/1012-5574.186528  
Objective The aim of this study was to compare the advantages and disadvantages of the coblation technique with the standard conventional curettage technique in the operation of adenoidectomy in pediatric patients. Study design This was a prospective randomized clinical study. Patients and methods From January 2010 to December 2014, 200 patients presented with obstructive adenoid hypertrophy. Their ages ranged between 3 and 10 years. The patients were classified randomly into two equal groups: group A was subjected to conventional curettage adenoidectomy and group B was subjected to coblation-assisted adenoidectomy. Operative time and intraoperative blood loss were recorded. Patients were scheduled for follow-up on the first day and first and second postoperative weeks. They were asked to record their pain and discomfort on a standardized Wong–Baker faces pain rating scale from 0 (no pain) to 10 (severe pain). Postoperative complications and/or recurrences were also recorded. Follow-up was for at least 1 year, with re-examination of the nasopharynx by means of endoscopy and/or lateral nasopharyngeal radiography. Results The conventional curettage adenoidectomy group recorded significantly less operative time and the coblation-assisted adenoidectomy group recorded significantly less intraoperative blood loss and also lower incidences of postoperative bleeding and adenoid recurrence. Both groups demonstrated insignificant difference as regards postoperative pain. Conclusion The use of the coblation technology in adenoidectomy gave more advantage to the procedure with regard to less intraoperative blood loss and lower incidences of postoperative bleeding and recurrence rate.
  2,956 186 -
CASE REPORTS
Acute parotitis in a newborn: a case report and review of the literature
Liliana Costa, Laurentino M Leal, Fernando Vales, Margarida Santos
July-September 2016, 32(3):236-239
DOI:10.4103/1012-5574.186539  
Acute parotitis is a rare disease in the neonatal period. Risks implicated in its pathogenesis are prematurity and dehydration. Staphylococcus aureus is the most common bacterial agent causing this condition. The diagnosis of acute neonatal parotitis is clinical. Treatment consists of intravenous antibiotics, and surgery is reserved for severe complications. The prognosis is favorable with rare recurrence. The authors describe a case of an 8-day-old, full-term boy diagnosed with acute parotitis.
  2,722 192 1
ORIGINAL ARTICLES
The positive correlation between migraine and vertigo: a review
Abhishek Mohan, Akansha Mohan, Mohammed Hassan-Ali, Louis Liogier-Weyback, Aaron J Roberto, Ashish Kumar
July-September 2016, 32(3):191-195
DOI:10.4103/1012-5574.186525  
Many studies have focused on understanding the correlation between migraine and vertigo. It has resulted in the emergence of several theoretical perspectives on these two conditions, attempting to explain the connection between them. This paper explores a wide range of research publications on migraine and vertigo in order to present a comprehensive perspective on the correlation. Distinctive analysis of each theory facilitates a clear understanding of each in connection with migraine and vertigo; these theoretical perspectives include (a) sensory exaggerations, (b) low blood pressure, (c) ear disorders, and (d) vascular complications (i.e. stroke, neurotransmitter changes, and cerebellar disturbances). There is an established link between Meniere’s disease, migraine, and vertigo. Through an analysis of results from various studies, the paper explores the relationship between Meniere’s disease and migraine. A better understanding of migraine and vertigo is also vital in identifying the conditions, diagnosis, and selection of appropriate treatment options.
  2,495 146 -
Study of Pragmatic Language ability in Children with Hearing loss
Rasha M Shoeib, Fatma El-Zahraa A Kaddah, Sally T Kheir El-Din, Nithreen M Said
July-September 2016, 32(3):210-218
DOI:10.4103/1012-5574.186526  
Background Pragmatic language refers to how language is used socially to achieve some purpose in communication. Pragmatic language impairment can be a disorder by itself, or as a sign of other accompanying disorders. Hearing-impaired children show less clear pragmatic communication functions. Knowledge of pragmatic abilities in children with hearing loss (HL) is lacking relative to that of children with normal hearing (NH). Aim The aim of this study was to examine the pragmatic language ability in Arabic-speaking children with sensorineural hearing loss in order to apply a proper intervention program to guard against the effect of early pragmatic language skill disorders on later academic and social abilities. Participants and methods Twenty-seven children with HL were subjected to pragmatic language assessment using the Arabic version of the Test of Pragmatic Language, 2nd edition and both the Observational Rating Scale and the Pragmatic Profile subtests of the Clinical Evaluation of Language Fundamental, 4th edition. The results obtained were compared with the results of 27 age-matched and sex-matched NH children. Results The results of this study revealed significantly lower pragmatic abilities in children with HL compared with children with NH. Male children were significantly more impaired compared with female children. There were significant correlations between the pragmatic variables and the degree of HL, speech discrimination ability, and the duration of auditory deprivation. Conclusion HL children had significantly lower pragmatic skills compared with NH children, with greater affection correlated with increasing severity of HL and the duration of auditory deprivation. The higher susceptibility to pragmatic impairment in this category of children as well as the importance of pragmatic skills for further social communicative and academic careers should be considered in their rehabilitative plan.
  2,051 340 1
Traumatic tympanic membrane perforations: an overview in tertiary care hospital
Shahid Rasool, Farooq Ahmad, Rauf Ahmad
July-September 2016, 32(3):187-190
DOI:10.4103/1012-5574.186531  
This hospital-based prospective study was conducted in the Department of Ear Nose Throat, Head and Neck Surgery, Government Medical College Srinagar, Jammu and Kashmir, for a period of 1 year from June 2013 to June 2014 with the aim of studying the aetiological factors, clinical presentation and management options for traumatic tympanic membrane perforations. A total of 50 patients with traumatic perforations of the tympanic membrane were enrolled in the study, comprising of 34 males and 16 females patients. Age of the patients ranged from 12 to 56 years, with a mean age of 32 years. The results showed that the most common mode of trauma was slaps (56%); sudden hearing loss and tinnitus were the two most common presentations (92%). Audiometry shows that the larger the tympanic membrane perforation, the larger the air–bone gap. Hearing loss was highest at the lowest frequencies and generally decreased as the frequency increased. The differences in air–bone gaps between small and large perforations were significant at all frequencies (P<0.05, Student’s t-test). Overall, 72% of patients responded to conservative management, whereas 28% needed fat myringoplasty and/or chemical cauterization.
  1,712 124 -
Microtia: A Combined Approach by Genetics and Audiology
Elham El-Saiid, Salwa Mahmoud, Hoda Abu Moussa, Nagwa Meguid, Ehab Ragaa
July-September 2016, 32(3):178-186
DOI:10.4103/1012-5574.186527  
Introduction Microtia is a condition in which the external portion of the ear (the auricle) is malformed. In the strictest definition, there is also narrowing or absence of the external auditory canal (external auditory meatus). Microtia varies in severity from barely discernible to an external ear with major structural changes. Hearing loss is a common feature that can be associated with microtia. There are different types of hearing loss – conductive, sensorineural, or mixed – depending on which part of the ear is not working as it should. Objectives The present study was designed with the following aims: (i) identification of the genetic etiology and patterns of inheritance of microtia for proper genetic counseling; (ii) early detection and identification of associated hearing impairment for proper management including use of a hearing aid and surgical intervention. Patients and methods Twenty children with microtia ranging in age between 1 and 15 years (mean: 6.2 ± 3.68 years) irrespective of sex were included in this study: 14 males and six females. All children were subjected to a full assessment of medical history, a general examination, an ENT examination, tympanometry, pure tone audiometry, and an auditory steady-state response test for patients not responding to a conventional audiometric test. Karyotyping, fluorescence in-situ hybridization (FISH) for Treacher Collins cases, radiological investigations, and fundus examination were also performed. Results Syndromic microtia was more frequent than nonsyndromic microtia. Treacher Collins syndrome was the most clinically diagnosed syndrome, followed by Goldenhar's syndrome. There was one case of Down's syndrome and another single case of Johnson–McMillin syndrome. Meatal atresia and preauricular tags were frequently present in the microtia cases, whereas middle ear and inner ear anomalies were only found in some cases. The most common presenting symptom of microtia is hearing loss. Its degree and type differ according to the severity of the disease and frequencies affected. In total, 88.5% (23 ears) have conductive hearing loss and 11.5% (three ears) have mixed hearing loss. Karyotyping was performed for 10 cases; nine cases were normal, whereas one case was abnormal (47XY,+21) (Down's syndrome), which represents 5% of all cases studied. FISH was performed for four cases of Treacher Collins syndrome using a probe for chromosome 5 with gene map locus 5q31q33, but no deletion was found in the chromosome 5 Treacher Collins–Franceschetti 1 (TCOF1) gene. Conclusion Genetic predisposition for both autosomal dominant and autosomal recessive inheritance seems to be a strong determinant factor in the etiology of microtia than the environmental one. As for Treacher Collins, which is the most frequently clinically diagnosed syndrome in the current study, the FISH study showed that the 5q31-q33 locus may not carry the causative mutation as no single case was positive for this locus. Hearing impairment, of the conductive type, is the most frequent symptom that leads parents to seek medical advice and genetic counseling.
  1,287 127 -
Relationship between the endoscopic, radiological, and operative findings in sinonasal polyposis
Nabil G Zeid, Ahmed A Kamel, Basim M Wahba, Mahmoud Youssef
July-September 2016, 32(3):147-151
DOI:10.4103/1012-5574.186533  
Objectives The aim of the present study was to assess the correlation between preoperative endoscopic, radiological, and operative findings of sinonasal polypsis. Materials and methods A total of 30 patients with sinonasal polypsis underwent preoperative endoscopic assessment using the Meltzer staging system, radiologic evaluation using the Lund–Macky staging system, and operative evaluation during functional endoscopic sinus surgery using the Meltzer staging system, and findings in each sinus (polyp, fungal mud, mucous, and normal) were recorded. Results There was a highly significant positive correlation between preoperative computed tomography (CT) and operative findings [right (RT) side=0.731 and left (LT) side=0.814, P<0.001]. There was also a highly significant positive correlation between the preoperative endoscopic and operative staging scores (RT side=0.892 and LT side=0.827, P<0.001). Furthermore, there was a highly significant positive correlation between preoperative endoscopic and CT staging scores (RT side=0.768 and LT side=0.782, P<0.001). Conclusion No single procedure can be sufficient in accurately diagnosing nasal polypsis, and both the preoperative CT and the preoperative endoscopic examination are complementary to each other.
  1,202 152 -
Endoscopic endonasal transsphenoidal surgery: predictors for disease control in a consecutive series of pituitary adenomas
Mostafa Ismail, Balegh Abdelhak, Jean D'Haens, Olaf Michel
July-September 2016, 32(3):130-140
DOI:10.4103/1012-5574.186523  
Background Endoscopic endonasal transsphenoidal surgery for pituitary lesions has been predestined and evolved since its incipient description. However, tumour size and extrasellar extensions of pituitary adenomas remain a challenge for disease control (DC) after surgery. This study was conducted to evaluate the predictors that determine the early outcome in a consecutive series of pituitary adenomas operated using an endoscopic transsphenoidal approach. Materials and methods Sixty-five consecutive pituitary adenomas presenting over a 36-month period subjected to excision through an entirely endoscopic transsphenoidal approach were reviewed. DC, based on the extent of tumour resection and endocrinological remission, was evaluated according to the recent radiological and hormonal consensus criteria. Results Of 65 pituitary adenomas operated, 24 were endocrinally nonfunctioning and 41 were functioning adenomas. The follow-up duration ranged from 3 to 33 months. The overall DC was 67.7% as measured using total tumour resection and endocrinal cure. Cavernous sinus invasion, suprasellar extension and revision surgery negatively influenced DC of pituitary adenomas. Postoperative complications related to surgical resection of adenomas were seen in 12 cases (18.5%) − mainly, cerebrospinal fluid leakage, anterior pituitary insufficiency, and diabetes insipidus. Conclusion This study reports standards for DC in a short follow-up series of purely endoscopic pituitary surgeries and identifies pituitary lesions associated with preoperative predictors that can influence postoperative outcome. These results authenticate the efficacy and safety of endoscopic endonasal transsphenoidal surgery in the treatment of pituitary adenomas, providing favourable DC for both functioning and nonfunctioning pituitary adenomas.
  1,125 125 1
CASE REPORTS
A rare pediatric malignant neck mass: Synovial sarcoma
Alper Dilci, Mehmet Duzlu, Metin Yilmaz, Ibrahim Onur Ozen, Faruk Guclu Pinarli
July-September 2016, 32(3):232-235
DOI:10.4103/1012-5574.186537  
Synovial sarcomas are rare soft tissue sarcomas that typically seen in the periarticular region and predominantly located in the extremities. It most commonly affects young adults of the second to fourth decade. Head and neck synovial sarcomas are uncommon and carry a poor prognosis. In the head and neck region, tumor is localized laterally in the parapharyngeal space often. The tumor can spread loco -regionally and systemically easily, so it makes management challenging. Herein, we report a case of a 12-year-old child with a synovial sarcoma located in the right parapharyngeal space of the neck. The lesion extended from parapharyngeal space to subglottic level of the neck and it fills the parapharyngeal space and compresses the major vascular, laryngeal and neural structures.
  1,056 84 1
ORIGINAL ARTICLES
Immunologic changes after diode laser inferior turbinoplasty in allergic rhinitis
Hazem M.A Saleh, Dalia R Ibrahim, Michael I Michael, Amal M Kamal, Ahmed M El-Kharbotly, Mervate M Bahgat
July-September 2016, 32(3):141-146
DOI:10.4103/1012-5574.186535  
Objectives It was suggested previously that turbinoplasty by laser improves the symptomatology of allergic rhinitis (AR) not only by a mechanical effect but also by inhibiting the local allergic reaction at the level of the inferior turbinates. The aim of this study was to determine whether the short-term immunologic effects of diode laser, when used to perform inferior turbinoplasty in AR, can also be detected at the systemic level. Patients and methods Twenty patients, seeking a treatment by laser for AR manifestations refractory to local and systemic medical therapy, were included in a prospective study. Blood picture, total immunoglobulin E, interleukin (IL)-4, IL-5, and interferon-γ levels were assessed immediately before and 1 month after diode laser inferior turbinoplasty (DLIT). Results One month after DLIT, the total leukocytic count increased with relative eosinopenia. Total immunoglobulin E and IL-5 decreased, together with insignificant changes in IL-4 and interferon-γ. Conclusion It is not impossible that DLIT modifies the clinical course of AR not only by a mechanical effect but also by its local or even by a systemic immunologic effect. The laser modulation of T-cell functions in the engorged turbinate submucosa is a plausible biomolecular interpretation of the observed effect.
  975 119 -
CASE REPORTS
Multiple parotid calculi: a rare case presentation
Avishek Palai, Subhrakanthi Sen, Somnath Saha
July-September 2016, 32(3):240-242
DOI:10.4103/1012-5574.186530  
Objective The aim of this study was to present a rare case of multiple parotid calculi (intraglandular and intraductal). Case presentation Here, we report the case of a 35-year-old man presenting with recurrent painful swelling over the left parotid region. Intervention Total conservative parotidectomy was performed. Results The patient was completely symptom free postoperatively and there was no complication. Conclusion Management of multiple intraparenchymal and intraductal parotid calculi is not straightforward. Parotidectomy may be required in some selected cases.
  988 74 -
ORIGINAL ARTICLES
Miniature cochlea: a study of radiological measurements and its implications during the cochlear implant surgery
Mahmoud N Tarabishi, Abdelrahim A Sarwat, Hossam M Rabie, Ihab M Nada, Ehab K Hakim, Mohamed S Hasaballah, Mohamed M El-Sharnouby, Togan T Abdel Aziz
July-September 2016, 32(3):170-177
DOI:10.4103/1012-5574.186524  
Hypothesis Approximately 25% of patients with congenital sensorineural or mixed hearing loss show bony inner ear malformations on computed tomography (CT) of the temporal bone, with significantly smaller cochlear height (CH) compared with normal-hearing patients. The miniature cochlea has an apparently normal radiological appearance and could be missed if proper measurements are not taken. Inner ear measurements not only aid in the duplication of radiologically diagnosed inner ear malformation but can also provide additional information about which specific part is abnormal. Aims The aims of the present study were to establish the normal measurements of the height and width of fully developed Egyptian cochleae using high-resolution CT scans of the temporal bone in normal individuals, and to predict the characteristic radiologic sings and measurements of miniature cochlea and its implication during cochlear implant surgery. Study design The authors conducted a prospective, comparative study. Patients and methods The study comprised three groups: the control group, which comprised 50 cochleae with normal hearing and negative history for head trauma or ear surgery; the patients group, which comprised candidates for cochlear implanting with a negative history for meningitis or head trauma, and was further subclassified into group A, which comprised 22 cochleae with CH small but not less than 2 SD from the controls, and group B, which comprised nine cochleae with CH less than 2 SD from the controls. High-resolution 64-slice CT scan of 1 mm slice thickness was obtained; in addition, CH, basal turn height and width, upper turn height and width, and oval window–round window distance were estimated according to well-established definitions in the literature. Results CH in the control group ranged between 4.8 and 6.9 mm, with a mean of 6.1 ± 0.29 mm, whereas, in group A, CH showed a mean of 5.9 ± 0.34 mm, which was statistically significant compared with the control group. In group B, CH showed a mean of 3.8 ± 0.31 mm, which was also statistically significant compared with the other two groups. The basal turn width, upper turn width, and oval window to the round window distance – all showed statistically significant difference when compared within the three groups. In contrast, both basal turn height and upper turn height showed no significant difference when compared within the three groups. Conclusion In cochlear implant surgery, the detailed and good radiological analysis aids in a safe, effective, and well-planned surgery. The development of standardized measurements to complement visual inspection improved the diagnostic accuracy and helped in the subclassification of hypoplastic cochleae. We found CH to be the most essential differentiating measurement in the subclassification and diagnosis of hypoplastic and dwarf cochleae. If dwarf cochlea is radiologically diagnosed, special surgical modifications regarding electrode length and site of cochleostomy during cochlear implanting should be applied.
  910 98 -
Reliability of auditory steady-state response to bone conduction stimuli in assessing hearing loss in children
Naema Ismaila, Elham El-Saiid, Amal El Sebaii, Hanaa Fadel
July-September 2016, 32(3):196-201
DOI:10.4103/1012-5574.186532  
Objective This study was designed to investigate bone Conduction (BC)/auditory steady state response (ASSR) in children with normal hearing, together with various types of hearing loss, to find out an objective method to differentiate between different types of hearing loss. Participants and methods A total of 80 children (with ages ranging between 3 and 6 years) were subjected to history taking, otological examination, and basic audiological evaluation in the form of pure-tone audiometry (air Conduction (AC), BC). Single monotic ASSR (AC, BC) was tested at 0.5, 1, 2, and 4 kHz. They were classified on the basis of hearing status into three categories (20 children each): category I, normal hearing; category II, sensorineural hearing Loss (SNHL) (subdivided into two groups: group 1, mild-to-moderate SNHL; and group 2, severe-to-profound SNHL), and category III, conductive hearing loss. Results BC thresholds were poorer for ASSR testing compared with thresholds obtained with behavioral testing in normal category using 9, 7.5, 5.5, and 10.5 dBHL at 0.5, 1, 2, and 4 kHz, respectively. In category II, in the mild-to-moderate SNHL group, it was poorer using 16.25, 5.75, 12.25, and 11.75 dBHL at the same measured frequencies. Minimum levels at which spurious BC/ASSR occurred were established in the group with severe-to-profound SNHL as 52, 66.5, 69, and 64 dBHL at 0.5, 1, 2, and 4 kHz, respectively (no BC/pure tone audiometry (PTA) could be measured). In conductive hearing loss (CHL) category, it was poorer using 12.5, 8.5, 9.5, and 9 dBHL at 0.5, 1, 2, and 4 kHz, respectively. Preliminary normal levels for BC/ASSR at 0.5, 1, 2, and 4 kHz were 23.5, 22.5, 20, and 25 dBHL, respectively. In children with conductive hearing loss, the average BC/ASSR thresholds corresponded closely to those in the normal-hearing group. Conclusion BC/ASSR thresholds could be recorded reliably in children with normal hearing and conductive hearing losses. Meanwhile, BC/ASSR may not provide a reliable measure in cases of SNHL, especially cases with moderate or greater loss due to the low levels at which spurious responses may occur.
  858 85 1
Mansoura University habilitation outcome of prelingual cochlear-implanted children: 5 years of experience
Tamer Abou-Elsaad, Hemmat Baz, Gihan A Allatif, Omayma Afsah, Ayman Amer, Nehal Marzouk
July-September 2016, 32(3):222-228
DOI:10.4103/1012-5574.186536  
Introduction The aim of this study was to explore the effects of different preimplantation and postimplantation factors on the postimplant outcome of prelingual cochlear-implanted (CI) children as regards their auditory and language development. Patients and methods This retrospective study included a sample of 33 prelingual CI children who were presented to the Phoniatric Unit, Mansoura University Hospitals, Mansoura, Egypt, and were implanted during the last 5 years starting from August 2009 to August 2014. All children received structured auditory and language therapy sessions after CI twice weekly. They were subjected to the protocol of assessment of a delayed language development (before and after language therapy sessions) using subjective and quasiobjective measures of evaluation including improvement quotient assessment, language assessment, and assessment of auditory abilities including detection, discrimination, identification, and comprehension. Results The results of the study proved that the better habilitation outcomes after CI children are correlated with young age at CI surgery, preoperative improvement quotient, language therapy before and after implantation, and regularity of hearing aids usage before surgery. Conclusion Early CI of the prelingual children is recommended to minimize initial language delays and to promote the development of age-appropriate communication skills.
  836 86 -
Olfactory function after total laryngectomy
Hesham Negm, Mohamed Mosleh, Hesham Fathy, Chahinaz Salem
July-September 2016, 32(3):219-221
DOI:10.4103/1012-5574.186538  
Objective The aim of this study was to assess the olfactory function in patients who underwent total laryngectomy. Patients and methods Olfactory function assessment using the Scandinavian Odor Identification Test was carried out in 32 patients who had undergone total laryngectomy and were being followed up in Kasr El Aini ENT Outpatient Clinic. Results The studied cases included both men (59%) and women (41%). Their ages ranged from 50 to 70 years. The duration between operation and olfactory assessment ranged from 4.5 to 15.5 months. Results showed 75% incidence for anosmia and 25% incidence for hyposmia. Both age and sex did not correlate with either pattern of olfactory loss. The mean duration between operation and olfactory assessment was statistically significantly different between those who developed hyposmia and those who developed anosmia, being longer in the latter group. There was also a linear relation between the number of odors that could be smelled and postoperative duration. The longer the duration, the fewer the number of odors that could be smelled. The study reviewed similar studies and discussed suggested explanations. Conclusion The study also recommended preoperative olfactory assessment as well as postoperative olfactory rehabilitation for such patients.
  821 62 -
Role of septoplasty in reducing the incidence of comorbidities associated with elevated levels of mean platelet volume
Abdur Rahman, Shahab F Hashmi, Syed A Hasan, Sayeedul H Arif
July-September 2016, 32(3):156-160
DOI:10.4103/1012-5574.186542  
Aim The aim of this study was to analyze the effect of septoplasty on mean platelet volume (MPV) levels in patients with marked nasal septal deviation (MNSD). Setting and design This is a prospective study that was carried out in a Government Medical College and Hospital. Materials and methods A total of 50 patients were selected after proper history and examination. Statistical analysis The data entries were entered into SPSS software and the paired t-test was applied. Results Data obtained from preoperative and postoperative blood investigation were analyzed and it was statistically proved that, after septoplasty, the MPV was significantly lowered in patients who had MNSD. Conclusion Septoplasty plays an important role in reducing the MPV value in cases with MNSD, and thus other comorbid conditions can be prevented by performing septoplasty in these patients.
  798 72 -
CASE REPORTS
Recurrent tracheoesophageal puncture fistula closure using a previous flap as donor: a case report
Dushyant Jaiswal, Prabha Yadav, Vinay Shankhdhar, Rahul Dalal
July-September 2016, 32(3):229-231
DOI:10.4103/1012-5574.186529  
Tracheoesophageal puncture (TEP)-site fistula dysfunction is a serious complication of TEP prosthesis. We successfully addressed a recurrent TEP-site fistula dysfunction by utilizing the previously done deltopectoral flap. This avoided a fresh donor site. Utilization of sound plastic surgery principles helps in tackling these problems effectively.
  782 55 -