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   2019| January-March  | Volume 35 | Issue 1  
    Online since February 14, 2019

 
 
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ORIGINAL ARTICLES
Evaluation of hearing outcome of tympanoplasty using cartilage graft versus temporalis fascia graft
Mohamed M El-Sheikh
January-March 2019, 35(1):1-5
DOI:10.4103/ejo.ejo_13_18  
Background Various materials such as fascia, perichondrium, and cartilage have been used for the reconstruction of the tympanic membrane in middle ear surgery. Owing to its stiffness, cartilage is resistant to resorption and retraction. Patients and methods This study comprised a randomized, controlled trial conducted to analyze the audiological gain when using cartilage grafts in type 1 tympanoplasty compared with temporalis fascia grafts on 60 patients suffering from chronic otitis media after successful tympanoplasty. The follow-up period was at least 6 months. All patients were subjected to audiological evaluation before and at least 6 months postoperatively. Results There was a significant reduction in mean air-bone gap (ABG) in both groups, whereas in group A (fascial graft) the mean preoperative ABG was 25±10.2 dB and the mean postoperative ABG was 13.5±7.3 dB, whereas in group B (cartilage graft) the mean preoperative ABG was 30.6±8.6 dB and the mean postoperative ABG was 15.9±8.7 dB, analyzing the effectiveness of both surgical techniques showed that both were equally effective in reducing ABG from preintervention to postintervention with no statistical significance among both groups (P=0.212). Conclusion Patients who had cartilage grafts showed similar hearing outcomes to those who had fascial grafts after a successful tympanoplasty procedure.
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ORIGINAL ARTICLE
Oropharyngeal dysphagia profile in early versus late stage dementia
Ayatallah Raouf Sheikhany, Aisha Fawzy Abdel Hady, sheikhany Farag
January-March 2019, 35(1):103-109
DOI:10.4103/ejo.ejo_98_18  
Objective The aim of this study was to evaluate swallowing in early and late stage dementia cases referred to the swallowing clinic with oropharyngeal dysphagia in order to have a comprehensive view about their characteristic oropharyngeal dysphagia profile toward different food textures to address them in their rehabilitation program. Patients and methods Fiber-optic endoscopic examination of swallowing (FEES) was conducted to evaluate formally the oropharyngeal stage of swallowing in 26 individuals diagnosed with early mild Alzheimer dementia and late severe Alzheimer dementia. The FEES protocol included symptoms of presentation, route of feeding, bedside evaluation using different textures followed by evaluation of the oral preparatory stage, and the pharyngeal stage through FEES. In addition to observing the ability of the patient to imitate various oromotor actions and ability to follow commands related to the oral phase of swallowing. Results For early stage dementia, all food consistencies were considered safe except for mixed consistencies, large volumes of thin liquids and jelly, while the safest consistencies to use with the late stage dementia cases for quality of life and pleasurable feeds were thickened liquids and jelly consistency. Conclusion Oropharyngeal dysphagia profiles in early stage Alzheimer dementia is different from late stage Alzheimer dementia indicating that the mechanism behind dysphagia is different in the two groups.
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ORIGINAL ARTICLES
Vestibular function assessment in cochlear implant patients
Alia A.R.M El-Karaksy, Hesham S Kouzo, Mohamed B Attallah, Mohamed A Talaat
January-March 2019, 35(1):63-70
DOI:10.4103/ejo.ejo_55_18  
Background Anatomical and embryological relations between cochlear and vestibular end organs predispose them to same noxious or developmental factors, thus these may affect either or both systems. Cochlear implantation being a widely used procedure for restoration of hearing in patients who are not candidates for regular amplification, may affect by different means the vestibular system. One of these factors include the surgical procedure. The aim of this study is to assess the vestibular function in cochlear implant candidates before surgery to exclude co-existing vestibular affection with the sensorineural hearing loss (SNHL). Reassessment after operation was done to determine the risk posed by surgery and for correlating the surgical approach to vestibular findings. Materials and methods The case series presented herein is of cochlear implant candidates who underwent full audiological and radiological assessment. Vestibular assessment was done before and after operation and included cervical vestibular evoked myogenic potential (cVEMP) and ocular vemp (oVEMP) for evaluation of otolith organs. Video head impulse test (VHIT) was used to evaluate semicircular canal. Results Preliminary results show that patients may exhibit vestibular loss concomitant to the SNHL even with the absence of vestibular complaints. Patients who had normal preoperative vestibular function showed affected vestibular tests after the surgery. There was a mismatch between these objective findings and the subjective complaint of imbalance or vertigo. Conclusion Despite the minor risk posed by cochlear implant (CI) surgery for the subjective vestibular affection, the side with worse vestibular function should be chosen for CI if other factors are equal to avoid postoperative vestibular loss.
  651 87 -
The role of simple office-based surgery in small central tympanic membrane perforation
Abdel-Latif I El-Rasheedy, Ayman A Abdel-Fattah, Heba A Abo El-Naga, Mustafa M El-Barbary
January-March 2019, 35(1):12-16
DOI:10.4103/ejo.ejo_54_18  
Objective The aim of this study was to evaluate the outcome of simple office-based surgery in small central tympanic membrane (TM) perforation. Background The purpose of closure of TM perforations is to restore the continuity of the TM in order to improve hearing and decrease the risk of middle ear infections. Rapid and cost-effective procedures like chemical cauterization and fat plug myringoplasty have been found to be effective in healing small central perforations with significant hearing improvement. Patients and methods Our prospective study was carried out on 40 patients aged more than 15 years with dry small central persistent perforation during the period spanning from April 2017 to March 2018, divided in two groups: group A (20 patients underwent fat graft myringoplasty) and group B (20 patients underwent chemical cautery of the edge of perforation). Results Our study included 26 male patients and 14 female patients; the mean age was 27.2±9.3 years. Our study showed a 70% success rate in the healing of TM perforation in group A while there was a 55% success rate in group B. Conclusion From our study, we found that the two procedures are easy to perform, reliable with a satisfactory outcome, simple, rapid, risk free, and also lessen the financial burden and morbidity on the patient.
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Efficacy of intranasal corticosteroids in improving nasal airway obstruction in children with symptomatic adenoidal hypertrophy: a meta-analysis and systematic review
Yasser M Elbeltagy, Samer A Ibrahim, Mohamed S Hasaballah, Omar M Sowilem
January-March 2019, 35(1):30-36
DOI:10.4103/ejo.ejo_57_18  
Background Adenoidal hypertrophy is considered one of the most common diseases in otolaryngology. It is usually associated with nasal obstruction symptoms like snoring and hyponasality. If not treated well, children will encounter many complications like otitis media with effusion and craniofacial abnormalities. Adenoidectomy is the main line of treatment for many otolaryngologists, but recently medical treatment by using intranasal corticosteroids (INCS) has shown beneficial effects in reducing the size of adenoids or improving the obstruction symptoms. Objectives To assess the efficacy of nasal corticosteroids in improving nasal airway obstruction in children with symptomatic adenoidal hypertrophy. Patients and methods A comprehensive search in MEDLINE and CENTRAL was undertaken (1985–2017). We identified all randomized controlled trials in children with adenoidal hypertrophy that compared the effects of nasal corticosteroids and normal saline nasal spray on different outcomes. The primary outcomes were improvement of nasal obstruction symptoms assessed by any symptoms score and reduction in adenoid size as demonstrated by fiberoptic nasopharyngoscopy or lateral nasopharynx radiograph. Results Twenty-three relevant potential citations were identified and screened for retrieval; nine articles were suitable for these meta-analyses. The included randomized controlled trials were enrolled in five meta-analyses. Three meta-analyses showed significant improvement in adenoid size after the use of INCS with a risk ratio of 0.68, standardized mean difference (SMD)=−2.97, SMD=−0.67, respectively. Two meta-analyses showed insignificant improvement in nasal obstruction symptoms with SMD=−1.53 and SMD=0.67, respectively. Conclusion INCS can be used in children with moderate to severe adenoid hypertrophy to reduce the adenoid size and improve the associated symptoms. Close monitoring of improving of the symptoms is a must to predict the need of nonmedical management.
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Auditory brainstem response and speech mismatch negativity in children with phonological disorders
Reem El-Beltagy, Dalia Galhom, El-Ham M Hassan
January-March 2019, 35(1):79-85
DOI:10.4103/ejo.ejo_87_17  
Objective This study was designed to explore the processing of auditory information through auditory brainstem and higher cortical regions in a sample of children with phonological errors compared to age-matched normal controls using AEPs. Subjects and Methods We recorded click and speech auditory brain-stem response and mismatch negativity in 30 children (15 children who were diagnosed clinically with phonological disorder, their ages ranged between 3.5–5.5 years, 15 children age-matched, sex matched and education matched with the study group, normal fluent speaker with no history of speech or language impairment). Results Absolute and inter-peak latency values of cABR demonstrated no statistically significant difference between the control and study groups. Moreover, All children had well identifiable and repeatable sABR and MMN but with delayed latencies in transient, transitional and sustained portions of speech-evoked ABR and MMN in study group when compared to control group. On the other hand, there were non significant difference as regard amplitude in the two groups as regard sABR and MMN. Conclusion Phonological disorder may affect the communication and language processes causing degradation of linguistic and para-linguistic information, also it can affect the quality of life and social interaction.
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The sensitivity of the ce-chirp auditory brainstem response in estimating hearing thresholds in different audiometric configurations
Moustafa El Kousht, Mohamed S El Minawy, Tarek M El Dessouky, Rabab A Koura, Mona Essam
January-March 2019, 35(1):56-62
DOI:10.4103/ejo.ejo_27_18  
Background CE-Chirp is a new broadband stimulus that permits the energy from the stimulus to reach the whole regions of the cochlea at approximately the same time. Aim Comparison of auditory brainstem response (ABR) thresholds obtained by using click stimulus, broadband CE-Chirp and 500 Hz, 1, 2, and 4 kHz narrow band CE-Chirp stimuli to those obtained by behavioral hearing thresholds in adults with normal hearing and with varying configurations of sensorineural hearing loss (SNHL). Patients and methods Ten adult patients with normal-hearing thresholds, whose age ranged from 19 to 50 years, with a mean age of 30.4±9.1 years constituted a control group (group 1). Thirty adult patients with different configurations of SNHL constituted group 2, whose age ranged from 18 to 65 years, with a mean age of 32.5±9.8 years. All cases and controls were subjected to pure-tone audiometry, click, CE-Chirp and four narrow band CE-Chirp (at 500, 1000, 2000, and 4000 Hz) evoked ABRs. Results ABR thresholds to chirps have a relationship closer to behavioral hearing thresholds than ABR thresholds to clicks in individuals with normal-hearing thresholds and SNHL. Wave V mean latencies at threshold in response to click stimuli were earlier than those obtained using CE-Chirp in both groups. Wave V mean amplitudes at threshold with CE-Chirp were significantly larger than those with click in both groups. Wave V amplitude increased and latency decreased as the stimulus frequency increased in both groups. Conclusion There are evidences to suggest that ABR recording in response to CE-Chirps provide an efficient tool for estimating hearing thresholds in normal-hearing thresholds and individuals suffering from SNHL in comparison to click stimuli. The use of CE-Chirp had the potential to provide high sensitivity and accuracy for frequency-specific thresholds estimation in young children and difficult to test adults.
  510 60 -
Effect of vitiligo on the cochlea
Mohamed Abd Elatif ElGohary, Reda Mohamed Abd Alwahab Behairy, Amal Mahmoud Awida
January-March 2019, 35(1):6-11
DOI:10.4103/ejo.ejo_49_18  
Background Vitiligo is the disappearance of functional melanocytes (MCs) from the involved skin by a mechanism(s) that has not yet been identified. Objective The aim was to study the effects of different types of vitiligo on cochlear function. Patients and methods This study involved 30 vitiligo patients who constituted the study group and 30 matched healthy individuals who served as the control group. Cochlear function was studied using pure-tone audiometry and transient-evoked otoacoustic emission. Results Normal pure-tone thresholds were found in vitiligo patients with no statistically significant difference between the control and vitiligo groups on both ears. There was a statistically significant difference between control and vitiligo groups as regards the signal-to-noise ratio at a frequency band of 4 kHz on both ears. Cochlear function is affected equally in both generalized and localized vitiligo subgroups. The duration of vitiligo does not have an effect on cochlear function.
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Comparison between local steroids and local steroids plus itraconazole effect in prevention of recurrence of allergic fungal sinusitis in hypertensive and/or diabetic patients
Ramez Reda, Wael Wageh, Mohammed Fawaz, Wassim Mikhaiel
January-March 2019, 35(1):25-29
DOI:10.4103/ejo.ejo_64_18  
Background Allergic fungal rhinosinusitis (AFRS) is the most common type of fungal diseases in nose and paranasal sinuses. It is due to hypersensitivity to fungal antigens. The standard treatment for control of AFRS is endoscopic sinus surgery followed by systemic and/or topical steroids. In spite of steroids known to have promising results for the management of AFRS, their prolonged use is not always advised. So, some authors have tried to decrease the recurrence rate of AFRS by using antifungal treatment. In this study, we compared the efficacy of local steroids (Fluticasone nasal spray) versus local steroids plus itraconazole postoperatively in the prevention of recurrence of allergic fungal sinusitis in patients known to be hypertensive or diabetic. Patients and Methods A total of 60 patients with AFRS and nasal polyposis were included in the study. Patients were divided randomly into two groups: group A used local steroid and group B used local steroid and itraconazole. Clinical parameters were compared at the end of 6 months. Results Patients of group B were better clinically and also by endoscopic examination. Conclusion Itraconazole is better to be added in the postoperative treatment of AFRS patients especially for patients who have contraindications for systemic steroids intake.
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CASE REPORTS
Bamboo nodes − two cases with literature review
Haziq Hakimi, Mawaddah Azman, Abdullah Sani
January-March 2019, 35(1):126-128
DOI:10.4103/ejo.ejo_50_18  
Bamboo nodes are benign lesions of the true vocal cords related to autoimmune diseases. The endoscopic characteristics of these lesions led to their name. These lesions are located within the lamina propria of the true vocal cords, disrupting the normal oscillation during phonation, which results in dysphonia. We present two female patients with distinctive presentation: the first is a patient with known autoimmune disease, and the second, undiagnosed. We find that videostroboscopy is the most useful tool to diagnose bamboo nodes. Surgery with postoperative intralesional steroid injection was performed in the first patient, showing promising voice outcome.
  499 54 -
ORIGINAL ARTICLES
Assessment of safety and efficacy of extraturbinal microdebrider-assisted turbinoplasty versus partial inferior turbinectomy
Balegh H Ali, Osama G.Abdel-Naby Awad, Aya Ibrahim, Ahmd A.Abdel Azez
January-March 2019, 35(1):17-24
DOI:10.4103/ejo.ejo_8_18  
Objective The aim was to compare the extraturbinal microdebrider-assisted turbinoplasty (MAT) with the partial inferior turbinectomy (PIT) based on subjective and objective parameters. Patients and methods A total of 18 patients with nasal obstruction owing to bilateral hypertrophied inferior turbinates were included in this study. All patients underwent extraturbinal MAT on one side of the nose and PIT on the other side in alternate manner. The patients were blinded to the technique used. This is a prospective blinded randomized trial was conducted. The study was conducted at a tertiary referral hospital. Main outcome measures Operative time, blood loss, subjective improvement of the nasal obstruction, degree of intranasal crustations, and degree of synechiae formation were the main outcomes recorded. Results The operative time and intraoperative blood loss were less in the extraturbinal MAT compared with PIT. At 2 weeks postoperatively, the sides with MAT had significantly better relief of nasal obstruction (P=0.007), less degree of nasal pain (P=0.002), less crustations (P=0.010), and better tissue healing (P =0.010) than sides with PIT. At 1 and 3 months postoperatively, the sides with MAT had statistically significant less crustations (P=0.040 and 0.032, respectively) and better tissue healing (P=0.010 and 0.010, respectively) compared with the sides with PIT; however, there were no statistically significant differences regarding relief of nasal obstruction and degree of nasal pain. Conclusions Extraturbinal microdebrider-assisted inferior turbinoplasty is more effective and safe compared with PIT, especially in short-term follow-up periods.
  488 59 -
Correlation between preoperative endoscopic findings and computed tomography with postoperative histopathology in the staging of laryngeal carcinoma
Louay El-Sharkawy, Adel El-Antably, Fadi Gharib, Amal Hareedy, Tareq Algarf
January-March 2019, 35(1):41-46
DOI:10.4103/ejo.ejo_71_18  
Background Laryngeal cancers represent 4.5% of all malignancies and 28% of malignancies of the upper aerodigestive tract. Different modalities for pretherapeutic assessment have been advocated including endoscopy and radiology. Aim The objective of the current study is to assess the accuracy of preoperative CT and clinical/endoscopic staging of laryngeal tumors by comparing clinical and imaging findings of each modality with histologic cross-sections of surgical specimens. Methods This prospective study included thirty patients with cancer larynx who underwent surgical treatment. All patients underwent transnasal fiberoptic laryngoscopy with photographic documentation. CT scan axial slices of 2-mm thickness with contrast were obtained. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT. Results The T stage was correctly determined by both endoscope and CT scan in 23 cases. The agreement between perceived T stage by endoscope and CT with histopathological analysis was 100% for T1, 66.7% for T2, 80% for T3 and 66.6% for T4. Conclusion Multi Slice CT scan is superior to laryngoscopy in the evaluation of T3 and T4 tumors. However, laryngoscopy is better than MSCT in the evaluation of T1 and T2 lesions.
  490 56 -
Microdebrider-assisted powered adenoidectomy: a prospective study
Fahd Alharbi, Mohammed Rifaat Ahmed, Wael Al Juraibi
January-March 2019, 35(1):37-40
DOI:10.4103/ejo.ejo_70_18  
Objective To assess the use of powered instrumentation and endoscopes to evaluate the efficacy and safety of this procedure in comparison to classic adenoidectomy using an adenoid curette. Patients and methods A prospective study performed at the Department of Otolaryngology, Head and Neck Surgery in Jazan General Hospital, Kingdom of Saudi Arabia. It includes 70 patients subjected to adenoidectomy who were divided into two equal groups: conventional curette adenoidectomy (CCA) group and microdebrider-assisted powered adenoidectomy (MPA) group. Both groups were assessed for operative time, average operative blood loss, duration of postoperative pain, return to normal diet and activities. Results There was no statistical significance between two groups regarding the operative time: the mean operative time in the CCA group was 13.7±3.5 min, while 12.9±4.3 min in the MPA group. The mean operative blood loss in the CCA group was 14.2±3.4 ml, while it was 13.5±2.9 in MPA group without any statically significant difference between the two groups. Conclusion MPA proved to be a good alternative to CCA technique as both techniques provide complete adenoid resection with fewer traumas to the adjacent tissue. Level of Evidence: 3b.
  489 54 -
Developing an Arabic speech intelligibility test for adolescents and adults
Mona A Hegazi, Ahmed Abdelhamid
January-March 2019, 35(1):86-91
DOI:10.4103/ejo.ejo_2_18  
Objectives The improvement of speech intelligibility of many patients is one of the primary aims of the therapy of communication disorders. The standard evaluations lack an Arabic test to measure speech intelligibility among adolescents and adults. Participants and methods This study was conducted on 200 participants with an age range from 12 to 60 years who can read Arabic. All participants were randomly selected from the outpatient clinic of phoniatrics from five speech disorders affecting speech intelligibility. Each participant included in the study was subjected to two evaluations: a subjective rating of the participant’s speech intelligibility and the developed Arabic speech intelligibility test, which is meant to be an objective measure. Results The results showed highly significant correlation between the scores of the Arabic speech intelligibility test and the average scores of the raters. Conclusion The developed test proved to be valid and reliable for measuring speech intelligibility and could be categorically classified into ranges of severity.
  463 64 -
Audiovestibular findings in autoimmune diseases
Takwa A Gabr, Mona A Kotait, Rasha A Abdel Noor
January-March 2019, 35(1):71-78
DOI:10.4103/ejo.ejo_15_18  
Background Audiovestibular manifestations are reported in autoimmune diseases including hearing loss and vestibular symptoms. Objectives This study is designed to evaluate the audiovestibular manifestations in patients with different autoimmune diseases especially asymptomatic cases. Subjects and Methods This work included two groups: study group (29 cases with different autoimmune diseases) and control group (20 healthy subjects). All participantswere subjected to basic audiologic evaluation, Sinusoidal harmonic acceleration (SHA) test of the rotatory chair at different frequencies (.01-.64Hz). Results patients with ADs showed elevated hearing thresholds (>25dBHL) at all tested frequencies. As regard SHA test, only 5 cases from the study grop showed normal results, while the rest of cases showed vestibular hypofunction (bilateral in 22 cases and unilateral in 3 cases). Conclusion Audiovestibular symptoms are common in different autoimmune diseases even asymptomatic cases. SHA test showed that vestibular affection is much more frequent than expected. So, regular screening of hearing and vestibular functions in patients with autoimmune should be done, for better and early management.
  429 46 -
Subepithelial hydrodissection improves voice outcome of microflap surgery for vocal cord cyst
Ezzat A Merwad, Magdy M AbdElftah, Said Abdelmonem, Elham M Hasan, Mohammad W El-Anwar
January-March 2019, 35(1):51-55
DOI:10.4103/ejo.ejo_75_18  
Objective The aim was to evaluate voice outcomes of microflap surgery with subepithelial infiltration for vocal fold cysts and to compare voice outcomes of microsurgery with and without subepithelial infiltration for vocal fold cysts. Patients and methods This study was conducted on patients with vocal folds cysts. Patients who met selection criteria were divided into two groups: group A was operated by microflap surgery with subepithelial infiltration, and group B was operated by microflap surgery without subepithelial infiltration. Results Within the included 24 patients (12 in each group), a significant improvement of average fundamental frequency/fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, maximal phonation time (MPT), and dysphonia was detected postoperatively in group A (with subepithelial infiltration), with 58.3% of patients resorted to grade 0 dysphonia. Statistically significant improvement of MPT and dysphonia was registered after intervention in group B (without hydrodissection). However, average fundamental frequency/fundamental frequency, jitter, shimmer, and harmonic to noise ratio (HNR) showed nonsignificant improvement after intervention. It was clear that dysphonia improved significantly more in hydrodissection group than nonhydrodissection group (P=0.0063). However, there was no significant difference in postoperative MPT (P=0.3138). Conclusion Subepithelial infiltration is beneficial during microflap surgery for vocal fold cysts, with statistically significant better voice results. Therefore, we recommend using this technique during microflap surgery to enhance vocal outcomes; however, further studies are needed on a large number of patients and for a prolonged period of follow-up.
  430 45 -
Comparison between functional outcomes in patients with unilateral vocal fold paralysis undergoing injection laryngoplasty under general anesthesia versus local anesthesia
Amr R El-Badrawy, Hassan M El-Hoshy, Ayatallah R Sheikhany, Wael S.A El-Rehim
January-March 2019, 35(1):92-102
DOI:10.4103/ejo.ejo_111_18  
Introduction Injection laryngoplasty (IL) continues to evolve, as new techniques, approaches, and injection materials are continuously being developed. Although it was performed under general anesthesia in the operating room, IL is now increasingly being performed in an office-based setting. Aim The aim of this study was to compare functional voice outcomes in patients with unilateral vocal fold paralysis undergoing injection laryngoplasty local versus general anesthesia. Patients and methods : A prospective interventional study was done to compare functional outcomes and patient satisfaction between group A (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under local anesthesia, versus group B (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under general anesthesia, by analyzing total Arabic Voice Handicap Index (VHI)scores and subscale scores preoperatively and post operatively. Results All results obtained in this study showed that there was no significant difference for the functional outcomes and patient satisfaction obtained for both groups under study. Conclusion In conclusion, IL under local anesthesia gives similar results as general anesthesia regarding functional outcomes and patient satisfaction of voice quality by themselves as well as by using the voice handicap index.
  400 55 -
CASE REPORTS
Submandibular abscess caused by Salmonella spp. in a diabetic patient: a case report
Abdul-Aziz Alaqeeli, Belal Alani, Moustafa Al Khalil
January-March 2019, 35(1):129-132
DOI:10.4103/ejo.ejo_54_17  
Head and neck infections normally arise from Streptococcus, Staphylococcus, or other anaerobic species, and infection by Salmonella spp. is rare. Patients with significant underlying conditions are at increased risk for the development of focal infection. This has been observed in patients with HIV, diabetes, and malignancy.
  395 55 -
ORIGINAL ARTICLES
Voice outcome after cold phonomicrosurgery for minimal-associated pathological lesions of the vocal folds
Ezzat A Merwad, Abd El Raof S Mohamed, Amal S Quriba, Amany M Abd Al Badea
January-March 2019, 35(1):110-114
DOI:10.4103/ejo.ejo_17_18  
Objective The aim was to assess the voice outcomes of cold phonomicrosurgery for minimal-associated pathological lesions of the vocal folds. Materials and methods A total of 26 patients with either unilateral or bilateral minimal-associated pathological lesions of the vocal folds from the Otorhinolaryngology Department in Zagazig University Hospitals between 2013 and 2014 were enrolled in the case group. Cold phonomicrosurgeries were performed. The control group comprised of 20 matched normal individuals. Matching was based on sex, age, and socioeconomic rank. Results All patients had videoendoscopic laryngeal evaluations in the preoperative and postoperative periods (3 months after surgery), and the results showed the absence of the lesion in comparison with the preoperative findings in 22 (84.62%) patients. All patients had perceptual voice analysis in the preoperative and postoperative periods (3 months after surgery), with all P values below 0.05, indicating statistically significant difference among the cases after the operation. Conclusion Although voice therapy is the cornerstone in treating benign vocal fold lesions, phonosurgery has an important role in some lesions.
  389 45 -
CASE REPORTS
Emergency management of an isolated sphenoidal mucopyocele with vision loss: a case report
Natarajan Ramalingam, Sivaraman Ganesan, Sithananda K Venkatesan, Sunil K Saxena
January-March 2019, 35(1):122-125
DOI:10.4103/1012-5574.251319  
Isolated mucocele is very rare in sphenoid sinus. It presents with varied symptoms in the form of vision loss, proptosis, and headache. We report a case of isolated sphenoidal mucocele that presented with vision loss. Although the vision loss was not sudden, immediate evacuation of pus and marsupialization was done on an emergency basis based on the clinical and radiological findings rather than relying on the history of insidious vision loss. The patient’s vision improved immediately after surgery. This underscores the importance of emergency drainage of this condition.
  373 45 -
ORIGINAL ARTICLE
The impact of high intensity versus low intensity behavioral therapy in establishment of functional routines in Egyptian autistic children
Yehia A Aboras, Rania M Abdou, Heba E Gaber
January-March 2019, 35(1):115-121
DOI:10.4103/ejo.ejo_52_18  
Objective To compare the effect of high-intensity versus low-intensity treatment in the establishment of functional routines in autistic children. Patients and methods This quasi-experimental study was conducted on 25 children of 2–6 years of age of both sexes at the Unit of Phoniatrics, Department of Otorhinolaryngology, Alexandria Main University Hospitals. An informed consent was taken from all patients in this part of the study. All cases included in the study underwent thorough history taking, comprehensive neurological examination, and diagnosis of autism based on Diagnostic and Statistical Manual of Mental Disorders, fifth ed., Childhood Autism Rating Scale, and Autism diagnostic interview-revised. The children were trained for 1 year using the STAR program. The children were divided into two groups: group I included 15 children who were trained 5 days per week, and group II included 10 children who were trained 3 days per week owing to family commitments. Results There was significant improvement in both groups in all lessons when comparing pretherapy and post-therapy results; however, group I showed significant degree of improvement when compared with group II in specific items. Conclusion Early intervention for autistic children helps in improving their prognosis and yields better results. The need to apply the treatment on daily basis is highly recommended.
  380 38 -
ORIGINAL ARTICLES
Helicobacter pylori in benign versus malignant laryngeal lesions
Mohammad W El-Anwar, Ashraf Raafat, Mohammad Abdehady, Eman A Eissa
January-March 2019, 35(1):47-50
DOI:10.4103/ejo.ejo_28_18  
Objective The aim was to investigate the existence of immunoglobulin (Ig)G antibody against Helicobacter pylori (H. pylori) in blood sample from patients having laryngeal lesions and comparing its level in benign versus malignant lesions. Patients and methods Under general anesthesia, direct laryngoscopy was performed for patients having laryngeal lesions, and biopsy was taken and sent for histopathology. Anti-H. pylori IgG antibodies were measured by enzyme-linked immunosorbent assay from venous blood samples from each patient. Results Within the included 56 patients, 30 had benign lesion and 26 (46%) had squamous cell carcinoma (SCC). Overall, 73.3% of patient with benign lesions were seropositive and 92.3% of patient with laryngeal SCC were seropositive. The mean anti-H. pylori IgG antibody level was significantly (P=0.0041) higher in patients who had SCC (23.93±19.6) than patients who had benign laryngeal lesions (38.9±27.5). Conclusion Laryngeal lesions are commonly associated with H. Pylori infection and showed significantly higher level in laryngeal SCC than benign lesions, reflecting more association of larynx cancer with H. pylori infection.
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ERRATUM
Erratum: Comparison between pitch discrimination in normal children, children with hearing aids, and children with cochlear implant

January-March 2019, 35(1):133-133
DOI:10.4103/1012-5574.251928  
  257 32 -