Παρασκευή, 12 Απριλίου 2019

Otolaryngology : Vitamin D levels in children diagnosed with acute otitis media,Selenium supplement for treatment of geriatric rhinitis,extraturbinal microdebrider-assisted inferior turbinoplasty in children,local anesthetics in the tonsillar fossa after tonsillectomy,

Selenium supplement for treatment of geriatric rhinitis
Esin Yalcinkaya, Hasmet Yazici, Hakan Kayir, Fatih K Soy, Hesham Negm

The Egyptian Journal of Otolaryngology 2019 35(2):135-139

With the aging of population, the incidence of geriatric problems is increasing. However, the diagnosis and treatment of geriatric problems are usually ignored. This study investigated the efficacy of supplemental selenium in patients with geriatric rhinitis (GR). The study was conducted at an academic secondary referral center in a prospective design. Patients were divided into two groups, and they were compared with healthy volunteers. The treatment group, including patients with GR, was given nasal saline wash four times daily and 100 µg of seleno-6 dietary supplements twice daily. The patient control group and the healthy volunteers were given only the nasal saline wash four times daily. Glutathione peroxidase, superoxide dismutase, and catalase levels were measured in all participants before and after treatment. In addition, the sino-nasal outcome test-20 and visual analog scale were applied before and after treatment. In the selenium supplement group, the visual analog scale, sino-nasal outcome test-20 scores, and enzyme levels were significantly improved compared with the untreated group. No adverse effects occurred in the selenium supplement group during the study. Supplemental selenium might be effective in the treatment of GR in terms of aging physiology and the oxidative system. However, large-scale randomized studies are needed to determine the optimal treatment. 


Safety and efficacy of extraturbinal microdebrider-assisted inferior turbinoplasty in children
Osama Galal Abdelnaby Awad

The Egyptian Journal of Otolaryngology 2019 35(2):140-146

Background Nasal obstruction is commonly seen in children and can be caused by a variety of factors. Turbinate hypertrophy has become a more frequent entity in pediatric patients presenting with nasal obstruction. Aim This study aims to assess the effectiveness and safety of extraturbinal microdebrider-assisted inferior turbinoplasty (MAIT) in relieving inferior turbinate hypertrophy in children. Patients and methods This prospective study was conducted from May 2016 to May 2017 in a tertiary referral hospital. Fifty pediatric patients with chronic hypertrophic rhinitis were enrolled in the study. We tried the extraturbinal MAIT technique to reduce inferior turbinate size. The degree of nasal obstruction was assessed using subjective, clinical symptom grading tools, visual analogue scale, and saccharin clearance test at 1 and 6 months postoperatively. Any postoperative complications were also noted. Results Mean age of patients were 12.7±9.5 years (range: 6–18 years). Significant postoperative improvement (P<0.001) was noted in the degree of nasal obstruction in 1 month and was maintained after a follow-up period of 6 months. Majority of patients had minimal crusting with good tissue healing with no adhesions or atrophic changes and with significant improvement of saccharin clearance time at 6 months postoperatively. Conclusion Extraturbinal MAIT is an effective and safe procedure in children compared with other reported procedures. 


Endoscopic endonasal prelacrimal recess approach for antrochoanal polyp
Wael F Ismaeil, Mohamed H Abdelazim

The Egyptian Journal of Otolaryngology 2019 35(2):147-154

Background The purpose of this study was to assess the effectiveness of endoscopic transnasal prelacrimal recess approach (ETPRA) in preventing the recurrence of antrochoanal polyps. Patients and methods A total of 32 patients with antrochoanal polyp were divided into two equal groups: group 1 included 16 patients who underwent endoscopic middle meatal antrostomy (EMMA), and group 2 included 16 patients who underwent a combined surgical technique using EMMA together with ETPRA. They were followed up from 24 to 36 months. Success rates for visualization of the origin of the polyps, surgical complications, and recurrence were evaluated. Results The most common symptoms were nasal obstruction (100%), snoring (75%), rhinorrhea (59.38%), headache (96.88%), and hyposmia (53.13%). The study found that postoperative complications varied between both groups. Recurrence was found in 18.75% in EMMA group and 0% in ETPRA group. They were statistically significant (P<0.05). However, nasolacrimal duct injury was found in two patients in ETPRA group, and postoperative lacrimation presented in only one (6.25%) patient of the same group. They were statistically insignificant (P>0.05). Conclusion Recurrence rate of antrochoanal polyp has been reduced with the usage of ETPRA in comparison with EMMA alone. 


The relation between chronic rhinosinusitis and sleep-disordered breathing
Yasser F El-Beltagy, Alaa F Ghita, Ossama M Mady, Ahmed M Ibrahim

The Egyptian Journal of Otolaryngology 2019 35(2):155-161

Background Chronic sinusitis is one of the most prevalent chronic illnesses affecting persons of all age groups. It is an inflammatory process that involves the paranasal sinuses and persists for 12 weeks or longer. Purpose The aim of this study was to investigate the effect of chronic rhinosinusitis (CRS) on sleep-disordered breathing. Patients and methods This study was conducted prospectively during the period spanning from June 2017 to June 2018 on 100 patients with CRS who attended to the ENT Departments of El-Maadi Armed Forces Medical Complex, Kobry El-Kobba Armed Forces Medical Complex, and El-Demerdash Hospitals. An additional 10 control patients were included in the study. All these patients gave informed consent to participate in this study. Results As regards apnea–hypopnea index, a comparative study between preoperative and postoperative measurements revealed a nonsignificant difference (P>0.05). As regards snore index and snore episodic measurements, the comparative study between preoperative and postoperative measurements revealed a highly significant decrease (P<0.01). As regards sleep efficiency and minimal and basal oxygen saturation measurements, the comparative study between preoperative and postoperative measurements revealed a highly significant increase (P<0.05). Conclusion Surgery decreased snoring and Epworth Sleepiness Scale scores, increased sleep efficiency and minimal and basal oxygen saturation measurements without changes in the apnea–hypopnea index, and improved sleep quality. 


Vitamin D levels in children diagnosed with acute otitis media
Mohamed A. M Salem, Mohamed Abdullah M., Zakria A Mohamed, Mohamed O. A Gad, Walla G Gadalla

The Egyptian Journal of Otolaryngology 2019 35(2):162-167

Objective To investigate the relationship between acute otitis media (AOM) and vitamin D level in children. Patients and methods This prospective study was conducted at Assiut University Hospital between December 2016 and March 2017. The study group comprised ambulatory children who were diagnosed with AOM and healthy controls. The blood sample (5 cm) was taken immediately after the diagnosis of AOM in the laboratory for measuring serum 25-hydroxyvitamin D. Abnormal value=deficiency+insufficiency. Results Of the 40 children included in this study, 30 were the cases and 10 were controls. The mean age of the cases was 4.92±3.08 and 5.92±4.04 years for the controls besides 18 (60%) of the AOM group were boys and 12 (40%) were girls, compared with five (50%) boys and five (50%) were girls in the control group. Otalgia and congested tympanic membrane were present in all children of the diseased group. Also 70% had upper respiratory tract infection preceding the attack of AOM and 33.3% had previous attack of AOM. Twenty-two (73.3%) out of 30 children of the AOM group have an abnormal value of vitamin D and it was statistically significant than the control group. Conclusion Both vitamin D deficiency and insufficiency were significant in children suffering from AOM than normal children. 


Impact of mastoidectomy on tympanoplasty for recurrent suppurative otitis media
Sayed Mohammed Said Kadah, Sayed Mohammed Mokhemar, Hoda. Ali Ibrahim, Hanem Elsayed Ibrahim

The Egyptian Journal of Otolaryngology 2019 35(2):168-172

Background There are still many questions about the pathogenesis of chronic suppurative otitis media (CSOM) and consequently about the optimal management medical or surgical interventions. Many otolaryngologists continue to routinely perform mastoidectomy with tympanoplasty, arguing that surgical aeration of the mastoid will improve outcomes by providing a reservoir of air that can buffer pressure changes in the middle ear according to Boyle’s law. Patients and methods During the period from December 2013 to October 2017, the mean age was ranging from 20 to 50 years; 25 (62.5%) patients were females, whereas 15 (37.5%) patients were male who were attending the Otorhinolaryngology Department, Al Zahraa University Hospital, with recurrent suppurative otitis media refractory to medical treatment. The 20 patients selected for this study were randomly assigned to undergo tympanoplasty with cortical mastoidectomy (n=20) and tympanoplasty alone (n=20). Results The factors that may influence surgery success rates are age, perforation location and size, Eustachian tube conditions, status of the middle-ear mucosa, the type of graft used, and surgeon experience. The primary argument in favor of mastoidectomy has been an improvement in the middle ear and mastoid environment through clearance of the diseased mucosa and through the ventilatory mechanisms of an open mastoid system, as a buffer to the changes in pressure within the middle ear. Conclusion There was no additional benefit to performing mastoidectomy with tympanoplasty for uncomplicated perforations. Mastoidectomies were generally performed with a worst disease, as suggested by the presence of extensive inflammation, or a sclerotic middle ear or mastoid. 


Effect on postoperative pain after topical application of local anesthetics in the tonsillar fossa after tonsillectomy
Ahmed El Daly, Moustafa Abd El Naby, Pola Emad

The Egyptian Journal of Otolaryngology 2019 35(2):173-181

Background Tonsillectomy is one of the most commonly performed surgeries in ENT practice. Despite improvements in anesthetic and surgical techniques, post-tonsillectomy morbidities continue to be a significant clinical concern. Pain is the cause of most of the postoperative morbidity after tonsillectomy. An effective pain therapy to block or modify the physiological responses to stress has become an essential component of modern pediatric anesthesia and surgical practice. Aim The present study compares the results between the effect of lidocaine 2% infiltration, lidocaine 10 % spray, and bupivacaine 0.5% spray in the tonsillar bed after tonsillectomy on postoperative pain. Materials and methods The study included a total of 120 patients aged 5–18 years who were candidates for tonsillectomy at the Otorhinolaryngology Department of Alexandria Main University Hospital. The patients were randomly divided into three groups of 40 patients each. Group A received lidocaine 2% (Xylocaine) peritonsillar infiltration 2 ml in one tonsillar bed and posterior pillar; group B received lidocaine 10% (Xylocaine) spray 2 puff in one tonsillar bed; group C received bupivacaine 0.5% (Marcaine) solution 2 ml in one tonsillar bed spray by syringe and the other tonsillar bed in each group receives pack with similar amounts of normal saline for 5 min as a control group after tonsillectomy before recovery from anesthesia. Results There was no statistical difference between the three studied groups as regards age and sex. There is significant statistical difference according to the frequency of throat pain and ear pain by comparing cases and controls of each group within the first 24 h after surgery. It appears that increased frequency of postoperative throat pain and ear pain is present with the control side (saline). Conclusion Topical application of the tonsillar bed with a local anesthetic after tonsillectomy results in significant reduction of postoperative throat pain and referred otalgia and should be used during surgery for tonsillectomy. 


Impact of voice disorders and microlaryngeal surgery on psychological profiles of Arabic-speaking professional and nonprofessional voice users
Ayatallah Sheikhany, Ahmed Atef, Osama Refaat, Ahmad Al Ali

The Egyptian Journal of Otolaryngology 2019 35(2):182-188

Introduction Voice disorders that impair normal social communication may cause subsequent emotional distress and are significantly associated with greater risk of anxiety and depression. The occurrence of vocal symptoms and voice disorders in professions where voice is an essential tool may cause stress and anxiety to the professionals suffering from them. Voice disorders in professionals have a major psychoemotional and social impact because they can threaten, shorten, or even end teachers’ and singers’ careers. Aim of the work Psychological impact of various voice disorders of professional and nonprofessional voice users has not yet been adequately studied according to the authors’ knowledge in the Egyptian population. It is therefore of great importance to shed light on the psychological impact of voice disorders on patients in an attempt to improve the quality of life of those patients. Patients and methods During the period of 6 months from June 2014 to December 2014, 40 patients were included prospectively in this work. Results and conclusion Professional voice users are more susceptible to psychological diseases than nonprofessional voice users. The degree of improvement postoperatively in professional voice users was statistically significant in all assessments of this study when compared with the nonprofessional voice users except in self-confidence and worth (Rosenberg self-esteem test). The best degree of improvement postoperatively was detected in the professional voice physically according to Jacobson scoring guidelines. There was a moderate relation between dysphonia and anxiety and depression according to the Voice Handicap Index and Kessler psychological distress scale results in this study. 


Formulation of a program for treatment of childhood dysphonia
Riham M Elmaghraby, Yehia A.A Ras, Maha M Elkaraksy

The Egyptian Journal of Otolaryngology 2019 35(2):189-194

Background Dysphonia is a disorder characterized by change in voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life. Childhood dysphonia has several adverse educational and psychosocial implications. Dysphonic children are not aware or not bothered by their voice disorder. Although dysphonia might, in some cases, improve by itself in adulthood, it can be of important value to treat the dysphonic voice already during childhood. Aim The aim of this study was to adapt and formulate a program of voice intervention for childhood dysphonia and apply it on Egyptian children to explore its effectiveness as a therapeutic tool. Patients and methods This study was conducted on 20 children of both sexes attending the Phoniatrics Unit in Alexandria Main University Hospital complaining of dysphonia. The remediation program aims to improve dysphonia in children using a combination of indirect and direct treatment techniques. It is a modification of The Boone Voice Program for Children combined with new technologies such as the voice games by Kay Elementrics. It is designed to provide the clinician with step-by-step procedures and materials to remediate voice disorders in school-aged children. The program was translated to Arabic and a number of modifications were done in order to adapt it to the Egyptian children. Results The study showed effectiveness of the remediation program for childhood dysphonia regarding some of the auditory perceptual assessment and acoustic analysis values. Some of the laryngeal examination findings also showed improvement post-therapy. The study showed significant relation between the children’s age, sex, diagnosis, and some pretherapy and post-therapy findings. Conclusion Data from the current study suggests that voice therapy may prove to be a valid alternative to just planned follow-up. 


A preliminary study on the composition of the early expressive lexicon in Egyptian infants and toddlers
Aisha F Abdel Hady, Heba M Farag, Ayatallah R Sheikhany

The Egyptian Journal of Otolaryngology 2019 35(2):195-206

Objective The aim of this study was to gain insight into early vocabulary size in Egyptian children aged between 12 and 30 months and to study the children’s lexicon composition at that young age while studying some demographic factors that might affect early vocabulary development. Participants and methods Parents of 150 children joining day care nurseries in Cairo were asked to fill in the Arabic vocabulary checklist designed in this study. The children were divided according to their age into three groups and then further subdivided according to their vocabulary size into low-vocabulary and high-vocabulary groups. Results Range and median and vocabulary percentages were estimated. Vocabulary size in older children is larger than younger children. More word types developed in the high-vocabulary group in younger age than in low-vocabulary group. All types of vocabulary continued to grow in older children in both low-vocabulary and high-vocabulary groups. There are differences between high-vocabulary and low-vocabulary groups in some demographic factors. Conclusion In this study, the vocabulary size for Arabic infants and toddlers is less than some languages. There are delays and differences between low-vocabulary and high-vocabulary groups regarding the linguistic composition and some demographic factors. 


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