Redefining the morphometry of subclavian vessels for clavicle fracture treatments

Abstract

Purpose

Clavicle fractures are common injuries in adults and children. Although neurovascular damage is rarely seen, acute subclavian artery pseudoaneurysms and injuries to subclavian vessels were reported for closed fractures of the clavicle. The aim of this study was to identify the morphological details of the subclavian vessels and their relation to the sternoclavicular joint and body of the clavicle.

Methods

127 patients (66 females and 61 males) were evaluated using reconstructed three-dimensional computed tomographic angiographies. The point at which the subclavian artery crossed posterior to the clavicle was detected as a landmark. The medio-lateral distance between the sternal end of the clavicle, landmark, antero-posterior distance between the clavicle and the subclavian artery, diameter of the artery and vein, angle between the subclavian artery and vein, distance of the subclavian vein to the subclavian artery and the clavicle at the landmark were measured. Measurements were compared according to gender and right and left sides, and age correlation was determined.

Results

Morphometric relationship between the subclavian vessels and clavicle presented differences between genders. We measured the antero-posterior distance between the subclavian artery and the clavicle to be less than 1 cm (0.91 cm).

Conclusion

The subclavian artery travelled longer distances in men than women to reach the point that it crossed the clavicle. Our results demonstrated that the subclavian artery does not pass from the inferior margin of the clavicle, thus, superior plate osteosynthesis does not have any risk to injury against the subclavian vessels during the management of the clavicle fractures.

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Redefining the morphometry of subclavian vessels for clavicle fracture treatments

Abstract

Purpose

Clavicle fractures are common injuries in adults and children. Although neurovascular damage is rarely seen, acute subclavian artery pseudoaneurysms and injuries to subclavian vessels were reported for closed fractures of the clavicle. The aim of this study was to identify the morphological details of the subclavian vessels and their relation to the sternoclavicular joint and body of the clavicle.

Methods

127 patients (66 females and 61 males) were evaluated using reconstructed three-dimensional computed tomographic angiographies. The point at which the subclavian artery crossed posterior to the clavicle was detected as a landmark. The medio-lateral distance between the sternal end of the clavicle, landmark, antero-posterior distance between the clavicle and the subclavian artery, diameter of the artery and vein, angle between the subclavian artery and vein, distance of the subclavian vein to the subclavian artery and the clavicle at the landmark were measured. Measurements were compared according to gender and right and left sides, and age correlation was determined.

Results

Morphometric relationship between the subclavian vessels and clavicle presented differences between genders. We measured the antero-posterior distance between the subclavian artery and the clavicle to be less than 1 cm (0.91 cm).

Conclusion

The subclavian artery travelled longer distances in men than women to reach the point that it crossed the clavicle. Our results demonstrated that the subclavian artery does not pass from the inferior margin of the clavicle, thus, superior plate osteosynthesis does not have any risk to injury against the subclavian vessels during the management of the clavicle fractures.

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[Immunohistochemical Detection of Mast and Dendritic Cells in Periprosthetic Tissues of Aseptically Loosened Total Prostheses].

CONCLUSIONS We proved the presence of two immunologically significant cell populations in periprosthetic tissues. The said findings indicate a conclusion of significant functional participation of mast and dendritic cells in pathogenesis of aseptic loosening and periprosthetic osteolysis. Nevertheless, this will have to be proved in another way and with the use of another method. Key words:dendritic cells, mast cells, aseptic loosening, total joint replacement, immune reaction, adverse reaction. PMID: 30383532 [PubMed - in process] (Source: Acta Orthopaedica)

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Something Smells Fishy

​A 32-year-old woman and her 36-year-old husband with no past medical history presented to the ED with palpitations, headache, a feeling of warmth all over, and a rash extending from their upper chests to their faces.The blood pressures of the wife and husband were 91/56 mm Hg and 93/61 mm Hg, respectively. Both were mildly tachycardic with heart rates of 112 bpm and 108 bpm. The patients described intense pruritus, and they had patchy blanching and erythema over their chests and faces with mild eyelid edema. They reported that their symptoms started five to 10 minutes after sharing an ahi tuna poke bowl.What Is the Differential Diagnosis?Allergic reaction, MSG reaction, disulfiram reaction, tyramine reaction, and carcinoid syndrome.What Is the Diagnosis?The patients were diagnosed ...

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[Immunohistochemical Detection of Mast and Dendritic Cells in Periprosthetic Tissues of Aseptically Loosened Total Prostheses].

CONCLUSIONS We proved the presence of two immunologically significant cell populations in periprosthetic tissues. The said findings indicate a conclusion of significant functional participation of mast and dendritic cells in pathogenesis of aseptic loosening and periprosthetic osteolysis. Nevertheless, this will have to be proved in another way and with the use of another method. Key words:dendritic cells, mast cells, aseptic loosening, total joint replacement, immune reaction, adverse reaction. PMID: 30383532 [PubMed - in process] (Source: Acta Orthopaedica)

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2D214ym

Something Smells Fishy

​A 32-year-old woman and her 36-year-old husband with no past medical history presented to the ED with palpitations, headache, a feeling of warmth all over, and a rash extending from their upper chests to their faces.The blood pressures of the wife and husband were 91/56 mm Hg and 93/61 mm Hg, respectively. Both were mildly tachycardic with heart rates of 112 bpm and 108 bpm. The patients described intense pruritus, and they had patchy blanching and erythema over their chests and faces with mild eyelid edema. They reported that their symptoms started five to 10 minutes after sharing an ahi tuna poke bowl.What Is the Differential Diagnosis?Allergic reaction, MSG reaction, disulfiram reaction, tyramine reaction, and carcinoid syndrome.What Is the Diagnosis?The patients were diagnosed ...

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Proliferating Trichilemmal Tumor of the Auricula: A Very Rare Locus

Abstract

Proliferating trichilemmal tumor (PTT) is a rare but morphologically characteristic tumor, derived from the external root sheath. They are commonly localized as a solitary lesion on the scalp. They rarely occur in other regions. PTTs generally behave in a benign fashion, up to 20% of the lesions may undergo malignant transformation into squamous carcinoma. We present an elderly woman with a cystic swelling on the crus of auricular helix diagnosed as PTT. To our knowledge, this is the first case in the English literature, of PTT of the auricula.

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Proliferating Trichilemmal Tumor of the Auricula: A Very Rare Locus

Abstract

Proliferating trichilemmal tumor (PTT) is a rare but morphologically characteristic tumor, derived from the external root sheath. They are commonly localized as a solitary lesion on the scalp. They rarely occur in other regions. PTTs generally behave in a benign fashion, up to 20% of the lesions may undergo malignant transformation into squamous carcinoma. We present an elderly woman with a cystic swelling on the crus of auricular helix diagnosed as PTT. To our knowledge, this is the first case in the English literature, of PTT of the auricula.

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Sublingual Immunotherapy Tablets Relieve Symptoms in Adults with Allergic Rhinitis: A Meta-analysis of Randomized Clinical Trials.

Conclusions: SLIT tablets effectively relieve rhinitis symptoms in adults with allergic rhinitis. Nevertheless, the current evidence may be limited due to sample size and the heterogeneity between studies. Large sample size and multiple center RCTs on the efficacy of different formulations of SLIT drugs are still needed to provide further evidence and a more precise recommendation. PMID: 30381592 [PubMed - in process] (Source: Chinese Medical Journal)

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Propofol (TIVA) Versus Volatile-Based Anesthetics: Is There Any Oncological Benefit?

Abstract

Purpose of Review

To summarize the most recent available clinical and pre-clinical research data concerning the effects of propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia on oncological outcomes and to discuss the biological basis by which these drugs are purported to exert effects on the cancer cell and on the host.

Recent Findings

Recent retrospective analyses of clinical datasets have generated considerable interest in the hypothesis that the two major classes of general anesthetics in clinical use for oncological surgery—namely inhalational fluranes and intravenous propofol—disparately influence post-operative cancer outcomes. There is also growing pre-clinical data to indicate that these drugs exert distinct effects on cancer cell and immune cell phenotypes.

Summary

The available evidence tends to support the superiority of propofol in terms of the effect on oncological outcomes, but there is a lack of prospective data and a need to be mindful of the complexity and heterogeneity of both the perioperative period and cancer as a disease when interpreting study results and deciding future directions.

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Rhytidectomy in Patients with Cochlear Implants

Facial plast Surg DOI: 10.1055/s-0038-1666872As the incidence of rhytidectomy and cochlear implantation increases, so does the likelihood that an individual patient will undergo both procedures over their lifetime. This is particularly relevant as the US population not only ages but ages well. The purpose of this paper is to describe cochlear implants and to characterize pre-, intra-, and postoperative considerations of rhytidectomy in patients with cochlear implants. A thorough understanding of the relevant anatomy and physiology is crucial to the avoidance of potentially serious complications in patients with cochlear implants. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Sou...

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Negative hearing effects of a single course of IV aminoglycoside therapy in cystic fibrosis patients

. (Source: International Journal of Audiology)

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Effects of signal bandwidth on listening effort in young- and middle-aged adults

. (Source: International Journal of Audiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zy5gmv

Inter-frequency amplitude ratio of oVEMP for differentiating Meniere ’s disease from BPPV: clinical validation using a double-blind approach

. (Source: International Journal of Audiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2SH2xQo

Sublingual Immunotherapy Tablets Relieve Symptoms in Adults with Allergic Rhinitis: A Meta-analysis of Randomized Clinical Trials.

Conclusions: SLIT tablets effectively relieve rhinitis symptoms in adults with allergic rhinitis. Nevertheless, the current evidence may be limited due to sample size and the heterogeneity between studies. Large sample size and multiple center RCTs on the efficacy of different formulations of SLIT drugs are still needed to provide further evidence and a more precise recommendation. PMID: 30381592 [PubMed - in process] (Source: Chinese Medical Journal)

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zm7bu8

Propofol (TIVA) Versus Volatile-Based Anesthetics: Is There Any Oncological Benefit?

Abstract

Purpose of Review

To summarize the most recent available clinical and pre-clinical research data concerning the effects of propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia on oncological outcomes and to discuss the biological basis by which these drugs are purported to exert effects on the cancer cell and on the host.

Recent Findings

Recent retrospective analyses of clinical datasets have generated considerable interest in the hypothesis that the two major classes of general anesthetics in clinical use for oncological surgery—namely inhalational fluranes and intravenous propofol—disparately influence post-operative cancer outcomes. There is also growing pre-clinical data to indicate that these drugs exert distinct effects on cancer cell and immune cell phenotypes.

Summary

The available evidence tends to support the superiority of propofol in terms of the effect on oncological outcomes, but there is a lack of prospective data and a need to be mindful of the complexity and heterogeneity of both the perioperative period and cancer as a disease when interpreting study results and deciding future directions.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2SHuzuL

Rhytidectomy in Patients with Cochlear Implants

Facial plast Surg DOI: 10.1055/s-0038-1666872As the incidence of rhytidectomy and cochlear implantation increases, so does the likelihood that an individual patient will undergo both procedures over their lifetime. This is particularly relevant as the US population not only ages but ages well. The purpose of this paper is to describe cochlear implants and to characterize pre-, intra-, and postoperative considerations of rhytidectomy in patients with cochlear implants. A thorough understanding of the relevant anatomy and physiology is crucial to the avoidance of potentially serious complications in patients with cochlear implants. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Sou...

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Negative hearing effects of a single course of IV aminoglycoside therapy in cystic fibrosis patients

. (Source: International Journal of Audiology)

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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2SMaioa

Effects of signal bandwidth on listening effort in young- and middle-aged adults

. (Source: International Journal of Audiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2zy5gmv

Inter-frequency amplitude ratio of oVEMP for differentiating Meniere ’s disease from BPPV: clinical validation using a double-blind approach

. (Source: International Journal of Audiology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2SH2xQo

School-based Interventions – Where Do We Go From Here?

(Source: Journal of Allergy and Clinical Immunology)

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IgE to galactose- α-1,3-galactose and the α-Gal syndrome: Insights from Basophil Activation Testing

(Source: Journal of Allergy and Clinical Immunology)

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School-based Interventions – Where Do We Go From Here?

(Source: Journal of Allergy and Clinical Immunology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2OoYp3U

IgE to galactose- α-1,3-galactose and the α-Gal syndrome: Insights from Basophil Activation Testing

(Source: Journal of Allergy and Clinical Immunology)

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Familial congenital choanal atresia with GATA3 associated hypoparathyroidism-deafness-renal dysplasia syndrome unidentified on auditory brainstem response

Hypoparathyroidism-deafness-renal dysplasia (HDR) syndrome is a rare autosomal dominant disorder primarily caused by GATA3 haploinsufficiency and is challenging to diagnose in early childhood. We report a Japanese family with HDR syndrome and congenital choanal atresia. The 6-year-old female proband was diagnosed with epilepsy at the age of three. Under carbamazepine monotherapy, the patient presented hypoparathyroidism accompanied by severe hypocalcemia. Subsequently, renal ultrasound analysis revealed bilateral multicystic dysplastic kidneys.

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Frito-Lay Issues Allergy Alert on Undeclared Milk In Select Smartfood Delight Sea Salt Flavored Popcorn

Frito-Lay announced a voluntary recall of select 1/2 oz. bags of Smartfood Delight Sea Salt Flavored popcorn because they were inadvertently filled with cheese flavored tortilla chips that contain undeclared milk ingredients. The recalled bags were sold only in the two variety packs listed below. (Source: Food and Drug Administration)

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Medical News Today: How to manage a polyester allergy

A person with a polyester allergy may experience irritation, redness, and other symptoms when their skin comes into direct contact with polyester. The best way to treat this allergy is to avoid all fabrics containing polyester. Learn more here. (Source: Health News from Medical News Today)

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Frito-Lay Issues Allergy Alert on Undeclared Milk In Select Smartfood Delight Sea Salt Flavored Popcorn

Frito-Lay announced a voluntary recall of select 1/2 oz. bags of Smartfood Delight Sea Salt Flavored popcorn because they were inadvertently filled with cheese flavored tortilla chips that contain undeclared milk ingredients. The recalled bags were sold only in the two variety packs listed below. (Source: Food and Drug Administration)

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Medical News Today: How to manage a polyester allergy

A person with a polyester allergy may experience irritation, redness, and other symptoms when their skin comes into direct contact with polyester. The best way to treat this allergy is to avoid all fabrics containing polyester. Learn more here. (Source: Health News from Medical News Today)

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Rhytidectomy in Patients with Cochlear Implants

Facial plast Surg
DOI: 10.1055/s-0038-1666872

As the incidence of rhytidectomy and cochlear implantation increases, so does the likelihood that an individual patient will undergo both procedures over their lifetime. This is particularly relevant as the US population not only ages but ages well. The purpose of this paper is to describe cochlear implants and to characterize pre-, intra-, and postoperative considerations of rhytidectomy in patients with cochlear implants. A thorough understanding of the relevant anatomy and physiology is crucial to the avoidance of potentially serious complications in patients with cochlear implants.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Donor limb assessment after vascularized groin lymph node transfer for the treatment of breast cancer-related lymphedema: Clinical and lymphoscintigraphy findings

Vascularized lymph node transfer is an established treatment for secondary lymphedema. Different donor sites of lymph node flap have been described. In our institute, vascularized groin lymph node (VGLN) flap is the workhorse flap for treating breast cancer-related lymphedema (BCRL). Potential complications of VGLN flap harvesting include seroma formation, thigh dysaesthesia and iatrogenic lymphedema.

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Lower eyelid excursion: A functional and cosmetically relevant parameter in the treatment of lower eyelid retraction

The purpose of this study was to assess and quantify lower lid excursion following repair of lower lid retraction.In this retrospective cohort study, a case review of patients who had undergone ear-cartilage grafting for lower lid retraction was undertaken. Surgical correction involved the placement of autologous cartilage between the tarsal plate and lower lid retractors. Measurements taken pre- and post-operatively were the marginal reflex 2 (MRD2) and the lower scleral show (LSS). The lower lid excursion on downgaze (LLE) was measured only post-operatively with a comparison made between operated eyes and control eyes.

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Rhytidectomy in Patients with Cochlear Implants

Facial plast Surg
DOI: 10.1055/s-0038-1666872

As the incidence of rhytidectomy and cochlear implantation increases, so does the likelihood that an individual patient will undergo both procedures over their lifetime. This is particularly relevant as the US population not only ages but ages well. The purpose of this paper is to describe cochlear implants and to characterize pre-, intra-, and postoperative considerations of rhytidectomy in patients with cochlear implants. A thorough understanding of the relevant anatomy and physiology is crucial to the avoidance of potentially serious complications in patients with cochlear implants.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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A New Technique for Augmentation Rhinoplasty Using Hybrid Autologous Grafts with Septal Extension Grafts in Asian Patients

Facial plast Surg
DOI: 10.1055/s-0038-1666992

Augmentation rhinoplasty is commonly performed to raise the nasal dorsum in Asian individuals. However, materials used for dorsal augmentation are associated with various surgical challenges and complications. In this article, the authors present a novel dorsal augmentation technique combining hybrid autologous costal grafts with septal extension grafts. The records of 28 patients (19 women and 9 men; mean age: 27 years; range: 18–43 years) who underwent augmentation rhinoplasty (primary or revision) with our novel technique from December 2007 to December 2016 were retrospectively reviewed. Our technique included septal extension grafts for nasal tip projection and hybrid costal cartilage grafts, with a solid boat-shaped portion for bony dorsum augmentation and a fascia-wrapped diced cartilage graft for cartilaginous dorsum augmentation. Objective and subjective outcomes and complications were evaluated. Anthropometric parameters were measured on facial photographs to evaluate surgical outcomes in the 15 primary cases. Objective anthropometric measurements revealed successful augmentation of all nasal parameters. The nasal tip was mobile and comfortable in all patients. Among the 28 patients, 12 (42.9%) were very satisfied, 10 (35.7%) were satisfied, and 6 (21.4%) were unsatisfied with surgical results and required revision surgery. No immediate postoperative complications occurred. Ten (35.7%) patients experienced graft-related complications, including visibility or warping of the solid graft, supratip depression, and caudal deviation of the septal extension graft. None of these complications was serious. Augmentation rhinoplasty using hybrid autologous costal grafts with septal extension grafts allows dorsal augmentation with suitable graft material for each recipient site and can achieve successful outcomes in Asian patients.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Donor limb assessment after vascularized groin lymph node transfer for the treatment of breast cancer-related lymphedema: Clinical and lymphoscintigraphy findings

Vascularized lymph node transfer is an established treatment for secondary lymphedema. Different donor sites of lymph node flap have been described. In our institute, vascularized groin lymph node (VGLN) flap is the workhorse flap for treating breast cancer-related lymphedema (BCRL). Potential complications of VGLN flap harvesting include seroma formation, thigh dysaesthesia and iatrogenic lymphedema.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Dkg4sE

Medical News Today: How to manage a polyester allergy

A person with a polyester allergy may experience irritation, redness, and other symptoms when their skin comes into direct contact with polyester. The best way to treat this allergy is to avoid all fabrics containing polyester. Learn more here. (Source: Health News from Medical News Today)

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Autoimmune inner ear disease (AIED): A diagnostic challenge.

Authors: Ciorba A, Corazzi V, Bianchini C, Aimoni C, Pelucchi S, Skarżyński PH, Hatzopoulos S Abstract Autoimmune inner ear disease (AIED) has been defined as a condition of bilateral sensorineural hearing loss (SNHL), caused by an 'uncontrolled' immune system response. The inner ear can be the direct target of the immune response, but it can be additionally damaged by a deposition of circulating immune complexes or by systemic immune-mediated diseases. The clinical expression of immune-mediated inner ear disease shows a progressive bilateral and asymmetric SNHL profile, which typically benefits from a steroid and immunosuppressive therapy. The onset of AIED is between 3 and 90 days. Cochlear symptoms can be associated with vestibular disorders and in 15%-30% of cases, AIED occ...

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Intratympanic steroids as a salvage therapy for severe to profound idiopathic sudden sensorineural hearing loss.

CONCLUSION: Intratympanic steroids failed to show a global auditory benefit as a salvage treatment in patients with severe ISSNHL. SIGNIFICANCE: Our data suggest that a salvage treatment with intratympanic dexamethasone may be offered to patients with total deafness for whom the first systemic treatment has failed. PMID: 30380957 [PubMed - as supplied by publisher] (Source: Acta Oto-Laryngologica)

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Frito-Lay Issues Allergy Alert on Undeclared Milk In Select Smartfood Delight Sea Salt Flavored Popcorn

Frito-Lay announced a voluntary recall of select 1/2 oz. bags of Smartfood Delight Sea Salt Flavored popcorn because they were inadvertently filled with cheese flavored tortilla chips that contain undeclared milk ingredients. The recalled bags were sold only in the two variety packs listed below. (Source: Food and Drug Administration)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Medical News Today: How to manage a polyester allergy

A person with a polyester allergy may experience irritation, redness, and other symptoms when their skin comes into direct contact with polyester. The best way to treat this allergy is to avoid all fabrics containing polyester. Learn more here. (Source: Health News from Medical News Today)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EXDSUN

School-based Interventions – Where Do We Go From Here?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2P2bQvQ

IgE to galactose-α-1,3-galactose and the α-Gal syndrome: Insights from Basophil Activation Testing

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CZXQvC

School-based Interventions – Where Do We Go From Here?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2P2bQvQ

IgE to galactose-α-1,3-galactose and the α-Gal syndrome: Insights from Basophil Activation Testing

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CZXQvC

Power Up, and Mix With Other Stars and Champions at Convention!

Want to promote your certification and professional services? Raise your profile in the community? See the professions featured more in the news? Become the next ASHA Member Media Champion? Learn how to do all this and more at the 2018 ASHA Convention. ASHA's Public Relations Department is sponsoring a variety of opportunities in Boston for certified members—focused on helping you promote yourself in the community, online and in the media. Read on to learn all these offerings November 15-17: Take part in the "Value of the CCCs" campaign photo shoot By now, you've probably seen ads for the "Value of the CCCs" campaign featuring ASHA-certified members. Part of the award-winning public relations campaign that is now in its fourth year, the ads showcase the uniqu...

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Foreign Bodies in the Ear and Nose a True Test of EP Mettle

​Pediatric patients frequently put foreign bodies into their mouths, noses, and ears. The spectrum of foreign bodies that children place into their facial orifices are impressive. Paper, vegetable matter (such as peanuts), toys, beads, metal screws, and Play-Doh are just a few examples.The insertions are often done surreptitiously, only to be discovered days or sometimes weeks later. Occasionally, the retained foreign nasal bodies will ferment and present with a purulent, unilateral nasal drainage, accompanied by an unrelentingly repulsive odor. Sometimes an occasional cockroach wanders into the external auditory canal looking for a dark, moist cavity for sleeping or laying eggs. There appears to be a preference for the right nostrils or right external auditory canal, which correlates wi...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Dld5QJ

Power Up, and Mix With Other Stars and Champions at Convention!

Want to promote your certification and professional services? Raise your profile in the community? See the professions featured more in the news? Become the next ASHA Member Media Champion? Learn how to do all this and more at the 2018 ASHA Convention. ASHA's Public Relations Department is sponsoring a variety of opportunities in Boston for certified members—focused on helping you promote yourself in the community, online and in the media. Read on to learn all these offerings November 15-17: Take part in the "Value of the CCCs" campaign photo shoot By now, you've probably seen ads for the "Value of the CCCs" campaign featuring ASHA-certified members. Part of the award-winning public relations campaign that is now in its fourth year, the ads showcase the uniqu...

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Foreign Bodies in the Ear and Nose a True Test of EP Mettle

​Pediatric patients frequently put foreign bodies into their mouths, noses, and ears. The spectrum of foreign bodies that children place into their facial orifices are impressive. Paper, vegetable matter (such as peanuts), toys, beads, metal screws, and Play-Doh are just a few examples.The insertions are often done surreptitiously, only to be discovered days or sometimes weeks later. Occasionally, the retained foreign nasal bodies will ferment and present with a purulent, unilateral nasal drainage, accompanied by an unrelentingly repulsive odor. Sometimes an occasional cockroach wanders into the external auditory canal looking for a dark, moist cavity for sleeping or laying eggs. There appears to be a preference for the right nostrils or right external auditory canal, which correlates wi...

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Very early-onset inflammatory bowel disease: an integrated approach

Purpose of review Immune dysregulation disorders are among the most rapidly growing set of inborn errors of immunity. One particular subset is the category where early-onset inflammatory bowel disease (IBD) is the most common manifestation. These disorders are being increasingly appreciated although there has been minimal effort to articulate a unified approach to their diagnosis and management. This review will cover current thinking and strategies related to diagnosis and management of very early-onset IBD. Recent findings There is an expanding set of monogenic causes of early-onset IBD. In many cases, the precise genetic cause dictates management. Lessons learned from the management of these monogenic conditions can sometimes be extrapolated to other refractory cases of IBD. Summa...

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Secondary antibody deficiency in neurology

Purpose of review Induction of lymphocyte depletion is increasingly used as a therapeutic strategy for central and peripheral neuroinflammatory disease. However, there is also a growing recognition of the treatment-related complication of secondary antibody deficiency (SAD). Although the occurrence of hypogammaglobulinaemia is a recognized phenomenon during immunomodulation, robust data on the coexistence of impaired responses to immunization, and significant and/or atypical infections is scarce. Here we review the literature on SAD in anti-CD20 therapy. Recent findings Several factors that may increase the incidence of SAD have now been identified, including low levels of immunoglobulins prior to the commencement of B-cell ablation therapy, duration of maintenance therapy, and concur...

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Allergen immunotherapy as add-on to biologic agents

Purpose of review In this review, we sought to outline many of the recent evidences about the available clinical trials in which biologic agents [i.e. omalizumab (OMA)] were associated as add-on to allergen-specific immunotherapy (AIT). Recent findings The available literature shows that OMA may be a valuable option as add-on to AIT for respiratory allergy, or food desensitization, especially in the escalation or build-up phases, in which adverse events are more commonly expected. The encouraging data for hymenoptera venom allergy remain limited to case reports, and no structured clinical trial is available. Summary Over the past decade, studies of OMA used with AIT have shown promising results. Today, big randomized, double-blind, placebo-controlled trials are needed to better sel...

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What is new in HIES? Recent insights from the interface of primary immune deficiency and atopy

Purpose of review Understanding the pathophysiology of monogenic primary immunodeficiency (PID) with atopic presentation has pivotal implications for intervention strategies and potentially wider polygenic atopic-related traits. This review will discuss advances in gene discovery arising from monogenic defects at the interface between PID and atopy, notably the hyper-IgE syndromes. Recent findings Key molecular pathways underlying development of primary atopic diseases have recently been proposed. We test this classification through reviewing novel genes reported in the last 2 years and compare insights from pathway-analysis of genome-wide association studies (GWAS) of atopic-related traits. Growing access to next-generation sequencing (NGS) has resulted in a surge in gene discovery,...

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Role of allergen-specific T-follicular helper cells in immunotherapy

Purpose of review The discovery of novel T-cell subsets including follicular helper T (Tfh) cells has broadened our knowledge on the complex immune networks in allergic diseases. This review summarizes the evidence for Tfh cells in controlling immune responses to allergens with a particular focus on immunoglobulin E (IgE) production and discusses the implication of such regulation in allergen-specific immunotherapy. Recent findings Tfh cells support the production of IgE in animal models for allergic diseases. Among Tfh cells, the type 2 subset (Tfh2) is considered as the major player that secretes IL-4 and promotes the isotype switching to IgE. In human inflammatory airway diseases, including allergic rhinitis, asthma, and nasal polyps, the increased frequencies of circulating or tis...

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Very early onset IBD: novel genetic aetiologies

Purpose of review To summarize the current understanding and recent advances on the genetic aetiology in the pathogenesis of very early onset inflammatory bowel disease (VEO-IBD). Recent findings IBD is a chronic disorder of the gastrointestinal tract whose manifestation is a result of complex interactions between genetics, environment, immune system and microbial flora. Over 230 IBD risk loci have been reported in genome wide association studies but the genetic contribution of the majority of these loci in the manifestation of IBD is very low. Patients with VEO-IBD present with a more severe disease than older patients, characterized by poor prognosis and failure of conventional therapy. Recent studies have reported several monogenic diseases with high penetrance that present with IB...

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Nasal challenges in allergen immunotherapy trials

Purpose of review The nasal allergen challenge (NAC) model can be a valuable diagnostic tool for allergic rhinitis. Alongside its clinical use, NACs can be used as primary and secondary endpoints in studies evaluating allergen immunotherapy (AIT) products for allergic rhinitis treatment. This review will discuss the technical aspects of the NAC model and provide a summary of recent studies using NACs to assess existing and new AIT treatments. Recent findings Over the last 2 years, both titrated and single-dose nasal challenge protocols have been used to evaluate immunotherapies targeting grass, birch, house dust mite, and cat allergens. Early efficacy and dose-finding trials showed improvements in allergic symptoms and nasal tolerance to allergens after AIT treatment with standardized...

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Advances in site-specific gene editing for primary immune deficiencies

Purpose of review Conventional gene therapy has been a successful, curative treatment modality for many primary immune deficiencies with significant improvements in the last decade. However, the risk of leukemic transformation with viral-mediated gene addition still remains, and unregulated gene addition is not an option for certain diseases in which the target gene is closely controlled. The recent bloom in genome modification platforms has created the opportunity to site-specifically correct mutated DNA base pairs or insert a corrective cDNA minigene while maintaining gene expression under control of endogenous regulatory elements. Recent findings There is an abundance of ongoing research utilizing programmable nucleases to facilitate site-specific gene correction of many primary im...

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Editorial introductions

No abstract available (Source: Current Opinion in Allergy and Clinical Immunology)

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Biological treatments for severe asthma: where do we stand?

Purpose of review For patients with severe asthma, disease control is not achieved resulting in persistent morbidity and risks for exacerbations. The advent of biologics is providing a new form of treatment for many with severe asthma. Recent findings Four mAb biologics are approved for clinical use: omalizumab (anti-IgE) and three antieosinophilic interventions (mepolizumab, reslizumab, and benralizumab). These four biologics target components of the type 2-inflammatory pathway which is reflected by biomarkers: peripheral blood eosinophils and exhaled nitric oxide. In severe asthma, biologics have reduced asthma exacerbations. The antieosinophilic biologics have also improved lung function. The safety profile of these biologics has been good. Summary For patients with severe asthm...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qt3QFn

Very early-onset inflammatory bowel disease: an integrated approach

Purpose of review Immune dysregulation disorders are among the most rapidly growing set of inborn errors of immunity. One particular subset is the category where early-onset inflammatory bowel disease (IBD) is the most common manifestation. These disorders are being increasingly appreciated although there has been minimal effort to articulate a unified approach to their diagnosis and management. This review will cover current thinking and strategies related to diagnosis and management of very early-onset IBD. Recent findings There is an expanding set of monogenic causes of early-onset IBD. In many cases, the precise genetic cause dictates management. Lessons learned from the management of these monogenic conditions can sometimes be extrapolated to other refractory cases of IBD. Summa...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CYSRez

Secondary antibody deficiency in neurology

Purpose of review Induction of lymphocyte depletion is increasingly used as a therapeutic strategy for central and peripheral neuroinflammatory disease. However, there is also a growing recognition of the treatment-related complication of secondary antibody deficiency (SAD). Although the occurrence of hypogammaglobulinaemia is a recognized phenomenon during immunomodulation, robust data on the coexistence of impaired responses to immunization, and significant and/or atypical infections is scarce. Here we review the literature on SAD in anti-CD20 therapy. Recent findings Several factors that may increase the incidence of SAD have now been identified, including low levels of immunoglobulins prior to the commencement of B-cell ablation therapy, duration of maintenance therapy, and concur...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qrLQeS

Allergen immunotherapy as add-on to biologic agents

Purpose of review In this review, we sought to outline many of the recent evidences about the available clinical trials in which biologic agents [i.e. omalizumab (OMA)] were associated as add-on to allergen-specific immunotherapy (AIT). Recent findings The available literature shows that OMA may be a valuable option as add-on to AIT for respiratory allergy, or food desensitization, especially in the escalation or build-up phases, in which adverse events are more commonly expected. The encouraging data for hymenoptera venom allergy remain limited to case reports, and no structured clinical trial is available. Summary Over the past decade, studies of OMA used with AIT have shown promising results. Today, big randomized, double-blind, placebo-controlled trials are needed to better sel...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CYSQav

What is new in HIES? Recent insights from the interface of primary immune deficiency and atopy

Purpose of review Understanding the pathophysiology of monogenic primary immunodeficiency (PID) with atopic presentation has pivotal implications for intervention strategies and potentially wider polygenic atopic-related traits. This review will discuss advances in gene discovery arising from monogenic defects at the interface between PID and atopy, notably the hyper-IgE syndromes. Recent findings Key molecular pathways underlying development of primary atopic diseases have recently been proposed. We test this classification through reviewing novel genes reported in the last 2 years and compare insights from pathway-analysis of genome-wide association studies (GWAS) of atopic-related traits. Growing access to next-generation sequencing (NGS) has resulted in a surge in gene discovery,...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qs8F1W

Role of allergen-specific T-follicular helper cells in immunotherapy

Purpose of review The discovery of novel T-cell subsets including follicular helper T (Tfh) cells has broadened our knowledge on the complex immune networks in allergic diseases. This review summarizes the evidence for Tfh cells in controlling immune responses to allergens with a particular focus on immunoglobulin E (IgE) production and discusses the implication of such regulation in allergen-specific immunotherapy. Recent findings Tfh cells support the production of IgE in animal models for allergic diseases. Among Tfh cells, the type 2 subset (Tfh2) is considered as the major player that secretes IL-4 and promotes the isotype switching to IgE. In human inflammatory airway diseases, including allergic rhinitis, asthma, and nasal polyps, the increased frequencies of circulating or tis...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CWU2ey

Very early onset IBD: novel genetic aetiologies

Purpose of review To summarize the current understanding and recent advances on the genetic aetiology in the pathogenesis of very early onset inflammatory bowel disease (VEO-IBD). Recent findings IBD is a chronic disorder of the gastrointestinal tract whose manifestation is a result of complex interactions between genetics, environment, immune system and microbial flora. Over 230 IBD risk loci have been reported in genome wide association studies but the genetic contribution of the majority of these loci in the manifestation of IBD is very low. Patients with VEO-IBD present with a more severe disease than older patients, characterized by poor prognosis and failure of conventional therapy. Recent studies have reported several monogenic diseases with high penetrance that present with IB...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qoVqPl

Nasal challenges in allergen immunotherapy trials

Purpose of review The nasal allergen challenge (NAC) model can be a valuable diagnostic tool for allergic rhinitis. Alongside its clinical use, NACs can be used as primary and secondary endpoints in studies evaluating allergen immunotherapy (AIT) products for allergic rhinitis treatment. This review will discuss the technical aspects of the NAC model and provide a summary of recent studies using NACs to assess existing and new AIT treatments. Recent findings Over the last 2 years, both titrated and single-dose nasal challenge protocols have been used to evaluate immunotherapies targeting grass, birch, house dust mite, and cat allergens. Early efficacy and dose-finding trials showed improvements in allergic symptoms and nasal tolerance to allergens after AIT treatment with standardized...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CWTZiS

Advances in site-specific gene editing for primary immune deficiencies

Purpose of review Conventional gene therapy has been a successful, curative treatment modality for many primary immune deficiencies with significant improvements in the last decade. However, the risk of leukemic transformation with viral-mediated gene addition still remains, and unregulated gene addition is not an option for certain diseases in which the target gene is closely controlled. The recent bloom in genome modification platforms has created the opportunity to site-specifically correct mutated DNA base pairs or insert a corrective cDNA minigene while maintaining gene expression under control of endogenous regulatory elements. Recent findings There is an abundance of ongoing research utilizing programmable nucleases to facilitate site-specific gene correction of many primary im...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2qnOVwk

Editorial introductions

No abstract available (Source: Current Opinion in Allergy and Clinical Immunology)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2CWTUf4

Biological treatments for severe asthma: where do we stand?

Purpose of review For patients with severe asthma, disease control is not achieved resulting in persistent morbidity and risks for exacerbations. The advent of biologics is providing a new form of treatment for many with severe asthma. Recent findings Four mAb biologics are approved for clinical use: omalizumab (anti-IgE) and three antieosinophilic interventions (mepolizumab, reslizumab, and benralizumab). These four biologics target components of the type 2-inflammatory pathway which is reflected by biomarkers: peripheral blood eosinophils and exhaled nitric oxide. In severe asthma, biologics have reduced asthma exacerbations. The antieosinophilic biologics have also improved lung function. The safety profile of these biologics has been good. Summary For patients with severe asthm...

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Working memory training and language outcomes in children with cochlear implants

Azza Samy, Azza Abdel Aziz, Iman El Rouby, Reham Ahmed

The Egyptian Journal of Otolaryngology 2018 34(4):301-307

Objective The aim of this study is to provide information on whether improvements in language skills might be achieved by improving working memory capacity in cochlear-implanted children. Patients and methods This study was carried out on 30 prelingual cochlear-implanted children at the Hearing and Speech Institute. They were divided into two groups: group I received communicative therapy plus a working memory training program. Group II received communicative therapy only. Post-therapy evaluation was carried out after 6 months using the Modified Preschool Language Scale-4 for assessing language and the working memory subtests measures of the Stanford–Binet Intelligence Scale '5th Arabic version' for the assessment of working memory. Results The results of this study showed an improvement in verbal working memory capacity, nonverbal working memory capacity, and the total working memory in the group of children with cochlear implants (CIs) who received 6 months of a working memory training program in addition to communicative therapy. The findings indicate that there is an improvement in the verbal and nonverbal working memory in the participants following the training on certain tasks in the computer-based working memory training program. This will lead to an improvement in the language skills as well. Conclusion Working memory training may improve some memory and language skills for children with CIs. As a result, interventions specifically designed to address the basic underlying verbal working memory deficits of children with CIs may be expected to have wide-ranging effects that generalize well beyond the trained working memory tasks and stimuli themselves and show transfer to nontrained language perception and memory tasks.

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Correction of prominent ear by the two parallel incision technique with definition and folding of the antihelix by vertical mattress sutures

Ashraf Khaled, Ramez Reda, Ahmed Kamel, Samir Shokr A Rhman

The Egyptian Journal of Otolaryngology 2018 34(4):217-223

Background Multiple techniques have been advocated over the years for correction of the prominent ear. The basic techniques used to correct prominent ears with a missing antihelix depends on incision, scoring, bending and reposition of the auricular cartilages. This study was undertaken to correct prominent ears using cartilage incision and vertical mattress sutures to define antihelix. Patients and methods This study was carried out on 13 patients (25 ears) in the period between February 2014 and June 2017, twelve patients of them were presented with bilateral prominent ears and one patient was presented with unilateral prominent (bat) ear. This series comprised 8 males and 5 females. Their ages ranged between 7 to 33 years. In this technique 2 parallel incision in auricular cartilage, definition of antihelix with vertical mattress sutures and ellipse of skin was removed. Results Satisfactory results were obtained in all patients. Complications occurred in 2 patients only: one of them had mild protrusion of upper third of auricle and the other had keloid. Conclusion Our technique produces natural-looking of the operated ears with low complication rates.

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Effect of adding platelet-rich plasma to fat grafts in myringoplasty

Tamer Fawzy, Mohamed Hussein, Said Eid, Sherif Guindi

The Egyptian Journal of Otolaryngology 2018 34(4):224-228

Background Platelet-rich plasma (PRP) is an autologous product derived from whole blood through the process of gradient density centrifugation. Autologous PRP, with growth factors up to 8 times that of normal serum, has been shown to be safe and effective in promoting natural processes of wound healing. Our study aims to examine the effect of combining the fat graft with PRP in myringoplasty procedures indicated for TMP secondary to chronic suppurative otitis media (CSOM) and whether it can significantly promotes Tympanic membrane (TM) healing. Methods This prospective study included forty patients, presenting with dry tympanic membrane secondary to tubo-tympanic CSOM. Half the patients underwent fat graft Myringoplasty with PRP application (group A), while others served as control and received the fat graft only, without PRP (group B). Results In group A, eighteen cases (90%) significantly showed an intact tympanic membrane, while Eleven cases (55%) were successful in group B. P=0.044. Conclusion Topical autologous PRP application during fat plug Myringoplasty is highly successful with no reported postoperative infections and minimal morbidity.

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Postauricular epidermoid and dermoid cysts in adults

Abdullahi Mohammed, Kabir Abdullahi

The Egyptian Journal of Otolaryngology 2018 34(4):213-216

Background Compared with other cutaneous cysts of the head and neck region, postauricular epidermoid and dermoid cysts are rare, asymptomatic benign swellings. Aim To describe the clinical profile of postauricular dermoid and epidermoid cysts in adults. Patients and methods A descriptive retrospective study was conducted on patients older than 16 years, diagnosed histologically with postauricular epidermoid and dermoid cysts who presented to the Ear, Nose and Throat Clinic of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January 2005 to December 2017. Results A total of eight patients were reviewed: two (25%) males and six (75%) females. The age ranged from 22 to 55 years (mean age, 30.1±11.2 years). Most cases (seven, 87.5%) were epidermoid cysts. The mean duration of cystic swellings was 9.8±5.7 years. All the patients presented with asymptomatic postauricular extracranial cysts mostly at the left postauricular side (five, 62.5%). Complete surgical excision was carried out for all the lesions, and no recurrence was observed in the two (25%) patients who came for follow-up; the rest were lost to follow-up. Conclusion Postauricular cysts, mostly epidermoid cyst, are rare unilateral asymptomatic, extracranial swellings that are associated with a delay in seeking medical intervention.

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Frontal sinus osteoplastic flap: is it relevant today?

Archana Shah, Moushumi Sengupta, Vedula P Saha, Somnath Saha

The Egyptian Journal of Otolaryngology 2018 34(4):229-233

In the present era where frontal sinus surgery is synonymous with functional endoscopic sinus surgery, we present a case series comprising six cases of varied frontal sinus pathology that were managed with an external approach using an osteoplastic flap technique. The study was carried out in the ENT Department of Calcutta National Medical College, a tertiary care center in Kolkata. A unilateral osteoplastic flap approach was adopted in three cases, of which two were reported as osteomas and one was that of inverted papilloma. Bicoronal osteoplastic flap was raised in another group, which included a case of communited fracture of the anterior wall of the frontal sinus with obvious cosmetic facial deformity, a case of fracture of the posterior wall of the frontal sinus with traumatic cerebrospinal fluid rhinorrhea with pneumoencephalus, and a case of plasmacytoma of the frontal sinus. The mean follow-up period ranged from 1 to 3 years. There was no recurrence of disease and no significant postoperative complications have been reported during the follow-up period so far.

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Comparison of triamcinolone and mitomycin C nasal pack in functional endoscopic sinus surgery: a randomized, clinical trial

Natarajan Ramalingam, Pradipta K Parida, Sunil K Saxena, Gopalakrishnan Surianarayanan

The Egyptian Journal of Otolaryngology 2018 34(4):242-247

Aims and Objectives Synechia formation in a postoperative nasal cavity is a major factor for suboptimal clinical outcome in functional endoscopic sinus surgery (FESS). Nasal packs medicated with steroids like triamcinolone and topical agents like mitomycin C have been shown to reduce the formation of synechiae in postoperative patients. This study attempts to compare the efficacy of mitomycin C and triamcinoloneimpregnated nasal pack in the prevention of crusting and synechiae formation in patients undergoing FESS. Methods Ninety-eight consenting patients with chronic rhinosinusitis were randomized into two groups of 49 each to receive either triamcinolone-impregnated or mitomycin C-impregnated nasal pack after FESS. Blinded, postoperative endoscopic examination was done at the first and third week and at first and third month and scoring was done according to the Lund Kennedy scoring system. The primary variable for assessing the outcome was synechiae formation in the postoperative period, while reduction of crusting, discharge, mucosal edema, polypoidal mucosal changes, and maintenance of ostial patency were secondary variables. Results Significant reduction in synechiae formation and crusting at 3 months duration was found in the group receiving triamcinolone nasal pack as compared with mitomycin C nasal pack. Mitomycin C was found to significantly reduce crusting in the first postoperative week. Positive trends in reduction of discharge, mucosal edema, polypoidal changes, and in maintenance of patency of ostia were observed in both the groups, but there was no significant difference between the two groups. Conclusion These results suggest that triamcinolone has a long-term effect in the reduction of synechia formation and crusting in post-FESS patients as compared with mitomycin C, though similar effects were seen in both groups in the immediate postoperative period.

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Assessing the correlations between subjective symptom scores and turbinoseptal relationships in pretreatment adults with chronic rhinosinusitis

Adekunle Adeyemo, Sanyaolu A Ameye, Yemisi B Amusa, Ajibola T Osukoya, Akumbu S Ohuche

The Egyptian Journal of Otolaryngology 2018 34(4):248-252

Background This study was undertaken to assess the correlations between subjective symptom score in patients with chronic rhinosinusitis and endoscopic turbinoseptal relationship (TSR). Aim To assess the pattern of TSR and their correlations with symptom score in patients with chronic rhinosinusitis. Settings and design This was an observational study in a tertiary/teaching hospital setting Patients and methods Consecutive pretreatment adults with chronic rhinosinusitis completed the sinonasal outcome test 22 (SNOT22) and had nasal endoscopy. At endoscopy, the TSR was determined, as well as the presence of nasal polyps. Statistical analysis Mean SNOT22 score was calculated and TSR types were grouped and their distribution documented with types 3 and 4 taken as unfavorable types. χ2-Tests were used to determine the correlations between turbinoseptal types, presence of nasal polys, and SNOT22 scores with the level of significance set at P value up to 0.05. Results A total of 53 [23 (43.4%) men and 30 (56.6%) women] patients with a mean age of 42.5±18.6, completed the study. Median symptom duration was 36 weeks (13–112 weeks). Mean SNOT22 score was 29.7±2.8. Unfavorable TSR types were found in 42.5% of nostrils, more on the right (χ2=13.2; P≤0.01). There is no significant correlation between the presence of unfavorable TSR and worsening total SNOT22 scores [R (K-S=0.13 P=0.95) L (K-S=0.34, P=0.07)]. Conclusion Unfavorable TSR is common in patients with chronic rhinosinusitis. However, there is no correlation between the presence of abnormal TSR and symptom scores.

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Montgomery tracheal t-tube stenting as a single first-line treatment in postintubation laryngotracheal stenosis

M. Ekram Osman, M.M. Roushdy, A.K. Abdel-Haleem, M.O. Ramadan

The Egyptian Journal of Otolaryngology 2018 34(4):293-300

Objective The aim was to evaluate the use of Montgomery tracheal T-tube stenting as a single first-line treatment for postintubation laryngotracheal stenosis (LTS), addressing the outcomes, its main complications, and how to manage them. Materials and methods From March 2012 to April 2017, 25 patients with postintubation LTS had contraindication(s) for laryngotracheal surgery and were treated by Montgomery tracheal T-tube stenting as a single first-line treatment. The preoperative, operative, and postoperative follow-up data were collected retrospectively and analyzed. Results Successful outcome was reported in 16 (64%) patients, whereas seven (28%) patients had recurrent stridor after T-tube removal. It was reinserted in two of them, and the rest were subjected to other surgical procedures. Mortality was reported in two patients. Complications of different nature, severity, and durations were reported, and most of them were detected and managed successfully by applying close follow-up protocols. Conclusion Montgomery tracheal T-tube stenting is a very valuable modality in the treatment of LTS as a single first-line treatment when surgical option is contraindicated. It has a relatively low incidence of treatable complications; however, false sense of security must be avoided to ensure good outcome.

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Effect of biodegradable versus nondegradable nasal packings in the outcome of functional endoscopic sinus surgery: clinical and histopathological study

Ayman Al-Madani, Ahmed Youssef, Ayman Abduljalil, Hoda Khalifa, Mohamed Zahran

The Egyptian Journal of Otolaryngology 2018 34(4):253-265

Background Nasal packing has been used to prevent bleeding and formation of adhesions between the middle turbinate and lateral nasal wall. There has been a debate whether biodegradable packing might improve the outcome, or could a nondegradable dressing offer a better course after endoscopic sinus surgery. Objective To compare the effect of biodegradable versus nondegradable nasal packings on the outcome of endoscopic sinus surgery on clinical, endoscopic, and histopathologic basis. Patients and methods Fifty patients with bilateral chronic rhinosinusitis of the same extent of sinus affection were enrolled in this study. None of them was a revision case. All patients had bilateral functional endoscopic sinus surgery by the same surgeon using the same technique of powered microdebrider utilization. At the end of the procedure, the operative cavity of each patient was randomly packed with Merocel as a nondegradable material on one side and a biodegradable material on the other side. We assessed the patients regarding immediate postoperative symptoms and endoscopic follow-up after 1- and 3-month postoperatively including biopsy taking for histopathological examination. Results Postoperative bleeding and patient discomfort were significantly higher in the nondegradable packing side, while biodegradable packing has caused significantly more edema. Merocel packed sides showed better epithelial restoration with marked epithelial hyperplastic changes and more goblet cells than the biodegradable sides. This difference was statistically significant 1-month postoperatively, but turned nonsignificant 3-month postoperatively. Conclusions Biodegradable nasal packing can offer patients a good quality of life during the early recovery period without beneficial or detrimental effects on postoperative mucosal healing. Nondegradable packs offer less post-functional endoscopic sinus surgery edema providing better aeration and rapid wound healing.

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High frequency audiometry in tinnitus patients with normal hearing in conventional audiometry

Doaa M Elmoazen, Hesham S Kozou, Alaa A Mohamed

The Egyptian Journal of Otolaryngology 2018 34(4):308-315

Context Hearing loss is the most important risk factor of tinnitus, but this relation is not straightforward; some patients with severe tinnitus have normal hearing, whereas many patients with hearing loss do not have tinnitus. Aims The aim was to determine if high frequency audiometry (HFA) may reveal significant differences between normal hearing participants with and without tinnitus. Settings and design This is a case–control study. Participants and methods HFA was done on two groups of participants with normal hearing sensitivity. The first group was composed of 20 adults with tinnitus, whereas the control group was 15 age-matched and sex-matched participants, not suffering from tinnitus. Statistical analysis Data were analyzed using SPSS software package version 20.0. Significance of the results was judged at the 5% level. χ2 with Fisher's exact as a correction, Kruskal–Wallis, Mann–Whitney, and Pearson's coefficient tests were used. Results HFA showed no significant difference between the two studied groups. Conclusion Tinnitus in normal hearing participants does not necessarily indicate corresponding damage in the cochlea

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Predicting factors of recurrent deviated nasal septum after primary septoplasty in Jeddah, Saudi Arabia

Abdullah A Alamri, Amjaad A Alsulami, Rawan A Almahyawi, Razan A Abushal, Abdulkreem R Fida

The Egyptian Journal of Otolaryngology 2018 34(4):266-271

Background Deviated nasal septum is a common cause of symptoms for nasal obstruction. Patients with nasal septum deviation who undergo septoplasty have improvements in their disease-specific quality of life for nasal obstruction. Objective The aim of this study was to identify the contributing factors of recurrent nasal septum deviation following primary septoplasty. Materials and methods This retrospective cross-sectional study reviewed the records of all patients who underwent primary septoplasty between 2017 and 2018; then presented to Otolaryngology-Head and Neck Surgery Outpatient Clinic, King Abdulaziz University Hospital with recurrent deviated nasal septum. Results In the current study, 362 patients were included. Most patients were Saudis (73.2%); and had neither comorbidities (73.5%) nor chronic diseases (92%). At the time of primary septoplasty, most patients were aged from 18 to 59 years (78.2%). Most patients had left septal deviation; underwent closed approach; and did not suffer postoperative complications (94.5%). The most common types of deviated nasal septum at the time of primary septoplasty were types 3 (38.1%) and 2 (31.5%), while type 2 was the most common at second septoplasty. The time between first septoplasty and recurrence of deviated nasal septum ranged from 1 to 72 months; with a median time of 12 months. The results of multiple linear regression showed that Saudi male patients who had a concomitant nasal surgery had a significantly increased time interval between first septoplasty and recurrence (P<0.05). The presence of either comorbidities or chronic diseases resulted in a decrease of the interval. Conclusion In patients who suffered from recurrence after primary septoplasty, types 2 and 3, left deviated nasal septum, and closed approach septoplasty were significantly frequent. Factors that resulted in longer time interval between first septoplasty and recurrence were male gender, Saudi nationality, concomitant nasal surgery, and absence of either comorbidities or chronic diseases.

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Assessment of effects of hearing aid fitting on the perceptual characteristics of tinnitus

Moustafa El Kousht, Tarek M.El Dessouky, Rabab A Koura, Mohamed Fawaz, Shaemaa A Sabry

The Egyptian Journal of Otolaryngology 2018 34(4):326-331

Background Evidence of systematic relationships between the perceptual characteristics of tinnitus, like its pitch or loudness, and those of the absolute hearing threshold curves, like the presence and degree of hearing loss at certain frequencies, would probably help to understand how tinnitus is related to the configuration of hearing loss. Objective The objective of this study was to determine the effects of hearing aid fitting on the perceptual characteristics of tinnitus. Participants and methods The participants of the study were 50 adults (20–60 years old) with subjective tinnitus and different degrees of hearing loss. Otorhinolaryngological examination, tonal audiometry, and acoustic immittance testing were done. Participants answered Tinnitus Handicap Inventory (THI) Questionnaire at the time of the first fitting with their hearing aid and performed at 0, 3, 6, and 12 months postfitting. Results THI showed a significant decrease throughout the 12 months from 74.80±15.98 at baseline to 61.84±14.02 3 months later, then 38.35±10.98 by the sixth month and 12.90±4.26 by the end of 12 months. At the baseline, no slight or mild cases were detected, whereas moderate THI represented 16%, severe 28%, and catastrophic 56%. These rates changed 3 months later as catastrophic cases decreased almost to one-third of its rate at the baseline. By the sixth month, no catastrophic cases were detected and severe stages recorded trivial rates, whereas most of cases were categorized as mild or moderate. By the end of the study, the great majority of cases were slight (81.6%) and the remaining portion was mild, with no moderate, severe, or catastrophic cases recorded. Conclusion Analysis of the results has shown that the use of hearing aids are one of the number of therapeutic options offered to tinnitus patients and promote the improvement in the perceptual characteristics of tinnitus.

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Assessment of the nasal obstruction after endoscopic septoplasty compared with conventional technique by computed tomography and Nasal Surgical Questionnaire

Ayat A El Nasr, Mohamed A.M Belih

The Egyptian Journal of Otolaryngology 2018 34(4):272-277

Background Nasal obstruction is a common annoying symptom of septal deviation, and endoscopic septoplasty gives better illumination and accurate vision, and hence can provide markedly good dealing with posterior deviations, isolated spurs, and high deviations. Computed tomography (CT) scan and Nasal Surgical Questionnaire (NSQ) are important for accurate postoperative follow-up. Objective The aim of this study was to express our experience in the assessment of the nasal obstruction after endoscopic septoplasty compared with conventional septoplasty in patients with nasal septum deviation by measuring the size of the inferior turbinate with CT scan and measuring patient satisfaction by NSQ score. Patients and methods This was prospective study of 100 patients, complaining mainly of nasal obstruction. They were divided into two groups: group A, who underwent endoscopic septoplasty, and group B, who underwent conventional septoplasty. All the patients underwent septoplasty alone without inferior turbinate surgery. Preoperative and postoperative CT scan and NSQ were the basic documentation for the results. Results Endoscopic septoplasty showed a better reduction in nasal obstruction than conventional septoplasty; however, the postoperative reduction on the size of the inferior turbinate and NSQ score were highly significant in both groups (P=0.001). Conclusion Both endoscopic and conventional septoplasty without turbinate surgery in patients with nasal septum deviation were effective in improving the nasal obstruction. However, endoscopic septoplasty had better results in improving nasal obstruction.

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Localized subglottic laryngeal amyloidosis: a case report

Hazem M Abdel Tawab, Ibrahim A Sulaiman

The Egyptian Journal of Otolaryngology 2018 34(4):337-340

Amyloidosis is a heterogeneous group of diseases characterized by accumulation of amyloid protein in different organs of the body. Localized affection of the larynx by amyloid deposits is a rare event. This is a case of localized laryngeal amyloidosis in a 24-year-old female patient presented with hoarseness of voice. The amyloid mass was occupying the anterior part of the subglottic region and reaching up between both the vocal folds. Complete excision was achieved by cold instruments. Localized laryngeal amyloidosis despite being rare should be kept in mind as one of the causes of mass lesions in the larynx.

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Middle ear myxoma: a diagnostic dilemma and its management, a case report

Santanu Dutta, Prasanta K Gure, Sudipta Pal, Somnath Saha

The Egyptian Journal of Otolaryngology 2018 34(4):351-354

The aim of this study was to present a rare case report of myxoma of the mastoid cleft/temporal bone with intracranial extension and its management and follow-up. A 13-year-old girl presented with discharge from the right ear with gradually progressive hearing loss for the last 4–5 years and facial palsy of grade III on the right side for the last 4–5 months. She was diagnosed as having chronic otitis media, squamosal type, and underwent canal wall down mastoidectomy on the same ear 6 months back. On examination, an aural polyp occupying the whole of the mastoid cavity along with mucopurulent discharge and lower motor neuron facial palsy were seen on the right side. high resolution ct scan (HRCT) of the temporal bone showed a soft tissue mass occupying the whole of the mastoid cavity breaching bony confinements, extending up to the posterior fossa, extradurally, and engulfing the facial nerve. The patient underwent re-exploration of the right mastoid cavity under general anaesthesia and a soft jelly-like substance was removed from whole of the mastoid cavity, extending anteriorly up to the Eustachian tube, inferiorly up to the jugular bulb, posteriorly up to the retrosigmoid cells, superiorly up to the tegmen plate, extending medially intracranially up to the posterior fossa dura through Trautmann's triangle and engulfing the facial nerve from the first genu to the stylomastoid foramen. Facial nerve decompression was performed along with disease clearance and wide conchomeatoplasty. The patient developed grade IV facial palsy postoperatively. The histopathology report of the dissected jelly-like soft tissue revealed myxoma. The patient is at present under regular follow-up and there is no recurrence after 6 months, although facial palsy is still persisting as grade IV. Myxoma of the temporal bone or the mastoid cleft is a rare entity. Complete surgical excision is the treatment of choice in this case, although recurrence is very common. The clinical presentation, management and outcome of this tumour are discussed in view of available literature.

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Correction of prominent ear by the two parallel incision technique with definition and folding of the antihelix by vertical mattress sutures

Ashraf Khaled, Ramez Reda, Ahmed Kamel, Samir Shokr A Rhman

The Egyptian Journal of Otolaryngology 2018 34(4):217-223

Background Multiple techniques have been advocated over the years for correction of the prominent ear. The basic techniques used to correct prominent ears with a missing antihelix depends on incision, scoring, bending and reposition of the auricular cartilages. This study was undertaken to correct prominent ears using cartilage incision and vertical mattress sutures to define antihelix. Patients and methods This study was carried out on 13 patients (25 ears) in the period between February 2014 and June 2017, twelve patients of them were presented with bilateral prominent ears and one patient was presented with unilateral prominent (bat) ear. This series comprised 8 males and 5 females. Their ages ranged between 7 to 33 years. In this technique 2 parallel incision in auricular cartilage, definition of antihelix with vertical mattress sutures and ellipse of skin was removed. Results Satisfactory results were obtained in all patients. Complications occurred in 2 patients only: one of them had mild protrusion of upper third of auricle and the other had keloid. Conclusion Our technique produces natural-looking of the operated ears with low complication rates.

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Comparison between pitch discrimination in normal children, children with hearing aids, and children with cochlear implant

Rania E Ahmed

The Egyptian Journal of Otolaryngology 2018 34(4):332-336

Background Cochlear hearing loss causes variations in the way that sounds are represented in the auditory system and for cochlear implant (Cl) users, pitch information that is transmitted to the central nervous system is not ideal. The aim of this study was to compare between pitch discrimination and its associated language development in normal children, children with cochlear implant and children with hearing aids to know which prostheses is more useful to the patient. Materials and Methods The study measured pitch discrimination test, just noticeable difference test and language evaluation in 45 children divided into 3 groups. Results This study suggested that CI had less pitch discrimination ability but better language development than HA. Conclusions The benefit that CI users get through better accessibility to high frequencies outweighs the deficit in pitch discrimination.

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Effect of adding platelet-rich plasma to fat grafts in myringoplasty

Tamer Fawzy, Mohamed Hussein, Said Eid, Sherif Guindi

The Egyptian Journal of Otolaryngology 2018 34(4):224-228

Background Platelet-rich plasma (PRP) is an autologous product derived from whole blood through the process of gradient density centrifugation. Autologous PRP, with growth factors up to 8 times that of normal serum, has been shown to be safe and effective in promoting natural processes of wound healing. Our study aims to examine the effect of combining the fat graft with PRP in myringoplasty procedures indicated for TMP secondary to chronic suppurative otitis media (CSOM) and whether it can significantly promotes Tympanic membrane (TM) healing. Methods This prospective study included forty patients, presenting with dry tympanic membrane secondary to tubo-tympanic CSOM. Half the patients underwent fat graft Myringoplasty with PRP application (group A), while others served as control and received the fat graft only, without PRP (group B). Results In group A, eighteen cases (90%) significantly showed an intact tympanic membrane, while Eleven cases (55%) were successful in group B. P=0.044. Conclusion Topical autologous PRP application during fat plug Myringoplasty is highly successful with no reported postoperative infections and minimal morbidity.

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Postauricular epidermoid and dermoid cysts in adults

Abdullahi Mohammed, Kabir Abdullahi

The Egyptian Journal of Otolaryngology 2018 34(4):213-216

Background Compared with other cutaneous cysts of the head and neck region, postauricular epidermoid and dermoid cysts are rare, asymptomatic benign swellings. Aim To describe the clinical profile of postauricular dermoid and epidermoid cysts in adults. Patients and methods A descriptive retrospective study was conducted on patients older than 16 years, diagnosed histologically with postauricular epidermoid and dermoid cysts who presented to the Ear, Nose and Throat Clinic of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, from January 2005 to December 2017. Results A total of eight patients were reviewed: two (25%) males and six (75%) females. The age ranged from 22 to 55 years (mean age, 30.1±11.2 years). Most cases (seven, 87.5%) were epidermoid cysts. The mean duration of cystic swellings was 9.8±5.7 years. All the patients presented with asymptomatic postauricular extracranial cysts mostly at the left postauricular side (five, 62.5%). Complete surgical excision was carried out for all the lesions, and no recurrence was observed in the two (25%) patients who came for follow-up; the rest were lost to follow-up. Conclusion Postauricular cysts, mostly epidermoid cyst, are rare unilateral asymptomatic, extracranial swellings that are associated with a delay in seeking medical intervention.

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Frontal sinus osteoplastic flap: is it relevant today?

Archana Shah, Moushumi Sengupta, Vedula P Saha, Somnath Saha

The Egyptian Journal of Otolaryngology 2018 34(4):229-233

In the present era where frontal sinus surgery is synonymous with functional endoscopic sinus surgery, we present a case series comprising six cases of varied frontal sinus pathology that were managed with an external approach using an osteoplastic flap technique. The study was carried out in the ENT Department of Calcutta National Medical College, a tertiary care center in Kolkata. A unilateral osteoplastic flap approach was adopted in three cases, of which two were reported as osteomas and one was that of inverted papilloma. Bicoronal osteoplastic flap was raised in another group, which included a case of communited fracture of the anterior wall of the frontal sinus with obvious cosmetic facial deformity, a case of fracture of the posterior wall of the frontal sinus with traumatic cerebrospinal fluid rhinorrhea with pneumoencephalus, and a case of plasmacytoma of the frontal sinus. The mean follow-up period ranged from 1 to 3 years. There was no recurrence of disease and no significant postoperative complications have been reported during the follow-up period so far.

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Assessment of cochlear implantation outcome in patients with enlarged vestibular aqueduct syndrome

Ossama A Sobhy, Mohamed B Attallah, Rania M Abdou, Amira M Al-Mahy

The Egyptian Journal of Otolaryngology 2018 34(4):316-325

Context Theoverall outcome of cochlear implantation (CI) in patients with enlarged vestibular aqueduct (EVA) was comparable to other CI users. However, there were various concerns regarding surgical issues that may affect postoperative outcome. Moreover, exact timing for CI is still a matter of debate owing to the fluctuating nature of the disorder. Aim This study aimed to investigate speech and language outcome in patients with EVA who had undergone CI. Patients and methods This prospective study included 48 participants who underwent CI. The participants' age ranged from 4 to 28 years. The participants were divided according to preoperative radiological studies of petrous temporal bone into isolated EVA, EVA-IPII (incomplete partition type II), and control groups. Patients' records were revised for preoperative investigations as well as available intraoperative data. Aided hearing thresholds, auditory skills, and aided speech perception abilities were all assessed postoperatively in all participants. Results No major surgical complications were found in patients with EVA. Speech and language development in EVA group was comparable to that of control group. Conclusion CI outcomes in patients with EVA regarding surgical issues, auditory benefit, and speech perception abilities are generally good.

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Kimura’s disease of the tongue: a new case report

Muraja Aldoori, Belal Alani, Adham Ammar, Moustafa Alkhalil

The Egyptian Journal of Otolaryngology 2018 34(4):341-344

Kimura's disease (KD), a chronic inflammatory disease of uncertain etiology, manifests as a painless subcutaneous swelling mostly in the head and neck region that involves major salivary glands and regional lymph nodes. To date, the majority of cases of KD have been documented in Asian men aged 20–40 years. However, the number of reported cases of KD involving the oral and maxillofacial area is limited, and since the masses appear similar to cysts or benign tumors, the establishment of an accurate preoperative diagnosis is challenging. The accurate diagnosis of KD is considered to require surgical excision followed by histopathological examination. In this case report, we present a case of KD affecting the ventral surface of the tongue, a unique site of the disease that is not reported earlier according to our knowledge.

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Comparison of triamcinolone and mitomycin C nasal pack in functional endoscopic sinus surgery: a randomized, clinical trial

Natarajan Ramalingam, Pradipta K Parida, Sunil K Saxena, Gopalakrishnan Surianarayanan

The Egyptian Journal of Otolaryngology 2018 34(4):242-247

Aims and Objectives Synechia formation in a postoperative nasal cavity is a major factor for suboptimal clinical outcome in functional endoscopic sinus surgery (FESS). Nasal packs medicated with steroids like triamcinolone and topical agents like mitomycin C have been shown to reduce the formation of synechiae in postoperative patients. This study attempts to compare the efficacy of mitomycin C and triamcinoloneimpregnated nasal pack in the prevention of crusting and synechiae formation in patients undergoing FESS. Methods Ninety-eight consenting patients with chronic rhinosinusitis were randomized into two groups of 49 each to receive either triamcinolone-impregnated or mitomycin C-impregnated nasal pack after FESS. Blinded, postoperative endoscopic examination was done at the first and third week and at first and third month and scoring was done according to the Lund Kennedy scoring system. The primary variable for assessing the outcome was synechiae formation in the postoperative period, while reduction of crusting, discharge, mucosal edema, polypoidal mucosal changes, and maintenance of ostial patency were secondary variables. Results Significant reduction in synechiae formation and crusting at 3 months duration was found in the group receiving triamcinolone nasal pack as compared with mitomycin C nasal pack. Mitomycin C was found to significantly reduce crusting in the first postoperative week. Positive trends in reduction of discharge, mucosal edema, polypoidal changes, and in maintenance of patency of ostia were observed in both the groups, but there was no significant difference between the two groups. Conclusion These results suggest that triamcinolone has a long-term effect in the reduction of synechia formation and crusting in post-FESS patients as compared with mitomycin C, though similar effects were seen in both groups in the immediate postoperative period.

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Assessing the correlations between subjective symptom scores and turbinoseptal relationships in pretreatment adults with chronic rhinosinusitis

Adekunle Adeyemo, Sanyaolu A Ameye, Yemisi B Amusa, Ajibola T Osukoya, Akumbu S Ohuche

The Egyptian Journal of Otolaryngology 2018 34(4):248-252

Background This study was undertaken to assess the correlations between subjective symptom score in patients with chronic rhinosinusitis and endoscopic turbinoseptal relationship (TSR). Aim To assess the pattern of TSR and their correlations with symptom score in patients with chronic rhinosinusitis. Settings and design This was an observational study in a tertiary/teaching hospital setting Patients and methods Consecutive pretreatment adults with chronic rhinosinusitis completed the sinonasal outcome test 22 (SNOT22) and had nasal endoscopy. At endoscopy, the TSR was determined, as well as the presence of nasal polyps. Statistical analysis Mean SNOT22 score was calculated and TSR types were grouped and their distribution documented with types 3 and 4 taken as unfavorable types. χ2-Tests were used to determine the correlations between turbinoseptal types, presence of nasal polys, and SNOT22 scores with the level of significance set at P value up to 0.05. Results A total of 53 [23 (43.4%) men and 30 (56.6%) women] patients with a mean age of 42.5±18.6, completed the study. Median symptom duration was 36 weeks (13–112 weeks). Mean SNOT22 score was 29.7±2.8. Unfavorable TSR types were found in 42.5% of nostrils, more on the right (χ2=13.2; P≤0.01). There is no significant correlation between the presence of unfavorable TSR and worsening total SNOT22 scores [R (K-S=0.13 P=0.95) L (K-S=0.34, P=0.07)]. Conclusion Unfavorable TSR is common in patients with chronic rhinosinusitis. However, there is no correlation between the presence of abnormal TSR and symptom scores.

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Montgomery tracheal t-tube stenting as a single first-line treatment in postintubation laryngotracheal stenosis

M. Ekram Osman, M.M. Roushdy, A.K. Abdel-Haleem, M.O. Ramadan

The Egyptian Journal of Otolaryngology 2018 34(4):293-300

Objective The aim was to evaluate the use of Montgomery tracheal T-tube stenting as a single first-line treatment for postintubation laryngotracheal stenosis (LTS), addressing the outcomes, its main complications, and how to manage them. Materials and methods From March 2012 to April 2017, 25 patients with postintubation LTS had contraindication(s) for laryngotracheal surgery and were treated by Montgomery tracheal T-tube stenting as a single first-line treatment. The preoperative, operative, and postoperative follow-up data were collected retrospectively and analyzed. Results Successful outcome was reported in 16 (64%) patients, whereas seven (28%) patients had recurrent stridor after T-tube removal. It was reinserted in two of them, and the rest were subjected to other surgical procedures. Mortality was reported in two patients. Complications of different nature, severity, and durations were reported, and most of them were detected and managed successfully by applying close follow-up protocols. Conclusion Montgomery tracheal T-tube stenting is a very valuable modality in the treatment of LTS as a single first-line treatment when surgical option is contraindicated. It has a relatively low incidence of treatable complications; however, false sense of security must be avoided to ensure good outcome.

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Effect of biodegradable versus nondegradable nasal packings in the outcome of functional endoscopic sinus surgery: clinical and histopathological study

Ayman Al-Madani, Ahmed Youssef, Ayman Abduljalil, Hoda Khalifa, Mohamed Zahran

The Egyptian Journal of Otolaryngology 2018 34(4):253-265

Background Nasal packing has been used to prevent bleeding and formation of adhesions between the middle turbinate and lateral nasal wall. There has been a debate whether biodegradable packing might improve the outcome, or could a nondegradable dressing offer a better course after endoscopic sinus surgery. Objective To compare the effect of biodegradable versus nondegradable nasal packings on the outcome of endoscopic sinus surgery on clinical, endoscopic, and histopathologic basis. Patients and methods Fifty patients with bilateral chronic rhinosinusitis of the same extent of sinus affection were enrolled in this study. None of them was a revision case. All patients had bilateral functional endoscopic sinus surgery by the same surgeon using the same technique of powered microdebrider utilization. At the end of the procedure, the operative cavity of each patient was randomly packed with Merocel as a nondegradable material on one side and a biodegradable material on the other side. We assessed the patients regarding immediate postoperative symptoms and endoscopic follow-up after 1- and 3-month postoperatively including biopsy taking for histopathological examination. Results Postoperative bleeding and patient discomfort were significantly higher in the nondegradable packing side, while biodegradable packing has caused significantly more edema. Merocel packed sides showed better epithelial restoration with marked epithelial hyperplastic changes and more goblet cells than the biodegradable sides. This difference was statistically significant 1-month postoperatively, but turned nonsignificant 3-month postoperatively. Conclusions Biodegradable nasal packing can offer patients a good quality of life during the early recovery period without beneficial or detrimental effects on postoperative mucosal healing. Nondegradable packs offer less post-functional endoscopic sinus surgery edema providing better aeration and rapid wound healing.

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High frequency audiometry in tinnitus patients with normal hearing in conventional audiometry

Doaa M Elmoazen, Hesham S Kozou, Alaa A Mohamed

The Egyptian Journal of Otolaryngology 2018 34(4):308-315

Context Hearing loss is the most important risk factor of tinnitus, but this relation is not straightforward; some patients with severe tinnitus have normal hearing, whereas many patients with hearing loss do not have tinnitus. Aims The aim was to determine if high frequency audiometry (HFA) may reveal significant differences between normal hearing participants with and without tinnitus. Settings and design This is a case–control study. Participants and methods HFA was done on two groups of participants with normal hearing sensitivity. The first group was composed of 20 adults with tinnitus, whereas the control group was 15 age-matched and sex-matched participants, not suffering from tinnitus. Statistical analysis Data were analyzed using SPSS software package version 20.0. Significance of the results was judged at the 5% level. χ2 with Fisher's exact as a correction, Kruskal–Wallis, Mann–Whitney, and Pearson's coefficient tests were used. Results HFA showed no significant difference between the two studied groups. Conclusion Tinnitus in normal hearing participants does not necessarily indicate corresponding damage in the cochlea

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Predicting factors of recurrent deviated nasal septum after primary septoplasty in Jeddah, Saudi Arabia

Abdullah A Alamri, Amjaad A Alsulami, Rawan A Almahyawi, Razan A Abushal, Abdulkreem R Fida

The Egyptian Journal of Otolaryngology 2018 34(4):266-271

Background Deviated nasal septum is a common cause of symptoms for nasal obstruction. Patients with nasal septum deviation who undergo septoplasty have improvements in their disease-specific quality of life for nasal obstruction. Objective The aim of this study was to identify the contributing factors of recurrent nasal septum deviation following primary septoplasty. Materials and methods This retrospective cross-sectional study reviewed the records of all patients who underwent primary septoplasty between 2017 and 2018; then presented to Otolaryngology-Head and Neck Surgery Outpatient Clinic, King Abdulaziz University Hospital with recurrent deviated nasal septum. Results In the current study, 362 patients were included. Most patients were Saudis (73.2%); and had neither comorbidities (73.5%) nor chronic diseases (92%). At the time of primary septoplasty, most patients were aged from 18 to 59 years (78.2%). Most patients had left septal deviation; underwent closed approach; and did not suffer postoperative complications (94.5%). The most common types of deviated nasal septum at the time of primary septoplasty were types 3 (38.1%) and 2 (31.5%), while type 2 was the most common at second septoplasty. The time between first septoplasty and recurrence of deviated nasal septum ranged from 1 to 72 months; with a median time of 12 months. The results of multiple linear regression showed that Saudi male patients who had a concomitant nasal surgery had a significantly increased time interval between first septoplasty and recurrence (P<0.05). The presence of either comorbidities or chronic diseases resulted in a decrease of the interval. Conclusion In patients who suffered from recurrence after primary septoplasty, types 2 and 3, left deviated nasal septum, and closed approach septoplasty were significantly frequent. Factors that resulted in longer time interval between first septoplasty and recurrence were male gender, Saudi nationality, concomitant nasal surgery, and absence of either comorbidities or chronic diseases.

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Assessment of effects of hearing aid fitting on the perceptual characteristics of tinnitus

Moustafa El Kousht, Tarek M.El Dessouky, Rabab A Koura, Mohamed Fawaz, Shaemaa A Sabry

The Egyptian Journal of Otolaryngology 2018 34(4):326-331

Background Evidence of systematic relationships between the perceptual characteristics of tinnitus, like its pitch or loudness, and those of the absolute hearing threshold curves, like the presence and degree of hearing loss at certain frequencies, would probably help to understand how tinnitus is related to the configuration of hearing loss. Objective The objective of this study was to determine the effects of hearing aid fitting on the perceptual characteristics of tinnitus. Participants and methods The participants of the study were 50 adults (20–60 years old) with subjective tinnitus and different degrees of hearing loss. Otorhinolaryngological examination, tonal audiometry, and acoustic immittance testing were done. Participants answered Tinnitus Handicap Inventory (THI) Questionnaire at the time of the first fitting with their hearing aid and performed at 0, 3, 6, and 12 months postfitting. Results THI showed a significant decrease throughout the 12 months from 74.80±15.98 at baseline to 61.84±14.02 3 months later, then 38.35±10.98 by the sixth month and 12.90±4.26 by the end of 12 months. At the baseline, no slight or mild cases were detected, whereas moderate THI represented 16%, severe 28%, and catastrophic 56%. These rates changed 3 months later as catastrophic cases decreased almost to one-third of its rate at the baseline. By the sixth month, no catastrophic cases were detected and severe stages recorded trivial rates, whereas most of cases were categorized as mild or moderate. By the end of the study, the great majority of cases were slight (81.6%) and the remaining portion was mild, with no moderate, severe, or catastrophic cases recorded. Conclusion Analysis of the results has shown that the use of hearing aids are one of the number of therapeutic options offered to tinnitus patients and promote the improvement in the perceptual characteristics of tinnitus.

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