BACKGROUND: The risk for transient tachypnea of newborns, a common cause of respiratory distress in the neonatal period, is 2- to 6-fold higher during elective cesarean delivery compared to vaginal delivery. Here, we evaluated the association between transient tachypnea of newborns and the degree and duration of predelivery maternal hypotension during spinal anesthesia for elective cesarean delivery. METHODS: Demographic data, details of anesthetic management, blood pressure measurements, and vasopressor requirement preceding delivery were compared between transient tachypnea newborns (n = 30) and healthy neonates (n = 151) with normal respiratory function born via elective cesarean delivery between July 2015 and February 2016. The degree and duration of hypotension were assessed using area under the curve for systolic blood pressure (SBP) ≤90 mm Hg and area under the curve for mean arterial pressure ≤65 mm Hg. After adjusting for confounders, multivariable logistic regression was used to evaluate the association between area under the curve for SBP and transient tachypnea of newborns. RESULTS: The median area under the curve for SBP was higher in cases of transient tachypnea of newborns (0.94; interquartile range, 0–28.7 mm Hg*min) compared to healthy controls (0; interquartile range, 0–3.30 mm Hg*min; P = .001). Similarly, median area under the curve for mean arterial pressure was also higher in cases of transient tachypnea of newborns (0; interquartile range, 0–18.6 mm Hg*min) compared to controls (0; interquartile range, 0–1.1 mm Hg*min; P = .01). Mothers of transient tachypnea newborns received significantly higher amounts of phenylephrine and ephedrine compared to controls (P = .001 and 0.01, respectively). Hence, the total vasopressor dose given to mothers in the transient tachypnea of newborn group was much higher than for the control group (P = .001). In the multivariable logistic regression, area under the curve for SBP was significantly associated with transient tachypnea of newborns (odds ratio, 1.02; 95% CI, 1.01–1.04, P = .005) after adjusting for gravidity and the type of anesthetic (spinal versus combined spinal epidural). CONCLUSIONS: Our results suggest that the degree and duration of maternal SBP
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Πέμπτη 14 Φεβρουαρίου 2019
In Response
Gender Inequality in Anesthesiology Research: An Overview of 2018
Clot Retraction: Lost in Interpretation?
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy
Enhanced recovery pathways have quickly become part of the standard of care for patients undergoing elective surgery, especially in North America and Europe. One of the central tenets of this multidisciplinary approach is the use of multimodal analgesia with opioid-sparing and even opioid-free anesthesia and analgesia. However, the current state is a historically high use of opioids for both appropriate and inappropriate reasons, and patients with chronic opioid use before their surgery represent a common, often difficult-to-manage population for the enhanced recovery providers and health care team at large. Furthermore, limited evidence and few proven successful protocols exist to guide providers caring for these at-risk patients throughout their elective surgical experience. Therefore, the fourth Perioperative Quality Initiative brought together an international team of multidisciplinary experts, including anesthesiologists, nurse anesthetists, surgeons, pain specialists, neurologists, nurses, and other experts with the objective of providing consensus recommendations. Specifically, the goal of this consensus document is to minimize opioid-related complications by providing expert-based consensus recommendations that reflect the strength of the medical evidence regarding: (1) the definition, categorization, and risk stratification of patients receiving opioids before surgery; (2) optimal perioperative treatment strategies for patients receiving preoperative opioids; and (3) optimal discharge and continuity of care management practices for patients receiving opioids preoperatively. The overarching theme of this document is to provide health care providers with guidance to reduce potentially avoidable opioid-related complications including opioid dependence (both physical and behavioral), disability, and death. Enhanced recovery programs attempt to incorporate best practices into pathways of care. By presenting the available evidence for perioperative management of patients on opioids, this consensus panel hopes to encourage further development of pathways specific to this high-risk group to mitigate the often unintentional iatrogenic and untoward effects of opioids and to improve perioperative outcomes. Accepted for publication December 11, 2018. Conflicts of Interest: See Disclosures at the end of the article. Funding: D.A.E. has received research support from Semnur Inc and Grunenthal for research unrelated to the topic or production of this manuscript. T.E.M. received research funding and is a consultant for Edwards Lifesciences and for Mallinckrodt. M.D.E. received research funding from the GE Foundation, Edwards Lifesciences, and Cheetah Medical for projects unrelated to this manuscript. The Perioperative Quality Initiative-4 consensus conference was supported by unrestricted educational grants from the American Society for Enhanced Recovery and the Perioperative Quality Initiative, which have received grants from Baxter, Bev MD, Cadence, Cheetah Medical, Edwards, Heron Pharmaceutical, Mallinckrodt, Medtronic, Merck, Trevena, and Pacira Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/KegmMq). Reprints will not be available from the authors. Address correspondence to David A. Edwards, MD, PhD, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN. Address e-mail to david.a.edwards@vanderbilt.edu. © 2019 International Anesthesia Research Society
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Randomized Trial Comparing Early and Late Administration of Rocuronium Before and After Checking Mask Ventilation in Patients With Normal Airways
BACKGROUND: During induction of general anesthesia, it is common practice to delay neuromuscular blockade until the ability to deliver mask ventilation has been confirmed. However, the benefits of this approach have never been scientifically validated. We thus compared the early and late administration of rocuronium before and after checking mask ventilation to investigate the efficiency of mask ventilation and the time to tracheal intubation in patients with normal airways. METHODS: Patients (n = 114) were randomized to receive IV rocuronium either before (early rocuronium group, n = 58) or after (late rocuronium group, n = 56) checking mask ventilation. Expiratory tidal volumes (VTs) were measured at 10, 20, 30, 40, 50, and 60 seconds after apnea during mask ventilation. We graded the ease of mask ventilation and measured the time from apnea to tracheal intubation. The primary outcome was the average of mask VTs measured at 10, 20, 30, 40, 50, and 60 seconds after apnea. The main secondary outcome was the time from apnea to tracheal intubation. STATA was used for statistical analysis. RESULTS: The average of mask VTs measured at 10, 20, 30, 40, 50, and 60 seconds after apnea was larger in the early rocuronium group than in the late rocuronium group (552 mL breath−1 [165 mL breath−1] vs 393 mL breath−1 [165 mL breath−1], mean difference, 160 mL breath−1; 95% CI, 98−221 mL breath−1; P
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Managing Complications in Paediatric Anaesthesia
Drug Calculation Errors in Anesthesiology Residents and Faculty: An Analysis of Contributing Factors
BACKGROUND: Limited data exist regarding computational drug error rates in anesthesia residents and faculty. We investigated the frequency and magnitude of computational errors in a sample of anesthesia residents and faculty. METHODS: With institutional review board approval from 7 academic institutions in the United States, a 15-question computational test was distributed during rounds. Error rates and the magnitude of the errors were analyzed according to resident versus faculty, years of practice (or residency training), duration of sleep, type of question, and institution. RESULTS: A total of 371 completed the test: 209 residents and 162 faculty. Both groups committed 2 errors (median value) per test, for a mean error rate of 17.0%. Twenty percent of residents and 25% of faculty scored 100% correct answers. The error rate for postgraduate year 2 residents was less than for postgraduate year 1 (P = .012). The error rate for faculty increased with years of experience, with a weak correlation (R = 0.22; P = .007). The error rates were independent of the number of hours of sleep. The error rate for percentage-type questions was greater than for rate, dose, and ratio questions (P = .001). The error rates varied with the number of operations needed to calculate the answer (P
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Transient Tachypnea of Newborns Is Associated With Maternal Spinal Hypotension During Elective Cesarean Delivery: A Retrospective Cohort Study
BACKGROUND: The risk for transient tachypnea of newborns, a common cause of respiratory distress in the neonatal period, is 2- to 6-fold higher during elective cesarean delivery compared to vaginal delivery. Here, we evaluated the association between transient tachypnea of newborns and the degree and duration of predelivery maternal hypotension during spinal anesthesia for elective cesarean delivery. METHODS: Demographic data, details of anesthetic management, blood pressure measurements, and vasopressor requirement preceding delivery were compared between transient tachypnea newborns (n = 30) and healthy neonates (n = 151) with normal respiratory function born via elective cesarean delivery between July 2015 and February 2016. The degree and duration of hypotension were assessed using area under the curve for systolic blood pressure (SBP) ≤90 mm Hg and area under the curve for mean arterial pressure ≤65 mm Hg. After adjusting for confounders, multivariable logistic regression was used to evaluate the association between area under the curve for SBP and transient tachypnea of newborns. RESULTS: The median area under the curve for SBP was higher in cases of transient tachypnea of newborns (0.94; interquartile range, 0–28.7 mm Hg*min) compared to healthy controls (0; interquartile range, 0–3.30 mm Hg*min; P = .001). Similarly, median area under the curve for mean arterial pressure was also higher in cases of transient tachypnea of newborns (0; interquartile range, 0–18.6 mm Hg*min) compared to controls (0; interquartile range, 0–1.1 mm Hg*min; P = .01). Mothers of transient tachypnea newborns received significantly higher amounts of phenylephrine and ephedrine compared to controls (P = .001 and 0.01, respectively). Hence, the total vasopressor dose given to mothers in the transient tachypnea of newborn group was much higher than for the control group (P = .001). In the multivariable logistic regression, area under the curve for SBP was significantly associated with transient tachypnea of newborns (odds ratio, 1.02; 95% CI, 1.01–1.04, P = .005) after adjusting for gravidity and the type of anesthetic (spinal versus combined spinal epidural). CONCLUSIONS: Our results suggest that the degree and duration of maternal SBP
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Consensus Statement of the Malignant Hyperthermia Association of the United States on Unresolved Clinical Questions Concerning the Management of Patients With Malignant Hyperthermia
At a recent consensus conference, the Malignant Hyperthermia Association of the United States addressed 6 important and unresolved clinical questions concerning the optimal management of patients with malignant hyperthermia (MH) susceptibility or acute MH. They include: (1) How much dantrolene should be available in facilities where volatile agents are not available or administered, and succinylcholine is only stocked on site for emergency purposes? (2) What defines masseter muscle rigidity? What is its relationship to MH, and how should it be managed when it occurs? (3) What is the relationship between MH susceptibility and heat- or exercise-related rhabdomyolysis? (4) What evidence-based interventions should be recommended to alleviate hyperthermia associated with MH? (5) After treatment of acute MH, how much dantrolene should be administered and for how long? What criteria should be used to determine stopping treatment with dantrolene? (6) Can patients with a suspected personal or family history of MH be safely anesthetized before diagnostic testing? This report describes the consensus process and the outcomes for each of the foregoing unanswered clinical questions. Accepted for publication December 2, 2018. Funding: Travel, hotel, and some food expenses for the attendees at the consensus meeting were paid by the Malignant Hyperthermia Association of the United States The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Ronald S. Litman, DO, ML, Department of Anesthesiology & Critical Care, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. Address e-mail to litmanr@email.chop.edu. © 2019 International Anesthesia Research Society
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In Response
Perioperative Epidural Use and Risk of Delirium in Surgical Patients: A Secondary Analysis of the PODCAST Trial
BACKGROUND: Postoperative delirium is an important public health concern without effective prevention strategies. This study tested the hypothesis that perioperative epidural use would be associated with decreased risk of delirium through postoperative day 3. METHODS: This was a secondary, observational, nonrandomized analysis of data from The Prevention of Delirium and Complications Associated With Surgical Treatments Trial (PODCAST; NCT01690988). The primary outcome of the current study was the incidence of delirium (ie, any positive delirium screen, postanesthesia care unit through postoperative day 3) in surgical patients (gastrointestinal, hepatobiliary-pancreatic, gynecologic, and urologic) receiving postoperative epidural analgesia compared to those without an epidural. As a secondary outcome, all delirium assessments were then longitudinally analyzed in relation to epidural use throughout the follow-up period. Given the potential relevance to delirium, postoperative pain, opioid consumption, sleep disturbances, and symptoms of depression were also analyzed as secondary outcomes. A semiparsimonious multivariable logistic regression model was used to test the association between postoperative epidural use and delirium incidence, and generalized estimating equations were used to test associations with secondary outcomes described. Models included relevant covariates to adjust for confounding. RESULTS: In total, 263 patients were included for analysis. Epidural use was not independently associated with reduced delirium incidence (adjusted odds ratio, 0.65 [95% CI, 0.32–1.35]; P= .247). However, when analyzing all assessments over the follow-up period, epidural patients were 64% less likely to experience an episode of delirium (adjusted odds ratio, 0.36 [95% CI, 0.17–0.78]; P= .009). Adjusted pain scores (visual analog scale, 0–100 mm) were significantly lower in the epidural group on postoperative day 1 (morning, −16 [95% CI, −26 to −7], P
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Proposal for a Revised Classification of the Depth of Neuromuscular Block and Suggestions for Further Development in Neuromuscular Monitoring
Gender Inequality in Anesthesiology Research: An Overview of 2018
Clot Retraction: Lost in Interpretation?
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy
Enhanced recovery pathways have quickly become part of the standard of care for patients undergoing elective surgery, especially in North America and Europe. One of the central tenets of this multidisciplinary approach is the use of multimodal analgesia with opioid-sparing and even opioid-free anesthesia and analgesia. However, the current state is a historically high use of opioids for both appropriate and inappropriate reasons, and patients with chronic opioid use before their surgery represent a common, often difficult-to-manage population for the enhanced recovery providers and health care team at large. Furthermore, limited evidence and few proven successful protocols exist to guide providers caring for these at-risk patients throughout their elective surgical experience. Therefore, the fourth Perioperative Quality Initiative brought together an international team of multidisciplinary experts, including anesthesiologists, nurse anesthetists, surgeons, pain specialists, neurologists, nurses, and other experts with the objective of providing consensus recommendations. Specifically, the goal of this consensus document is to minimize opioid-related complications by providing expert-based consensus recommendations that reflect the strength of the medical evidence regarding: (1) the definition, categorization, and risk stratification of patients receiving opioids before surgery; (2) optimal perioperative treatment strategies for patients receiving preoperative opioids; and (3) optimal discharge and continuity of care management practices for patients receiving opioids preoperatively. The overarching theme of this document is to provide health care providers with guidance to reduce potentially avoidable opioid-related complications including opioid dependence (both physical and behavioral), disability, and death. Enhanced recovery programs attempt to incorporate best practices into pathways of care. By presenting the available evidence for perioperative management of patients on opioids, this consensus panel hopes to encourage further development of pathways specific to this high-risk group to mitigate the often unintentional iatrogenic and untoward effects of opioids and to improve perioperative outcomes. Accepted for publication December 11, 2018. Conflicts of Interest: See Disclosures at the end of the article. Funding: D.A.E. has received research support from Semnur Inc and Grunenthal for research unrelated to the topic or production of this manuscript. T.E.M. received research funding and is a consultant for Edwards Lifesciences and for Mallinckrodt. M.D.E. received research funding from the GE Foundation, Edwards Lifesciences, and Cheetah Medical for projects unrelated to this manuscript. The Perioperative Quality Initiative-4 consensus conference was supported by unrestricted educational grants from the American Society for Enhanced Recovery and the Perioperative Quality Initiative, which have received grants from Baxter, Bev MD, Cadence, Cheetah Medical, Edwards, Heron Pharmaceutical, Mallinckrodt, Medtronic, Merck, Trevena, and Pacira Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://bit.ly/KegmMq). Reprints will not be available from the authors. Address correspondence to David A. Edwards, MD, PhD, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN. Address e-mail to david.a.edwards@vanderbilt.edu. © 2019 International Anesthesia Research Society
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Randomized Trial Comparing Early and Late Administration of Rocuronium Before and After Checking Mask Ventilation in Patients With Normal Airways
BACKGROUND: During induction of general anesthesia, it is common practice to delay neuromuscular blockade until the ability to deliver mask ventilation has been confirmed. However, the benefits of this approach have never been scientifically validated. We thus compared the early and late administration of rocuronium before and after checking mask ventilation to investigate the efficiency of mask ventilation and the time to tracheal intubation in patients with normal airways. METHODS: Patients (n = 114) were randomized to receive IV rocuronium either before (early rocuronium group, n = 58) or after (late rocuronium group, n = 56) checking mask ventilation. Expiratory tidal volumes (VTs) were measured at 10, 20, 30, 40, 50, and 60 seconds after apnea during mask ventilation. We graded the ease of mask ventilation and measured the time from apnea to tracheal intubation. The primary outcome was the average of mask VTs measured at 10, 20, 30, 40, 50, and 60 seconds after apnea. The main secondary outcome was the time from apnea to tracheal intubation. STATA was used for statistical analysis. RESULTS: The average of mask VTs measured at 10, 20, 30, 40, 50, and 60 seconds after apnea was larger in the early rocuronium group than in the late rocuronium group (552 mL breath−1 [165 mL breath−1] vs 393 mL breath−1 [165 mL breath−1], mean difference, 160 mL breath−1; 95% CI, 98−221 mL breath−1; P
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Managing Complications in Paediatric Anaesthesia
Drug Calculation Errors in Anesthesiology Residents and Faculty: An Analysis of Contributing Factors
BACKGROUND: Limited data exist regarding computational drug error rates in anesthesia residents and faculty. We investigated the frequency and magnitude of computational errors in a sample of anesthesia residents and faculty. METHODS: With institutional review board approval from 7 academic institutions in the United States, a 15-question computational test was distributed during rounds. Error rates and the magnitude of the errors were analyzed according to resident versus faculty, years of practice (or residency training), duration of sleep, type of question, and institution. RESULTS: A total of 371 completed the test: 209 residents and 162 faculty. Both groups committed 2 errors (median value) per test, for a mean error rate of 17.0%. Twenty percent of residents and 25% of faculty scored 100% correct answers. The error rate for postgraduate year 2 residents was less than for postgraduate year 1 (P = .012). The error rate for faculty increased with years of experience, with a weak correlation (R = 0.22; P = .007). The error rates were independent of the number of hours of sleep. The error rate for percentage-type questions was greater than for rate, dose, and ratio questions (P = .001). The error rates varied with the number of operations needed to calculate the answer (P
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Custom Tuned Hearing Aids from Comfort of Home: Interview with Adam Karp and Dr. Harvey Abrams of Lively
Lively, a New York-based hearing aid provider, has recently announced their online platform for customers to take virtual hearing tests, purchase hearing aids, and receive videocall support from doctors to fine-tune their hearing aids. The platform represents a telemedicine solution for the hearing-impaired, and allows people to receive treatment for their hearing loss from the comfort of their own home. The company reports that 35 million Americans suffer hearing loss, and over 85% of these are untreated. Lively aims to make it easier for people to access treatment for their hearing loss, and has turned to telemedicine to achieve this. The system involves participants taking an online hearing test, and then meeting with an audiologist through a video conference call. Participants then hav...
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An Administrator —and Former SLP—Shares His Perspective on the LA Teachers’ Strike
Editor's note: We are publishing this post after the conclusion of the LA teachers' strike in order to share insights for members about the continuing wave of strikes, such as the current one in Denver. As an administrator in the Speech and Language Program in the Los Angeles Unified School District (LAUSD), I belong to the Associated Administrators of Los Angeles, the union representing administrators. I'm not a member of the union on strike—United Teachers of Los Angeles—so my role during the strike was to provide instruction and supervisory support to those students who reported to school during this time. Schools remained open during the strike and students participated in instructional programs. Qualified LAUSD staff—including reassigned administrators like...
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Custom Tuned Hearing Aids from Comfort of Home: Interview with Adam Karp and Dr. Harvey Abrams of Lively
Lively, a New York-based hearing aid provider, has recently announced their online platform for customers to take virtual hearing tests, purchase hearing aids, and receive videocall support from doctors to fine-tune their hearing aids. The platform represents a telemedicine solution for the hearing-impaired, and allows people to receive treatment for their hearing loss from the comfort of their own home. The company reports that 35 million Americans suffer hearing loss, and over 85% of these are untreated. Lively aims to make it easier for people to access treatment for their hearing loss, and has turned to telemedicine to achieve this. The system involves participants taking an online hearing test, and then meeting with an audiologist through a video conference call. Participants then hav...
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An Administrator —and Former SLP—Shares His Perspective on the LA Teachers’ Strike
Editor's note: We are publishing this post after the conclusion of the LA teachers' strike in order to share insights for members about the continuing wave of strikes, such as the current one in Denver. As an administrator in the Speech and Language Program in the Los Angeles Unified School District (LAUSD), I belong to the Associated Administrators of Los Angeles, the union representing administrators. I'm not a member of the union on strike—United Teachers of Los Angeles—so my role during the strike was to provide instruction and supervisory support to those students who reported to school during this time. Schools remained open during the strike and students participated in instructional programs. Qualified LAUSD staff—including reassigned administrators like...
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Study in Cat-Allergic Patients With Asthma to Evaluate the Efficacy of a Single Dose of REGN1908-1909 to Reduce Bronchoconstriction Upon Cat Allergen Challenge
Conditions: Cat Allergy; Mild Asthma Interventions: Drug: REGN1908-1909; Drug: Placebo Sponsor: Regeneron Pharmaceuticals Not yet recruiting (Source: ClinicalTrials.gov)
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Combining TLR9 Agonist With bNAbs for Reservoir Reduction and Immunological Control of HIV
Condition: HIV-1-infection Interventions: Drug: Saline; Drug: Lefitolimod; Drug: 3BNC117 and 10-1074 Sponsors: University of Aarhus; Aalborg Universitetshospital; Odense University Hospital; Rigshospitalet, Denmark; Hvidovre University Hospital; The Peter Doherty Institute for Infection and Immunity; University of Utah Not yet recruiting (Source: ClinicalTrials.gov)
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The Influence of ANS-6637 on Midazolam Pharmacokinetics in Healthy Volunteers
Condition: Opioid Addiction Interventions: Drug: MDZ; Drug: ANS-6637 Sponsors: National Institutes of Health Clinical Center (CC); National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)
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Allergy UK Research and Development Nurse Project
Condition: Allergy Intervention: Other: Nurse Led Allergy Clinic Sponsors: University of Edinburgh; Allergy UK Recruiting (Source: ClinicalTrials.gov)
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Study in Cat-Allergic Patients With Asthma to Evaluate the Efficacy of a Single Dose of REGN1908-1909 to Reduce Bronchoconstriction Upon Cat Allergen Challenge
Conditions: Cat Allergy; Mild Asthma Interventions: Drug: REGN1908-1909; Drug: Placebo Sponsor: Regeneron Pharmaceuticals Not yet recruiting (Source: ClinicalTrials.gov)
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The Influence of ANS-6637 on Midazolam Pharmacokinetics in Healthy Volunteers
Condition: Opioid Addiction Interventions: Drug: MDZ; Drug: ANS-6637 Sponsors: National Institutes of Health Clinical Center (CC); National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)
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Allergy UK Research and Development Nurse Project
Condition: Allergy Intervention: Other: Nurse Led Allergy Clinic Sponsors: University of Edinburgh; Allergy UK Recruiting (Source: ClinicalTrials.gov)
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Non-Invasive Diagnosis of Pediatric Pulmonary Invasive Mold Infections
Conditions: Pulmonary Invasive Mold Infections; Pulmonary Invasive Aspergillosis Intervention: Diagnostic Test: Non-Invasive Testing for PIMI Sponsors: Duke University; Children's Hospital of Philadelphia; National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)
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Retrospective Chart Review of Candida Fungemia
Condition: Candida Intervention: Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) Active, not recruiting (Source: ClinicalTrials.gov)
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Safety Study of Hepatitis E Vaccine (HEV239) in Healthy US Adult Population
Conditions: Hepatitis E; Immunisation Interventions: Biological: HEV 239; Other: Placebo Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)
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Spontaneous bilateral osteonecrosis of the mandible in a bisphosphonate-naive patient
We report a case of spontaneous bilateral osteonecrosis of the mandible in a patient with no previous exposure to either. (Source: The British Journal of Oral and Maxillofacial Surgery)
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Systematic review of the role of corticosteroids in cervicofacial infections
The role of corticosteroids in the management of cervicofacial infections continues to cause controversy. Systemic anti-inflammatory and immunomodulatory effects that reduce swelling and improve symptoms in the head and neck may make these agents an effective addition to the antibiotics used and to surgical management, although this same effect may dull the physiological response to infection, and allow infections to progress. We have systematically reviewed the evidence for the use of corticosteroids in common cervicofacial infections following the PRISMA guidelines. (Source: The British Journal of Oral and Maxillofacial Surgery)
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Spontaneous bilateral osteonecrosis of the mandible in a bisphosphonate-naive patient
We report a case of spontaneous bilateral osteonecrosis of the mandible in a patient with no previous exposure to either. (Source: The British Journal of Oral and Maxillofacial Surgery)
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Systematic review of the role of corticosteroids in cervicofacial infections
The role of corticosteroids in the management of cervicofacial infections continues to cause controversy. Systemic anti-inflammatory and immunomodulatory effects that reduce swelling and improve symptoms in the head and neck may make these agents an effective addition to the antibiotics used and to surgical management, although this same effect may dull the physiological response to infection, and allow infections to progress. We have systematically reviewed the evidence for the use of corticosteroids in common cervicofacial infections following the PRISMA guidelines. (Source: The British Journal of Oral and Maxillofacial Surgery)
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Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a oral spray for children with recurrent streptococcal pharyngotonsillitis: a randomized placebo-controlled clinical study
Abstract
Purpose
Group A beta-hemolytic Streptococcus (GABHS) causes a recurrent acute pharyngotonsillitis (RAPT) in children. Moreover, the repeated use of antibiotics contributes to its resistance. However, S. Salivarius 24SMB and S. oralis 89a were effective probiotics in other infections. Thus, we decided to evaluate this combination efficacy compared to placebo in RAPT.
Methods
Patients with microbiologically confirmed GABHS were enrolled in this randomized, placebo-controlled trial. They received the aforementioned combination or placebo as an oral spray. We investigated episodes of frequency and duration, need for antibiotics, school days lost, the treatment impact on life quality, treatment compliance and side effects during a 90-day treatment and a 6-month follow-up.
Results
We included 41 patients in each group. The mean number of GABHS infection was significantly lower during both study periods for the two groups. However, our treatment group showed a lower rate. Moreover, the probiotic group had a lower mean number and a shorter median duration of GABHS episodes during both study periods than controls. Furthermore, the mean duration of antibiotic treatment was lower in the probiotic group during the 90-day and 6-month follow-up periods. Similarly, patients in the probiotic group showed a significantly lower mean number of absence days from school but higher EQ-VAS score. Indeed, all patients included were compliant to treatment.
Conclusions
We identified potential probiotics, possessing desirable features against GABHS pharyngotonsillitis. Our findings represent the first evidence which throws the light on using these probiotics that can reduce antibiotics use which did not have efficient results regarding recurrence.
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Articular soft tissue injuries associated with mandibular condyle fractures and the effects on oral function
The majority of studies debating the optimization of treatment for condylar mandibular fractures focus on the bony aspect first. However, fractures of the mandibular condyle may go together with soft tissue injury of the temporomandibular joint. An electronic literature search for this topic was undertaken. Assessment of quality was carried out using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Sixteen articles were included in this review. The reviewed literature showed that intracapsular fractures and dislocated condylar fractures result in more severe injuries. (Source: International Journal of Oral and Maxillofacial Surgery)
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Relationship between the degree of mastoid pneumatization and the presence of persistent foramen of Huschke
The aim of this study was to determine the relationship between the degree of mastoid pneumatization and the presence of persistent foramen of Huschke (FH). Temporal computed tomography images of 714 patients (1428 ears) who applied to the Otorhinolaryngology Department of Karabuk University Training and Research Hospital between January 2016 and June 2018 were retrospectively analysed. We compared the mastoid pnomatization levels of 95 patients (74 females, 21 males, mean age 53.18 ±15.09years) who had persistent FH and 135 patients (103 females, 32 males, mean age 54.29±15.82years) with no FH who had similar age and gender. (Source: International Journal of Oral and Maxillofacial Surgery)
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Effectiveness of dental implants placed in bone graft area of cleft Patients
The purpose of this study was to determine the effectiveness of dental implants placed in the bone graft area of cleft patients. Electronic databases and relevant journals were searched to the end of August 2018. A total of 11 articles were eligible for systematic review considering the previously established inclusion and exclusion criteria, and then underwent risk of bias assessment. A total of 483 implants were placed and showed a survival rate of 93% after a mean follow-up of 60.5 months. The iliac bone was the most used for the reconstructive surgery in cleft patients, followed by the mandible. (Source: International Journal of Oral and Maxillofacial Surgery)
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Computer-assisted osteotomy guides and pre-bent titanium plates improve the planning for correction of facial asymmetry
This study investigated the surgical outcomes and accuracy of computer-assisted osteotomy guides and pre-bent titanium plates in the treatment of patients with facial asymmetry. Thirteen patients with facial asymmetry undergoing bimaxillary orthognathic surgery were included. Virtual simulation of Le Fort I osteotomy, sagittal split ramus osteotomy, and genioplasty, if needed, was conducted on the preoperative three-dimensional model. Computer-assisted osteotomy guides and pre-bent titanium plates were produced and used in the actual operation. (Source: International Journal of Oral and Maxillofacial Surgery)
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Hard and soft tissue changes and long-term stability after vertical height reduction genioplasty using biodegradable fixation
The aim of this work was to analyse the stability of vertical height reduction genioplasty using biodegradable material, as well as to determine vertical changes of hard and soft tissues during this procedure.Forty patients underwent vertical height reduction genioplasty using two types of biodegradable fixation (Biosorb FX ® or OSTEOTRANS-MX®), combined with mandibular setback surgery. We assessed lateral cephalographs over time (pre-operation; immediately post-operation; 3 months, 6 months and 12 months post-operation). (Source: International Journal of Oral and Maxillofacial Surgery)
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Benefit of directional microphones for unilateral, bilateral and bimodal cochlear implant users
. (Source: Cochlear Implants International)
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Three-dimensional finite-element analysis of the cochlear hypoplasia.
CONCLUSIONS: Numerical modeling was used to demonstrate the effect of cochlear hypoplasia on sound conduction and cochlear sensitivity. Cochlear hypoplysia causes changes in biomechanics of middle ear and inner ear, which lead to hearing loss. The current modeling results suggest that the frequency-dependent decrease of the stapes vibration can be used in clinics for diagnosing cochlear hypoplasia. This is particularly important because the middle ear function measurement can be used to diagnose unmeasurable inner ear disorders. PMID: 30758241 [PubMed - as supplied by publisher] (Source: Acta Oto-Laryngologica)
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Articular soft tissue injuries associated with mandibular condyle fractures and the effects on oral function
The majority of studies debating the optimization of treatment for condylar mandibular fractures focus on the bony aspect first. However, fractures of the mandibular condyle may go together with soft tissue injury of the temporomandibular joint. An electronic literature search for this topic was undertaken. Assessment of quality was carried out using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Sixteen articles were included in this review. The reviewed literature showed that intracapsular fractures and dislocated condylar fractures result in more severe injuries. (Source: International Journal of Oral and Maxillofacial Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N8xZ7B
Relationship between the degree of mastoid pneumatization and the presence of persistent foramen of Huschke
The aim of this study was to determine the relationship between the degree of mastoid pneumatization and the presence of persistent foramen of Huschke (FH). Temporal computed tomography images of 714 patients (1428 ears) who applied to the Otorhinolaryngology Department of Karabuk University Training and Research Hospital between January 2016 and June 2018 were retrospectively analysed. We compared the mastoid pnomatization levels of 95 patients (74 females, 21 males, mean age 53.18 ±15.09years) who had persistent FH and 135 patients (103 females, 32 males, mean age 54.29±15.82years) with no FH who had similar age and gender. (Source: International Journal of Oral and Maxillofacial Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SSQGkW
Effectiveness of dental implants placed in bone graft area of cleft Patients
The purpose of this study was to determine the effectiveness of dental implants placed in the bone graft area of cleft patients. Electronic databases and relevant journals were searched to the end of August 2018. A total of 11 articles were eligible for systematic review considering the previously established inclusion and exclusion criteria, and then underwent risk of bias assessment. A total of 483 implants were placed and showed a survival rate of 93% after a mean follow-up of 60.5 months. The iliac bone was the most used for the reconstructive surgery in cleft patients, followed by the mandible. (Source: International Journal of Oral and Maxillofacial Surgery)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N4rZgf
Computer-assisted osteotomy guides and pre-bent titanium plates improve the planning for correction of facial asymmetry
This study investigated the surgical outcomes and accuracy of computer-assisted osteotomy guides and pre-bent titanium plates in the treatment of patients with facial asymmetry. Thirteen patients with facial asymmetry undergoing bimaxillary orthognathic surgery were included. Virtual simulation of Le Fort I osteotomy, sagittal split ramus osteotomy, and genioplasty, if needed, was conducted on the preoperative three-dimensional model. Computer-assisted osteotomy guides and pre-bent titanium plates were produced and used in the actual operation. (Source: International Journal of Oral and Maxillofacial Surgery)
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Benefit of directional microphones for unilateral, bilateral and bimodal cochlear implant users
. (Source: Cochlear Implants International)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SNhu6l
Three-dimensional finite-element analysis of the cochlear hypoplasia.
CONCLUSIONS: Numerical modeling was used to demonstrate the effect of cochlear hypoplasia on sound conduction and cochlear sensitivity. Cochlear hypoplysia causes changes in biomechanics of middle ear and inner ear, which lead to hearing loss. The current modeling results suggest that the frequency-dependent decrease of the stapes vibration can be used in clinics for diagnosing cochlear hypoplasia. This is particularly important because the middle ear function measurement can be used to diagnose unmeasurable inner ear disorders. PMID: 30758241 [PubMed - as supplied by publisher] (Source: Acta Oto-Laryngologica)
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Infant Midnasal Stenosis: Reliability of Nasal Metrics [HEAD & NECK]
BACKGROUND AND PURPOSE:
Midnasal stenosis is a poorly defined entity that may be a component of other conditions of nasal obstruction contributing to respiratory distress in infants. We sought to establish whether midnasal vault narrowing is a component of well-defined syndromes of nasal narrowing, such as bilateral choanal atresia and pyriform aperture stenosis, and to characterize the nasal anatomy of patients with syndromic craniosynostosis.
MATERIALS AND METHODS:A convenience sample of patients with pyriform aperture stenosis, bilateral choanal atresia, and Apert and Crouzon syndromes with maxillofacial CT scans was identified. Patients with Pierre Robin Sequence were used as controls. Nasal measurements were performed at the pyriform aperture, choana, and defined midnasal points on axial and coronal CT scans. Intra- and interrater reliability was quantified with the intraclass correlation coefficient. T tests with Bonferroni adjustment were used to assess differences from controls.
RESULTS:The study included 50 patients: Eleven had pyriform aperture stenosis, 10 had Apert and Crouzon syndromes, 9 had choanal atresia, and 20 were controls. Measurements in patients with pyriform aperture stenosis and Apert and Crouzon syndromes were narrower than those of controls at all measured points (P < .001). Measurements in patients with choanal atresia were only narrow in the posterior half of the nose (P < .001). The intra- and interrater reliability of midnasal and pyriform measurements was very good to excellent (intraclass correlation coefficient > 0.87). The choanal measurement was good (intraclass correlation coefficient = 0.76–0.77).
CONCLUSIONS:Pyriform aperture stenosis, Apert and Crouzon patients were narrower at all measured points compared to controls. Bilateral choanal atresia patients were only narrower in the posterior half of the nose. More research is needed to evaluate the clinical implications of these radiographic findings.
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Longitudinal White Matter Changes following Carbon Monoxide Poisoning: A 9-Month Follow-Up Voxelwise Diffusional Kurtosis Imaging Study [FUNCTIONAL]
BACKGROUND AND PURPOSE:
Patients with carbon monoxide (CO) intoxication exhibit progressive WM changes that are not well-understood. The purpose of this study was to detect longitudinal WM changes using voxelwise diffusional kurtosis imaging in patients with CO intoxication from the acute-to-chronic stage after CO intoxication.
MATERIALS AND METHODS:Twenty-four patients with CO intoxication and 21 age- and sex-matched healthy controls were enrolled in this study. Diffusional kurtosis imaging was performed on all subjects and was conducted repeatedly in patients at 1 week and 1, 3, and 9 months after CO intoxication. Voxelwise diffusional kurtosis imaging analysis was performed to detect global WM changes in the patients with and without WM lesions. Receiver operating characteristic analysis was performed to compare the performance of diffusional indices in differentiating patients with delayed neuropsychiatric sequelae from patients without them.
RESULTS:In voxelwise analysis, progressive WM changes were detected in patients with WM lesions. In the acute phase, WM injuries were found mainly in the dopaminergic pathways at 1 week, whereas in the chronic stage, WM injuries extended toward subcortical areas from 1 to 9 months. However, no significant WM change was noted in patients without WM lesions during the 9 months after CO intoxication. Moreover, receiver operating characteristic analysis demonstrated that axial kurtosis and mean kurtosis values had better performance than other diffusional indices in differentiating patients with delayed neuropsychiatric sequelae from patients without them at 1 week after CO intoxication.
CONCLUSIONS:Voxelwise diffusional kurtosis imaging analysis was helpful to longitudinally investigate WM changes and predict the prognosis of patients after CO intoxication.
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Imaging Review of New and Emerging Sinonasal Tumors and Tumor-like Entities from the Fourth Edition of the World Health Organization Classification of Head and Neck Tumors [REVIEW ARTICLE]
SUMMARY:
The sinonasal tract is an environment diverse with neoplasia. Given the continued discovery of entities generally specific to the sinonasal tract, the fourth edition of the World Health Organization Classification of Head and Neck Tumors was released in 2017. It describes 3 new, well-defined entities and several less-defined, emerging entities. The new entities are seromucinous hamartomas, nuclear protein in testis carcinomas, and biphenotypic sinonasal sarcomas. Emerging entities include human papillomavirus–related sinonasal carcinomas, SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1–deficient sinonasal carcinomas, renal cell-like adenocarcinomas, and chondromesenchymal hamartomas. The literature thus far largely focuses on the pathology of these entities. Our goal in this report was to familiarize radiologists with these new diagnoses and to provide available information regarding their imaging appearances.
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Flow-Diversion Treatment of Unruptured Saccular Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis [INTERVENTIONAL]
BACKGROUND:
Flow diversion for anterior communicating artery aneurysms required further investigation.
PURPOSE:Our aim was to analyze outcomes after treatment of anterior communicating artery aneurysms with flow-diverter stents.
DATA SOURCES:A systematic search of 3 data bases was performed for studies published from 2008 to 2018.
STUDY SELECTION:According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting anterior communicating artery aneurysms treated with flow diversion.
DATA ANALYSIS:Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and factors influencing the studied outcomes.
DATA SYNTHESIS:We included 14 studies and 148 unruptured saccular anterior communicating artery aneurysms treated with flow diversion. The long-term complete/near-complete (O'Kelly-Marotta C–D) occlusion rate was 87.4% (91/105; 95% CI, 81.3%–93.6%; I2 = 0%) (mean radiologic follow-up of 11 months). The treatment-related complication rate was 8.6% (14/126; 95% CI, 4%–13.1%; I2 = 0%), with morbidity and mortality rates of 3.5% (5/126; 95% CI, 2%–7%; I2 = 0%) and 2.5% (2/148; 95% CI, 0.3%–5%; I2 = 0%), respectively. Most complications were periprocedural (12/126 = 7%; 95% CI, 3%–11%; I2 = 0%). Thromboembolic events were slightly higher compared with hemorrhagic complications (10/126 = 6%; 95% CI, 2%–10%; I2 = 0% and 4/126 = 3%; 95% CI, 1%–6%; I2 = 0%). Branching arteries (A2 or the recurrent artery of Heubner) covered by the stent were occluded in 16% (7/34; 95% CI, 3.5%–28%; I2 = 25%) of cases. Pre- and posttreatment low-dose and high-dose of antiplatelet therapy was not associated with significantly different complication and occlusion rates.
LIMITATIONS:We reviewed small and retrospective series.
CONCLUSIONS:Flow diversion for unruptured saccular anterior communicating artery aneurysms appears to be an effective alternative treatment for lesions difficult to treat with coiling or microsurgical clipping. The treatment-related complication rate was relatively low. However, larger studies are needed to confirm these results.
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Comparison between functional outcomes in patients with unilateral vocal fold paralysis undergoing injection laryngoplasty under general anesthesia versus local anesthesia
Amr R El-Badrawy, Hassan M El-Hoshy, Ayatallah R Sheikhany, Wael S.A El-Rehim
The Egyptian Journal of Otolaryngology 2019 35(1):92-102
Introduction Injection laryngoplasty (IL) continues to evolve, as new techniques, approaches, and injection materials are continuously being developed. Although it was performed under general anesthesia in the operating room, IL is now increasingly being performed in an office-based setting. Aim The aim of this study was to compare functional voice outcomes in patients with unilateral vocal fold paralysis undergoing injection laryngoplasty local versus general anesthesia. Patients and methods : A prospective interventional study was done to compare functional outcomes and patient satisfaction between group A (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under local anesthesia, versus group B (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under general anesthesia, by analyzing total Arabic Voice Handicap Index (VHI)scores and subscale scores preoperatively and post operatively. Results All results obtained in this study showed that there was no significant difference for the functional outcomes and patient satisfaction obtained for both groups under study. Conclusion In conclusion, IL under local anesthesia gives similar results as general anesthesia regarding functional outcomes and patient satisfaction of voice quality by themselves as well as by using the voice handicap index.
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The Egyptian Journal of Otolaryngology 2019 35(1):92-102
Introduction Injection laryngoplasty (IL) continues to evolve, as new techniques, approaches, and injection materials are continuously being developed. Although it was performed under general anesthesia in the operating room, IL is now increasingly being performed in an office-based setting. Aim The aim of this study was to compare functional voice outcomes in patients with unilateral vocal fold paralysis undergoing injection laryngoplasty local versus general anesthesia. Patients and methods : A prospective interventional study was done to compare functional outcomes and patient satisfaction between group A (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under local anesthesia, versus group B (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under general anesthesia, by analyzing total Arabic Voice Handicap Index (VHI)scores and subscale scores preoperatively and post operatively. Results All results obtained in this study showed that there was no significant difference for the functional outcomes and patient satisfaction obtained for both groups under study. Conclusion In conclusion, IL under local anesthesia gives similar results as general anesthesia regarding functional outcomes and patient satisfaction of voice quality by themselves as well as by using the voice handicap index.
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Evaluation of hearing outcome of tympanoplasty using cartilage graft versus temporalis fascia graft
Mohamed M El-Sheikh
The Egyptian Journal of Otolaryngology 2019 35(1):1-5
Background Various materials such as fascia, perichondrium, and cartilage have been used for the reconstruction of the tympanic membrane in middle ear surgery. Owing to its stiffness, cartilage is resistant to resorption and retraction. Patients and methods This study comprised a randomized, controlled trial conducted to analyze the audiological gain when using cartilage grafts in type 1 tympanoplasty compared with temporalis fascia grafts on 60 patients suffering from chronic otitis media after successful tympanoplasty. The follow-up period was at least 6 months. All patients were subjected to audiological evaluation before and at least 6 months postoperatively. Results There was a significant reduction in mean air-bone gap (ABG) in both groups, whereas in group A (fascial graft) the mean preoperative ABG was 25±10.2 dB and the mean postoperative ABG was 13.5±7.3 dB, whereas in group B (cartilage graft) the mean preoperative ABG was 30.6±8.6 dB and the mean postoperative ABG was 15.9±8.7 dB, analyzing the effectiveness of both surgical techniques showed that both were equally effective in reducing ABG from preintervention to postintervention with no statistical significance among both groups (P=0.212). Conclusion Patients who had cartilage grafts showed similar hearing outcomes to those who had fascial grafts after a successful tympanoplasty procedure.
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The Egyptian Journal of Otolaryngology 2019 35(1):1-5
Background Various materials such as fascia, perichondrium, and cartilage have been used for the reconstruction of the tympanic membrane in middle ear surgery. Owing to its stiffness, cartilage is resistant to resorption and retraction. Patients and methods This study comprised a randomized, controlled trial conducted to analyze the audiological gain when using cartilage grafts in type 1 tympanoplasty compared with temporalis fascia grafts on 60 patients suffering from chronic otitis media after successful tympanoplasty. The follow-up period was at least 6 months. All patients were subjected to audiological evaluation before and at least 6 months postoperatively. Results There was a significant reduction in mean air-bone gap (ABG) in both groups, whereas in group A (fascial graft) the mean preoperative ABG was 25±10.2 dB and the mean postoperative ABG was 13.5±7.3 dB, whereas in group B (cartilage graft) the mean preoperative ABG was 30.6±8.6 dB and the mean postoperative ABG was 15.9±8.7 dB, analyzing the effectiveness of both surgical techniques showed that both were equally effective in reducing ABG from preintervention to postintervention with no statistical significance among both groups (P=0.212). Conclusion Patients who had cartilage grafts showed similar hearing outcomes to those who had fascial grafts after a successful tympanoplasty procedure.
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The role of simple office-based surgery in small central tympanic membrane perforation
Abdel-Latif I El-Rasheedy, Ayman A Abdel-Fattah, Heba A Abo El-Naga, Mustafa M El-Barbary
The Egyptian Journal of Otolaryngology 2019 35(1):12-16
Objective The aim of this study was to evaluate the outcome of simple office-based surgery in small central tympanic membrane (TM) perforation. Background The purpose of closure of TM perforations is to restore the continuity of the TM in order to improve hearing and decrease the risk of middle ear infections. Rapid and cost-effective procedures like chemical cauterization and fat plug myringoplasty have been found to be effective in healing small central perforations with significant hearing improvement. Patients and methods Our prospective study was carried out on 40 patients aged more than 15 years with dry small central persistent perforation during the period spanning from April 2017 to March 2018, divided in two groups: group A (20 patients underwent fat graft myringoplasty) and group B (20 patients underwent chemical cautery of the edge of perforation). Results Our study included 26 male patients and 14 female patients; the mean age was 27.2±9.3 years. Our study showed a 70% success rate in the healing of TM perforation in group A while there was a 55% success rate in group B. Conclusion From our study, we found that the two procedures are easy to perform, reliable with a satisfactory outcome, simple, rapid, risk free, and also lessen the financial burden and morbidity on the patient.
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The Egyptian Journal of Otolaryngology 2019 35(1):12-16
Objective The aim of this study was to evaluate the outcome of simple office-based surgery in small central tympanic membrane (TM) perforation. Background The purpose of closure of TM perforations is to restore the continuity of the TM in order to improve hearing and decrease the risk of middle ear infections. Rapid and cost-effective procedures like chemical cauterization and fat plug myringoplasty have been found to be effective in healing small central perforations with significant hearing improvement. Patients and methods Our prospective study was carried out on 40 patients aged more than 15 years with dry small central persistent perforation during the period spanning from April 2017 to March 2018, divided in two groups: group A (20 patients underwent fat graft myringoplasty) and group B (20 patients underwent chemical cautery of the edge of perforation). Results Our study included 26 male patients and 14 female patients; the mean age was 27.2±9.3 years. Our study showed a 70% success rate in the healing of TM perforation in group A while there was a 55% success rate in group B. Conclusion From our study, we found that the two procedures are easy to perform, reliable with a satisfactory outcome, simple, rapid, risk free, and also lessen the financial burden and morbidity on the patient.
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Emergency management of an isolated sphenoidal mucopyocele with vision loss: a case report
Natarajan Ramalingam, Sivaraman Ganesan, Sithananda K Venkatesan, Sunil K Saxena
The Egyptian Journal of Otolaryngology 2019 35(1):122-125
Isolated mucocele is very rare in sphenoid sinus. It presents with varied symptoms in the form of vision loss, proptosis, and headache. We report a case of isolated sphenoidal mucocele that presented with vision loss. Although the vision loss was not sudden, immediate evacuation of pus and marsupialization was done on an emergency basis based on the clinical and radiological findings rather than relying on the history of insidious vision loss. The patient's vision improved immediately after surgery. This underscores the importance of emergency drainage of this condition.
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The Egyptian Journal of Otolaryngology 2019 35(1):122-125
Isolated mucocele is very rare in sphenoid sinus. It presents with varied symptoms in the form of vision loss, proptosis, and headache. We report a case of isolated sphenoidal mucocele that presented with vision loss. Although the vision loss was not sudden, immediate evacuation of pus and marsupialization was done on an emergency basis based on the clinical and radiological findings rather than relying on the history of insidious vision loss. The patient's vision improved immediately after surgery. This underscores the importance of emergency drainage of this condition.
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Assessment of safety and efficacy of extraturbinal microdebrider-assisted turbinoplasty versus partial inferior turbinectomy
Balegh H Ali, Osama G.Abdel-Naby Awad, Aya Ibrahim, Ahmd A.Abdel Azez
The Egyptian Journal of Otolaryngology 2019 35(1):17-24
Objective The aim was to compare the extraturbinal microdebrider-assisted turbinoplasty (MAT) with the partial inferior turbinectomy (PIT) based on subjective and objective parameters. Patients and methods A total of 18 patients with nasal obstruction owing to bilateral hypertrophied inferior turbinates were included in this study. All patients underwent extraturbinal MAT on one side of the nose and PIT on the other side in alternate manner. The patients were blinded to the technique used. This is a prospective blinded randomized trial was conducted. The study was conducted at a tertiary referral hospital. Main outcome measures Operative time, blood loss, subjective improvement of the nasal obstruction, degree of intranasal crustations, and degree of synechiae formation were the main outcomes recorded. Results The operative time and intraoperative blood loss were less in the extraturbinal MAT compared with PIT. At 2 weeks postoperatively, the sides with MAT had significantly better relief of nasal obstruction (P=0.007), less degree of nasal pain (P=0.002), less crustations (P=0.010), and better tissue healing (P =0.010) than sides with PIT. At 1 and 3 months postoperatively, the sides with MAT had statistically significant less crustations (P=0.040 and 0.032, respectively) and better tissue healing (P=0.010 and 0.010, respectively) compared with the sides with PIT; however, there were no statistically significant differences regarding relief of nasal obstruction and degree of nasal pain. Conclusions Extraturbinal microdebrider-assisted inferior turbinoplasty is more effective and safe compared with PIT, especially in short-term follow-up periods.
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The Egyptian Journal of Otolaryngology 2019 35(1):17-24
Objective The aim was to compare the extraturbinal microdebrider-assisted turbinoplasty (MAT) with the partial inferior turbinectomy (PIT) based on subjective and objective parameters. Patients and methods A total of 18 patients with nasal obstruction owing to bilateral hypertrophied inferior turbinates were included in this study. All patients underwent extraturbinal MAT on one side of the nose and PIT on the other side in alternate manner. The patients were blinded to the technique used. This is a prospective blinded randomized trial was conducted. The study was conducted at a tertiary referral hospital. Main outcome measures Operative time, blood loss, subjective improvement of the nasal obstruction, degree of intranasal crustations, and degree of synechiae formation were the main outcomes recorded. Results The operative time and intraoperative blood loss were less in the extraturbinal MAT compared with PIT. At 2 weeks postoperatively, the sides with MAT had significantly better relief of nasal obstruction (P=0.007), less degree of nasal pain (P=0.002), less crustations (P=0.010), and better tissue healing (P =0.010) than sides with PIT. At 1 and 3 months postoperatively, the sides with MAT had statistically significant less crustations (P=0.040 and 0.032, respectively) and better tissue healing (P=0.010 and 0.010, respectively) compared with the sides with PIT; however, there were no statistically significant differences regarding relief of nasal obstruction and degree of nasal pain. Conclusions Extraturbinal microdebrider-assisted inferior turbinoplasty is more effective and safe compared with PIT, especially in short-term follow-up periods.
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Comparison between local steroids and local steroids plus itraconazole effect in prevention of recurrence of allergic fungal sinusitis in hypertensive and/or diabetic patients
Ramez Reda, Wael Wageh, Mohammed Fawaz, Wassim Mikhaiel
The Egyptian Journal of Otolaryngology 2019 35(1):25-29
Background Allergic fungal rhinosinusitis (AFRS) is the most common type of fungal diseases in nose and paranasal sinuses. It is due to hypersensitivity to fungal antigens. The standard treatment for control of AFRS is endoscopic sinus surgery followed by systemic and/or topical steroids. In spite of steroids known to have promising results for the management of AFRS, their prolonged use is not always advised. So, some authors have tried to decrease the recurrence rate of AFRS by using antifungal treatment. In this study, we compared the efficacy of local steroids (Fluticasone nasal spray) versus local steroids plus itraconazole postoperatively in the prevention of recurrence of allergic fungal sinusitis in patients known to be hypertensive or diabetic. Patients and Methods A total of 60 patients with AFRS and nasal polyposis were included in the study. Patients were divided randomly into two groups: group A used local steroid and group B used local steroid and itraconazole. Clinical parameters were compared at the end of 6 months. Results Patients of group B were better clinically and also by endoscopic examination. Conclusion Itraconazole is better to be added in the postoperative treatment of AFRS patients especially for patients who have contraindications for systemic steroids intake.
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The Egyptian Journal of Otolaryngology 2019 35(1):25-29
Background Allergic fungal rhinosinusitis (AFRS) is the most common type of fungal diseases in nose and paranasal sinuses. It is due to hypersensitivity to fungal antigens. The standard treatment for control of AFRS is endoscopic sinus surgery followed by systemic and/or topical steroids. In spite of steroids known to have promising results for the management of AFRS, their prolonged use is not always advised. So, some authors have tried to decrease the recurrence rate of AFRS by using antifungal treatment. In this study, we compared the efficacy of local steroids (Fluticasone nasal spray) versus local steroids plus itraconazole postoperatively in the prevention of recurrence of allergic fungal sinusitis in patients known to be hypertensive or diabetic. Patients and Methods A total of 60 patients with AFRS and nasal polyposis were included in the study. Patients were divided randomly into two groups: group A used local steroid and group B used local steroid and itraconazole. Clinical parameters were compared at the end of 6 months. Results Patients of group B were better clinically and also by endoscopic examination. Conclusion Itraconazole is better to be added in the postoperative treatment of AFRS patients especially for patients who have contraindications for systemic steroids intake.
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Voice outcome after cold phonomicrosurgery for minimal-associated pathological lesions of the vocal folds
Ezzat A Merwad, Abd El Raof S Mohamed, Amal S Quriba, Amany M Abd Al Badea
The Egyptian Journal of Otolaryngology 2019 35(1):110-114
Objective The aim was to assess the voice outcomes of cold phonomicrosurgery for minimal-associated pathological lesions of the vocal folds. Materials and methods A total of 26 patients with either unilateral or bilateral minimal-associated pathological lesions of the vocal folds from the Otorhinolaryngology Department in Zagazig University Hospitals between 2013 and 2014 were enrolled in the case group. Cold phonomicrosurgeries were performed. The control group comprised of 20 matched normal individuals. Matching was based on sex, age, and socioeconomic rank. Results All patients had videoendoscopic laryngeal evaluations in the preoperative and postoperative periods (3 months after surgery), and the results showed the absence of the lesion in comparison with the preoperative findings in 22 (84.62%) patients. All patients had perceptual voice analysis in the preoperative and postoperative periods (3 months after surgery), with all P values below 0.05, indicating statistically significant difference among the cases after the operation. Conclusion Although voice therapy is the cornerstone in treating benign vocal fold lesions, phonosurgery has an important role in some lesions.
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The Egyptian Journal of Otolaryngology 2019 35(1):110-114
Objective The aim was to assess the voice outcomes of cold phonomicrosurgery for minimal-associated pathological lesions of the vocal folds. Materials and methods A total of 26 patients with either unilateral or bilateral minimal-associated pathological lesions of the vocal folds from the Otorhinolaryngology Department in Zagazig University Hospitals between 2013 and 2014 were enrolled in the case group. Cold phonomicrosurgeries were performed. The control group comprised of 20 matched normal individuals. Matching was based on sex, age, and socioeconomic rank. Results All patients had videoendoscopic laryngeal evaluations in the preoperative and postoperative periods (3 months after surgery), and the results showed the absence of the lesion in comparison with the preoperative findings in 22 (84.62%) patients. All patients had perceptual voice analysis in the preoperative and postoperative periods (3 months after surgery), with all P values below 0.05, indicating statistically significant difference among the cases after the operation. Conclusion Although voice therapy is the cornerstone in treating benign vocal fold lesions, phonosurgery has an important role in some lesions.
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Efficacy of intranasal corticosteroids in improving nasal airway obstruction in children with symptomatic adenoidal hypertrophy: a meta-analysis and systematic review
Yasser M Elbeltagy, Samer A Ibrahim, Mohamed S Hasaballah, Omar M Sowilem
The Egyptian Journal of Otolaryngology 2019 35(1):30-36
Background Adenoidal hypertrophy is considered one of the most common diseases in otolaryngology. It is usually associated with nasal obstruction symptoms like snoring and hyponasality. If not treated well, children will encounter many complications like otitis media with effusion and craniofacial abnormalities. Adenoidectomy is the main line of treatment for many otolaryngologists, but recently medical treatment by using intranasal corticosteroids (INCS) has shown beneficial effects in reducing the size of adenoids or improving the obstruction symptoms. Objectives To assess the efficacy of nasal corticosteroids in improving nasal airway obstruction in children with symptomatic adenoidal hypertrophy. Patients and methods A comprehensive search in MEDLINE and CENTRAL was undertaken (1985–2017). We identified all randomized controlled trials in children with adenoidal hypertrophy that compared the effects of nasal corticosteroids and normal saline nasal spray on different outcomes. The primary outcomes were improvement of nasal obstruction symptoms assessed by any symptoms score and reduction in adenoid size as demonstrated by fiberoptic nasopharyngoscopy or lateral nasopharynx radiograph. Results Twenty-three relevant potential citations were identified and screened for retrieval; nine articles were suitable for these meta-analyses. The included randomized controlled trials were enrolled in five meta-analyses. Three meta-analyses showed significant improvement in adenoid size after the use of INCS with a risk ratio of 0.68, standardized mean difference (SMD)=−2.97, SMD=−0.67, respectively. Two meta-analyses showed insignificant improvement in nasal obstruction symptoms with SMD=−1.53 and SMD=0.67, respectively. Conclusion INCS can be used in children with moderate to severe adenoid hypertrophy to reduce the adenoid size and improve the associated symptoms. Close monitoring of improving of the symptoms is a must to predict the need of nonmedical management.
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The Egyptian Journal of Otolaryngology 2019 35(1):30-36
Background Adenoidal hypertrophy is considered one of the most common diseases in otolaryngology. It is usually associated with nasal obstruction symptoms like snoring and hyponasality. If not treated well, children will encounter many complications like otitis media with effusion and craniofacial abnormalities. Adenoidectomy is the main line of treatment for many otolaryngologists, but recently medical treatment by using intranasal corticosteroids (INCS) has shown beneficial effects in reducing the size of adenoids or improving the obstruction symptoms. Objectives To assess the efficacy of nasal corticosteroids in improving nasal airway obstruction in children with symptomatic adenoidal hypertrophy. Patients and methods A comprehensive search in MEDLINE and CENTRAL was undertaken (1985–2017). We identified all randomized controlled trials in children with adenoidal hypertrophy that compared the effects of nasal corticosteroids and normal saline nasal spray on different outcomes. The primary outcomes were improvement of nasal obstruction symptoms assessed by any symptoms score and reduction in adenoid size as demonstrated by fiberoptic nasopharyngoscopy or lateral nasopharynx radiograph. Results Twenty-three relevant potential citations were identified and screened for retrieval; nine articles were suitable for these meta-analyses. The included randomized controlled trials were enrolled in five meta-analyses. Three meta-analyses showed significant improvement in adenoid size after the use of INCS with a risk ratio of 0.68, standardized mean difference (SMD)=−2.97, SMD=−0.67, respectively. Two meta-analyses showed insignificant improvement in nasal obstruction symptoms with SMD=−1.53 and SMD=0.67, respectively. Conclusion INCS can be used in children with moderate to severe adenoid hypertrophy to reduce the adenoid size and improve the associated symptoms. Close monitoring of improving of the symptoms is a must to predict the need of nonmedical management.
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Submandibular abscess caused by Salmonella spp. in a diabetic patient: a case report
Abdul-Aziz Alaqeeli, Belal Alani, Moustafa Al Khalil
The Egyptian Journal of Otolaryngology 2019 35(1):129-132
Head and neck infections normally arise from Streptococcus, Staphylococcus, or other anaerobic species, and infection by Salmonella spp. is rare. Patients with significant underlying conditions are at increased risk for the development of focal infection. This has been observed in patients with HIV, diabetes, and malignancy.
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The Egyptian Journal of Otolaryngology 2019 35(1):129-132
Head and neck infections normally arise from Streptococcus, Staphylococcus, or other anaerobic species, and infection by Salmonella spp. is rare. Patients with significant underlying conditions are at increased risk for the development of focal infection. This has been observed in patients with HIV, diabetes, and malignancy.
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Microdebrider-assisted powered adenoidectomy: a prospective study
Fahd Alharbi, Mohammed Rifaat Ahmed, Wael Al Juraibi
The Egyptian Journal of Otolaryngology 2019 35(1):37-40
Objective To assess the use of powered instrumentation and endoscopes to evaluate the efficacy and safety of this procedure in comparison to classic adenoidectomy using an adenoid curette. Patients and methods A prospective study performed at the Department of Otolaryngology, Head and Neck Surgery in Jazan General Hospital, Kingdom of Saudi Arabia. It includes 70 patients subjected to adenoidectomy who were divided into two equal groups: conventional curette adenoidectomy (CCA) group and microdebrider-assisted powered adenoidectomy (MPA) group. Both groups were assessed for operative time, average operative blood loss, duration of postoperative pain, return to normal diet and activities. Results There was no statistical significance between two groups regarding the operative time: the mean operative time in the CCA group was 13.7±3.5 min, while 12.9±4.3 min in the MPA group. The mean operative blood loss in the CCA group was 14.2±3.4 ml, while it was 13.5±2.9 in MPA group without any statically significant difference between the two groups. Conclusion MPA proved to be a good alternative to CCA technique as both techniques provide complete adenoid resection with fewer traumas to the adjacent tissue. Level of Evidence: 3b.
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The Egyptian Journal of Otolaryngology 2019 35(1):37-40
Objective To assess the use of powered instrumentation and endoscopes to evaluate the efficacy and safety of this procedure in comparison to classic adenoidectomy using an adenoid curette. Patients and methods A prospective study performed at the Department of Otolaryngology, Head and Neck Surgery in Jazan General Hospital, Kingdom of Saudi Arabia. It includes 70 patients subjected to adenoidectomy who were divided into two equal groups: conventional curette adenoidectomy (CCA) group and microdebrider-assisted powered adenoidectomy (MPA) group. Both groups were assessed for operative time, average operative blood loss, duration of postoperative pain, return to normal diet and activities. Results There was no statistical significance between two groups regarding the operative time: the mean operative time in the CCA group was 13.7±3.5 min, while 12.9±4.3 min in the MPA group. The mean operative blood loss in the CCA group was 14.2±3.4 ml, while it was 13.5±2.9 in MPA group without any statically significant difference between the two groups. Conclusion MPA proved to be a good alternative to CCA technique as both techniques provide complete adenoid resection with fewer traumas to the adjacent tissue. Level of Evidence: 3b.
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Audiovestibular findings in autoimmune diseases
Takwa A Gabr, Mona A Kotait, Rasha A Abdel Noor
The Egyptian Journal of Otolaryngology 2019 35(1):71-78
Background Audiovestibular manifestations are reported in autoimmune diseases including hearing loss and vestibular symptoms. Objectives This study is designed to evaluate the audiovestibular manifestations in patients with different autoimmune diseases especially asymptomatic cases. Subjects and Methods This work included two groups: study group (29 cases with different autoimmune diseases) and control group (20 healthy subjects). All participantswere subjected to basic audiologic evaluation, Sinusoidal harmonic acceleration (SHA) test of the rotatory chair at different frequencies (.01-.64Hz). Results patients with ADs showed elevated hearing thresholds (>25dBHL) at all tested frequencies. As regard SHA test, only 5 cases from the study grop showed normal results, while the rest of cases showed vestibular hypofunction (bilateral in 22 cases and unilateral in 3 cases). Conclusion Audiovestibular symptoms are common in different autoimmune diseases even asymptomatic cases. SHA test showed that vestibular affection is much more frequent than expected. So, regular screening of hearing and vestibular functions in patients with autoimmune should be done, for better and early management.
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The Egyptian Journal of Otolaryngology 2019 35(1):71-78
Background Audiovestibular manifestations are reported in autoimmune diseases including hearing loss and vestibular symptoms. Objectives This study is designed to evaluate the audiovestibular manifestations in patients with different autoimmune diseases especially asymptomatic cases. Subjects and Methods This work included two groups: study group (29 cases with different autoimmune diseases) and control group (20 healthy subjects). All participantswere subjected to basic audiologic evaluation, Sinusoidal harmonic acceleration (SHA) test of the rotatory chair at different frequencies (.01-.64Hz). Results patients with ADs showed elevated hearing thresholds (>25dBHL) at all tested frequencies. As regard SHA test, only 5 cases from the study grop showed normal results, while the rest of cases showed vestibular hypofunction (bilateral in 22 cases and unilateral in 3 cases). Conclusion Audiovestibular symptoms are common in different autoimmune diseases even asymptomatic cases. SHA test showed that vestibular affection is much more frequent than expected. So, regular screening of hearing and vestibular functions in patients with autoimmune should be done, for better and early management.
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Endovascular Treatment of Unruptured MCA Bifurcation Aneurysms Regardless of Aneurysm Morphology: Short- and Long-Term Follow-Up [INTERVENTIONAL]
BACKGROUND AND PURPOSE:
The optimal treatment of unruptured middle cerebral aneurysms is still under debate. Although today almost any aneurysm can be treated endovascularly, there is a lack of data comparing endovascular and microsurgical repair of MCA aneurysms. The aim of our analysis is to provide data on the efficacy, clinical outcome, complications and re-treatment rates of endovascular treatment of this subtype of aneurysms.
MATERIALS AND METHODS:Between May 2008 and July 2017, endovascular treatment of 1184 aneurysms in 827 patients was performed in our department. Twenty-four percent of these aneurysms were located at the MCA, and 150 unruptured MCA bifurcation aneurysms treated with coiling, stent-assisted-coiling, or endovascular flow diverter (WEB device) were identified for this retrospective data analysis. Ninety-six percent of all aneurysms, ruptured and unruptured, were treated by an endovascular approach, which yields a low selection bias for aneurysms suitable for endovascular treatment. Follow-up examinations were performed after 12 and 36 months and then every 1–3 years after embolization. Procedures were analyzed for periprocedural complications, outcome, and retreatment rate of the WEB (n = 38) and coiling with (n = 45) or without stent assistance (n = 67).
RESULTS:The procedure-associated good clinical outcome (mRS less double equals 2) was 89.9%, and the mortality rate was 2.7%. Short-term follow-up good clinical outcome/mortality rates were 91.3%/0.7%. At discharge, 137 patients had an mRS of 0–2 (91.3%) and 13 had an mRS of 3–6 (8.7%). The retreatment rate was significantly higher in the WEB group (21.1%) compared with the coiling group with (5.9%) or without (2.2%) stent placement (P < .05).
CONCLUSIONS:Regardless of the architecture of MCA bifurcation aneurysms, the endovascular treatment can be performed with low morbidity/mortality rates. The higher retreatment rate in the WEB group correlates with the learning curve in choosing the right device size.
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Infant Midnasal Stenosis: Reliability of Nasal Metrics [HEAD & NECK]
BACKGROUND AND PURPOSE:
Midnasal stenosis is a poorly defined entity that may be a component of other conditions of nasal obstruction contributing to respiratory distress in infants. We sought to establish whether midnasal vault narrowing is a component of well-defined syndromes of nasal narrowing, such as bilateral choanal atresia and pyriform aperture stenosis, and to characterize the nasal anatomy of patients with syndromic craniosynostosis.
MATERIALS AND METHODS:A convenience sample of patients with pyriform aperture stenosis, bilateral choanal atresia, and Apert and Crouzon syndromes with maxillofacial CT scans was identified. Patients with Pierre Robin Sequence were used as controls. Nasal measurements were performed at the pyriform aperture, choana, and defined midnasal points on axial and coronal CT scans. Intra- and interrater reliability was quantified with the intraclass correlation coefficient. T tests with Bonferroni adjustment were used to assess differences from controls.
RESULTS:The study included 50 patients: Eleven had pyriform aperture stenosis, 10 had Apert and Crouzon syndromes, 9 had choanal atresia, and 20 were controls. Measurements in patients with pyriform aperture stenosis and Apert and Crouzon syndromes were narrower than those of controls at all measured points (P < .001). Measurements in patients with choanal atresia were only narrow in the posterior half of the nose (P < .001). The intra- and interrater reliability of midnasal and pyriform measurements was very good to excellent (intraclass correlation coefficient > 0.87). The choanal measurement was good (intraclass correlation coefficient = 0.76–0.77).
CONCLUSIONS:Pyriform aperture stenosis, Apert and Crouzon patients were narrower at all measured points compared to controls. Bilateral choanal atresia patients were only narrower in the posterior half of the nose. More research is needed to evaluate the clinical implications of these radiographic findings.
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Diagnostic Utility of Optic Nerve Measurements with MRI in Patients with Optic Nerve Atrophy [HEAD & NECK]
BACKGROUND AND PURPOSE:
No MR imaging measurement criteria are available for the diagnosis of optic nerve atrophy. We determined a threshold optic nerve area on MR imaging that predicts a clinical diagnosis of optic nerve atrophy and assessed the relationship between optic nerve area and retinal nerve fiber layer thickness measured by optical coherence tomography, an ancillary test used to evaluate optic nerve disorders.
MATERIALS AND METHODS:We evaluated 26 patients with suspected optic nerve atrophy (8 with unilateral, 13 with bilateral and 5 with suspected but not demonstrable optic nerve atrophy) who had both orbital MR imaging and optical coherence tomography examinations. Forty-five patients without optic nerve atrophy served as controls. Coronal inversion recovery images were used to measure optic nerve area on MR imaging. Retinal nerve fiber layer thickness was determined by optical coherence tomography. Individual eyes were treated separately; however, bootstrapping was used to account for clustering when appropriate. Correlation coefficients were used to evaluate relationships; receiver operating characteristic curves, to investigate predictive accuracy.
RESULTS:There was a significant difference in optic nerve area between patients' affected eyes with optic nerve atrophy (mean, 3.09 ± 1.09 mm2), patients' unaffected eyes (mean, 5.27 ± 1.39 mm2; P = .008), and control eyes (mean, 6.27 ± 2.64 mm2; P < .001). Optic nerve area ≤ 4.0 mm2 had a sensitivity of 0.85 and a specificity of 0.83 in predicting the diagnosis of optic nerve atrophy. A significant relationship was found between optic nerve area and retinal nerve fiber layer thickness (r = 0.68, P < .001).
CONCLUSIONS:MR imaging–measured optic nerve area ≤ 4.0 mm2 has moderately high sensitivity and specificity for predicting optic nerve atrophy, making it a potential diagnostic tool for radiologists.
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Longitudinal White Matter Changes following Carbon Monoxide Poisoning: A 9-Month Follow-Up Voxelwise Diffusional Kurtosis Imaging Study [FUNCTIONAL]
BACKGROUND AND PURPOSE:
Patients with carbon monoxide (CO) intoxication exhibit progressive WM changes that are not well-understood. The purpose of this study was to detect longitudinal WM changes using voxelwise diffusional kurtosis imaging in patients with CO intoxication from the acute-to-chronic stage after CO intoxication.
MATERIALS AND METHODS:Twenty-four patients with CO intoxication and 21 age- and sex-matched healthy controls were enrolled in this study. Diffusional kurtosis imaging was performed on all subjects and was conducted repeatedly in patients at 1 week and 1, 3, and 9 months after CO intoxication. Voxelwise diffusional kurtosis imaging analysis was performed to detect global WM changes in the patients with and without WM lesions. Receiver operating characteristic analysis was performed to compare the performance of diffusional indices in differentiating patients with delayed neuropsychiatric sequelae from patients without them.
RESULTS:In voxelwise analysis, progressive WM changes were detected in patients with WM lesions. In the acute phase, WM injuries were found mainly in the dopaminergic pathways at 1 week, whereas in the chronic stage, WM injuries extended toward subcortical areas from 1 to 9 months. However, no significant WM change was noted in patients without WM lesions during the 9 months after CO intoxication. Moreover, receiver operating characteristic analysis demonstrated that axial kurtosis and mean kurtosis values had better performance than other diffusional indices in differentiating patients with delayed neuropsychiatric sequelae from patients without them at 1 week after CO intoxication.
CONCLUSIONS:Voxelwise diffusional kurtosis imaging analysis was helpful to longitudinally investigate WM changes and predict the prognosis of patients after CO intoxication.
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Imaging Review of New and Emerging Sinonasal Tumors and Tumor-like Entities from the Fourth Edition of the World Health Organization Classification of Head and Neck Tumors [REVIEW ARTICLE]
SUMMARY:
The sinonasal tract is an environment diverse with neoplasia. Given the continued discovery of entities generally specific to the sinonasal tract, the fourth edition of the World Health Organization Classification of Head and Neck Tumors was released in 2017. It describes 3 new, well-defined entities and several less-defined, emerging entities. The new entities are seromucinous hamartomas, nuclear protein in testis carcinomas, and biphenotypic sinonasal sarcomas. Emerging entities include human papillomavirus–related sinonasal carcinomas, SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1–deficient sinonasal carcinomas, renal cell-like adenocarcinomas, and chondromesenchymal hamartomas. The literature thus far largely focuses on the pathology of these entities. Our goal in this report was to familiarize radiologists with these new diagnoses and to provide available information regarding their imaging appearances.
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Flow-Diversion Treatment of Unruptured Saccular Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis [INTERVENTIONAL]
BACKGROUND:
Flow diversion for anterior communicating artery aneurysms required further investigation.
PURPOSE:Our aim was to analyze outcomes after treatment of anterior communicating artery aneurysms with flow-diverter stents.
DATA SOURCES:A systematic search of 3 data bases was performed for studies published from 2008 to 2018.
STUDY SELECTION:According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting anterior communicating artery aneurysms treated with flow diversion.
DATA ANALYSIS:Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and factors influencing the studied outcomes.
DATA SYNTHESIS:We included 14 studies and 148 unruptured saccular anterior communicating artery aneurysms treated with flow diversion. The long-term complete/near-complete (O'Kelly-Marotta C–D) occlusion rate was 87.4% (91/105; 95% CI, 81.3%–93.6%; I2 = 0%) (mean radiologic follow-up of 11 months). The treatment-related complication rate was 8.6% (14/126; 95% CI, 4%–13.1%; I2 = 0%), with morbidity and mortality rates of 3.5% (5/126; 95% CI, 2%–7%; I2 = 0%) and 2.5% (2/148; 95% CI, 0.3%–5%; I2 = 0%), respectively. Most complications were periprocedural (12/126 = 7%; 95% CI, 3%–11%; I2 = 0%). Thromboembolic events were slightly higher compared with hemorrhagic complications (10/126 = 6%; 95% CI, 2%–10%; I2 = 0% and 4/126 = 3%; 95% CI, 1%–6%; I2 = 0%). Branching arteries (A2 or the recurrent artery of Heubner) covered by the stent were occluded in 16% (7/34; 95% CI, 3.5%–28%; I2 = 25%) of cases. Pre- and posttreatment low-dose and high-dose of antiplatelet therapy was not associated with significantly different complication and occlusion rates.
LIMITATIONS:We reviewed small and retrospective series.
CONCLUSIONS:Flow diversion for unruptured saccular anterior communicating artery aneurysms appears to be an effective alternative treatment for lesions difficult to treat with coiling or microsurgical clipping. The treatment-related complication rate was relatively low. However, larger studies are needed to confirm these results.
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Comparison between functional outcomes in patients with unilateral vocal fold paralysis undergoing injection laryngoplasty under general anesthesia versus local anesthesia
Amr R El-Badrawy, Hassan M El-Hoshy, Ayatallah R Sheikhany, Wael S.A El-Rehim
The Egyptian Journal of Otolaryngology 2019 35(1):92-102
Introduction Injection laryngoplasty (IL) continues to evolve, as new techniques, approaches, and injection materials are continuously being developed. Although it was performed under general anesthesia in the operating room, IL is now increasingly being performed in an office-based setting. Aim The aim of this study was to compare functional voice outcomes in patients with unilateral vocal fold paralysis undergoing injection laryngoplasty local versus general anesthesia. Patients and methods : A prospective interventional study was done to compare functional outcomes and patient satisfaction between group A (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under local anesthesia, versus group B (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under general anesthesia, by analyzing total Arabic Voice Handicap Index (VHI)scores and subscale scores preoperatively and post operatively. Results All results obtained in this study showed that there was no significant difference for the functional outcomes and patient satisfaction obtained for both groups under study. Conclusion In conclusion, IL under local anesthesia gives similar results as general anesthesia regarding functional outcomes and patient satisfaction of voice quality by themselves as well as by using the voice handicap index.
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The Egyptian Journal of Otolaryngology 2019 35(1):92-102
Introduction Injection laryngoplasty (IL) continues to evolve, as new techniques, approaches, and injection materials are continuously being developed. Although it was performed under general anesthesia in the operating room, IL is now increasingly being performed in an office-based setting. Aim The aim of this study was to compare functional voice outcomes in patients with unilateral vocal fold paralysis undergoing injection laryngoplasty local versus general anesthesia. Patients and methods : A prospective interventional study was done to compare functional outcomes and patient satisfaction between group A (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under local anesthesia, versus group B (15 patients) with unilateral vocal fold paralysis undergoing injection laryngoplasty under general anesthesia, by analyzing total Arabic Voice Handicap Index (VHI)scores and subscale scores preoperatively and post operatively. Results All results obtained in this study showed that there was no significant difference for the functional outcomes and patient satisfaction obtained for both groups under study. Conclusion In conclusion, IL under local anesthesia gives similar results as general anesthesia regarding functional outcomes and patient satisfaction of voice quality by themselves as well as by using the voice handicap index.
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Evaluation of hearing outcome of tympanoplasty using cartilage graft versus temporalis fascia graft
Mohamed M El-Sheikh
The Egyptian Journal of Otolaryngology 2019 35(1):1-5
Background Various materials such as fascia, perichondrium, and cartilage have been used for the reconstruction of the tympanic membrane in middle ear surgery. Owing to its stiffness, cartilage is resistant to resorption and retraction. Patients and methods This study comprised a randomized, controlled trial conducted to analyze the audiological gain when using cartilage grafts in type 1 tympanoplasty compared with temporalis fascia grafts on 60 patients suffering from chronic otitis media after successful tympanoplasty. The follow-up period was at least 6 months. All patients were subjected to audiological evaluation before and at least 6 months postoperatively. Results There was a significant reduction in mean air-bone gap (ABG) in both groups, whereas in group A (fascial graft) the mean preoperative ABG was 25±10.2 dB and the mean postoperative ABG was 13.5±7.3 dB, whereas in group B (cartilage graft) the mean preoperative ABG was 30.6±8.6 dB and the mean postoperative ABG was 15.9±8.7 dB, analyzing the effectiveness of both surgical techniques showed that both were equally effective in reducing ABG from preintervention to postintervention with no statistical significance among both groups (P=0.212). Conclusion Patients who had cartilage grafts showed similar hearing outcomes to those who had fascial grafts after a successful tympanoplasty procedure.
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The Egyptian Journal of Otolaryngology 2019 35(1):1-5
Background Various materials such as fascia, perichondrium, and cartilage have been used for the reconstruction of the tympanic membrane in middle ear surgery. Owing to its stiffness, cartilage is resistant to resorption and retraction. Patients and methods This study comprised a randomized, controlled trial conducted to analyze the audiological gain when using cartilage grafts in type 1 tympanoplasty compared with temporalis fascia grafts on 60 patients suffering from chronic otitis media after successful tympanoplasty. The follow-up period was at least 6 months. All patients were subjected to audiological evaluation before and at least 6 months postoperatively. Results There was a significant reduction in mean air-bone gap (ABG) in both groups, whereas in group A (fascial graft) the mean preoperative ABG was 25±10.2 dB and the mean postoperative ABG was 13.5±7.3 dB, whereas in group B (cartilage graft) the mean preoperative ABG was 30.6±8.6 dB and the mean postoperative ABG was 15.9±8.7 dB, analyzing the effectiveness of both surgical techniques showed that both were equally effective in reducing ABG from preintervention to postintervention with no statistical significance among both groups (P=0.212). Conclusion Patients who had cartilage grafts showed similar hearing outcomes to those who had fascial grafts after a successful tympanoplasty procedure.
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The role of simple office-based surgery in small central tympanic membrane perforation
Abdel-Latif I El-Rasheedy, Ayman A Abdel-Fattah, Heba A Abo El-Naga, Mustafa M El-Barbary
The Egyptian Journal of Otolaryngology 2019 35(1):12-16
Objective The aim of this study was to evaluate the outcome of simple office-based surgery in small central tympanic membrane (TM) perforation. Background The purpose of closure of TM perforations is to restore the continuity of the TM in order to improve hearing and decrease the risk of middle ear infections. Rapid and cost-effective procedures like chemical cauterization and fat plug myringoplasty have been found to be effective in healing small central perforations with significant hearing improvement. Patients and methods Our prospective study was carried out on 40 patients aged more than 15 years with dry small central persistent perforation during the period spanning from April 2017 to March 2018, divided in two groups: group A (20 patients underwent fat graft myringoplasty) and group B (20 patients underwent chemical cautery of the edge of perforation). Results Our study included 26 male patients and 14 female patients; the mean age was 27.2±9.3 years. Our study showed a 70% success rate in the healing of TM perforation in group A while there was a 55% success rate in group B. Conclusion From our study, we found that the two procedures are easy to perform, reliable with a satisfactory outcome, simple, rapid, risk free, and also lessen the financial burden and morbidity on the patient.
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The Egyptian Journal of Otolaryngology 2019 35(1):12-16
Objective The aim of this study was to evaluate the outcome of simple office-based surgery in small central tympanic membrane (TM) perforation. Background The purpose of closure of TM perforations is to restore the continuity of the TM in order to improve hearing and decrease the risk of middle ear infections. Rapid and cost-effective procedures like chemical cauterization and fat plug myringoplasty have been found to be effective in healing small central perforations with significant hearing improvement. Patients and methods Our prospective study was carried out on 40 patients aged more than 15 years with dry small central persistent perforation during the period spanning from April 2017 to March 2018, divided in two groups: group A (20 patients underwent fat graft myringoplasty) and group B (20 patients underwent chemical cautery of the edge of perforation). Results Our study included 26 male patients and 14 female patients; the mean age was 27.2±9.3 years. Our study showed a 70% success rate in the healing of TM perforation in group A while there was a 55% success rate in group B. Conclusion From our study, we found that the two procedures are easy to perform, reliable with a satisfactory outcome, simple, rapid, risk free, and also lessen the financial burden and morbidity on the patient.
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Assessment of safety and efficacy of extraturbinal microdebrider-assisted turbinoplasty versus partial inferior turbinectomy
Balegh H Ali, Osama G.Abdel-Naby Awad, Aya Ibrahim, Ahmd A.Abdel Azez
The Egyptian Journal of Otolaryngology 2019 35(1):17-24
Objective The aim was to compare the extraturbinal microdebrider-assisted turbinoplasty (MAT) with the partial inferior turbinectomy (PIT) based on subjective and objective parameters. Patients and methods A total of 18 patients with nasal obstruction owing to bilateral hypertrophied inferior turbinates were included in this study. All patients underwent extraturbinal MAT on one side of the nose and PIT on the other side in alternate manner. The patients were blinded to the technique used. This is a prospective blinded randomized trial was conducted. The study was conducted at a tertiary referral hospital. Main outcome measures Operative time, blood loss, subjective improvement of the nasal obstruction, degree of intranasal crustations, and degree of synechiae formation were the main outcomes recorded. Results The operative time and intraoperative blood loss were less in the extraturbinal MAT compared with PIT. At 2 weeks postoperatively, the sides with MAT had significantly better relief of nasal obstruction (P=0.007), less degree of nasal pain (P=0.002), less crustations (P=0.010), and better tissue healing (P =0.010) than sides with PIT. At 1 and 3 months postoperatively, the sides with MAT had statistically significant less crustations (P=0.040 and 0.032, respectively) and better tissue healing (P=0.010 and 0.010, respectively) compared with the sides with PIT; however, there were no statistically significant differences regarding relief of nasal obstruction and degree of nasal pain. Conclusions Extraturbinal microdebrider-assisted inferior turbinoplasty is more effective and safe compared with PIT, especially in short-term follow-up periods.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N68fbY
The Egyptian Journal of Otolaryngology 2019 35(1):17-24
Objective The aim was to compare the extraturbinal microdebrider-assisted turbinoplasty (MAT) with the partial inferior turbinectomy (PIT) based on subjective and objective parameters. Patients and methods A total of 18 patients with nasal obstruction owing to bilateral hypertrophied inferior turbinates were included in this study. All patients underwent extraturbinal MAT on one side of the nose and PIT on the other side in alternate manner. The patients were blinded to the technique used. This is a prospective blinded randomized trial was conducted. The study was conducted at a tertiary referral hospital. Main outcome measures Operative time, blood loss, subjective improvement of the nasal obstruction, degree of intranasal crustations, and degree of synechiae formation were the main outcomes recorded. Results The operative time and intraoperative blood loss were less in the extraturbinal MAT compared with PIT. At 2 weeks postoperatively, the sides with MAT had significantly better relief of nasal obstruction (P=0.007), less degree of nasal pain (P=0.002), less crustations (P=0.010), and better tissue healing (P =0.010) than sides with PIT. At 1 and 3 months postoperatively, the sides with MAT had statistically significant less crustations (P=0.040 and 0.032, respectively) and better tissue healing (P=0.010 and 0.010, respectively) compared with the sides with PIT; however, there were no statistically significant differences regarding relief of nasal obstruction and degree of nasal pain. Conclusions Extraturbinal microdebrider-assisted inferior turbinoplasty is more effective and safe compared with PIT, especially in short-term follow-up periods.
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Auditory brainstem response and speech mismatch negativity in children with phonological disorders
Reem El-Beltagy, Dalia Galhom, El-Ham M Hassan
The Egyptian Journal of Otolaryngology 2019 35(1):79-85
Objective This study was designed to explore the processing of auditory information through auditory brainstem and higher cortical regions in a sample of children with phonological errors compared to age-matched normal controls using AEPs. Subjects and Methods We recorded click and speech auditory brain-stem response and mismatch negativity in 30 children (15 children who were diagnosed clinically with phonological disorder, their ages ranged between 3.5–5.5 years, 15 children age-matched, sex matched and education matched with the study group, normal fluent speaker with no history of speech or language impairment). Results Absolute and inter-peak latency values of cABR demonstrated no statistically significant difference between the control and study groups. Moreover, All children had well identifiable and repeatable sABR and MMN but with delayed latencies in transient, transitional and sustained portions of speech-evoked ABR and MMN in study group when compared to control group. On the other hand, there were non significant difference as regard amplitude in the two groups as regard sABR and MMN. Conclusion Phonological disorder may affect the communication and language processes causing degradation of linguistic and para-linguistic information, also it can affect the quality of life and social interaction.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQl9A7
The Egyptian Journal of Otolaryngology 2019 35(1):79-85
Objective This study was designed to explore the processing of auditory information through auditory brainstem and higher cortical regions in a sample of children with phonological errors compared to age-matched normal controls using AEPs. Subjects and Methods We recorded click and speech auditory brain-stem response and mismatch negativity in 30 children (15 children who were diagnosed clinically with phonological disorder, their ages ranged between 3.5–5.5 years, 15 children age-matched, sex matched and education matched with the study group, normal fluent speaker with no history of speech or language impairment). Results Absolute and inter-peak latency values of cABR demonstrated no statistically significant difference between the control and study groups. Moreover, All children had well identifiable and repeatable sABR and MMN but with delayed latencies in transient, transitional and sustained portions of speech-evoked ABR and MMN in study group when compared to control group. On the other hand, there were non significant difference as regard amplitude in the two groups as regard sABR and MMN. Conclusion Phonological disorder may affect the communication and language processes causing degradation of linguistic and para-linguistic information, also it can affect the quality of life and social interaction.
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Comparison between local steroids and local steroids plus itraconazole effect in prevention of recurrence of allergic fungal sinusitis in hypertensive and/or diabetic patients
Ramez Reda, Wael Wageh, Mohammed Fawaz, Wassim Mikhaiel
The Egyptian Journal of Otolaryngology 2019 35(1):25-29
Background Allergic fungal rhinosinusitis (AFRS) is the most common type of fungal diseases in nose and paranasal sinuses. It is due to hypersensitivity to fungal antigens. The standard treatment for control of AFRS is endoscopic sinus surgery followed by systemic and/or topical steroids. In spite of steroids known to have promising results for the management of AFRS, their prolonged use is not always advised. So, some authors have tried to decrease the recurrence rate of AFRS by using antifungal treatment. In this study, we compared the efficacy of local steroids (Fluticasone nasal spray) versus local steroids plus itraconazole postoperatively in the prevention of recurrence of allergic fungal sinusitis in patients known to be hypertensive or diabetic. Patients and Methods A total of 60 patients with AFRS and nasal polyposis were included in the study. Patients were divided randomly into two groups: group A used local steroid and group B used local steroid and itraconazole. Clinical parameters were compared at the end of 6 months. Results Patients of group B were better clinically and also by endoscopic examination. Conclusion Itraconazole is better to be added in the postoperative treatment of AFRS patients especially for patients who have contraindications for systemic steroids intake.
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The Egyptian Journal of Otolaryngology 2019 35(1):25-29
Background Allergic fungal rhinosinusitis (AFRS) is the most common type of fungal diseases in nose and paranasal sinuses. It is due to hypersensitivity to fungal antigens. The standard treatment for control of AFRS is endoscopic sinus surgery followed by systemic and/or topical steroids. In spite of steroids known to have promising results for the management of AFRS, their prolonged use is not always advised. So, some authors have tried to decrease the recurrence rate of AFRS by using antifungal treatment. In this study, we compared the efficacy of local steroids (Fluticasone nasal spray) versus local steroids plus itraconazole postoperatively in the prevention of recurrence of allergic fungal sinusitis in patients known to be hypertensive or diabetic. Patients and Methods A total of 60 patients with AFRS and nasal polyposis were included in the study. Patients were divided randomly into two groups: group A used local steroid and group B used local steroid and itraconazole. Clinical parameters were compared at the end of 6 months. Results Patients of group B were better clinically and also by endoscopic examination. Conclusion Itraconazole is better to be added in the postoperative treatment of AFRS patients especially for patients who have contraindications for systemic steroids intake.
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Efficacy of intranasal corticosteroids in improving nasal airway obstruction in children with symptomatic adenoidal hypertrophy: a meta-analysis and systematic review
Yasser M Elbeltagy, Samer A Ibrahim, Mohamed S Hasaballah, Omar M Sowilem
The Egyptian Journal of Otolaryngology 2019 35(1):30-36
Background Adenoidal hypertrophy is considered one of the most common diseases in otolaryngology. It is usually associated with nasal obstruction symptoms like snoring and hyponasality. If not treated well, children will encounter many complications like otitis media with effusion and craniofacial abnormalities. Adenoidectomy is the main line of treatment for many otolaryngologists, but recently medical treatment by using intranasal corticosteroids (INCS) has shown beneficial effects in reducing the size of adenoids or improving the obstruction symptoms. Objectives To assess the efficacy of nasal corticosteroids in improving nasal airway obstruction in children with symptomatic adenoidal hypertrophy. Patients and methods A comprehensive search in MEDLINE and CENTRAL was undertaken (1985–2017). We identified all randomized controlled trials in children with adenoidal hypertrophy that compared the effects of nasal corticosteroids and normal saline nasal spray on different outcomes. The primary outcomes were improvement of nasal obstruction symptoms assessed by any symptoms score and reduction in adenoid size as demonstrated by fiberoptic nasopharyngoscopy or lateral nasopharynx radiograph. Results Twenty-three relevant potential citations were identified and screened for retrieval; nine articles were suitable for these meta-analyses. The included randomized controlled trials were enrolled in five meta-analyses. Three meta-analyses showed significant improvement in adenoid size after the use of INCS with a risk ratio of 0.68, standardized mean difference (SMD)=−2.97, SMD=−0.67, respectively. Two meta-analyses showed insignificant improvement in nasal obstruction symptoms with SMD=−1.53 and SMD=0.67, respectively. Conclusion INCS can be used in children with moderate to severe adenoid hypertrophy to reduce the adenoid size and improve the associated symptoms. Close monitoring of improving of the symptoms is a must to predict the need of nonmedical management.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2N5W3Id
The Egyptian Journal of Otolaryngology 2019 35(1):30-36
Background Adenoidal hypertrophy is considered one of the most common diseases in otolaryngology. It is usually associated with nasal obstruction symptoms like snoring and hyponasality. If not treated well, children will encounter many complications like otitis media with effusion and craniofacial abnormalities. Adenoidectomy is the main line of treatment for many otolaryngologists, but recently medical treatment by using intranasal corticosteroids (INCS) has shown beneficial effects in reducing the size of adenoids or improving the obstruction symptoms. Objectives To assess the efficacy of nasal corticosteroids in improving nasal airway obstruction in children with symptomatic adenoidal hypertrophy. Patients and methods A comprehensive search in MEDLINE and CENTRAL was undertaken (1985–2017). We identified all randomized controlled trials in children with adenoidal hypertrophy that compared the effects of nasal corticosteroids and normal saline nasal spray on different outcomes. The primary outcomes were improvement of nasal obstruction symptoms assessed by any symptoms score and reduction in adenoid size as demonstrated by fiberoptic nasopharyngoscopy or lateral nasopharynx radiograph. Results Twenty-three relevant potential citations were identified and screened for retrieval; nine articles were suitable for these meta-analyses. The included randomized controlled trials were enrolled in five meta-analyses. Three meta-analyses showed significant improvement in adenoid size after the use of INCS with a risk ratio of 0.68, standardized mean difference (SMD)=−2.97, SMD=−0.67, respectively. Two meta-analyses showed insignificant improvement in nasal obstruction symptoms with SMD=−1.53 and SMD=0.67, respectively. Conclusion INCS can be used in children with moderate to severe adenoid hypertrophy to reduce the adenoid size and improve the associated symptoms. Close monitoring of improving of the symptoms is a must to predict the need of nonmedical management.
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Microdebrider-assisted powered adenoidectomy: a prospective study
Fahd Alharbi, Mohammed Rifaat Ahmed, Wael Al Juraibi
The Egyptian Journal of Otolaryngology 2019 35(1):37-40
Objective To assess the use of powered instrumentation and endoscopes to evaluate the efficacy and safety of this procedure in comparison to classic adenoidectomy using an adenoid curette. Patients and methods A prospective study performed at the Department of Otolaryngology, Head and Neck Surgery in Jazan General Hospital, Kingdom of Saudi Arabia. It includes 70 patients subjected to adenoidectomy who were divided into two equal groups: conventional curette adenoidectomy (CCA) group and microdebrider-assisted powered adenoidectomy (MPA) group. Both groups were assessed for operative time, average operative blood loss, duration of postoperative pain, return to normal diet and activities. Results There was no statistical significance between two groups regarding the operative time: the mean operative time in the CCA group was 13.7±3.5 min, while 12.9±4.3 min in the MPA group. The mean operative blood loss in the CCA group was 14.2±3.4 ml, while it was 13.5±2.9 in MPA group without any statically significant difference between the two groups. Conclusion MPA proved to be a good alternative to CCA technique as both techniques provide complete adenoid resection with fewer traumas to the adjacent tissue. Level of Evidence: 3b.
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The Egyptian Journal of Otolaryngology 2019 35(1):37-40
Objective To assess the use of powered instrumentation and endoscopes to evaluate the efficacy and safety of this procedure in comparison to classic adenoidectomy using an adenoid curette. Patients and methods A prospective study performed at the Department of Otolaryngology, Head and Neck Surgery in Jazan General Hospital, Kingdom of Saudi Arabia. It includes 70 patients subjected to adenoidectomy who were divided into two equal groups: conventional curette adenoidectomy (CCA) group and microdebrider-assisted powered adenoidectomy (MPA) group. Both groups were assessed for operative time, average operative blood loss, duration of postoperative pain, return to normal diet and activities. Results There was no statistical significance between two groups regarding the operative time: the mean operative time in the CCA group was 13.7±3.5 min, while 12.9±4.3 min in the MPA group. The mean operative blood loss in the CCA group was 14.2±3.4 ml, while it was 13.5±2.9 in MPA group without any statically significant difference between the two groups. Conclusion MPA proved to be a good alternative to CCA technique as both techniques provide complete adenoid resection with fewer traumas to the adjacent tissue. Level of Evidence: 3b.
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Audiovestibular findings in autoimmune diseases
Takwa A Gabr, Mona A Kotait, Rasha A Abdel Noor
The Egyptian Journal of Otolaryngology 2019 35(1):71-78
Background Audiovestibular manifestations are reported in autoimmune diseases including hearing loss and vestibular symptoms. Objectives This study is designed to evaluate the audiovestibular manifestations in patients with different autoimmune diseases especially asymptomatic cases. Subjects and Methods This work included two groups: study group (29 cases with different autoimmune diseases) and control group (20 healthy subjects). All participantswere subjected to basic audiologic evaluation, Sinusoidal harmonic acceleration (SHA) test of the rotatory chair at different frequencies (.01-.64Hz). Results patients with ADs showed elevated hearing thresholds (>25dBHL) at all tested frequencies. As regard SHA test, only 5 cases from the study grop showed normal results, while the rest of cases showed vestibular hypofunction (bilateral in 22 cases and unilateral in 3 cases). Conclusion Audiovestibular symptoms are common in different autoimmune diseases even asymptomatic cases. SHA test showed that vestibular affection is much more frequent than expected. So, regular screening of hearing and vestibular functions in patients with autoimmune should be done, for better and early management.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SQ7hGg
The Egyptian Journal of Otolaryngology 2019 35(1):71-78
Background Audiovestibular manifestations are reported in autoimmune diseases including hearing loss and vestibular symptoms. Objectives This study is designed to evaluate the audiovestibular manifestations in patients with different autoimmune diseases especially asymptomatic cases. Subjects and Methods This work included two groups: study group (29 cases with different autoimmune diseases) and control group (20 healthy subjects). All participantswere subjected to basic audiologic evaluation, Sinusoidal harmonic acceleration (SHA) test of the rotatory chair at different frequencies (.01-.64Hz). Results patients with ADs showed elevated hearing thresholds (>25dBHL) at all tested frequencies. As regard SHA test, only 5 cases from the study grop showed normal results, while the rest of cases showed vestibular hypofunction (bilateral in 22 cases and unilateral in 3 cases). Conclusion Audiovestibular symptoms are common in different autoimmune diseases even asymptomatic cases. SHA test showed that vestibular affection is much more frequent than expected. So, regular screening of hearing and vestibular functions in patients with autoimmune should be done, for better and early management.
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Simultaneous Radiological and Fiberendoscopic Evaluation of Swallowing ( “SIRFES”) in Patients After Surgery of Oropharyngeal/Laryngeal Cancer and Postoperative Dysphagia
AbstractTo compare the results of a simultaneously performed videofluoroscopic swallowing study and fiberendoscopic evaluation of swallowing in patients with dysphagia after surgery and radiotherapy for oropharyngeal or laryngeal cancer. This prospective study included 31 patients who were examined simultaneously with a standardized protocol. The fiberendoscopic and videofluoroscopic swallowing loops were independently scored by two otorhinolaryngologists/phoniatricians and two radiologists. The presence of penetration/aspiration, the amount of pharyngeal residues and the position of the bolus head when triggering of pharyngeal swallow begins were evaluated. Generalized linear models were used to model the impact of rater, method, bolus and quantities as well as specified moderation effect...
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Simultaneous Radiological and Fiberendoscopic Evaluation of Swallowing ( “SIRFES”) in Patients After Surgery of Oropharyngeal/Laryngeal Cancer and Postoperative Dysphagia
AbstractTo compare the results of a simultaneously performed videofluoroscopic swallowing study and fiberendoscopic evaluation of swallowing in patients with dysphagia after surgery and radiotherapy for oropharyngeal or laryngeal cancer. This prospective study included 31 patients who were examined simultaneously with a standardized protocol. The fiberendoscopic and videofluoroscopic swallowing loops were independently scored by two otorhinolaryngologists/phoniatricians and two radiologists. The presence of penetration/aspiration, the amount of pharyngeal residues and the position of the bolus head when triggering of pharyngeal swallow begins were evaluated. Generalized linear models were used to model the impact of rater, method, bolus and quantities as well as specified moderation effect...
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A reliable method to avoid contamination during cartilage graft preparation in septorhinoplasty
Abstract
Purpose
The aim of the study is to determine the risk of contamination in the cartilage graft materials prepared on the swester table and those prepared in a sterile package, and to reveal a more reliable method by performing the microbiological examination of these materials.
Methods
Cartilages removed from the nasal septum were divided into four pieces. The first part (Sample A) was directly placed into the medium. Sample B was prepared by being crushed in a sterile package. Sample C was prepared on the auxiliary swester table, and Sample D was prepared on the main swester table actively used by surgery team. All samples were transferred in a 1 ml brain heart(BH) liquid medium. From each BH medium, 100 µl culture was performed on blood agar, eosin–methylene blue–lactose–sucrose agar and chocolate agar.
Results
Bacterial growth was detected in 2 of the samples A, in 4 of the samples B, in 24 of the samples C, and in 36 of the samples D. The number of patients with bacterial growth in the samples C and/or D despite no growth in the sample B was 35. When the samples A/B and C/D were compared in terms of bacterial growth, a significant difference was found in all matchings (p < 0.001 for all comparisons).
Conclusion
These findings showed that preparation of the cartilage grafts on the swester table was extremely risky for microbiological contamination. Arslan and his colleagues suggest that preparing a graft material in a sterile package is extremely simple, cheap, and it also reduces contamination risk significantly.
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