Objective: Conduct the first prospective randomized controlled study investigating the safety and... more Objective: Conduct the first prospective randomized controlled study investigating the safety and efficacy of endocanalicular high pressure 5-mm balloon catheter endoscopic dacryocystorhinostomy (DCR) in adult patients with acquired complete nasolacrimal obstruction. Method: This prospective randomized controlled study was conducted between 2004 and 2009 including 70 procedures of endoscopic dacryocystorhinostomy. They were prospectively equally randomized into 2 groups; endocanalicular high-pressure 5-mm balloon catheter endoscopic DCR (group I) and conventional endoscopic DCR (group II). Regular follow up settings were done to document the patient's subjective improvement, to judge ostium patency on irrigation, and to record any complications. Statistical analysis was done using SPSS for Windows. The primary end point was determined to be the success of the surgery as defined by the subjective disappearance of symptoms. Results: Both groups demonstrated a success rate of 91.4%. There was a shorter mean operative time (25.7 minutes) in the endocanalicular balloon catheter endoscopic DCR group. Conclusion: The endocanalicular balloon catheter endoscopic DCR shares the benefits and success rate of conventional endoscopic DCR. In addition, it is simpler, requires less manipulation, consumes a shorter operative time, has a better safety profile, and can be totally utilized under local anesthesia with minimal sedation.
Objective To investigate the safety and efficacy of two topical blood stopper modulators; Ankafer... more Objective To investigate the safety and efficacy of two topical blood stopper modulators; Ankaferd blood stopper (ABS) and feracrylum 1% solution (FS) during adenoid surgery. Study design Prospective randomized trial. Methods Two hundred and twenty five consecutive pediatric adenoid patients aged from 9 months to 2 years old were studied. Patients were randomly allocated into two haemostatic groups; (ABS, FS) and normal saline (control group). Results ABS and FS groups showed a significantly less intra operative blood loss (16.4 ± 2.6/22 ± 6.2), operative time (9.31 ± 1.9/11.2 ± 1.6 min), use of cautery (10.6/25.3%), postoperative analgesics (3 ± 1.1/3.8 ± 1.2), duration to return normal diet (2.4 ± 1.2/3.9 ± 0.9) and operating theatre cost (233 ± 48$ and 279 ± 40$) than the control group. Conclusion AFS and FS are easy, safe, and reliable topical haemostatic modulators that could be used in adenoid surgery.
Assessment of adding lidocaine to dexamethasone in the intratympanic injections for the treatment... more Assessment of adding lidocaine to dexamethasone in the intratympanic injections for the treatment of subjective idiopathic tinnitus (SIT). A prospective, controlled, randomized, double-blind study of forty-four patients with SIT diagnosed in the Department of Otolaryngology, Tanta University Hospital, a tertiary academic medical centre from March 2015 to October 2016. 44 patients were recruited in the study and were categorized into two groups; (A) included 22 patients managed with ITLD, and (B) included 22 patients managed with intratympanic postoperative ITD injection. Intratympanic injections were double-blind performed three times with one weak interval. After three and six months, the tinnitus improvement was studied using the following parameters: Arabic tinnitus questionnaires (ATQ), loudness matching test and Tinnitus handicap index (THI). The effectiveness rates of ITLD for idiopathic tinnitus reported in the ATQ, THI, and in the loudness matching test were 74.5% in the ITD...
To conduct a prospective, randomized, controlled trial determining the feasibility of radiofreque... more To conduct a prospective, randomized, controlled trial determining the feasibility of radiofrequency with or without topical mitomycin C application in delaying the closure time of human tympanostomy and screening its efficacy in management of recurrent acute otitis media and otitis media with effusion. From November 2002 to January 2004, 96 patients (180 ears) who were to undergo surgical intervention for recurrent acute otitis media or otitis media with effusion were included in this study. Sixty ears with a diagnosis of recurrent acute otitis media were equally randomized to three procedures: cold knife myringotomy (Group A), radiofrequency tympanostomy (Group B), and radiofrequency tympanostomy with topical mitomycin C application (Group C). One hundred twenty ears diagnosed as having otitis media with effusion were equally randomized to the last two procedures only. Patients were followed-up every week in the first month, every 2 weeks in the second month, and monthly after that until closure of the tympanostomy. A special follow-up setting was designed 3 months after tympanostomy closure where tympanograms and pure-tone audiograms were obtained. Groups B and C showed a significantly slower rate of closure than Group A. At the same time, Group C demonstrated a slower rate when compared with Group B. The mean closure time of Group B was 3.5 weeks, with no difference between recurrent acute otitis media and otitis media with effusion. In contrast, the mean closure times for Group C were 5.3 and 7 weeks in cases of otitis media with effusion and recurrent acute otitis media, respectively, with the latter demonstrating a significantly slower closure rate. No recurrence of acute otitis media was reported in 10, 45, and 80% of Groups A, B, and C, respectively. Fifty-nine percent of Group C showed no clinical or tympanometric signs of otitis media with effusion 3 months after closure of tympanostomy. In contrast, Group B reported a lower cure rate (28%), with a statistically significant difference between both groups. Absence of recurrence and improvement in tympanometry signs correlated significantly with the duration of patency of tympanostomy (p < 0.01). The success rate was higher in patients who underwent adenoidectomy, but this did not reach statistical significance except in Group C (p < 0.01). Radiofrequency and mitomycin C delay the closure rate of human tympanostomy. The efficacy of mitomycin C seems to be amplified in the presence of an inflamed tympanic membrane. Radiofrequency-assisted mitomycin-enhanced tympanostomy is a precise, safe, and cost-effective procedure that provides a viable approach in the management of recurrent acute otitis media and otitis media with effusion, especially when used in conjunction with adenoidectomy.
OBJECTIVES: To conduct the first prospective randomized controlled study 1) evaluating the possib... more OBJECTIVES: To conduct the first prospective randomized controlled study 1) evaluating the possibility of improving the quality of the operative field and to provide a bloodless functional endoscopic sinus surgery (FESS) in children through total intravenous anesthesia (TIVA) using remifentanil combined with propofol, and 2) testing the safety and efficacy of remifentanil in propofol-TIVA in inducing controlled hypotension in children at a target mean arterial blood pressure of 50 mm Hg. STUDY DESIGN: Randomized controlled trial. SETTING: General hospital. SUBJECTS AND METHODS: Seventy children underwent FESS under hypotensive general anesthesia with equal randomization into two groups. Group I received TIVA with remifentanil, whereas group II had balanced anesthesia (BA) with esmolol. Heart rate, blood pressure, operative time, blood loss, and quality of the surgical conditions were recorded. RESULTS: Intraoperative blood loss in the TIVA group was less than in the BA group. The qu...
OBJECTIVES: To conduct a prospective randomized controlled study presenting and comparing bipolar... more OBJECTIVES: To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra-operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage. MATERIALS AND METHODS: From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intraoperative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with. RESULTS: There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT ...
Objective:To conduct an adequately powered, prospective, randomised, controlled trial comparing a... more Objective:To conduct an adequately powered, prospective, randomised, controlled trial comparing adult dissection tonsillectomy using either ultrasonic scalpel, bipolar electrocautery, bipolar radiofrequency or ‘cold steel’ dissection.Methods:Three hundred patients were randomised into four tonsillectomy technique groups. The operative time, intra-operative bleeding, post-operative pain, tonsillar fossa healing, return to full diet, return to work and post-operative complications were recorded.Results:The bipolar radiofrequency group had a shorter mean operative time. The mean intra-operative blood loss during bipolar radiofrequency tonsillectomy was significantly less compared with cold dissection and ultrasonic scalpel tonsillectomy. Pain scores were significantly higher after bipolar electrocautery tonsillectomy. Patients undergoing bipolar electrocautery tonsillectomy required significantly more days to return to full diet and work. The bipolar electrocautery group showed signifi...
The process of wearing head scarf is very complex; girls used to hold a number of pins in the mou... more The process of wearing head scarf is very complex; girls used to hold a number of pins in the mouth and utilize them one by one to Wx the scarf. Loss of concentration results in pin aspiration. We presented our experience with scarf pin aspiration and discussed the unique clinical characteristics of this problem. We reviewed the records of 73 patients who underwent bronchoscopy for scarf pin inhalation during the period from January 1995 to May 2009. The following data were collected, history of aspiration, time lag before presentation, symptoms and signs, radiological Wndings, bronchoscopic Wndings, number of repeated bronchoscopy, complications, need for thoracotomy and time of discharge. All patients were female, mean age 13.4 years. The time lag before admission was <12 h for 59 (81%) patients. Positive history was present in all cases. Chest radiography identiWed the pins in all cases. The foreign bodies were seen in the left bronchial system in 37 (50.7%) patients, in the right bronchial system in another 24 (32.9%), and in the trachea in 12 (16.4%) patients. In 66 (90.4%) patients, the foreign body was removed in the Wrst bronchoscopic trial; a second trial was needed in 5 (6.8%) patients, and thoracotomy was performed in two patients. In conclusion, head scarf pin aspiration occurs in adolescent Islamic girls. The clinical presentation and radiological Wndings are diagnostic in all cases. Rigid bronchoscopy is the preferred treatment modality. Health education is the key issue in the prevention of this problem.
Objectives. To conduct a prospective randomized controlled study to investigate the safety and ef... more Objectives. To conduct a prospective randomized controlled study to investigate the safety and efficacy of endocanalicular, high-pressure, 5-mm balloon catheter, endoscopic dacryocystorhinostomy (DCR) in adult patients with acquired complete nasolacrimal obstruction. Study Design. Prospective randomized controlled study. Setting. General hospital. Subjects and Methods. Sixty-six adult patients with a total of 70 procedures were recruited to undergo endoscopic DCR. They were prospectively, equally randomized into 2 groups: endocanalicular, high-pressure, 5-mm balloon catheter, endoscopic DCR (group I) and conventional endoscopic DCR (group II). Regular follow-up sessions were conducted to document the patient’s subjective improvement, judge ostium patency on irrigation, and record any complications. Results. Both groups demonstrated a success rate of 91.4%. There was a shorter mean operative time (25.7 minutes) in group I (P < .001). The number of adverse events was significantly ...
No sponsorships or competing interests have been disclosed for this article. Objectives. (1) To c... more No sponsorships or competing interests have been disclosed for this article. Objectives. (1) To conduct an adequately powered rando-mized controlled trial investigating the safety and efficacy of mitomycin C–enhanced revision endoscopic dacryocystorhi-nostomy (DCR) and (2) to analyze causes of failure after primary endoscopic DCR. Study Design. A randomized controlled study. Setting. General hospital. Subjects and Methods. Seventy-six revision endoscopic DCRs were randomized into 2 groups: endoscopic DCR with mito-mycin (group I), where 0.5 mg/mL mitomycin C was applied for 10 minutes, and endoscopic DCR without mitomycin (group II). Follow-up settings were done to document the patient’s subjective improvement, to judge ostium patency on irrigation, and to record any complications. Results. Causes of failure in the original 92 patients included canalicular obstruction (14%), small misplaced bony window (43%), very small nasolacrimal stoma due to development of synechia (23%), and co...
No sponsorships or competing interests have been disclosed for this article. Objectives. (1) To c... more No sponsorships or competing interests have been disclosed for this article. Objectives. (1) To conduct an adequately powered rando-mized controlled trial investigating the safety and efficacy of mitomycin C–enhanced revision endoscopic dacryocystorhi-nostomy (DCR) and (2) to analyze causes of failure after primary endoscopic DCR. Study Design. A randomized controlled study. Setting. General hospital. Subjects and Methods. Seventy-six revision endoscopic DCRs were randomized into 2 groups: endoscopic DCR with mito-mycin (group I), where 0.5 mg/mL mitomycin C was applied for 10 minutes, and endoscopic DCR without mitomycin (group II). Follow-up settings were done to document the patient’s subjective improvement, to judge ostium patency on irrigation, and to record any complications. Results. Causes of failure in the original 92 patients included canalicular obstruction (14%), small misplaced bony window (43%), very small nasolacrimal stoma due to development of synechia (23%), and co...
Introduction Caudal end septal deformities are common deformities. Trauma is a main cause of thes... more Introduction Caudal end septal deformities are common deformities. Trauma is a main cause of these deformities. there is lack of an algorithm for choosing the suitable technique for the type of deformity. The aim of this retrospective study was to put an algorithm for approaching different caudal end deformities. Patients and methods Retrospective review of 136 patients underwent surgical correction for caudal end deformities. Data collection included functional breathing outcomes and drawbacks of different techniques as postop caudal end sublaxation and firm nasal tip sensation. Results Patients were divided into 4 groups (according to the technique by which the caudal end of nasal septum was managed) as following: Group A: 90 patients who had undergone surgeries with swinging door or modified swinging door techniques with fixation to anterior nasal spine technique, Group B: 26 patients who had undergone surgery with tongue in groove technique, Group C: 10 patients who had undergon...
Current opinion in otolaryngology & head and neck surgery, 2009
To describe the current support in the literature for radiophonosurgery in cases of vocal fold no... more To describe the current support in the literature for radiophonosurgery in cases of vocal fold nodules. Radiophonosurgery is a recent innovation in the field of laryngeal surgery. It is emerging as a reliable and practical method for treating benign superficial vocal fold lesions that is increasingly becoming popular. It induces an excellent subjective and objective improvement in voice parameters. Histologically, it produces unremarkable lateral thermal damage and char penetration, which is quite crucial in a functional surgery such as in phonosurgery. Well designed probes are still lacking in the market. Radiophonosurgery provides a new approach for patients with vocal fold nodules. It combines the advantages of both cold knife and laser phonosurgery and is easy, well tolerated, precise and effective with excellent tactile and hemostatic properties.
To conduct the first prospective, randomized, controlled trial evaluating and comparing the medic... more To conduct the first prospective, randomized, controlled trial evaluating and comparing the medical and surgical treatment of polypoid and nonpolypoid chronic rhinosinusitis (CRS). Ninety patients with CRS were equally randomized either to medical or surgical therapy. All patients underwent pre- and posttreatment assessments of visual analogue score (VAS), the Sinonasal Outcome Test-20 (SNOT-20), the Short Form 36 Health Survey (SF-36), nitric oxide (NO), acoustic rhinometry, saccharine clearance time (SCT), and nasal endoscopy. Each patient had three assessments: before starting the treatment, after 6 months, and, finally, after 1 year. Both the medical and surgical treatment of CRS significantly improved almost all the subjective and objective parameters of CRS (P <.01), with no significant difference being found between the medical and surgical groups (P >.05), except for the total nasal volume in CRS (P <.01) and CRS without polyposis (P <.01) groups, in which the su...
To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions... more To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions. Charts of 392 patients were reviewed and categorised according to disease nature and extent as follows: group 1 comprised isolated sphenoid sinus lesion cases, group 2 consisted of pansinus lesion cases and group 3 comprised lateral sphenoid recess lesion cases. Surgical approaches, difficulties and complications were noted. A transnasal approach was employed in 40.8 per cent of cases (23.2 per cent were group 1 patients, 16.1 per cent were group 2 patients and 1.5 per cent were group 3 patients), a transethmoidal approach was utilised in 54.3 per cent of cases (group 2 patients) and a transpterygopalatine fossa approach was selected in 4.9 per cent of cases (group 3 patients). Surgical difficulties were encountered in 11.9, 10.8 and 0 per cent of patients in whom transnasal, transethmoidal or transpterygopalatine approaches were utilised, respectively. Radio-pathological categorisation provided a means of developing an algorithm for selecting the most appropriate endoscopic approach. Transnasal sphenoidotomy should be the first choice of approach whenever applicable. Lateral sphenoid recess non-inflammatory diseases should be managed through a transpterygopalatine fossa approach. Revision surgery does not play a key role in the algorithm.
The aim of this work was to focus on the development and validation of the use of topical fluores... more The aim of this work was to focus on the development and validation of the use of topical fluorescein in the intraoperative localization of cerebrospinal fluid (CSF) fistulas, and to screen its use in preoperative diagnosis of CSF rhinorrhea as well as postoperative detection of a recurrence. Twenty-five patients with CSF rhinorrhea were treated with an endoscopic endonasal technique. Topical intranasal 5% fluorescein was used for preoperative diagnosis and intraoperative localization of the site of the leak. A change in the color of the fluorescein from yellow to green fluorescence and sometimes streaming the fluorescein over the nasal mucosa and blood denoted the presence of CSF, and the site of the leak could be traced. The cause of the leak was accidental trauma in 11 patients, spontaneous in 9 patients, and iatrogenic in 5 patients. The ethmoidal roof was the most common site of leak (52%) followed by the cribriform plate (40%) and then the sphenoid sinus (8%). We have achieved 100% success rate in sealing the CSF fistulas in our 25 patients with no recurrence detected during the follow-up period (mean, 19+/-10 months). The preoperative use of fluorescein-soaked cotton pledgets was 100% accurate in diagnosing CSF rhinorrhea when compared with B2 transferrin testing. The intraoperative use of topical intranasal fluorescein was also 100% accurate in locating the site of the CSF fistula when compared with the surgical findings. No major complications have been reported. In the presence of a clinically diagnosed CSF leakage, topical fluorescein is a very easy, sensitive, safe, and highly accurate tool in the intraoperative localization of the site and extent of CSF fistulas, and should be considered a viable noninvasive alternative to intrathecal fluorescein. We also recommend its use as a simple and quick outpatient clinic test for preoperative diagnosis of CSF rhinorrhea. It can be used postoperatively as well when there is a doubt of recurrence of the CSF leak.
To conduct the first prospective randomized controlled trial, evaluating and comparing the effect... more To conduct the first prospective randomized controlled trial, evaluating and comparing the effect of medical and surgical treatment of chronic rhinosinusitis (CRS) on quality of life. Ninety patients with CRS, who remained symptomatic after initial medical treatment with Dexarhinaspray duo and nasal douche, were randomized either to medical or surgical therapy. All patients underwent pre- and post-treatment assessments of the Sinonasal Outcome Test-20 (SNOT-20), and the Short Form 36 Health Survey (SF-36). Each patient had three assessments: before starting the randomized treatment, after six months and finally after one year. Both the medical and surgical treatment of CRS significantly improved almost all the parameters of SNOT and SF-36 (p<0.05), with no significant difference being found between the medical and surgical groups (p>0.05). Both maximal medical and surgical therapy of CRS improves the quality of life of CRS patients, providing further evidence that chronic rhin...
Objective: Conduct the first prospective randomized controlled study investigating the safety and... more Objective: Conduct the first prospective randomized controlled study investigating the safety and efficacy of endocanalicular high pressure 5-mm balloon catheter endoscopic dacryocystorhinostomy (DCR) in adult patients with acquired complete nasolacrimal obstruction. Method: This prospective randomized controlled study was conducted between 2004 and 2009 including 70 procedures of endoscopic dacryocystorhinostomy. They were prospectively equally randomized into 2 groups; endocanalicular high-pressure 5-mm balloon catheter endoscopic DCR (group I) and conventional endoscopic DCR (group II). Regular follow up settings were done to document the patient's subjective improvement, to judge ostium patency on irrigation, and to record any complications. Statistical analysis was done using SPSS for Windows. The primary end point was determined to be the success of the surgery as defined by the subjective disappearance of symptoms. Results: Both groups demonstrated a success rate of 91.4%. There was a shorter mean operative time (25.7 minutes) in the endocanalicular balloon catheter endoscopic DCR group. Conclusion: The endocanalicular balloon catheter endoscopic DCR shares the benefits and success rate of conventional endoscopic DCR. In addition, it is simpler, requires less manipulation, consumes a shorter operative time, has a better safety profile, and can be totally utilized under local anesthesia with minimal sedation.
Objective To investigate the safety and efficacy of two topical blood stopper modulators; Ankafer... more Objective To investigate the safety and efficacy of two topical blood stopper modulators; Ankaferd blood stopper (ABS) and feracrylum 1% solution (FS) during adenoid surgery. Study design Prospective randomized trial. Methods Two hundred and twenty five consecutive pediatric adenoid patients aged from 9 months to 2 years old were studied. Patients were randomly allocated into two haemostatic groups; (ABS, FS) and normal saline (control group). Results ABS and FS groups showed a significantly less intra operative blood loss (16.4 ± 2.6/22 ± 6.2), operative time (9.31 ± 1.9/11.2 ± 1.6 min), use of cautery (10.6/25.3%), postoperative analgesics (3 ± 1.1/3.8 ± 1.2), duration to return normal diet (2.4 ± 1.2/3.9 ± 0.9) and operating theatre cost (233 ± 48$ and 279 ± 40$) than the control group. Conclusion AFS and FS are easy, safe, and reliable topical haemostatic modulators that could be used in adenoid surgery.
Assessment of adding lidocaine to dexamethasone in the intratympanic injections for the treatment... more Assessment of adding lidocaine to dexamethasone in the intratympanic injections for the treatment of subjective idiopathic tinnitus (SIT). A prospective, controlled, randomized, double-blind study of forty-four patients with SIT diagnosed in the Department of Otolaryngology, Tanta University Hospital, a tertiary academic medical centre from March 2015 to October 2016. 44 patients were recruited in the study and were categorized into two groups; (A) included 22 patients managed with ITLD, and (B) included 22 patients managed with intratympanic postoperative ITD injection. Intratympanic injections were double-blind performed three times with one weak interval. After three and six months, the tinnitus improvement was studied using the following parameters: Arabic tinnitus questionnaires (ATQ), loudness matching test and Tinnitus handicap index (THI). The effectiveness rates of ITLD for idiopathic tinnitus reported in the ATQ, THI, and in the loudness matching test were 74.5% in the ITD...
To conduct a prospective, randomized, controlled trial determining the feasibility of radiofreque... more To conduct a prospective, randomized, controlled trial determining the feasibility of radiofrequency with or without topical mitomycin C application in delaying the closure time of human tympanostomy and screening its efficacy in management of recurrent acute otitis media and otitis media with effusion. From November 2002 to January 2004, 96 patients (180 ears) who were to undergo surgical intervention for recurrent acute otitis media or otitis media with effusion were included in this study. Sixty ears with a diagnosis of recurrent acute otitis media were equally randomized to three procedures: cold knife myringotomy (Group A), radiofrequency tympanostomy (Group B), and radiofrequency tympanostomy with topical mitomycin C application (Group C). One hundred twenty ears diagnosed as having otitis media with effusion were equally randomized to the last two procedures only. Patients were followed-up every week in the first month, every 2 weeks in the second month, and monthly after that until closure of the tympanostomy. A special follow-up setting was designed 3 months after tympanostomy closure where tympanograms and pure-tone audiograms were obtained. Groups B and C showed a significantly slower rate of closure than Group A. At the same time, Group C demonstrated a slower rate when compared with Group B. The mean closure time of Group B was 3.5 weeks, with no difference between recurrent acute otitis media and otitis media with effusion. In contrast, the mean closure times for Group C were 5.3 and 7 weeks in cases of otitis media with effusion and recurrent acute otitis media, respectively, with the latter demonstrating a significantly slower closure rate. No recurrence of acute otitis media was reported in 10, 45, and 80% of Groups A, B, and C, respectively. Fifty-nine percent of Group C showed no clinical or tympanometric signs of otitis media with effusion 3 months after closure of tympanostomy. In contrast, Group B reported a lower cure rate (28%), with a statistically significant difference between both groups. Absence of recurrence and improvement in tympanometry signs correlated significantly with the duration of patency of tympanostomy (p &amp;amp;amp;amp;amp;amp;lt; 0.01). The success rate was higher in patients who underwent adenoidectomy, but this did not reach statistical significance except in Group C (p &amp;amp;amp;amp;amp;amp;lt; 0.01). Radiofrequency and mitomycin C delay the closure rate of human tympanostomy. The efficacy of mitomycin C seems to be amplified in the presence of an inflamed tympanic membrane. Radiofrequency-assisted mitomycin-enhanced tympanostomy is a precise, safe, and cost-effective procedure that provides a viable approach in the management of recurrent acute otitis media and otitis media with effusion, especially when used in conjunction with adenoidectomy.
OBJECTIVES: To conduct the first prospective randomized controlled study 1) evaluating the possib... more OBJECTIVES: To conduct the first prospective randomized controlled study 1) evaluating the possibility of improving the quality of the operative field and to provide a bloodless functional endoscopic sinus surgery (FESS) in children through total intravenous anesthesia (TIVA) using remifentanil combined with propofol, and 2) testing the safety and efficacy of remifentanil in propofol-TIVA in inducing controlled hypotension in children at a target mean arterial blood pressure of 50 mm Hg. STUDY DESIGN: Randomized controlled trial. SETTING: General hospital. SUBJECTS AND METHODS: Seventy children underwent FESS under hypotensive general anesthesia with equal randomization into two groups. Group I received TIVA with remifentanil, whereas group II had balanced anesthesia (BA) with esmolol. Heart rate, blood pressure, operative time, blood loss, and quality of the surgical conditions were recorded. RESULTS: Intraoperative blood loss in the TIVA group was less than in the BA group. The qu...
OBJECTIVES: To conduct a prospective randomized controlled study presenting and comparing bipolar... more OBJECTIVES: To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra-operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage. MATERIALS AND METHODS: From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intraoperative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with. RESULTS: There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT ...
Objective:To conduct an adequately powered, prospective, randomised, controlled trial comparing a... more Objective:To conduct an adequately powered, prospective, randomised, controlled trial comparing adult dissection tonsillectomy using either ultrasonic scalpel, bipolar electrocautery, bipolar radiofrequency or ‘cold steel’ dissection.Methods:Three hundred patients were randomised into four tonsillectomy technique groups. The operative time, intra-operative bleeding, post-operative pain, tonsillar fossa healing, return to full diet, return to work and post-operative complications were recorded.Results:The bipolar radiofrequency group had a shorter mean operative time. The mean intra-operative blood loss during bipolar radiofrequency tonsillectomy was significantly less compared with cold dissection and ultrasonic scalpel tonsillectomy. Pain scores were significantly higher after bipolar electrocautery tonsillectomy. Patients undergoing bipolar electrocautery tonsillectomy required significantly more days to return to full diet and work. The bipolar electrocautery group showed signifi...
The process of wearing head scarf is very complex; girls used to hold a number of pins in the mou... more The process of wearing head scarf is very complex; girls used to hold a number of pins in the mouth and utilize them one by one to Wx the scarf. Loss of concentration results in pin aspiration. We presented our experience with scarf pin aspiration and discussed the unique clinical characteristics of this problem. We reviewed the records of 73 patients who underwent bronchoscopy for scarf pin inhalation during the period from January 1995 to May 2009. The following data were collected, history of aspiration, time lag before presentation, symptoms and signs, radiological Wndings, bronchoscopic Wndings, number of repeated bronchoscopy, complications, need for thoracotomy and time of discharge. All patients were female, mean age 13.4 years. The time lag before admission was <12 h for 59 (81%) patients. Positive history was present in all cases. Chest radiography identiWed the pins in all cases. The foreign bodies were seen in the left bronchial system in 37 (50.7%) patients, in the right bronchial system in another 24 (32.9%), and in the trachea in 12 (16.4%) patients. In 66 (90.4%) patients, the foreign body was removed in the Wrst bronchoscopic trial; a second trial was needed in 5 (6.8%) patients, and thoracotomy was performed in two patients. In conclusion, head scarf pin aspiration occurs in adolescent Islamic girls. The clinical presentation and radiological Wndings are diagnostic in all cases. Rigid bronchoscopy is the preferred treatment modality. Health education is the key issue in the prevention of this problem.
Objectives. To conduct a prospective randomized controlled study to investigate the safety and ef... more Objectives. To conduct a prospective randomized controlled study to investigate the safety and efficacy of endocanalicular, high-pressure, 5-mm balloon catheter, endoscopic dacryocystorhinostomy (DCR) in adult patients with acquired complete nasolacrimal obstruction. Study Design. Prospective randomized controlled study. Setting. General hospital. Subjects and Methods. Sixty-six adult patients with a total of 70 procedures were recruited to undergo endoscopic DCR. They were prospectively, equally randomized into 2 groups: endocanalicular, high-pressure, 5-mm balloon catheter, endoscopic DCR (group I) and conventional endoscopic DCR (group II). Regular follow-up sessions were conducted to document the patient’s subjective improvement, judge ostium patency on irrigation, and record any complications. Results. Both groups demonstrated a success rate of 91.4%. There was a shorter mean operative time (25.7 minutes) in group I (P < .001). The number of adverse events was significantly ...
No sponsorships or competing interests have been disclosed for this article. Objectives. (1) To c... more No sponsorships or competing interests have been disclosed for this article. Objectives. (1) To conduct an adequately powered rando-mized controlled trial investigating the safety and efficacy of mitomycin C–enhanced revision endoscopic dacryocystorhi-nostomy (DCR) and (2) to analyze causes of failure after primary endoscopic DCR. Study Design. A randomized controlled study. Setting. General hospital. Subjects and Methods. Seventy-six revision endoscopic DCRs were randomized into 2 groups: endoscopic DCR with mito-mycin (group I), where 0.5 mg/mL mitomycin C was applied for 10 minutes, and endoscopic DCR without mitomycin (group II). Follow-up settings were done to document the patient’s subjective improvement, to judge ostium patency on irrigation, and to record any complications. Results. Causes of failure in the original 92 patients included canalicular obstruction (14%), small misplaced bony window (43%), very small nasolacrimal stoma due to development of synechia (23%), and co...
No sponsorships or competing interests have been disclosed for this article. Objectives. (1) To c... more No sponsorships or competing interests have been disclosed for this article. Objectives. (1) To conduct an adequately powered rando-mized controlled trial investigating the safety and efficacy of mitomycin C–enhanced revision endoscopic dacryocystorhi-nostomy (DCR) and (2) to analyze causes of failure after primary endoscopic DCR. Study Design. A randomized controlled study. Setting. General hospital. Subjects and Methods. Seventy-six revision endoscopic DCRs were randomized into 2 groups: endoscopic DCR with mito-mycin (group I), where 0.5 mg/mL mitomycin C was applied for 10 minutes, and endoscopic DCR without mitomycin (group II). Follow-up settings were done to document the patient’s subjective improvement, to judge ostium patency on irrigation, and to record any complications. Results. Causes of failure in the original 92 patients included canalicular obstruction (14%), small misplaced bony window (43%), very small nasolacrimal stoma due to development of synechia (23%), and co...
Introduction Caudal end septal deformities are common deformities. Trauma is a main cause of thes... more Introduction Caudal end septal deformities are common deformities. Trauma is a main cause of these deformities. there is lack of an algorithm for choosing the suitable technique for the type of deformity. The aim of this retrospective study was to put an algorithm for approaching different caudal end deformities. Patients and methods Retrospective review of 136 patients underwent surgical correction for caudal end deformities. Data collection included functional breathing outcomes and drawbacks of different techniques as postop caudal end sublaxation and firm nasal tip sensation. Results Patients were divided into 4 groups (according to the technique by which the caudal end of nasal septum was managed) as following: Group A: 90 patients who had undergone surgeries with swinging door or modified swinging door techniques with fixation to anterior nasal spine technique, Group B: 26 patients who had undergone surgery with tongue in groove technique, Group C: 10 patients who had undergon...
Current opinion in otolaryngology & head and neck surgery, 2009
To describe the current support in the literature for radiophonosurgery in cases of vocal fold no... more To describe the current support in the literature for radiophonosurgery in cases of vocal fold nodules. Radiophonosurgery is a recent innovation in the field of laryngeal surgery. It is emerging as a reliable and practical method for treating benign superficial vocal fold lesions that is increasingly becoming popular. It induces an excellent subjective and objective improvement in voice parameters. Histologically, it produces unremarkable lateral thermal damage and char penetration, which is quite crucial in a functional surgery such as in phonosurgery. Well designed probes are still lacking in the market. Radiophonosurgery provides a new approach for patients with vocal fold nodules. It combines the advantages of both cold knife and laser phonosurgery and is easy, well tolerated, precise and effective with excellent tactile and hemostatic properties.
To conduct the first prospective, randomized, controlled trial evaluating and comparing the medic... more To conduct the first prospective, randomized, controlled trial evaluating and comparing the medical and surgical treatment of polypoid and nonpolypoid chronic rhinosinusitis (CRS). Ninety patients with CRS were equally randomized either to medical or surgical therapy. All patients underwent pre- and posttreatment assessments of visual analogue score (VAS), the Sinonasal Outcome Test-20 (SNOT-20), the Short Form 36 Health Survey (SF-36), nitric oxide (NO), acoustic rhinometry, saccharine clearance time (SCT), and nasal endoscopy. Each patient had three assessments: before starting the treatment, after 6 months, and, finally, after 1 year. Both the medical and surgical treatment of CRS significantly improved almost all the subjective and objective parameters of CRS (P <.01), with no significant difference being found between the medical and surgical groups (P >.05), except for the total nasal volume in CRS (P <.01) and CRS without polyposis (P <.01) groups, in which the su...
To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions... more To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions. Charts of 392 patients were reviewed and categorised according to disease nature and extent as follows: group 1 comprised isolated sphenoid sinus lesion cases, group 2 consisted of pansinus lesion cases and group 3 comprised lateral sphenoid recess lesion cases. Surgical approaches, difficulties and complications were noted. A transnasal approach was employed in 40.8 per cent of cases (23.2 per cent were group 1 patients, 16.1 per cent were group 2 patients and 1.5 per cent were group 3 patients), a transethmoidal approach was utilised in 54.3 per cent of cases (group 2 patients) and a transpterygopalatine fossa approach was selected in 4.9 per cent of cases (group 3 patients). Surgical difficulties were encountered in 11.9, 10.8 and 0 per cent of patients in whom transnasal, transethmoidal or transpterygopalatine approaches were utilised, respectively. Radio-pathological categorisation provided a means of developing an algorithm for selecting the most appropriate endoscopic approach. Transnasal sphenoidotomy should be the first choice of approach whenever applicable. Lateral sphenoid recess non-inflammatory diseases should be managed through a transpterygopalatine fossa approach. Revision surgery does not play a key role in the algorithm.
The aim of this work was to focus on the development and validation of the use of topical fluores... more The aim of this work was to focus on the development and validation of the use of topical fluorescein in the intraoperative localization of cerebrospinal fluid (CSF) fistulas, and to screen its use in preoperative diagnosis of CSF rhinorrhea as well as postoperative detection of a recurrence. Twenty-five patients with CSF rhinorrhea were treated with an endoscopic endonasal technique. Topical intranasal 5% fluorescein was used for preoperative diagnosis and intraoperative localization of the site of the leak. A change in the color of the fluorescein from yellow to green fluorescence and sometimes streaming the fluorescein over the nasal mucosa and blood denoted the presence of CSF, and the site of the leak could be traced. The cause of the leak was accidental trauma in 11 patients, spontaneous in 9 patients, and iatrogenic in 5 patients. The ethmoidal roof was the most common site of leak (52%) followed by the cribriform plate (40%) and then the sphenoid sinus (8%). We have achieved 100% success rate in sealing the CSF fistulas in our 25 patients with no recurrence detected during the follow-up period (mean, 19+/-10 months). The preoperative use of fluorescein-soaked cotton pledgets was 100% accurate in diagnosing CSF rhinorrhea when compared with B2 transferrin testing. The intraoperative use of topical intranasal fluorescein was also 100% accurate in locating the site of the CSF fistula when compared with the surgical findings. No major complications have been reported. In the presence of a clinically diagnosed CSF leakage, topical fluorescein is a very easy, sensitive, safe, and highly accurate tool in the intraoperative localization of the site and extent of CSF fistulas, and should be considered a viable noninvasive alternative to intrathecal fluorescein. We also recommend its use as a simple and quick outpatient clinic test for preoperative diagnosis of CSF rhinorrhea. It can be used postoperatively as well when there is a doubt of recurrence of the CSF leak.
To conduct the first prospective randomized controlled trial, evaluating and comparing the effect... more To conduct the first prospective randomized controlled trial, evaluating and comparing the effect of medical and surgical treatment of chronic rhinosinusitis (CRS) on quality of life. Ninety patients with CRS, who remained symptomatic after initial medical treatment with Dexarhinaspray duo and nasal douche, were randomized either to medical or surgical therapy. All patients underwent pre- and post-treatment assessments of the Sinonasal Outcome Test-20 (SNOT-20), and the Short Form 36 Health Survey (SF-36). Each patient had three assessments: before starting the randomized treatment, after six months and finally after one year. Both the medical and surgical treatment of CRS significantly improved almost all the parameters of SNOT and SF-36 (p<0.05), with no significant difference being found between the medical and surgical groups (p>0.05). Both maximal medical and surgical therapy of CRS improves the quality of life of CRS patients, providing further evidence that chronic rhin...
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Papers by Sameh Ragab