Papers by Khaled M Mokbel
Mansoura Medical Journal, 2001
Background: Clinical tests performed in posturography are a useful element in evaluating balance ... more Background: Clinical tests performed in posturography are a useful element in evaluating balance and postural control. It usually demands, however, large and expensive equipment and for this reason this examination is not performed by many neurotologists. Aims/Objectives: This study was conducted with a recently developed posturography system -Balance Angular Posturography (BAP) -in order to evaluate it to clinical practice. Ten healthy volunteer without vestibular disease or complaint of loss of balance were studied prospectively using BAP to establish the reference values of the variables, standardizing its use. They were tested standing over the floor or over a foam platform and were stimulated with right and left Head Tilt, Head-Shaking and right and left Fast Head-Turning tests. The stimuli were presented both with eyes open and closed. Results: Ten volunteer were enrolled in this study. The results varied but allowed for the establishment of reference values. The validated BAP protocol may become useful to study patients with imbalance complaint and document their improvement after vestibular rehabilitation.
The Journal of International Advanced Otology, 2018
While an accurate placement in cochleostomy is critical to ensure appropriate insertion of the co... more While an accurate placement in cochleostomy is critical to ensure appropriate insertion of the cochlear implant (CI) electrode into the scala tympani (ST), the choice of preferred cochleostomy sites widely varied among experienced surgeons. We present a novel technique for precise yet readily applicable localization of the optimum site for performing ST cochleostomy. Twenty fresh frozen temporal bones were dissected using the mastoidectomy-posterior tympanotomy approach. Based on the facial nerve and the margins of the round window membrane (RWM), the cochleostomy site was chosen to insert the electrode into the ST while preserving the surrounding intracochlear structures. There is a limited safe area suitable for the ST implantation in the area inferior and anterior to the RWM. There is a higher risk of scala vestibuli (SV) insertion anterior to that area. Posterior to that area, the cochlear aqueduct (CA) and inferior cochlear vein (ICV) are liable for the injury. For atraumatic CI, precise and easy localization of the site of cochleostomy play a pivotal role in preserving intracochlear structures. Accurate setting of the vertical and horizontal orientations is mandatory before choosing the site of cochleostomy. The facial nerve and the margins of the RWM offer a very helpful clue for such localization; meanwhile, it is readily identifiable in the surgical field.
Journal of Otolaryngology and Rhinology, 2015
been done through a postauricular incision in order to obtain wide exposure . Cartilage graft is ... more been done through a postauricular incision in order to obtain wide exposure . Cartilage graft is widely used and strongly established to be beneficial in obtaining good take rate in myringoplasty. Cartilage graft is rigid with more durability and resistance so it is preferred in repair of large tympanic membrane perforations . After getting approval of the institutional ethical committee and written consent from all enrolled patients, this study was conducted on 80 patients with unilateral dry subtotal tympanic membrane perforation repaired by an ultrathin auricular cartilage shield graft covered by temporalis fascia where it is the preferred graft of the senior first author . They included 36 females and 44 males. Their ages range from 18-50 years with mean of 33 years. Patients in our study were selected from the Otologic Outpatient Department of Mansoura University Hospital from January 2011-February 2014. Complete Oto-endoscopic examination was performed for all patients. Preoperative audiological investigations were completed for all patients in the form of pure tone audiometry (air conduction and bone conduction thresholds at frequencies from 500-4000 Hz and air bone gap (ABG). Patients were divided blindly into 2 groups. The patient and the surgeon were unaware of which group, endoscopic or microscopic, the patient was in. The patients were numbered from 1 to 80. Patient no. 1 was assigned for group A and patient no. 2 assigned for group B and so on. All patients were fulfilled all the inclusion criteria which included; dry perforation for 3 months or more, no evidence of ossicular disease with air bone gap (ABG) of ≤ 35 dB, no previous ear surgery, no sinonasal problems and medical fitness with no diabetes mellitus. Group A included 40 patients operated by the endoscopic transcanal approach and group B included another 40 patients repaired by microscopic postauricular approach. In both groups we used the underlay/overlay technique placing the graft under the annulus and remnants of tympanic membrane but over the malleus handle. Follow up was ranged from 6 to 24 months. Data were evaluated using online GraphPad software where mean and standard deviation were calculated and unpaired t test was used to compare between two mean to calculate P value.
Bangladesh Journal of Otorhinolaryngology, 2016
Congenital choanal atresia (CA) is a rare abnormality characterized by unilateral or bilateral ob... more Congenital choanal atresia (CA) is a rare abnormality characterized by unilateral or bilateral obstruction of the posterior end of the nasal cavity. With an incidence of 1:1000 to 1:8000 births, it is more in female than in males and unilateral more common than bilateral. Surgical procedures aim to provide adequate functional choanal patency and a low rate of rest enosis, with shorter surgery and hospitalization times, to minimize morbidity and mortality, this study done to evaluate the effectiveness and safety of endoscopic nasal surgical techniques for the treatment of congenital choanal atresia in patients with unilateral and bilateral atresia and to emphasis in the important of second look procedure at the time of removal of stent to assess the wideness of neochoana, and to remove any granulation tissue ,or polyps, it involved 13 patients, 10 with unilateral CA and 3 bilateral CA, all involved in surgery and second look.
Egyptian Journal of Ear, Nose, Throat and Allied Sciences, 2011
The aim of this study was to evaluate stapedial decapitation technique with preservation of the s... more The aim of this study was to evaluate stapedial decapitation technique with preservation of the stapes suprastructure for the treatment of stapedial otosclerosis. Patients and methods: This study included 42 patients (17 males and 25 females) subjected to decapitation technique and 32 patients (10 males and 22 females) subjected to the usual small fenestra technique as control. Results: Hearing sensitivity and air bone gap of the two groups before and five years after operations were analyzed. The mean hearing threshold level (500-4000 Hz) of preoperative versus postoperative was compared. There were no significant postoperative statistical differences in hearing threshold improvement and air bone gap closure between the two techniques used in this study all over the postoperative five years.
The Journal of International Advanced Otology, 2014
OBJECTIVE: Vestibular migraine is vertigo caused directly by migraine. Otoacoustic emission (OAE)... more OBJECTIVE: Vestibular migraine is vertigo caused directly by migraine. Otoacoustic emission (OAE) is a low sound generated in the cochlea and measured in the outer ear canal. The purpose of this study was to determine whether vestibular migraine with normal pure tone audiometry has abnormal changes in cochlear (OHC) function measured by distortion product otoacoustic emissions (DPOAEs). DPOAEs were measured from 34 definite vestibular migraine patients with normal peripheral hearing sensitivity (11 males and 23 females), and they were compared to the results of 30 normal subjects (12 males and 18 females). The mean emission amplitudes across the DPOAE-measured frequencies in both ears of patients with definite vestibular migraine were lower than that of the normal subjects but statistically non-significant (p>0.05). The emission amplitudes that were reduced could be attributed to the patho-physiologic mechanism encountered in the ears of those patients, in spite of being of non-statically significant values. Our results suggest that definite vestibular migraine patients with normal peripheral hearing sensitivity may have subclinical cochlear affection associated with this disease.
European Archives of Oto-Rhino-Laryngology, 2010
The objective of the study was conducted to evaluate the effectiveness of nasal endoscopy for bot... more The objective of the study was conducted to evaluate the effectiveness of nasal endoscopy for both diagnosis and localized excision of intranasal contact areas that cause headache and/or facial pain as well as to evaluate the use of lidocaine test for diagnosis of such cases and predicting the result of surgery. This study included 120 patients aged between 18 and 45 years, with an average period of headache and/or facial pain of 2.5 years. Patients were classified into two groups according to lidocaine test. Group A that was lidocaine positive and group B which was negative. Excision of contact points was done, under endoscopic guidance, from the septum as well as the lateral nasal wall. 98.75% of patients in group A got benefit from surgery as most cases were cured from headache and facial pain. In group B, 40% got benefit with most patients had unchanged symptoms. In conclusion, endoscopic surgery gives a more precise complete excision of limited areas without time wasting or morbidity. Lidocaine test can be used as a test to aid in diagnosis and to predict the result of surgery where there were high cure rate within the lidocaine-positive group.
European Archives of Oto-Rhino-Laryngology, 2011
Our aim is to evaluate the function and take rate of 0.2 mm thickness cartilage shield for repair... more Our aim is to evaluate the function and take rate of 0.2 mm thickness cartilage shield for repair of subtotal tympanic membrane perforation by comparing it with full thickness cartilage and temporalis fascia. Repair of tympanic membrane was done in 85 patients with unilateral chronic otitis media with subtotal perforation. The patients were classified into three groups: group 'A' where 0.2 mm thickness cartilage graft was used, group 'B' repaired with full thickness cartilage graft and group 'C' where temporalis fascia graft was used. Over the follow-up period, we found that the graft take was complete with both partial and complete thickness cartilage grafts while it was not complete in fascia cases. On the other hand, there was marked improvement in hearing in cases repaired by fascia and partial thickness grafts as compared to hearing results of full thickness grafts. We concluded that 0.2 mm partial thickness cartilage graft is optimal in reconstruction of subtotal tympanic membrane perforation because it is excellent to obtain high take rate with good hearing results.
European Archives of Oto-Rhino-Laryngology, 2011
Our objective was to evaluate single flap with three pedicles, bone pate ´and split-thickness ski... more Our objective was to evaluate single flap with three pedicles, bone pate ´and split-thickness skin graft for mastoid cavity obliteration after canal wall down mastoidectomy done for chronic suppurative otitis media and its efficacy in producing a small and dry mastoid cavity. Over a period of 7 years (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010), 100 consecutive procedures in 100 patients with chronic suppurative otitis media were performed at the Mansoura University Hospital (Egypt) with a minimum follow-up of 12 months (range 12-72 months). All patients had canal wall down mastoidectomy with simultaneous tympanoplasty. Anteriorly, inferiorly and superiorly pedicled periosteal flap, which was covered by split-thickness skin graft, was used in conjunction with autologous bone pate ´to obliterate the mastoid cavity. Postoperative evaluation was done based on certain criteria and grading system from 0 to 3. Grade 0 is considered perfect, grade 3 represents failure and grade 1 and 2 are adequate but not perfect. The summation of grade ''0'' (perfect dry) and grade ''1'' (adequate dry) was 88, 95, 97.23 and 98.44% after follow-up periods of 12, 24, 36 and 48 months, and 100% after 60 and 72 months. Periosteal flap based on three pedicles (anterior, inferior and superior) covering the bone pate ´is simple, perfect and adequate for obliteration of mastoid cavity after canal wall down mastoidectomy. Split-thickness skin graft is important to hasten the epithelialization that helps to obtain a dry cavity. The use of local tissues saves costs and avoids complications from the synthetic materials.
European Archives of Oto-Rhino-Laryngology, 2011
Our objective was to conWrm the necessity of nasal endoscopy in the diagnosis and treatment of ch... more Our objective was to conWrm the necessity of nasal endoscopy in the diagnosis and treatment of choanal adenoid in adult patients with persistent bilateral nasal obstruction and recurrent nasal infections that may lead to repeated unsuccessful medical and surgical procedures. We present a series of 64 adult patients (18-37 years: 40 males, 24 females). All patients had persistent bilateral nasal obstruction and recurrent nasal infections. There was history of repeated medical and surgical unsuccessful procedures. Choanal adenoid was conWrmed by nasal endoscopy and CT scanning. Absence of adenoid tissues in the nasopharynx was conWrmed in all cases. Surgical removal of choanal adenoids was undertaken in all cases endoscopically. Some other surgical procedures like straightening of a deviated septum or reduction of a hypertrophied turbinate were undertaken in some indicated cases. Most of the cases experienced complete relief from obstruction and return of a patent nasal airway, and improvement of associated complaints such as dry mouth and persistent cough. A thorough review of this phenomenon and its clinical relevance, and methods of diagnosis and management are presented. We recommend a thorough nasal endoscopy as a routine in cases of persistent nasal obstruction even in the presence of an apparent cause of obstruction.
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Papers by Khaled M Mokbel