The therapeutic role of corticosteroids and/or corticosteroids with antiviral agents for sudden s... more The therapeutic role of corticosteroids and/or corticosteroids with antiviral agents for sudden sensorineural hearing loss (SSNHL) has yet to be fully elucidated; however, in cases where deafness is profound and of recent onset, a therapeutic trial is indicated. To investigate treatment regimens and their efficacies, as well as evaluating the potential prognostic correlates and allowing comparison between local and national standards of care for SSNHL. A retrospective evidence-based case series of 143 patients seen at the University of Rochester, Department of Otolaryngology between 1999 and 2002 was investigated. Treatment modalities included (1) observation, (2) steroids, and (3) steroids with antivirals. The study demonstrates that steroid treatment, alone or in combination with antivirals, results in a significant improvement rate compared with observation. Results indicate that the more expediently a patient with SSNHL is seen by an otolaryngologist, the better their prognosis.
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021
Background: Canal wall down mastoidectomy are still practiced in cases of chronic suppurative oti... more Background: Canal wall down mastoidectomy are still practiced in cases of chronic suppurative otitis media with cholesteatoma to ensure complete disease removal. The resulting cavity is prone to recurrent infection, chronic discharge and frequent care. Reconstruction of the posterior canal wall should be planned by the surgeon. Various techniques for external auditory canal (EAC) reconstruction have been recommended to eliminate open cavity problems. The surgeon should choose the type of grafts either autologous, homografts or synthetic materials. Furthermore, the surgeon should decide whether to do the reconstruction either immediate in the first stage of surgery or delayed as a second stage.Methods: In this study, the ridge was reconstructed at the same time of mastoidectomy by autologous tissues. The presenting study reconstructed the posterior canal wall in four layers; skin, perichondrial flap, cartilage and periosteal flap in that order from the meatal side to the mastoid side...
International Journal of Otorhinolaryngology and Head and Neck Surgery, May 26, 2021
Background: Canal wall down mastoidectomy are still practiced in cases of chronic suppurative oti... more Background: Canal wall down mastoidectomy are still practiced in cases of chronic suppurative otitis media with cholesteatoma to ensure complete disease removal. The resulting cavity is prone to recurrent infection, chronic discharge and frequent care. Reconstruction of the posterior canal wall should be planned by the surgeon. Various techniques for external auditory canal (EAC) reconstruction have been recommended to eliminate open cavity problems. The surgeon should choose the type of grafts either autologous, homografts or synthetic materials. Furthermore, the surgeon should decide whether to do the reconstruction either immediate in the first stage of surgery or delayed as a second stage. Methods: In this study, the ridge was reconstructed at the same time of mastoidectomy by autologous tissues. The presenting study reconstructed the posterior canal wall in four layers; skin, perichondrial flap, cartilage and periosteal flap in that order from the meatal side to the mastoid side. The presenting study included 48 patients (32 males and 16 females) with age ranged from 18-55 and 20-50 years. All included patients were presented at the outpatient clinic with unilateral chronic suppurative otitis media with persistent discharge. They had been operated at our tertiary hospital between January. 2012 to March 2014. Results: Successful reconstruction was obtained in all cases, with no dehiscence or necrosis. Conclusions: The reconstruction of the posterior wall by the four layers technique was successful and efficient. It is recommended to do this repair concomitantly with canal wall down mastoidectomy as one stage surgery.
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. Materials and Methods: 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. Conclusion: The validated BAP protocol may become useful to study patients with imbalance complaint and document their improvement after vestibular rehabilitation.
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. MATERIALS and METHODS: 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. RESULTS: 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. CONCLUSION: 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.
been done through a postauricular incision in order to obtain wide exposure [3]. Cartilage graft ... more been done through a postauricular incision in order to obtain wide exposure [3]. 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 [4]. Materials and Methods 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 [4]. 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.
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). MATERIALS and METHODS: 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). RESULTS: 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). CONCLUSION: 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.
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.
Our objective was to evaluate single flap with three pedicles, bone paté and split-thickness skin... more Our objective was to evaluate single flap with three pedicles, bone paté 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 (2003-2010), 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 paté 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 paté 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.
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.
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
Myringoplasty is a common surgery in our practice so every Otolaryngologist should do this operat... more Myringoplasty is a common surgery in our practice so every Otolaryngologist should do this operation by using different graft materials to gain a comprehensive experience with familiarity about those grafts. In this study fat grafts were used in 80 patients. They were divided into 2 groups. In group A, fat graft was obtained from ear lobule and in group B from abdominal fat. After analysis of clinical and audio logical data we concluded that fat from ear lobule was anatomically and functionally better than those of abdominal fat in repair of tympanic perforations.
The therapeutic role of corticosteroids and/or corticosteroids with antiviral agents for sudden s... more The therapeutic role of corticosteroids and/or corticosteroids with antiviral agents for sudden sensorineural hearing loss (SSNHL) has yet to be fully elucidated; however, in cases where deafness is profound and of recent onset, a therapeutic trial is indicated. To investigate treatment regimens and their efficacies, as well as evaluating the potential prognostic correlates and allowing comparison between local and national standards of care for SSNHL. A retrospective evidence-based case series of 143 patients seen at the University of Rochester, Department of Otolaryngology between 1999 and 2002 was investigated. Treatment modalities included (1) observation, (2) steroids, and (3) steroids with antivirals. The study demonstrates that steroid treatment, alone or in combination with antivirals, results in a significant improvement rate compared with observation. Results indicate that the more expediently a patient with SSNHL is seen by an otolaryngologist, the better their prognosis.
International Journal of Otorhinolaryngology and Head and Neck Surgery, 2021
Background: Canal wall down mastoidectomy are still practiced in cases of chronic suppurative oti... more Background: Canal wall down mastoidectomy are still practiced in cases of chronic suppurative otitis media with cholesteatoma to ensure complete disease removal. The resulting cavity is prone to recurrent infection, chronic discharge and frequent care. Reconstruction of the posterior canal wall should be planned by the surgeon. Various techniques for external auditory canal (EAC) reconstruction have been recommended to eliminate open cavity problems. The surgeon should choose the type of grafts either autologous, homografts or synthetic materials. Furthermore, the surgeon should decide whether to do the reconstruction either immediate in the first stage of surgery or delayed as a second stage.Methods: In this study, the ridge was reconstructed at the same time of mastoidectomy by autologous tissues. The presenting study reconstructed the posterior canal wall in four layers; skin, perichondrial flap, cartilage and periosteal flap in that order from the meatal side to the mastoid side...
International Journal of Otorhinolaryngology and Head and Neck Surgery, May 26, 2021
Background: Canal wall down mastoidectomy are still practiced in cases of chronic suppurative oti... more Background: Canal wall down mastoidectomy are still practiced in cases of chronic suppurative otitis media with cholesteatoma to ensure complete disease removal. The resulting cavity is prone to recurrent infection, chronic discharge and frequent care. Reconstruction of the posterior canal wall should be planned by the surgeon. Various techniques for external auditory canal (EAC) reconstruction have been recommended to eliminate open cavity problems. The surgeon should choose the type of grafts either autologous, homografts or synthetic materials. Furthermore, the surgeon should decide whether to do the reconstruction either immediate in the first stage of surgery or delayed as a second stage. Methods: In this study, the ridge was reconstructed at the same time of mastoidectomy by autologous tissues. The presenting study reconstructed the posterior canal wall in four layers; skin, perichondrial flap, cartilage and periosteal flap in that order from the meatal side to the mastoid side. The presenting study included 48 patients (32 males and 16 females) with age ranged from 18-55 and 20-50 years. All included patients were presented at the outpatient clinic with unilateral chronic suppurative otitis media with persistent discharge. They had been operated at our tertiary hospital between January. 2012 to March 2014. Results: Successful reconstruction was obtained in all cases, with no dehiscence or necrosis. Conclusions: The reconstruction of the posterior wall by the four layers technique was successful and efficient. It is recommended to do this repair concomitantly with canal wall down mastoidectomy as one stage surgery.
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. Materials and Methods: 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. Conclusion: The validated BAP protocol may become useful to study patients with imbalance complaint and document their improvement after vestibular rehabilitation.
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. MATERIALS and METHODS: 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. RESULTS: 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. CONCLUSION: 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.
been done through a postauricular incision in order to obtain wide exposure [3]. Cartilage graft ... more been done through a postauricular incision in order to obtain wide exposure [3]. 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 [4]. Materials and Methods 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 [4]. 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.
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). MATERIALS and METHODS: 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). RESULTS: 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). CONCLUSION: 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.
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.
Our objective was to evaluate single flap with three pedicles, bone paté and split-thickness skin... more Our objective was to evaluate single flap with three pedicles, bone paté 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 (2003-2010), 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 paté 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 paté 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.
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.
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
Myringoplasty is a common surgery in our practice so every Otolaryngologist should do this operat... more Myringoplasty is a common surgery in our practice so every Otolaryngologist should do this operation by using different graft materials to gain a comprehensive experience with familiarity about those grafts. In this study fat grafts were used in 80 patients. They were divided into 2 groups. In group A, fat graft was obtained from ear lobule and in group B from abdominal fat. After analysis of clinical and audio logical data we concluded that fat from ear lobule was anatomically and functionally better than those of abdominal fat in repair of tympanic perforations.
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