Hazem Saeed Amer

Olfactory Bulb Volume Changes in Patients with Sinonasal Polyposis: A Magnetic Resonance Imaging Study

Objectives The olfactory bulb (OB) is thought to be a plastic structure with highly active afferent neurons. The aim of this study was to evaluate the effect of olfactory deprivation caused by sinonasal polyps on OB volume. Study Design Cross-sectional study. Setting Tertiary university hospital, Department of Otolaryngology. Subjects and Methods Twenty-two subjects were included: 11 adult patients with bilateral allergic sinonasal polyposis (patient group) and 11 adult healthy controls (control group). Both study groups were matched for age and sex. OB volumes in all study subjects were evaluated in T2-weighted coronal MRI images by planimetric manual contouring. Results In the patient group, OB volume measurements ranged from 5.2 to 19.5 mm3 (mean ± SD, 10.14 ± 3.8). In the control group, volume measurements ranged from 35 to 75.8 mm3 (mean ± SD, 47.66 ± 10.75). The difference in OB volumes between patient and control groups was statistically significant (P < .001). Conclusion Our study highlights the significant reduction in OB volume in patients with bilateral sinonasal polyposis as compared with its volume in healthy controls. Further studies are required to evaluate the impact of OB volume reduction on olfactory recovery postoperatively.

Voice Outcome after Gore-Tex Medialization Thyroplasty

Introduction Although medialization thyroplasty utilizing Gore-Tex (Gore and Associates, Newark, Delaware, United States) has been discussed in the literature, few reports have assessed voice quality afterward, and they did not use a full assessment protocol. Objective To assess the improvement in voice quality after medialization thyroplasty utilizing Gore-Tex in patients with glottic insufficiency of variable etiology. Methods Eleven patients with glottic insufficiency of different etiologies that failed compensation were operated by type 1 thyroplasty utilizing Gore-Tex. Pre- and postoperative (1 week, 3 months, and 6 months) voice assessment was done and statistical analysis was performed on the results. Results In all postoperative assessments, there was significant improvement in the grade of dysphonia (p < 0.004) and highly significant reduction in the size of glottic gap and prolongation of maximum phonation time (p < 0.0001). The difference in voice parameters in the early (1 week) and the late (3 and 6 months) postoperative period was not significant. None of the patients developed stridor or shortness of breath necessitating tracheotomy, and there was no implant extrusion in any patient during the study period. Conclusion Gore-Tex medialization provides reliable results for both subjective and objective voice parameters. It leads to a satisfactory restoration of voice whatever the etiology of glottic incompetence is. This technique is relatively easy and does not lead to major complications. Further studies with larger number of patients and more extended periods of follow-up are still required to assess the long-term results of the technique regarding voice quality and implant extrusion.

Single Triangular Suture: A Modified Technique for Hyoid Suspension as a Treatment for Obstructive Sleep Apnea: our experience with twenty four patients

1 Hyoid suspension is a part of a multilevel surgery concept that is often combined with other procedures as uvulopalatopharyngoplasty to treat obstructive sleep apnea. 2 Between February 2012 and November 2016, twenty- four patients underwent the single triangular suture technique for hyoid suspension as a treatment for obstructive sleep apnea. 3.Successful outcome was reported in 12 patients, while 9 patients were responders (reduced cardiovascular risk). 4.Postoperatively, the mean AHI dropped significantly and the mean lowest oxygen saturation level increased significantly. 5.The procedure is safe, well-tolerated by patients and has a readily progressive learning curve. It is an economic and less traumatic maneuver. This article is protected by copyright. All rights reserved.

5 years follow up after transnasal endoscopic surgery of Thornwaldt's cyst with powered instrumentation

OBJECTIVE To assess the long term results of a transnasal endoscopic, power-assisted marsupilization of Thornwaldts cyst (TC). METHODS Patients who were operated and followed up at our institution for the management of symptomatic TC in the period from February 2002 till May 2012 were included in the study. All the patients were operated through a transnasal endoscopic power-assisted marsupilization of the cyst. RESULTS Eleven patients with a diagnosis of TC (by nasaoendoscopy, CT and MRI) were included in this study. They included six males and five females with age ranging from 15 to 55 years. Transnasal endoscopic, power-assisted marsupilization was performed for all cases with no intra- or postoperative complications. Throughout 5 years follow up, no recurrence of the cyst or its related symptoms were reported. CONCLUSION Long term (5 years) follow up showed that transnasal endoscopic marsupilization of Thornwaldts cyst using micodebrider is a safe and effective maneuver with no cyst recurrence, eustachian tube affection or post-operative complications.

Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome

Introduction  Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective  To assess hyoid suspension surgery as part of a multilevel OSA surgery, also including palatal surgery. Methods  The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results  The mean AHI dropped significantly ( p  < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O 2 ) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 ( p  < 0.0001). In addition, the snoring score significantly decreased ( p  < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements ( p  < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion  Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.

Relation of Lower Last Molar Teeth With Mandibular Fractures.

Objectives:The objectives of this study were to study and investigate the relation between the state of the lower last molar teeth eruption and the site of the mandibular fractures. Methods:Adult patients with traumatic mandibular fractures were included in this study. Panorama and computed tomography was performed for all patients. The relation between the state of the lower last molar eruption and criteria of the fracture was analyzed. Results:In 106 patients who had 168 mandibular fractures, impacted lower third molar teeth were found to significantly increase the incidence of mandibular angle fracture while they had nonsignificant effect on incidence of other sites of mandibular fractures. Conclusion:Impacted lower third molar teeth significantly increase the incidence of mandibular angle fracture but did not have the same effect on other sites of mandibular fractures.

Ipsilateral Reduced Olfactory Bulb Volume in Patients with Unilateral Nasal Obstruction

Objectives To evaluate the effect of unilateral nasal obstruction (by nasal polyps of different histopathology) on olfactory bulb volume using MRI technique. Study Design Cross-sectional study. Setting Tertiary university hospitals, Departments of Otolaryngology and Radiology. Subjects and Methods Eleven patients with a few months of complete unilateral nasal obstruction of different pathological etiologies were selected. MRI assessment of olfactory bulb volume was performed using planimetric manual contouring. The contralateral olfactory bulb was used as a comparative control for the same patient. Eleven healthy controls constituted the control group. Results Mean olfactory bulb volume ±SD of obstructed side = 14.3 ± 3.7 mm3, mean olfactory bulb volume ±SD of nonobstructed side = 43.49 ± 10.7 mm3. The difference between the 2 sides was significant (P = .003). The difference in olfactory bulb volume between normal subjects and nonobstructed nasal side was statistically nonsignificant (t = .9118, P = .3727), while the difference between normal subjects’ olfactory bulb volume and obstructed nasal side olfactory bulb volume in our patients was extremely statistically significant (t = 9.7320, P < .0001). A strong negative correlation was found between duration of obstruction and olfactory bulb volume (R = −0.9761). Conclusion This study shows that unilateral nasal obstruction may be associated with a lateralized ipsilateral difference of olfactory bulb volume.

Effect of central inset pharyngeal flap for velopharyngeal insufficiency on eustachian tube function.

The aim of this study was to assess the effect of the central inset pharyngeal flap, used for correcting persistent velopharyngeal incompetence after cleft palate repair, on Eustachian tube (ET) function.

Nasalance Changes Following Various Endonasal Surgeries

Introduction There is change in nasalance post endonasal surgery which is not permanent. Objectives The objective of this study is to evaluate the long-term nasalance changes following different types of endonasal surgeries. Methods We included in this study patients who underwent sinonasal surgery at the Otorhinolaryngology Department in Zagazig University Hospitals from February 2015 until March 2016. We divided the patients into two groups according to the surgeries they underwent: Group (A) was the FESS group and group (B), the septoturbinoplasty group. We checked nasalance using a nasometer before and after the sinonasal surgery. Results Nasalance increased at one month after the operation in both groups. However, it returned to nearly original levels within three months postoperatively. Conclusion FESS, septoplasty, and turbinate surgery may lead to hypernasal speech. This hypernasal speech can be a result of change in the shape and diameter of the resonating vocal tract. Hypernasal speech in these circumstances may be a temporary finding that can decrease with time. Surgeons should inform their patients about the possibility of hypernasality after such types of surgery, especially if they are professional voice users.

Outcomes of Using Otoendoscopy During Surgery for Cholesteatoma

To determine the impact of using otoendoscopy at the time of primary surgery of cholesteatoma in identifying hidden “cholesteatoma remnant”. Study was prospective study. Setting was University tertiary care hospital. One hundred fifty, patients diagnosed clinically and by CT as having cholesteatoma, have been operated. 64 patients operated by using canal up technique and 86 patients operated by using canal down technique. Once all visible cholesteatoma was removed with standard microscopic techniques, otoendoscopy was utilized in every patient to identify any hidden “cholesteatoma remnant”. Despite apparent total microscopic eradication of cholesteatoma of the operated cases, otoendoscopy at time of primary surgery revealed an overall incidence of hidden cholesteatoma remnants of 18%. The incidence of hidden cholesteatoma remnants identified by otoendoscopy was 23% in the canal up group and 14% in the canal down group. Otoendoscopy should be used as an adjunct with standard microscopic technique to identify hidden cholesteatoma remnants during surgery of cholesteatoma.