Mohamed Rifaat Ahmed

Percutaneous dilatational versus conventional surgical tracheostomy in intensive care patients

Background: Tracheostomy is usually performed in patients with difficult weaning from mechanical ventilation or some catastrophic neurologic insult. Conventional tracheostomy involves dissection of the pretracheal tissues and insertion of the tracheostomy tube into the trachea under direct vision. Percutaneous dilatational tracheostomy is increasingly popular and has gained widespread acceptance in many intensive care unit and trauma centers. Aim: Aim of the study was to compare percutaneous dilatational tracheostomy versus conventional tracheostomy in intensive care patients. Patients and Methods: 64 critically ill patients admitted to intensive care unit subjected to tracheostomy and randomly divided into two groups; percutaneous dilatational tracheostomy and conventional tracheostomy. Results: Mean duration of the procedure was similar between the two procedures while the mean size of tracheostomy tube was smaller in percutaneous technique. In addition, the Lowest SpO2 during procedure, PaCO2 after operation and intra-operative bleeding for both groups were nearly similar without any statistically difference. Postoperative infection after 7 days seen to be statistically lowered and the length of scar tend to be smaller among PDT patients. Conclusion: PDT technique is effective and safe as CST with low incidence of post operative complication.

Comparison between Power-Assisted Turbinoplasty and Submucosal Resection in the Treatment of Inferior Turbinate Hypertrophy

Objectives: To compare the efficacy of power-microdebrider-assisted inferior turbinoplasty (PAT) with submucosal resection (SMR) in the treatment of inferior turbinate hypertrophy. Methods: A prospective randomized clinical trial study of 46 patients with bilateral inferior turbinate hypertrophy. Patients were randomly divided into 2 groups: PAT and SMR. Results: Intraoperative blood loss was 37.1 ± 7.4 ml in the PAT group and 47.8 ± 9.5 ml in the SMR group (means ± SD), while the operative times were 11.1 ± 1.7 and 29.4 ± 4.7 min, respectively. There was statistically significant lower blood loss in the PAT group, due to the shorter operating time. Conclusion: PAT is equally as safe and effective as SMR. It has a shorter operation time and reduced intraoperative blood loss.

Treatment of Clinically Diagnosed Laryngopharyngeal Reflux Disease

OBJECTIVES To determine the incidence of Helicobacter pylori (HP) stool antigen (HPSA) in patients with laryngopharyngeal reflux disease (LPRD), and to make a comparison of 2 treatment regimens that have been used based on the presence or absence of HPSA positivity in patients with LPRD. DESIGN Randomized controlled study. SETTING Suez Canal University Hospital, Ismalia, Egypt. PATIENTS A total of 212 patients with symptoms of LPRD. INTERVENTION Patients were evaluated by laryngoscopy, ambulatory pH monitoring for 24 hours, and HPSA testing. Esomeprazole magnesium as a monotherapy was evaluated vs triple therapy in patients with HP infection. MAIN OUTCOME MEASURES To determine the incidence of HPSA in patients with LPRD, and to make a comparison of 2 treatment regimens that have been used based on the presence or absence of HPSA positivity in patients with LPRD. RESULTS Persistent dry cough and a feeling of a lump in the throat (globus sensation) were the most frequent symptoms of LPRD, while posterior laryngeal inflammation was the main laryngoscopic finding. Results from the HPSA test were positive in 57% of the studied group. Patients with negative HPSA were treated with esomeprazole as single modality with a reported improvement score of 96.6%. Patients with positive HPSA test results were divided into 2 groups: 1 received only esomeprazole, with reported improvement in 40%, whereas the second group was treated with esomeprazole, plus amoxicillin sodium and clarithromycin (triple therapy) and reported a 90% incidence of symptom improvement. CONCLUSION The incidence of HP infection in patients with LPRD in our study was 57%. Triple therapy showed a higher cure rate in patients with HPSA-positive test results.

Laser-assisted myringotomy versus conventional myringotomy with ventilation tube insertion in treatment of otitis media with effusion: Long-term follow-up.

BACKGROUND Otitis media with effusion is the most common cause of conductive hearing loss in the pediatric population. Insertion of ventilation tubes with or without adenoidectomy is the accepted and standard surgical procedure. CO2 laser myringotomy without tube placement has been advocated as an alternative treatment. AIM To compare long-term follow-up results of laser versus classical myringotomy with ventilation tube insertion over five years. MATERIALS AND METHODS 86 patients with bilateral otitis media with effusion were divided into two groups: laser myringotomy group and myringotomy with ventilation tube insertion group, with follow-up in hearing results and recurrence rates over five years. RESULTS The mean patency time of myringotomy in laser group was 23 days, while the mean patency time of the ventilation tubes ears was 4.0 months in myringotomy group. Twelve patients in laser group (13.9%) showed a recurrent otitis media with effusion compared to 9 patients in myringotomy group (10.4%). CONCLUSION Laser fenestration is a less effective alternative to myringotomy and tube placement. The recurrence rates after both procedures did not show statistical significance over long follow-up. It might be considered as an effective alternative to classical surgery and ideal for short-term ventilation.

Management of recurrent tonsillitis in children

OBJECTIVE To compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children. METHODS The study comprised of 350 children with recurrent streptococcal tonsillitis, 284 of whom completed the study and 162 children received conventional surgical treatment. The rest of the children, 122, were divided randomly into two equal main groups. Group A children received a single intramuscular BP (600,000IU for children≤27kg and 1,200,000IU for ≥27kg) every two weeks for six months. Group B children received single oral AZT (250mg for children≤25kg and 500mg for ≥25kg) once weekly for six months. RESULTS Both groups showed marked significant reduction in recurrent tonsillitis that is comparable to results of tonsillectomy. There were no statistical differences between group A and B regarding the recurrence of infections and drug safety after six-month follow-up. Group B showed better compliance. CONCLUSION AZT proved to be good alternative to BP in the management of recurrent tonsillitis with results similar to those obtained after tonsillectomy.

Evaluation of hearing among kindergarten children in Jazan (Kingdom of Saudi Arabia).

INTRODUCTION Hearing loss among kindergarten children is considered as a major health problem especially when there is a deficiency in routine hearing screening during the clinical examination. The aim of the study was to detect any pattern of hearing loss among kindergarten children in Jazan (Kingdom of Saudi Arabia). METHODS A total of 1220 kindergarten students in Jazan (Kingdom of Saudi Arabia) were subjected to meticulous hearing evaluation using otological examination, Tuning fork tests, pure tone audiometry (PTA), speech audiometry, and tympanometry. RESULTS We found that 18 kindergarten students had type C tympanogram (Eustachian tube dysfunction), 28 had type B tympanogram (secretory otitis media with conductive hearing loss), 4 had chronic otitis media with conductive hearing loss, and 6 had mild sensorineural hearing loss. CONCLUSIONS Early detection and eradication of hearing loss improves quality of life outcomes of children which reduces the incidence of social burden from unrecognized hearing loss.

Management of patients with cancer of the larynx in Suez Canal University Teaching Hospital: 5 years' experience

Background Suez Canal University Hospital, which is the only tertiary care facility in the Suez Canal and Sinai area, is estimated to service more than 5 million patients. Cancer of the larynx, which is the most common head and neck cancer, is also the most common tumor presented to the otolaryngology departments. Aim To evaluate the results of interventional protocols for patients with cancer of the larynx treated in Suez Canal University Hospital. Patients and methods This was a retrospective study carried out on 53 patients with cancer of the larynx reviewed from 1 January 2007 to 1 January 2012 according to demographic, clinical, radiological, operative, pathological data, and possible complications. Results Fifty-three patients, mean age 58 years (71.1% were from urban areas), were studied. The main presenting symptom was hoarseness of voice (66%). Glottis carcinoma was the most common type of cancer found in 41.1% patients. Stage IVa was the most common presenting stage in 39.6% of the patients. Emergent tracheostomy was performed for 39.6% of the patients. According to the treatment protocol, single treatment modality was recommended for 38 (71.6%) patients: 17 (32%) patients were recommended total laryngectomy, followed by radiotherapy in 11 (20.7%) patients, chemotherapy was recommended for eight (15.1%) patients, concurrent chemoradiotherapy was offered to one (1.9%) patient, and partial laryngectomy with preservation of both arytenoids was offered to one (1.9%) patient. In addition, 15 (28.4%) patients were subjected to combined therapy: total laryngectomy combined with radiotherapy in nine (17%) patients and total laryngectomy with chemoradiotherapy in six (11.4%) patients. Conclusion Although the standards of management of laryngeal carcinoma in Suez Canal University hospital are almost in compliance with regional and international standards, we need to deal with the time delay between the diagnosis and definitive treatment to revise the items in the medical records and its registration.

Utilization of CO2 Laser for Temporal Fascia Graft Welding in Myringoplasty: An Experimental Study on Guinea Pigs

An experimental study was undertaken to investigate the use of a CO2 laser welding technique in myringoplasty. Albumin solder was used to fix a temporal fascia graft via an overlay transcanal approach. The results of the operative procedure were assessed by microscopic and histopathologic examination over an interval of 1, 2, 3 and 4 weeks postoperatively. Materials and Methods: Forty-eight adult guinea pigs were divided into two groups after permanent perforation of the tympanic membrane was created: laser-assisted myringoplasty group and surgical myringoplasty group. Laser beam power was 0.4 W, pulse duration 0.75 s, pulse interval 0.1 s and spot size 250 µm. Each experimental group was further subdivided into four subgroups of 6 animals each. Histological and microscopic findings of the tympanic membrane for both groups after 1, 2, 3, and 4 weeks were compared. Results: Microscopic examination of the tympanic membrane showed high success rate in the laser-assisted myringoplasty group compared to the control group. Histological evaluation for the tympanic membrane showed complete repair of the tympanic membrane in the laser-assisted myringoplasty group. Conclusion: Laser-assisted myringoplasty using CO2 might be a promising new method in surgical myringoplasty.

Intratympanic methylprednisolone acetate versus intratympanic lidocaine in the treatment of idiopathic subjective unilateral tinnitus of less than 1-year duration: a randomized, double-blind, clinical trial

Background Tinnitus, which can persist for many years, usually affects the quality of life. Tinnitus is challenging to manage with a variety of options including psychotherapy and pharmacological treatment. Intratympanic (IT) injections of steroids or lidocaine (LD) are two of the pharmacological treatment options used in the treatment of idiopathic tinnitus. Objective The aim of the study was to evaluate the efficacy and safety of IT-methylprednisolone acetate (MPA) versus IT-LD in the treatment of idiopathic subjective unilateral tinnitus of less than 1-year duration. Participants and methods In this randomized, double-blind, clinical study, 46 people who had been diagnosed with idiopathic subjective unilateral tinnitus were randomly divided into two groups and treated with IT-MPA acetate or IT-LD, accordingly. Improvement was evaluated in both groups 3 months after the injections and then again after 1 year. Safety was evaluated by recording the side effects of the injections. Results At 3 months after the injections, the mean improvement rates (using visual analog scale) were 56.5% in the MPA group and 47.8% in the LD group. After 1 year, this declined to 30.4 and 26.1%, respectively. The difference in improvement was not statistically significant. The side effects were all minor, and were primarily reported after LD injection. Conclusion IT injections of MPA and LD result in moderate improvement in tinnitus, but no statistically significant differences between these treatments were found.

The role of sentinel lymph node biopsy in the management of laryngeal carcinoma

Hearing loss and its management are a crucial issue across the health system; this is well indicated by the up-to-date review. The number of referrals made for hearing assessment has increased from previous years; however, 2015 demonstrates a decline. Despite this, the number of hearing aid fittings is increasing. Considering the financial and socioeconomic impact of hearing loss, this places a substantial burden upon the NHS. A future review of similar data will help with monitoring expenses and performance within the departments of audiology and otolaryngology.