Omar Sabra

Vocal symptoms and acoustic changes in relation to the expanded disability status scale, duration and stage of disease in patients with multiple sclerosis

Vocal symptoms and acoustic measures of patients with multiple sclerosis (MS) are investigated in relation to the duration of the disease, stage of the disease and the degree of disability. Eighty-two patients were enrolled in this study (40 MS, 42 controls). In the MS group, the most common vocal symptoms were vocal breaks and vocal fatigue present in 10. None of the patients in the control group had voice breaks. In the male group, there was a significant decrease in the fundamental frequency, habitual pitch and maximum phonation time with a significant increase in Shimmer. In the female group, there was a significant decrease in the maximum phonation time only. There was no correlation between vocal symptoms and acoustic measures versus duration of the disease and extent of disability except for vocal fatigue which significantly associated with EDSS (expanded disability status scale) score. Patients with MS may develop vocal symptoms irrespective of the EDSS score, duration and stage of the disease. Vocal fatigue and vocal breaks are more common than hoarseness.

Vocal Changes in Patients Using Nasal Continuous Positive Airway Pressure

The aim of this prospective study is to assess the vocal changes in patients using nasal continuous positive airway pressure (CPAP). A total of 18 subjects using nasal CPAP were assessed by grading their voice perceptually as G0 for normal voice and G3 for severe hoarseness. Acoustic analysis was also performed and the following parameters were measured: fundamental frequency, habitual pitch, shimmer, relative average perturbation, voice turbulence index, and noise-to-harmonic ratio. The same was done for a control group matched according to age and gender. There was a statistically significant difference in the perceptual evaluation between the CPAP group and controls, with more patients in the former group having moderate hoarseness. There was also an increase in the perturbation parameters and a decrease in the fundamental frequency and habitual pitch in the CPAP group compared to controls. The increase in shimmer was statistically significant. The usage of nasal CPAP seems to induce vocal changes that are perceived as mild to moderate hoarseness, together with an increase in the perturbation parameters. These seem to be secondary to the upper airway dryness reported in these patients. The hypothetical effect of nasal CPAP on the sol layer of the vocal folds is discussed.

Brucella melitensis infection of a branchial cyst.

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Airway obstruction secondary to thoracic aortic aneurysm leak A case report

Retropharyngeal hematoma is a rare entity that has various etiologies. Anticoagulation is believed to be the most common cause. Aortic aneurysm leak was reported as a cause of this disease only once. We believe that our case is the second case of retropharyngeal hematoma caused by a leaking aortic aneurysm. A case discussion and management is presented in this article.

Atypical lipomatous tumors of the face: a controversial issue

We reviewed the topic of atypical lipomatous tumors including definition, diagnosis and management, with special emphasis on head and neck location and to report on the management of a rare case located in the temporalis muscle. Atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLS) are rarely reported in the head and neck. Their behavior dictates a complete resection. Resection with a safety margin is sometimes needed according to the histological characteristics. Tumors located to the masticator space can be accessed through a mucosal approach achieving relative safety to the facial nerve. ALT constitute a group of tumors of a borderline behavior. Their management can be affected by some histological criteria and by their location in the head and neck region where vital structures can be affected.

A dual nodular thyroid ectopy, presenting with massive bleeding during pregnancy, treated by Sistrunk procedure.

Embryologically, the thyroid gland originates from the lingual foramen cecum. Its migration through the neck leads to the formation of the thyroglossal tract, which degenerates during embryological life. In abnormal migration, abnormalities may arise, such as thyroglossal duct cysts (TGDCs) and thyroid gland ectopias. Those might even be associated. The Sistrunk procedure is the accepted treatment for TGDCs, but there is no standardized procedure for thyroid ectopia. We present a rare case of dual thyroid ectopy, treated by the Sistrunk procedure. This study was approved by the local institutional review board. A 28-year-old woman was hospitalized during the third trimester of pregnancy for upper gastrointestinal bleeding. After a C-section, performed for fetal suffering, an upper gastrointestinal endoscopy revealed a tongue base mass. Thyroid function tests revealed subclinical hypothyroidism. Thyroid scan showed dual foci of uptake at the tongue base level, with no signal in the normal thyroid bed. The patient was started on levothyroxine suppressive therapy. After six months, a follow-up MRI confirmed the dual ectopy, with one part at the base of the tongue and the second directly infrahyoid, with two nodular formations in the infrahyoid part. A follow-up thyroid function test revealed a hyperthyroid state. The hormonal treatment was adjusted, and a decision was made to do a total thyroidectomy to prevent rebleeding and evaluate the nodules (Fig 1). With the patient under general anesthesia, through a horizontal neck incision, the lower part of the ectopic gland, with its surrounding connective tissue, was dissected to the level of the hyoid bone. The body of the hyoid was resected and kept attached to the gland. At this level, a midline pharyngotomy was necessary to excise the upper submucosal part of the gland. The pharyngotomy incision was closed primarily, and the wound was closed in layers. Postoperative feeding was started on the sixth postoperative day. Histopathological examination revealed normal thyroid tissue, with two follicular nodules measuring 2 and 3 cm in diameter.