The role of cochlear implantation in alleviating Tumarkin drop attacks of Meniere's disease; a case report

Ménière's disease (MD) patients may suffer episodes of sudden falls, named Tumarkin drop attacks (DAs). This fall occurs abruptly and without warning or loss of consciousness. DAs usually aggravate the clinical picture of MD and are challenging to manage. The present report describes a case treated by cochlear implantation (CI) due to concomitant deafness and offers some clinical considerations for this condition. A male patient aged 48 years with a 10-year history of definite bilateral MD had profound SNHL on the right and severe SNHL on the left side. He suffered from intermittent attacks of vertigo, ear fullness, and tinnitus and, in the last year, had developed DAs and experienced 14 episodes in the previous six months. The preoperative category of acoustic performance was 3. The Dizziness Handicap Inventory (DHI) questionnaire showed a total score of 46, which indicated a moderate degree of disability. A CI was planned for the right side. The patient did not report any further DAs episode for two years since then. The postoperative category of acoustic performance became 11, and the postoperative DHI questionnaire showed a decrease in the total score (from 46 to 19), which indicated a mild disability. Unilateral CI effectively alleviated the DAs associated with bilateral MD. Our report proposes a new modality for managing vertiginous symptoms in cases of MD with hearing loss without the need for more aggressive surgical interventions with the need for clinical trials to confirm our results

The Use of Nanoparticles in Otoprotection

The inner ear can be insulted by various noxious stimuli, including drugs (cisplatin and aminoglycosides) and over-acoustic stimulation. These stimuli damage the hair cells giving rise to progressive hearing loss. Systemic drugs have attempted protection from ototoxicity. Most of these drugs poorly reach the inner ear with consequent ineffective action on hearing. The reason for these failures resides in the poor inner ear blood supply, the presence of the blood-labyrinthine barrier, and the low permeability of the round window membrane (RWM). This article presents a review of the use of nanoparticles (NPs) in otoprotection. NPs were recently used in many fields of medicine because of their ability to deliver drugs to the target organs or cells. The studies included in the review regarded the biocompatibility of the used NPs by in vitro and in vivo experiments. In most studies, NPs proved safe without a significant decrease in cell viability or signs of ototoxicity. Many nano-techniques were used to improve the drugs' kinetics and efficiency. These techniques included encapsulation, polymerization, surface functionalization, and enhanced drug release. In such a way, it improved drug transmission through the RWM with increased and prolonged intra-cochlear drug concentrations. In all studies, the fabricated drug-NPs effectively preserved the hair cells and the functioning hearing from exposure to different ototoxic stimuli, simulating the actual clinical circumstances. Most of these studies regarded cisplatin ototoxicity due to the wide use of this drug in clinical oncology. Dexamethasone (DEX) and antioxidants represent the most used drugs in most studies. These drugs effectively prevented apoptosis and reactive oxygen species (ROS) production caused by ototoxic stimuli. These various successful experiments confirmed the biocompatibility of different NPs and made it successfully to human clinical trials

Arabic Cross-Cultural Adaptation and Validation of Health-Related Quality of Life Measures for Chronic Otitis Media (COMQ-12)

Objective: Our study aimed to translate the chronic otitis media questionnaire-12 (COMQ-12) into the Arabic lan-guage, evaluate the internal consistency of the test and test- retest reliability, and validate the adaptation for further use in Arabic studies. Study Design: A prospective observation monocenter cohort study. Settings: This study was done at Kafrelsheikh University Hospital, Egypt. Patients: One hundred twenty five ear pathology-free patients were asked to complete the questionnaire forming group A. One hundred twenty five patients with different forms of COM completed the questionnaire 2 weeks before the planned ear surgery and the same day of the operation, forming group B. Those patients who underwent the ear surgery, completed the questionnaire again 6 months after the operation forming group C. Intervention: We did an Arabic forward and backward translation of the original COMQ-12. The patients in group B underwent ear surgery (tympanoplasty with or without mastoidectomy). After fulfilling the questionnaire in different groups, we assessed the psychometric properties of the Arabic version of COMQ-12: internal consistency, reliability, reproducibility, validity, and responsiveness. Main Outcome Measures: Cronbach’s a was 0.973. The Spearman’s rank correlation coefficient was 0.981, while the Intraclass correlation coefficient was 0.973. Results: A statistically significant difference was present between group A (average total score 2.38 1.543) and group B (average total score 35.86 5.98). Also, there was a statistically significant difference between group B and group C (average total score 7.46 8.294). The calculated cut-off point of the total score was more than or equal to eight. Conclusion: The cross-culturally Arabic adaptation of COMQ-12 was reliable, valid with strong internal consis-tency and responsiveness. It can detect the significant effect of COM on the quality of life of Arabic patients. This effect would be improved obviously after surgical management that markedly enhanced the preoperative hearing problem

Impact of intralesional botulinum toxin type A therapy on the keloid-related quality of life

Abstract Background We aimed to validate the translated Arabic version of the head and neck keloid quality-of-life (QOL) questionnaire. We also aimed to evaluate the impact of intralesional botulinum toxin type A (BTA) therapy on the keloid-related quality of life. Methods This prospective study included 140 patients with a keloid in the head and neck regions. They were divided into two groups. In Group A, the patient filled out the questionnaire four times: 1 week before the start of the treatment, the first injection (day using intralesional BTA, the second injection day, and 6 months after the first injection. In group B, the patients completed the questionnaires once before any keloid therapy (control group). Results Cronbach’s alpha between all questions was 0.921. The intra-class correlation coefficient between the first and second visits was above 0.8. In Group A, the total score in the first visit was 84.12 ± 5.86, while it was 34.87 ± 3.73 in the fourth fulfilment, with a statistically significant difference between them as the P-value was < 0.0001. The results of Group A differed significantly from the control group. Conclusions The translated Arabic version of the head and neck QOL questionnaire was reliable and reproducible. It has strong internal consistency, responsiveness, and validity. According to this study, intralesional BTA injection effectively improved the QOL of patients with keloids

The novel traction‐suturing technique in correction of caudal end deviation of the nasal septum

Background Caudal end correction is one of the main challenges during septoplasty that needs extra steps and skills. This complex area affects the shape of the nose. Moreover, the caudal end represents the medial boundary of the internal nasal valve. Thus, any deviation may disturb this critical area causing nasal obstruction. This study aimed to evaluate the novel traction-suture technique to correct septal caudal end deviation and its postoperative impact. Study design This prospective case-series study. Settings It was held in a tertiary referral university institute between January 2019 to February 2022. Methods We included 95 cases who suffered from nasal obstruction and a cosmetic problem because of mild or moder- ate caudal end deviation. Under general anesthesia, the caudal end was corrected by the novel traction-suturing technique (TST). To evaluate the surgical outcomes and patients' related quality of life, we used two validated questionnaires; the Nasal Obstruction Symptom Evaluation and the Rhinoplasty Outcome Evaluation before the surgery and 1 year after the surgery. Results NOSEandROEquestionnairesshowedstatisticallysignificantimprovementsafterthesurgery(Pvaluewas&lt;0.001). Complications occurred in seven patients (7.3%), all of which were minor complications. Conclusions Traction-suturing technique (TST) improved nasal breathing and patients’ satisfaction with their nasal con- figuration. Traction-suturing is a simple short maneuver that junior doctors can easily learn without distinct complications or recurrence

A novel radiological method to evaluate the posterior tympanotomy depth for cochlear implantation: our experience in 257 patients

Purpose This study aimed to validate our novel proposed radiological evaluation of the posterior tympanotomy (PT) depth. This dimension represents the bone of the facial recess needed to be drilled to get access into the middle ear during cochlear implantation. Methods It was a retrospective observational study that included 257 patients who underwent cochlear implantation from July 2018 to April 2021 in tertiary referral institutions. Two physicians evaluated the preoperative HRCT to measure the PT depth in the oblique para-sagittal cut. On the other hand, two other physicians evaluated the unedited surgical videos to judge the PT depth and classified it into an ordinary PT or deep PT. Then, the preoperative radiological measurements were correlated with the intraoperative findings. Results The radiological PT depth ranged from 2.5 to 5.4 mm with a mean of 3.91 ± 0.886. Sixty-six patients had ordinary PT, and 191 patients had deep PT. Spearman’s correlation coefficient revealed a strong correlation between the preoperative radiological PT depth measurements and the intraoperative PT depth judgments (p value &lt; 0.0001). Conclusions We created a novel radiological method to measure the posterior tympanotomy depth. This method was valid, reproducible, and reliable in the preoperative radiological evaluation of the PT depth with high sensitivity (91.71%), speci- ficity (90.62%), and accuracy (91.44%). We also found a significant impact of the PT depth on the PT difficulty during cochlear implantation

The impact of fusion imaging technique on middle ear cholesteatoma surgery. a prospective comparative study

Background: The fusion of computed tomography images with non-echo planner diffusion-weighted magnetic resonance images may overcome the limitations of each individual modality. Objectives: This study aimed to assess the ability of the ’fusion’ technique to predict the location of middle ear cholesteatoma by evaluating Its impact on preoperative surgical planning and postoperative results. Methodology: Eighty-three adults with cholesteatoma underwent preoperative CT scans and non-EPI-DW-MRI with or without the ‘fusion’ technique. We evaluated cholesteatoma localization in both groups, selecting the most appropriate surgical technique, and correlating it with the intraoperative findings. Both groups were compared in terms of residual/recurrent cholesteatoma at one, six and twelve months after surgery. Results: The ‘fusion’ technique’s sensitivity, specificity, and accuracy in predicting the location of cholesteatoma were 97.5. 97.4, and 97.5%, respectively, versus 97.59, 57.69, and 73.21% of CT alone. There was a total operators agreement after the evaluation of the ’fusion’ images with the adopted surgical technique. A statistically significant decrease in residual and recurrence cholesteatoma rates was found in group A. Conclusions: The ’fusion’ technique provides the surgeon with the precise cholesteatoma location, guiding him in making the correct surgical decision, contributing to the decrease in postoperative residual and recurrence rates

Long-term follow-up after surgical management of laryngeal malignant pleomorphic sarcoma ‒ a case report

No abstract availabl

Evaluation of prednisolone and prednisolone sodium succinate concentrations in human plasma and inner ear perilymph during cochlear implantation 24 h after intratympanic injection

Background: The use of intratympanic (IT) steroids has drastically increased over the past 10-15 years to manage many otological pathologies. Objectives: This study aimed to compare the concentrations of prednisolone and prednisolone sodium succinate (SS) in the plasma and inner ear perilymph of participants who underwent cochlear implantation 24 h after IT injection. Materials and methods: It was a prospective comparative randomized study. Twenty participants received an IT injection of prednisolone SS ∼24 h before the cochlear implantation. The other five participants received an IT saline injection and represented the control group. Perilymph and blood were sampled during the cochlear implantation surgery. Results: Both prednisolone and prednisolone SS were still present in perilymph ∼24 h after the IT administration. Only prednisolone was present in the blood plasma of seven participants (35%). Conclusion: IT injection of prednisolone SS resulted in high perilymph concentrations of prednisolone and prednisolone SS, which could stay in the perilymph for at least 24 h. Using a mini-endoscope during the IT injection may effectively detect barriers infront of the round window membrane, increasing the drug concentration in the inner ear. Significance: IT injection is an effective method for delivering prednisolone to the inner ear

The impact of COVID-19 in daily life and practice of otolaryngology physicians

Introduction The coronavirus disease 2019 (COVID-19) has made otolaryngologists more susceptible than their counterparts to its effect. Objective This study aimed to find if COVID-19 had a different impact on ear, nose, and throat (ENT) physicians’ of various categories (residents, registrars, and consul- tants ) regarding many aspects of the quality of life (protection, training, financial, and psychological aspects). Methods We included 375 ENT physicians, of different categories (residents, regis- trars, and consultants), from 33 general hospitals and 26 university hospitals in Egypt. The study was conducted using a 20-item questionnaire with a response scale consisting of three categories: yes, no, and not sure. It covered infection control and personal protective equipment (PPE) usage; medical practice and safety; online consultation and telemedicine,; webinars and online lectures; COVID-19 psychological, financial, and quarantine period effects; and future expectations. Results The results of the questionnaire showed that COVID-19 had a statistically significant impact on the daily life of the responders. There were statistically significant differences among the three involved categories, based on their answers. Conclusion This study showed a statistically significant difference regarding the impact of COVID-19 on many aspects of the quality of life (protection, training, financial, and psychological aspects) of ENT physicians of various categories (residents, registrars, and consultants), and these effects may persist for a long time