Atypical pharyngitis in suppurative otitis media cases

Unexplained persistent or recurrent bacterial pharyngitis in some patients who are suffering from infected middle ear cleft. Bacteriological swabs were obtained from both ears and pharynx of thirty-seven cases with chronic otorrhea and perforation, who are complaining of recurrent or persistent sore throat. isolation and identification of the microorganisms were done. This included examination by direct Gram stained films and cultures. Isolated Gram-negative bacilli were subjected to further identification by biochemical reactions and antimicrobial susceptibility testing using modified Kirby Bauer disk diffusion method. Identical isolates from the same patient [ear and pharyngeal swabs] were subjected to further identification by genotyping using the pulsed field gel electrophoresis technique [PFGE]. Six cases [16%] showed identity in both phenotypes and genotypes for ear and pharyngeal samples from the same patient. Four of the isolates were Pseudomonas aeruginosa, one was Proteus mirabilis, and one was Escherichia coli. None of these three species is known to be among the primary organisms that may cause pharyngitis. Bacterial pharyngitis in patients with chronically infected middle ear cleft may be attributed to the same organism invading the middle ear mucosa. In addition, this study highlights some organisms as pharyngeal invaders although they are not among the previously documented causatives of bacterial pharyngitis. However, the study did not confirm the method of spread of these organisms between the middle ear cleft and the pharynx and did not prove whether the spread was directly via the eustachian tube or not. The study correlates the causative organism of the middle ear infection and that infected the pharyngeal mucosa by using phenotypic and genotypic bacteriological identification and typing methods

Significance of cyanoacrylate glue in type I tympanoplasty: a prospective study and review of literature

To study the use of tissue glue composed of N-butil-2-cyanoacrylate during type I tympanoplasty and its impact on the surgical and functional results of the procedure. In addition, to recognize any local or systematic side effects from the use of this material locally in the ear during the surgery. In addition, to perform an extensive review of the publlshed literature about the usage of the tissue adhesives in tympanoplasty to investigate its history, advantages, disadvantages and safety. Prospective case study. The study included forty-eight adult cases with dry central tympanic menibrane perforations, randomized into two groups. Both groups were operated upon with type I tympanoplasty using autogenous temporalis fascia graft, but in first group using the glue to fix the graft to flaps and surroundings. All cases were followed-up for at least six months postoperatively. The main outcome measure was the tympanoplasty surgical and functional results. The surgical outcome was a healed and intact tympanic membrane without lateralization or anterior blunting and with near normal membrane translucency. The hearing results were obtained following the 1995 guidelines described by the American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium for evaluation of results of treatment of conductive hearing loss. In addition, the two groups were compared regard some variable measures to assess their influence on the results. These variables were patients' age and sex, smokers distribution, the preoperative Middle Ear Risk Index [MERI 2001] and the site and size of perforation. The surgical success rate was 100% in the glue group and 85.2% in the control group [control group showed three residual perforations and one re-perforation] and it was significantly different statistically [P=0.005]. Both groups after six months showed a statistically significant improvement in the three-tone pure-tone averages for air conduction [PTA] at 500, 1000, and 2000 Hz [10 dB for both groups and P=0.001]. In addition, in the glue group, 79.2% of the patients achieved an average postoperative air-bone gap [ABG] of less than 10 dB. In the control group, 82.6% of the cases without residual or recurrent perforations had an average postoperative air-bone gap [ABG] of less than 10 dB. Non of the studied variable measures showed statistical significance, but the site and size of the perforation was important to the surgical success. The mean follow-up periods for the glue group and the control group were 12.8 months and 13.1 months, respectively. No significant complications were recorded. The use of the tissue glue composed of N-butil-2-cyanoacrylate during type I tympanoplasty improved the perforation closure rate and reduced the rate of reperforation without any negative impaction on the hearing functional result. The material usage was safe as no significant local or systematic side effects or ototoxicity were reported during the study

effect of preoperative dexamethasone on the post-tonsillectomy recovery period

To assess the effectiveness of intravenous single dose of dexamethasone at induction of anesthesia to reduce postoperative morbidty after tonsillectomy. This study involved 379 tonsillectomy cases of both adults and children in a prospective and randomized pattern. The study cases were divided into two groups. One group received a single dexamethasone dose at induction of anesthesia and the other group was a control one. Consistent surgical technique, anesthetic protocol and postoperative regimen were used to all cases. The FLACC Pain Scale, verbal communication and observation were used to determine the early postoper ative morbidity in the recovery room and ward. Further episodes of vomiting, need for analgesia or antiemetics, time and volume of oral liquid and soft food intake were recorded. Post-discharge, the Wong-Baker Faces pain rating scale and patient care diary sheets were used to collect data for 10 days. Collected data included details about postoperative nausea and vomiting, postoperative pain and need for analgesics, oral intake, voice changes [rhinolalia aperta] and any other symptoms as fever and bleeding. Totally 115 cases were excluded due to protocol violation. Overall, there was statistical significant improvement in postoperative nausea and vomiting [PONV] due to the use of dexamethasone in all ages [P=0.035 in adufts and=0.025 in children]. There was only significant improvement in pain intensity early postoperatively in the recovery room [P=0.02]. In addition, there was significant improvement in the use of pain medications early postoperatively [P=0.04] and in the time until first oral fluid intake [P=0.04] and soft diet intake [P=0.01]. The incidence of postoperative bleeding was higher in the dexamethasone group [4: 1] but it did not reach significant difference [P=0.7]. None of the cases reported any of the steroids specific side effects. Dexamethasone as a single dose at induction of anesthesia for tonsillectomy cases in both adults and children significantly reduces the postoperative nausea and vomiting and to some extent pain intensity. In addition, it improves the postoperative oral intake. Although the study found this method for reducing post-tonsillectomy morbidity safe and inexpensive, the increased risk of postoperative bleeding needs further evaluation