Post-operative pain in relation to different tonsillectomy techniques

Tonsillectomy, with or without adenoidectomy, is a commonly performed operation. The surgical procedure is recommended for recurrent infected tonsils as well as enlarged tonsils, which can lead to pediatric sleep apnea and other breathing disorders. The pain can be severe, and patients are often unable to perform in work or school or eat regular food for a number of days after surgery. Our study investigated four different tonsillectomy techniques in order to show the effect of different techniques on post-operative pain and these techniques were performed on 60 patients indicated for tonsillectomy. All patients were above the age of 12 years. The choice of the age above 12 years is due to the fact that pain is experienced more after tonsillectomy in adults and also to ensure better cooperation in post-operative questionnaire. In our study we divided the 60 patients into 3 equal groups; we removed the right tonsil by conventional dissection technique in all cases and used as a control side while the left tonsil was removed by different technique in each group; laser in group A, bipolar diathermy in group B and dissection with obliteration of the bed in group C. All patients received similar post operative treatment regimen and followed up for 15 days. We found that each technique has some advantages and also disadvantages as regards post-operative pain and healing and so the conventional technique is the safest for our patients and easy technique and has less complications as it decreases the morbidity after tonsillectomy

Impact of implementation of hearing conservation program on hearing threshed among noise exposed workers

Occupational noise-induced hearing loss [NIHL] is an important yet often overlooked illness that can affect an individual's performance and safety at work. This study was conducted on twenty male workers exposed to both noise and vibration hazards generated from metal grinding and wood sanding in one of the military factories in Helwan. The average daily noise intensity was 105 +/- 7.9 dB. The examined group was all males with age ranging from 28 - 58 years with a mean duration of exposure of 10.75 +/-3.62 years. The workers were evaluated using a self- administered questionnaire, a medical examination including an ear examination, audiological assessment, and serum cortisol as a bioindicator for stress. Reassessment was done after one year from implementation of a noise damping procedure by shifting the workers to a new building opened from the sides and reducing the impact noise transmission by floating floors. So, the average noise level decreased to 80.6 +/- 4.0 dB. The study showed that maxim ii diminution of hearing was observed in the high tones more than 2000 Hz], with significant improvement in hearing threshold after establishing the engineering control, The improvement is more significant at higher frequencies, 4 kHz and higher. The mean level of plasma cortisol was 24.6 +/- 7.15 microg%, then decreased to 13.0 +/- 3.81 microg% after the engineering control with a difference of about 11.6 microg%. Both systolic and diastolic blood pressures were higher among the examined group and were markedly decreased after implementation of the engineering program and medical treatment with a mean difference of about 41.5 mmHg in systolic and 17 mmHg in diastolic blood pressure. Also, 75% of the workers reduced their dose of the treatment after implementation of the HCP but still most of them are controlled by medication. It is recommended that engineering control should be the first order of protection from excessive noise exposure. Physicians should become aware about the medical consequences of excessive noise, support legislation to reduce the problem and promote program aiming at noise control and prevention of hearing loss aiming at improving psychosocial stresses and increasing the performance capacity

Adenotonsillar hypertrophy and cor pulmonale in children

Pulmonary heart disease occurring in children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy was previously described. Sixty children with adenotonsillar hypertrophy were subjected to cardiac evaluation using chest radiography, ECG and echocardiography as well as arterial blood gas analysis. Chest radiographs showed cardiomegaly in seven cases, ECG showed right ventricular hypertrophy in six cases, while echocardiography showed right ventricular hypertrophy in nine cases with pulmonary hypertension in twelve cases. Adenotonsillectomy was carried out for all children included in the study. Six months later, all cases improved except one case remained with pulmonary hypertension and right ventricular hypertrophy

Endoscopic septoplasty

The aim of this study was to compare the efficacy of endoscopic septoplasty with traditional septoplasty in treating cases having septal deviations. The study included 60 patients complaining mainly of nasal obstruction due to significant septal deviations. They were divided into two groups: Group A 30 patients who had endoscopic septoplasty performed in order to correct their deviated septum and group B 30 patients who had a traditional septoplasty performed as a method of treatment of their septal deviation. Each patient was subjected to a preoperative assessment protocol that included a thorough history taking, general and local examination, nasal endoscopic examination and active anterior rhinomanometry. Postoperatively, the patients were subjected to an assessment protocol similar to the preoperative one

Medical treatment of nasal polyposis with intranasal antifungal solution: preliminary findings

The aim of this work was to evaluate reported success in treatment of nasal polyposis with local intranasal antifungal preparations. Forty three patients suffering from nasal polyposis were randomly included in this prospective study. After clinical staging of the extent of nasal polyposis, the patients were randomized into three treatment groups. Group I received topical steroid nasal spray, Group II patients were treated with nasal irrigation with Amphotericin B solution and Group III patients were treated with Amphotericin B and topical steroid spray. The efficacy of treatment was evaluated objectively through endoscopic assessment of the post treatment stage of nasal polyposis. In the population of 26 patients who received amphotericin B [group II and III], 12 patients [46%] achieved complete success and disappearance of the nasal polyps, while 15 patients [58%] had partial success with improvement of their pre-treatment clinical staging. The smaller polyps were easier to treat yielding a success of 78% in stage I, versus 42% and 9% in stage II and III. In conclusion, the results of this preliminary study suggest that intranasal irrigation with amphotericin B solution is safe and effective in treatment of stage I and II nasal polyposis

Laser management of subglottic stenosis

This study aimed to evaluate the use of laser in treating subglottic stenosis. The study included ten patients suffering from laryngeal stenosis of various etiologies. The stenosed segments were excised using CO2 laser. Successful improvement in respiration occurred in eight patients during the follow up period [six months]. Decannulation was performed in four cases out of the six tracheostomized patients. It was believed that laser seems to be an excellent method to manage subglottic stenosis especially when the stenosed segment is less than 1 cm in length