Outcome of topical mitomycin in CO2 laser arytenoidectomy

Healing problems following CO[2] laser arytenoidectomy include granulation tissue formation into the laryngeal lumen and/or fibrous tissue proliferation with scar contracture, both resulting in postoperative airway stenosis. Thus laryngeal stenosis may develop after arytenoidectomy. Mitomycin topically applied leads to almost complete, irreversible inhibition of fibroblast proliferation. The objective of this study is to investigate whether mitomycin limits granulation tissue formation and allows the healing process to complete without airway stenosis. The study was done on 20 patients with severely impaired airway due to bilateral vocal cords paralysis. Ten patients were treated by CO[2] laser arytenoidectomy followed by immediate topical applications of mitomycin to the ary-cnoidectomy wound. The other 10 patients were treated by CO[2] laser arytenoidectomy without mitomycin application. All patients treated with aryteniodectomy and mitomycin had successful restoration of airway, while the other 10 patients treated by arytenoidectomy had, insufficient airway in two patients and granuloma formation in two other patients. The study showed that topical treatment with low dose mitomycin significantly reduces post CO[2] laser arytenoidctomy wound complications in the from of granulation tissue and fibrosis which may impair the airway

Time management of recurrent cholesteatoma following open mastoidectomy: a suggested follow-up schedule

Recurrent cholesteatoma is a serious complication due to its insidious, progressive and destructive nature. It should be detected and managed as early as possible. In a previous study we retrospectively reviewed the files of a series of 42 cases of cholesteatoma that underwent open mastoidectomy techniques [modified radical mastoidectomies and atticotomies] by the author at the Hearing and Speech Institute in Egypt. We identified the incidence, clinical findings, types and characteristics of recurrent cholesteatoma by regular long term follow-up. There were two main types of recurrence; the open [or flat] type with the clinical picture of active cholesteatoma with an incidence of 9.5% with average time of onset of 4 months postoperative, and the closed silent epidermoid cyst [or pearl] in an otherwise healthy mastoid/middle ear cavity [24%] with average onset of II months postoperative. Both types presented in the same ear in two cases [4.7%], and were termed the mixed type. All pearls were successfully removed per-meatal as an out-patient procedure with minimal morbidity and mostly under local anesthesia. While all recurrence of the open type required revision surgical exploration under general anesthesia. The aim of present study is to use the above information to design a follow up time schedule that will enable the timely detection and removal of recurrence at an early stage and reduce the incidence of late recurrence that will require revision surgery. A suggested follow-up schedule was designed. The most important aspect of which is the scrutiny of examination at one year postoperative to detect hidden pearls which formed the majority of recurrent cases. Early removal of these pearls is believed to markedly reduce the incidence of recurrent active cholesteatoma that will require revision surgery

role of the subperiosteal hematoma in the management outcome of traumatic fractures of the nasal bone

The aim of this study is to show the importance of addressing the associated sub-periosteal hematoma in the management of acute nasal bone fractures whether or not associated with bone deformity. The goal in management is to perform a proper reduction early and right from the first time, and to prevent a residual SPH from organisation and resulting in nasal bone deformity. This is hoped to improve the results of management of acute nasal traumatic deformities avoid the need for a revision septo-rhinoplasty. A prospective study was none on a group of patients from the Hearing and Speech Institute where upon a technique was adopted to evacuate associated SPH with bone reduction of the fracture displacements. A control group of similsr cases was studies retrospectively from the patient records and the results were compared to the former group

Iatrogenic cholesteatoma following tympanoplasty for non-cholesteatomatous chronic otitis media

Iatrogenic cholesteatoma is a form of recidivism that results from squamous epithelial seeding or entrapment as a result of the surgical. They may occur after tympanoplasty, whether or not cholesteatoma was originally present. Incidence of iatrogenic cholesteatoma resulting from ear surgery for non cholesteatomatous otitis media is around 5%. In this retrospective study we describe the site of origin and time of occurrence of iatrogenic epidermoid cysts or cholesteatoma following a series of cases that underwent tympanoplasty for CSOM without cholesteatoma by the author at the Ear Nose and Throat Teaching Hospital. The significance of this information is to help us predict the type character, site and postoperative time of appearance of iatrogenic cbolesteatoma. Managed in the right time, this step is hoped to prevent the development of a more extensive disease and thus reduce the incidence of recurrent active cholesteatoma. A series of 180 tympanoplasties with or without Mastoidectomy, for COM without cholesteatoma were included. Eight cases of iatrogenic cholesteatoma [4.4%] were identified in the form of epidermoid cysts [pearls] [n=8] or frank open cholesteatoma [n=2]. Postoperative time of detection was 4-12 months for the pearls and 4 and 5 years for the open cholesteatoma Site of recurrence for pearls were mainly related to the annulus and the handle of the malleus. While cholesteatoma of the open type originated in the posterior bony wall of the external auditory canal eroding the bone and invading the mastoid where they extended to the antrum and attic. Suggestions for prevention early detection and management of these recurrences are presented

Evaluation of the lateral pharyngoplasty operation for obstructive sleep apnea hypopnea syndrome

The aim of this study was to evaluate the efficiency of lateral pharyngoplasty [LPP] as a surgical technique for treatment of selected cases of obstructive sleep apnea hypopnea syndrome [OSAS]. The present study was conducted on a series of 20 patients diagnosed with OSAS who presented to the Otolaryngology Outpatient Clinic at the Hearing and Speech Institute. Preoperative investigations and surgical technique of lateral pharyngoplasty were discussed. From this study we conclude that the lateral pharyngoplasty operation provided support to the lateral pharyngeal wall and produced subjective and objective improvement in respiratory sleep disorders in selected cases of OSAS

Elevated concentration of s-ICAM-1 and s-VCAM-1 in IDDM patients with hearingloss

This study was carried out on IDDM patients classified into group I and group II according to the absence or presence of impairment of hearing, respectively. Impairment of hearing was determined by using pure tone audiometry [PTA], distortion product otoacoustic emissions [DPOAE] and brain stem evoked response audiometer [ABR]. The selection of cases, the idea of the study, interpretation of data and comments were presented. It was concluded that soluble VCAM- 1 and s- ICAM-1 were positively associated with the risk for hearing loss in IDDM patients. Soluble VCAM-1 and sICAM-1 may be useful indicators of hearing loss in IDDM patients