Evaluation of intranasal microscopic sinus surgery in 112 patients

One hundred twelve patients underwent intranasal microscopic sinus surgery [11 unilateral and 101 bilateral] for chronic sinusitis, orbital abscess decompression and fronto-ethmoidal mucocele. The operating microscopy was used to perform ethmoidectomy, middle meatal antrostomy, frontal sinusotomy, and to open the sphenoid sinus. The "angled 30", telescope was used, when direct visualization of the frontal sinus recess or maillarly sinus ostium was not achieved by the operating icroscxope or when direct inspection of the interior of the frontal, maxillary, and or sphenoid sinus was indicated. Visualization of the maxillary sinus ostium and the frontal recess, by the operating microscope were achieved in 81% and 64.3% of cases respectively. The presenting symptoms in order of frequency were facial pain [100%], postnasal discharge [89.2%], nasal obstruction [75.8%] and smell affection [24.1%]. After intranasal microscopic sinus surgery, headache improved in 85.7%, postnasal discharge improved in 62%, nasal obstruction improved in 98.8% and smell affection improved in 92.6%. 36 patients had monir complications, which included, synechia between the middle turbinate and lateral nasal wall [17.8%], postoperative hemorrhage [6.25%] and orbital ecchymosis [3.6%]. The incidence of synechia was higher in the group of patients [45 cases], in which partial resection of the middle tubrinale was not performed inspite of placing a spacer between the middle turbinate and the lateral nasal wall. For this reason it is wise to remove the anterior part and inferior free margin of the middle turbinate. As regard postoperative hemorrhage, the incidence was higher in the group of patients [27 cases] which did not perform bipolar cauterization of the inferior turbinate after partial resection. For this reason it wise to use bipolar cautery, when the inferior turbinate and or the turbinate are partially rsected. Or bital ecchymosis, can be avoided by placing the middle metal antrosomy just above the lateral attachment of the inferior turbinate and the maxillary sinus at the junction of the vertical and horizontal limbs of the infundibulum. Combination of the microscope and telescope was valuable in the treatment of paransala sinus diseases, minimizing the disadvantages of each technique and permitting a more safe and successful procedure with minimal complications

Studies on the audiological changes following minor head injury

Thirty patients were suffering from trauma to a moving head with no audiological changes [60%], six patients were suffering from trauma to a moving head with audiological changes [12%], ten eases were suffering from mild trauma to fixed head with audiological changes [20%], while four cases were suffering from mild trauma to a fixed with less than 5 hours in all cases. In this study the incidence of hearing loss in the immediate post- injury period was 20% and it was of sensorineural type. The change in hearing was found to be contra or homolateral to the injured side but more commonly bilateral high tone deficit, mostly around 4000 Eight cases [80%] out of the ten cases with sensorineural hearing loss were found to be due to cochlear lesion as manifested by audiological tests, while the other two cases [20%] were found to be due to retrocochlear lesion, but central hearing impairment was not observed. Three months later the situation has changed quite dramatically, as all cases [ten cases] recovered completely in this period. I.e. They have suffered a concussion type injury. The incidence of hearing loss was 27.2% for occipital injuries and 26.3%, 12.5% and 0% for temporal, frontal and vertical injuries respectively