Necessity of repeated physical maneuver, mastoid vibration and posture restriction in treating benign positional paroxysmal vertigo [BPPV]

Since Epley introduced his canalith repositioning maneuver [CRM] There has been a debate about the necessity of the use of multiple CRM per session, the application of bone vibrator during CRM and the value of post maneuver posture restriction, in order to study these points 320 patients with BPPV were treated using different modifications in the CRM, according to the different forms of treatment they were classified into 4 subgroups. Subgroup A: They had single CRM. Subgroup B: The CRM was repeated 3 times in the same session Subgroup C: CRM was done using bone oscillator vibrator. Subgroup D: they received post CRM posture restriction instructions only Subgroup B had higher cure rate compared to the other subgroups. Repeating the CRM in the same session would result in higher cure rate compare to single CRM, There is no clinical evidence supporting the use of bone vibrator during CRM or posture restriction instruction after CRM

Comparison of sevoflurane and propofol anesthesia on surgical field and recovery characteristics in patients undergoing endoscopic sinus surgery

The endoscopic surgical procedures have been developed specifically for the areas located in the key points of the lateral nasal wall. Small areas of bleeding in the operative field can reduce visibility and considerably impair surgical conditions. This randomized, prospective study was performed to compare propofol and sevoflurane based anesthesia on the surgical field in patients undergoing endoscopic sinus surgery and to compare the recovery characteristics between them. Patients and Methods Forty patients ASA I and II, scheduled for elective endoscopic sinus surgery were randomly divided into two equal groups to receive either propofol or sevoflurane as a maintenance anesthetic. Propofol was the induction agent in both groups. Group 1 received propofolnitrous oxide for maintenance of anesthesia [Propofol group] while group 2 patients received sevoflurane-nitrous oxide [Sevoflurane group]. in this study, the attending otorhinolaryngological surgeon was unaware of the type of anesthesia administered immediately after the operation, the surgeon rated surgical conditions [bleeding from the surgical field] on a visual analogue scale [0-10 cm] and on a verbal rating scale. Also we compare the two groups [15 regards recovery profile [extubation time, command response, orientation time, and time until eligible for discharge]. Blood pressure was not different between the two groups, but heart rate was lower in the intravenous anesthesia group. Surgical conditions were rated to be significantly better during anesthesia with propofol compared with sevoflurane. There were no differences in the recovery character between the two groups. Total intravenous anesthesia with propofol has the advantage of decreased bleeding compared with sevoflurane anesthesia. Therefore, making endoscopic surgery technically easier and safer by improving endoscopic visualization of the surgical field. Both sevoflurane and propofol have comparable recovery profiles

Treatment of subglottic stenosis with CO2 laser excision and topical application of mitomycin C

Twenty patients were gathered from El Menoufiya university hospital with subglottic stenosis caused by laryngoscleroma. The patients were divided into two groups group [A] and [B] .Patients were treated by CO2 laser excision of subglottic stenosis and topical application of mitomycin C high concentration 10 mg/ml group [A] and low concentration 0.4 mg/ml group [B]. seven patients in group [A] and six patients in group [B] get improved after single surgical procedure. One patient in each group get impoved after two surgical procedures. Two patients in group [A] and three patients in group [B] undergone three surgical procedures with no improvement

Open approach for secondary Rhinoplasty

Revision Rhinoplasty presents reconstructive challenges to the nasal surgeon different from those encountered in primary surgery. The patient requesting secondarny Rhinoplasty presents complex psychological as well as anatomical problems to the nasal surgeon. In this study 25 patients with variable postoperative nasal deformities are managed by the open approach Rhinoplasty. Postoperatively, 80% of the patients were satisfied with their aesthetic results and the remaining 20% had minor problems that may require further surgery; there were no problems with the transcolumellar scar. The Nasal obstruction was improved in 83% of patients with preoperative nasal obstruction. The open approach gives the surgeon complete anatomic exposure that allows him to perform all his surgical tasks more accurate and easily than the closed approach

Prevalence and role of respiratory viruses in the etiopathogenesis of acute otitis media

Aim: To investigate the prevalence of various respiratory viruses in middle ear effusion [MEE] and nasopharyngeal specimen in 54 children with recurrent acute otitis media [AOM] with effusion who had failed to improve after antimicrobial therapy and to determine the incidence of respiratory syncytial virus [RSV] as one of most common respiratory viruses in AOM

Methods: Middle ear effusion [MEE] samples collected at the time of tympanostomy tube placement from 54 children with recurrent acute otitis media were subjected to reverse transcriptase polymerase chain reaction [RT-PCR] to detect the presence of RSV genomic sequences. Also MEE and nasopharyngeal specimens were subjected to viral and bacterial cultures and to detect viral antigens. The viral cause of the infections was also assessed by serologic studies of serum samples obtained during the acute illness and convalescence

Results: Viral infection was detected in 43 out of 54 children [79.6%], RSV was isolated from 57.1% of patients by viral culture and antigen detection and from 81.5% by RT-PCR

Conclusion: Viral infection particularly RSV either alone or concurrent with bacteria is present in larger percentage of children with recurrent acute OME than previously suspected. PCR has proved to be more sensitive and specific than viral cultures and immunoassays in the detection of viruses in specimens. This would be helpful in guiding the use of preventive measures such as RSV vaccine

Endoscopic transnasal management of bilateral congenital choanal atresia

Recent computed tomography and histopathological studies showed higher incidence of mixed bony and membranous [70%] and pure bony atresia [30%] with no pure membranous anomalies. This condition occurs about one for every 7000 live births. Before the development of endoscope, the transpalatal approach is considered the most appropriate technique, but endoscopic approach is the most popular nowadays as it provides better visualization and accessibility, and less operative and postoperative bleeding and early postoperative feeding for children. My technique was endoscopic tramisnasal removal of choanal atresia and putting a stent for very short period in the left choana with fashioning endoscopic flap and removing atretic plate putting a stent for very short period in the right choana. This short period was fourty eight hours postoperatively to diminish postoperative restenosis