Temporalis fascia versus composite cartilage perichondrial graft in the reconstruction of total and subtotal tympanic membrane perforations

Objective: The purpose of this study was to compare between temporalis fascia and composite cartilage perichondrium grafts in reconstruction of the total and subtotal tympanic membrane perforations

Study Design: Prospective study consisted of ninety five consenting patients with chronic inactive suppurative otitis media with total and subtotal perforations. The patients were classified into two groups; group A [75 ears in 75 patients] in whom cartilage graft was used and group B [20 ears in 20 patients] in whom temporalis fascia was used

Results: For group A tymapanic membrane closure was achieved in 71 patient [94.6%] while in group B tympanic membrane closure was achieved in 7 patients [35%]. The hearing results showed that, there was highly significant postoperative improvement in pure tone averages as well as air bone gap averages. In group A the air bone gap was closed to less than 10 dB in 21.7% and from 10 to 25 dB in 73.9% and to more than 25 dB in 4.4 %, on the other hand the air bone gap was closed to less than 10 dB in 16.7 % and from 10 to 25 dB in 66.6 % and to more than 25 dB in 16.7 % in group B. In this study, the average pre and postoperative air bone gap [500-4000 Hz] were 26.8 dB and 13 dB respectively, for cartilage group and 25.1 dB and 12.3 dB for fascia group

Conclusions: This study revealed that Composite cartilage perichondrial grafts are excellent graft material for total and subtotal perforations. The palisade technique is an effective and straight forward technique with high success rate and good hearing results with no postoperative complications

Cartilage tympanoplasty: a technique to combat eustachian tube dysfunction

This study included 199 cases suffering from inactive chronic suppurative otitis media and operated up on at the Otorhinolaryngology Department Mansoura University from 2000 to 2003. Patients were divided into 3 groups according to their Eustachian tube function [good, fair and poor]. Tympanoplasties were done using 3 types of graft materials [full thickness cartilage graft, partial thickness cartilage graft and temporalis fascia graft]. The take rate was better with good Eustachian tube function than poor Eustachian tube function in the 3 groups, in fascia group there was a significant difference between good and poor Eustachian tube function. There was no significant difference in hearing results between the fascia group and cartilage groups. Type A tympanogram was obtained in partial thickness cartilage graft and temporalis graft more than the full thickness cartilage graft. According to our results the use of cartilage is the preferred graft material for tympanoplasty in cases with poor Eustachian tube function

Pneumatic balloon dilatation in achalasia: the optimum size of the balloon

Background: Pneumatic dilatation is considered to be the first line therapy for achalasia, but long-term outcome studies are scarce and limited by their retrospective design. There is also no consensus on the Optimal method for performing pneumatic dilation as regard to balloon diameter, amount and the rate inflation pressure

Aim: To address these questions in a large long-term prospective study

Methods: Over a period of 10 Years 262 achalasia patients referred to Mansoura Gastroenterology Surgical Center and Ear, Nose and Throat department, Mansoura University were enrolled. All patients underwent a pre-treatment clinical evaluation and were followed every 6 months. The first 62 patients [group A] underwent dilatation with initial use of a 35 mm balloon with inflation pressure of 10 psi in 10 seconds [5]. In group B [200 patients] we initially used a 30 mm balloon with inflation pressure of 10 psi in 30 s. Dilatation was repeated with incrementally larger balloons [35 and 40 mm] in case of relapse. We used rigiflex balloon and maintained pressure for 60 s after inflation in both groups

Results: Three perforations occurred in group A whereas no perforation took place in Group B. The cumulative proportional remission rate with single dilatation in groups A and B decreased from 83 and 75% in 6 months to 60 and 57% after 30 months of therapy respectively, the differences did not reach statistical significance. In patients who had undergone further dilatations the probability of remaining in remission at 1 year after the first and the second dilatation was 38 and 88% in group A, 20 and 89% in group B respectively. The probability of remaining in remission for 2 years increased from 20% after the first dilatation to 70% after the second dilatation

Conclusion: Graded pneumatic balloon dilatation with 30 mm diameter and slower rate of balloon inflation is an effective and safe initial method of therapy for achalasia. The duration of remission can be extended by repeated dilatation with larger size balloon

Outcome of endoscopic sinus surgery for nasal polyposis

Nasal polyposis is the most common mass lesions in the nose. It has been shown that it reduces quality of life. It has characteristically frequent recurrences. The objective of this study is to evaluate the outcome of nasal polyposis with medium term follow up [mean of 42 months]. This s M y included 216 adult patients with nasal polyps treated with endoscopic sinus surgery in the period from June 1997 to June 2003. All operations were done at Otori7inoiaryngoiogy Department, Mansoura University Hospital. Patients were grouped into polyposis, polyposis with asthmas, and polyposis with aspirin intolerance. Outcome measures include symptomatic improvement, residual and recurrent diseases, CT score, endoscopic score and complications. Patients symptom score and CT scores improved significantly after surgery. Recurrence rate was 19.9% [16%, 34%, and 38%] for the three groups, respectively]. Better control of asthma with less dependency on medication was not achieved in patients with asthma as well as patients with aspirin intolerance In conclusion; endoscopic sinus surgery is effective in treating patients with nasal polyposis. Patients with asthma and aspirin intolerance have worse outcome than patients with polyps with no asthma

Stapes surgery: preinsertion technique

Two hundred ears with otosclerosis have been operated upon using stapedotomy technique with insertion of the prosthesis before removal of the superstructure [preinsertion technique] in 100 ears and the usual stapedotomy technique as described by Schuknecht in 100 ears. The postoperative air-bone gap, calculated as the difference between the postoperative air and bone conduction levels, was smaller in the stapedotomy technique for all frequencies except at 2000 Hz, the differences were statically insignificant except at 4000 Hz, the mean postoperative air-bne gap was 8.7 dB and 7.5 dB for the 1st and 2nd group, respectively, which is statistically insignificant. We found no postoperative loss of bone conduction exceeding 15 dB in this series of patients. There was a deterioration of more than 10 dB in four ems, one in the first group and three in the second group. According to ow results we conclude that the small fenestra technique provides good results with minimal complications in treatment of otosclerosis. The preinsertion technique provides more advantages, being easier and minimize trauma to the inner ear

Sleep on lateral position as a treatment of obstructive sleep apnea syndrome

Sleep on lateral position was supposed to be the most conservative method for treatment of patients with obstructive sleep apnea syndrome [OSAS]. This study was performed to objectively evaluate the effect of sleep position on one hundred-eight cases suffering from OSAS with mean age 46.7+12.4 years and mean body mass index [BMI] 26.6+3.7 Kg/m[2]. Polysomnographic recording was done for each patient after insertion of a soft silicon catheter with 4 barosensors. The terminal sensor was adjusted at the lower half of the esophagus to be confirmed by roentogenography. The study was conducted during the afternoon period; one hour on supine position and one hour on lateral position. Analysis of the pressure recording indicated that the negative intrae-sophageal pressure decreased from 54. 7+24.2 cm H[2]O on supine position to 33.9+25.7 cm H[2]O on lateral position [38%, P<0.001, n= 108]. Sixty-three patients [58.3%] indicated a remarkable response during sleep on lateral position [Le. 75-100% decrease of either intraesophgeal pressure or apnea/ hypopnea index]. We concluded that prescription of lateral position as a treatment of OSAS can be useful for some patients without surgery and can be adjuvant for others after performing sleep apnea surgery. This should be based on upper airway pressure recording to exclude patients who indicate no improvement and those who become worse