Comparison between minimally invasive myringoplasty using permeatal temporalis fascia graft harvesting and posterior tragal perichondrial graft myringoplasty

The aim of this study is to compare permeatal temporalis fascia harvesting technique and posterior perichondrial harvesting technique myringoplasty. Twenty three patients presented with small or medium sized central perforations were included in this study. The patients were divided into two groups; the first group [n=11 patients] was subjected to permeatal temporalis fascia harvesting myringoplasty [TFG], the second group [n=12 patients] was subjected to posterior tragal perichondrium graft myringoplasty [PG]. The operative parameters which were compared between the two groups include: the operating time and bleeding. The postoperative parameters include: perforation closure rate and healing time and wound complication. Pre- and postoperative pure tone audiometric results were also compared, The bleeding was more in TFG than PG. The minimum operating time for TFG patients was 50 minutes, the maximum time was 75 minutes and the mean time was 55.9 minutes. While the minimum operating time for PG patients was 40 minutes, maximum time was 55 minutes and the mean time was 46.3 minutes. So, the operating time in PG was less than TFG. Two patients from TFG had residual perforation [18.2%] with success rate [81.8%]. One patient from PT group had residual perforation [8.3%] with success rate 91.7%. So, three patients from all the patients had residual perforation [13%], with overall success rate was about 87% [20/23]. Three patients from TFG developed small granulations after 7, 8 and 10 weeks. One patient from PG developed small granulation at the site of tympanomeatal flap. Postoperative audiometric evaluation was similar in both groups. Posterior perichondrial graft is easier to perform with less operating time. Post operative wound complications is less. The success rate, healing time and postoperative hearing results are nearly similar for both techniques

Circadian rhythms: chronotherapeutic study of non sedating antihistamines in treating allergic Rhinitis

The first aim of this study is to determine if there is circadian rhythm variation in persistent allergic rhinitis symptoms. The second aim is to evaluate the role of morning vs. evening non-sedating antihistamine therapy in achieving the improvement of these symptoms. One hundred patient suffering from allergic rhinitis symptoms were included in this study. A questionnaire regarding allergic rhinitis symptom was filled for each patient. Five symptoms [nasal itching, runny nose, nasal blockage, sneezing and eye symptoms] were graded from 0 to 3 [no, mild, moderate and sever respectively] with total symptom score equals 15. This questionnaire was filled before therapy. The patients were randomly divided into two groups, one group received non-sedating antihistamine once daily [cetirizine hydrochloride 10 mg or desloratidine 5 mg] at morning [AM-group] and the other one received the same antihistamine at evening [PM-group]. The same questionnaire was filled again after 2 weeks for each patient. Both Binomial Method and Kolmogorov-Smirnov Test [non-parametric tests] indicate that there was a significant difference between the total scores of symptoms at morning [AM] and night [PM]. P-Value of any of the two tests was less than 0.05. Using Spearman Rank Correlation, any symptom tends to lower its intensity during night. After treatment, using Kolmogorov-Smirnov test, TSS in PM-group is very significantly lower than that of AM-group. The adverse events were comparable in both groups and also comparable for cetirizine and desloratidine. The commonest side effects were gastro-intestinal upset [nausea and abdominal discomfort] in 13 patients [13%] and headache in 11 patients [11%]. The present study confirmed the morning versus evening variation of allergic rhinitis symptoms. The symptoms were more worse in the early morning. Giving antihistamine medication at night has a better therapeutic outcome in most of the patients. However, the timing of treatment must be individualized to each patient according to his own symptoms' circadian rhythm

Relationship between thyroid pathology and globus pharyngeus. Does thyroidectomy cause globus symptoms or improve it? A preliminary study

The first aim of this study is to detect the frequency of globus symptoms in patients with thyroid pathologies who will be subjected for thyroidectomy. The second aim is to know if thyroidectomy can cause or improve these symptoms. Thirty patients with thyroid pathology who were scheduled for thyroidectomy were included in our study. Glasgow-Edinburgh Throat Scale was filled for each patient preoperatively, and 3 months and 6 months postoperatively. Computerized tomographic scanning of the neck and barium swallow were done for patients who have globus symptoms. Seven patients had globus positive symptoms preoperatively. The duration of symptoms varied between 3 months and 10 years [mean 30.5 months]. The commonest throat specific symptom were [feeling of something stuck in the throat] and [discomfort/ irritation in the throat] in 4 patients. The remaining 3 patients symptoms are [feeling of something stuck in the throat] and [pain in the throat]. Three months postoperatively, 5 patients improved completely from throat specific symptoms. The remaining two patients improved six months postoperatively. The 2 somatic stress symptoms improved after 6 month. Four patients with positive symptoms were euthyroid and three were hyper thyroid patients. None of the operated patients developed globus symptoms. Barium swallow and CT findings [apart from details of the thyroid gland] were normal. Thyroid pathologies can cause globus symptoms. However, any patient with goitre and is suffering from these symptoms must be thoroughly investigated to rule out any sinister pathology before considering goitre as a cause. Barium swallow is the least to be done to exclude other pathologies, we can also conclude that thyroidectomy does not cause globus symptoms but rather improves it