Effect of passive smoking on ciliary regeneration of nasal mucosa after functional endoscopic sinus surgery in children

Passive smoking in the pediatric age group is associated with increased frequency of a number of childhood respiratory disorders, but its effect on the power of ciliary regeneration after functional endoscopic sinus surgery [FESS] for chronic sinusitis has never been tried in the literature. We are conducting a prospective non randomized cohort study on pediatric patients with chronic sinusitis to compare between two patient groups, passive and non passive smokers as regard the power of ciliary degeneration after FESS. On a total number of 38 patients passive smoking had a negative impact on the power of regeneration of sinus cilia after FESS

Correction of post-palatoplasty velopharyngeal insufficiency by two different techniques

Evaluation the success of 2 different techniques in treating post-palatoplasty residual velopharyngeal insufficiency [VPI]. Prospective study on 48 cases of post-palatopl asty hypernasality. The cases classified into 3 groups according to the type of velopharyngeal closure. Group A had coronal closure pattern and treated by sphincter pharyngoplasty, group B had sagittal closure pattern and treated by pharyngeal flap and group C had circular closure pattern and treated by sphincter pharyngoplasty. Postoperative follow-up by flexible nasopharyngoscopy, auditory perceptual assessment and parent's questionnaire. The incidence of residual VPI after sphincter pharyngoplasty was 11.5% while it was 9% after pharyngeal flap [p value=0.784]. The satisfactory speech improvement was 88.5% for cases underwent sphincter pharyngoplasty and 91% for cases underwent pharyngeal flap [p value=0.784]. The incidence of snoring was 3.8% for cases underwent sphincter pharyngoplasty and 27% for cases underwent pharyngeal flap [p value=0.038]. No cases developed sleep apnea after pharyngoplasty while it was developed in 13.5% after pharyngeal flap [p value=0.089]. No statistically significant difference in outcomes between the 2 procedures for speech assessment score [p value=0.540]. Mobility was detected in the flaps of sphincter pharyngoplasty while the posterior pharyngeal flaps were static. Sphincter pharyngoplasty and pharyngeal flap are good operations for correction of post-palatoplasty hypernasality. But in cases with circular closure pattern, sphincter pharyngoplasty is the operation of choice as it carries low risk of obstructive complications and it is dynamic

Endoscopic versus open approaches in trating huge locally advanced angiofibromas

Juvenile nasopharyngeal angiofibroma [JNA] is a combined vascular and fibrous neoplasm arising in the nasopharynx of prepubertal and adolescent males. Studies indicate that surgery is a good form of treatment, especially when there is no intracranial involvement. The surgical approach depends on the pre-operative findings. Recurrence is a common problem in JNA treatment. A recent study by Radkowski et al. found that pre-operative tumor stage was the most important factor in determining the chances of recurrence after surgery. A retrospective chart analysis study was done for 42 cases of histologically proved angiofibromas staged II or III -according to Andrew's [Modified Fisch] classification- managed in the department of otolaryngology faculty of medicine Cairo University in the period between February 1996 and March 2003 with Minimal follow up of 3 years. Group 1, 29 patients were subjected to open surgical approach [Mainly before 2001] in the form of 1-ateral rhinotomy in 14 cases, and 2-facial degloving approach in 15 cases. Group 2, 13 patients mainly after 2001 were treated with endoscopic removal of tumor. Comparative analysis was done between both groups as regard local control parameters and morbidity parameters. Endoscopic approaches were superior to open approaches as regard total eradication of neoplasm as the incidence of residual tumor was nearly the double with open approaches compared to endoscopic approaches. As regard recurrent tumor both techniques were nearly equal as regard the incidence of recurrent tumors As regard the Morbidity Parameters, endoscopic approaches were associated with much less morbidity than open approaches. From previous results it is quite clear that endoscopic approach offers patients with huge advanced angiofibromas less morbidity with equal or even better local control

Obstructive sleep apnea and hypothyroidism

Excessive daytime somnolence, apathy and lethargy are known to occur in persons with hypothyroidism, the same symptoms have been recognized in some persons who have obstructive sleep apnea. The occurrence of these symptoms in both conditions raises the question to define the exact incidence, relation in-between and to settle down a rational for management. In the department of otolaryngology of Kasr El-Aini Beni Suif University and new dar al sheaf [Kuwait] hospitals, 2 groups of patients; 1[st] group with hypothyroidism and a 2[nd] group with obstructive sleep apnea were included in this study, from September 2004 to March 2006. The records of these patients were reviewed. In the 1[st] group, eight patients, from total number of eleven, had episodes of apnea, with the number of episodes per hour of sleep, apnea index, ranging from 18 to 169 [mean 69.7]. Six of the eight patients were obese and had 92.6 episodes per hour compared with 17.3 episodes per hour in the 2 non obese patients [p<0.001]. After 4-12 months of thyroxine replacement therapy, the mean apnea index decreased from 69.7 to 12.5 episodes per hour, without reduction in body weight [p<0.001]. In the 2[nd] group [36 patients], the incidence of hypothyroidism among the patients suggestive to have obstructive sleep apnea [OSA] was 5.6% [2 patients]. In patients diagnosed as hypothyroidism, OSA was controlled to a significant degree with thyroxine replacement therapy, even without changes in body weight. The incidence of hypothyroidism among the patients suggestive to have OSA is low and so measurement of thyroid hormones is not a routine step in this type of patients

Adenotonsillar hypertrophy and cor pulmonale in children

Pulmonary heart disease occurring in children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy was previously described. Sixty children with adenotonsillar hypertrophy were subjected to cardiac evaluation using chest radiography, ECG and echocardiography as well as arterial blood gas analysis. Chest radiographs showed cardiomegaly in seven cases, ECG showed right ventricular hypertrophy in six cases, while echocardiography showed right ventricular hypertrophy in nine cases with pulmonary hypertension in twelve cases. Adenotonsillectomy was carried out for all children included in the study. Six months later, all cases improved except one case remained with pulmonary hypertension and right ventricular hypertrophy