Areolar fascia with and without conchal cartilage in tympanoplasty

This retrospective study included 110 patients operated for chronic tympanic membrane perforations in the period between 1998 and 2004. Areolar fascia was used for central [small and medium sized] and posterior perforations [60 patents]. Conchal cartilage was used in conjunction with areolar fascia for large, subtotal and anterior perforations [50 patients]. The surgical success rates for areolar and fascia-cartilage graft groups were 90% and 91.6% respectively. There was significant improvement of air conduction levels after tympanoplasty for both groups. A significant improvement in air bone gap [ABG] was noted at each frequency in both groups. These findings revealed the overall gains of 15.3 dB for the fascia group and 12.6 dB for the cartiIage-fascia group. ABG closure to within 20 dB was encountered in 51 [85%] patients of the fascia group whereas this was achieved in 41[82%] patients of the cartilage-fascia group. Study showed that areolar fascia has comparable success rate to the standard temporalis muscle fascia. The present study has shown that cartilage tympanoplasty did not adversely affect hearing result

Early and advanced allergic fungal rhinosinusitis

Allergic fungal sinusitis [AFS] has remained a diagnostic and therapeutic challenge. Early cases of allergic fungal sinusitis are rarely described prospective study in tertiary care facilities 26 patients diagnosed with AFS were treated by the author in the period from 2002 to 2005; most cases were from Jazan area in Saudi Arabia. Most cases were young women. Systemic corticosteroids, local corticosteroid and local amphotrecin B were used for all cases after surgery. Very high incidence of AFS in Jazan area. Patients with AFS have characteristic manifestation easily distinguishable from other rhino sinusitis and nasal polyposis patients. Ig E was consistently high in both early [750] and advanced [1550] cases, Ig E dropped significantly after treatment. CT scan findings were diagnostic except in very early cases. Erosion of the lamina paperacea was found in 5 cases. Erosion of the sphenoid sinus with intracranial extension was found in 2 cases. AFS is common in certain geographic areas and rare in other areas. All cases with nasal polyposis should be suspected to have AFS in areas with high incidence of the disease. Early cases of AFS are helpful for studying the natural history of this disease. Enviromental studies are needed to explore the pathogenesis of this disease

Choanal adenoids in adults: diagnosis and treatment

Choanal adenoids, a rather rarely defined phenomenon, is the presence of adenoid tissues in the choanae, without being extension of the commonly well-known nasopharyngeal adenoids. We present a series of 22 adult patients [17-38 years; 15 males, 7females], with persistent bilaeral nasal obstruction and recurrent nasal infections, and with history e of repeated unsuccessful medical and, in many cases, repeated surgical procedures, in whom choanal adenoids was diagnosed by nasal endoscopy and/or CT scanning. Absence of adenoid tissues in the nasopharynx was confirmed in all cases. Surgical removal of choanal adenoids was undertaken in all cases endoscopically. Some other surgical. procedures like straightening of a deviated septum or reduction of a hypertrophied turbinate were undertaken in some indicated cases. Most of cases experienced complete relief of obstruction and return of a patent nasal airway and improvement of associated complaints as dry mouth and persistent cough. A thorough review of this phenomenon and its clinical relevance and methods of diagnosis and management are presented. We recommend a thorough nasal endoscopy as a routine in cases of persistent nasal obstruction even in the presence of an apparent cause of obstruction

General anaesthesia for endoscopic sinus surgery; hypotensive anaesthesia versus isoflurane - local epinephrine

This study included 30 patients, they were randomly classified into two groups. In hypotensive anesthesia [HA] group, anesthesia was maintained by N2O: O2, halothane 0.4-1% and atracurium. Deliberated hypotension was achieved using nitroglycerine infusion [2-5 mug/kg/min.]. In isoflurane-epinephrine [IE] group, halothane was replaced by isoflurane and epinephrine [1: 100,000] injected into the nasal mucosa. HR, MAP, SPO2 and ETpCO2 were recorded in the perioperative period. A surgical field was assessed and an average blood loss was calculated