Effect of topical mometasone furoate on adenoidal lymphoid tissue: a light microscopic study.

BACKGROUND: Adenoid hypertrophy is a common cause of upper airway obstruction, and adenoidectomy is one of the most frequently performed operations in children. Topical nasal steroids can act directly on nasopharyngeal lymphoid tissue to decrease its reactive inflammatory changes and potentially reduce its size. OBJECTIVE: To study the light microscopic changes in adenoidal lymphoid tissue after one month of topical steroid use. METHODS: Twenty-six children with adenoid hypertrophy grade 3 scheduled for adenoidectomy were randomly divided into two equal groups: one group received mometasone furoate aqueous nasal spray (Nasonex) 100 mcg/day for four weeks, and a control group received nasal normal saline 0.9 per cent for four weeks. The removed adenoids were examined histopathologically. RESULTS: Adenoidal tissue from the mometasone group had less reactive germinal centres and less spongiosis compared to the control group. The latter showed proliferating, reactive, variable sized and shaped lymphoid follicles, with congested blood vessels in the interfollicular areas. CONCLUSION: The use of intranasal mometasone furoate aqueous nasal spray (Nasonex) for one month reduced adenoidal tissue reactive cellular changes and its vascularity. This is, however, a pilot study; a longer treatment period is needed to assess the effect of treatment on adenoidal size.

Endoscopic push-through technique compared to microscopic underlay myringoplasty in anterior tympanic membrane perforations.

BACKGROUND: Microscopic myringoplasty is the most frequently performed procedure for repairing tympanic membrane perforations. The endoscopic transcanal approach bypasses the narrow ear canal segment and provides a wider view. METHODS: An open-label randomised clinical trial was conducted on 56 patients with small anterior tympanic membrane perforations. Perforations were repaired with an endoscopic push-through technique (n = 28) or a microscopic underlay technique (n = 28). Follow up was conducted using endoscopic examination and pure tone audiometry three months' post-operatively. RESULTS: Graft success rate was 92.9 per cent in the endoscopic group versus 85.7 per cent in the microscopic group. The corresponding pre-operative mean air-bone gaps were 17.4 dB and 18.5 dB, improving to 6.1 dB and 9.3 dB post-operatively (p > 0.05). Mean air-bone gap closure was 11.4 dB in the endoscopic group and 9.2 dB in the microscopic group (p > 0.05). Mean operative time and estimated blood loss were 37.0 minutes and 29 ml in the endoscopic group, versus 107 minutes and 153 ml in the microscopic group (both p < 0.05). CONCLUSION: The endoscopic push-through technique for anterior tympanic membrane perforations is as effective as microscopic underlay myringoplasty; furthermore, it is less invasive and takes less operative time.

Correlation of obstructive sleep apnoea and laryngopharyngeal reflux: phmetry study.

OBJECTIVE: To study the correlation of obstructive sleep apnoea (OSA) and laryngopharyngeal reflux (LPR). DESIGN: A descriptive study. SETTING: Suez Canal University Hospital, Ismailia, Egypt. PATIENTS: 62 patients with polysomnography confirmed OSA. INTERVENTION: Patients were evaluated with ambulatory 24-h double channel pH monitoring. RESULTS: Mean reflux symptom index in the study group was 9 ± 5.5, and it was > 13 in all patients with severe OSA. Signs of LPR reflux were present in 34 (55%) patients. Abnormal reflux was detected in the distal oesophagus in 41 patients (66%) and in the proximal oesophagus in 21 patients (34%). Patients with severe OSA had significantly higher nocturnal LPR reflux episodes compared to patients with mild disease (P < .05). Number of reflux episodes and total duration of reflux during sleep are significantly correlated to degree of OSA (P < .05). No difference was found in relation to age or sex. Daytime reflux was not related to the degree of obstructive sleep apnoea (P > .05). CONCLUSION: LPR is common in patients with OSA. Patients with severe OSA have significantly higher nocturnal LPR. This should be considered when treating this group of patients.

Otomycosis with Perforated Tympanic Membrane: Self medication with Topical Antifungal Solution versus Medicated Ear Wick.

OBJECTIVES: In otomycosis with tympanic membrane perforation, many physicians prefer to insert an ear wick medicated with antimycotic cream. This needs multiple visits to the clinic and keeps the ear blocked for several days. Direct instillation of alcohol based antimycotic solution causes severe burning if it reaches the middle ear. In this work we compare patient's self medication with clotrimazole antimycotic solution used on Q-tips with physician-inserted ear wicks; in terms of safety, efficacy and patient satisfaction. STUDY DESIGN #ENTITYSTARTX00026; SETTING: Prospective controlled study in ambulatory setting. METHODOLOGY: Forty consecutive patients with otomycosis with tympanic membrane perforation were included in the study. Diagnosis of otomycosis was both clinical and with mycological culture. Mean pure tone average (PTA) in the involved ear was measured after cleaning fungal debris. Patients were then, randomized into two groups; Q-tip group patients (n=20) were taught to self-medicate their ears two times daily with the clotrimazole solution on suitable Q-tips for three weeks. In ear wick group (n=20), a gauze wick impregnated with clotrimazole cream was inserted in the ear. Wick was changed every third day for two more visits (one week overall). Patients were followed up for 3 months. RESULTS: After three weeks all patients in Q-tip group and ear wick group had relief of their ear itching and complete disappearance of fungal growth in the deep meatus and on the tympanic membrane. PTA was 22 ± 11dB in Q-tip group and 25 ± 12 dB in ear wick group; the difference was not statistically significant (p= 0.11). Patients in ear wick group had sense of ear blocking and wetness during period of treatment. Transient burning sensation was reported by 2 patients in Q-tip group. During three months, there was recurrence of otomycosis in 5 patients from ear wick group and no recurrence in Q-tip group (p=0.04). CONCLUSION: Self medication with clotrimazole solution on Q-tips and physician inserted medicated wicks are equally safe in treating otomycosis with perforated tympanic membrane. However, self medication with antimycotic solution on Q-tips gives more patient satisfaction and less rate of otomycosis recurrence.

Daily versus self-adjusted dosing of topical mometasone furoate nasal spray in patients with allergic rhinitis: randomised, controlled trial.

BACKGROUND: Many patients with allergic rhinitis are reluctant to use daily intranasal steroids for prolonged periods. A self-adjusted regimen which delivers reasonable control of allergic rhinitis may be more acceptable to such patients. OBJECTIVES: To compare the efficacy of daily use of mometasone furoate nasal spray, versus a self-adjusted regimen, in patients with chronic allergic rhinitis, in terms of symptom control and nasal volume change. SETTING: Ambulatory visits in an office setting. PATIENTS AND METHODS: Sixty patients with chronic allergic rhinitis were randomised: 30 were prescribed mometasone furoate nasal spray once daily for six weeks, while 30 were prescribed the same spray daily for one week, every alternate day for one week and then on a self-adjusted regimen for four weeks. Patients kept a symptom diary documenting sneezing, rhinorrhoea, nasal blockage and nasal itching. Acoustic rhinometry was used to measure the total nasal cavity volume at the first visit and at the end of the treatment period. RESULTS: The total nasal score on treatment days showed an improvement in both groups, compared with baseline measurements. There was no significant difference in total nasal scores between the two groups, except on days 10 (p = 0.043), 20 (p = 0.008), 23 (p = 0.19), 30 (p = 0.008) and 37 (p = 0.000), when the daily group's total nasal score was significantly lower than the self-adjusted group's total nasal score, and on day 8 (p = 0.004), when the self-adjusted group's total nasal score was significantly lower than the daily group's total nasal score. Total nasal cavity volume significantly increased in both groups (p = 0.0001), with no statistically significant difference between the groups. CONCLUSIONS: Self-adjusted dosage of mometasone furoate nasal spray gives reasonable control of allergic rhinitis (albeit with some 'breakthrough' symptoms). Patients should learn how to control these symptoms with the least number of steroid doses.

Management of clinically diagnosed subacute rhinosinusitis in children under the age of two years: a randomized, controlled study.

BACKGROUND: In children, a diagnosis of rhinosinusitis is usually made on clinical grounds. Subacute rhinosinusitis (SRS) may be the cause of persistent cough, low-grade fever, snoring, ear problems and difficult feeding in children under the age of two years. OBJECTIVE: To compare the efficacy of culture-based antibiotics and empiric amoxicillin-clavulanate (40 mg/kg/day) in treating SRS in children under the age of two years. STUDY DESIGN: Randomized, controlled study. POPULATION: Sixty children with persistent nasal discharge and nasal obstruction (and other related symptoms) for 30-90 days. METHODS: Group one (n = 30) received culture-based antibiotics and group two (n = 30) were treated empirically with 40 mg/kg/day of amoxicillin-clavulanate. Treatment was continued for two weeks. RESULTS: At the end of the three-week follow-up period, statistically significant greater improvements in nasal obstruction (p = 0.037) and nasal discharge (p = 0.003) were seen in group one compared with group two. CONCLUSION: culture-based antibiotics were more efficacious than empiric amoxicillin-clavulanate (40 mg/kg/day) in treating SRS in children under the age of two years.