The Clinical Role of Diffusion-Weighted MRI for Detecting Residual Cholesteatoma in Canal Wall up Mastoidectomy.

OBJECTIVES: The purpose of this study was to assess the value of the diffusion MRI with the non-echoplanar imaging (Non-EPI) technique for follow-up the post-operative patients to detect residual cholesteatomas. STUDY DESIGN: This prospective study was performed on 40 patients. All patients were at least one year after Canal Wall Up mastoidectomy surgery for cholesteatoma and scheduled for a second-look surgery. PATIENTS AND METHODS: This prospective study was performed on 40 patients. All patients were subjected to Canal Wall Up surgery and planned for the second-look operation. After one year as removal of choleasteatoma is uncertain in first surgery. The study done at Tertiary referral centers (Ain shams, Mansoura, and Minia university hospitals), non-echoplanar diffusion MRI (NEP-DWI) technique for follow-up the post-operative patients to detect residual cholesteatomas, then second look surgery done 2 weeks after MRI. RESULTS: Forty patients underwent MRI with Non-echoplanar diffusion-weighted imaging (NEP-DWI). Twenty-six patients had positive MRI results with the remaining 14 patients had negative results. These results were compared to operative findings. All positive MRI cases showed positive intra-operative findings. Ten of negative MRI cases showed negative intra-operative findings. Four of DWI-negative cases showed small cholesteatomas. CONCLUSION: The use of NEP-DWI is a valuable tool in detecting residual cholesteatoma that could replace the second look surgery in many cases.

Assessment of Severity of Stuttering in Native Versus Foreign Language in Secondary (Late) Bilingual Children.

The present study was conducted to investigate the severity of stuttering in native versus foreign language in secondary (late) bilingual children. The speech sample of 31 children with stuttering (age ranges 10 years, 1 month to 11 years, 8 months old) speaking in their first Arabic as a (native) language and acquired second English (foreign) language in the KG1 Class of school around the age of 4 years as secondary (late) bilinguals. The speech samples were recorded using Sony MHC-E60X mini Hi Fi component cassette with a fixed distance 15 cm between the speaker and the recorder. The severity of stuttering is assessed using Arabic version of stuttering severity index (A-SSI). The results indicate that there is a significant correlation between stuttering severity in both languages, being more severe in English (foreign) language than in Arabic (native) language.

Role of immunoglobulin E and gastro-esophageal reflux disease in the development of otitis media with effusion.

INTRODUCTION: The role of allergy in chronic otitis media with effusion (OME) is controversial. AIM OF THE WORK: To study the role of allergy and gastroesphogeal reflux diseases in the etiology of OME. MATERIALS AND METHODS: It is a prospective study that was done on 43 cases; 30 patients suffer from OME with mean age 6.8 years and 13 control child with mean age 8.3 years. Blood sample were taken from patients and control children for assay of total Immunoglobulin E (IgE) and serum pepsinogen 1 (PG1). Effusion fluid samples were taken from middle ear of the patients during myringotomy and ventilation tube insertion; IgE and PG1 were assayed in the effusion samples. Total IgE and PG1 were assayed by enzyme-linked immunosorbent assay. RESULTS: Our results showed that, there is a correlation between serum IgE and Effusion IgE in the patients group, there is a significant negative correlation between PG1 in the effusion and serum of the studied patients. CONCLUSION: Allergy is a possible risk factor for the development of OME. The level of PG1in the effusion is one tenth of its level in the serum of the patients.

Magnetic resonance imaging versus computed tomography and different imaging modalities in evaluation of sinonasal neoplasms diagnosed by histopathology.

OBJECTIVE: The study purpose was to detect the value of magnetic resonance imaging (MRI) compared to computed tomography (CT) and different imaging modalities as conventional radiology in evaluation of sinonasal neoplasms diagnosed by Histopathology. METHODS: Thirty patients (16 males and 14 females) were complaining of symptoms related to sinonasal tract. After thorough clinical and local examination, the patients were subjected to the following: conventional radiography, CT, MRI, and histopathological examination. RESULTS: The nasal cavity was the most commonly involved site with sinonasal malignancies followed by the maxillary sinuses. The least commonly affected site was the frontal sinuses. Benign sinonasal tumors were present in 14 cases. The most common benign lesion was juvenile nasopharyngeal angiofibroma (6 cases), followed by inverted papilloma (3 cases). While malignant sinonasal tumors were present in 16 cases, squamous cell carcinoma was present in 5 cases, and undifferentiated carcinoma, in 3 cases. Lymphoepithelioma and non-Hodgkin lymphomas were present in 2 cases each, while adenocarcinoma, chondrosarcoma, adenoid cystic carcinoma, and rhabdomyosarcoma were present in 1 case each. CONCLUSION: MRI with its superior soft tissue contrast and multiplanar capability is superior to CT in pretreatment evaluation of primary malignant tumors of sinonasal cavity.

Evaluation of temporal bone cholesteatoma and the correlation between high resolution computed tomography and surgical finding.

BACKGROUND: Acquired cholesteatomas are commonly seen in patients less than 30 years. There is a typical history of recurrent middle ear infections with tympanic membrane perforation. The diagnosis of cholesteatoma is usually made on otologic examination. OBJECTIVE: The aim of the work was to study the role of high resolution computed tomography (HRCT) in detecting, evaluating, and diagnosing middle ear cholesteatoma. PATIENTS AND METHODS: This was a prospective study that included 56 consecutive patients with chronic suppurative otitis media, unsafe type cholesteatomas. Each patient was subjected to full clinical evaluation, and HRCT examination. Intravenous contrast media was used in some patients with suspected intracranial complication. Preoperative radiological data were correlated with data related to surgical findings. RESULTS: The study showed that a high incidence of cholesteatoma in the third decade of life. The scutum and lateral attic wall were the most common bony erosions in the middle ear bony wall (64.3%), and the incus was the most eroded ossicle in the middle ear (88.2%). Sclerosing of mastoid air cells were encountered in 60.7% of patients and the lateral semicircular canal was affected in 9%, while facial canal erosion was found in 21.4%. Temporal bone complications are more common than intracranial complications. HRCT findings were compared with operative features; the comparative study included the accuracy and sensitivity of HRCT in detecting cholesteatoma (92.8%), its location and extension (96.4%), ossicular chain erosion (98%), labyrinthine fistula and intracranial complications (100%). CONCLUSION: The important role of HRCT scannig lies on the early detection of cholesteatoma, and more conservative surgical procedures can be used to eradicate the disease.

Effect of adenoid hypertrophy on the voice and laryngeal mucosa in children.

INTRODUCTION: The adenoids, or pharyngeal tonsils, are lymphatic tissue localized at the mucous layer of the roof and posterior wall of nasopharynx. Dysphonia defined as perceptual audible change of a patient's habitual voice as self judged or judged by his or her listeners. The diagnosis of dysphonia relies on clinical judgment based on phoniatric symptoms, auditory perceptual assessment of voice (APA) and full laryngeal examination. PATIENTS AND METHODS: Our study was conducted to evaluate the effect of adenoid hypertrophy on voice and laryngeal mucosa. The study sample composed of sixty children, forty of them had adenoid hypertrophy (patient's group) and twenty healthy children (control group). Patient's group composed of 17 boys (42.5%) and 23 girls (57.5%), while control group consists of 8 males (40%) and 12 females (60%). All patients and control group subjected to history taking, clinical examination, lateral soft tissue X-ray on the nasopharynx, APA based on the modified GRBAS scale and full laryngeal examination. The data are collected and analyzed statistically by using software SPSS. RESULTS: Our results showed that there is a significant association between adenoid hypertrophy and, degree of dysphonia, leaky voice, pitch of voice and laryngeal lesion. Adenoid hypertrophy did not associate with loudness of voice, as well as character (irregular, breathy and strained). Laryngeal lesions were detected in thirteen children from patient group (32.5%): nodules (n = 6), thickening (n = 5), congestion (n = 2), while one child only out of 20 children of the control group had congestion (5.0%). CONCLUSION: Our results showed the importance of the assessment of voice and laryngeal examination in patients with adenoid hypertrophy, also treating the minimal mucosal lesions that results from adenoid hypertrophy should be taken in consideration.

Value of high resolution ultrasonography in assessment of laryngeal lesions.

OBJECTIVE: The aim of this study is to evaluate the value of high resolution ultrasonography (HRUS) in diagnosis of various laryngeal lesions which already diagnosed with rigid endoscopy. STUDY DESIGN: Prospective study with control group. PATIENTS AND METHODS: Sixty-six patients were suffering from throat symptoms and pre-examined by rigid endoscopy under local anesthesia and diagnosed to have a laryngeal lesion and 32 volunteers compose the control group. All 98 persons (patients and control groups) were examined by HRUS. RESULTS: HRUS was helpful in describing various laryngeal lesions, vocal fold polyps (17) 25.7%, glottic cancer (6) 9.1%, epiglottic enlargement (2) 3.1% and one patient had laryngocele (1.5%). HRUS was highly significant in diagnosis of subglottic lesions (10) 15.2%. Also vocal fold mobility can be demonstrated by HRUS. While interarytenoid lesions (17) 25.8% and small laryngeal lesions as vocal fold nodules (13) 19.6% were difficult to be described. CONCLUSION: Rigid endoscopy in laryngeal examination gives us large, bright image but it is difficult to diagnose patients with a sensitive gag reflex, patients with neck or jaw diseases or stridor and very difficult in infants and children. HRUS is an alternative method in diagnosis of some laryngeal lesions, and it is superior in the diagnosis of small subglottic lesions.

Risk of acute otitis media in relation to acute bronchiolitis in children.

OBJECTIVE: A prospective study was carried out to evaluate the prevalence and the etiology of acute otitis media (AOM) in children with acute bronchiolitis. Also to determine whether AOM occurring with acute bronchiolitis is accompanied with another pathogens or not. SUBJECTS AND METHODS: One hundred and eighty children with acute bronchiolitis aged 3-18 months who were admitted to pediatrics department, Minia University hospital, were included in the study done in the winter and spring of 2009. In patients with AOM at entry or developed AOM within 14 days, Gram-stained smears, bacterial cultures, and enzyme-linked immunosorbent assay (ELISA) were performed on middle-ear aspirates to detect the presence of bacterial pathogens and RSV respectively. RESULTS: One hundred children (55.6%) with acute bronchiolitis had AOM at entry or developed AOM within 14 days, 45 patients (25%) had developed otitis media with effusion, and only 35 patients (19.4%) remained free throughout the 2-week observation period. Of 135 middle-ear aspirates (65 unilateral and 35 bilateral), bacterial pathogens were isolated in 86 patients (86%) [37 bacteria alone "37%" and 49 mixed bacteria and RSV "49%"], RSV was identified in 56 patients (56%) of middle ear aspirates [mixed with bacteria in 49 patients and RSV alone in 7 cases (7%). CONCLUSION: We concluded that bacterial AOM is a complication in most children with acute bronchiolitis. Streptococcus pneumonia and Haemophilus influenza were the commonest organisms isolated from middle ear aspirate. RSV is identified in 56% of acute otitis media with bronchiolitis.