The safety of posterior tympanotomy in otitis media with effusion during cochlear implantation: clinical retrospective cohort study.

BACKGROUND: Posterior tympanotomy (PT) is an important step in cochlear implant (CI) surgery, as it is the main access to the round window. Some CI candidates, especially children, may have concomitant otitis media with effusion (OME) which may result in technical issues during PT. There is still a debate whether to wait for OME resolution preoperatively or to proceed to surgery with suspected difficulties. AIMS/OBJECTIVE: To evaluate the safety of PT during CI surgery in patients with OME. MATERIAL AND METHODS: we included 102 consecutive pediatric candidates in this retrospective study with an age range of 12 months to 6 years. All the patients underwent CI surgery using trans-mastoid, PT to access round window (RW) area. We investigated the effect of the pathology caused by OME on the operative procedure in PT and post-operative consequences. THE RESULTS: out of 102 patients included in this study, there were 22 patients with OME who had unilateral cochlear implantation with no major operative or post-operative events. Nevertheless, some minor intra operative events and difficulties were encountered. CONCLUSION AND SIGNIFICANCE: The presence of OME in CI surgery indicates possible surgical challenges such as difficult PT, minor intra-operative risks and with no major post-operative events.

Validation and adaptation of the Arabic version of the Tonsil and Adenoid Health Status Instrument.

OBJECTIVES: Validation and cross-cultural adaptation of the Tonsil and Adenoid Health Status study tool, in Arabic while studying its psychometric properties. STUDY DESIGN: prospective -validation study. SETTINGS: Multiple tertiary centers. PATIENTS/AND OTHER PARTICIPANTS: 63 consecutive patients who underwent tonsillectomy or adenotonsillectomy operation (pre-operative and 6 months post-operative) and 65 asymptomatic controls. INTERVENTION/METHODS: FOLLOWING: Guidelines for the cross-cultural adaptation process, to translate the original English language version into an Arabic language one. MAIN OUTCOME MEASURES: We assessed the psychometric properties of the Arabic version of the TAHSI (A-TAHSI) its feasibility, reproducibility, internal consistency, reliability, discriminatory validity and responsiveness to change. RESULTS: The Mann-Whitney test showed a statistically significant difference for the mean score between the patients and the control group denoting good clinical validity. The Cronbach's coefficient value for the A- TAHSI for 63 cases was 0.983, demonstrating good internal consistency. The Wilcoxon signed-rank test showed a marked improvement in the patients' scores 6 months post-operatively. Spearman's rank and Pearson's correlations were used to correlate the level of resemblance of the mean score of the A-TAHSI, which showed statistically significant results. CONCLUSIONS: The A-TAHSI is a valid instrument for evaluating the subjective effect of tonsillectomy on the health and quality of life and hence is recommended to be used in tonsillectomy research and daily practice. LEVEL OF EVIDENCE: 3b.

The safety of bipolar mode radiofrequency (BMRF) on cochlear implant integrity test; a clinical prospective study.

PURPOSE: We aimed to assess the effect of bipolar mode radiofrequency (BMRF) tonsillectomy as a model of oro-pharyngeal surgical maneuver on the integrity of the internal device in patients with cochlear implants (CIs). MATERIALS AND METHODS: This prospective case series included 15 consecutive pediatric patients with CIs (age range 4 to 8 years, mean 5.2 years) who underwent BMRF tonsillectomy. The postoperative integrity of the internal device was evaluated by comparing the electric current response tested preoperatively with that tested 2 days postoperatively. RESULTS: There were differences in the current levels in the main regions of the cochlea; (the apical, mid-turn, and basal) after comparing preoperative and postoperative values, but they were not statically significant. CONCLUSION: BMRF seems to be safe for tonsillectomy in children with CIs without negative impact on the integrity of the internal device.

The utilization of round window membrane surface tension in facilitating slim electrodes insertion during cochlear implantation.

This is a prospective randomized study aimed to evaluate the round window membrane (RWM) surface tension in facilitating slim electrodes insertion during cochlear implantation. A total number of (118) children were included in this study (118 implantations). Mean age was 36.72 months (range from 18 to 60 months). This study was conducted from January 2015 to September 2016 at a cochlear implant centre in a tertiary referral hospital. Slit incision in the anterosuperior quadrant of the RWM was done in 70 cases, While RWM cruciate incision was done in 48 cases. Of the 48 patients who underwent RWM cruciate incision, 13 cases had no problem, while in 35 cases, we faced difficult insertion. When slit incision of the RWM was done (70 cases), 68 cases showed smooth insertion, meanwhile, we faced increased operative time due to flopping of the electrode in 2 cases only. Moreover, residual low-frequency hearing preservation was more achieved when slit incision of the RWM was done. Tensile strength of the round window membrane after slit incision of the RWM offers support to slim electrodes during introduction, decreasing incidence of kinking and floppiness, hence shortening the maneuver time and minimizing the number of trials. This facilitates easy smooth slim electrodes introduction, decreasing intracochlear trauma. Moreover, slit incision of the RWM may offer better residual hearing preservations than cruciate incision of the RWM during slim electrodes introduction.

Utility of apparent diffusion coefficient in characterization of different sinonasal pathologies.

BACKGROUND: Sinonasal lesions are a heterogeneous group of lesions that span from a tumor to tumor-like nature. Characterization of such cases preoperatively can improve the surgical control and the overall outcome of these patients. OBJECTIVE: In this prospective study, we aimed at evaluation of the role of apparent diffusion coefficient (ADC) in the differentiation between benign and malignant sinonasal lesions. SUBJECTS AND METHODS: All patients scheduled to have sinonasal surgical intervention at Ain Shams University Hospitals, Cairo, Egypt, were enrolled. Diffusion-weighted (DW) magnetic resonance imaging (MRI) with calculation of ADC were done for all cases. Radiologic findings were then compared with histologic findings, and the sensitivity, specificity, negative and positive predictive values (PPVs) of the conventional MRI, DW-MRI, and ADC value in differentiation of benign from malignant sinonasal lesions were then calculated. RESULTS: There were 59 patients with median age of 43 years old. There were 20 cases of inflammatory lesions, 16 cases of benign tumors, and 23 cases of malignant lesions. The ADC values of all cases ranged from 0.4 × 10(-3) to 2 × 10(-3) (median = 1.5 × 10(-3)). The median ADC value for the malignant lesions was 0.6 × 10(-3), whereas that for the inflammatory conditions was 1.6 × 10(-3) and that for the benign tumors was 1.5 × 10(-3) with a highly significant difference (p < .001). Analysis of the conventional MRI and DW-MRI to differentiate between malignant and benign lesions showed that the sensitivity, specificity, PPV, and negative predictive value (NPV) were 100%, 97%, 96%, and 100% and 91%, 97%, 95%, and 95%, respectively. CONCLUSION: DW-MRI did not add significantly to the information gained from conventional MRI. It should be considered complimentary only to standard MRI in uncertain cases when malignancy is still a concern.