1,720,981 research outputs found
Inner ear impairment after stapedotomy. do the cervical vestibular evoked myogenic potentials play a diagnostic role?
No full textBackground Otosclerosis is characterized by a bony remodeling process that ends up with stapes fixation. The hearing impairment can be recovered by surgery by replacing the stapes superstructure. Due to the surgical management of the vestibule, the vestibular examination could provide an insight into the correlation between this kind of surgery and vestibular changes. Objectives To evaluate the impact of the stapedotomy on the inner ear. Methods We evaluated pure tone audiometry and the presence of vestibular evoked myogenic potentials (VEMPs) in 41 patients with otosclerosis before and after the stapedotomy operation. Results Air conduction (Ac)-VEMPs were present in 18 cases preoperatively and 31 cases postoperatively. Bone conduction (Bc)-VEMPs were present in 23 cases preoperatively and 33 cases postoperatively. ABG was closed to less than 20 dB in all cases after the operation Conclusions The preoperative Bc-VEMPS had an outstanding capability to predict the type of hearing loss. The postoperative absence of VEMPS despite the closure of ABG indicated the impact of otosclerosis on the saccular cells. The use of Thulium Laser in stapedotomy didn't affect significantly the saccular cells. Significance Integrated use of audiometry and VEMPs was effective to evaluate the changes associated with otosclerosis and the stapedotomy operation
Proposal of a magnetic resonance imaging follow-up protocol after cholesteatoma surgery: a prospective study
No full textBackground: Non-echo planar (EPI) diffusion-weighted (DW) MRI has become an effective tool for the follow-up after cholesteatoma surgery and decreased the rate of second-look surgeries. Objectives: To shed light on the optimal imaging follow-up protocol to detect postoperative residual or recurrent cholesteatoma. Materials and methods: 64 patients were included in this prospective study. Three different surgical procedures were considered: canal-wall-up (26 patients), canal-wall-down (20 patients), and obliterative (18 patients). The imaging follow-up protocol included non-EPI DW MRI during the following postoperative periods: 1 month, 6 months, and 1, 3, 5, and 7 years after the primary surgery. Results: MRI-positive lesions were present in 18.75% of patients. 50% of the MRI-positive findings occurred at the 1-month follow-up. The other peak of MRI positivity occurred at the 3-year follow-up. The last MRI-positive finding appeared at the 5-year follow-up. Conclusions: The timing for the imaging protocol proposed by this prospective study to detect recidivism after cholesteatoma surgery stressed the importance of performing non-EPI DW MRI for detecting residual, though rare, disease. Likewise, extending the follow-up to a least 5 years after primary surgery was also recommended to detect any recurrent cholesteatoma that would appear unlikely to be present beyond this time se
The novel retro-conchal approach for middle ear surgeries: Our experience in 196 patients
No full textBackground: This study aimed to describe a new proposed retro-conchal approach for middle ear surgery and to evaluate its advantages and postoperative impact. Methodology: A retrospective case-series study was held at a tertiary university hospital from March 2008 to April 2022. We included 196 adult patients who were candidates for middle ear surgery because of chronic otitis media. The retro-conchal approach entailed a skin incision on the medial conchal surface 1 cm anterior to the auricular sulcus. It allowed the harvesting of the required size of conchal cartilage and temporalis fascia through the same incision with access into the middle ear and complete exposure to the mastoid process. In addition, we evaluated the use of this approach in tympanoplasty, including cholesteatoma surgeries with at least one-year postoperative follow-up. Result: The long-term follow-up (22.9 ± 6.37 months) revealed that most operated cases (89%) did not develop postoperative sequelae related to this approach. On the other hand, 22 patients (11%) developed adverse outcomes, with a statistically significant difference regarding adverse outcomes as the P-value <0.001. Conclusion: According to our experience with a relatively large number of patients, the retro-conchal technique was practical for various middle ear surgeries. It allowed optimal access to different middle ear areas and obtaining large-sized conchal cartilage and temporalis fascia (if needed) through the same incision without needing extra surgical steps. In addition, it was a safe maneuver without significant adverse outcomes in the long-term follow-up
A novel radiological method to evaluate the posterior tympanotomy depth for cochlear implantation: our experience in 257 patients
No full textPurpose This study aimed to validate our novel proposed radiological evaluation of the posterior tympanotomy (PT) depth. This dimension represents the bone of the facial recess needed to be drilled to get access into the middle ear during cochlear implantation.
Methods It was a retrospective observational study that included 257 patients who underwent cochlear implantation from July 2018 to April 2021 in tertiary referral institutions. Two physicians evaluated the preoperative HRCT to measure the PT depth in the oblique para-sagittal cut. On the other hand, two other physicians evaluated the unedited surgical videos to judge the PT depth and classified it into an ordinary PT or deep PT. Then, the preoperative radiological measurements were correlated with the intraoperative findings.
Results The radiological PT depth ranged from 2.5 to 5.4 mm with a mean of 3.91 ± 0.886. Sixty-six patients had ordinary PT, and 191 patients had deep PT. Spearman’s correlation coefficient revealed a strong correlation between the preoperative radiological PT depth measurements and the intraoperative PT depth judgments (p value < 0.0001).
Conclusions We created a novel radiological method to measure the posterior tympanotomy depth. This method was valid, reproducible, and reliable in the preoperative radiological evaluation of the PT depth with high sensitivity (91.71%), speci- ficity (90.62%), and accuracy (91.44%). We also found a significant impact of the PT depth on the PT difficulty during cochlear implantation
The role of cochlear implantation in alleviating Tumarkin drop attacks of Meniere's disease; a case report
Full text linkMénière's disease (MD) patients may suffer episodes of sudden falls, named Tumarkin drop attacks (DAs). This fall occurs abruptly and without warning or loss of consciousness. DAs usually aggravate the clinical picture of MD and are challenging to manage. The present report describes a case treated by cochlear implantation (CI) due to concomitant deafness and offers some clinical considerations for this condition. A male patient aged 48 years with a 10-year history of definite bilateral MD had profound SNHL on the right and severe SNHL on the left side. He suffered from intermittent attacks of vertigo, ear fullness, and tinnitus and, in the last year, had developed DAs and experienced 14 episodes in the previous six months. The preoperative category of acoustic performance was 3. The Dizziness Handicap Inventory (DHI) questionnaire showed a total score of 46, which indicated a moderate degree of disability. A CI was planned for the right side. The patient did not report any further DAs episode for two years since then. The postoperative category of acoustic performance became 11, and the postoperative DHI questionnaire showed a decrease in the total score (from 46 to 19), which indicated a mild disability. Unilateral CI effectively alleviated the DAs associated with bilateral MD. Our report proposes a new modality for managing vertiginous symptoms in cases of MD with hearing loss without the need for more aggressive surgical interventions with the need for clinical trials to confirm our results
Radio-clinical assessment of crista fenestra during pediatric cochlear implantation
No full textObjectives: This study aimed to assess the ability of preoperative computed tomography (CT) to predict the crista fenestra (CF) type during cochlear implantation and correlate these types with intraoperative findings. This may allow for precise preoperative planning with better surgical outcomes. Study design: A prospective observational study. Settings: The study was done in multiple tertiary centers between September 2021 and March 2024. Method: ology: We correlated the preoperative radiological type of the CF with the intraoperative CF type to evaluate the accuracy and sensitivity of the HRCT to predict the CF type. We also assessed the need for CF drilling in each case. Results: Our study included 154 patients who underwent CI. They were 90 (58.4 %) males and 64 (41.5 %) females with ages ranging from 2.1 to 7.6 years, with a mean of 4.69 ± 1.19. The intra-class correlation coefficient between both radiological evaluators was 0.985, which indicated a high agreement between them. The intraoperative surgical types of CF were significantly related to the radiological types as the Spearman correlation coefficient was 0.976, and the P-value was <0.001. Conclusions: Our study revealed that preoperative CT is a precise tool for predicting the intraoperative type of CF during cochlear implantation type with a sensitivity of 96.67 % and an accuracy of 94.17 %. Moreover, drilling of the CF is recommended in type A3 and type B
The Impact of COVID-19 on the Daily Life and Medical Practice of Otolaryngology Physicians
No full textIntroduction The coronavirus disease 2019 (COVID-19) has made otolaryngologists more susceptible than their counterparts to its effect. Objective This study aimed to find if COVID-19 had a different impact on ear, nose, and throat (ENT) physicians' of various categories (residents, registrars, and consultants ) regarding many aspects of the quality of life (protection, training, financial, and psychological aspects). Methods We included 375 ENT physicians, of different categories (residents, registrars, and consultants), from 33 general hospitals and 26 university hospitals in Egypt. The study was conducted using a 20-item questionnaire with a response scale consisting of three categories: yes, no, and not sure. It covered infection control and personal protective equipment (PPE) usage; medical practice and safety; online consultation and telemedicine,; webinars and online lectures; COVID-19 psychological, financial, and quarantine period effects; and future expectations. Results The results of the questionnaire showed that COVID-19 had a statistically significant impact on the daily life of the responders. There were statistically significant differences among the three involved categories, based on their answers. Conclusion This study showed a statistically significant difference regarding the impact of COVID-19 on many aspects of the quality of life (protection, training, financial, and psychological aspects) of ENT physicians of various categories (residents, registrars, and consultants), and these effects may persist for a long time
Does the scutum of the external auditory canal have a role in the stapedotomy operation? A radio-clinical evaluation
No full textObjective: This study aimed to assess the impact of scutum on oval window (OW) accessibility during stapedotomy operation. Radio-clinical correlation was done to illustrate this purpose. Methods: It was a prospective observational case-series study. We included 127 candidates for stapedotomy operation. According to the accessibility of the stapes footplate, we classified the oval fossa into two types. Results: Both groups showed a statistically significant difference in preoperative radiological length as the P-value < 0.001. The Spearman correlation coefficient revealed that the intraoperative oval window fossa related significantly only to the radiological scutum length, as the P-value was <0.001. Conclusions: Our results revealed that preoperative radiological length can predict the intraoperative oval fossa type with high sensitivity and specificity. Patients with a preoperative scutum length of less than 2.35 mm were predicted to have an easily accessible oval window without requiring intraoperative scutum curettage
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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