Crooked Nose: Aesthetic and Functional Outcomes.

Purpose: To highlight a detailed analysis of aesthetic and functional rhinoplasty outcomes utilizing the most recent highly validated Standardized Cosmesis Health Nasal Outcomes Survey (SCHNOS) for Middle Eastern crooked nose patients. Methods: A longitudinal cohort study scrutinizing preoperative rhinoplasty patients' satisfaction retrospectively and their postoperative outcomes prospectively. The patients fulfilled the Arabic SCHNOS during postoperative follow-up. Preoperative and postoperative responses were recorded and then reviewed and analyzed. Results: This study included 41 patients with a mean age of 27.8 years. Females represented 41.5% of patients. About 73% of patients had a history of trauma. 90% of patients underwent primary procedures for crooked nose correction. Twelve patients (29.3%) underwent surgery for functional reasons, and twenty-six (63.4%) had it for both aesthetic and functional issues. There was a statistically significant difference regarding changes in SCHNOS regarding nasal obstruction scores (SCHNOS-O) and nasal cosmesis scores (SCHNOS-C) (p < 0.001). These findings coincided with a substantial reduction of all SCHNOS items postoperatively (p < 0.001). There was no statistically significant relationship between changes in (SCHNOS-O) or (SCHNOS-C) pre-and postoperatively and either age, sex, history of trauma, or type of surgery. However, a statistically significant difference was detected when assessing the relationship between changes in SCHNOS-O and the reason for surgery. Conclusion: A thorough knowledge of three-dimensional pathology and time-associated changes is required to achieve optimal aesthetic and functional outcomes for crooked nose patients. The use of highly validated questionnaires like SCHNOS in clinical practice is highly encouraged to modify and trace surgical techniques to the most appropriate and successful ones for the patients.

The association of bacterial biofilm and middle ear mucosa in patients with mucosal chronic suppurative otitis media.

OBJECTIVES: To evaluate the bacterial biofilm's role in mucosal chronic suppurative otitis media (CSOM) utilizing scanning electron microscopy (SEM). METHODS: This study involved 123 participating patients with active and inactive mucosal CSOM who underwent tympanomastoid surgery. SEM was used to examine middle ear mucosa biopsies for the development of biofilms. Middle ear discharge or mucosal swabs from patients were cultured to detect any bacterial growth. The biofilm formation was correlated to the culture results. RESULTS: The biofilm was present in 69.9 % of patients (59% of them were with active mucosal CSOM) and absent in 30.1% of the patients (70% of them were with inactive mucosal CSOM), being more statistically significant in active mucosal CSOM (p-value = 0.003). A correlation that was statistically significant was found between active mucosal CSOM and higher grades (3 and 4) of biofilms (p-value <0.05). The mucosal CSOM type and the results of the culture had a relationship that was statistically significant (p-value <0.001). 60% of patients had positive culture (70% of them were with active mucosal CSOM). There was a statistically significant relation between Pseudomonas aeruginosa bacterial growth and active mucosal CSOM (p-value = 0.004) as well as higher grades of biofilms in mucosal CSOM. CONCLUSION: Mucosal CSOM, especially the active type, is a biofilm-related disease. There is a significant relation between the state of mucosal CSOM (active or inactive) and culture results with predominance of Pseudomonas aeruginosa bacterial growth in active mucosal CSOM and in higher grades of biofilms in mucosal CSOM.

Endoscopic-Assisted Cochlear Implantation in Far Advanced Otosclerosis.

OBJECTIVES: To evaluate the effectiveness of cochlear implantation (CI) in case of far advanced otosclerosis and to evaluate the value of using intraoperative otoendoscopy to facilitate the identification of the round window membrane and the scala tympani without the need to remove the posterior canal wall or to perform a subtotal petrosectomy. STUDY DESIGN: Retrospective case-series study. SETTING: Tertiary academic CI center. PATIENTS AND METHODS: This study was conducted on patients with far advanced otosclerosis who underwent endoscopic-assisted CI between January 2010 and June 2020 at the same CI center. The minimum follow-up period was 2 years after surgery. RESULTS: Fourteen patients were included in the study. Ten patients had undergone a previous stapedotomy. Electrode insertion in the scala tympani was successfully accomplished in all cases included in the study. There was a statistically significant improvement in pure-tone average and speech discrimination scores in all cases of the study group (p < 0.0001). There were no statistically significant differences in postoperative pure-tone average or speech discrimination scores between cases with and without cochlear ossification or between cases with and without a previous stapedotomy (p > 0.05). CONCLUSION: Endoscopic-assisted CI is an effective option for hearing restoration in patients with far advanced otosclerosis. Otoendoscopy can facilitate visualization and access to the scala tympani without the need to remove the posterior canal wall or to perform a subtotal petrosectomy.

The role of using the submucosal conchoplasty technique for the management of concha bullosa in decreasing post-operative middle meatus synechia formation after functional endoscopic sinus surgery: a randomised controlled trial.

OBJECTIVE: The study aimed to compare the applicability of classic lateral lamellectomy versus submucosal conchoplasty techniques in managing concha bullosa during and after functional endoscopic sinus surgery. METHODS: The study randomly divided 56 patients with bilateral concha bullosa into two groups. One group of patients underwent the submucosal conchoplasty technique and the other group underwent the lateral lamellectomy technique. The study compared the intra-operative findings, including the time required for each technique, the amount of intra-operative bleeding and the post-operative endoscopic outcome of the middle meatus and middle turbinate stability. RESULTS: Submucosal conchoplasty was significantly more time-consuming than the lateral lamellectomy technique (p = 0.001*). The difference in the intra-operative amount of bleeding was (p = 0.086*). The lateral lamellectomy group showed a higher rate of synechia formation in the middle meatus (p = 0.012*). CONCLUSION: Submucosal conchoplasty is a valid technique for managing concha bullosa with better post-operative endoscopic outcomes.

Localization of the Vertical Part of the Facial Nerve in the High-Resolution Computed Tomography During Pediatric Cochlear Implantation.

BACKGROUND: This study proposed a classification of the vertical portion of the facial nerve (VPFN) location, incorporating the previous classifications regarding the posterior-to-anterior and medial-to-lateral dimensions. We also evaluated the implication of this proposed classification on the round window visibility during pediatric cochlear implantation (CI). METHODS: It was a retrospective multicenter observational cohort study. This study included 334 cases that underwent CI between 2015 and 2022 at multiple referral institutes. Two physicians evaluated the preoperative computed tomography images of 334 patients and determined the radiological type of the VPFN. These types were matched with intraoperative round window accessibility. RESULTS: The Spearman's correlation coefficient showed a strong correlation between the proposed VPFN type and the intraoperative round window visibility, as the P-value was <.001. CONCLUSION: This classification could provide the surgeon preoperatively with the precise location of the VPFN in the lateral-to-medial and posterior-to-anterior dimensions. Furthermore, this location classification of the VPFN was significantly correlated with intraoperative round window accessibility, with an accuracy of 90.42%. Therefore, types C and D were expected to have difficult accessibility into the round window, and more surgical interventions were needed to modify the posterior tympanotomy or use other approaches.

Radioclinical Assessment of Posterior Tympanotomy Difficulties during Ordinary Cochlear Implantation: A Prospective Case-Series Study.

OBJECTIVES: This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI). STUDY DESIGN: It was a prospective case-series study. SETTINGS: The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023. SUBJECTS: We included 73 CI candidates performed via the PT approach. INTERVENTION: The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery. MAIN OUTCOME MEASURE: We correlated this score with the intraoperative difficulty and surgical duration. RESULTS: The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p < 0.0001). CONCLUSIONS: Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.

The Efficacy of Budesonide as Intrapolyp Injection Agent in the Management of Type 2 CRSwNP.

OBJECTIVES: To assess the efficacy and safety of budesonide as an intrapolyp injection in chronic rhinosinusitis with nasal polyps (CRSwNP) in comparison to control and systemic steroids. METHOD: In a prospective double-blinded controlled randomized clinical trial, 150 patients with CRSwNP were divided into 3 groups in a ratio 1:1:1 where group (A) was given oral prednisolone 1 mg/kg tapered daily for 2 weeks, group (B) was given budesonide intrapolyp injection weekly for 5 consecutive weeks, and group (C) was given intrapolyp injection with saline as the control group. Patients were assessed upon Sinonasal Outcome Test (SNOT-22) score, Total Nasal Polyp score (TNPS), Serum IgE, absolute eosinophilic count, and morning cortisol level before treatment, 1 week and 6 months after completing their treatment protocol. RESULTS: SNOT 22 score improved significantly in all groups compared to those at baseline. Reduction in the oral and injection groups was much greater than the control group (P2 < 0.001), (P3 < 0.001), and the same trend concerning TNPS score (P2 < 0.001), (P3 < 0.001) but with no significant change in the control group. CONCLUSION: Intrapolyp steroid injection is considered a safe and effective method in nasal polyposis with limited side effects in comparison to systemic steroids. Using Budesonide as an agent for intrapolyp injection appears to be promising. It's advisable in patients with multiple relapses or high-risk patients to avoid repeated courses of oral steroids. LEVEL OF EVIDENCE: 2 Laryngoscope, 134:2085-2092, 2024.

The Prevalence and Association of Biofilms With Otitis Media With Effusion: A Systematic Review and Meta-Analysis.

PURPOSE: We aimed to identify the role of bacterial biofilms in the chronicity of otitis media with effusion and its resistance to antibiotics. We illustrated this role by reviewing, analyzing, and correlating the findings with the results of the included studies to reach clear evidence. METHODS: A comprehensive search of electronic databases (Scopus, PubMed, Web of Science, Cochrane, and GHL databases) was performed for all studies using the following strategy till April 2021 with the search terms: Biofilm and Middle ear effusion. We found 935 references, 421 were duplicates, and 514 were needed for further screening, and it was as follows: PubMed 215, Scopus 18, Cochrane 130, Web of Science 136, and GHL 15. RESULTS: The pooled prevalence of culture-positive effusions was estimated to be 40% (95% CI [28%, 53%]) of the total OME population. Overall, the prevalence of PCR-positive effusions was estimated to be 97% (95% CI [95%, 99%]) of the total OME population. The pooled prevalence of EM-positive effusions was estimated to be 82% (95% CI [69%, 95%]) of the total OME population. CONCLUSION: The data presented in this study coincide with the significant role of bacterial biofilms in the pathogenesis of chronic otitis media with effusion. The involvement of bacterial biofilm as a component of the OME pathogenic process can help us to explain why antimicrobial therapy is not always effective in the eradication of the disease process and, also explain the recurrence of middle ear effusion after treatment with tympanostomy tubes either with or without adenoidectomy.

The role of budesonide intrapolyp injection in the management of type 2 chronic rhinosinusitis with nasal polyps: a randomised clinical trial.

PROBLEM: To assess the efficacy of budesonide intrapolyp injection in chronic rhinosinusitis with nasal polyps. METHOD: Ninety patients were divided into three groups; group A was given oral prednisolone, group B was given budesonide intrapolyp injection weekly for five consecutive weeks and group C was given budesonide as nasal irrigation for one month. Patients were assessed using Sino-Nasal Outcome Test 22 score, total nasal polyp score, serum immunoglobulin E, absolute eosinophilic count, and morning cortisol level before treatment, one week and three months after completing their treatment. RESULTS: Total nasal polyp score decreased significantly in all groups compared to those at baseline. Reduction in the oral and injection groups was greater than the wash group (p2 = 0.004), (p3 < 0.001), and the same trend concerning Sino-Nasal Outcome Test 22 score (p2 < 0.001), (p3 < 0.001). CONCLUSION: Budesonide is an effective agent used in intrapolyp injection with no documented systemic or visual side effects that has comparable results with oral steroids.

Surgical Management of Bilateral Abductor Paralysis: Diode Laser Versus Coblation; A Prospective Study.

OBJECTIVES: We aimed to compare the results of both diode laser and coblation in the treatment of bilateral vocal fold immobility (BVFI). MATERIALS AND METHODS: This prospective clinical study was performed on 80 non-tracheostomised patients with bilateral vocal fold paralysis divided into two groups; Group A: diode laser, Group B: coblation. Medical Research Council "mMRC" Dyspnea scale, maximal phonatory time (MPT), Voice handicap index (VHI), and functional outcome swallowing scale (FOSS) were assessed preoperatively and postoperatively. Also, the VAS pain scale and operative time of both groups are recorded. RESULTS: Within each group, there was a statistically significant decrease in the mMRC dyspnea scale and maximum phonation time and a significant increase in VHI (P < 0.001). There was a statistically significant difference between the studied groups postoperative and regarding the percent change of the MPT ( more decrease in the coblation group). Concerning the operative time and the VAS pain score, there was a statistically significant difference between the studied groups regarding operating time and the VAS pain scale (significantly lower in the coblation group) (P < 0.001). CONCLUSION: Both Coblation and diode laser are effective tools in the treatment of BVFI with similar minimal voice quality affection. The maximum phonation time decreased more in the coblation group, while the voice handicap index did not significantly differ between both groups. However, Coblation may be superior to diode laser in terms of less operative pain and shorter intraoperative time. Coblation may be more favorable for patients at risk of prolonged general anesthesia duration.

Lower Four Cranial Nerves in the Management of Glomus Jugulare: Anatomical Study

Abstract Introduction The surgical management that achieves minimal morbidity and mortality for patients with glomus and non-glomus tumors involving the jugular foramen (JF) region requires a comprehensive understanding of the complex anatomy, anatomic variability, and pathological anatomy of this region. Objective The aim of this study is to propose a rational guideline to expose and preserve the lower cranial nerves (CNs) in the lateral approach of the JF. Methods The technique utilized is the gross and microdissection of 4 fixed cadaveric heads to revise the JF's surgical anatomy and high part of the carotid sheath compared with surgical cases to understand and preserve the integrity of lower CNs. The method involves radical mastoidectomy, microdissection of the JF, facial nerve, and high neck just below the carotid canal and the JF. The CNs IX, X, XI, and XII are microscopically dissected and kept in sight up to the JF. Results This study realized well the surgical and applied anatomy of the lower CNs with relation to the facial nerve and JF. Conclusions The JF anatomy is complicated, and the key to safely operate on it and preserving the lower CNs is to find the posterior belly of the digastric muscle, to skeletonize the facial nerve, to remove the mastoid tip preserving the stylomastoid foramen, to skeletonize the sigmoid sinus and posterior fossa dura not only anterior but also posteroinferior to reach and drill the jugular tubercle.

Lower Four Cranial Nerves in the Management of Glomus Jugulare: Anatomical Study.

Introduction The surgical management that achieves minimal morbidity and mortality for patients with glomus and non-glomus tumors involving the jugular foramen (JF) region requires a comprehensive understanding of the complex anatomy, anatomic variability, and pathological anatomy of this region. Objective The aim of this study is to propose a rational guideline to expose and preserve the lower cranial nerves (CNs) in the lateral approach of the JF. Methods The technique utilized is the gross and microdissection of 4 fixed cadaveric heads to revise the JF's surgical anatomy and high part of the carotid sheath compared with surgical cases to understand and preserve the integrity of lower CNs. The method involves radical mastoidectomy, microdissection of the JF, facial nerve, and high neck just below the carotid canal and the JF. The CNs IX, X, XI, and XII are microscopically dissected and kept in sight up to the JF. Results This study realized well the surgical and applied anatomy of the lower CNs with relation to the facial nerve and JF. Conclusions The JF anatomy is complicated, and the key to safely operate on it and preserving the lower CNs is to find the posterior belly of the digastric muscle, to skeletonize the facial nerve, to remove the mastoid tip preserving the stylomastoid foramen, to skeletonize the sigmoid sinus and posterior fossa dura not only anterior but also posteroinferior to reach and drill the jugular tubercle.

Evaluation of swallowing in children with higher grades glottic web.

PURPOSE: to evaluate the swallowing function in children with higher grades of glottic web and to detect the impact of surgical division of the glottic web on the swallowing parameters. We also performed a voice analysis as a secondary objective in this study. METHODS: This prospective case series study included 12 children with higher grades of the glottic web; grades 3 and 4. Evaluation of the swallowing function was done by clinical swallowing evaluation including symptoms and signs of swallowing dysfunction during feeding, such as vomiting, coughing, choking, or cyanosis, and bedside swallowing assessment using the 3-oz water swallow test. Instrumental evaluation of swallowing function was performed using flexible endoscopic evaluation of swallowing (FEES). The evaluation was performed both preoperatively and postoperatively. RESULTS: The number of children suffering from swallowing difficulties significantly increased during the postoperative evaluation where 6 (50%) children demonstrated choking during feeding after the surgical division of the web in comparison to only 3 (25%) preoperatively. Also, coughing and choking during the 3-oz water swallow test significantly increased following the division of the web with P < 0.001. CONCLUSION: Swallowing assessment is mandatory as children with higher grades of the glottic web, requiring reconstructive surgeries, are at risk of swallowing deficit which can be aggravated postoperatively. With improvement in the airway and surgery-specific outcomes, swallowing function is an important secondary outcome that has a significant impact on the lives of these kids and their families.

Transection Of Sternothyroid Muscle Increases The Rate Of Exposure Of The External Branch Of The Superior Laryngeal Nerve During Thyroidectomy.

Objectives: To assess the benefits of transection of the sternothyroid muscle compared to conventional approach for detecting the external branch of the superior laryngeal nerve while dealing with the upper pole of the thyroid gland. METHODS: The randomised controlled clinical trial was conducted at Kafrelsheikh University Hospital, Egypt, from January 2021 to January 2022, and comprised patients who were eligible for total thyroidectomy and met the American Thyroid Association guidelines. They were randomised and divided into conventional approach group A and sternothyroid muscle transection approach group B. The rate of exposure of the external branch of the superior laryngeal nerve, injury, classification, operative time and voice outcomes at 2 weeks and 3 months post-intervention were noted in both the groups. Data was analysed using SPSS 22. RESULTS: Of the 102 patients, 50(49%) were in group A; 5(10%) males and 45(90%) females with mean age 40.48±12.58 years and mean body massindex 30.676±2.305. There were 52(51%) patientsin group B; 5(9.6%) males and 45(90.4%) females with mean age 39.67±11.60 years and mean body mass index 30.096±2.776. The rate of external branch of the superior laryngeal nerve identification was higher and the operative time was shorter in group B compared to group A (p=0.05). No significant difference was noted in terms of voice outcomes either at baseline or at any of the two follow-up points between the groups (p>0.05). CONCLUSIONS: The transection of sternothyroid muscle improved the rate of external branch of the superior laryngeal nerve exposure and preservation compared to the conventional technique during thyroidectomy.

Assessment of the ability of the radiological incudo-stapedial angle to predict the stapedotomy technique type: a prospective case-series study.

PURPOSE: This study aimed to propose a radiological classification of the incudo-stapedial angle by preoperative high-resolution computed tomography (HRCT) images and to highlight its importance for predicting the use of reversal-steps stapedotomy (RSS) rather than the traditional non-reversal technique. METHODS: We included 83 candidates for stapedotomy operation. Two physicians measured the radiological incudo-stapedial joint angle in the preoperative HRCT. According to this measurement, the radiological incudo-stapedial joint was classified into three types: obtuse, right, and acute. In addition, this radiological classification was correlated with the intraoperative use of the stapedotomy technique, either reversal or non-reversal. RESULTS: The RSS technique was used in forty-two (97.7%) cases with an obtuse angle and twenty-six (89.7%) with a right angle. At the same time, the traditional non-reversal technique was used in all patients with an acute angle. The three groups differed significantly regarding the method used for stapedotomy (P value < 0.001). Moreover, Spearman's correlation coefficient revealed a significant correlation between the used technique and the radiological type of the incudo-stapedial angle (P value < 0.001). CONCLUSIONS: This prospective study proposed a preoperative radiological classification of the incudo-stapedial angle. This classification was significantly correlated with the type of stapedotomy technique. The RSS technique was feasible in most cases with an obtuse and right radiological incudo-stapedial angle. In contrast, the non-reversal method was used in all patients with an acute radiological incudo-stapedial angle. This radiological classification could predict the choice for the stapedotomy technique with an accuracy of 95.18%, a sensitivity of 73.33%, and a specificity of 100%.

Arabic translation, cultural adaptation, and validation of the BDDQ-AS for rhinoplasty patients.

BACKGROUND: Body Dysmorphic Disorder (BDD) is a significant aspect that compromises patient satisfaction after rhinoplasty. BDDQ-AS (Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery) is a validated, simple, reliable patient-reported outcome measure. It is a screening tool to detect body dysmorphic disorder in rhinoplasty patients. This study aimed to translate, culturally adapt, and validate BDDQ-AS to Arabic as a novel tool for screening and detecting BDD in Arabic rhinoplasty individuals. METHODS: BDDQ-AS was translated from English to Arabic following the international consensus guidelines. We tested the translation on ten Arabic-speaking rhinoplasty patients to ensure that the final version was understandable and acceptable. The proposed Arabic version was then completed by 112 patients whose average age was 28.79 ± 9.32 years. The screening is assumed positive if the patients expressed bother and preoccupation about their appearance (questions 1 and 2 "yes"), as well as a moderately disrupted everyday life (question 7 "yes" or questions 3, 4, 5, or 6 are equal to or greater than "3''). The internal consistency, test-retest reliability, and item-response theory (IRT) were used to evaluate psychometric validations. RESULTS: The Arabic BDDQ had a high level of internal consistency, as measured by Cronbach's alpha 0.995. The A-BDDQ-AS was deemed reliable with an Intraclass Correlation Coefficient (ICC) of 0.989. A-BDDQ had good discrimination scores (above 2.0) with adequate difficulty parameters. The overall scale content validity average was 0.83, affirming that all items were relevant, clear, and straightforward. CONCLUSION: The Arabic version of the BDDQ-AS is reliable, culturally adapted, and psychometrically validated to be readily used and incorporated into clinical practice. It is a beneficial tool that can guide the screening of Arabic rhinoplasty patients suffering from body dysmorphic disorder and be utilized in further studies to optimize patient outcomes.

Invasive fungal rhinosinusitis associated with COVID-19: Course changes and prognosis predictors.

BACKGROUND: This study aimed to analyze the behavior of acute invasive fungal rhinosinusitis (AIFRS) associated with COVID-19 infection as there has been an increase in the rate of AIFRS cases in the last two years, and many reports connected this rising with the COVID-19 infection. We studied most factors that may impact the prognosis as a trial to find the most affecting factors to improve the outcomes. METHODS: It was a retrospective observational study that included cases from four tertiary referral institutions between November 2020 to February 2022. We included sixty-six patients who suffered from AIFRS associated with confirmed COVID-19. We observed the prognosis of all included patients with a six-month follow-up. We correlated the prognosis with many factors, such as demographic data, medical conditions, blood investigations, the features of fungal infections, and management. RESULTS: Forty-two patients (64%) survived after the AIFRS associated with COVID-19, and twenty-two patients (36%) died. High doses of corticosteroids with prolonged use were the main factors that affected the behavior of the AIFRS associated with COVID-19. HbA1c was a good predictor of the prognosis; a level less than 9.35% may indicate survival with 87.5% sensitivity. CONCLUSIONS: According to this multi-center study, the mortality of the AIFRS associated with COVID-19 was high. The behavior was affected by glycemic control, the type of fungal species, and the type of antifungal therapy. Early surgical debridement, a combination of Amphotericin B with Voriconazole, and anticoagulants helped improve the prognosis.

The novel traction-suturing technique in correction of caudal end deviation of the nasal septum.

BACKGROUND: Caudal end correction is one of the main challenges during septoplasty that needs extra steps and skills. This complex area affects the shape of the nose. Moreover, the caudal end represents the medial boundary of the internal nasal valve. Thus, any deviation may disturb this critical area causing nasal obstruction. This study aimed to evaluate the novel traction-suture technique to correct septal caudal end deviation and its postoperative impact. STUDY DESIGN: This prospective case-series study. SETTINGS: It was held in a tertiary referral university institute between January 2019 to February 2022. METHODS: We included 95 cases who suffered from nasal obstruction and a cosmetic problem because of mild or moderate caudal end deviation. Under general anesthesia, the caudal end was corrected by the novel traction-suturing technique (TST). To evaluate the surgical outcomes and patients' related quality of life, we used two validated questionnaires; the Nasal Obstruction Symptom Evaluation and the Rhinoplasty Outcome Evaluation before the surgery and 1 year after the surgery. RESULTS: NOSE and ROE questionnaires showed statistically significant improvements after the surgery (P value was < 0.001). Complications occurred in seven patients (7.3%), all of which were minor complications. CONCLUSIONS: Traction-suturing technique (TST) improved nasal breathing and patients' satisfaction with their nasal configuration. Traction-suturing is a simple short maneuver that junior doctors can easily learn without distinct complications or recurrence.

The impact of adding platelet-rich plasma during fat graft myringoplasty for managing medium-sized tympanic membrane perforations: A prospective randomized case-control study.

PURPOSE: This study aimed to evaluate the effect of adding platelet-rich plasma (PRP) during FGM to close medium-sized TM perforations. METHODS: This prospective randomized case-control study was conducted from February 2017 to March 2022. We included 320 patients with a medium-sized TM perforation with inactive mucosal otitis media. Transcanal FGM managed all patients under general or local anesthesia according to the patient preference. According to PRP, patients were divided into two groups: the first with PRP (170 patients) and the other without PRP (150 patients). We evaluated the closure rate of both groups one month, six months, and one year after the surgery. Also, we assessed the audiological performance before and one year after the operation for the patients with a successful closure. RESULTS: The closure rate was 87.6 % in the first group and 72.7 % in the second group, with a statistically significant difference between both groups as the P-value, was 0.001. Successful closure of the ABG to <10 dB occurred in 95.3 % of group A and 90.8 % of group B without a statistically significant difference between both groups (P-value = 0.163). CONCLUSIONS: This prospective comparative study on a relatively large number of patients revealed that FGM effectively closed medium-sized TM perforations. It also significantly improved postoperative audiological performance in both groups. Adding PRP during the FGM enhanced the closure success and the healing process without recorded complications. We recommend using the PRP in the routine FGM for closing medium-sized TM perforations.