Click SP/AP Area Ratio Vesrus Tone Burst SP Amplitude to Diagnose Ménière's Disease Using Electrocochleography.

OBJECTIVES: To evaluate the sensitivity and the specificity of summating potential (SP)/action potential (AP) area under the curve (AUC) ratio by a transtympanic electrode and a click stimulus (TT-CS), SP/AP AUC ratio by an extratympanic electrode and a click stimulus (ET-CS) and SP amplitude value by a transtympanic electrode and tone burst stimulus (TT-TBS) in regard of Ménière's disease (MD) diagnosis. This is the first study that compares SP amplitude value performed by a TT-TBS and the SP/AP AUC ratio performed by a TT-CS. STUDY DESIGN: Retrospective comparative study. SETTINGS: Ninety-five patients met the inclusion criteria for electrocochleography (ECochG) testing in a tertiary care center. METHODS: The sensitivity and specificity of our different ECochG protocols were calculated in regard of the diagnosis of MD. RESULTS: The patients' mean age was 54 years old (female predominance). The sensitivity and the specificity of SP/AP area ratio by a TT-CS were 88.5% and 70.0%, respectively. On the other hand, the sensitivity and specificity for the SP amplitude value by a TT-TBS were 60.0% and 55.6%, respectively. SP/AP area ratio by TT-CS was statistically better than SP amplitude value by TT-TBS to detect MD disease (P = .016). However, no difference was identified between SP/AP area ratio by ET-CS and SP amplitude value by a TT-TBS (P = .573). CONCLUSION: SP/AP area ratio by click stimulation has higher sensitivity and specificity to detect MD compared to SP amplitude value by tone burst stimulation. ECochG would be extremely useful in the diagnosis of MD if we use the SP/AP area ratio (sensitivity: 88.5%); therefore, it changes the bad reputation of ECochG sensitivity using SP/AP amplitude ratio (sensitivity: 51.7%) for the diagnosis of MD.

Suspicion and Treatment of Perilymphatic Fistula: A Prospective Clinical Study.

Background: Since the discovery of the perilymphatic fistula (PLF), the diagnosis and treatment remain controversial. If successfully recognized, the PLF is surgically repairable with an obliteration of the fistula site. Successful treatment has a major impact on patient's quality of life with an improvement in their audiological and vestibular symptoms. Objective: To prospectively investigate patients' clinical and audiological evolution with PLF suspicion after middle ear exploration and obliteration of the round and oval window. Study Design: Prospective comparative study. Setting: Tertiary care center. Methods: Patients were divided into two groups: Group I consisted of patients where no PLF had been identified intraoperatively at the oval and/or at the round window, and Group II consisted of patients where a fistula had been visualized. Patient assessment was a combination of past medical history, the presence of any risk factors, cochlear and vestibular symptoms, a physical examination, temporal bone imaging, audiograms, and a videonystagmogram (VNG). Results: A total of 98 patients were divided into two groups: 62 in Group I and 36 in Group II. A statistically significant difference regarding gender was observed in Group II (83.3% of males vs. 16.7% of females, p = 0.008). A total of 14 cases (4 and 10 in Groups I and II, respectively) were operated for a recurrent PLF. Fat graft material was used in the majority of their previous surgery; however, no difference was found when comparing fat to other materials. In addition, no statistically significant difference was noted between Groups I and II concerning predisposing factors, imaging, VNG, symptom evolution, or a physical exam before the surgery and at 12 months post-operative. However, both groups showed statistically significant hearing and vestibular improvement. On the other hand, the air conduction (AC) and bone conduction (BC) at each frequency were not statistically different between the two groups before surgery but showed statistically significant improvement at 12 months post-operatively, especially for the BC at the frequencies 250 (p = 0.02), 500 (p = 0.0008), and 1000 Hz (p = 0.04). Conclusions: Whenever you suspect a perilymphatic fistula, do not hesitate to explore middle ear and do window obliterations using a tragal perichondrium material. Our data showed that cochlear and vestibular symptoms improved whether a fistula had been identified or not.

Is gelfoam sealing necessary in stapes surgery?

BACKGROUND: Sealing the oval window around the piston after fenestration with Gelfoam® is a common practice in stapes surgery for otosclerosis. OBJECTIVES: To analyse the effect of using or not using Gelfoam® as a sealing material. METHODS: A retrospective study was performed on 418 patients who underwent stapes surgery from 2013 until 2019. Data were collected from medical records in a tertiary centre. 215 cases in the Gelfoam group and 203 cases in the control group without sealing were included. The main comparisons were made between these two groups in terms of vestibular (primary outcome) and audiological outcomes and complications. RESULTS: The patients' mean age was 47 years with a mean follow up of 50 months and a female predominance (65.6%, p = .049). There was no significant difference in terms of postoperative vertigo (11.6% vs 8.4%) or audiological outcomes in between Gelfoam and control group respectively. The average postoperative air-bone gap in the Gelfoam group was 4.6 dB vs. 5.3 dB in the control group (p = .634). CONCLUSION AND SIGNIFICANCE: No difference were identified in vestibular or audiological outcomes during stapes surgery when using or not using Gelfoam® in the middle ear.

Tolerance and safety of 45S5 bioactive glass used in obliteration procedures during middle ear surgery: Preliminary results.

OBJECTIVE: Otologists face many disadvantages after extensive mastoid drilling and canal wall down technique in cholesteatoma surgery. Mastoid and epitympanic cavity obliterations or reconstructions after canal wall down procedure using bioactive glass seem to be an interesting solution to overcome some of these disadvantages. Bioactive glass offers many benefits including the availability when there are no sufficient autologous materials for obliteration, its antibacterial activity in chronic infected ear and decreasing the recidivism of cholesteatoma. The objective of this study is to evaluate the tolerance and safety of 45S5 bioactive glass as a filing bone-synthetic material by clinical, audiological and radiological examinations. METHODOLOGY: A retrospective study of 42 patients who had undergone obliteration of mastoid or/and epitympanic cavity with 45S5 bioactive glass between, November 2017 to January 2019. Data from clinical follow-ups, audiological assessment, CT-scan and MRI were analyzed. RESULT: The patients' mean age was 49.8 years old. Microscopic examinations showed dry well-healed tympanic membranes and external auditory canals for 95.2% of the patients after 1 year. Inner ear injuries after obliteration were not observed by comparing pre and post-operative bone conduction audiometry (p value 0.457). No facial palsy was reported post-operatively. One-year postoperative radiological assessments did not reveal any silent implantation of cholesteatoma or residual disease. CONCLUSION: Mastoid and epitympanic obliterations with 45S5 bioactive glass seem to be a tolerable and safe option in cholesteatoma surgery with favorable outcomes similar to other member of bioactive glass especially the S53P4.

Magnetic resonance imaging after cochlear implants.

INTRODUCTION: Most cochlear implants are currently compatible with magnetic resonance imaging (MRI) up to 3 T. Nevertheless, this does not completely eliminate the risk of serious accidents. Implant displacements and other adverse events with compatible implants have been reported in the literature. CASE REPORTS: Among the six patients who had MRI after receiving implants at our center, we report three cases with adverse events related to the examination. The first case was complicated by magnet displacement with partial demagnetization. The second case showed total demagnetization, which necessitated removal and reimplantation of the implant. The third case involved severe pain sensation which disrupted the MRI scan. The smallest artifact was found with 3D MRI angiography, and largest artifact was found with diffusion and T2 FLASH. DISCUSSION: Moving the patient into the MRI apparatus must be supervised by an otorhinolaryngology specialist or an experienced radiologist. It is important to consider the magnetic field directions, so that angle between the implant magnetic fields and the MRI B0 always remains less than or equal to 90°. In addition, we recommend the use of an "arrow drawing" to facilitate the orientation of the magnetic field directions. Furthermore, to prevent magnet displacement, we recommend systematic use of a protective splint in addition to bandaging.

Sialendoscopy under conscious sedation versus general anesthesia. A comparative study.

OBJECTIVE: Sialendoscopy is a minimally invasive emerging approach, the general surgical technique has been published but many essential questions still need to be addressed with the aim of improving outcomes. For instance, should we systematically perform sialendoscopy under conscious sedation (CS) or general anesthesia (GA)? What are the limitations of CS? The objective of this study is to compare these two modalities. METHODOLOGY: A retrospective study of 70 patients who had undergone a sialendoscopy between 2014 and 2016 (34 under GA and 36 under CS). Comparisons were made between these two groups in term of operative time, stone size and location, tolerability, operative success and post-operative pain. RESULT: The patients' mean age was 45.33 years. The operative success rate among the GA group was 79.4% vs. 88.9% in the CS group (P = 0.276), while complications for both groups were comparable. All patients considered the intervention under CS to be tolerable. CONCLUSION: Sialendoscopy under CS or GA demonstrated the ability to access large and distal stones among the different salivary glands with an excellent tolerability. Anesthesia type should be based on surgeon and patient preference Nevertheless, patient reassurance and surgeon experience are important to producing a good result with CS.

Acute rhinosinusitis during Hajj season 2014: Prevalence of bacterial infection and patterns of antimicrobial susceptibility.

BACKGROUND: The presence of large number of pilgrims during Hajj in Makkah region increases the risk of respiratory diseases. In this study, we aimed to assess the bacteriology of acute rhinosinusitis (ARS) during Hajj season and to demonstrate the antimicrobial susceptibility patterns that should guide the clinicians towards more appropriate antibiotic use. METHODS: Patients with ARS presenting during Hajj season of 2014 were prospectively enrolled. According to EPOS2012 criteria. Sampling of sinus secretions was performed from the middle meatus adjacent to the maxillary sinus ostium via endoscopic guidance. Over all, the study has covered all ENT, emergency and outpatient departments in Hajj. RESULTS: Two hundred and twenty six patients with ARS were enrolled in the study. Pathogenic bacteria were identified in 93 (41.2%) patients. Of the 93 patients with bacterial ARS, Staphylococcus aureus was isolated in 46 (49.5%) patients, out of which 13 (28.3%) were methicillin-resistant Staphylococcus aureus (MRSA).The second most common group of bacterial isolates was Enterobacteriaceae such as Escherichia coli, and various Klebsiella species. Antibiotic sensitivity showed that methicillin-sensitive Staphylococcus aureus (MSSA) was also sensitive to cephalosporins, quinolones and clindamycin, while exhibiting relatively less sensitivity rates to amoxicillin-clavulinic acid and macrolides. CONCLUSION: Our study demonstrates the importance of assessing the bacteriology of ARS to help implement guidelines for proper treatment and prevention protocols during Hajj season.

Endoscopic Dacryocystorhinostomy (DCR): a comparative study between powered and non-powered technique.

BACKGROUND: Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstruction. Essentially there are two approaches: external and endoscopic. Several modalities are used in endoscopic DCR; all aiming to improve success rate, reduce complications, and shorten operative time. Both kerrison punch and drill are widely used in endoscopic DCR with non-conclusive knowledge about differences in operative details as well as on the outcome. The aim of this study is to compare between powered (drill) and non-powered (kerrison punch) DCR to clarify the superiority of one over the other. METHODS: A retrospective chart review of 59 patients who underwent endoscopic DCR procedure at our institution from June 2013 until July 2014 (34 kerrison punch and 32 powered drill). Operative details, surgical outcome and complications were compared between both groups. RESULTS: A total of 66 endoscopic DCRs were performed on 59 patients. Procedure success rate among kerrison punch group was 87.88% vs. 90.9% in powered drill group (p = 0.827), while complications for both groups were statistical not significant (p = 0.91). The mean operating time among kerrison punch group was significantly lower than in powered drill group (75 min vs. 125 min, p = 0.0001). CONCLUSION: Kerrison punch showed significant reduction in operating time when compared to powered drill for endoscopic DCR. No statistically significant difference was found between both groups regarding procedures' success rate and complication.

Malignant transformation of persistent endometriosis after hysterectomy.

The malignant transformation of persistent endometriotic implants into endometrioid adenocarcinoma is rare, especially after remote hysterectomy and salpingo-oophorectomy (TAH-BSO), and there are few cases reported in the English language literature. Patients receiving estrogen replacement therapy are common among the reported cases. We present a case that demonstrates the possibility of malignant transformation in a 53-year-old female, known case of endometriosis, who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with no evidence of malignancy in the final pathology report. After 9 years, she presented with lower abdominal mass, and histopathological studies confirmed the diagnosis of well-differentiated endometrioid adenocarcinoma. The possibility of malignant transformation and possible risk factors are discussed with a brief literature review. 

Avastin and diode laser: a combined modality in managing epistaxis in hereditary hemorrhagic telangiectasia.

A patient with hereditary hemorrhagic telangiectasia is a rare presentation to the otolaryngologist in clinical practice. They almost present with epistaxis, which is recurrent, spontaneous and can be functionally and socially debilitating for the patient. Diode laser cauterization and Avastin intranasal injection showed significant improvement in epistaxis severity score. We report a case of hereditary hemorrhagic telangiectasia with chronic epistaxis (hemoglobin 3.4 mg/dl) managed with Diode laser and intranasal Avastin injection with great improvement in life quality and decrease in epistaxis attacks. Despite all treatment options absolute eradication of epistaxis attacks is difficult to obtain in these cases.