Efficacy of autologous platelet-rich plasma on graft uptake in myringoplasty: a single-blinded randomized control trial

Background and aim Chronic otitis media is defined as a chronic inflammation of the middle ear cleft producing irreversible pathological changes. The myringoplasty aims at the reconstruction of the tympanic membrane using a graft material. Autologous platelet-rich plasma can be used along with the graft to have a successful outcome. The aim of the study was to assess the efficacy of autologous platelet-rich plasma on graft uptake in myringoplasty. Methods This was a randomized controlled trial with a sample size of 76 patients. All patients were above 18 and below 55 years of age diagnosed with chronic suppurative otitis media and were planned for myringoplasty. The participants were randomly allotted to two groups by block randomization (block of 4). Intra-operatively, group I (n=38) received platelet-rich plasma–soaked gel foam and group II (n=38) was taken as the control group who received saline-soaked gel foam and examined by a blinded examiner at the end of 1st and 3rd months. Results The mean air-bone gap reduction post-operatively in the platelet-rich plasma group was 8.68 ± 4.8 (P value 0.034) and 6.05 ± 4.05 in the control group. The improvement in pure-tone average in the platelet-rich plasma group (P = 0.009) is more than that in the control group. The graft uptake was higher among the platelet-rich plasma group than the control group both at 1st and 3rd months (P value 0.049) which were statistically significant. Conclusion The present study concludes that the usage of platelet-rich plasma in the conventional myringoplasty technique has improved the success rate of graft uptake and reduced the graft migration. Trial registration Clinical Trials Registry-India (ICMR-NIMS) CTRI/2020/04/024416. Date of registration: 01/04/2020. Date of enrolment of the first participant to the trial: 06/04/2020. URL of the trial registry: http://www.ctri.nic.in. Highlights Usage of autologous platelet-rich plasma (PRP) in conventional myringoplasty in underlay technique. Assessment of graft uptake, percentage of perforation closure, and the audiological outcome. Significant mean reduction of ABG in the PRP group. Significant improvement in PTA average in the PRP group. Graft uptake and percentage of perforation closure were higher in the PRP group and the control group. PRP is also beneficial in revision cases.

Relation between exposure to different multimedia programs and presentation of attention deficit hyperactivity disorder

Background The current study aimed at constructing an Arabic-language questionnaire to investigate the association of the severity of ADHD with children’s degree of exposure to multimedia per day and the age of starting the engagement, and the effect of different multimedia programs on the attention, language, and socio-behavioral aspects in children presented with attention deficit hyperactivity disorder (ADHD). The present study was conducted on 69 children who attended the Phoniatric Unit at Mansoura University Hospitals and were divided into 2 groups: 30 normal typically developing children as a control group and 39 children with ADHD as the study group. The study group was subdivided into 3 subgroups according to ADHD severity; each subgroup consisted of 13 children. Results The time at which the child started to be exposed to multimedia showed no significant differences among ADHD subgroups as all of the cases started before the age of 2 years. Kids with mild ADHD had a significant increase in watching children’s programs, cartoons, rhymes, and commercials than the other two higher grades (moderate and severe) of ADHD. Conclusion The constructed Arabic questionnaire proved to be reliable and a valid tool that examined the relationship between multimedia usage and ADHD.

A large and invasive pleomorphic adenoma of nasal cavity: a rare case report and review of literatures

Background Pleomorphic adenomas are common tumors of major salivary glands. However, the localization in nasal cavity originating from the lateral wall is exceptional. This work is a presentation of a very rare case that presents the diagnostic challenge, considering the multitude of malignant and benign differential diagnosis. A discussion of surgical approach, and the possible complications associated with it. Case presentation This is the case of an invasive nasal pleomorphic adenoma in a 48-year-old patient; the patient underwent complete excision through combined left lateral rhinotomy and functional endoscopic sinus surgery. Conclusion Pleomorphic adenoma is a very rare benign tumor of the nasal cavity. Clinical diagnosis is generally difficult regarding the multitude of differential diagnosis. Confirmation is established upon histological aspect. This is a case of a very rare large pleomorphic adenoma of nasal cavity originating from the lateral wall, associated with differential diagnosis, and surgical approaches, as well as perceivable complications. The strength of this work is to point out the importance of complete surgical extirpation and thorough follow-up to prevent recurrences and malignant transformation.

Low-level laser therapy for treatment of tinnitus in Red Sea scuba divers: a randomized clinical study

Background Scuba diving has become a popular hobby. However, diving puts the auditory system at the risk of a wide variety of complaints including tinnitus. Low-level laser therapy is a new modality in treatment of tinnitus. This study evaluates effect of laser therapy on tinnitus of scuba divers in Red Sea. This randomized study included 200 scuba diving patients with tinnitus without any other audiological symptoms. They were randomly divided into two groups: GI (n=100) patients were subjected to 60 sessions of laser therapy, and in the other group GII (n=100), the machine was off while doing the procedure. The Tinnitus Questionnaire (TQ) was done every 20 days to evaluate the severity of the tinnitus for both groups. Results Both groups were matched regarding age and sex distribution. GI group experienced significantly decreased tinnitus severity compared to GII after laser therapy. There was no relation between duration of diving and laser therapy effect in GI. Conclusion Laser therapy is effective in treatment of tinnitus of scuba divers and its effect is increased by number of laser sessions.

Acoustic characteristics of voice and speech in Arabic-speaking stuttering children

Background Using different methodologies, several researchers have reported certain acoustical and physiological differences between fluent utterances of stutterers and normally fluent speakers. The aim of this study was to determine acoustic characteristics of voice and speech in Arabic-speaking stuttering children in comparison to normal children and correlate these characteristics with stuttering severity. A sample of 80 Arabic-speaking Egyptian children (including 40 typically developing children and 40 stuttering children) in the age range 5–8 years were subjected to acoustic analysis of voice and speech using the Praat software. Results The stuttering children showed significantly higher values of jitter and shimmer in prolonged /a/ vowel sample, as compared to the normal group. This may reflect the subtle differences in laryngeal functioning or in the complex interaction among the laryngeal, respiratory, and the vocal tract systems in stuttering children. Both jitter and shimmer of prolonged /a/ vowel demonstrated significant positive moderate correlation with stuttering severity as assessed by SSI3. F0 was significantly higher in females than in males, both in normal and stuttering children. Conclusions The present study revealed significant differences in the acoustic parameters of voice and speech between Arabic-speaking stuttering children and normal children. Some of these acoustic parameters were significantly correlated with stuttering severity. Acoustic analysis can be used as simple, quick, and cheap tool for assessment of stuttering in children and might be a valuable addition to the diagnostic set for assessment of stuttering severity.

Vitamin D level in Egyptian children with otitis media with effusion

Background This prospective case-control study was conducted from June 2018 to October 2019 in a tertiary referral hospital to investigate the correlation between otitis media with effusion (OME) and serum vitamin D level in children. The study population included 50 children with adenotonsillar hypertrophy and OME (group A) who underwent adenotonsillectomy with tympanostomy tubes insertion compared to 50 children free from any medical or surgical disease (control group). Serum 25-hydroxy vitamin D was measured using electrochemiluminescence technique for both groups. Results The mean age in group A was 53.4 ± 9.2 months whereas in group B (control group) it was 65.0 ± 13.2 months (P <0.001). In group A, there were 29 (58 %) male children and 21 (42%) female children while in group B, there were 27 (54%) male children and 23 (46%) female children (P = 0.689). The mean vitamin D level in group A was 16.0 ± 6.1 ng/mL with a minimum of 7 ng/mL and a maximum of 32.10 ng/mL. In group B, the mean vitamin D level was 15.7 ± 5.3ng/mL with a minimum of 7.38 ng/mL and a maximum of 27.90 ng/mL. The statistical analysis showed that there was no significant difference in the level of vitamin D level between both groups (P = 0.770). Conclusion In this study, the mean level of serum vitamin D was low in children suffering from OME with adenotonsillar hypertrophy and in children without any medical or surgical disease; however, there was no statistically significant difference in the mean serum level of vitamin D between both groups. Therefore, a further study on a larger sample is needed.

Post-traumatic tension pneumocephalus and cystic angiomatosis of the skull: case report

Background Tension pneumocephalus is an increasing air trapped intracranially. Either spontaneous, post-traumatic or iatrogenic in origin. Cystic angiomatosis is a benign vascular hamartoma of the skeleton, when acquired it is either due to trauma or infection. This is the second report in English literature of post-traumatic delayed tension pneumocephalus with the development of cystic angiomatosis of the skull bone. Case presentation A 55-year-old gentlemen, presented with scalp swelling of 6-month duration with history of head trauma 2 years back. The swelling was increasing and associated with progressive walking difficulties and left hearing loss. CT scan and MRI revealed extradural pneumocephalus, parietal and occipital pneumatocele, and multiple lytic bony lesions, left mastoid hyperpneumatization with inner table defect communicating with the extradural space. Diagnosis of delayed extradural tension pneumocephalus was made. Surgical exploration revealed multiple bony defects of parietal, temporal and squamous part of left temporal bones, confirmed extradural pneumocephalus with intact dura. Repair of mastoid defect of (0.5 × 0.5 cm), excision of pneumatocele and removal of lytic bones were performed. Defective bone “cribriform-like” was identified at occipital and parietal regions centrally with a defect of nearly 7 × 7 cm. Future cranioplasty was considered after 6 months. Histology of bony chips and surrounding soft tissues is recognized as cystic angiomatosis. Conclusions The present case developed two very rare complications, following trivial head trauma; the first complication was delayed extradural tension pneumocephalus with pneumatocele which presented 2 years after trauma, the origin of air was from a defect of the inner table of the mastoid, the second complication was cystic angiomatosis of the skull bones. Both complications were managed surgically in one operative session as a combined neurosurgery and otolaryngology teams approach.

Audiological findings of a patient with H syndrome: case report

Background H syndrome is an autosomal recessive disorder caused by mutations in SLC29A3. Hyperpigmentation, hypertrichosis, hyperglycemia, and hearing loss are some characteristics of this disorder, and it has a prevalence of < 1/1000. The aim of this report is to spread awareness among otologists, audiologists, and pediatricians about this syndrome and its audiological features. Case presentation An 8-year-old male with a diagnosed H syndrome registered to our clinic with a complaint of hearing loss. The patient was diagnosed with hearing loss in a different clinic using only the air-conducted click auditory brainstem response test which showed wave V at 60 dB nHL for the right ear and at 80 dB nHL for the left ear. The initially performed pure tone audiometry (PTA) test in our clinic revealed a bilateral asymmetric hearing loss with a moderate sensorineural hearing loss in the right ear and a profound mixed hearing loss in the left ear. The performed air conducted click auditory brainstem response (ABR) result showed wave V at 55 dB nHL for the right ear and at 70 dB nHL for the left ear. Then, the repeated PTA test revealed a mild-severe sensorineural sloping hearing loss in the right ear and a severe sensorineural hearing loss in the left ear. Conclusion Although hearing thresholds in H syndrome could be within normal limits in some patients, sensorineural hearing loss is an important characteristic feature for this syndrome. Sensorineural hearing loss could be progressive or of sudden onset and ranges from mild to profound. Thus, it must be taken into consideration to apply the audiological follow-up regularly and paying attention to the patient’s complaints; also, a regular follow-up for language development of children with H syndrome and for the hearing aids is advised.

Olfactory dysfunction as a screening tool for mild and moderate cases of COVID-19: a single-center prevalence study of 646 patients in flu clinic

Background To evaluate the prevalence of olfactory dysfunction (OD) in the Indian population and to establish olfactory dysfunction as a screening tool in COVID-19-positive patients. Data was collected using a questionnaire from laboratory-confirmed COVID-19 patients. The patient’s demographic and clinical details were analyzed to calculate the prevalence of olfactory dysfunction, general symptoms like fever, cough, malaise, diarrhea, along with the sinonasal symptoms. All the symptoms were self-reported, and no objective tests were carried out. Results Out of 646 laboratory-confirmed cases of COVID-19 infection, olfactory dysfunction was self-reported by 465 (72%) patients and gustatory dysfunction (GD) was seen in 406 (62.8%) patients. The affected males (416) were proportionately more than females (230), with the mean age of our study population being 39.47 ± 13.85 (range 18–85 years). The most common symptoms were myalgia (n = 494, 76.5%), cough (n = 471, 72.9%), and fever (n = 444, 68.7%). Out of 465 patients with olfactory dysfunction, only 108 (23.2%) reported nasal obstruction. Five hundred thirty-three (82.5%) RT-PCR-positive patients did not give a history of smoking; however, co-morbidity was reported by 163 patients, of which 117 were found to have olfactory dysfunction. One hundred seventy (26.3%) patients gave a positive contact history. 13.6% reported olfactory dysfunction as their first symptom. A positive association was seen between olfactory dysfunction and gustatory dysfunction Conclusions Our study demonstrates a high prevalence of 72% in the Indian population. We recommend that anosmia be used as a screening tool to identify mild to moderate cases of COVID-19.

Efficacy of intranasal fluticasone propionate and budesonide in management of allergic rhinitis—a prospective comparative study

Background Allergic rhinitis (AR) or Hay fever is a chronic inflammation of the nasal mucosa induced by IgE-mediated hypersensitivity due to exposure of various allergens. AR occurs as a response against these inhaled allergens that cause inflammation of nasal mucosal membranes. In this study, a reliable treatment for allergic rhinitis with maximum effectiveness and minimal side effects was assessed. This study compared the effectiveness of intranasal Fluticasone propionate (FUP) and intranasal Budesonide (BUD) in reducing the eosinophil count and in improving the nasal and ocular symptoms. This prospective study was conducted on 62 cases of allergic rhinitis and patients with mild-to-moderate allergic rhinitis were selected for the study. They were randomly divided into two groups; group I consists of 30 patients who received intranasal Fluticasone propionate aqueous spray, total daily dose of 200 μg (50 μg/spray) as 2 sprays in each nostril administered once daily, whereas the group II consists of 32 patients who received intranasal Budesonide aqueous spray, total daily dose of 400 μg/day (100 μg/spray) as 1 spray in each nostril administered twice daily. Results Analysis on patient-based symptom scores revealed that both the groups showed statistically significant reduction in symptoms. Fluticasone propionate was found to be significantly more effective (P < 0.05) than Budesonide in reducing sneezing, nasal itching and majority of symptoms of individual symptom scores. Budesonide showed somewhat similar effect in reducing nasal blockage at 4 weeks of treatment. Conclusion Clinically, both the drugs showed statistically significant improvement when compared to baseline, but Fluticasone propionate was superior at reducing nasal symptoms, ocular symptom and eosinophil count.