Objectives: The objective of the current study was to standardize the newly developed, computer based, Arabic Central Auditory Processing Disorder Remediation Program for Selective Auditory Attention Ability. Methods: This was done through the administration of the program to 60 normal Egyptian children aged from 6-12 years. This program included simple non verbal (phase I), verbal (phase II) & complex verbal (phase III) remediation materials recorded in different background noises (story, broad band, babble & cafeteria noise) through 9 levels representing the Signal to Noise ratio starting from level 1 ( ratio +8) & ending by level 9 ( ratio -8). Variables affecting the results of the program games namely age, type of speech material, signal to noise ratio & type of background noise were studied. Results: All tested children could perform all the games except when using speech material (words & phonemes) in story background noise. There was a statistically significant difference between the performance of the children as regards their age & different background noises and signal to noise ratio. Phase III was the easiest game to play & story background noise was the most challenging especially with different speech materials but turned out to be the easiest in phase I when the tested material was environmental sounds Conclusion: The developed Arabic Central Auditory Processing Disorder remediation program by cooperation between Audiology unit, Ain Shams University and Horizon Interaction (soft ware computer company) funded by Information and Communication Technology (ICT) (2006) was standardized including a protocol for rehabilitation of selective auditory attention ability.

Background: Orbital complications of allergic fungal rhinosinusitis (AFRS) are uncommon but can result in significant morbidity if inappropriately managed. Objective: To evaluate the clinical presentation, diagnosis, management, and outcome of orbital complications of AFRS. Methods: Retrospective chart review of 200 cases diagnosed with AFRS. Results: Thirty-two patients had orbital complications of which the most common ophthalmic presentation was proptosis (83%), followed by epiphora (33%), ophthalmoplegia (33%), diplopia (22%), visual loss (13%), and subperiosteal abscess (6%). CT sinus scans showed that 62% of patients had erosion of the lamina papyracea, 24% had intraorbital extension of the disease associated with skull base erosion, 16% presented with bilateral erosion of lamina papyracea, 50% presented with bilateral pansinusitis, and 61% had right-sided predominance. Conclusion: Although orbital complications of AFRS are uncommon, they can be serious and necessitate immediate surgical intervention. Ophthalmologists and otorhinolaryngologists should be familiar with these complications.

Objective: To review the profile and data of patients presenting with unilateral tinnitus in Sohag community and to compare with recorded ones in literature . Subjects and Methods: Four hundrad and sixteen patients presented to Sohag University hospital, Audiology and Balance Unit from January 2005 to August 2010. All patients were complaining of unilateral tinnitus of variable duration. The data reviewed were complete E.N.T examination, basic audiologic evaluation, detailed history of tinnitus, tinnitus matching tests and different investigations according to individual cases. Results: Unilateral tinnitus is a very common problem. It is usually related to serious medical disorders. The most two common causes were unknown etiology in 68 patients (16.3%) and retrocochlear lesions in 64 patients (15.4%). The most two common presentations of hearing were normal hearing in 84 patients (20.1%) and moderate SNHL in 72 patients (17.3%). ABR was the main investigation done for 105 patients, followed by MRI for 85 patients.

Objective(s): To introduce an objective assessment tool designed to measure the development and the evaluation of Naso-septal reconstruction skills by surgeons in the operating room . Study Design: Prospective, observational data collection Setting: Tertiary academic institution Subjects: Otolaryngology residents and otolaryngologists. Methods: We objectively assessed 8 residents in a 5-year residency training program and 2 otolaryngologists using this measure intra operatively. These residents and otolaryngologist were provided with constructive feedback on the basis of their results. Results: In this study both instruments showed face validity, with an overall trend toward a higher score with a more advanced postgraduate year of training and the faculty substantially outperformed residents Conclusion: This Naso-septal Reconstruction assessment tool is a feasible and valid method of evaluating Naso septal Reconstruction skills in the operating Room. We recommend integrated it into surgical evaluation and develop other similar procedural tools

Objective: To compare otoacoustic emissions and auditory brain stem responses in hearing-impaired diabetic patients and matched controls in order to determine the lesion site for hearing loss in diabetic patients. Subjects and Methods: This matched case-control study compared 88 hearing-impaired type 2 diabetic patients with 63 age- and gender-matched controls. Cochlear function was evaluated on the basis of otoacoustic emissions. The presence and amplitude of spontaneous otoacoustic emissions, distortion product amplitudes and latencies were recorded. Retrocochlear function was evaluated on the basis of auditory brainstem response. Absolute latencies of waves I, III, and V and inter-peak latencies of I–III, III–V, and I–V of the auditory brainstem were compared. Results: In the case of diabetic patients, no spontaneous otoacoustic emissions were produced, suggesting cochlear damage. Distortion product otoacoustic emission amplitudes at 1, 2, 4, and 6 kHz, but not the latencies, were significantly different between diabetic and control patients. Wave V latency was also significantly different between the 2 groups while the values of all other auditory brainstem parameters were similar. Conclusion: Cochlear damage may be one of the causes of hearing loss in diabetic patients. Distortion product otoacoustic emission amplitude may be used for assessment of hearing loss in diabetic patients.

Objectives: To evaluate the safely and effectively using of Hemostatic Fibrin Glue in drain-free thyroidectomies. Study Design: Prospective cohort study of 25 patients undergoing thyroidectomies. Surgery was done using tessel without the use of surgical drains. The complication and duration of the hospital stay were obtained. Methods: Thyroidectomies were undertaken by one surgeon. Prior to wound closure, the skin flap and wound bed were approximated using Tisseel tissue sealant, and no drains were used. Data regarding incidence of any complication and the duration of the hospital stay were obtained. Patients were followed to assess surgical outcome and document any complications. Results: There were no cases of seroma, hematoma, recurrent laryngeal nerve paresis or paralysis. However, there were six patient who had hypocalcaemia post operatively. Three of those six patient had hypocalcaemia for one month, two patients had it for three months, and one patient had it for more than six months. Conclusions: Thyroidectomies can be undertaken safely and effectively without the need for surgical drains. Hemostatic actions of fibrin glue precluded the necessity of usage of drains.

Background and Objectives: Allergic fungal sinusitis (AFS) is a chronic disease of immune competent patients. Some time expansion, thinning and erosion of the paranasal sinus (PNS) wall can be seen in these cases. We like to elaborate on what seems to be a serious sequelae of this common disease. Methods: We reviewed 84 cases of AFS regarding behavior of the disease and incidence and characteristics of paranasal sinus wall expansion, thinning and erosion. Results: Twenty-two patients were deemed to have bone erosion ascertained by CT scan and/or MRI. Eight patients showed intraorbital extension and 7 patients had intracranial extradural extension. All patients were treated by endoscopic sinus surgery and medical treatment. Conclusion: Paranasal sinus wall expansion, thinning and erosion is a well known feature of the AFS which can lead to a serious complication if not diagnosed and treated properly. CT Scan imaging of PNS is critical to diagnose and assess the erosion and its extent. No extra measure need to be done for the erosion or the extension of the disease apart from clearing the sinuses from the inflammation.

Background: Tonsillectomy with or without adenoidectomy is a worldwide famous pediatric surgery performed by otorhinolaryngologists. This study was designed to review the records of carefully selected children under 4 years of age who underwent tonsillectomy with or without adenoidectomy over a period of 5 years. We studied the safety and indications for tonsillectomy. Design and Setting: A retrospective study was conducted in King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia. Subjects & Methods: The study included 51 children (29 male & 22 female), under 4 years of age (ranged from 12 to 48 months) who underwent tonsillectomy with or without adenoidectomy in between 1989 and 1993 in the Otorhinolaryngology Department, King Abdulaziz University Hospital. Safety and indications for tonsillectomy were also recorded. Myringotomy with or without ventilation tube insertion was performed in cases of otitis media with hearing loss and tonsillitis. Results: Through 1989-1993, the overall number of tonsillectomy with or without adenoidectomy, performed in the Otorhinolaryngology Department, King Abdulaziz Uuniversity Hospital, was 1159. Of the 1159, only 51 (4.4%) were under 4 years of age, ranged from 12 to 48 months. 1108 (95.6%) of total were over 4 years of age. Indications for tonsillectomy under 4 years of age were recorded and were as the following: Recurrent tonsillitis in 24 children (47.05%). Upper airway obstruction due to adenotonsillar hyperplasia causing nasal obstruction and mouth breathing in 16 children (31.37%), Recuurrent otitis media with hearing loss and tonsillitis in 6 children (11.76%), Tonsillar mass in 4 children (7.84%) and Ventricular septal defect in 1 child only (1.6%). The postoperative follow up of these 51 children was uneventful and all children were discharged in the next day of surgery. Conclusion: The results of this study show that tonsillectomy under the age of four is a safe procedure, provided that the patient is carefully selected, using expert anaesthesia on an in-patient basis with close post-operative monitoring. We recommend conducting a recent similar retrospective study to see if there is epidemiologic change in trend of indications for tonsillectomy in our saudi pediatric community.

Surgical correction of craniofacial deformities and asymmetries remains to be an extreme challenge. There are numerous surgical procedures which could be performed in order to correct such deformities. Surgical correction consists of a combination of osteotomies and bone grafting techniques. However, bone grafting techniques have some disadvantages, which include donor site morbidity and graft resorption. Ever since the introduction of distraction osteogenesis (D.O) to the craniofacial region it has been used to correct many congenital and acquired facial deformities. D.O could be used as part of a staged surgical procedure , which may need to be reapplied according to the degree of deformity or it is sometimes used as a definitive surgical correction. We discuss the use of D.O as a set up surgical procedure which creates a more favourable surgical base for further surgical procedures like osteotomies and bone grafts to prevent surgical relapse and failure .We report two cases with facial asymmetry in which DO was used as a set up surgery .In addition , we discuss the indications and list the advantages of D.O in each case.

Adenoid cystic carcinoma is a well recognized tumor that is frequently encountered in the major salivary glands and in minor salivary glands. It is rarely seen in larynx. Here we are reporting a unique case of rare presentation of this tumor in the larynx.

Intractable epistaxis is an otolaryngological emergency condition with high morbidity and potential mortality, which warrants urgent attention and intervention. Different methods of treatment are available including nasal packing, cauterization, artery ligation & embolisation. We report 3 cases that underwent selective angioembolization after failure of the conventional methods of nasal packing and cautery to the bleeding areas under general anaesthesia. They all received blood transfusion. Post procedure they made a quick recovery and were discharged with no complications.

Internal jugular vein (IJV) thrombosis is a rare but potentially fatal condition. A 59-year old female patient was referred to our hospital 3 weeks after ingesting foreign body (FB). Two endoscopic examinations at the referring hospital were negative. On arrival at our hospital, she was in pain and the left side of her neck was swollen. Computed tomography (CT) of the neck revealed the presence of a slender pointed radio-opaque FB in the left IJV together with large thrombus containing small central abscess. Surgical removal of the foreign body was performed together with ligation of the left IJV. Postoperative recovery was uneventful. Medical centers without proper diagnostic facilities should herald up transferring such cases to better equipped centers.