Publications by authors named "Samy Elwany"

16 Publications

  • Page 1 of 1

Passive smoking induces nasal biofilms in children.

Int J Pediatr Otorhinolaryngol 2021 Jul 7;146:110755. Epub 2021 May 7.

Clinical Sciences Department, University of Sharjah, United Arab Emirates.

Objectives: Passive exposure of children to cigarette smoke has been implicated in several recalcitrant respiratory childhood disorders. However, to our knowledge, no information is available regarding the connection between passive exposure to tobacco smoke and the formation of nasal biofilms in children. The present study was therefore geared at investigating the hypothesis that exposure of children to household passive smoking may induce the formation of nasal biofilms.

Methods: The study included 20 children between the ages of 6 and 12 years with a positive history of prolonged exposure to household passive smoke, and who required inferior turbinate reduction together with other procedures. Another 20 children who required similar surgeries but with negative history of exposure to household smoking formed the control group. None of children, in the study and control groups, had evidence of adenoids or infective rhinosinusitis. At the time of surgery, a tiny biopsy was taken from the lower border of the inferior turbinate. The specimens were processed for scanning and transmission electron microscopy.

Results: The nasal mucosa of 11 out of 20 children with positive history of exposure to passive smoking showed biofilm formation. Ten of these biofilms grew S. aureus. On the other hand, only one child in the control group showed nasal biofilm. Longer exposure to tobacco smoke and higher urinary cotinine levels were associated with more frequent biofilm formation. Likewise, children of heavy smokers developed biofilms more frequently than other children. On the other hand, the age of the children and nasal allergy had no effect on the chances of biofilm formation.

Conclusions: This is a preliminary report showing that children exposed to household passive cigarette smoking may develop nasal biofilms. Development of these biofilms may increase susceptibility of affected children to persistent sinonasal and possibly other respiratory infections.
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http://dx.doi.org/10.1016/j.ijporl.2021.110755DOI Listing
July 2021

Quitting smoking reverses nasal mucosal changes.

Eur Arch Otorhinolaryngol 2020 Jun 12;277(6):1691-1698. Epub 2020 Mar 12.

LHI, Orlando, USA.

Background: Smoking, whether active or passive, has proven deleterious effects on the nasal mucosa. There is also a link between smoking and development and/or maintenance of chronic rhinosinusitis (CRS). Reversal of smoking-induced mucosal changes after quitting smoking is still unconfirmed and controversial. The present study investigated the possibility of reversal of smoking-related nasal mucosal changes back to normal after completely quitting smoking.

Methods: The study was performed on 32 smokers whose nasal mucosa was previously biopsied for electron microscopic examination and then they completely quit smoking. Smoking history of the participants and duration of cessation of smoking were recorded. A tiny 1-mm3 biopsy was taken from the inferior turbinate 1 cm behind its anterior end and processed for electron microscopy. The specimens were processed for electron microscopy and the sections were examined by a pathologist who was blinded to the identity and smoking status of the participant. The results of electron microscopic examination of the nasal mucosa before and after quitting smoking were compared.

Results: The mean duration of quitting smoking was 30.75 months (± 8.26). Examination of the electron microscopic sections before quitting smoking showed variable degrees of loss of cilia and columnar cells, edema between the epithelial cells, few goblet cells, hyperplasia of seromucinous acini, and vascular congestion. The pathologic changes correlated positively with the smoking index of the participant. On the other hand, the sections after quitting smoking showed variable degrees of regeneration of the ciliated cells and decreased vascular congestion. Numerous goblet cells and seromucinous acini were seen. Less pathologic changes were observed with longer durations of cessation of smoking.

Conclusions: The present study showed an association between smoking and the nasal mucosa. Smoking has several injurious effects on the nasal mucosa. However, the nasal mucosa has excellent regeneration potentials and quitting smoking for sufficient periods of time may reverse these deleterious changes. Considering the established link between smoking and CRS, quitting smoking may help smokers to overcome their recalcitrant disease. This should be further investigated.
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http://dx.doi.org/10.1007/s00405-020-05896-xDOI Listing
June 2020

A Myriad of Scleroma Presentations: The Usual and Unusual.

Head Neck Pathol 2020 Sep 16;14(3):588-592. Epub 2019 Sep 16.

Department of Otolaryngology, Alexandria University, 4 Kafr Abdou Street #605, Alexandria, 21529, Egypt.

To prospectively study a series of scleroma patients with a focus on socioeconomic status, clinical presentation, pathology, microbiology, and treatment. A total of 52 patients diagnosed with scleroma were included in the study. Demographic data of the patients were collected and clinical, radiographic, and histopathologic findings were analyzed. Biopsies from atypical patients were sent for electron microscopic examination. Patients were treated both medically and surgically with clinical follow-up to determine outcomes and the incidence of recurrence. Fifty-two patients were included in the study. There were 23 males (44.2%) and 29 females (55.8%). The highest incidence of scleroma was identified in individuals from poor, rural areas in the third to fourth decades of life. The nose was affected in all cases. Other affected sites included the nasopharynx, soft and hard palate, larynx and trachea, lacrimal passages, skin, and gingiva. Some patients had atypical presentations. Complete follow-up of all patients was hindered by non-compliance with clinic visits and the long duration of medical treatment. Recurrence or relapse of the granulomatous lesions after initial improvement occurred in 11 patients (21.2%) within 1 to 3 years. Scleroma is a stubborn, chronic, granulomatous bacterial disease. The diverse presentations may mimic neoplasms and other granulomatous conditions. We present cases with unusual presentations and demonstrate the transmission electron microscopic features of these lesions. Furthermore, we confirm the importance of achieving full eradication of the etiologic bacilli to prevent recurrent disease.
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http://dx.doi.org/10.1007/s12105-019-01075-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413941PMC
September 2020

Combining Spreader Grafts with Suture Suspension for Management of Narrow Internal Nasal Valve Angles.

Turk Arch Otorhinolaryngol 2018 Mar 1;56(1):25-29. Epub 2018 Mar 1.

Department of Otorhinolaryngology, Alexandria University Alexandria School of Medicine, Alexandria, Egypt.

Objective: The present study aimed to evaluate the long-term results of combining spreader grafts with lateral suspension techniques for management of narrow internal nasal valves.

Methods: This prospective study included 79 patients who underwent surgical interference for dysfunctional nasal valve. The surgical intervention was a combination of two commonly used techniques for management of internal nasal valve dysfunction: spreader graft insertion and lateral suspension of the upper lateral cartilages. The patients were assessed using the nasal obstruction symptom evaluation (NOSE) tool, computed tomography (CT) scans, and endoscopic examinations.

Results: All patients reported initial improvement and satisfaction in nasal breathing. Seventy-two patients (91%) reported sustained relief of nasal breathing for at least 3 years postoperatively. The mean NOSE scores decreased from 69.8 to 20.65 postoperatively. The internal nasal valve angle, as measured endoscopically, increased from 7.23° to 13.05° on the right side and from 6.75° to 11.98° on the left side; the increase was statistically significant. The angle, as measured on axial CT scans, increased from 8.11° to 14.15° on the right side and from 6.98° to 12.13° on the left side' this increase, too, was statistically significant.

Conclusion: Combining spreader grafts with lateral suspension sutures provide good, stable, and sustained repair of dysfunctional narrowed internal nasal valves.
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http://dx.doi.org/10.5152/tao.2018.2996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6017213PMC
March 2018

Extramucosal pyriplasty without stenting for management of pyriform aperture stenosis.

Eur Arch Otorhinolaryngol 2018 Jun 16;275(6):1469-1475. Epub 2018 Apr 16.

Department of Otolaryngology, Alexandria Faculty of Medicine, 4 Kafr Abdou street # 605, Alexandria, 21529, Egypt.

Purpose: The current management options of congenital pyriform aperture stenosis (CNPAS) are either conservative measures awaiting further growth of the bony nasal framework or surgical intervention that focuses on bone removal from the margin of the pyriform aperture (PA) without exposure of the nasolacrimal duct (NLD) followed by stenting. Recently, CT measurements of the nasal cavity in CNPAS have shed light that the site of maximal bony obstruction corresponds to the bony buttress encasing the NLD rather than the margin of the PA as initially thought. Herein, we present an extramucosal pyriplasty technique that can be used without stenting to enlarge the PA and achieve immediate and sustained relief of nasal obstruction.

Methods: Retrospective chart review of 4 patients with radiologically confirmed CNPAS who had undergone extramucosal pyriplasty without stenting during the period from 2012 to 2016.

Results: Three patients were full term without any clinically detectable congenital anomaly. The fourth patient was preterm infant who needed ICU management. On computerized tomography scan, the PA width ranged from 5.8 to 7.1 mm with a mean of 6.4 mm while site of maximal stenosis ranged from 5.4 to 6.8 with a mean of 6 mm. Extramucosal pyriplasty relieved nasal obstruction and restored normal oral feeding in all patients. Postoperative follow-up endoscopy revealed an adequately patent airway with no scarring, granulation or restenosis.

Conclusions: Extramucosal pyriplasty with decompression of the NLD without stenting is a treatment modality for CNPAS that provides prompt sustainable relief of nasal obstruction and avoids the drawbacks of stenting and shortcomings of the current conservative methods.
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http://dx.doi.org/10.1007/s00405-018-4969-5DOI Listing
June 2018

Endoscopic endonasal multilayer repair of traumatic CSF rhinorrhea.

Eur Arch Otorhinolaryngol 2016 Apr 6;273(4):921-6. Epub 2015 Jun 6.

Department of Otolaryngology, Alexandria Medical School, Alexandria, Egypt.

The incidence of traumatic CSF has increased in recent years due to increased incidence of road traffic accidents (RTA) as well the increasing number of endoscopic sinus surgeries (ESS). The objective of this study is to present our experience in management of traumatic CSF leaks using the endoscopic multilayer repair technique. Forty-two patients (aged 10-75 years, 30 males and 12 females) presenting with confirmed post-traumatic CSF rhinorrhea were operated upon between January 2007 and December 2013. The endoscopic multilayer technique was used in all cases. Electromagnetic navigation was used in some cases. All cases presented with intermittent watery rhinorrhea. The duration of the rhinorrhea ranged from 3 days to 1 year before repair. One case presented after 10 years from the causative trauma. Ten cases had a history of meningitis. Nine cases had more than one defect. Iatrogenic defects were larger than defects following accidental trauma. Two cases, following RTA, developed pseudo-aneurysm of internal carotid artery. Ten cases had associated pneumocephalus. The mean duration of postoperative hospitalization was 6 days (range 4-8 days). The mean follow-up duration was 31.2 +/- 11.4 months (range 16-48 months). None of our patient developed serious intra- or postoperative complications. Only one case required another surgery to repair a missed second defect. Post-traumatic CSF leaks can be successfully managed via the endonasal endoscopic route using the multilayer repair technique. It is important to look for multiple defects in these cases. CT angiography is recommended for traumatic leaks involving the lateral wall of the sphenoid sinus to diagnose or exclude the development of pseudo-aneurysm of the internal carotid artery.
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http://dx.doi.org/10.1007/s00405-015-3681-yDOI Listing
April 2016

Modified autospreader flap for nasal valve support: utilizing the spring effect of the upper lateral cartilage.

Eur Arch Otorhinolaryngol 2015 Feb 30;272(2):497-504. Epub 2014 Sep 30.

Department of Otorhinolaryngology, Alexandria Faculty of Medicine, Alexandria, Egypt,

Nasal valve dysfunction has a role in up to 13% of adults complaining of chronic nasal obstruction yet it is overlooked by many physicians. In rhinoplasty and other nasal surgeries, preserving nasal function is the most significant issue. The autospreader flap has proved to be an effective spreader graft alternative. Adding the spring effect proposed in this study to the autospreader flap increases the width of the internal nasal valve, thus gaining two factors supporting the internal nasal valve. The modified autospreader flap technique is described in detail. Patients in this study were classified into two groups. The first group had no obstructive complaints and the second group had nasal obstructive complaints. Quantitative analysis of NOSE scale scores, endoscopic evaluation, and tomographic evaluation before and after the surgery were performed using statistical analysis. Survey responses were received from 22 patients. Significant improvement in the nasal valve angle width was found in both groups by the endoscopic and tomographic evaluation. Subjective evaluation using NOSE scale scores showed improvement in both groups. The greatest advantage of this technique is that it adds to the autospreader flap a spring action that widens the valve area. We found this technique to be reliable and simple to be performed with fairly good results and patient satisfaction. Level of evidence V Evidence from systematic reviews of descriptive and qualitative studies.
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http://dx.doi.org/10.1007/s00405-014-3309-7DOI Listing
February 2015

Binasal endoscopic approach to the sellar region: experience and outcome analysis of 80 cases.

J Neurol Surg B Skull Base 2012 Aug;73(4):287-91

Department of Neurosurgery, Alexandria Medical School, Alexandria, Egypt.

A prospective study was performed on 80 cases of different types of sellar lesions during the period between January 2007 and December 2010. The binasal approach was used in all patients. Functioning lesions were diagnosed in 59 patients. The most common secretory tumors were prolactinomas (37 patients) followed by adrenocorticotropic hormone producing tumors (11 patients) and growth hormone producing tumors (11 patients). Nonfunctioning lesions included: 14 pituitary adenomas, 2 chordomas, 2 metastatic lesions (ovarian carcinoma and thyroid carcinoma), and 1 case of sarcoidosis, Rathke's cleft cyst, and craniopharyngioma. Seven nonfunctioning cases developed apoplexy. Among the 59 patients with functioning pituitary lesions, postoperative endocrinological control was achieved in 51 of them (86.5%) 3 months postoperatively with normalization of pituitary functions and complete tumor resection as proved by postoperative magnetic resonance imaging. Postoperative visual field defect improvement was achieved in 15 out of 23 patients (65.2%), including the cases with apoplexy, with complete tumor resection. Postoperative discomfort such as headache, vomiting, or dizziness was minimal and hospitalization period was 2 to 3 days. Postoperative leak continued in one patient in whom revision surgical repair was performed 7 days later. The merits, outcome, and limitations of the approach were discussed.
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http://dx.doi.org/10.1055/s-0032-1312714DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424030PMC
August 2012

Cytotoxicity and DNA cleavage with core-shell nanocomposites functionalized by a KH domain DNA binding peptide.

Nanoscale 2013 Dec;5(23):11394-9

Department of Otorhinolaryngology and Head & Neck Surgery, University of Alexandria Medical School, Azarita Medical Campus, Champollion Street, Khartoum Square, Alexandria, Egypt.

A nanoconjugate was composed of metal oxide nanoparticles decorated with peptides and fluorescent dye and tested for DNA cleavage following UV light activation. The peptide design was based on a DNA binding domain, the so called KH domain of the hnRNPK protein. This "KH peptide" enabled cellular uptake of nanoconjugates and their entry into cell nuclei. The control nanoconjugate carried no peptide; it consisted only of the metal oxide nanoparticle prepared as [email protected] nanocomposite and the fluorescent dye alizarin red S. These components of either construct are responsible for nanoconjugate activation by UV light and the resultant production of reactive oxygen species (ROS). Production of ROS at different subcellular locations causes damage to different components of cells: only nanoconjugates inside cell nuclei can be expected to cause DNA cleavage. Degradation of cellular DNA with KH peptide decorated nanoconjugates exceeded the DNA damage obtained from control, no-peptide nanoconjugate counterparts. Moreover, caspase activation and cell death were more extensive in the same cells.
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http://dx.doi.org/10.1039/c3nr02203jDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825787PMC
December 2013

Effect of passive smoking on the ultrastructure of the nasal mucosa in children.

Laryngoscope 2012 May 23;122(5):965-9. Epub 2012 Mar 23.

Department of Otolaryngology, Alexandria Medical School, Alexandria, Egypt.

Objectives/hypothesis: Passive exposure to cigarette smoke has been implicated in a number of respiratory childhood disorders. Most studies concerning smoking were directed to its carcinogenic effect on the lungs. However, the effects of smoking on nasal respiratory mucosa have not been widely studied. The aim of the present study was, therefore, to study the ultrastructural changes in the nasal mucosa of a pediatric population exposed to passive smoking.

Study Design: The study included 20 children between the ages of 5 and 11 years, who were scheduled for tonsillectomy and at the same time had a positive history of prolonged exposure to household passive smoke. Another 10 children with a negative household smoking history were included as a control group. All children were nonatopic and with a negative family history of allergy. None of them had adenoids or infective rhinosinusitis.

Methods: At the time of surgery, a 1-mm(3) biopsy was taken was taken from the lower border of the inferior turbinate. The specimens were processed and examined with electron microscopy

Results: Examination of the nasal mucosa showed several ultrastructural changes. These included patchy loss of cilia, generalized loss of cilia, squamous metaplasia, hyperplasia of goblet cells and seromucinous acini, and vascular congestion. More severe changes were observed with longer passive exposures to cigarette smoke. The study did not disclose any evidence of ongoing allergic reaction or neoplastic transformations.

Conclusions: Children exposed to passive cigarette smoke may develop several structural changes in the respiratory nasal mucosa with subsequent negative effects on its ciliary activity and mucociliary function. As a result of these effects, defense mechanisms of the nose may be ruined or lost, and those children may develop persistent sinonasal infections. Exposure of these children to passive smoking for longer periods of time may also induce other significant changes that were not detected in the present study.
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http://dx.doi.org/10.1002/lary.23246DOI Listing
May 2012

Endoscopically directed middle meatal cultures vs computed tomographic scans in the diagnosis of bacterial sinusitis in intensive care units.

J Crit Care 2012 Jun 27;27(3):315.e1-5. Epub 2011 Jul 27.

Department of Otolaryngology, Alexandria Medical School, Alexandria, 21925, Egypt.

Purpose: The objective of the study was to evaluate the accuracy of endoscopically directed middle meatal cultures in the diagnosis of bacterial sinusitis in intensive care unit (ICU) patients in comparison with computed tomographic (CT) scans.

Patients And Methods: The study was conducted at Alexandria University Hospitals on 51 ICU patients with occult fever and clinical signs suggestive of sinusitis. Sinus CT scans were done for all patients, and Calgi swabs were obtained from the middle meatus bilaterally under endoscopic vision using sterile endoscopes with avoidance of any contamination of the swabs. The results of middle meatal cultures were compared with the results of CT scans.

Results: Radiologic signs of sinusitis were bilateral in 10 patients (19.6%), unilateral in 31 patients (60.8%), and negative in 10 patients (19.6%). Middle meatal swabs yielded positive cultures on both sides in 13 patients (25.5%) and on one side in 27 patients (52.9%). On the other hand, the cultures were negative in 11 patients (21.6%). Middle meatal cultures had a sensitivity of 92.8%, a specificity of 80.0%, and an accuracy of 90.2% in comparison with CT scans. Polymicrobial colonization was more frequent than monomicrobial colonization. The organisms isolated most frequently were coagulase-negative staphylococci, Staphylococcus aureus, and Pseudomonas aeurginosa. Of 47 patients with actual or previous intubation, 38 (80.9%) had positive cultures. In addition, 92.3% of patients with unilateral positive cultures acquired sinusitis on the same side of previous intubation.

Conclusions: The data of the present study indicated that endoscopically directed middle meatal cultures had high positive and negative predictive values and accurately diagnosed bacterial sinusitis and identified the causative bacteria with high sensitivity and specificity in comparison with the criterion standard CT scans. The procedure is simple, noninvasive, and can be easily performed at the bedside without discomfort or morbidity. Based on our data, the procedure can be considered as a trustworthy substitute to sinus CT scans in ICU patients especially when it is difficult to transport the patients for imaging. Computed tomographic scans can, therefore, be reserved for patients who do not respond to culture-specific antibiotherapy. A further advantage of this approach is avoidance of the cumulative effect of unnecessary radiation. The study also confirmed the role of nasogastric and nasotracheal intubation in the pathogenesis of ICU sinusitis.
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http://dx.doi.org/10.1016/j.jcrc.2011.06.010DOI Listing
June 2012

The nasal seromucinous glands after endoscopic sphenopalatine artery coagulation.

Eur Arch Otorhinolaryngol 2009 Sep 19;266(9):1417-22. Epub 2009 Feb 19.

Department of Otolaryngology, Alexandria University, Alexandria, Egypt.

Endoscopic coagulation of the sphenopalatine artery (SPA) is indicated in patients with recurrent or severe posterior epistaxis. The present work aimed at studying the effects of the sphenopalatine artery coagulation on the nasal seromucinous glands. The study was carried out on 30 patients who were scheduled for endoscopic SPA coagulation. All patients signed informed consents that were approved by the Committee of Medical Ethics. Minute punch biopsies were taken from the inferior turbinates, under local anesthesia, just before the procedure as well as 12 weeks and 1 year postoperatively. The biopsies were stained with hematoxylin and eosin and PAS Alcian blue. Histochemical examination was done for the activity of the succinic dehydrogenase, alkaline phosphatase and cholinesterase enzymes. Morphometric analysis as well as analysis of the histological and histochemical results showed that SPA coagulation was followed by an early decrease in the size, number and secretory activity of the nasal seromucinous glands, which was associated with decreased activity of the alkaline phosphatase enzyme in the endothelial cells of the nasal blood vessels and decreased activity of the cholinesterase enzyme in the cholinergic nerve fibers. These changes, however, were temporary and reversible since examination of the late postoperative biopsies, at 1 year, showed normalization of the number, appearance, and histochemical activity of the glandular acini as well as the surrounding blood vessels and cholinergic nerve fibers.
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http://dx.doi.org/10.1007/s00405-009-0917-8DOI Listing
September 2009

Familial aggregation of nasal conditioning capacity.

J Appl Physiol (1985) 2007 Sep 19;103(3):1078-81. Epub 2007 Jul 19.

Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, 5841 S. Maryland Ave., MC 1035, Chicago, IL 60637, USA.

In our previous studies on nasal conditioning, we observed a large variability among individuals to condition inspired air. Although we previously investigated various physiological parameters (age, sex, nasal mucosal temperature, heart rate, blood pressure, and nasal volume) that might underlie these differences, we have been unable to explain this variability. Many proteins and molecules, which are under genetic control and could affect nasal conditioning, are involved in water transport,. In this study, we hypothesized that familial factors may contribute to the differences in nasal conditioning capacity (NCC). We performed a prospective study of 47 sibling pairs. Cold dry air was delivered to the nose, and the total water gradient (TWG) was calculated to determine the NCC. We found a highly significant intraclass correlation of 0.53 (P < 0.0001) between sibling pairs for the TWG. These results suggest that there is a familial basis for nasal conditioning and a large enough genetic component to search for genes explaining the observed correlation.
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http://dx.doi.org/10.1152/japplphysiol.00299.2007DOI Listing
September 2007

Effects of saline sprays on symptoms after endoscopic sinus surgery.

Am J Rhinol 2006 Mar-Apr;20(2):191-6

Section of Otolaryngology-Head and Neck Surgery, The Pritzker School of Medicine, The University of Chicago, Chicago, Illinois 60637, USA.

Background: Topical saline is commonly recommended after endoscopic sinus surgery. The efficacy in this situation has never been shown.

Methods: We performed a controlled clinical trial to determine the effect of saline sprays on symptoms after endoscopic sinus surgery. Patients were randomized to receive normal saline (NS; n = 20), buffered hypertonic saline (HS; n = 20), or no spray (n = 20). A questionnaire measured symptoms of nasal obstruction, discharge, pain, headache, and trouble sleeping. Daily pain medication usage was recorded.

Results: Symptom scores over the first 5 postoperative days showed higher nasal discharge scores in the HS group. Day-by-day comparisons showed that the HS group reported significantly higher pain scores during some postoperative days. The NS group showed similar scores to control.

Conclusion: NS and HS sprays do not have a beneficial effect on symptoms compared with no treatment. HS sprays enhanced nasal drainage and pain. Our results do not support prescribing saline sprays early after sinus surgery but do not exclude the use of topical saline in other forms or for other uses, although they may be used for other intentions.
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November 2006

Chronic subglottic and tracheal stenosis: endoscopic management vs. surgical reconstruction.

Eur Arch Otorhinolaryngol 2003 Aug 26;260(7):374-80. Epub 2003 Mar 26.

Department of Otolaryngology, Head and Neck Surgery, Alexandria Faculty of Medicine, Alexandria, Egypt.

Laryngotracheal stenosis has been and remains one of the most vexing problems in the field of head and neck surgery. Two treatment modalities prevail, endoscopic and external. The indication for each modality is not yet clearly defined. This undefined situation motivated our current work, and we decided to assess laser-assisted endoscopy (with or without stenting) vs. open surgery for treating chronic laryngotracheal stenosis. Our study included 28 cases of chronic laryngotracheal stenosis that were classified according to treatment in two main groups: group I included 13 patients who were endoscopically treated and group II included 15 patients with surgical reconstruction. The mean follow-up period was 12.58 months for group I and 27.43 months for group II. Respiratory function tests (RFT) were carried out preoperatively, 1-month postoperatively and on completion of follow-up. Except for age, which was significantly higher in group I (P<0.001), there was no significant difference between both groups. Although the incidence of complications was higher in group I (69%) than in group II (47%), it was nonsignificant. The postoperative RFT improved significantly in both groups. Although the improvement was higher in group I than group II, the difference was nonsignificant. The correlation between preoperative stridor and all other variables demonstrated that preoperative stridor correlated with the diameter of the stenosed segment (rs=-0.631, P<0.001) and the peak expiratory flow rate (PEFR) (rs=-0.488, P=0.030). Our results indicate that open surgery is the treatment of choice. Compared with endoscopic treatment, it provides a higher success rate and better functional results, especially long term. However, if contraindications to open surgery exist, whether local or general, laser-assisted endoscopy with stenting can offer good palliative results.
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http://dx.doi.org/10.1007/s00405-002-0578-3DOI Listing
August 2003

Some risk factors for refractory chronic sinusitis: an immunohistochemical and electron microscopic study.

J Laryngol Otol 2002 Feb;116(2):112-5

Departments of Otolaryngology and Medical Laboratories, Saqr Hospital (United Arab Emirates).

The goal of the present work was to investigate possible risk factors for the poor response of some cases of chronic sinusitis to endoscopic sinus surgery in spite of the precision of the surgical technique. Eleven adult patients who were scheduled for revision endoscopic sinus surgery underwent a complete allergy workup. At the time of surgery, a tiny biopsy was taken from the maxillary sinus mucosa close to the middle turbinate. The specimens were processed for histochemical and transmission electron microscopic examination. Six patients (55 per cent) proved to be allergic. Their sinus mucosa showed eosinophilic infiltration (6.1 cells/mm(2)), and mast cell degranulation. This proves that allergens can reach the sinus mucosa and have a direct impact on it. Another three patients (27 per cent) were non-allergic but exhibited mucosal eosinophilia (5.0 cells/mm(2)), and two of them showed mast cell degranulation. These patients were diagnosed as having nonallergic rhinosinusitis with eosinophilia (NARSE). The nasal mucosa of the remaining two patients did not reveal any characteristic pathological findings, and no pathologic diagnosis could be established for them. None of the patients showed electron microscopic evidence of purulent inflammatory changes, and the bacterial cultures recovered normal respiratory flora in nine patients (82 per cent). The present research spotlights the importance of allergy and nonallergic eosinophilic infiltration of the mucosa as possible risk factors that may degrade the results of endoscopic sinus procedures and discusses some pertinent pathological and clinical aspects.
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http://dx.doi.org/10.1258/0022215021910050DOI Listing
February 2002