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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 10 | Issue 1
Page Nos. 1-43

Online since Tuesday, June 30, 2020

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EDITORIAL  

Editorial p. 1
Reda Kamel, Ahmed El-Farouk
DOI:10.4103/pajr.pajr_4_20  
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ORIGINAL ARTICLES Top

Role of bi-portal endoscopic approach to frontal sinus in managing frontal sinus diseases p. 2
Abdelrahman Y Ali, Sameh M Zamzam
DOI:10.4103/pajr.pajr_23_19  
Background In spite of recent evolution of endoscopic frontal sinus surgery, some cases are still challenging due to the difficulty to reach the lateral frontal sinus even with Draf type III. This study aims to highlight the bi-portal approach to the frontal sinus disease. Materials and methods This study is a prospective study that was conducted on four patients with mean age of 56 years. Two cases were presented with allergic fungal sinusitis, one case showed an inverted papilloma and a single case of granulomatous fungal sinusitis. All patients underwent bi-portal surgery which entailed endoscopic frontal sinus surgery either Draf IIb or III plus as an external approach through the upper eyelid. Results Complete removal of the disease with no major postoperative complications, with no detection of recurrence during the 12–30-month-follow-up period. Conclusion Bi-portal frontal sinus approach is an easy noninjurious technique with very little cosmetic drawbacks allowing rhinologists to access the whole aspects of the frontal sinus, especially the lateral part.
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The IMPACT of chronic rhinosinusitis on olfaction (immunohistochemical study) p. 6
Yasser F Elbeltagy, Hesham S Elhalabi, Nagla S Ahmed, Ahmed M Maarouf, Mina F Saleeb
DOI:10.4103/pajr.pajr_5_20  
Introduction Chronic sinusitis is considered one of the most important causes of olfactory dysfunction, and this is attributed to the obstructive effect of swollen mucosa and nasal polyps or inflammatory process in the olfactory mucosa. Patients and methods This study enrolled 60 patients [20 chronic rhinosinusitis with nasal polyps (CRSwp), chronic rhinosinusitis without nasal polyps (20 CRSsp), and 20 control] and used nestin antibody, a marker found in olfactory mucosa and directly related to function, to prove the etiology of olfactory dysfunction in CRS. Results It was found that nestin staining is decreased in both cases groups, but on the contrary, patients with CRSwp have more olfactory dysfunction than patients with CRSsp. This means that the inflammatory process is strongly present in both case groups; however, the presence of polyps increases olfactory function loss. Conclusion This study led to an important conclusion that both obstructive and inflammatory causes contribute to olfactory dysfunction in patients with CRS.
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Jordan smell test: a pilot study p. 13
Rasha Alabd Alrhman, Nedal F Qudah, Ali Al-zubidi, Mohannad Al-Qudah
DOI:10.4103/pajr.pajr_13_19  
Objective An objective smell test is essential to identify the level of smelling sensation and provide information on changes in olfaction after treatment. The aim of this study is to describe a simple, portable, inexpensive, and reliable olfaction identification test in the Arab population (Jordan smell test). Patients and methods Seven odorants that are familiar to Arab people were selected for this smell test. In academic tertiary medical center setting, odor discrimination testing in patients with sinonasal disease and in nonsmoker healthy volunteers was performed, and the results were compared with appropriate statistical formulas. Results A total of 25 healthy volunteers and another 25 age-matched and sex-matched patients with sinonasal pathology were evaluated with our smell test. Volunteers scored 13.2 in Jordan smell test, whereas the score was 9.2 in the patients (P < 0.0001). For each tested odor, there was a significant difference between both groups. Volunteers scored least for the tobacco smell, and patients scored highest for coffee. Conclusion Jordan smell test is a novel, office-based, and easy administrable method to objectively assess olfaction sensation in the Arab population. The test is flexible to changes in its different variables, such as the type or number of odors. Further studies with a larger number of participants in different Arab countries are needed to validate our results.
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Challenges and controversies in endoscopic management of cerebrospinal fluid rhinorrhea p. 17
Mostafa ElTaher, Mohamed Ahmed, Ahmad Ismail, Usama Taya
DOI:10.4103/pajr.pajr_18_19  
Introduction Endoscopic management of cerebrospinal fluid (CSF) rhinorrhea is considered by many as the ideal approach due to its low morbidity and higher closure rate. However, many challenges and controversies are still reported. Objective The aim was to discuss the challenges of endonasal repair of CSF leaks and controversies regarding the use of intrathecal fluorescein (ITF) and the number of graft layers. Materials and methods This retrospective study included 30 patients who had had endoscopic repair for their CSF rhinorrhea in our institute between July 2015 and June 2017. Fifteen (50%) patients were managed using the two-layer repair without ITF injection (group I), while the remaining were managed using three or more graft layers and ITF (group II). Results The study included 30 patients: 17 (57%) women and 13 (43%) men. Their age ranged from 4 to 68 years with mean ± SD = 38 ± 15.86 years. Eighteen cases presented with spontaneous leaks (nine of them had normal CSF pressure). Four (13.3%) cases had defects in the posterior wall of the frontal sinus while other defects involved the fovea ethmoidalis, lateral lamella, and the cribriform plate of the ethmoid. Success rate was equal in both groups (93%). Conclusion Endoscopic management of CSF rhinorrhea has many challenges including repair in the pediatric population and anatomical areas with difficult accessibility, for example, frontal sinus leaks. It requires good endoscopic visualization and endoscopic instrumentation facilities in addition to experienced surgical hands. Double-layer repair and avoidance of ITF show the same success rate as other more time-consuming strategies with life-threatening complications.
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Role of static MRI in assessment of velopharyngeal insufficiency p. 21
Tarek M. Y. El Banoby, Fawzy A Hamza, Mahmoud I Elshamy, Amro M. A. Ali, Ahmed A Abdelmonem
DOI:10.4103/pajr.pajr_5_19  
Aim The purpose of this study was evaluation of static MRI in assessment of VPI and correlation to auditory perceptual assessment (APA) and nasoendoscopy. Background Velopharyngeal insufficiency (VPI) occurs owing to insufficient tissues of the velopharyngeal valve. Patients and methods This was a multidisciplinary prospective study conducted at Al-Azhar and Beni-Suef University Hospitals, Egypt. The study group consisted of 20 children with VPI postpalatoplasty, aged from 3 to 9 years. Normal MRI values were obtained from Ruotolo et al, and Perry et al. Patients were evaluated by history taking, Gutzman's and Czermark's tests, APA, nasoendoscopy, and static palatal MRI. Results APA revealed that most of the patients had bad speech scales. Nasoendoscopy revealed that most of patients had concave velum, absent posterior pharyngeal wall movement, and circular velopharyngeal gap. MRI revealed that patients' velopharyngeal parameters were significantly lower than normal values, and most of patients had symmetrical muscle limbs. Velar length and thickness had a significant positive linear correlation with degree of velar movement. Effective velar length had a moderate negative correlation with degree of velar movement and degree of open nasality. Conclusion Static MRI is an important tool in assessment of VPI but should be accompanied by dynamic tools in cases with relatively normal ranged anatomy.
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Endoscopic score: a new method for evaluating different inferior turbinate reduction techniques p. 27
Mohamed A Sabaaa, Meaad Haithamb, Mahmoud El-Essawya, Abdelhaleem Mohammeda, Khaled Azooza
DOI:10.4103/pajr.pajr_6_19  
Background Nasal airway obstruction is a common complaint faced in otorhinolaryngology, which may significantly impair the patients' quality of life. Inferior turbinate hypertrophy is one of the main causes of chronic nasal obstruction, and different surgical techniques have been described for its reduction. Aim This study compared three different inferior turbinate reduction techniques using a new objective method in addition to a subjective one. Materials and methods A randomized controlled trial was carried out on 45 patients with hypertrophied inferior turbinates, who were randomly divided into three equal groups: group A underwent partial inferior turbinectomy, group B was subjected to inferior turbinate bipolar surface cautery, and group C underwent inferior turbinoplasty. Assessment was done preoperatively and postoperatively at 2 weeks, 1 month, and 3 months using total nasal symptom score (TNSS) and endoscopic score. Results All groups had significant improvements in the TNSS and endoscopic score when compared with baseline data. TNSS mean for all groups declined from 5 to 3 at 3 months after surgery, with P values less than 0.001. Most of the cases of group A (87%), group B (60%), and group C (93%) had an endoscopic score of 0, with nasal airways greater than 6 mm at 3 months after surgery. Conclusion Partial turbinectomy, bipolar cauterization, and turbinoplasty techniques for the inferior turbinate reduction are comparable and effective regarding improvement of the obstructive as well as the nonobstructive nasal symptoms. Endoscopic score is a helpful tool for easy, rapid, and objective assessment of the nasal airway.
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Surgical treatment of rhinogenic contact point headache p. 34
Mo'men A. A. Hamela, Sherif A Raafat, Nassim T Ghobrial
DOI:10.4103/pajr.pajr_2_20  
Aim The aim of the study was to search for the role of correction of abnormalities of the nasal cavity in rhinogenic contact point headache and to evaluate its role in the treatment of this type of headache. Patients and methods The study included 20 patients who were recruited from September 2016 till December 2016 with rhinogenic contact headache of more than 1-year duration. Evaluation of surgical management for these cases was done as regards improvement of headache duration, intensity, and frequency over a follow-up period of 3 months at least after the operation. Results In all, 20 patients were included with ages in the range from 19 to 45 years; 11 of them were men and nine were women. Sixteen cases showed complete cure, two showed improvement, and two showed unsatisfied results. Deviated septum was found in 17 (85%) cases, concha bullosa in seven (35%) patients, and hypertrophied inferior turbinate in six (30%) patients. More than one anatomical variation was encountered in most of the cases. The two failed cases showed preoperative long duration since they started to complain of headache and longer duration of each headache attack. Conclusion Intranasal anatomical variations play a role in the pathogenesis of contact rhinogenic headache and the surgical treatment of these anatomical variations helped in improving contact headache.
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CASE REPORT Top

Sphenoid sinus cholesterol granuloma with orbital complications: a case report p. 40
Qais Aljfout, Maysoon Al-Ruhaibeh, Laith Dahoun, Waffa Al-Shawayat, Sara Qais
DOI:10.4103/pajr.pajr_17_19  
Cholesterol granulomas are benign lesions that affect many parts of the body. Although they are benign, their expansile properties might affect important neighborhood structures which is an associated risk. Paranasal sinuses are rare locations to be affected. A case of sphenoid sinus cholesterol granuloma with orbital complications is presented. The study places emphasis on preoperative examination, radiological evaluation, and endoscopic management, and we recommend including cholesterol granulomas in the differential diagnosis of cystic lesions in paranasal sinuses.
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