Hussein, A., H. Fathy, S. Amin, and N. Elsisy, "Oral steroids alone or followed by intranasal steroids versus watchful waiting in the management of otitis media with effusion", The Journal of Laryngology & Otology, vol. 131, pp. 907-913, 2017. printed_paper.pdf
El-Beih, A. A., N. Talaat, A. E. F. A. Elfattah, M. Qotb, H. Fathy, and S. Ilia, Sinus involvement in cases of rhinoscleroma: a cause of antibiotic resistance and early recurrence after medical treatment, , 2012.
Hazem Aboul Oyoun, M. D., M. D. Maha Abou-Elew, M. D. Mohamed Mosleh, M. D. HESHAM FATHY, M. D. WAEL WAGEEH, and M. A. Hassan, Systemic steroids and intratympanic steroids perfusion as an initial therapy for idiopathic sudden sensorineural hearing loss; a comparative study., , 2013. Abstract

Objective: The objective of this study is to compare the efficacy of systemic steroids (SS) and the intratympanic steroids (ITS) in the treatment of idiopathic sudden sensorineural hearing loss (SSNHL). Study design: This is a prospective study. Material and methods: This study included 21 patients suffering from idiopathic SSNHL. They were divided into 2 groups according to the modality of treatment. Group A included 10 patients who were treated with SS and group B included 11 patients who were treated with ITS due to their refusal or contraindication to take SS. A pre-treatment pure tone audiometry (PTA) was performed for all patients at their first presentation for establishment of the
diagnosis and assessment of the degree of the hearing loss. A post-treatment PTA was done at the follow up visit 2 weeks later for the assessment of the degree of hearing loss and hearing improvement. The data of both groups were compared together. Results: For group A the pre-treatment PTA average ranged from 37.5 to 113.3 db with a mean of 72.3± 25.11 db and the post-treatment PTA average ranged from 13.3 to 113.3 db with a mean of 49.24± 33.72 db. On comparing the means of the pre-treatment and the post-treatment PTA averages the difference was found to be statistically significant (P=0.03). The overall hearing improvement rate using SS was 60%. For group B the pre-treatment PTA average ranged from 50 to 115 db with a mean of 77± 18.98 db and the post-treatment PTA average ranged from 26.6 to 101.8 db with a mean of 50.05± 23.3 db. On comparing the means of the pre-treatment and the post-treatment PTA averages the difference was found to be statistically highly significant (P=0.001). The overall hearing improvement rate using ITS was 72.7%. Conclusion: Both SS and ITS have proven to be effective in the treatment of idiopathic SSNHL, however SS seems to have a better effect in terms of cure with complete recovery to normal hearing, while ITS exerts most of its effect in partial recovery.

1) Hesham Negm, M. D., M. D. 2) Mohamed Mosleh, 3) N. H. MD, M. D. 4) Hesham Fathy, and 5) N. Fahmy, Objective.The objective of this study is to evaluatethe efficacy of image-guided systems in nasal and skull base surgeries.Study design. This is a prospective case control study. Material and methods. A total number of 24 patients were included in this st, , 2013. Abstract

Objective: The objective of this study is to evaluate the effect of radiotherapy (RT) as one of the modalities of treatment in patients with head and neck tumors on the Eustachian tube and middle ear. Study design: This is a prospective study. Material and methods: This study included 20 patients suffering from squamous cell carcinoma of the head and neck other than nasopharynx and parotid. They were treated either by surgery and postoperative radiotherapy or by primary radiotherapy alone or by concomitant chemoradiotherapy. Audiological evaluation was performed both pre-treatment and post- treatment in the form of pure tone threshold audiometry (PTA), tympanometry, stapedius acoustic reflex and eustachian tube (ET) function test. Results: The 20 patients corresponded to 40 ears which were analyzed. Post RT tympanometry done revealed 16 (40%) ears with normal type A tympanogram and 24 (60%) ears with abnormal tympanometry findings, Post RT ET function test done revealed 7 (17.5%) ears with good ET function and 33 (82.5%) with abnormal ET function, acoustic reflex done post RT revealed 36 (90%) ears with absent acoustic reflex bilaterally and 4 (10%) ears with preserved acoustic reflex and Post RT PTA done revealed 16 (40%) ears with normal PTA, 13 (32.5%) ears with conductive hearing loss (CHL), 8 (20%) ears with sensori neural hearing loss (SNHL) and 3 (7.5%) ears with mixed hearing loss. Conclusion: Patients with head and neck tumors given RT as one of the modalities of treatment have a high incidence of affection of middle ear function and ET dysfunction as well as development of CHL.

hesham negm, M. D., M. D. hussam El-Bosraty, M. D. Mohamed Mosleh, M. D. hesham ahmed fathy, and M. C. Mina Safwat, Image guided nasal and skull base surgery; a case control study., , 2013. Abstract

Objective.The objective of this study is to evaluatethe efficacy of image-guided
systems in nasal and skull base surgeries.Study design. This is a prospective case
control study. Material and methods. A total number of 24 patients were included in this
study. The relevant pre-operative, operative and post-operative records were collected
and analyzed. Results:The mean total operative time was greater for the imageguidance
surgery group (130 minutes; range 95-160 minutes) than for the control
group (119 minutes; range 85-150 minutes). However, the mean actual operative time
was less for the image-guidance surgery group (93 minutes; range 65-120 minutes)
than the control group (99 minutes; range 70-130 minutes).The image-guidance
surgery group had no major complications. However the control group had 3 major
complications (25%).The average estimated blood loss (EBL) was higher for the
image-guidance surgery group (395 mL; range 130-1100 mL) than the control group
(380 mL; range 100-950 mL).Conclusion: Image guided system may reduce the
complications associated with endoscopic sinus surgery and allow for a more thorough
operation

Wahaba, M. A. S., H. Fathy, R. Ismail, and N. Mahmoud, Recurrent epistaxis in children: When should we suspect coagulopathy?, , 2014. Abstract

Objective
The objective of this study was to evaluate children and adolescents with recurrent epistaxis
and to spot variables that may predict underlying bleeding disorder.
Study design
This was a prospective study.
Materials and methods
Thirty-six children with recurrent epistaxis were recruited from ENT outpatient clinic as well
as emergency room of Cairo University children hospital. Patients with systemic causes for
epistaxis were not included. All patients were subjected to basic workup to differentiate between
ENT and hematological causes of epistaxis. Accordingly, extended ENT investigations or
coagulation studies were performed.
Results
Results showed 47.6% incidence for bleeding disorders, 39.7% incidence for ENT causes,
and 12.7% incidence for idiopathic causes. Reported coagulopathies included idiopathic
thrombocytopenic purpura with an incidence of 26.7%, platelet functions disorders such as
Glanzmann’s thrombasthenia (13.3%) and Bernard–Soulier syndrome (10%), aplastic anemia
(3.3%), hemophilia A (3.3%), Von Willebrand disease (3.3%), and unclassified (40%). Reported
local ENT causes included bacterial rhinitis (88%) (lodged foreign body was found in 1/3 of
these patients, digital trauma by habitual nose picking was detected in another 1/3, and the
remaining 1/3 represented cases of complicated previous viral rhinitis), nasal allergy (8%),
and adenoid (4%).
Conclusion
The study recommended some statistically significant predictors for bleeding disorders such
as positive consanguinity, high epistaxis bleeding score, presence of other bleeding sites,
low hemoglobin level and platelet count, and elevated activated partial thromboplastin time.

HESHAM FATHY, M. D., M. D. BADAWY KHALIFA, M. D. WAEL WAGEEH, M. D. NEVEEN EL HELALY, and M. D. FADWA ABDELREHEEM, Role of fungi as aeroallergens in allergic rhinitis, , 2014. Abstract

Introduction and Aim: Inhalation of fungal spores is shown to participate in the development of allergic rhinitis symptoms. The aim of this study is to evaluate the relation between presence of fungi in the human nasal cavity and allergic rhinitis.
Patients and Methods: The study was conducted on 40 patients with allergic rhinitis as study group and 20 healthy persons without allergic rhinitis, considered as control. High IgE and normal sinus radiography were among inclusion criteria of patient group to confirm its allergic etiology and exclude associated sinusitis consequently. Direct microscopy and culture of nasal secretions were performed to detect the fungi in both groups. Polymerase chain reaction (PCR) was done for those with positive fungal culture in both groups to identify the fungus type. Skin prick tests using three types of fungal extract allergens (Candida albicans, Aspergillus fumigatus, Alternaria tenuis) were done to all patient group.
Results: Results showed positive fungal culture of nasal secretions in 12 patients (30 %) of case group and 2 cases (10 %) in control group. Aspergillus and Candida were identified by PCR as the fungi present. Positive skin tests to one or more of the used fungal allergens were
detected in 14 cases of patient sample, reporting an incidence of 35% for cases with fungal sensitization among patient group. Ten cases out of the 14 showed fungal elements in nasal secretions (25%) associated with positive skin tests to its type, and 4 cases (10%) did not show any fungi in culture but was associated with positive skin tests to one or more of the used fungal allergens suggesting free air fungal spores as the provoking allergens. Cases with negative fungal sensitization included 2 cases (5%) with positive fungal culture and 24 cases (60%) with sterile fungal culture. High blood eosinophilia and IgE in such 14 cases with fungal sensitization, confirm the role of type 1 hypersensitivity reactions to fungal allergens .Other allergens triggered the disease in the remaining cases (2 cases with positive fungal cultures and negative skin tests and 24 cases free from fungi in their nasal secretion cultures).
Conclusion: Fungal sensitization in nasal allergy is high especially when patients show fungal nasal colonization. Still those with free cultures may be provoked with free air fungal spores. Fungal skin prick tests should be done to all cases with nasal allergy especially for those who showed positive nasal fungal culture. This will help to consider patient desensitization therapy with fungal extracts especially in resistant cases to antihistaminics and corticosteroids.

1. Mohamed Mosleh, M. D., and undefined, Advanced laryngeal cancer with skin infiltration: survival analysis., , 2013. Abstract

Objective: The objective of this study is to investigate T4 laryngeal cancer cases with skin infiltration regarding survival and different variables that may influence the survival. Study design: This is a retrospective analytic study. Material and methods: This study included 14 patients suffering from laryngeal carcinoma with tumor extending to involve the skin of the front of the neck. Total laryngectomy was performed for all patients together with excision of the overlying skin and pectoralis major myocutaneous flap (PMMF) was used for reconstruction of the skin defect in all cases. Analysis of the pre-operative, operative, post-operative and follow up patients' data was done. The one, 2, 3 and 5 years survival rates were estimated. Results: The overall mean survival time for all cases was 51.1±8.3 months. The mean survival time for cases with recurrent disease was 16.4±3.5 months and for cases without recurrent disease was 70.7±6 months. The one,2,3 and 5 years survival rates were 92.9%, 71.4%, 64.3% and 50% respectively. The univariate analysis revealed that previous treatment before definitive surgery was the only variable that had a statistical influence on the overall 5 years survival rate (P=0.046). Conclusion: Extended laryngectomy with skin removal offers reasonable 5 years survival rate for T4 laryngeal cancer cases with skin invasion and reconstruction of the neck skin defect with a pectoralis major myocutaneous flap is a reliable method of repair.

Negm, H., M. Mosleh, H. Fathy, A. Hareedy, and A. Elbattawy, "Cytokeratin immunohistochemically detected nodal micrometastases in N0 laryngeal cancer: impact on the overall occult metastases.", European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, vol. 270, issue 3, pp. 1085-92, 2013 Mar. Abstract

The objective of this study is to evaluate the incidence of occult nodal micrometastases in N0 laryngeal squamous cell carcinoma using cytokeratin immunohistochemical analysis (CKIHA) and its influence on the overall occult metastatic rate. This is a prospective cohort study. A total number of 30 patients with N0 stage laryngeal cancer underwent 46 selective neck dissections for elective treatment of the neck. Nodes found to be negative using routine histopathological examination were evaluated for the presence of micrometastasis using CKIHA. The occult micrometastasis rate for all cases was 26.7 % which significantly increased the overall occult metastasis rate to 50 % (P = 0.014). The micrometastasis rate was 30.8, 25 and 20 % for glottic, supraglottic and transglottic tumors, respectively, which increased the overall occult metastasis rate to 53.8, 50 and 40 % but without statistical impact. The micrometastasis rate was 35.7 and 23.1 % in T3 and T4 tumors, respectively, and this increased the overall occult metastasis rate to 50 and 61.5 % with statistical influence in T3 tumors (P = 0.046). Micrometastasis upstaged the neck in 7 (23.3 %) patients with statistical impact on the PN stage (P = 0.007). The overall occult nodal metastasis rate in N0 laryngeal cancer is underestimated. Nodal micrometastasis may be missed during routine histopathological examination and can be detected using CKIHA.

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