Otolaryngology & Head and Neck Surgery
RESEARCH PROJECTS
Concha bullosa in relation to sinus disease A
retrospective chart review of 143 patients who underwent endoscopic sinus
surgery at AUBMC. Thirty patients proved to have Concha Bullosa and were
included in this study. The clinical and radiological significance of concha
bullosa in relation to sinusitis were analyzed. The presence of concha
bullosa, sinusitis and osteomeatal complex disease was found to be independent
variables using chi-square analysis. A. Abdel-Latif Hamdan, U.
Hadi, H. Ahmad, M. Jaber.
Speech recognition ability of listeners with impaired hearing in simulated and real listening environments Binaural
hearing enhances our ability to understand speech in multi-talker environments.
It is not clear, however, whether hearing-impaired individuals share the
same benefits in noisy environments. The current research assesses the
ability of listeners with impaired hearing (IH) and normal hearing (NH)
to monitor target (T) messages in the presence of synchronous, competing
(C) messages in four modes: (1) with T- and C-messages presented diotically
through earphones, (2) with the T- and C-messages presented dichotically
through earphones, (3) with T- and C-messages presented through loudspeakers
at 45 and 135-deg azimuth (subject seated in room), and (4) with virtual
sources at 45 and 135-deg azimuth under earphones. Twelve subjects with
NH and twelve with IH listened to T-messages selected from lists of 2034
10-syllable sentences. In each mode, T-messages were presented in the presence
of 0, 1, 2, and 3 C-messages; subjects recorded the T-messages. Results
suggest that speech recognition for IH subjects is significantly poorer
NH listeners for all levels of interference, but speech recognition performance
in the sound field and 3-D audio conditions for equivalent for each group.
K.S.
Abouchacra. (Supported by US ARL.)
Assessment of filtered sound effects (FSE) stimuli for use in the clinical testing of young children Frequency-specific
information about hearing is gained from a test called pure-tone audiometry.
When used with children, pure-tones (PTs), quickly becomes uninteresting
, which results in an incomplete assessment of the child’s hearing. Our
recent studies with adults using filtered sound effects (FS) as stimuli
rather than tones, revealed that accurate, frequency-specific hearing thresholds
can be obtained with these more interesting sounds. The present research
will assess whether FSEs can be used effectively with children and have
any advantages over PTs. Four groups of children [aged 3-4, 4-5, 5-6, and
6-7 years (control)] will have their hearing tested with PT and FSE stimuli.
PT stimuli will include 250, 500, 1000, 2000, and 4000 Hz, and FSE stimuli
will include ten natural sounds spectrally limited to an octave band around
these same frequencies. Comparisons will be made between PT and FSE thresholds
for each group. Thresholds of younger children will be compared with thresholds
of the control group using appropriate descriptive and parametric statistics.
Findings should help determine whether FSEs are a viable alternative to
PT stimuli for use with young children. K.S. Abouchacra. (Supported
by US ARL.)
The effect of insert-type hearing protector selection method on field attenuation and the ability to communicate in noise In
this study, insert-type hearing protection devices (HPDs) will be selected
according to one of three methods for individuals regularly exposed to
high levels of industrial noise. Specifically, the HPDs will be selected
according to 1) EN 458 method, 2) EN 458 method in conjunction with a field
monitoring system, and 3) maximum attenuation method. Two groups of 36
subjects will be tested biweekly and will participate in the study over
a 15-month period. The effectiveness of the HPD for a specific noise environment
will be based on objective measures of HPD attenuation, communication ability
and localization accuracy, and subjective measures of general comfort and
acceptance of the HPDs will also be recorded. The results will provide
background data on field monitoring systems (ANSI S12/WG11) and communication
ability in noise while wearing HPDs (ANSI S12/WG35). K.S. Abouchacra,
K. Michael*. (Supported by U.S. Industrial Safety Equipment Association.)
Characteristics of Pathogen recovered from the Tonsils & Adenoids in a group of Lebanese Children undergoing T&A with or without Bilateral Myringotomy with insertion of PE tubes A
prospective study whereby the tonsils were obtained from 50 children undergoing
tonsillectomy for chronic tonsillitis. The surface microflora, obtained
using a throat swab taken from the adenoids and both tonsils surface, were
compared with the microflora of the deep tonsils. Risk factors will be
determined from analysis of several clinical parameters. All recognized
pathogens recovered from the culture medium were identified. The results
indicate that most aerobic bacteria that were found in the tonsils and
adenoid core were cultured from the surface of both tissues. H. influenzae
was found to be the most resistant germ to antibiotics therapy and was
thus the most frequent cause for recurrent tonsillitis. M. El Hajj,
U. Hadi, G. Mattar, M. Uwayda, N. Fuleihan.
The role of CT guided surgery in the anterior skull base and sinuses Image
guided surgery is the name given to the technology in which preoperative
slice data acquired by CAT scan are used to guide surgical procedures.
CT guided image surgery was recently introduced to assist surgeons in endoscopic
sinus surgery and anterior skull base surgery. The scans are acquired prior
to surgical intervention onto a computer workstation (VTI system). The
system is connected to a position sensor and the images are registered
to the patient just prior to surgical intervention. During the procedure
the surgeon uses electromagnetic sensors attached to surgical instruments
to verify the location. CT image guided surgery gives an accurate determination
of the surgical determination of the surgical boundaries and important
anatomic structures. A description of anatomical and clinical applications
for the use of this technology is presented. N. Fuleihan, M. Jaber.
Community-acquired P. Aeruginosa respiratory infection in an immuno competent hoss: a predisposing condition that may be easily overlooked Respiratory
tract infections are among the most common diseases that afflict mankind,
the severity of the illness, its clinical manifestation, and its potential
complications are dependent on several host-related and pathogen factors.
Pseudomonas Aeruginosa rarely encountered as causative agent in community-acquired
infections in previously healthy subjects. Whenever such an infection is
confirmed, the presence of an underlying host-related abnormality should
be suspected. This case report points to rhinolith as one predisposing
factor that could be easily overlooked. Failure of early detection is likely
to lead to costly and sometimes toxic antimicrobial therapy that is ineffective,
unless the rhinolith is identified and removed. U. Hadi, S. Ghossaini,
M. Uwaydah.
Rhinolithisis revisited A
retrospective chart review of Rhinolithiasis over the past 10 years. We
are reporting on a series of 8 cases that were treated over the past 10
years. Rhinoliths are rare and uncommon nasal masses. The clinical symptoms
and physical findings are illustrated. The chemical composition and the
microscopic features are emphasized. Means of diagnosis as well as management
will be highlighted. U. Hadi, S. Ghossaini, G. Zaytoun.
Characteristics of pathogens encountered in otitis externa in a group of Lebanese patients U.Hadi,
H.Harakeh, S.Serhal, G.Matar.
Endoscopic management of C.S.F., Rhinorrhea Cerebrospinal
fluid rhinorrhea may be noted during or following sinus surgery, or following
head trauma. In the past, neurosurgical procedures were employed for closure
of defects in anterior skull base. Recently, with the advent of endoscopic
sinus surgery techniques, the closures of such skull base defects became
feasible. We are reporting our experience in the closure of such defects
performed recently on 9 patients. The diagnostic work up, and the surgical
techniques employed will be discussed. U. Hadi, G. Kahwaji, G Haddad.
Tuberculosis Parotitis: a forgotten entity The
clinical presentation of granulomatous lesions of the salivary glands can
be misdiagnosed in the height of their infrequent occurrence in a general
otolaryngologic practice. We believe that tuberculosis of the major salivary
glands, although rare, should be considered in the differential diagnosis
and work up of patients presenting with a solitary salivary gland tumor.
We are reporting on such a case with a discussion of the clinical presentation,
management and differential diagnosis of solitary parotid masses. U.
Hadi, N. Shabb, A. Abdel-Latif Hamdan.
Median palatal cyst: a rare entity with an unusual presentation There
are different types of cysts of developmental origin that present themselves
in the palate and alveolar ridge. Most of these are of congenital nature
though their true origin might be difficult to determine due to their appearance
during adulthood. They have been broadly classified as odontogenic and
fissural. Fissural cysts can be either midline or lateral. Globulomaxillary
cysts and nasoalveolar cysts are examples of lateral fissural cysts. Median
cysts can arise in the anterior upper alveolus ridge or more posteriorly
in the palate. Naso-palatine cysts arise from the incisive canal and present
as a small submucosal palate mass. Whereas the median palatal cyst occur
posterior to the alveolus and tend to present as a bulge in the hard palate
orally. Occasionally, the cyst tends to bulge into the floor of the nose
without deforming the hard palate. We are reporting on such a case with
a large median palatal cyst that first presented to us with nasal obstruction,
and had a normal hard palate. To our knowledge, only sixteen cases of median
palatal cyst are reported in the literature; none had a cyst presenting
in the nasal cavity. U. Hadi, A. Younes, S. Ghoussaini, A. Tawil.
Kikuchi Fujimoto Disease (KFD): report of two cases with review of the literature KFD
or histiocytic necrotizing lymphadenitis is a benign self limiting disease
of young Asian females described first in Japan. Clinically the presentation
is that of cervical adenopathnot responding to medical treatment and diagnosis
should be confirmed by histology. No specific etiology has been described
and usually KFD has a favorable prognosis with no treatment. Our experience
with two cases of KFD is reviewed with a review of the literature. M.
Jaber, A. Abdel-Latif Hamdan, N. Fuleihan.
Two-step PCR-based for identification of bacterial etiology of otitis media with effusion in infected Lebanese children We
developed and evaluated a two-step polymerase chain reaction (PCR)-based
assay using universal primers and genus—or species—specific primers for
detecting the most prevalent bacterial etiologies of Otitis Media with
Effusion (OME) in children from Lebanese hospitals. A total of 47 MEE samples
were aspirated from 36 patients during tympanostomy-tube insertion. Thirty-five
MEE samples (74.5%) gave the expected 370-bp band, indicating the presence
of bacterial DNA in tested samples. Out of these 33 (94.3%) were positive
for Haemophilus, 3 (8.6%) were positive for Streptococcus, and 10
(28.6%) were positive for both Haemophilus and M. catarrhalis.
Culture was simultaneously performed on all 47 MEE samples. Ten of them
(21.3%) exhibited bacterial growth. The remaining positive samples were
negative by culture, thus showing about 53% discordance between PCR results
and culture results. The PCR assay proved more sensitive than culture,
more rapid, and less cumbersome and cost effective than available PCR-Southern
hybridization-based assays. G. Matar, N Sidani, M. Fayad, U. Hadi.
Epidemiological analysis of otosclerosis in Lebanon: mapping of new genes Otosclerosis
is a late-onset deafness, characterized by progressive conductive or mixed
loss requiring hearing aids and/or surgical intervention. The exact etiology
is yet unknown, however, both genetic and environmental factors play a
role in its etiology. Little progress has been made in searching for genes
responsible for otosclerosis. Difficulties hindering genetic analysis of
otosclerosis are due to its multifactorial etiology, genetic heterogeneity
and absence of large families in Western societies. Therefore, interest
has shifted to studying highly in-bread populations or large consanguineous
families living in isolated geographical regions for several generations.
In such populations, the probability of more than one defective gene segregating
in the same family is minimized. In these cases, a multifactorial disease
may appear to result from either a single locus or a small number of loci
that can be detected by conventional linkage analysis. Taking these epidemiological
data into consideration, as well as the high rate of consanguinity within
different ethnic groups in Lebanon, our population offers an excellent
opportunity to identify new genes responsible for otosclerosis. Our preliminary
data demonstrate the presence of additional genes responsible for otosclerosis
in the Lebanese population. R. Slim, K.S. Abouchacra, N. Fuleihan, G.
Zaytoun.
Bacteriology of Chronic Sinusitis Data
has been collected. First draft to be written soon. G. Zaytoun.
Perilymphatic Fistulae in Chronic Otitis Media Tremendous
delays are encountered in the collection of data due to lack of enough
information in the charts. A prospective study will instead be planned
and will start soon. G. Zaytoun.
The lateral venous sinus in mastoid surgery. Normal anatomic variations and report on three unusual cases The
second draft is to be revised, corrected and sent for publication. G.
Zaytoun.
Otosclerosis revisited, the AUBMC experience Several
large families have already been identified and are typed for the gene
at the genetics division. Collection of data to review experience will
start soon. G. Zaytoun.
Abouchacra, K., Binaural and spatial hearing in real and virtual environments (Book review). Ear and Hearing, 19 (3), 250-252, 1998. Abouchacra, K., Emanuel, D.*, Blood, I.*, and Letowski, T.*, Spatial perception of speech at various signal-to-noise ratios. Ear and Hearing, 19 (4), 298-309, 1998. Abouchacra, K., and Letowski, T.*, Effects of definitions and the listener’s jury testing experience on perceived generality and importance of selected importance of selected sound quality attributes. NOISE-CON, 1, 497-502, 1997. ———, Filtered sound effects for Audiological testing II. Compact Disc 1B. Abouchacra, K., Letowski, T.*, Koehnke, J.*, and Besing, J.*, Spatial Audiometry: Detection of Spondaic Words in Noise. Journal of the American Academy of Audiology, 9 (6), 399-409, 1998. Besing, J.*, Koehnke, J.*, Abouchacra, K., and Letowski, T.*, Contemporary approaches to audiological assessment in young children. Topics in LanguageDisorders, 18 (3), 52-71, 1998. Dolan, R.*, Vaughan, C.*, and Fuleihan, N.S., Metachronous cancer: Prognostic factors including prior irradiation. Otolaryngology- Head and Neck Surgery, 119 (6), 619-623, 1998. ———, Symptoms in early head and neck cancer: An independent indicator. Otolaryngology- Head and Neck Surgery, 119 (5), 463-467, 1998. Fuleihan, N.S., The evaluation and management of nasal valve dysfunction. Current Opinion in Otolaryngology- Head and Neck Surgery, 7 (1), 226-32, 1999. ———, The transvestibular approach to the nasal tip and dorsum: A new refinement in Rhinoplasty. Journal of Plastic and Reconstructive Surgery, 101,453-460, 1998. Mattar, G., Sidani, N., Fayyad, M., and Hadi, U., A two steps PCR for the identification of the Bacterial Etiology of Otitis Media with effusion in children. Journal of Clinical Microbiology, 36 (5), 1998. Hadi, U., and Mallak, J., Otic Rosacea. Archives of Otolaryngology- Head andNeck Surgery. 125 (4), 479, 1999. Hadi, U., Shreif, J., Obeid, M., and Soubra, M., Valsalva induced Thymic Cyst. Otolaryngology- Head and Neck Surgery Journal, 117 (6), 570-574, 1997. Hadi, U., Yazbek, P., Extensive laryngotracheal necrosis following open heart surgery. Lebanese Journal of Anesthesiology, 1998 Mustapha, M., Azar ST., Bou, Moghlabey, Y., Saouda, M., and Zaytoun, G., Further refinement of Pendred Syndrome locus by Homozygosity analysis to a 0.8cm internal flanked by D7S496 and D7S2425. The American Journal of Human Genetics, 161 (4), 202-204, 1997. Nogueira, C.*, Dolan, R.*, Gooey, J.*, Byahatti, S.*, Vaughan, C.*, and Fuleihan, N.S., Inactivation of p53 and amplification of Cyclin D1 correlate with clinical outcome in head and neck cancer. The Laryngoscope, 108, 345-350, 1998. Salman, S., Hadi, U., The inferior meatal nasoantralwindow in the era of the middle meatal antrostomy. Current Opinion in Otolaryngology-Head and NeckSurgery, 1998. Yamout,
B.I., Zaytoun, G., and Nuwayhid, I., The role of facial nerve conduction
studies and Electromyography in predicting the outcome of Bell’s Palsy.
TheEuropean
Journal of Neurology, 4, 1-4, 1997.
ABSTRACTS,
PRESENTATIONS AND PROCEEDINGS
Abouchacra, K., Tran, T.*, Koehnke, J.*, Besing, J.* The effects of message competition and reverberation on a binaural speech recognition task. Abstracts of the NIDCD/VA Second Biennial Hearing Aid Research and Development Conference, 11-P-34. 1997. Fuleihan, N.S., New Refinements in Nasal Tip Surgery. American Academy of Facial Plastic & Reconstructive Surgery. 6th International Symposium, Orlando- Florida, USA, 1998. ———, Choice of Flaps in Head and Neck Reconstruction. American Academy of Otolaryngology-Head and Neck Surgery: Annual Conference. Orlando- Florida, USA, 1997 ———, Endonasal rhinoplasty technique. American Academy of Otolaryngology-Head and Neck Surgery, Annual Conference, Orlando- Florida, USA, 1997. ———, Organ preservation approaches in Head and Neck malignancies. 34thMiddle East Medical Assembly, Beirut- Lebanon 1999. Hadi, U., 13th Annual Meeting of the American Society of Pediatric Otolaryngology (C.O.S.M). Palm Beach, Florida, USA, 1998. ———, Resection of a transclival meningocele: Case report and review of the literature. 9th Annual Meeting of the North American Skull base Society, Hawaii, 1998 ———,
Neurogenic Tumors of the neck with emphasis on a rare tumor of the sympathetic
chain: the Ganglioneuroma. Congres Francophone d’ORL et de Chirurgie
CerFaciale, Beirut, Lebanon, 1997.
|
