Sinonasal polyps are very common benign lesions of the nasal mucosa. Most of nasal polyps (NP) are idiopathic, and the pathophysiology of this disease is still incompletely understood. Nitric oxide (NO) is a reactive molecule generated by nitric oxide synthase (NOS). NO has been identified as an important mediator in airway function and pathogenesis of several respiratory system diseases. Histological and genetical expression of iNOS was detected to evaluate the role of NO in the pathogenesis of allergic (ANP) and nonallergic nasal polyps (NANP). Forty patients with nasal polyps (20 allergic and 20 nonallergic) were identified by history, clinical examination, and investigation. NPs were obtained from the middle turbinate (MT) during concha bullosa surgery. Twenty normal MT nasal tissues were taken as the control from patients undergoing concha bullosa surgery, without any evidence of allergy or inflammation. A nasal polyp specimen from each patient was subjected for immune-histochemical study followed by histological examination to detect the expression of iNOS. RT-PCR was used to evaluate the iNOS gene expression in isolated tissues. The expression of iNOS in both epithelial and stromal layers was greater in NP than in MT tissues. The ANP group showed more iNOS expression than those of the NANP group. The relative mRNA levels of iNOS gene were significantly higher in ANP (2.5-fold) compared to the normal (1.02-fold, P < 0.001) and NANP (1.5-fold, P < 0.01) groups. NP exhibited a significantly high expression of iNOS at both histological and genetical levels. NO might be an essential factor in the life history of NP. Further studies in a larger sample size are required to explain the probable mechanisms of NO in pathogenesis of NP.

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ObjectiveChanges in vocal patterns after adenotonsillectomy are questionable. Few studies have assessed acoustic voice changes before and after adenotonsillectomy. The objective of this study wasto evaluate the impact of adenotonsillectomy on the voice of children with adenotosillarhypertrophy. Participants and Methods The study included fifty children ranging in age between 4 and 12 years, with adenotonsillar hypertrophy, indicated for adenotonsillectomy. Auditory perceptual assessment of speech included nasality, degree of hyponasality, degree of open nasality, and degree of dysphonia. Acoustic analysis was carried out before and after one month and three months of surgery, using multidimensional voice program software (MVDP). The vowels were analyzed as to their acoustic parameters: fundamental frequency (Hz), jitter (%), shimmer (dB) and noise-harmony ratio (NHR; dB). ResultsAt oneand threemonths after surgery, preoperative readings were of F0 score while jitter and shimmer normalized only at the 3 rd month. There were significant differences between readings at one month and threemonths of F0 and jitter. Auditory perceptual assessment(APA) of voice (dysphonia) and APA of speech (hyponasality) significantly improved at 1 st and 3 rd month after surgery with significant differences between results of 1 st and 3 rd month. Harmonic noise ratio (HNR) had negative, significantly fair correlation with APA of Voice (dysphonia). ConclusionHyponasal speech and with dysphonia preoperatively often have normal resonance and voice following adenotonsillectomy. Objective and subjective evaluation of speech and voice can help the specialist in the management of patients with adenotonsillar hypertrophy.

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Sadek et al., 291Four-strands versus six-strands core sutures technique for surgical management of acute zone II flexor tendon injury

Objective: To demonstrate glossopharyngeal nerve block by local anesthetics on posttonsillectomy pain management Patients and Methods: Two hundred and ten children aged seven to fifteen underwent elective tonsillectomy after parents documented agreement, divided into two equal groups-one hundred and five candidates in each chosen group, from Minia university hospital, otorhinolaryngology outpatient clinic. Group A: received glossopharyngeal nerve block (intra-oral approach), using bupivacaine 0.5% (1mg/kg divided in both sides) immediately after endotracheal intubation (pre-incisional). Group B: received 5 ml sterile saline on each side. Chronic tonsillitis was the indication of tonsillectomy in our study. Results: Glossopharyngeal nerve block can decrease postoperative pain scores. VAS (Visual Analogue Scale) was higher in group B, compared to group (A) up to 24 hours postoperative. Time for the first need for pain killer was delayed in the group (A) compared to group (B), (P < 0.0001). The postoperative dose of rescue analgesia consumed in group (A) was lower than in the control group (P < 0.0001). The time of first oral intake was prolonged in the group (B) compared to group (A)(P < 0.0001). Patients that needed additional analgesia represented 30 % of the group(A) and 62 % in the group (B). The pattern of sleep during the first post-operative night was good in the group (A) in comparison with group (B) (P = 0.003). No secondary hemorrhage was reported in both groups Conclusion: Glossopharyngeal nerve block with bupivacaine (0.5%) significantly reduces postoperative analgesic use, and delays the time for the first need for a rescue pain killer.