Background Intraoperative bleeding during functional endoscopic sinus surgery (FESS) poses a challenge to both surgeon and anesthetist. The primary aim of this study was to evaluate the effectiveness of local, intravenous and combined use of tranexamic acid (TA) in improving the surgical field quality during FESS. Methods We conducted a randomized controlled double‐blinded prospective trial on 120 patients scheduled for elective FESS. After induction of general anesthesia, patients were randomly and evenly assigned to one of four groups; IV TA, local TA, both IV and local TA, and placebo. Surgical field was assessed using five‐point Boezaart scale. Total fentanyl and esmolol consumption, operative time, recovery time, and postoperative complications were recorded. Results Surgical field quality score was the best in IV and local TA group compared to others (p < 0.001). Mean operative time was found significantly shorter in IV and local TA group than placebo one. Total fentanyl consumption was significantly lower in IV and local TA group comparing to others (p = 0.025). Mean recovery time was significantly shorter for IV and local TA group compared to others. Total fentanyl consumption was significantly lower in IV and local TA group comparing to others. No significant differences were found of mean arterial pressure and heart rate decline in four groups. None of the patients in four groups required esmolol administration. No statistically significant differences were found in change of hemoglobin, hematocrit, prothrombin time, and partial thromboplastin time over time in all groups. Conclusion The combined use of topical and intravenous TA provided the best surgical field in FESS, less fentanyl consumption, and less recovery time without causing significant side effects.

Objective The current study showed the relation between otitis externa and COVID-19 infection and compared otitis externa with other symptoms of COVID-19 as anosmia. Methods 257 cases who were confirmed positive for COVID-19, were examined otoscopic and endoscopic for otitis externa, onset of starting symptoms of otitis externa and its relation to days of infection with COVID-19 were documented and the prevalence of otitis externa with anosmia in the study group were estimated. Results Increased incidence of otitis externa in COVID-19 patients (18% of study group) and symptoms starting mainly between the 5th to 8th day of COVID-19 infection. Combined otitis externa and anosmia occurred in 13% of study group. Conclusions Otitis externa has a relation to COVID-19 infection. Further research needed to study its pathogenesis and mechanisms.

Background. Tumor budding is a promising prognostic indicator in several cancers especially in colorectal cancer. However, only few studies have been conducted to assess and validate its prognostic value in laryngeal squamous cell carcinoma; none of which used pancytokeratin immunohistochemistry. In view of the modest results of treatment of laryngeal squamous cell carcinoma, the need of new prognostic indicators becomes of paramount importance. Aim of the Study. We aim to evaluate tumor budding in laryngeal squamous cell carcinoma, by haematoxylin and eosin, as well as by pancytokeratin immunohistochemistry. Material and Methods. A retrospective study on 118 cases of laryngeal squamous cell carcinoma from archives of Pathology Lab of Ain Shams University Specialized Hospital and Ain Shams University Hospitals from January 2014 to January 2017. The ENT and histopathology reports were reviewed to determine clinicopathologic data of the patients. Results. Tumor budding shows high statistically significant relations ( p = 0.0001 for each) with important clinicopathological parameters of laryngeal carcinoma (site, grade, tumor stage, lymph node stage, lymph node extracapsular invasion, and vascular invasion). The extent of tumor budding correlated with overall survival, local recurrence disease free, and distant metastasis disease free ( p = 0.001 for each). Multivariate analysis showed tumor budding to be an independent prognostic factor affecting progression-free survival. There was a moderate agreement between H&E and IHC by pancytokeratin as regards detection of budding among study cases ( kappa = 0.593 ). Conclusions. Tumor budding was correlated with poor prognostic clinicopathologic indicators in laryngeal squamous cell carcinoma. It is recommended to use pancytokeratin immunohistochemistry to evaluate tumor budding in laryngeal squamous cell carcinoma especially in confusing cases.

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The Journal of International Advanced Otology (J Int Adv Otol) is an international, peer reviewed, open access publication that is fully sponsored and owned by the European Academy of Otology and Neurotology and the Politzer Society. The journal is published triannually in April, August, and December and its publication language is English.The scope of the Journal is limited with otology, neurotology, audiology (excluding linguistics) and skull base medicine.The Journal of International Advanced Otology aims to publish manuscripts at the highest clinical and scientific level. J Int Adv Otol publishes original articles in the form of clinical and basic research, review articles, short reports and a limited number of case reports. Controversial patient discussions, communications on emerging technology, and historical issues will also be considered for publication.Target audience of J Int Adv Otol includes physicians and academics who work in the fields of otology, neurotology, audiology and skull base medicine.

Background Chronic sinusitis is one of the most prevalent chronic illnesses affecting persons of all age groups. It is an inflammatory process that involves the paranasal sinuses and persists for 12 weeks or longer. Purpose The aim of this study was to investigate the effect of chronic rhinosinusitis (CRS) on sleep-disordered breathing. Patients and methods This study was conducted prospectively during the period spanning from June 2017 to June 2018 on 100 patients with CRS who attended to the ENT Departments of El-Maadi Armed Forces Medical Complex, Kobry El-Kobba Armed Forces Medical Complex, and El-Demerdash Hospitals. An additional 10 control patients were included in the study. All these patients gave informed consent to participate in this study. Results As regards apnea–hypopnea index, a comparative study between preoperative and postoperative measurements revealed a nonsignificant difference (P>0.05). As regards snore index and snore episodic measurements, the comparative study between preoperative and postoperative measurements revealed a highly significant decrease (P<0.01). As regards sleep efficiency and minimal and basal oxygen saturation measurements, the comparative study between preoperative and postoperative measurements revealed a highly significant increase (P<0.05). Conclusion Surgery decreased snoring and Epworth Sleepiness Scale scores, increased sleep efficiency and minimal and basal oxygen saturation measurements without changes in the apnea–hypopnea index, and improved sleep quality.

Background The use of a topical anticholinergic medication, ipratropium bromide, and its ability to inhibit methacholine and rhinitis-induced hypersecretion is emphasized. Ipratropium bromide appears to be both safe and effective in reducing this troublesome symptom. This study is designed to show the therapeutic effect of anticholinergic local treatment on nasal mucosa in patients with vasomotor rhinitis. Objective To assess the therapeutic effect of local anticholinergic treatment on nasal mucosa in patients with vasomotor rhinitis compared to non-vasomotor (allergic) patients and normal individuals, and if there any down regulation of the muscarinic receptors or not. Patients and methods This prospective intervention study was conducted in Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University. This study was conducted on 60 cases. All patients were divided into 3 groups: study group (1) includes 20 patients diagnosed clinically non-allergic rhinitis suggestive to be vasomotor rhinitis. Study group (2) includes 20 patients diagnosed as allergic rhinitis. Study group (3) includes 20 patients performing surgery for non-vasomotor rhinitis non-allergic causes (as septoplasty or rhinoplasty). Results Comparison between the pre- and post-SNOT questionnaire of symptoms among vasomotor group showed that there was a significant difference between the pre- and post-treatment SNOT questionnaire symptoms; nasal obstruction, runny nose, post-nasal drip, thick nasal discharge and Lack of good night sleep. Among allergic cases group, there was a significant difference between the pre- and post-treatment IHC (immunohistochemistry) findings considering Epithelium, Glands, arteries and veins. 20% of cases had grade 3 epithelium before treatment while after treatment, this was dropped to 0%. Comparison between the pre- and post-SNOT questionnaire of symptoms among allergic group showed that there was a significant difference between the pre- and post-treatment SNOT questionnaire symptoms; runny nose, post-nasal drip, and thick nasal discharge. Among non-vasomotor rhinitis non-allergic causes (as septoplasty or rhinoplasty) group, there was a significant difference between the pre- and post-treatment IHC findings considering epithelium, glands, and arteries; however, no significant difference between the pre- and post-IHC veins grade. Also, there was no significant difference between the pre- and post-treatment SNOT questionnaire symptoms. Conclusion Topical anticholinergics such as ipratropium bromide nasal spray are effective in treating rhinorrhea symptoms in allergic and non-allergic rhinitis. Further controlled studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.

Objectives: To define the value of mastoidectomy in cases of malignant otitis externa. Study design: Case Series. Patients and Methods: Study of Patients with malignant otitis externa (MOE) treated by mastoidectomy from Jan 2016 to October 2018 and followed up clinically, laboratory and radiologically. Results: Postsurgical siginifacant resolution of symptoms and regression of the disease. Otalgia showed siginificant decrease by assessment with Visual Analogue Score. Also there are improvement of otorrhea, decrease of the reactive indicators as Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and radiological improvement of osteomyelitis in Computed Tomography and technetium-99m methylene diphosphonate (MDP) and gallium-67 citrate scintigraphy. Conclusion: In patients with MOE, resistant to medical treatment and have evidence of mastoiditis and Middle ear affection, cortical mastoidectomy may be the treatment for both symptom relieve and regression of the disease.