Bacterial biofilms have been shown to play a major role in many chronic infections, in addition, there is growing evidence that bacterial biofilms may play a role in some forms of refractory CRS that persists despite proper surgery and culture directed antibiotic therapy. The objective is to determine the effect of application of topical ofloxacin on nasal and sinus mucosa in patients with proven existence of bacterial biofilms and persistent chronic sinusitis after FESS. The study design is a prospective controlled study. The study included a total of 12 patients who had refractory CRS in spite of undergoing FESS for that specific reason (study group), and control group (involved 25 patients), for whom FESS was done, with complete improvement postoperatively in 15 of them, and persistence of symptoms in the other ten. Topical ofloxacin eye drops (0.3 %) tds for 12 weeks were prescribed for (study group), culture and sensitivity and scanning electron microscopy were done for middle meatal mucosal specimens for all patients and controls, all of them were followed up for a minimum of 9 months (range 9-18 months). Of the study group, 80 % showed marked improvement in the structure of the mucosa, with the regaining of normal respiratory epithelium, with complete disappearance of the biofilm surface, and the remaining 20 % showed only reduction in the number of inflammatory cells and regaining cilia with scattered patches of very thin biofilm. Biofilms formation plays an active role in perpetuating inflammation in CRS patients and enhanced the recurrence and resistance in those patients, we found a statistically significant improvement in patients' group (P < 0.001), after 12 weeks of topical ofloxacin (without any evidence of any side effects). So, we concluded that topical ofloxacin seems to be an effective, tolerable, convenient, cheap and even safe mode of treatment of refractory CRS after FESS due to biofilms' formation. Thus, we recommend such modality of treatment postoperatively especially in refractory cases of CRS.
ConclusionPectoralis major ap will give the patients the advantages of less stula formation, good wound healing, early oral feeding, short hospital stay and protection against catastrophic vascular blowouts.
Objectives: To evaluate the incidence, presentations and different treatment outcomes of orbital complications secondary to sinusitis.Methods: We conducted a retrospective chart review of patients with orbital complications secondary to sinusitis seen at Ain-Shams University Hospitals (Department of OtoRhinoLaryngology, Cairo, Egypt) over a period of three years. Data obtained from the charts included clinical presentations, contrast enhanced computed tomography data, type of treatment, surgical approaches used and their outcomes.Results: Thirty-five patients (35) presented to Ain Shams University Hospital over the three year period with orbital complication secondary to sinusitis. Medical treatment was successful in 15 patients; surgical drainage was done in 19 cases (13 cases were done endoscopically and 6 were drained externally) including orbital exenteration and Caldwell Luc procedure which were done in the same patient (fungal infection). One case developed coma and passed away the same day of presentation despite aggressive management and neurological consultation.Conclusion: Orbital complications of sinusitis have a good prognosis when detected early and managed appropriately. The key point here should be increasing physician awareness towards this problem as well as encouraging early referral to specialized centers for the proper management of these cases.
Background: The principal aims of a tympanoplasty operation are to create an intact tympanic membrane and to restore an optimal hearing improvement. Many surgeons have used cartilage for grafting due to its increased stability and resistance to negative pressure. Cartilage has been criticized because of concerns regarding hearing results.Objectives: The aim of this study is to present the experience of using cartilage for grafting central perforations in type I tympanoplasty procedure with some novel modifications and evaluate its take rate and audiologic results.Methods: This is a prospective study including 40 patients (45 ears) who underwent type I cartilage tympanoplasty. All patients are primary cases of chronic suppurative otitis media of tubotympanic type. The following parameters were evaluated at least after 3 months from surgery: graft take and change between the pre-and post-operative pure-tone average air-bone gap (PTA-ABG).Results: Thirty-nine patients included in the study underwent 45 cartilage tympanoplasty type I operations. The mean age of the patients was 24.9 ± 9.5 years (range, 15-51 years). The mean follow up period was 6.2 months (range, 3-9 months). All perforations were found to be closed with a 100% graft take rate. The overall mean pre-operative PTA-ABG was 26.0 ± 4.4 dB, whereas the postoperative PTA-ABG was 13.8 ± 5 dB (p < 0.0001) which is highly significant. The percent of reduction of PTA-ABG was about 46.6%.Conclusion: Bi-island chondroperichondrial type I tympanoplasty is an effective and reliable technique with a high success rate and minimal complications.
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