Samir Asal - Academia.edu (original) (raw)

Papers by Samir Asal

International journal of molecular epidemiology and genetics, 2014

BACKGROUND & AIM Hearing loss is the most frequent form of neurosensory deficit in humans. Althou... more BACKGROUND & AIM Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority of hereditary hearing loss is due to nuclear gene mutations, it has become clear the significant contribution of mitochondrial genes. The first mitochondrial mutation shown to cause non-syndromic hearing loss in humans was the A1555G mutation in the small ribosomal RNA gene (12S rRNA). It has been detected in hundreds of families of different ethnic backgrounds, making it one of the prevalent genetic causes of hearing loss currently identified. However, there are major differences between ethnic groups regarding the frequency of this mutation. Few studies have been made in Arab countries, especially in Egypt. Here we report the prevalence of the mitochondrial mutation A1555G among patients with non-syndromic hearing loss (NSHL) and in healthy individuals with normal hearing in the Egyptian population. SUBJECTS & METHODS The study was conducted on 97 patients with SNHL and...

The Egyptian Journal of Otolaryngology, 2018

Background and objective The head impulse test is a well-known clinical test that uses video-ocul... more Background and objective The head impulse test is a well-known clinical test that uses video-oculography to quantify vestibulo-ocular reflex (VOR). Normative data for VOR gain are accessible, but most studies just report horizontal-plane VOR characteristics, overlooking variations in vertical-plane VOR gains. The aim of this study is to supply normative data for different age groups to permit future comparison of results to the matching norms. Patients and methods The study was accomplished on 50 individuals who have normal peripheral hearing sensitivity, no otological disorder, and have no history of vestibular disorder, and were divided according to age into five groups, each one comprising 10 participants: individuals in the first group were aged 10–25 years, individuals in the second group were aged 25–35 years, individuals in the third group were aged 35–45 years, individuals in the fourth group were aged 45–55 years, and individuals in the fifth group were aged more than 55 ye...

Objective Age-related changes in the central auditory system, particularly auditory temporal proc... more Objective Age-related changes in the central auditory system, particularly auditory temporal processing abilities, were considered among most important factors affecting speech understanding performance in older adults. Once these factors are identified, clinical management procedures could be developed for prevention and treatment. The aim of this study was to determine the effects of short-term auditory training on the behavioral and electrophysiological measurements of auditory function in individuals with age-related temporal processing deficit. Participants and methods A prospective study of 20 individuals aged 60–67 years with either normal or bilateral symmetric high-frequency hearing loss was conducted. Evaluations of auditory temporal processing using behavioral tests (Pitch Discrimination Test, Pitch Pattern Sequence Test, Auditory Fusion Test-Revised, and Time Compressed Speech Test), P300 potential, and the administration of ‘Amsterdam inventory for auditory disability a...

Background & Aim: Hearing loss is the most frequent form of neurosensory deficit in humans. Altho... more Background & Aim: Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority of hereditary hearing loss is due to nuclear gene mutations, it has become clear the significant contribution of mitochondrial genes. The first mitochondrial mutation shown to cause non-syndromic hearing loss in humans was the A1555G mutation in the small ribosomal RNA gene (12S rRNA). It has been detected in hundreds of families of different ethnic backgrounds, making it one of the prevalent genetic causes of hearing loss currently identified. However, there are major differences between ethnic groups regarding the frequency of this mutation. Few studies have been made in Arab countries, especially in Egypt. Here we report the prevalence of the mitochondrial mutation A1555G among patients with non-syndromic hearing loss (NSHL) and in healthy individuals with normal hearing in the Egyptian population. Subjects & Methods: The study was conducted on 97 patients with SNHL a...

The Egyptian Journal of Otolaryngology

Background The aim of this study was to determine whether different concentrations of intratympan... more Background The aim of this study was to determine whether different concentrations of intratympanic (IT) injection of dexamethasone at a dose of 4 and 10 mg/mL have an effect on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Results Our study was conducted on 30 adult patients with unilateral ISSNHL who failed to respond or with contraindications to systemic steroids. Patients were categorized into two groups; each one included 15 patients. IT injection of 4 mg/mL dexamethasone was done in one group (IT dexamethasone (Dex) 4 mg/mL), while 10 mg/mL dexamethasone was administered intratympanically in the other group (IT Dex 10 mg/mL). IT injection was performed twice weekly for two successive weeks. PTA thresholds were assessed at 0.5, 1, 2 and 4 kHz before and 1 month after the treatment. In the group with IT Dex 10 mg/mL, the average PTA improved significantly from 75.50 ± 12.59 to 49 ± 24.04 dB with an average gain of 26.50 ± 14.25 (p = 0.0...

The Egyptian Journal of Otolaryngology

Background Cochlear implant (CI) is an electronic device that provides direct electrical stimulat... more Background Cochlear implant (CI) is an electronic device that provides direct electrical stimulation to the auditory division of the eighth cranial nerve. The integrity of the internal CI part after implantation can be assessed through objective measures, which are a widely used and valuable tool in the field of CIs. Impedance measurement and electrically evoked compound action potential (ECAP) are the most frequently used tests to facilitate programming of the implants especially in young children. Aim This study was carried out to compare ECAP thresholds and electrode impedance at the time of surgery, at the first stimulation session, and monthly for the next 2 months to assess whether a significant change take places with time. Patients and methods Fifteen deaf children implanted unilaterally with a MED-EL Sonata Implant System with an Opus 2 speech processor were included in this study. All patients received the implant if they fulfilled the Alexandria main hospital criteria for receiving CIs. The group studied included seven males and eight females; they ranged in age from 2 to 6 years. Two of the patients had received implantation in the left ear, whereas the rest of the patients had received a CI in the right ear. Results Intraoperative impedance was the lowest among all postoperative readings in all electrodes. The highest value was that measured 1 month after surgery, after which impedance values continued to decrease significantly, but not to the intraoperative values. The ECAP threshold showed no significant P values between the ECAP threshold measured in the intraoperative and the postsurgery follow-up period. Conclusion The measured impedance showed significant changes in the form of increasing values postoperatively relative to the intraoperative time. The ECAP threshold did not change significantly intraoperatively and postoperatively, showing that intraoperative ECAP can be useful in mapping as it shows no changes.

The Egyptian Journal of Otolaryngology

The aim of this study was to test the effect of direct application of dexamethasone on the round ... more The aim of this study was to test the effect of direct application of dexamethasone on the round window (RW) after its adequate exposure following a transcanal approach in patients with sudden sensorineural hearing loss (SSNHL). Study design This investigation was designed to be a prospective cohort study. Patients and methods This study included eighteen adult patients with SSNHL who attended our outpatient clinic at Alexandria Main University Hospital between 1 July 2015 and 1 July 2016. Under general anesthesia the small tympanomeatal flap was elevated to visualize the RW. If it was fully exposed, dexamethasone (4 mg/ml) was applied directly over a piece of gel foam; if not fully exposed the overhang was removed first and then dexamethasone was applied. After 2 weeks, a repeat audiogram was taken in all patients in order to evaluate the efficacy of the treatment on their hearing ability. Results Post-treatment assessment revealed 50% of patients with variable levels of improvement, whereas 50% did not respond to the given treatment. Of the patients showing improvement, 16.7% had normal hearing levels restored. Thus, direct application of dexamethasone on the RW membrane after its adequate exposure may reverse the hearing deficits in a few patients with SSNHL. Conclusion There is a definitive improvement in hearing in patients with SSNHL on direct application of dexamethasone on the RW membrane after its adequate exposure in patients.

The Egyptian Journal of Otolaryngology

The aim of this work was to study whether or not the hearing loss encountered in some hypothyroid... more The aim of this work was to study whether or not the hearing loss encountered in some hypothyroid patients can be improved with L-thyroxine hormone therapy, as other symptoms of hypothyroidism. Study design The study design was a prospective cohort one. Patients and methods This study included 30 patients of either sex who were proved to be in a hypothyroid state with an additional symptom of hearing impairment. The study was carried out in Alexandria Main University Hospital and was conducted in a prospective manner. All selected patients were proved to be in a hypothyroid state in the Endocrinology Department. Moreover, their symptom of hearing impairment was confirmed by thorough audiological examination supplemented by pure-tone audiometry plus tympanometry that was carried out in the ENT Department and the associate Audiology Unit. L-thyroxine treatment for hypothyroidism was initiated in all cases for 6 months to maintain a state of euthyroidism. At the end of 6 months, a repeat audiogram and tympanometry were performed in all patients in order to evaluate the efficacy of the said treatment protocol on the hearing in these patients. Cases proved to have hearing impairment irrelevant to the hypothyroid condition were excluded. Informed consent was compulsory for recruitment in this study. Results Post-treatment assessment revealed that variable improvement was achieved in 48% of ears, whereas 52% did not respond to the given treatment, with the impairment remaining nearly the same as it was before. Of the improved ears, in 15% of ears hearing levels were restored to normal hearing levels. Thereby, adherence to replacement therapy may reverse the hearing deficits in a few number of hypothyroid patients. Conclusion There is a definitive improvement in hearing with the use of L-thyroxine treatment of hypothyroid patients with hearing impairment.

The Egyptian Journal of Otolaryngology

The tested hypothesis states that by manipulating body position, a differentiation in the optimum... more The tested hypothesis states that by manipulating body position, a differentiation in the optimum body position for ocular vestibular-evoked myogenic potential (oVEMP) testing could be obtained. Patients and methods The present study was conducted on 33 ears (33 healthy adult volunteers) with no age or sex limit or any ontological complaint in the audiology unit of Alexandria Main University Hospital. Pure-tone audiometry, tympanometry, and oVEMP testing were performed. Ocular VEMP was performed in four different positions − sitting, supine, right decubitus, and left decubitus positions. Ocular VEMP waveforms were analyzed regarding morphology, latency, amplitude, and threshold. Results (a) oVEMP was present in 90% of the studied cases. (b) The sitting position produced the shortest latencies. (c) The independent position provided the largest amplitude. (d) The dependent position elicited the highest thresholds. Conclusion Although the best position for oVEMP test could not be determined by the present study, the trends found support that the sitting position may be preferred for future oVEMP testing based on the short latencies produced in this position. On the other hand, high thresholds were obtained in the dependent (left decubitus) position, which indicates that it is the least favorable position.

Acta Otorrinolaringológica Española

BACKGROUND AND OBJECTIVE Benign paroxysmal positioning vertigo (BPPV) is the most common peripher... more BACKGROUND AND OBJECTIVE Benign paroxysmal positioning vertigo (BPPV) is the most common peripheral vestibular disorder. Canalolithiasis in the posterior semi-circular canal is the most common underlying pathology that can be treated effectively by repositioning maneuvers. Our hypothesis suggested that successful maneuvers can lead to repositioning of dislodged otoconia to the utricle. MATERIALS AND METHODS Air conducted oVEMP, which is thought to originate from the contra-lateral utricular organ was measured in twenty patients with unilateral BPPV and we compared n1-p1 peak to peak amplitude of the affected ears in 3 separate intervals: on pre-treatment when typical nystagmus was confirmed, immediately after, and 1 week after repositioning maneuvers to assess change, if any, in amplitude. RESULTS This study showed significant increase of oVEMP amplitude in the affected ears after successful repositioning maneuver that was more significant after 1 week. CONCLUSIONS oVEMP can be used as a reliable objective test for ensuring a successful maneuver rather than subjective dependence on the patient's symptoms, which may be misleading due to a remission.

The Egyptian Journal of Otolaryngology, Jul 1, 2013

Superior canal dehiscence syndrome is a rare medical condition with many variants. In this case r... more Superior canal dehiscence syndrome is a rare medical condition with many variants. In this case report, we present a 35-year-old patient who presented with atypical presentation of superior canal dehiscence syndrome. We discuss his audiological, vestibular, and radiological findings before and after surgery. We present a protocol to establish the diagnosis of a similar condition, especially those presenting atypically.

The Egyptian Journal of Otolaryngology, 2016

The Egyptian Journal of Otolaryngology, 2015

No overall signi cant effect on hearing was found. IT gentamicin had signi cant effect on cVEMPs ... more No overall signi cant effect on hearing was found. IT gentamicin had signi cant effect on cVEMPs with 100% abolition, as well as a statistically signi cant effect on oVEMP with 70% abolition and distortion of the remaining 30%. In these remaining 30% latencies and amplitudes, there was no signi cant difference in values before and after injection. Conclusion A 12 mg single dose of gentamicin can abolish otolithic function without affecting hearing.

International Journal of Molecular Epidemiology and Genetics

Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority o... more Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority of hereditary hearing loss is due to nuclear gene mutations, it has become clear the significant contribution of mitochondrial genes. The first mitochondrial mutation shown to cause non-syndromic hearing loss in humans was the A1555G mutation in the small ribosomal RNA gene (12S rRNA). It has been detected in hundreds of families of different ethnic backgrounds, making it one of the prevalent genetic causes of hearing loss currently identified. However, there are major differences between ethnic groups regarding the frequency of this mutation. Few studies have been made in Arab countries, especially in Egypt. Here we report the prevalence of the mitochondrial mutation A1555G among patients with non-syndromic hearing loss (NSHL) and in healthy individuals with normal hearing in the Egyptian population. The study was conducted on 97 patients with SNHL and 300 unrelated healthy Egyptian indi...

Journal of the American Academy of Audiology, 2015

A deficit in the processing of auditory information may underlie problems in understanding speech... more A deficit in the processing of auditory information may underlie problems in understanding speech in the presence of background noise, degraded speech, and in following spoken instructions. Children with auditory processing disorders are challenged in the classroom because of ambient noise levels and maybe at risk for learning disabilities. 1) Set up and execute screening protocol for auditory processing performance (APP) in primary school children. 2) Construct database for APP in the classroom. 3) Set critical limits for deviant performance. Our hypothesis is that screening for APP in the classroom identifies pupils at risk for auditory processing disorders. Study consisted of two phases. Phase 1: 2,015 pupils were selected from fourth-, fifth-, and sixth-graders using stratified random sampling with the proportional allocation method. Male and female students were equally represented. Otoscopic examination, screening audiometery, and screening tests for auditory processing (AP) a...

International journal of molecular epidemiology and genetics, 2014

Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority o... more Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority of hereditary hearing loss is due to nuclear gene mutations, it has become clear the significant contribution of mitochondrial genes. The first mitochondrial mutation shown to cause non-syndromic hearing loss in humans was the A1555G mutation in the small ribosomal RNA gene (12S rRNA). It has been detected in hundreds of families of different ethnic backgrounds, making it one of the prevalent genetic causes of hearing loss currently identified. However, there are major differences between ethnic groups regarding the frequency of this mutation. Few studies have been made in Arab countries, especially in Egypt. Here we report the prevalence of the mitochondrial mutation A1555G among patients with non-syndromic hearing loss (NSHL) and in healthy individuals with normal hearing in the Egyptian population. The study was conducted on 97 patients with SNHL and 300 unrelated healthy Egyptian indi...

The Egyptian Journal of Otolaryngology, 2015

The aim of this study was to detect 35delG and 167delT mutations in the connexin 26 gene among Eg... more The aim of this study was to detect 35delG and 167delT mutations in the connexin 26 gene among Egyptian patients with nonsyndromic sensorineural hearing loss, allowing accurate diagnosis, proper genetic counseling, and carrier detection. Patients and methods Fifty-one patients were subjected to 35delG and 167delT mutations detection using PCR-based techniques. Results Seven patients had the 35delG mutation. Four patients were homozygous and four patients were heterozygous for this deletion. Two homozygotes were sibs and two heterozygotes were sibs as well. The allelic frequency for 35delG was 10.8%. The 167delT was not detected in any of the patients studied. Conclusion The 35delG is a common pathogenic mutation and an important contributor toward autosomal recessive nonsyndromic hearing loss in the Egyptian population.

Egyptian Journal of Ear, Nose, Throat and Allied Sciences, 2014

Objectives: This study aimed at assessing the reversibility of Brainstem Auditory Evoked Response... more Objectives: This study aimed at assessing the reversibility of Brainstem Auditory Evoked Response (BAER) abnormalities in neonates; with risk factors such as hyperbilirubinemia or hypoxia after therapy. Methodology: Two groups A and B consisting of 10 neonates with hyperbilirubinemia (term and preterm) and 10 hypoxic neonates (term and preterm) respectively, had their BAER initially recorded at an age of less than 1 month (as soon as they were discharged from the neonatal intensive care unit), and later at the age of 6 months. Criteria for diagnosing infants with hyperbilirubinemia or hypoxia were a serum bilirubin of >20 mg/dl and an Apgar score less than 6, respectively. A complete medical and family history was taken from the parents. Otoscopic examination, tympanometry, Transient evoked otoacoustic emissions (TEOAEs) were also done. Results: All neonates (100%) had initial BAER abnormalities; thus fulfilling our selection criteria. BAER after 6 months showed significant improvements in both groups; 60% for group A and 55% for group B. Conclusions: Serial BAER is a useful, noninvasive tool to detect neurodevelopmental delay secondary to neonatal hyperbilirubinemia and hypoxia.

The Egyptian Journal of Otolaryngology, 2014

Diagnostic testing of the vestibular system is an essential component for the correct treatment a... more Diagnostic testing of the vestibular system is an essential component for the correct treatment and rehabilitation of patients with balance dysfunction. Stimulus-related electromyogenic changes can be recorded from the extraocular muscles and is termed ocular vestibular-evoked myogenic potential (oVEMP). These changes are a reflection of the otolith organ functionality. The purpose of this study was to investigate the effect of age on the amplitude, threshold, and latency of the oVEMP, to establish age-appropriate norms that will help in the correct diagnosis of balance dysfunction accordingly.

The Egyptian Journal of Otolaryngology, 2014

The effect of the usage of central auditory processing disorder rehabilitation programs on those ... more The effect of the usage of central auditory processing disorder rehabilitation programs on those children should further be assessed.

International journal of molecular epidemiology and genetics, 2014

BACKGROUND & AIM Hearing loss is the most frequent form of neurosensory deficit in humans. Althou... more BACKGROUND & AIM Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority of hereditary hearing loss is due to nuclear gene mutations, it has become clear the significant contribution of mitochondrial genes. The first mitochondrial mutation shown to cause non-syndromic hearing loss in humans was the A1555G mutation in the small ribosomal RNA gene (12S rRNA). It has been detected in hundreds of families of different ethnic backgrounds, making it one of the prevalent genetic causes of hearing loss currently identified. However, there are major differences between ethnic groups regarding the frequency of this mutation. Few studies have been made in Arab countries, especially in Egypt. Here we report the prevalence of the mitochondrial mutation A1555G among patients with non-syndromic hearing loss (NSHL) and in healthy individuals with normal hearing in the Egyptian population. SUBJECTS & METHODS The study was conducted on 97 patients with SNHL and...

The Egyptian Journal of Otolaryngology, 2018

Background and objective The head impulse test is a well-known clinical test that uses video-ocul... more Background and objective The head impulse test is a well-known clinical test that uses video-oculography to quantify vestibulo-ocular reflex (VOR). Normative data for VOR gain are accessible, but most studies just report horizontal-plane VOR characteristics, overlooking variations in vertical-plane VOR gains. The aim of this study is to supply normative data for different age groups to permit future comparison of results to the matching norms. Patients and methods The study was accomplished on 50 individuals who have normal peripheral hearing sensitivity, no otological disorder, and have no history of vestibular disorder, and were divided according to age into five groups, each one comprising 10 participants: individuals in the first group were aged 10–25 years, individuals in the second group were aged 25–35 years, individuals in the third group were aged 35–45 years, individuals in the fourth group were aged 45–55 years, and individuals in the fifth group were aged more than 55 ye...

Objective Age-related changes in the central auditory system, particularly auditory temporal proc... more Objective Age-related changes in the central auditory system, particularly auditory temporal processing abilities, were considered among most important factors affecting speech understanding performance in older adults. Once these factors are identified, clinical management procedures could be developed for prevention and treatment. The aim of this study was to determine the effects of short-term auditory training on the behavioral and electrophysiological measurements of auditory function in individuals with age-related temporal processing deficit. Participants and methods A prospective study of 20 individuals aged 60–67 years with either normal or bilateral symmetric high-frequency hearing loss was conducted. Evaluations of auditory temporal processing using behavioral tests (Pitch Discrimination Test, Pitch Pattern Sequence Test, Auditory Fusion Test-Revised, and Time Compressed Speech Test), P300 potential, and the administration of ‘Amsterdam inventory for auditory disability a...

Background & Aim: Hearing loss is the most frequent form of neurosensory deficit in humans. Altho... more Background & Aim: Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority of hereditary hearing loss is due to nuclear gene mutations, it has become clear the significant contribution of mitochondrial genes. The first mitochondrial mutation shown to cause non-syndromic hearing loss in humans was the A1555G mutation in the small ribosomal RNA gene (12S rRNA). It has been detected in hundreds of families of different ethnic backgrounds, making it one of the prevalent genetic causes of hearing loss currently identified. However, there are major differences between ethnic groups regarding the frequency of this mutation. Few studies have been made in Arab countries, especially in Egypt. Here we report the prevalence of the mitochondrial mutation A1555G among patients with non-syndromic hearing loss (NSHL) and in healthy individuals with normal hearing in the Egyptian population. Subjects & Methods: The study was conducted on 97 patients with SNHL a...

The Egyptian Journal of Otolaryngology

Background The aim of this study was to determine whether different concentrations of intratympan... more Background The aim of this study was to determine whether different concentrations of intratympanic (IT) injection of dexamethasone at a dose of 4 and 10 mg/mL have an effect on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Results Our study was conducted on 30 adult patients with unilateral ISSNHL who failed to respond or with contraindications to systemic steroids. Patients were categorized into two groups; each one included 15 patients. IT injection of 4 mg/mL dexamethasone was done in one group (IT dexamethasone (Dex) 4 mg/mL), while 10 mg/mL dexamethasone was administered intratympanically in the other group (IT Dex 10 mg/mL). IT injection was performed twice weekly for two successive weeks. PTA thresholds were assessed at 0.5, 1, 2 and 4 kHz before and 1 month after the treatment. In the group with IT Dex 10 mg/mL, the average PTA improved significantly from 75.50 ± 12.59 to 49 ± 24.04 dB with an average gain of 26.50 ± 14.25 (p = 0.0...

The Egyptian Journal of Otolaryngology

Background Cochlear implant (CI) is an electronic device that provides direct electrical stimulat... more Background Cochlear implant (CI) is an electronic device that provides direct electrical stimulation to the auditory division of the eighth cranial nerve. The integrity of the internal CI part after implantation can be assessed through objective measures, which are a widely used and valuable tool in the field of CIs. Impedance measurement and electrically evoked compound action potential (ECAP) are the most frequently used tests to facilitate programming of the implants especially in young children. Aim This study was carried out to compare ECAP thresholds and electrode impedance at the time of surgery, at the first stimulation session, and monthly for the next 2 months to assess whether a significant change take places with time. Patients and methods Fifteen deaf children implanted unilaterally with a MED-EL Sonata Implant System with an Opus 2 speech processor were included in this study. All patients received the implant if they fulfilled the Alexandria main hospital criteria for receiving CIs. The group studied included seven males and eight females; they ranged in age from 2 to 6 years. Two of the patients had received implantation in the left ear, whereas the rest of the patients had received a CI in the right ear. Results Intraoperative impedance was the lowest among all postoperative readings in all electrodes. The highest value was that measured 1 month after surgery, after which impedance values continued to decrease significantly, but not to the intraoperative values. The ECAP threshold showed no significant P values between the ECAP threshold measured in the intraoperative and the postsurgery follow-up period. Conclusion The measured impedance showed significant changes in the form of increasing values postoperatively relative to the intraoperative time. The ECAP threshold did not change significantly intraoperatively and postoperatively, showing that intraoperative ECAP can be useful in mapping as it shows no changes.

The Egyptian Journal of Otolaryngology

The aim of this study was to test the effect of direct application of dexamethasone on the round ... more The aim of this study was to test the effect of direct application of dexamethasone on the round window (RW) after its adequate exposure following a transcanal approach in patients with sudden sensorineural hearing loss (SSNHL). Study design This investigation was designed to be a prospective cohort study. Patients and methods This study included eighteen adult patients with SSNHL who attended our outpatient clinic at Alexandria Main University Hospital between 1 July 2015 and 1 July 2016. Under general anesthesia the small tympanomeatal flap was elevated to visualize the RW. If it was fully exposed, dexamethasone (4 mg/ml) was applied directly over a piece of gel foam; if not fully exposed the overhang was removed first and then dexamethasone was applied. After 2 weeks, a repeat audiogram was taken in all patients in order to evaluate the efficacy of the treatment on their hearing ability. Results Post-treatment assessment revealed 50% of patients with variable levels of improvement, whereas 50% did not respond to the given treatment. Of the patients showing improvement, 16.7% had normal hearing levels restored. Thus, direct application of dexamethasone on the RW membrane after its adequate exposure may reverse the hearing deficits in a few patients with SSNHL. Conclusion There is a definitive improvement in hearing in patients with SSNHL on direct application of dexamethasone on the RW membrane after its adequate exposure in patients.

The Egyptian Journal of Otolaryngology

The aim of this work was to study whether or not the hearing loss encountered in some hypothyroid... more The aim of this work was to study whether or not the hearing loss encountered in some hypothyroid patients can be improved with L-thyroxine hormone therapy, as other symptoms of hypothyroidism. Study design The study design was a prospective cohort one. Patients and methods This study included 30 patients of either sex who were proved to be in a hypothyroid state with an additional symptom of hearing impairment. The study was carried out in Alexandria Main University Hospital and was conducted in a prospective manner. All selected patients were proved to be in a hypothyroid state in the Endocrinology Department. Moreover, their symptom of hearing impairment was confirmed by thorough audiological examination supplemented by pure-tone audiometry plus tympanometry that was carried out in the ENT Department and the associate Audiology Unit. L-thyroxine treatment for hypothyroidism was initiated in all cases for 6 months to maintain a state of euthyroidism. At the end of 6 months, a repeat audiogram and tympanometry were performed in all patients in order to evaluate the efficacy of the said treatment protocol on the hearing in these patients. Cases proved to have hearing impairment irrelevant to the hypothyroid condition were excluded. Informed consent was compulsory for recruitment in this study. Results Post-treatment assessment revealed that variable improvement was achieved in 48% of ears, whereas 52% did not respond to the given treatment, with the impairment remaining nearly the same as it was before. Of the improved ears, in 15% of ears hearing levels were restored to normal hearing levels. Thereby, adherence to replacement therapy may reverse the hearing deficits in a few number of hypothyroid patients. Conclusion There is a definitive improvement in hearing with the use of L-thyroxine treatment of hypothyroid patients with hearing impairment.

The Egyptian Journal of Otolaryngology

The tested hypothesis states that by manipulating body position, a differentiation in the optimum... more The tested hypothesis states that by manipulating body position, a differentiation in the optimum body position for ocular vestibular-evoked myogenic potential (oVEMP) testing could be obtained. Patients and methods The present study was conducted on 33 ears (33 healthy adult volunteers) with no age or sex limit or any ontological complaint in the audiology unit of Alexandria Main University Hospital. Pure-tone audiometry, tympanometry, and oVEMP testing were performed. Ocular VEMP was performed in four different positions − sitting, supine, right decubitus, and left decubitus positions. Ocular VEMP waveforms were analyzed regarding morphology, latency, amplitude, and threshold. Results (a) oVEMP was present in 90% of the studied cases. (b) The sitting position produced the shortest latencies. (c) The independent position provided the largest amplitude. (d) The dependent position elicited the highest thresholds. Conclusion Although the best position for oVEMP test could not be determined by the present study, the trends found support that the sitting position may be preferred for future oVEMP testing based on the short latencies produced in this position. On the other hand, high thresholds were obtained in the dependent (left decubitus) position, which indicates that it is the least favorable position.

Acta Otorrinolaringológica Española

BACKGROUND AND OBJECTIVE Benign paroxysmal positioning vertigo (BPPV) is the most common peripher... more BACKGROUND AND OBJECTIVE Benign paroxysmal positioning vertigo (BPPV) is the most common peripheral vestibular disorder. Canalolithiasis in the posterior semi-circular canal is the most common underlying pathology that can be treated effectively by repositioning maneuvers. Our hypothesis suggested that successful maneuvers can lead to repositioning of dislodged otoconia to the utricle. MATERIALS AND METHODS Air conducted oVEMP, which is thought to originate from the contra-lateral utricular organ was measured in twenty patients with unilateral BPPV and we compared n1-p1 peak to peak amplitude of the affected ears in 3 separate intervals: on pre-treatment when typical nystagmus was confirmed, immediately after, and 1 week after repositioning maneuvers to assess change, if any, in amplitude. RESULTS This study showed significant increase of oVEMP amplitude in the affected ears after successful repositioning maneuver that was more significant after 1 week. CONCLUSIONS oVEMP can be used as a reliable objective test for ensuring a successful maneuver rather than subjective dependence on the patient's symptoms, which may be misleading due to a remission.

The Egyptian Journal of Otolaryngology, Jul 1, 2013

Superior canal dehiscence syndrome is a rare medical condition with many variants. In this case r... more Superior canal dehiscence syndrome is a rare medical condition with many variants. In this case report, we present a 35-year-old patient who presented with atypical presentation of superior canal dehiscence syndrome. We discuss his audiological, vestibular, and radiological findings before and after surgery. We present a protocol to establish the diagnosis of a similar condition, especially those presenting atypically.

The Egyptian Journal of Otolaryngology, 2016

The Egyptian Journal of Otolaryngology, 2015

No overall signi cant effect on hearing was found. IT gentamicin had signi cant effect on cVEMPs ... more No overall signi cant effect on hearing was found. IT gentamicin had signi cant effect on cVEMPs with 100% abolition, as well as a statistically signi cant effect on oVEMP with 70% abolition and distortion of the remaining 30%. In these remaining 30% latencies and amplitudes, there was no signi cant difference in values before and after injection. Conclusion A 12 mg single dose of gentamicin can abolish otolithic function without affecting hearing.

International Journal of Molecular Epidemiology and Genetics

Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority o... more Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority of hereditary hearing loss is due to nuclear gene mutations, it has become clear the significant contribution of mitochondrial genes. The first mitochondrial mutation shown to cause non-syndromic hearing loss in humans was the A1555G mutation in the small ribosomal RNA gene (12S rRNA). It has been detected in hundreds of families of different ethnic backgrounds, making it one of the prevalent genetic causes of hearing loss currently identified. However, there are major differences between ethnic groups regarding the frequency of this mutation. Few studies have been made in Arab countries, especially in Egypt. Here we report the prevalence of the mitochondrial mutation A1555G among patients with non-syndromic hearing loss (NSHL) and in healthy individuals with normal hearing in the Egyptian population. The study was conducted on 97 patients with SNHL and 300 unrelated healthy Egyptian indi...

Journal of the American Academy of Audiology, 2015

A deficit in the processing of auditory information may underlie problems in understanding speech... more A deficit in the processing of auditory information may underlie problems in understanding speech in the presence of background noise, degraded speech, and in following spoken instructions. Children with auditory processing disorders are challenged in the classroom because of ambient noise levels and maybe at risk for learning disabilities. 1) Set up and execute screening protocol for auditory processing performance (APP) in primary school children. 2) Construct database for APP in the classroom. 3) Set critical limits for deviant performance. Our hypothesis is that screening for APP in the classroom identifies pupils at risk for auditory processing disorders. Study consisted of two phases. Phase 1: 2,015 pupils were selected from fourth-, fifth-, and sixth-graders using stratified random sampling with the proportional allocation method. Male and female students were equally represented. Otoscopic examination, screening audiometery, and screening tests for auditory processing (AP) a...

International journal of molecular epidemiology and genetics, 2014

Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority o... more Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority of hereditary hearing loss is due to nuclear gene mutations, it has become clear the significant contribution of mitochondrial genes. The first mitochondrial mutation shown to cause non-syndromic hearing loss in humans was the A1555G mutation in the small ribosomal RNA gene (12S rRNA). It has been detected in hundreds of families of different ethnic backgrounds, making it one of the prevalent genetic causes of hearing loss currently identified. However, there are major differences between ethnic groups regarding the frequency of this mutation. Few studies have been made in Arab countries, especially in Egypt. Here we report the prevalence of the mitochondrial mutation A1555G among patients with non-syndromic hearing loss (NSHL) and in healthy individuals with normal hearing in the Egyptian population. The study was conducted on 97 patients with SNHL and 300 unrelated healthy Egyptian indi...

The Egyptian Journal of Otolaryngology, 2015

The aim of this study was to detect 35delG and 167delT mutations in the connexin 26 gene among Eg... more The aim of this study was to detect 35delG and 167delT mutations in the connexin 26 gene among Egyptian patients with nonsyndromic sensorineural hearing loss, allowing accurate diagnosis, proper genetic counseling, and carrier detection. Patients and methods Fifty-one patients were subjected to 35delG and 167delT mutations detection using PCR-based techniques. Results Seven patients had the 35delG mutation. Four patients were homozygous and four patients were heterozygous for this deletion. Two homozygotes were sibs and two heterozygotes were sibs as well. The allelic frequency for 35delG was 10.8%. The 167delT was not detected in any of the patients studied. Conclusion The 35delG is a common pathogenic mutation and an important contributor toward autosomal recessive nonsyndromic hearing loss in the Egyptian population.

Egyptian Journal of Ear, Nose, Throat and Allied Sciences, 2014

Objectives: This study aimed at assessing the reversibility of Brainstem Auditory Evoked Response... more Objectives: This study aimed at assessing the reversibility of Brainstem Auditory Evoked Response (BAER) abnormalities in neonates; with risk factors such as hyperbilirubinemia or hypoxia after therapy. Methodology: Two groups A and B consisting of 10 neonates with hyperbilirubinemia (term and preterm) and 10 hypoxic neonates (term and preterm) respectively, had their BAER initially recorded at an age of less than 1 month (as soon as they were discharged from the neonatal intensive care unit), and later at the age of 6 months. Criteria for diagnosing infants with hyperbilirubinemia or hypoxia were a serum bilirubin of >20 mg/dl and an Apgar score less than 6, respectively. A complete medical and family history was taken from the parents. Otoscopic examination, tympanometry, Transient evoked otoacoustic emissions (TEOAEs) were also done. Results: All neonates (100%) had initial BAER abnormalities; thus fulfilling our selection criteria. BAER after 6 months showed significant improvements in both groups; 60% for group A and 55% for group B. Conclusions: Serial BAER is a useful, noninvasive tool to detect neurodevelopmental delay secondary to neonatal hyperbilirubinemia and hypoxia.

The Egyptian Journal of Otolaryngology, 2014

Diagnostic testing of the vestibular system is an essential component for the correct treatment a... more Diagnostic testing of the vestibular system is an essential component for the correct treatment and rehabilitation of patients with balance dysfunction. Stimulus-related electromyogenic changes can be recorded from the extraocular muscles and is termed ocular vestibular-evoked myogenic potential (oVEMP). These changes are a reflection of the otolith organ functionality. The purpose of this study was to investigate the effect of age on the amplitude, threshold, and latency of the oVEMP, to establish age-appropriate norms that will help in the correct diagnosis of balance dysfunction accordingly.

The Egyptian Journal of Otolaryngology, 2014

The effect of the usage of central auditory processing disorder rehabilitation programs on those ... more The effect of the usage of central auditory processing disorder rehabilitation programs on those children should further be assessed.