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Papers by mohamed shabana

Ain-Shams Journal of Anesthesiology, 2016

Objectives The aim of this study was to compare the sedative effect of midazolam and propofol alo... more Objectives The aim of this study was to compare the sedative effect of midazolam and propofol alone or in combination on hemodynamic stability and subsequent intracranial pressure (ICP) changes in adults with severe traumatic brain injury. Patients and methods All patients received fentanyl continuous infusion and were randomly divided into three groups: group I received midazolam continuous infusion, group II received propofol continuous infusion, and group III received midazolam and propofol combination at half the dose used for groups I and II. Doses were titrated with gradual increments until the patients were well-sedated irrespective of the upper-dose limit as long as hemodynamic stability was maintained. Intraventicular ICP sensor was inserted at the end of the surgery for patients who underwent surgical interference or through Kocher′s pathway at the right frontal lobe for patients did not undergo surgical interference. Patients were monitored to maintain mean arterial pressure at 80 mmHg or greater and cerebral perfusion pressure and ICP in the range of 50-70 and 18-21 mmHg, respectively. Sedation was judged according to the behavioral pain scale and Bispectral Index. Results Intraoperative catheter was applied in 72 patients and through Kocher′s pathway in 48 patients. The catheter was removed without complications in 104 patients (86.7%). The applied therapeutic strategies provided a significant reduction in ICP compared with baseline measures, but with significantly lower ICP in group III compared with other groups. The number of patients who had an ICP less than 21 mmHg was significantly higher in group III compared with other groups. Nineteen patients required mannitol therapy and 20 patients required muscle relaxant infusion, with a significant difference in favor of group III. The mean total Glasgow Coma Scale of patients in group III was significantly higher compared with groups I and II, with a significantly higher difference in favor of group II. Conclusion Midazolam-propofol combination in the used dosage allowed proper control of hemodynamic changes and improved cerebral perfusion pressure with reduction in ICP and minimizing the need for additional therapy.

Hearing, Balance and Communication, 2019

Introduction: Hearing aid benefit could be measured objectively by electrophysiological tests. Ob... more Introduction: Hearing aid benefit could be measured objectively by electrophysiological tests. Objective measures are important for hearing assessment in individuals who are unable to provide behavioural responses to reach optimal hearing aids fitting verification. Purpose: This study was designed to compare the Functional Gain (FG) of Auditory Steady State Response (ASSR) and Tone Burst Auditory Brainstem Response (TB ABR) as objective tools with the subjective FG using sound field pure tone audiometry (PTA) in adult patients with sensorineural hearing loss using two hearing aid fitting formulae; DSL v5 and NAL-NL2. Material and methods: This study included twenty hearing-impaired adults, their hearing thresholds ranged from moderate to moderately severe sensorineural hearing loss with flat or gradually falling configuration. Their age ranged from eighteen to sixty years. Subjects were examined in three scheduled sessions; unaided, aided NAL-NL2 and aided DSL V5. Each session included free field PTA, TB ABR and ASSR testing at four tested frequencies 500, 1000, 2000 and 4000 Hz. Results: The mean difference between free field PTA FG and TB ABR FG was 6.02 ± 5.11 and 6.51 ± 4.53 by NAL-NL2 and DSL v5 respectively. The cumulative percentage of cases who had mean total differences within ±2 SD (< ±15 dB) was 100% in both formulae. The mean difference between free field PTA FG and ASSR FG was 2.00 ± 7.48 and 2.00 ± 6.99 by NAL-NL2 and DSL v5 formulae respectively. The cumulative percentage of cases who had mean total differences within ±2 SD (< ±15 dB) was 90% in NAL-NL2 formula and 95% in DSL v5 formula. When using identical test conditions and the same type of stimulus, NAL-NL2 and DSL v5 revealed similar functional gain measurements. Conclusions: Both TB ABR and ASSR are valuable objective measures for thresholds detection. The FG measured by TB ABR and ASSR could be applied as an objective tool for hearing aid fitting verification in hearing impaired individuals.

The Medical journal of Cairo University

The Egyptian Journal of Otolaryngology, 2014

Hearing, Balance and Communication, 2015

Abstract Objectives: This is a cross-sectional study conducted on cochlear implant recipients, to... more Abstract Objectives: This is a cross-sectional study conducted on cochlear implant recipients, to monitor changes in recorded impedance telemetry and evoked compound action potentials (ECAP) measured during surgery versus the same measures at post implant follow-up visits. An additional aim was to correlate the recorded ECAP measures with the patient's post-operative performance and to evaluate the incidence of abnormal intra-operative cochlear implant telemetry measurements and their changes at device activation. Study design: The present study comprised 44 subjects – 12 adults and 32 children of both genders – implanted at the Cochlear Implant Unit, Cairo University. ECAP thresholds and electrode impedance measures were collected intra-operatively, at initial stimulation, and at 9–12 months post initial stimulation. Measurements were compared at the three intervals and ECAP measures were correlated to the patient's post-operative performance in the form of aided sound field thresholds, speech detection and discrimination for adults and language assessment for children. Results: In the absence of electrical stimulation, there was an increase of impedance on all electrodes at the initial stimulation visit, which decreased at the 9–12 months follow-up. Open circuit findings were more prevalent than short circuits. Children had higher impedance values at post implant activation compared to adult patients. No correlation existed between ECAP thresholds and post-operative patient performance at the one-year evaluation. Conclusion: At the time of surgery, telemetry provides valuable information regarding the electrical output of the implant and the response of the auditory system to electrical stimulation; however, it is not a valuable predictor of post-operative performance.

Audiological Medicine, 2010

... Mohamed Ibrahim Shabana 1 , Ayman Rashad Amer 2 , Abeir Osman Dabbous 1 &amp;amp; Amani A... more ... Mohamed Ibrahim Shabana 1 , Ayman Rashad Amer 2 , Abeir Osman Dabbous 1 &amp;amp; Amani Ahmed Al-Sunni 1 1 Audiology Unit; Otolaryngology Department; Kasr Al-Aini Faculty of Medicine; Cairo University, Egypt. ... However, our results disagree with Tunca et al. ...

The Egyptian Journal of Otolaryngology, 2012

Introduction Studies using clinical tests have reported abnormal postural balance in children wit... more Introduction Studies using clinical tests have reported abnormal postural balance in children with autism generally but it was only clinically significant when somatosensory input was disrupted alone or in combination with other sensory challenges. Objective To assess the postural control system in autistic children and correlate their age and Child Autism Rating Scale (CARS) score with their postural control. Methods Computerized dynamic posturography was performed in 20 autistic children with (IQ470) between the ages of 5 and 15 years and 15 age-matched healthy children. Results There was a statistically significant positive correlation between age in both the study and the control groups and the Sensory Organization Test (SOT) results in all SOT conditions. As regards the degree of autism, this study included 20 autistic children diagnosed by CARS and their CARS values ranged from 30 to 46, with a mean (33.7 ± 3.22). In our study, we found that there was a statistically significant negative correlation between the CARS score in the study group and SOT results in all conditions, except in SOT condition 1. Conclusion The evidence from this study suggests the more general involvement of neural circuitry beyond the neural systems for social behavior, communication, and reasoning, all of which share a high demand on neural integration of information.

Hearing, Balance and Communication, 2018

Background: Counselling, stress reduction and sound stimulation have been effective in the manage... more Background: Counselling, stress reduction and sound stimulation have been effective in the management of tinnitus. Aim of the work: It was to investigate the effectiveness of counselling and amplification and sound stimulation (Zen tones of fractal music) technology for hearing impaired patients suffering from tinnitus. Methods: This study included 40 hearing impaired subjects with tinnitus, divided into two groups: Both received counselling for 2 months then amplification for 4 months. The study group had their hearing aids with Zen program activated. Results: Post-counselling, none of the cases or controls showed improvement >20 points in the total tinnitus handicap inventory (THI) score. Only 20% of the study group and 15% of the controls showed improved tinnitus severity. Only one of the study group showed improvement in the tinnitus functional index (TFI) > 13 points. After hearing aids, 80% of the study group showed improvement in the tinnitus severity degree compared to 60% of the controls. And 20% improved !20 points in the total THI score, compared to none of the controls. Half of the study group improved in the TFI >13 points, compared to only 10% of the controls, and this was statistically significant. After 6 months, both groups showed comparable improvement in THI tinnitus severity degree: But 60% of the study group and only 15% of the controls improved !20 points in total THI score and this difference was statistically significant. And (85%) of the study group improved >13 points in total TFI score following both counselling and hearing aid fitting, compared to 50% of the controls, and this was statistically significant. Conclusion: Counselling alone had no significant effect on tinnitus improvement in the hearingimpaired patients. The combined approach of counselling and amplification resulted in remarkable improvement. And added music resulted in greater improvements, but was more effective when the loudness of the perceived tinnitus was weaker.

The Egyptian Journal of Otolaryngology, Sep 1, 2012

Participants and methods This study included 20 dizzy children, who were compared with 10 healthy... more Participants and methods This study included 20 dizzy children, who were compared with 10 healthy children, aged 6-12 years. Assessment of history taking was carried out using an Arabic dizziness questionnaire, for which a scoring system was designed to include a thorough evaluation of the different systems involved in balance control; a comparison with the results of referral was carried out. Objective To categorize the causes of dizziness into diagnostic categories and to determine the ability of the scoring system to direct to a certain referral for diagnosing the cause of dizziness. Results The questionnaire's diagnostic categories matched the diagnosis on referral in 75% of cases. Its sensitivity in diagnosing vestibular category was 88.89%. The scoring was applied to the present history, but relevant data in the past medical and family histories were taken into consideration. Conclusion The questionnaire seems to be a reasonable anamnesis for use in training, with a scoring system that can categorize dizzy children by the system/systems affected. It provides questions that a trainee needs to be considering when managing balance disorders in the clinic.

Advanced Arab Academy of Audio-Vestibulogy Journal, 2015

Background Multiple sclerosis (MS) is the quintessential neurologic disorder from which one can g... more Background Multiple sclerosis (MS) is the quintessential neurologic disorder from which one can gain insights into the principles of afferent and efferent neuro-ophthalmology. The popularity of eye movements as an experimental tool can be partly attributed to the fact that they can be conveniently and accurately measured and analyzed, and also because much is known about their neural substrate. It is therefore no surprise that eye movements have been commonly applied to better understand the visual and motor disorders in patients with MS. Objectives The aim of this study was to demonstrate the vast ocular motor abnormalities that occur in this disease using videonystagmography as our tool of description and determine the relationship with Expanded Disability Status Scale (EDSS) and MRI findings. Materials and methods The current study included 76 patients who were divided into two groups. Group I comprised 54 patients with relapsing-remitting multiple sclerosis who fulfilled the Revised Mcdonald′s criteria for diagnosis of MS. The age of the patients in group I ranged from 20 to 68 years, with a mean of 35.13 ± 9.42 SD (23 men and 31 women). Group II comprised 22 healthy age-matched and sex-matched individuals who were recruited from the general population and were not relatives of the patients. Their ages ranged from 19 to 54 years, with a mean of 33.81 years ± 10.07 SD (11 men and 11 women). Video-nystagmography, saccadic tracking, random horizontal saccades, optokinetic tracking (at 20, 40, and 60΀/s), smooth pursuit (0.2, 0.3, 0.4, 0.5, 0.6, and 0.7 Hz), and gaze-evoked nystagmus were examined in both groups. Group I, in addition, was subjected to a thorough neurological history and neurological examination, EDSS assessment, ophthalmologic examination (visual acuity and ocular motility), and radiological assessment by MRI with and without contrast. Results The eye movement disorders most commonly noted are saccadic dysmetria, followed by gaze-evoked nystagmus and pendular nystagmus. They are caused by disease affecting the brain stem and cerebellar circuits. Reduced pursuit gain and saccadic pursuit were also noted. A strong correlation between brainstem and cerebellar MRI lesions and the affection of the ocular motor system was well noted. A high EDSS score was well correlated with abnormal ocular motor test findings. Conclusion Ocular motor system tests are more sensitive than conventional clinical examinations in identifying abnormalities in MS.

Audiological Medicine, 2011

Abstract Objective: The aim of this study was to assess the ability of hearing aid (HA) experienc... more Abstract Objective: The aim of this study was to assess the ability of hearing aid (HA) experience to improve central auditory skills by making use of auditory plasticity. The aim would be achieved through studying the unaided auditory perception of a time ...

Audiological Medicine, 2012

ABSTRACT Objective: Sensorineural hearing loss (SNHL) results in reduced sensitivity, abnormal gr... more ABSTRACT Objective: Sensorineural hearing loss (SNHL) results in reduced sensitivity, abnormal growth of loudness, reduced frequency selectivity and reduced temporal resolution (1). Our aim was to study frequency discrimination abilities in children with SNHL using the psychophysical Pitch Pattern Sequence Test (PPST) and an electrophysiological measure, the Mismatch Negativity Test (MMN). Methods: This is a cross-sectional study that included 90 children, ages ranging from 6 - 12 years, divided into a study group of 60 children with mild to moderate SNHL and a control group of 30 normal hearing children. Both groups were subdivided into 3 subgroups according to age. Results: Subgroups of children with SNHL showed statistically significant poorer scores on the PPST than their well-matched controls. Although MMN can be elicited in children with mild to moderate degree of SNHL, its latency was prolonged. The older control subgroups did not show any statistically significant better scores on the PPST; MMN latencies were longer with increased duration of hearing loss. Degree of hearing loss, gender and side had no effect on PPST or MMN. There was no statistically significant correlation between the results of the PPST and MMN. Conclusion: SNHL affects frequency discrimination abilities demonstrated in poor scores on the PPST and prolonged MMN latency.

Clinical Neurophysiology, 2013

Prostaglandin F2a (PGF) treatment is routinely used in the reproductive management of mares to in... more Prostaglandin F2a (PGF) treatment is routinely used in the reproductive management of mares to induce luteolysis and allow a subsequent return to estrus. The objective of this retrospective study was to assess the effect of follicle size at the time of administration of cloprostenol on interval to subsequent ovulation. A secondary objective was to determine the incidence of hemorrhagic anovulatory follicle (HAF) formation after PGF administration. Reproductive records of 275 mares monitored over a total of 520 estrous cycles were evaluated. All mares received a single intramuscular dose of 250 mg of the synthetic PGF analog cloprostenol sodium between days 5 and 12 after ovulation. The average interval from PGF to ovulation was 8.4 AE 2.5 days. The interval from PGF administration to subsequent ovulation was inversely proportional to the diameter of the largest follicle at the time of treatment. Administration of cloprostenol to mares with a large (!35 mm in diameter) diestrous follicle resulted in one of three outcomesdovulation within 48 hours (13.4%) with variable uterine edema, ovulation after 48 hours usually accompanied by the presence of uterine edema (73.1%), or regression without ovulation followed by emergence and eventual ovulation of a new dominant follicle (13.4%). There was no effect of mare age or season on interval from PGF to ovulation. The overall incidence of HAF development after PGF administration in this study was low (2.5%).

The Egyptian Journal of Otolaryngology

Background Scientific studies require a well-prepared cascade of steps starting from the idea and... more Background Scientific studies require a well-prepared cascade of steps starting from the idea and formulating a research question passing through collecting data and analysis of the results to proper writing a good article and publication. The methodology section is the core of any scientific article. Main body Study designs in otolaryngology can be classified as “observational studies,” “experimental (interventional) studies,” and “meta-analysis—systematic review.” There may be a huge range in quality between kinds of studies. To standardize the method of reporting the quality of studies and include all important aspects in the evaluation process, a team of scientists created the reporting guidelines checklists. Conclusions In this article, we give a comprehensive review that can help authors to understand study designs in otolaryngology along with the appropriate reporting guidelines used in each study.

Journal of Hearing Science, 2014

BackgroundVestibular evoked myogenic potentials (VEMPs) are reflex myogenic potentials of the nec... more BackgroundVestibular evoked myogenic potentials (VEMPs) are reflex myogenic potentials of the neck muscles elicited by stimulating the vestibular system with a click or tone burst sound stimulus. VEMP responses depend on good energy transfer of sound from the middle ear to the inner ear and are presumed absent in the presence of a conductive hearing loss (CHL) of more than 20 dB air-bone gap (ABG). The aim of this study was to evaluate VEMPs in patients with chronic suppurative otitis media (CSOM) before and after surgery.Material and MethodsT he study was conducted on 20 patients with CSOM preoperatively and postoperatively and on 20 controls. Their ages ranged from 20 to 50 years. Each subject underwent history taking, otologic examination, basic audiological evaluation, and air- and bone-conducted VEMP testing.ResultsAll perforated ears showed a lost air conduction VEMP response pre-operatively without any post-operative improvement. This can be attributed to the absence of any s...

Advanced Arab Academy of Audio-Vestibulogy Journal, 2017

Introduction The effectiveness of real word satisfaction is very important for optimal hearing ai... more Introduction The effectiveness of real word satisfaction is very important for optimal hearing aid (HA) fitting, which can be assessed using self-report questionnaires. The Client Oriented Scale of Improvement (COSI) and Abbreviated Profile of Hearing Aid Benefit (APHAB) are useful tools for assessing the effectiveness of HA in achieving patient satisfaction. Patients and methods This study included 20 hearing-impaired adults. Their hearing thresholds ranged from moderate to moderately severe sensorineural hearing loss and had previous experience with HAs. Their ages ranged from 18 to 60 years, and the mean duration of HA experience was 3.85±5.02 years. Participants were examined in three scheduled sessions: unaided, aided National Acoustics Laboratories-Nonlinear 2 (NAL-NL2), and aided desired sensation level (DSL) v5. Each session was scheduled 2 months after the previous session. Patient satisfaction was assessed using the COSI and APHAB questionnaires for each HA fitting formulae. Results Both formulae have improved patient’s five client needs of the COSI; however, NAL-NL2 had better final ability score compared with DSL v5. Using the APHAB questionnaire, both formulae have decreased the listening difficulty score significantly. Using APHAB questionnaire, NAL-NL2 showed significantly less listening difficulty compared with DSL v5 as regards difficulties in ease of communication, broadband noise, and reverberation. However, both formulae did not improve ‘aversiveness’ conditions. Conclusion Questionnaires are equally important to audiometric tests and should not be underestimated and hence should be relied upon it in HA-fitting verification.

Advanced Arab Academy of Audio-Vestibulogy Journal, 2017

Sound therapy, or use of any sound for the purposes of tinnitus management, is widely accepted as... more Sound therapy, or use of any sound for the purposes of tinnitus management, is widely accepted as a management tool for tinnitus. Sound therapy have varying goals. Reducing the attention drawn to tinnitus, reducing the loudness of tinnitus, substituting a less disruptive noise. Sound therapy can be achieved with many modalities: Environmental Enrichment, tinnitus maskers, hearing aids and combination instruments such as: Danalogic iFIT Tinnitus, ReSound Live TS, Oticon’s Tinnitus “SoundSupport”, Phonak’s Tinnitus Balance and Widex Zen Fractal Tones. There are other sound devices e.g.: Acoustic Co-ordinated Reset, Neuromodulation, Serenade, Neuromonics, Phase-Out, Phase-shift and tinnitus inhibitory pathway activation. The advantages of sound therapy are: being non-invasive, reduce patient frustration and anxiety, some patients experience residual inhibition and it can facilitate patient’s habituation to tinnitus.

The Egyptian Journal of Otolaryngology, Apr 1, 2013

Introduction Hearing rehabilitation using nonlinear hearing aid (HA) fitting formulae provides he... more Introduction Hearing rehabilitation using nonlinear hearing aid (HA) fitting formulae provides hearing-impaired individuals with the audibility, comfort, and speech intelligibility for a better life. Objective To compare three nonlinear HA fitting formulae in adults in a Channel Free artificial intelligence parallel processing HA. Materials and methods The study included 19 adults with bilateral moderate to severe sensorineural hearing loss, monaurally fitted with nonlinear HA. Comparisons were made on the basis of aided speech intelligibility in quiet and in noise, aided sound field thresholds, and functional performance in real life using APHAB, COSI, and GHABP questionnaires. Results The three formulae have significantly improved speech discrimination in adults, with no significant difference among the formulae for speech intelligibility in quiet or in noise, with no sex or HA experience differences. The three formulae have significantly improved functional performance in real-life speech communication, with the NAL-NL1-based formula showing the greatest degree of benefit and improvement in listening needs, followed by NAL-NL1 and then DSL [I/O]. However, amplification with the three formulae increased aversiveness to environmental sounds. Participants reported significant benefits using NAL and NAL-NL1-based formulae. Experienced HA users, using the NAL-NL1-based formula, showed significantly less difficulty in listening quality in large spaces and greater capacity to recognize speech within competitive noise and better tolerance to environmental sounds than nonexperienced users. The SPIN test correlated well with real-life speech communication. Conclusion The three fitting rationales have equally improved intelligibility, with variable degrees of improvement in real-life speech communication with preferences for NAL-NL1 and the manufacture-specific NAL-NL1-based formula.

The Egyptian Journal of Radiology and Nuclear Medicine, 2016

To assess the usefulness of MR spectroscopy (MRS) in grading of primary brain tumors. Methods: MR... more To assess the usefulness of MR spectroscopy (MRS) in grading of primary brain tumors. Methods: MRS was performed in 22 patients with primary brain tumors. Metabolite ratios of Choline (Cho)/N-acetylaspartate (NAA), Cho/Creatine (Cr), Cho+Cr/NAA as well as lipids and lactate (LL)/Cr were calculated at short and intermediate echo times (TEs). Additionally, myoinositol (mI)/Cr was calculated at short TE. Tumors were subdivided into low grades and high grade on the basis of histopathology. Receiver operating characteristic analysis of metabolite ratios was performed to find cutoff values between high and low grade tumors. The resulting sensitivity, specificity and accuracy were calculated. Results: At intermediate TE, Cho/NAA, Cho+Cr/NAA and Cho/Cr were significantly higher in high grade tumors than in low grade tumor. At short TE, Cho/Cr and LL/Cr ratios were significantly higher in high grade tumors than in low grade tumor. The diagnostic accuracy of metabolite ratios at intermediate TE was 86% whereas at short TE, the diagnostic accuracy was 75%. Combination of both TEs revealed a diagnostic accuracy of 88%. Conclusion: Cho/NAA, Cho+Cr/NAA and Cho/Cr are reliable in determining the tumor grade. LL/Cr is highly related to high grade tumors. Combination of both short and intermediate TEs provides better accuracy, in grading of brain neoplasm, compared to that when using each TE separately.

Ain-Shams Journal of Anesthesiology, 2016

Objectives The aim of this study was to compare the sedative effect of midazolam and propofol alo... more Objectives The aim of this study was to compare the sedative effect of midazolam and propofol alone or in combination on hemodynamic stability and subsequent intracranial pressure (ICP) changes in adults with severe traumatic brain injury. Patients and methods All patients received fentanyl continuous infusion and were randomly divided into three groups: group I received midazolam continuous infusion, group II received propofol continuous infusion, and group III received midazolam and propofol combination at half the dose used for groups I and II. Doses were titrated with gradual increments until the patients were well-sedated irrespective of the upper-dose limit as long as hemodynamic stability was maintained. Intraventicular ICP sensor was inserted at the end of the surgery for patients who underwent surgical interference or through Kocher′s pathway at the right frontal lobe for patients did not undergo surgical interference. Patients were monitored to maintain mean arterial pressure at 80 mmHg or greater and cerebral perfusion pressure and ICP in the range of 50-70 and 18-21 mmHg, respectively. Sedation was judged according to the behavioral pain scale and Bispectral Index. Results Intraoperative catheter was applied in 72 patients and through Kocher′s pathway in 48 patients. The catheter was removed without complications in 104 patients (86.7%). The applied therapeutic strategies provided a significant reduction in ICP compared with baseline measures, but with significantly lower ICP in group III compared with other groups. The number of patients who had an ICP less than 21 mmHg was significantly higher in group III compared with other groups. Nineteen patients required mannitol therapy and 20 patients required muscle relaxant infusion, with a significant difference in favor of group III. The mean total Glasgow Coma Scale of patients in group III was significantly higher compared with groups I and II, with a significantly higher difference in favor of group II. Conclusion Midazolam-propofol combination in the used dosage allowed proper control of hemodynamic changes and improved cerebral perfusion pressure with reduction in ICP and minimizing the need for additional therapy.

Hearing, Balance and Communication, 2019

Introduction: Hearing aid benefit could be measured objectively by electrophysiological tests. Ob... more Introduction: Hearing aid benefit could be measured objectively by electrophysiological tests. Objective measures are important for hearing assessment in individuals who are unable to provide behavioural responses to reach optimal hearing aids fitting verification. Purpose: This study was designed to compare the Functional Gain (FG) of Auditory Steady State Response (ASSR) and Tone Burst Auditory Brainstem Response (TB ABR) as objective tools with the subjective FG using sound field pure tone audiometry (PTA) in adult patients with sensorineural hearing loss using two hearing aid fitting formulae; DSL v5 and NAL-NL2. Material and methods: This study included twenty hearing-impaired adults, their hearing thresholds ranged from moderate to moderately severe sensorineural hearing loss with flat or gradually falling configuration. Their age ranged from eighteen to sixty years. Subjects were examined in three scheduled sessions; unaided, aided NAL-NL2 and aided DSL V5. Each session included free field PTA, TB ABR and ASSR testing at four tested frequencies 500, 1000, 2000 and 4000 Hz. Results: The mean difference between free field PTA FG and TB ABR FG was 6.02 ± 5.11 and 6.51 ± 4.53 by NAL-NL2 and DSL v5 respectively. The cumulative percentage of cases who had mean total differences within ±2 SD (< ±15 dB) was 100% in both formulae. The mean difference between free field PTA FG and ASSR FG was 2.00 ± 7.48 and 2.00 ± 6.99 by NAL-NL2 and DSL v5 formulae respectively. The cumulative percentage of cases who had mean total differences within ±2 SD (< ±15 dB) was 90% in NAL-NL2 formula and 95% in DSL v5 formula. When using identical test conditions and the same type of stimulus, NAL-NL2 and DSL v5 revealed similar functional gain measurements. Conclusions: Both TB ABR and ASSR are valuable objective measures for thresholds detection. The FG measured by TB ABR and ASSR could be applied as an objective tool for hearing aid fitting verification in hearing impaired individuals.

The Medical journal of Cairo University

The Egyptian Journal of Otolaryngology, 2014

Hearing, Balance and Communication, 2015

Abstract Objectives: This is a cross-sectional study conducted on cochlear implant recipients, to... more Abstract Objectives: This is a cross-sectional study conducted on cochlear implant recipients, to monitor changes in recorded impedance telemetry and evoked compound action potentials (ECAP) measured during surgery versus the same measures at post implant follow-up visits. An additional aim was to correlate the recorded ECAP measures with the patient's post-operative performance and to evaluate the incidence of abnormal intra-operative cochlear implant telemetry measurements and their changes at device activation. Study design: The present study comprised 44 subjects – 12 adults and 32 children of both genders – implanted at the Cochlear Implant Unit, Cairo University. ECAP thresholds and electrode impedance measures were collected intra-operatively, at initial stimulation, and at 9–12 months post initial stimulation. Measurements were compared at the three intervals and ECAP measures were correlated to the patient's post-operative performance in the form of aided sound field thresholds, speech detection and discrimination for adults and language assessment for children. Results: In the absence of electrical stimulation, there was an increase of impedance on all electrodes at the initial stimulation visit, which decreased at the 9–12 months follow-up. Open circuit findings were more prevalent than short circuits. Children had higher impedance values at post implant activation compared to adult patients. No correlation existed between ECAP thresholds and post-operative patient performance at the one-year evaluation. Conclusion: At the time of surgery, telemetry provides valuable information regarding the electrical output of the implant and the response of the auditory system to electrical stimulation; however, it is not a valuable predictor of post-operative performance.

Audiological Medicine, 2010

... Mohamed Ibrahim Shabana 1 , Ayman Rashad Amer 2 , Abeir Osman Dabbous 1 &amp;amp; Amani A... more ... Mohamed Ibrahim Shabana 1 , Ayman Rashad Amer 2 , Abeir Osman Dabbous 1 &amp;amp; Amani Ahmed Al-Sunni 1 1 Audiology Unit; Otolaryngology Department; Kasr Al-Aini Faculty of Medicine; Cairo University, Egypt. ... However, our results disagree with Tunca et al. ...

The Egyptian Journal of Otolaryngology, 2012

Introduction Studies using clinical tests have reported abnormal postural balance in children wit... more Introduction Studies using clinical tests have reported abnormal postural balance in children with autism generally but it was only clinically significant when somatosensory input was disrupted alone or in combination with other sensory challenges. Objective To assess the postural control system in autistic children and correlate their age and Child Autism Rating Scale (CARS) score with their postural control. Methods Computerized dynamic posturography was performed in 20 autistic children with (IQ470) between the ages of 5 and 15 years and 15 age-matched healthy children. Results There was a statistically significant positive correlation between age in both the study and the control groups and the Sensory Organization Test (SOT) results in all SOT conditions. As regards the degree of autism, this study included 20 autistic children diagnosed by CARS and their CARS values ranged from 30 to 46, with a mean (33.7 ± 3.22). In our study, we found that there was a statistically significant negative correlation between the CARS score in the study group and SOT results in all conditions, except in SOT condition 1. Conclusion The evidence from this study suggests the more general involvement of neural circuitry beyond the neural systems for social behavior, communication, and reasoning, all of which share a high demand on neural integration of information.

Hearing, Balance and Communication, 2018

Background: Counselling, stress reduction and sound stimulation have been effective in the manage... more Background: Counselling, stress reduction and sound stimulation have been effective in the management of tinnitus. Aim of the work: It was to investigate the effectiveness of counselling and amplification and sound stimulation (Zen tones of fractal music) technology for hearing impaired patients suffering from tinnitus. Methods: This study included 40 hearing impaired subjects with tinnitus, divided into two groups: Both received counselling for 2 months then amplification for 4 months. The study group had their hearing aids with Zen program activated. Results: Post-counselling, none of the cases or controls showed improvement >20 points in the total tinnitus handicap inventory (THI) score. Only 20% of the study group and 15% of the controls showed improved tinnitus severity. Only one of the study group showed improvement in the tinnitus functional index (TFI) > 13 points. After hearing aids, 80% of the study group showed improvement in the tinnitus severity degree compared to 60% of the controls. And 20% improved !20 points in the total THI score, compared to none of the controls. Half of the study group improved in the TFI >13 points, compared to only 10% of the controls, and this was statistically significant. After 6 months, both groups showed comparable improvement in THI tinnitus severity degree: But 60% of the study group and only 15% of the controls improved !20 points in total THI score and this difference was statistically significant. And (85%) of the study group improved >13 points in total TFI score following both counselling and hearing aid fitting, compared to 50% of the controls, and this was statistically significant. Conclusion: Counselling alone had no significant effect on tinnitus improvement in the hearingimpaired patients. The combined approach of counselling and amplification resulted in remarkable improvement. And added music resulted in greater improvements, but was more effective when the loudness of the perceived tinnitus was weaker.

The Egyptian Journal of Otolaryngology, Sep 1, 2012

Participants and methods This study included 20 dizzy children, who were compared with 10 healthy... more Participants and methods This study included 20 dizzy children, who were compared with 10 healthy children, aged 6-12 years. Assessment of history taking was carried out using an Arabic dizziness questionnaire, for which a scoring system was designed to include a thorough evaluation of the different systems involved in balance control; a comparison with the results of referral was carried out. Objective To categorize the causes of dizziness into diagnostic categories and to determine the ability of the scoring system to direct to a certain referral for diagnosing the cause of dizziness. Results The questionnaire's diagnostic categories matched the diagnosis on referral in 75% of cases. Its sensitivity in diagnosing vestibular category was 88.89%. The scoring was applied to the present history, but relevant data in the past medical and family histories were taken into consideration. Conclusion The questionnaire seems to be a reasonable anamnesis for use in training, with a scoring system that can categorize dizzy children by the system/systems affected. It provides questions that a trainee needs to be considering when managing balance disorders in the clinic.

Advanced Arab Academy of Audio-Vestibulogy Journal, 2015

Background Multiple sclerosis (MS) is the quintessential neurologic disorder from which one can g... more Background Multiple sclerosis (MS) is the quintessential neurologic disorder from which one can gain insights into the principles of afferent and efferent neuro-ophthalmology. The popularity of eye movements as an experimental tool can be partly attributed to the fact that they can be conveniently and accurately measured and analyzed, and also because much is known about their neural substrate. It is therefore no surprise that eye movements have been commonly applied to better understand the visual and motor disorders in patients with MS. Objectives The aim of this study was to demonstrate the vast ocular motor abnormalities that occur in this disease using videonystagmography as our tool of description and determine the relationship with Expanded Disability Status Scale (EDSS) and MRI findings. Materials and methods The current study included 76 patients who were divided into two groups. Group I comprised 54 patients with relapsing-remitting multiple sclerosis who fulfilled the Revised Mcdonald′s criteria for diagnosis of MS. The age of the patients in group I ranged from 20 to 68 years, with a mean of 35.13 ± 9.42 SD (23 men and 31 women). Group II comprised 22 healthy age-matched and sex-matched individuals who were recruited from the general population and were not relatives of the patients. Their ages ranged from 19 to 54 years, with a mean of 33.81 years ± 10.07 SD (11 men and 11 women). Video-nystagmography, saccadic tracking, random horizontal saccades, optokinetic tracking (at 20, 40, and 60΀/s), smooth pursuit (0.2, 0.3, 0.4, 0.5, 0.6, and 0.7 Hz), and gaze-evoked nystagmus were examined in both groups. Group I, in addition, was subjected to a thorough neurological history and neurological examination, EDSS assessment, ophthalmologic examination (visual acuity and ocular motility), and radiological assessment by MRI with and without contrast. Results The eye movement disorders most commonly noted are saccadic dysmetria, followed by gaze-evoked nystagmus and pendular nystagmus. They are caused by disease affecting the brain stem and cerebellar circuits. Reduced pursuit gain and saccadic pursuit were also noted. A strong correlation between brainstem and cerebellar MRI lesions and the affection of the ocular motor system was well noted. A high EDSS score was well correlated with abnormal ocular motor test findings. Conclusion Ocular motor system tests are more sensitive than conventional clinical examinations in identifying abnormalities in MS.

Audiological Medicine, 2011

Abstract Objective: The aim of this study was to assess the ability of hearing aid (HA) experienc... more Abstract Objective: The aim of this study was to assess the ability of hearing aid (HA) experience to improve central auditory skills by making use of auditory plasticity. The aim would be achieved through studying the unaided auditory perception of a time ...

Audiological Medicine, 2012

ABSTRACT Objective: Sensorineural hearing loss (SNHL) results in reduced sensitivity, abnormal gr... more ABSTRACT Objective: Sensorineural hearing loss (SNHL) results in reduced sensitivity, abnormal growth of loudness, reduced frequency selectivity and reduced temporal resolution (1). Our aim was to study frequency discrimination abilities in children with SNHL using the psychophysical Pitch Pattern Sequence Test (PPST) and an electrophysiological measure, the Mismatch Negativity Test (MMN). Methods: This is a cross-sectional study that included 90 children, ages ranging from 6 - 12 years, divided into a study group of 60 children with mild to moderate SNHL and a control group of 30 normal hearing children. Both groups were subdivided into 3 subgroups according to age. Results: Subgroups of children with SNHL showed statistically significant poorer scores on the PPST than their well-matched controls. Although MMN can be elicited in children with mild to moderate degree of SNHL, its latency was prolonged. The older control subgroups did not show any statistically significant better scores on the PPST; MMN latencies were longer with increased duration of hearing loss. Degree of hearing loss, gender and side had no effect on PPST or MMN. There was no statistically significant correlation between the results of the PPST and MMN. Conclusion: SNHL affects frequency discrimination abilities demonstrated in poor scores on the PPST and prolonged MMN latency.

Clinical Neurophysiology, 2013

Prostaglandin F2a (PGF) treatment is routinely used in the reproductive management of mares to in... more Prostaglandin F2a (PGF) treatment is routinely used in the reproductive management of mares to induce luteolysis and allow a subsequent return to estrus. The objective of this retrospective study was to assess the effect of follicle size at the time of administration of cloprostenol on interval to subsequent ovulation. A secondary objective was to determine the incidence of hemorrhagic anovulatory follicle (HAF) formation after PGF administration. Reproductive records of 275 mares monitored over a total of 520 estrous cycles were evaluated. All mares received a single intramuscular dose of 250 mg of the synthetic PGF analog cloprostenol sodium between days 5 and 12 after ovulation. The average interval from PGF to ovulation was 8.4 AE 2.5 days. The interval from PGF administration to subsequent ovulation was inversely proportional to the diameter of the largest follicle at the time of treatment. Administration of cloprostenol to mares with a large (!35 mm in diameter) diestrous follicle resulted in one of three outcomesdovulation within 48 hours (13.4%) with variable uterine edema, ovulation after 48 hours usually accompanied by the presence of uterine edema (73.1%), or regression without ovulation followed by emergence and eventual ovulation of a new dominant follicle (13.4%). There was no effect of mare age or season on interval from PGF to ovulation. The overall incidence of HAF development after PGF administration in this study was low (2.5%).

The Egyptian Journal of Otolaryngology

Background Scientific studies require a well-prepared cascade of steps starting from the idea and... more Background Scientific studies require a well-prepared cascade of steps starting from the idea and formulating a research question passing through collecting data and analysis of the results to proper writing a good article and publication. The methodology section is the core of any scientific article. Main body Study designs in otolaryngology can be classified as “observational studies,” “experimental (interventional) studies,” and “meta-analysis—systematic review.” There may be a huge range in quality between kinds of studies. To standardize the method of reporting the quality of studies and include all important aspects in the evaluation process, a team of scientists created the reporting guidelines checklists. Conclusions In this article, we give a comprehensive review that can help authors to understand study designs in otolaryngology along with the appropriate reporting guidelines used in each study.

Journal of Hearing Science, 2014

BackgroundVestibular evoked myogenic potentials (VEMPs) are reflex myogenic potentials of the nec... more BackgroundVestibular evoked myogenic potentials (VEMPs) are reflex myogenic potentials of the neck muscles elicited by stimulating the vestibular system with a click or tone burst sound stimulus. VEMP responses depend on good energy transfer of sound from the middle ear to the inner ear and are presumed absent in the presence of a conductive hearing loss (CHL) of more than 20 dB air-bone gap (ABG). The aim of this study was to evaluate VEMPs in patients with chronic suppurative otitis media (CSOM) before and after surgery.Material and MethodsT he study was conducted on 20 patients with CSOM preoperatively and postoperatively and on 20 controls. Their ages ranged from 20 to 50 years. Each subject underwent history taking, otologic examination, basic audiological evaluation, and air- and bone-conducted VEMP testing.ResultsAll perforated ears showed a lost air conduction VEMP response pre-operatively without any post-operative improvement. This can be attributed to the absence of any s...

Advanced Arab Academy of Audio-Vestibulogy Journal, 2017

Introduction The effectiveness of real word satisfaction is very important for optimal hearing ai... more Introduction The effectiveness of real word satisfaction is very important for optimal hearing aid (HA) fitting, which can be assessed using self-report questionnaires. The Client Oriented Scale of Improvement (COSI) and Abbreviated Profile of Hearing Aid Benefit (APHAB) are useful tools for assessing the effectiveness of HA in achieving patient satisfaction. Patients and methods This study included 20 hearing-impaired adults. Their hearing thresholds ranged from moderate to moderately severe sensorineural hearing loss and had previous experience with HAs. Their ages ranged from 18 to 60 years, and the mean duration of HA experience was 3.85±5.02 years. Participants were examined in three scheduled sessions: unaided, aided National Acoustics Laboratories-Nonlinear 2 (NAL-NL2), and aided desired sensation level (DSL) v5. Each session was scheduled 2 months after the previous session. Patient satisfaction was assessed using the COSI and APHAB questionnaires for each HA fitting formulae. Results Both formulae have improved patient’s five client needs of the COSI; however, NAL-NL2 had better final ability score compared with DSL v5. Using the APHAB questionnaire, both formulae have decreased the listening difficulty score significantly. Using APHAB questionnaire, NAL-NL2 showed significantly less listening difficulty compared with DSL v5 as regards difficulties in ease of communication, broadband noise, and reverberation. However, both formulae did not improve ‘aversiveness’ conditions. Conclusion Questionnaires are equally important to audiometric tests and should not be underestimated and hence should be relied upon it in HA-fitting verification.

Advanced Arab Academy of Audio-Vestibulogy Journal, 2017

Sound therapy, or use of any sound for the purposes of tinnitus management, is widely accepted as... more Sound therapy, or use of any sound for the purposes of tinnitus management, is widely accepted as a management tool for tinnitus. Sound therapy have varying goals. Reducing the attention drawn to tinnitus, reducing the loudness of tinnitus, substituting a less disruptive noise. Sound therapy can be achieved with many modalities: Environmental Enrichment, tinnitus maskers, hearing aids and combination instruments such as: Danalogic iFIT Tinnitus, ReSound Live TS, Oticon’s Tinnitus “SoundSupport”, Phonak’s Tinnitus Balance and Widex Zen Fractal Tones. There are other sound devices e.g.: Acoustic Co-ordinated Reset, Neuromodulation, Serenade, Neuromonics, Phase-Out, Phase-shift and tinnitus inhibitory pathway activation. The advantages of sound therapy are: being non-invasive, reduce patient frustration and anxiety, some patients experience residual inhibition and it can facilitate patient’s habituation to tinnitus.

The Egyptian Journal of Otolaryngology, Apr 1, 2013

Introduction Hearing rehabilitation using nonlinear hearing aid (HA) fitting formulae provides he... more Introduction Hearing rehabilitation using nonlinear hearing aid (HA) fitting formulae provides hearing-impaired individuals with the audibility, comfort, and speech intelligibility for a better life. Objective To compare three nonlinear HA fitting formulae in adults in a Channel Free artificial intelligence parallel processing HA. Materials and methods The study included 19 adults with bilateral moderate to severe sensorineural hearing loss, monaurally fitted with nonlinear HA. Comparisons were made on the basis of aided speech intelligibility in quiet and in noise, aided sound field thresholds, and functional performance in real life using APHAB, COSI, and GHABP questionnaires. Results The three formulae have significantly improved speech discrimination in adults, with no significant difference among the formulae for speech intelligibility in quiet or in noise, with no sex or HA experience differences. The three formulae have significantly improved functional performance in real-life speech communication, with the NAL-NL1-based formula showing the greatest degree of benefit and improvement in listening needs, followed by NAL-NL1 and then DSL [I/O]. However, amplification with the three formulae increased aversiveness to environmental sounds. Participants reported significant benefits using NAL and NAL-NL1-based formulae. Experienced HA users, using the NAL-NL1-based formula, showed significantly less difficulty in listening quality in large spaces and greater capacity to recognize speech within competitive noise and better tolerance to environmental sounds than nonexperienced users. The SPIN test correlated well with real-life speech communication. Conclusion The three fitting rationales have equally improved intelligibility, with variable degrees of improvement in real-life speech communication with preferences for NAL-NL1 and the manufacture-specific NAL-NL1-based formula.

The Egyptian Journal of Radiology and Nuclear Medicine, 2016

To assess the usefulness of MR spectroscopy (MRS) in grading of primary brain tumors. Methods: MR... more To assess the usefulness of MR spectroscopy (MRS) in grading of primary brain tumors. Methods: MRS was performed in 22 patients with primary brain tumors. Metabolite ratios of Choline (Cho)/N-acetylaspartate (NAA), Cho/Creatine (Cr), Cho+Cr/NAA as well as lipids and lactate (LL)/Cr were calculated at short and intermediate echo times (TEs). Additionally, myoinositol (mI)/Cr was calculated at short TE. Tumors were subdivided into low grades and high grade on the basis of histopathology. Receiver operating characteristic analysis of metabolite ratios was performed to find cutoff values between high and low grade tumors. The resulting sensitivity, specificity and accuracy were calculated. Results: At intermediate TE, Cho/NAA, Cho+Cr/NAA and Cho/Cr were significantly higher in high grade tumors than in low grade tumor. At short TE, Cho/Cr and LL/Cr ratios were significantly higher in high grade tumors than in low grade tumor. The diagnostic accuracy of metabolite ratios at intermediate TE was 86% whereas at short TE, the diagnostic accuracy was 75%. Combination of both TEs revealed a diagnostic accuracy of 88%. Conclusion: Cho/NAA, Cho+Cr/NAA and Cho/Cr are reliable in determining the tumor grade. LL/Cr is highly related to high grade tumors. Combination of both short and intermediate TEs provides better accuracy, in grading of brain neoplasm, compared to that when using each TE separately.