Background: Middle turbinate (MT) is one of the important anatomical and physiological structures of the nasal cavity. After the widespread use of nasal endoscope and paranasal sinus computed tomography (CT), many MT variations have been described. This study aimed to determine the incidence of MT variations by computed tomography (CT) in asymptomatic adult, their relation to each other, and to deviated septum (DS). Results: In the included 86 subjects (172 MTs), pneumatized MT was the most common MT variation followed by paradoxical MT (PMT). Septal deviation did not appear to affect occurrence of pneumatized or PMT. Fifty-nine percent of the reported bilateral PMT were associated with pneumatized MT, while 35.7% of unilateral PMT were associated with pneumatized MT with non-significant difference. Conclusion: MT variations in adults are common mainly pneumatized MT then PMT with no apparent relation to septum deviation.

The detailed CT measurement of the NP in normal adult is an easy and reliable measurement. This study put the base of CT measurement of NP for further work to describe changes in such measures in patients with nasal and paranasal sinus anomalies.

Background: The expanded endonasal approaches to the skull base are modular approaches that arise from the sphenoidal sinus. The reconstructive techniques in these approaches are key to avoid postoperative complications. Available flaps for reconstruction include the pedicled nasoseptal flap, the trans-pterygoid temporoparietal fascia flap, and the posterior pedicle inferior turbinate flap (PPITF), among others. Recently, the middle turbinate flap and nasoseptal flap have been described in a cadaveric study. Objective: The aim of the current study was to compare results of using nasoseptal versus middle turbinate flaps in skull base reconstruction. Patients and methods: This interventional cohort study was carried out on 24 patients in

Purpose: To evaluate reconstruction of posterior meatal and/or lateral attic walls in cholesteatoma surgery using the autologous bony posterior canal wall and bone pâté during the first stage operation. Patients and methods: Twenty ears of twenty patients with chronic suppurative otitis media with cholesteatoma. Cases with extensive destruction of posterior canal wall and mastoid cortex, low tegmen, significant anterior or lateral sigmoid sinus, only functioning ear, labyrinthine fistula and previous canal wall down mastoidectomy were excluded. The surgical technique includes cortical mastoidectomy and bone pâté collection,temporary removal of the bony posterosuperior meatal wall(PMW) by cutting the entire PMW as one piece with a microsagittal saw to offer optimal exposure of tympanic cavity,attic and retrotympanum for complete eradication of cholesteatoma and then repositioning of this wall in its anatomical site supported with bone pâté in attic and mastoid.The condition of reconstructed PMW and the status of middle ear were evaluated by computed tomography scan, otoendoscopic examination and staged second-look surgery. Results:Cholesteatoma in the mastoid, antrum , attic and retrotympanum could be removed with safety in all cases; no serous intraoperative complications occurred, intraoperative difficulties included: damage of posterosuperior canal wall during saw cutting in one case(5%) and mild dural injury during superior cutting in one case(5%) , through follow-up , the new reconstructed canal appeared to be of near normal size, shape and contour, and no dislocation or necrosis of the reconstructed posterior canal wall was noted. The postoperative complications included: wound infection in one case (5%) , tinnitus in two cases (10%) and recurrent cholestearoma in one case(5%). Conclusion: Our surgical technique which includes reconstruction of posterior meatal and/or lateral attic walls in cholesteatoma surgery using the autologous bony posterosuperior meatal wall after its temporary removal provides optimal surgical exposure during the procedure, restores near normal anatomy of the external auditory canal , has low recurrence rate(5%) and avoids the troubles of open mastoid cavity, making this surgical procedure an attractive alternative to the standard CWU and CWD procedures.

Background: Cholesteatoma is a surgical disease for which the primary universally accepted goal is total eradication of cholesteatoma to obtain a safe and dry ear. The second objective is restoration or maintaining the hearing. Objective: This study was aimed to solve the problem of residual cholesteatoma and decrease the problem of large mastoid cavities and to increase the learning curve of endoscopic ear surgery. Patients and Methods: non-randomized controlled trial study performed in Otolaryngology, Head and Neck Surgery Departments, Zagazig University Hospitals in the period from February 2018 to February 2021 on 30 patients suffering from middle ear cholesteatoma. Otoendoscopic evaluation were used for detection of the presence of attic perforation, posterosuperior perforation, aural polyps and, whitish shadow behind intact tympanic membrane. All patients were operated under general anesthesia with controlled hypotensive technique. Results: After 1 year of follow-up in 15 patients using endoscopic approach and 15 patients using microscopic approach, the recidivistic cholesteatoma was found in 6.7% in endoscopic group while it was 20% in microscopic group. Conclusions: It could be concluded that the use of an endoscope provided important benefits to patients with middle ear cholesteatoma and offer superior visualization than microscope.