Background: Otitis media with effusion (OME) is a collection of non-purulent fluid in the middle ear space; it is almost universal in children with cleft palate. Cleft palate (CP) is among the most common congenital malformations, with an overall incidence of around 1 in 700 individuals. Surgical closure of the cleft palate may lead to improvement in the audiological status of the patients, but whether early surgical correction can improve the middle ear status in CP children remains open for debate. Aim: A meta-analytical study to evaluate and compare the outcome of ventilation tube insertion versus conservative management in management of otitis media with effusion accompanying cleft palate. Methods: A review process was used to assess eligible studies drawn from included published medical articles about conservative management versus ventilation tube insertion in children with otitis media with effusion accompanying cleft palate through searching the Medline data base (www.pubmed.com) and Cochrane library. Then Data were extracted and analyzed from the included studies. Results: 30 relevant articles were found, by application of inclusion criteria 8 articles were found meeting the inclusion criteria and could undergo Meta-analysis. Our results have shown that OME in children with repaired cleft palate can be managed satisfactorily without routine use of ventilation tube (VT). The presence of OME does not lead to long term complications in all patients. Hearing impairment due to OME can be satisfactorily treated with hearing aid (HA) in a majority of children. VT need to be inserted only if the child is not compliant with using a HA or develops recurrent suppurative otitis media. Patients should be followedup closely for OME to prevent complications. Conclusion: Routine use of ventilation tube in CP patients should be discouraged; instead Treatment should be based on the need and willingness of the children and their parents. Also with respect to individual bases such when the child is proved to have OME and hearing loss that affect child language and speech development. Insertion of ventilation tubes should be offered as an alternative to hearing aids or conservative management by close otological and audiological follow up.

Introduction: Botulinum toxin is a neurotoxin produced by a gram-positive, anaerobic spore-forming bacterium called Clostridium botulinum recently used as an effective and safe line of treatment for the temporomandibular joint disorders (TMDs) through temporarily inhibition of the masticatory muscles. TMDs is a collective non-specific term used to describe disorders that involve the TMJ, masticatory muscles and/or associated structures. Aim of the Work: A meta-analysis was conducted to evaluate the efficacy of intramuscular Botulinum toxin-A injection (BTX-A) in the treatment of myogenic temporomandibular joint (TMJ) disorders. Patients and Methods: A systematic literature search was done to identify relevant studies published within the last 25 years on humans. Literature search had been done including PubMed, Medline, Scopus, Web of science, EBSCOhost and Cochrane databases. The study included published medical articles about intramuscular botulinum toxin-A injection in patients suffering from myogenic TMD. The results of the similar studies were pooled in the meta-analysis. Results: Thirty-nine studies with 1538 participants were included in our systematic review and 23 of these studies were pooled in the meta-analysis. The current study showed that the difference of VAS (visual analogue scale) score at 1 and 3 months associated with intramuscular BTX-A injection (pre-and post-treatment) and BTX-A versus control is statistically significant. The difference of MMO (maximum mouth opening) at 1 and 3 months between BTX-A and control is not statistically significant. The difference of EMG amplitude at 1 month between BTX-A and control is not statistically significant while at 3 months is statistically significant. The change in maximum bite force at 3 and 6 months between BTX-A and control is statistically significant. Conclusion:The available data favors the efficacy of usage of intramuscular BTX-A injection in cases of myogenic TMD, further randomized controlled studies must be conducted in the future.

Background More than 5% of the world population lives with a hearing impairment. The main factors responsible for hearing degeneration are ototoxic drugs, aging, continued exposure to excessive noise and infections. The pool of adult stem cells in the inner ear drops dramatically after birth, and therefore an endogenous cellular source for regeneration is absent. Objectives The purpose of this study is to evaluate the role of mesenchymal stem cells in the treatment of severe to profound sensorineural hearing loss as regarding permanent regeneration of the auditory hair cells. Materials and Methods It is a prospective study which was performed in the period of May 2019 till December 2019 and encountered 40 adult male guinea pigs, aged 6 to 8 weeks (body weight 250-500 gram). 30 guinea pigs had been subjected to right side intratympanic injection of Garamycin sulphate to induce sensorineural hearing loss then the 30 animals were subdivided after that into 2 groups; Group A (15 animals) were treated by mesenchymal stem cells implantation in right inner ear cochlea and group B (15 animals) left untreated and the remaining 10 guinea pigs; Group C left normally as a control group. Results As respect to histopathological examination, 100% of animals in group B (n = 15) expressed severe degenerative changes in the peripheral organs. The outer hair cells showed severe destruction with individual loss of the inner hair cells. Also the supporting cells of Corti’s organ presented severe necrosis which was more relevant in the basal turns. We used the bone marrow differentiated MSCs to evaluate their potency in regeneration of the damaged and lost sensorineural elements in gentamicin injured cochlea. In group A (n = 15) 9 out of 15 (60%) expressed profound regeneration and 4 out of 15 (26.66%) expressed early regenerative changes, while 2 animals (13.33%) expressed less degenerative changes which impacted by gentamicin. Conclusion Stem cell transplantation is a promising approach for hearing loss therapy. The choice of stem cell type for transplantation plays a crucial role in the outcome. MSCs are multipotent cells that can be isolated from adult bone marrow and can be induced to differentiate into a variety of tissues in vitro and in vivo.