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Background: Adenoidectomy is one of the most common operations performed in pediatric population. Different techniques have been described for adenoidectomy. Aim of the study: Prospective study to compare post-operative outcome of surgical management of patients with adenoid hypertrophy complicated by persistent otitis media with effusion (OME) by endoscopic adenoidectomy versus conventional adenoidectomy. Patients and Methods: Sixty patients, (aged from 4 to 16 years) diagnosed as adenoid hypertrophy and persistent otitis media with effusion were randomly classified into two groups, with 30 patients in each group. Group A (endoscopic group): who had endoscopic adenoidectomy. Group B (conventional group): who had conventional adenoidectomy. All patients had myringotomy and ventilation tubes insertion. Results: In group (A) the mean age of subjects is 8.02 ± 3.91years. There are 17 males and 13 females. While in group B the mean age of subjects is 6.76 ± 3.21years. There are 17males and 13 females. Endoscopic group has better significant results than conventional group regarding mean operative time, mean intraoperative blood loss, the presence of an adenoid remnant, injury of surrounding tissue and also improvement of the patients according to NOSE score. Conclusion:Endoscopic adenoidectomy technique provides less intra-operative blood loss, less injury to the surrounding structures and less post-operative adenoid tissue remnants, also Endoscope allows good documentation, visualization, more improvement of nasal symptoms and improvement of quality of life, but endoscope is time consuming and costing. while conventional adenoidectomy has its advantages in its simplicity, low cost, and its availability in many places, but it has many disadvantages that makes endoscopic adenoidectomy is the best choice for pediatrics with adenoid hypertrophy..

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Objectives: Allergic rhinitis ( AR) has been recently increasing in prevalence, and traditional treatment strategies sometimes show limited effectiveness for patients with intractable AR. Botulinum toxin type A (BTX-A) is among the increasingly used alternative treatment options. This study was conducted aiming at clinical assessment of the effect of combined septal and turbinate injection of BTX-A for management of uncontrolled AR. Design and setting: A single-arm pilot study enrolled 40 patients having moderate to severe uncontrolled AR were recruited in between October 2018 and August 2019. Each patient received 45 units of BTX-A injected in 3 fixed points of each side of the nose: inferior turbinate (15IU), middle turbinate (15IU) and nasal septum (15IU). All patients were evaluated in terms of nasal hypersecretions, congestion and sneezing with visual analogue scale prior to treatment and at weeks 1, 2, 4, 8 and 12 during the follow-up period. Results: Throughout the 12 weeks follow-up period, a significant difference in the degree of nasal hypersecretions could be identified before and after BTX-A injection. Sneezing differed significantly only in the first 4 weeks while nasal congestion did not differ significantly, before and after BTX-A injection. BTX-A was well tolerated by the patients, with no serious adverse or systemic effects. Conclusion: Combined septal and turbinate injection of BTX-A, in patients with uncontrolled AR, may be a long-lasting therapeutic option for the treatment of nasal hypersecretions, but not as effective as for sneezing and nasal congestion.

Background Severe epistaxis is one of the most common emergencies in rhinology practices. The commonly used endoscopic cauterization of the sphenopalatine artery (SPA), alone or with the anterior ethmoidal artery (AEA), has a high success rate for controlling severe epistaxis. The current study was conducted to evaluate the endoscopic intra-operative variations of SPA between epistaxis and non-epistaxis cases. Forty consecutive patients who underwent exploration of SPA were included in the study. They were distributed into two groups depending upon the indication of SPA exploration; the epistaxis group (group A, n=25 patients, n=26 sides) and the non-epistaxis group (group B, n=15 patients, n=25 sides). Criteria of the main SPA in the two groups were compared regarding four parameters; arterial diameter, arterial adherence to the mucosa of the lower part of the basal lamella, sphenopalatine nerve bundle, and crista ethmoidalis erosion. Results A significant difference was found regarding the diameter of SPA between the two groups; a mean diameter of 4.2±0.64 mm was compared to 3.2±0.35 mm for group A and B, respectively (p=0.043). Moreover, a highly significant tendency was observed regarding the arterial adherence to the mucosa of the lower part of the basal lamella and sphenopalatine nerve bundle in the epistaxis group; (p≤0.01). Conclusion These data clearly signify the importance of intraoperative identification of SPA criteria during surgical management of severe epistaxis. These criteria may help in altering the surgical decision between solely SPA and concomitant SPA/AEA cauterization.