OBJECTIVE:To discuss the different modalities for managing necrosis of the long process of the incus in revision stapedectomy on the basis of the degree of necrosis and compare the results with those reported in the literature. MATERIALS and METHODS:Thirty-six patients underwent revision stapedectomy with the necrosis of the long process of the incus from 2009 to 2016. The patients were divided into three groups on the basis of the degree of necrosis. For group A (minimal necrosis), augmentation technique with bone cement was performed. For group B (partial necrosis), the cement plug technique was performed. For group C (sever necrosis), malleus relocation with malleovestibulopexy was performed using reshaped necrosed incus. Air and bone conduction thresholds at frequencies of 500-3000 Hz were reviewed pre-and postoperatively using conventional audiometry. The air-bone gap (ABG) and bone conduction thresholds were measured. RESULTS:Postoperative ABG was reduced to <10 dB in 28 cases (77.8%) and <20 dB in all cases (100%). There was no significant change in postoperative bone conduction thresholds. The mean patient follow-up duration was 23 (range, 18-36) months. The cement plug technique was used in 75% of cases. CONCLUSION:Managing necrosis of the long process of the incus in revision stapedectomy should be considered according to the degree of necrosis. The cement plug technique is considered to be a reasonable option in most cases. Malleus relocation with malleovestibulopexy is an effective alternative to prosthesis.

Although the lake is still considered as the largest of the Egyptian Delta Lakes, its area has been gradually decreased. Extensive land reclamation during the last century has reduced the lake surface area to less than half of its original size. In 1900's, its area was estimated at about 1,709.4 km 2. By the end of the previous century, the area of the lake was estimated to be 1000 km 2. The area of the open water is only 742.8 km 2 due to the presence of a large number of islets in the lake. During the last decade, the reclamation is progressing at an accelerating pace where land had subsequently been created and islands enlarged. Creation of canals and drains such as the Bahr El-Bakar drain, the Sirw drain, the Ramsis drain and the Hadous drain has created an eutrophic condition and low salinity levels in the lake. The areas around the drain outlets in the south and west are characterized by brackish water and the areas in the northeast, near the sea outlets, are saline [1]. The Lake suffers from water pollution induced by agricultural drainage, industrial wastes and sewage and has been shown to be contaminated by persistent organochlorine pollutants [2].This pollution condition of the lake has increased bacterial content particularly that of pathogenic bacterial indicators, such as the fecal coliforms, E.coli, Enterococci and Clostridium perfringes and is manifested in the water as well as in the fish population [3]. pathogenic species such as, Aeromonas hydrophila and Aeromonas sobria, Pseudomonas aeruginosa, Pseudomonas fluorescence and Vibrio anguillarum, were present in the gills, intestines and flesh of the fish samples. The specimens exhibited toxigenic characteristics as well as multi-drug resistance which could explain the marked reduction of fish and the increase of diarrhoeal diseases among human populations residing in the north eastern coast of Egypt [4-6]. This study aims at characterization of microbial pollution of Lake Manzala, focusing on the antibiotic resistant bacterial strains. Materials and Methods Seasonally during the year 2014, water samples were taken from Kapoty, Bashtier, Mataryia and Gamil outlet areas, fish samples were collected from El-Bashtier Area and El-Mataryia Area. The selected sites are host to significant populations around the lake and receive various types of pollutants which negatively affect the condition of the lake and human health. Sampling sites El-Kapoty Area Samples were taken from the end of the junction canal, which connects the Suez Canal with Lake Manzala; the main source of pollution in this area comes from the city of Port-Said. Effluents such as sewage water and industrial wastes from multiple factories are disposed of in this area of the Lake. This site is close to El-Kapoty village, a fishing village in Port-Said, where they dispose of raw sewage directly into the Lake water. El-Bashtier Area is considered a midpoint between the El-Kapoty and the Mataryia areas; it receives water currents from different directions resulting in high water levels. The de...

Objective:The aim of this study to compare the outcome of endoscopic with that of microscopic stapedectomy. Methods: This comparative study involved a prospective analysis of patients with conductive hearing loss who underwent stapedectomy at the department of Otorhinolayngology, Assiut University hospital between July 2015 and October 2017. The patients were divided into two groups: Patients in group I were operated with endoscope and patients in group II were operated with microscope. Pure tone audiometry was carried out in all patients preoperatively and postoperatively. Air and bone conduction thresholds were measured at frequencies of 500, 1000, 2000 and 4000 HZ and the median and interquartile range (IQ) of the pre and postoperative air-bone gap were noted. Extent of bone work at the posterosuperior part of the external auditory canal, accessibility to the oval window and manipulation of the chorda tympani nerve, postoperative complications and hearing results were also noted and compared between the two groups. Results: The median preoperative air-bone gap was 35.8 dB (30.4-45.03) in group I (endoscopic) and 35.85 dB (32.1-43.38) in group II (microscopic) whereas the median postoperative air-bone gap was 16.7 dB (5-39.58) in group I and 15.85 dB (10 -19.58) in group II. There was no statistical difference for hearing results between both groups. The need for bone work and manipulation of the chorda tympani nerve for better visualization was more in microscopic group than the endoscopic group and the difference between both groups was statistically significant. The incidence of complications in both groups was nearly the same in both groups and the difference between them was statistically insignificant. Conclusion: Endoscopic stapedectomy has many advantages over microscopic stapedectomy as better visualization, and easy accessibility to the stapes, oval window niche, and facial nerve. Drilling of the posterosuperior part of the external auditory canal or removal of the scutum and manipulation of the chorda tympani nerve are less frequent with the endoscopic technique.