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Objective Different surgical techniques and management approaches have been introduced to manage the cleft palate (CP) and its complications, such as otitis media with effusion (OME) and auditory problems. The optimal method, as well as the ideal time for palatoplasty and ventilation tube insertion, are the subject of controversy in the literature. We aimed to evaluate The Effect of Intervelar Veloplasty under Magnification (Sommerlad’s Technique) without Tympanostomy on Middle Ear Effusion in Cleft Palate Patients. Methods non-syndromic cleft palate patients from birth to 24 months who needed primary palatoplasty from April 2017 to 2019 were enrolled in this study. intravelar veloplasty (IVVP) surgery under magnification has been done by the same surgeon. Likewise, Otoscopy, Auditory Brainstem Response (ABR), and tympanometry were performed for all the patients before and six months after palatoplasty. Results Tympanograms were classified into two categories according to shape and middle ear pressure, and it was done in 42 children (84 ears). Type B curve was seen in 40 cases (80 ears) before surgery which reduced significantly (P < 0.005) to 12 cases in the left ear and 14 cases in the right ear after surgery. So, after surgery, 70 % of the tympanogram of left ears and 66.6 % of the tympanogram of Rt ears were in normal condition (type A tympanometry). ABR was done for 43 patients (86 ears) before surgery and six months after palatoplasty. Data were shown that 40 of the patients had mild to moderate hearing loss before surgery, which reduced significantly (P < 0.005) to 9 in the left ear and 11 in the right ear after palatoplasty. So, after surgery, 79 % of ABR of left ears and 73.8 % of ABR of right ears were in normal status (normal hearing threshold). Conclusions Intervelar veloplasty under magnification (Sommerlad’s technique) significantly improved the middle ear effusion without the need for tympanostomy tube insertion.

Objective: We carried out this research to assess and compare post-stapedotomy hearing results of Matrix titanium prosthesis with a Teflon piston prosthesis, specifically the fluoroplastic (Teflon) Causse loop piston prosthesis in patients who suffered from otosclerosis.Methodology: In this retrospective study, Causse loop piston prosthesis was used in 81 ears, and the Matrix prosthesis was applied in 44 ears. For pairwise matching with Matrix prosthesis, 44 out of 81 Causse loop piston-treated ears were selected based on preoperative audiometric data. Then, postoperative audiometric results of these two groups were compared. The main outcomes were pure tone audiometric results and airbone gap (ABG) closure before and after the surgery. Incidence of postoperative sensorineural hearing loss was also evaluated and compared between the two groups. Results:The results revealed no significant difference in improvement of speech reception threshold, mean air conduction, bone conduction gain, ABG closure, and incidence of postoperative sensorineural hearing loss at the frequencies of 0.5-4 kHz between the two groups. However, performance of Matrix prosthesis was better in ABG closure at a frequency of 250 Hz. Conclusion:Herein, similar postoperative improvement was achieved at the frequencies of 0.5-4 kHz; nevertheless, Matrix provided better ABG closure at frequency of 250 Hz in short term.

A 24-year-old regularly transfused patient with b-thalassemia major presented with a lateral neck mass. Computed tomography and magnetic resonance imaging showed an enhanced mass 2.3 3 2 3 2.2 cm in the right parotid gland (panels A-B, arrows) with expansion and coarsening of the bony parts (panel A, arrowheads). Differential diagnosis included salivary gland tumors, metastases, hematomas, hemangioma, and extramedullary hematopoiesis (EMH). Fine-needle aspiration of the mass showed normal bone marrow elements (panel C), and EMH was suggested. Pathology showed a soft, dark red, clot-like mass (panel D) that was confirmed as nodal EMH (panels E-F).EMH and bone changes are well established in b-thalassemia. EMH is primarily seen in untreated or inadequately treated patients with thalassemia major or thalassemia intermedia and may not be prevented even by hypertransfusion regimens, whereas it is very rare in patients with thalassemia major who have received the appropriate treatment. Although EMH is usually primarily restricted to the liver or spleen, soft-tissue masses of EMH are rare. Biopsy is indicated when EMH occurs in very rare and unusual locations to exclude other differential diagnoses. If EMH is in a typical location and is not causing clinical problems, close monitoring without biopsy, in addition to attempts to suppress ineffective erythropoiesis or increase its efficacy, may suffice.For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org.