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Tawfik A, El-Fattah AMA, Hassan A, Helal FA, Ebada HA. Discrepancy between clinical and pathological staging of laryngeal carcinoma: a dilemma to be solved. Eur Arch Otorhinolaryngol 2024; 281:2507-2513. [PMID: 38345614 PMCID: PMC11023994 DOI: 10.1007/s00405-024-08506-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/24/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVES The aim of this study was to investigate the degree of discrepancy between the clinical and pathological staging of laryngeal carcinoma, and the potential impact of this discrepancy on the outcomes and prognosis. METHODS This study was conducted on 127 patients who underwent total laryngectomy over five years (October 2016-October 2021). Data collected from pretherapeutic clinical staging regarding the extent of the tumor affection of different laryngeal subsites was compared to the postsurgical pathological assessment. RESULTS Overall, 12 out of 127 patients (9.4%) in the current study, were clinically over-staged from T3 to T4 due to radiological diagnosis of tumor infiltration of laryngeal cartilages that proved pathologically to be free of tumor. Additionally, discordance in the N stage was found in 12.6% (n = 16). However, stage discrepancy did not have a significant impact on the prognosis and survival. CONCLUSION Discordance between clinical and pathological TNM staging of laryngeal carcinoma may affect the decision making and the choice of the treatment options. Some improvement can be probably achieved with advancements and higher accuracy of the preoperative diagnostic tools.
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Affiliation(s)
- Ali Tawfik
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt
| | | | | | - Fatma Ahmad Helal
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt
| | - Hisham Atef Ebada
- Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt.
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Ebada HA, Abd El-Fattah AM, Tawfik A. Management of frontal sinus fungal osteomyelitis in the COVID 19 era: A case series. J Craniomaxillofac Surg 2022; 50:692-698. [PMID: 35961885 PMCID: PMC9339170 DOI: 10.1016/j.jcms.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/28/2022] [Accepted: 07/20/2022] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to review different approaches and outcomes in the management of post-COVID-19 frontal sinus fungal osteomyelitis. The study included 19 patients with frontal sinus fungal osteomyelitis. The main line of treatment was surgical debridement (sequestrectomy). Approaches included combined external and endoscopic approaches (n = 15) and pure endoscopic approaches (n = 4) according to the extent and accessibility of the sequestrum. Postoperative healing was satisfactory in all patients. All patients returned to their normal daily activity within 4–6 weeks, without residual or recurrent frontal sinus infection, osteomyelitis or need for revision procedures. Within the limitation of this case series, it seems that there is no need to adopt a new therapy regimen for treatment of frontal sinus fungal osteomyelitis because the conventional and well-known treatment approach combining surgery and antifungal drugs seems to work well. However, early, and adequate debridement and sequestrectomy is crucial. Furthermore, an open approach may be required according to the extent of osteomyelitis.
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Tawfik A, Abd El-Fattah AM, El-Sisi H, Kamal E, Ebada HA. Nasal Spine of the Frontal Bone: A Consistent Landmark for Safe Outside-In Frontal Drill-Out. Am J Rhinol Allergy 2022; 36:773-779. [PMID: 35769036 DOI: 10.1177/19458924221111831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Outside-in frontal drill out entails drilling the frontal sinus floor in the midline before identifying and dissecting the frontal recesses. It is a more direct approach, especially in revision surgery or cases with challenging anatomy. OBJECTIVES The aim of this study was to highlight the anatomical and surgical concepts for easy and safe outside-in frontal drill out by a preclinical anatomic study on cadaveric heads. In addition, to review our experience with this approach over a 5-year period for challenging frontal sinus pathologies. METHODS The study included 2 sectors; a preclinical study, in which 5 cadaveric heads were dissected and studied to identify and standardize the anatomical landmarks of this approach. This was followed by a clinical case series which included 22 patients with challenging frontal sinus pathologies that were treated with this proposed approach. RESULTS We concluded from the anatomic study that the nasal spine of the frontal bone (NSFB) and its anatomical orientation in relation to the nasal branch of the anterior ethmoidal artery (NBAEA) is a consistent landmark that enables the surgeon to identify the correct coronal trajectory of drilling to avoid injury of the cribriform and the skull base. The clinical case series included 22 patients that were successfully treated with the proposed approach. No intraoperative nor postoperative complications were reported in this study. Long-term follow-up showed that the frontal neo-ostium was patent in all cases (n = 22). CONCLUSION Outside-in frontal drill-out is a safe and easy approach; especially in challenging frontal sinus pathologies; using the NSFB and its anatomical coronal orientation to the NBAEA as a consistent landmark, anterior to the skull base. This approach offers early, safe, and direct bone removal without the need for initial identification and dissection of the frontal recess.
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Affiliation(s)
- Ali Tawfik
- Department of Otorhinolaryngology, 68780Mansoura University, Egypt
| | | | - Hossam El-Sisi
- Department of Otorhinolaryngology, 68780Mansoura University, Egypt
| | - Elsharawy Kamal
- Department of Otorhinolaryngology, 68780Mansoura University, Egypt
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El-Fattah AMA, Attia M, Ebada HA. Endoscopic assisted transoral approach with palatal splitting for a giant retropharyngeal schwannoma: a challenging case. J Korean Assoc Oral Maxillofac Surg 2022; 48:111-116. [PMID: 35491142 PMCID: PMC9065648 DOI: 10.5125/jkaoms.2022.48.2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Retropharyngeal schwannoma is rare. To the best of our knowledge, only 18 cases have been published in the English literature. Complete surgical excision is the treatment of choice for schwannomas. Transoral approaches have been applied for smaller lesions, and external cervical approaches are preferred for larger and more complex lesions. In this report, we present a case of large retropharyngeal schwannoma that was excised using an endoscopic-assisted transoral approach with palatal splitting. Postoperative functional and oncologic outcomes were satisfactory with no reported intraoperative/postoperative complications.
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Affiliation(s)
| | - Mohamed Attia
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hisham Atef Ebada
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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El-Kholy NA, El-Fattah AMA, Khafagy YW. Invasive Fungal Sinusitis in Post COVID-19 Patients: A New Clinical Entity. Laryngoscope 2021; 131:2652-2658. [PMID: 34009676 PMCID: PMC8242424 DOI: 10.1002/lary.29632] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/23/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022]
Abstract
Objectives Occurrence of invasive fungal respiratory superinfections in patients with COVID‐19 has gained increasing attention in the latest studies. Yet, description of acute invasive fungal sinusitis with its management in those patients is still scarce. This study aims to describe this recently increasing clinical entity in relation to COVID‐19 patients. Study Design Longitudinal prospective study. Methods Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID‐19 infection. Antifungal agents given included amphotericin B, voriconazole, and/or posaconazole. Surgical treatment was restricted to patients with PCR negative results for COVID‐19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow‐up for survived patients was maintained regularly for the first postoperative month. Results A total of 36 patients with a mean age of 52.92 ± 11.30 years old were included. Most common associated disease was diabetes mellitus (27.8%). Mycological analysis revealed infection with Mucor and Aspergillus species in 77.8% and 30.6% of patients, respectively. Sino‐nasal, orbital, cerebral, and palatine involvement was found in 100%, 80.6%, 27.8%, and 33.3% of patients, respectively. The most common reported symptoms and signs are facial pain (75%), facial numbness (66.7%), ophthalmoplegia, and visual loss (63.9%). All patients were treated simultaneously by surgical debridement with antifungal medications except for two patients with PCR‐positive swab for COVID‐19. These two patients received antifungal therapy alone. Overall survival rate was 63.89% (23/36). Conclusion Clinical suspicion of acute invasive fungal sinusitis among COVID‐19 patients and early management with antifungal therapy and surgical debridement is essential for better outcomes and higher survival. Level of Evidence 4 Laryngoscope, 131:2652–2658, 2021
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Affiliation(s)
- Noha Ahmed El-Kholy
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Musaad Abd El-Fattah
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yasser W Khafagy
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Abd El-Fattah AM, Khafagy YW, El-Sisi H, Elkahwagi M, Ebada HA. Ectopic maxillary sinus third molar with dentigerous cyst in 11 patients: Tailored endoscopic-assisted approaches for a successful outcome. Clin Otolaryngol 2021; 46:1095-1099. [PMID: 33773043 DOI: 10.1111/coa.13771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/15/2021] [Accepted: 03/14/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | - Yasser Wafik Khafagy
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hossam El-Sisi
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Elkahwagi
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hisham Atef Ebada
- Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Elshipli NAS, El-Sisi HE, El-Fattah AMA, Al-Saddeik MAEH. Outcome comparison of submucous resection versus combined submucous diathermy and outfracture for treatment of inferior turbinate hypertrophy. Eur Arch Otorhinolaryngol 2021; 278:3827-3837. [PMID: 33582852 DOI: 10.1007/s00405-021-06663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/29/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to compare the outcome of submucous resection and combined submucous diathermy with outfracture technique in treatment of nasal obstruction caused by inferior turbinate hypertrophy. METHODS This study is a prospective randomized clinical trial involving 90 patients with hypertrophied inferior turbinate not responding to medical treatment. All patients were selected with equal or near equal mucosal and bony turbinate components using computed tomography (CT) and then randomly allocated into two groups; group A (n = 45): underwent submucous resection in both sides and group B (n = 45): underwent combined submucous diathermy and outfracture in both sides. Subjective (NOSE score) and objective (4-grades endoscopic classification system and PNIF evaluation) measures of nasal airflow were done preoperatively and postoperatively. RESULTS Subjective assessment using NOSE scale proved that both techniques were effective in relieving nasal obstruction as it improved in both groups postoperatively compared to the preoperative data. However, resection technique was better than diathermy technique with a statistically significant difference (p < 0.05), while objective assessment of nasal obstruction showed better results in resection group than diathermy group, but with no statistically significant difference. CONCLUSION Both techniques are effective in relief of nasal obstruction due to inferior turbinate hypertrophy. However, submucous resection showed marked improvement compared to diathermy technique especially at long-term follow-up.
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Hayes SMS, El-Bendary HM, Ramzy EA, Abd El-Fattah AM, Rizk EMAEA. Efficacy of unilateral combined (superficial and deep) cervical plexus block as a preemptive analgesia for unilateral neck dissection surgery. Egyptian Journal of Anaesthesia 2019. [DOI: 10.1016/j.egja.2012.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Salwa Mohamed Sabry Hayes
- Anesthesia and Surgical Intensive Care, Mansoura University , Faculty of Medicine , Mansoura City, Egypt
| | - Hanaa Mahmoud El-Bendary
- Anesthesia and Surgical Intensive Care, Mansoura University , Faculty of Medicine , Mansoura City, Egypt
| | - Eiad Ahmed Ramzy
- Anesthesia and Surgical Intensive Care, Mansoura University , Faculty of Medicine , Mansoura City, Egypt
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El-Fattah AMA, Ebada HA, Amer HE, Abosamra MM, Tawfik A. Partial cricotracheal resection for severe upper tracheal stenosis: Potential impacts on the outcome. Auris Nasus Larynx 2017; 45:116-122. [PMID: 28363712 DOI: 10.1016/j.anl.2017.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/01/2017] [Accepted: 03/14/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the potential impact of multiple preoperative and intraoperative variables on the outcome of partial cricotracheal resection and tracheal resection anastomosis (PCTR/TRA). METHODS The study was conducted on 35 consecutive patients of grade III and IV upper tracheal stenosis with or without subglottic involvement. The indication of PCTR/TRA was post intubation stenosis in all patients. Overall complications (major and minor) occurred in 18 patients. Perioperative mortality occurred in 1 patient. Anastomotic complications do not always mean failure of surgery. They may indicate one or more interventions; such as removal of granulation tissue or dilatation of restenosis, with good results in most cases. RESULTS At the end of treatment, 30 (85.7%) patients were decannulated successfully with effortless breathing and with good phonation and swallowing. Several perioperative factors were found to have a significant impact on the outcome of PCTR/TRA. Of these factors, comorbidities had the most significant negative impact, and indeed all the three patients who had comorbidities, were not successfully decannulated. Duration of intubation, length of resected segment and previous open airway interventions was reported to have a significant negative impact on the outcome of surgery. CONCLUSION PCTR/TRA for treatment of post traumatic subglottic or upper tracheal stenosis has a high success rate, especially in healthy patients without comorbidities, and without previous open airway interventions.
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Abstract
OBJECTIVES Evaluation of the aesthetic outcome and functional aspect after surgical correction of bifid nose by combined Millard forked flap with external rhinoplasty BACKGROUND Bifid nose is a rare congenital anomaly that results during facial development but the explicit mechanism is not clearly understood. Clinical findings are quite variable with a wide range of severity. Surgical correction still represents great challenge to facial plastic surgeons; extensive deformities in many cases, rarity of condition and paucity of publications are contributing factors. METHODS Surgical correction of six patients with bifid nose by a combined Millard forked flap with external rhinoplasty RESULTS The aesthetic and functional outcomes were acceptable for all patients and parents. There were no considerable postoperative complications. CONCLUSIONS This approach is highly effective for various grades of bifid nose. Early management is preferable to avoid psychological morbidity. Secondary rhinoplasty is usually needed for cosmetic refinement.
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Affiliation(s)
- Ali Tawfik
- Otolaryngology Department, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
| | - Hossam Elsayed El-Sisi
- Otolaryngology Department, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt.
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El-Fattah AMA, Naguib A, El-Sisi H, Kamal E, Tawfik A. Midline nasofrontal dermoids in children: A review of 29 cases managed at Mansoura University Hospitals. Int J Pediatr Otorhinolaryngol 2016; 83:88-92. [PMID: 26968060 DOI: 10.1016/j.ijporl.2016.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Nasal dermoids are congenital anomalies constituting 3.7-12.6% of dermoids in the head and neck. Most of lesions are superficial but there is always a risk that it may end blindly within the deep structures of the nose or extend intracranially. Complete excision, regardless of extension, is essential and must be balanced against cosmoses. This study reviews the clinical characteristics and imaging findings as well as the appropriate surgical approach adopted for 29 cases managed at Mansoura University Hospitals. METHODS A retrospective analysis was performed in 29 patients admitted for management of nasal dermoid between Jan 2001 and Jan 2015 at the Otolaryngology department of our tertiary referral university hospital. Recorded data included patient's demographics, complaint, lesion's site, pre-operative radiological findings, surgical technique, intra-operative findings, and post-operative squeal. RESULTS This series included 12 (41%) female and 17 (59%) male children, with a mean age of 2.5 years. Twenty seven children presented with a nasofrontal swelling of which 20 had an apparent sinus. Other presentations included a swelling in the inner canthum (1), nasal tip and columella (1). Nine (31%) patients had a history of infection and two patients gave a positive history of meningitis. Intracranial extradural extension was identified in 10 patients (34.5%) during preoperative imaging. Surgical modalities included local excision and direct closure (12), open rhinoplasty (7), bicoronal excision and craniotomy (10). In 9 cases, the tract was adherent to the dura but was carefully dissected and in one case resection required excision of a segment of dura and reconstruction. In a follow up period of 1-8 years, recurrence was detected in one case and the cosmetic results were satisfactory. CONCLUSIONS Those lesions are rare and require early precise surgical planning to achieve complete en bloc excision. This study reports a low morbidity associated with management of nasal dermoids with intracranial extension.
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Affiliation(s)
| | - Ahmed Naguib
- Neurosurgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hossam El-Sisi
- Otolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Elsharawy Kamal
- Otolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ali Tawfik
- Otolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Kamal E, El-Fattah AMA, Emam H, Kassem M, Elashry M, Abd Elwahab AEM, Tawfik A. Esthesioneuroblastoma: Mansoura University Hospitals’ experience with multimodality therapy in 10years. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.ejenta.2012.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kamal A, Abd El-Fattah AM, Tawfik A, Abdel Razek AAK. Cervical sympathetic schwannoma with postoperative first bite syndrome. Eur Arch Otorhinolaryngol 2007; 264:1109-11. [PMID: 17431654 DOI: 10.1007/s00405-007-0308-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 03/27/2007] [Indexed: 10/23/2022]
Abstract
Extracranial schwannomas occurring in the head and neck region may arise from cranial, peripheral or autonomic nerves. Determination of the nerve of origin is not often made until the time of surgery. Schwannomas arising from the cervical sympathetic chain are extremely rare. These interesting tumors along with schwannomas in general and the remaining class of neurogenic tumors are known for their ability to mimic the physical and radiological findings of carotid body tumors. Surgery is the treatment of choice and major complications are infrequent. However, we report a case of cervical sympathetic chain schwannoma with postoperative first bite syndrome.
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Affiliation(s)
- Alsharawy Kamal
- Otolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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El-Fattah AMA, Maksoud GA, Ramadan A, Abdalla AF, Abdel-Aziz M. 08:50 AM: Pepsin Assay: A Marker for Reflux in Pediatric Glue Ear. Otolaryngol Head Neck Surg 2006. [DOI: 10.1016/j.otohns.2006.06.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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