Publications
139 results found
Nouraei SAR, Lloyd-Hughes H, Saleh HA, et al., 2008, Development of a software for objective assessment of facial symmetry., Clin Otolaryngol, Vol: 33, Pages: 637-638
Jaberoo M-C, Saleh HA, 2008, A novel appliance for intra-operative filming of rhinoplasty., Clin Otolaryngol, Vol: 33, Pages: 382-383
Keh SM, Facer P, Simpson KD, et al., 2008, Increased Nerve Fiber Expression of Sensory Sodium Channels Nav1.7, Nav1.8, and Nav1.9 in Rhinitis, LARYNGOSCOPE, Vol: 118, Pages: 573-579, ISSN: 0023-852X
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- Citations: 22
O'Hanlon S, Keh SM, Saleh HA, 2008, The role of neuronal mechanisms in allergic rhinitis, Otorinolaringologia, Vol: 58, Pages: 17-30, ISSN: 0026-4938
Allergic rhinitis is a common condition with considerable morbidity, but the pathophysiology of allergic rhinitis is not fully understood. In fact, several different mechanisms contribute to the symptoms and signs of this condition. Many studies have focused on the role of the immune system in allergic rhinitis and only a few have considered that of sensory nerves and neuropeptides. Little is known, instead, about the influence of the ion channels and transient receptor proteins in allergic rhinitis. This article takes in consideration the role of some of the sensory neuropeptides (substance P, calcitonin gene related peptide , vasoactive intestinal peptide, and adrenergic neuropeptides), the sodium channels, the transient receptor protein and the nerve growth factor in allergic rhinitis referring to up-to-date published literature and the Authors' personal experience in this area. All these substances interact with the immune system in a synergic fashion. Without any doubt the neuronal mechanism represents an exciting challenge for the target of future treatments of allergic rhinitis.
Jaberoo MC, Saleh H, 2008, Minerva, BMJ, Vol: 337, ISSN: 0959-8138
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- Citations: 1
Orban N, Durham SR, Saleh HA, 2008, Allergic and Non-Allergic Rhinitis, Middleton’s Allergy: Principles and Practice, 7th Edition
Saleh HA, Durham SR, 2007, Perennial rhinitis, BMJ-BRITISH MEDICAL JOURNAL, Vol: 335, Pages: 502-507, ISSN: 1756-1833
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- Citations: 16
O'Hanlon S, Facer P, Simpson KD, et al., 2007, Neuronal markers in allergic rhinitis: Expression and correlation with sensory testing, LARYNGOSCOPE, Vol: 117, Pages: 1519-1527, ISSN: 0023-852X
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- Citations: 45
Chatrath P, Nouraei SAR, De Cordova J, et al., 2007, Endonasal endoscopic approach to the petrous apex: an image-guided quantitative anatomical study, 8th Congress of the European-Skull-Base-Society, Publisher: BLACKWELL PUBLISHING, Pages: 255-260, ISSN: 1749-4478
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- Citations: 27
Nouraei SAR, Maani T, Hajioff D, et al., 2007, Outcome of endoscopic sphenopalatine artery occlusion for intractable epistaxis: a 10-year experience., Laryngoscope, Vol: 117, Pages: 1452-1456, ISSN: 0023-852X
OBJECTIVE/HYPOTHESIS: To evaluate the efficacy of surgical sphenopalatine artery occlusion (SAO) for treating intractable epistaxis, and identify factors associated with long-term success or failure of this procedure. METHODS: A retrospective chart review of patients undergoing SAO surgery between January 1995 and 2005 was undertaken. Clinical and hematologic information, preoperative and surgical care, short-term complications, and long-term outcome were recorded. Binary logistic regression was used to identify risk factors for early re-bleeding, and log-rank statistics with Cox regression were used to identify risk factors for long-term operative failure. RESULTS: Sixty-seven patients underwent 71 SAO operations. The average age at surgery was 56 +/- 18 years. Thirty percent of patients were being treated for hypertension, 19% were taking aspirin, and 11% were anticoagulated with warfarin. Many patients (46%) had >72 hours of epistaxis before admission, and 25% required preoperative transfusion. There were 13 (19%) bilateral procedures, six patients underwent concomitant anterior ethmoid artery occlusion, and 12 patients had concomitant septoplasty. Eight patients had significant early re-bleeding. Platelet levels on admission and not using diathermy to occlude the sphenopalatine artery were independent risk factors for this (P values .03, and .02, respectively). Not using diathermy was also an independent risk factor for late operative failure on Cox regression, reducing the mean re-intervention-free interval from 94 +/- 7 to 32 +/- 7 months (P < .007; hazard ratio 6.4; 95% confidence interval 1.7-24.9). CONCLUSIONS: SAO is an effective operation and, in trained hands, an appropriate first-line procedure for treating intractable epistaxis. Use of diathermy significantly improves the short- and long-term outcome of this surgery.
Chatrath P, Nouraei SAR, De Cordova J, et al., 2007, Endonasal endoscopic approach to the petrous apex: an image-guided quantitative anatomical study., Clin Otolaryngol, Vol: 32, Pages: 255-260, ISSN: 1749-4478
BACKGROUND: The petrous apex is a relatively inaccessible region, deeply situated within the skull base. Removal of lesions from this area, traditionally accomplished via lateral approaches, can cause significant morbidity. We undertook an anatomical study to investigate the surgical anatomy of the petrous apex through an endonasal endoscopic approach, which has been sporadically described in the literature, to investigate its feasibility and to characterise clear and consistent surgical landmarks for access. METHODS: Cadaveric dissections were performed on five heads. Pre-dissection computed tomography scans were used, with the BrainLab navigation system, to verify entry into the petrous apex. Surgical landmarks were characterised in relation to fixed sphenoid sinus structures, and surgical access before and after drilling the sphenoid sinus rostrum was quantitatively compared. RESULTS: The landmark for entry into the petrous apex was the intersection of a vertical line halfway between the medial surface of the internal carotid artery and the midline, with a horizontal line one-third of the way up from the postero-inferior floor of the sphenoid sinus. The dimensions of the postero-superior sphenoid sinus were characterised by the inter-carotid distance, pituitary-to-sphenoid-floor distance and the width of the sphenoid sinus floor, which were 15 +/- 3 mm, 16 +/- 3 mm and 26 +/- 1.6 mm respectively. The surface area of surgical access was 193 +/- 28 mm(2), increasing to 316 +/- 39 mm(2) after drilling of the sphenoid rostrum (P < 0.001; paired t-test). CONCLUSIONS: Endoscopic approach to the petrous apex is anatomically feasible, and, aided by image navigation, could extend the scope of endonasal surgery to access highly-selected lesions in the middle cranial fossa.
Majithia A, Tatla T, Sandhu G, et al., 2007, Erratum: Intracranial polyps in patients with Samter's triad (American Journal of Rhinology (2007) 21, 1), American Journal of Rhinology, Vol: 21, ISSN: 1050-6586
Shukla S, Keh SM, Andrews P, et al., 2007, Isolated inflammatory sphenoiditis with multiple unilateral cranial nerve palsies., J Laryngol Otol, Vol: 121, Pages: 186-188
Isolated sphenoidits is a rare entity that often presents with vague, non-specific symptoms. We present the case of a 36-year-old Middle Eastern man, who developed headache and a painful right eye. A diagnosis of acute sphenoiditis was made. Shortly afterwards, he developed diplopia due to isolated abducent nerve involvement. Within two months, the extent of cranial nerve involvement had increased to include cranial nerves II, III, and V. Subsequently, this was treated by functional endoscopic sinus surgical drainage and biopsy. Histology revealed inflammatory changes. The patient made a dramatic recovery post-operatively, with resolution in all symptoms.
Tysome JR, Saleh HA, 2007, Sphenochoanal polyp presenting with concomitant nasal polyps., Ear Nose Throat J, Vol: 86, Pages: 50-52, ISSN: 0145-5613
A sphenochoanal polyp is a rare lesion that originates in the sphenoid sinus. It occurs most often in adolescents and young adults. We present what to the best of our knowledge is the first reported case of a sphenochoanal polyp associated with concomitant nasal polyps. The patient was a 54-year-old man who presented with bilateral nasal obstruction, possible obstructive sleep apnea, and an altered voice, all of which had likely been caused by the presence of a massive left sphenochoanal polyp and bilateral grade III anterior and posterior ethmoid polyps. Because the patient had dilated cardiomyopathy, he was not a good candidate for general anesthesia. Therefore, the polyps were removed endoscopically under local anesthesia. The sphenochoanal polyp measured 7.5 cm in its greatest dimension and weighed 41 g. The patient remained symptom-free at the 1-year follow-up. The presentation of a sphenochoanal polyp is similar to that of the more common antrochoanal polyp, but the two can usually be differentiated on computed tomography. Endoscopic sinus surgery allows for complete removal of the polyp, including its site of origin, which minimizes the risk of recurrence.
Chatrath P, De Cordova J, Nouraei SAR, et al., 2007, Objective assessment of facial asymmetry in rhinoplasty patients., Arch Facial Plast Surg, Vol: 9, Pages: 184-187, ISSN: 1521-2491
OBJECTIVES: To determine the incidence and nature of facial asymmetry in patients referred for consideration of aesthetic rhinoplasty and to assess whether objective anthropometric facial measurements correlate with subjective perceptions of asymmetry. DESIGN: Two independent observers measured facial features, including midline to medial and lateral canthi, tragus, ala, and oral commissure distances, in 234 prerhinoplasty surgical photographs. The photographs were rated by 10 independent observers for a global "first impression" of facial symmetry, and the relationship between anthropometric measurement and subjective perception of facial symmetry was explored with logistic regression. RESULTS: Objectively, 97% of patients had significant degrees of facial asymmetry, with the midline to ala distances showing the most variations and the midline to oral commissures showing the least variations. Subjectively, 38% of results were perceived as asymmetrical, with the degree of midline to lateral alar margin asymmetry being an independent predictor of the perception of facial asymmetry on binary logistic regression (P<.003). CONCLUSIONS: A significant correlation was found between the degree of objective facial asymmetry, particularly in anthropometric nasal measurements, and the subjective perception of a face as asymmetrical in patients requesting aesthetic rhinoplasty. This relationship may be a factor in patients who request rhinoplasty and should be explored in this patient group.
Noureai SAR, Randhawa P, Andrews PJ, et al., 2007, The role of nasal feminization rhinoplasty in male-to-female gender reassignment., Arch Facial Plast Surg, Vol: 9, Pages: 318-320, ISSN: 1521-2491
OBJECTIVE: To objectively assess the results of rhinoplasty in feminizing the facial profiles of male-to-female transsexual patients undergoing gender reassignment. METHODS: Twelve patients underwent nasal feminization as part of male-to-female gender reassignment. Global assessments of facial profile were performed, and nasofrontal, nasolabial, and supratip angles and the Goode ratio were objectively measured. Postoperative and long-term patient satisfaction was assessed. RESULTS: The surgical procedures created more feminine nasal profiles in all patients. The mean +/- SD nasofrontal angle changed from 141.6 degrees +/- 6.0 degrees to 150.5 degrees +/- 5.5 degrees (P < .001). The nasolabial angle changed from 107.4 degrees +/- 14.3 degrees to 115.2 degrees +/- 11.7 degrees (P < .001), and the supratip angle from 1.7 degrees +/- 4.9 degrees to 12.8 degrees +/- 5.8 degrees (P < .001). The Goode ratio did not change significantly, remaining on average around 1.64 +/- 0.15. In 4 cases, spreader grafts were used to reconstruct the nasal valve, and no cases of valve insufficiency occurred. CONCLUSIONS: Rhinoplasty is effective in achieving feminine facial profiles in patients undergoing male-to-female gender reassignment. This requires reducing the overall nasal size and changing nasal angles to those more reminiscent of the female form. Because of the extensive resections often required to modify the nasal form, it is important to pay particular attention to preserving function, which may require concomitant nasal valve reconstruction.
Hesham Saleh, 2007, Occupational rhinitis, Scott-Brown’s Otolaryngology, Editors: Gleeson, Lund
Ragab S, Scadding GK, Lund VJ, et al., 2006, Treatment of chronic rhinosinusitis and its effects on asthma, EUROPEAN RESPIRATORY JOURNAL, Vol: 28, Pages: 68-74, ISSN: 0903-1936
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- Citations: 97
Savage JR, Saleh HA, Clarke PM, 2006, A new combined approach to the nasopharynx in head and neck plastic surgery: technique and application, JOURNAL OF LARYNGOLOGY AND OTOLOGY, Vol: 120, Pages: 591-593, ISSN: 0022-2151
Ragab SM, Lund VJ, Saleh HA, et al., 2006, Nasal nitric oxide in objective evaluation of chronic rhinosinusitis therapy., Allergy, Vol: 61, Pages: 717-724, ISSN: 0105-4538
BACKGROUND: The assessment of the response of chronic rhinosinusitis (CRS) to therapy is difficult. Computerized tomographic (CT) scans cannot be repeatedly used so measures such as symptom scores, endoscopic findings, and parallel measures such as saccharin clearance time are employed instead. OBJECTIVE: To study the effect of CRS therapy on nasal nitric oxide and to see whether nasal nitric oxide level changes correlate with other assessments. METHODS: The study was a prospective randomized trial of patients with CRS, with or without polyps, who had failed initial medical therapy with douching and nasal corticosteroids and who then had abnormal CT scans. They were treated either medically or surgically, with follow up at 6 and 12 months whilst still taking nasal corticosteroids. Nasal nitric oxide was measured initially and at 6 and 12 months as well as symptom scores, endoscopy, polyp grading, and saccharin clearance time. RESULTS: Initial absolute nasal nitric oxide levels correlated inversely with CT scan changes, (P<0.001). The percentage rise in nasal nitric oxide seen on both medical and surgical treatment correlated with changes in symptom scores (P<0.001), saccharin clearance time (P<0.001), endoscopic changes (P<0.001), polyp grades (P<0.05 at 6 months, P<0.01 at 12 months) and surgical scores (P<0.01). There was no significant correlation with age, sex, smoking or allergy. CONCLUSION: Nasal nitric oxide, which is easily measured, provides a valuable non-invasive objective measure of the response of CRS to therapy. Topical nasal corticosteroids may be needed to reduce the contribution of nasal epithelial nitric oxide and allow that emanating from the sinuses to be measured.
Chatrath P, Saleh HA, 2006, Endoscopic repair of cerebrospinal fluid rhinorrhea using bone pate., Laryngoscope, Vol: 116, Pages: 1050-1053, ISSN: 0023-852X
Nouraei R, Chatrath P, Saleh HA, et al., 2006, An instrument for precise cartilage excision in nasal septal surgery., Ann Plast Surg, Vol: 56, Pages: 467-468, ISSN: 0148-7043
Hade Vuyk, Hesham Saleh, 2006, Management of the Deviated Asymmetric Nose, Facial Plastic and Reconstructive Surgery, Editors: Vuyk, Lohuis, London, Publisher: Hodder Arnold
Hade Vuyk, Hesham Saleh, 2006, Auricular Reconstruction, Facial Plastic and Reconstructive Surgery, Editors: Vuyk, Lohuis, London, Publisher: Hodder Arnold
Nouraei SAR, Hajioff D, Almeyda J, et al., 2005, Measurement of absolute dimensions in endoscopic sinus surgery., Laryngoscope, Vol: 115, Pages: 889-893, ISSN: 0023-852X
OBJECTIVE: To develop and evaluate a simple, noninvasive technique for the precise measurement of antrostomy dimensions using standard endoscopic views. METHODS: We produced an antrostomy probe and devised a method, on the basis of techniques of aerial planimetry, for measuring antrostomies using standardized endoscopic views. Ten shapes of known surface areas were measured independently by three experienced endoscopic sinus surgeons using 30 and 70 degree endoscopes. The accuracies of surgeon assessment and interobserver concordance were calculated. RESULTS: The three surgeons were able to calculate the surface areas with great precision (Pearson's coefficient of correlation > 0.85 in all cases) using both 30 and 70 degree endoscopes. An intraclass correlation coefficient of 0.92 was obtained, indicating a high degree of concordance between the measurements obtained by different surgeons. CONCLUSION: This technique shows considerable promise as a tool for precise measurement of antrostomy dimensions in both clinical and research settings.
White PS, Nassif R, Saleh H, et al., 2004, Pilot study of a device for measuring instrument forces during endoscopic sinus surgery., Acta Otolaryngol, Vol: 124, Pages: 176-178, ISSN: 0001-6489
ESS is a form of minimal access surgery that includes different tasks and manoeuvres requiring sophisticated psychomotor coordination with varying levels of force application. The avoidance of complications is partially dependent upon reducing surgical force application when operating against vital barriers such as the skull base and the medial orbital wall. The study of the surgical forces in endoscopic sinus surgery offers the potential for surgeons to identify the appropriate application of the instrument forces and torques necessary to conduct safe surgery. We have developed Sinoforce, a sinus surgery force-measuring instrument, which comprises modified Blakesley forceps fitted with specialized force sensors The instrument produces a real-time visual display of the various forces applied by the surgeon to the forceps during endoscopic ethmoidectomy. A pilot study was conducted using four cadaveric head specimens. We measured the force needed to break through the different parts of the ethmoidal bony labyrinth and skull base. Comparable forces were needed to break through the ethmoidal bulla and uncinate process. However, a force of > 2 kg, exceeding the forceps calibration, was needed to break through the different parts of the skull base. In this article we describe the new forceps, present our preliminary results and explore the potential benefits of this new instrument.
Magarey MJR, Jayaraj SM, Saleh HA, et al., 2004, Ball valve nasal obstruction following incomplete inferior turbinectomy, JOURNAL OF LARYNGOLOGY AND OTOLOGY, Vol: 118, Pages: 146-147, ISSN: 0022-2151
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- Citations: 1
de Ru JA, Lohuis PJFM, Saleh HA, et al., 2002, Treatment of chondrodermatitis nodularis with removal of the underlying cartilage alone: retrospective analysis of experience in 37 lesions., J Laryngol Otol, Vol: 116, Pages: 677-681, ISSN: 0022-2151
Most otolaryngologists treat patients with chondrodermatitis nodularis (CDN) by wedge excision. Although the results of this technique are generally good, it can leave the patient with an asymmetric, deformed ear. In the dermatological literature, a relatively straightforward technique has been described for the treatment of CDN by smoothing only the underlying cartilage. This is based on the assumption that CDN is caused by pressure necrosis of protuberant cartilage, and thus is primarily not a skin disease. Reports on this technique claim excellent cosmetic results with only a small chance of recurrence. In the present study we analyse the application of this technique to 34 patients with 37 CDN lesions. All patients were symptom-free with a minimum follow-up of three months according to their medical reports. Seventeen patients with 19 lesions were interviewed later by telephone. In a mean follow-up of 30.7 months, 34 of these patients remained symptom-free and only one required revision surgery. The authors recommend this safe and simple technique to other physicians who treat patients with CDN.
Saleh H, Brookes N, 2002, Medical treatment of nasal polyps, Asthma Journal, Vol: 7, Pages: 69-72, ISSN: 1363-268X
Nasal polyps are more common in people with asthma, particularly in those whose condition is aspirin-sensitive. It is not known why they develop. Treatment is with a combination of corticosteroid therapy and surgical intervention, as Hesham Saleh and Natalie Brooks describe.
Brookes N, Saleh H, Mackay I, 2002, 10-minute consultation: rhinitis. Referral to specialist otolaryngologist may be advisable., BMJ, Vol: 324
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