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OBJECTIVE We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that scrutinized the oncological benefits and postsurgical complications of total thyroidectomy (TT) plus prophylactic central neck dissection (pCND) versus TT alone among clinically node-negative (cN0) papillary thyroid cancer (PTC) patients. METHODS We screened five databases from inception to September 4, 2021 and evaluated the risk of bias of the eligible studies. We pooled dichotomous outcomes using the risk ratio (RR) with 95% confidence interval (CI). RESULTS Overall, we included 5 RCTs with low risk of bias comprising 795 patients (TT plus pCND = 410 and TT alone = 385). With regard to efficacy endpoint, the rate of structural loco-regional recurrence did not significantly differ between both groups (n = 4 RCTs, RR = 0.49, 95% CI [0.19, 1.27], P = .14). With regard to safety endpoints, the rates of hypoparathyroidism (n = 5 RCTs, RR = 1.48, 95% CI [0.73, 2.97], P = .27), recurrent laryngeal nerve injury (n = 5 RCTs, RR = 1.34, 95% CI [0.59, 3.03], P = .48), and bleeding (n = 3 RCTs, RR = 1.75, 95% CI [0.42, 7.26], P = .44) did not significantly differ between both groups. CONCLUSION For cN0 PTC patients, there was no significant difference between TT plus pCND and TT alone with regard to the rate of structural loco-regional recurrence or frequency of postsurgical complications. Adaptation of pCND in cN0 PTC patients should be contemplated by taking into consideration the clinical oncological benefits and rate of postsurgical adverse events. LEVEL OF EVIDENCE 1 Laryngoscope, 2021.

Periodic Fever, Aphthous Ulcers, Pharyngitis and Adenitis (PFAPA) Syndrome’s etiology is not well understood. The objective of this study is to explore the association between vitamin D level and PFAPA syndrome. A systematic review of all publications addressing the association between vitamin D level and PFAPA syndrome prior to May 2019 was conducted. Data were collected from online medical databases namely, PubMed, Ovid Medline, Embase, Cochrane Library, Google Scholar, and Scopus. The review adhered to the PRISMA statement and was performed in 3 main phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles. 3 prospective review-based and one case report articles were included with a total of 281 patients, 98 of whom were cases of PFAPA, while 183 were controls. Vitamin D levels were deficient in 27% of PFAPA group as compared with the control. Vitamin D supplementation was given as an initial treatment in 25/98 of the patients. Only 1 patient received it as a second treatment. After vitamin D supplementation, a marked reduction of the number of febrile episodes and modification of the mean duration were recognized. There may be an association between Vitamin D deficiency and a higher frequency of PFAPA episodes. Vitamin D supplementation in children with PFAPA may reduce the frequency of episodes and help manage the condition.

To survey Otolaryngology residents to evaluate their operative airway exposure during their training and to assess if the exposure was adequate to decide whether to pursue fellowship in pediatric. A modified and validated survey was distributed among otolaryngology trainees in the Western region of Kingdom of Saudi Arabia. It assesses operative airway exposure during training, adequacy of experience to decide on whether to pursue fellowship in pediatric otolaryngology, and plan to perform the following six procedures (diagnostic rigid bronchoscopy, diagnostic flexible bronchoscopy, endoscopic airway foreign body removal, rigid esophagoscopy with or without foreign body removal, suspension microlaryngoscopy procedures, open tracheostomy) in practice. Only 24/60 (60%) of respondents perceived that they had adequate training as to whether or not to make them decide to pursue fellowship in pediatric. In regard to over all assessment of the level of exposure: the vast majority of trainees regarded the training as adequate 30/60 (50%), 3/60 (5%) thought it was excellent, 6/60 (10%) thought it was good, and 21/60 (35%)assessed the training adequacy as poor. 24/33 (72.7%) perceived that the presence of a pediatric fellow with them enhanced their training. In regards to performing surgeries after training, 78% were planning to perform rigid bronchoscopy, flexible bronchoscopy (58%), endoscopic airway FB removal (92%), esophagoscopy (54%), suspension microlaryngoscopy (82%), and open tracheostomy (100%). The presence of a pediatric fellow in service was thought of by most residents as being beneficial, however, the exposure to airway surgeries were not adequate as to inform trainees if they want to pursue fellowship in pediatric, when they were not exposed to a fellow.

Sickle cell disease (SCD) typically manifests in early childhood as attacks of pain known as vaso-occlusive crises. Infection and hypoxemia have been linked with these recurrent episodes and with prolonged hospitalization in SCD patients. However, adenoids and tonsils as sources of infection and causes of hypoxemia have not been adequately investigated in association with vaso-occlusive crises in SCD. To assess the association between adenotonsillectomy and frequency of vaso-occlusive crisis in SCD patients who underwent this procedure at our Hospital, and between adenotonsillectomy and frequency of blood transfusions and emergency department and intensive care unit admissions. We used medical record data to conduct a retrospective review of SCD patients who underwent adenoidectomy and/or tonsillectomy between 2005 and 2017. Eligible subjects were assessed for frequency of vaso-occlusive crises, blood transfusions, and emergency department and intensive care unit admissions. Using the Wilcoxon signed rank test, we compared the frequencies of each outcome preoperatively and 1, 3, 5, and 10 years postoperatively. Of 524 records reviewed, 40 eligible patients were included in the study. Minimal reduction was observed in the frequency of vaso-occlusive crisis episodes within 1 and 3 years after adenotonsillectomy (p = 0.337 and p = 0.549, respectively). Although the 5- and 10-year postoperative vaso-occlusive crisis frequency tended to be higher than that in the preoperative period, none of the results reached statistical significance. The number of emergency department admissions showed a statistically significant increase 3 years postoperatively compared with that in the preoperative period (P = 0.043). There were no statistically significant differences in perioperative blood transfusion frequency or number of intensive care unit admissions in any period. Adenotonsillectomy in SCD patients does not seem to be related to the frequency of vaso-occlusive crises, blood transfusions, or emergency department or intensive care unit admissions. Prospective studies with larger sample sizes are recommended to further evaluate these findings.

Background: Bell's palsy is a paralysis of the seventh cranial nerve that controls the muscles of the face, leading to sudden weakness on one side of the face. Of the total, 60–75% of Bell’s palsy cases are considered idiopathic. Thirty percent of the patients have poor recovery as they may experience facial muscle weakness, facial disfigurement, psychological trauma, and facial pain. Method: This study aimed to examine the awareness level regarding Bell’s palsy among the general population of the Makkah, Jeddah and Taif regions of Saudi Arabia. A cross-sectional study design was undertaken from June to September 2021, included 418 participants, and data were collected using an Arabic self-administered online survey. Institutional review board approval and informed consent were obtained. Results: There was a significant association between sex and the knowledge of Bell’s palsy (P=.022). In addition, a previous history of Bell’s palsy was significantly associated with a good knowledge level: 38.1% of participants with a previous history of facial palsy had a good awareness level compared with 17.6% of those who did not (P=.019). Conclusion: The overall awareness regarding Bell’s palsy was unsatisfactory. More efforts, including health education programs, should be made to improve public awareness regarding this disorder and to achieve favorable outcomes and avoid future complications of the condition.

Background. Dentures are a common cause of inadvertent foreign body ingestion particularly in the elderly. Due to their radiolucent nature, they often present a diagnostic challenge to care providing physicians. Case Presentation. A 66-year-old female presented to our otolaryngology clinic with a 2-year history of dysphagia. Her physical examination was unremarkable. Computed tomography scan of the neck and barium swallow suggested Zenker diverticulum. She was planned for endoscopic diverticulotomy; however, during surgery, a foreign body was incidentally found and retrieved, which was a partial lower denture. The diverticulum resolved thereafter, and the patient's symptoms abated. Conclusion. The authors recommend evaluating the esophagus endoscopically first in cases of upper esophageal diverticular formation, even when planning an open repair approach, to rule out any concealed foreign bodies.

A surgical safety checklist is essential to ensure patient safety. The purpose of this study was to evaluate the implementation of surgical time-out at an academic medical center in Saudi Arabia, and to reveal potential factors that may influence the compliance of time-out. A cross-sectional study observing elective surgeries was performed at King Abdulaziz University Hospital. Sixteen operating theaters were screened, corresponding to 15 different specialties being examined. Overall, one hundred and sixteen elective procedures were observed. The time-out checklist was employed by staff in 45.7% of cases and was fully completed in 26.7%. Factors influencing the time-out adherence included overall staff presence and the involvement of the primary surgeon during the time-out phase (p < 0.001). Absence of some staff members was significantly associated with a higher rate of time-out noncompliance (OR = 0.04; 95%; CI = 0.01, 0.21; p < 0.001). There was no significant association between time-out and the time of the day that the surgery was performed (p = 0.83), nor the number of surgeries performed in the day. Overall, time-out compliance was suboptimal in this study. Time-out was conducted at a similar rate throughout the day, regardless of the surgical load and the length of the pre-incision period.

Aim To find out the factors and causes that motivate medical students to choose ear, nose, and throat (ORL head and neck surgery) as a specialty in Saudi Arabian medical universities. Materials and methods A cross-sectional study was conducted at Kingdom of Saudi Arabia by distributing a self-administered questionnaire to 1,516 medical students across all medical universities. Chi-squared test and logistic regression analyses were used to examine the association between the participants' choices and factors motivating their choice of specialty. Results ORL head and neck surgery was chosen as a future specialty by 27% of the participants. Of these, 52% chose lifestyle as the most influential factor determining their choice of specialty. Further analysis of participant preferences revealed that 87.6% listed flexibility within medicine as their main reason for choosing a specialty, followed by reasonable hours of practice in 86%, while 15.9% considered a strong mentor relationship to be important. Students from King Abdulaziz University more frequently chose ORL head and neck, along with those from the eastern kingdom compared with other areas. Student preference for ORL head and neck did not vary significantly with gender, age, or duration of clinical rounds. Conclusion Approximately 27% of students chose ORL head and neck, with lifestyle being the most influential factor, followed by flexibility within medicine. Among students who chose ORL head and neck, the highest percentage was from King Abdulaziz University.

Laryngotracheal reconstruction is the most common and effective treatment in childhood subglottic stenosis (SGS). Our aim is to review the success rate of laryngotracheoplasty (LTP) in pediatric high grade SGS cases in our tertiary center. The retrospective review was conducted on children with high grade subglottic stenosis who had undergone laryngotracheoplasty over a 7-year period (2013–2020) in tertiary pediatric care. A total of 20 patients who had history of high grade SGS during the stipulated period were included. All of them had undergone LTP. Decannulation was considered the primary outcome measure of success. Surveillance bronchoscopy was performed one year post airway reconstruction to detect residual stenosis. From January 2013 to December 2020, 20 patients aged between 1 and 16 years old underwent LTP. Among them, 10 patients (50%) had Grade III SGS while 5 had Grade III SGS with glottis stenosis (25%). The remaining 5 (25%) had severe Grade IV stenosis. Decannulation was achieved in 14 patients overall (70%) including 1 with revision. These 14 patients who achieved decannulation included 7 out of the 10 patients (70%) with Grade III, 2 out of the 5 (40%) patients with Grade III with glottic involvement, and 4 out of the 5 patients (80%) with Grade IV SGS. Fifteen (80%) patients had double stage LTP while 5 patients had single stage LTP. The study suggests that LTP is a promising approach in the treatment of Complex SGS. Furthermore, pediatric SGS, which is inherently complicated, can be treated with LTP effectively.

Background Rhinitis represents a global health problem, affecting 10%-20% of the population in Saudi Arabia. Topical intranasal corticosteroids (INCS) are widely used by otolaryngologists to treat patients with rhinitis for long periods. Although the effects of orally administered corticosteroids on intraocular pressure (IOP) and lens opacity are well established, the impact of INCS is not well defined. In the present study, we aimed to assess the effect of using INCS on IOP over a six-month period in patients with rhinitis. Methodology In this study, a questionnaire was distributed to 93 patients diagnosed with rhinitis in the Ear, Nose, and Throat Clinic of King Abdulaziz University Hospital, Saudi Arabia, between February and July 2019. Thereafter, each patient was evaluated in the Ophthalmology Clinic with optical coherence tomography of the optic nerve using Cirrus HD-OCT (Carl Zeiss Meditec, Inc., Dublin, CA, USA) optic disc scans, visual acuity testing, and Goldmann applanation tonometry. Pearson correlation coefficients and two-tailed tests of significance were used to assess the relationships between variables. Results All 93 patients were using a dose of two puffs at least twice daily for each nostril. Their IOPs, as depicted by Goldman applanation tonometry, were found to be within normal limits. Retinal nerve fiber layer thickness was also found to be normal in 95% of the participants. Conclusions Our study showed no correlation between INCS and IOP. As an increase in IOP can lead to glaucoma, our data demonstrate the safety profile of INCS use. For patients with rhinitis, this finding could change compliance to medication and reduce the burden of the disease.

Introduction Children with Down syndrome (DS) who have Laryngomalacia represent a specific management challenge due to their inherent multiple levels of airway obstruction and hypotonia. Therefore, the purpose of this study is to determine the outcome of supraglottoplasty (SGP) in children with DS. Data source A systematic review was performed following the PRISMA guideline. Data were collected from online medical databases– CINAHL, Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid MEDLINE in process, PubMed, and Scopus. Review methods all publications that address the outcome of supraglottoplasty in children who are less than 18 years old with Down syndrome prior to December 2018 were collected. The data were collected on different phases: Screening review using search words and controlled vocabularies during the period of November–December 2018, followed by a detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles. Results Nine articles were included in the qualitative analysis. These articles included 231 subjects, out of which 32 children with DS met the inclusion criteria. Twenty patients (62.5%) were considered successfully treated and 12/32 failed including 1/32 (3.1%) mortality in the postoperative period. The duration of follow-up was 12–102 days. All of the patients whose treatment failed had significant comorbidities. Conclusion Although the success of SPG in children with DS is less than in otherwise healthy children, it remains an option especially in patients without comorbidities. Preoperative counseling of the families and thorough assessment are necessary to determine candidacy for SPG in children with DS.

The role of vitamin D deficiency has been linked with recurrent upper respiratory tract infections, but its impact on the frequency of tonsillitis is not yet fully understood. The objective of this study is to determine the association between vitamin D deficiency and recurrent tonsillitis based on current literature.A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were collected from online medical databases (PubMed, MEDLINE, EMBASE, and Cochrane Collaboration Registry of Controlled Trials).All studies addressing the association of vitamin D deficiency and recurrent tonsillitis prior to March 2019. The data were collected in different phases: screening review using search words and controlled vocabularies followed by detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles.Fifty-three studies were potentially eligible; of these, 4 publications met the inclusion criteria and were included in the quantitative synthesis. There was a statistically significant reduction of vitamin D levels in patients with recurrent tonsillitis as compared to healthy controls (mean difference, -10.71; 95% CI, -19.12 to -2.31;Vitamin D deficiency was present in patients with recurrent tonsillitis and might be associated with an increase in the risk of recurrent tonsillitis. There is a need to explore these findings via clinical trials based on large populations.

Background/Aims: Gastroesophageal reflux disease (GERD) is a common condition that can lead to significant morbidity. Laryngopharyngeal reflux (LPR) is a distinct clinical entity that can occur simultaneously with GERD, necessitating additional treatment measures. The degree of overlap and clinical predictors of LPR among patients with GERD remains unknown. We aim to measure the prevalence of LPR in patients with GERD and identify clinical predictors. Patients and Methods: We performed a cross-sectional study involving patients with confirmed GERD according to the GERD questionnaire (GerdQ) using the reflux symptom index (RSI). Data on demographics, comorbidities, past and current medications, and GERD-related lifestyle measures were documented. The prevalence of LPR was calculated. Linear and logistic regression analyses were conducted to correlate GerdQ and RSI, and to identify clinical predictors of LPR, respectively. Results: A total of 80 patients with confirmed GERD were consecutively recruited and surveyed. Mean age was 43 (±16) and 60% were females. The majority of patients were Saudis (51%) and only 24% were smokers. The mean duration of GERD was 7 (±4.4) years and the average body mass index (BMI) was 36 ± 22. Sixty-six percent of the patients consumed coffee on regular basis. On simple and multiple linear regression analyses, a strong, positive correlation was observed between the GerdQ and RSI scores (coefficient = 1.13, 95%CI = 0.39–1.86), and ipratropium bromide inhaler was positively associated with RSI scores (coefficient = 13.12, 95%CI = 0.16–26.09). LPR was identified in 57 patients (71%). On simple and multiple logistic regression analyses, GerdQ scores (OR = 1.78, 95%CI = 1.13–2.80), BMI (OR = 1.07, 95%CI = 1.01–1.14), duration of GERD in years (OR = 1.42, 95%CI = 1.04–1.93), and the type of gender (OR = 49.67, 95%CI = 1.32–1870) appeared to increase the risk of LPR, whereas coffee consumption (OR = 0.0005, 95%CI = 1.82e–06, 0.13) appeared to be negatively associated with LPR. Conclusions: Contradictory to what is frequently reported, LPR commonly occurs and positively correlates with GERD. Several modifiable clinical predictors of LPR might exist, which highlight the importance of performing a complete clinical assessment of the patients with reflux symptoms.

Aggressive fibromatosis, also defined as desmoid tumor, is an uncommon tumor. A review of literature detected less than 100 cases that have been reported of pediatrics aged 16 years or younger with aggressive fibromatosis in the head and neck. In this study we report a 1-year old girl who presented with an oral mass . The clinical , radiological, the histopathological features, and treatment are discussed .

Objectives: To assist the endoscopic localization of the lacrimal sac (LS) relative to nearby landmarks. Methods: This is a descriptive prospective anatomical study. Sixteen lateral nasal walls were dissected endoscopically to identify and localize the LS between October and November 2015. Multiple measurements were obtained from the NS to the anterior and posterior walls of the LS, as well as to the middle turbinate axilla (MTA) and from the MTA to the LS borders. Results: The average distance from the NS to the anterior border of the LS was 42.0 mm and the posterior border was 48.5 mm. The average widths of the LS were 7.55 mm superiorly, and 6.6 mm inferiorly representing a mathematical proof that the LS is a trapezoid shape. The mean distance from the NS to the MTA was 47.3 mm. Nine of the 16 lacrimal sacs (56.3%) were found to be partially overlapped by the MTA. The LS was only totally overlapped and lying posterior to the MTA in one side (6.3%), while in 6 sides (37.5%) the LS lay anterior to the MTA. Conclusion: Endoscopic surgeons should be aware of the location of the LS relative to nearby landmarks, particularly the MTA. Representing a mathematical proof that the LS is wider at it upper part than lower part best presented as a trapezoid shape. We have provided additional measurements that may prove useful in cases of difficult exposure. Saudi Med J 2017; Vol. 38 (3): 245-250 doi: 10.15537/smj.2017.3.15937 How to cite this article: Alherabi A, Marglani O, Herzallah I, Shaibah H, Alaidarous T, Alkaff H, et al. Endoscopic anatomy of the lacrimal sac for dacryocystorhinostomy. A cadaveric study. Saudi Med J . 2017 Mar;38(3):245-250. doi: 10.15537/smj.2017.3.15937.

BACKGROUND: Nasal deformity is an abnormality in the appearance of the nose due to either congenital defect or trauma. In traumatic cases, patients often present with combined functional and cosmetic complaints. Therefore, otolaryngologists take into account both breathing and aesthetic nasal issues. OBJECTIVES: To evaluate the changes in the nasal dorsum and base; compare breathing and aesthetic satisfaction scores between two approaches to lateral nasal osteotomy: low-to-low and low-to-high. DESIGN: Comparative observational; data gathered retrospectively and prospectively. SETTING: Head and Neck and Skull Base Center, King Abdullah Medical City, Makkah, Saudi Arabia. PATIENTS AND METHODS: Patients who received hump reduction rhinoplasty from 2013 to 2016 met the inclusion criteria. MAIN OUTCOME MEASURE(S): The differences in dorsal (DW) and ventral (VW) widths with a fixed interpupillary distance (IPD). Satisfaction scores for both cosmetic perspective and breathing functionality. RESULTS: We included 46 patients; 28 patients underwent low-to-low osteotomy and 18 patients underwent low-to-high osteotomy. With both approaches, there were statistically decreases from preoperative to postoperative ratios of VW/IPD and DW/IPD. However, differences in DW/IPD ratio and VW/IPD ratio (pre- versus post-op) were significantly higher in the low-to-low group (P

Objectives: To determine the diagnostic accuracy of fine needle aspiration (FNA) for detecting malignant parotid tumors. Methods : We conducted a retrospective study of all patients diagnosed with benign or malignant parotid gland tumors in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2004 and May 2015. The records of 65 subjects were obtained. Histopathological findings and data from FNA examinations were obtained from medical records. Twenty-three subjects were excluded due to missing FNA, histopathology results or both. The sensitivity, specificity, negative predictive value, and positive predictive value of FNA for detecting malignant lesions were estimated and compared with the gold standard, histopathology. Results : The specimens of 5 cases were insufficient for diagnosis; therefore, 38 cases were diagnosed by FNA and had histopathological reports. Three cases were diagnosed positive for cancer using histopathology and missed by FNA, 3 were diagnosed as malignant lesions using both FNA and histopathology, and 32 cases were determined benign based on histopathology and FNA analysis. The total prevalence of parotid malignancies was 15.8%. The sensitivity of FNA for detecting malignancy was 50%, and the specificity was 100%; with a positive predictive value of 100% and negative predictive value of 91.4%. Conclusion : Fine needle aspiration is a highly specific, but only moderately sensitive test. We support the use of this method as an initial tool for diagnosing parotid gland malignancies, as it is a safe, rapid, and painless procedure, compared to histopathology. Saudi Med J 2017; Vol. 38 (10): 1000-1006 doi: 10.15537/smj.2017.10.20988 How to cite this article: Marzouki HZ, Altabsh MA, Albakrei MO, Al-Khatib TA, Merdad MA, Farsi NJ. Accuracy of preoperative fine needle aspiration in diagnosis of malignant parotid tumors. Saudi Med J . 2017 Oct;38(10):1000-1006. doi: 10.15537/smj.2017.10.20988.

Objective: This study aimed to provide recent data about the causative organisms of ear infection and their antibiotic sensitivity at King Abdulaziz University Hospital. Materials and Methods: This retrospective study involved 160 patients with ear infection collected between March 2010 and February 2016. Ear swabs were investigated by conventional microbiology methods including cultures and biochemical reactions for identification of microorganisms and antibiotic sensitivity tests. Results: Out of total number of cases, 120 (75%) cases were infected by bacteria and 25 (15.6%) were infected by yeast cells. The majority of patients (n = 61, 38.1%) were of the children and young age group (0–17 years). Most of the patients were diagnosed with chronic suppurative otitis media (OM) (n = 73, 45.6%), followed by OM (n = 48, 30.0%), and otitis externa (n = 39, 24.4%). We also found that the most common pathogens cause ear infection were Pseudomonas aeruginosa, Staphylococcus aureus, and yeast cells. Conclusion: Ear infections are known as a mild disease and are usually treated with empiric therapy, and as our study revealed the most common causative agents of ear infections and their patterns of sensitivity and resistance, this will help in the proper selection of empiric therapy and prevention of the emergence of resistant strains.

Kimura disease is a chronic inflammatory disease that mainly manifests as a lump in the cervical region. Although the underlying pathophysiology is not clear yet, the diagnosis can be established based on specific histopathological characteristics. The first case of this disease was described in China, as well as the majority of subsequent cases that were also described in the Far East countries made Kimura disease traditionally a disease of adult patients of Asian descent. This report describes the occurrence of Kimura disease in pediatric non-Asian patient with a similar clinicopathologic presentation.

This study aims to determine the number of patients with cleft palate requiring treatment for otitis media with effusion. Speech and hearing assessments were also considered. We conducted a retrospective study from January, 2005 through December, 2012 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, on otitis media with effusion in patients with cleft palate. We reviewed patients’ medical records to determine the number requiring treatment for otitis media with effusion, the timing of middle ear ventilation tube insertion, the number of tubes to be inserted, and the type of tube to be used. Data were collected from the patients’ medical records. Ethical approval was obtained by the university’s ethical committee. A total of 101 patients were diagnosed with cleft palate spectrum. Among them, we found that only 12 patients had a hearing assessment and tympanograms performed followed by middle ear ventilation tube insertion. This may indicate the need for more involvement of the otolaryngologists in the multidisciplinary clinical teams for evaluating cleft palate patients.

Objective nbsp The aim of the research was to find out if administration of low dose Aspirin mg had a protective impact against age related hearing loss Methods nbsp We performed a retrospective non interventional study of all patients at King Abdulaziz University hospital KAUH who had age related hearing loss A total of patients were collected looking at different variables among them A telephone questionnaire was included to collect missing information We further classified them based on the use of low dose Aspirin and degree of hearing loss by looking at their last audiometric data Lastly we selected patients who had multiple audiometric data to see the effect of low dose aspirin on their hearing Results A total of patients with age related hearing loss were included in this study out of them were males from which were on low dose aspirin and were females from which were on low dose Aspirin With classification of their degree of hearing loss the majority of patients on low dose aspirin had mild to moderate hearing loss while the majority of patients not on Aspirin had normal to mild degree of hearing loss When we looked at the differences between intensities of each frequency of multiple readings of patients which showed that of them were on low dose aspirin and all of them showed preservation in their hearing However patients who were not on Aspirin of them showed preservation in their hearing and did not have any effect on hearing preservation Conclusion nbsp Low dose aspirin did not show hearing protection when we looked at one audiometric data done for patients with age related hearing loss However when multiple audiometric data were compared among patients depending whether they are using low dose Aspirin or not there was a positive impact of low dose aspirin on the preservation of hearing Studies with larger sample sizes are needed to support our observation

To assess the role of preoperative serum 25 hydroxyvitamin D as predictor of hypocalcemia after total thyroidectomy.Retrospective cohort study.University teaching hospital.All consecutively performed total and completion thyroidectomies from February 2007 to December 2013 were reviewed through a hospital database and patient charts. The relationship between postthyroidectomy laboratory hypocalcemia (serum calcium≤2 mmol/L), clinical hypocalcemia, and preoperative serum 25 hydroxyvitamin D level was evaluated.Two hundred thirteen patients were analyzed. The incidence of postoperative laboratory and clinical hypocalcemia was 19.7% and 17.8%, respectively. The incidence of laboratory and clinical hypocalcemia among severely deficient (25 nmol/L), deficient (50 nmol/L), insufficient (75 nmol/L), and sufficient (≥75 nmol/L) serum 25 hydroxyvitamin D levels was 54% versus 33.9%, 10% versus 18%, 2.9% versus 11.6%, and 3.1% versus 0%, respectively. Multiple logistic regression analysis revealed preoperative severe vitamin D deficiency as a significant independent predictor of postoperative hypocalcemia (odds ratio [OR], 7.3; 95% confidence interval [CI], 2.3-22.9; P=.001). Parathyroid hormone level was also found to be an independent predictor of postoperative hypocalcemia (OR, 0.6; 95% CI, 0.5-0.8; P=.002).Postoperative clinical and laboratory hypocalcemia is significantly associated with low levels of serum 25 hydroxyvitamin D. Our findings identify severe vitamin D deficiency (25 nmol/L) as an independent predictor of postoperative laboratory hypocalcemia. Early identification and management of patients at risk may reduce morbidity and costs.

Patient: Male, 59 Final Diagnosis: Benign carotid body tumor Symptoms: Neck mass Medication: — Clinical Procedure: — Specialty: Otolaryngology Objective: Rare disease Background: Carotid body tumors are rare tumors that arise from the paraganglionic cells of the carotid body. They are usually benign, requiring surgical resection as the treatment of choice. Case Report: We present a case of a 59-year-old man with a benign left carotid body tumor that progressed to a very large size, compromised the patient’s airway, completely encased the carotid vessels, vagus and hypoglossal nerves ipsilaterally, and reached the contralateral carotid vessels and ipsilateral skull base. Because of the cranial extension of the tumor, the patient had to undergo preoperative endovascular coiling of the carotid vessels prior to total excision of the tumor. Conclusions: Due to the critical location of carotid body tumors, their vascularity, and high risk of neurovascular complications, surgical resection can be quite challenging, especially when the tumor is large. We propose an approach to managing large parapharyngeal tumors by endovascular occlusion of the internal carotid artery above the skull base. Further, a suggestion is made to add a category to Shamblin’s classification – Shamblin IV – for patients with skull base extension requiring preoperative endovascular intervention.

Purpose Nasopharyngeal cancer (NPC) is the most common head and neck cancer in Saudi Arabia. This study reports the locoregional disease control and survival outcomes in patients with NPC treated in King Abdulaziz University Hospital. Methods Patients treated for NPC between June 2007 and October 2014 were retrospectively reviewed. Demographic information, clinicopathologic variables, and chemotherapy data were collected and analyzed. Cumulative survival and disease control rates were calculated by Kaplan-Meier product-limit actuarial method. Results Thirty-nine patients with NPC were reviewed. Thirty-five (90%) patients received definitive radiotherapy (RT) and four (10%) had palliative RT. Mean prescribed dose for definitive RT was 68 Gy (range, 60 to 70.2 Gy), delivered with mean doses per fraction of 1.9 Gy (range, 1.8 to 2.1 Gy). After a median follow-up of 15 months (range, 1 to 84 months), 22 (63%) patients who underwent definitive RT were disease free and 13 (37%) were still with disease. During this period, seven (18%) patients died of the disease; five (13%) of them received definitive RT. After 2 years’ follow-up, the actuarial estimate rates were: 85.7% for local control, 91.4% for nodal control, and 85.7% for distant control. Conclusion Our study showed a disease with clinical behavior similar to what has been observed in East and Southeast Asia. Further it explored the neoadjuvant chemotherapy approach in treating NPC with results that are comparable to literature. However, little is known about the molecular pathogenesis of this disease in this region, and further research integrating clinical and molecular biomarkers is required.

The aim of this study was to evaluate the post-operative complications of using balloon-expandable metallic stents in treatment of benign, major subglottic and tracheal stenosis in adult patients whom conventional therapy has failed and to demonstrate how to deal with these complications in the long run. A retrospective review of five cases; adlut patiets with benign, major subglottic and upper tracheal stenosis whom were treated with balloon expandable metallic stents at King Abdulaziz University Hospital, in the years between 2008 and 2013. Granulation tissue formed in five of the four cases and restenosis occurred. Other complications encountered were stent infection and dislodgment. The complications were managed by removing the stents surgically via a laryngofissure incision and required the placement of a Montgomery T-tube. Managing the restenosis due to granulation tissue formation around the metallic stents is best achieved by removing the embedded metallic stents surgically via open technique and then by placement of a Montgomery T-tube as a bridging option to successful decannulation. Open surgical procedures remain the mainstay treatment for advanced airway stenosis.

Aim: to evaluate the outcome of endoscopic technique for treating choanal atresia (CA) cases as well as to compare it with that of transnasal puncture. Methods: A retrospective cohort study was performed at the Otolaryngology-Head Neck Surgery department, King Abdulaziz University Hospital, Jeddah, KSA during the period between 2010-2017. Results: The type of first operation (endoscopic or transnasal puncture) was shown to have a significant relation to the restenosis rate after the first operation (P=0.02), where initial puncture repair had less restenosis rate. On the other hand, there was no significant difference between the two surgical techniques regarding the duration between the first and second operations (p-value=0.064), the required stenting period postoperatively (p-value=0.934), nor the total number of required operations (p-value=0.206). The use of Mitomycin, stents and decongestants had no significant effect on restenosis rate (p-values=0.515, 1.00 and 0.838 respectively). Conclusion: Endoscopic transnasal choanal atresia repair technique did not prove to be superior to older puncture technique. Stenting had no significant effect on repair outcome. Mitomycin C had somewhat a positive effect on prolonging restenosis. We believe that a transoral endoscopic approach might be superior technique to current transnal technique.

Desmoid tumors (fibromatosis) are rare benign tumors, they arise from musculoaponeurotic structures throughout the body. They are locally infiltrative, resulting in a high rate of local recurrence following surgical resection. Due to the rarity of these tumors in the head and neck region, we report a case of a patient with a desmoid tumor in the upper neck that was diagnosed and treated in our institution, to increase the awareness of the Otolaryngology-Head and Neck surgeons, and report available treatment options of this condition.

Objectives. To investigate patients’ perception regarding medical students’ role in the operating theatre.Methods. A cross-sectional study was conducted on a randomly selected sample at King Abdulaziz University Hospital.Results. 131 participated in this study. 77 of the participants were females and 50 participants were males. 46.4% think that it was important for the future doctors to be in theater during surgery. 60.2% thought that medical students only observed surgeons in the theatre and 39% thought that medical students performed minor procedures in the theatre.Conclusion. Patients underestimated the importance of medical students’ attendance and involvement in theatre compared to bedside teaching and outpatient clinics. Patients believed that medical students should obtain their consent prior to observing them in the theatre.

Saccular disorders are rare representing only 1.5 % of all laryngeal anomalies. Bifid epiglottis is also an extremely rare congenital anomaly that usually occurs in a syndromic picture in association with other anomalies such as polydactyly, cleft palate and micrognathia, which are seen in Pallister–Hall Syndrome and rarely with other syndromes. We report a case of bilateral saccular cysts and bifid epiglottis in a full term neonate presenting with stridor. The patient’s other congenital anomalies included microretrognathia, short neck, polydactyly of four extremities and hypospadias. The patient underwent staged endoscopic microsurgical marsupialization of both cysts and endoscopic repair of the bifid epiglottis.

Background Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstruction. Essentially there are two approaches: external and endoscopic. Several modalities are used in endoscopic DCR; all aiming to improve success rate, reduce complications, and shorten operative time. Both kerrison punch and drill are widely used in endoscopic DCR with non-conclusive knowledge about differences in operative details as well as on the outcome. The aim of this study is to compare between powered (drill) and non-powered (kerrison punch) DCR to clarify the superiority of one over the other. Methods A retrospective chart review of 59 patients who underwent endoscopic DCR procedure at our institution from June 2013 until July 2014 (34 kerrison punch and 32 powered drill). Operative details, surgical outcome and complications were compared between both groups. Results A total of 66 endoscopic DCRs were performed on 59 patients. Procedure success rate among kerrison punch group was 87.88 % vs. 90.9 % in powered drill group (p = 0.827), while complications for both groups were statistical not significant (p = 0.91). The mean operating time among kerrison punch group was significantly lower than in powered drill group (75 min vs. 125 min, p = 0.0001). Conclusion Kerrison punch showed significant reduction in operating time when compared to powered drill for endoscopic DCR. No statistically significant difference was found between both groups regarding procedures’ success rate and complication.

Background: Objective: The study was designed to investigate factors influencing career choice among medical students interested in Otorhinolaryngology (ORL) at Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia. Methods: In this cross-sectional study, a total of 531 medical students participated. A questionnaire was used to collect the data. Data were analyzed using SPSS-16. Results: A total 531 participating medical students belonged to 4th, 5th, and 6th year. Two hundred twenty-one (41.6%) were interested in ORL specialty. Almost all of the students (95%) agreed that a patient’s ear, nose, throat, and head & neck health plays an important role in their overall health. The majority of the participants (68%) disagreed that that ORL is less important than other specialties. There were several reasons for selecting ORL as career choice such as: a secured and respected job (71%), well-paid job (63%), rewarding work, grateful patients (69%), opportunity to meet people of different age groups and various backgrounds (68%), a window into ordinary people’s everyday life (52%), comprehensive doctor-patient relationships (54%), versatile, challenging work (54%), and long-term doctor-patient relationships (58%). Conclusion: Overall participants’ responses were overwhelmingly positive to pursue a career in ORL specialty.

1) Review the incidence of thyroid gland invasion by squamous cell laryngeal carcinoma reported in the literature. 2) Assess the association between thyroid gland invasion and anatomical characteristics of the laryngeal tumor.MEDLINE (1967-2007) and EMBASE (1980-2007). These databases were supplemented with 61 patients from McGill University who underwent total laryngectomy with hemi- or total thyroidectomy from 2001-2006.Systematic review for series of laryngeal carcinoma that commented on thyroid gland invasion according to tumor subsite and pathological characteristics. Total laryngectomy specimens for primary laryngeal squamous cell carcinoma with concomitant thyroid resection were included in the analysis.In total, eight series (n = 399) were included in the meta-analysis. Thyroid gland invasion was present in 33 laryngectomy specimens (8%); the principal method of invasion of the gland was by direct extralaryngeal extension. Subglottic extension10 mm (OR 7.22 [2.05 to 25.46]; P = 0.002), transglottic tumors (OR 3.23 [1.16 to 9.00]; P = 0.025), and subglottic subsite (OR 5.66 [1.34 to 23.87]; P = 0.018) were all significantly associated with thyroid gland invasion. Cartilaginous invasion by tumor was not a significant predictor of thyroid gland invasion (P0.05).Thyroid gland invasion is not a general feature of squamous cell laryngeal carcinoma. When present, it is strongly associated with anteroinferior spread of advanced laryngeal tumors. Thyroidectomy may only be required during total laryngectomy for transglottic tumors, subglottic tumors, and tumors with subglottic extension10 mm.

Objectives: To determine the efficacy, tolerability, and safety of an aqueous extract of Costus speciosus ( C. speciosus ) rhizome in pediatric and adult patients suffering from acute pharyngitis and tonsillitis as an alternative to antibiotics use. Methods: This pilot cohort trial was conducted at King Abdulaziz University in Saudi Arabia between May and December 2014, among 15 patients with acute pharyngitis and tonsillitis who were administered nasal drops of aqueous extract of C. speciosus rhizome at a dose of 15-30 drops every 8 hours for 3 days. The primary outcome measure was the clinical improvement and remission rate within the first 5 days. Results: The administration of C. speciosus resulted in an improvement in acute symptoms in 60% of the patients treated within the first 24 hours, and remission rate of 93% by day 5, without any recorded adverse effects. Conclusion: This study revealed a significant efficacy of the aqueous extract of C. speciosus rhizome in acute pharyngitis and tonsillitis. Saudi Med J 2015; Vol. 36 (8): 997-1000 doi: 10.15537/smj.2015.8.11377

Objective: Facial nerve paralysis is one of the most devastating complications after parotid gland surgery. We aimed to determine the prevalence and risk factors of facial palsy after parotidectomy.Methods: We performed a retrospective review of the data from 54 patients who underwent parotid surgery between 2004 and 2015 at a tertiary medical care center. The prevalence of facial nerve paralysis and possible risk factors (demographic characteristics, tumor characteristics, and operative factors) associated with postoperative paralysis were assessed. Categorical variables were evaluated using the Fisher’s exact test, and a two-tailed t-test was used to assess the associations between continuous and binary outcome variables.Results: The postparotidectomy prevalence of temporary and permanent facial nerve paralysis were 26% and 13%, respectively. Tumors involving both lobes were significantly associated with permanent facial nerve paralysis (p = .048). Long operative duration (> 164 minutes) was associated with both temporary and permanent facial nerve paralysis (p = .040).Conclusions: Operative factors such as operative duration and tumor characteristics such as bilobal involvement increased the risk of postparotidectomy facial nerve paralysis. Such factors should be considered to reduce the risk of palsy in patients undergoing parotidectomy.

Objectives: To identify nurses pre and post graduate clinical support and confidence level for tracheostomy management. Methods: A cross sectional study was carried out in two tertiary care centers in Jeddah, Saudi Arabia; King Abdulaziz University and King Fahad Military Hospital, during the period from February to October 2014. Results: Two hundred and six nurses were enrolled in the study. Majority of nurses (69%) had an experience of less than 11 years and they were mostly working for forty hours or more weekly (77.5%). The respondent nurses indicated that they were working in different departments with varied frequencies and they were confronted with different age group of patients. Sixty two point three per cent indicated that they had from 1-10 hours of formal training on managing patients with tracheostomy. It was observed that almost one half of the nurses (53.2%) perceived that they are up to date with the available evidence-based practice regarding tracheostomy management. However, only 11.4% of the nurses perceived that they were very confident in managing patients with tracheostomy and those who require ventilator assistance in addition. Conclusion: Our study demonstrates the importance of formal training and exposure, which reflect on nurses training, clinical support and confidence in management of tracheostomy patients.

To assess the perception of otolaryngology-related diseases among parents of children with Down syndrome (DS).A cross-sectional survey design. A questionnaire was distributed to parents of children with DS. The parents were attending an event aiming to raise awareness that was organized on World Down Syndrome Day on the 21st of March 2013, organized by Princess Al-Jawhara Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia. The complete dates of study were March to May 2013.Questionnaires were completed and perceptions regarding 10 common otolaryngology-related diseases were obtained from 78 parents. The data shows that most of the parents were not familiar with these otolaryngology-related diseases.Many parents were not aware of some of the otolaryngology related conditions affecting children with DS, and did not have regular follow-up. Perception was highly affected by the presence of the condition in the children. Awareness of otolaryngology-related diseases affecting children with DS should be raised.

Objective: To assess the awareness of physicians at King Abdulaziz University Hospital (KAUH), a tertiary care centre in Jeddah, Saudi Arabia, about the scope of practice of otolaryngologist (OTL) - head and neck surgeons. Furthermore, to identify diseases of the head and neck in which physicians may underestimate the role of OTLs. Study Design: Cross-sectional analysis. Background: The scope of practice of ear, nose and throat surgeons has impressively widened to include many subspecialities such as head and neck surgery (HNS). Encountering diseases that used to be or could be handled by other surgical specialities may cause confusion among physicians. This confusion may extend to mislead some physicians while referring. Methods: A total of 336 questionnaires were distributed to physicians at KAUH. The questionnaire targeted consultants, specialists and residents of different departments. The survey asked the responders which specialty they believed was the expert in managing certain clinical conditions related to OTLs. The respondents were allowed to choose one or more speciality for each question. Results: One hundred and seventeen questionnaires of the total 336 were analysed with a response rate of 34.8%. The analysis showed that 94.9% of the respondents believed that OTLs were experienced in dealing with pharyngeal lesions. Regarding hoarseness, 96% of the physicians thought that it was a symptom managed by OTLs. About 94% of the respondents chose OTLs as experts in managing patients with a foreign body ingestion. Almost 89% (88.9%) thought that OTLs were the physicians who perform tracheostomies. However, regarding cold or flu and oral lesions, OTLs only scored 68.4% and 64.1%, respectively. Conclusion: The study revealed the awareness of physicians at KAUH in regards to the extent of services provided by OTL-HNS as not fully satisfactory. It is our job as OTLs to raise awareness of our speciality among colleagues of other departments.

the diagnostic accuracy of otitis media with effusion (OME) has been shown to be poor among medical students, residents, and practicing physicians.to determine if the use of pneumatic video-otoendoscopic examination (VOE) improves the diagnostic accuracy of OME among residents.pediatric residents were randomized into a "pneumatic" examination group (intervention) and a "still" examination group (control). The control group viewed a set of 25 still VOE images of the tympanic membranes of both normal and OME ears. The intervention group viewed the same still images but with the addition of pneumatic VOE assessments. Each resident documented each of his or her diagnoses as normal or OME. The accuracy of assessment for both the static and the pneumatic methods was compared.twenty-nine pediatric residents participated in this study: 15 in the intervention group and 14 in the control group. The overall diagnostic accuracy was 91% for the intervention group versus 78% for the control group (p = .0003).pneumatic video-otoscopy teaching improves the diagnostic accuracy of OME among residents.

Objective To assess the long-term ototoxicity effect of platinum chemotherapy in a series of pediatric patients. Design A prospective cohort study. Methods Patients who received platinum chemotherapy were identified through review of the pharmacy records from 2000 to 2005. Audiograms pre- and post-treatment with cisplatin were noted. The patients were brought back long after treatment for a repeat audiogram and a questionnaire to assess the impact of ototoxicity on their quality of life. Results Forty-nine patients received platinum chemotherapy. Patients’ exclusion: two had no pre-chemo audiograms, one had retinoblastoma with congenital hearing loss, three were lost to follow up, five deceased, and seven refused participation. The total number of patients included was 31 with long-term follow up total of 21 patients. The follow up period ranged from 1.5 to 6.6 years (median of 3.4 years). Fourty-two percent (13/31) of the patients suffered from otoxicity (3 mild, 3 moderate, 7 severe-profound). Thirty-three (7/21) of audiograms worsened on long-term follow up. Questionnaire revealed 70% subjective hearing loss with 40% requiring hearing aids. Conclusion Ototoxicity after platinum chemotherapy can present or worsen years after completion of therapy. Therefore, we recommend long-term follow up.

To evaluate the incidence and nature of thyroid gland invasion (TGI) in laryngeal carcinoma at the head and neck centres at McGill University.A retrospective case series was undertaken of 74 total laryngectomies performed at both McGill head and neck centres from 2001 to 2006. Thirteen specimens were excluded because thyroidectomies were not performed or laryngectomies were performed for nonprimary laryngeal carcinoma. Tumour stage, subsite, anatomic characteristics, and thyroid gland involvement were analyzed based on pathologic specimens. Pre- and postoperative radiation therapy treatment and thyroid function were also noted.Twenty supraglottic, 21 glottic, 15 transglottic, and 5 subglottic tumours were analyzed. Subglottic extension10 mm was noted in 22 specimens (36%). Cartilaginous invasion was noted in 37 of our specimens (61%), and lymph node metastasis was noted in 12 specimens (20%). One subglottic tumour demonstrated bilateral invasion of the thyroid gland and lymph node metastasis. Forty patients (54%) received preoperative radiation therapy and 34 patients (46%) received postoperative radiation therapy, with pre- and postoperative rates of hypothyroidism of 38.9% and 91%, respectively.TGI is rare for laryngeal cancer. Tumours with subglottic involvement or very advanced tumours may show a greater tendency for TGI over other tumours.

Objective1. Review the incidence of thyroid gland invasion by squamous cell laryngeal carcinoma in the literature. 2. Correlate thyroid gland invasion with anatomical characteristics of the laryngeal tumor. Do laryngeal tumors which invade the thyroid gland share certain characteristics which can aid in determing the management of the thyroid gland during total laryngectomy?MethodsSystematic review of MEDLINE (1967–2007) and EMBASE (1980–2007) for all total laryngectomy series which commented on thyroid gland invasion according to tumor subsite and pathological characteristics. These results were supplemented with 61 patients from our centers who underwent total laryngectomy with hemi- or total thyroidectomy. Eleven series in total (n = 535) were included in the meta-analysis (fixed effects model).ResultsThyroid gland invasion was present in 47 laryngectomy specimens (9%); the main method of invasion of the gland was by direct extralaryngeal extension. Subglottic extension > 10mm (OR 6.27 [2.16 to 18.19];...