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   Table of Contents - Current issue
January-June 2020
Volume 22 | Issue 1
Page Nos. 1-39

Online since Monday, June 1, 2020

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Factors affecting outcomes of injection laryngoplasty: A systematic review p. 1
Isra Ali Al-Jazeeri, Hassan Ali Al-Jazeeri
Vocal cord palsy is a common reason for visiting an otolaryngologist. In cases of unilateral involvement, patients primarily present with recurrent choking and aspiration, breathy voice, and inability to perform the Valsalva maneuver. Injection laryngoplasty (IL) is one of the least invasive and promising lines of treatment for unilateral vocal cord palsy (UVCP). The present study identified the existing evidence on factors that may affect the voice and swallowing outcomes of IL in adult patients with UVCP. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and PRISMA checklist. The U.S. National Library of Medicine (PubMed) database was searched for studies on UVCP managed with IL. Sixteen articles investigated six distinct factors that affected the outcomes of IL. These six factors include early intervention, the approach used for injection, the degree of the posterior glottic gap, the number of irregular peaks, previous radiation therapy history, and the material used for injection.: This review is the first study to investigate all of the possible factors that affect IL. This review found six distinct factors that affected the outcomes of IL. Each of the retrieved studies investigated a different factor without considering the confounding effect of the other factors. This review guides future research for the development of a much more structured protocol to elucidate the weight of each factor in affecting outcomes.
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The association between age-related sensorineural hearing loss and saccular dysfunction in the elderly p. 7
Gehan Mohamed Shafeek Abdel-Salam
Introduction: Presbycusis or age-related sensorineural hearing loss (ARSNHL) is a complex disorder that results in a slow deterioration in auditory function. A considerable high number of these presbycusis or ARSNHL patients also suffer from dizziness and related vestibular symptoms. Although auditory and vestibular systems are distinct, they work just alike. Hence, there is a great relation among their functions. Once one is stimulated, the other suffers changes as well. Methodology: Participants in this study comprised forty adult patients (60–75 years) divided into two groups: control group with normal hearing and without any vestibular symptoms or diagnosed vestibular diseases and study group with mild-to-moderately severe sensorineural hearing loss with or without dizziness in the form of a sense of imbalance during walking or a sense of rotation of the surrounding, especially on sitting or standing from lying position. All patients in this study were without any history of noise exposure in their life. The audiological status was measured with pure-tone audiometry and auditory brainstem response (ABR). The vestibular system was assessed using videonystagmography test battery and cervical vestibular-evoked myogenic potential (cVEMP). Timed up and go test was used as a quick screening tool for detecting balance problems. ABR and cVEMP results of the groups were calculated and compared. Results: The absolute peak latencies of ABR wave I, III, and V were prolonged in the study group than that in the control group. Vestibular-evoked myogenic potential results showed that P13 and N23 latencies were prolonged and P13–N23 amplitude was decreased in the study group when compared to the control group. Conclusion: Thoughtful examination of the vestibular system, in conjunction with auditory functions in elderly persons, is recommended. This may help discover their subclinical vestibular problem and guide physicians to design a suitable treatment plan that helps in decreasing the risk of falls for aged persons.
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A comparative study of thyroid surgery with and without a microscope p. 13
Harendra Kumar Gautam, Vinod Kumar, Devendra Maurya
Introduction: The purpose of this prospective study was to evaluate microsurgical thyroidectomy by comparing it with traditional thyroidectomy. Material and Method: Before surgery, patients were assigned either to the microscopic thyroidectomy group (MT group), with the use of the surgical microscope, or the traditional thyroidectomy group (TT group), without the use of visual magnification. Aims and Objective: Outcome measures were operative time, intraoperative bleeding, and complication rates including injury to the recurrent laryngeal nerve (RLN), the external branch of the superior laryngeal nerve (EBSLN), or the parathyroid glands. Result: Sixty patients underwent thyroid surgery (30 patients in the MT group and 30 patients in the TT group). The two groups were almost similar in age, sex, surgical procedures, and histological findings. There was no difference between the two techniques regarding the operative time and the amount of blood loss. Neither permanent nerve palsy nor persistent hypocalcemia occurred in either group. Transient nerve palsies (RLN and EBSLN) were lower in the MT group (3.3%) compared to the TT group (6.6%). Overall transient hypocalcemia was significantly lower in the MT group (3.3%) compared with the TT group (13.3%). If the population was restricted to total thyroidectomy, the rate of transient hypocalcemia was 1% in the MT group and 1% in the TT group, respectively. Conclusion: In conclusion, thyroid surgery with a microscope is significantly reduced the complication without increasing the operative time compare to without microscope.
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Prevalence of cochlear dead regions in hearing-impaired patients p. 16
Asmaa Moaty, Medhat Fathy Yousef, Ayman Abd Alaziz, Abd Allatif Elrasheedy
Objective: The aim is to study the prevalence of dead regions in the cochlea in hearing-impaired patients with different audiometric configurations and to study the speech discrimination scores in dead regions of the cochlea. Materials and Methods: Eighty participants, with age ranging from 18 to 50 years, were divided into control group (30 normal-hearing participants) and study group (50 patients suffering from sensorineural hearing loss). All participants in the study were submitted to the following: medical and audiological history, otological examination, basic audiological evaluation in the form of pure-tone audiometry and tympanometry, auditory brainstem response, and the threshold-equalizing noise (TEN) test. Results: Thirty-nine patients in the study group gave negative results of TEN test and 11 patients gave positive results of TEN test. Conclusions: The prevalence of dead regions of the cochlea in this study was 22%. Dead regions in the cochlea were more common in patients with sloping, long-standing hearing loss and in high frequencies.
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Do filters and pose in selfies have an effect on cosmetic procedures p. 21
Badi Aldosari
Background: Filters and pose in selfies are becoming popular in Saudi Arabia. At the same time, there appears to be an increasing demand for cosmetic procedures in this country, suggesting that the two phenomena may be related. Objectives: The aim of this study was to evaluate the effect of filters and pose in selfies on the desire to seek cosmetic surgery in Saudi Arabia. Patients and Methods: A cross-sectional survey was randomly distributed among 653 Saudi residents aged 18–65 years (mean: 29.4 ± 10.9 years). About 25.1% of respondents were male (164 men) and 74.9% were female (489 women) from May to July 2018. The survey was used to determine if the participants have considered cosmetic surgery because of filters and pose in selfies. Results: Social media was used by 98.3% of participants, and selfies were taken by 93.4%. Further, 37.8% of those who took selfies wanted to undergo a cosmetic procedure because of selfies, with 85% of them being females. Moreover, 60% of our respondents who were interested in undergoing cosmetic surgeries were using filters, and 53.0% of them were preferred the frontal view when taking a selfie. Conclusion: Our study demonstrated an effect of filters and pose in selfies on the desire to seek cosmetic surgery in Saudi Arabia. Limitations: Our study included a small number of males and was limited to residents born in Saudi Arabia. Further studies with a larger sample of males and international cohorts are essential to evaluate the global effect of selfies on cosmetic procedures.
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Obstructive laryngeal schwannoma - A rare tumor excised transorally p. 24
Vaibhav Saini, Shashikant A Pol, Sanjeev Yadav, Anand Subhash
Laryngeal schwannomas are rare benign encapsulated nerve sheath tumor, which are difficult to manage and a patient may require tracheostomy before definitive management. The present case report is of a 35-year-old female complaining of change in voice quality, snoring with infrequent apnea episodes, dyspnea more on exertion, and lying supine. The patient underwent complete excision using microdebrider-assisted transoral microlaryngoscopy, thus avoiding the need of imminent tracheostomy. Postoperative after 2 months, the patient had normal voice and vocal fold mobility with preserved laryngeal mucosa. Although a novel technique, it is quite effective and safe in the excision of laryngeal Schwannoma without injury to the surrounding structures.
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Mucormycosis: Atypical presentation and the associated red flags p. 28
Muneera Al-Khalifa, Saud Alsaif, Salma Al Bahrani
Mucormycosis previously known as zygomycosis is a type of scarce infection caused by fungi. Mucorales is the order that mucormycosis is related to, with Rhizopus being the most common genus. Mucormycosis occurs usually in immunocompromised individuals such as diabetics or posttransplant patients. Diabetes is the most common predisposing factor for rhino-orbital-cerebral mucormycosis. The first documented case of an upper airway mucormycosis was described by Paltauf, in 1885. Thereafter, Gregory reported three cases of rhinocerebral mucormycosis in 1943. In rhino-orbital-cerebral mucormycosis, the spores adhere to the nasal mucosa and rapidly proliferate in the ideal metabolic hypoxic state found in diabetics. Being an angiotropic fungus, mucor swiftly invades the elastic lamina of the blood vessels, leading to necrosis and ischemic infarctions. Patients with rhino-orbital-cerebral mucormycosis may present with sinusitis, rhinitis, ocular complaints, or facial pain. Here, we present a subtle presentation of an isolated case of rhinosinusitis mucormycosis in a 50-year-old male presenting to the emergency department with 1-week history of headache aggravated at night and the red flags that lead to the diagnosis. On presentation, the patient was afebrile and generally well. Nasal examination revealed a patch of necrotic mucosa on the nasal septum. The patient was admitted with the differentials of either invasive rhinosinusitis or granulomatous disease. Nasal swabs were collected revealing a colonization of methicillin-resistant Staphylococcus aureus; nevertheless, the red flags that lead to suspecting a more aggressive infection were the complain of paresthesia of the cheek and upper lip, a necrotic patch on the hard palate, and the aggravated nocturnal headache. The definitive diagnosis was achieved by histopathology demonstrating the importance of high index of suspicion in such cases.
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Elective short-term nasotracheal intubation for postthyroidectomy tracheomalacia due to a long-standing large goiter: An experience at tertiary care center p. 32
Vikas Chauhan, Isha Preet Tuli, Rohit Bhardwaj, Ankur Gupta, Sabarirajan Ponnusamy
Long-standing large goiters impose possibility of various complications. Tracheomalacia is one such feared problem. The presence of bilateral mobile vocal folds and extubation failure after surgery affirms diagnosis. Methods to deal with tracheomalacia include silicon tracheal stent grafts, tracheostomy, and prolonged intubation. We share our experience of the successful management of tracheomalacia with elective short-term endotracheal intubation. A 36-year-old female presented with a massive neck swelling, for the past 9 years along with slight change in voice and breathing difficulty. We performed near total thyroidectomy for colloid goiter. Intra-operative assessment suggested tracheomalacia. We kept patient on nasotracheal intubation for 1 week, and then extubated successfully. Postthyroidectomy tracheomalacia is a rare but significant complication. We advocate trial of our successful method of elective short-term intubation for its management. This can prove an easy and cost-effective alternative in comparison with tracheostomy or tracheal stent grafts.
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Internal auditory canal osteoma: Wait or operate – Case report and literature review p. 36
Abdulaziz AlEnazi, Houri Albalawi, Ali Alhaidy, Munahi Al-Qahtani
Internal auditory canal osteomas (IACOs) are rare, slow-growing, and benign bone tumors. They are most often found incidentally with few-reported cases. Osteomas involving the internal auditory canal (IAC) are particularly rare. The symptoms of the IACO usually arise due to direct pressure on the vestibulocochlear nerve; however, etiology, mechanism, and management remain unclear. The present report describes the rare case of IACO involving a 15-year-old male who was referred to a tertiary referral center with a history of chronic supportive otitis media, which was otherwise asymptomatic. The ensuing discussion and brief literature review address whether to wait or operate. IACO in this patient exhibited slow-growing features, and audiology assessment revealed no sensory neural hearing loss. Computed tomography (CT) revealed a round, radiopaque pedunculated bony outgrowth in the right IAC. Magnetic resonance imaging using a selected T2-weighted sequence revealed the osteoma projecting from the posterior superior aspect of the right IAC. Accordingly, clinical observation was recommended. Observation, including serial CT, is recommended for asymptomatic patients. Surgery is not advisable in slow-growing and asymptomatic cases because the risks are due to its dangerous location. Decisions regarding the management must consider according to symptom severity, progression, and risks in surgery. The question of whether to operate, therefore, should be carefully considered depending upon patient complaints and medical findings.
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