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Year : 2001  |  Volume : 3  |  Issue : 1  |  Page : 29-33

Selected abstracts from the 4th international conference of the saudi otorhinolaryngolgoy society, 17- 19 october 2000 Riyadh, Saudi Arabia

Date of Web Publication9-Jul-2020

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DOI: 10.4103/1319-8491.289358

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How to cite this article:
. Selected abstracts from the 4th international conference of the saudi otorhinolaryngolgoy society, 17- 19 october 2000 Riyadh, Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg 2001;3:29-33

How to cite this URL:
. Selected abstracts from the 4th international conference of the saudi otorhinolaryngolgoy society, 17- 19 october 2000 Riyadh, Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2001 [cited 2021 May 5];3:29-33. Available from: https://www.sjohns.org/text.asp?2001/3/1/29/289358

  A comparative study of the prevalence of CSOM in Saudi Children Top

By Prof. Siraj Zakzouk,FRCSEd, ENT Department,Security Forces Hospital, Riyadh, Saudi Arabia

An epidemiological survey completed in February 2000 to study the prevalence of chronic suppurative otitis media ( CSOM ) was accomplished. 9540 children aged up to 12 years were examined clinically by otolaryngologist. 125 children 1.3% suffered from CSOM, 4 with cholesteatoma. The prevalence in the central province of the Kingdom was found to be 1.15%. During the first * study done in Qassim 1982, the prevalence was 5.5% among 293 children aged 6-18 years. In the second study done and completed in 1991 where 6421 children were surveyed, 94 children found to suffer from CSOM i.e. 1.5% with 6 children having cholsteatoma. These results showed decrease in incidence of CSOM in the central province. Although in other parts of the Kingdom, the prevalence was found to be as high as 2.89%. The factors predisposing to or associated with chronic ear disease will be discussed, and the results will be compared with results published from other centers.

  Tympanoplasty on only hearing/ better hearing ears. Top

Prof. J. Suzuki

Professor Emeritus Teikyo University School of Medicine, Japan.

a)- Planning and conduction of tympanoplasty in the safest possible way: There are several important issues related with he most conservative or least harmful; method of tympanoplasty:

  1. Closed-method tympanoplasty should be applied because this method, utilizing nature s healing mechanism, will create a lifelong care-free ear.
  2. The posterior canal wall reconstruction technique of the closed method is preferable because it provides a large surgical field wnicn enables more direct-vision surgery,
  3. It is important to remember that the ossicular chain, if it is remaining, should be touched as little as possible. Thus, if the drum perforation is small, “ inlay-underlay” rather than “inlay” is recommended for repair of the drum perforation.
  4. Minimum manipulation should be done for the dangerous areas in the middle ear- the round window niche, the oval window niche, labyrinthine fistula ( if any), etc.
  5. Manipulation should be carefully planned and conducted. If the ossicular chain shows neither fixation nor disconnection, the ossicles should be minimally touched. If the attic route is patent and the ossicles are not fixed, the attic and the antrum do not need to be opened and should not be touched.
  6. The use of artificial materials is not recommended, especially in the first operation. An inert material may be used in the second operation where no microbes should be present in the middle ear. The use of well- vascularized pedicles is mandatory, aiming at a quick and primary healing of the surgical wounds.

Minimum surgical invasions are planned as much as possible, if they are inevitable, they should be carried out with the use of instruments, knives, gouges, chisels, burrs and scissors which are kept at maximal sharpness.

Two check lists for only-hearing/better-hearing ear operation:


  1. Informed consent
  2. Microbe test repeated.
  3. Cleaning ear with warm saline, repeated.
  4. Audiometry, Weber test repeated
  5. Speech audiometry, “Patch” speech audiometry, trumpet-hearing test
  6. Vestibular examination including positional/positioning, caloric tests elctronystagmography.
  7. Fitting air conduction hearing aid, record the amplification
  8. Fitting bone-conduction hearing aid, record the amplification.
  9. Special notice to nurse in operation theatre (intraoperative)
  10. Cleaning and disinfections under protection of middle ear.
  11. Level of blood pressure, special notice lo anesthesiologist.
  12. Administration of antibiotics when needed.
  13. Administration of steroids, when needed ( Postoperative).
  14. Check any complaints of tinnitus and vertigo, tight after operation.
  15. Check complaints everyday.
  16. Simple hearing test at bedside, Weber test.
  17. Observation of spontaneous, positional nystagmus ( behind Frenzel glasses ).
  18. Apply bone conduction hearing aid and check the amplification
  19. Control of antibiotics and steroids (if needed).
  20. Audiometry, Weber test, speech audiometry, repeated.

  The impact of early otorrhoea on tympanoslcerosis following grommet insertion in children Top

Prof. Mohammed Attallah Department of Otorhinolarygology, King Abdulaziz University Hospital, Riyadh, Saudi Arabia.

Purpose: To analyze the effect of otorrhoea following grommet insertion with or without ade- noidectomy or adenotonsillectomy and the development of tympanosclerosis in children with hearing impairment due to otitis media with effusion.

Material and Method: 305 children with otitis media with effusion underwent general anaesthesia for myrngotomy and grommet insertion. Preoperative assessment include a careful history of hearing loss, otoscopic evidence of OME as indicated by B tympanogram, and when possible pure tone audiometry were obtained.

Results: 67 patients ( 31.16%) suffer from otorrhoea, 34 (15.8%) patients had history of early otorrhoea, 25 (11.62%) late otorrhoea and 8 (3.72%) with history of early and late otorrhoea. 44 (20.46%) had tympanosclerosis, 24 (11.16) patients with history of early otorrhoea,3 (1.3%) patients with history of late otorrhoea,8(3.72%) with history of early and late otorrhoea, and 9 (4.18%) patients without any history of otorrhoea.

Conclusion: We conclude that early otorrhoea following grommet insertion is a major factor in the development of tympanosclerosis.

Keywords: Otorrhoea, grommet insertion, tympanosclerosis.

  Posterior canal wall reconstruction type of closed method tympanoplsty Top

Prof. J.Suzuki Professor Emeritus Teikyo University School of Medicine, Japan.

The posterior canal wall reconstruction technique of a closed method tympanoplasty is also called ‘Open-and-Closed’ method. This method has two aspects of both open and closed methods, namely, the wide surgical view of the open method, and the postoperative care free ear of the closed method. However, the ‘Open-and-Closed’ technique requires additional work reconstruction has to be successfully accomplished. The posterior canal wall reconstruction may be very extensive in case of a huge cholesteatoma or in cases of post radical operation, when very limited when there is no need of intervention either in the antrum or in the attic. We adopted and have been testing this technique for about 25 years. We still continue and now recommend to young ear surgeons to learn this technique. We are producing only care free ears and few failures with this technique.

In our institution, with a few exceptions requiring only simple myringoplasty, we apply this closed method. Open-and Closed technique, for any type of chronic otitis media, cholesteatoma, postoperative conditions, congenital, aural atresia with microsia, and even just to stop draining of the ear with no hearing.

  Common allergens in Riyadh Top

Dr. Abdulrahman Al-Fayez

ENT Consultanty King Fahad National Guard Hospital, Riyadh, Saudi Arabia.

Riyadh is a city with high temperature in summer and low humidity ( typically desert weather). But lately there has been great interest in agriculture and improving the irrigation system which lead to increase in vegetation. Also environmental changes and air pollution. And an increase in the field of allergy & immunology and its disease. Our aim of the study is to determine the common allergens and the pattern of immediate type of hypersensitivity reaction among the atopic population. We tested 60 atopic patients in Allergy/Rhinology clinic at King Fahad National Guard Hospital- Riyadh. By prick skin test obtained from Greer Laboratories Inc. Our results shows that Russian Thistle is the most common allergen 58.3% fo1lowed by Lambs Quarter 55% Bermuda 43.3%,Timothy Grass 38.3%%,Mesquite (Prosopis)36.7% Cockroach 36.7% Alfalafa Pollen 33.36%, Cat Hair 26.7% house dust mite 23.3% & 26.7%

The result shows that atopy is highly prevalent among our patients, also confirm that plant pollens and grasses are the most common allergens.

  Management of allergic rhinitis in children Top

Dr. S. Assiri, Consultant Otolaryngologist, Security Forces Hospital, Riyadh, Saudi Arabia

Dr. Eman Al-Mashbrawi, KSUF King Abdulaziz University Hospital, Riyadh, Saudi Arabia.

Pediatrician, family practioners, pediatric allergists and otorhinolaryngologists are increasingly aware of allergic rhinitis and its association with preponderance in later development of other atopic disease e.g. asthma. Distinguishing allergic rhinitis in children is a prerequisite for sound management . Rhinitis is defined as the inflammation of the lining of the nose, presenting one or more of the following symptoms: nasal congestion, rhinorhoea, sneezing or itching. This is also applicable to almost all forms of rhinitis in childhood.Other symptoms of rhinosinusitis described specifically among children include coughing, halitosis, post nasal discharge, fever, headache, sore throat, facial sensitivity, and periorbital edema. The term “Rhinopathy” has been recently adapted to fit the allergic form where pathophysiological back- graound does not implicate the classical inflammatory infectious form. There are no widely or universally accepted criteria for classification of rhinitis . Mackey,19S9, subdivided rhinitis into allergic rhinitis, seasonal or perennial and nonallelic rhinitis, infectious and non-infectious.

The etiology, pathophysiology and epidemiology of the disease will be summarized to specific diagnostics in childhood including the vast field of therapeutic measures from prevention to pharmacotherapy.

  Fungal sinusitis: A time to review our controversy Top

Dr. Awad Al-Serhani

Associate Professor,ENT Department, King Abdulaziz University Hospital, Riyadh, Saudi Arabia.

Background: Fungal sinusitis has been addressed from different aspects recently. The prevalence as well as the different forms epidemiology arc variable. Sudan, India and Saudi Arabia have been claimed to be particularly endemic with chronic invasive forms. However, allergic fungal sinusitis(AFS) and other forms are found.

Objective: The present paper addresses the controversy of the presence of different forms, the population affected, the characteristics and the management.

Results: Fifty-two patients (22 males and 30 females) with positive culture and/or microscopy were included in this study. The mean age was 32.9 years, 51% were below the age 30 years. Emigrants formed 18.4% The majority (71%) had AFS followed by chronic invasive and fungal ball (9.6% each), fulminatnt fungal sinusitis (5.8%) and rhi- nosporidiosis (3.8%)The management consisted of different surgical procedures in addition to IV or oral anti fungal drugs for invasive and fulminant cases. The majority needed close, continuous care (57.1%). Recurrence occurred in 24.5% and 18.4% were stabilized under long interval follow up or are cured. The diagnostic features, fungi species and the therapeutic modalities will also be discussed.

Conclusion: The fungal sinus disease is a complex process forming a growing epidemiological map that needs to be well understood for better approach and hence outcome. In contrary to previous reports from Saudi Arabia,AFS is the commonest form in this series which is more than all cases reported in 4 previous papers from the country. The diagnosis, classification and management options are under continuous review.

  Malignancy of the sinunasal tract Top

Dr. Khalid Taibah

Consultant & Otolaryngologist, ENT Department, King Faisal Specialist Hospital & Research Center

Malignant neoplasm of the nose and paransasal sinuses are hetrogenous group led by squamous cell carcinoma which accounts for more then fifty percent (50%) of cases of the maxillary sinus is the most involved site being affected in more than fifty percent (50%) of cases. A review of pertinent literature reveals that sinusnasal malignancies account for less than one per cent of all human malignancies and only three per ccnt of those in upper aero- diagestive tract. Several studies clearly link the development of sinusnasal neoplasm and exposure to industrial fumes ( nickel, chromiumjsoprpopyl oils, volatile hydrocarbons ) and wood dust and other environmental toxics. Workers in nickel refinery have 250 times greater risk of developing squamous cell or ncaoplastic carcinoma than that of the general population. The medical records of 128 patients with malignant neoplasm of the nose and paranasal sinuses seen at King Faisal Hospital and Research Center, Riyadh between 19S0 and 1993 were retrospectively reviewed and analyzed.

This study showed an almost equal incidence of epithelial and non-epithelial cell malignant neoplasms involving nose and paranasal sinuses in al its histologic diversity. This paper has attempted to present the entire spectrum of the disease from symptoms through diagnosis, staging treatment and finally survival rate.

  Simultaneous open rhinoplasty & alar base esxcision: Is there a problem with the blood supply of the nasal tip & columellar skin? Top

DR. Sameer Bafaqeeh

Associate Professor, ENT Department, King Abdulaziz University Hospital

Purpose: In a prospective study,25 consecutive patients who underwent simultaneous open rhinoplasty and alar base excision were included to investigate whether there is problem with the blood supply of the nasal tip and columellar skin.

Methods: 15 consecutive, non-cleft Saudi patients underwent simultaneous open rhinoplasty and alar base excision with minimum follow up of 1 year. During the surgical procedure, there was transection of the columellar arteries and external nasal arteries, and frequently of the alar branches of the angular artery.

Results: None of the patients had any evidence of ischaemia of the nasal tip or columellar skin, and there was primary wound healing with a thin-line transcolumellar scar in all patients.

Conclusion: It was concluded that simultaneous open rhinoplasty and alar base excision is safe as long as certain surgical principles are applied. Techniques to avoid injury to the lateral nasal artery and nasal tip plexus are discussed.

  The Marrara Syndrome: Acute specific allergic rhinitis-manifestations Top

Prof Hashem Yagi.FRCS Consultant & Otolaryngologist, ENT Department, King Fahad University Hospital, Al-Khobar, Saudi Arabia.

The Marrara Syndrome is a hypersensitivity reaction caused by nymphs of Linguatula Serrata. The condition follows the consumption of Marrara, a popular Sudanese dish, some of the constituents of which are raw liver and rumen of goats and sheep. The Syndrome ensues when the larvae of Linguatula Serrata are present in above food. Linguatula Serrata were found in nasal passages of dogs. Nymphs were recovered from liver and lungs of goats.

Pharyngeal Tuberslosis

Dr. Awad Al-Serhani

Associate Professor,ENT Department, King Abdulaziz University Hospital, Riyadh, Saudi Arabia.

Objective: To increase awareness of Tuberculosis (TB) a s an important differential diagnosis of lesions in the pharynx and discuss its presentation.

Setting: A university hospital based retrospective study from 1988-1998.

Patients and Methods: The study included nine patients, two males and seven females, each with a diagnosis of pharyngeal tuberculosis(PTB). Of these, three had nasopharyngeal tuberculosis, five tonsillar tuberculosis and one hypopharyngeal tuberculosis. The criteria for diagnosis was either positive smear or histopathological features of caseating granuloma consistent with TB in the biopsy specimen and a response to treatment.

Results: All patients had primary infection. The main presenting symptom in all pharyngeal TB was neck mass while tonsillar TB patients presented with sore throats or discomfort. Dysphagia was the presenting symptom in hyppharyngeal TB. Six patients ( three nasopharyngeal TB and three tonsillar TB) had cervical adenopathy. The smear of Acid-Fast Bacillus ( AFB) was positive in two patients ( 22.2% ). Histopathological features of caseating granuloma, consistent with TB were present in all patients who received antituberculous medications.

Conclusion: Otolaryngologists should consider pharyngeal tuberculosis as one of the differential diagnosis if lesions of the pharynx especially in those countries where TB is endemic.

  Sudden snesorineural hearing loss. Analysis of outcome & confounding factors. Top

Dr. Suad A.Al-Mubarak. MBBS, King Fahad University Hospital, Qatif Saudi Arabia.

Objective: To analyze the outcome of treatment of sudden sensorineural hearing loss (SSNHL) and to identify prognostic factors.

Design: Retrospective chart review.

Setting: King Fahad Hospital of the University, Al- Khobar, Saudi Arabia.

Patients and Methods: Thirty two patients diagnosed with SSNHL were studied,aged 7-64 (mean age 30 ) year,9 females (28.3%) and 23 males (71.87%). Twenty five patients received treatment.Four of them treated surgically. In the remaining patients, bed rest and multidrug regimen were the mainstay of treatment. Daily pure tone audiograms(PTA ) were performed. The outcome of treatment is the mean hearing recovery compared to audiogram at presentation or to be unaffected ear at these adjacent frequencies. The results were divided into 4 groups: 1- Complete recovery 2- marked improvement 3- fair improvement and 4- no change.

Results: Out of 25 patients treated 8 ( 32% ) had complete recovery, 5 ( 20% ) had marked improvement, 5 ( 20% ) fair improvement and 7 ( 28%) had no change. Younger patients and patients who presented earlier had a better outcome. Concomitant tinnitus and vertigo had no effect on outcome.

Conclusion: Treatment of SSNHL is directed towards all possible aetiologies. Exploratory tympanotomy of inner ear membrane rupture is expected. Multidrug therapy is the mainstay of treatment. The most important prognostic factors are time of presentation, age and type of PTA.

Keywords: Hearing loss, sudden, treatment, outcome.

  Misleading Brain Stem Response in children with neurologic deficits Top

DR. Osam El-Sayed Badran, AudioJogist Specialist King Fahad Hospital of the University, Al-Khobar, Saudi Arabia.

The introduction of (ABR) in paediatric audiology represents a great step forward. In fact, the method seems to be superior to any other subjective audio- logical tests in uncooperative children and high risk neonates. This report described 5 children with neurologic deficits, in whom no response could be elicited during ABDR at maximum click intensity despite normal or near normal hearing sensitivity . This phenomenon could be explained on the basis of the faculty synchronization of biological response to clicks. Attention is drawn to the fact that the lack of response in ABR in cases with CNS involvement is not necessarily proof of severe HL but could supply important diagnostic.

  Voice outcome after Iaryngotracheoplsty in children Top

Dr. Ahmed Al-Ammar, MD, SKSU

Assistant Professor, Consultant & Otolaryngologist. King Abdulaziz University Hospital, Riyadh, Saudi Arabia.

Objective: This study presents the effects of laryn- gotracheoplasty with and without rib grafting, the use of endolaryngeal stent and its duration on children voice

Design: Case series study that assess the voice of 7 children with the diagnosis of laryngotracheal stenosis, who underwent laryngotracheoplasty between October 1989 and October 1998. Setting: Otolaryngology Department in a tertiary care center.

Method: The voice of the children were assessed perceptually by a speech- language pathologist specially trained and experienced in the are of voice disorders. The voices were evaluated by different measures that included voice quality, pitch and loudness. Voice assessment also included measuring the fundamental frequency and fundamental frequency perturbation (jitter)

Results: There was a persistence of abnormal voice quality in all the patients post operatively. Voice weakness was a universal finding in a all patients after the surgery. Also voice pitch was abnormal after surgery for all the patients except one. The pitch was generally lowered. This study demonstrated a reduction of the fundamental frequency post operatively compared to the preoperative findings and that of the controls. The fundamental frequency perturbation (jitter) was abnormally high for all patients after surgery.

Conclusion: Laryngotracheoplasty may establish a mean of oral communication for patients with laryngotracheal stenosis. However, it is commonly results in an abnormal voice quality pitch and loudness. The role of the use of enolaryngeal stent in developing abnormal phonation post operatively is not very clear. This is due to the difficulties in assessing the voice of such children preoperative- ly and the amount of endolaryngeal damage those children present with before surgery.


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  In this article
A comparative st...
Tympanoplasty on...
The impact of ea...
Posterior canal ...
Common allergens...
Management of al...
Fungal sinusitis...
Malignancy of th...
Simultaneous ope...
The Marrara Synd...
Sudden snesorine...
Misleading Brain...
Voice outcome af...

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