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ORIGINAL ARTICLES
Universal neonatal hearing screening in a tertiary care center in South India
Ramiya Ramachandran Kaipuzha, Davis Thomas Pulimoottil, Padmanabhan Karthikeyan
July-December 2019, 21(2):29-32
DOI:10.4103/SJOH.SJOH_6_19  
Objective: The aim of the study is to determine the prevalence of hearing loss among newborn infants and to assess the effectiveness and utility of otoacoustic emission (OAE) as a screening tool to detect hearing impairment in newborns and the relationship between selected risk factors and hearing loss. Study Design: This study involved 3121 newborns delivered in a tertiary care center over a 3-year period, who were subjected to distortion product OAE (DPOAE) within 24–72 h of life; failed candidates underwent repeat DPOAE after 30 days. Infants failed the second DPOAE test and then underwent DPOAE and brain stem-evoked response audiometry (BERA) at 3 months of life. Results: 20.95% newborns failed the first screening test, 11.77% failed the second test, and 61.91% of these infants failed the third OAE test. Of the 26 infants who failed the third test, 15 had abnormal results on BERA. Overall, the prevalence of hearing loss was 0.48%. Conclusion: Implementation of a national universal newborn hearing screening program in India is the need of the hour, as early detection of hearing loss will aid early rehabilitation and better outcomes.
  2,527 344 1
Does adding computed tomography on top of ultrasonography for evaluating thyroid diseases provide a better outcome?
Haneen Hussain Sebeih, Khalid Alqahtani, Jabir Alharbi, Nasser Alwehaibi, Ahmad A Aldereihim, Taherah Islam
July-December 2019, 21(2):40-46
DOI:10.4103/SJOH.SJOH_7_19  
Introduction: Thyroid disease is a common medical disorder. And thyroid cancer considered the second-most common cancer among the young Saudi females. Ultrasonography (US) and computed tomography (CT) are used in the diagnosis of thyroid nodules. However, US has its limitations, and CT scan is superior in detecting important details that would affect patient care and prevents possible complications. Objective: The study evaluates the benefits of CT scans implementation together with the US as a preoperative evaluation of any thyroid diseases which can improve thyroid patient care. Methodology: The retrospective study was conducted on a total of 207 patients, in a tertiary center, Riyadh, Saudi Arabia. Results: A total of 207 patients with thyroid diseases who had both US and CT scan done despite thyroid surgery done or not (164 females and 43 males; mean age, 44.6 ± 14.5 years) were included in our study, and any patient with improper imaging protocol or poor US or CT image quality was excluded. From there, 207 patients, we had 88 patients with benign and 85 with malignant pathology (+34 patients no surgery done for them). The present study showed that US had better specificity and accuracy in the prediction of thyroid malignancy comparing to the CT scan. Furthermore, CT had a significant P < 0.05 in detecting extension to retrosternal or surrounding structures, major vessels involvement, tracheal compression, and pathological lymph node. Conclusions: CT scan of the neck is a useful technique in detecting additional details about the thyroid and surrounded tissues. This study suggests that preoperative CT scan implementations on top of US are positively associated with a good strategy of surgery, postoperative complication prevention, and to success the thyroid surgery in the Saudi population.
  2,286 256 -
Risk factors of recurrent chronic rhinosinusitis after functional endoscopic sinus surgery
Waleed Abdullah Mohsenh, Raneem Abdulaziz Aljthalin, Raseel Abdulaziz Aljthalin, Sameer Al-Bahkaly
July-December 2019, 21(2):33-36
DOI:10.4103/SJOH.SJOH_4_19  
Background: Chronic rhinosinusitis (CRS) is one of the most common chronic diseases, which is defined as an inflammation of the nose and paranasal sinuses. Computed tomography (CT) scan of paranasal sinuses has become mandatory for all patients undergoing functional endoscopic sinus surgery (FESS), which is, nowadays, regarded as the gold standard for treatment of CRS after a trial of medical treatment. Our aim in this study is to explore the risk factors and anatomical findings on CT scan of CRS patients who had recurrence after FESS in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: A retrospective chart review study was conducted in the section of otolaryngology head and neck surgery to assess the risk factors of patients with recurrent CRS after FESS. The study included all patients, who were adults 16 years of age and above of both genders that had FESS after a diagnosis of CRS between 2016 and 2018. Results: The study identified 257 patients with CRS, of which 38 (14.79%) patients had recurrence after FESS. Various risk factors were taken into consideration such as age, gender, airway and inflammatory autoimmune diseases, smoking, type of sinusitis, and anatomical variations and findings on CT scan. However, only fungal type of sinusitis was found to be a significant risk factor of a recurrent CRS. Anatomical findings on CT scan postoperatively were mucosal thickening, nasal polyps, nasal septum deviation, and obliterated osteomeatal complex. Conclusion: CRS patients were assessed for various risk factors of recurrent CRS. The overall incidence of recurrent CRS was 14.79%. Fungal rhinosinusitis was found to be a significant risk factor. The most common anatomical findings on CT scan postoperatively were mucosal thickening in paranasal sinuses followed by nasal polyps.
  2,177 349 -
Risk of submandibular gland metastasis in early-stage oral cavity cancer: A national multicentric study
Jabir Alharbi, Haneen Sebeih, Mohammed Alshahrani, Mohammed Algarni, Hadi Al-Hakami, Abdullah Alnemare, Abdullah M Assiri, Tahera Islam, Khalid Alqahtani
July-December 2019, 21(2):37-39
DOI:10.4103/SJOH.SJOH_3_19  
Background: The objective of this study was to evaluate the safety of preserving the submandibular gland in early-stage oral cavity cancer. Materials and Methods: We retrospectively collected the data for all patients who present with early-stage oral cavity cancer and underwent local wide excision with concomitant neck dissection over 8 years from 2008 to 2016 at two tertiary oncology centers in Saudi Arabia. Results: Forty-seven patients, comprising 26 males (55.3%) and 21 females (44.7%), were included in the study; the primary presentation, documented risk factors, and postoperative pathological results were evaluated. Conclusion: The present study showed that risk of submandibular gland metastasis in clinically early-stage oral cavity squamous cell carcinoma was almost nil.
  1,677 268 -
The association between age-related sensorineural hearing loss and saccular dysfunction in the elderly
Gehan Mohamed Shafeek Abdel-Salam
January-June 2020, 22(1):7-12
DOI:10.4103/SJOH.SJOH_19_19  
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.
  1,749 193 -
Do filters and pose in selfies have an effect on cosmetic procedures
Badi Aldosari
January-June 2020, 22(1):21-23
DOI:10.4103/SJOH.SJOH_1_20  
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.
  1,703 201 -
CASE REPORTS
Aberrant carotid bulb in bilateral tonsillar fossae: An exceptional discovery during tonsillectomy
Brook Assefa Aylele, Ramiya Ramachandran Kaipuzha, Akilesh Suvindran, Nasser Alhajri
July-December 2019, 21(2):47-51
DOI:10.4103/SJOH.SJOH_5_19  
Tonsillectomy, though a popular surgery, has now downsized to limited indications. Although rare, this surgery may cause trauma to the great vessels leading to life-threatening hemorrhage. The congenitally tortuous internal carotid artery (ICA) is an unusual but important anomaly, especially when it is situated in the tonsillar fossae. About 1%–16% of patients have a surgically vulnerable ICA manifested clinically. Here, we present the first reported case of carotid bulb in the right tonsillar fossa. A 7-year-old female child underwent tonsillectomy for obstructive sleep apnea syndrome. Intraoperatively, she was found to have a carotid bulb in both tonsillar fossae, right more prominent than left one. Computed tomography angiogram confirmed the presence of a prominent carotid bulb in the right tonsillar fossa at the C2level. This case report highlights the importance of a heightened awareness of the anatomic variations of carotid artery, in particular, the carotid bulb. This is of critical significance for a safe tonsillectomy as well as any procedure performed in the oropharyngeal region.
  1,611 265 -
REVIEW ARTICLE
Factors affecting outcomes of injection laryngoplasty: A systematic review
Isra Ali Al-Jazeeri, Hassan Ali Al-Jazeeri
January-June 2020, 22(1):1-6
DOI:10.4103/SJOH.SJOH_17_19  
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.
  1,552 223 -
ORIGINAL ARTICLES
A comparative study of thyroid surgery with and without a microscope
Harendra Kumar Gautam, Vinod Kumar, Devendra Maurya
January-June 2020, 22(1):13-15
DOI:10.4103/SJOH.SJOH_10_19  
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.
  1,319 191 -
Prevalence of cochlear dead regions in hearing-impaired patients
Asmaa Moaty, Medhat Fathy Yousef, Ayman Abd Alaziz, Abd Allatif Elrasheedy
January-June 2020, 22(1):16-20
DOI:10.4103/SJOH.SJOH_20_19  
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.
  1,207 166 -
CASE REPORTS
Tooth in maxillary sinus, less than what commonly anticipated
Mohammed Alwabili, Mohammad Aloulah, Raseel Alsuwaidan, Ahmed Altuwaijri
July-December 2019, 21(2):52-54
DOI:10.4103/SJOH.SJOH_8_19  
The maxillary sinus can be a host of a wide range of different types of foreign bodies as a result of its size and the anatomical relation to multiple different skull compartments. Displacement of maxillary molars to the maxillary sinus can occur, although it is rarely reported and the incidence of such condition is still unknown. Most of reported cases in the literature of a tooth in maxillary sinus regardless of its etiology have symptomatic presentation. Different approaches can be utilized to manage such condition; however, surgical management by functional endoscopic sinus surgery is preferred given its advantages of better sinus aeration and less postoperative complication.
  1,050 158 -
ORIGINAL ARTICLES
Nasal bone measurements in the middle eastern population based on radiological analysis: A cross-sectional retrospective study
Salma Saud Al Sharhan, Maha I Al Somali, Fahad S Al Zahrani, Mona M Ashoor, Sawsan F Almarzouq, Afnan F Almuhanna, Adnan T Samarah
July-December 2020, 22(2):57-62
DOI:10.4103/SJOH.SJOH_10_20  
Objectives: Performing septorhinoplasty surgery requires comprehensive knowledge of nasal morphology. The effect of racial differences on nasal bone morphology has gathered increasing interest. However, previous studies have primarily focused on the Western population with a few studies assessing the Middle Eastern participants. We aimed to provide itemized measurements of the nasal bone morphology as the baseline data for the Middle Eastern population. Study Design: This was a retrospective cross-sectional single-center study. Materials and Methods: We included patients who underwent maxillofacial computed tomography between February and August 2019 at King Fahad Hospital of University. The Kolmogorov–Smirnov test was used to check the assumption of data normality. The Mann–Whitney U-test and Student's t-test were used for nonsymmetrical and symmetrical variables, respectively. One-way analysis of variance was used for symmetrical data. Chi-square test was used to compare the categorical variables. Results: We included 276 cases. The mean right and right nasal bone length was significantly larger in men than in women. Moreover, patients with severe nasal septal deviation angle had significantly lower left and right medial bone thickness, as well as the internasal angle. Conclusion: There were significant between-sex differences in the nasal bone morphology. There was no side predilection for deviated nasal septum and nasal bone thickness. However, severe cases of deviated nasal septum presented a lower medial nasal bone thickness, which could be attributed to ethnic variations in the Middle Eastern population.
  989 68 -
Validation and reliability of Arabic voice handicap index-10
Mohamad Farahat
January-June 2012, 14(1):11-18
DOI:10.4103/1319-8491.274765  
Background And Objective: The voice handicap index-10 (VHI-10) questionnaire is widely used and is self-administered by the patient. It saves time for both patient and clinician as it is a 10-item questionnaire compared to the 30-item questionnaire in the original version of VHI. The purposes of the present study were to generate an Arabic version of the VHI-10, and to evaluate its validity, consistency, and reliability in normal and voice-disordered Arabic population. Setting And Design: This is a prospective study that has been carried out at Communication and Swallowing Disorders Unit, King Saud University. Subjects And Methods: The validated Arabic VHI-10 was administered to 100 patients with variable voice disorders and 165 control subjects. Internal consistency and test re-test reliability were evaluated. The results of the pathological and the control groups were compared. Results: The Arabic VHI-10 showed high internal consistency (Cronbach’s α = 0.88). Excellent test–retest reliability was found for the total scores of the Arabic VHI-10 (r = 0.920, P = 0.001). There was a significant difference between VHI-10 scores of the control and the voice disordered group (P < 0.001). Conclusion: This study demonstrated that Arabic VHI-10 is a valid tool for self-assessment of voice disorders that can be used by Arabic language speakers.
  956 56 2
Incidence of head and neck cancers in jazan province, Saudi Arabia
Fahd Alharbi
July-December 2017, 19(2):47-50
DOI:10.4103/1319-8491.275315  
Objectives: The objective of this study was to evaluate the incidence of various types of head and neck cancer in Jazan province, Saudi Arabia. Material and Methods: This was a prospective study of histologically confirmed cancer cases in Jizan, Saudi Arabia. One hundred and thirty two cases were histologically confirmed to have cancer in the head and neck region. Type of management for each case was also included. Results: The type of cancer which was more frequently seen among the studied sample was squamous cell carcinoma (SCC). Almost 61.3% of the patients were seen to be affected with SCC followed by thyroid cancer (21.2%). Non-Hodgkin’s lymphoma was seen in (12.3%) of the cases, which was the most common site in the recorded data. Conclusion: Head and neck cancers are increasing in Jazan region. Oral and oropharyngeal cancers show the most significant rise due to smokless tobacoo, with implications for public health action and service provision.
  914 69 1
Long-term cosmetic and functional outcomes of rhinoplasty: A cross sectional study of patients’ satisfaction
Sara Howldar, Abdulkareem Fida, Ohoud Allinjawi, Faisal Zaqzoog, Ghofran Qurban
January-June 2018, 20(1):1-12
DOI:10.4103/1319-8491.273913  
Objective: To assess patients’ satisfaction about cosmetic and functional outcomes of uncomplicated rhinoplasty and the consequent psychological impact Materials and Methods: A cross-sectional study was carried in adult patients (≥20 years), who underwent primary, functional/cosmetic rhinoplastic surgery at Al Mashfa hospital, Jeddah, before January 2015 (1 year of postoperative follow-up). Patients were contacted for an anonymous telephonic interview using a validated [1], semi-structured questionnaire investigating 7 postoperative satisfaction parameters. Results: Two hundred patients who underwent functional (13.5%), cosmetic (20.5%) or both functional and cosmetic (66.0%) rhinoplasty were included. Satisfaction analysis showed 48.0% satisfied rate. Female and divorced participants had lower satisfaction compared to their counterparts; and divorced women had lowest satisfaction score 28.33/100. Pre- to post-rhinoplasty assessments showed remarkable improvement in nose function (mean±SD=53.72±27.10 to 95.71±8.86; p<0.001), appearance (41.70±26.29 to 95.49±9.18; p<0.001) and patient’s mood (51.34±29.83 to 95.84±11.47; p<0.001), respectively. Change in mood was correlated with both change in function (r=0.412; OR [95%CI]=1.61 [1.39; 1.86]; p<0.001) and appearance (r=0.748; OR [95%CI]=2.30 [2.07; 2.55]; [p<0.001). Conclusion: Patients who underwent primary uncomplicated rhinoplasty have fair satisfaction about functional long-term outcomes but remain relatively dissatisfied esthetically; especially female, divorced and unemployed patients. The functional and cosmetic improvements have positive impact on the patient’s psychological wellbeing.
  847 77 -
Vocal cord dysfunction evaluation and outcome of conservative treatment
Hatem Ezzeldin Hassen, Ahmed Abo Hasseba
July-December 2015, 17(2):63-69
DOI:10.4103/1319-8491.274660  
Objective: This article reports evaluation of 30 patients with Vocal Cord Dysfunction (VCD) and the outcome of conservative management program including voice therapy and breathing exercises. Study design: A prospective observational follow up study. Methods: Thirty consecutive referrals of refractory asthma patients and patients presented by laryngeal symptoms diagnosed as having VCD were assessed, treated and followed for at least 6 months after treatments. Results: 53% of patients had adduction of vocal folds during inspiration, 50% had posterior glottis congestion and 95% had constriction of supraglottic area during inspiration. There was highly significant differences in the scores of both self-reported questionnaire and laryngeal parameters before and after therapy with lowering the scores after voice therapy Conclusion: There are signs during laryngeal examination which could be used for diagnosis of VCD in between attacks and we can conclude that voice therapy with psychological counseling and anti-reflux treatments are effective in controlling the manifestations of VCD.
  851 58 -
Impact of Flab Technique Versus Non-Flap Techniques on Endoscopic Dacryocystorhinostomy
Fahd Alharbi, Sherif Kamel, Bassam El-Zuraiqi
July-December 2018, 20(2):46-48
DOI:10.4103/1319-8491.273920  
Objective: to compare the influence of flap versus non-flap technique on endoscopic dacryocystorhinostomy (EDCR). Patients and Method: A prospective randomized trial in patients with bilateral nasolacrimal duct obstruction, comparing the two techniques to avoid inter-patient variability. We included all patients where bilateral epiphora, excluding unilateral, previously operated or recurrent cases. Results: One hundred patients, fifty females and fifty males with bilateral epiphora due to naso-lacrimal duct obstruction were operated upon by EDCR with or without flap technique. Out of 100 EDCR procedures with flap technique, only 3 had recurrent epiphora with stenosis of the ostium on endoscopic examination and failed fluorescein dye test. In contrast, 4 procedures without flap failed as evident by recurrent epiphora, endoscopic and fluorescein dye test criteria. Conclusion: There is no difference between DCR with flap preservation and flap removal in success rate but the preservation of both lacrimal and mucosal flaps aids in reducing the post-operative granuloma development.
  821 76 -
Smoked cooked meat as a risk factor for Nasopharyngeal Carcinoma: A case control study among Saudi populations
Khalid Hakami, N Prepageran, Talal Al Thubaity, Eidah Al Juaid, Nawaf Al Solami
January-June 2018, 20(1):13-19
DOI:10.4103/1319-8491.273914  
Background: Head and neck cancers constitute about 6% of malignancies diagnosed annually in the Kingdom of Saudi Arabia and represent 33% of these are of nasopharyngeal origin. The epidemiological studies of nasopharyngeal carcinoma (NPC) suggested that factors like viral agents, dietary factors and genetic susceptibility have a major role to play in the disease etiology. Objective: To investigate the possible roles of smoked cooked meat (like Mandi which is traditional dish in Saudi Arabia) in the development of NPC. Subjects and Methods: A case-control study included 43 incident cases of NPC and 84 control subjects was carried out at Otorhino laryngology, Head and Neck Surgery department at Al-Hada Armed Forces Hospital, Saudi Arabia, throughout the period 2014-2015. All information on dietary, environmental, social, and demographic factors was collected. Univariate and multivariate logistic regression analysis using maximum likelihood method was used to analyze data. Results: The study included 43 cases with confirmed nasopharyngeal carcinoma and 84 age and sex matched control subjects. Most of cases 29 (67.4%) were presented with neck mass whereas the remaining 14 (32.6%) presented with otitis media. Multivariate logistic regression analysis revealed that smokers were at almost 3-fold risk to develop nasopharyngeal carcinoma compared to non-smokers (Adjusted “AOR”=3.05; 95% confidence intervals: 1.37-6.79) and consumption of smoked meat as participants consumed it on weekly or monthly bases were at highly significant risk to develop NPC compared to those who never consumed it (AOR=9.32; 95% CI: 1.12—77.39 and 14.44; 95% CI: 1.71-121.81. respectively) [Table 2].However, consumption of Canned Fava beans and Arabic Coffee were not found to be associated with NPC. Conclusion: The rate of consumption of meats was increased in the last tow decades among Saudi population. The N-nitrosamines (NA) is a large group of compounds of which many are carcinogenic. In many studies, the nitrosamines were detected as high level in smoked meat. The results from this study suggested that consumption of smoked cooked meat and cigarette smoking is independent risk factors for NPC in Saudi Arabia.
  818 72 -
The outcome of temporalis fascia versus diced cartilage wrapped in temporalis fascia for dorsal augmentation in septorhinoplasty
Mohammed Saad Eldin Aly, Syed Aqeel Raza, Bassam Al-Zuraiqi, Baraa Ibrahim Awad, Ahmed Saleh Alghamdi, Mohammed Sameer Ibrahim, Bashaer Muteb Aldhahwani, Rahma Shahbahi, Arij Awad Alzaidi, Ibtehal Abdulmalik Althobaiti, Osama Marglani
July-December 2017, 19(2):58-64
DOI:10.4103/1319-8491.275317  
Objective: Rhinoplasty is a difficult operation and has the highest rates of revision surgery. It is often accompanied by septoplasty. Osseocartilagenous vault irregularity, radix depression and saddle deformity of the nose are common problems encountered in rhinoplasty. Deep temporalis fascia available in large quantity can be used alone or in combination with diced cartilage for augmentation rhinoplasty, and to camouflage the nasal dorsal irregularities. A wide variety of grafts is used to augment the nasal dorsum. The aim of the study was to note the nasofrontal, nasolabial, nasofacial angles measurements, functional and aesthetic assessment before and after septorhinoplasty. Methods: A retrospective chart review was done on 69 patients, who underwent septorhinoplasty at our institute (Jan 2011 – Jan 2014). Out of these, 31 patients underwent dorsal augmentation with temporalis fascia as a blanket endonasal coverage in one group and diced cartilage with temporalis fascia in the other group (38 patients). The diced cartilage was obtained from nasal septum in 16 cases (42.1%), chonchal cartilage in 14 cases (36.84%), rib cartilage in 5 cases (13.15%) and Goretex in 3 cases (7.89%) wrapped in temporalis fascia for dorsal augmentation was included in the same group.The operative details, surgical outcome, and complications noted have been mentioned. Results: The nasofrontal angle, nasal labial angle and nasofacial angle were reduced in the dorsal augmentation using diced cartilage with temporalis fascia group compared to the temporalis fascia alone group. As per the functional point of view (breathing quality) score, we found in the first group that all 31 patients were satisfied (100%), while in the second group we found that 37 patients out of 38 were satisfied (97.4%). Only one patient (3.2%) out of 31 patient in the first group was not satisfied form the aesthetic point of view while in the second group we found that 6 patients (15.5%) out of 38 were not satisfied. Conclusion: Temporalis fascia used in any form like a blanket, or with diced cartilage wrapped with fascia offers the advantage of smooth nasal dorsum, a reasonable functional improvement and a better option for nasal dorsal osseocartilagenous reconstruction.
  829 57 -
Delayed Complications of Cochlear Implant Surgical Site, Al Nahdha Hospital 17 Year's Experience
Khalid Al Zaabi, Ammar Al Lawati
January-June 2018, 20(1):29-34
DOI:10.4103/1319-8491.273916  
Background: Since the era of Cochlear Implant (CI) has started varies complications were reported in the literature. These complications range from simple wound infection to much more severe and complicated complications such as meningitis and facial nerve paralysis. In Oman we started our CI program in 2000 and we came across several complications over the last decade. Objective: To report our hospital experience in post CI complications at the wound site in the last 17 years. Methods: Retrospective analysis of 350 cases operated at our tertiary hospital in the period of 2000 until March 2017. Results: 11 cases developed wound site complications in which 6 of them needed to be taken to the operating theatre while 5 cases were managed as outpatients. The types of complications were seroma, hematoma, wound infection, Abscess and we had one patient with device extrusion. Conclusion: Post CI wound site complications are uncommon but when present, they might lead to major morbidities. Early detection and management is highly advised.
  801 61 -
CLINICAL CASE
Operative Challenges in Doing Cochlear Implant in an Ossified Cochlea, is it Worth it? Case Report and Reviewing the Literature
Farid Alzhrani
July-December 2018, 20(2):68-73
DOI:10.4103/1319-8491.273924  
Objectives: To present an unusual way of cochlear implant electrode insertion and discuss the audiological as well as the speech outcome. Study Design: Case report. Method: Will be reviewing a file of a deaf patient who underwent retrograde insertion of cochlear implant array. Once the audiological and speech findings are evaluated then the literature for similar cases and alternative techniques will be discussed. Results: A case of a 24-year-old male patient that underwent cochlear implantation due to post meningitis deafness. Considering an ossified cochlea a cochlear implant array was inserted in a retrograde manner from the apex toward the basal turn of the cochlea. There was neither an intraoperative nor postoperative complication. The post implantation audiological outcome was comparable with those subjects who have no ossification in the cochlea. The patient started to use a mobile phone 4 months post- op. 76% speech discrimination score at 60 dB has been achieved within 5 months post implantation. Conclusion: The apical cochleostomy with descending cochlear implant array insertion is an efficient procedure that has very good postoperative results.
  772 82 -
ORIGINAL ARTICLES
Factors influencing career choice in otorhinolaryngology among medical students at King Abdulaziz University, Jeddah, Saudi Arabia
Ghofran Qorban, Talal Al-Khatib, Sara Howldar, Ohoud Allinjawi, Hanan Jawa, Mukhtiar Baig
January-June 2018, 20(1):20-28
DOI:10.4103/1319-8491.273915  
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.
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The evidence of safely using tisseel in drain-free thyroidectomies prospective cohort study
K AL-Qahtani
July-December 2011, 13(2):125-129
DOI:10.4103/1319-8491.274757  
Objectives: To evaluate the safely and effectively using of Hemostatic Fibrin Glue in drain-free thyroidectomies. Study Design: Prospective cohort study of 25 patients undergoing thyroidectomies. Surgery was done using tessel without the use of surgical drains. The complication and duration of the hospital stay were obtained. Methods: Thyroidectomies were undertaken by one surgeon. Prior to wound closure, the skin flap and wound bed were approximated using Tisseel tissue sealant, and no drains were used. Data regarding incidence of any complication and the duration of the hospital stay were obtained. Patients were followed to assess surgical outcome and document any complications. Results: There were no cases of seroma, hematoma, recurrent laryngeal nerve paresis or paralysis. However, there were six patient who had hypocalcaemia post operatively. Three of those six patient had hypocalcaemia for one month, two patients had it for three months, and one patient had it for more than six months. Conclusions: Thyroidectomies can be undertaken safely and effectively without the need for surgical drains. Hemostatic actions of fibrin glue precluded the necessity of usage of drains.
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Delayed facial palsy after mastoid and middle ear surgery
Abdulrahman Al-Essa
July-December 2009, 11(2):78-81
DOI:10.4103/1319-8491.275334  
Objectives: The purpose of this report is to provide data on delayed facial palsy (DFP) after mastoid and middle ear surgery, and to discuss the possible etiology. Study Design and Setting: This is a retrospective report carried out at a university-based hospital Patients: The records of 1980 patients with normal facial function before mastoid and middle ear surgery were reviewed. Measures: Delayed facial palsy was defined as facial palsy occurring after the initial postoperative evaluation. Results: During the 6-year period from 1998 to 2003 consecutive mastoid and middle ear operations were reviewed. A total of 7 delayed facial palsies (DFP) were identified. All were incomplete and recovered completely following conservative treatment. The mechanism of DFP was not known in two cases , chorda tympani stretching in one case , iatrogenic facial exposure in two patients and herpes viral reactivation in two patients. Conclusion: DFP occurred in 0.35% after middle ear and mastoid operations. Several factors may contribute to DFP including chorda tympani injury,iatrogenic, infection, facial canal edema ,immune response and recently several reports suggesting strongly viral reactivation as one of the main causes of DFP.
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Patient satisfaction following closed reduction of nasal bone fracture
Ahmad Al Arfaj, Yasin S Subhan, Tareq Al Otaibi, Amani Ahmed Obeid
July-December 2015, 17(2):37-39
DOI:10.4103/1319-8491.274654  
Objective: To present the clinical profile of patients subjected to closed reduction of fractured nasal bone and review the outcome of the procedure from the patient’s perspective. Methods: Patients with nasal bone fracture treated with closed reduction in King Abdulaziz University Hospital, Riyadh between 1 January 2008 and 31 December 2013 were included. The essential data consisting of personal details, history, examination, details of surgical corrections were charted. Patients were followed-up by a telephonic interview to obtain their level of satisfaction of the outcome. Results: Of the 163 patients who were studied, 147 patients could be successfully contacted and interviewed, and 16 patients could not be contacted. Of the 147 patients, 65 (44%) patients expressed full satisfaction with the functional and aesthetic outcome; 42 (29%) patients were partially satisfied but would not consider revision surgery; 39 (27%) patients were not satisfied and would consider revision surgery. Conclusion: Despite a relatively high patient satisfaction rate with the functional and aesthetic outcome of closed reduction of nasal fracture, a significant number of patients (27%) are unsatisfied.A thorough pre-operative evaluation of the nasal deformity including presence of pre-existing deformities and meticulous surgical correction might reduce the rate of the unsatisfactory outcome of the primary surgical procedure.
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