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Year : 1999  |  Volume : 1  |  Issue : 2  |  Page : 100-108

Abstracts from the 8th national symposium of the Saudi Oto-Rhino-Laryugology Society 5-6 May 1999 Mecca-Saudi Arabia

Date of Web Publication16-Jun-2020

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-8491.286862

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How to cite this article:
. Abstracts from the 8th national symposium of the Saudi Oto-Rhino-Laryugology Society 5-6 May 1999 Mecca-Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg 1999;1:100-8

How to cite this URL:
. Abstracts from the 8th national symposium of the Saudi Oto-Rhino-Laryugology Society 5-6 May 1999 Mecca-Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 1999 [cited 2023 Jan 30];1:100-8. Available from: https://www.sjohns.org/text.asp?1999/1/2/100/286862

  Nasal endoscopy and CT scan study of Pharoanic and Roman mummies. Top

H. Gaafar, M.H. Abdel-Monem, S. El Sheikh ENT and Radiology Departments, Alexandria Medical School, Alexandria, Egypt.

In Ancient Egypt, mummifications had started. The viscera] organs (lungs, stomach, liver, bowel) were removed from the body, cleansed, desiccated, and placed in four canopic jars. The brain was removed from the body and not preserved. Exactly how this was accomplished is not clear.

This study was done to investigate the route of brain removal during mummification. Nasal endoscopy was done in twenty pharaonic and Roman mummies. C.T. scan examination was performed for two mummy heads. In all mummies, a communication between the cranial and nasal cavities was found passing through the posterior eth- moids and cribriform plates. The cranial cavity was empty. Our results have demonstrated that brain removal during mummification was performed endonasally by trained personnel having good knowledge of anatomy and using special instruments capable of creating a clean cut endonasal craniotomy

  Surgery of the lower lateral nasal cartilage Top

Atef El Kholy FRCS, Al-Hada Military Hospital, Taif, Saudi Aeabia.

The main frame of the nasal tip is made of the lower lateral cartilage. The major nasal tip support mechanisms are the cartilage of medial and lateral crura. The attachment of the medial crura is to the caudal septum and the attachment of the lateral crura is to the upper lateral cartilage. In this short presentation we will discuss two techniques:

1-Total replacement of the lower lateral cartilage using cartilage harvested from the pinna. This technique could be used after traumatic loss of the lower lateral cartilage and in the case of revision rhinoplasty. A short video (five minutes) could be shown. 2) Nasal tip plasty using a strut for management of under projected overprojected and asymmetrical nasal tip.

  The otolaryngologist's approach to the inferior turbinate. Top

Prof. Siraj Mustafa Zakzouk, Security torces Hospital, Riyadh, Saudi Arabia

The symptoms of chronic nasal obstruction is one of the common problem facing the ENT physician. Swelling (hypertrophy) of the inferior turbinate is the most common modalities to overcome this problem and addressed several approaches to deal with the inferior turbinate swelling, of reducing its size and relieving nasal obstruction. Medical treatment should be always tried. Several methods were tried during the past century i.e.

  1. Cautery - linear and submucosal (Sinsky 1932) (Richardson 1948, Simpson and Groves 1958).
  2. Cryo turbinectomy (Ozenberger 1973. Moore and Bicknell 1980, Bumsted, 1984).
  3. Partial or total radical turbinectomy - outfracture (Moore et al 1985, Ophir et al (Partial Goode 1977, Sounders 1982).
  4. Laser turbinectomy (Selkin 1985, Fukutakeel al 1988).
  5. Turbinoplasty or submucosal resection of bon (House 1951, Goode 1977).
  6. Conco-antropexy (Fateen 1967).
  7. Infra red coagulation (Moulton-Barrett el al 1994).
  8. Injection of sclerosant or steroids (Goode 19’ )•
  9. Functional turbinate surgery.

The various approaches will be discussed review of literature.

  Lobular capillary haemangioma (Pyogenic granuloma) of the nose. Top

Dr Awad Al-Serhani, MD. Associate Professor, Head ofENT Department, Chief of Medical Staff- KAUH, Riyadh, Saudi Arabia.

To present a number of cases with lobular capillary haemangioma (pyogenic granuloma) of the nose- and to discuss the clinical and histopathological diagnosis of this disorder.

Methods: A clinicopathological study of patients diagnosed with nasal lobular capillary haemangioma who were treated at King Abdulaziz University Hospital, Riyadh from 1986 to 1995.

Results: The study group consisted of 12 patients (four males and eight females ranging in age from 17 to 65 years: mean 30.1 years). Clinically, most patients presented with epistaxis and a rapidly growing unilateral haemorrhagic mass. Most lesions were located on the septal mucosa. The clinical impression was misleading in some cases. The histological diagnosis was based on the lobular arrangement of capillaries. One instance of recurrence was recorded.

Conclusion: This uncommon lesion should be considered in the differential diagnosis of a rapidly growing haemorrhagic lesion within the nasal fossa. Clinical and histological diagnostic pitfalls occur frequently.

  Antrochoanal polyps: Surgical treatment. Top

Nabil M Ardah, M.D., J.B., Arafat Ayoub, M.D., PRCS. Otolaryngology Department, King Hussein Medical Center, Amman, Jordan.

Objective: To indicate and clarify a simple surgical procedure which can be applied either under local or general anaesthesia, for excision of antrochoanal polyps (ACP).

Materials and Methods: Antral puncture and evacuation of the cystic fluid via aspiration from the affected maxillary sinus, followed by using avulsion nasal snare to remove a unilateral polyp either through the nose or the oral cavity, were performed on 15 patients, nine (60%) males and six, (40%) females.

Results: Complete excision of (ACP) with no recurrences (2 years follow up) was achieved in all patients.

Conclusion: Antral puncture and aspiration of the cystic fluid followed by avulsion of the polyp, is a simple, safe and effective procedure to be performed for the treatment of (ACP).

  Laser tonsillectomy versus conventional technique. Recommendations to modify the cost benifit ratio. Top

Mohamed Magdy Zakaria, Mohamed Kamal Mobashir,Osama laid, Sherif Adly, Wafik Abdel Naeim Amine, Jeddah, Saudi Arabia.

The aim of this study was to evaluate both the conventional and laser tonsillectomy techniques. Four hundred scheduled patients for elective tonsillectomy were divided into two equal groups. Group I underwent conventional tonsillectomy, while Group II were subjected to laser tonsillectomy. The mean ± SD of age was 26 ± 2.1 years and 27- ± 1.9 years respectively. Intra-operative bleeding, procedure’s duration, postoperative pain and postoperative complications were investigated in both groups. It was found that intra-operative minimal bleeding was 1% in Group I while it was 84% in Group 11. The means duration of the procedures in group I and group 11 were 35 ± 3.1 minutes 21 ± 6.2 minutes respectively with statistical significant difference between both groups (p<0.05). Postoperative mean ± SD pain scores after two hours were 4.61 ± 2 in group I and 1.9 ± 1.3 in group 1!. While the mean ± SD postoperative pain scores at time of deglutition were 5.9 ± 1.2 and 2.6 ± 2 respectively. ‘The pain scores showed statistically significant difference at the two readings. Postoperative complications were less in the laser group, with marked difference in the late complications. Thermal studies revealed that the effect of laser was mainly localised to the site of laser beam. A modification in laser tonsillectomy technique was applied making the dissection through the anatomical capsule with better results. It was found that laser tonsillectomy is more convenient than conventional technique. Some recommendations were suggested to modify the cost benefit ratio regarding the endotracheal tube and a day - case consideration.

  Comparison of electrodissection and dissec- tion/snarc tonsillectomy in childrn. Top

Daifallah Raggad. M.D., Asem Al Omari, M.D., Mohammed Raggad, M.D., Muafaq Qhawi, M.D., KhansaAbu Gonmy, M.D., Amman, Jordan.

Objective:Comparison of a new surgical tonsillectomy technique, electrodissection, using bipolar diathermy with the traditional dissection/snare technique.

Methods: A randomised prospective study on one hundred patients who underwent tonsillectomy between 1st January - 31st October 1997, at Queen Alia Military Hospital (QAMH) was carried out. The enrolled patients were alternatively randomised to either bipolar electrodissection (Group ]) or dissection/snare technique (Group 11).

Results: The operative time was shorter in group I compared to group II, 1 1 min. vs. 21.5 min (p<0.0001), and the intraoperative blood loss was 5cc vs. 36 cc respectively (p<O.OOOl). The time to the first intake of solid food, but not liquids, was significantly shorter in group I compared to group 11, 9.5 vs 16.5 hours (p<O.OOOl).

Conclusion: Dipolar electrodissection is an effective and safe surgical technique compared to the traditional methods and is highly recommended in the paediatric age group.

  Tracheostomy: Al-Noor experience. Top

Abdulrashid Bhat, Shamim Ahmed. Al-Noor Specialist Hospital,Makkah, Saudi Arabia.

Two hundred tracheotomies were performed in Al- Noor Specialist Hospital, Makkah Al-Mukaramah from 1414H to 1416H (1994-1996).Road traffic accident with head injury and polytrauma was the most common indication both in adults and children. Males were affected more than twice as females (males 138: females 62) and the age ranged from 11 days to 90 years. Tracheostomy is quite a safe procedure but needs proper technique and postoperative management. Emergency tracheostomy sould be prevented by timely assessment and management of airway obstruction. Every surgeon should have technical knowledge of this procedure and every medical practitioner should know its management.

  Voice rehablitation post total laryngectomy Top

Dr. Tariq Abdullah Ashour, M.D. (FACHARTZ), ENT Center,King Fahad Hospital, Jeddah, Saudi Arabia.

Voice restoration after total laryngectomy is quite essential for every patient.[/TAG:2]

Two patients with glottic, supra glottic T3 No Mo squamous cell carcinoma were managed in the ENT Center, King Fahd Hospital, Jeddah five months ago.

The technique was to build a neoglottis by using pharyngeal mucosa and pectoralis major muscle to make a tunnel like fistula connecting the first tracheal ring to the hypopharynx without using anv prosthesis.

Results were excellent and both patients could talk clearly 3 weeks postoperatively.

  Treatment modality and prognosis as a function of topography and clinical staging in laryngeal carcinoma. Top

Prof. MJalisi, Karachi, Pakistan

Treatment modality and prognosis in laryngeal cancer depends on topography and clinical staging.

While conservative surgery is indicated in early supraglottic and glottic eases, total removal of larynx is the choice in subglottic and late suprglottic and glottic tumours. Total laryngectomy is also indicated after failure of conservative operations and D.X.R. We use deep X-ray therapy as a post-operative supplement in advanced cases where we remove larynx as well as some adjoining infiltrated areas such as pharynx, tongue base, etc. D.X.R. is also indicated for pallitiation. As regards prognosis, it is best in early clinical stage I tumours, specially in glottic area. Advanced cases where one has to remove extensively do not fare so well. Same is true of cases who require neck dissection.

  The use oflaser in the management of carcinoma of the larynx. Top

Zakaria El Rate Soliman,MD, Cairo, Egypt.

We present 78 cases with glottic (52 cases) and supraglottic (26 cases) carcinoma treated over the period from 1989 to 1997 using C02 laser microlaryngeal surgery aiming at preservation of the function without compromising total tumor removal.Their age ranged from 38 to 82 years. Seventy patients were males and 8 were females. Laser resection of the primary was used in glottic stage Ts (1 8 cases), T1 (23 cases) and T2 (6 cases), Five T2 glottic cases had postoperative radiotherapy. Twelve T2 supraglottic cases were primarily treated with laser. Postoperative radiotherapy was used in supraglottic T2 (6 cases) and T3 and T3 (5 cas-es). Three cases with radiation failure T3 lesions. The average 3 year - survival rate was 100% in Ts, 90% in T2 supraglottic cases survival was 84% compared to 65% in T3. The study showed that early detection and diagnosis of the lesion determines the survival. It is emphasised that surgical strategy should be determined not only by the preoperative findings but should also be guided by the intra-operative frozen as well as the paraffin permanent sections. Postoperative radiotherapy is reserved for cases with possible breach of the laryngeal perichondrium and or neck disease.

  Our experience of reconstructive laryngectomy. Top

A.Lazrak, Professor of ENT, Hospital Des Specialites,Rabat, Morocco.

Since 1990, we have done 92 partial and reconstructive laryngectomies especially for tumors classified T1 or T2 of epigiottis, vestibular folds or vocal cord. For partial laryngectomy, the most important interventions are, cordectomy, frontolat- eral laryngectomy and supraglottic laryngectomy. For the other part, crico-hyoidoepiglottopexy and intervention of Tucker are essential. Except 2 deaths, which are in relation to acute respiratory and digestive diseases, the results - in oncological terns - are excellent in 90% of cases with a good control in average of 6 years.

The functional results were satisfactory globally in both of laryngeal functions, swallowing and breathing. The quality of voice was dependent on the type of intervention. Voice quality was divided into 3 classes according to the appreciation of the patient and the surgeon.

Class 1 - bad to average (in 16% of cases), was the main result of crico-hyoidoepiglottopexy and laryngectomy type Pearson.

Class 2- acceptable (20% of cases) was clear with frontolateral calssic cordectomy

Class 3- very good, intensive and clear in all circumstances (64% of patients) was obtained with supraglottic laryngectomy and Tucker procedure. Less than 5% of our patients need, after surgery, telecobalt irradiation of the neck since the histological status of nodes was considered N+. This situation is frequent with tumours of epiglottis and aryepiglottic fold.

  Evaluation of laryngopharyngeal manifestations of gatroesophageal reflux disease. Top

Nabil El Morshedy, M.D., Nabil Gad El-Hak, M,D., Ahmed Elasfour, M.D., Otorhinolaryngology and Gastroenterology Department, s, Faculty of Medicine, Mansoura University,Matisoura, Egypt.

The exact relationship between gastroesophageal reflux disease (GERD) and ORL complaints had not been clearly defined. Thirty-one patients with recurrent severe reflux symptoms were studied for oesophageal motility, endoscopy, radiology as well as 24-hour pH oesophageal monitoring. All patients were subjected to full history taking and fiberoptic laryngoscopy.Twenty-three patients (74.2%) had persistent laryngopharyngeal symptoms mainly dysphonia. Erythema was a constant sign in all complaining patients and there were 8 cases with contact granuloma and 6 cases had cordal nodules.

The occurrence of laryngopharyngeal manifestations (LPHM) in our GERD patients was not related neither to the severity of endoscopic esophagitis to the lower oesophageal sphincter pressure (LESP) and oesophageal body peristaltic abnormalities. On the other hand, the LPHM were more related to hiatal hemia (88.9%) and abnormally relaxed upper oesophageal monitoring was a valuable tool in detecting pathologic acid reflux in 76.9% of the patients sphincter. The 24-hour pH oesophageal and its results were proportionate to the severity of LPHM.

  Prolapse of aryepiglottic folds and stridor in children. Top

Abdel Wahab M. Abdel Wahab, M.D., ENT Department, Mansoura Faculty of Medicine, Mansoura, Egypt.

To study the significance of laryngeal inlet in stridor in children, videotelelaryngoscopy and videomicrolaryngoscopy were used to analyse three groups of subjects. The first group (11 children) was diagnosed as laiyngomalacia, had stable stridor and showed medially posed aryepiglottic folds that prolapsed inwards with inspiration causing stridor. The epiglottis was curled-in and showed backward - paradoxical -movement with inspiration in 10 out of 11 cases. All cases were self controlled after 2 years old.The second group (6 patients) had severe stridor for which urgent tracheostomy was done. Microlaryngoscopic examination revealed marked prolapse of the aryepiglottic folds that obstructed the larynx completely and their excision, without epiglottic interference, resulted in immediate improvement. The epiglottis was curled-in, in 5 out of 6 cases.The third non- stridulous control group (200 subjects) was examined routinely and showed curled-in epigiottis in 19 cases only. We concluded that the constant finding in laryngomalacia is the medially posed aryepiglottic folds. Laryngeal inlet prolapse is limited to the aryepiglottic folds that may be redundant enough to obstruct the larynx completely and their excision is sufficient to treat stridor. Omega-shaped epiglottis (curled-in) has no significance. The laryngeal inlet prolapse is a new terminology in this article and is suggested to be more precise than laryngomalacia in describing the anatomical abnormality that causes the inspiratory stridor.

  Malignant tumours of the parotid gland. (presentation of 123 eases). Top

El Amine El Alami.MN, Ouddi, Jazouli N, Boulaich M, Benchekroun M, Kzadri. Rabat, Morocco.

This study consists of 123 patients with malignant tumours of parotid seen between 1985-1996, in order to determine the clinical, histological and therapeutic particularities of these neoplasms.

The histological analysis was the only method able to confirm their malignant character.

The aggressive histopathological aspects of some neoplasms types or a delayed diagnosis have incited us to choose, in those cases, radical surgery.

In our study, the association of surgery and radiotherapy gives better results than protocols using only one of these therapeutic methods.

  The role of speech language pathologist in different setting(Hospital, School and Rehabilitation center). Top

Mona Abdul Aziz Saleh, Speech Language Specialist, Jeddah, Saudi Arabia

Definitions of communication disorders and their subdivisions:

  1. Speech disorder
  2. Language disorder
  3. Hearing disorder

1) Speech disorder is an impairment of the articulation of speech sounds, fluency and/or voice. There is a wide range of normal in the development of speech among children. Although most children follow a consistently similar developmental sequence in their speech and language, some develop faster than others and different children develop different aspects of their communicative skills at different rates.

*Possible signs of conditions that may result in speech disorder with or without hearing loss.

2) Language disorder is impaired comprehension and / or use of spoken, written and/or other symbol system. When observing language, we are concerned with the forms of connected speech phrases, sentences, and combinations of these into larger units in some cases . To point out the importance of the two aspects of language (receptive & expressive) and to be charted individually because they are two different process both of which develop in an orderly manner with language comprehension always preceding expression.

*Possible signs of receptive language problems and the signs of expressive language problem.

3) Hearing disorder is the result of impaired auditory sensitivity of the physiological auditory system. To point out the importance of hearing to the child’s developing speech & language and the need for early detection of hearing loss, or suspected loss, and intervention.

*A list of possible signs of hearing loss.

  Effects of epidural anaesthesia on transient otoacoustic emissions. Top

Osama Ahmed, El Ghraeeb Zayed, M.D., Mohammed MagdyZakatia, M.D., Khairy MohamiiiedAbut Nasr M.D., Salah Eldin Mahmoud Soliman, M.D ENT Department, Cairo, Egypt.

Epidural anaesthesia may cause some auditory symptoms.the aim of this pilot the effect of epidural anaesthesia on the cochar function by evaluatmg the transient evoked o oa coustic emission (TEOAE). Forty patients were randomly divided into two equal groups. The first group received normal saline and the second group received 1.5% xylocaine. TEOAE was done for both ears of all patients in the two groups, before, immediately and 20 minutes after epidural injection. The patients were asked for any auditory syrmptoms. During epidural injection, two patients complained of fullness in the ear in the saline group and one patient had transient vertigo in the xyto- cairie group. The Mean ± SD amplitude response of TEOAE increased in most cases, when recorded immediately after epidliral injection for most frequency levels with only a statistical significance (p <0.05), at 1.0 kHz frequency. At this frequency level, it increased from 3.40 ±2.70 dB to 7.71 ±1.92 dB in saline group and from 4.10 ±].93dB to 7.12 ±1.91 dB in xylocaine group. In both groups, the mean amplitude response of TEOAE (at 20 min after epidural injection) started to decrease in most cases, at most ranges of frequency as compared to those recorded immediately after epidural injection. This could be explained by the gradual decrease of the epidural pressure, after the initial rise following the epidural fluid injection. The most acceptable mechanism for -TEOAE changes during epidural anaesthesia is pressure changes in the inner ear (cochlear part), resulting from the intradural pressure changes secondary to the effect of epidural pressure changes. These changes of the inner ear might explain the mechanism of some auditory symptoms that occur in some patients, during epidural anaesthesia.

  Comparison of hearing threshold levels using TDH-39 and TDH-49 earphones Top

Hussein Al-Qasem, Shawkat Al-Tamimi, M.D., JB,KhaledA/-Qdah, M.D., JB, NawafAbu Jamous, M.D., JB, Ali Al-Jundi, M.D., JB, Mohammad Twalbeh. Amman, Jordan.

Normal threshold of hearing at 6 kHz in young adults has been reported to be out of line with values obtained at other frequencies by 5-10 dB. A current study suggests that this deviation at 6 kHz has more recently disappeared. One reason may be a change of earphone characteristics with successive telephonic design from TDH-39 through TDH-39P to TDH-49. Coupler measurements have shown that the two types of TDH-39 earphones exhibit significant difference at 6 kHz and that the TDH -49 earphnes also differ significantly from both TDH-39 types. The nature of the coupler measurements in the region of 6 kHzmight explain the discrepant results in human subjects. The object of this work, reported here, was to test that hypothesis by carrying out subjective measurements of hearing threshold using different types of earphones on the same subjects.

The human results are consistent with previous coupler results showing differences in the order of 6 dB around 6 kHz using international standard methods for calibration- that is, using the 1EC 303 coupler and associated RETSPHs for the TDFI-39, and the [EC 318 artificial ear for the TDH-39P, TDH-49 and TDH-49P. The source of the discrepancy appears to be an interaction specifically between the TDH-39 earphone types and the IEC 303 coupler.

It is concluded that a move away from the use of two different couplers and two different sets of associated RETSPLs for different earphone types would be beneficial. The results advocate the adoption of the IEC 318 artificial ear as the sole calibration device for all supra-aural audiometric earphones, and phasing out the TDH-39 and TDH- 39? types in favour of earphones with a smoother frequency response, such as the TDH-49 or TDH- 49P.

  Auditory brainstem responses in relation to coronary heart disease. Top

Ayman E. El-Sharabasy, PhD, Mamdouh R. El- Nahas, MD, Osama El-Baz, MD, Audiology unit, Internal Medicine Department,Clinical Pathology Department, Mansoura University, Mansoura, Egypt.

It has been found that atherogenic factors have greater effect on microvascular circulation within the cochlea rather than within the heart. Therefore, we studied coronaiy heart disease (CHD) in relation to auditory brainstem evoked responses (ABRS) using low and high repetition stimulus rates. Twenty seven neurologically free subjects suffering from CHD (study group) and twenty healthy age and sex matched subjects with normal hearing (control group) were selected for this Study.

ABRs were recorded for all subjects (control and study groups) in response to a single level (70 dBnHL) rarefaction clicks with two different repetition rates (low=l 1.1/sec. and high=51.1/sec.) and 100-3000 Hz filter sitting. ABR records were analyzed for morphology, waves 1, III and V absolute latencies, and I-III, I1I-V and I-V interpeak latencies. Moreover, both the study and the control groups were submitted to basic audiological evaluation including pure tone audiometry, speech audiometry and immitance measurements. Absolute and interpeak latencies obtained from CHD subjects were found to be significantly pronged as compared to those obtained from the control group only in response to stimuli with high repetition rates. No significant differences were found in the basic audiological testing results between the study and the control groups. In conclusion, ABR recording may provide valuable information regarding prediction of CHD. Risky patients should be thoroughly investigated and primary preventive measures could be used.

  A survey for noise induced hearing loss on 1780 subjects in the Jordanian army. Top

Mohammad Al-Omari, JB, Mohammad AI-Masri, PhD.,Shawkat Al-Tamimi, JB. Khaled Qudah, JB, Mohammed Ali Hiari.Audiology Department, The Applied Science University, Jordan.

Hearing survey for noise induced hearing loss was carried out in the Jordanian Army using 1780 conscripts working in different occupations. Noise exposure level was measured using the B&K noise measurement laboratory. The result show that more than 50% of the subjects suffer from noise induced hearing loss. Majority of them has unilateral or asymmetrical sensorineural hearing loss. More importantly, the results illustrate that magnitude of noise induced hearing loss among Jordanians is significantly higher than the predicted values by the ISO 1999. These suggested that the ISO 1999 is not applicable to military personnels. It is clear from this study that there is strong need for hearing conservation program in the Jordanian Army. Further studies are also needed to examine the reasons for asymmetrical and unilateral noise induced hearing loss.

  An unusaul prevealence of complications of chronic suppurative otitis media in young adults. Top

Shamboul K.M., FRCSI

Complications of chronic suppurative otitis media as seen in 117 patients are presented. Fifty per cent of the patients had cholesteatoma, and 28 per cent revealed complications. Two thirds of these complications especially the serious intracranial ones, were encountered in young females. This female predominance was attributed to late presentation because of social reasons, or to undue susceptibility to the destructive effect of cholesteatoma. Radical and modified radical operations were recommended to render the ears safe, as most of the patients came from distant rural areas and were judged to have poor compliance to report for regular checks.

  Glomus tumours-when to operate. Top

Mohammad Al-Zuwayed,Consultant, Dim,on of ENT Surgery,King Fahad National Guard Hospital. Riyadh, Saudi Arabia.

Two cases Of glomus tumors with different presentations are presented with one operated upon and the other not. Although glomus tumours are usually slowly growing tumors, delay in diagnosis and referral may contribute to the tumour being non- operable.This paper reviews glomus tumours and shows the importance of early diagnosis and discusses their management.

Video tape of 5 minutes will show the operated case.

  The impact of early otorrhoea on tympanosclerosis folhvoing grommct insertion. Top

Mohammad S. AttaUah, M.D. Riyadh, Saudi Arabia.

Purpose: To analyse 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.

Materials and Methods: 305 children with otitis media with effusion underwent general anaesthesia for myringotomy and grommet insertion. Preoperative assessment included a careful history of hearing loss, otoscopic evidence of OME as indicated by B tympanogram, and whenever possible pure tone audiograms were obtained.

Results: 67 patients (31.16%) suffered from otorrhoea, 34 (15,81%) 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 otorrlioea, 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.

  Preoperative external carotid artery embolization in vascular tumours of the head and neck. Top

Talal Amer, M.D., Ahmed Y. Kandeel MD Ali Tawftk, M.D. Egypt.

Purpose:The value of preoperative embolization in vascular tumours of the head and neck has always been a matter of controversy. The aim of this study was to assess the role of preoperative embolization in the treatment of these tumours

Materials & Methods: This study included 33 patients (29) males and 4 females) with surgically proved vascular tumours of the head and neck (nasopharyngeal angiofibroma = 25, cavernous haemangioma of the maxillary sinus = 2Elomus jugular = 2, glomus tympanism = 2, arterloven^u malformation of the maxilla = 1, and vascular nasal polyp = 1)- Embolization was done by the trans- femoral route in ail patients. It was done using getfoam in 7 patient and contour in the remaining 26 patients.

Results: Embolization was effective in reducing intraoperative blood loss at primary surgery from an average of 2100 cc to less than 400 cc. All patients experienced minor complications in the form of facial pain and transient fever. Only one patient developed major complication in the form of dimension of vision after embolization due to either spasm or partial occlusion of the ipsilateral ophthalmic artery, which had an aberrant origin in this case from the internal maxillary arteiy.

Conclusion: Preoperative embolization of vascular tumours of the head and neck is effective in reducing intraoperative blood loss and contribute to improved surgical results. We recommend it as a routine preoperative procedure.

  The role of 18-FDG positron emission tomography (PET Scan) in post radiotherapy nasopharyngeal cancer. Top

Muhammad Saleem, PRCS, Khalid Taibah, FRCS(C), Abdullah Al-Amro, PRCS (C),Siema Bakheet, M.D. Sven Larson, M.D., John Powe, FRCP(C). Department of Otolaryngology - Head and Neck Surgery, Radiation Oncology, Radiology , King Faisal Specialist Hospital and Research Centei, Riyadh, Saudi Arabia.

Oboective: Postradiotherapy nasopharyngeal fibrosis represents a diagnostic dilemma in the follow up of patients with nasopharyngeal carcinoma. Neither clinical exam nor current anatomical radiological studies can differentiate between benign post therapy fibrosis and recurrence. The objective of the study was to assess the role of PET scan in identification of viable tumour.

Methods: Forty nine patients with nasophatyngeal carcinoma underwent 18-FDG PET scan following radiotherapy which was undertaken 3-21 months prior to PET scan. In this retrospective study we compared the PET scan findings with clinical and CT findings.

Results: Fifteen patients out of 49 had negative findings on clinical examination, CTand PET scan. Remaining 34 patients had evidence of recurrence either clinically or on CT scan or both. Of these, 9 patients had a positive PET scan at primary site. Seven were proven histologically while in the remaining two no biopsy was done due to presence of concurrent distant metastasis. Of the remaining 25 patients who had a negative PET scan but positive clinical examination and CT scan findings, 10 patients had a negative biopsy while the remaining patients have been followed for an average of twelve months with no evidence of recurrence.

Conclusion: 18-FDG PET scan is a useful tool in differentiating between post radiotherapy fibrosis and recurrent disease.

  CT-MRI >n chronic suppurative otitis media. A correlation of surgical and imaging findings. Top

Prof. Mohamed M.El-Shaer,Head of ORL Department, Faculty of Medicine, Mansoura, Egypt.

This study comprises 63 patients with active chronic suppurative otitis media. They were subjected to clinical and otoscopic examination and investigated audiologically by PTA, bacteriologically and CT scanning for all patients and MRI for 35 cases. All cases were explored surgically using canal wall up and down mastoidectomies. The operative findings were compared with the CTand MRI findings. CT scanning was highly sensitive for demonstration of soft tissue masses, visualization of hidden areas as sinus tympani, facial recess, accurate detection of bone erosion associated with chronic suppurative otitis media as ossicular necrosis and detection of intracranial complication. MRI showed high sensitivity in detection of soft tissue abnormalities as well as intracranial complications.

  Predictive value of mastoid pneumotization in the outcome of medical treatment of secretory otitis media. Top

Mohamed M. El-Okda, Mansoura Faculty of Medicine, Mansoura, Egypt.

This study was conducted to assess the role played by the size of mastoid cellular system in the final outcome of medical treatment of recently developed secretary otitis media (SOM). Sixty nine children (133 ears) were classified according to the size of the mastoid cellular system into three groups; group I with large mastoids (15 ears), group 2 with middle -sized mastoids (98 ears), and group 3 with small mastoids (20 ears). Audiological investigations were performed for the three groups prior to the start of therapy and repeated at 3 weeks and 3 months. At 3 weeks, resolution occurred in 87%, 39% and 0% in group 1, 2 and 3 respectively. The difference was statistically signif- <cant. After 3 months, group 1 showed 100% reso- ?ution, group 2 showed 76% resolution and group 3 showed 10% resolution. There was a statistically significant difference between the three groups as regards the need for ventilation tube insertion (0%, 24% and 90% respectively). Also, hearing level reflected by air-bone gap deteriorated in group 1along the treatment period. One can conclude that arrest 0f pneumotization constitutes an unfavourable prognostic factor for the final outcome of medical treatment of recently developed SOM. Hence, early intervention to re-establish middle ear ventilation is recommended to abort the chronic pathologic alteration of middle ear mucosa.

  Antro-fronto-ethmoidal tumours. Surgical approaches and end results of treatment. Top

Prof. Waheed Yousry Gareer,Professor Of Surgical Oncology NCI Cairo University, Head of Surgery Department, Al-Salama Hospital, Jeddah, Saudi Arabia.

This study included 40 patients with advanced (T3- T4) para-nasal sinuses tumours extending to the base of skull. Fifteen males and twenty five females with age ranging from 4 to 72 years (average 43). Twenty two patients had recurrent disease after primary surgical or radiotherapy treatment while the remaining had an advanced disease on presentation. In 30 cases radical craniofacial surgery had been performed. Surgical techniques are detailed together with different reconstructive methods. Follow-up for 10 years revealed the following: 3 years-survival: 70% and 5 years survival - 66 % for all, patients while T3 patients had 80% - 5 years survival against 53% for T4 patients. This study proved the possibility of achieving a good cure rate in advanced paranasal sinuses tumours invading the base of skull even if cure could not be obtained, good palliation can be achieved for years.

  Malignant external otitis Top

Moutawakel Hajjaj, Al Madina Al Munawarah, Saudi Arabia.

Severe progressive infection starting in the external meatus and rapidly involving the temporal bone and adjacent soft tissues. (Chandler, 1968). Mainly a disease of elderly diabetics.High morbidity and mortality rate. Case reports and discussion.

  Craniofacial approach for nasopharyngeal angiofibroma with intracranial extension. Top

Ali Tawfik, Mohammad Safwat, Mohammed El- Okda, MahmoudYosef. Ahmed Elasfour, Faculty of Medice,Mansoura University, Mansoura, Egypt.

Juvenile nasopharyngeal angiofibroma (JNA) is a benign, slowly growing, very vascular, locally invasive tumour. JNA has no true capsule and spread beneath the mucosa. It occurs almost exclusively in adolescent males. The site of origin of JNA still remains unclear. Although JNA is a benign tumour but occasionally extends mtracra- nially. Such tumours with intracranial extension were considered unresectable. Advances in imaging and skull base surgery with cooperation between otolaryngologists and neurosurgeons have led to the development of techniques that allow complete excision of such tumours. In this article, we present the craniofacial approach for surgical excision of JMA with intracranial extension.

  Five year review of ncck masses. Top

Mostafa Tajaldeen, ENT Surgery Consultant, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.

There is a controversy of who should operate on neck masses; EMT or General Surgery. Sixty per cent of post nasal space cancer presented with neck masses. An enlarged lymph node should never be excised as a first step in the diagnosis. If, as a last resort, a cervical node must be removed for diagnosis, the operation must be performed by a surgeon who is able to treat the primary if it is found later somewhere in the head and neck. In our hospital, all neck masses are operated on by ENT surgeons with the exception of the thyroid. Our schemes for diagnosis of neck masses are.

  • Proper head and neck examination with the help of fibreoptic scope and FNA on the first visit
  • If FNA reveals cancer cells and no primary was found upon examination, a blind panendoscopy biopsy would be taken.

We reviewed 101 cases over a five-year period (1993-1998) and found that all neck masses were properly diagnosed and managed using this scheme. Of the 101 cases reviewed we found that 53 cases were of inflammatory origin and 48 cases were neoplastic in nature. The details of our diagnostic scheme and the nature of neck masses will be presented and discussed.

  Microbiological evaluation and the management of chronic suppurative otitis media among Saudi children Top

Asiri Saad A and banjar Adel A.Indian J Otol 1999;33-36

Chronic Suppurative Otitis Media is a common disease and the medical management of chronic suppurative otitis media without cholesteatoma should be applied and tried before any surgical intervention. Therefore, information on the microbiology and the sensitivity to antimicrobial agents is important. Between January 1993 and December 1995 a total of 190 children with chronic suppurative otitis media (16 patients with cholesteatoma, and 174 patients without cholesteatoma) entered into bacteriological and clinical study to identify the common organisms involved among Saudi children

The study also evaluates the efficacy of the medical management (aural toilet and topical and systemic antibiotics) in controlling otorrhea in non- cholesteatoma patients. The study showed monobacterial infections in 74.2% cases and negative cultures in 19.5% cases. Pseudomonas aeruginosa was isolated in 21% cases was more and commonly seen organism in patients with cholesteatoma while staphylococcus oureus (27.4%) and haemophilus influenzae (10%), the main organisms in non-cholesteatomatous patients. Resistances to commonly used antibiotic (Amoxicillin) was observed. Medical management especially with dry mopping and topical antibiotics was effective in controlling the otorrhea and minimizing the referrals for surgery.

  Tympanoplasty audit in training programme in Saudi Arabia Top

Telmesani Lail M. Indian J Otol 1999; 5(1) : 37-40

Asurgical audit, of the outcome of one stage tympanoplasty, performed over a five year period and followed up for a minimum of 6 months is reported. Twelve variables were analysed in each patient. Factors found to influence the outcome of surgery were in order of significance: the surgeon, operative factors, ossiculoplasty, presence of bilateral disease and graft material used. The first 3 factors are attributable to the experience of the surgeon. The last factor has resulted in abandoning the use of homograft lyodura for tympanic membrane grafting. A prospective study is being conducted to study the possibility of overcoming the influence of bilateral ear disease on the outcome of tymponoplasty.

  External auditory canal cholesteatoma in children. An unusal etiological Pathogenesis. Top

Al-Anazy Fatma H. Ibrahim Mohd, Asiri Saad, Zakzouk Siraj M. Indian J Otol 1999;5(1):41-44

Two cases of External Auditory Canal Cholesteatoma (EACC) are presented. In one, the cause was found as iatrogenic following canalo- plsaty; the second case was seen secondary to (burn) cautery of ear canal done as a folk treatment for Leishmania.

Treatment is primarily surgical. The unusual occurrence of such disease secondary to cautery is amazing and deserves reporting and discussion.


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Antrochoanal pol...
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Comparison of el...
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Malignant tumour...
The role of spee...
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Comparison of he...
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A survey for noi...
An unusaul preve...
Glomus tumours-w...
The impact of ea...
Preoperative ext...
The role of 18-F...
CT-MRI >n ch...
Predictive value...
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Craniofacial app...
Five year review...
Microbiological ...
Tympanoplasty au...
External auditor...

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