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Year : 2004  |  Volume : 6  |  Issue : 2  |  Page : 90-96

Abstracts from the thirteenth national symposium of Saudi ORL - H & N surgery society wednesday & thursday : 19 & 20 Muharram 1425(10 & 11 March 2004)

Date of Web Publication12-Jul-2020

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-8491.289590

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How to cite this article:
. Abstracts from the thirteenth national symposium of Saudi ORL - H & N surgery society wednesday & thursday : 19 & 20 Muharram 1425(10 & 11 March 2004) . Saudi J Otorhinolaryngol Head Neck Surg 2004;6:90-6

How to cite this URL:
. Abstracts from the thirteenth national symposium of Saudi ORL - H & N surgery society wednesday & thursday : 19 & 20 Muharram 1425(10 & 11 March 2004) . Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2004 [cited 2022 Nov 30];6:90-6. Available from: https://www.sjohns.org/text.asp?2004/6/2/90/289590

  The Prevalence of Severe to Profound Sensorineural Hearing Loss (SNHL) in Saudi Children and the need for Cochlear Implants. Top

Dr. Abdulmomm Al-Shaikh, FACHARZT Prof. Siraj M. Zakzouk. FRCS

Objective: This investigation was aimed to determine the current status of sensorineural hearing loss in children from the different provinces of Saudi Arabia and report on those with severe to profound SNHL who are in need of cochlear implant.

Material and Methods: A comprehensive random sample survey of 9540 Saudi children was carried out. The subjects were randomly selected from 4 main provinces of the country. The main objectives were to screen these children for hearing impairment. A survey team included an ENT Specialist, a nurse, a social worker and an audiologist. A questionnaire was completed, clinical examination and audioiogical assessment were performed. Those confirmed and in doubt cases were referred for further audioiogical and clinical assessment, including computerized tomography scan and auditory brain stem response.

Results: The over-all prevalence of hearing impairment was 13% (1241 out of 9540). Those with SNHL was 142 (1.5%) and those with sever to profound (76 n lOOdB loss) was 68 (0.7%). 7 of them suffered from unilateral, while 135 suffered from bilateral sensorineural hearing loss. We have 5490 hearing impaired children who may be in need of cochlear implant.

Conclusion and Recommendation: The prevalence rate of severe to profound sensorineural hearing loss is high in our country compared to developed countries. Cochlear implant is a useful procedure for those with severe and profound sensorineural hearing and speech centers to be available for those who arc in need of them, at least in the big cities in each province.

The total required cochlear implant cost is 128,7709,000 Saudi Riyals, equal to 34,322.400 US dollars.

  Angiofibroma, Endoscopic Transnasal Removal is possible. Top

Dr. Tariq A. Ashour

Objective: The experience of the ENT Centre, in managing very rare cases of angiofibroma arising from middle turbinate and sphenopalataine foramen.

Material and Methods: The presentation contains live video show from intra-operative and post-operative.

Results: The paper discussed also causes, site of origin, relation of the disease with other diseases and syndromes, rules of body hormones like Testosterone.

Conclusion and Recommendation: I will discuss also the pre-operative preparations which include CT, MRI and immobilization.

  Prophylactic Antibiotic Therapy in Tympanoplasty, A Comparative Study of Cefuroxime versus Amoxicillin. Top

Prof. Mohammad S. Aitallah

Objective: To compare the clinical efficacy of two antibiotics-cefuroxime and amoxicillin-in tympanoplasty-

Material and Methods: This study was carried out at the ENT Dept., King Abdulaziz University. Riyadh, Saudi Arabia, One hundred and forty-three patients with chronic suppurative otitis media were enrolled in the study and were assigned to receive 5-day prophylactic treatment with cefuroxime l.5gm intravenously at time of surgery, followed by cefuroxime axelil 250mg twice daily (n = 74) or amoxicillin 500mg three times daily (n = 69).

Results: The results showed that prophylactic antimicrobial therapy with cefuroxime is more effective in preventing early post-operative infection as compared to amoxicillin therapy.

Conclusion and Recommendation: No significant difference in regard to late post-operative inlcction, or late atrophy of the graft was observed between the two drugs.

  Prevalence of Cholesteatome among Saudi Adult population. Top

Siraj M. Zakzouk

introduction: Saudi Arabia is a country with a population of around 17 million people, 5% of them are children under 15 years of age. The health services started with limited resources and developed rapidly during the last few years. Ear disease i.e. Chronic supportive otitis media (CSOM) was very common and hearing loss. An epidemiological survey to study hearing impairment in children was completed in the year 2000.

Objective: To screen adults accompanying the children for hearing loss and to study the prevalence of CSOM and cholesteatoma and to compare that with children findings.

Material and Methods: 1536 adult subjects were examined chemically by ENT doctor Amodfied questionnaires of WHO PD/HI were used. The sample were the companion of the surveyed children who were randomly selected from the 4 main provinces of the country. They represent different socio-economic and demographic group.

Results: 1536 adult age ranged between 16 to 85 years. 56.6% were male and 43.4% were female. 170 (11.1%) subjects were CSOM, 82 of them with discharging ears and 88 with dry perforation. 7 subjects with cholesteatoma, 5 male and 2 female. Their age range from 16 n 36 years, mean age 23 years. The prevalence is 0.46%.

Conclusion and Recommendation: The prevalence rate of CSOM was 11.1% while cholesteatoma was found among 0.46%, male were more affected than female, 5:2 compared to 0.09% in children of the same area. The prevalence of CSOM was high in areas with less health services facilities.

  Neurofibrosarcoma of the Neck Top

Dr. Abdulmonem Al-Shaikh, MD, FACHARZT, ENT Consultant

Dr Mohammed Zahran, MD, FRCS, ENT Consultant

Dr Ashraf A. Jabbar, MD, AB, JB, ENT Specialist

The soft tissue sarcomas are a group of cancers which develop from a number of different supportive tissue in the body, including fibrous tissue, muscic, ligaments, tendons and fat.

Soft tissue sarcomas are rare. Less than 1% of all cancers, with only about 1200 new cases being diagnosed each year in the United Kingdom.

More than 60 different types, or subtypes, of soft tissue sarcoma. Most have names based on the type of normal cells from which the cancer started, but some soft tissue sarcomas does not seem to be any equivalent normal cell and so special names have been given to these tumours. About half of all neurofibrosarcomas develop in people, who have an inherited condition called neurofibromatosis with mutation of NFI Locus and disruption of neurofibromia production or Von Recklinghausenis disease. The condition leads to coffee colored patches on the skin (caflE-au-lait spots) and benign no-cancerous tumours of the nerve sheath cells in the nerves just below the skin, forming lumps under the skin (called dermal neurofibromas). In about one in ten people with Von Recklinghausenis disease at some time in their life, one of the benign dermal neurofibromas will become cancerous and change to a neurofibrosarcoma. The usual sign of this change is that the swelling begins to grow quite rapidly.

Like most other soft tissue sarcomas, the treatment of neurofibrosarcoma is surgery, wherever possible, to remove the growth. If the tumour is of a low grade appearance under the microscope, then this may be all the treatment that is required. If the tumour is of a higher grade than surgery. Occasionally a neurofibrosarcoma is too large or stuck down to make an operation possible, but the surgeon feels that it might become operable if it could be reduced in size. In this situation, the doctors may recommend a course of radiotherapy or chemotherapy before the operation in the hope that it may shrink the sarcoma and make it more operable. 1 f the neurofibrosarcoma is in the part of the body where surgery is impossible or dangerous, then radiotherapy is used and often combined with chemotherapy.

  Al-Mosadia ENT Centre new trial in treating aspergillus malignant otitis externa: a ease report and literature review Top

Dr. Mohid M. Zahran, MD. FRCSI (ORL)

Aspergillus malignant otitis externa (AMOE) is a rare form of necrotizing skull base osteomy litis that presents difficulties in treatment. There is a few reported cases worldwide with a noticeable high mortality and morbidity. We report a case of AOEM in a 70 years old insulin dependant diabetic patient with renal impairment with a literature review. We present a local trial of a new regimen including oral Itraconazole and Amphoteracine B car irrigation and drops in 0.05% mg/ml concentration for three months. He was successfully treated with this regimen without any remarkable side effects. No such regimen have been reported in literature and this is considered as a first report of using Amphotcracine B ear drops and irrigation in AMOE.

  Surgery or Radiosurgery for Acoustic Shwannoma. Top

Ahmed Ammar, MD, Ph.D

The personal accumulating experience with Acoustic shwannoma patients, showed the outcome of acoustic shwannoma patients is guarded by several factors such as:

  1. Early diagnosis.
  2. Size of the tumor.
  3. Involvement of other cranial nerves.
  4. Brainstem signs.

Small tumors of 2.5 diameters are treated best by radiosurgery either gamma knife or linneraccelerator. Microsurgical technique is proved also to have excelient results for such patients; case with regained hearing was seen after excision of such tumor.

Moderate and large size tumors with prolonged history of deafness and facial palsy did not have such favorable results. We prefer the subocciptal retromastoid approach for microsurgical removing of the tumors. Between 38 personal surgical cases, no mortality with seen with total removal was achieved in 35 cases. Permanent hearing loss was found in 34 cases, 4 patients regained some to good hearings. Temporary facial nerve palsy which was recovered in 3 n 6 months was seen in 13 patients. One patient only with very large tumor developed long track signs and remained having right side hemi paresis after surgery. The experience of Dr Steiner with over 500 patients of such tumor who are treated with gamma knife (Karloniska Hospital and Virginia University) will be presented as well.

  Congenital Choanal Atresia n Prevalence in Hail Region. Top

Dr Elgasim E. Elnagar, FRCS

Objective: To analyse the study of cases diagnosed or referred for management (KKH Hail) since June 1997 to June 2003.

Design and Setting: Retrospective study at KKH Hail. Patients and Method: Chart of all patients diagnosed as congenital choanal atresia (CA) between June 1997 n June 2003 were reviewed. Age, sex, type of atresia, tribe, presence or absence of other congenital anomalies, method of surgical repair and post-op complications were looked into.

Result: Total number of patients - 21.

10 females and 7 males (81%) were having bilateral choanal atresia (BCA).

4 eases (19%) were of unilateral choanal atresia (UCA).

Age ranged from one hour to 24 hours for BCA and 4 cases of UCA were aging 2 yrs, 4 yrs, 17 yrs and 22 yrs, averaging 11 yrs.

Membranous atresia ñ 8 eases (38%)

Atretic plate ñ 13 cases (62%)

3 patients (14.2%) had other congenital anomalies which were seen more commonly with BCA and in females.

  1. Reversed nostrils / one eye, cardiac and genitalia anomalies. Died 4 days post delivery.
  2. Facial asymmetry, patent ductus arteriosis. Died 6 months post delivery.
  3. Aortic stenosis:

One case of UCA was with Down Syndrome. 19 cases were corrected with nasal approach. One case failed and one awaiting surgery.

Conclusion: With our limited resources, we managed the majority of patients with nasal approach and stent- ing, followed by intermittent dilatation under L.A. and G.A. Availability of LASER may reduce the stunting duration and recurrence.

  Sudden Sensorineural Hearing Loss n Analysis of outcome and confounding Factors. Top

Dr. Muhammad Said / Dr. Elgasim E. Elnagar

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

Design: Retrospective study.

Patients and Method: Nine patients diagnosed with SSNHL were studied in 2003. there were 7 males (77.7%) and 2 females (22.3%), aged II n 55 years (mean age 30). Out of 9 patients, 5 (55.5%) had unilateral and 4 (44.5%) bilateral sensorineural hearing loss. All the 9 patients received treatment. One patient was referred for cochlear implant. All the patients were treated as outpatients. Multidrug regimen was the mainstay of treatment. Frequent pure tone audiograms were performed. The outcome of the treatment is the mean hearing recovery compared to the audiogram at presentation at three adjacent frequencies. The results were divided into 4 groups. (1) Complete recovery’- (2) Marked improvement. (3) Fair improvement and (4) No change.

Result: Out of nine patients treated, 4 (44.5%) had complete recovery, 1 (11,1%) marked improvement, I (11.1%) marked improvement, 1 (11.1%) fair improvement and 3 patients (33.3%) had no recovery’ one month of treatment.

Conclusion: Treatment of SSNHL is directed towards all possible etiologies. Multidrug therapy is the mainstay of treatment. The most important prognosis factors are time of presentation and age.

  Glue Ear Operative Audit - 2003. Top

Dr. Elgasim E. Elnagar

Objective: Are wc complying with the recommended watchful period?

  • Is the patient waiting for 1st visit reliable,
  • How reliable is tympanometry.

Design: Retrospective study.

Setting: KKH - Hail, KSA.

Patient and Methods: 111 patients were reviewed. There were 62 (55.8%) males and 49 (44.2%) females, age incidence 2 n 14 years. All had surgery after full clinical and audiological assessment. Type B and C2 were only subjected to surgery after a watchful period of three months at least.

Result: The highest incidence of glue ear was age 5 ft 6 years. 200 (90%) ears had effusion. 22 (10%) had dry tab. All had ventilation insertion. Those who had dry tab. had v entilation insertion because of dry otalgia or retraction pocket.

The average hearing improvement was 18dB. Tympanometry hit rate was reliable in the study for type B tympanogram.

Conclusion: Watchful period had been observed ft majority of patients were seen within three months. Clinical judgement is the keystone in decision making in ventilation insertion.

  Choanal Atresia : A retrospective study of 31 cases. Top

Laila Telmesani .FR.C.S.. ED-KFUF.ORI. Khalid Abo Shama, M.Sc, ORL. M.B.B.ch KFUF.

Objective: To perform an analytic study of all cases diagnosed as congenital Choanal Atresia in the last 16 years.

Design and Setting: A retrospective study at King Fahad Hospital of the University at A1 Khobar, Saudi Arabia

Patients and Methods: The medical records of all patients diagnosed as a congenital choanal atresia (CA) and treated between 1987 and 2002, were reviewed. Information collected included sex, age, type and site of atresia, pressure or absence of other congenital anomalies, method of surgical repair and post-operative complications.

Results: We had a total number of 31 patients, 19 female and 12 male patients (1.6:1). Age range is from two days newborn to 20 years. Unilateral choanal atresia (UCA) was seen in 18 patients (58%). The bilateral choanal atresia (BCA) was founded in 13 patients (42%). Atretic plate was mixed type in 23 cases (74.3%). Family history was positive in 9.7% of cases. 16 out of 31 patients (51.6%) had other congenital anomalies which were seen more common with the BCA (69.2%) than in UCA cases (33.3%).

Twenty five cases were corrected using the Transnasal approach. Transpalatal approach was used in 8 cases and Transnasal endoscopic repair was used in last 3 cases.

Conclusion and Recommendation: The present report encompasses one of the largest series of children treated for CA in Saudi Arabia. Fifty percent of children had other concurrent congenital anomalies, warranting comprehensive evaluations. The Transnasal approach was effective in correcting CA. Surgical outcome by using the transnasal endoscopy is promising to reduce the stenting duration as well as the follow up dilatation surgery.

  Open T.B. presenting as Hoarseness : An unusual presentation. Top

Dr. Abdullah Bajaber, MD

Dr. Ashraf Abduljabbar, MD

Dr Rajab Al-Zahrani. MD. BCh.

Open Tuberculosis (T.B.) presenting as productive cough, dypsnea or loss of weight is a common presentation.

But open pulmonary T.B. presenting as hoarseness without any significant pulmonary symptom is unusual. A case is described of a patient with the change of voice secondary to open T.B. without any pulmonary symptoms.

X-rays, Computer Tomography (CT) and physical findings are discussed with the need to recognise the different and unusual presentation of this disease.

  Acute Retropharyngeal Abscess. Top

Dr Naina Mohamed Na\-asi

Acute retropharyngeal abscess is most common in infancy and young children, though not uncommon in adults. It occurs in three situations:

First and most commonly, it occurs in children due to suppurating retropharyngeal lymph nodes consequent to upper respiratory tract infection.

The other two causes are a perforating foreign body or following tuberculosis of the cervical spines.

We present three cases belonging to each category of aetiology. The timely intervention and successful management of these cases are discussed.

  The Silent Otitis Media secondary to external otitis with Foreign Body - A potential cause of brain abscess. Top

Dr Lalifi Asrar

Dr Nureni Oyetunji

Right temporal lobe absccss due to external otitis secondary to foreign body (toothpick) is a rare but serious complication. The case of 52 year old male who developed severe otitis externa with silent otitis media with its complication following scratching the ear due to tooth pick is presented. Pathophysiology and management options are discussed. To the best of our knowledge this case is the first of its kind in the ENT literature.

  Sore Throat Following ENT Surgery; Effect of using small tracheal tube. Top

Ali S At-Qcthtani, KSUF (ENT) and Farouk M Messahel, FRCA

Sore throat following surgery is common and is due to multitude of factors. It causes postoperative pain and considerable discomfort to patients. The highest incidence of sore throat tends to occur in patients who have undergone tracheal intubation. Between 14.4% to 50% of intubated patients complain of sore throat and hoarseness in the immediate postoperative period, 3% of them are still hoarse after a week. This contributes to higher incidence of postoperative morbidity and patient dissatisfaction of the service. A prospective study was conducted to demonstrate the incidence of hoarseness and sore throat following the use of small tracheal tubes (size 7-7.5 in males and 6-6.5 in females). 1618 patients enrolled in the study, their ages ranged between 16-62 years (average: 23.3 yrs) with male to female ratio of 2:1.1. All patients have been visited within 24 hrs of surgery. Postoperative hoarseness occurred in 189 patients (11.7%), while 1429 (88.3%) (P= 0.0001, Odd ratio: 7) did not show signs of postoperative hoarseness. We conclude that the use of small tube in intubating the trachea, together with other measures as lubricating the tube with water soluble jelly, careful airway instrumentation. intubation only when patient is fully relaxed, careful suctioning technique, and extubation when the tracheal tube cuff is fully deflated have dramatic cffects on minimizing the incidence of postoperative hoarseness and sore throat. Accordingly, patient satisfaction has been reported to be very high.

  New Stent for Prevention of Stenosis - After Choanal Atresia repair. Top

Ali S Af-Qahlani, KSUF (ENT)

Several surgical approaches for the repair of congenital choanal atresia have been described since its first correction by Emmert in 1854. To date, there is no standard stent to be used and all stents have to be fashioned at the time of surgery from soft and hard materials. The most common is the preformed plain endotracheal tube. Several problems associated with the current methods of preventing recurrence of stenosis. This explains the high incidence of restenosis (may reach 80%). Stents made of PVC soften at body temperature and may collapse under pressure from without. Stents made of rubber or PVC may induce localised tissue reaction. Repeated anesthetics may unnecessarily subjcct the newborn to the hazards of anesthesia and tracheal intubation.

The newly designed stent is composed of two parallel tubes made of reinforced silicone rubber. The front part of each tube contains a hole on each side, so that the four holes are on the same,line. A bridge consists of a hollow tube made of PVC, with a piecc of sponge attached to it, is fixed by a thread passing through the holes and the inside of the PVC tube. The sponge protects the columella from undue pressure. The two tubes are connected posteriorly by strip made of same material metal reinforcement. Two solid-tipped PVC catheters (one for each tube) arc used to position the stent in the nostrils through the mouth.

The new stent has several advantages over the available stents presently in use. These advantages are:

  1. The ready made stent dramatically shortens the operative time.
  2. The imbedded metal wire within the wail of the two parallel tubes keeps their lumen patent and makes suction of secretions easier.
  3. The metal wire expands at body temperature; rather than collapsing in front of the attempts of the choanae to close again, the reinforced tube stands against pressure created by the process of restenosis.
  4. The spiral metal wire adds flexibility to the stent easing its way during insertion.
  5. The presence the attached piece of sponge to the bridge prevents pressure necrosis of the columella.

It is produced from material previously tested and licensed for use in humans (Z79-IT). This means that its presence in direct contact with mucous membranes for long periods does not initiate inflammatory toxic tissue reaction, which eventually results in scar tissue formation and possible restenosis.

  Nasopharyngeal Carcinoma in the Saudi Arabian female population. Top

K. Malakerl, AID., Ph.D.,

V. Kundapurl MD,

A. W. Andejani 2.3, FRCPC

Prior to investigating nasopharyngeal carcinoma (NPC) in Saudi females, the status of gender variance in cancer incidence globally was studied by reviewing and reanalyzing available data from WHO, 1RCA, Globocan etc.

Aim: The aim of this presentation is to carry out a comparative study of the incidence of NPC in the Saudi Arabian female and male populations, in some representative countries of the rest of the world; and some countries where it has a high endemic incidence.

Methods: The incidence of NPC from various sources including: the WHO, the UICC, the [ARC, Globocan, the USA, Canada, the UK, Franco, China, Taiwan, Singapore, Kuwait, Brazil and some other countries, has been compared with data in the Saudi Arabian Cancer registry for both sexes. Apart from the actual age specific rates (ASR), the distribution of nasopharyngeal cancers by age and sex was also studied.

Results: For NPC:

  • The ASI for both males and females in Saudi Arabia has a steep identical rise from the age of 5 or 6 years until 15-20 years.
  • From 20 years the ASR of males continues to rise to adulthood with a noticeable peak at 55-60 years, but in the case of females, the ASR actually plateaus, or shows slight broad elevation without a noticeable peak.
  • Its pattern of early childhood incidence in Saudi Arabia is different from that of Western Europe and North America and other countries where it is endemic.
  • The pattern of incidence in adolescence and adults in both sexes in other countries and Saudi Arabian males show a peak at 55-60 years, but Saudi females do not demonstrate such a peak.

  Conclusion: Top

  • The females in every country arc considered to have a lower ASR NPC compared with their male counterparts. However, the male and female age distribution patterns are similar and peak between 55- 60 years. Interestingly, Saudi Arabian females do not ha\ c any significant peak.
  • The comparatively early onset of childhood NPC in Saudi Arabia indicates the possibility of a major genetic contribution to the etiology.
  • There is a significantly lower ASI of NPC in Saudi females and this lack of a peak after adolescence suggests that the social practice of their wearing a
  • Bourga (facial mask) from the onset of puberty may be associated with induction of NPC.
  • This finding indicates NPC is, to some extent, a preventable condition. A case for priority prevention programme put forward. Details of analysis of this conclusion, will be presented.

  Acute Hinnn Dye Poisoning. Top

H.Yagi, A.M. El Hindi, S.I. Khalil

Objective: To report a series of Patients with Acute Hinna Dye (paraphenylenediamine) Poisoning.

Method: A prospective study in which a series of 18 patients with acute Hind Dye (Hair Dye) poisoning were studied. The was analysed. The clinical features were noted. A method for the biological diagnosis was established. The management is discussed.

Results: The main features were a swollen face with a protruding wooden hard tongue and a chocolate brown colour of the urine. The dye is detected in the urine. The dye proved to be paraphenylenediamine. Tracheostomy was life saving in the serious cases.

Conclusion: Hinna Dye is paraphenylenediamine. It challenges life by causing asphyxial death by a wooden hard upper respiratory tract oedema. The biological diagnosis is by detection of the dye in the urine by thin layer chromatography. Early tracheostomy in the serious cases is life saving.

  Post Adenotonsillectomy complication Top

Prof Tariq Jamal,

Chairman. ORL Department, K.A.U.H. Jeddah Dr Eidha Al-Juaid.

ENT Resident, Al-Hada Hospital, Taif

Objective: To review the complication of Adenotosillectomy in two hospitals (National Guard Hospital and King Abdulaziz University Hospital).

Study Design: Retrospective Study.

Methods: 858 Adenotonsillectomy over 1-year duration were reviewed to determine the complication and compare our complication with international complication.

Results: Bleeding 1.5%, Post-Operative Pain 5.0%. Recurrence 1%.

Conclusion: Our complication within or below the international range.

  Histopathology of sinonasal tumors. Top

Wasim F. Raslan, MD, Ph.D.

Tumors of the nose and the paranasal sinuses are not only rare and heterogenous, but also present a major challenge to the pathologist and the treating physician. Sinonasal malignancies arc among the first tumors, which were directly linked to occupational exposure to wood dust, and a wide variety of industrial chemical carcinogcns. The great majority of sinonasal tumors are of epithelial origin, arising from the surface epithelium or from the submucosal minor salivary glands. While half of the nasal tumors are benign, most sinus neoplasms are malignant. The most common benign nasal epithelial tumor is papilloma and the most common malignant sinus tumor is squamous cell carcinoma. Maxillary sinus is most often affected by carcinoma followed in descending order by the ethmoids. the frontal and the sphenoid sinuses. The lecture will give and overview of the sinonasal malignancies from the clinical and the pathological point of view and will focus on the clinical pathological correlation.

  Universal New Born Hearing Screening Program in King Fahd Military Mcdical Complex. Top

Dr. Tawfik Shahaka (Physiart Audiologist, KFMMC) Dr. Sand Al-Saif (Co)isultant d Head of ENT, KFMMC

Hearing loss is one of the most common congenital anomalies, occurring in approximately three neonates per 1,000 births. The prevalence of hearing loss in neonatal intensive care units is approximately 20 to 50 per 1000 births. The prevalence of hearing loss is greater than that of most other diseases and syndromes for instance Phenylketonuria, which is also screened at birth. Early identification and intervention can prevent severe psychosocial, educational, and linguistic repercussions.

Our aim in KFMMC was to establish the universal newborn hearing screening (UNHS) program and to find the prevalence of hearing loss in neonates delivered at KFMMC Hospital. The UNHS program consisted of four stages. The first stage consisted of screening Transient Evoked Otoacoustic Emissions (TEOAEs), where as the second stage consisted of diagnostic TEOAEs. The third stage consisted of screening ABR and the fourth diagnostic ABR. A total of four hundred twenty eight (428) neonates were screened for hearing loss. The total babies passed by screening TEOAEs were 69.6% and increased to be 89% by diagnostic TEOAEs then to 91.6% by screening ABR and lastly to 95.7% by diagnostic ABR. Three percent (3%) of the study group was excluded, because they were lost for follow up. The prevalence of hearing loss in KFMMC Hospital was found to be 1.3%. This hearing loss prevalence is higher than the international record, which is 0.3%.

  Sleep Apnoea Diagnosis and Management. Top

Brig. Gen. Dr. Adularia A! Said, MD, PhD. FCCP. FRCP (Lon).

Sleep Apnoea is conventionally defined as the cessation of airflow for 10 seconds or more because of either obstruction of the upper airways or failure to drive a stimulus to initiate breathing (central Apnoea). Obstructive sleep apnoea is most common and usually due to the occlusion of the airways in the level of the tongue and laiynx. Which is related firstly to the loss of the tone in the dilator muscle of the upper airway and secondly due to the narrowing of the upper airways for many intrinsic and extemsic reasons (enlarged tonsils, anatomical changes and fat deposition, etc.)

The main symptoms are loud snoring, arousal from sleep and excessive daytime sleepiness, which may lead to high fatality risks.

The pathophysiology of OSA is related to transient frequent oxygen disturbance leading in chronic eases to increase PAP and systemic blood pressure and many homodynamic changes contributing probably to the risk of strokes and Mi in comorbid patients (diabetic, hyper- cholesterolamic and cardiac patients). The principles of the management of OSA concentrate on occluded upper airways including removing of he enlarged tonsils as an exceptional way of first aid otherwise surgical treatments arc rarely effective. Weight loss, mandibular advancement device (oral appliances) may help to increase the size of the pharyngeal airway by pulling the base of the tongue anteriorly and they are used usually in mild OSA.

The gold standard nowadays for treatment of OSA is (CPAP) system, which is a non-invasive airway split which opens the airways immediately and allows the patient to sleep and it appears that CPAP reverses the physiological and behavioral disturbances and gradually improves the higher mental function.


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  3. McEvoy RD, Thornton AT. Treatment of obstructive sleep apnea syndrome with nasal continuous positiv e airway pressure, Sleep 1984; 7(4) 313-25.
  4. Fielcher FC, Schaaf JW, Miller J, Fletcher JG. Longterm Cardiopulmonary Sequelae in patient with sleep apnoea and chronic lung disorder. Am Rev Respire Disease 1987;I35;525-533.
  5. Weitzcnblum E, Kreiger J, Appvill M, Vallee E, Ehrhavt M, Ratamahavo J, Oswald M, Kurtz D.
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  7. Guillenminault C, pertinent, Eds. Obstructive Sleep Apnoea Syndrome: Clinical Research and Treatment, New York, Rowan Press, 1990.

  Skull base imaging Top

“Between the Head & the Neck”

Saltam S. Lingawi, MD, FRCPC, ABR

The skull base is more or less a iNo Mannis Landi being lost between the Neurosurgeons and the Head and Neck surgeons. This presentations aim to present an approach to skuli base pathology related to the Head and Neck specialty.

The basic skull base anatomy will be reviewed and classical cases of skull base pathology will be presented. An approach to radiological differential diagnosis of skull base lesions based on anatomic location will be discussed.

The roles of different imaging modalities including CT and MRI are discussed. Presented cases include:

  • Normal Anatomy
  • Vestibular schwannoma
  • Glomus Jugulare
  • Malignant Otitis Externa
  • Nasopharyngeal Carcinoma


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  In this article
The Prevalence o...
Angiofibroma, En...
Prophylactic Ant...
Prevalence of Ch...
Al-Mosadia ENT C...
Surgery or Radio...
Congenital Choan...
Sudden Sensorine...
Glue Ear Operati...
Choanal Atresia ...
Open T.B. presen...
Acute Retrophary...
The Silent Otiti...
Sore Throat Foll...
New Stent for Pr...
Nasopharyngeal C...
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