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Table of Contents
Year : 2016  |  Volume : 18  |  Issue : 2  |  Page : 68-100

Abstracts from the 6th emirates rhinology & otology congress Dubai, 2016

Date of Web Publication6-Jan-2020

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-8491.275267

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How to cite this article:
. Abstracts from the 6th emirates rhinology & otology congress Dubai, 2016. Saudi J Otorhinolaryngol Head Neck Surg 2016;18:68-100

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. Abstracts from the 6th emirates rhinology & otology congress Dubai, 2016. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2016 [cited 2022 Nov 30];18:68-100. Available from: https://www.sjohns.org/text.asp?2016/18/2/68/275267

  Music perception in cochlear implant listeners Top

Dr. Yang-Sun Cho

While cochlear implantation (CI) is remarkably effective in speech perception, they are less adequate for listening to the music. Music appreciation and perception is quite important on a daily life of normallisteners and CI recipients as well. However, music perception is challenging for CI listeners and the majority of CI users reported music to sound strange, noisy, unnatural, and mechanical. As music is connected with the everyday environment and emotional communication, perceptibility of music for CI recipients is related to quality of life and social integration

We conducted a prospective study to assess long-term post-implant changes in music perception in CI listeners using the Korean version of the Clinical Assessment of Music Perception (K-CAMP) test and questionnaire for music listening. Twenty-seven patients, including 5 men and 22 women participated in this prospective study. Their music perception ability was evaluated with the K-CAMP test which consists of pitch discrimination, melody and timbre identification. Also, a questionnaire was completed to quantify listening habits, and level of musical experiences.

As a result, median postoperative durations of first and second test were 12.8 and 30.9 months. Participants were divided into two groups, good or poor performance in the first test with reference to the average of each performance. Among the demographic factors, good performance group was younger than poor performance group at the time of the test (p = 0.038 for first test, p = 0.030 for second test), and the ability of pitch discrimination decreased with aging at 262 Hz for first test (p = 0.042, ρ = 0.765) and at 391 Hz for second test (p = 0.013, ρ = 0.473). Pitch discrimination of the second test in good performance group showed no difference with the first test (p = 0.468), but in poor performance group, the pitch discrimination score significantly improved (p = 0.005). Similarly, timbre test results significantly improved in poor performance group (p = 0.029). In melody identification test, two groups showed no change at the second test. Scores for listening habit and level of musical experience decreased after CI surgery (p = 0.06 and p< 0.001, respectively), and did not recover during follow-up period.

  Early Pediatric Cochlear implantation: 20 Years’ Experience in Bordeaux Top

Dr. Jean Bebear

Aim: The objective of this work was to observe and analyze the evolution of communication in very young cochlear implant users by using a newly developed scale to monitor communication before and after implantation.

Material and methods: The evolutionin communication mode for a group of cochlear-implanted children was monitored through a specific scale focussed on three main domains: perception/oral comprehension,oral production and gesture production.

Results: The scale will be introduced first, with particular attention paid to the different skills and the interaction between them. The children’s scores will then be presented.

Conclusions: In very young cochlear implant users, the oral language can develop rapidly and depends both on pre-verbal communication (oral and/or gestures) built before implantation and on early oral comprehension abilities developed after implantation. Those results support the idea of immediate cochlear implantation after deafness diagnosis with adapted monitoring of communication.

  Imaging for Cochlear Implant: The Surgeon’s view Top

Prof. Fatthi Abdel Baki

Imaging plays a crucial role before; during and after Cochlear implantation. Before surgery it can detect conditions where cochlear implant is contra-indicated. Some imaging findings may point to possible associated lesions constituting syndromic hearing loss. A preoperative temporal bone CT scan, done routinely in many centers, serves as a roadmap to the anatomical layout of the ear to be implanted. During surgery there are several key steps for a cochlear implant including: cortical mastoidectomy; opening the facial recess and round window membrane identification and opening. These steps may be influenced by anatomical variations which can pose unanticipated technical challenges with respect to obtaining good surgical access. Identification of round window is of paramount importance since random drilling on the convexity of the promontory should be avoidedbecause this can result in intracochlear damage. The presentation will focus on different parameters which are useful in predicting potential difficulties encountered during the key steps involved in cochlear implant surgery. This will help the surgeon to anticipate technical challenges that may be encountered during the operation. Post operatively Imaging will assure physical integrity of cochlear implant.

  The Submandibular Gland Transfer (SGT) Procedure Top

Dr. Hani Z. Marzouki

Introduction: One of the most common complications of head and neck cancer treatment is radiation-induced xerostomia, which significantly affect patients’ quality of life. This occurs because the submandibular gland sits in the radiation field and is damaged by radiation therapy leaving patients unable to produce sufficient basal saliva to properly lubricate the oral cavity. Treatment of xerostomia is varied but one of the strategies developed was the preserve of one submandibular gland by surgically transferring it to the submental space and shielding it form the full dose of radiation. The main disadvantage of the classical SGT procedure is that it is contraindicated in oral cavity cancer because the submental space cannot be effectively or safely shielded.

Objective: To introduce a modification of sub- mandibular gland transfer (SGT) procedure for patients with oral cavity cancers. This paper will focus on whether the technique is surgically viable; Our group will continue asses quality of life and saliva production data to determine whether the technique is clinically useful in preventing radiation induced xerostomia for future publications.

Methods: This is a prospective feasibility study involving 10 patients with a new diagnosis of advanced head and neck cancer undergoing major head and neck cancer resection with postoperative adjuvant radiation therapy. The new modified salivary gland transfer procedure was performed on all the eligible patients after obtaining informed consent and the glands total dose received with radiation therapy was assessed.

Results: All the modified SGT procedures were successful with no post-operative complications. The radiation oncology team has been able to successfully localize the transferred submandibular glands and shield them from the radiation beam post operatively.

Conclusions: This is a novel surgical strategy that may prevent radiation-induced xerostomia in the oral cavity cancer patients.

  Functional Neck Dissection: the great unknown Top

Dr. Javier Gavilán

Current classifications of neck dissection include a large number of different operations which are often difficult to manage. However, from a practical standpoint two basic approaches functional and radicalenclose all types of neck dissection. Selective procedures are modifications of the two basic approaches, designed to fit the operation to the patient on a more individualized basis.

FND was originally described by Osvaldo Suárez in the early 1960s and uses the facial compartmentalization of the neck to remove the lymphatic tissue while preserving important non-lymphatic structures. This lecture deals with the history, basic concepts and surgical technique of functional neck dissection.

  Decision Making in Head and Neck Oncology Top

Dr. Nigel P. Beasley

There is extensive guidance published on the management of patients with Head and Neck Cancer but we know that there are significant variations in the treatment offered to patients and patient outcomes that cannot be explained by the site or stage of cancer. Some of this is down to the training and beliefs of the teams treating the patient, but much is unexplained. I will discuss the importance, when making decisions about treatment in patients with Head and Neck Cancer, of the tumour type and stage, the treatment options available, and the patient as a host. I will consider the interaction between all three, and importance of this in obtaining the best outcome for patients. I will discuss Shared Decision Making and the value of publishing hospital and surgeon level outcome data in the public domain. At the end of the presentation delegates should have a clear understanding of the key factors to consider when making decisions about treatment in patient with Head and Neck Cancer.

“Thyroid FNAB diagnosis and the need” for Molecular Testing

Prof. Mohammed Satti

Thyroid fine needle aspiration remains an important and cost effective screening test for the management of thyroid nodules, provided that technical adequacy, high quality interpretation and imaging correlation are considered. This presentation will address the utility of the “Betheseda System of reporting thyroid nodules” and the recommended management for each diagnostic category with a brief display of our data at KAMC- WR. Furthermore, a brief discussion on the need and value of Molecular testing on samples from selected diagnostic categories will be made.

  Evaluation and management of parathyroid carcinoma Top

Dr. M Shahed Quraishi

Parathyroid carcinoma is a rare malignancy of the parathyroid glands and may be associated with genetic disease. Parathyroid cancer typically runs an indolent, albeit tenacious, course because the tumor has a rather low malignant potential. Patients usually present late with severe manifestation of hyperparathyroidism with severe bone disease and renal stones. It locally invades the thyroid gland, muscles, recurrent laryngeal nerve, trachea or oesophagus. A high index of suspicion in a patient with an abnormally high serum PTH >25 and calcium may help in preoperative diagnosis, but it usually cannot be confirmed prior to operation.

Surgery is the mainstay of therapy, en bloc removal is the procedure of choice. The morbidity and mortality primarily results from the metabolic consequences of the disease and not directly from malignant growth. Five-year survival is about 85%.

  IOPM Protocols in para thyroidectomy surgery, technical steps, Important tools Top

Dr. Raiab Al Zahrani

Introduction: Since 1st successful parathyroidectomy by Felix Mandl in 1925 using time consuming bilateral neck exploration and with advantages of new technique of parathormon monitoring during operation we can cut the time with lower complication rate in general with the same good outcome.

Subject: Intra operative parathormon monitoring is introduced earlier with different school algorithm which will be discussed in the presentation.

Recommendation: To use the best methods in Saudi Arabia centers during parathyroid surgery with also minimal Invasive Surgery getting more acceptance with lower operating time and cosmetic advantages. Further, IOPM in the way to be stander care of managements in the tertiary care center worldwide which we need at least to introduce it and popularize it

I conclude by: PTH measurement is very useful, avoiding unnecessary bilateral exploration and the related risk of complications with a slight increase of the costs.

  Day Case minimally invasive parathyriodectomy (MIP) for solitary adenoma. Outcome of surgery Top

Dr. M. Shahed Quraishi

Primary hyperparathyroidism is the commonest cause of hypocalcaemia in the out-patient setting. Eighty percent of which is caused by solitary parathyroid adenoma. Surgical approaches to parathyroidectomy include bilateral neck exploration (BNE), unilateral neck exploration (UNE) and minimally invasive parathyroidectomy (MIP). Of which, BNE is considered as the gold standard approach. However, with the advent of improved preoperative localisation imaging technique allowing better patient selection, MIP is establishing itself as the more acceptable, more economical and highly effective definitive treatment for solitary adenoma causing hyperparathyroidism. High quality preoperative dual modality imaging (ultrasound scan and 99mTc sestamibi) is the key for successful open MIP.

Open MIP confers significant advantage over the gold standard BNE for solitary parathyroid adenoma and can be performed safely as a day case. It leads to efficient use of hospital resources and is beneficial for patient experience. High quality preoperative imaging for accurate localisation is the key for successful MIP.

  Role of sinus imaging in preventing surgical complications Top

Dr. Abdulaziz Alqahtani

Cross-sectional imaging (CT & MRI) has clearly been one of the backbones that have made possible the remarkable evolution of endoscopic sinus surgery. Constant effort towards integration ofclinical and radiological information is of paramount importance in performing safe surgery.

Three anatomic areas, corresponding to the narrowest tracts of drainage pathways, are crucial for endoscopic surgery planning: the ostiomeatal complex, the frontal recess, and the sphenoethmoid recess. Each one has specific radiological findings that recall careful interpretation in order to avoid complications. Additionally, selection of the appropriate surgical approach and extension of resection is emphasized by the correlation of imaging with the clinical findings.

  Recent trends in management of chronic rhino sinusitis Top

Prof. Reda Kamel

Chronic rhinosinusitis [CRS] is a common disorder. Etiology is incompletely understood, suggested Inflammation, rather than infection. There is no standard management of CRS including medical therapy and surgery.

Medical therapy is the key strategy and should be maximal. It includes Systemic corticosteroid, antimicrobials and immune modulating medications as well as topical intranasal saline, topical steroids and topical antibiotics. Surgery is reserved to refractory and recalcitrant cases.

The aim of work of this presentation is to present current advances in management of CRS. This includes emerging systemic strategies including leukotriens antagonists, anti-AgE therapy and anti-IL-5 therapy in addition to local surfactant [baby shampoo]. Also emerging strategies in Endosocpic surgery is demonstrated stressing on drug eluting implants, image-guided surgery, balloon dilation technology (BDT), multi angle endoscopes and robotic surgery.

  Aetiology and pathology of refractory chronic Rhino sinusitis Top

Dr. Mohammed Alfelasi

Refractory chronic sinusitis (RCRS) is defined as persistence of signs and symptoms of chronic rhinosinusitis, despite technically adequate endoscopic sinus surgery. Endoscopic sinus surgery has a reported success rate of up to 90%. However with multiple risk factors this success can drop to 50%.

Identification of patients with risk factors helps to better categorize CRS patient this includes past medical history of asthma, immunodeficiency, family history of CRS and smokers. Furthermore, investigations and laboratory assessment to look for systemic disease e.g. Wegner’s, infectious disease, genetic testing and inflammatory markers help to identify patients with high risk factor. The pathogen plays an important role in the prognosis, which implies different factors, the superantigen production, fungus, biofilm formation and recently microbiome dysbiosis. The microbiome of post-ESS sinus cavities differs according to disease state, with poor evolution characterized by reduction in bacterial diversity. Chronic rhinosinusitis is a multifactorial disease characterized by high rates of recurrence. Personalizing therapy by identification of patients with underlying disease and/or at high risk for recurrence helps to better select the optimal treatment for our patients.

  AFS: Is there a need for prophylactic extensive ESS Top

Prof. Reda Kamel

Allergic fungal rhino-sinusitis is becoming a more common happening amongst cases of sinonasal polyps. They have characteristic endoscopic and radiologic findings. Management includes steroid therapy [systemic and topical], surgical debridement and immunotherapy. It may be unilateral or bilateral with high incidence of persistence and/or recurrence.

Recurrence may occur at the same side/s at primary site/s or on the other side or other sinuses.

The aim of work of this presentation is to demonstrate the incidence of unilateral allergic fungal rhino-sinusitis and different modalities of recurrences in comparison to bilateral cases. This verifies whether prophylactic extensive FESS is justified or not in AFS.

  Trans-orbital endoscopic approach:crossing borders Top

Dr. Shawkat Alaa Shawkat

Great challenges with pathology that involves middle cranial fossa structures are still pushing the surgeons for choosing the best approach (es). With the great evolution of endoscopic techniques, their advantages and application in skull base surgery allowed to overcome the disadvantages of conventional externa approach, playing a major role in skull base pathology management. In spite of this they still have some limitations. In the searching of new pathways we describe a novel technique passing through a direct transorbital endoscopic extradural approach to the middle cranial fossa. This aim was achieved directly by considering the orbit as a corridor, then drilling out the approach reduces collateral damage for noble tissues of the orbit, overcoming the limitations of irans nasal route and disadvantage of transeranial external techniques, with same target territories exposure (middle fossa structures).

Methods: With Cadaveric dissection of five silicon- injected heads .Intraorbital fluid injection. Total of 10-bilateral transorbital approach was performed. Identification of the landmarks, main anatomical structures, feasibility of the approach. Rod lens endoscope (with 0 degree and 45 degree lenses) and endoscopie instruments were used to complete the dissection .

Results: Transorbital approach showed great versatility and provides the surgeon with direct route to wings of sphenoid, the middle cranial fossa and its structures. For safe intraorbital dissection Optic nerve and superior orbital fissure were the landmarks for the deep orbital wall craniotomies. Transorbital avascular plane showed no conflict with major nerves or vessels. Large exposures area from far lateral Middle cranial fossa floor to structures located lateral to optic nerve trajectory was demonstratedwith significant control of neurovascular structures passing thought. Foramen Spinosum, Ovale, Rotundum Superior orbital fissure and paracliniod part of interal carotid artery. Transorbital endoscopic approach provides considerable value in form of extent of the exposure, image magnification, and the fre hand movement of the two surgeons .

Conclusion: Trans orbital endoscopic approach to middle cranial fossa provides a possible direct, feasible access to middle cranial fossa; moreover it simply allows employing advantages of conventional external approach.

  Endoscopic DCR Review of 104 cases Top

Dr. Mohammed Zahran

Blockage of nasolacrimal duct can be inflammatory, traumatic or neoplastic.

Dactrocystorhinostomy (DCR) is a surgical treatment of choice. Review of 104 endoscopic DCR cases done between 2008-2015 will be presented with comparison of different causes and surgical technique.

  Endoscopic grading of neo-choanal patency Top

Dr. Thamer Assaf

Objectives: This is a new technique and grading of the posterior choanal patency to evaluate the patient both pre- and postoperatively in case of choanal atresia or stenosis

Method: Theprospective study technique uses the endoscopes in the out-patient department in King Saud Medical City, between 01 January 2007 and 30 December 2011, for 10 patients with both uni and bilateral choanal atresia.

Results: 8 females and 2 males, 6 with bilateral choanal atresia and 4 with unilateral atresia underwent successful repair of the atresia, as well as endoscopic grading pre and postoperatively.

Conclusion: Applying this new and objective method is important in the clinical assessment of posterior choanae both pre-and postoperatively. This new method can also be easily applied and tracked.

Keywords: Choanal atresia repair, posterior choano-plasty, posteriorchoanal patency, KSMC (King Saud Medical City), KSMC grading.

  Day case rhinology services in a tertiary university hospital: Our current practice Top

Dr. Abdulmoniem Alshwareb, Dr. Heba Al Reefy

Aim: The world has been moving towards day case services in otolaryngology practice generally. Rhinology has taken the lead this with the development of endoscopic sinus surgery and minimally invasive procedures. However, the majority of rhinology procedures are performed as inpatient surgeries until now.

We would like to share our experience with our current practice in performing complex advanced sinus surgeries as well as cosmetic rhinoplasties as day case surgeries. This has only been available in the presence of competent team including our experienced nurses, experienced trainees, as well as competent anaesthetist who adjust anesthetics in the pre, intra, and postoperative stages to suite day case setting.

Method and results: We present our data over the last two years in a complex tertiary centre in advanced and basic rhinological procedures performed as day case surgeries.

Conclusion: Advanced rhinology appears to be safe and effective in day case setting.

  Endoscopic Frontal Sinus Surgery: How to navigate without a navigator Top

Dr. Islam Herzallah

Endoscopic frontal sinus surgery remains one of the challenging areas for otolaryngologists. Proper understanding of the endoscopic anatomy is of vital importance in order to perform both safe and effective endonasal procedure. This is, however, limited by different variations in the frontal sinus anatomy which mandate a three dimensional orientation to the surgical field. Additionally, the location of the frontal sinus usually necessitates the use of specially designed instruments and may require performance of some ancillary proceduresOur talk takes audience into a 3D anatomical journey for better understanding of different cell types in relation to the frontal recess area. From there, additional procedures that maximize access to the frontal sinus outflow tract are addressed. Current controversies and future research areas will be also highlighted.

  Management of complications of sinus surgery Top

Dr. Claire Hopkins

Although the risk of major complications from sinus surgery is low, any surgeon undertaking ESS must be familiar with the management of intracranial, infraorbital and vascular complications. This session will cover these issues, with a particular focus on CSF leaks.

  Congenital nasal pyriform aperture stenosis Top

Dr. Iman Almashharawi

Nasal airway obstruction is a potentially life-threatening condition in the newborn. Neonates are obligatory nasal breathers. The pyriform aperture is the narrowest, most anterior bony portion of the nasal airway, and a decrease in its cross-sectional area will significantly increase nasal airway resistance. Congenital nasal pyriform aperture stenosis (CNPAS) is a rare, unusual form of nasal obstruction. It should be considered in the differential diagnosis of any neonate or infant with signs and symptoms of upper airway compromise. It is important to differentiate this level of obstruction from the more common posterior choanal stenosis or atresia. CNPAS presents with symptoms of nasal airway obstruction, which are often characterized by episodic apnea and cyclical cyanosis, 6 cases referred to our department in the last two years the clinical presentation and the surgical technique well be discussed in detail.

  Optimal Management of a 2-Hour-Old Newborn With Severe Congenital Subglottic Stenosis and Multiple Congenital Heart Diseases Top

Jaber Alshammari

Introduction: Congenital subglottic stenosis (C-SGS) is the third most common congenital anomaly of the larynx. It necessitates tracheotomy in new born if it causes severe airway obstruction. When the negative impact of tracheostomy cannot be tolerated, as in presence of congenital heart disease requiring further surgical intervention, other alternative procedures are required.

This case report is the first of its kind reporting airway expansion in a neonate in the first few hours after birth.

Case Report: A 38-week-fetus male was born with multiple congenital heart anomalies and C-SGS of grade III. Single-stage laryngotracheoplasty (SS-LTP) with anterior thyroid alar cartilage (TAC) grafting was performed. Our team was fully aware of all potential risks during SS-LTP procedure in such debilitated patient.

Discussion: Treatment of C-SGS in premature neonates is tracheostomy to avoid prolonged intubation. In some cases, tracheostomy is not a good option as in presence of congenital heart disease necessitating urgent further surgical interventions. Among all surgical procedures to augment the airway without tracheostomy, SS-LTP with placement of anterior TAC graft was our choice.

Conclusion: This case report demonstrated that SS- LTP with anterior TAC graft can be performed in a newborn with severe C-SGS and congenital heart disease. It can alleviate the need for tracheostomy and avoid unnecessary delay for subsequent cardiac interventions. However, further study is likely needed to make a definitive statement of its safety and efficacy.

  Endoluminal Stenting for Tracheal Stenosis Top

Prof. Badr Eldin Mostafa

Tracheal stenosis is a complex problem. Endoluminal treatment has evolved with the introduction of lasers and balloons. However maintenance of a lumen and stabilization of the trache are continuous problems. This presentation discusses the role of endoluminal stents in the management of tracheal stenosis. A cohort of 100 patients were stented with a follow up ranging between 6 months and 15 years. The indications, technique, follow up and complications are presented.

  Update on laryngomalacia Top

Dr. Fahad Alsaab

Laryngomalacia is a well described cause of newborn stridor. The spectrum of disease presentation, progression, and outcomes is varied. Some infants will have inconsequential stridor where others will develop feeding symptoms or even severe or life-threatening complications of airway obstruction. The disease has some contributing factors, which affect the approach of the management. The purpose of this presentation and review is to update our knowledge of the recent advances in diagnosis, management and to identify factors that influence disease severity and outcomes.

  Management of cystic neck masses in incisionless manner via use of Agent Ok-432 Top

Dr. Hesham Hassan

Penicillin and heat, with subsequent elimination of its toxin producing and proliferation capabilities. It was first used by Ogita in 1986, who found that its injection in a cystic lymphatic mass would result into regression of the cyst. Since then, OK-432 got investigated widely for its potential benefits H&N cysticmasses in children as well in adults. In this paper, we able to present our experience in using this agent on 5 cases of cystic masses of different nature to find out that it is a reliable alternative yet relatively cheap modality for managing primary as well recurrent cystic neck masses in incisionless manner, with nosignificant associated morbidity.

Dr. Ad Snik

Introduction. Bone conduction works and can be used to help patients with conductive hearing loss. However, bone conduction is as much as 50 dB less effective than air conduction. This implies that the demands for the development of effective bone-conduction devices (BCD) are very high, close to technical limits.

A categorisation of today’s BCD was made including conventional devices and implantable devices like the percutaneous devices (Baha) and transcutaneous devices (Sophono, Baha Attract). Furthermore, outcomes of applying such devices in children with aural atresia and chronic draining ears will be discussed.

Results. The categorization of BCDs is based on the maximum output, and this objective evaluation shows clearly that the different types of BCDs are not equivalents. From an audiological point of view, percutaneous BCDs are the most powerful ones. Concerning application of percutaneous Baha in children with aural atresia, post-intervention thresholds are on the average 20-25 dB better than those obtained post surgical atresia repair (see e.g. Nadaraja et al. 2013). Consequently, speech recognition is better with Baha application.

The application of BCDs in chronic draining ears instead of conventional behind-the-ear devices has a significant effect, first of all, on ear discharge and ENT visits. In addition, concerning hearing, results with the percutaneous BCD are better than those obtained with a conventional behind-the-ear device if the air-bone gap exceeds 25 dB.

Conclusion. Studies indicate that percutaneous BCDs are most probably the best option to treat children with conductive hearing loss (component) due to aural atresia or chronic middle ear infections. Transcutaneous devices can also be of help as long as the sensorineural hearing loss component is limited. However, even then, percutaneous devices are preferred from an audiological point of view.

  P1cortical response: A new perspective in CI programming Top

Prof. Iman Sadek

During the last years, the indications for cochlear implantation extended significantly due to positive experience with cochlear implants (CIs). Nowadays, associated disabilities (like mental retardation, autism) do not exclude the child from implantation.

For very young children or children with special needs, the fitting process is complex and challenging. Many children do not possess the hearing experience, the language skills, or the reasonable conceptual development necessary to provide sophisticated feedback. In addition to implementing objective techniques for fitting the speech processor, the observation of the child’s behavior and/or speech production following each fitting session is essential in the fitting process. Unfortunately, it is affected by his age, mentality and the presence of other disabilities.

This research was designed to study the value of Speech P1 CAEP as a reliable and objective tool in CI programing independent of the abilities or degree of cooperation of the implanted children.

The study comprised 40 children implanted at least for one year and from whom a reliable consistent behavioral threshold could be obtained. Twenty five age-matched normal hearing children served as a control group. For all children participating in the study, sound field evaluation using warble tones 500-8000 Hz including the mid octave frequencies and speech reception thresholds to synthetic syllables ‘ba, ga, sa’ were performed. Speech P1 cortical auditory evoked potentials (CAEP) using synthetic speech syllables (ba, ga, sa) at intensity of 80 dB SPL and down to threshold were also recorded. The three syllables represented the low, mid and high frequency spectrum. The tests were conducted for the implanted children while wearing their CIs. The correlation between Speech P1 CAEP and behavioral thresholds was studied. The speech CAEP was correlated with the behavioral thresholds of the three stimuli used with different sensation levels. This study demonstrated the effectiveness of implementing this test in programing children especially difficult to test ones.

  Cognitive development of young children after cochlear implantation Top

Dr. Murad Al Momani

Objective: To evaluate cognitive development in young children after receiving cochlear implant. Methodology: 150 children between the ages of 2 and 6 years old who received unilateral or bilateral cochlear implant underwent a prospective cognitive assessment at baseline, 6, 12, 18 and 24 months post implant. Pattern of cognitive development was compared to age-matched control group (normal hearing children). All children in all groups were assessed by using Leiter International Performance Scale and Sensory Integration and Praxis Tests (SIPT). Initially, the instruments used to assess cognitive development were validated to be used in Arabic speaking population.

Results: Results suggest that early implanted (three years or less) children show a cognitive development pattern similar to that of normal hearing age-matched children. Late implanted children, however, deviate significantly from normal hearing age-matched children in terms of pattern of cognitive development.

  “Screening and therapeutic Regime for Hearing Disorders in Newborns;18 Years New Born Hearing Screening in Würzburg with the BERAphon Top

Prof. Wafaa Deiler

Abstract: The ABR-based universal new born hearing screening program has been established in Wuerzburg since August, 1997. Till 2015, more than 22 thousand new born infants have undergone primary and/or control-screening with the BERAphon. The screening device MB 11 with the BERAphon allows a quick AABR measurement. The test time is as short as needed for an OAE screening, with the advantage of the higher sensitivity and specificity. 546 Infants with hearing loss were identified in our program Two thirds of whom had undergone primary screening in other programs and have been referred to our program for control- screening and evaluation. All infants that have failed the screening were followed up till the final diagnosis and treatment has been established.

The results of the measurements with the different algorithms and an overview of the types and degrees of hearing loss as well as the age of identification and treatment will be presented and discussed.

  The Relationship between Cochlear Implant Electrode Array Placement and Performance Top

Dr. Shaza Saleh

Introduction: Surgical placement of the cochlear implant (CI) electrode array (EA) can affect performance. Deep insertions have been advocated to match the CI stimulated frequency and the normal cochlear tonotopic-organisation (Baskent and Shannon, 2005). However, it was associated with insertion trauma and reduced electrode-differentiation (ED) of the apical-electrodes (Finley and Skinner, 2008).

Unintentional scalar-placement of the EA in scala- vestibuli (SV) versus scala-tympani (ST) reduced speech perception (SP) (Finley and Skinner, 2008). This study evaluates the relationship between SP and the angular-depth of insertion (ADI) of the EA in 16 participants and the relationship between SP and scalar- placement of the EA in 9 participants.

Method: Cone-beam computed tomography images were used to evaluate scalar-placement and plain X-ray images were used to estimate ADI. BKB in quiet and in noise were used to evaluate SP. ED was tested with a pure-tone ED test. The “frequency-shift” was calculated as the difference between the estimated characteristic-frequency of the apical-electrode and the centre-frequency of the filter assigned to that electrode.


There was: 1. significant correlation between (a) ADI and BKB in quiet (Pearson’s r=0.56*, p<0.05) and in noise (Pearson’s r=0.71**, p<0.01) (b) the frequency- shift and BKB in noise only (Pearson’s r = 0.63*, p<0.05).

2. no correlation between (a) ADI and ED of apical- electrodes (b) percentage of electrodes placed in ST and SP (c) scalar-placement and ED for each electrode.

Conclusion: In the absence of insertion trauma, deeper insertion of the EA positively affects CI performance partly due to a smaller frequency-shift while scalar- placement in ST versus SV doesn’t affect performance.

  Fast Psychopysical Tuning Curves Measurement for Diagnosis of Dead Regions of the Cochlea and its Implications on Adult Amplification Top

Dr. Mona Dokla

Cochlear hearing loss is associated with damage to hair cells in the cochlea. Cochlear dead zones are regions where the inner hair cells and/or adjacent neurons are not functional. The presence of a DR has several consequences on the perception of loudness, pitch and speech, even with the provision of proper amplification. The two most commonly used methods to detect DR are: measurement of PTCs and measurement of masked thresholds of a sinusoid in threshold-equalizing noise. Fast PTC test is a fast computer based method that aims to assess the frequency selectivity of the cochlea and detect dead regions. In this work we applied TEN test and f-PTC on subjects with cochlear hearing loss to diagnose dead regions.

Thirty two adult hearing impaired patients were evaluated for the presence of dead regions by TEN and f-PTC test. HA satisfaction was assessed using IOI-HA questionnaire.

DRs were found to be more common with a hearing loss of high frequency configuration. There was a good correlation between the results of the TEN test and f-PTC. Q10 values (as a measure of frequency resolution) showed abnormality despite the absence of DR. Applying the TEN test and the f-PTC before HA fitting would save the hassles of a refitting.

Key words: Q10, fast psychophysical tuning curves, cochlear hearing loss, threshold equalizing noise, cochlear dead regions.

  State of art lecture new era of Ménière disease treatment. Where do we stand in 2016 Top

Dr. Issam Saliba

Ménière’s disease is an idiopathic condition characterized by vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The exact underlying pathophysiological mechanism of this disease remains unknown. Therefore, its treatment remains controversial, empirical and mainly symptomatic against the vertigo attacks. Several medical and surgical therapies are used to control the symptoms of Ménière’s disease.

We have reported in January 2015a novel surgical technique for the treatment of Ménière’s disease: Endolymphatic Duct Blockage (EDB), after 5 years of follow-up. It is an effective surgical non-ablative technique: there is no clinically cochlear damage, and no more vestibular damage. There is a significantly better control of the vertigo attacks when compared to the traditional endolymphatic Sac Decompression (ESD). In fact, a recent Cochrane analysis found no evidence basis to recommend ESD for this indication.

In our study, we found no significant difference between the two groups in the number of vertigo spells per months preoperatively (p = 0.153). Twelve months postoperatively, 94 % of the EDB group had achieved a complete control of vertigo spells against 37.5 % of the ESD group with a statistically significant difference (p= 0.002).

There was a better control of tinnitus and aural fullness with ECB (p = 0.0366 and p = 0.0295 respectively).

There was no statistically significant difference in hearing level preoperatively (p = 0.976) and 12 months postoperatively (p = 0.287) between the two groups. Hearing level was preserved in each group with no significant difference between the preoperative and the postoperative levels (p>0.05). However, 20% of EDB group improves their hearing postoperatively.

Quality of Life (QOL) evaluation of patients treated by EDB for Ménière’s disease with a dedicated questionnaire shows the efficacy of EDB to improve the QOL of Ménière’s disease patients in all the physical, social and mental aspects.

Our results indicate that the occurrence of intraoperative cerebrospinal fluid leak may cause a temporary worsening of hearing in the short-term postoperative period without any difference at 6 months postoperatively.

In addition, our datareveal that aggressive decompression of the ELS by opening the sac does not improveor worsen patients in the early postoperative period. The short-term success of EDB surgery is attributable to effective obstruction of the endolymphatic duct regardless of pressure in the ELS.

The two main concerns remain vestibular migraine and an exact positioning of the duct clips. Clinical presentation of vestibular migraine can be confusing; we have to be sure of the diagnosis before suggesting surgery to patients.

In cases of vertigo attacks recurrence after EDB surgery, a postoperative CT Scan is mandatory in order to determine to position of the titanium clips.

Endolymphatic duct blockage is more efficient than the traditional Endolymphatic sac decompressionin controlling the symptoms of Meniere’s disease. Endolymphatic Duct blockage is safe and a promising novel surgical technique for the treatment of Ménière’s disease.

  Diabetic Ear - more questions than answers Top

Prof. Hassan Wahba

Diabetes Mellitus is a condition that causes many complications all over the body. These complications are mainly related to the duration of the condition as well as whether it si properly controlled or not. Some of these complications occur in the ear and are very difficult to control. The conditions affecting the ear are commonly a necrotizing external otitis NEO or an acute otitis media in a diabetic patient AOM. It is the intention of this presentation to highlight the differences between both conditions, how to investigate and how to manage. It is also the intention to show how modern imaging techniques especially diffuse weighted MRI can make a difference in the assessment of the condition and thus affect decision making in the management.

  Staging and surgery of tympanomastoid cholesteatoma 2016 Top

Prof. Aziz Belal

Two new concepts were introduce to surgery of tympanomastoid cholesteatoma in the 21st century: Staging of cholesteaoma and surgical roadmap based on staging the disease.

The TMC ehnico-radiological staging system of cholesteatoma was introduced by Belal et at in 2005. Accordingly, the FMMS surgical roadmap was introduced.Accordingly, the FMMS surgical roadmap was introduced.

  Paediatric cholesteatoma Top

Dr. Mohamed Bassuni

Objective: To compare the histopathological structure and immunohistochemical characteristics of acquired cholesteatoma in children and adults.

Study design: Prospective clinical study in a tertiary care centers.

Material & methods: This study was conducted on 40 patients presenting with cholesteatomatous middle ear disease. Twenty patients were of a pediatric age group (<18 years) and the rest were adults (>18 years). Patients were admitted to either the ENT Department of Alexandria University Hospital or that of the Students’ Hospital. All cholesteatoma specimens were collected intraoperatively and preserved for histopathological examination and immunohistochemical technique using proliferating cell nuclear antigen (PCNA) and epidermal growth factor (EGF) monoclonal antibodies.

Results: Histopathological examination of the submitted specimens revealed that strips of stratified squamous epithelium with the underlying tissues were fibrous in adults while cellular inflammatory infiltrates were seen in children. The degree of fibrosis was significantly higher in the adult group while the pediatric group had higher inflammatory infiltrate. Immunohistochemical examination revealed significantly higher expression of EGF and PCNA in children compared to adults both in matrix and perimatrix of acquired cholesteatoma

Conclusion: Children with acquired cholesteatoma had higher inflammatory infiltration and significant expression of EGF and PCNA in both matrix and perimatrix with less fibrosis compared to adults explaining the possible pathogenesis of aggressive behaviour of cholesteatoma in children.

  Cholesteatoma Surgical Strategy Top

Dr. Sarah Alshehri

Purpose of the presentation: The goal of the surgery in case of cholesteatoma is to eliminate the disease, to preserve or restore hearing and to preserve and restore normal ear anatomy and patients must understand the goals of surgery, these will be achieved by selecting appropriate approach and planning the proper strategy. We present types of surgical approach of cholesteatoma, indications of each after explaininfg the classifications of cholesteatoma.

  The modern concept of middle ear restoration Top

Dr. Oliver Kaschke

A scheme of five basic types of operations for reconstruction of the middle ear was introduced in ear surgery in the 1952. Today only types I and type III are of practical significance because fenestrations of the semicircular canal are no longer performed and the lever mechanism of the ossicles was overestimated in its importance. Type III summarizes the reconstruction of the ossicular chain (ossiculoplasty), having the aim of restoring the sound-pressure transformation from the tympanic membrane to the footplate in the oval window. The condition of the stapes is particularly important for this procedure. Ossiculoplasty can be realized by the use of different materials, mainly by alloplastic implants (gold, titanium, plastic, ceramic). These implants acting as passive implants should fulfill following requirements: biostability, biocompatibility, no tissue-toxic effects, low weight, individual malleability, stiffness and MRI-safey . Remnants of true ossicles are used whenever possible. Long-term stability of these ossicle remnants is verified.

Examples of reconstruction procedures will be presented. Risks during surgery and long-term results will be discussed.

  Possible indications for computer aided surgery on the lateral skull base Top

Dr. Marco Caversaccio

Navigation surgery of the lateral skull base is a rare intervention in daily practice. It’s often a delicate and difficult minimal invasive intervention in a narrow space. Therefore the orientation in the temporal bone is often difficult. In case of aural atresia or tumors the normal anatomical landmarks are often missing rendering the orientation more difficult. Navigation together with imaging like CT, MR and Angiography support the surgeon in such cases to perform the operation more accurate and in some cases also in shorter time. With the incorporation of augmented reality, image-guided PET- CT , actual cone beam CT images surgery will evolve into “information guided surgery”. Since 18 years we are developing and evaluating enabling navigations surgery tools for simulation, planning, training, education and performance in Bern. This clinically applied technological research was complemented by a series of patients.Worldwide, no clear indications for navigated surgery on the lateral skull base exist.

Acknowledgments: Supported by the Swiss National Science Foundation www.co-me.ch and the Commission of Technology and Innovation in Switzerland. ISTB: Prof. L.P. Nolte www.istb.unibe. ch; and ARTORG: Prof. S. Weber www.artorg.unibe.ch

  Nystagmus based positional vertigo Top

Prof. Khaled Alnoury

Benign paroxysmal positional vertigo is a common disorder that otolaryngology faces in their practice. Understanding the pathophysiology is crucial in managing this disorder. Nystagmus generated in positional testing is the key for proper diagnosis and management.This presentation will give broad overview of the pathophysiological aspects of all types of positional vertigo as well as detailed types of nystagmus generated.

  Self-developed robot for cochlea implantation: reality or future? Top

Dr. Marco Caversaccio

The aims of minimally invasive cochlear implant surgery are manifold. Different surgical methods exist such the suprameatal, transcanal or pericanal approach. These methods aim to avoid wide mastoidectomies while at the same time targeting the round window of the cochlea. In the last 10 years, patient-specific stereotactic templates, skull-mounted or more conventional image-guided robotic approaches have been presented by different groups. Robotic minimally invasive access to the cochlea is gained through a direct cochlear access, which is a small tunnel drilled from the mastoid surface to the cochlea passing through the facial recess. In addition in a minimaly invasive access, the preservation of intracochlear structures during and after electrode array insertion is an important research topic. Since 2008 we are developing in Bern our own robot for hearing implants together with our Biomedical Engineering center (ARTORG). Tests on human cadaver heads show high precision of our self-constructed robot and is approved by the Swiss Ethical Committee for surgery.

Acknowledgments: supported by the Swiss National Science Foundation (Nano Tera www.nano-tera.ch), the Hear-EU project FP7 www.hear-eu.eu and Med- EL. Artorg: www.artorg.unibe.ch Prof. S. Weber.

  Endoscopic pituitary surgery in ACH Top

Dr. Ali Al Zarei

The introduction of the endoscope to trans-sphenoidal pituitary surgery is relatively new, but repre sents a major advancement in the field.

The use of the endoscope to visualize the sella via a direct endonasal approach offers the surgeon dramatically better visualization as well as improved range of motion compared to the operating microscope. Growing evidence confirms that these improvements directly translate into better surgical resections and outcomes. Further, patient comfort and satisfaction are higher with the endonasal method compared with other transsphenoidal approaches, and it is a cost effective technology.

We will highlight on the indication , surgical techniques, complications and our preliminary results of endoscopic pituitary surgery in Aseer central hospital, Abha city.

  Effect of topical ofloxacin on bacterial biofilms in refractory post-sinus surgery rhino-sinusitis Top

Prof. Waleed Ezzat

Bacterial biofilms have been shown to play a major role in many chronic infections, in addition, there is growing evidence that bacterial biofilms may play a role in some forms of refractory CRS that persists despite proper surgery and culture directed antibiotic therapy. The objective is to determine the effect of application of topical ofloxacin on nasal and sinus mucosa in patients with proven existence of bacterial biofilms and persistent chronic sinusitis after FESS. The study design is a prospective controlled study. The study included a total of 12 patients who had refractory CRS in spite of undergoing FESS for that specific reason (study group), and control group (involved 25 patients), for whom FESS was done, with complete improvement postoperatively in 15 of them, and persistence of symptoms in the other ten. Topical ofloxacin eye drops (0.3%) tds for 12 weeks were prescribed for (study group), culture and sensitivity and scanning electron microscopy were done for middle meatal mucosal specimens for all patients and controls, all of them were followed up for a minimum of 9 months (range 9-18 months). Of the study group, 80% showed marked improvement in the structure of the mucosa, with the regaining of normal respiratory epithelium, with complete disappearance of the biofilm surface, and the remaining 20% showed only reduction in the number of inflammatory cells and regaining cilia with scattered patches of very thin biofilm. Biofilms formation plays an active role in perpetuating inflammation in CRS patients and enhanced the recurrence and resistance in those patients, we found a statistically significant improvement in patients’ group (P < 0.001), after 12 weeks of topical ofloxacin (without any evidence of any side effects). So, we concluded that topical ofloxacin seems to be an effective, tolerable, convenient, cheap and even safe mode of treatment of refractory CRS after FESS due to biofilms’ formation. Thus, we recommend such modality of treatment postoperatively especially in refractory cases of CRS.

  The nasal polyp from benign to malignant Top

Dr. Ali Almomen

Sinonasal polyps may be of inflammatory origin, infective origin,neoplastic and miscellaneous type.

In this clinical review, different clinical cases of sinonasal polyps will be presented.

The clinical presentations, the radiological findings, the surgical management and the final histopathological diagnosis will be presented and discussed.

  Is CA-MRSA acute rhinosinusitis a predisposing factor for the recurrence of AFRS Top

Dr. Wasan F. Almarzouq

Objectives: Community acquired MRSA infection is defined as the isolation of MRSA in an outpatient or within 48 hours after hospital admission without history of hospitalization, surgery, dialysis, or residence in a long-term care facility within 1 year of MRSA culture date with no previous isolation of MRSA and absence of indwelling catheter or percutaneous device at time of culture. Over last few decades, CA-MRSA became the most common cause of skin and soft tissue infections presenting to ER in USA. There is a significant increase in the rate of recovery of MRSA in patients with acute and chronic sinusitis over the last several years. Mortality associated with invasive MRSA infections is up to 17%. We report 4 cases of CA-MRSA acute sinusitis associated with recurrence of AFRS.

Methods: Clinical observation and report of case series of CA-MRSA acute sinusitis with literature review from the Otolaryngology department of Dammam Medical Complex, Saudi Arabia.

Results: Four case reports of patients with allergic fungal rhinosinusitis who were operated and developed recurrence during an attack of acute rhinosinusiits caused by CA-MRSA.

Conclusion: There is an ongoing body of research correlating fungal rhinosinusitis with Staphylococcus aureus Scientific Name Search  infection. There is also a significant increase in the rate of recovery of MRSA in patients with acute and chronic sinusitis over the last decade.

High index of suspicion for the presence of MRSA in sinusitis and greater use of sinus cultures, especially in patients who fail to respond to antimicrobial treatment is recommended.

  Paediatric FESS and skull base surgery Top

Dr. Ali Almomen

Pediatric functional endoscopic sinus surgery (FESS) & endoscopic skull base surgery (ESBS) has changed the current management of pediatric sino nasal and skull base disorders.

The indications for endoscopic skull base surgery continue to expand as experience and technology evolve.

40 pediatric patients. With different pathologies (revision cho anal atresia, complicated sinusitis, afs, invasive fungal sinusitis, isolated sphenoid lesions, mucopyoceles and benign and malignant Tumors abutting the orbit, infra temporal fossa, cavernous sinus and skull base, different sites of csf leaks and meningoencephaloceles and pituitary lesions) will be presented and discussed.

  Paediatric skull base Surgery Top

Dr. Shahzada Ahmad

Pediatric endoscopic anterior skull base surgery (PEASB S) is a relatively new approach to managing a wide range of diseases that were previously within the domain of the neurosurgical and cranio-facial teams. Transferring the skills developed in adult endoscopic skull base surgery to a paediatric setting requires modifications related to anatomy, physiology and disease-specific pathology. In addition, the long-term sequelae of this surgery are not fully understood. This presentation summarises the key points of anatomy and physiology that must be addressed by the surgeon performing PEASBS, as well as examples of the types of pathology encountered and the potential complications, based on current literature and review of our own practice.

  Visual loss Caused by Allergic Fungal Rhinosinusitis: Management and Outcome Top

Dr. Bayan Besharah

Introduction: Presentation of allergic fungal rhinos- inusitis (AFRS) may progress to ophthalmic manifestations, although visual loss is a rare complication. We highlight the management and outcome in two AFRS cases that presented to our institution with visual deterioration.

Methods: We report two young Saudi females complaining of nasal obstruction and progressive visual loss for more than a month, presenting to the Rhinology Clinic at King Abdullah Medical City (KAMC). Paranasal sinus CT scan and MRI supported the diagnosis of AFRS, along with other diagnostic criteria. The two cases underwent functional endoscopic sinus surgery (FESS) to remove the pathology from the sinuses and in a trial to improve the visual acuity and field. Both patients received peri-operative steroids. Visual assessment was documented pre- and postoperatively.

Results: Significant improvement in visual acuity and field was reported in both patients following the meticulous and timely endoscopic approach, coupled with the medical management.

Conclusion: Visual loss secondary to AFRS showed significant improvement after appropriate FESS and medical treatment. The rule of early intervention should not be underestimated despite the relatively long duration of visual deterioration.

  Assessment for Rhinoplasty Top

Dr. Hesham Saleh

A systematic approach to the assessment of patients for rhinoplasty/septorhinoplasty facilitates appropriate patient selection and surgical planning. I will provide a comprehensive yet practical method for rhinoplasty assessment that can be incorporated into clinical practice. Successful surgical outcomes require realistic patient expectation, careful consideration of facial aesthetics and a detailed examination of the nose.

  Saddle nose Top

Dr. Nizar Fakeeh

Saddle nose deformity is a common deformity in Middle East it is due to trauma surgical iatrogenic ethnic infection and congenital different type of graft been used for augmentation in this presentation we will describe different type of graft and the indication for each graft.

  PDS plate in rhinoplasty and nasal reconstruction Top

Dr. Basil Hassouneh

The introduction of absorbable PDS plates has added an important armamentarium to the facial plastic surgeon. Although several authors reported on the applications of PDS plates, their usage remains limited.

This presentation provides and introduction to the use of PDS plate in septorhinoplasty. The presentation will provide technical details on septal reconstruction, structural cartilage positioning and the correction of twisted middle vault using PDS plate.

Several cases with operative photography are used to demonstrate how PDS plate can facilitate the use of cartilage segments that may otherwise be unstable or unusable including: splinting fractured cartilage, piecing together cartilage segments or straighten warped cartilage. Tips and recommendations to avoid and manage complications such as exposure and infection will also be reviewed.

  Rhinoplasty for the difficult nose Top

Dr. Hesham Saleh

Rhinoplasty is considered the most difficult operation in plastic surgery. It is generally accepted that this is related to the wide variation in the patient’s nasal anatomy and aesthetic desires. While no single rhinoplasty should be thought of as “simple”, some factors may make the operation even more difficult. I have devised a scheme whereby rhinoplasty is categorised into three grades of difficulty. This aims to facilitate assessment and planning of surgery. In this lecture my focus will be on the management of the difficult grade.

  Endonasal Rhinoplasty: tip suturing techniques Top

Dr. Hesham Saleh

John Orlando Roe from Rochester, New York is credited with the first description of closed or endonasal rhinoplasty in 1887. Following from Rethi’s first description of a high columellar incision in 1921, Goodman and Charles popularized open rhinoplasty in the 1970s with the transcolumellar incision that offered unparalleled exposure. Many surgeons replaced the endonasal approach with the open approach particularly for work on the nasal tip. Over the recent years, there has been a revival of the endonasal approach with the amalgamation of techniques that have been developed for the open approach. Virtually all of the tip suturing techniques described can be used through the endonasal approach. I will demonstrate these techniques with some examples of patients’ results.

  Experience in avoiding & managing Revision Rhinoplasty Top

Prof. Sameer Bafakeeh

Revision Rhinoplasty is one of the most challenging facial plastic surgical procedures. Many of our referral unhappy or dissatisfied revision cases have been to the plastic surgeon for their primary assessment or their first surgery and referred to us for both functional and aesthetic correction of their iatrogenic deformities after having had their primary surgery by the plastic surgeon. Additionally, there are usually psychological issues that need to understand and deal with to achieve a satisfactory outcome, assessment and careful pre-operative analysis remains the key for any successful revision Rhinoplasty surgery. The best form of treatment is prevention. This requires an understanding of the complex anatomy and physiology of the nose.

The external approach is applied for most revision cases, which offers several advantages: direct visualization of underlying anatomic structures, adequate diagnosis of the existing deformity, and exact placement of grafts and implants. The treatment is also multifactorial: Osteotomy and rasp techniques are used to realign; (intact, crushed, diced, or morsilized) cartilage grafts are used to fill in, camouflage, smooth out, elevate, and contour different defects. In severe cases irradiated rib cartilage or alloplastic Gore-Tex in Fascia lata are used to fill in large defects when other grafting options are not available.

The most common postoperative Rhinoplasty deformities encountered are described and how they can be corrected is presented, with pearls for preventing such problems.

Keyword: Rhinoplasty, Revision, Functional, Reconstruction.

  Endoscopic Management of Blow-out fractures (BOF) Top

Dr. Ahmed Al Saggan

Management of blow-out fractures (BOF) is addressed by different specialities which have a substantial difference in opinions. However, there is a wide consensus that patients with the potential for late enophthalmus development require early surgical intervention. If improperly diagnosed or treated, these fractures may lead to serious complications, usually diplopia, enophthalmus, hypoglobus, restriction of eyeball motility and disturbances in sensory innervations.

The timing of treatment, surgical technique and type of reconstruction material used is debated. The key to successful surgical repair of these injuries are adequate exposure, complete visualization of the entire fracture and anatomic reconstruction of the defect. The recently advocated combination of traditional trans-conjunctival approach and endoscopic transantral approach allows reduction and reconstruction under clear endoscopic vision without a facial skin incision.

  Middle East nose for rhinoplasty Top

Prof. Sameer Bafakeeh

Rhinoplasty remains one of the most challenging operations, as exemplified in the Middle Eastern patient. Which is becoming more frequent, as more people break the cultural barrier locally and get international; mostly western exposure. This has meant a huge number of patients spend a huge amount of time and money on cosmesis. Mature patients often request a more refined, feminine nose, whereas younger patients (aged 15 to 25 years) want a smaller, cuter nose. When patients consider cosmetic facial surgery, a multitude of factors surround their decisions, ideas of beauty change depending upon the social and cultural time. The concept of beauty is and always will be subjective. In the past, standardized mathematical proportions have been used, such as “phi mask” of Marquardt. This mask is a model based on the golden, or “phi,” ratio found in beautiful things in nature and validated by a large database of attractive faces.

Modifications were made to include not only a Caucasians versions but also African and Asian versions, these models are incapable of including the full range of ethnicities that often present to the facial plastic surgeon. Nevertheless, there are some characteristics of beauty that are agreed upon across race and gender.

These features include symmetry and a composite of average facial features.

  Endoscopic skull base surgery for malignant disease Top

Dr. Shahzada Ahmad

Skull base surgery has been transformed by the development of endoscopic techniques. Endoscopic anterior skull base surgery to treat malignant disease is an oncologically viable and preferred alternative to conventional open approaches in many situations. A range of skull base malignancies are discussed and the literature reviewed with case examples resulting in lower morbidity and faster recovery in many cases. Vascularised reconstruction is desirable as many patients undergo subsequent radiotherapy and various reconstructive options are also discussed. The multidisciplinary team is at the heart of successful outcomes and ultimately improved survival rates.

  Combined FESS and rhinoplasty: success and limitations Top

Dr. Basil Hassouneh

Combining functional nasal surgery with aesthetic rhinoplasty: success and limitations.

Many patients seeking aesthetic rhinoplasty also have functional nasal complaint such as nasal valve insufficiency or chronic rhinosinusitis. The presentation reviews recent reports indicating the success and limitations of combining functional nasal surgery with aesthetic rhinoplasty. We review important technical consideration when either functional nasal valve surgery or functional endoscopic sinus surgery is combined with aesthetic rhinoplasty. Special measures should be undertaken to avoid complications and achieve a successful outcome.

  Video Head Impulse test, its position in vestibular assessment Top

Prof. Mohammed Shabana

Head Thrust test is one of the bedside examination tests, and has its clinical value in evaluating the Vestibulo-occular reflex. With the introduction of Video recording in the field of vestibular assessment, Video nystagmography replaced the conventional Elecro nystagmography and because of the added merits in revealing the nystagmus more clinical valued were added.

Same happening in Video HIT where more analysis in the behaviour of the VOR reflexes. Now we are in the phase of evaluating the Video VOR, more experience should be added to reach a consensus for the Role of vHIT.

  Approach to Dizziness in the Emergency Department Top

Dr. Bassant Soliman

Vertigo is a common presenting complaint resulting from central or peripheral etiologies. Because central causes may be life-threatening, ascertaining the nature of the vertigo is crucial in the emergency department (ED). With a broad range of potential etiologies, distinguishing central causes from benign peripheral causes is a diagnostic challenge. Fortunately, common benign peripheral vestibular disorders all have characteristic features enabling a bedside diagnosis.

Thus the most effective way to “rule-out” a central disorder is to “rule-in” a specific peripheral vestibular disorder.

In this article, we emphasizes critical steps in evaluating and managing patients who present with dizziness symptoms in the emergency setting, and the key elements of the bedside examination and describes a method for managing vertigo patients in the emergency department.

  “Evaluation of the sensitivity of Cochlear Hydrops Analysis Masking Procedure (CHAMP) in patients with Unilateral Definite Meniere’s Disease Top

Dr. Samir Assal

About ten years ago, Cochlear Hydrops Analysis Masking Procedure (CHAMP) was introduced by Don et al as a new method for diagnosis of early Meniere’s disease. In this test the ABR is measured in response to Click alone and in response to lick + 500 Hz high pass masking noise. Then calculate the difference in between wave V peak latency in the first response and in second response.

In Meniere disease patients this difference According to Don et al (CHAMP latency delay) should be less than 0.3 ms.This achieve 100% sensitivity and 100% specificity

The aim of this study is to investigate the usefulness of the CHAMP test to diagnose MD. It was carried out on 10 patients with unilateral definite MD with no age or sex limit and 10 control subject. The CHAMP test was done as described by Don et at then wave V latency delay were calculated for study and control groups.

Results showed that if we use diagnostic criterion described by Don et al (0.3 msec) the test achieved 20% sensitivity and 100 Specificity so we recommended a new diagnostic criterion which is 1.5 msec this achieved 90% sensitivity and specificity .we recommended that Earlier results with CHAMP should be reconsidered using this criterion instead of 0.3 ms.

  Effect of Age on Postural Control Top

Prof. Naema Isamail

Background: Postural control continues to change in later stages of life. Age-related changes may occur within or between sub-systems involved in postural control. It is thought clinically that these changes are important as they often result in falls & injury.

Aim of the Work: To compare between balance characteristics among different age groups using computerized dynamic posturography to provide clinicians with normal references.


Inclusion criteria: Study group consisted of (30) normal healthy individuals, age range 16-79 years, with neither hearing nor vestibular complaints. It was divided into 3 age groups; each group consisted of 10 patients. Group (A) Young: 16-39 years, group (B) Middle: 40-59 years & group (C) Elderly: 60-79 years. Exclusion criteria: History of neuro-mascular or neuro- skeletal disease, symptoms of unsteadiness, dizziness or vertigo, symptoms of impaired sensory function, symptoms of arthritis or lower limb problem, symptoms of uncorrected visual problems, symptoms of postural hypotension or diabetes, medication intake such as sedatives, hypnotics, anxiolytics & antidepressants. All participants were subjected to: Full history taking, otologic examination, basic audiologic evaluation, computerized dynamic posturography which included sensory organization test, limits of stability & rhythmic weight shift.


Sensory organization test: The elderly group (C) had lowest equilibrium score with eyes open, closed & with conflicted visual cues on swayed surface (condition 6) and also this group have lowest percentage of SOT strategy. There was a statistically significant difference among A & C groups when using sensory organization test strategy in all conditions. Limits of stability test: The elderly group has higher overall reaction time. There was statistically significant difference in all conditions of limits of stability as regards directional control. Rhythmic weight shift right & left test: There was a statistically significant difference between groups A & C in low & medium speed on on-axis velocity & directional control. Rhythmic weight shift front & back test: There was no statistically significant difference between all groups as regards on-axis velocity. There was highly statistically significant difference between all groups in all trials as regards directional control.

Conclusion: Postural instability occurs frequently in healthy elderly subjects. Sensory organization test is the most effective test to compare balance function among different age groups.

  Video Head Impulse in Unilateral vestibular deficit Top

Dr. Mohammed Abdeltwab

Background: Vestibular neuritis (VN) is an acute peripheral vestibulopathy that manifests with acute spontaneous vertigo, nausea and sometimes vomiting, and postural imbalance. Video head impulse test (vHIT) is an objective measure of responses of semicircular canals using high speed video measures of eye movement response to head impulses.

Objectives: The purpose of this study was to measure and analyze horizontal and vertical vestibular canals responses measured by vHIT in acute unilateral VN and to compare the results with the un-affected sides in those patients.

Design: The responses of vHIT were obtained from 31 patients with acute VN (16 females and 15 males) ranging in age from 24 to 54 years.Audiological and vestibular assessments were done to all participants that include pure tone, speech audiometry, tympanometry, acoustic reflexes, vestibular bed side evaluation and caloric testing.

Results: The mean age of VN patients was 38.03 ± 7.96 year. The right side was affected in 14 and left in 17 patients. The gain of vHIT was reduced in the affected side of VN which was statistically significant when compared with the un-affected side. Isolated horizontal canal was observed in 15 patients whereas mixed horizontal and vertical canals were observed in 9 patients. Vertical canals were affected in 7 out of 31 patients.

Discussion and Conclusion: Acute VN patients do have single or multi-semicircular canals affection which can be objectively measured for each canal by vHIT. The lesion is manifested by reduction in amplitude response for affected canal which can affect the superior division mainly and to less extent the inferior vestibular division.

  Update in the management of salivary gland malignancies Top

Dr. Salih Al-Dahri

  • During this presentation an over view of the current modality of treatment with up-to-date review about the recent recommended regimens and their expected outcome.
  • Salivary gland cancers represent a fairly heterogeneous group of tumors with frequently different biologic behaviors.
  • Most of the more frequently observed subtypes are generally indolent and oligosymptomatic also after recurrence and in presence of metastases, thus justifying a ‘‘watch and wait policy’' to be carried out until clear evidence of disease progression.
  • The participation of patients with advanced disease to multicenter cooperative studies should be largely encouraged.
  • For the time being, neither conventional chemotherapy, nor newer costly targeted drugs are to be considered satisfactory approaches.

  Salivary Gland Neoplasms: the good, the bad, and the ugly Top

Dr. Nigel P. Beasley

Salivary gland neoplasms range from the simple pleomorphic adenoma in the parotid tail to complex malignant disease involving the temporal bone. I will describe a structured approach to evaluation of salivary gland neoplasms including the evaluation of parapharyngeal space neoplasms. I will describe the value of ultrasound guided fine needle aspiration cytology versus ultrasound guided core biopsy and the value of MRI, CT and PET imaging in malignant disease. I will describe the different surgical approaches to salivary gland neoplasms including a structured approach to the management of recurrent pleomorphic salivary adenoma, and retrograde and anterograde approaches to the facial nerve. I will describe the value of adjuvant treatment following surgery and the potential for molecular therapies to influence future treatments. At the end of the presentation delegates will be able to describe a structured approach to salivary gland neoplasms from the simple to the complex.

  Contemporary management strategy of parotid tumors Top

Dr. Nabil Al Zaher

Contemporary Management Strategy of Parotid Tumors: This is a study based on the past personal experience as well as the experience of the Head & Neck Surgery Unit at the King Faisal Specialist

Hospital & research Center in Riyadh, Saudi Arabia in addition to the recent updates, guidelines and advances reported in the medical literature.

  Facial Reanimation Top

Dr. Mazin Merdad

Facial paralysis is a dreadful condition that has tremendous functional and physiological impact on patients. This presentation will cover the different options available for facial reanimation. The goal of the presentation is provide the audience with an algorithm that can assist them in choosing the most appropriate reconstruction option for their patients.

  Orbital Tumors Top

Dr. Abdullah Al Qahtani

Surgical machines go through a lot of improvement in last decade having make us capable of diagnosing and treat many oncological problems easier than before. Diagnostic and therapeutic applications of vitrectomy in typical and atypical manifestations of primary intraocular lymphoma (PIOL) that could mislead or delay the diagnosis also as therapeutic measure for choroidal melanoma in which many of them end up by neovascular glaucoma and losing the eye if not by the tumer itself it is by the radiational effect of the management.

With good indications and perfect use, we can get the most of those surgical vitrectomy machines, Vitrectomy can play crucial role in diagnosing of primary intraocular lymphoma which is challenging and diagnostic delay in this condition is frequent. It also plays role in treating melanoma more effective than any previous time.

  Trans-Oral Robotic Surgery (TORS) In Oropharyngeal Cancer Top

Dr. Mazin Merdad

Transoral robotic surgery (TORS) is one of the emerging surgical technologies that is creating a paradigm shift in the treatment of multiple oropharyngeal diseases. This presentation will cover the different indications for TORS including oropharyngeal cancer and cancers of unknown origin. The goal of the presentation is to assist the audience in identifying the specific patient population that could benefit from TORS.

  The role of partial laryngectomy for function preservation in laryngeal cáncer Top

Dr. Javier Gavilán

For laryngeal cancer there is no treatment of choice, but choices of treatment. The main options are: surgery (open or endoscopic) and radiotherapy (alone or combined with chemotherapy). We do not treat “cancers” but “patients”. Thus, the TNM classification is not useful for treatment planning, as many other factors should be taken into account (occupation, pulmonary function, expectations,…). Partial laryngectomy is as useful as other treatment modalities to manage laryngeal cancer, as long as it is properly indicated and performed. Most patients undergoing a partial laryngectomy preserve normal laryngeal function. These procedures should be considered as another treatment modality for “organ” (function) preservation in selected patients. Open partial laryngectomy can be classified in two groups: vertical (cordectomy and extensions) and horizontal procedures (supraglottic and supracricoid laryngectomies). Supra- glottic laryngectomy allows the removal of the whole supraglottic structure in an oncologycally safe manner, with good functional results.

  Tongue cancer experience at KAMC Jeddah Top

Dr. Hadi Hakami


  • To evaluate the experience with tongue cancer post glossectomy in our institute.
  • To address the outcome and correlate with other related clinical and pathological variables.


A retrospective cohort study was done on 38-tongue cancer cases were presented to Prince Nora Oncology Centre and treated surgically by two surgeons between May 2007 and May 2015. 4 cases were excluded. Clinical, operative and pathological data were reviewed and analyzed. The association between outcome and other variables was studied. Statistical analysis was performed using Winstat for Excel.


38 patients were corresponding to this study criteria, 4 of them was excluded because of significant missed data and 34 was included in this study. 14 Female and 20 male.24 patient (70.6%) was present with ulcer, 7 patient (20.6%) presented with Exophytic Lesion and 3 patient (8.8%) present with Nodular Lesion and Leukoplakia. 85.3 % of the patient which count of 29 were referred to the oncology center while 5 patient (14.7%) was diagnosed in the ENT or oncology clinic. In regarding to the risk factors, the majority of the patients have no obvious risk factors and those are 17 and accounting 50% of the subjects. The rest of the subjects have a risk factors like smoking (9 patients), Shamma and Qaat abuse (3 patients) and dental problems (8 patients). 12 patients of the subjects was diagnosed in stage 1 cancer, 9 in stage 2, 4 in stage 3 and 8 patients was diagnosed in stage 4. All the tumor resection has a free margin with thickness equal to or less than 5mm in 7 cases and more than 7mm in 24 cases (71%) and the data were missed for three cases. The lympgovascular invasion was positive in 7 cases and negative in 26 (76.5%) and the data was missed in one case. The Perineural invasion was positive in 14 cases and negative in 20 (58.8%). The neck was dissected Ipsilaterally in 16 and Bilaterally in 18 and the status of neck dissection was ( N0 = 22 (64.7%), N1 = 4 , N2a = 3, N2b = 2 , N2c = 2, N3 = 0 ). The Extracapsular invasion was positive in 6 cases and negative in 27 (79.4%) and missed data in one case. After the surgery 13 patients received, chemo- radiotherapy and 11 patient received radiotherapy only while 10 patients receveied no adjuvant therapy. The outcome of the subject in this study was Free 5 years in6 patients (17.6%), Free 3 years in 10 patients (29.4%), Free 1 years in 4 patients, the recurrence was happen locally in 6 patients distant and regional recurrence was happen with 1 patient for each one, 6 patients (17.6%) was passed away and 1 patient developed a second primary, the rest 3 patients was missed follow-up in our oncology center.


  • In the present study, we found the 3-5 year survival was 47%.
  • The recurrence and mortality 41%.
  • Regional lymph nodes metastasis in both neck correlate with bad prognosis.
  • No significant p value between thickness and outcome.

  New strategy of neck dissection in cancer larynx Top

Dr. Samir El-Kotb


Introduction: Cancer larynx comprises approximately about 3-3.5% of all malignancies that are diagnosed in the world annually. Cancer larynx is one of the most curable cancers in head and neck, if the precise evaluation of the primary tumor and neck is performed and treatment is planned properly. The number, size, levels, side (ipsilateral, contralateral or bilateral), presence of extracapsular lymph node metastatic spread and the presence of soft tissue neck metastases are highly significant and had an impact role of survival in malignant tumors of head and neck. It has always beenassumed that the neck metastases in tumors of the head and neck are in the lymph nodes.The extent of neck dissection in laryngeal cancer surgery is still controversial matter. The predictable pattern and detection of metastases in certain levels help in planning and choosing of proper treatment of the neck in neck metastases.

Objective: The objective of this study was to determine the incidence of neck metastases in different neck levels, to show the pattern and most common sites (levels at risk) in cancer at different sites of the larynx {supraglottic, glottis, subglottic and transglottic} and to apply the results of the study to the strategy of neck dissection in management of cancer larynx. .

Methods: This preliminary prospective randomized and multi-institutional study was conducted on 128 cases of cancer larynx. The levels and sublevels of cervical lymph nodes and soft tissues dissected were labeled, enumerated and reported. The lymph nodes and soft tissues that were included in surgical specimens of neck dissection(ND) of all cases (128) were examined histopathologically.

Results: The common site of primary tumors was transglottic 60.2% (77/128) then supraglottic 25.8% (33/128) followed by glottic 13.2% (17/128) and the primary subglottic tumors was very rare 0.8% (1/128). The incidence of pathological neck metastases in cancer larynx was 30.5% (39/128). The metastasis was lymph nodal in 21.1% (27/128), free soft tissues 4.7% (6/128) and both lymph nodal and soft tissues 4.7% (6/128). All soft tissue metastases were in the lymph nodes bearing tissues. The incidence of lymph node metastasis without extra-capsular spread was 11% (14/128) and with extracapsular spread in 10.1% (13/128). The incidence of neck metastases was high in supraglottic tumors 42.4% (14/33), followed by transglottic tumors 29.9% (23/77). The incidence of neck metastases in purely glottic tumors was 11.8% (2/17) and 0.0% (0/1) in purely subglottic tumors. The frequency and incidence of neck metastases were high at level IIA 38.9% (37/95), level III 25.2% (24/95), level IVA14.7% (14/95), level VIA 10.5% (10/95). But, the incidence of neck metastases were low at level VA 4.2% (4/95), level II B (2/95), level IV B 2.1% (2/95), level IA 1.1% (1/95), level VIB(1/95) and 0% in level IB and level VII.

Conclusion: Staging of neck lymph nodes metastases must be changed to be staging of neck metastases {including both nodal and soft tissue metastases}. The most common neck levels that were invaded with neck metastases in cancer larynx were levels IIA, III, IVA and VIA. No need for dissection of level I, level IIB, level IVB, level V and level VII in the management of the neck in laryngeal cancer as the incidence of neck metastases at these levels were rare and low according to the results of this study unless the neck metastases are detected clinically or radiologically by CT neck with contrast at these levels. Selective and limited neck dissection were effective oncologically in N0 neck in cancer larynx. In N+ neck {clinical or radiologically by CT}, the neck dissection side, type, levels dissected should be tailored according to histological type, histological grade, site and T stage of primary tumor [clinico-radiological] and evaluation of the neck metastases levels and N stage {clinical and radiologically by CT}.

Keywords: cancer larynx, supraglottic, glottis, subglottic, transglottic, neck metastases, neck levels, lymph nodes metastases without extracapsular spread,lymph nodes metastases with extracapsular spread, free soft tissue metastases, neck dissection.

  Paragangliomas of the head and Neck: presentations, management and outcomes Top

Prof. Badr Eldin Mostafa

Aim: Outlining the different clinical presentations of head and neck paragangliomas and the optimal management policies in our practice

Method: Overview of 80 head and neck paragangliomas presenting to our department. All patients underwent clinical and radiological evaluation. All patients underwent surgical excision after embolisation according to their site. Adjunctive radiation therapy was advocated for selected patients with residual lesions in critical locations.

Results: Total excision was possible in 75 cases. In the remaining small remnants were left on the carotid artery and irradiated. The commonest post-operative morbidity was facial nerve paralysis followed by lower cranial nerve palsies. Facial rehabilitation was performed by either cable grafting or VII-XII anastomosis. Vocal fold paralysis with dysphonia and aspiration was treated by injection thyroplasty and swallowing rehabilitation.

Conclusion: Paragangliomas are not common with a slow insidious onset. Presentation is usually late with large tumours which are surgical challenges. Most cases could be surgically excised with acceptable morbidity. We had no related mortalities.

  Prospective functional outcomes in sequential population based cohorts of stage III/ IV oropharyngeal carcinoma patients treated with 3D conformal vs. intensity modulated radiotherapy Top

Dr. Mohammed Alessa


Background and Purpose: To compare early (3 and 6 month) and later (12 and 24 month) functional outcomes of stage III and IV (M0) oropharyngeal squamous cancer patients treated in sequential cohorts with 3D conformal (3DCRT) or intensity modulated radiotherapy (IMRT).

Patients and Methods: 200 patients in sequential population based cohorts of 83 and 117 patients treated at a single institution with 3DCRT and then IMRT respectively were prospectively assessed at pretreatment and 3, 6, 12 and 24 months post treatment. A standard functional outcomes protocol including performance status (KPS, ECOG), 3 Performance Status scales for Head and Neck (PSS-HN), the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), Voice Handicap Index-10 (VHI-10) and self-rated xerostomia were applied.

Results: Mean age at diagnosis was 59 years. The primary site was base of tongue in 77 and tonsil or soft palate in 123 patients. Median follow up was 2.5 years for the second cohort. Concomitant therapy was used in 159 (79.5%). Overall survival at 3 years was 75.6% and 71.5% for IMRT and 3DCRT cohorts respectively (not significant). A multiple imputation technique was used to estimate missing values in order to avoid a healthy patient bias. KPS and ECOG reached nadirs at 3 to 6 months but approached baseline values at 12 to 24 months and did not differ by treatment. The 3 PSS-HN scales, Eating in Public (p < 0.001), Understandability of Speech (p = 0.009) and Oral Diet Texture (p = 0.002) and all showed significantly better outcomes in favor of IMRT. The RBHOMS showed a difference in favor of IMRT which appeared during 3 to 6 months (p < 0.001). The VHI-10 also showed a difference in favor of IMRT (p = 0.015). Self-rated xerostomia did not differ at 3 and 6 months but was significantly better in favor of IMRT after 12 months p = 0.005 CONCLUSIONS: A prospectively administered functional outcomes protocol showed meaningful differences in favor of IMRT over 3DCRT early (3-6 months) and later (12-24 months) in the treatment of oropharyngeal carcinoma with equivalent survival. These data support the adoption of IMRT as the standard radiation treatment method for patients with stage III and IV (M0) oropharyngeal squamous carcinoma. KPS and ECOG may not be sensitive to oropharyngeal cancer patients’ functional outcomes by treatment.

  Otosclerosis and cochlear implants: technical features and long-term results Top

Dr. Jean Bebear

Otosclerosis is a relatively common cause of acquired severe to profound bilateral deafness and represents 7-10 % of cochlear implants indications in adults. However, the presence of otosclerosis remains classically considered a poor prognostic factor in terms of functional outcomes of cochlear implantation, particularly in cases of advanced peri-cochlear lesions witch may complicate electrode array insertion.

The objective of this study is to present our experience and medium and long-term results on 47 patients with otosclerosis implanted inUniversity Hospital of Bordeaux.

Quality MRI and thin-section CT imaging is essential to take stock of the lesions and provide any surgical difficulties, especially near the round window and basal turn of the cochlea. The choice of implanted side partly depends on thisradiological diagnosis. In our experience, surgical difficulties are often minimal, and a posterior tympanotomy with round window approach allowed full insertion of the electrode array in 39 cases out of 47. In case of obstruction of the basal turn of the cochlea, milling 3 to 4mm deep into the basal turn usually can remove the obstacle. The functional results are quite comparable to those of other etiologies of deafness receiving cochlear implants. In our series, more than 70% of patients with otosclerosis have achieved good or very good audiometric results 18 months after cochlear implantation. When possible, bilateral cochlear implantation further improves performance, primarily for sound localization and speech understanding in noisy environments.

  Implantable hearing aids Top

Dr. Khalid Taiba

Although technical improvements and modifications have improved the fidelity of conventional aids, hearing aids still have many limitations. The aids may be difficult to maintain, require frequent cleaning, dehumidification, and battery changes. Some patients may perceive them as being uncomfortable because they simply cannot tolerate an object in the ear canal. Patients often report the occlusion effect of an object occluding or blocking the entire lateral ear canal. [2] Several types of devices can be considered implantable hearing devices. These include cochlear implants, auditory brainstem implants (ABIs), bone-anchored hearing aids, and implantable middle-ear devices. Implantable middle-ear devices are generally available in 3 types—piezoelectric, electromehanical and electromagnetic and may be further categorized as either partially or totally implanted.

We like to discuss in this article our experience with different type of implantable hearing Aids or devices from surgical and audiological outcome and patient’s satisfaction.

  Intra operative Challenges in Cochlear Implant Surgery, Can I predict It? Top

Prof. Laila Telmissani

Using round window membrane as a portal of insertion of the electrode in cochlear implant surgery has been markedly emphasized.operating mainly on pediatric population would increase the chances of intra operative difficulties such s posteriorly oriented round window niche or laterally placed vertical segment of the facial nerve .Can CT of the temporal bone used as a predictor to such difficulties.

  Modified End aural Approach For Cochlear Implantation Surgery Top

Prof. Mohamed Adel Khalifa

Objectives: To describe the modified endaural approach for cochlear implant surgery.

Introduction: The transmastoid posterior tympanotomy and cochlestomy is the standard and most commonly used approach for doing cochlear implant surgery in children. Many types of incisions were used .the most common one is the postauricular incision, which have many limitations.

Materials and Methods: This study was performed on 200 patients operated upon in our centre. Most of these cases were children. Our modified endaural approach was used in all these cases.

Results: 200 cases went with no drawbacks or complications, only 3 cases had some post-operative collections (seroma) which were treated promptly .

Conclusion: The modified endaural approach is simple and easy .it leads to a very wide exposure of the mastoid cortex. The line of incision is not crossing the device.

  Innovations in Surgical Simulation in Otolaryngology Top

Dr. Lily Nguyen

The adoption of simulation in healthcare education has grown exponentially in recent years, largely in response to demands for increased patient safety. Amongst others, simulation can improve technical skills, can enhance communication amongst team members, and can identify/mitigate system-based hazards. With advances in technology, a variety of innovative simulator types are now easily accessible. Yet the notion of how best to use simulation can remain elusive for many healthcare educators.

This presentation will provide an overview of the latest innovations in simulation, and discuss its application in the field of OTL-HNS. In addition, it will focus on the evidence-based, educational principles that promote effective learning in simulation. Key topics highlighted include virtual reality, three dimensional printing, and high-fidelity manikins. Additional emphasis will be placed on other important features of successful simulation, such as deliberate practice, mastery learning, as well as the role of feedback and debriefing.

  Competency Based Medical Education Top

Dr. Lily Nguyen & Dr. John Manukian

The presentation will highlight the following:

  • Understand the rationale for competency-based medical education.
  • Understand the definitions used by the Royal College of Physicians and Surgeons of Canada.
  • Discuss the importance of work-based (‘point of care’) assessment in CBME.
  • Recognize that ‘assessment drives learning’ and how aligning objectives, educational programs and assessments helps to optimize learning.

  Fetal tracheal balloon occlusion in the treatment of congenital diaphragmatic hernia; the role of pediatric otolaryngology Top

Dr. Iman Almashharawi

Congenital diaphragmatic hernia (CDH) affects approximately 1 in 2000 newborns. Although great strides have been made in the management of CDH, significant morbidity and mortality persist. We will present a small series of fetal tracheal balloon occlusion done in prince sultan military medical city, the focus of the talk will be the role of pediatric otolaryngologist in these cases as they are at great risk to develop premature labor and which usually require EXIT procedure to be able to do bronchoscopy can removal of the balloon.

  Oromandibular reconstruction in kids Top

Dr. Mohammed Algarni

Head and neck Tumors that requires resection and reconstruction in kids are rare , but it is quite technical and needs detailed knowledge about facial growth centers and important area points in the head and neck to take care about during reconstruction, it is crucial to perform the optimal reconstructive technique in this category of patient and it seems that free tissue transfer is very safe and resulted in excellent cosmetic outcome and do not affect much the facial growth in those patients. The presentation will cover different tumors types and option of treatment, and the reconstructive option emphasizing of the technical part and the differences in comparison to adult mainly in the oromandibular section.

  Effect of otitis media with effusion on cochlear implant surgery: technical difficulties, post-operative complications and outcome Top

Dr. Bassam Alzuraiqi

Objective: This study evaluated the complications and outcomes of cochlear implantation in patients who had otitis media with effusion at the time of surgery.

Methods: A retrospective chart review study was performed of 87 consecutive paediatric patients (age range 22 months to 10 years, mean 4.8 years) who underwent successful cochlear implantation, with follow-up periods of 5-6 years. All patients had unilateral implants, with eight on the left side. All devices were activated two weeks after implantation. The effect of the middle-ear condition on the procedure, post-operative complications and outcome were evaluated.

Results: Unilateral ears of 17 otitis media with effusion patients were implanted with some surgical difficulties but no long-term post-operative complications.

Conclusion: For children admitted for cochlear implantation who are subsequently found to have otitis media with effusion, surgeons should be aware of possible surgical difficulties. Greater intra-operative risks should be anticipated and more surgical time allowed for cochlear implantation in these patients.

  “CO2 laser assisted endoscopic primary laryngotracheoplasty for high grade circumferential subglottic stenosis without tracheostomy Top

Dr. Mohammed Halawani, Dr. Jaber Al Shammari

Objectives: The introduction of a new endoscopic approach for treating high subglottic stenosis& the explanation of an innovated surgical technique emphasizing the importance of the evolutions that occurred in endoscopy.

Methods: We retrospectively reviewed data from 2011 to 2015, involving children and adults with a Cotton- Myer grade II to III acquired subglottic stenosis. Our technique included the use of endoscopic CO2 laser for excising the stenosis, reshaping the cricoid and injecting steroids. The philosophy of our procedure is returning the tissues to the earliest healing stages presented post intubational trauma prior to scar formation. Subsequent sessions ranging between 2-4 weeks took place to control the natural healing process, remove granulation tissue formation and prevent recurrence of stenosis. No patients required tracheostomies within a one-year postoperative follow up period. The total number of surgeries and the grade of stenosis of each case were specified. All was performed by a single surgeon.

Results: The sample’s total number is 7 cases;three males and four femaleswith a mean age of 10.6 years at the time of diagnosis (range 0.3 - 42 years). Three cases were associated with neurological diseases and one with a cardiac condition. All of our cases were acquired due to prolonged intubation. Preoperatively, 6 cases had grade 3 subglottic stenosis & only one case had grade 2. While postoperatively, almost all cases had grade 0 stenosis. P-value is 0.0082, which according to Friedman’s test, indicates a significant difference. The average number of surgeries is 7.

Conclusion: We recommend theendoscopic CO2 laser technique since it involves less complications compared to its advantages including minimum invasion, less operating time and could be performed on comorbidity cases. Above all, this technique does not require tracheostomy.

  Post tonsillectomy bleeding Top

Dr. Mohammed Al-Johani

Objectives: Post-tonsillectomy bleeding is one of the known complications after tonsillectomy. Our aim is to fine the relation between post-tonsillectomy bleeding with the year seasons

Materials and Methods: We collected the tonsill- ectomy cases that done in SFH in Riyadh Saudi Arabia from 30/12/2012 until 8/12/2013, a total of 514 patients underwent tonsillectomy as day case surgery, 15 patients (2.92%) came back to our hospital with post- tonsillectomy bleeding within the first two weeks after the surgery.

We took into consideration: patient age (14 years and younger or older than14) and gender, operating surgeon (consultant or resident), the surgical technique (cold or hot dissection), and during which season of the year it was done

Results: Incidence of post tonsillectomy bleeding increased in cases done by consultants and in adults (>14 years) patients but Seasonal changes has no effect on secondary post tonsillectomy bleeding

Conclusion: we concluded that weather changes had no effect on post-tonsillectomy bleeding.

  Requirements of Septoplasty Methods in Children Associated with the Peculiarities of Nasal Septum Development Top

Prof. Azizagha Talishinskiy

Background: Procedures in children’s nasal septum (NS) is often the cause of retardation of nasal cavity and midface development. However, infrequent deformation of NS, acute respiratory worsening or absence of nasal breathing makes this step inevitable. We aimed to study the characteristics of NS growth in children and its relevance in surgical procedures.

Material and Methods: The study was carried out on 36 cadaveric NS obtained from children 3-12-years old. We came up with morphometric evaluation of growth its anatomical structures. Septoplasty with consideration of age-appropriative development of NS was applied in 70 children.

Results: In 3-year-old children sagittal dimension of NS exceeds its height by 1.9 times. In 5-year-old children NS length and height increases. In 12-year-old horizontal-to-vertical ratio (H/V) reduces upto 1.79. Septal cartilage (SC) has greatest length in ages 3-4 among studied groups; H/V is equal to 2.26. In 5 year- old children SC height increases, length and posterior process of SC shortens, H/V decreases (1.6) and in 11-year-old it becomes lowest (1.27). Child’s growth is associated with intensive growth of SC in height and surface area. This indicated nasal cartilage growth is related with SC and incision should be made in the vertical plane to prevent violation of SC development. In 3-year-old length of vomer is 2.5-3 times greater than its height and surface area occupies 25% of NS. In 5-year-old there is intensive growth in length and area of the vomer and in 7-12 year-old - increased length and height. Therefore, operation on vomer up to 12-year- old should be limited by resection of spina and crista. Perpendicular plate of the ethmoid bone of 3-year-old children consists of small bone plate with surface area corresponding to 1/6 of NS square. In 5-year-old all parameters of perpendicular plate increases and this age is associated with the most rapid growth time. In 11-12 year-old vertical plate percentage in NS surface area becomes highest among all studied groups. This is the basis of only applying window resection on vertical plate during its deformation.

Conclusions: It is crucial to take into consideration age related characteristics of development of NS in children during septoplasty.

  Preoperative intravenous dexamethasone combined with glossopharyngeal nerve block: Role in pediatric postoperative analgesia following tonsillectomy Top

Dr. Sherif Kamel

Tonsillectomy is one of the most frequently performed ambulatory surgical procedures in children. Several techniques have been described for alleviation of pain. The objective of this study determination of the postoperative analgesic efficacy of the pre-surgical intravenous administration of dexamethasone together with glossopharyngeal nerve block (GNB) in children undergoing tonsillectomy. Prospective double blind randomized control study using both pre-operative injection of 0.5 mg/kg dexamethasone iv and 3 ml of 0.5% bupivacaine local injection for bilateral glossopharyngeal nerve block. Patients in group B had significantly less visual analogue scale values, longer absolute analgesia time, lesser swallowing difficulty and they were discharged earlier from the hospital when compared to patients in both groups D and G. Using both pre-operative dexamethasone IV injection with GNB has reduced postoperative pain and morbidity to a great extent than using either alone.

  Validity of scoring systems suggested for drug-induced sleep endoscopy for upper airway evaluation in pediatric population with obstructive sleep apnea Top

Dr. Yousif Ahmed AlAmmar

Objectives: Is to validate three scoring systems (Velum, Oropharynx, Tongue and Epiglottis (VOTE), Boudenwayns and Chan’s classifications) utilizing overnight Polysomnography in cases of pediatric sleep disturbed breathing.

Methodology: This is a prospective, observational study involved 35 children, with age ranging between 1-12 years. All of them presented with obstructive sleep apnea symptoms and underwent Adenoidectomy and/ or Tonsillectomy. Every one of the children underwent preop and postoperative Polysomnography. Drug- induced sleep endoscopy (DISE) was performed as well and recorded at the time of anesthesia induction. Intraoperative endoscopy recording was assessed by 4 raters blinded to patient’s information by utilizing the 3 scoring systems suggested in the literature. The raters were requested to suggest an alternative procedure based on the recording. A postoperative Polysomnography was done to assess the change in the OSAS score and whether the suggested procedure by the raters is needed or not. The internal reliability and validity of each of the scoring system for sleep endoscopy was statistically evaluated.

Results: Mean age was 6.2, with 21 males and 14 females. A total 28 (80%) underwent Adenotonsillectomy and 7 (20%) underwent only Adenoidectomy .In general, postoperative Polysomnography showed no significant improvement (P .062). Synchronous obstructing lesions was found in 60% of the children with no significant improvement (P 0.355) and the group without synchronous lesions showed significant improvement (P 0.008) in postoperative Polysomnography .The Inter rater agreement was found to be best in Boudenwayns system ( P 0.965) followed by Chan (P 0.956) and Vote (P 0.319).

Conclusion: DISE can offer valuable added information in managing children with OSAS. Since Boudenwyns system was the highest in agreement among raters it can be used as a documentation and communication tool. Although, further studies with larger number of cases is recommended.

  The Role of Tracheostomy in Tetanus Neonatorum: Outcome in a Pediatric Intensive Care Unit Setting Top

Dr. Lujain Khaled Abdalwassie

Objective: To assess the role of tracheostomy in Tetanus Neonatorum in terms of Pediatric Intensive Care Unit (PICU) length of stay.

Study design: Retrospective chart review.

Setting: Pediatric Intensive Care Unit at King Abdulaziz University Hospital (KAUH).

Subjects and Methods: All documented cases of Tetanus Neonatorum admitted to KAUH from January 2009 until December 2013 were reviewed. Pediatric intensive care unit length of stay and complications were the measured outcomes in patients that underwent tracheostomy and patients that did not have the procedure.

Results: A total of 59 Tetanus Neonatorum cases were analyzed in the study. In total 11 neonates (18.6%) had tracheostomy done. There average length of stay in PICU for the tracheostomized versus non- tracheostomized group was statistically insignificant. While post PICU length of stay showed significantly larger mean length of stay in tracheostomized than non-tracheostomized group (30.6±14.2 vs. 15.7±9.7 days, P <.001). In addition, tracheostomy group had significantly longer mean total length of stay (PICU and pediatric ward stay) (56.4±18.1 vs. 42.3±16.7 days, P= .017.

Conclusion: We conclude that performing tracheostomy does not affect PICU length of stay yet it may lead to prolonged total length of hospital stay.

  Measurement duration and clinical effectives of the wireless intraoperative remote assistant Top

Dr. Fida Almohawas

Background: The Wireless Intraoperative Remote Assistant is the second generation of hand-held remote controls that enables electrode tests and AutoECAP measurements on a cochlear implant during surgery. The ergonomics and ease-of-use of this device are anticipated to result in freeing up clinical resources, a decreased test duration time and more consistent overall intraoperative testing. This investigation aims to understand what increase in clinical efficiency this device offers over the standard clinical system and methodology.

Primary objective: Identify the duration of impedance and ECAP threshold measurement time with the Wireless Intraoperative Remote Assistance compared to the current Computer biased clinical system.

Secondary objectives: Determine the clinical effective-ness of the wireless Intraoperative Remote Assistant, compared to the current computer biased clinical system by identifying the success rate.

  Superior Canal Dehiscence Syndrome: Suspicion, Diagnosis and Treatment Top

Dr. Issam Saliba

Superior Canal Dehiscence Sydrome (SCDS) was reported by Minor in 1998. There is an absence of the bone coverage of the canal.

Patients with SCD have cochlear and / or vestibular symptoms.

They are suffering from hyperacousis, autophonia, ear fulness, pulsatile tinnitus, ossillopsia, tulio phenomenon and disequilibrium.

Hearing test shows a low frequency air-bone gap and a negative bone conduction at the lower frequencies. cVEMP (cervical vestibular evoked myogenic potential) and oVEMP (ocular VEMP) threthold are below normal level.

Bilateral Simultaneous Caloric Test (BSCT) shows that even though we obliterate the canal, its vestibular function remains about 30%.

The symptoms are explained by the theory of the 3rd window created by the superior canal dehiscence and affecting the endolymph of the inner ear, giving the cochlear and vestibular symptoms.

Presentation objectives:

  1. Discuss the assumptions behind the etiology of SCS.
  2. Report symptoms and management of SDS.
  3. Present the radiological tools to diagnose the SCS.
  4. Report cochlear and vestibular pre and postoperative data.
  5. Present details of the middle fossa approach for superior canal plugging.

  Cochlear implantation in the obliterated cochlea Top

Prof. Hassan Wahba

Cochlear implantation is the method for rehabilitation for patients that have acquired a profound sensorineural hearing loss following meningitis. Pneumococcal meningitis is the worst followed rapidly by an ossification in the cochlear lumen leading to obliteration of the cochlea and difficult and sometimes impossible surgery. Trauma and otosclerosis are other causes for obliteration of the cochlea. Time is the most important factor here. Waiting for recovery of hearing is a waste of time and will eventually lead to impossibility of surgery. This presentation will cover all aspects of cochlear implantation in the obliterated cochlea especially imaging in such cases as well as tips during the surgery itself.

  Decision making in petrous apex lesions: the role of imaging Top

Dr. Esam Saleh

Objective: The aim of this study is to report on the radiological characteristics of a series of petrous apex lesions and to discuss the management of these cases based on the clinical picture, diagnosis and lesion extension.

Patients and Methods: Thirty five patients with radiological diagnosis of petrous apex lesions were included in this study. MRI was performed in all cases whereas CT scan was performed in 32 cases. The imaging characteristics were recorded, analyzed and correlated with the clinical picture in each case.

Results: There were 11 cases of primary and 24 cases of secondary petrous apex lesions. Cholesterol granuloma, cholesteatoma, asymmetric fatty marrow, petrous apex effusion and encephalocele were the most common primary lesions. Glomus tumors, neurinoma, osteomyelitis of the skull base, chordoma, chondrosarcoma and meningioma were the most common 2ry lesions encountered. The different CT & MRI findings were outlined with emphasis on the imaging characteristics of individual lesions. Seven 1ry cases were advised regular follow-up. Five cases of skull base osteomyelitis were managed by medical treatment whereas the remaining cases underwent surgery.

Conclusion: CT & MRI play a fundamental and complementary role in the diagnosis of petrous apex lesions. Decision making depends on the diagnosis, clinical picture and lesion extension. A proper diagnosis and clinical correlation are needed to avoid unnecessary surgery in selected cases.

  Patterns of epithelial migration in chronic otitis media Top

Dr. Rayan Al Hussini

The epithelial migration of tympanic membrane (TM) and external ear canal (EAC) is a self-cleansing mechanism of human ears. The desquamated epithelium is carried in a lateral direction to prevent the accumulation of epithelial debris deep in the ear canal. The patterns of epithelial migration on normal ears have been studied extensively in the literature .However there are a few clinical studies on pathological ears. In this clinical study the patterns of the desquamated epithelium in the external canal in ears with chronic otitis media (COM) are presented.

Objective: To study the patterns of desquamated epithelial migrations in the EAC in ears with COM. Study design: prospective clinical study.

Methods: from January 2010 to January 2012, patients with chronic otitis media presented to otology clinic, Riyadh Military Hospital were examined with rigid ear endoscope. Panoramic photographs of the TMs and EACs and short digital videos were recorded. The patterns of desquamated epithelial migration in the EAR were studied.

Results: Specific patterns of desquamated epithelial migration where noticed in the external ear canals for different middle ear and TM pathologies.

Conclusion: Specific patterns of desquamated epithelial migrations in the external ear canals can be a useful clinical signs in ears with chronic otitis media.

  Vestibular Schwannoma - diagnostic and treatment options Top

Dr. Oliver Kaschke

Vestibular schwannomas (also known as acoustic neuromas, acoustic schwannomas, acoustic neuri- nomas, or vestibular neurilemomas) are Schwann cell- derived tumorsaccount for approximately 8 percent of intracranial tumors in adults and 80 to 90 percent of tumors of the cerebellopontine angle (CPA).

The incidence appears to be increasing, due at least in part to the incidental diagnosis of asymptomatic lesions with the widespread use of magnetic resonance imaging (MRI) and computed tomography.

The goal of treatment for benign tumors is to eradicate the tumor while preserving form and function. This holds true for Vestibular Schwannomas as well. There are three treatment options for patients with a Vestibular Schwannoma, observation, radiotherapy, and surgery. Which option is best for each individual must be carefully determined based on the size of the tumor, the location of the tumor, the symptoms, the patient’s age and general health, and the patient’s goals and concerns. This decision is made by the patient after discussing all the options, each with unique risks and benefits.

Examples of surgically treated cases as well as results will be presented.

  Management of Pulsatile Tinnitus Top

Dr. Issam Saliba

Pulsatile tinnitus has a long differential diagnosis including some non-vascular causes (e.g. conductive hearing loss), neoplasms, and vascular anomalies. It is important for the treating physician to have a systematic approach to the evaluation of these patients.

In patients with pulsatile tinnitus it is critically important to attempt to determine if the bruit is arterial or venous by compressing each side of the neck (ipsilateral and contralateral to the symptom) with enough pressure to occlude the venous system and then the arterial system (restricted to young patients).

Except in patients with allergy to contrast, we have abandoned the use of magnetic resonance angiography (MRA) in the evaluation of patients with pulsatile tinnitus. The vascular anatomy demonstrated by the CT angiography is superior to MRA and the bony anatomy of the temporal bone can be reformatted in multiple planes to demonstrate bony anomalies like sigmoid diverticulum and dehiscent superior semicircular canal not seen on MRI.

Based on our findings, we suggest an algorithm exposing the differential diagnosis for evaluating patients with pulsatile tinnitus.

Pulsatile tinnitus requires a careful physical examination and evaluation with selected imaging techniques to identify the origin of the symptoms. Pulsatile tinnitus has a difficult differential diagnosis and no single imaging study is appropriate for all individuals. A diagnostic algorithm based on initial symptoms and progressing to more invasive imaging studies is presented. Using this algorithm we suggest that the physician can make the most cost efficient use of diagnostic testing.

  Management of facial nerve tumor Top

Dr. Yung-Sun Cho

Although the estimateprevalence is extremely low, Facial nerve schwannomas (FNS) are the most commonprimary tumor of the facial nerve (FN). FNS are slow-growing benign tumors that can arise along any segment of FN from the cerebellopontine angle to the peripheralbranches in the face and usually involve multiple nerve segments.

The most common locations have been reported to be the geniculate ganglion, and FNS limited to the internal auditory canal (IAC) and/or the cerebellopontine angle are less common.

Symptoms include slowly progressive facial paresis or paralysis and hearing loss, although tinnitus, pain, vestibular symptoms, or an ear canal mass may be present. Facial twitching followed by progressive paresis is very characteristic of these tumors.

Although the principal goal of management is to maximize facial function over the longest period possible in the absence of other symptoms demanding treatment, no clear treatment consensus has been developed because of theinfrequent presentation of these tumors.

Observation has been advocated for tumors inpatients with good facial function without any symptoms resulting from structural compression by the tumor. Tumors may be observed for many years without requiring additional intervention.

Stereotactic radiation has recently been advocated for the treatment of FNS, but studies using this modality are few and long-term follow-up data are still limited.

Surgical resection is the primary method of treatment when cranial neuropathy is noted, and surgical options include FN decompression versus to talor subtotal resection. The FNS can be completely resected while preserving the FN or the FN may require anastomosis, both with variable functional outcomes.

In this talk, current concepts and consensus of management of FN tumor will be discussed. Clinical manifestation and outcomes of 19 cases of FNS and 1 case of glomus faciale surgically-managed in Samsung Medical Center from 1999 to 2015 will be also introduced.

There are 8 men and 12 women, and their mean age was 42.0 years old. In 4 cases, FNS was located only in the IAC without facial palsy, and presented as vestibular schwannoma. Once identified as FNS in the IAC, these tumors should be managed conservatively as possible. Fascicle preservation surgery was not possible in most cases, and facial outcome was better in cases operated earlier after initiation of facial palsy. Based on our experience, early House-Brackmann grade III is the best time point for surgical intervention.

  Technique of endoscopic endonasal Top

Dr. Mohammed Albar

Objectives/Hypothesis: To describe the technique of endoscopic endonasal hemi skull base resection and reconstruction using a single layer of acellular dermal allograft.

To review the perioperative outcomes of patients undergoing hemi-anterior skull base resection at our institution.

To assess postoperative olfaction in patients underwent hemi-anterior skull base resection with preservation of one olfactory apparatus.

Methods: A retrospective chart review in a tertiary medical center of all patients treated for skull base tumors with an endoscopic hemi-anterior skull base resection and reconstruction at our institution.

Results: Seventeen patients were treated from 2008 to 2015, with an endoscopic HASB resection and reconstruction for squamous cell carcinoma (3 patients), adenocarcinoma (2 patients), esthesioneuroblastoma (2 patients), glomangiopericytoma (2 patients), mucosal melanoma (2 patients), sinonasal low grade sarcoma (1 patient), synovial cell sarcoma (1 patient), malignant solitary fibrous tumor (1 patient), fibrosarcoma (1 patient), Ewing sarcoma (1 patient) and one Carcinoma in Situ. Duration of follow-up ranged from 4 to 42 months. Olfaction was assessed in nine patients using the University of Pennsylvania Smell Identification Test (UPSIT) postoperatively. Five patients completed radiation therapy prior to smell identification test. All nine patients had mild microsmia to total anosmia with an UPSIT score ranging from 9 to 32. Two out of the seventeen patients had recurrent disease. One of them had a local recurrence. Reconstruction was performed using a single layer of acellular dermal graft in all patients. One patient required an additional reconstructive layer using a nasoseptal flap for the primary reconstruction of the skull base defect. One patient had a postoperative cerebrospinal fluid leak requiring revision surgery.

Conclusions: We conclude that endoscopic hemi- anterior skull base resection is promising technique to achieve complete oncologic resection and successful defect repair in select patients with unilateral sinonasal tumors. A controlled powered study is necessary to assess the effectiveness of this technique as compared to conventional endoscopic anterior skull base surgery. With preservation of olfaction in one patient only we conclude that postoperative residual olfaction were not favorable (however more than half of the patients underwent radiation).

Level of evidence: 4

  CSF rhinorrhea: our experience Top

Dr. Samy Elwany

CSF leaks are now commonly managed by ENT surgeons alone or in cooperation with neurosurgeons. CSF leaks may be congenital, traumatic, or pathological. Our preferred diagnostic tools include multi-slice CT scans, T2 MRI, and CTA in selected cases. The timing and type of repair varies from case to case. Using our protocol ,we achieved over 95% success rate. Recurrences were almost only confined to cases with high intracranial pressure (benign increase of intracranial pressure). Our experience and some difficult cases will be presented, and some commonly missed complications will be discussed.

  Injury to carotid artery during endonasal surgery Top

Dr. Abdulaziz Alqahtani

Skull base surgery has undergone a remarkable metamorphosis over the past two decades. However, despite the fact that extended endonasal approaches (EEAs) are effective and less invasive than traditional techniques, some surgeons consider that the risk of injury and inability to control or repair, a major vascular injury is a significant surgical limitation. Injury to the ICA and the resultant bleeding may lead to catastrophic complications that include permanent disabilities and death. Therefore, the prevention and management of such an injury is of paramount importance.

There is scant literature regarding the comprehensive management of an ICA injury and hemorrhage. This presentation defines the risk factors that include the anatomical risks, pathological risks as well as the skills and resources related risks to ICA injury during EEAs. The most important preoperative workup is detailed as a checklist along with the intraoperative preparation and protocol to prevent the injury. In addition, perioperative management strategies including post-injury rescue plan are highlighted to yield the best possible outcome in case the ICA is injured. Furthermore, it will suggest a plan of action based on the available literature and the experts opinions.

  Endoscopic approaches to the orbit and optic nerve Top

Dr. Shahzada Ahmad

While several approaches have been described to the orbit and optic nerve, the endoscopic endonasal route is gaining favour because it provides excellent exposure of the optic canal and the orbital apex in a minimally invasive manner. A range of pathologies and also a range of endoscopic approaches to the orbit and optic nerve are discussed with case examples demonstrating the efficacy of this procedure. Endoscopic endonasal orbital and optic nerve surgery is a safe, effective, and minimally invasive technique affording the potential restoration of visual function.

  Systematic approach to evaluate nasal obstruction Top

Dr. Basil hassouneh

This presentation reviews the mucosal and structural factors that affect the nasal airway. It provides a systemic approach though history taking and detailed clinical assessment to reach better understanding of the most responsible etiology for the patient’s symptom. The review will include patient and physician based assessments with clinical examples illustrated with video and photography.

  Paranasal sinuses mucoceles:The expected and the unexpected Top

Dr. Ayman Madani

Objective: To present my experience managing mucoceles over the last 5 years highlighting the limitations of the endoscopic approach and describing some of the difficult cases where combined external and endoscopic approaches were used.

Methods: Retrospective analysis of the clinical characteristics and treatment outcome of 80 patients with paranasal sinus mucoceles managed by the author over a 5 years period. All patients were subjected to thorough history taking, general otolaryngologic examination, nasal endoscopy and preoperative CT scan of the paranasal sinuses. MRI was done whenever indicated to evaluate intracranial and /or intraorbital extension. An ophthalmological examination was carried out in patients with ocular or visual disturbances. Results: The patients were 48 males and 32 females, 6 to 53 years. The clinical presentation consisted mainly of ophthalmological signs and symptoms that reflects the preferential localization of mucoceles in the frontoethmoid complex (52.5%). Seventy two cases were managed solely and successfully via endoscopic means. The remaining 8 cases were managed by external approach alone (4 cases ) or through combined external and endoscopic approaches ( 4 cases). Follow- up ranged between 10 - 60 months. At the last follow up visit, the presenting symptoms resolved completely in 66 patients, improved in 10 patients. Four patients reported persistence of headache which was later diagnosed as migraine.

Conclusion: Our study pointed out the usefulness of the endoscopic approach for both the treatment and follow up of mucoceles. This mini-invasive technique permits accurate drainage and marsipulization of the mucocele with low morbidity, excellent visualization, lack of external incision, and a short hospital stay. Throughout our experience, the endonasal endoscopic approach has proved to be a reliable intervention modality with a favourable long term outcome.

  Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis Top

Dr. Mohammed Farouk Helal

Background: Allergic fungal sinusitis (AFS) was recognized in 1981. Since 1983, a form of sinusitis histologically similar to AFS except for the absence of fungal hyphae has also been noted. The designation “eosinophilic mucin rhinosinusitis (EMRS)” is proposed. Its relationship to AFS is controversial and problematic.

Aim: To determine whether distinctive clinical and immunological differences exist to differentiate the histological entity of EMRS from AFS.

Methods and Result: Patients with histological evidence of allergic mucin, with and without fungus, were identified and retrieved from the surgical pathology files of a tertiary-care institution. The patients were separated into 2 groups for analysis, and their clinical and pathologic findings were reviewed and compared. AFS (n = 13) and EMRS (n = 29) accrued in the present study. A total of 13 AFS patients were compared with 29 EMRS patients. The mean age of patients with AFS was significantly younger than patients with EMRS (30.7 y compared with 48.0 y, respectively; P < .001). Male-to-female ratios were 1.26:1 for AFS and EMRS, and were not significantly different. Forty-one percent of patients with AFS were asthmatic compared with 93% of patients with EMRS (P < .0001). Thirteen percent of patients with AFS were aspirin sensitive compared with 54% of patients with EMRS (P < .0001). Polyp occurrence was almost 100% in both groups. Eighty-four percent of patients with AFS had allergic rhinitis (AR), while only 63% of patients with EMRS had AR (P = .004). Fifty-five percent of AFS patients had bilateral disease, in contrast to the 100% of EMRS patients with bilateral disease (P < .0001). Although average total immunoglobulin E (IgE) was elevated in both groups, it was significantly more elevated in AFS patients (range, 12-13,084 mg/ dL; mean, 1,941 mg/dL) compared with EMRS patients (range, 14-1,162 mg/ dL; mean, 267 mg/dL; P < .001).

Conclusions: Significant clinical and immunological differences exist to distinguish AFS from EMRS. It is postulated that AFS is an allergic response to fungi in predisposed individuals, while EMRS occurs because of a systemic dysregulation of immunological controls.. Fungal immunotherapy following surgical extirpation of AFS is useful in preventing AFS recurrence. It is predicted that fungal immunotherapy and antifungal agents will be ineffective in patients with EMRS.

  Hypoplastic maxillary sinuses Top

Dr. Hesham Hassan

Maxillary sinus hypoplasia is an uncommon pathology of the paranasal sinuses than an ENT doctor might encounter. Radiological evaluation, namely Computed tomography scan, helps in confirming its existence and delineating the presence of any associated anatomical variations that might coexist. Symptomatic maxillary sinus hypoplasia patients with a diseased osteomeatal complex are accepted to carry special diagnostic consideration and therapeutic challenge. In this lecture we aim to present a series of three cases of maxillary sinus hypoplasia which were diagnosed and managed inour department with special light thrown on related literature.

  Crista Galli shift in congenital meningoencephaloceles Top

Dr. Omar Banhawi

The crista galli is a median ridge of bone that projects from the cribriform plate of the ethmoid bone. It is where the falx cerebri attaches anteriorly to the skull. Congenital infantile midline nasal meningoencephaloceles are rare anomalies. They are malformations of the central nervous system caused by a developmental failure in the differentiation of the surface ectoderm and neuroectoderm in the midline subsequent to closure of the neural folds. Defined by the protrusion of brain tissue through an osseous midline defect in the cranium, these lesions are classified according to the location of the skull defect. .In this presentation a series of congenital infantile midline nasal meningoencephaloceles showed evidence of crista galli deviation at the site of origin of congenital meningoencephalocele are presented. This sign will help in diagnosis and determination of the site of protrusion of brain tissue through the skull base defect and its successful reconstruction.

Pituitary apoplexy as a new comer Otorhinolaryngology emergency

Surgery on the pituitary gland is increasingly being performed through an endoscopic approach by rhinologists with neurosurgeons. Hemorrhage and/or infarction of the pituitary gland can occur in the course of pituitary tumor waiting for surgery or after surgery. Classical pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone maybe lifesaving.

It is a clinical syndrome characterised by the sudden onset of headache, vomiting, visual impairment and decreased consciousness caused by haemorrhage and/ or infarction of the pituitary gland. It is associated with the sudden onset of headache accompanied or not by neurological symptoms involving the second, third, fourth and sixth cranial nerves. If diagnosed patients should be referred to a multidisciplinary team comprising, amongst others, of a neurosurgeon and an endocrinologist. In this presentation a series of pituitary apoplexy will be presented to increase awareness of this clinical entity for rhinologists and highlights on its clinical, endocrine and radiological assessment and its management.

Clinical applications of Cone-Beam Computed Tomography in rhinology practice: Cone-beam computed tomography (CBCT) systems have been designed for imaging hard tissues of the maxillofacial region. CBCT is capable of providing sub-millimetre resolution in images of high diagnostic quality, with short scanning times (10-70 seconds) and radiation dosages reportedly up to 15 times lower than those of conventional CT scans. Increasing awareness and availability of this technology provides the rhinologist with an imaging modality capable of providing a 3- dimensional representation of the maxillofacial skeleton with minimal distortion. This presentation provides some Clinical Applications of Cone-Beam Computed Tomography in rhinology practice and reviews the specific application of various CBCT display modes to clinical rhinology practice.

  The value of CT scan of Paranasal sinus in diagnosis of hidden rhinolith Top

Dr. Daifallah Alamri

Rhinolith is uncommon nasal mass, we report a 25 years old lady with a long history of progressive bilateral nasal obstruction and recurrent epistaxis, which was clinically diagnosed as left deviated nasal septum with right hypertrophied inferior turbinate, with help of ct scan paranasal sinus we discovered the presence of large rhinolith in the right nasal cavity ,inside the inferior turbinate

Rhinolith was removed by using 00 rigid nasal endoscope.

This article includes a brief review of the literature.

  Different techniques for the correction of dorsal septal deviation Top

Dr. Mohamed Saad Eldin

In rhinoplasty surgery, we use different techniques for the correction of the Dorsal Bony and Cartilagenous Septal deviation.

Objective: The objective of this study were to describe and compare between five techniques used to correct the dorsal septal deviation bony and cartilagenous parts. Study design: The auther conducted a retrospective clinical chart review in 130 patients the age range from (18-60) years, cases varied between 35 patients underwent septorhinoplasty with close technique, 50 patients with Daniel technique, 55 patient with Dallas technique and 10 cases with toriumi technique. The corresponding author perform all operations over a period of 5 years at the Department of Otorhinolaryngology, Head and Neck Surgery at King Abdullah Medical City, Makkah, Saudi Arabia.

Method: Patient and diseases information were collected retrospectively and analyzed after IRB approval.


– There was subjective improvement in breathing according to the patent satisfaction score in breathing was 85% of close one and 84.5% in all other techniques.This difference was not statistically significan,but in aesthetic point of view with patient satisfaction score the last three techniques give a best resuls than the first two techniques.

– Observation of the dorsal aethetic lines pre and post operative, we observe that in close technique and extracorporial techniques the lines not in an ideal symetry but in daniel, dallas and toriumi techniques the dorsl lines become in an ideal symetry

– The nasolibial angle, in close technique we find no change in the angels pre and post operative, in extracorporial one the angels increased more than the ideal so need revision surgery due to working in a k stone area, but in daniel, dallas and toriumi techniques the angel improved and reach to the ideal range so there a significent difference calculated in our study.

Conclusion: Treatment of dorsal septal deviation may be technicaly challenging and many functional, structural, and esthetical consedration must be taken into accounton the bases of this series both dallas and torumi technique may be consirdered for correction of deviations in this area. The functional improvement in all techniques due to straigttining of the septum and reduction of the turbinate size in most of our patient by laser assiste tuebinoplasty.

  McGill Otolaryngology Head and Neck Fellowship Programs Top

Dr. John Manoukian

The presentation will highlight the different types of McGill Otolaryngology Head and Neck fellowships offered. It will clarify how to apply for these positions. It will describes the process of application, admission and the required documents.

It will mention the different sites of trainig, the responsible fellowships supervisors, the different sites of training, the number of fellows accepted for each type of fellowship together with the duration of training. A general idea for each fellowship pedagogic and clinical duties will be mentioned. The process of evaluation and successful completion of the fellowship for obtaining a McGill Otolaryngology fellowship diploma will be stressed.

  Open Access ENT Training: The ENT Masterclass® Story Top

Dr. Shahid Quraishi

ENT Masterclass® is a novel concept to provide high quality training in Otorhinolaryngology, free at the point of delivery. It is a multimedia-training platform in Otolaryngology and allied fields, delivered by a faculty of National and International repute. The first course took place in January 2005 and was a runaway success. We are now in our twelfth year and the 12th Annual International ENT Masterclass® was held at the Royal College of Surgeons, London (29th-31st Jan 2016).

In addition, a dozen other themed ENT Masterclasses are held covering different aspects of our specialty.

ENT professionals from the UK, Europe, Australia, America, Africa and Asia have attended and benefitted from these intensive Masterclasses.

An International academic bridge was launched in 2014, linking the UK with Masterclasses in Australia, India, China and Europe. The ENT Masterclass® has established itself as a well-recognized international training platform. It is a must for the ENT surgeon’s diary and has an allocation of CPD credit from the Royal College of Surgeons.

  Post Thyroidectomy Hypoparathyroidism a New Look to an Old Problem Top

Dr. Salih Al-Dahri

Post-thyroidectomy hypocalcaemia is the most common procedure complication, with reported incidence between 16.51 and 66.6%.

In this presentation an over view of the history of hypoparathyrodism and the current general practice. The risk factors well be addressed as well as an evidence based protocol for the management.

  • Early post op PTH is a reliable and cheap tool to predict risk of hypocalcemia
  • Pre op PTH, post op PTH % of drop and BMI are a significant factors in post thyroidectomy hypoparathyroidism management
  • The percentage of drop in the PTH level is more accurate than the absolute level of PTH in predicting the possibility of hypocalcaemia and the appropriate therapeutic doses
  • Patients with high BMI will require higher doses of calcium and VitD
  • Doses of Ca and VitD3 should be based on the BMI and the % of PTH drop.

  Nasopharyngeal carcinoma. The next episode Top

Dr. Nabeel Alsafadi

Nasopharyngeal carcinoma (NPC) is a true “success story” in head and neck cancer. Remarkable improvement in outcome especially in locally advanced disease was achieved during the last 25 years. Local control rates exceeding 80% are now achievable even in locally advanced stages. The achievement was attributed originally to the use of concomitant chemo-radiotherapy (CRT) following Al-Sarraf trial and other Asian trial. However, many other factors have significantly contributed to the dramatic change in outcome. Modern radiotherapy techniques (IMRT), modern imaging and staging tools, and better patient selection are all extremely important. We are probably witnessing a second Hodgkin lymphoma story. However, a few important questions remain to be answered. Can we salvage difficult cases notably those with intra-cranial extension? Can we improve the distant control rates in patients with advanced neck stage? Can we control the metastatic disease? Can we identify the patients fit for treatment de-intensification, especially the youngsters? Can we have better control of long-term treatment toxicity? Can we prevent late recurrence? I shall review the present literature with a hint on our own series.

  Oral Squamous Cell Carcinoma and Associated Risk Factors in Jazan, Saudi Arabia: A Hospital Based Case Control Study Top

Dr. Fahad Al Harabi

Background: Oral cancer is the third most common malignancy in Saudi Arabia, the highest incidence of which is reported from Jazan province. The objective of this study was to evaluate the association of various locally used substances, especially shamma, with oral cancer in the Jazan region of Saudi Arabia.

Materials and Methods: A hospital-based case- control study was designed and patient records were scanned for histologically confirmed oral cancer cases. Forty eight patients who were recently diagnosed with oral cancer were selected as cases. Two healthy controls were selected for each observed case and they were matched with age (±5 years) gender and location. Use of different forms of tobacco such as cigarettes, pipe-smoking and shamma (smokeless-tobacco) was assessed. Khat, a commonly used chewing substance in the community was also included. Descriptive analysis was first performed followed by multiple logistic regression (with and without interaction) to derive odds ratios (ORs) and 95% confidence interval (CIs).

Results: Mean age of the study sample (56% males and 44% females) was 65.3 years. Multinomial regression analysis revealed that shamma use increased the odds of developing oral cancer by 29 times (OR=29.3; 10.383.1). Cigarette (OR=6.74; 2.18-20.8) was also seen to have an effect. With the interaction model the odds ratio increased significantly for shamma users (OR=37.2; 12.3-113.2) and cigarette smokers (OR=10.5; 2.883.11). Khat was observed to have negative effect on the disease occurrence when used along with shamma (OR=0.01; 0.00 - 0.65).

Conclusions: We conclude that shamma, a moist form of smokeless tobacco is a major threat for oral cancer occurrence in the Jazan region of Saudi Arabia. This study gives a direction to conduct further longitudinal studies in the region with increased sample size representing the population in order to provide more substantial evidence.

  Altered fractionation in head and neck cancer radiotherapy. The pendulum is swinging back Top

Dr. Nabeel Asafadi

Altered fractionation radiotherapy (AFRT) gained significant popularity in the 80s and early 90s after the publication of several randomized clinical trials (RCTs) comparing AFRT to standard fractionation (SFRT) in locally advanced head and neck cancer (LAHNC). This was followed by the publication of an important meta-analysis establishing AFRT as superior to SFRT in terms of local control and overall survival (OS). The following years witnessed the emergence of concomitant chemo-radiation (CRT) as treatment of choice in LAHNC, yielding encouraging early results with doubling of local control rates and an absolute 8% improvement of OS when compared to SFRT alone. The popularity of AFRT therefore declined steadily especially when considering the associated logistic issues. However, CRT was never properly tested against AFRT in RCTs. Using indirect comparison, the results are comparable especially for the hyperfractionation regimen. The latter has the advantage of less late toxicity. In the following presentation, I shall review the potential role of AFRT in LAHNC in light of the recently published trials notably from the RTOG 9003.

  Benign Salivary Gland Disease Top

Dr. Nigel Beasley

Benign salivary gland disease usually presents as pain and or swelling of one or more salivary glands. The differential diagnosis is often wide and determining the underlying cause of the problem may be difficult. I will describe a structured approach to differentiate between different causes of benign salivary disease. These include benign neoplasia, congenital conditions, autoimmune disease, infectious and idiopathic disease. I will look at the value of blood tests, ultrasound, sialography and MRI imaging plus newer techniques such as sialendoscopy. I will describe alarm symptoms to different benign from malignant disease. Having explored the underlying cause of benign salivary gland disease I will describe both surgical and non surgical treatment options. At the end of the presentation delegates should be able to describe a structured approach the diagnosis and treatment of benign salivary gland disease.

  Salvage Total Laryngectomy Top

Dr. Lobna Al Fikky

In the era of organ preservation protocols, chemoradiotherapy (CRT) have largely taken over the management of advanced Laryngeal carcinoma over primary total laryngectomy followed by radiotherapy. This made a shift to salvage total laryngectomy for those who fail this line of treatment. Salvage laryngectomy is always dreaded with high morbidity and complications due to bad healing following initial treatment. In this work we expose the percentage of complications occurrence during salvage surgery, the relation to predisposing factors, the ominous signs for occurrence of complications. Recommendations to be followed in cases of salvage laryngectomy are highlighted.

  Oral cavity Reconstruction Top

Dr. Hani Z. Marzouki

Traditionally, tobacco and alcohol use have subscribed to be the primary risk factors for squamous cell carcinomas (SCC) of the oral cavity. Although the cure of cancer is the fundamental goal in treating these cancer patients, their functional and quality of life (QOL) outcomes are becoming a primary concern of the patients and the health care providers. The issue of these outcomes after surgical treatment has received considerable critical attention. Studies have reported an excellent functions and quality of life after surgical resection and reconstruction with free flaps.

Methods of reconstruction of the oral cavity are composed of a wide range of techniques ranging from a simple skin primary closure or skin graft to a more complex reconstruction using soft tissue and or boney free flaps.

The purpose of this presentation is to go over the different methods of oral cavity reconstruction, to describe the beavertail modification of the radial forearm-free flap in oral tongue reconstruction and to discuss the digitally planned Contemporary Jaw Reconstruction and its different approaches.

  Skull Base Reconstruction after tumour extirpation Top

Dr. Mansour Aseeri

Skull base reconstruction is an important step in managing patients with skull base tumors. The defect can involve the dura, bone, skin and other parts of the adjacent craniofacial structures . The objectives of this reconstruction are not much different from other head and neck reconstructions namely to close the defect, prevent possible complications from that specific defect and improve cosmesis. It is needless to emphasis that the reconstructive options and aspects should be incorporated in the initial plan of tumor resection.

The following clinical cases involved different defects of the anterior and lateral skull bases. Some of the defects also involve the other adjacent nearby structures. The reconstructive options involved local , regional but mostly free tissue transfer.

  Pharyngeal reconstruction for advanced laryngopharyngeal cancer Top

Dr. Ahmed Tantawi

Hypopharyngeal carcinomas present late, and is associated with lymph node metastasis due to rich lymphatic network in the sub mucosal tissue.

The poor prognosis of Hypopharyngeal cancers compel the surgeon to choose a technique which allows wide resection associated with a reconstructive procedure to assure prompt restoration of physiological functions, low morbidity and short hospital stay.

Different methods of reconstruction are discussed with special emphasis on gastric transposition technique.

  The Posterior Tibial Artery Perforator Flap in Head &Neck Reconstruction. Case Series and Review of Literature Top

Dr. Mansour Aseeri

The Posterior Tibial Artery (PTA) Perforator flap is relatively a newly described flap for head and neck reconstruction. It is based on perforator/s from the posterior tibial artery. It can provide pliable skin for different reconstructive options for the head and neck defects. In this article , this flap was used successfully in four cases. The pros and cons of this flap is discussed.

  Effect of thermal stimulation on temporal measures in patients with neurogenic oropharyngeal dysphagia post cerebrovascular stroke Top

Dr. Mohammed Farahat

Background/Objective: Thermal stimulation is considered one of the behavioral therapy that is used to improve and facilitate swallowing mechanism in patients with oropharyngeal dysphagia. The aim of this work was to study the effect of thermal stimulation on different temporal measures of oropharyngeal swallowing in patients with oropharyngeal dysphagia post cerebrovascular stroke.

Materials and methods: In this study, thermal stimulation was applied on 23 patients with affected temporal measures (prolonged pharyngeal delay time and pharyngeal transit time) in patients with oropharyngeal dysphagia post cerebrovascular stroke.

Results: There was significant statistical difference in pharyngeal delay time pre-thermal stimulation from post-thermal stimulation for all the tested consistencies except thin liquid consistency and significant difference of the pharyngeal transit time only with solid consistency.

Conclusion: The results of this study proved the effectiveness of thermal stimulation in improving the affected changes on temporal measures that occurred with certain consistencies in patients with oropharyngeal dysphagia post cerebrovascular stroke.

Key words: Dysphagia, thermal stimulation, temporal measures, videofluoroscopy

  Voice problems in laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring Top

Dr. Tamer Mesallam

Background and Objectives: There is a lack of consensus regarding the clinical presentation and diagnosis of laryngopharyngeal reflux (LPR). The aim of this study was to explore voice-related abnormalities in a group of LPR patients, diagnosed with a 24-hour oropharyngeal pH monitoring.

Patients and Methods: Eighty-two patients with voice- related problems participated in the study. Diagnosis of LPR was made using a 24-hour oropharyngeal pH monitoring. Patients were divided accordingly into positive and negative pH groups. Comparisons between the two groups were done, including results of clinical presentation, Voice Handicap Index-10 (VHI- 10), reflux symptom index (RSI), reflux finding score (RFS), and acoustic measurements. The correlation was conducted between Ryan scores and other variables including VHI-10, RSI, and RFS.

Results: Significant differences were found between the two groups for RSI and VHI-10. No significant differences were found between the two groups regarding clinical presentation, RFS or acoustic measures. Significant positive correlations were found be- tween the Ryan composite measurements and both severity ratings (VHI-10, RSI).

Conclusion: LPR clinical presentation appears to be non-specific in terms of symptoms and laryngeal findings. LPR appears to have an effect on the patients’ self-perception of voice problems. Further studies are needed to clarify the effect of LPR on acoustic measurements.

  The Jordanian expressive vocabulary test study Top

Dr. Yaser Al Sabi

This study examined the accuracy in measuring language through a new expressive vocabulary test, the Jordanian Expressive Vocabulary test (JEVT), for Jordanian Arabic speaking children between the ages of 3:0 and 5:11 (years: months). Two hundred and fifty five normal children were randomly selected from the city of Irbid, Jordan. The research study was descriptive with between-subject design. Items selected for the initial version of the JEVT were reviewed and validated by 10 teachers, 10 parents and four speech-language pathologists. The word validation results revealed an agreement rate of 100% among reviewers, and 86% consensus on the pictures selected. A pilot study was conducted to validate the items selected for the study. The two-way ANOVA of Variance (F) test was used to analyze the data. The results indicated significant differences in the performance of the participants on the JEVT in the three cohort groups (3:0-3:11, 4:0-4:11, and 5:0-5:11). Significant differences were found in the scores of boys and girls in the 3:0-3:11 age group and the scores of boys and girls in the other two age groups However, no significant differences between boys and girls aged 3:0-3:11 years and boys and girls aged 4:04:11 years. The performance of boys and girls in the 4:0-4:11 age group was statistically significant when compared with the performance of boys and girls in the 3:0-3:11 age group, however, no significance was found when compared with the performance of boys and girls in the 5:0-5:11 age group. Results further showed significant differences between the performance of boys and girls in the 5:0-5:11 and the performance of boys and girls in the 3:0-3:11 and 4:0-4:11 age groups. Results showed that the JEVT exhibited a high degree of validity and reliability. Participants from urban areas scored higher than participants from rural areas. Significant differences were found between fathers and mothers with high or elementary school education and fathers with B.A degrees. No significance was found between fathers or mothers holding B.A. degrees and fathers or mothers holding Ph.D. The administration time of the JEVT was calculated and found to be relatively short.

  Voice restoration after total laryngectomy Top

Dr. Hatem Ezzeldin

Despite advances in conservative laryngeal surgery and radiotherapy, total laryngectomy still remains the procedure of choice for advanced-stage laryngeal carcinoma.

The functional rehabilitation of the laryngectomized patients has been a concern of head and neck surgeons and speech Pathologist.

At present time, there are different methods of alaryngeal speech:

  1. Oesophageal speech: In this method air is swallowed into the cervical oesophagus. This swallowed air is immediately expelled out causing vibrations of pharyngeal mucosa. The produced sound is then resonated and articulated into speech output.
  2. Artificial larynx: either electric or pneumatic types can be used when esophageal speech failed.
  3. Tracheo-esophageal puncture & voice prosthesis: one-way valve in which voice prosthesis is inserted into a surgically created, midline fistula between trachea and esophagus. Tracheoesophageal speech is produced when the force of expired air entering the esophagus from the trachea causes the pharyngoesophageal membranes to vibrate.

  Feeding issues in cleft lip and palate babies Top

Mrs. Sanaa Almane

Reports of feeding difficulties, as a result of cleft lip and palate in babies, date back to early as 1619. It was recognized when children with a cleft lip, cleft palate, or a combined cleft lip and palate were unable to adequately suck and often died of malnutrition. It is estimated that there is one in every 750 to 1000 live births has a cleft lip with or without cleft palate. Proper nutrition and growth is highly needed for these babies so they can tolerate the surgeries needed for the repair.

Care providers and parents should be well educated about the special needs these babies require during the first month of their lives. This presentation will highlight the best Feeding utensils and positions to use with the Cleft lip and palate babies. A Multidisciplinary team is highly required to provide the proper care needed for these babies, the team would include and not limited to Pediatricians, Nurses, Dietitians , Plastic surgeons, ENT and GI doctors and Speech therapists.

  Modified Voice Therapy Technique for Successful Management of Functional Aphonia, the experience of a Tertiary Health Care Center in Makkah, Saudi Arabia Top

Dr. Ali Abualyon

Background: Aphonia is acute sudden voice loss; it is a rather rare disorder with a point prevalence of 0.4%, it is more frequently in females than in males. A characteristic of functional aphonia that phonations of a nonverbal type, such as coughing, throat clearing, and crying, usually remain intact, while all voluntary speech attempts are characterized by a whisper.

Objective: Report the experience of a tertiary care center in Makkah, Saudi Arabia in managing cases of functional aphonia.

Subjects & Methodology: 14 cases managed in the period from March 2011 to June 2015 in the Phoniatrics outpatient clinics at King Abdulla Medical City (KAMC) in Holy Makkah, Saudi Arabia diagnosed as functional aphonia and managed by modified voice therapy technique.

Results: The majority of patients were females 85.7% and males were 14.3% with success rate of the procedure of management was 100%.

Conclusion: Using the non phonatory function of vocal folds in modified way by experienced therapist leading to recovery of voice regardless the period of aphonia.

  Prevalence and Risk Factors of Voice Disorders Among The Attendants of Speech and Language Clinic at King Abdulaziz Medical City Top

Dr. FerasAlkholaiwi

This study examined the prevalence and risk factors of voice disorders in all patients whom attended the speech and language clinic. We reviewed 2508 patients’ charts but we included only 998 charts in our data analysis, we excluded patient based on repeated files, incomplete data and out of the intended study period i.e. 2007 - 2013.

The result of the study showed:

- Gender was almost evenly distributed in the sample.

- The majority of the sample were non-smokers.

- 45.7% of the sample are employed.

- The three top diagnoses were (Gastro-esophageal reflux disease 43.49%, Vocal fold cyst 11.824%, Vocal fold paralysis 10.32%).

- The overall prevalence of voice disorder accounted for 37.37%.

- The prevalence of Voice disorder showed significant difference between genders (P-value= 0.0007) and between different age groups (P-value= < 0.0001).

  Surgical management of velopharyngeal insufficiency Top

Dr. Mosaad Abdel-Aziz

Purpose: Velopharyngeal insufficiency (VPI) is a common problem especially after cleft palate repair; it causes hypernasal speech with its consequent problems. Hypernasality can render a child’s speech unintelligible and can affect communication. Children with hyper- nasal speech are often considered less intelligent, less pleasant, and less attractive. Such perceptions can seriously affect the social life of children. Secondary corrective surgery may be needed to treat this condition. The study aims to give guidelines for evaluation and treatment of patients with VPI.

Methods: Evaluation tools include auditory perceptual assessment (APA) of speech, nasometry, and flexible nasopharyngoscopy. Different surgical options have been discussed, including posterior pharyngeal flap, sphincter pharyngoplasty, Furlow palatoplasty, palatal re-repair, and posterior pharyngeal wall augmentation. Surgical procedure was selected according to the type of velopharyngeal closure pattern.

Results: High success rate was obtained for velopharyngeal function, with improvement of speech, nasalance score, and velopharyngeal closure.

Conclusions: To optimize the surgical results, the procedure selected for treatment should be tailored to the preoperative velopharyngeal closure pattern.

  Flexible Nasolarygoscopy in Pediatric Laryngology Top

Prof. Ashraf Abuelezz

Flexible nasolaryngoscopy was performed on 67 infants and children suffering from stridor and/ or dysphonia. Endoscopic evaluation and video documentation revealed that distribution of cases was as followed: Laryngomalacia (18 cases), Laryngeal web (7 cases), Vocal fold paralysis (6 cases), Multiple laryngeal papillomatosis (3 cases), Transient spasm of the vocal fold (3 cases), Vocal fold oedema (2 cases), Subglottic narrowing (1 case), Wegener’s granuloma (1 case), and Chronic habitual childhood dysphonia with development of vocal nodules (21 cases). No findings despite positive history were encountered in 5 cases. Flexible nasolaryngoscopy proved to be helpful and harmless in pediatric laryngology

  Auditory Processing Training: A New Approach in Rehabilitation of Pediatric Cochlear Implant Recipients Top

Dr. SomiaTawfik

Background: Most of the auditory training programs designed for children following cochlear implantation (CI) focused on sound pitch and loudness discrimination. Training on other auditory processing abilities in CI children gained less attention.

Purpose: This study was designed to explore the value of applying auditory training programs targeting both temporal processing and phonemic awareness abilities in the post-operative rehabilitation of these children.

Method: Arabic computer-based auditory training(A- CBAT) programs developed at the Audiology unit, Ain Shams University were applied on 33 children using Nucleus 24 CIwho used their devices for at least one year. All children received hospital-based 30 minutes sessions A-CBAT twice/week for a period of three months.

Results: Showed that the A-CBAT programs were successfully applied on 25 children. Following training, there was significant improvement in the Arabic version of MAIS questionnaire, Arabic speech perception tests (Elkholi et al, 2001) andauditory fusion test (McCroskey & Keith, 1996) which measures temporal processing. The neuro-plastic changes following remediation was documented electro-physiologically by increased mismatch negativity (MMN) amplitude. Such improvement was retained for a period of 6 months up to two years post-training. However, there was no significant change in the Arabic language test scores.

Conclusion: This study supports the inclusion of computer-based training on temporal and phonemic abilities in CI recipients. Long-term studies are needed to monitor the possible positive impact of such training on speech and language development when applying in conjunction with regular rehabilitation programs.

  27 years’ experience with Oto-acoustic emission (Kemp’s Echoes) Top

Dr. Mohamed Shabana

During the last thirty years, a lot of innovations had been carried out in oto-acoustic emission instrumentation, owing to the computer technology and software application. Due to the minute signals detected from the inner ear in response to sound, which called oto- acoustic emission and defined as energy by-products of healthy functioning Cochlea, give the clinician a genius objective test in the audiological science.

Now oto-acoustic emission test is an integral part in hearing screening and diagnosing diseases like auditory neuropathy. Also, clinical applications using combo system having both evoked potentials and oto acoustic emission have a big credibility in hearing evaluation.


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