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   Table of Contents - Current issue
Coverpage
January-March 2022
Volume 24 | Issue 1
Page Nos. 1-50

Online since Wednesday, March 30, 2022

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ORIGINAL ARTICLES  

Prevalence and clinical features of deviated nasal septum in the pediatric age group in Najran Region, Saudi Arabia p. 1
Alshehri , Ali Abdullah
DOI:10.4103/sjoh.sjoh_37_21  
Background: The aim of this study is to evaluate the prevalence and clinical features of deviated nasal septum (DNS) among children under 14 years of age from the Najran region of Saudi Arabia. Materials and Methods: One thousand six hundred and eighty-one patients under 14 years of age were evaluated for DNS. They were divided into five age subgroups of <28 days, 29 days-3 years, 3–6 years, 6–12 years, and 12–14 years. The type of DNS according to Guyuron's classification and associated clinical features were recorded for each patient. Results: Nine hundred and ninety-one (59%) pediatric patients had DNS. Most DNS was found in the 12–14 years group (41%) and least in the <28 days group (9%). Class 1 DNS was maximum in the overall sample, <28 days and 29 days-3 years group. Class 2 DNS was maximum in 3–6 years and 6–12 years group. Class 6 DNS was maximum in the 12–14 years group. Statistically significant difference (P < 0.05) was found between <28 days and 6–12 years, <28 days to 12–14 years, 29 days-3 years to 12–14 years, and 3–6 years to 12–14 years age groups. Clinically in the overall sample, 66.3% had nasal obstruction, 35.6% had nasal discharge, 30.4% had external deformity, 15.5% had rhinitis, 12.6% had pain or headache, 12.34% had sore throat, and 11.6% had snoring. Conclusion: We found that 59% of the pediatric Najran population has DNS. Class I is the most common deformity and the incidence of DNS increases with age. Nasal obstruction and nasal discharge are the most common clinical features associated with DNS.
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Impact of the COVID-19 pandemic on otolaryngology – Head-and-neck surgery residency training p. 6
Abdulaziz Saad Alhammad, Dhaifallah S Mulafikh, Saad A Alsaleh
DOI:10.4103/sjoh.sjoh_48_21  
Context: The novel coronavirus disease (COVID-19) has swept globally, leading to a crisis that affects all aspects of human life. Aims: This study aimed to investigate the impact of COVID-19 on otolaryngology-head-and-neck surgery (ORL-HNS) residency training in Saudi Arabia and assess the study habits of residents during the pandemic and the impact of COVID-19 on training. Settings and Design: This was a cross-sectional quantitative study that utilized a 36-item questionnaire, investigating demographic data, study habits during the pandemic, clinical involvement in various training domains before and during the pandemic, and COVID-19-related exposure and training. Subjects and Methods: The questionnaire was sent to all ORL-HNS residents in Saudi Arabia via email, except those in their first year of residency. Statistical Analysis Used: A Wilcoxon signed-rank test was performed to assess the difference in clinical involvement before and during the pandemic. Results: A total of 165 residents participated in this study (response rate = 72.7%). A statistically significant decrease in clinical involvement from before to during the pandemic was noted in all training domains, including the average number of emergency consultations during on-call duty, outpatient clinics, in-office diagnostic procedures, and operative procedures for oto-neurotology, rhinology and skull base, head and neck, pediatric and airway, and facial plastic. However, an increase in the consultation via telemedicine was apparent during the pandemic in comparison to before. Conclusion: The COVID-19 pandemic has affected ORL-HNS residency training considerably. We recommend implementing alternative didactic strategies to mitigate the decreased exposure of residents to ORL-HNS clinical training.
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Assessment of functional and esthetic outcomes of external approach septorhinoplasty with spreader graft in North India p. 12
Sabarirajan Ponnusamy, Sandeep Trehan, Himani Lade, Rohit Bhardwaj
DOI:10.4103/sjoh.sjoh_31_21  
Introduction: Rhinoplasty is one of the most commonly performed facial plastic surgeries. Esthetic rhinoplasty can be exclusively esthetic or for both functional and esthetic concerns combined. The spreader graft can be used as a spacer where a patient with nasal obstruction who is also having external nasal deformity can be benefitted in both the areas. Objectives: The objective is to assess the functional and esthetic outcomes pre- and post-operatively in patients undergoing external approach rhinoplasty with spreader grafting. Methodology: Thirty patients were included in the study. Internal valve collapse was confirmed by modified Cottle's maneuver and diagnostic nasal endoscopy. All surgeries were done using an external approach under general anesthesia. Pre- and post-operative nasal obstruction symptom evaluation (NOSE) and rhinoplasty outcome evaluation (ROE) score were taken. Results: The preoperative NOSE score average was 64.5. After 3 months of postoperative follow-up, the NOSE score reduced to a mean value of 11.83. The preoperative ROE score average was 6.73. Postoperative ROE score improved to a mean value of 18.83. Conclusion: Rhinoplasty is a delicate, skill demanding surgical procedure which, when done along with a spreader graft will be beneficial both functionally and cosmetically in patients with external nasal deformity with obstruction symptoms. Comparison of esthetic and functional results could be done further in future studies which will provide further inputs in the field of rhinoplasty.
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Basal cell carcinoma and its burden on sudanese patients p. 17
Safi Eldin E. Ali, Hamadnalla Sir El Khatim, Shiraz Elnur, Saad. M Asiri, Sami Fatehi Abdalla Billal
DOI:10.4103/sjoh.sjoh_46_21  
Background: Basal cell carcinoma (BCC) is the most frequent malignant tumor in dermatology. The burden of advanced BCC is not fully understood and was not well studied in Sudan. Objective: The objectives of this work were to study the BCC disease characteristics, burden, and morbidity on a group of Sudanese patients. Patients and Methods: This is a retrospective, hospital-based study of patients' records presented to the Military Dermatology Hospital and diagnosed with BCC. The study period was 2012–2017. Results: Our team identified a total number of 27 patients to have BCC. 15 (55.6%) were males and 12 (44.4%) were females. The mean age was 54 years (with a range of 26–75 years). The site of the location of the lesions was mostly the face in 22 (81.5%), face and extremities in 4 (14.8%) patients, and in only one (3.7%) patient, it was on the abdomen. The face distribution includes the forehead (14.5%), periocular (18.5%), nose (18.5%), nose, mouth, and cheek (7.4%). The clinical presentation of the lesions includes pigmentation (70.4%), ulcers (63%), plaques (55.6%), nodules (40.7%), scars (11.1%), and deformity associated with advanced BCC in (48.2%) of the patients. The associated comorbidities were (11.1%), albinism (11.1%), and basal cell nevus syndrome (BCNS) (3.7%). Concerning the outcome and prognosis, 11 (40.7%) had a good prognosis and 16 (59.3%) had a bad prognosis. Conclusions: BCC has similar epidemiological and clinical presentation as many international studies with younger age incidence. Delay presentation results in local disease advancement and increases severity and burden. This bad burden could be attributed to inadequate health facilities.
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The public awareness of protruding ears and its management in Saudi Arabia p. 22
Badi Aldosari, Mohammed Khan, Mohammed Alkarzae, Atheer Abdulaziz Alzubaidi, Johara Abdulkarim, Bayan Alsharif
DOI:10.4103/sjoh.sjoh_49_21  
Background: Protruding ears are a well-known auricular deformity characterized by dominant autosomal inheritance A corrective surgery for protruding ears was developed with positive postoperative outcome. Currently, there has been no research conducted in Saudi Arabia to assess the public's awareness of protruding ears and its management. Materials and Methods: This observational cross-sectional study of 1002 participants distributed through electronic questionnaire in the Arabic language. By taking advantage of social media, the study represents the population in different regions. It was used to estimate the awareness of protruding ears among the public in Saudi Arabia. Results: 42.7% of the participants were aware of protruding ears. The most common sources of awareness were the Internet (37.4%), social media (33.2%), and brochures/scientific journals (17.6%). Awareness about protruding ears was observed more among participants working in a medical field than those working in a nonmedical field (58.9% vs. 34.6%, P < 0.001). Most of the participants who were aware of the protruding ears (70.6%) were aware of the cosmetic surgery option to repair protruding ears. The Internet (41.3%) and social media (37.1%) were the most reported sources of hearing about cosmetic surgery for repair of protruding ears. The majority of who had heard of the cosmetic surgery were working in the medical field (82.3%). Conclusions: Our study is the first to demonstrate the public awareness about protruding ears and its management. The results showed that there is a lack of awareness about the disorder and its management in Saudi Arabia. We recommend increasing the efforts to raise the awareness in the population.
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Ear-related problems among headphone users in the Kingdom of Saudi Arabia p. 27
M Sattam Aljuaid, Hazem Khairan Althobaiti, S Hamoud Alotaibi, Abdulhameed Fouad Sarriyah, Mohammed Abdullah Alsuwat, H Eyad Alfaqih, Rakan Fiasel Mohammed Almnjwami
DOI:10.4103/sjoh.sjoh_50_21  
Background and Objectives: The middle ear cleft and the tympanum inflammation are defined as otitis media. The patient's use of headphones has been linked to aural hygiene issues and ear canal infections. Interestingly, there are not enough studies discussing the hazardous effects of prolonged use of headphones. This study aims to estimate the prevalence of ear infection among headphone users. Materials and Methodology: A cross-sectional study was conducted between February 2021 and December 2021 among 435 Saudi participants through a pretested questionnaire that was published using an online-based (electronic) form. The questionnaire included items related to pattern of hearing devices used among them and ear-related problems. This study includes all persons using earphones in the Kingdom of Saudi Arabia whose native language is Arabic. Results: Experiencing ear-related problems is statistically significantly correlated with ear infection (P = 0.000), using both ears (P = 0.000), female gender (P = 0.009), being a student (P = 0.003), using the hearing device >120 min/day (P = 0.015); however, it is not statistically correlated with age, type of residency, or the type of device being used (P > 0.05). Conclusion: Increased usage of hearing devices and prolonged time of use can have detrimental effects on ear problems. These possible effects are statistically significantly correlated with young age, female gender, being a student, using the device for more than 120 min/day, using the device for more than 4 years, or having chronic diseases in the past.
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Endoscopic treatment of rhinogenic contact point headache-our experiences at a tertiary care teaching hospital of Eastern India p. 35
Santosh Kumar Swain, Rohit Agrawala
DOI:10.4103/sjoh.sjoh_4_22  
Background: Headache is a universal clinical presentation in the course of everyone's life. In Rhinogenic contact point headache (RCPH), intranasal mucosal contact points are seen between the opposing mucosal surface of the nasal septum and turbinates of the lateral wall of the nasal cavity. Objective: To study the details of endoscopic treatment of RCPH and its effectiveness to relieve headache. Materials and Methods: There were 68 patients of RCPH who participated in this prospective study. The mucosal contact points inside the nasal cavity were excised by the endoscopic approach under general anesthesia. The olfactory mucosal lining was protected from injury during this surgical process. P < 0.05 were considered statistically significant. Results: Out of 68 patients with RCPH participated in this study with 38 (55.88%) males and 30 (44.11%) females with a male-to-female ratio of 1.26:1. All patients underwent endoscopic excision of the intranasal mucosal contact points. After 3 months of endoscopic excision of the intranasal mucosal contact points, the symptoms disappeared in 52 (76.47%) patients, and significantly improved in 13 (19.1%) patients. Only 3 (4.41%) patients did not show obvious improvement. Satisfactory results were archived by endonasal excision of the mucosal contact points in 65 (95.58%) patients with RCPH. Conclusion: RCPH is an important cause of headache. Endoscopic surgical excision of the intranasal mucosal contact points in patients of RCPH is useful to relieve headache effectively.
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Association between intraoperative nerve monitoring and the duration of thyroid surgery: A tertiary care center experience p. 40
Hani Z Marzouki, Ammar Ali Alasmari, Fahad Saad Alsallum, Mohammad Alzahrani, Majed Alharbi, Faisal Zawawi, Amani Alhozali, Mazin Merdad, Shaza Samargandy
DOI:10.4103/sjoh.sjoh_5_22  
Background: Recurrent laryngeal nerve (RLN) injury is one of the serious complications of thyroid surgeries, which has been a topic of medicolegal concern. Although the course of the nerve can vary between patients, RLN visualization has been the gold standard method for identifying the nerve intraoperatively. However, over recent years, intraoperative nerve monitoring (IONM) has gained more acceptance and has been standardized and utilized, in addition to visual nerve identification, in many thyroids and parathyroid surgery centers. In this study, we aim to determine the association between the use of nerve integrity monitoring systems and the duration of thyroid surgery. Materials and Methods: This is a retrospective chart review, conducted at hospital in Jeddah, Saudi Arabia. We included all patients who underwent thyroid surgery during the period between 2014 and 2019, with no exclusion criteria. We studied variables including duration of surgery, preoperative assessment, diagnosis, surgical procedure, use of IONM, and comorbidities. Results: A total of 236 patients were included, of which 69 (29.2%) cases used IONM. The mean duration of all surgeries was 179.95 ± 96.9 min, whereas the mean duration of surgeries using IONM only was 214.39 min, compared to 165.72 min of surgeries without IONM, which reveals a statistically significant association between the use of nerve monitoring and an increase in the duration of surgery (P ≤0.002). Conclusion: IONM utilization in thyroid surgeries was associated with a longer duration of surgery. However, more studies are required to support this result.
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Ultrasound features and estimated risk of malignancy in thyroid nodules p. 44
Aseel O Doubi, Nouf H Alshammari, Reenad Hussain Bedaiwi, Ali Mohammad Alshdokhi, Dana Aljomah, Ahmad Albosaily, Saleh Aldhahri
DOI:10.4103/sjoh.sjoh_8_22  
Introduction: A significant uncertainty surrounding the diagnostic accuracy of ultrasound (US) and the risk features in thyroid nodules exist to date which impacts clinical practice and guidelines. Methods: This retrospective descriptive observational study included patients with thyroid nodules with US reports over 10 years and either had a fine-needle aspiration (FNA) cytology result, a pathology report or both. Results: A total of 483 patients were included. Most of the patients were <55 years old (67.3%) and the majority of them were females (91.3%). The FNA cytology results indicated that 311 (64.4%) of the thyroid nodules were benign and 32 (6.6%) were malignant. Overall, only 181 (37.5%) of the patients had a final histopathologic assessment; of these, 80 (44.2%) had malignant thyroid nodules, 78 (43.1%) had benign nodules, and 23 (12.7%) had microcarcinoma. multivariate logistic regression analysis revealed that having US features of hypoechogenicity (adjusted odd ratio 3.37; 95% confidence interval [CI] 1.03–11.00) and a microlobulated or irregular margin (aOR 3.65; 95% [CI] 1.13–11.79) were the only sonographic characteristics that had a statistically significant association with thyroid cancer based on final pathology. Conclusion: Thyroid nodules showing hypoechogenic echogenicity and microlobulated or irregular margin on US need to be closely followed and given the appropriate management based on their risk criteria.
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