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   Table of Contents - Current issue
July-September 2021
Volume 23 | Issue 3
Page Nos. 91-126

Online since Tuesday, October 5, 2021

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Pathophysiology of skull base defects and cerebrospinal fluid leak p. 91
Saud Romaih Alromaih
Cerebrospinal fluid (CSF) leak is a rare pathology with many etiologies. It can be spontaneous, congenital, iatrogenic, or traumatic [Figure 1]. A skull base defect may occur along the anterior or lateral skull base manifesting as CSF rhinorrhea or CSF otorrhea. It occurs whenever there is a mucosal, bony, and dural defect. These defects could lead to communication between the nasal cavity, the paranasal sinuses, or the middle ear cavity and the subarachnoid space. Idiopathic intracranial hypertension (IIH), obesity, obstructive sleep apnea (OSA), and malignancies are well-known conditions that contribute to the development of a CSF leak (1). In this article, we review the pathophysiology of each etiology.
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Viability of ambulatory major ear surgery and patient satisfaction p. 95
Mudy Alafaleq, Salma Alafaleq, Musaed Alzahrani
Background: Ambulatory ear surgery is expanding worldwide due to improvements in surgeries, and this has had a highly positive impact on both hospital and patient satisfaction. However, ambulatory major ear surgery remains controversial in our region due to a lack of research, which motivated us to conduct this study. The purpose of the research is to assess the safety of ambulatory major ear surgery and elaborate on the patient satisfaction rate. Methods: To assess complications, the readmission rate, and patient satisfaction with ambulatory major ear surgery, a prospective study of all such surgeries on pediatric and adult patients in a 1-year period in a tertiary hospital was carried out. Results: A total of 47 patients underwent ambulatory major ear surgery, and the results indicated an 89.4% discharge rate and 10.6% readmission rate, as well as high patient satisfaction. Conclusion: Our study showed a rather low complication rate and high patient satisfaction rate with ambulatory major ear surgery. This should encourage other hospitals in the Kingdom of Saudi Arabia to apply ambulatory ear surgery.
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The COVID-19 and its impact on otolaryngology trainees' competency and their psychological well-being: A nationwide cross-sectional study p. 100
Salma Saud AlSharhan, Mohammed H Al Bar, Abdulmalik S AlSaied, Abdulaziz S ALEnazi, Hussain Jwad Aljubran, Saud K AlKhaldi, Amal A Alghamdi
Background: As a consequence of the COVID-19 global pandemic, otolaryngology residents are at high risk due to the nature of the specialty and long work hours. Moreover, COVID-19 could have a severe impact on residents from different frontline specialties, particularly otolaryngology. To the best of our knowledge, this is the first nationwide survey providing insights into the otolaryngology residents' prospective of view about the impact of COVID-19 on their training competency development as well as related worries and concerns. Methods: A cross-sectional questionnaire-based study was conducted among all otolaryngology training centers of Saudi Arabia to investigate the extent of the impact of COVID-19 on otolaryngology residents and the learning process. Results: A total of 152 residents were contacted to participate in the study, and 101 participants were included after successfully completing the questionnaire. The mean age of the participants was 28.12 years (standard deviation = 1.89, max = 36, min = 25). There has been a significant impact on outpatient clinics, elective operations, consultations, and working hours. Further, we evaluated the impact on academic training activities, the frequency of training activities per week, and the psychological impact of the COVID-19 pandemic on otolaryngology residents as well. Conclusion: COVID-19 has had a serious impact on residents both physically and mentally; otolaryngology residents have been hit, especially hard by this emergency pandemic period. Trainees suffered from excessive worries regarding clinical training, specifically academic concerns for different training levels. Further studies need to be done here in Saudi Arabia to evaluate this impact in greater detail and to protect the residents.
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Bone marrow failure disease and head-and-neck squamous cell carcinoma in king faisal specialist hospital and research center in Riyadh p. 107
Alaeddin Jebreel, Rawan Salem Alayed, Rahaf M Bashar Al-Soufi, Rana Hani Farahat
Objective: This study aims to look at bone marrow failure disease patients who presented to our center, as to analyze the presentation and possible ways to improve the survival outcome in these cases. Methods: This was a retrospective chart review study. Results: In our series, most of the head-and-neck squamous cell carcinomas (HNSCCs) were found in Fanconi anemia (FA) patients, and most are located within the oral cavity, most frequently at the tongue margins and the gingival areas. These tumors arise in both male and female bone marrow failure disease patients without a prior history of excessive tobacco and alcohol use. Even if a patient presents at an early stage, there are frequent relapses. The highly aggressive nature of the tumors is reflected by poor survival, amounting to <2 years. FA is a rare but well-studied inherited disorder that is clinically characterized by progressive bone marrow failure, congenital malformations, and increased incidence of malignancies, especially acute myeloid leukemia and squamous cell carcinomas (SSCs) of the head and neck. Greatly improved protocols for stem cell transplantation increasingly save the lives of these young patients. However, in both transplanted and not transplanted patients, the emergence of aggressive SSC represents a major medical challenge. Noninvasive screening options, including frequent self-examination and inspection by a medical team, should lead to early detection and treatment. Standard platinum-based chemotherapy in combination with radiotherapy cannot be used in FA patients due to therapy-associated toxicities and mortalities even with reduced dosing. Therefore, surgery is the most important treatment option for HNSCC in bone marrow failure disease patients and requires an early and efficient detection of malignant lesions. Conclusion: So far, no uniform treatment protocol for the management of HNSCCs in FA patients exists. Therefore, we propose that the information on affected FA patients should be collected worldwide, practical therapeutic guidelines developed and national treatment centers established.
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Retrospective review of outcomes of thyroid surgeries performed over 4 years at a single center p. 112
Thamer Alghamdi, Abdulaziz Alabidi, Mohammed Gamal Aly
Context: Thyroid surgery may have severe postoperative complications; however, there is a lack of national data on its outcomes in Saudi Arabia. Aims: The aim of this study was to improve practice and develop efficient pre- and postoperative data. Settings and Design: A retrospective review of the medical files of 277 patients undergoing thyroidectomy, including total thyroidectomy, hemithyroidectomy, and completion thyroidectomy, for various indications at a single center from January 2016 to December 2019 was performed. Materials and Methods: The demographic and histopathological data and surgical outcomes were recorded. Statistical Analysis: Only descriptive statistics were used. Results: A total of 198 (71.4%) patients were female and 79 (28.5%) were male. Benign lesions were observed in 65.6% of the patients, while 34.4% of the patients had malignant lesions. Papillary thyroid carcinoma was the most common malignant pathology, followed by follicular thyroid carcinoma, medullary carcinoma, and mucosa-associated lymphoid tissue lymphoma. The total complication rate was 17.3%, and 81.2% of the complications occurred in females. Temporary hypocalcemia developed in 9% of the patients and permanent hypocalcemia in 2.9%. A postoperative hematoma occurred in 1.1%. Temporary and permanent recurrent laryngeal nerve injuries were recorded in 2.9% and 1.4% of the patients, respectively. Conclusions: Thyroidectomy is a safe and effective surgical procedure, and the results obtained in this study were similar to data in the literature. Auditing and reporting of the surgical outcomes of thyroidectomy at our institute and other national centers could help establish national guidelines that will improve these outcomes and ensure patient safety.
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The prevalence of chronic sinusitis symptoms among inflammatory bowel disease patients at tertiary hospital in Riyadh p. 117
Saud Alromaih, Alanoud Abuhaimed, Saad Alkhowaiter, Khaled Alkethiri, Omar Alfarhan, Saad Alkhurayji, Naif Alhazmi, Ibrahim Sumaily
Background: The etiologies of both chronic rhinosinusitis (CRS) and inflammatory bowel disease (IBD) are not well known. Both are inflammatory diseases that are triggered by genetic and environmental factors. Existing literature lacks the evaluation of the overlap between these clinical entities. Herein, we attempt to determine the prevalence of CRS symptoms among the patients with IBD at King Khalid University Hospital. Methodology: This text presents a cross-sectional study on patients with confirmed diagnoses based on colonoscopy and histological findings. Patients were evaluated using the chronic sinusitis survey (CSS) and the rhinosinusitis disability index (RSDI). Other variables evaluated in this study include age, gender, chronic illnesses, duration of the IBD, smoking, medications, and family history. Results: Eighty-two IBD patients were enrolled in the study, and of these patients, 61 have Crohn's disease (CD) and 21 have ulcerative colitis (UC). There was no statistically significant difference in the presence of sinonasal symptoms between patients with CD and UC: 11.47% and 9.52%, respectively. CSS score was nonsignificantly higher among CD patients: 10.79 compared to 6.15 for UC patients, P = 0.125. In addition, the RSDI score was higher among CD patients: 13.11 compared to 5.14 in UC patients. However, this difference is not significant, P = 0.069. Conclusion: The prevalence of CRS symptoms among IBD patients is comparable to the general population. It was nonsignificantly less prevalent in UC patients in comparison to CD patients.
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Isolated soft-tissue aspergilloma at the right lateral side of nose mimicking as tuberculoma p. 123
Nagendra Mahendra, Abhijeet Ingle, Majed Abdul Basit Momin, Shumaila Abdul Rehman, Dharmendra Kumar Borad
Aspergilloma is a mycotic infection and is characterized by a mass with soft-tissue attenuation without tissue invasion. Aspergilloma at the lateral aspect of the nose is a very rare location and poses clinical and diagnostic challenge as cytological examination mimics tuberculoma. We report the case of an immunocompetent elderly male with painless nodular swelling at the right side of the nose for 3 months with fine-needle aspiration cytology (FNAC) reported elsewhere as granulomatous inflammation suggestive of tuberculosis. Subsequently, repeat FNAC cytological examination with the application of special stain and submission of aspirated material for microbiological 10% potassium hydroxide mounting and culture-confirmed fungal infection as Aspergillus flavus. A high index of clinical suspicion, the utility of FNAC, application of special stains, and communication with pathologist and microbiologist clinches the diagnosis. The patient was successfully treated with antifungal therapy (Voriconazole) and swelling completely resolved after 6 weeks of treatment.
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Povidone–iodine: An essential antiseptic in the COVID-19 pandemic p. 126
Satvinder Singh Bakshi, Sumita Bakshi
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