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   Table of Contents - Current issue
April-June 2022
Volume 24 | Issue 2
Page Nos. 51-87

Online since Tuesday, June 28, 2022

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Benign paroxysmal positional vertigo in patients with Meniere's disease p. 51
Santosh Kumar Swain
Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. BPPV often occurs after head trauma, viral neurolabyrinthitis, following surgery, and prolonged bed rest. BPPV may be associated with Meniere's disease (MD) and may be found at any stage of this disease. There is a recognized relationship between MD and BPPV. However, the frequency and clinical characteristics of BPPV in MD are not clear. Hydropically induced damage to the maculae of the utricle and saccule or partial obstruction of the membranous labyrinth may be the cause for the coexistence of MD and BPPV. MD may be considered one of the important causes of persistent vertigo in patients with BPPV, which makes it difficult in obtaining the correct diagnosis and aggravates the ability to predict the prognosis. Patients with both MD and BPPV suffer from the intractable type of BPPV despite medical or surgical control of their MD. There are a lower treatment success rate and a higher chance of recurrence rate in patients of BPPV with MD compared to BPPV patients without MD. The recurrence rate is higher in patients with multiple semicircular canal BPPV with MD. The objective of this review article is to discuss the epidemiology, etiopathology, clinical features and diagnostic evaluation, and treatment of BPPV in patients with MD. The databases searched are PubMed, Scopus, Medline, and Google Scholar.
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Do we need to order prothrombin time/international normalized ratio and activated partial thromboplastin time for children undergoing adenotonsillar surgery? p. 56
Tanvir Nazir, Noor Adam, Samina Afzal, Mohamad A Bitar
Objectives: The objectives of this study were to check the prevalence of abnormal preoperative bleeding tests in children planned for adenotonsillar surgery, highlight the workup, and describe the perioperative management for the confirmed cases. Subjects and Methods: This was a retrospective study. We reviewed the age, gender, test values, bleeding tendency, workup of affected patients, and perioperative management. Results: We reviewed 365 patients; 71 patients were found to have abnormal prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), or both. There was no history of bleeding tendency. Thirty-six patients had a repeat of the abnormal tests, 17 were still abnormally high (>2 s), 19 normalized or had values decreased to <2 s; 9 had workup, and 6 found to have factor deficiencies. All but eight patients (who lost to follow-up) were operated uneventfully. Conclusion: Patients booked for adenotonsillar surgery need PT/INR and aPTT tested preoperatively. The patients with abnormal results are investigated according to an algorithm. Perioperative planning is essential to avoid intra- and postoperative complications.
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Physician and patient satisfaction of otolaryngology virtual clinic during the COVID-19 pandemic: The qatif central hospital experience p. 61
Mohammad Al Eid, Rana AlMuslem, Suad AlMubarak, Alia Al Naji
Introduction: A virtual clinic was implemented to replace routine outpatient visits for all specialties during the peak of COVID-19 in the area as a protective measure to patients and medical staff to limit the virus's spread. Objectives: The objective of the study was to determine the response and efficacy of the virtual clinic and measure patient and physician satisfaction. Methods: A study of virtual clinic response and patient and doctor satisfaction with telemedicine consultations was undertaken in the otolaryngology department of Qatif central hospital, where telemedicine consultations replaced scheduled outpatient consultations. Patient and doctor satisfaction was rated on a scale from 1 (least satisfied) to 5 (highly satisfied). Statistical analysis was conducted using SPSS 23.0 software. Results: During this study, there were 398 scheduled virtual clinic appointments. The response rate was 79%. Not answering the virtual clinic phone call was twice as likely to occur during morning clinics than during afternoon clinics (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.14–3.345, P value 0.015). Adults (15–60 years old) had higher odds of not answering appointment phone calls than children (≤14 years old) (OR 2.38, 95% CI 1.28–4.42, P value 0.006). Patients' satisfaction levels were obtained for 310 (98.7%) patients' virtual clinic consultations; 96.8% of these patients were satisfied (scale 4–5). Physicians' satisfaction levels were completed for 309 (98.4%) virtual clinic consultations, and 94.2% of physicians were satisfied (scale 4–5). Conclusion: Patients and doctors found the otolaryngology virtual clinic an acceptable solution for maintaining continuity of care during the COVID-19 peak in the area.
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Prevalence, knowledge, and practice regarding allergic rhinitis among Madinah Population, Saudi Arabia, in 2019–2020 p. 67
Nisreen Ghazi Albouq, Rayan Ahmad Julaidan
Background: Allergic rhinitis (AR) is a common chronic respiratory disorder characterized by itching, sneezing, nasal congestion, and rhinorrhea, prevalent in Saudi Arabia. Objectives: This study investigates the AR prevalence and assesses the knowledge and practices of the population about the disease. Materials and Methods: A cross-sectional study was conducted at Otolaryngology and Allergy Clinics, Ohud Hospital, Madinah in 2019–2020. The data were collected by an electronic self-administered questionnaire, grouped into four sections: demographic data, the prevalence of AR using a valid translated scoring tool, and knowledge and practice of the population about AR. Results: The study included 524 participants, of which 56.1% were aged 20–29 years. Female participants were 324.88 (62%), and male participants were 199.12 (38%). Using a valid translated scoring tool, the prevalence of AR was 27.9%, and only a family history of allergy was a significant factor associated with AR (P < 0.001). Overall, most of the participants (76.3%) had adequate knowledge about AR, in which AR (P = 0.001) or a family history of AR (P < 0.001) was significantly associated with AR adequate knowledge. Moreover, 26.3% responded that they are visiting physicians when developing symptoms. However, 31.2% of participants used steroid nasal sprays. Nearly half (47.9%) of the participants bought over-the-counter drugs without consulting a physician. Conclusion: AR is a common problem affecting a considerable proportion of the population in Madinah city, Saudi Arabia, particularly those with a positive family history. Fortunately, knowledge about the disease is adequate. However, health workers must improve the practice of the population.
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Changes in the histological characteristics of patients from a Southern Saudi Population with chronic rhinosinusitis with nasal polyps over time p. 73
Nasir A Magboul, Abdelaziz Qobty, Ali Alzarei, Areej Rajah, Meshary Alshahrani, Zubaidah Alahmari
Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is the most common type of inflammation of the mucosa of the sinonasal cavity. Approximately 65%–90% of CRSwNP cases exhibit eosinophilic inflammation. Patients with CRSwNP respond to corticosteroids but tend to have more severe diseases with higher recurrence rates. We aimed to determine the histopathological types of CRSwNP in patients who underwent surgery at Asir Central Hospital in Asir Region, Saudi Arabia, and compared patients admitted from 2013 to 2016 and 2018 to 2020 to identify changes in their histological patterns. Materials and Methods: We retrospectively examined medical records of patients who underwent surgery to remove nasal polyps during two different time periods (2013–2016 and 2018–2020). A pre-structured data collection sheet was used to extract data from medical records to ensure consistency. A histological review of nasal polyp tissue was collected during the surgery, immediately fixed in 10% formalin, and sent for histopathology. All specimens were processed in the same pathologic laboratory using the same histopathologic techniques. The average number of eosinophils, neutrophils, lymphocytes and plasma cells per high-power field (HPF) for each sample was recorded. Tissue eosinophil histopathologically defined when tissue eosinophil was >10/HPF. Results: Among the patients with CRSwNP admitted for surgical intervention, 162 and 92 patients were admitted from 2013 to 2016 (Group A) and 2018 to 2020 (Group B), respectively. Neutrophilic polyps were present in 30.2% of Group A patients compared to 27.2% of Group B patients. There were significantly more eosinophilic polyps diagnosed in Group B than in Group A (51.9% vs. 72.8%, respectively; P = 0.001). Significantly more polyps were benign in Group B than in Group A (97.8% vs. 71.6%, respectively; P < 0.001). Conclusions: There was an increase over time in eosinophilic nasal polyps among cases of CRSwNP in the Asir region. The frequency of neutrophilic polyps decreased over 7 years.
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Changes of cochlear implant programming in cochlear implant user with middle ear disease p. 78
Shahad Saeed Bamhair
We present a cochlear implant (CI) adult with active middle ear disease (MED). A 55-year-old Saudi female had sudden hearing loss (HL) since she was 18 years old (sensorineural HL). The patient developed MED after a period of CI programming stabilization that negatively affected the CI function. This case study clarifies these adverse effects on subjective hearing and objective CI measures (impedance and electrical compound action potential). Reprogramming the CI is recommended during the active MED and monitoring the middle ear status for cochlear-implanted children when noticing changes of objective CI measures accompanied with decreased overall performance.
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Descending necrotizing mediastinitis of odontogenic origin - Management by minimal invasive approach p. 82
Nikhil Arora, Ashiya Goel, Pratik Kumar, Aarushi Wadhawan
Descending necrotizing mediastinitis is an uncommon, rapidly progressive pathology originating from odontogenic or cervical infections. It usually has a fulminant course, frequently leading to sepsis and mortality. A rare case of cervical necrotizing fasciitis and descending mediastinitis in a healthy young man, after an odontogenic infection with a successful outcome without aggressive surgical debridement, has been presented.
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Congenital vomer agenesis p. 85
Abdullah Al-Shahrani, Anas Alshehri
The nasal septum is composed of the quadrangular septal cartilage, crests of the maxillary and palatine bones, the perpendicular plate of the ethmoid bone and the vomer. vomer agenesis is a very rare condition in which misinterpreted as other causes including pervious trauma, infection, neoplasia, and Granulomatous and Systemic Diseases Affecting the Nose. This is a 35-year-old male diagnosed with chronic rhinosinusitis with nasal polyposis (CRSWNP). While performing a preoperative CT scan, there was a defect in the vomerian bony part of the nasal septum. Congenital vomer agenesis is a rare condition and few reports are mentioned in the literature. It can be associated with other head and neck diseases. A careful history and physical examination are needed to exclude other causes of the septal defect. The utilization of imaging studies and endoscopic examinations will reveal more cases in the future.
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