Objective: To study the serious complications of minor nasal injuries in children. Patients and Methods: This was a retrospective study of 102 children presented to the emergency rooms of Prince Rashed Ibn Al-Hassan and Prince Hashem Ibn Al-Hussein Hospitals in Jordan between January 1994 and December 1998 with a primary diagnosis of nasal trauma. Twelve children were admitted to the hospital with serious complications, while the others were discharged in the same day with a trival nasal trauma. Patient characteristics, cause of injury, time elapsed before treatment following trauma, and treatment patterns were studied. Results : Sixty-six out of 102 children were males (male to female ratio was about 2:1). Mean age was 8 years. The most common cause of isolated nasal trauma was simple fall (50%). Out of 102 children with history of nasal trauma only 12 patients (12%) developed serious complications including nasal bone fracture, haematoma or abscess collection and severe epistaxis. The diagnosis was made 1 to 7 days (mean 5 days) after the episode of trauma. Nasal bleeding was the most common symptom while nasal obstruction was the most common sign of complication. Nasal fracture was present in 10 children. Severe nasal bleeding was the cause of admission in 2 children. Haematoma was found in 4 patients, it was associated with cartilage destruction in 1 patient. Abscess of the nasal septum was found at surgery in 2 children, both of them had septal cartilage destruction. Organisms cultured were Staphy. aureus, Strept. pneumonia, and group A B-Hemolytic Strept. They were obtained from both patients with septal abscess and from one patient with septal haematoma. Conclusions: The incidence of severe complications in nasal injuries is directly related to delay in treatment. Diagnosis of nasal septal haematoma and abscess should be considered in all children with recent nasal trauma, to minimize the risk of nasal deformity and prevent the development of septal complications. All children with even minor nasal injuries should be seen for follow up after 24 and 72 hours to detect early the development of complications.

Objective: This study was performed to determine the common features of orbital complications of rhinosinusitis. Material and Method: This was a retrospective study of 21 patients’ charts who were diagnosed and treated for orbital complications of rhinosinusitis in King Abdul Aziz University Hospital (Riyadh, Saudi Arabia) over 10 years period (from 1992 to 2001). Results: The most common presentations of orbital complications of rhinosinusitis were swollen upper eyelid (95.2%) followed by redness of the eyes (90.5%), pain and inability to open the involved eye (71.4%). Other less common features included diplopia (14.5%), proptosis (9.5%), and lower eyelid involvement (5%). The most common orbital complications was preseptal cellulitis (52.4%), followed by orbital cellulitis (33.3%) and subperiosteal abscess (14.3%). Features of Rhinosinusitis in patients with orbital suppuration were uncommon (23.8%). The most commonly affected sinuses were the ethmoids (43%) followed by the ethmoids in association with the maxillary sinus (24%), the frontal sinus (19%) and the sphenoid sinus (14%). The most common causative organisms were Staph, aureus (55%) followed by Streptococcus and H. influenza(15% each) and Moraxilla catarrhales (10%). Conclusion: We conclude from this study that the most commonly involved single sinus related to orbital disease is the ethmoid sinuses followed by ethmoids in association with maxillary, frontal and sphenoid sinuses, while Staph, aureus as the commonest causative organism. The majority were diagnosed as cellulitis. Orbital abscess as well as cavernous sinus thrombosis were not found. All patient with orbital suppuration should be evaluated clinically and radiologically for sinus disease even if they do not have stigma of rhinosinusitis.

Objective: To assess the diagnostic value of symptoms, signs, and imaging studies of Iaryngo-tracheo- bronchial foreign bodies (FBS). Methods: A retrospective analysis of data available from files of 39 consecutive children with presumptive diagnosis of FB aspiration. Based on bronchoscopic findings children were divided into group A (30 children) with FB aspiration, and group B (9 children) no FB aspiration. Comparison between findings in each group was carried out. Result: History, considering coughing and choking together, had a sensitivity of 67% and specificity of 78% for FB aspiration. The combination of unilateral reduction of air entry with wheezing resulted in a specificity of 100%, however, with a sensitivity of 17% only for FB aspiration. Chest radiograph was found to have a sensitivity of 57% and a specificity of 50% for FB aspiration. Conclusion: The diagnosis of aspirated FBs should take an advantage of all the available indicators of airway FBS, and above all implement high index of suspicion. This study shows that history seems to have a more diagnostic value than physical examination and chest radiography

Aim: To examine the N1/P2 complex of the auditory evoked potential and its susceptibility to PPI and to compare the amplitudes of these responses and their suppression. Material and Methods: Twenty healthy volunteers, ten males and ten females were entered in this study. Their mean age 21.5 years. Before entering the study their hearing thresholds at 0.5,1,2, and 4k HZ were measured, none of them were found to have thresholds above 20dB. Results: The female subjects in this study showed slightly higher auditory evoked potential responses and lower response latencies than the males. Conclusion: Our findings are consistent with sex differences. These are attributed to differences in skull dimensions, brain volume and conduction distances.

Objective: The aim of this work was to evaluate the role of MRI in prediction of nasopharyngeal carcinoma (NPC) response to radiotherapy. Materials and Methods: Fifty-two NPC patients had MRI before and after radiotherapy to the local disease and the nodal involvement. The MRI assessed the size, site, signal intensity, enhancement pattern and extension of the regional disease in twenty-five anatomical sites. Radiotherapy was delivered using X-rays of 4-6 MV Linac. Results: Complete remission (CR) rates in the lateral, anterior, inferior, intracranial, orbital, skull base and paranasal sinuses extensions were 77% (177/229), 89%(23/28), 68%(13/19), 18%(5/28), 0%(0/5), 16%(28/17l) and 31%(9/29) respectively. The CR rate of the lateral, anterior, inferior extensions collcctivcly (Tl-2 lesions) was 77% (213/276) compared with 17.6% (42/238) for intracranial, orbital, skull base and paranasal sinuses extensions collectively (T3-4 lesions) (p<0.0000!). Among T2 lesions the CR rate was 89% (23/28) for nasal versus 68% (13/19) for oropharyngeal extension (p=0.04). Conclusion: The intracranial, orbital, skull base and paranasal sinuses extensions of NPC were associated with significantly lower rates of CR.

Amyloidosis is a disturbance of metabolism characterized by a deposition of proteinaceous material in different organs and results in a wide range of clinical manifestations. Involvement of the pharynx and larynx is a rare and benign process. We report two cases involving the pharynx and larynx separately. This is an update of the literature review, the classification of amyloidosis, its pathogenesis and its management.

Kikuchi-Fujimoto’s Disease (KFD) is basically a benign, rare disorder of the lymph nodes of the cervical region. Otolaryngologists who are mainly involved in the diagnosis and management of neck masses are virtually unaware of this disease. We report a case of an Asian pregnant woman presenting with cervical lymphadenopathy associated with fever and sore throat. Aetiology, pathology, differential diagnosis, associated diseases and treatment options arediscussed in brief. This paper was written to increase the awareness of this disease among the practising otolaryngologists and to include this entity in the differential diagnosis of neck masses.

Aspergillus species are ubiquitous in the environment worldwide. They can be found in the soil, water and vegetation. Non-invasive aspergillus lesions maydevelop in healthy paranasal sinuses or in pre-existing pulmonmary cavities. However, invasive aspergillosis (IA) is primarily an infection of severely immunocompromised patients and one of the most life-threatening conditions in this group of patients, with very high fatality rate. However, in immunocompetent persons, fulminant invasion of tissues is very rare. We report a case of a 30-year-old Saudi lady who developed invasive aspergillosis of the cervicalregion extending into the mediastinum and the vertebral foramina. This unusual infection was produced simultaneously by two species of Aspergillus i.e. A.fumigatus and A. niger. She was treated with a combination of amphotericin B i.v and itraconazole orally for 6 months. She responded very well to the combination therapy and made a remarkable recovery. Treatment options of this fatal infection are briefly reviewed and discussed.

A rare case of a sheep’s metacarpal condyle impacted in the oesophagus is reported. The radiological appearance of a “duplicate seventh cervical vertebra” caused confusion due to an initial poor history of suspected fish bone ingestion. The timely arrival of the patient’s daughter saved the day.