Background and Objectives: The Pediatric Voice Handicap Index (VHI) is a valid tool for assessing self-perceived voice handicap in children. We developed an Arabic abbreviated version of pediatric Voice Handicap Index (pVHI) for future use in Arab pediatric population. Setting and Design: The study was conducted on nondysphonic children at King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia. Subjects and Methods: The original English pediatric VHI which is composed of 23-items was shortened to 10-items and translated into Arabic by a committee of two Pediatric Otolaryngologists and one Phoniatrician. The translated Arabic version was administered to the parents of 137 children without voice disorders or communication disorders. Results: The subjects of our study had low scores which were comparable with control groups of different worldwide pediatric VHI studies. Also, there was an insignificant effect of gender on VHI subscales (P > 0.025). Obviously, the validity of these results may be limited by the absence of another dysphonic group. However, the preliminary results have encouraged us to report it and when a dysphonic group is available it will be possible to better validate this pVHI in term of performance. Conclusion: Arabic version of the pVHI is a valuable tool for voice specialists dealing with Arabic speaking children. Future testing of our developed Arabic abbreviated pVHI with dysphonic groups to confirm its reliability in differentiating control subjects from dysphonic subjects is recommended.

Introduction: Velopharyngeal dysfunction following adenoidectomy is not uncommon. Incidence range from 1 per 1,500 to 1 per 10,000 patients. Children at risk can be identified including cleft palate, sub mucous cleft, and palatal hypotonia, but if it occurred in the absence of structural abnormalities, increased pharyngeal width or short soft palate has been proposed. Methods: The study included 227 children, 71 females and 156 males. Plain x-ray lateral view nasopharynx was done during pronouncing the vowel Eeee aiming to assess the degree of closure and the point of contact between the contracted soft palate and the adenoid pad. Children with cleft palate, bifid uvula , mythsenia gravis and congenital abnormality of the hard palate were excluded from the study Results: Thirteen patients out of 227 were included with a median age of 5.8 years having short functional length of the soft palate. Only 4 (1.7 %) among the studied patients developed velopharyngeal incompetence. All patients with short functional length of the soft palate demonstrate attachment to the adenoid anterior surface rather to others show posterior pharyngeal wall attachment. Results showed that there was an increased incidence of velopharyngeal incompetence with patients having short functional length of the soft palate. Conclusion: Plain x-ray lateral view nasopharynx during phonation of the vowel Eeee could be cheap and sensitive method in predicting velopharyngeal incompetence in children undergoing adenoidectomy.

Purpose: To record language and auditory skills development before and after cochlear implantation (CI) in children with auditory neuropathy (AN), and to determine the outcome after cochlear implant in patients with AN in comparison to patients with sensorineural hearing loss (SNHL) Material and Methods: Cases included in this study were divided into two groups. Group I included 13 children diagnosed with AN, 7 of them were subjected to CI. Group II included, 20 cases of SNHL, 10 of them were subjected to cochlear implant. For all cases language therapy was given regularly for 6 months pre-operatively and 6 months post-operatively. Auditory Skills Checklist (ASC) and The Arabic language test (receptive, expressive and total language Quotients) were used to monitor the progress concerning auditory skills and language development. Results: There was significant improvement in SNHL group and AN group after cochlear implantation concerning auditory skills (AS) and language development and almost the same outcome was obtained in both groups. Conclusions: Cases with AN improved markedly after cochlear implantation and no differences were noticed in outcome between SNHL & AN groups.

Objective: To determine the resident’s satisfaction from surgical exposure in local otolaryngology training program. Methods: A survey questionnaire was designed to explore the views of all residents in otolaryngology training programme in Riyadh regarding the satisfaction of surgical exposure during their training. Sex, level of training, number of surgical sessions, teaching in the operating room, the amount of surgical exposure in the operating room and compare that with recommendations of the local training committee. Finally the adequacy and the general satisfaction from local training were included. Results: Twenty six out of 30 residents responded, 16 were males and 10 females. Majority (57.7%) were junior residents. In general 80.8% of residents agreed that there is teaching and immediate supervision. Half of the residents had at least one operating session per week. In comparison with the recommendations of the Saudi local training committee, 53.8% of residents feel the surgical exposure is less . Residents (84.8 %) were found to be satisfied with the local training. Conclusion: These results show general satisfaction with current training. The study suggests that there are significant strong points in the current program. We feel monitoring and frequent evaluation are the warranty for improving local program.

Background and Objectives: The exposure to otolaryngology in medical school curriculum is relatively less compared to other specialties. The aim of this study was to review this attitude toward otolaryngology, head and neck surgery. Methods: A cross-sectional, self-constructed questionnaire was administered to medical students within Saudi Arabia from different universities during their attendance of medical career day (2010). Questions were primarily closed ended. The analysis was made using SPSS. Results: The overall response rate was 76.22%. Male response was 57.4%, compared to females 42.6% (P-value = 0.008). 6.6% of the medical students reported a primary interest in otolaryngology as a postgraduate career. The overall percentage of females interested in otolaryngology was 7.2% compared to 5.7% in males. Out of the medical students who were interested in otolaryngology, 7.9% were interns, whereas 39.8% were senior medical students. According to the questionnaire, the best area to study otolaryngology diseases is at the hospital clinics 76.9% followed by the daily rounds 12%, lectures in the medical school 7.6%, and operative rooms 3.5%. The medical students considered that the best way to improve teaching of otolaryngology diseases is by increasing the training period 60.3%. The average exposure time to otolaryngology in medical schools was 3.25 weeks (95% CI 3.05-3.45). North America was the preferred area for postgraduate residency training program according to 50.2% of the students, followed by local Saudi program 33.4%. Conclusions: Undergraduate exposure to otolaryngology is probably limited, may need to be increased and to include operating room teaching to widen the concept of our

Objectives: The primary objective of this study was to determine the association between chronic rhinosinusitis in children (CRS) and extraesophageal laryngopharyngeal reflux (EEGR). Methods: The proposed study was done in Montreal Children Hospital (Montreal, Canada)) from April 2009 till January 2010. Tissue from the paranasal sinus and adenoids were obtained from 14 patients with CRS (age 2-18 years) undergoing endoscopic sinus surgery (ESS) and 18 matched control subjects with no history of CRS (only adenoid tissue) were obtained during adenoidectomy (+/- tonsillectomy). We have used Immunocytochemistry (ICC) to evaluate the presence of pepsinogen in the paranasal sinus tissue of children with CRS group.We have also examined the presence of pepsinogen in adenoid tissue of CRS group and compared them with adenoid tissue of control group. Results: Immunoreactivity for pepsinogen was identified in the epithelial layer of adenoid tissue (50%) and paranasal sinus tissue (65%) in the CRS group. Only occasional staining was observed in the epithelial layer of the adenoid tissue of the control group. Conclusions: The detection of immunoreactivity of pepsinogen in paranasal sinus tissue suggested a possible role of EEGR in CRS in children .

Aims: Fungal sinusitis is frequently encountered in daily clinical practice. The aim of this study was to determine the most common cause of fungal sinusitis and to compare the results of histopathology, radiology and intra-operative examination with those of fungal culture. Material and Methods: We performed a retrospective study on patients with allergic fungal sinusitis (AFS) and invasive fungal sinusitis (IFS) who had undergone functional endoscopic sinus surgery for chronic fungal sinusitis at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, from January 2001 to January 2011. Descriptive statistics was performed using the Statistical Package for the Social Sciences. Fisher’s exact test was used to compare the frequency of fungal and non-fungal infection among males and females. P <0.05 was considered significant. Results: The frequency of fungal sinusitis among patients with chronic sinusitis at KAUH was 16.5% (40 out of 243 cases). Twenty-eight patients met the criteria for AFS; 12 met the criteria for IFS. Females represented 65% of the study population. Aspergillus species was the only causative agent identified. Radiology was the most sensitive test (100%). However, when histopathology, radiology and intra-operative examination were compared with results of fungal cultures, histopathology was the most specific test. Conclusion: Fungal sinusitis is not uncommon among patients followed up for chronic sinusitis at KAUH. Aspergillus species was the main causative agent in these patients. Radiology is an excellent tool in providing a preoperative diagnosis of this condition, and it should be followed by an extensive work-up, including histopathology and fungal cultures.

Objective: To re-investigate the findings of previous researchers regarding columellar scars visibility results on Middle Eastern patients. Method: Case analysis report and review of the medical literature on the said topic. Subject: Eighty seven Middle Eastern patients who underwent primary open rhinoplasty and/or septorhinoplasty. Results: Only 9 patients (10.3% of patients) considered their scar unsatisfactory and 2 patients (3. 4 %) considered as objective failure when assessed by another rhinoplastic surgeon. Conclusion: This study concludes that columellar scars in Middle Eastern patients can be highly unnoticeable if optimum technique of wound closure will be used.

We describe a rare case of a previously healthy 27 year old man who presented to the otolaryngology clinic with bilateral peritonsillar abscess. The clinical presentation of sore throat, fever, odynophagia and trismus were consistent with peritonsillar abscess, but the presence of symmetric tonsillar swelling and midline uvula misguided the diagnosis. Diagnosis can be based on clinical criteria or imaging techniques. A clinical presentation of peritonsillar abscess with a physical examination of bilateral swollen tonsils and midline uvula is suggestive of bilateral peritonsillar abscess. The general principle of treatment is systemic antibiotics and drainage of the pus.

Objectives: To present a rare case of osteoblastoma of the nasal dorsum, and to demonstrate the importance of considering this rare entity when assessing patients presenting with a lesion of the dorsum of the nose. Case Report: Benign osteoblastoma is a rare tumor, Most case occur in the long bones. Osteoblastoma involving the nasal bone is rare. We report a case of osteoblastoma originating from the bony nasal dorsum in a 30-year-old woman. Conclusion: This is the first report of osteoblastoma originating from the bony nasal dorsum among Saudi Arabia.