Background: Foreign body (FB) ingestion is a frequent home accident in the pediatric population and is one of the leading causes of morbidity and mortality in children. We aimed to describe the problem of pediatric esophageal FB ingestion at King Abdulaziz University Hospital over 10 years regarding patient, visit, and management characteristics and identify the pediatric specialty team that was called first to the emergency department in such cases. Materials and Methods: This retrospective study included 117 pediatric patients admitted for esophageal FB ingestion in a tertiary care center in Saudi Arabia from 2011 to 2020. We used Chi-squared and one-way analysis of variance tests to determine the associations. Data on demographic and clinical variables were compared between patients with and without neurodevelopmental disabilities, and their associations were assessed. Results: The mean age of patients was 4.7 ± 3.7 years, with slightly higher rates in males (57.3%). Six patients (5.1%) had a history of preexisting esophageal conditions, and five (4.3%) had previous FB ingestion. The most commonly ingested item was a coin (n = 53) and was mostly located in the upper esophagus (n = 56). Gastrointestinal and respiratory symptoms occurred in 78 and 29 patients, respectively. The Otolaryngology Department contributed the highest number of admissions (63.8%). Conclusion: FB ingestion is common in Saudi Arabian preschoolers. These data indicate the need for caregivers to be educated about FB ingestion. Additional investigations should emphasize addressing the consequences of FB ingestion.

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Background: Allergy skin testing can help identify the specific causative allergens to confirm the diagnosis and design treatment for Allergic rhinitis. Objective: The study aimed to assess the types of allergens among participants who underwent Skin Allergy Test in the Southern Region of Saudi Arabia. Methods: This retrospective review of hospital records examined the results of the skin prick test from January 2018 to October 2020. Participants who underwent the same panel of allergens were included. Results: Forty-two participants were included. Only one participant (2.4%) showed no response toward any allergen, while the remainder (97.6%) exhibited a positive reaction toward at least one allergen. The highest rates of sensitization were to pollens (83.3%), followed by house dust mites (14.3%), and animal epithelia (28.6%). The most frequent pollens were Bermuda grass (64.3%), followed by Ryegrass (26.2%) and Russian thistle (21.4%). Positive reactions to Dermatophagoides pteronyssinus and Dermatophagoides farinae were observed in 14.3% and 9.5% of participants, respectively. The rates of sensitization to Epithelia of the cats were higher than that to Epithelia of dogs (26.2% vs. 14.3%, respectively). No significant association was detected between the type of aeroallergen and the age or gender of the participants. Conclusions: The most prevalent aeroallergens in the Southern region of Saudi Arabia are pollens, followed by house dust mites and animal epithelia. Sensitization to more than one allergen was common. The use of preventive measures is warranted to reduce sensitization to allergens.

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Background: Branchial cleft anomalies are the second-most common congenital malformation in the head-and-neck region. They arise from persistent ruminants of pharyngeal clefts and pouches and are classified into four distinct types; the most prevalent one is type 2, which involves the sternocleidomastoid muscles (SCM). The definitive treatment for the four types is complete surgical excision of the anomaly. Objective: The present study describes the clinical features and surgical outcomes for both unilateral and bilateral branchial cleft cysts at a tertiary care hospital in Saudi Arabia. Design and Setting: This retrospective study involved collecting data from patients' records of King Faisal Specialist Hospital, Saudi Arabia, who had surgical excision for branchial cleft cyst in the duration between January 2010 and September 2020. The collected data included patients' demographics, characters of the branchial anomaly, complications, and characters of the procedure. Statistical analysis was performed using IBM SPSS v. 20. for both descriptive and comparative analysis. Results: A total of 18 cases were eligible for inclusion. Of the whole cohort, 55.6% were females. All cases were type 2, with the majority being in the anterior border of sternoclenomastoid (83.3%) and unilateral (77.8%). Discharge was reported as the most common complication, occurring among half of the patients. The diagnostic investigation was only performed in situations of recurrence (22.2%). The prevalence of the bilateral cyst is 22.2%. There was no statistically significant association between the associated genetic disease and the unilateral or bilateral cysts (P = 0.054). Conclusion: Type 2 unilateral cysts are the most prevalent for the examined population, specifically on the anterior border of SCM. A low recurrence rate and low incidence of complications propose an effective management strategy.

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Objectives: This work aimed to study the feasibility and stakeholders' satisfaction with remote programming (RP) of cochlear implants. Materials and Methods: This prospective study was conducted in a tertiary referral ear specialist center. The audiological and speech outcomes of the patients were measured. The satisfaction of all stakeholders, including remote experts (REs), local hosts (LHs), and patients/families, was evaluated through detailed questionnaires. Results: Twenty-two RP sessions for 15 patients were included. The satisfaction levels of LH, REs, and patients/families with the RP sessions were all above 6/10, 5/10, and 7/10 Likert scale, respectively (with 10/10 being the most satisfied). All stakeholders would recommend RP to others. There was no statistically significant difference in the audiological outcomes including for Pure Tone Average (PTA4), speech reception threshold, and word recognition score between the session preceding RP, RP session and the session after the RP (Wilcoxon test, P value ranging from 0.06 to 0.73). Data logging after the RP session showed a higher duration of speech processor usage (mean difference 0.64 h/day, Wilcoxon test, P = 0.006). Conclusion: In the era of coronavirus disease 2019 pandemic, RP of confidence interval (CI) can be a safe, feasible, and satisfactory alternative to classical in-office programming sessions. Further studies and efforts should be done to make the RP an available option for CI recipients to save time and cost.

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Background: Choosing the appropriate endotracheal tube (ETT) size in pediatric patients is crucial to guarantee well ventilation and reliable end-tidal gas monitoring. Different methods have been established for choosing appropriate ETT size with varied validities depending on the demographics of the patients. Objectives: The primary objective is to investigate a relationship between the height of the patient and the appropriate ETT size and form a predictive formula. Design: A prospective, observational study was conducted between November 2019 and March 2020 in a pediatric hospital, Riyadh, Saudi Arabia. Setting: Patients below 14 years of age admitted for elective day surgery with American Society of Anesthesiologist Class 1 or 2 were invited to participate. Patients with anticipated difficult airway or neck mass or those refused to enroll were excluded. Methods: After obtaining institutional review board approval, informed consents were taken from all patients' guardians. Collected data were gathered in excel sheet. Main Outcome Measures: Demographic and clinical data were collected. The subglottic area was measured before induction of anesthesia by bedside ultrasound machine. No formulas were used for ETT size used. Sample Size: 71 children were included in the study. Results: The ETT based on the height of the patient was estimated using the formula below as “estimated ETT size if other formula used:” {INSIDE:1] estimated based on height. Pearson's correlation results revealed a positive association between the ETT used and ETT estimated. The relationship between variables is insignificant, with a P > 0.05. There was an overestimation in both the ETT used and ETT estimated in the stepwise regression analysis. About 88.5% overestimate the ETT used based on age, and about 89.7% overestimate the ETT based on patient height. The F-value change statistics indicates a statistical significance of ETT used and ETT estimated. Conclusion: It is crucial to have an accurate ETT tube size used in children. The height of the child was found to have good correlation with ETT size in our Saudi population. Limitation: Part of the limitations faced was the fact that it was a single-center study which may not represent the population from other areas.

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Introduction: Workforce planning is a relatively new approach to identify the supply and demand of labor. The goal of workforce planning is to identify talent surpluses and shortages, project future needs, and facilitate matching training decisions. Methods: An online survey was sent to otolaryngologists with a high volume of rhinology practice. Results: Twenty-nine surgeons participated in the survey. All respondents had completed a rhinology fellowship and 20% practiced exclusively rhinology. The majority of surgeons reported <5 days of access to the operative room. More than 50% of surgeons reported having access to image-guided surgery. According to 65% of respondents, the number of surgeons practicing rhinology in Saudi Arabia is adequate. Overall, 62% of respondents were satisfied with their careers. Conclusion: The outcomes from this survey provided the necessary information required for rhinology physicians workforce modeling and allow us to begin strategically planning for Saudi Arabia's future rhinology needs and local fellowship requirements.

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Tenosynovial giant cell tumor (TGCT) is a rare benign craniofacial soft-tissue tumor characterized by overgrowth of the synovial tissue, tendon sheath, bursa, and joint structure. It is classified into two types, diffuse and localized TGCT, and has rarely been reported in the temporomandibular joint. The etiology of TGCT is unknown, and the management of TGCT varies depending on the tumor location and treatment-related morbidity. Here, we describe the case of a 47-year-old man who presented with a complaint of a right parotid mass that had slowly increased over 2 months and was associated with ear fullness. Initially, the lesion was painless, but pain during chewing without any limitation of the jaw movement developed subsequently. The patient was diagnosed with diffuse TGCT with chondroid metaplasia.

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Background: Advancements in airway procedures and intensive care medicine have resulted in a reduction in open tracheostomy (OT) performed annually which could affect the training of residents. The aim of this study is to highlight the otolaryngology-head-and-neck surgery (OHNS) trainees' perception of their surgical exposure and competency in performing OT. Methodology: A cross-sectional questionnaire-based study (using a 22-item previously validated, peer-reviewed, and published questionnaire) conducted from June 2019 to February 2020 of OHNS residents training in multiple hospitals in the two metropolitan cities. Results: The response rate was 54% (which represents n = 67 out of 125 in both cities). There were 35 juniors (52.2%) and 32 seniors (47.8%). Thirty (44.8%) residents estimated that there are ≤50 tracheostomies/year in their hospital. Only 6% of the residents reported scheduled teaching regarding OT, and only one-third (34.3%) were actually aware of the different types of cannulas and postoperative care. Conclusion: The reason behind the lower confidence of trainees is likely multifactorial, and requires restructuring of the training program to improve the confidence of graduating trainees.

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Objectives: The objective is to investigate anosmia in patients with COVID-19 in tertiary care hospitals in two major cities in the Kingdom of Saudi Arabia to determine its prevalence, clinical characteristics, duration, and outcome. Methods: A retrospective study on COVID-19 patients who are admitted to our tertiary care hospital between May and December 2020. The inclusion criteria were all patients who are admitted to our tertiary care hospital with a confirmed diagnosis of COVID-19 in this study, we enrolled 545 patients for this study. Results: Of the 545 contacted subjects, 277 (50.82%) answered, whereas 268 were excluded, 26 (4.8%) of which passed away. One hundred and nineteen (42.96%) subjects were female whereas 158 (57.04%) were male. The mean age was 42.81 ± 16.76 standard deviation. About 162 (58.47%) of the 277 who completed the interview had anosmia; moreover, anosmia was grouped into transient and persistent anosmia. It was persistent in 15 subjects (5.4%) and transient in 147 subjects (94.6%); the range duration of transient anosmia was 1–180 days with a median of 10 (6, 20) days (median and interquartile range). Of the 277 subjects, 148 (53.4%) had ageusia; 15 subjects (5.4%) experienced anosmia as the only symptom, and 12 subjects (4.33%) developed ageusia as the only symptom. Of all the symptomatic subjects with anosmia 162 (58.5%), and 76 (41.36%) subjects reported a subjective impact on quality of life. Conclusion: More than half of the COVID-19 patients in the study presented with anosmia that was transient in the majority of cases.

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Background: Deep neck infections (DNIs) are characterized by inflammation in the deep spaces and fasciae of the head and neck, with or without pus. Parapharyngeal, infratemporal, pterygomaxillary, temporal, parotid, masticator, submandibular, visceral, carotid sheath, peritonsillar-pharyngeal mucosal, retropharyngeal, danger, and prevertebral spaces are the different types of DNIs. These infections are potentially fatal, and they spread quickly, causing serious problems. Even in recent research on DNSI cases, potentially life-threatening complications have been recorded at a rate of 10%–20%. Objective: The objective of this study was to identify the most common organisms causing DNIs in Asir Central Hospital (ACH), Saudi Arabia in addition to identifying the most common sensitive antibiotic using to treat DNIs in ACH. Results: Data were retrieved from the records of 108 patients with DNIs (67.6% males, 91.7% Saudis). These included 23 patients in the pediatric group (21.3%) and 85 patients (78.7%) in the adult group. The most common sites for neck abscesses in the whole sample included the submandibular abscess (46.3%). Two types of DNIs were predominating in the pediatric group, including submandibular abscess and anterior neck abscess (30.4% for each type), while submandibular neck abscess was the most common type in the adult group (50.6%). Regarding the previous onset of a recent infection, a total of 67 infections were reported in 63 patients. Upper respiratory tract infections represented the majority of infectious conditions (77.6%) followed by dental infections (22.4%). Among the whole sample, the most commonly isolated pathogen was Staphylococcus species (n = 14, 13.0%), of which 12 Staphylococcus aureus isolates were detected. The 25 isolates with positive cultural growth had undergone culture sensitivity analysis; these showed sensitivity to 89 antibiotics. Bacterial isolates were predominantly sensitive to vancomycin (n = 16, 18.0%), linezolid (n = 14, 15.7%), and ciprofloxacin (n = 13, 14.6%). Conclusion: DNIs in children feature different characteristics from those in adults regarding severity and preceding illness. However, the causative microorganisms and antibiotics sensitivity were similar. S. aureus and vancomycin were the most common bacteria and sensitive antibiotic, respectively.

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Background: One of the most common types of allergies is allergic rhinitis (AR). According to recent studies, its prevalence has fluctuated from 1.4% to 45% in the last few decades. AR has both direct and indirect consequences on one's quality of life, and it's often accompanied by asthma, middle ear irritation, nasal polyps, sinusitis, and lower respiratory tract infections. There is evidence that AR is frequently undertreated, mainly in its moderate and severe/intense persistent forms. The management of patients with AR involves proper pharmacological therapies, including allergen immunotherapy. Immunotherapy with allergens has been shown to be effective in the treatment of AR, asthma, and insect sting allergies. Objectives: The objective of this study was to measure the impact of immunotherapy on refractory AR patients in armed force hospital southern region, Saudi Arabia. In addition to detect the minimal duration required for immunotherapy. Materials and Methods: The study was conducted as an quasi-experimental intuitional – based study, total number of 52 patients used in this study which is all patients who fulfilled the inclusion criteria and initiated immunotherapy for refractory AR during period from Jan 2019 to Oct 2021, Data was collected using standardized online self-administered questionnaires using google forms. Results: A total of 52 patients responded to the questionnaire. About two-thirds of patients were males (67.3%), and aged 21–40 years (76.9%). The majority of them had a history of chronic rhinosinusitis (90.4%), whereas less than half of the patients had bronchial asthma (46.2%), nasal polyps (36.5%) and skin allergy (36.5%). Regarding the characteristics of immunotherapy, about one-quarter of the patients were receiving the immunotherapy for less than 6 months (26.9%), whereas 32.7%, 36.5% and 3.8% of them were receiving the therapy for 7 months to 1 year, more than 1 year to 2 years and more than 2 years, respectively. The reliability of the SNOT-22 scale was excellent as indicated by a Cronbach's alpha (α = 0.907). The most common problematic aspects before the immunotherapy (responses ranging from moderate to bad problems) were related to sneezing (96.1%), blockage/congestion of nose (94.2%) and runny nose (92.3%). These problematic aspects were indicated by 17.3%, 15.3% and 11.5% of patients after the intervention, respectively. The overall SNOT-22 score decreased significantly after the immunotherapy compared to before the intervention (median = 79.5, interquartile range [IQR] = 67.5–87.0 before the intervention and median = 18.0, IQR = 13.5–23.0 after the intervention, P < 0.0001). Similarly, the median values of all items of the SNOT-22 questionnaire reduced significantly (P < 0.0001 for all). The percentage improvement of the SNOT-22 score was 71.3% ±19.5 for the whole sample. Results of the correlation testing revealed a significant association between the pre-immunotherapy score and the percentage improvement (Spearman correlation coefficient = 0.32, P = 0.019), which indicates that patients with higher pre-therapeutic scores had a greater improvement with immunotherapy. Considering the factors associated with percentage improvement, results showed that the improvement in the overall SNOT-22 score differed significantly based on the duration of immunotherapy. Conclusion: As overall, this study can conclude that sublingual immunotherapy as treatment of AR led to a reduction in all symptoms studied, improving the quality of life of patients, proving itself as an important therapeutic tool for these pathological conditions. In addition to that, it has a known and relatively low risk of severe adverse events. Furthermore, a significant association was noted between the preimmunotherapy score and the percentage improvement which indicates that patients with higher pretherapeutic scores had a greater improvement with immunotherapy.

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