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   2010| July-December  | Volume 12 | Issue 2  
    Online since January 2, 2020

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Voice disorders among Saudi teachers in Riyadh City
Khalid H Malki
July-December 2010, 12(2):31-40
Background and Objectives: The teaching voice and its impact on the teaching profession have gained a special interest in several studies concerned with occupational voice disorders. To the best of our knowledge, no study had investigated this problem among Saudi teachers. This study aimed at investigating the prevalence of voice disorders among Saudi teachers in Riyadh city in addition to the possible risk factors to these disorders. Subjects and Methods: A voice questionnaire was distributed to a random sample of Saudi teachers in Riyadh city. The study included 416 teachers with a mean age of 34.3±5.2 years. Based on the results of the self-administered questionnaires, teachers with voice complaints (TVC) were identified. Significant differences between teachers regarding possible risk factors were investigated. Results: Thirty three percent of Saudi teachers in Riyadh city reported to have voice problems. Females were significantly more prone to develop voice problems than males. Teachers who reported the presence of some living habits, teaching characteristics, and health conditions were significantly at higher risk of developing voice disorders. Conclusion: Voice problems seem to be a prevalent problem among Saudi teachers in Riyadh city. Such condition could have negative impacts on the teaching profession. There appears to be many risk factors that can significantly affect the voice quality of teachers.
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Congenital absence of the epiglottis
Ahmed Mohammed Al Dkhyyal, Hasan Ali Alshehri, Saad al-Asiri
July-December 2010, 12(2):79-81
The Congenital absence of the epiglottis is a very rare anomaly. Only 6 cases were reported worldwide. This is the first case reported in Saudi Arabia. We present a patient who has a complete absence of the epiglottis with hoarseness, chocking with thin fluid and failure to thrive. Both endoscopic and computed tomography (CT) documentation are provided. Management and review of literature are discussed.
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Superior laryngeal nerve schwanoma presenting as a neck mass: A case report
Nada Al-Bahrani, Laila M Telmesani
July-December 2010, 12(2):76-78
This is a report of the first case of schwannoma originating from the external branch of superior laryngeal nerve. Solitary and extracranial schwannomas are extremely rare. To our knowledge, no case of schwannoma originating from external branch of superior laryngeal nerve has been reported.
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Diagnostic significance of immunohistochemistry in cases of undifferentiated nasopharyngeal carcinoma
Magdy I Gouda, Sherif M Askar, Masoud M Omar, Raafat Hegazy
July-December 2010, 12(2):68-72
Background: Undifferentiated nasopharyngeal tumors represent a great diagnostic difficulty in pathology laboratories specially in small crushed pathology specimens. Many of such tumors are anaplastic and difficult to distinguish from other neoplasms such as malignant lymphoma or soft tissue sarcoma. Antibodies to cytokeratin (CK) have been shown to be of diagnostic value in assessment of epithelial nature in both primary and metastatic poorly differentiated neoplasms. also common leukocytic antigen (CLA) and desmin help in exclusion of non-hodgkin’s lymphoma and soft tissue sarcoma. Material and Methods: Twenty eight nasopharyngeal tumors were collected from surgical specimens received at Pathology Department - Zagazig University, Egypt, during the period from may 2005 to december 2008. All biopsy specimens were subjected to routine histopathological diagnosis and immunohistochemical staining by broad spectum cytokeratin (CK), (CLA), and desmin. Results: All cases of undifferentiated nasopharyngeal carcinoma revealed variable degree of positive immunoreactivity for cytokeratin, regardless of their degree of differentiation with negative staining reaction for desmin and CLA. The three cases of non-hodgkin’s lymphoma were positive for CLA and negative for desmin and cytokeratin which stained only dendritic cells. The case of rhabdomyosarcoma revealed strong positive staining for desmin with negative reaction for cytokeratin and CLA. Conclusion: Immunostaining for broad-spectrum cytokeratin, CLA and desmin monoclonal antibodies have a great diagnostic aid in diagnosis of undifferentiated nasopharyngeal tumors with consequent effect on treatment and prognosis. Also the regular positive cytokeratin immunoreactivity in undifferentiated nasopharyngeal carcinomas supports the view that these tumors are homogenous group exhibiting variable degrees of squamous differentiation.
  1,007 57 -
The anatomical and perceptual correlates of speech intelligibility in children with repaired cleft palate.
Nahla Abdulaziz Rifaie, Amal Sayed Saber, Fatma Abdelhamid Kaddah
July-December 2010, 12(2):49-54
Speech is considered as one of the primary outcome measures of cleft lip and palate management. Speech intelligibility in case of velopharyngeal incompetence depends on the summation of the perceptual subjective degree of hypernasality, glottal articulation, pharyngeal articulation and audible nasal air emission. Objectives: The objective was to correlate between variables related to open nasality and speech intelligibility from anatomical and perceptual point of view to detect which factors have an effect more than others on speech intelligibility. Methods: This study was carried out on 23 children with a mean age of 12.65 year who were suffering from open nasality of speech after repaired cleft palate and did not received any line of speech therapy. Assessment of the patients included both objective and subjective measures Results: By using the logistic mutli-regression analysis, 15 subjective and objective variables were arranged in a numerical order to determine the most effective variable on speech intelligibility. It was shown that the most sensitive predictors (P < 0.005) for speech intelligibility were pharyngealization of fricatives and nasalance scores of oral sentence, while the degree of both open nasality, and palatal mobility were moderate sensitive predictors of speech intelligibility, however all the other remaining parameters were the least sensitive predictors of speech intelligibility. Conclusion: The different parameters used to assess the speech in patients with repaired cleft palate were variably affecting the speech intelligibility. Four certain parameters out of our results were recommended to be highlighted as valid measures of speech outcome in children with hypernasality.
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Management of parotid tumours: a 17- year experience at tertiary institutions
Faisal M H Al-Mashat, Saad M Al Muhayawi
July-December 2010, 12(2):41-48
Objective: The aim of this study was to evaluate our personal experience (surgical oncologist and ENT surgeon) of parotid surgery for various parotid pathologies and to compare our results with other centres. Methods: A 17-year retrospective review of 130 parotidectomies for benign and malignant diseases, collecting and analysing data about presentation, investigations, surgical treatment, postoperative facial nerve function, Frey’s syndrome and other surgical complications and follow-up. Results: All patients presented with parotid swelling, unilateral or bilateral. Few patients had pain and preoperative facial palsy. There were 66 males and 64 females . Their median age was 46.5 years , average duration of symptoms 48 months and mean size of swelling ± SD was 4.4±1.4 cm. Bilateral swellings were observed in 8 patients (6.2%). The investigations done included : fine needle spiration FNA), ultrasound (US), computed tomography (CT), magnetic resonance imaging MRI), magnetic resonance angiography (MRA), isotope scan and angiography. The surgical treatment was superficial parotidectomy for 116 patients, total parotidectomy for 14 patients and total parotidectomy with neck dissection for 12 patients. The traditional antegrade approach was used in 121 patients (93.1%). The overall rate of complications was 43.1%. The most common post operative complication was facial nerve paralysis which was noted in 38 patients (29.2%). The paralysis was temporary in 27 patients (73.0%) and permanent in 10 patients (27.0%). Frey’s syndrome was seen in 19 patients (14.6%). The final histopathology was 73.1% benign and 26.9% malignant. The median follow-up was 52 weeks. Operative mortality was zero. Conclusion: Parotid surgery is a delicate surgical intervention requiring a sound anatomical knowledge and surgical expertise to provide a safe and oncologically acceptable outcome. Our results are in parallel with other reported studies.
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Laryngopharyngeal Reflux Disease (LPRD) and pH-metry King Saud University Experience
Khalid H Malki, Ahmad Al Zahrani, T Mohammed Farahat, Tamer A Mesallam, Manal Bukhari, Saleh Al Amri
July-December 2010, 12(2):62-67
Background/Hypothesis: Laryngopharyngeal reflux disease (LPRD) patients can present with a variety of symptoms such as throat clearing, persistent cough, globus throat sensation, and dysphonia. Although 24-hour double-probe pH-monitoring is assumed to be the most sensitive test for diagnosing LPRD, a lot of controversy does exist regarding the placement of the upper probe as well as the interpretation of its results. The aim of this study was to present the experience of King Saud University (KSU) Hospitals, Saudi Arabia in the application of pH-metry in patients suspected to have LPRD. Materials and Methods: A retrospective chart review was done for the medical records of those patients who had a pH-metry study at KSU hospitals from 2005 to 2008. The main data that has been collected were demographics, causes of referral, main presenting symptoms, and pH study results. A correlation was done between pH-metry results and patients’ symptoms. Results: Sixty seven patients were included in the study. Twenty eight patients had double-probe studies, while the remaining 39 patients had single probe (distal) pH-metry. Forty patients out of the 67 showed positive results whether in the distal or the proximal pH sensors. The main cause of referral was patients refractory to anti-LPRD medications. The most frequently presenting symptom was heartburn, while globus throat sensation was the only symptom that correlated significantly with positive double-probe pH-metry results. Conclusion: pH-metry is not a commonly used primary tool for assessing LPRD-suspected patients in KSU hospitals. Most of the patients were given medical treatment once they were suspected to have LPRD. The pH-metry studies were only recommended for those patients who did not respond to medical treatment. Globus throat sensation appears to be the most extra-esophageal symptom that could be relevant to LPRD in the study group.
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Myoepithelial carcinoma of the parotid gland arising in a pleomorphic adenoma: A case report
Fatma Homoud Al Anazy
July-December 2010, 12(2):82-84
Background: We describe an unusual salivary neoplasm, an epithelial-myoepithelial carcinoma of the parotid gland that occurred in a 36-year-old woman with a pleomorphic adenoma of the parotid gland. Methods: The clinical, radiological, and hsitological findings of the patient are presented. Results: The initial tumor was a pleomorphic adenoma with epithelial and myoepithelial elements. Subsequently the tumour recurred three times surgery was required and the patient refused radiotherapy with huge growth during 10 years of irregular follow up. Extensive, although good recovery occurred. Conclusions: Although myoepithelial carcinomas (EMC) comprise approximately only 1% of all salivary gland tumours it should be suspected when there is recurrence in a pleomorphic adenoma .
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The outcome of myringoplasty in a residency training program in Saudi Arabia
Abdulrahman Alsanosi
July-December 2010, 12(2):73-75
Objective: The purpose of this study was to evaluate the outcome of myringoplasty performed by residents in a training program in a tertiary referral hospital in Saudi Arabia, and to compare the results with other published reports in the literature. Design: A retrospective chart review. Setting: King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Patients & Methods: A retrospective chart review of 356 patients who underwent myringoplasty as a primary surgery between January 2002 and December 2007. Cases involving cholesteatoma, retraction pocket or ossicular chain reconstructions were excluded. Dry ear and intact tympanic membrane were considered to be successful outcome. Results: Closure of perforation was achieved in 87.9% of the ears and 81.5 % of patients achieved postoperative air bone gap closure to <20 dB. Conclusion: The success rate of myringoplasty performed by residents in our centre is comparable to other published reports.
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The 16th National Symposium of the Saudi Oto-Rhino-Laryngology society held in Abha 5-6 May 2010

July-December 2010, 12(2):85-90
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Study of dead regions in the cochlea: New insight for management of auditory neuropathy/dys-synchrony
Nadia Kamal, Amani Shalaby, Khairy Abul Nasr, Wafaa El Kholi, Soha Mekky, Tayseer Taha, Dalia Helal
July-December 2010, 12(2):55-61
Objectives:This research was done to investigate dead regions of the cochlea in auditory neuropathy / dys-synchrony (AN/AD) patients and how much their presence affects the benefit from hearing aids. Methods:Twenty adolescent and adult patients with auditory neuropathy / dys-synchrony (AN/AD) together with a control group of forty age-matched patients with sensory neural hearing loss (SNHL) were examined. Both groups were evaluated for the presence of dead regions of the cochlea by TEN-HL test (Moore et al., 2004) [1]. TEN-HL test demonstrated positive criteria in 95% of ears in AN/AD patients which was mainly at low frequency bands, while 15% had positive TEN-HL test across all the tested frequency range. On the contrary, SNHL patients showed positive TEN-HL test in 16.5% of examined ears mainly in the mid frequency bands. The number of dead regions was negatively correlated to speech recognition. Results:Open hearing aid fitting was tried in AN/AD patients aiming to minimize the masking produced by low frequency dead regions and emphasize the high frequency components of speech. Binaural open hearing aid fitting showed improvement in high frequency detection thresholds that was significantly better than monaural fitting. Benefit from amplification was negatively correlated to the number of dead regions in TEN-HL test. Training of AN/AD patients on the use of these high frequency cues was suggested. Conclusion:Diagnosis of dead regioncan be taken as a guide in hearing aid fittingas well as in cochlear implant programming.
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