Objectives/Hypothesis: To identify risk factors contributing to AR among preschool children in Jeddah (SAUDI ARABIA). Study design: Case control study. Methods: The study comprised 128 children with ISAAC diagnosed AR, and 189 children as controls. Logistic regression was used. The odds ratio (OR) and 95% confidence intervals (95% CI) were calculated. Results: The significant risk factors for AR were high socio-economic class (OR 3.08; 95% CI 1.69, 5.165), smoking of the father (OR 0.379; 95% CI 0.214, 0.674), age of the child (OR 2.665; 95% CI1.445, 4.910), formula feeding (OR 5.41; 95% CI 3.024, 9.679), family history of allergy (OR 4.27; 95% CI 2.74, 7.39), obesity (OR 2.234; 95% CI 1.18, 4.22), and respiratory tract infection (OR: 7.997; 95% CI: 4.019, 15.913). Conclusions: Environmental, genetic, nutritional as well as life style factors are risk factors for development of AR, and should be considered when planning medical care services for preschool children.

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Background: Choanal atresia (CA) is a rare congenital anomaly that is characterized by posterior nasal choanal obstruction either unilateral or bilateral. Endonasal endoscopic repair is the current modality of treatment. Restenosis is still a common concerning complication post-surgery. In this study, we studied the impact of many factors on the recurrence rate. Objectives: This study aimed at evaluating the success rate of endonasal endoscopic repair of choanal atresia and the influence of many factors on the recurrence rate: age at intervention, laterality, use of mitomycinC , presence of syndromes and adenoid hypertrophy. Design: Retrospective study by chart review Settings: King Saud University Medical City, Riyadh, Saudi Arabia. Material and Methods: We considered all cases of choanal atresia operated in our center for the period from January 2014 to May 2017. We included only the primary cases (operated for the first time) in this study. We excluded any case that was operated on before in any other center, missed to follow-up or with incomplete medical records. Results: The sample comprised 22 cases of CA, with an equal distribution of males and females. Four of the patientsexperienced recurrence(recurrence rate 18%), and the mean follow-upperiod was 21.3 months. The recurrence rate was higher in syndromic patients (2 out of 3 versus 2out of 19 nonsyndromic). Mean age at intervention in successful cases was 17 months and in the recurrence group was 7.15 months. Unilateral cases were more common than bilateral (14 versus 8). The rate of recurrence was 10% in themitomycin group and 25% in the nonmitomycin group. Conclusions: The recurrence rate of post-choanal atresia repair was 18% and recurrence in syndromic patientswas higher in this study.

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Background: Necrotizing otitis externa defined as an infectious disease affecting external auditory canal and might involve the mastoid space and base of skull as well, and thus a fatal neurological complications if left untreated. Generally; there’s an emergence of antibiotics resistance have been reported as well as a various causative organisms. Objectives: To investigate the clinical presentation, related co-morbidities, antimicrobial patterns, and associated complications. Patients and Methods: This is a case series of patients with diagnosis of necrotizing otitis externa who admitted and treated at otolaryngology department, king Fahad hospital, Jeddah from üctober-2007 to üctober-2017. Detailed medical data were reviewed included demographics, clinical presentation, antimicrobial sensitivity, and clinical outcome. Results: Fourteen patients with NOE were treated at our institution, of these, eleven were male and three were female. All the included patients were diabetic and they had aural polyp. Ear discharge was the most common presenting symptoms. Eight cultures isolated a pseudomonas aeruginosa. All patients received an intravenous antibiotics either monotherapy or combination therapy. The mean hospital stay was 39 days. Zero mortality rate 30 days post discharge. Conclusion: Necrotizing otitis externa remain an aggressive disease with growing bacterial resistance so the choice of antimicrobial should be chosen with cautious. Nevertheless; severe ear pain, and ear discharge in elderly diabetic patients the diagnosis of NOE should be ruled out. Prevalence of pseudomonas aeruginosa is remain quite high, although non-pseudomonal organisms are increasing over should paid.

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Background: The variations in structures of the nasal cavity are essential to identify while practicing endoscopic sinus surgery (ESS). Inadequate knowledge of surgeons performing ESS, regarding the commonly occurring anatomical variations can lead to a variety of complications having substantial mortality and morbidity. Objective: This study aims to evaluate the prevalence of clinically significant anatomical variations of the paranasal sinuses in a Saudi population. Methods: A retrospective analysis of 106 computed tomography (CT) examinations of adult Saudi population were conducted to determine the prevalence of clinically significant anatomical variations of the paranasal sinuses. The study was conducted from January 2012 to October 2013 at King Abdulaziz University Hospital. Results: The findings showed concha bullosa in 41.5% of cases, Paradoxical middle turbinate in 5.7% of cases, Haller type of cell was seen in 11.3%, Onodi type of cell in 13.2%, pneumatization of uncinate process in 3.8 % of CT scans analyzed. Internal carotid artery (ICA) bulge in the sphenoid sinus was seen in 2.8% cases, whereas no ICA dehiscence was seen in any study. Optic nerve bulge in the sphenoid sinus was observed in 9.4% of the cases. Conclusion: Knowledge regarding the existence of anatomical variations of the sinuses has a clinical significance beyond any doubt as it minimizes the probability of surgical complications especially in ESS.

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Juvenile nasopharyngeal angiofibroma (JNA) is a highly aggressive locally invasive vascular neoplasm found almost exclusively in prepubescent and pubescent boys. It accounts for 0.05% of all head and neck tumors and is the most common benign tumor involving the pterygopalatine and infratemporal fossa^[1]. Although histologically benign, it is locally invasive and, if left untreated, has the potential to erode through the skull base^[2]. Here we present a case report of a 13 years old boy came with history of obstruction in the right nasal cavity associated with epistaxis and discharge. Computed tomography with contrast imaging revealed an enhancing heterogeneous mass lesion in the nasopharynx and posterior choana extending to pterygopalatine and infratemporal fossa in the right side.

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