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  Citation statistics : Table of Contents
   2021| January-March  | Volume 23 | Issue 1  
    Online since May 6, 2021

 
 
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ORIGINAL ARTICLES
Hydrogen peroxide as a hemostatic agent in tonsillectomy: Is it beneficial?
Saai Ram Thejas, Ravindranath Vinayak, Mohan Sindu
January-March 2021, 23(1):36-40
DOI:10.4103/sjoh.sjoh_40_20  
Background: Tonsillectomy as a surgical procedure has been practiced by ENT surgeons for a very long time. A common indication for Tonsillectomy is Chronic Tonsillitis, among others. The surgery is largely safe irrespective of the method used. Haemorrhage can be a life-threatening complication post Tonsillectomy if it is not identified and treated immediately. Various techniques are used to achieve haemostasis and prevent haemorrhage including surgical tie, cautery, local application of adrenaline or hydrogen peroxide among others. Aims and Objectives: To understand the vasoconstrictive and haemostatic properties of Hydrogen Peroxide in Tonsillectomy. Materials and Methods: One hundred and thirty-three (133) patients undergoing Tonsillectomy for Chronic Tonsillitis were part of the study. Dissection and Snare technique was performed. 23 patients needed the use of cautery/knot for haemostasis and were then excluded from the study. To avoid bias, dissection of the right tonsil was taken as Group 1 and left tonsil as Group 2. Normal Saline soaked cotton ball was used to give local pressure in the tonsillar fossa in Group 1 and 3% Hydrogen Peroxide soaked cotton ball was used in Group 2. Blood loss and time taken to dissect were taken as parameters of study. Observations and Results: In Group 1, it took 14.29 minutes on an average from first incision to completion. In Group 2, it took 12.15 minutes on an average from first incision to completion. The time in Group 2 was 14.97% lesser than Group 1. The average blood loss in Group 1 was 56.47 ml and in Group 2 the same value stood at 47.41 ml. The blood loss in Group 2 was 16.04% lesser than in Group 1. There were no complications encountered. Conclusion: 3% Hydrogen Peroxide is a potent agent for antimicrobial activity and haemostasis when introduced in the tonsillar fossa post tonsillectomy. When used in moderation, it is very effective in preventing blood loss. Also, there are no serious complications associated with the use of Hydrogen Peroxide as a haemostatic agent.
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Mastoid cavity obliteration with hydroxyapatite granules: A prospective study
Jitu Sam George, Vikas Kakkar, Vikasdeep Gupta, S Dheeraj, Sandeep Bhukar, Swati , Manish Verma
January-March 2021, 23(1):6-10
DOI:10.4103/SJOH.SJOH_22_20  
Background: Modified radical mastoidectomy is the mainstay in the treatment of a case of unsafe CSOM. In order to reduce the side effects of an open matoid cavity, many methods to obliterate the cavity have been devised. Aims & Objectives: Cavity obliteration was done to study the efficacy of mastoid cavity obliteration Material and Methods: We carried out cavity obliteration with hydroxyapatite in 20 patients and compared the results with non obliteration. Results: We observed that in addition to reduction in size of cavity, there is better epithelisation and hence faster healing of the mastoid cavity. There is also a significant improvement in hearing status of the patients. Conclusion: Modified Radical Mastoidectomy followed by cavity obliteration with hydroxyapatite granules has numerous advantages compared to leaving the cavity as such.
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CASE REPORTS
Giant parathyroid adenoma presenting as neck swelling: A rare case report
Vaibhav Saini, Nitin Gupta, Vikasdeep Gupta, Amanjot Kaur, Gagandeep Kaur
January-March 2021, 23(1):47-49
DOI:10.4103/SJOH.SJOH_28_20  
The normal weight of parathyroid gland lies between 50 and 70 mg. Any adenoma weighing more than 3.5 g is labeled giant parathyroid adenoma. It forms a distinct clinical entity in terms of difficulty in differentiation from parathyroid carcinoma and more aggressive postoperative management due to higher chances of postoperative hypocalcemia. We present the case report of a 35-year-old woman presenting with multiple fractures and neck swelling which was diagnosed as giant parathyroid adenoma and managed by parathyroidectomy.
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The unpredictable pathway of foreign bodies in penetrating neck trauma: A case report and review of the literature
Sara Alquorain, Shatha Alshamsi
January-March 2021, 23(1):50-54
DOI:10.4103/SJOH.SJOH_7_20  
Saudi Arabia has the world's highest number of deaths due to road traffic accidents (RTAs). Penetrating neck trauma is a peculiar sequela of RTA, which may be complicated by the implantation of foreign bodies. Foreign bodies penetrating the neck have an unpredictable course, ranging from being completely asymptomatic to being fatal. We present an interesting case of penetrating neck trauma due to RTA that was complicated by implantation of sharp foreign bodies in the neck. These bodies migrated over time to penetrate major blood vessels. In this case, the authors discuss the current management of penetrating neck trauma and highlight the complications of residual foreign bodies in the neck and their management.
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ORIGINAL ARTICLES
How Harmful is your personal listening device: A knowledge and attitude survey among college-going students of India
Satvinder Singh Bakshi, Vinoth Kumar Kalidoss, Seepana Ramesh, M Kiruba Shankar
January-March 2021, 23(1):41-46
DOI:10.4103/sjoh.sjoh_55_20  
Objectives: Over 1 billion people globally are at risk of hearing loss due to unsafe listening practices. The most common unsafe practice is using personal listening devices (PLDs), especially along with headphones. This study aimed to determine the knowledge regarding hearing loss due to the use of PLDs and practice concerning these devices among the college-going population (18–25 years) in India. Methodology: A cross-sectional study was conducted among college-going students aged 18–25 years. Data were collected using an anonymous web-based self-administered questionnaire. Results: A total of 255 male and 133 female students were enrolled (n = 388). Most participants listened to music more than an hour a day and 44% listened to loud and very loud music. More than half chose to ignore the warning message on their PLD and around 30% had never come across any educational material regarding the risk of hearing loss due to the use of PLDs. Conclusion: The findings indicate the need for the development of more targeted educational material and outreach programs to reduce the burden of hearing loss due to the use of PLDs.
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Comparison of different surgical treatment modalities for nasal obstruction caused by inferior turbinate hypertrophy
Ibrahim K Al Jabr, Njood Alaboud, Faissal A Al Habeeb
January-March 2021, 23(1):11-15
DOI:10.4103/SJOH.SJOH_39_20  
Background: Hypertrophied inferior turbinates considered the second most frequent contributor to nasal obstruction after septal defects. Various medical measures can be used to treat inferior turbinate hypertrophy (ITH). After failure of medical methods, surgery becomes the cornerstone of management, which is still a controversial issue in the otorhinolaryngology field. Although these surgeries have been practiced for decades, no conclusion has been drawn about the best and optimal choice. Objectives: The objectives were to compare the results between submucosal diathermy (SMD) and partial inferior turbinectomy (PIT) in terms of postoperative bleeding, crusting, dry throat, voice change, postnasal drip, nasal obstruction, need for re-use of medications, and further need for nasal surgery. Subjects and Methods: A prospective observational study involving 100 patients with ITH. Patients were randomly divided into two groups: Group A underwent SMD and Group B underwent PIT. Postoperative follow-up was done at 1 week, 1 month, and 6 months. Results: At 1-week, nasal crusting, postnasal drip, and dry throat were reported more in SMD. At 1-month, nasal crusting and voice change were experienced more in PIT. At 6-month, nasal crusting and voice change occurred more in PIT. Nasal obstruction occurred more in SMD. Re-use of medications and further nasal surgery were more in SMD. Conclusion: SMD is less invasive with fewer complications regarding bleeding and crusting in comparison to PIT, but its effectiveness compared to PIT in re-use of medications and need for further nasal surgery is less.
  - 1,590 140
Management of vocal complications post thyroidectomy at king abdullah medical city from 2011 to 2018
Saeed Abdullah Alghamdi, Amani Mohammad Alyamani, Rawan Rajallah Aljohani, Wajd Mohammad Benjabi, Raghad Abdulrahman Althobaiti, Walaa Abdullah Takrooni, Yousef Zaben Alotaibi, Khalid Mahmoud Badr, Sherif Kamel Abdelmonim
January-March 2021, 23(1):16-20
DOI:10.4103/SJOH.SJOH_25_20  
Background: The most common critical complication after thyroidectomy is vocal cord dysfunction. The leading cause of that problem is injury to the recurrent laryngeal nerve (RLN). Materials and Methods: A retrospective cohort study was applied to 266 patients who underwent thyroidectomy procedures at King Abdullah Medical City between the years of 2011 and 2018. Patients with preexisting vocal cord abnormalities and neurological conditions affecting the voice or swallowing ability were excluded. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics V21.0). Results: Out of the 266 patients, the incidence of RLN injury was significantly higher if the patient had a previous thyroid surgery, especially among cancer patients (30.4% in cancer vs. 9.2% in noncancer, P = 0.001). Patients who presented with postoperative vocal complications were only five; four of them developed temporary unilateral vocal cord palsy (1.6%) and were managed with speech therapy, however, one patient had a permanent bilateral vocal cord palsy (0.4%) that was managed with tracheostomy and laser vocal cordotomy. Conclusion: The incidence of vocal cord complication due to thyroidectomies was comparatively rare. Thyroid complications were present more in cancer patients.
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Pilot study: Cochlear implant nonuse secondary to maintenance issues in saudi Arabian children – unilateral versus bilateral
Turki Hagr, Shaza Saleh, Abdulrahman Hagr
January-March 2021, 23(1):21-25
DOI:10.4103/SJOH.SJOH_37_20  
Introduction: The study aimed to explore the implanted children's parents' attitudes toward what could be considered an acceptable period to address speech processors (SPs) dysfunction and indirectly of cochlear implantation (CI) nonuse secondary to SP's problems in unilaterally and bilaterally implanted patients. Methods: A questionnaire was administered to CI recipients from multiple centers to investigate how long it took them to seek help in case of a SP problem and how long it took them to receive a replacement/loaner device in unilateral and bilateral CI cases. The questionnaire also investigated whether they had a backup device or not. Results: One hundred and forty-three CI recipients' parents filled the questionnaire. Thirty-two percent of unilaterally implanted recipients had backup SPs in comparison to 18% only of the bilaterally implanted, yet statistically significant correlation was found between the time it took them to seek help and whether the recipient had a unilateral or bilateral CI, χ2 (5, n = 143) = 11.07, P < 0.05). Without having a backup SP, 67% of unilaterally implanted individuals sought help immediately versus 61% of the bilaterally implanted. Conclusions: CI nonuse secondary to SP issues was found to be a problem which could be due to delayed reporting or device replacement issues. SP requires daily ear specific testing and high maintenance to ensure consistent use which can be partially solved by backup devices. Some CI recipients and their families might perceive having a second CI as a backup which may contribute to the delay in seeking help for faulty SPs among the bilaterally implanted CI recipients.
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Validity and reliability of the arabic version of the wisconsin upper respiratory symptom survey (AWURSS-11)
Mohamed Farahat, Tamer A Mesallam, Abdullah A Alrasheed, Khalid H Malki
January-March 2021, 23(1):26-30
DOI:10.4103/SJOH.SJOH_36_20  
Background: The Wisconsin Upper Respiratory Symptom Survey (WURSS) is a patient-oriented tool that has been developed to evaluate patient QOL in a disease-specific manner. Objectives: This study aimed to generate an Arabic purview of Wisconsin Upper Respiratory Symptom Survey WURSS-11 (AWURSS-11) and to assess its validity and reliability in normal subjects and common cold patients. Materials and Methods: This cross-sectional study has been carried out in King Abdulaziz University Hospital and Prince Sultan Medical Military City Riyadh, Saudi Arabia, between October 2017 and May 2018. The generated AWURSS-11 was administered to 197 patients with common cold and 67 asymptomatic participants. Cronbach's alpha tested the internal consistency of the AWURSS-11, while intraclass correlation coefficient was used to study test-retest reliability. The patients and control results were compared to test the clinical validity of the AWURSS-11. Results: AWURSS-11 showed good internal consistency (Cronbach's α = 0.896). Furthermore, good test-retest was found for the three domains and the total scores with significantly high intra-class correlation coefficient (ICC = 0.93). Significant difference was resulted between the AWURSS-11 score of the patients and the asymptomatic group (P = 0.0001). Conclusion: The results showed that the AWURSS-11 is a tool that is valid and reliable and can be even be used to assess common cold symptoms in patients who are Arabic speakers.
  - 1,195 89
Primary nerve sheath tumors of the parapharyngeal Space: A retrospective review
Muhammad Rashid, Muhammad Noman Karim, Humaira Saleem, Ameer Abdullah, Farhan Akbar, Abdul Hakim
January-March 2021, 23(1):31-35
DOI:10.4103/SJOH.SJOH_32_20  
Aims: The aims of this study were to retrospectively analyze the presentation, diagnostic challenges, and optimum treatment of nerve sheath tumors (NSTs) in parapharyngeal space (PPS). Settings and Design: This is a retrospective chart review done at a tertiary care hospital, Pakistan, from January 2009 to April 2020. Methods: All PPS tumors of nerve sheath origin were included in the study. A total of 18 patients satisfied the inclusion criteria. Their clinical presentation, diagnostic modality, surgical approach, and complications were analyzed. Statistical Analysis Used: SPSS version 20 was used for statistical analysis. Results: The male-to-female ratio was 11:7, with a median age at the time of surgery being 43 ± 10.19 years. The most common clinical symptom was neck swelling. Computed tomography scan was the mainstay of investigation (15 cases). Fine-needle aspiration cytology was diagnostic only in three cases. Transcervical approach was used in all the patients except in one patient. The sympathetic chain was involved in five, vagus in two, and hypoglossal and glossopharyngeal in one patient each. However, nerve involvement was uncertain in nine patients. Among postoperative complications, Horner's syndrome was the most common followed by first bite syndrome. Conclusions: PPS NSTs offer a great deal of diagnostic dilemma and an operative challenge. With currently available imaging techniques and meticulous surgery, it is possible to treat PPS NSTs effectively. The nerve of involvement is also important as it can indicate the potential complication that may occur.
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REVIEW ARTICLE
Inverted papilloma in children
Mazyad Alenezi, Fatemah Altheyab, Saleh Alabood, Abdulhakeem Almutairi, Sultan Alanazy, Osama Al-Wutayd
January-March 2021, 23(1):1-5
DOI:10.4103/SJOH.SJOH_2_20  
Inverted papilloma (IP) is considered a rare benign sinonasal lesion, which is usually presented in adults. The presentation of IP is usually a unilateral nasal obstruction. IPs in the pediatric age group are quite rare as only a few cases were reported. This review aims to increase the awareness of IP to consider this entity in the diagnosis of unilateral nasal obstruction in children. This study was a review of 10 articles which reported the occurrence of IPs in children. Data include age, presentation, diagnosis, and treatment which were extracted and analyzed. The total number of cases was 12. The mean age of all cases was 10.5 years. The majority were male (66%). The main presenting symptom of all cases was nasal obstruction along with other nasal symptoms. The majority of the patients were treated by surgical excision of the lesion. Most of the cases 6 (50%) used endoscopic sinus surgery, and 5 (41%) of them were managed by lateral rhinotomy with or without medial maxillectomy. Follow-up showed that 7 (58%) of the cases did not document any recurrence of the disease. The reoccurrence occurred in 5 (41%) of the cases within the 1st year after the management. IPs can arise in the pediatric age group and should be considered in the differential diagnosis of unilateral nasal obstruction. It is diagnosed and treated likewise in adults.
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