Allergic rhinitis in relation to food allergies: pointers to future research

Allergic rhinitis is a ubiquitous type of allergic reaction which results in significant costs to affected patients and their families. Although allergic rhinitis can coexist with other atopic conditions, the role of food allergies in the development of allergic rhinitis has not been well studied. This article explores relevant literature on this subject in order to identify gaps in the available body of knowledge and elucidate scope for further research

accuracy of IOS device-based uHear as a screening tool for hearing loss: a preliminary study from the Middle East

Objectives: To determine and explore the potential use of uHear as a screening test for determining hearing disability by evaluating its accuracy in a clinical setting and a soundproof booth when compared to the gold standard conventional audiometry

Methods: Seventy Sultan Qaboos University students above the age of 17 years who had normal hearing were recruited for the study. They underwent a hearing test using conventional audiometry in a soundproof room, a self-administered uHear evaluation in a side room resembling a clinic setting, and a self-administered uHear test in a soundproof booth. The mean pure tone average [PTA] of thresholds at 500, 1000, 2000 and 4000 Hz for all the three test modalities was calculated, compared, and analyzed statistically

Results: There were 36 male and 34 female students in the study. The PTA with conventional audiometry ranged from 1 to 21 dB across left and right ears. The PTA using uHear in the side room for the same participants was 25 dB in the right ear and 28 dB in the left ear [3-54 dB across all ears]. The PTA for uHear in the soundproof booth was 18 dB and 17 dB [1-43 dB] in the right and left ears, respectively. Twenty-three percent of participants were reported to have a mild hearing impairment [PTA > 25 dB] using the soundproof uHear test, and this number was 64% for the same test in the side room. For the same group, only 3% of participants were reported to have a moderate hearing impairment [PTA > 40 dB] using the uHear test in a soundproof booth, and 13% in the side room

Conclusion: uHear in any setting lacks specificity in the range of normal hearing and is highly unreliable in giving the exact hearing threshold in clinical settings. However, there is a potential for the use of uHear if it is used to rule out moderate hearing loss, even in a clinical setting, as exemplified by our study. This method needs standardization through further research

Clinically significant anatomical variants of the paranasal sinuses

Anatomic structural variations of the paranasal sinuses have a practical significance during surgical procedures conducted on the sinuses by otolaryngologists. This study aims to evaluate the prevalence of clinically significant anatomical variations of the paranasal sinuses. A prospective analysis of 435 computed tomography [CT] examinations of adult Omani patients was conducted to determine the prevalence of clinically significant anatomical variations of the paranasal sinuses. A total of 360 CT scans were included from January 2009 to January 2010. The findings showed abnormal Agger nasi cells in 49% of cases [95% CI: 44-54%], concha bullosa in 49% [95% CI: 44-54%], Haller cells in 24% [95% CI: 18-31%], asymmetry in anterior ethmoidal roof 32% [CI: 29-37%], Onodi cells in 8% [CI: 5%-10%]. The type of skull base were as follows; Type 1 was 30% [n=107; 95% CI: 25-35%], Type 2 was 34% [n=123; 95% CI: 29-39], and Type 3 was 36% [n=130; 95% CI: 31-41%]. Many other surgically significant anatomical variations in small numbers [1-3] were incidentally identified. Knowledge of the presence of anatomical variations of the sinuses has a clinical significance as it minimizes the potential for surgical complications. There is an ethnical difference in the prevalence of anatomical variations. Further studies of anatomical variations with clinical disease correlations are needed.

Effect of locally administered ciliary neurotrophic factor on the survival of transected and repaired adult sheep facial nerve

To determine whether the administration of Ciliary Neurotrophic Factor [CNTF] at the site of repaired facial nerve enhances regeneration in the adult sheep model. Ten adult sheep were divided into 2 groups: control and study group [CNTF group]. In the CNTF group, the buccal branch of the facial nerve was transected and then repaired by epineural sutures. CNTF was injected over the left depressor labii maxillaris muscle in the vicinity of the transected and repaired nerve for 28 days under local anesthesia. In the CNTF group, the sheep were again anesthetized after nine months and the site of facial nerve repair was exposed. Detailed electrophysiological, tension experiments and morphometric studies were carried out and then analyzed statistically. The skin CV min, refractory period, Jitter and tension parameters were marginally raised in the CNTF group than the control but the difference was statistically insignificant between the two groups. Morphometric indices also did not show any significant changes in the CNTF group. CNTF has no profound effect on neuronal regeneration of adult sheep animal model

Allergic rhinitis and associated comorbidities: prevalence in Oman with knowledge gaps in literature

Allergic rhinitis [AR] is a global health problem and its impact on health related quality of life for patients is substantial, and the economic impact often underestimated. The prevalence of allergic rhinitis in Oman is unknown. This study aimed to estimate the prevalence of AR and associated co-morbidities among adults in Oman. Its secondary objective was to identify knowledge gaps in the literature with the aim of directing future research. A prospective, cross-sectional study of patients who presented to the outpatient otolaryngology clinic at Sultan Qaboos University Hospital with nasal symptoms between June 2010 and June 2011 was conducted. A total of 887 patients were seen with nasal complaints. Among them 127 patients were diagnosed with non-infective rhinitis, the mean age of presentation was 27 years. AR was noted in 48% of patients, and non-allergic rhinitis in 52%. The prevalence of AR was 7%, with females being more affected than males, and age ranging from 18 to 51 years. Prevalence of perennial AR was 84% compared to seasonal AR which was 16%. The most common perennial antigens were house dust mites [80%] followed by cockroaches [67%]. All patients diagnosed with seasonal AR were found to be sensitive to Russian thistle. The prevalence of chronic rhinosinusitis in patients with AR was 34%. The prevalence of AR in the adult population presenting with nasal symptoms was found to be 7%, with associated chronic rhinosinusitis present in a third of these patients. However, there appears to be substantial knowledge gaps regarding the association of other comorbidities, like otitis media, bronchitis and bronchial asthma, the long-term outcomes of medical management, and indication of surgical intervention in patients with AR. Future research in AR among Omani patients should aim to address these issues

Patient satisfaction survey as a tool towards quality improvement

Over the past 20 years, patient satisfaction surveys have gained increasing attention as meaningful and essential sources of information for identifying gaps and developing an effective action plan for quality improvement in healthcare organizations. However, there are very few published studies reporting of the improvements resulting from feedback information of patient satisfaction surveys, and in most cases, these studies are contradictory in their findings. This article investigates in-depth a number of research studies that critically discuss the relationship of dependent and independent influential attributes towards overall patient satisfaction in addition to its impact on the quality improvement process of healthcare organizations

Diagnosis of adult chronic rhinosinusitis: can nasal endoscopy predict intrasinus disease?

To define the role of endoscopic evaluation of middle meatus in adult patients clinically diagnosed to have chronic rhinosinusitis and its ability to predict intra-sinus mucosal involvement as compared to CT scan. This prospective analytical study was conducted on consecutive patients with diagnosis of chronic rhino-sinusitis who were symptomatic and fulfilled the American Academy of Otolaryngology - Head and Neck Surgery Task Force criteria. The patients were enrolled prospectively and were subjected to rigid diagnostic nasal endoscopy and classified as defined by the revised Sinus Allergy Health Partnership Task Force criteria. The patients then underwent non contrast CT sinuses on the same day. Results were analyzed as a diagnostic test evaluation using CT as a gold standard. Among the 75 study patients with symptom based chronic rhino-sinusitis, nasal endoscopy was abnormal in 65 patients [87%]. Of these patients, 60/65 [92%] showed positive findings on CT scan. Ten patients had normal endoscopy, of these 6/10 [60%] had abnormal CT scan. Sensitivity and specificity of diagnostic nasal endoscopy against CT scan were 91% [95% CI: 81-97] and 44% [95% CI: 14-79], respectively. The likelihood ratio for positive nasal endoscopy to diagnose chronic rhino-sinusitis was 1.6 and the likelihood ratio to rule out chronic rhino-sinusitis when endoscopy was negative was 0.2. Nasal endoscopy is a valid and objective diagnostic tool in the work up of patients with symptomatic chronic rhinosinusitis. When clinical suspicion is low [<50%] and endoscopy is negative, the probability of rhino-sinusitis is very low [<17%] and there is no need to perform a CT scan to reconfirm this finding routinely. Endoscopy alone is able to diagnose chronic rhinosinusitis in >90% of patients when clinical suspicion is high [88%] as defined in this study by AAO-HNS Task Force criteria. Negative endoscopy, however, does not totally exclude the sinus disease in patients fulfilling task force criteria. CT scan may be needed on follow-up if there is clinical suspicion in 10% of these patients who are negative on endoscopy if symptoms persists. It is thus possible to reduce the number of CT scans if patients are carefully selected based on clinical criteria and endoscopy is done initially as part of their evaluation.

Putting research findings into clinical practice feasibility of integrated evidence-based care pathways in otorhinolaryngology head and neck surgery at Sultan Qaboos University Hospital, Oman

A perception exists that clinicians in Oman are reluctant to adopt evidence-based practice [EBP]. This pilot study was undertaken to study the feasibility of using EBP pathways at the point of care in otorhinolaryngology head and neck surgery. The ultimate aim was to facilitate EBP with the probability of developing a new system for implementing research findings/translational research at the clinical point of care. A cross-sectional prospective questionnaire pilot survey of clinicians at Sultan Qaboos University Hospital [SQUH], Oman, a tertiary care medical centre, was undertaken. Respondents included 135 physicians and surgeons with between 3 months and 25 years of clinical experience and included personnel ranging from interns to senior consultants, in areas ranging from primary care to specialist care. Of those polled, 90% [95% confidence interval [CI] 85-95%] either strongly agreed or agreed that evidence-based practice protocols [EBPP] could help in decision making. A total of 87.4% of participants [95% CI 81.8-93%] either strongly agreed or agreed that EBPPs can improve clinical outcomes; 91.8% of participants [95% CI 87.2-96.4%] would use and apply EBPP in day-to-day care if they were available at the point of care and embedded in the hospital information system. The perception that clinicians at SQUH are reluctant to adopt EBP is incorrect. The introduction of EBP pathways is very feasible at the primary care level. Institutional support for embedding EBP in hospital information systems is needed as well as further outcome research to assess the improvement in quality of care

novel V- silicone vestibular stent: preventing vestibular stenosis and preserving nasal valves

This report presents a novel style of placing nasal stents. Patients undergoing surgical procedures in the region of nasal vestibule and nasal valves are at risk of developing vestibular stenosis and lifelong problems with the external and internal nasal valves; sequels of the repair. The objective of the report is to demonstrate a simple and successful method of an inverted V- Stent placement to prevent potential complication of vestibular stenosis and nasal valve compromise later in life. Following a fall on a sharp edge of a metallic bed, a sixteen month old child with a deep lacerated nasal wound extending from the collumellar base toward the tip of the nose underwent surgical exploration and repair of the nasal vestibule and nasal cavity. A soft silicone stent fashioned as inverted V was placed bilaterally. The child made a remarkable recovery with no evidence of vestibular stenosis or nasal valve abnormalities. In patients with nasal trauma involving the nasal vestibule and internal and external nasal valves stent placement avoids sequels, adhesions, contractures, synechia vestibular stenosis and fibrosis involving these anatomical structures. The advantages of the described V- stents over the traditional readymade ridged nasal stents, tubing's and composite aural grafts are: a] technical simplicity of use, b] safety, c] less morbidity, d] more comfortable, and e] economical. To our knowledge, this is the first report of such a stent for prevention of vestibular stenosis and preserving nasal valves

Information mastery, effective health care, evidence-based practice and the otolaryngologist

The objectives of this study were to study the information-seeking behaviour of otolaryngologists in Oman, and their willingness to learn and acquire evidence-based practice [EBP] skills. A cross-sectional survey was carried out by distribution of a questionnaire to 63 otolaryngologists [ranging from residents to consultants] employed in Oman who attended a national otolaryngology meeting in January 2010. Forty-nine completed questionnaires were received; 57% of the respondents had more than 10 years' experience, and 60% were from tertiary care; 38.8% "totally agreed", and 36.7% "partially agreed" that EBP would improve the quality of care and thus provide effective health care to patients. More than 46.9% had 1-5 questions per week, 18.4% had 11 or more questions per week at the point-of-care; 69.4% were willing to acquire information mastery skills. There was a statistical correlation between the number of years of experience, the number of questions, and willingness to acquire information mastery skills. In day-to-day clinical practice, web-based resources are of increasing significance. Most otolaryngologists in Oman not only believed that it is essential to acquire information mastery skills, but also that effective health care depends on such skills and on EBP. Most were willing to acquire these skills. In the future, these skills will be vital in helping otolaryngologists deliver effective health care solutions

Schwannoma of the cervical symphathetic chain first case report from Oman

Schwannomas are benign, encapsulated and slow-growing nerve sheath tumours arising from Schwann cells. The schwannoma arising from the cervical sympathetic chain [SCSC] is a very rare tumour. It usually presents as a slow growing, painless and asymptomatic neck mass, hence preoperative clinical diagnosis is difficult. Radiological investigation and fine needle aspiration cytology make only a small contribution to its preoperative diagnosis, histopathological examination being much more useful. We report here the first case report of SCSC from Oman. It occurred in a 45 year-old female and was successfully excised

Non allergic rhinitis: prevalence, clinical profile and knowledge gaps in literature

Although Nasal symptoms induced by Non-allergic rhinitis| [NAR] are a cause of wide spread morbidity; the disease is trivialized. There is a lack of Epidemiological studies on the prevalence of non-allergic rhinitis. In spite of being one of the commonest conditions presenting to the General practitioner and otolaryngologists, the clinical profile, diagnosis, and management outcomes are unknown. The objectives of the study were to examine the prevalence and clinical profile of non-allergic rhinitis in Oman. Secondary objective was to identify Knowledge gaps in literature with the aim of directing future research. A cross sectional study of 610 consecutive adult patients presenting to the Ear, Nose and Throat clinic at Sultan Qaboos University Hospital is presented in this paper. The diagnosis of NAR was mainly based on step wise fashion; including a thorough clinical history and exclusion of other causes of rhinitis; all consecutive patients diagnosed with rhinitis [n=113] had a detailed history, nasal endoscopy, nasal smears, CT scans and an antihistamine response trial. The prevalence of NAR with its clinical profile was subsequently determined. Primary research articles and meta-analysis evaluated for the knowledge gap study were identified through MEDLINE search of English language literature published between 2000-2011. A total of 610 consecutive patients were studied. The overall prevalence of rhinitis was 18.5% [n=113]. The prevalence of NAR was 7.5% [n=46]. Cases of allergic rhinitis [5.7%; n=35], Chronic rhinosinusitis [1.8%; n=11], and miscellaneous causes [3.4%; n=21] were excluded. Among the rhinitis population [n=113], the prevalence of NAR was 57% [n=46]. The major presenting symptoms included nasal obstruction [93%; n=43], postnasal drainage [78%; n=36], and rhinorrhea [62%; n=29]. For the knowledge gap study; 115 Medline titles were reviewed, four systematic reviews, and 34 research papers were reviewed. The text of two recent otolaryngology text books was also reviewed, and the main results of the study revealed the prevalence of NAR had not previously been studied in Oman. Although the recent text now clearly defines NAR, there is scant literature on the prevalence, diagnosis and management outcomes of NAR in the literature. The study found that more than half of rhinitis patients suffered from NAR. There are no specific diagnostic tests for NAR; a thorough case history is the best diagnostic tool to date. A substantial knowledge gap exists in literature with relations to pathogenesis, clinical and laboratory diagnosis, as well as in reference to medical and surgical outcomes. Larger studies are required and management outcomes need to be studied

New era of endoscopic approach for sialolithiasis: sialendoscopy

Sialendoscopy is one of the innovations introduced in the last few years in the field of otolaryngology, head and neck surgery. Sialolithiasis and sialadenitis are two of the most frequently presenting disorders of the salivary glands. The diagnosis is most frequently confirmed by radiology and the treatment of sialolithiasis ranges from the use of surgery, intra-oral extraction or external lithotripsy, to the more frequent external excision of the gland. Sialendoscopy uses minimal invasive surgical techniques which allows for optical exploration of the salivary ductal system and extraction of the stones by a basket under endoscopic view. Sialendoscopy incorporates diagnostic with therapeutic procedures, as dictated by the clinical findings. This technique can be performed in most cases as an ambulatory, outpatient procedure under local anaesthesia