Attic reconstruction techniques in cholesteatoma surgery: a comparative analysis of cartilage versus bone pate.

BACKGROUND: Cholesteatoma surgery involves canal wall down (CWD) and canal wall up (CWU) mastoidectomy. CWU is associated with higher cholesteatoma recurrence, often linked to attic retraction pockets. Attic reconstruction with cartilage or bone pate lacks comparative evidence. AIMS/OBJECTIVES: To compare the effectiveness of cartilage and bone pate in attic reconstruction during CWU mastoidectomy for cholesteatoma. MATERIAL AND METHODS: We conducted a retrospective study at King Abdullah University Hospital (KAUH) in Jordan, analyzing surgeries performed from 2011 to 2021. Patients who underwent CWU mastoidectomy with attic reconstruction using tragal cartilage with perichondrium or bone pate were included. RESULTS: Of 48 patients analyzed, 26 had cartilage graft attic reconstruction, and 22 received bone pate. Recurrent cholesteatoma occurred in 19.23% of the cartilage group but none in the bone pate group (p = .001). Ear discharge was observed in 19.23% of the cartilage group and 18.18% of the bone pate group, while tympanic membrane perforations and external auditory canal cholesteatoma were more prevalent in the cartilage group. CONCLUSIONS AND SIGNIFICANCE: Our study indicates that bone pate results in significantly lower cholesteatoma recurrence than cartilage grafting in CWU mastoidectomy attic reconstruction. Bone pate offers stability and favorable long-term outcomes for outer attic wall repair.

Nodular Fasciitis and Myxolipoma of the Larynx: A rare case report with brief literature review.

Nodular fasciitis (NF) is a peculiar, rapid-growing soft tissue lesion, typically appearing in subcutaneous tissue. Approximately 20% of NF occurs in the head and neck region, where they can involve any anatomic site. Laryngeal involvement, however, is quite rare. Lipoma is recognised as a slow growing, benign mesenchymal tumour; myxolipoma is a rare variant which has a prominent myxoid background. Laryngeal lipoma is infrequent, accounting for only 0.6% of all benign laryngeal lesions. We report a 61-year-old male patient with laryngeal nodular fasciitis coexisting with myxolipoma who presented to a tertiary care hospital in Ar Ramtha, Jordan, in 2020. Radiological and histological findings were indicative of laryngeal nodular fasciitis and myxolipoma was incidentally diagnosed. Following trans-oral debulking of the lesion the mass enlarged rapidly and the patient underwent a tracheostomy with complete mass excision and right partial laryngectomy through an open surgical approach. The patient had an uneventful recovery with no evidence of recurrence. The purpose of this report is to broaden the differential diagnosis of rapid-growing laryngeal masses that cause airway obstruction and to stress the significance of integrative interdisciplinary collaboration to establish an accurate diagnosis, thereby allowing proper management for benign pathologies and avoid futile aggressive treatment.

An Overview of the Effect of Age at Time of Cochlear Implantation on Language Outcomes in Jordan: A Retrospective Cohort Study.

INTRODUCTION: Cochlear Implantation (CI) surgery has long been used as an effective treatment for children with bilateral profound sensorineural hearing loss who failed to benefit from the use of hearing aids. Among other factors, the age at which implantation is done is thought to have an effect on the speech progression outcome of patients postoperatively. OBJECTIVES: The Jordanian CI Program has limited resources, and Jordan has an underdeveloped early screening and intervention program for deafness. In this study, we aimed to explore the effect of age at time of implantation on receptive and expressive language outcomes in Jordan, to guide funding and focus efforts on patient groups who would benefit most, thus reducing unnecessary longterm morbidity and disability, and improving cost efficiency. METHODS: Data was gathered from all major sectors in Jordan on patients who underwent CI from 2006 to 2018 (a total of 1815 patients). We compared the language outcome 2 to 4 years after implantation for patients aged below 3 years, 3 to under 6, 6 to under 9 years, and 9 and older at the time of implantation. RESULTS AND CONCLUSION: We found a statistically significant difference in language outcomes between patients aged below 6 years vs those 6 and older, with better receptive and expressive language outcomes in the younger age groups.

The Bacteriology of Middle Meatus and Ethmoid Sinuses in Chronic Rhinosinusitis: Epidemiological Analysis and Surgical Impact.

OBJECTIVES: The aim of this study was to explore the difference between sinus bacteriology in chronic rhinosinusitis patients with and without nasal polyposis. We also analyzed the possible differences in culture results from swabs taken from the middle meatus versus the ethmoid sinus. METHODS: Retrospective chart review of adult chronic rhinosinusitis patient data from the year 2006 to 2020. Nasal swabs were taken under endoscopic guidance either intraoperatively from either the ethmoid sinus or middle meatus, or in the outpatient clinic from the middle meatus. The results were categorized based on the most common microorganisms affecting the nose and sinuses. RESULTS: We found that, the presence of nasal polyps seemed to have no effect on sinus bacteriology as whole. There was also no significant difference between the bacteriology of chronic rhinosinusitis patients who did not need surgery and those who did. Finally, we found that middle meatal cultures, taken endoscopically, give similar bacteriology results to that of ethmoid sinus cultures (taken intraoperatively). CONCLUSION: Middle meatal culture results accurately represent true sinus flora, and therefore can be used to aid in appropriate culture guided antibiotic therapy for patients visiting the outpatient clinic.

The feasibility of vagal nerve stimulation revision surgery and surgical techniques: a retrospective review.

BACKGROUND: With the large number of VNS implants performed worldwide, the need for removal or replacement of the device in selected cases is emerging, this removal or replacement of VNS can be challenging. AIMS/OBJECTIVE: To describe the feasibility and safety of revising vagal nerve stimulation surgery in terms of the indications, surgical techniques, and outcomes. MATERIALS AND METHODS: A retrospective study, a series of eight cases with VNS implants that needed revision surgery have been reviewed, four devices were completely removed and four were only revised. The revision surgery was performed after a range of 7 months to 6 years, due to different reasons. Initial surgeries and revisions were performed at the otolaryngology department in a major tertiary center. CONCLUSIONS AND SIGNIFICANCE: We concluded that the previously implanted vagal nerve stimulation electrodes can be completely removed without any significant sequelae on the nerve. It may also be re-implanted safely at the previously used segment of the vagus nerve with a similar outcome in seizure control as the initial implantation.

The impact of COVID-19 outbreak on otolaryngology practice, jordanian experience: A qualitative study.

BACKGROUND: In response to the rapid spread of coronavirus disease 2019 (COVID-19) caused by "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2), many countries including Jordan have implemented strict lockdowns. These lockdowns were associated with temporary suspension of all outpatient clinics and all elective (Non emergent, non-oncologic) surgical procedures. OBJECTIVE: We aimed to report the impact of COVID-19 outbreak on otolaryngology practice in Jordan. METHODS: Retrospectively we reviewed all admissions to the otolaryngology wards of King Abdullah University Hospital during the lockdown and for the same dates for the year 2019, results were compared.Additionally, an online questionnaire was sent to a sample of Jordanian otolaryngologists in June 2020. The questionnaire was comprised of a series of multiple choice questions regarding each physician's participation in the treatment or screening of COVID-19 patients, the number of consultations during the lockdown, the numbers of elective and emergency surgical procedures performed during the lockdown and the effects the lockdown had on their practices, their patients conditions and teaching and training processes.The study was done in line with the criteria set by the Standards for Reporting Qualitative Research (O'Brien et al., September 2014) [12]. STRENGTHS AND WEAKNESSES: In our study, we aimed to include the experience of all otolaryngology practitioners in Jordan, providing a comprehensive view of the lockdown effects on practice in the region. The data found is likely representative of lockdown effects on all departments, not just otolaryngological practice, and may be beneficial in providing a pathway to minimize any negative impact on patient care.However, our data may be limited due to its dependence on responses through a Whatsapp questionnaire, with no guarantee that the answers provided are fully accurate. It also may have a certain degree of sampling bias, as while the questionnaire was sent to all ENT practitioners in Jordan, answering it was totally optional, and so people who did not respond to the survey were not accounted for. RESULTS: During the lockdown period in Jordan all outpatient clinics were closed, and all elective surgical procedures (non-emergency and non-oncologic procedures) were suspended. During the lockdown it was observed that there was a reduction in the number of admissions related to post-operative complications, head and neck abscesses & infections and foreign bodies related admission when compared to the same period of 2019.A total of 144 otolaryngologists have participated in the questionnaire part of the study. More than half of the participants (n = 80, 55.6%) reported providing 10 or less consultations during the lockdown, more than half of the them have not performed any emergency surgical procedures during the lockdown, and a total of 110 (76.4%) of the 144 participants reported having at least 1 patient whose condition worsened during the lockdown due to lack or delay in medical care. CONCLUSION: The COVID-19 pandemic, and the resultant lockdown period in Jordan has caused a significant shift in otolaryngological practice throughout the country, with a complete cessation of all outpatient clinics and elective surgical procedures and admissions, with activity being limited to oncological and emergency procedures only. These changes have already impacted the dynamics of patient care and might lead to a risk of diagnostic delays which will have severe impacts on patient's health.

Overview of Upper Airway Management During COVID-19 Outbreak: Head and Neck Surgeon's Perspective.

At the end of December, 2019, a new virus was named severe acute respiratory syndrome coronavirus 2 appeared in Wuhan, China, and the disease caused is called as coronavirus disease 2019 (COVID-19) by World Health Organization, which to date having infected more than 3,588,773 people worldwide, as well as causing 247,503 deaths. A human to human transmission is thought to be predominantly by droplet spread, and direct contact with the patient or contaminated surfaces. This study aims to provide a comprehensive overview as well as to highlight essential evidence-based guidelines for how head and neck surgeon and healthcare providers need to take into consideration during their management of the upper airway during the COVID-19 pandemic safely and effectively to avoid the spread of the virus to the health provider.