Trends and patterns in urgent pediatric otolaryngology inter-hospital referrals in Saudi Arabia.

OBJECTIVES: To assess trends in otolaryngology-head and neck surgery (ORL-HNS) referrals among pediatric patients, and to address common urgent causes of ORL-HNS referrals in this population. Additionally, to give recommendations regarding these causes, and assessing the impacts of coronavirus desease-19 on such referrals. METHODS: A retrospective descriptive study were the data was extracted from the referral system of the Saudi Ministry of Health (Ehalati), from 2019-2020. Pediatric patients from all hospitals across Saudi Arabia with problems related to ORL-HNS who have been referred urgently to other hospitals were included. RESULTS: A total of 1318 urgent ORL-HNS referrals were collected. The average age of the sample was 6.5 years, with the unavailability of specialty being the major cause for referrals. Foreign bodies, recurrent epistaxis, and tracheostomy were also common clinical causes. The average time for accepting referrals was 21 hours. Most cases had medical or surgical intervention prior to referral. The Western region of Saudi Arabia was the most common sender and receiver of all referrals. In 2020, referrals decreased by 18.4%. CONCLUSION: Maternity and pediatric hospitals make up the largest number of referring hospitals for ORL-HNS urgent cases. Expanding ORL-HNS services has been recommended in highly demanding areas. standards for urgent ORL-HNS referrals may limit inappropriate urgent referrals.

Non-axial proptosis secondary to pneumosinus dilatans of the maxillary sinus.

Pneumosinus Dilatans (PD) is a rare condition characterized by abnormal enlargement of one or more paranasal sinuses that can lead to different functional and cosmetic presentations. Here we report right non-axial proptosis in a 47-year-old female secondary to pneumosinus dilatans of the maxillary sinus with superior bowing of the orbital floor.

Safety of intranasal corticosteroid sprays during pregnancy: an updated review.

INTRODUCTION: Rhinitis and rhinosinusitis are commonly encountered in pregnant women. Intranasal corticosteroid (INCS) sprays are generally safe and effective in the treatment of these conditions in the general population. However, the use of some of these INCS sprays during pregnancy is still controversial. OBJECTIVE: To review the current literature about the safety of intranasal corticosteroid sprays during pregnancy. METHODOLOGY: Using different search engines, each type of INCS was reviewed separately (triamcinolone, beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, mometasone, and ciclesonide). A total of 51 full-length articles were examined for eligibility. After applying inclusion and exclusion criteria, a total of three articles were reviewed. RESULTS: No significant association with congenital organ malformations has been linked to intranasal use of beclomethasone, budesonide, fluticasone propionate, fluticasone furoate, or mometasone. Intranasal triamcinolone, however, has been found to have a significant association with respiratory tract defects. Data about the safety of intranasal ciclesonide during pregnancy are not available. CONCLUSION: Lacking sufficient clinical trials on the use of intranasal corticosteroid sprays in pregnancy, we suggest that the intranasal use of fluticasone furoate, mometasone, and budesonide is safe if they are used at the recommended therapeutic dose after a proper medical evaluation. Intranasal fluticasone propionate might be a safe option in the absence of other INCS options due to its questionable efficacy during pregnancy. Risk-benefit ratio should always be considered before prescribing any intranasal corticosteroid sprays during pregnancy.

Oronasal fistula post-septoplasty.

Nasal septal surgery is one of the most common otolaryngology procedures performed, with rare occurrences of major postoperative complications. Oronasal fistula is a rare complication of septal surgery, with only few cases being reported in the literature. It is commonly caused by a congenital cleft palate, cleft palate surgery, traumatic injuries, infections, or neoplasms; however, it does not usually occur post-septal surgery. Here, we report the case of a 55-year-old male who presented with a symptomatic oronasal fistula post-septoplasty. Unlike other reported cases, there were no features of underlying palatal pathologies, and no previous history of other nasal or oral procedures. We described a multilayer surgical closure technique that was utilized in this case, with no recurrence seen during a 6-month follow-up period. Additionally, we reviewed the other 3 reported cases of this complication, and discussed the possible etiology in this case.

Hemoptysis. A rare presentation of a vallecular cyst.

Hemoptysis is a frightening experience for both patient and clinician and warrants prompt evaluation and diagnosis. We report a case of a vallecular cyst (VC) in a 30-year-old gentleman presenting with hemoptysis. Carbon dioxide laser dissection of the VC after needle decompression was carried out with no complications or recurrence in a 2 months follow-up. In such rare lesions, the authors tend to have conflicting opinions in their classification, evaluation, and management. In this report, these opinions are reviewed and discussed.