Cochlear implantation at King Abdulaziz University Hospital, Riyadh, Saudi Arabia: a 12-year experience.

OBJECTIVE: This paper aims to report our experience with different multichannel cochlear implant devices, and to discuss the outcomes of our cochlear implant programme, together with the problems encountered. SETTING: Cochlear implantation was undertaken in 117 patients (35 post-lingual and 82 pre-lingual cases; 70 males and 47 females) over a 12-year period. Three cochlear implant systems were used: Nucleus (22 and 24), Med-El and Advanced Bionics Clarion. An extended endaural incision was used in 78 cases and a minimally invasive approach in 39 cases. RESULTS: Complications occurred in 16.2 per cent of patients. All patients showed a significant post-implantation improvement in their perception and discrimination of sound and speech. Better results were noted in pre-lingual patients under the age of six years. The cause of hearing loss was unknown in 81 per cent of patients. CONCLUSION: The outcomes of our cochlear implantation series are comparable to previous reports. The possibility of an abnormally rotated cochlea should be borne in mind when difficulty is encountered during cochleostomy.

Reversible neuropraxic visual loss induced by allergic Aspergillus flavus sinomycosis.

This work reports a patient with visual loss treated successfully with surgical removal of the Aspergillus flavus sinomycosis. Vision was partially reversed within hours after surgery before starting planned corticosteroid therapy. The patient's visual acuity continued to improve steadily until it became equal to that of the other eye. The immediate gain in vision and continued improvement without corticosteroid therapy suggest a new hypothesis for visual loss induced by allergic sinonasal Aspergillosis. Simple mechanical pressure alone of the aspergillus mass over the nerve can produce visual loss, and this loss is reversed by removing the mass without corticosteroid therapy.

A parallel-group comparison of astemizole and loratadine for the treatment of perennial allergic rhinitis.

The efficacy and safety of the two antihistamines, astemizole and loratadine, were compared in a double-blind study of 84 patients with perennial allergic rhinitis. Patients were randomized to receive orally either astemizole 10 mg once daily (n = 40) or loratadine 10 mg once daily (n = 44) for 1 week. No other antirhinitis medication was allowed during the study. By day 7 the mean daily symptom scores, recorded on diary cards, were lower in patients receiving astemizole than in those receiving loratadine for runny nose, itchy nose and sneezing, although not for blocked nose, and treatment differences only reached statistical significance for runny nose. After 7 days, 53.75% of patients on astemizole and 38.6% on loratadine were free of symptoms, and 87% of patients on astemizole described the treatment as good or excellent compared with 62% on loratadine. The present results suggest that astemizole may be more effective than loratadine in controlling symptoms of perennial allergic rhinitis.

Hearing loss and herpes simplex.

A survey to identify the aetiology of hearing impairment among Saudi children was carried out. Children were divided into two groups according to presence or absence of laboratory evidence of herpes simplex virus infection 'at risk' and 'not at risk'. Serological tests for herpes simplex virus infection were performed on 1054 children. We found positive IgM antibody against herpes simplex virus, type 1 (HSV1) in the blood of 82 of the 1054 children (8 per cent), and positive IgM antibody against herpes simplex virus type 2 (HSV2) in eight of the 1054 children (0.8 per cent) ages ranged between 12 months and 14 years). Forty-six of the eighty-two infected children (56 per cent) with HSV1 were found to have bilateral sensorineural hearing loss (16 to 26 children of the at risk group and 30 of 56 from the "not at risk' group). Only one case of the eight infected children with HSV2 was found to have bilateral sensorineural hearing loss of moderate degree. This case was in the 'not at risk' group. Hearing impairment was bilateral in all 46 cases, profound in seven, moderate to severe in 23 and mild in 16. Known causes of hearing impairment were excluded together with hearing impairment due to multiple TORCH agents. The high prevalence of hearing impairment among children due to herpes simplex virus infection is described.

Cicatricial pemphigoid of the larynx: a case report of surgical treatment.

Although laryngeal stenosis caused by cicatricial pemphigoid (CP) is a well documented entity, reports about its surgical treatment are scant. This may be due to the reluctance of the surgeons to excise the scarring, knowing the recurrent nature of the disease. In this paper we report a case of severe laryngeal stenosis caused by CP which necessitated a tracheostomy. When the disease had stabilized, laryngeal airway was restored following open surgical excision and stenting. The historic, clinical, histologic, immunopathologic and therapeutic features of CP are presented with special reference to the laryngeal lesions.

Prevalence of sensorineural hearing loss due to rubella in Saudi children.

We found positive IgM antibody against rubella virus in the blood of 23 out 1,054 (2.2%) children (age ranged between 12 months and 14 years). Fifteen 23 infected children were found to have bilateral sensorineural hearing loss children of the at-risk group and 11 of 19 from the not-at-risk group). Hearing impairment was bilateral in all cases, profound in 1, moderate to severe in and mild in 5. The serological results of the examined children are discuss and compared with other reported results. The prevalence rate of rubella infection is low. This is attributed to the universal childhood vaccination programme compulsory for all Saudi children.

Prevalence of sensorineural hearing loss due to toxoplasmosis in Saudi children: a hospital based study.

A survey to identify the aetiology of hearing impairment among Saudi children was carried out. Children were divided into 2 groups according to presence or absence of laboratory evidence of toxoplasmosis "at risk' and "not at risk.' Serological tests for toxoplasmosis were done to 1054 children. We found positive IgM antibody against Toxoplasma gondii in the blood of 70 of the 1054 children (6.6%) (age ranged between 12 months and 14 years). Forty nine of the seventy infected children (70%) were found to have bilateral sensorineural hearing loss (11 of 19 children of the at risk group and 38 of 51 from the "not at risk' group). Hearing impairment was bilateral in all cases profound in 9, moderate to severe in 29 and mild in 11. Known causes of hearing impairment were excluded. The high prevalence of hearing impairment among children due to toxoplasmosis is presented.

Hearing impairment among "at risk' children.

A survey was carried out to identify the prevalence and the aetiology of hearing impairment among infants and children at risk based on the criteria. Out of 6421 surveyed children. 1256 (19.6%) were found "at risk' for hearing impairment. Children with hearing impairment in this study were found to be 494 which represent 39.3% of the "at risk' children. We found 326 (66%) children had conductive hearing loss almost all associated with secretory otitis media (n = 232). Sensorineural hearing loss affected 168 (34%) children. Heredo-familial causes were responsible for about 111 (66.1%) cases. The detailed causes of conductive and sensorineural hearing loss are presented and compared with other studies in the literature. Conductive hearing impairment was mild in the majority of the cases n = 271, (83%), moderate in 55 (17%) cases. Sensorineural hearing loss was mild in 113 (67.3%), moderate in 32 (19%) and profound in 23 (13.7%) cases. A large scale Kingdom-wide study to focus on aetiology of deafness among Saudi infants and children to find out the extent of this problem is recommended.