Diagnostic accuracy of intrathecal fluorescein versus other radiological modalities in evaluating non-congenital skull base defects: a systematic review and meta-analysis.

PURPOSE: The intraoperative detection of cerebrospinal fluid (CSF) leaks during endoscopic skull base surgery is critical to ensure watertight sealed defects. Intrathecal fluorescein (ITF) is a valuable adjunct to intraoperative investigation. Hence, our aim is to summarize the evidence of the efficacy of ITF as an accurate diagnostic modality and reconstruction guide for non-congenital skull base defects. METHODS: Using the Cochrane Central, MEDLINE, and Embase databases, we identified studies involving the use of ITF in non-congenital CSF leaks which were published until November 2023. The STATA 18 software was used for meta-analysis. RESULTS: Fourteen studies met the inclusion criteria, in which seven studies were included in the meta-analysis. ITF was used in 1898 (90.3%) of patients, with a detection rate of 88.1%. The overall detection rate of non-congenital CSF leaks among ITF concentrations of 5% and 10% had a statistically significant pooled effect size of 2.6 (95% CI = 2.25, 2.95), while when comparing the ITF to other alternative radiological tests, it was not statistically significant with a mean difference of 0.88 (95% CI = - 0.4, 2.16). Moreover, the pooled prevalence was statistically significant in regards of the complications associated with ITF with an effect size of 0.6 (95% CI = 0.39, 0.82), indicating that 60% of patients who underwent ITF would experience at least one of the measured complications. CONCLUSION: ITF is considered as an efficient tool in localizing skull base defects. However, there was no significant results when comparing the ITF to other alternative radiological tests. Accordingly, if the ITF intervention is indicated, patients should be carefully selected based on their clinical need.

Voice acoustic characteristics of children with late-onset cochlear implantation: Correlation to auditory performance.

OBJECTIVES: To study the voice acoustic parameters of congenitally deaf children with delayed access to sounds due to late-onset cochlear implantation and to correlate their voice characteristics with their auditory performance. METHODS: The study included 84 children: a control group consisting of 50 children with normal hearing and normal speech development; and a study group consisting of 34 paediatric cochlear implant (CI) recipients who had suffered profound hearing loss since birth. According to speech recognition scores and pure-tone thresholds, the study group was further subdivided into two subgroups: 24 children with excellent auditory performance and 10 children with fair auditory performance. The mean age at the time of implantation was 3.6 years for excellent auditory performance group and 3.2 years for fair auditory performance group. Voice acoustic analysis was conducted on all study participants. RESULTS: Analysis of voice acoustic parameters revealed a statistically significant delay in both study groups in comparison to the control group. However, there was no statistically significant difference between the two study groups. DISCUSSION: Interestingly, in both excellent and fair performance study groups, the gap in comparison to normal hearing children was still present. While late-implanted children performed better on segmental perception (e.g. word recognition), suprasegmental perception (e.g. as demonstrated by objective acoustic voice analysis) did not progress to the same extent. CONCLUSION: On the suprasegmental speech performance level, objective acoustic voice measurements demonstrated a significant delay in the suprasegmental speech performance of children with late-onset CI, even those with excellent auditory performance.

Can a second look improve the outcome of endoscopic choanal atresia repair?

PURPOSE: To evaluate the outcome of a routine postoperative endoscopic micro-debridement of granulation tissue after stentless transnasal endoscopic repair of choanal atresia (CA). METHODS: This prospective case series included congenital CA patients who underwent stentless transnasal endoscopic repair, followed by an endoscopic second look and micro-debridement of granulation tissue at 1-2 weeks post-repair. Patients were followed every three months for assessment of nasal airway symptoms and objective evaluation by flexible nasolaryngoscopy. RESULTS: Sixteen CA patients (8 bilateral and 8 unilateral) underwent surgical repair (12 primary and 4 revisions). The median  age was 13 days (range 1 day-6 months) in bilateral and 3 years  (range 7 months-15 years) in unilateral atresia. The mean follow-up was 1.5 years (range 1 year-3 years). In primary procedures, the obstruction was bony-membranous in 7 cases and bony in 5 cases. The mean interval time between the CA repair and re-examination was 10.75 days (range 6-18 days). Clinically significant neochoanal restenosis was not encountered. CONCLUSIONS: Re-examination under general anesthesia with endoscopic micro-debridement of granulation tissue is a safe, potentially effective adjunct when done during the proliferative phase of neochoanal wound healing. This procedure might help in maintaining neochoanal patency by remodeling tissue healing process. Large-scale, long-term cohort studies are imperative.

The Utilization of Pediatric Hip Spica Tables Among Orthopedic Surgeons: Locally Customized versus Company-Manufactured (Cross-Sectional Study).

Background: Hip spica tables are widely used among pediatric orthopedic surgeons to maintain the hip position during cast application and drying processes for a better outcome. Locally customized spica tables can be a significant concern if their limitations significantly interfere with the quality of care. Objective: This study aims to explore the current practice of pediatric hip spica table application among hospitals in the GCC countries and report comprehensive data that help surgeons enhance their practice. Methods: This is a cross-sectional study on pediatric orthopedic surgeons using a self-administered Online Questionnaire. The respondents were grouped as those using locally customized tables, where further information about the material and characteristics were collected, and those using company manufactured tables. Both groups answered analytical questions related to their current practice of hip spica tables. Results: Sixty-three surgeons completed the survey. More than half the physicians in this study are using locally customized spica tables (n= 41, 65%). Compared to company-manufactured tables, locally customized tables were associated with a higher rate of difficulties when taking an X-ray, when the patient weighs more than 50.0 kg, and with anesthesia, although not statistically significant. Conclusion: Obtaining a good quality spica table at a suitable price is a primary obstacle pediatric orthopedic surgeons face. This study shows no statistically significant difference between locally customized and company-manufactured tables regarding the outcomes and that spica tables have room for development to optimize their utilization.

Atypical site of nasopharyngeal branchial cleft cyst: A case of an unusual age presentation.

Nasopharyngeal branchial cleft cysts (NBC) are generally single, unilateral, and asymptomatic. They may get infected or produce obstructive symptoms as it enlarges. The definitive diagnosis is usually confirmed by Magnetic resonance imaging (MRI) and histopathology. A 54-year-old male patient presented with progressive bilateral nasal obstruction, more on the right side, associated with hyponasal voice and postnasal discharge of 2 years' duration. A cystic mass was found by nasal endoscopy on the lateral right side of the nasopharynx, extending to the oropharynx, and was confirmed with MRI findings. Uneventful total surgical excision and marsupialization were done with follow up of nasopharyngeal endoscopic examination on each visit. The pathological features and the site of the cyst were compatible with a second branchial cleft cyst. Although rare, NBC should be considered one of the differential diagnoses of nasopharyngeal tumors. Surgical excision and marsupialization are the main treatment with low complication and recurrence rates.

Late presentation of laryngeal lipoid proteinosis: a case report and review of the literature.

Lipoid proteinosis (LP) is a rare autosomal-recessive disease characterized by the deposition of hyaline material infiltrating multiple body organs, including the larynx. The possible clinical presentations are wide-ranging. Laryngeal involvement results in dysphonia that is noted at birth or infantile years. The diagnosis is based on histological findings, and the management options vary depending on the severity of the symptoms. In this paper, we report an unusual case of LP with laryngeal involvement in an adult patient, along with a review of current literature.

Patterns of Otorhinolaryngological Manifestations of Covid-19: A Longitudinal Questionnaire-Based Prospective Study in a Tertiary Hospital in Saudi Arabia.

OBJECTIVE: Many studied investigated the manifestations of COVID-19, yet few described the pattern and severity of otolaryngological symptoms. We aim to describe the picture of COVID-19-associated otorhinolaryngological manifestations and recovery to explore individualized treatment, onward referral, and complications prevention. DESIGN: Prospective longitudinal questionnaire-based study. SETTING: The online questionnaire was filled 3 times through a remote interview over a period of 1 month from June 2020 to July 2020. PARTICIPANTS: Patients with confirmed COVID-19 by RT-PCR who were clinically stable. MAIN OUTCOME MEASURES: Date of diagnosis, sociodemographic data, and the presence of predictive factors, such as nasal and paranasal disease, anosmia and dysgeusia. Validated tools were used, such as Sino-nasal Outcome Test (SNOT-22), smell test (medical academy screening tool), Voice Handicap Index (VHI), and Reflux Symptoms Index (RSI). RESULT: The questionnaire was sent to 363 patients and the response rate was 70.80% (n = 257). The mean age was 34.58 years (SD = 11.22) and the rate of male participants was 60.7%. The most common otorhinolaryngological symptoms at the time of enrollment was fever (48.6%), whilst the commonest severe symptom was cough (57%). After 1 month, only 11 participants had persistent severe symptoms, especially sleep and psychological symptoms (73%), and the majority were female (63.6%). All of them had at least 1 comorbidity. There was a significant difference between the mean age of participants with severe symptoms (mean = 27.45, SD = 8.39) and without severe symptoms (mean = 34.90, SD = 2.53, t(255) = 2.17, P = .031). CONCLUSION: COVID-19 has a wide-ranged spectrum of presentations, with otorhinolaryngological symptoms being the commonest and most serious. Studying these symptoms is vital to advance management options.

The Difficulties Encountered by Pediatric Cochlear Implant Patients and Their Parents during the COVID-19 Pandemic.

INTRODUCTION: The daily escalation in incidence and mortality caused by Coronavirus disease (COVID-19) has mandated forced curfew in our country (same as many other countries) to limit the spread of infection. This is predicted to have a more negative impact on cochlear implant (CI) patients since this group of patients needs a unique type of psychological, medical, and technical care in addition to a daily rehabilitation program. METHODS: A cross-sectional study based on Arabic questionnaire that looked into the collateral consequences of COVID-19 on the pediatric CI patients. The questionnaire was designed to highlight different problems such as exposure to head trauma or ear infection, difficulties in device maintenance and getting spare parts, impacts of the delay of programing or switch on appointments, and the impacts of missing rehabilitation sessions. Different ways of management of these problems are presented and discussed. RESULTS: A total of 174 parents responded to the questionnaire. The main problem met by the patients was missing their device programing and rehabilitation sessions. Many children had device maintenance and spare parts problems. Virtual clinics were helpful in solving different problems. Additionally, children who needed device programing were scheduled for remote programing sessions. CONCLUSION: Although the inevitable consequences of the COVID-19 pandemic are catastrophic, they are forcing the medical field to explore new opportunities by sitting up an infrastructure for future usage of telemedicine. Telemedicine is cost-effective and more convenient and enables health-care providers to be immune to future circumstances.

Efficacy of the Accent Method of Voice Therapy in Professional Voice Users with Minimal Associated Pathological Lesions of the Vocal Folds.

Aims: Minimal associated pathological lesions (MAPLs) of the vocal folds are a group of benign disorders commonly related to phonotraumatic conditions and behaviors. Voice therapy (VT) can play a major role in readjusting these maladaptive behaviors and improve overall voice quality, thereby replace surgical intervention in some cases or act as a complementary treatment to enhance the ultimate therapeutic outcomes. This study aims to explore the short-term effect of the Accent method of VT on vocal subjective measures and acoustics in professional users with MAPLs, evaluate the responsiveness of each vocal fold lesion to the VT, and propose a simple model for providing VT to a sector of the population in great need of non-invasive management. Materials and methods: This analytical cross-sectional included fifty professional voice users with different MAPLs were exposed to multidimensional voice assessments before and after receiving VT training in a tertiary care hospital. These assessments include GRBAS score, Multidimensional Voice Program (MDVP) and validated Arabic version Voice Handicap Index (VHI-30). Results: This study showed variable positive effects of VT on the different types of MAPLs. Cysts had the highest level of responsiveness to VT in comparison to other lesions, followed by nodules, polyps, contact granuloma, and Reinke's edema. Conclusions: VT is a substantial solution for managing voice disorders. It should be considered in the management plan of the various types of MAPLs, even in Reinke's edema, which showed the minimum improvement.

Endoscopic transorbital management of frontal sinus mucocele: a case report and review of the literature.

The frontal sinus is the most common site for paranasal mucoceles, resulting in potentially threatening intraorbital or intracranial complications. Surgical drainage of mucoceles is the mainstay of treatment, which can be achieved usually through open or endoscopic transnasal approaches. Transorbital endoscopic surgery is a relatively novel approach to selective skull base lesions with limited data in the literature. It could be utilized as a safe and effective alternative approach in managing frontal sinus lesions when the endoscopic transnasal access alone is insufficient or inadequate. Here, we present a case of an isolated lateral left frontal mucocele that was managed successfully using an endoscopic transorbital approach alone with complete resolution of symptoms during a 10-month follow-up period.

The Rare Occurrence of Post-tonsillectomy Surgical Emphysema.

Subcutaneous facial emphysema is a rare complication of tonsillectomy that can lead to infection, upper airway obstruction or invasion into the thorax. The latter can cause pneumomediastinum or pneumothorax, with possible subsequent cardiorespiratory function impairment. Although multiple causes are suggested in the literature, the main causative factor is still unclear. Moreover, the rationale for its management is inconsistent and the outcomes are unpredictable. We report a case of a 14-year-old pediatric male patient, known to have a hypersensitive gag reflex, who developed post-tonsillectomy cervicofacial subcutaneous emphysema; management has achieved complete clinical resolution after two weeks of complication onset. Additionally, we present a literature review that showcases the potential causes and management of subcutaneous emphysema.