The Effect of Using Ofloxacin Ear Drops in Traumatic Tympanic Membrane Healing: A Systematic Review and Meta-Analysis.

Objectives: To evaluate the effectiveness of ofloxacin ear drops versus no intervention in the repair of traumatic tympanic membrane (TM) perforations from randomized controlled trials (RCTs). Data Sources: Medline/PubMed, CENTRAL, Clinical Trials.Gov, and Google Scholar. Study Selection: Inclusion criteria: (1) English language; (2) RCT studies; (3) reported the outcomes on the application of ofloxacin and outcomes of spontaneous healing. Exclusion criteria: (1) studies without a control group; (2) patient with severe otologic disease such as chronic suppurative otitis media or ossicular disruption or patients with craniocerebral injury; (3) studies with no pretreatment values or single-arm clinical studies. Data Extraction: Country, year of publication, number of participants in each arm, patient characteristics such as age, sex, intervention details, laterality, cause of TM perforation, position of perforation, follow-up time, hearing gain, rate of TM closure, and closure time. Results: A total of 6 RCTs studies were analyzed. A total of 502 participants were included; the relative risk for closure rate of ofloxacin treatment was 1.18 [95% confidence interval (CI), 1.08 to 1.28, P < .001] and the mean difference (MD) for healing time was -18.4 (95% CI, -19.96 to -16.82, P < .001), suggesting ofloxacin has a significant effect on closure of TM perforations. However, no clinically significant effect in hearing (SMD: 0.21, 95% CI, 0.02 to 0.40, P = .03) was seen in ofloxacin group. Also, patients in the ofloxacin group were associated with a 13% reduction in the risk of infections compared to their observation-assigned counterparts, but this estimate was not statistically significant. Conclusion: Ofloxacin use in patients with traumatic TM perforation is effective in reducing healing time and increasing rate of TM perforation closure. No evidence of increased risk of hearing loss or infection rates are encountered when ofloxacin is prescribed to patients with traumatic TM perforation.

Comparison of the efficacy and safety of conventional curettage adenoidectomy with those of other adenoidectomy surgical techniques: a systematic review and network meta-analysis.

OBJECTIVES: There is a lack of robust evidence in regards to whether the intra and post-operative safety and efficacy of conventional curettage adenoidectomy is better than those of other available surgical techniques. Therefore, this study was conducted as a systematic review and network meta-analysis of published randomized controlled trials (RCTs) with the aim of comparing the safety and efficacy of conventional curettage adenoidectomy with all other available adenoidectomy techniques. MATERIALS AND METHODS: A systematic search of published articles was performed in 2021 using databases such as PubMed/Medline, EMBASE, EBSCO, and the Cochrane Library. All RCTs that compared conventional curettage adenoidectomy with other surgical techniques and were published in English between 1965 and 2021 were included. The quality of the included RCTs have been assessed using Cochrane Collaboration Risk of Bias Tool. RESULTS: After screening 1494 articles, 17 were identified for comparing several adenoidectomy techniques and were eligible for quantitative analysis. Of those, 9 RCTs were analyzed for intraoperative blood loss, and 6 articles were included for post-operative bleeding. Furthermore; 14, 10, and 7 studies were included for surgical time, residual adenoid tissue, and postoperative complications respectively. Endoscopic-assisted microdebrider adenoidectomy yielded a statistically significantly greater estimate of intraoperative blood loss compared with conventional curettage adenoidectomy (mean difference [MD], 92.7; 95% confidence interval [CI] 28.3-157.1), suction diathermy (MD, 117.1; 95% CI 37.2-197.1). Suction diathermy had the highest cumulative probability of being the preferred technique because it was estimated to result in the least intraoperative blood loss. Electronic molecular resonance adenoidectomy was estimated to be more likely to result in the shortest surgical time (mean rank, 2.2). Participants in the intervention group were 97% less likely to have residual adenoid tissue than children in the conventional curettage group (odds ratio 0.03; 95% CI 0.01-0.15); therefore, conventional curettage was not considered an appropriate technique for complete removal of adenoid tissue. CONCLUSION: There is no single technique that can be considered best for all possible outcomes. Therefore, otolaryngologists should make an appropriate choice after critically reviewing the clinical characteristics of children requiring adenoidectomy. Findings of this systematic review and meta-analysis may guide otolaryngologists when making evidence-based decisions regarding the treatment of enlarged and symptomatic adenoids in children.

The incidence and impact of anosmia on daily life after COVID-19 infection: A cross-sectional study in a tertiary center in Saudi Arabia.

OBJECTIVES: To investigate the impact of olfactory dysfunction's (OD) on patients with coronavirus disease-19 (COVID-19) and evaluate the risk factors associated with it. METHODS: This cross-sectional study analyzed patients who tested positive for COVID-19 over a period of 4 months (May-July 2020) and experienced OD and mild illness. Selected patients were given 2 scales Olfactory Disorders Negative Statement (QOD-NS) and Sino-nasal Outcome Test (SNOT-22). RESULTS: A total of 256 patients were enrolled, out of which 196 had anosmia after COVID-19 infection. More than 75% of the participants were aged between 20-40 years and 64.3% were women. The mean score of the patients was 25.13 (SD 19.6) on the SNOT-22, while it was 4.9 (SD 4.85) on the QOD-NS. There was no association between anosmia and other comorbidities and factors (age, smoking history, allergic rhinitis history, asthma, and so on). Only 39% of patients who had anosmia after COVID-19 recovered in less than 4 months. CONCLUSION: Olfactory dysfunction is a common symptom of COVID-19 infection and it can take more than 4 months to recover. Nevertheless, this cohort reports a moderate impact on their quality of life due to anosmia.

Pediatricians' knowledge and attitude toward hearing loss and newborn hearing screening programs.

INTRODUCTION: Early detection of hearing loss is important to the management of infants and young children with hearing loss. Pediatricians are often the first to encounter a child suspected to have hearing loss. The objective of this study is to evaluate the knowledge and attitude of newborn hearing screening and management of hearing in among pediatricians. METHODS: A cross-sectional survey-based study utilizing a validated questionnaire that was distributed to pediatricians in single tertiary academic health care institution that aims to evaluate the knowledge and attitudes related to children with hearing loss and newborn hearing screening. RESULTS: A total of 67 pediatricians agreed to participate and were involved in our study. Mean age was 35 years and 44.1% were males. The majority (79.4%) thought it was very important to have a newborn hearing screening program. However, two-thirds (64.7%) were unsure that there is a universal hearing screening program in the country. Never the less, the majority of the respondents (75%) were at least somewhat confident in explaining the hearing screening program process in our institution. There was a gap in the knowledge of our pediatricians with regard to the process of dealing with a newborn who failed screening program and the candidacy for cochlear implants. Also, some participants were unsure whether to refer a child with hearing impairment to an otolaryngologist or not. Most of the participants thought that physicians need more information related to permanent hearing loss. CONCLUSION: There are gaps in Pediatricians knowledge and awareness towards hearing loss assessment and management in newborns. This likely requires further academic collaboration between specialties to improve the care of newborns. Future research should focus on the auditory and speech outcome and rehabilitation awareness.

A Young Healthy Male with Spontaneous Subcutaneous Emphysema Occurring in Neck, Retropharyngeal and Mediastinal Spaces.

We present a case of spontaneous cervical, retropharyngeal, and mediastinal emphysema occurring in a previously healthy young male, which is the first described case in Saudi Arabia. The patient was admitted to the ward for observation, monitoring of vital signs, analgesia, and prophylactic antibiotics. The patient was kept under observation for 8 days. During that time, neck pain improved gradually with no episodes of oxygen desaturation or vital sign deterioration. The patient was later discharged with very mild persistent pain. Two weeks after discharge, patient was seen in outpatient clinic and was free of symptoms. Spontaneous subcutaneous emphysema remains a rare presentation encountered in emergency department. The investigations and treatment required for such patients has no consensus between authors. Although most of the reported cases described an uncomplicated course, there is a need for clear guidelines on management protocol.

Patients With Nasal Fracture.

Nasal fractures are the most common type of facial bone fracture. Studies conducted globally have shown that nasal fractures represent a significant liability on the health care system due to the frequency of its occurrence among most populations. This study aimed to describe the frequency, etiology, and demographics of nasal fractures in patients presenting to King Fahad General Hospital, Jeddah, Saudi Arabia.This study was a cross-sectional questionnaire-based study and included all patients with a nasal fracture who were referred from the emergency department to the ENT unit of King Fahad General Hospital over a four-month period (December 2018 to March 2019).A total of 130 patients with nasal fracture were included in the present study; most of the included patients were males (83.1%). The mean age of the patients was 28.5 years. The most frequent cause of nasal fracture was physical assault (54.6%), followed by road traffic accidents (20%). Most patients had epistaxis and presented with either active epistaxis at the time of assessment or epistaxis that spontaneously resolved after injury. Patients who had lacerations on the nose were more likely to have a displaced nasal bone (P = 0.016). Isolated nasal bone fractures were more commonly noted in victims of physical assault, whereas combined facial bone fractures were commonly noted in patients involved in road traffic accidents (P < 0.001).Most of the injuries occurred in the city, particularly among foreigners and young adults. Physical assault was reported to be the leading cause of nasal fractures.

Surgical Complications After Thyroid Surgery: A 10-Year Experience at Jeddah, Saudi Arabia.

To evaluate the incidence and predictive risk factors of complications in patients who underwent thyroid surgery at our hospital with a residency training program. This retrospective cohort study analyzed the complications in all patients who underwent thyroid surgery between January 2008 and December 2017. Demographic data, preoperative diagnosis based on fine needle aspiration cytology, surgical approach, permanent pathology, postoperative complications, and factors associated with complications were recorded. At our hospital, 456 patients underwent thyroidectomy. The most common surgical complications were asymptomatic biochemical hypocalcemia and symptomatic hypocalcemia in 109 (23.9%) and 50 (11%) patients, respectively. Other surgical complications included permanent hypocalcemia, transient vocal cord palsy, permanent vocal cord palsy, hematoma, seroma, chyle fistula, and Horner's syndrome. Mean age > 45 years and more extensive surgery were significantly associated with overall complications (P = 0.003; < 0.001). Mean age > 50 years and vitamin D level < 25 nmol/L (< 10 ng/mL) were significantly associated with hypocalcemia (P = 0.008; < 0.001). Moreover, the extent of surgery and advanced thyroid carcinoma were significantly associated with vocal cord palsy (P < 0.001; 0.05). Hypocalcemia and vocal cord palsy are the most significant complications. Thyroid surgery can be performed safely by senior residents in the residency training program under the direct supervision of an experienced surgeon.

Predictors for Salivary Gland Cancer Recurrence at Two Tertiary Hospitals in Saudi Arabia.

Background Tumors of salivary glands are enlarged as a low-risk mass and mostly benign in nature. The treatment of salivary gland malignancy remains quite challenging because of its relative infrequency, unreliable biological manners, and risk of re-emergence. For effective treatment planning, prediction of factors associated with the recurrence of salivary gland malignancy is essential. Aim The objective of this study was to identify the factors associated with recurrence of salivary gland malignancy at two tertiary hospitals in Saudi Arabia. Material and methods A cross-sectional study was conducted at two tertiary hospitals in Saudi Arabia, where data of patients were recorded from the medical records of hospitals from 2012 to 2018. 63 patients who were diagnosed with salivary gland malignancy, whether originated from parotid, submandibular, sublingual, and minor salivary glands were included in the study. Descriptive statistics are shown in mean, frequency, and percentages, while comparative analysis was done using the Chi-square test, where p < 0.05 is considered significant. Results This study included 63 participants. The majority of malignant salivary gland cancers arise from the parotid gland (47.6%), and mucoepidermoid carcinoma was the commonest form of malignancy in 36.5% of the studied population. Out of 63 patients, 17 had a recurrence of cancer, and the initial advanced stage of the disease is apparently associated with the re-emergence of salivary gland cancer. Conclusion The initial advanced stage of cancer has a significant role in the recurrence of salivary gland malignancy. As salivary gland malignancy is rare and has unreliable behavior, establishing an adequate treatment plan prediction for recurrence is essential.

Balloon Laryngoplasty in Pediatric Population with Subglottic Stenosis: 5 Years Experience in King Abdulaziz University Hospital a Tertiary Center.

We reviewed our experience with balloon laryngoplasty (BLP) as a primary management of SGS in a tertiary care center in Saudi Arabia. In this review, a total of 147 patients who underwent Laryngobronchoscopy were reviewed. Only 10 pediatric patients diagnosed with SGS who underwent BLP as primary treatment in the period from January 2012 to December 2017 were included. After obtaining ethical approval, included patients' charts were reviewed. Adult patients and those with airway anomalies other than SGS were excluded. This study describes the outcome of 25 episodes of BLP for the selected participants. Sixty percent of the participants were males. Participants' age ranged from 1 to 14 years (mean 6.4 years). Four participants had comorbidities other than SGS. Most patients required more than one episode of BLP (average 3 episodes). Mean hospital stay was 11.7 days. There was no difference in recurrence of symptoms between using laser or knife in subglottic tissue release (p = 0.182). Although recurrence of symptoms was seen in 56% of the patients, almost all patients (100%) became free of symptoms eventually. Patients with co-morbid diseases were more likely to be transferred to PICU post-operatively (p = 0.003). In the treatment of acquired SGS, BLP is an effective and relatively safe alternative to open airway surgery.

Risk Factors of Incidental Parathyroidecomy in Thyroid Surgery.

BACKGROUND: Incidental parathyroidectomy with subsequent hypoparathyroidism and postoperative hypocalcemia is thought to be one of the common complications of thyroidectomy. Current literature reports wide discrepancy in incidence and risk factors. OBJECTIVES: The aim of our study was to evaluate the incidence and risk factors of incidental parathyroidectomy in thyroid surgery. METHODS: A retrospective study included 270 patients who had thyroid surgery that was performed over two years from January 2017 to December 2018 in two tertiary care hospitals. Preoperative and postoperative records were assessed. Factors such as gender, diagnosis, type of surgery, and usage of surgical loupes during the procedure were evaluated and were compared to find the association with incidental parathyroidectomy in thyroid surgery. RESULTS: Incidental parathyroidectomy was noticed in 62 (23%) surgical specimens during histopathologic examination. There was no significant association between incidental parathyroidectomy and sex of patient, use of surgical loupes, pathology of thyroid disease, or neck dissection. CONCLUSION: Although the risk of incidental parathyroidectomy is inevitable, careful dissection and meticulous intraoperative identification of parathyroid gland during thyroidectomy can reduce the incidence of incidental parathyroidectomy, thereby minimizing the risk of postoperative hypoparathyroidism and hypocalcemia.