The impact of using intranasal splints on morbidity and prevalence of adhesions.

OBJECTIVE: To study the effect of using intranasal splints for prevention of adhesions and to assess the morbidity associated with their use. METHODS: A retrospective study based on 2 tertiary hospitals from 1988-1995. One hundred and fourteen patients were divided into 2 groups. Group one with splints and group 2 without. The splints were used for 10 days and nasal toilet was carried out twice. Score of adhesions, perforation, bleeding, pain, crusting, and septum position were recorded. RESULTS: Adhesions in both groups were almost the same as well as septum medialization and perforation scores. Pain and crusting were more common in the splinted group (p-value <0.001). CONCLUSION: The use of intranasal splints should be individualized. Nasal irrigation is of importance to prevent crusting. The morbidity associated with intranasal splints should be considered before use.

Iatrogenic incudostapedial joint dislocation in transcanal tympanoplasty.

PURPOSE: To report the result of transcanal tympanoplasty using Lyodura as a graft. MATERIALS AND METHODS: One hundred thirty-seven patients with chronic suppurative otitis media with a dry perforation were considered for tympanoplasty. The transcanal permeatal approach was adopted. Lyodura as a ready-made graft was used. RESULTS: The success rate of the graft was 78%. Latrogenic incudostapedial joint dislocation was found in six patients (4.4%), and sensorineural hearing loss occurred in nine patients (6.5%). CONCLUSION: The use of thick dura as a graft for repair of the tympanic membrane may result in damage to the ossicular chain or dislocation of the incudostapedial joint when used as underlay. Excessive manipulation of the ossicles or drilling should be avoided.

A survey of childhood hearing impairment.

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Epidemiology and etiology of hearing impairment among infants and children in a developing country. Part I.

OBJECTIVES: The study identifies children at risk for hearing impairment and determines the etiology, type, degree, and onset of deafness of Saudi children living in the city of Riyadh. The relationship to other anomalies is also explored, and a review of the literature is included. METHOD: This study features an extensive screening programme involving interviews, clinical and laboratory examinations, anthropometric and audiologic measurements, and family demographic data gathering of subjects both in the field and in clinics randomly selected throughout Riyadh. A control group of normal-hearing children was also selected. RESULTS: Of the 6421 children surveyed (55% male), aged 2 months to 12 years, the mean birth weight was 3050 g; the average number of siblings was 5.39; and the majority were from consanguineous families. Male children, lower birth weights, ocular problems, consanguinity, perinatal problems, lower socioeconomic level, and a family history of hearing impairment or other disease (e.g., meningitis) correlated with an increased risk of impairment in these children, as did the attendance of their mothers at an antenatal clinic. CONCLUSION: The study points to the significance of hearing impairment and its effect on communication and psychological and educational development, as well as the necessity for programmes to address these issues in children, both in management and prevention.

Otolaryngological manifestation of Gorlin Goltz syndrome.

A 46-year-old Jordanian man was seen in ENT clinic complaining of progressive left nasal obstruction and hearing loss for the last five years with a history of multiple surgical removal of dental cysts. Clinical and radiological investigation revealed a cystic mass occupying the left maxillary sinus protruding to the nasal cavity, calcification of the falx cerebri and bifid ribs. On these findings Gorlin-Goltz syndrome was confirmed. The case is presented and the literature reviewed.

Jervell and Lange-Nielsen QT syndrome: a case report from Saudi Arabia.

A family with two of its members having Jervell and Lange-Nielsen syndrome is reported for the first time from Saudi Arabia. A history of syncopal attack in a child with hearing loss and the sudden death of her brother while playing suggested the possibility of the syndrome. Electrocardiogram and full ENT and audiological assessment revealed Jervell and Lange-Nielsen syndrome in the living child. Treatment was given and the condition is now under control.

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.

The impact of social and environmental changes on allergic rhinitis among Saudi children. A clinical and allergological study.

Eighty four children with allergic rhinitis out of 316 consecutive cases were investigated, treated and followed-up for 2 years. Diagnostic skin testing were done with identified common allergens found in Saudi environment (2). Cat fur, Bermuda grass and mesquite were the most common allergens found. Symptoms of recurrent rhinosinusitis, otitis media with effusion, tonsils and adenoids infection were commonly noticed among them. The rapid change of environment in Saudi Arabia in the form of agricultural and other factors seem to play part in the increasing incidence of allergic manifestation in paediatric population. With antiallergic treatment and control of infection, most of these children responded well and only four children required surgery. The treatment of allergic disease saves a lot of children from unnecessary surgical procedures usually carried out on them.

Prevalence of severe to profound sensorineural hearing loss in children having family members with hearing impairment.

The purpose of this paper is to study the prevalence rate of hearing impairment among children with siblings and family members having hearing and speech disorders. A random survey of 6,421 Saudi infants and children between 2 months and 12 years of age was conducted in the Riyadh area. Children with no or few siblings and those who were firstborn were at relatively higher risk, and there was a strong association between children in the hearing-impaired group among those having living siblings with deafness. Those children who had family members with hearing and speech problems were at twice the risk of their counterpart groups regarding hearing impairment.

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.

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.

Hearing impairment in association with distal renal tubular acidosis among Saudi children.

A follow-up of seven patients with the autosomal recessive inherited syndrome of distal renal tubular acidosis (RTA) and sensorineural hearing loss is described. Five patients were diagnosed as having primary distal renal tubular acidosis and rickets, four were found to have severe sensorineural hearing loss of over 80 dB: two of which are brothers. Two patients were diagnosed as having secondary distal renal acidosis due to a genetic disorder called osteopetrosis; they are brothers and their audiograms showed a mild conductive hearing loss of an average 35 dB bilaterally. All patients had growth retardation with improvement due to alkaline therapy but their hearing loss was not affected by the medication. The pedigrees of two families with half sibs showed the familial incidence for consanguineous marriage. Consanguinity was found to be positive in five out of the seven patients. The tribal tradition in Saudi Arabia fosters consanguineous marriages for cultural and social reasons and pre-arranged marriages are still seen.

Familial hereditary progressive sensorineural hearing loss among Saudi population.

Clinical and audiological studies of 234 Saudi patients from the central area of Saudi Arabia with progressive sensorineural hearing loss were carried out in Riyadh. One hundred and sixty-four came from 38 families, i.e. 70% of the total and 30% were sporadic cases. Consanguinity was found in 80.8%. Their hearing loss was characterized as being bilateral sensorineural, starting at 1 kHz frequency and gradually sloping the pure tone audiogram to severe and profound hearing loss at 8 kHz. Special tests for recruitment indicate hair cell lesions. Caloric tests were normal in 56 patients tested. No abnormal internal ears were found in a C.T. scan done for 84 cases. Serology for TORCH and non-TORCH agents were done for (124) selected cases. Syphilis was negative, however, positive immunoglobulins for cytomegalovirus, herpes simplex type 1 and 2, and toxoplasmosis were seen in 52 cases. All patients came from one area called Qassim where old customs and the tradition of consanguineous marriage were still practiced. Some of these families are now under molecular and cytogenetic study.

Hearing impairment among children in Saudi Arabia: familial incidence and potential risk factors.

A comprehensive clinical and laboratory study was carried out to elucidate the aetiology, risk factors, and familial incidence of hearing impairment. The study involved 1072 children at risk for hearing impairment as well as 17 families. Evaluation of the mothers' clinical histories/findings suggested that the leading possible risk factors for hearing impairment in children were frequent pregnancies, miscarriages and low birth weight. Hearing and/or speech problems in siblings, parents, or even grandparents, were noted to be of significance in hereditary transmission. Among 42 clinically-diagnosed and laboratory confirmed cases, the aetiologic agent found to occur most frequently was, unusually, herpes simplex virus type 1, a non-TORCH agent. Second in frequency of occurrence was Toxoplasma gondii. There was IgM positivity for multiple agents including rubella virus with cytomegalovirus. In the family study, a reliable laboratory confirmation of clinically-diagnosed hearing impairment was obtained in 10-17 families (58.8%). An interesting finding, and one which concurred with clinical histories/findings, was that the incidence of hearing impairment could be reliably correlated with high positivities to IgG, particularly cytomegalovirus.

Relevant demographic factors and hearing impairment in Saudi children: epidemiological study.

A representative sample of 6421 Saudi children were clinically examined and screened for hearing loss. Hearing impairment was detected in 494 children (7.7 per cent). In 326 of the children it was due to chronic secretory and suppurative otitis media (5.07 per cent) and in 168 of them sensorineural hearing loss (2.6 per cent). The study revealed that parental education, low income, and employment of the mother showed a slightly higher at risk rate of hearing impairment. Children from related parents were also at a higher risk of hearing impairment and they demonstrated a marked adverse effect on the incidence of hereditary sensorineural hearing impairment. Comparison with other surveys of school children in developed and developing countries has been carried out.

Bacterial meningitis and hearing impairment: A prospective study.

The purpose of this study is to demonstrate the incidence and the pattern of post-meningitis hearing impairment. A prospective study of 68 meningitis patients was performed. The patients' hearing was evaluated immediately following acute illness and periodically checked for two years. The incidences of the initial sensorineural and conductive deafness were 26.4% and 20.6%, respectively. Two patients (3%) suffered from mixed deafness. No consistent audiometric pattern was found in the cases of sensorineural hearing loss. Serial hearing evaluations demonstrated complete recovery of all cases of conductive hearing loss with only a slight improvement in the low tones noted in one patient with sensorineural hearing loss. No late development of sensorineural loss has occurred.

Congenital nasopharyngeal teratoma in newborn: case report and review of literature.

A rare case of nasopharyngeal teratoma (epignathus) is described in a newborn female, presenting with life threatening respiratory embarrassment. Complete excision was achieved. The management and differential diagnosis are discussed, accompanied by a review of the literature.

Tonsillitis and respiratory infections of viral aetiology in a developing country.

Among 75 clinically diagnosed cases of tonsillitis, 55 (73.3%) were found to be of viral aetiology. Serological and virological investigations identified adenovirus as the main causative agent in children as well as in adults. In only two instances, both in children, was an association with respiratory syncytial virus (RSV) in tonsillitis detected, an extremely rare finding. A cross-sectional sero-epidemiological study of respiratory infections caused by adenovirus, RSV, influenza (A,B) and para-influenza (types 1,2,3) viruses was carried out in 289 Saudi children (newborn to 15 years of age) and 86 adults (healthy male blood donors and pregnant women) using a single serological technique. In children as well as in adults, adenoviruses were the most predominant respiratory pathogens, with no marked variation in age-specific antibody prevalence rates.

Ear, nose and throat diseases in Saudi Arabia. Microbiology and clinical observations.

Clinical specimens from 243 patients attending the ENT clinics at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia were investigated for the pathogens attributing to otitis media and tonsillitis. In children as well as in adults with otitis media, the main bacterial causative organisms were Staph, aureus and Ps. aeruginosa; Asp. flavus was detected in 1% and 4% of adult and children cases of otitis media. In tonsillitis H. influenzae, Strept. pneumoniae, Staph. aureus, Strept. gr. A were isolated in only 18% of the children and Strept. pneumoniae, Strept. gr A in 16% of adults. A possible involvement of viruses in tonsillitis is indicated.