Universal neonatal hearing screening in a tertiary care center in South India Ramiya Ramachandran Kaipuzha, Davis Thomas Pulimoottil, Padmanabhan Karthikeyan Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2019 21(2):29-32 Objective: The aim of the study is to determine the prevalence of hearing loss among newborn infants and to assess the effectiveness and utility of otoacoustic emission (OAE) as a screening tool to detect hearing impairment in newborns and the relationship between selected risk factors and hearing loss. Study Design: This study involved 3121 newborns delivered in a tertiary care center over a 3-year period, who were subjected to distortion product OAE (DPOAE) within 24–72 h of life; failed candidates underwent repeat DPOAE after 30 days. Infants failed the second DPOAE test and then underwent DPOAE and brain stem-evoked response audiometry (BERA) at 3 months of life. Results: 20.95% newborns failed the first screening test, 11.77% failed the second test, and 61.91% of these infants failed the third OAE test. Of the 26 infants who failed the third test, 15 had abnormal results on BERA. Overall, the prevalence of hearing loss was 0.48%. Conclusion: Implementation of a national universal newborn hearing screening program in India is the need of the hour, as early detection of hearing loss will aid early rehabilitation and better outcomes.

Risk factors of recurrent chronic rhinosinusitis after functional endoscopic sinus surgery Waleed Abdullah Mohsenh, Raneem Abdulaziz Aljthalin, Raseel Abdulaziz Aljthalin, Sameer Al-Bahkaly Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2019 21(2):33-36 Background: Chronic rhinosinusitis (CRS) is one of the most common chronic diseases, which is defined as an inflammation of the nose and paranasal sinuses. Computed tomography (CT) scan of paranasal sinuses has become mandatory for all patients undergoing functional endoscopic sinus surgery (FESS), which is, nowadays, regarded as the gold standard for treatment of CRS after a trial of medical treatment. Our aim in this study is to explore the risk factors and anatomical findings on CT scan of CRS patients who had recurrence after FESS in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: A retrospective chart review study was conducted in the section of otolaryngology head and neck surgery to assess the risk factors of patients with recurrent CRS after FESS. The study included all patients, who were adults 16 years of age and above of both genders that had FESS after a diagnosis of CRS between 2016 and 2018. Results: The study identified 257 patients with CRS, of which 38 (14.79%) patients had recurrence after FESS. Various risk factors were taken into consideration such as age, gender, airway and inflammatory autoimmune diseases, smoking, type of sinusitis, and anatomical variations and findings on CT scan. However, only fungal type of sinusitis was found to be a significant risk factor of a recurrent CRS. Anatomical findings on CT scan postoperatively were mucosal thickening, nasal polyps, nasal septum deviation, and obliterated osteomeatal complex. Conclusion: CRS patients were assessed for various risk factors of recurrent CRS. The overall incidence of recurrent CRS was 14.79%. Fungal rhinosinusitis was found to be a significant risk factor. The most common anatomical findings on CT scan postoperatively were mucosal thickening in paranasal sinuses followed by nasal polyps.

Risk of submandibular gland metastasis in early-stage oral cavity cancer: A national multicentric study Jabir Alharbi, Haneen Sebeih, Mohammed Alshahrani, Mohammed Algarni, Hadi Al-Hakami, Abdullah Alnemare, Abdullah M Assiri, Tahera Islam, Khalid Alqahtani Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2019 21(2):37-39 Background: The objective of this study was to evaluate the safety of preserving the submandibular gland in early-stage oral cavity cancer. Materials and Methods: We retrospectively collected the data for all patients who present with early-stage oral cavity cancer and underwent local wide excision with concomitant neck dissection over 8 years from 2008 to 2016 at two tertiary oncology centers in Saudi Arabia. Results: Forty-seven patients, comprising 26 males (55.3%) and 21 females (44.7%), were included in the study; the primary presentation, documented risk factors, and postoperative pathological results were evaluated. Conclusion: The present study showed that risk of submandibular gland metastasis in clinically early-stage oral cavity squamous cell carcinoma was almost nil.

Does adding computed tomography on top of ultrasonography for evaluating thyroid diseases provide a better outcome? Haneen Hussain Sebeih, Khalid Alqahtani, Jabir Alharbi, Nasser Alwehaibi, Ahmad A Aldereihim, Taherah Islam Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2019 21(2):40-46 Introduction: Thyroid disease is a common medical disorder. And thyroid cancer considered the second-most common cancer among the young Saudi females. Ultrasonography (US) and computed tomography (CT) are used in the diagnosis of thyroid nodules. However, US has its limitations, and CT scan is superior in detecting important details that would affect patient care and prevents possible complications. Objective: The study evaluates the benefits of CT scans implementation together with the US as a preoperative evaluation of any thyroid diseases which can improve thyroid patient care. Methodology: The retrospective study was conducted on a total of 207 patients, in a tertiary center, Riyadh, Saudi Arabia. Results: A total of 207 patients with thyroid diseases who had both US and CT scan done despite thyroid surgery done or not (164 females and 43 males; mean age, 44.6 ± 14.5 years) were included in our study, and any patient with improper imaging protocol or poor US or CT image quality was excluded. From there, 207 patients, we had 88 patients with benign and 85 with malignant pathology (+34 patients no surgery done for them). The present study showed that US had better specificity and accuracy in the prediction of thyroid malignancy comparing to the CT scan. Furthermore, CT had a significant P < 0.05 in detecting extension to retrosternal or surrounding structures, major vessels involvement, tracheal compression, and pathological lymph node. Conclusions: CT scan of the neck is a useful technique in detecting additional details about the thyroid and surrounded tissues. This study suggests that preoperative CT scan implementations on top of US are positively associated with a good strategy of surgery, postoperative complication prevention, and to success the thyroid surgery in the Saudi population.

Aberrant carotid bulb in bilateral tonsillar fossae: An exceptional discovery during tonsillectomy Brook Assefa Aylele, Ramiya Ramachandran Kaipuzha, Akilesh Suvindran, Nasser Alhajri Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2019 21(2):47-51 Tonsillectomy, though a popular surgery, has now downsized to limited indications. Although rare, this surgery may cause trauma to the great vessels leading to life-threatening hemorrhage. The congenitally tortuous internal carotid artery (ICA) is an unusual but important anomaly, especially when it is situated in the tonsillar fossae. About 1%–16% of patients have a surgically vulnerable ICA manifested clinically. Here, we present the first reported case of carotid bulb in the right tonsillar fossa. A 7-year-old female child underwent tonsillectomy for obstructive sleep apnea syndrome. Intraoperatively, she was found to have a carotid bulb in both tonsillar fossae, right more prominent than left one. Computed tomography angiogram confirmed the presence of a prominent carotid bulb in the right tonsillar fossa at the C2level. This case report highlights the importance of a heightened awareness of the anatomic variations of carotid artery, in particular, the carotid bulb. This is of critical significance for a safe tonsillectomy as well as any procedure performed in the oropharyngeal region.

Tooth in maxillary sinus, less than what commonly anticipated Mohammed Alwabili, Mohammad Aloulah, Raseel Alsuwaidan, Ahmed Altuwaijri Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2019 21(2):52-54 The maxillary sinus can be a host of a wide range of different types of foreign bodies as a result of its size and the anatomical relation to multiple different skull compartments. Displacement of maxillary molars to the maxillary sinus can occur, although it is rarely reported and the incidence of such condition is still unknown. Most of reported cases in the literature of a tooth in maxillary sinus regardless of its etiology have symptomatic presentation. Different approaches can be utilized to manage such condition; however, surgical management by functional endoscopic sinus surgery is preferred given its advantages of better sinus aeration and less postoperative complication.