Sleep Patterns and Associated Insomnia in Junior and Senior Medical Students: A Questionnaire-Based Cross-Sectional Study

Introduction  Appropriate quality and quantity of sleep are critical for good mental health, optimal body functioning, memory consolidation, and other cognitive processes. Objectives  To evaluate the sleeping patterns of medical students in Saudi Arabia and their relationships with psychological distress. Methods  This was a cross-sectional, self-administered, questionnaire-based study. The study included medical students from a university in Jeddah, Saudi Arabia. The Pittsburgh Sleep Quality Index (PSQI) and the Athens Insomnia Scale (AIS) were used to evaluate the prevalence and burden of inadequate sleep quality and insomnia in the participants. Results  The majority of the participants was women (76.6%). Furthermore, most participants (96.2%) were aged between 18 and 24 years old, while 54.4% of the participants were in their senior year. According to the AIS scores (mean: 15.85 ± 4.52), 98.7% of the participants exhibited insomnia symptoms. The PSQI scores (mean: 9.53 ± 5.67) revealed that 70.5% of the participants had poor sleep quality. Students in their fundamental and junior years had significantly higher percentages of insomnia symptoms and poor sleep quality compared with students in their senior years. Conclusion  The prevalence of insomnia and poor sleep quality is high among medical students. Therefore, appropriate strategies for early detection and intervention are warranted.

Factors influencing quality of life in children with tracheostomy with emphasis on home care visits: a multi-centre investigation

OBJECTIVE

Only a few studies have assessed the quality of life in children with tracheostomies. This study aimed to evaluate the quality of life and the factors influencing it in these children.

METHOD

This cross-sectional, two-centre study was conducted on paediatric patients living in the community with a tracheostomy by using the Pediatric Quality of Life Inventory. Clinical and demographic information of patients, as well as parents' socioeconomic factors, were obtained.

RESULTS

A total of 53 patients met our inclusion criteria, and their parents agreed to participate. The mean age of patients was 6.85 years, and 21 patients were ventilator-dependent. The total paediatric health-related quality of life score was 59.28, and the family impact score was 68.49. In non-ventilator-dependent patients, multivariate analyses indicated that social functioning and health-related quality of life were negatively affected by the duration of tracheostomy. The Quality of Life of ventilator-dependent patients was influenced by care visits and the presence of pulmonary co-morbidities.

CONCLUSION

Children with tracheostomies have a lower quality of life than healthy children do. Routine care visits by a respiratory therapist and nurses yielded significantly improved quality of life in ventilator-dependent children.

Predicting the Magnet Strength Using a Tablet-Based Tool for Patients Undergoing Cochlear Implantation

Objectives Preoperative image analysis of skin flap thickness and determining the required magnet strength are important in the management of CI surgery. The primary aim of this study is to analyze the application of OTOPLAN®, a tablet-based otological preplanning tool, in assessing skin flap thickness. The secondary aim was to determine if there is any correlation between the skin flap thickness and the selected magnet strength. Methods Fifty-seven computer tomography (CT) image datasets of temporal bones of cochlear implant (CI) patients were collected. CE marked OTOPLAN® planning otology software was used to load the patient's preoperative images for measuring the skin flap thickness in both axial and coronal views. To standardize the skin flap thickness measurement, the top of the pinna on the side of implantation was taken as the measurement point. Results The mean age of the patients was 7.98 ± 1.54 years. The body mass index (BMI) was not considered in this study. The average skin flap thickness was 4.5 ± 1.2 mm (range: 2-7 mm). The inter-rater reliability test revealed strong agreement between the two reviewers (Cronbach's alpha = 0.90). The majority of the patients were fitted with a magnet strength of 3. A statistically significant positive correlation was observed between the skin flap thickness and the age of the patients (r = 0.69, p = 0.002). Also, between the skin flap thickness and the magnet strength, a strong positive correlation was observed (r = 0.82, p < 0.0001). Conclusions OTOPLAN® is a reliable tool in the measurement of skin flap thickness with little effort. The age and the magnet strength were positively correlated with the skin flap thickness.

Comparison of Cochlear Implantation Complications with Subperiosteal Pocket Technique Versus Well-Drilling Technique in Pediatric Patients: A Retrospective Study

Aims: Cochlear implantation is becoming the standard treatment for rehabilitating patients with sensorineural hearing (SNH) impairment. Various techniques can be used to achieve this goal. In the current study, we compared the subperiosteal technique (SPT) with the development of a subperiosteal pocket without fixation to the well-drilling method (WD) by constructing an incision into the scalp with suture fixation. Materials and methods: Our study weighted the efficiency of children who underwent WD or SPT from 2017 to 2021 at King Abdulaziz University Hospital. In this retrospective records review, we compared 63 SPT cases with 104 WD cases during a 5-year period who were followed for 1 month or more. Results: There were 88 females (50.9%) and 79 male (45.7%) with a mean age of 4.49 ± 3.06 years at the time of surgery. The mean WD duration was 2.47 ± 1.05 h, and 2.91 ± 1.05 h for SPT (P = 0.01). Moreover, there was a significant relationship between comorbidities and electrode complications (P = 0.022). There was no significant correlation between the surgical method and intraoperative complications (P = 0.714), electrode array issues (P = 0.88), or serious postoperative complications including device failure and migration skin problems (P = 0.207). Conclusion: Overall, the WD technique was faster. However, both methods can be used safely and effectively, as no significant intraoperative or postoperative complications were observed. Further long-term studies are required to validate our findings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03735-z.

Translation and Validation of the Hearing Environments and Reflection on Quality of Life (HEAR-QL) Questionnaire for Children and Adolescents in Arabic

Background There are numerous quality-of-life (QoL) assessment tools available; however, only a few are designed specifically for children with chronic conditions. Among these assessment tools are the Hearing Environments and Reflection on QoL questionnaires for children (HEAR-QL26, HEAR-Q28) developed by Washington University. Unfortunately, there are no other tools that assess hearing loss, and none of them are in Arabic. This paper aims to adapt the HEAR-QL to Arabic and provide an accessible method of measuring the QoL of children with hearing loss in our Arabic-speaking populations. Methodology An independent medical translator translated the HEAR-QL26 and HEAR-QL28 into Arabic. The translations were then examined by two bilingual, native Arabic-speaking otolaryngologists who modified the inadequate questions. Back-translation of the Arabic version into English was subsequently performed by an independent translator. Intra-rater reliability was tested for each of HEAR-QL26 and HEAR-QL28 using 10 participants for each survey, where the participants answered the surveys twice with a period of two weeks between them. A pilot study was conducted which had a total of 40 participants divided equally between the two surveys where each group had an equal number of hearing participants and participants with hearing loss. Results Both HEAR-QL26 and HEAR-QL28 were validated with an overall intra-rater reliability of 88.85% and 87.86% respectively. In the pilot study, the HEAR-QL26 participants with normal hearing scored a median of 2437.5, while the participants with hearing loss scored a median of 1837.5 (p = 0.001). Moreover, HEAR-QL28 participants had a median score of 2725 among participants with normal hearing and 1725 for participants with hearing loss (p = 0.001). Conclusion HEAR-QL is a well-established QoL in children with hearing loss. The validated Arabic adaptation can now be used to measure deafness in Arabic-speaking children.

Biologic Therapies in Chronic Rhinosinusitis with Nasal Polyposis: Overview of Systematic Reviews and Updated Systematic Review

Objectives

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a highly prevalent and challenging disease to manage. Several systematic reviews (SRs) have been carried out to evaluate the efficacy and safety of biologic therapies. We aimed to evaluate the current and available evidence of the biologics in treating CRSwNP.

Data Source

Systematic Review of three electronic databases.

Review Methods

Following the PRISMA Statement, the authors explored three main databases through February 2020 for pertinent SRs and meta-analyses (MAs) as well as experimental and observational studies. A Measurement Tool to Assess Systematic Reviews Version-2 (AMSTAR-2), was employed to evaluate the quality of methodology of SRs and MAs.

Results

A Total of five SRs were included in this overview. The AMSTAR-2 final summary was moderate to critically low. Although conflicting findings were reported, anti-immunoglobulin E (Anti-IgE) and anti-interleukin-4 (Anti-IL-4) were superior to placebo for improving total nasal polyp (NP) score, particularly in patients with asthma. Findings of the included reviews revealed that both sinus opacification and the Lund-Mackay (LMK) total scores significantly improved after biologics use. Subjective quality-of-life (QoL) assessment provided by general and specific questionnaires illustrated favorable results of biologics for CRSwNP, whereas no significant adverse events were reported.

Conclusion

The current findings support the use of biologics for CRSwNP patients. However, the evidence for their use in such patients should be cautiously adopted because of the questionable evidence.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03144-8.

The Hearing Aid Effect in the 2020s: Where Do We Stand?

Introduction The 'hearing aid effect' is a negative perception toward individuals using hearing assistive devices (HADs), which is a primary reason for parents and children refusing to use them. We aimed to determine the current perception toward individuals using HADs and the associated factors. Methods A 30-item photo-based survey was conducted to analyze the participants' perception toward individuals using HADs as compared to healthy (H) individuals and individuals with disabilities (D). The survey was validated with an intrarater reliability of 86%. A cross-sectional study was conducted by approaching individuals who visited one of the largest shopping centers in a metropolitan city to participate in the survey. Demographic information, including age, gender, and educational background, was collected. Results A total of 517 participants completed the survey. Nearly two-thirds of the participants (59.7%) did not consider individuals using HADs as those who needed assistance as compared to H individuals. Interestingly, Generation X and Z participants had a significantly better perception toward individuals using HADs (63.1% and 59%, respectively) as compared to participants of the Baby Boomers generation (54.3%). The majority of participants who considered HD use a handicap compared to healthy individuals (79.9%) did not have a family member that used a HAD. Conclusion The stigma of wearing a HAD is significantly reducing with time, and the younger generations are not considering it as a disability. This is an important point that can be highlighted while counseling parents and young adults who are candidates for HAD use.

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.

Qualitative Assessment of Quality and Readability of Patient-Directed Online Resources for Cochlear Implants in Children

OBJECTIVE

Children with sensorineural hearing loss can benefit from cochlear implantation (CI). Patients can obtain direct access to medical information on the internet. However, the internet is uncontrolled, and the quality and readability of information are unpredictable. The quality and readability of websites providing information about CI in children were assessed in this study.

STUDY DESIGN

Cross-sectional study.

SETTING

Online search.

METHODS

The 3 most popular search engines (Google, Bing, and Yahoo) were queried with the phrases "cochlear implant" and "cochlear implant in children." The DISCERN instrument was used to assess the information quality. The readability was evaluated using 5 validated readability indices.

RESULTS

Of 103 websites, the median DISCERN quality score was 33 (interquartile range [IQR], 27-41). Only 5 websites were considered to be of good quality, and 1 was excellent. The median readability school grade was 11th (IQR, 10-12), which fell within the range defined as difficult. No website was at or below the recommended sixth-grade level. There was no correlation between readability and the DISCERN scores (r = -0.105, p = .291).

CONCLUSION

Our study suggests that most websites with information on CI for children are of variable quality and are written beyond the reading ability of the general population. Website builders should focus on improving the readability of their online material to help the average reader understand and benefit from the content.

Acquired laryngeal hemangioma: A rare presentation in an adult

Laryngeal hemangiomas are rare vascular tumors that mostly present in children. The objective of this publication is to shed the light over this rare diagnosis. We report a case of adult onset of laryngeal hemangioma arising from the junction of the vocal fold and vocal process. The patient presented with a history of hoarseness of voice. An in-office laryngoscopy was performed that revealed a pink lobulated mass arising from the left hemilarynx. Intraoperatively, suspension microlaryngoscopy was performed; the lesion was identified and successfully resected using cold dissection technique. Histopathological analysis was consistent with laryngeal hemangioma. The patient is now a year post resection and remains asymptomatic without signs of recurrence. To conclude, adult onset of laryngeal hemangioma is very rare. When present, resection with either or both cold steel (microscissors) and laser have shown good outcome. Patients should be monitored afterwards for possible recurrence.

Olfaction and Gustation in Children With Primary Ciliary Dyskinesia

Objective

Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder whereby abnormal cilia cause a wide array of respiratory tract manifestations including chronic rhinosinusitis. The purpose of this study was to determine whether olfaction and gustation are impaired in children with PCD.

Study Design

Cross-sectional study.

Setting

Tertiary pediatric academic hospital.

Methods

Children with confirmed PCD based on having at least 1 of 3 approved diagnostic criteria as per The American Thoracic Society guidelines were recruited from The PCD Clinic in our tertiary care pediatric hospital. Odor identification ability was tested using the Universal Sniff (U-Sniff) test and taste threshold was measured using an electrogustometer. The main outcome of this study is to determine the incidence of olfactory dysfunction in children with PCD and investigate if there is an associated gustatory dysfunction.

Results

Twenty-five children participated (14 male, 11 female), The median age was 10.8 years (range: 4.1-17.9 years). Only 4/25 (16%) complained of olfactory dysfunction prior to testing. None of the patients complained of dysgeusia. However, 48% (12/25) scored less than 7 on the U-Sniff, signifying hyposmia or anosmia. In contrast, scores obtained by electrogustometry were in the normal range. There was no correlation between performance on the U-Sniff and electrogustometry testing.

Conclusion

Olfactory impairment in children with PCD is common but underrecognized by patients. This is not associated with abnormal gustation. Among other, this places children with PCD at an increased risk with respect to smelling a fire or detecting spoiled or poisonous food.

Operative Airway Exposure in an Otolaryngology-Head and Neck Surgery Training Program. A Survey of Current Trainees

To survey Otolaryngology residents to evaluate their operative airway exposure during their training and to assess if the exposure was adequate to decide whether to pursue fellowship in pediatric. A modified and validated survey was distributed among otolaryngology trainees in the Western region of Kingdom of Saudi Arabia. It assesses operative airway exposure during training, adequacy of experience to decide on whether to pursue fellowship in pediatric otolaryngology, and plan to perform the following six procedures (diagnostic rigid bronchoscopy, diagnostic flexible bronchoscopy, endoscopic airway foreign body removal, rigid esophagoscopy with or without foreign body removal, suspension microlaryngoscopy procedures, open tracheostomy) in practice. Only 24/60 (60%) of respondents perceived that they had adequate training as to whether or not to make them decide to pursue fellowship in pediatric. In regard to over all assessment of the level of exposure: the vast majority of trainees regarded the training as adequate 30/60 (50%), 3/60 (5%) thought it was excellent, 6/60 (10%) thought it was good, and 21/60 (35%)assessed the training adequacy as poor. 24/33 (72.7%) perceived that the presence of a pediatric fellow with them enhanced their training. In regards to performing surgeries after training, 78% were planning to perform rigid bronchoscopy, flexible bronchoscopy (58%), endoscopic airway FB removal (92%), esophagoscopy (54%), suspension microlaryngoscopy (82%), and open tracheostomy (100%). The presence of a pediatric fellow in service was thought of by most residents as being beneficial, however, the exposure to airway surgeries were not adequate as to inform trainees if they want to pursue fellowship in pediatric, when they were not exposed to a fellow.

The Association Between Vitamin D Level and PFAPA Syndrome: A Systematic Review

Periodic Fever, Aphthous Ulcers, Pharyngitis and Adenitis (PFAPA) Syndrome's etiology is not well understood. The objective of this study is to explore the association between vitamin D level and PFAPA syndrome. A systematic review of all publications addressing the association between vitamin D level and PFAPA syndrome prior to May 2019 was conducted. Data were collected from online medical databases namely, PubMed, Ovid Medline, Embase, Cochrane Library, Google Scholar, and Scopus. The review adhered to the PRISMA statement and was performed in 3 main phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles. 3 prospective review-based and one case report articles were included with a total of 281 patients, 98 of whom were cases of PFAPA, while 183 were controls. Vitamin D levels were deficient in 27% of PFAPA group as compared with the control. Vitamin D supplementation was given as an initial treatment in 25/98 of the patients. Only 1 patient received it as a second treatment. After vitamin D supplementation, a marked reduction of the number of febrile episodes and modification of the mean duration were recognized. There may be an association between Vitamin D deficiency and a higher frequency of PFAPA episodes. Vitamin D supplementation in children with PFAPA may reduce the frequency of episodes and help manage the condition.

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.

Neurobrucellosis Complicated by Sensorineural Hearing Loss: A Case Report

Brucellosis is a zoonotic disease. It is also one of the neglected infectious diseases and is less well-known compared to other diseases. It is acquired from infected animals (cattle, sheep, goats, camels, pigs, or other animals) through the consumption of unpasteurized dairy products or contact with tissues or fluids. Sensory neural hearing loss (SNHL) in neurobrucellosis had been described in the literature, mostly as an incidental finding that otolaryngologists should consider in any patient with fever and a history of travel to the Middle East, Central or South America, or other brucellosis-endemic countries. We present a neurobrucellosis case with profound bilateral SNHL that was treated with combination antibiotic therapy for long periods of time and highlight the clinical course of the patient.

Characteristics of Choanal Atresia in Patients With Congenital Anomalies: A Retrospective Study

Introduction

Choanal atresia (CA) is an uncommon congenital anomaly. There are various syndromes that are associated with CA. The purpose of this study is to determine the differences in CA's presentation and outcome when associated with other congenital anomalies and syndromes.

Method

This is a retrospective review study of all children (18 years and younger) who underwent CA repair in a tertiary referral healthcare center from January 2005 to April 2022. Demographics, comorbidities, radiological testing, operative reports, and outpatient reports were collected. Success was determined as a child with bilateral patent choana that is able to breathe from both nostrils comfortably.

Result

Twenty-four patients met the criteria for inclusion in this study. Bilateral CA was present in 15 (62.5%) patients. Mixed CA was the most common variant. There were various congenital anomalies in association with CA patients who are yet to be classified into a syndrome. The most common congenital anomaly was cleft lip and palate. Bony and mixed types were significantly associated with non-syndromic patients (p<0.05). Twenty patients (83%) were diagnosed with CA at age of less than one year, and four patients were diagnosed after one year of age. There were 36 surgeries performed on 24 patients, of which 27 were endoscopic and nine were using Hugher dilator. The overall success rate for CA repair was 50%. The median number of revisions per patient was 0.5.

Conclusion

CA is a challenging anomaly to repair. There are various factors that influence the outcome of children with CA. Otolaryngologists should counsel the patient and their families regarding possible need for revision especially in those with other craniofacial anomalies.

Management outcomes of otitis media with effusion in children with down syndrome: A systematic review

OBJECTIVE

To assesses the current state of uncertainty concerning the management options used for otitis media with effusion (OME) in children with trisomy 21.

REVIEW METHODS

A systematic review of adhering to the PRISMA statement of studies evaluating the management of OME in trisomy 21 children prior to September 2021 was conducted. Studies were identified using the following medical databases: PubMed, Google Scholar, CINAHL, Scopus and Medline. Data extraction was performed by screening of titles and abstracts based on eligibility criteria, followed by full-article analysis of selected records.

RESULTS

Twenty articles were included in this review. Studies showed conflicting outcomes regarding the different interventions used for OME in children with trisomy 21. Of those evaluating pressure equalizing tubes (PET), some studies report pronounced complication rates and recommend using a conservative approach unless complications arise and/or hearing loss is severe. In contrast, other studies reported significantly reduced complication rates and improved hearing with earlier intervention and adaptations to PETs. Hearing aids may be provided after multiple failed PETs.

CONCLUSION

Clinical equipoise still persists regarding the best method to manage children with trisomy 21 who have OME. Although PETs exhibited the lowest complication rates and highest improvement rates, further prospective trials are warranted to assess the various treatment modalities and determine which of them would provide the best outcome while reducing complications as well as the age of treatment.

Vestibular and Balance Impairment Is Common in Children With Primary Ciliary Dyskinesia

OBJECTIVE

Primary ciliary dyskinesia (PCD) is a rare genetic disorder that presents with a wide range of respiratory complaints. The most common otologic associated disorder is middle ear effusion. We ask if children with PCD suffer from vestibular impairment.

STUDY DESIGN

Cross-sectional cohort study.

SETTING

Tertiary pediatric referral hospital.

PATIENTS/PARTICIPANTS

Children with confirmed PCD.

INTERVENTION/METHODS

All included participants were clinically assessed to be at baseline then basic demographics and medical histories were collected, including the specific genetic mutation these patients have. After which, all patients underwent two vestibular tests. The first was to assess their ability to stand on one foot with their eyes open and then with their eyes closed and the second was video head impulse test (vHIT).

MAIN OUTCOME MEASURES

Ability standing on one foot with the eyes closed and vHIT.

RESULTS

During this period, 25 children with PCD were recruited for the study. The mean age at recruitment was 11.26 years (4-18 yr). There were 11 women and 14 men. All patients were able to participate in both tests. Nineteen participants (76%) had vestibular impairment. Fifteen of them failed to stand on one foot with their eyes closed and six of 25 had abnormal vHIT. The most common involved gene was DNAH5 8/25 (32%) and it was associated with vestibular impairment in seven of eight participants (87.5%).

CONCLUSION

The majority of children with PCD that we tested suffered from vestibular impairment that was previously undiagnosed. This potentially indicates that imbalance and vestibular pathology is under-diagnosed in children with PCD.

Arabic Translation and Validation of Olfactory-Specific Quality of Life Assessment Questionnaire

BACKGROUND

 Olfaction plays a critical role in our health, emotions, social life and safety, which is why olfactory dysfunction has a great impact on a person's life. This has been highlighted with the recent coronavirus disease 2019 (COVID-19) pandemic. Despite Arabic being the fifth most commonly spoken language and one of the six official languages of the United Nations, there is no Arabic version for an olfactory-specific quality of life assessment tool.

METHOD

 The Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS) is a validated questionnaire that assesses many aspects of a patient's daily life. We translated this questionnaire to the Arabic language following European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group Translation Procedure guidelines. A pilot-testing of the Arabic version was done among 20 participants, 10 of whom were confirmed to have normosmia based on scoring at least 11/12 on the Sniffin' Sticks (SS) olfactory testing (Group 1) and another 10 participants who reported anosmia and scored less than 7/12 on the SS test. Patients could agree, partially agree, partially disagree, or disagree with each questionnaire statement.

RESULTS

 The pilot study revealed that participants with confirmed anosmia had higher questionnaire scores compared to participants with normosomia (median 22 compared to 1, p value < 0.001). For each statement on the Arabic questionnaire, all questions scored at least 80% of intra-rater reliability, and the overall intra-rater reliability was 90%.

CONCLUSION

 The Arabic translation of QOD-NS is a validated questionnaire that can be used both in academic and clinical practice.

Otolaryngology Manifestations of Primary Ciliary Dyskinesia: A Multicenter Study

OBJECTIVE

This project aims to prospectively and objectively assess otolaryngological manifestations and quality of life of children with primary ciliary dyskinesia (PCD) and compare these findings with healthy pediatric controls.

STUDY DESIGN

Cross-sectional.

SETTING

Two high-volume pediatric PCD specialty centers.

METHODS

Standardized clinical assessment; Sino-Nasal Outcome Test 22 (SNOT-22); Hearing Environment and Reflection Quality of Life (HEAR-QL); Reflux Symptom Index (RSI); standardized physical examination of the sinonasal, laryngeal, and otological systems; and investigations including pure-tone audiograms (PTAs) and sinonasal cultures were collected.

RESULTS

Forty-seven children with PCD and 25 control participants were recruited. Children with PCD had more upper airway symptoms than healthy children. They had significantly higher scores in both SNOT-22 and RSI, indicating worse sinonasal and reflux symptoms, with worse quality of life on the HEAR-QL index compared to healthy children (P < .05). Fifty-two percent of children with PCD-related hearing loss were not aware of their hearing deficit that was present on audiological assessment, and only 23% of children who had ventilation tubes had chronic otorrhea, most of which was easily controlled with ototopic drops. Furthermore, although all children with PCD had chronic rhinosinusitis, only 36% of them were using topical nasal treatment. The most common bacteria cultured from the middle meatus were Staphylococcus aureus in 11 of 47 (23%), followed by Streptococcus pneumoniae in 10 of 47 (21%).

CONCLUSION

This multisite cohort highlights the importance of otolaryngology involvement in the management of children with PCD. More rigorous otolaryngological management may lead to reductions in overall morbidity and improve quality of life for children with PCD.

Supraglottoplasty in the management of laryngomalacia in children with down syndrome: A systematic review

INTRODUCTION

Children with Down syndrome (DS) who have Laryngomalacia represent a specific management challenge due to their inherent multiple levels of airway obstruction and hypotonia. Therefore, the purpose of this study is to determine the outcome of supraglottoplasty (SGP) in children with DS.

DATA SOURCE

A systematic review was performed following the PRISMA guideline. Data were collected from online medical databases- CINAHL, Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid MEDLINE in process, PubMed, and Scopus.

REVIEW METHODS

all publications that address the outcome of supraglottoplasty in children who are less than 18 years old with Down syndrome prior to December 2018 were collected. The data were collected on different phases: Screening review using search words and controlled vocabularies during the period of November-December 2018, followed by a detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles.

RESULTS

Nine articles were included in the qualitative analysis. These articles included 231 subjects, out of which 32 children with DS met the inclusion criteria. Twenty patients (62.5%) were considered successfully treated and 12/32 failed including 1/32 (3.1%) mortality in the postoperative period. The duration of follow-up was 12-102 days. All of the patients whose treatment failed had significant comorbidities.

CONCLUSION

Although the success of SPG in children with DS is less than in otherwise healthy children, it remains an option especially in patients without comorbidities. Preoperative counseling of the families and thorough assessment are necessary to determine candidacy for SPG in children with DS.

How I do it: Proximal cochlear implant electrode fixation using Ned's Knot

OBJECTIVES

Electrode extrusion is an under-recognized complication of cochlear implants, especially in those with straight electrodes.

METHODS

This paper describes in details the steps to perform proximal fixation of an electrode around the incus buttress using Ned's knot technique. Written and video illustration is included.

CONCLUSIONS

Ned's Knot is an easy technique that can help diminish the extrusion rate of straight cochlear implants electrodes.

Frequency of Preoperative Localization Techniques of Parathyroid Adenoma at King Abdulaziz University Hospital, Saudi Arabia

Background Accurate preoperative radiological localization of parathyroid pathologies paves the way to enable less invasive surgical procedures. Results on the accuracy of the different diagnostic measures are conflicting. Also, little is known about the most common location of parathyroid lesions. This paper aims to determine the most common location of parathyroid adenoma and evaluate the diagnostic performance of radiological modalities such as ultrasonography, sestamibi scintigraphy/single-photon emission computerized tomography (SPECT), magnetic resonance imaging (MRI), and computed tomography (CT) scan for the preoperative localization of parathyroid pathologies. Methods This is a retrospective study. Data were collected from patients who underwent total or partial parathyroidectomy at King Abdulaziz University Hospital between January 2000 and March 2020. The parathyroid adenoma site was detected preoperatively by a radiological method and confirmed postoperatively by the histopathology report. The performance of each preoperative localizing radiological method was evaluated based on the accuracy in localizing parathyroid pathology. Results A total of 73 patients were included in the analysis, with females being the most common gender in the study at 64%. Only complete data files were included and incomplete data files were excluded. The most frequent mode of detecting parathyroid adenoma was a sestamibi/SPECT scan (62.5%) followed by a CT scan (50%), ultrasound (34.6%), and MRI (25%). The most common location of a parathyroid adenoma was the left side. Conclusion Sestamibi/SPECT is a frequent radiological method for detecting the parathyroid lesion site as compared with CT, MRI, and ultrasonography.

Effect of Intranasal Corticosteroids on Intraocular Pressure and Nerve Fiber Layer Thickness: A Cross-Sectional Study at a Tertiary Care Hospital in Western Saudi Arabia

Background

Rhinitis represents a global health problem, affecting 10%-20% of the population in Saudi Arabia. Topical intranasal corticosteroids (INCS) are widely used by otolaryngologists to treat patients with rhinitis for long periods. Although the effects of orally administered corticosteroids on intraocular pressure (IOP) and lens opacity are well established, the impact of INCS is not well defined. In the present study, we aimed to assess the effect of using INCS on IOP over a six-month period in patients with rhinitis.

Methodology

In this study, a questionnaire was distributed to 93 patients diagnosed with rhinitis in the Ear, Nose, and Throat Clinic of King Abdulaziz University Hospital, Saudi Arabia, between February and July 2019. Thereafter, each patient was evaluated in the Ophthalmology Clinic with optical coherence tomography of the optic nerve using Cirrus HD-OCT (Carl Zeiss Meditec, Inc., Dublin, CA, USA) optic disc scans, visual acuity testing, and Goldmann applanation tonometry. Pearson correlation coefficients and two-tailed tests of significance were used to assess the relationships between variables.

Results

All 93 patients were using a dose of two puffs at least twice daily for each nostril. Their IOPs, as depicted by Goldman applanation tonometry, were found to be within normal limits. Retinal nerve fiber layer thickness was also found to be normal in 95% of the participants.

Conclusions

Our study showed no correlation between INCS and IOP. As an increase in IOP can lead to glaucoma, our data demonstrate the safety profile of INCS use. For patients with rhinitis, this finding could change compliance to medication and reduce the burden of the disease.

Efficacy and safety of paranasal sinus balloon catheter dilation in pediatric chronic rhinosinusitis: a systematic review

Objective

Chronic rhinosinusitis (CRS) negatively affects quality of life (QoL), and balloon catheter sinuplasty (BCS) has shown good outcomes in adult patients. However, there has not been much research on the effects of BCS on pediatric patients. The objective of this review is to systematically assess the literature for studies demonstrating the effectiveness and safety of BCS in pediatric CRS patients.

Data sources

PubMed, Embase and Cochrane Library.

Study selection

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations (PRISMA) to conduct our study. Observational- and interventional-based studies reporting efficacy and/or side effects of BCS among pediatric populations were included. Efficacy was evaluated by clinically reliable measures including Sino-Nasal 5 (SN-5) QoL scale. Antibiotic usage and revision surgery were also evaluated.

Data extraction

Articles were screened, and data were obtained. Study design, sample size and demographics, treated sinuses, criteria of inclusion, adjunct procedure(s), follow-up time, and outcomes measured were reported.

Main findings

Out of 112 articles identified, 10 articles were included: two interventional controlled trials and eight observational studies. All studies evaluating QoL by SN-5 showed a remarkable reduction in SN-5 score postoperatively. Improvement in the computed tomography (CT) and endoscopic findings for up to 1 year after operation was reported. Furthermore, the majority of patinets treated with BCS did not recieve any course of sinusitis-indicated antibiotics during long-term follow-up, and they had low surgical revision rates. Minor side effects were reported, most commonly synechia.

Conclusion

Available evidence suggests that BCS is safe and effective for the treatment of CRS in pediatric patients. Future randomized controlled studies with large sample size are warranted. Such studies can further determine the efficacy of BCS in managing children with CRS.

The Association Between Vitamin D Deficiency and Recurrent Tonsillitis: A Systematic Review and Meta-analysis

OBJECTIVES

The role of vitamin D deficiency has been linked with recurrent upper respiratory tract infections, but its impact on the frequency of tonsillitis is not yet fully understood. The objective of this study is to determine the association between vitamin D deficiency and recurrent tonsillitis based on current literature.

DATA SOURCE

A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data were collected from online medical databases (PubMed, MEDLINE, EMBASE, and Cochrane Collaboration Registry of Controlled Trials).

REVIEW METHODS

All studies addressing the association of vitamin D deficiency and recurrent tonsillitis prior to March 2019. The data were collected in different phases: screening review using search words and controlled vocabularies followed by detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles.

RESULTS

Fifty-three studies were potentially eligible; of these, 4 publications met the inclusion criteria and were included in the quantitative synthesis. There was a statistically significant reduction of vitamin D levels in patients with recurrent tonsillitis as compared to healthy controls (mean difference, -10.71; 95% CI, -19.12 to -2.31; P = .01). The odds of vitamin D insufficiency were significantly higher in patients with recurrent tonsillitis as compared to the control group (odds ratio, 4.37; 95% CI, 2.78-6.88; P < .001).

CONCLUSION

Vitamin D deficiency was present in patients with recurrent tonsillitis and might be associated with an increase in the risk of recurrent tonsillitis. There is a need to explore these findings via clinical trials based on large populations.

Severe Primary Hyperparathyroidism Caused by Parathyroid Carcinoma in a 13-Year-Old Child; Novel Findings From HRpQCT

Primary hyperparathyroidism is a condition that occurs infrequently in children. Parathyroid carcinoma, as the underlying cause of hyperparathyroidism in this age group, is extraordinarily rare, with only a few cases reported in the literature. We present a 13-year-old boy with musculoskeletal pain who was found to have brown tumors from primary hyperparathyroidism caused by parafibromin-immunodeficient parathyroid carcinoma. Our patient had no clinical, biochemical, or radiographic evidence of pituitary adenomas, pancreatic tumors, thyroid tumors, pheochromocytoma, jaw tumors, renal abnormalities, or testicular lesions. Germline testing for AP2S1, CASR, CDC73/HRPT2, CDKN1B, GNA11, MEN1, PTH1R, RET, and the GCM2 gene showed no pathological variants, and a microarray of CDC73/HRPT2 did not reveal deletion or duplication. He was managed with i.v. fluids, calcitonin, pamidronate, and denosumab prior to surgery to stabilize hypercalcemia. After removal of a single parathyroid tumor, he developed severe hungry bone syndrome and required 3 weeks of continuous i.v. calcium infusion, in addition to oral calcium and activated vitamin D. Histopathological examination identified an angioinvasive parathyroid carcinoma with global loss of parafibromin (protein encoded by CDC73/HRPT2).HRpQCT and DXA studies were obtained prior to surgery and 18-months postsurgery. HRpQCT showed a resolution of osteolytic lesions combined with structural improvement of cortical porosity and an increase in both cortical thickness and density compared with levels prior to treatment. These findings highlight the added value of HRpQCT in primary hyperparathyroidism. In addition to our case, we have provided a review of the published cases of parathyroid cancer in children. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Ectopic cervical thymus in children: Clinical and radiographic features

OBJECTIVES

Ectopic thymus is rare and can be a diagnostic challenge. This study evaluated the management of children radiographically diagnosed with ectopic cervical thymus.

METHODS

A retrospective review of 100 patients was performed. Data related to clinical presentation, radiological imaging, pathology, and management were collected. Changes in lesion volume were tracked over time. Clinical characteristics were compared based on lesion location in the neck using analysis of variance modelling.

RESULTS

There were 115 lesions with radiographic features of ectopic cervical thymus (15 children had bilateral lesions). Diagnosis was based on ultrasound in 98% of patients, magnetic resonance imaging in 18%, and computed tomography in 11%. Mean (SD) follow-up duration was 2 (2.2) years. Forty-four percent (51/115) of lesions involved the thyroid gland, 29% (33/115) were in the central neck but separate from the thyroid, 18% (21/115) had mediastinal extension, and 8% (9/115) involved the submandibular region. Location was unclear for two patients. Submandibular lesions were on average 12.4 cm³ larger (95% CI, 8.2, 16.6) than mediastinal lesions at diagnosis, P ≤ .001. Volume of thymic tissue decreased over time, from a mean (standard deviation [SD]) volume of 4.3 cm³ (9.2) at initial ultrasound to 2.7 cm³ (6.1) at final ultrasound (paired t-test, P = .008). Only two patients required surgery: one for compressive symptoms, and the other to rule out malignancy.

CONCLUSION

Ninety-eight percent of children with ectopic cervical thymus were managed conservatively without issues. We propose a classification system based on location to ease communication among clinicians and to help follow these lesions over time.

LEVEL OF EVIDENCE

4, case series Laryngoscope, 130:1577-1582, 2020.

Cranial orthosis after cochlear implantation in an infant: Helmet modifications

We present an infant with bilateral sensorineural hearing loss caused by bacterial meningitis, and moderate/severe plagiocephaly requiring simultaneous treatment of cochlear implantation for hearing loss and cranial orthosis for plagiocephaly. A helmet modification was created, so that the infant was able to be treated for his plagiocephaly while bilateral cochlear implants were in place, bringing attention to serve needs of those patients requiring cochlear implant and cranial orthosis concurrently. While this case was the first time such a modification was required, which was due to the young age at implantation, the occurrence of the concurrent need may increase as we continue to push the boundaries of early implantation.

Emberger syndrome: A rare association with hearing loss

Emberger Syndrome (ES) is a rare genetic disorder characterized by lymphedema and myelodysplasia. It is also associated with hearing loss. The genetic mutations associated with ES are not part of the comprehensive 80 gene next generation sequencing (NGS) panel. As a result, the otolaryngologist should maintain an index of suspicion for ES in any child with SNHL who presents repeatedly with recurrent infections, lymphedema and/or cutaneous warts. This paper describes the clinical evolution and management of two children who were followed up for hearing loss and eventually were diagnosed with ES.

Resolution of unilateral sensorineural hearing loss in a pediatric patient with a severe phenotype of Muckle-Wells syndrome treated with Anakinra: a case report and review of the literature

Background

Muckle-Wells syndrome (MWS) is a rare auto-inflammatory disease characterized by the presence of recurrent urticaria, deafness and amyloidosis. Progressive sensorineural hearing loss (SNHL) is reported to occur in up to 85% of patients occurring in the second and third decades and as early as the first decade in patients with a more severe phenotype, thus potentially having a significant impact on a child’s development. IL-1 inhibitors, such as Anakinra, have been described to improve systemic inflammation, and stabilize or improve hearing status as well. However, complete resolution of hearing loss has been rarely reported. The objective of this article is to highlight the clinical presentation of a pediatric patient with a severe form of MWS and report on the complete resolution of SNHL with the use of Anakinra.

Case presentation

A 3-year-old boy was referred to our hospital to assess for the possibility of MWS given a history of hives and recurrent episodes of fever with a family history of MWS in his mother. Of note, the patient’s history was significant for conductive hearing loss, speech delay, as well as recurrent acute otitis media episodes. Genetic analysis was performed and diagnosis of MWS was confirmed due to the presence of a NLRP3 gene mutation. Further work-up demonstrated the presence of papilledema and elevation of systemic inflammatory markers for which Canakinumab was initiated. Despite initiation of this treatment, audiogram evaluation demonstrated a new right-sided SNHL. Lumbar puncture also revealed aseptic meningitis. Canakinumab was eventually discontinued and Anakinra initiated. Within 7 months of treatment with Anakinra at 5 mg/kg sc daily, resolution of the SNHL was observed. With further escalation of the Anakinra dose, there was also complete resolution of the aseptic meningitis.

Conclusions

Progressive hearing loss is a significant finding in patients with MWS. Early screening as well as initiation of Anakinra can lead to complete resolution of SNHL even in a patient with a severe spectrum of MWS. However, as this case demonstrates, longer treatment duration and higher doses of Anakinra may be required to achieve this.

Direct tracheobronchopexy via left lateral thoracotomy for severe tracheobronchomalacia

An infant with pulmonary atresia/ventricular septal defect/major aortopulmonary collateral arteries underwent unifocalization, ventriculoseptal defect closure and placement of a right ventricle to pulmonary artery conduit via median sternotomy. Aortopexy and pulmonary arteriopexy via redo sternotomy were insufficient to allow weaning of continuous positive airway pressure and he required direct tracheobronchopexy via left lateral thoracotomy to alleviate posterior trachealis intrusion along the length of the trachea and left main bronchus. He also underwent laryngotracheoplasty with placement of a posterior costal cartilage graft for bilateral vocal cord paralysis. The patient was weaned from positive pressure and discharged in stable condition.

Management of cricopharyngeal achalasia in an 8-month child using endoscopic cricopharyngeal myotomy

A term baby was transferred to our tertiary care center with desaturations and inability to manage upper airway secretions. Rigid bronchoscopy and swallowing study revealed cricopharyngeal (CP) achalasia. A gastrostomy tube insertion and Botulinum Toxin-A injection were performed at 6 weeks of age. Improvement of symptoms was observed, however were short-lived requiring recurrent injections. Given the symptom severity, at 8 months, a successful endoscopic CP myotomy was performed. Patient was able to tolerate oral feeds as early as 2 months post-operatively. This is the youngest patient, to our knowledge, treated with endoscopic CP myotomy. Intraoperative pictures and video are presented.

Preoperative TSH and thyroglobulin levels: would it predict thyroid cancer?

OBJECTIVE

The goal of this study is to determine whether preoperative TSH and Tg levels can be used as predictors of thyroid cancer.

STUDY DESIGN

Retrospective chart review.

METHODS

Charts of patients who had undergone thyroid surgery between 2006 and 2012 were subjected to review. Demographic data, preoperative TSH and Tg levels, and final histopathological results were recorded. Patients were divided depending on preoperative TSH and Tg levels. Group 1 consisted of patients with elevated TSH and Tg, Group 2 had elevated TSH only, Group 3 - elevated Tg only, and in Group 4 neither TSH nor Tg were elevated.

RESULTS

653 patient charts were reviewed and 386 patients were excluded due to incomplete information. 212 patients were female. Mean age was 50 years. Group 1 included 52 patients, 25 of them (48%) had well-differentiated thyroid cancer (WDTC). Relative risk was 1.59 and the odds ratio amounted to 1.79. Group 2 included 80 patients, 36 (45%) of whom had WDTC. Group 3 consisted of 58 patients, 23 (39.6%) of them with WDTC. Group 4 comprised 77 patients, where WDTC was present in 16 (20.8%) cases.

CONCLUSION

TSH and Tg levels can aid in preoperative assessment of a thyroid nodule.

Concha bullosa mucocele: A case series and review of the literature

Background:

Concha bullosa mucocele is a rare diagnosis that presents as a nasal mass. It impinges on surrounding structures and can easily be mistaken for a neoplasm.

Objective:

The objective of this study was to shed light on this rare entity and report its diagnostic features and treatment outcomes.

Methods:

A case series conducted in a tertiary health care center. Demographic data, clinical presentation, imaging, cultures, and treatments were recorded. Operative video illustration and key images were obtained. A review of the literature was also performed.

Results:

A total of five cases were reviewed, four of which were concha bullosa mucoceles and one was a mucopyocele. Three of the patients had some form of previous nasal trauma. Headache and nasal obstruction were the most common symptoms with a nasal mass finding on physical examination. Computed tomography was used in all the patients, and magnetic resonance imaging was used in four of the five patients. Four patients had coexistent chronic rhinosinusitis, and three had positive bacterial cultures. All these patients were treated endoscopically either with middle turbinate marsupialization or subtotal resection. No recurrence has been noted thus far.

Conclusion:

Concha bullosa mucocele is a rare diagnosis. Imaging characteristics are helpful in considering the diagnosis, although surgical intervention is often necessary to confirm the diagnosis and treat concha bullosa mucocele.

Can preoperative thyroglobulin antibody levels be used as a marker for well differentiated thyroid cancer?

Background

It has been reported that thyroglobulin antibody are more frequently elevated in patients with thyroid cancercompared to general population. This study aims at evaluating whether preoperative thyroglobulin antibody (TgAb) levels increase the likelihood that a thyroid nodule is malignant.

Methods

A retrospective review of 586 patients who underwent thyroidectomy was conducted. Demographic data, TgAb levels, and final histopathology were recorded. Patients were divided into two groups: TgAb positive (defined as TgAb ≥ 30 IU/ml) and TgAb low/negative (defined as TgAb < 30).

Results

Preoperative TgAb levels were available in 405 patients. There were 353 (87 %) patients in the TgAblow/negative group (malignancy rate: 50.42 %) and 52 (13 %) patients in the TgAb positive group (malignancy rate: 65.38 %). The sensitivity, specificity, positive predictive value and negative predictive value of TgAb ≥ 30 IU/ml for thyroid malignancy were 16.04 %, 90.67 %, 65.38 % and 49.58 %, respectively. The relative risk of having a malignant thyroid nodule when the TgAb titers were≥30 IU/ml was 1.30 (CI1.04-1.62) and the odds ratio was 1.86 (CI 1.01-3.41). Both the Pearson chi-square test (p = 0.024) and Fisher’s exact test (p = 0.017) yielded statistical significance between the two groups.

Conclusions

In this study, patients with preoperative TgAb ≥ 30 IU/ml had a higher rate of malignancy when compared topatients with TgAb < 30 IU/ml. This suggests that an elevated TgAb level may indicate that a thyroid nodule is at an increased risk for malignancy.

Atypical Presentation of a Common Disease: Shingles of the Larynx

OBJECTIVE

Herpes zoster is a neurocutaneous disease resulting from the reactivation of endogenous varicella-zoster virus (VZV) in dorsal sensory or cranial nerve ganglia. Rarely, this infection manifests without the characteristic dermatomal rash, a condition termed zoster sine herpete. Viral spreading of herpes zoster in the head and neck may manifest as various signs and symptoms because of the multiple possible combinations of cranial neuropathies. With only six cases reported in the English literature up to now, isolated neuropathies of the vagus nerve in the absence of cutaneous lesions tend to be misdiagnosed as idiopathic laryngeal paralysis.

METHODS

We report a case of herpes zoster of the larynx in an 80-year-old man presenting with sore throat, dysphagia, and hoarseness.

RESULTS

Endoscopic examination revealed unilateral vocal fold paralysis, pooling of secretions, and mucosal vesicles of the hemilarynx. After the diagnosis of VZV infection with polymerase chain reaction (PCR) testing, the patient was treated with valacyclovir and corticosteroids, leading to complete recovery after 2 months.

CONCLUSIONS

Herpes zoster of the larynx is an uncommon condition that should be included in the differential diagnosis of laryngeal paralysis of idiopathic cause. We recommend performing a thorough examination of the pharyngolaryngeal structures and ordering PCR testing as the diagnostic method of choice.

The Mcgill thyroid nodule score - does it help with indeterminate thyroid nodules?

BACKGROUND

Ultrasound guided fine-needle aspiration (USFNA) biopsy of thyroid nodules often gives a result of indeterminate pathology, placing thyroid specialists in difficult management situations. The aim of this study is to evaluate the incidence of malignancy in patients undergoing surgery and to correlate these results with the McGill Thyroid Nodule Score (MTNS).

METHODS

We performed a retrospective study comparing USFNA results, MTNS and histopathology of patients undergoing thyroid surgery between 2010 and 2012. Pre-operative USFNA results were divided into three subgroups: benign, indeterminate and suspicious for/malignant. The indeterminate USFNA subgroup comprised of Bethesda type III (atypia of undetermined significance) and Bethesda type IV (follicular neoplasms, including Hurthle cell neoplasms) lesions. Post-operative histopathology was divided into benign or malignant groups.

RESULTS

Of the 437 patient charts reviewed, 57.0% had an indeterminate USFNA biopsy. Within the indeterminate group, the malignancy rate was 39.8%. For indeterminate USFNA, the median MTNS was 7 (32% risk of malignancy) for benign nodules and 9 (63% risk of malignancy) for malignant nodules on post-operative histopathology (p < 0.05).

CONCLUSION

The rate of malignancy in operated patients with an indeterminate USFNA result was 39.8%. The MTNS can be of value to thyroid specialists in pre-operative decision-making when dealing with an indeterminate result of a thyroid nodule on USFNA.

Can Preoperative Thyroglobulin Antibody Levels Be Used as a Marker for Well-Differentiated Thyroid Cancer?

Objectives:

Evaluate whether the presence of preoperative thyroglobulin antibody (TgAb) levels can help predict the final pathology of thyroid nodules. Assess whether higher levels of preoperative TgAb increase the likelihood that a thyroid nodule is malignant.

Methods:

A retrospective chart review of patients who underwent thyroidectomy in 3 McGill University-affiliated hospitals between January 2012 and 2014 was conducted. Demographic data, TgAb levels, and final histopathology were recorded. Patients were divided into 2 groups: TgAb positive (defined as TgAb ≥30 IU/mL) and TgAb low/negative (defined as TgAb <30). Micropapillary thyroid carcinomas were considered to be benign. These data were then statistically analyzed using SPSS.

Results:

Preoperative TgAb levels were available in 412 patients. There were 360 patients in the TgAb low/negative group (malignancy rate: 51.39%) and 52 patients in the TgAb positive group (malignancy rate: 65.38%). The sensitivity, specificity, positive predictive value, and negative predictive value of TgAb ≥30 IU/mL as a diagnostic test for thyroid malignancy were 15.53% (confidence interval [CI] 11.00-21.01), 90.67% (CI 85.66-94.38), 65.38% (50.91-78.03), and 48.61% (CI 43.34-53.91), respectively. The relative risk was 1.2723 (CI 1.0192-1.5883) and the odds ratio was 1.7868 (CI 0.9732-3.2804). Both the Pearson chi-square test ( P = .024) and Fisher’s exact test ( P = .017) yielded statistical significance between the 2 groups.

Conclusions:

Our study demonstrates that patients with preoperative TgAb ≥30 IU/mL had a higher rate of malignancy when compared to patients with TgAb <30 IU/mL. This suggests that an elevated TgAb level may increase the risk that a thyroid nodule is malignant.

Acute Mastoiditis in Children with Cochlear Implants

Objective

Acute mastoiditis is an uncommon but challenging condition when it occurs in children with cochlear implant. The literature is scarce as to the management of this condition with regards to explantation. The objective of the study is to determine the need for explantation in patients with cochlear implants who suffer from acute mastoiditis.

Data Sources

Online medical databases—PubMed, Ovid Medline, Ovid Medline in process, Embase, Cochrane Library, CINAHL, Biosis, Google Scholar, and Scopus.

Review Methods

A systematic review of all publications addressing the treatment of mastoiditis in cochlear implant children prior to November 2013 was conducted. Data were collected from online medical databases—PubMed, Ovid Medline, Ovid Medline in process, Embase, Cochrane Library, CINAHL, Biosis, Google Scholar, and Scopus. The review was performed in 3 phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles.

Results

Twelve articles were found eligible for this systematic review including a total of 43 patients. Subperiosteal abscess was present in 14.3%. All patients received intravenous antibiotics as an initial treatment, and if needed, surgical intervention was performed. Only 1 patient required explantation (2.3%).

Conclusion

Prompt, aggressive medical and if needed surgical therapy can help in saving the implant and result in a favorable outcome.

Ultrasound-guided fine-needle aspiration of thyroid nodules: does size matter?

PURPOSE

Some authors have questioned the benefit of fine-needle aspiration (FNA) of thyroid nodules ≥ 4 cm. They report that the results of the FNA are not as reliable when compared to nodules <4 cm. The aims of this study are to evaluate the accuracy and predictive values of ultrasound-guided FNA (USFNA) of thyroid nodules ≥ 4 cm and compare these findings to nodules <4 cm.

METHODS

A retrospective study of 998 patients who underwent thyroid surgery between 2006 and 2012 at the McGill University Thyroid Cancer Center was performed. USFNA and post-operative pathology diagnoses of nodules ≥ 4 cm versus those <4 cm were compared. Pre-operative USFNA results were divided into three groups: benign, indeterminate, and malignant/suspicious for malignancy subgroups. Post-operative results were separated into benign and malignant groups.

RESULTS

There were 225 patients with nodules ≥ 4 cm and 773 patients with nodules <4 cm. The sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules ≥ 4 cm were 84.62% (CI 71.91-93.10), 91.49% (CI 79.6-97.58), 91.67% (CI 80.0-97.63) and 84.31% (CI 71.4-92.95), respectively. The sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules <4 cm were 90.48% (CI 86.1-93.8), 85.92% (CI 75.6-93.02), 95.8% (CI 92.41-97.96) and 71.76% (CI 60.95-81.0), respectively. The difference in diagnostic accuracy of USFNA between both groups was not statistically significant (p>0.05).

CONCLUSION

This study shows that the sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules ≥ 4 cm are similar to that of smaller nodules. It is therefore suggested that these nodules undergo USFNA.

Castleman's Disease: a rare finding in a pediatric neck

Castleman's Disease is a rare lymphoproliferative disorder. In the literature, only 29 cases, associated with the neck presentation in children, have been reported. This is another case report regarding a 5-year old child who presented with a persistent cervical lymphadenopathy. Final pathology, after undergoing exploratory neck dissection and surgical excision, revealed Castleman's Disease. This report, augmented with a literature review of all the 29 cases, compares the clinical course of this patient with the other cases. In conclusion, although Castleman's Disease carries a favorable prognosis in children, surgical excision is recommended to confirm the diagnosis and to rule out other causes.

Bone-anchored hearing aid: why do some patients refuse it?

OBJECTIVE

Bone-anchored hearing aid (BAHA™) is a proven tool to improve hearing. Nevertheless, there are patients who are candidates for BAHA™ implants that end up refusing the surgery. The objective of this study is to review our BAHA™ experience with particular emphasis on reasons behind the refusal of some candidates.

METHODS

A prospective cohort of 100 consecutive new candidates referred to The BAHA™ program in a tertiary health care center. Candidates' demographics, hearing status, Co-morbidities and audiometeric tests were all recorded. Patients' acceptance or refusal was noted alongside the reasons to refuse BAHA™.

RESULTS

100 new candidates were seen for BAHA™ assessment, 10 patients were excluded due to incomplete data. There were 68 children and 22 adults. Unilateral Conductive Hearing Loss was the most common reason for consultation (40%), followed by unilateral SNHL (23.3%). Aural Atresia was the commonest clinical finding (36.6%). The commonest reason for refusal was social acceptance by the parents due to concern with cosmesis.

CONCLUSION

The main reason of BAHA™ surgery refusal, in otherwise eligible candidates, is related to cosmesis. Patients with congenital anomalies were the most likely candidates to accept BAHA™ implants.

Intraoperative parathyroid hormone level in parathyroidectomy: which patients benefit from it?

BACKGROUND

Intraoperative parathyroid hormone level (IOPTH) is withdrawn during parathyroidectomy to confirm the success of the procedure. Recently, the importance of IOPTH has been put to question. The purpose of this study is to determine whether IOPTH is necessary for all patients undergoing parathyroidectomy in the presence of frozen section.

MATERIALS AND METHODS

A cohort study of parathyroidectomies was performed in three university affiliated hospitals during 2007-2012. The patients were divided into two groups. Group 1: Patients with two preoperative concordant imaging localizing a hyperactive gland. Group 2: Patients without two concordant imaging. A comparison of benefit of IOPTH was carried out. Frozen section results were also analyzed to determine sensitivity and predictability of a parathyroid adenoma.

RESULTS

The study considered 221 patients having parathyroidectomies for primary hyperparathyroidism (PHPT). Of them, 10 were excluded due to incomplete data. Among the remaining, 186 had 2 concordant imaging preoperatively localizing an adenoma. 93.5% of whom were found intraoperatively in that location. IOPTH was not found to be of importance in 98.92% of the preoperative localized adenomas in the presence of frozen section. IOPTH added an estimate of 30.9 minutes on average to the surgery time.

CONCLUSION

This study demonstrates that the added operating time associated with IOPTH may not be justified for patients undergoing parathyroidectomy who have 2 concordant imaging preoperatively in the presence of frozen section. This study suggests a simple algorithm, The McGill Parathyroid Protocol (MPP), to help in approaching PHPT patients undergoing parathyroidectomy.

Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: Does Size Matter?

Objectives:

Evaluate the accuracy and predictive values of ultrasound guided fine-needle aspiration (USFNA) of nodules ≥4cm compared to smaller nodules. Authors have reported that fine-needle aspiration (FNA) biopsies of thyroid nodules ≥4cm are unnecessary since they often yield inaccurate results compared to nodules <4cm. They therefore recommend diagnostic thyroid lobectomies for nodules ≥4cm and FNA for smaller nodules.

Methods:

A retrospective study at the McGill University Thyroid Cancer Center was performed on patients between 2006-2012 comparing the USFNA and post-operative pathology diagnoses of nodules ≥4cm versus those <4cm. Pre-operative USFNA results were divided into benign, indeterminate and malignant/suspicious for malignancy subgroups. Postoperative results were separated into benign and malignant groups. SPSS was used for data analysis using the chi-square method.

Results:

There were 225 patients with nodules ≥4cm and 773 patients with nodules <4cm. The sensitivity, specificity, positive predictive value, and negative predictive value for USFNA of nodules ≥4cm were 84.62% (confidence interval [CI] 71.91-93.10), 91.49% (CI 79.6-97.58), 91.67% (CI 80.0-97.63) and 84.31% (CI 71.4–92.95), respectively. The sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules <4cm were 90.48% (CI 86.1-93.8), 85.92% (CI 75.6-93.02), 95.8% (CI 92.41-97.96) and 71.76% (CI 60.95-81.0), respectively. The difference in diagnostic accuracy of USFNA between both groups was not statistically significant ( P > 0.05).

Conclusions:

This study shows that USFNA of nodules ≥4cm is as accurate as smaller nodules. It is therefore suggested that these nodules be managed similarly to their smaller counterparts.

Thyroid gland rupture: a rare finding after a blunt neck trauma

This is a case report of a 13 years old boy with a thyroid rupture secondary to a hockey stick blunt trauma to his neck and a literature review focused on diagnosis and management. There are 14 other cases in the literature, 7 of which required surgical intervention mainly to evacuate a hematoma. The case in this review did not develop any complications. This is the first reported case in the literature of thyroid gland rupture due to a blunt trauma in a child. Patients with thyroid gland rupture should be monitored closely for developing a hematoma or thyroid storm.