The association between consanguineous marriage and offspring with congenital hearing loss

BACKGROUND

Consanguinity is a commonly recognized practice among marriages in the Middle East and may lead to an increase in the prevalence of inherited disorders. Autosomal recessive deafness is the most common form of inherited congenital hearing loss (CHL).

OBJECTIVES

Determine the association of consanguineous marriages with congenital sensorineural hearing loss (SNHL) and auditory neuropathy.

DESIGN

Descriptive and analytical cross-sectional study.

SETTING

Ear specialist hospital.

PATIENTS AND METHODS

Children with severe-to-profound congenital SNHL, who had been referred to the specialist hospital for cochlear implant were analyzed. Patients were divided into subgroups based on degree of consanguinity.

MAIN OUTCOME MEASURE

The relative risk of having more than one child with SNHL in offspring of a consanguineous marriage.

SAMPLE SIZE

189 parents and children with CHL.

RESULTS

The parents of 157 children (83.1%) were blood-related. Of those, 48 had more than one child with CHL (31.4%), while only two parents who were not blood-related had more than one child with CHL (6.25%; P=.005). Among the 189 children, 131 (69.3%) parents were direct cousins. Only 39 (20.6%) and 43 (22.8%) children had family histories of CHL on the paternal and maternal sides, respectively. There was no statistically significant difference in the prevalence of auditory neuropathy between the offspring of consanguineous and non-consanguineous marriages (P=.648).

CONCLUSION

The risk of having more than one child with SNHL in the offspring from a consanguineous marriage is 3.5 times higher than that of a non-consanguineous mating.

LIMITATION

The association of hearing loss degree with consanguinity was not studied.

CONFLICT OF INTEREST

None.

Cochlear electrode array tip fold-over in incomplete partition-I - A case report

Electrode tip fold-over is a rare complication of cochlear implantation (CI), especially in lateral wall (LW) electrodes. We describe a case of LW electrode tip fold-over in a patient with incomplete partition type-1 (IP-I). Preoperative measurement of cochlear length is important for optimal CI electrode selection. In cochlear malformation, Stenvers x-ray is superior to spread of excitation in detecting tip fold-over. Despite tip fold-over, hearing threshold, speech reception threshold, and word recognition score were almost symmetrical bilaterally. Therefore, revision surgery should be reserved for patients with persistent symptoms or markedly affected speech performance, in whom deactivation did not suffice.

Middle Ear Implant in a Patient With Fibrous Dysplasia: An Alternative for Hearing Restoration

We propose middle ear implants (MEI) as alternative hearing restoration option for patients with fibrous dysplasia of the temporal bone (FDTB). A 60-year-old man presented with unilateral right-sided conductive hearing loss (CHL) and FDTB. The Vibrant Soundbridge (VSB) MEI was implanted in the right ear. Preoperatively, the right side had a pure tone average (PTA) threshold of 67 dB, speech reception threshold (SRT) = 75 dB HL, and speech discrimination score (SDS) = 54% at 80 dB HL presentation level. Postoperative aided PTA threshold of the right ear was 28 db, aided SRT = 30 db, and SDS = 96% at 65dB HL. After excluding cholesteatoma, VSB provides an alternative hearing restoration technique for adults with FDTB and CHL due to stenosis of the external auditory canal and/or ossicular crowding.

Systematic Review of Granulomatous Invasive Fungal Sinusitis Management

Objectives

Granulomatous invasive fungal sinusitis (GIFS) affects immunocompetent individuals. There is ongoing debate over whether surgery, antifungal medication, or a combined approach is the best treatment. This article summarizes reports about GIFS and its management.

Methods

Eight search engines, gray literature, and review articles were searched. Two independent reviewer groups screened the eligibility of articles. An independent reviewer solved disagreements. Exclusion criteria included non-English language reports, papers with unavailable full-texts, reviews, publications before 1980, and studies lacking information about GIFS management.

Results

Of the 279 identified articles, 41 studies were included (n = 89 patients). Sinonasal GIFS with skull-base/intracranial extension was associated with an increase in mortality (p = 0.002, OR = 14.083; 95% CI = 1.753-113.157). Treatment was associated with an 87.2% remission rate (p < 0.001, OR = 7.818; 95% CI = 4.502-13.576); a combined medical and surgical approach had a 74.2% recovery rate. Of surgical interventions, the highest recovery rates were associated with endoscopic debulking (52.5%), extensive surgical debulking (32.5%), and open sinonasal approach (15%, p = 0.132). The utilization of voriconazole was associated with higher recovery rates, but this was not significant (76.9 vs. 56%, p = 0.548).

Conclusion

Sinonasal GIFS with skull-base/intracranial extension is associated with higher mortality rates. The superiority of the endoscopic debulking and voriconazole protocol in managing these cases warrants further investigation.

Level of Evidence

Level 4.

Subperiosteal abscess volume; an objective indication for surgical management in pediatrics

PURPOSE

Subperiosteal abscess (SPA) can lead to devastating morbidity and mortality. Prompt management is important; however, the choice of management route is controversial. This study investigates factors associated with surgical management and defines a cut-off abscess volume prompting surgical intervention.

METHODS

SPA cases presented to King Saud University Medical City (KSUMC) from 2014 to 2023 were reviewed. The surgical approach was studied in association with factors including age, gender, symptoms and signs, laboratory results, computed tomography (CT) characteristics, medications, and surgical approach. Multiple statistical tests were used for analysis, including student t-test, chi-square, multiple logistic regression analysis, and receiver operating characteristic (ROC) analysis.

RESULTS

Patients were managed medically (n = 14, 45.16%) or surgically (n = 17, 54.84%). The average duration of antibiotics was 15 days. Superior SPA favors surgical management (OR = 6.722, CI [1.332-33.913], p = 0.029), along with the use of steroids (OR = 5.625, CI [0.915-34.572], p = 0.049), and abscess volume (OR = 10.003, CI [1.418-70.540], p < 0.001). However, the only factor attributing to a surgical decision on multivariate logistic regression analysis was abscess volume (OR = 5.126, CI [1.023-25.694], p = 0.047). SPA volume of ≥ 0.648 ml strongly prompts surgical management, with a sensitivity of 94.1% and a specificity of 71.4% (p = 0.000).

CONCLUSION

SPA volume increases the likelihood of surgical intervention by five times, especially when abscess volume is ≥ 0.648 ml.

Atypical Presentation of Oronasal Herpes Simplex Virus (HSV) in an Immunocompromised Patient: A Case Report and Literature Review

Herpes simplex virus (HSV) typically presents with characteristic mucocutaneous vesicular lesions. However, atypical manifestations can occur and can be challenging to diagnose, especially in immunocompromised individuals. This case report describes a nine-year-old immunocompromised girl who developed a left nasal vestibular ulcer covered by hemorrhagic crustation and granulation tissue, progressively worsening to a friable exophytic lesion with intact nasal mucosa. The lesion was refractory to local treatment, wide-spectrum antibiotics, and antifungal therapy, hence requiring a biopsy. The diagnosis of HSV infection was confirmed by histopathology, and IV acyclovir successfully treated the initial infection. This case emphasizes the importance of considering HSV infection when evaluating persistent, refractory skin lesions, particularly in immunocompromised patients, which can ensure early diagnosis and appropriate antiviral therapy.

Balloon-assisted placement of rib graft in endoscopic posterior cricoid split; a new technique

OBJECTIVE

This study aims to compare the outcomes of balloon-assisted rib graft placement with traditional graft placement in Endoscopic Posterior Cricoid Split with Rib Graft Placement (EPCS/RG).

METHODS

We conducted a retrospective analysis of 23 patients who underwent EPCS/RG by a single senior surgeon at King Saud University Medical City from 2017 to 2024. Data were collected on demographics, surgical approach, and operative time. Statistical analyses included Mann-Whitney U tests for continuous variables and Fisher's exact test for categorical variables, with significance set at p-value < 0.05. Univariate binary regression was reported as Odds Ratio (OR) with 95% Confidence Interval (CI).

RESULTS

Of the 23 cases, 16 (69.5%) utilized the balloon-assisted technique. Age ranged from 8 months to 19 years (median age 10 years). Older age was significantly associated with the balloon-assisted technique (OR 1.627, p-value 0.022). Balloon-assisted cases demonstrated longer split lengths and graft widths, though data limitations hindered definitive conclusions. Tracheostomy was avoided in 65.2% of cases. The operative duration averaged 240 min, showing no significant difference between balloon-assisted or the standard techniques (OR 1.015, CI 0.993-1.038, p-value 0.177).

CONCLUSION

Balloon-assisted rib graft placement in EPCS/RG facilitates surgical approach, particularly in older patients. It does not extend operative duration, offering a promising advancement in airway surgery.

LEVEL OF EVIDENCE

Level 3.

Pre- and post-operative outcomes of endoscopic posterior cricoid split with graft placement

PURPOSE

The primary objective of this study was to assess the impact of EPCS/RG on swallowing function using Dysphagia Outcome and Severity Scale (DOSS) scores. Secondary objectives included decannulation rates, voice changes, and breathing improvements assessed by Empey index.

METHODS

This retrospective study included patients who underwent EPCS/RG between 2017 and 2024. Patient demographics, pre- and post-procedure swallowing capacity (DOSS), tracheostomy status, and pulmonary function were extracted from medical records. Statistical analysis included Fisher exact test, Mann-Whitney-U test and Spearman's correlation.

RESULTS

A total of 23 patients were included. The mean age was 9 years, with 68% being male. The median DOSS score changed insignificantly from 7 pre-op to 6 post-op (p = 0.8087), while Empey index significantly improved (p = 0.022).

CONCLUSION

EPCS/RG did not significantly affect swallowing capacity but improved pulmonary function and increased decannulation rates.