Potential barriers to the daily use of hearing aids in children.

OBJECTIVES: To identify factors affecting hearing aid usage in children. METHODS: This retrospective study examined 59 hearing-impaired children fitted with hearing aids for at least 6 months. Patients with moderate to profound sensorineural hearing loss with complete data-logging information stored in the hearing aid programming file from January 2020 until June 2021 were included. Children with concomitant disabilities were excluded. Data for audiological assessments included hearing assessment, aided hearing thresholds, and aided speech tests. RESULTS: The children's age ranged from 6 months to 6 years. Average daily hearing aid usage was 5.5 hour (h) after 3 months, 7 h after 6 months; and 8.7± 4.7 h as reported by parents. Patient age was positively correlated with data logging at 3 months (r=0.414, p=0.01) and 6 months (r=0.406, p=0.01). CONCLUSION: We found that children's age, gender, severity of hearing loss, residential location, and parents' educational level had a significant effect on daily hearing aid usage. Whereas, family size and a family history of hearing loss or use of amplification devices had no discernible influence.

Assessment of the ability, perception, and readiness of nurses to manage tracheostomy-related complications in Riyadh City: a cross-sectional study.

BACKGROUND: Nursing staff play a key role in the bedside management of tracheostomized patients in both intensive care units and general floors. Effective provision of postoperative care to these patients by nurses is critical. This study aimed to assess the readiness of nursing staff to manage tracheostomy-related complications in Riyadh, Saudi Arabia. METHODS: This cross-sectional study enrolled 395 nurses in Riyadh, Saudi Arabia. A self-administered questionnaire developed by the authors was distributed to nurses via an online survey. The questionnaire assessed nurses' socio-demographic characteristics and their knowledge and practices regarding tracheostomy indications, postoperative care, and management of its complications. RESULTS: Of respondents, approximately 59% (232/395) had poor knowledge regarding tracheostomy-related complications and indications, 39% (154/395) had moderate knowledge, and only 2%(9/395) had good knowledge. Several factors were associated with increased knowledge, including having a higher education degree, working in a tertiary/quaternary hospital, being a government employee, caring for tracheostomized patients, and attending courses or lectures on managing tracheostomized patients. CONCLUSIONS: Knowledge level and practices regarding tracheostomy-related complications and indications among nurses remain limited. In-service continuous professional development programs for nurses working in all hospital settings are strongly recommended. Further research is warranted to elicit the major factors contributing to inadequate knowledge and practices among nurses in Riyadh.

Impact of COVID-19 pandemic on Saudi medical students' career choices and perceptions of health specialties: findings from a national cross-sectional study.

BACKGROUND: The COVID-19 pandemic has had a devastating effect on people across the globe. Its impact on medical students' education has also been profound. Here, we aimed to comprehensively determine the nature of this impact on their choice of specialty. METHOD: A cross-sectional study was conducted among medical students in Saudi Arabia during the pandemic from May to June 2021. Data collected from 1984 medical students were analyzed. RESULTS: Of the total sample, 810 (40.8%) respondents reported that the pandemic could affect their choice of specialty, with the majority being in the third year (n = 235). Across all class-years, the most common reason chosen was the inability to explore specialties of interest (n = 539, 66.5%). Another reason cited was the inability to support residency application (n = 175, 21.6%). A majority expressed concerns regarding enrollment in research activities. As high as 17.9% (n = 356) of the respondents admitted that they were trying to avoid specialty with frontline exposure to COVID-19, while 353 students (17.8%) were considering local training programs only. While examining certainty levels, of the 1174 (59.2%) students who reported not being affected by the pandemic, 924 (78.7%) had a weak certainty level. The majority were in the third (54.8%, n = 342) and fourth years (44.8%, n = 212). CONCLUSIONS: This study is the first attempt to thoroughly examine the effect of COVID-19 on medical students' choice of specialty. This effect unfurled in 4 out of 10 surveyed students. Many students reported concerns regarding the inability to explore medical specialties and the inadequacy of obtained clinical knowledge. However, a subsidiary effect was observed among students who were assertive about their choice of specialty. These findings shed new light on the exigency of establishing a career counseling framework designed to meet individual learner needs, thereby galvanizing their morale. Further research could explore the long-term implications of the Saudi Commission for Health Specialties Matching System.

Midline Facial Nerve Monitoring: Single-Center Experience and Review of Literature.

BACKGROUND: Facial nerve monitoring system has enabled facial muscle activity detection using electrodes placed over the target muscles. In an effort to enable the best and minimally invasive surgical approach, a midline facial nerve monitor was applied during bilateral cochlear implantation surgical intervention in our center and the feasibility of placing midline facial nerve monitor electrodes during bilateral cochlear implantation operations was evaluated. METHODS: The medical records and operative notes of all patients who underwent bilateral cochlear implantation surgery between January 2017 and April 2018 in a quaternary care center were retrospectively reviewed and divided into 2 groups based on the facial nerve monitoring methods: facial nerve monitoring with the midline (midline facial nerve monitor) or bilateral (bilateral facial nerve monitor) electrode placements. Basic demographic information, comorbidities, and facial nerve status (pre- and postoperatively) were collected from patient electronic medical charts. The operative notes were reviewed for abnormal facial nerve findings, as well as for any reported difficulties with the identification or stimulation of facial nerve. The primary outcome was facial nerve identification postoperative function. RESULTS: Seventy-eight patients met our inclusion criteria. Midline facial nerve monitor was used in 49 patients and bilateral facial nerve monitor was used in 29 patients. No documented difficulty was identified at the step of facial nerve identification in either group, and none of the patients developed facial nerve weakness postoperatively. CONCLUSION: Midline facial nerve monitor is a safe and reliable method that can be used in bilateral cochlear implantation surgeries and other surgeries requiring facial nerve monitoring.

Practice of ear candling during lockdown due to COVID-19 in the Kingdom of Saudi Arabia.

Objectives: Cerumen production is a protective process for the ear canal. Cerumen impaction causes unpleasant symptoms. There are various cerumen removal practices. These include irrigation, application of softeners/solvents, mechanical removal, and micro-suction. However, during the lockdown period of the COVID-19 pandemic, some patients opted for some procedures, such as ear candling, which are not evidence-based. This study aimed to explore the awareness of ear candling among otolaryngology doctors and record cases with complications of such practice in the Kingdom of Saudi Arabia (KSA). Methods: This was a cross-sectional study. A questionnaire was developed after an extensive literature search, and distributed to otolaryngology residents, fellows, and consultants of different hospitals across the country. A total of 80 respondents agreed to participate in the study. Results: A total of 16 doctors reported seeing cases of ear candling, of which 13 patients had different complications, of which ear pain was the most commonly reported. The majority of participants (42.5%) thought the lack of medical access during lockdown enhanced the practice of alternative medicine for ear-related complaints in society compared to 35% of participants who had a neutral response regarding this idea and 22.5% who disagreed. Conclusions: Although the practice of ear candling is not widely spread in KSA, different types of ear complications were recorded by the otolaryngologist. We would like to encourage the doctors to report such complications, especially after the lockdown period.

The role of malleostapedotomy in intra-operative incus injury: A review of 2 cases.

Malleostapedotomy (MS) is an evolving otology procedure that involves attaching prosthesis to the malleus on one end and the stapes footplate on the other end. It has multiple indications and requires skills and experience. We present 2 cases operated in our center (King Abdullah Ear Specialist Center, Riyadh, Saudi Arabia) in which intraoperative incus injury occurred, and MS was used to reconstruct the ossicular chain with good postoperative outcomes and patient satisfaction. As the procedure was surgically difficult and time consuming, many otologists prefer not to do it. Nevertheless, we believe that all surgeons dealing with stapes surgery should be familiar and gain confidence in performing MS considering that intraoperative incus dislocation is a complication that can happen even with great caution.

Tongue Cyst in a Neonate: Unusual Presentation.

Congenital cysts of the tongue base are an uncommon cause of airway obstruction. The diagnosis of upper airway cysts requires a high index of clinical suspicion. We report a case of a vallecular cyst that uniquely extended to the dorsum of the tongue, and the patient presented with airway distress. We found that this presentation may facilitate an early diagnosis, as asymmetry of the tongue can be picked up easily during proper clinical examination.Therefore, inspection and palpation of the dorsal surface of the tongue is crucial for the approach of pediatric patients with airway obstruction.

Automated remote intraoperative cochlear implant device testing (CR220). Is it clinically efficient?

OBJECTIVES: To compare the clinical efficiency of the CR220 intraoperative remote assistant device used by the surgical team with that of the custom sound (CS) system used by an audiologist. METHODS: This was a prospective clinical study in a quaternary care center (King Abdullah Ear Specialist Centre) in Riyadh, Saudi Arabia, between October 2018 and March 2019. We included adult and pediatric patients who underwent cochlear implant (CI) surgeries. For every participant, the intraoperative CI testing was performed via both the aforementioned methods. The time taken to complete the measurements with both approaches, including the time required by the audiologist to reach the operating room (OR) and to complete the test, was recorded. RESULTS: There were no significant differences in the number of responding electrodes between the 2 approaches. For the 25 participants, the time taken for the measurements was 566 minutes with the CS and 173 with the CR220 systems. This significant difference indicates that considerable time can be saved. CONCLUSION: The CR220 enables intraoperative CI electrode tests and auto-NRT measurements. Its ergonomics and ease-of-use help the surgical team conduct the tests without an audiologist in the OR, resulting in the efficient use of clinical resources. Further, the results generated were consistent with those of the CS system.

Financial Benefits of the Early Fitting of a Cochlear Implant Speech Processor: Assessment of the Direct Cost.

Objective Cochlear implants (CIs) are typically activated four weeks after the implantation surgery. This delay between device implantation and activation lengthens the implant process and consequently induces personal and financial burdens for some patients who travel from remote regions to receive the surgery. However, fitting the speech processor and eliminating the waiting period could decrease the indirect cost associated with cochlear implantation. The objective of this study was to assess the impact of an early CI fitting on the overall cost paid by patients and their families aiming to improve future care strategies for patients receiving CIs. Methods This retrospective study was conducted in a tertiary referral center. All patients who received any kind of CI with early fitting of the speech processor were included. The total financial benefit for the patients and their families over the standard activation visit was investigated by assessing the cost of the non-medical expense for one hospital visit. Results Our results showed that the non-medical cost for each hospital visit associated with cochlear implantation was higher for those who traveled from remote areas: 81 USD for each patient within 200 km of the implantation center and 748.56 USD for each patient farther than 200 km from the implantation center. Conclusions Using the early fitting approach, some of the financial burden associated with implantation could be alleviated.

Surgical considerations and speech outcomes in infants who undergo cochlear implantation. Experience of the King Abdullah Ear Specialist Center.

OBJECTIVES: To evaluate the feasibility and outcomes of cochlear implantation (CI) in infancy. METHODS: All infants who underwent CI from January 2011 to October 2018 at a tertiary referral center in the Kingdom of Saudi Arabia were retrospectively reviewed. Demographic data, factors associated with early detection, and any surgical difficulties or postoperative complications were extracted from the medical records. The outcome of CI was determined by a speech pathologist. RESULTS: Fifteen patients underwent CI during the study period (9 bilateral and performed simultaneously, 6 unilateral). The round window was difficult to identify in 5 cases. Incomplete electrode insertion because of cochlear ossification secondary to meningitis was documented in one patient. No major postoperative complications were encountered. The average auditory performance score was 7 and the speech intelligibility rating was 5. CONCLUSIONS: This study represents the largest national cohort of pediatric patients undergoing CI in infancy. In this series, the surgery was safe and the speech outcome was good. With implementation of the neonatal screening program in the Kingdom of Saudi Arabia, the number of infants undergoing CI is likely to increase in the near future, paving the way for more research in infant CI.