Sclerotherapy vs. surgical excision for lymphatic malformations of the head and neck: a systematic review and meta-analysis.

OBJECTIVES: Lymphatic malformations (LMs) are abnormal lymphatic vessels with cystic characteristics, categorized as macrocystic, microcystic, or a combination of both. They represent the second most common vascular malformations, and their management involves multidisciplinary approaches based on clinical assessments and imaging studies. LMs manifest as a challenge to medical professionals in the head and neck, posing functional and aesthetic concerns. Our systematic review aims to compare the efficacy of sclerotherapy and surgery for LMs, identifying optimal treatment modalities for each scenario. METHODS: We searched four electronic databases for related studies. Data were extracted from the included studies. We calculated the pooled rate ratios with 95% confidence intervals (CIs). The I2 test was used to detect heterogeneity. The inclusion of the studies required the following prerequisites: 1- Studies focusing on any lymphatic malformations in the head and neck, whether microcystic, macrocystic, or a mix of both; 2- Studies performed on more than ten patients; 3- All interventions used as surgery, sclerotherapy, or both. RESULTS: We included 58 studies in our systematic review, of which 45 were eligible for the meta-analysis. For macrocystic LMs, sodium tetradecyl sulfate (STS) mixed with ethanol and excision achieved the highest complete response rates at (92.9%) and (92.5%), respectively. Surgical excision showed the lowest poor response rate. Polidocanol microfoam had the highest poor response rate (11.1%). In microcystic LMs, combining sclerotherapy with excision showed the highest complete response rate (70.3%) and the lowest poor response rate (1.3%). Picibanil had the lowest complete response rate (9.1%) and the highest rate of poor response (61.4%). In mixed LMs, surgical excision had the highest complete response rate (70.3%). CONCLUSION: Both surgical excision and STS combined with ethanol are highly effective for treating macrocystic LMs, achieving similar complete response rates. The combination of sclerotherapy and surgical excision demonstrated the best outcomes in microcystic LMs. Surgical excision demonstrates superior efficacy over sclerotherapy for mixed LMs. These findings suggest that excision is generally more effective in achieving complete and excellent responses across all LM subtypes. Further high-quality studies are necessary to standardize and optimize treatment protocols.

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.

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

Abstract 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.

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.

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.

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.

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.

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.

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.

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.

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.

Pediatric Allergic Fungal Rhinosinusitis: Does Age Make a Difference?

Background Allergic fungal rhinosinusitis (AFRS) is a hypersensitive response to fungi within the sinus cavity. Children represent a challenging group of patients with sinonasal disorders, as their sinus anatomy is not fully developed. This study aimed to determine the various clinical manifestations and management outcomes in children with AFRS. Methods A retrospective chart review of children who underwent sinus surgery for AFRS at a tertiary healthcare center between 2005 and 2021 was performed. Demographics, clinical manifestations, radiological and laboratory results, treatment regimens, complications, and recurrence rates were collected. Subanalysis was performed based on age at first surgery: group A (<13 years) and group B (≥13 years). Results Overall, 35 children underwent sinus surgery for AFRS during the study period. The mean patient age at the time of surgery was 14 years. Bilaterality was present in 15/35 (42.9%) patients and anosmia in 12/35 (34.3%). Polyps on examination were present in 31/35 (88.6%) patients and proptosis in 8/35 (22.9%). Sub-analysis revealed that group A showed less bilateral disease (11.4%) than group B (31.4%) and a lower Lund-Mackay score (median=11.50 and 17, respectively, p=0.002). Conclusion Age at surgery did not have an impact on the outcome. A high index of suspicion should be exercised when dealing with children with sinonasal symptoms that do not respond to routine treatment and should be investigated for chronic sinusitis.

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.

Pediatricians' knowledge and attitude toward hearing loss and newborn hearing screening programs.

INTRODUCTION: Early detection of hearing loss is important to the management of infants and young children with hearing loss. Pediatricians are often the first to encounter a child suspected to have hearing loss. The objective of this study is to evaluate the knowledge and attitude of newborn hearing screening and management of hearing in among pediatricians. METHODS: A cross-sectional survey-based study utilizing a validated questionnaire that was distributed to pediatricians in single tertiary academic health care institution that aims to evaluate the knowledge and attitudes related to children with hearing loss and newborn hearing screening. RESULTS: A total of 67 pediatricians agreed to participate and were involved in our study. Mean age was 35 years and 44.1% were males. The majority (79.4%) thought it was very important to have a newborn hearing screening program. However, two-thirds (64.7%) were unsure that there is a universal hearing screening program in the country. Never the less, the majority of the respondents (75%) were at least somewhat confident in explaining the hearing screening program process in our institution. There was a gap in the knowledge of our pediatricians with regard to the process of dealing with a newborn who failed screening program and the candidacy for cochlear implants. Also, some participants were unsure whether to refer a child with hearing impairment to an otolaryngologist or not. Most of the participants thought that physicians need more information related to permanent hearing loss. CONCLUSION: There are gaps in Pediatricians knowledge and awareness towards hearing loss assessment and management in newborns. This likely requires further academic collaboration between specialties to improve the care of newborns. Future research should focus on the auditory and speech outcome and rehabilitation awareness.

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.

Surgical Parapharyngeal Space Tumor Analysis with Case Series Study.

BACKGROUND: The parapharyngeal space is a hypothetical region in the neck that stretches from the base of the skull to the bigger corner of the hyoid bone. The fascia that connects the styloid process to the tensor veli palatini separates the compartment into prestyloid and poststyloid compartments, with the prestyloid compartment being larger. In the general population, tumors of the parapharyngeal area are very uncommon, accounting for less than 1% of all head and neck neoplasms in the population. In this location, CT scanning and magnetic resonance imaging (MRI) exams are complimentary, and both tests should be performed to examine any lesions found. The most critical component of treatment is the total surgical removal of all the cancerous tissue. Identifying and treating primary parapharyngeal space (PPS) tumors are among the most challenging tasks in the treatment of head and neck cancer. They are also among the most aggressive ones. The primary goal of this study is to review our current knowledge at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, which serves as an academic tertiary referral center and a major teaching center. We will focus on clinical findings, tumor structure, tumor histological distribution, and surgical approaches. MATERIALS AND METHODS: The processing starts with two modules. The first module starts with the input images obtained from various patients and collected as a database. The second module starts with the collection of case series of nine patients undergoing excision via multiple different approaches: transoral, transcervical, transparotid, transmandibular, or infratemporal approach. All cases were conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, between 2014 and 2018. All operative interventions were performed by an otolaryngology-head and neck surgeon. RESULTS: Our study comprised nine patients, of which two underwent transparotid and seven transcervical and combined transcervical/transparotid approach. Complications faced included a hematoma in one of our cases. CONCLUSION: The transcervical approach appeared to be the superior surgical approach when facing a pleomorphic adenoma within the parapharyngeal space, arising from the deep lobe of the parotid gland or parapharyngeal space-occupying paraganglioma.

Hypopharyngeal Reconstruction: Possibilities, Outcomes, and Updates for Improving the Human Health for Quality of Life.

Hypopharyngeal carcinoma is usually present at late stages, necessitating an aggressive line of management consisting of surgical procedures, chemotherapy, and radiation therapy, depending on the case. Practitioners tend to support total laryngectomies or total esophagostomies for most cases of hypopharyngeal carcinoma. The extensive procedures needed will most probably require, depending on the residual defect, a follow-up reconstructive procedure that might require utilizing flaps. Types of reconstructive methods and types of grafts or flaps used could be divided into a multitude of categories depending on the magnitude, shape, extension, and whether the underlying defect that is being reconstructed is circumferential or not. These reconstructive procedures are aimed at improving the quality of life, improving the aesthetic outcome, and restoring the functionality of the pharyngoesophageal segment. When it comes to hypopharyngeal cancer, the most common kind is squamous cell carcinoma (SCC), which has the worst prognosis of all the head and neck malignancies. Overall, the 5-year survival rate remains low, despite recent advancements in diagnostic imaging, radiation, and chemotherapy, as well as enhanced surgical methods and techniques. Hypopharyngeal malignancies are more probable than other tumors to present with advanced primary illness, with nodal metastasis a distinct possibility. The size and amount of local dissemination of the original carcinoma, as well as the extent of involvement of regional lymph nodes, are the most critical factors in predicting prognosis. Hypopharyngeal cancers are more likely than other head and neck cancers to manifest with distant metastases at the time of diagnosis. The appearance of second primary tumors, as well as the development of distant metastases, is a contributing factor to poor survival rate. Imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) with contrast remain the gold standard for evaluating hypopharyngeal carcinoma in the early stages. In most cases, imaging leads to an increase in the tumor stage at the time of presentation. Objectives. The main objectives are to review the research published about flaps, outline the optimum situations that will dictate the usage of a few of the most often used flaps for the rebuilding of the hypopharyngeal segment defects, and outline some of the complications associated with reconstruction. Methods. The processing was carried out with the title-specific search of the PubMed database using the query terms "hypopharyngeal carcinoma" and "reconstruction" to identify the most relevant articles without restricting publication dates. Information about the types of defects and methods of reconstruction was extracted from the reviewed articles. Two books were also reviewed, which were Regional and Free Flaps for Head and Neck Reconstruction (second edition) and Head and Neck Reconstruction: A Defect-Oriented Approach. Conclusion. Deciding the appropriate approach to a case should be individualized and should depend on the capabilities of the center, the defect's size and status, and lastly, the surgeon's training. The use of interpretation in the diagnosis of flaps can offer the best results in restoring functionality and vascularity and might also offer improved cosmesis.