Incidence of Cochlear Implantation Complications in Saudi Arabia: A Comprehensive Systematic Review of the Literature.

This review aimed to determine the incidence of complications associated with cochlear implants (CI) in Saudi Arabia. We systematically searched PubMed, AIRE, OaIster, MEDLINE, Directory of Open Access Journals, Scopus, and Ovid from inception to January 2024. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023486687). Studies that reported CI complications in Saudi Arabia were included. This systematic review was conducted in accordance with PRISMA guidelines. A total of 17 articles with 2216 patients were included. The most common intraoperative complication was cerebrospinal fluid leakage (23 patients, 0.99%), followed by surgical difficulties (six patients, 0.26%), and dural accidental exposure and bleeding (three patients, 0.13%); the most common postoperative complications were vestibular symptoms (20 patients, 0.86%), followed by infection (17 patients, 0.73%), and device malfunction or migration (12 patients, 0.52%). The total complication rate ranged from 4-13%. Most of the included studies had a low risk. CI in Saudi Arabia has a complication rate similar to that reported in international studies. This review emphasizes the need for continued surveillance of CI outcomes to optimize procedural techniques and improve the safety and efficacy of CI in Saudi Arabia.

McGill Thyroid Nodule Score in Differentiating Thyroid Nodules in Total Thyroidectomy Cases of Indeterminate Nodules.

Fine-needle aspiration biopsy (FNAB) is the first-line modality in the evaluation of thyroid nodules. However, the results of indeterminate pathology place the thyroid surgeon in difficult management situations. This study evaluates McGill Thyroid Nodule Score (MTNS) to identify thyroid nodules that harbor malignancy in cases of indeterminate FNABs and to guide surgeon about the need and extent of surgery. We conducted a retrospective chart review of 344 patients who underwent total thyroidectomy between January 2013 and January 2018. Patients with FNAB of indeterminate nodules (Bethesda types III, IV, and V) and calculated MTNS were included in the study. Postoperative histopathology was divided into benign and malignant groups. The median and the mean MTNS, the malignancy rate, and the standard deviations were calculated for each subgroup. Of the 344 patient charts reviewed, 106 (30.8%) had an indeterminate FNA biopsy. Eighty-one (76.4%) patients were females and 25 (23.6%) were males. Final pathology revealed malignancy in 69 patients (65.1%). The mean MTNS of patients with malignant pathology (12.81  ± 3.55) was higher than the mean in the benign group (8.32  ± 2.32). 82.4% of thyroid nodules with median MTNS of less than 8 had a benign pathology, and 91.4% of thyroid nodules with median MTNS equal or more than 11 had a malignant pathology (p = 0.002). The rate of malignancy in our series of indeterminate FNABs was 65.1%. The MTNS can be of value to thyroid surgeons in preoperative decision-making when dealing with an indeterminate thyroid nodule.