Cross-cultural modification of the University of Pennsylvania smell identification test for the Saudi Arabian population: Validation and normative values.

OBJECTIVES: To develop a reliable version of the Saudi Arabian-University of Pennsylvania smell identification test (SA-UPSIT) and to establish normative values for both genders. METHODS: This cross-sectional study was carried out on voluntarily recruited normal participants in King Saud University Medical City, Riyadh, Saudi Arabia, from April 2018 to May 2023. Culture-familiar odors were chosen and the kit was translated into Arabic for the study. The test was modified 3 times in 4 versions. Following this, a random sample was collected to carry out a re-test after 6 weeks. RESULTS: A total of 288 subjects participated in the development of the SA-UPSIT across all versions, including 146 females and 142 males. The average age of the participants was 28.4±9.9 years. In the final version, 111 participants scored an average of 34.5±2.5 for the total score, 35±2.3 for females, and 34.1±2.6 for males. The test-retest reliability coefficient was 0.73, indicating acceptable reliability. CONCLUSION: The new changes carried out to the SA-UPSIT increased the average scores and demonstrated good reliability, making it clinically applicable for diagnosing and monitoring olfactory dysfunction.

Reliability and validity of the Arabic version of the brief version of the Questionnaire of Olfactory Disorders.

Background: An accessible self-assessment questionnaire is needed to evaluate quality of life in olfactory dysfunction. The need to address this gap led to the development of the brief version of the Questionnaire of Olfactory Disorders (brief QOD), which holds particular value in the context of telemedicine. Objectives: The aim of this study is to examine the reliability and validity of the Arabic brief QOD. Methods: This study included 307 patients suffering from olfactory dysfunction as well as a control group filled a questionnaire including demographic information, the olfaction Visual Analog Scale (VAS), the Sino-nasal Outcome Test 22 (SNOT-22) questionnaire, and the Arabic version of the brief QOD. The Arabic brief QOD's reliability was assessed using Cronbach's α to measure internal consistency. To evaluate test-retest reliability, the intraclass correlation coefficient (ICC) was employed. The discriminative ability: score differences between the two groups were analyzed. The validity Arabic brief QOD was evaluated by comparing it to the olfaction VAS. Results: The Cronbach's α coefficients were 0.757 for Questionnaire of Olfactory Disorders-Parosmia (QOD-P), 0.832 Questionnaire of Olfactory Disorders-quality of life (QOD-QoL), and 0.817 Questionnaire of Olfactory Disorders-visual analog scale (QOD-VAS). The reliability of the overall brief QOD was 0.93. The ICC exceeded the acceptable threshold of 0.7, indicating strong test-retest reliability. The highest correlation was observed between the SNOT-22 and QOD total scores (r = 0.552 and p < .001) as well as between SNOT-22 and QOD VAS (r = 0.512 and p < .001). Conclusion: Excellent validity and reliability have been shown for the Arabic brief QOD as a self-assessment tool assessing quality of life among olfactory dysfunction patients. Level of evidence: NA.

Validation and cross-cultural adaptation of the Arabic version of the self-reported mini olfactory questionnaire (Self-MOQ).

Background: A simple self-assessment screening questionnaire for olfactory dysfunction is direly needed in Rhinology practice, and this questionnaire should be accessible to affected individuals. The self-reported mini olfactory questionnaire (Self-MOQ), constructed to fill this gap, could be an important tool, especially in the era of telemedicine. Objectives: The aim of this study was to assess the validity and reliability of the Arabic version of the self-reported mini olfactory questionnaire (Self-MOQ) in patients with olfactory dysfunction. Methodology: This cross-sectional study included all adult patients who visited a rhinology clinic between January and June 2023 with a complaint of olfactory dysfunction and a control group. The participants completed a questionnaire that included items on demographics, risk factors of olfactory dysfunction, the olfaction VAS, SNOT-22, and Arabic Self-MOQ. The Self-MOQ was forward- and back-translated by qualified professional translators familiar with American English and Arabic.The reliability of the Arabic Self-MOQ was evaluated using Cronbach's α. The test-retest reliability was assessed by estimating the intraclass correlation coefficient (ICC) for the total Arabic Self-MOQ score and the individual items. The discriminative ability was examined by comparing the scores of the case and control groups. The construct validity was assessed by comparing the Arabic Self-MOQ to the olfaction VAS. Results: The study sample included 307 respondents (196 cases and 111 controls; 34 undertook the retest). The Cronbach's α coefficients were 0.92 (total Self-MOQ) and considered excellent. The ICC for the total Self-MOQ score was 0.87 (95% CI: 0.757, 0.933; p < .001), which indicated good test-retest reliability. Strong correlations were observed between the Self-MOQ items and VAS scores (r = 0.732, p < .001), (r = 0.689, p < .001). Conclusion: The current investigation showed the Arabic version of the Self-MOQ to be a reliable tool for olfactory dysfunction screening.

An Updated Review on Atrophic Rhinitis and Empty Nose Syndrome.

Objective: Atrophic rhinitis (AR) is a rare clinical condition affecting the nasal mucosa. It is characterized by progressive nasal congestion and thick, bothersome nasal secretions. In this narrative review, pathogenesis, differences between the 2 types of AR, new management modalities, and the impact of management on lifestyle have been highlighted. Materials and Methods: An extensive literature search was conducted using PubMed, Web of Science, Google Scholar, and Saudi Digital Library databases. The articles were investigated to extract information on the pathogenesis, types, new treatment modalities, and the impact of management on lifestyle. Results: AR has primary and secondary types that affect different populations and have specific clinical presentations. Primary AR is common in women and countries with long, warm seasons. Secondary AR is the most common disease in the industrialized world. It is more common among adults who have systemic disease, have undergone extensive nasal surgery, and have experienced nasal trauma. Certain infections, autoimmune disorders, chronic sinusitis, hormonal imbalance, poor nutritional condition, and iron deficiency anemia have been suggested as etiological factors. Conservative treatment is safe, inexpensive, and effective. Hygiene, a well-balanced diet, smoking cessation, and early detection and treatment of nasal pathology can help prevent AR. Some interventions shown to improve quality of life was explained in detail. Conclusions: This paper reviewed published relevant literature on AR related to pathogenesis, types, new treatment modalities, and the impact of treatment on lifestyle, thus, providing a comprehensive view of the management and prevention of AR.

Incidence of pediatric rigid esophagoscopy for foreign body removal before and after coin currency implementation in Saudi Arabia in 2017.

BACKGROUND: Foreign body (FB) ingestion is a common problem in children, which can lead to severe complications. Coins are the most common FB ingested. Since coin currency was recently implemented in Saudi Arabia, we decided to assess whether any changes have occurred in the incidence of FB removal by esophagoscopy. OBJECTIVES: Incidence of rigid esophagoscopy for ingested FB removal before and after coin currency implementation. DESIGN: Medical record review SETTINGS: Main referral hospital in Jazan region. PATIENTS AND METHODS: Our study included pediatric patients who underwent rigid esophagoscopy for removal of FB between February 2015 and July 2020 in the otorhinolaryngology department. We reported the incidence, age, gender, and type of FB. As the coin currency implementation started on December 2, 2017, the data were analyzed before and after this date. MAIN OUTCOME MEASURES: Annual incidence of pediatric rigid esophagoscopy for removal of ingested FB and type of the FB. SAMPLE SIZE: 124 patients RESULTS: The median age and interquartile range was 6.0 (5.0) years. After implementation of coins in 2017, 104 cases were reported over 32 months; before that date, 20 cases were reported over 34 months. Coins were the FB in 2 cases (10%) before implementation of coins and in 83 cases (79.8%) after implementation (P=.0001). CONCLUSIONS: The annual incidence of pediatric esophagoscopy for FB removal has increased more than five times since implementation of coin currency. This increase is exclusively related to the increase in coins as a FB. LIMITATIONS: Retrospective study. CONFLICT OF INTEREST: None.

Alveolar Soft-Part Sarcoma in Olfactory Cleft: A Case Report and Clinicopathological Review.

Sinonasal alveolar soft-part sarcoma (ASPS) is a rare malignant disease that comprises 0.4% to 1.2% of all soft-tissue sarcomas. Alveolar soft-part sarcoma is usually difficult to diagnose because it has many clinical and pathological mimickers. In this case study, ASPS occurred in the olfactory cleft, representing the second case in this location in the literature. This article presents the clinical presentation, radiologic, and histopathological case, and reviews the literature regarding the differentials.

Extent of Nasal Irrigation in Non-operated Sinuses: A Cadaveric Trial.

BACKGROUND: Nasal irrigation is among the most widely used treatment modalities for sinonasal diseases. The extent of irrigation is well studied in operated sinuses but not for non-operated sinuses. Moreover, the preferred head positioning during irrigation is not known. Herein, we studied the extent of nasal irrigation in cadaveric heads with non-operated sinuses. METHODS: Nine cadaveric heads were used. Normal saline solution mixed with radiological contrast material was used to irrigate the nasal cavities with the heads in 2 different positions: standing-leaning-forward (SLF) and Head-down forward (HDF). After each irrigation, computed tomography images of the head were acquired. The extent of irrigation was assessed for each subunit of the sinonasal cavity. RESULTS: Irrigation was performed twice on a total of 18 sides, each time in 1 position. Nine subunits were evaluated: inferior, middle, and superior meati; the olfactory cleft; and the frontal, maxillary, anterior, and posterior ethmoid and sphenoid sinuses. The extent of irrigation was significantly better in the HDF position for the olfactory cleft (100% vs 33%), P-value=.001, frontal sinus (33% vs 11%), P-value=.002, maxillary sinus (78% vs 17%), P-value=.001, and anterior ethmoid sinus (89% vs 17%), P-value=.001. There was no significant difference in the extent of irrigation between the 2 positions for the other evaluated subunits. The overall extent of irrigation was 70.37% of the subunits in HDF position and 45.06% of the subunits for SLF position, P-value= .001. CONCLUSIONS: Nasal irrigation reached the cavities of non-operated paranasal sinuses. However, while the extent of irrigation was limited in the SLF, it was well achieved in the HDF position. Studies on the clinical efficacy of irrigation in this position are recommended.

Incidence of Olfactory Dysfunction in Patients with COVID-19 in a Tertiary Hospital in Saudi Arabia.

Background: Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2, a novel virus that emerged in China in December 2019. In many cases of COVID-19, olfactory dysfunction (OD) is the only symptom. Objectives: This study aimed to examine the incidence of OD in patients with COVID-19 and identify an association between OD and COVID-19-related morbidity and admission. Design: This was a cross-sectional study. Methods: Real-time reverse transcription polymerase chain reaction-confirmed cases of COVID-19 from the Security Forces Hospital electronic registry from June 2020 to September 2020 were included in our study. Data on medical background, severity of the disease, and other related factors were collected through phone calls and electronic healthcare systems and analyzed to investigate OD in the participants. Results: Of the participants, 68% had OD, with a mean recovery time of 18 days and a mean follow-up time of 129 days (76-211 days). OD was negatively correlated with admission and morbidity. Conclusion: OD is a common presentation of COVID-19 and is more prevalent in mild cases of infection.

Graft-Extended Nasoseptal Flap for Endoscopic Anterior Skull Base Reconstruction: A Novel Technique.

Reconstruction of the anterior part of the anterior skull base with a nasoseptal flap (NSF) is technically demanding. This challenge is mainly related to the real possible length of the flap. Herein, we describe a new technique for extending the NSF such that it can sufficiently cover the far anterior part of the anterior skull base. Three cadaveric heads were used for mucosal graft extension of the NSF. The graft was harvested from the other side, sutured to the NSF, then repositioned over the skull base after opening all the paranasal sinuses. Each head was operated by a rhinologist and a skull base surgeon. The study variables were the initial length of the NSF, the length of the graft harvested, the new length of the graft-extended NSF, and the length of the new graft-extended NSF from the nasal spine. The average length of the NSFs was 6.4 cm (± 0.2); that of the harvested grafts was 2.93 cm (± 0.1); that of the graft-extended NSF was 9.33 cm (± 0.4); and that of the graft-extended NSF from the nasal spine was 3.93 cm. The graft-extended NSF is an easy and extremely useful technique for the reconstruction of the far anterior parts of the skull base. However, further prospective studies on the clinical usefulness of this technique and its long-term results are yet to be performed. Level of evidence: IV.

Isolated intramaxillary sinus cell causing long-standing facial pain: A case report.

INTRODUCTION: Sinus pneumatization by definition is a cystic enlargement within the paranasal sinuses, and that expansion causes clinical symptoms. IMPORTANCE: This case highlights the importance of identifying clinically significant sinus pneumatization and the significant role of surgical treatment. CASE PRESENTATION: This case report describes a clinical presentation of intramaxillary sinus cell affecting the patient's quality of life. Despite the rare location of the cyst, it was diagnosed by computed tomography and managed by Functional Endoscopic Sinus surgery (FESS). CLINICAL DISCUSSION: This case discussion describes the nomenclature, classifications, location and the treatment of sinus pneumatic dilatations. CONCLUSION: Our case demonstrates the importance of managing the underlying cause of the patient symptoms by a thorough history and physical examination and it can be confirmed by imaging. Symptomatic maxillary air cysts, albeit controversial in its nomenclature and mechanism, should be addressed surgically as it carries high levels of success.

Cholesterol Granuloma of the Maxillary Sinus-A Case Report and Literature Review.

Cholesterol Granulomas of the Maxillary Sinus, considered an unusual presentation at this anatomical site. Over last 2 decades, only few cases are reported in the literature (English) and no available comprehensive reviews or studies on this entity. Herein in this article we present a comprehensive literature review of the available reports of 16 cases along with reporting a new case which we managed, aided with its histopathological pictures. This review article can be a reference for practitioners in the field of otorhinolaryngology who may encounter these cases. Also, it attracts the attention to consider this pathology among the differential diagnoses of nasal masses. Moreover, including a described pathological imaging may help young pathologist to identify this pathology.

Chronic Granulomatous Invasive Fungal Sinusitis: A Case Series and Literature Review.

Chronic granulomatous invasive fungal sinusitis (CGIFS) is a peculiar disease of the paranasal sinuses due to its rarity, patient subset, and disease course. We describe 7 cases of histopathologically confirmed CGIFS with different treatment plans and varying outcomes. Of particular note was that one of these patients developed allergic fungal rhinosinusitis after complete resolution of his primary invasive disease, a finding that has never been reported in the literature. Another patient had an atypical fungal species (Aspergillus nidulans) on fungal stain and culture, while one immunodeficient patient had a large intracerebral disease component and died after 2 months of treatment. We also present a review of the pertinent literature investigating this rare disease.

Sphenoid Sinus Involvement in Chronic Rhinosinusitis Without Polyps.

BACKGROUND: Chronic rhinosinusitis (CRS) is a common chronic disease. It has 2 main clinical subtypes: CRS with nasal polyposis (CRSwNP) and without nasal polyps (CRSsNP). The sphenoid sinus appears to be less frequently involved in CRSsNP cases. Thus, we aimed to compare the incidence of sphenoid sinus involvement between CRSsNP and CRSwNP cases. METHODS: A retrospective chart review of CRS cases was performed. The clinical and imaging findings, including age, sex, adenoid, and inferior turbinate hypertrophy (ITH), deviation of the nasal septum (DNS), presence of polyps, Lund-McKay scores, and the final diagnosis, were assessed. The incidence of sphenoid sinus involvement in each CRS subtype and its correlation with the aforementioned variables were studied. RESULTS: Of the 289 cases, 151 met the inclusion criteria including 82 CRSwNP and 69 CRSsNP cases. The mean patient age was 35.48 ± 11.88 years. The incidence of men and women were 66.9% and 33.1%, respectively. The sphenoid sinus involvement was 89% and 65.2% in the CRSwNP and CRSsNP cases (P = .0001), respectively. The involvement of other paranasal sinuses showed no statistically significant differences between the 2 phenotypes. No other evaluated variables, including age, gender, DNS, ITH, or adenoid hypertrophy, significantly correlated with the incidence of sphenoid sinus involvement. CONCLUSIONS: This is the first study to demonstrate that the sphenoid sinus is less frequently involved in CRSsNP cases. Further studies should investigate the underlying factors causing the lower incidence of sphenoid sinus involvement in CRSsNP.

Seeker Uncinectomy: A Randomized Controlled Cadaveric Trial.

BACKGROUND: Endoscopic sinus surgery is a common surgery, in which the uncinate process of the ethmoid is removed as the first surgical step. There are multiple techniques for uncinectomy. Herein we describe a new and simple uncinectomy technique. METHODS: We performed a randomised controlled trial with blinded assessors. Eight cadaveric heads were used to compare the new technique to the commonly used technique; retrograde uncinectomy. The procedures were performed by 2 rhinologists, and the findings were evaluated by 2 senior rhinologists blinded to the technique and the surgeon who did. They assessed the final view of the procedure and the complications. Thereafter, they assessed the procedure for the duration and ease of each technique for teaching purposes. RESULTS: Fifteen uncinectomies were performed, 7 using the retrograde technique, and 8 using the new technique. The mean durations were 5.64 min using the seeker uncinectomy and 7.57 min using the retrograde uncinectomy, p-value = 0.017. The completion was better in seeker uncinectomy; however, not significant statistically, p > 0.05. The complications with the new technique were inferior turbinate injury in 12.5% and natural ostium non-identification in 12.5%, p > 0.05. With retrograde uncinectomy, lacrimal injury occurred in 14.3%, p > 0.05. The ease of teaching scores was higher for the seeker uncinectomy. CONCLUSION: Based on this cadaveric trial, seeker uncinectomy seems to be a safe and easy to perform technique. However, injury to the inferior turbinate and missing the natural ostium must be taken into consideration. These warrant further studies on the clinical application of this procedure.

Paranasal Sinus Wall Erosion and Expansion in Allergic Fungal Rhinosinusitis: An Image Scoring System.

Background Bone erosions are common in allergic fungal rhinosinusitis (AFRS). This study aimed at developing an image-based grading and scoring system for paranasal sinus (PNS) wall erosion in AFRS. Methods A retrospective review of all confirmed AFRS cases based on the Bent and Kuhn criteria was conducted. Preoperative computed tomography (CT) images were studied to detect PNS wall erosion with expansion. Based on our observation, we described a grading system based on the proportion of PNS wall erosion, with 1 if less thanone-third, 2 if between one-third and two-thirds, and 3 if more than two-thirds of the wall is eroded. This method provides a new scoring system ranging from 0 to 72. The inter-observer reliability of this scoring system was tested and the percent of agreement was found to be 90%. Results Among 142 AFRS cases, 82 patients (57.7%) had bone erosion. Orbital extension via lamina papyracea erosion occurred in 28.2% and 17.6% of the anterior and posterior ethmoid sinuses respectively, via floor erosion in 8.3% of the frontal sinuses, and via roof erosion in 2.1% of the maxillary sinuses. Intracranial extension caused by the anterior skull base erosion occurred in 19.4%, 10.9%, and 6% of the posterior ethmoid, anterior ethmoid, and frontal sinuses, respectively. The middle and posterior cranial fossa skull base was eroded in 14.4% and 9.2% of the sphenoid sinuses, respectively. Infratemporal extension occurred via erosion of the sphenoid sinus lateral wall in 17.3% of the sphenoid sinuses and via erosion of the maxillary sinus posterior wall in 6.7% of the maxillary sinuses. The mean of bone erosion score was 9.52, and the highest score was 34/72. Conclusion The orbit is the most common extra-sinus extension site via the lamina papyracea erosion. We propose a new grading and scoring system to assess disease severity and progress.

Bone Regeneration in Allergic Fungal Rhinosinusitis: Post-treatment Image Follow Up.

BACKGROUND: Bone erosion is a feature of allergic fungal rhinosinusitis (AFRS). The incidence of bone regeneration after treatment is unknown. The objective of this study is to evaluate the fate of bone erosion in AFRS. MATERIALS AND METHODS: A retrospective chart review was conducted for all AFRS patients who had preoperative evidence of bone erosion on the computed tomography (CT) of the paranasal sinus (PNS) and at least one postoperative image. We used the bone erosion score (BES) as a valid tool to evaluate the preoperative bone erosion extension and the rate of regeneration on postoperative images. RESULTS: A total of 40 patients met our enrollment criteria. Of these, 30 patients underwent CT within nine months postoperatively (mean baseline BES: 9.07, SD: 8.11), 33 patients underwent CT between nine and 18 months postoperatively (mean baseline BES: 9.36, SD: 8.80), and 34 patients underwent CT after 18 months postoperatively (mean baseline BES: 8.56, SD: 7.69). The BES improved by 88.92% within nine months postoperatively with a follow-up BES of 0.93 (SD: 1.65), by 90.29% between nine and 18 months with a follow-up BES of 0.91 (SD: 2.15), and by 96.57% after 18 months with a follow-up BES of 0.29 (SD: 0.62). Complete bone regeneration occurred in 27 patients (67.50%); this was noted within nine months in 21 patients and after 18 months in six. Among them, 16 were male and 11 were female (p = 0.75). Regarding their ages, eight were pediatric and 19 were adult patients (p = 0.31). CONCLUSION: Bone erosion in AFRS is a mostly reversible process. Complete bone regeneration occurred in more than two-thirds of patients within a short period of time.

Impact of Suture Conchopexy on Olfaction and the Risk of Middle Turbinate Lateralization.

INTRODUCTION: Middle turbinate (MT) lateralization is one of the common causes of endoscopic sinus surgery (ESS) failure and often necessitate revision surgery. To avoid this sequala, surgeons have attempted several methods to keep the MT medialized. One such method is conchopexy. However, the impact of this procedure on olfaction remains unclear. METHOD: A retrospective cohort study was conducted to compare the subjective olfaction outcome of ESS in patients for whom conchopexy was performed and in controls where a spacer was applied in the middle meatus. Also, the risk of lateralization in both techniques was compared. In addition, other factors related to the outcome of olfaction, such as age, gender, type of chronic rhinosinusitis (CRS), and partial resection of the MT, were assessed. RESULTS: Out of 299 patients with CRS who underwent ESS, 134 met our inclusion criteria. In total, 62.7% were male and 37.3% were female, and their mean age was 37.4 years. Sixty-one patients (cases) underwent conchopexy, and 73 patients (controls) underwent insertion of a middle meatus spacer. None of the subjects in both groups developed anosmia or hyposmia as a complication. The improvement of olfaction was almost equal in both groups (for anosmia: 92.9% in cases vs. 87.5% in control; for hyposmia 87.1% in cases vs. 89.7% in control). In patients with anosmia, the improvement of olfaction was lower when the MT was partially resected (71.4% vs. 95.7%); whereas, in patients with hyposmia, the improvement was not significantly different (87% vs. 93.8% when the MT was partially resected). The improvement of olfaction was higher in patients with allergic fungal sinusitis (AFS) and CRS with nasal polyps (CRSwNP) than in those with CRS without nasal polyps (CRSsNP). The MT lateralization was almost equal in both groups (9.0% in cases vs. 9.6% in controls). CONCLUSION: Conchopexy does not affect olfaction subjectively. The improvement of olfaction is related more to the underlying disease, i.e., less improvement occurs in cases of CRSsNP. The risk of lateralization is equal with either conchopexy or middle meatus spacer.