Syndromic surveillance of respiratory-tract infections and hand hygiene practice among pilgrims attended Hajj in 2021: a cohort study.

BACKGROUND: The risk of transmission of viral respiratory tract infections (RTIs) is high in mass gatherings including Hajj. This cohort study estimated the incidence of symptomatic RTIs and hand hygiene compliance with its impact among Hajj pilgrims during the COVID-19 pandemic. METHODS: During the week of Hajj rituals in 2021, domestic pilgrims were recruited by phone and asked to complete a baseline questionnaire. Pilgrims were followed up after seven days using a questionnaire about the development of symptoms, and practices of hand hygiene. Syndromic definitions were used to clinically diagnose 'possible' influenza-like illnesses (ILI) and COVID-19 infection. RESULTS: A total of 510 pilgrims aged between 18 and 69 (median of 50) years completed the questionnaire, 280 (54.9%) of whom were female, and all of them (except for one) were vaccinated against COVID-19 with at least one dose. The mean (± SD) of pilgrims' hand hygiene knowledge score (on a scale of 0 to 6) was 4.15 (± 1.22), and a higher level of knowledge was correlated with a higher frequency of handwashing using soap and water. Among those 445 pilgrims who completed the follow-up form, 21 (4.7%) developed one or more respiratory symptoms, of which sore throat and cough were the commonest (respectively 76.2% and 42.8%); 'possible ILI' and 'possible COVID-19' were present in 1.1% and 0.9% of pilgrims. Obesity was found to be a significant factor associated with the risk of developing RTIs (odds ratio = 4.45, 95% confidence interval 1.15-17.13). CONCLUSIONS: Hajj pilgrims are still at risk of respiratory infections. Further larger and controlled investigations are needed to assess the efficacy of hand hygiene during Hajj.

Percutaneous ultrasound-guided alcohol ablation of solitary parathyroid adenoma in a patient with primary hyperparathyroidism.

Parathyroidectomy is considered the definitive cure for primary hyperparathyroidism due to a single parathyroid adenoma, which represents the most common cause of chronic hypercalcemia. However, in few cases, surgery may be technically difficult or risky. We report the use of percutaneous ultrasound-guided alcohol ablation of a parathyroid adenoma as an alternative to surgery in an 88-year-old male patient with significant medical comorbidities.

Endoscopic localization of the sphenopalatine foramen: do measurements matter?

The objective of this study was to evaluate different methods and measurements for localization of the sphenopalatine foramen (SPF) during endoscopic transnasal exposure. The study design consisted of descriptive anatomical study and the setting was in Microsurgical Cadaver Dissection Lab. Sixteen lateral nasal walls were dissected endoscopically to identify and localize the SPF. Multiple measurements were obtained from nasal sill (NS) to SPF, ethmoid crest (EC), and other related landmarks. The results showed that EC was identified in all sides with different degrees of projection. SPF extended below the inferior edge of EC, i.e., lying both in the superior and middle meatus, in 12 sides (75 %), while it was laying only in the superior meatus in 4 sides (25 %). An accessory foramen was identified in 3 sides (18.7 %), all of which were located in middle meatus. The distance from NS to SPF ranged widely from 55 to 76 mm (mean ± SD 64.4 ± 6 mm). The average angle of elevation formed between SPF to NS and nasal floor was 11.4° (range 11-12°). Although many previous studies have reported measurements to SPF, we do not believe these measurements are of practical help due to the wide range of measurements and the lack of standard reference points. The main constant landmark for SPF remains the EC. Since SPF frequently extends below EC, the mucoperiosteal flap should be extended below the inferior edge of this crest to avoid missing the middle meatal part of SPF or any accessory foramina.

Emerging Therapies in the Medical Management of Allergic Fungal Rhinosinusitis.

A non-invasive type of chronic sinusitis named allergic fungal rhinosinusitis (AFRS), which is a variant of allergic bronchopulmonary aspergillosis with nasal obstruction, was first described in 1976. The goal of this article was to provide an overview of various treatment approaches and how they can be used to control AFRS. Since this is an inflammatory disease rather than an invasive fungal infection, the treatment tries to modulate inflammation and reduce disease burden. A comprehensive treatment strategy must incorporate medicinal, surgical, biological, and immunological techniques. Owing to the chronic nature of allergic fungal rhinosinusitis and its high propensity for flare-ups and recurrence, multiple procedures are frequently required. The most likely method of establishing a long-term disease control for AFRS is a comprehensive management strategy that integrates medical, surgical, and immunological care. However, there are still disagreements regarding the exact combinations. In this review, we have mentioned different modalities in the management of AFRS, such as monoclonal antibodies, probiotic Manuka honey, and aPDT among others, some of which are promising but require further research.

Dupilumab improves outcomes in patients with chronic rhinosinusitis with nasal polyps irrespective of gender: results from the SINUS-52 trial.

Objectives: This post hoc analysis assessed disease characteristics and response to dupilumab treatment in male and female patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) (SINUS-52 study; NCT02898454). Methods: Patients received dupilumab 300 mg or placebo every 2 weeks for 52 weeks on background intranasal corticosteroids. Efficacy was assessed through Week 52 using nasal polyp score (NPS), nasal congestion/obstruction score, loss of smell score and University of Pennsylvania Smell Identification Test score. Disease-specific health-related quality of life (HRQoL) was assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22). Results: The analysis included 192 male and 111 female patients. Female patients had higher mean SNOT-22 total score (56.6 vs. 49.1, P < 0.01) and more coexisting asthma (78.4% vs. 46.4%, P < 0.0001) and non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NSAID-ERD) (38.7% vs. 18.8%, P = 0.0001) than male patients, but other baseline characteristics were similar. Dupilumab significantly improved CRSwNP outcomes vs. placebo at Week 52, regardless of gender: least squares mean differences (95% confidence interval) for NPS were -2.33 (-2.80, -1.86) in male and -2.54 (-3.18, -1.90) in female patients (both P < 0.0001 vs. placebo), and for SNOT-22 were -19.2 (-24.1, -14.2) in male and -24.4 (-31.5, -17.3) in female patients (both P < 0.0001 vs. placebo). There were no significant efficacy-by-gender interactions. Conclusion: Female patients had greater asthma, NSAID-ERD and HRQoL burden at baseline than male patients. Dupilumab treatment significantly improved objective and subjective outcomes compared with placebo, irrespective of gender.

Risk factors for postoperative hypocalcemia following total thyroidectomy: a retrospective study.

BACKGROUND: and Objectives: Hypocalcemia is a commonly reported complication after thyroid surgery. Many possible risk factors have been identified. The purpose of this study is to analyze various risk factors possibly associated with development of postoperative hypocalcemia after thyroid surgery by dividing the sample population into postoperative hypocalcemia and normal calcium groups. DESIGN: Retrospective. SETTING: Multiple centers in the Makkah region of Saudi Arabia. PATIENTS AND METHODS: Risk factors for postoperative hypocalcemia that were obtained for analysis include patient factors, perioperative blood parameters factors, disease-related factors, and surgical factors. Postoperative hypocalcemia was defined as a reduction of the total calcium level to <8.0 mg/dL. Hypocalcemic and normocalcemic patients were compared by multivariate logistic regression. MAIN OUTCOME MEASURES: Distinguish independent risk factors for postoperative hypocalcemia after thyroidectomy. SAMPLE SIZE: 215 patients. RESULTS: The incidence of hypocalcemia was 52.1% (112 of 215 patients). According to multivariate analysis, statistically significant risk factors for predicting postoperative hypocalcemia included postoperative parathyroid hormone level <10 pg/dL, inadvertent parathyroid gland resection, and neck dissection surgeries. CONCLUSION: The causes of postoperative hypocalcemia are multi-factorial. Because many of these factors are modifiable, they should be identified postoperatively to distinguish high-risk groups and implement early preventive measures. LIMITATIONS: Retrospective with a relatively small size. We encourage additional prospective studies with a larger sample size in multiple regions of the country, which might reveal further significant results.

Assessment of chronic rhinosinusitis with nasal polyps: Development of the Nasal Polyp Patient Assessment Scoring Sheet tool.

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disorder with a wide range of validated subjective and objective assessment tools to assess disease severity. However, a comprehensive and easy-to-use tool that integrates these measures for determining disease severity and response to treatment is still obscure. The objective of this study was to develop a standardized assessment tool that facilitates diagnosis, uniform patient monitoring, and comparison of treatment outcomes between different centers both in routine clinical practice and in research. Methods: To develop this tool, published literature on assessment tools was searched on various databases. A panel of 12 steering committee members conducted an advisory board meeting to review the findings. Specific outcome measures to be included in a comprehensive assessment tool and follow-up sheet were then collated following consensus approval from the panel. The tool was further validated for content and revised with expert recommendations to arrive at the finalized Nasal Polyp Patient Assessment Scoring Sheet (N-PASS) tool. Results: The N-PASS tool was developed by integrating the subjective and objective measures for CRS assessment. Based on expert opinions, N-PASS was revised to be used as an easy-to-use guidance tool that captures patient-reported and physician-assessed components for comprehensively assessing disease status and response to treatment. Conclusion: The N-PASS tool can be used to aid in the diagnosis and management of CRS cases with nasal polyps. The tool would also aid in improved monitoring of patients and pave the way for an international disease registry. Level of evidence: Oxford Level 3.

Avastin and diode laser: a combined modality in managing epistaxis in hereditary hemorrhagic telangiectasia.

A patient with hereditary hemorrhagic telangiectasia is a rare presentation to the otolaryngologist in clinical practice. They almost present with epistaxis, which is recurrent, spontaneous and can be functionally and socially debilitating for the patient. Diode laser cauterization and Avastin intranasal injection showed significant improvement in epistaxis severity score. We report a case of hereditary hemorrhagic telangiectasia with chronic epistaxis (hemoglobin 3.4 mg/dl) managed with Diode laser and intranasal Avastin injection with great improvement in life quality and decrease in epistaxis attacks. Despite all treatment options absolute eradication of epistaxis attacks is difficult to obtain in these cases.

Nasal hemophilic pseudotumor in a 2-year-old with recurrent epistaxis: a case report and review of the literature.

Hemophilic pseudotumor is a rare, yet dangerous complication of hemophilia. It has been reported previously at sites prone to recurrent trauma like long bones and pelvis. However, in the field of otorhinolaryngology, few cases are reported and therefore there is no established protocol for management. We hereby report a case of a 2-year-old boy, a known case of hemophilia A (factor VIII deficiency), who presented with recurrent epistaxis not responding to medical management. Imaging was done and revealed a heterogenous nasal mass compressing the left orbital wall, extending to the sphenoid sinus, and causing skull base erosion. The patient was successfully managed by evacuation and drainage of the pseudotumor via endoscopic endonasal approach and replacement of factor VII pre-and post-operatively. To our knowledge, this is the first case of nasal hemophilic pseudotumor managed by evacuation and drainage through an endoscopic endonasal approach, which was deemed successful.

Prevalence of Asthma, Allergic Rhinitis, and Atopic Dermatitis and Their Association With Oral Health in Saudi Arabia.

Background  The word "atopy" is frequently used to describe immunoglobulin E (IgE)-mediated diseases. The prevalence of atopic dermatitis, allergic rhinitis, and asthma is increasing and disconcerting in Saudi Arabia. This study aims to investigate the association between allergic rhinitis, atopic dermatitis, asthma, and oral health among adults in the Makkah region of Saudi Arabia. Methods A cross-sectional study of 726 adults using an electronic questionnaire was adopted. The study was carried out from January to December 2022. The questionnaire included demographic data, patients' diseases in response to inclusion and exclusion criteria, oral health status and symptoms, and dental health-related behaviors. Results Most participants were aged from 18 to <40 years (79.1%). More than half of the participants were females (53.6%); 39.7% of participants had poor oral health. Poor health was significantly higher among obese subjects as well as those with lower levels of physical activity, higher perceived levels of stress, those who received a sealant, and those who brushed their teeth for ≤ one time per day. The results showed that the individual symptoms of oral health did not associate significantly with being diagnosed with allergic rhinitis or asthma in the past 12 months. However, atopic dermatitis was independently associated with a chipped or broken tooth (OR = 1.52) and pain in the tongue or inside the cheeks (OR = 3.57). Conclusion Poor oral health was significantly associated with atopic dermatitis in Saudi adults. Some systemic diseases are considered chronic diseases, and they are multifactorial; thus, we cannot claim that periodontal pathogens are the definite cause of systemic infections. More studies are necessary to find a definitive association.

Management of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the Pan-Arab Region: Consensus Recommendations from a Multidisciplinary Expert Working Group.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic and often debilitating inflammatory condition of the nasal and paranasal tissues. An expert panel of specialists from the Gulf region (the Kingdom of Saudi Arabia, Kuwait, Oman and the United Arab Emirates) and from Egypt gathered to evaluate existing guidance and develop regional guidance on the management of CRSwNP through a consensus approach. The present article presents the main observations and recommendations from this panel. CRSwNP diagnosis requires the presence of bilateral, endoscopically visualized polyps in the middle meatus (via nasal endoscopy or CT). In most patients, CRSwNP is mediated through predominantly type 2 inflammatory processes and is often observed in patients with asthma and other allergic disease. While many patients respond to medical treatment (principally topical irrigation and intranasal corticosteroids, and adjunctive short-term use of systemic corticosteroids), clinical management of CRSwNP is challenging, and a multidisciplinary approach for complete evaluation and treatment is recommended. Patients with more severe/uncontrolled disease (despite adequate medical therapies) require a complete endoscopic sinus surgery (ESS), although outcomes can be unsatisfactory, and further revision surgery is common. Biological therapies targeting underlying inflammatory processes offer additional, effective treatment options for those patients with persistent symptoms despite complete ESS, and also in those patients where surgery may be contraindicated.

An Assessment of the Knowledge and Awareness of Common Otorhinolaryngology-Related Issues Among School and University Students in Makkah City, Saudi Arabia: A Cross-Sectional Study.

Background Otorhinolaryngology (ENT) illnesses commonly affect all individuals with a broad range of symptoms, and most causes are preventable. According to the WHO, more than 278 million people have bilateral hearing loss. Locally, a previously published study done in Riyadh showed that most participants (79.4%) had a poor level of knowledge on common ENT-related diseases. The current study aims to investigate and explore the knowledge of and attitudes toward common ENT problems among students in Makkah City, Saudi Arabia. Method This descriptive, cross-sectional study used an Arabic-language electronic questionnaire to assess knowledge of common ENT problems. It was distributed to medical students at Umm Al-Qura University and students attending Makkah City high schools in Saudi Arabia between November 2021 and October 2022. The sample size was calculated to be 385 participants. Results Overall 1080 respondents were enrolled in this survey from Makkah City. Participants with good knowledge of common ENT diseases were over 20 years of age with a p-value <0.001. Furthermore, females also had a significant p-value of <0.004, and those with bachelor's or university degrees showed a statistically significant p-value of <0.001. Conclusion Female participants with bachelor's or university degrees and participants aged 20 and older showed superior knowledge. Our findings indicate that students need educational implications and awareness campaigns to increase their knowledge, practice, and perception toward common otorhinolaryngology-related issues.

Successful Use of Dupilumab as a Salvage Therapy for Recalcitrant Allergic Fungal Rhinosinusitis: A Case Report.

Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic rhinosinusitis with nasal polyps (CRSwNP) which is distinguished by the presence of eosinophilic mucin, type 1 hypersensitivity reaction resulting from fungi residing within the sinus, and characteristic imaging findings of the paranasal sinuses. Surgical intervention, sinonasal irrigations, and topical and systemic medications are commonly used to reduce the fungal load and antigenic stimulation. Despite the advancement of medical and surgical management of AFRS, a high recurrence rate is still a significant concern. The proper treatment for refractory AFRS remains controversial. Herein, we discuss the use of dupilumab for controlling refractory AFRS. We report a case of a 33-year-old female patient known to have had AFRS for 16 years. Due to the recurring nature of her illness, 16 functional endoscopic sinus surgeries (FESS) have been done to control her symptoms. The last operation was done in our institution; evidence for cure was insufficient with the persistence of symptoms. After a consensus decision with the multidisciplinary management team, she was an appropriate candidate for therapy with dupilumab. After six months of using the medication, magnificent improvement and control of symptoms were noted, and post-treatment CT scans illustrated excellent progression from previous scans. AFRS could be an extremely debilitating disease with significant impairment of quality of life even when standard therapy and extensive surgical interventions are implemented. Dupilumab can be an excellent option as a salvage therapy for recalcitrant AFRS with significant improvement in patients' quality of life and resolution of symptoms.

Dupilumab: An emerging therapy in allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) is a highly resistant disease and is challenging to treat. Patients with recurrent attacks of the disease despite surgical management can benefit from biologics as adjunct therapies. Dupilumab has shown promising endpoints in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). This case series reports 4 patients with resistant AFRS concomitant with asthma, for which dupilumab therapy was administered. Long-term follow-ups showed that dupilumab improved the symptoms and improved the results of objective tools such as imaging and pulmonary function test.

Solitary Extramedullary Plasmacytoma of the Oropharynx: A Case Report.

Plasma cell neoplasms rarely manifest as a solitary extramedullary plasmacytoma. Oropharyngeal involvement had been already reported in the literature. The most common malignancy of the oropharynx is squamous cell carcinoma, while soft tissue malignancy is extremely rare. In our present case report, the patient presented with a huge oropharyngeal mass which developed in a short duration. His family's concerns were mostly about his survival and quality of life. After complete checkup, a diagnosis for solitary extramedullary plasmacytoma of the oropharynx was concluded. The patient received neo-adjuvant chemotherapy and radiotherapy. The mass markedly decreased in size with complete regression as seen both clinically and radiologically. Our main aim for reporting this present case of pathology in oropharyngeal malignant masses is to increase the awareness and draw attention of Otolaryngology, the Head and Neck surgeons.

Shoulder Metastasis: A Rare Nasopharyngeal Carcinoma Presentation.

BACKGROUND Nasopharyngeal carcinoma (NPC) is a rare malignant tumor that arises from the mucosal lining epithelium of the nasopharynx, most commonly at the lateral nasopharyngeal recess or fossa of Rosenmüller. According to global age-standardized incidence rates (ASIRs), in 2018 the incidence rate of nasopharyngeal carcinoma varied from 2.1 to 0.4 per 100 000 in Asia and Europe, respectively. The number of deaths exceeded 50 000. It is one of the few head and neck tumors prone to distant metastasis, most commonly to bones, lung, and liver. CASE REPORT In this case report, we present a rare case in which a 23-year-old male patient presented to our head and neck clinic. The patient presented initially to the orthopedic clinic with a right humeral mass lesion 10 cm with history of pain for the last 7 months. A Tru-Cut biopsy confirmed metastatic NPC. A nasopharyngeal biopsy further revealed his lesion to be an NPC undifferentiated type III. The patient was diagnosed with a T3 N2b M1 stage tumor and he was treated with chemoradiotherapy. CONCLUSIONS NPCs that present with a shoulder/humoral metastasis are very rare clinically. We are presenting this case to increase the awareness of the Otolaryngology - Head & Neck surgery, Orthopedic, and Oncology community of such a rare presentation.

Expert Opinion on Biological Treatment of Chronic Rhinosinusitis with Nasal Polyps in the Gulf Region.

Chronic rhinosinusitis (CRS) is defined as the inflammation of nose and paranasal sinuses, affecting the patients' quality of life and productivity. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a principal clinical entity confirmed by the existence of chronic sinonasal inflammation and is characterized by anterior or posterior rhinorrhea, nasal congestion, hyposmia and/or facial pressure or facial pain. Several epidemiologic studies have revealed wide variations in the incidence of CRS among regions globally ranging from 4.6% to 12%. The Gulf countries are also witnessing an unprecedented burden of CRSwNP. According to the current clinical guidelines, glucocorticosteroids and antibiotics are the principal pharmacotherapeutic approaches. Endoscopic sinus surgery is recommended for those who have failed maximal pharmacotherapy. Recently, biologics are considered as an alternative best approach due to the complications associated with medical therapy and surgery. However, precise data on the clinical position of biologic agents in the management of CRSwNP in the Gulf region is not available. The present review article addresses the current diagnostic and management approaches for CRSwNP and also emphasizes the role of emerging biologics in the current treatment strategies for CRSwNP in the Gulf region. Further, a consensus protocol was convened to rationalize the guideline recommendations, strategize the best practices with biologics, and develop clinical practice guidelines for all primary-care specialists in the Gulf region. The consensus-based report will be a useful reference tool for primary-care physicians in primary-healthcare settings, regarding the appropriate time for the initiation of biological treatment in the Gulf region.

Persistent Parosmia Caused By COVID-19 Infection: An Emerging Symptom.

Objectives Coronavirus disease 2019 (COVID-19) is associated with several known signs and symptoms, including olfactory disturbances leading to anosmia and parosmia. This study aimed to evaluate the clinical features of the emerging symptoms of post-COVID-19 parosmia and to report the outcome of commonly used intervention methods. Methods The study's sample included post-COVID-19 patients who complained of parosmia, presented to otorhinolaryngology clinics at private tertiary care hospitals from December 2020 to April 2021. Patients' data were collected from the hospital system and through direct phone interviews. The Modified Arabic 20-Items Sino-Nasal Outcome Test (MA-SNOT-20) was used to measure the severity of rhinosinusitis symptoms. Results Twenty-one patients were included in the study, and their ages mainly ranged between 20 and 39 years (76.2%), predominantly females 19 (90.5%). Post the COVID-19 illness course, nearly half of the patients (9; 42.9%) reported full recovery of olfaction and taste senses. Nine cases (42.9%) received treatment with intranasal and oral steroids, of which only three cases (14.3%) noticed improvement. The remaining 12 cases (57.1%) did not receive any treatment, two of which improved (9.5%). The maximum MA-SNOT score was 37 while the minimum was 3, and eight patients (38.1%) scores were between one and 10 points. Conclusion Olfactory and taste dysfunctions are common symptoms of COVID-19. The emerging symptom of parosmia is worth reporting in the literature to increase the awareness of this particular symptom in this pandemic era. Many management strategies have been introduced that might be effective. However, further studies are needed to establish evidence-based management protocols.

Post-COVID-19 Vaccine Parosmia: A Case Report.

We present the case of a healthy 38-year-old male who developed parosmia following a second dose of AstraZeneca with a negative nasal swab of coronavirus disease 2019 (COVID-19) infection. The patient noted parosmia that started suddenly after one week of receiving the second dose of AstraZeneca with no association with other symptoms. The patient has still not recovered from his parosmia until the publication of this article. The olfactory disorder was confirmed using a validated questionnaire for parosmia assessment and examination by rhinoscopy. Parosmia is a rare side effect of COVID-19, and its pathophysiological mechanism is still unknown. More research in the future is needed to know the association of parosmia with COVID-19 vaccine.

Outcome and Complications of Frontal Sinus Stenting: A Case Presentation and Literature Review.

INTRODUCTION: Frontal sinus surgery remains challenging to manage because of its complex anatomy and narrow outflow tract. A number of studies suggest the success of frontal sinus stenting to reduce postoperative complications in endoscopic frontal sinus surgery. However, failure and complications of frontal sinus stenting may occur. METHOD: We present a case of frontal sinus stenting with migration of the stent and erosion of the lamina papyracea together with a granulomatous reaction around the stent. PubMed and Medline search was also conducted to study the current evidence on frontal sinus stenting benefits and complications. RESULTS: Still there are no guidelines or universally accepted indications for the use of frontal sinus stenting in the literature. A limited number of studies suggest the success of frontal sinus stenting to reduce postoperative stenosis in endoscopic frontal sinus surgery. However, failure and complications of frontal sinus stenting may occur. Infection, pain, edema, and stent obstruction may also occur. Our case report also highlights the potential of orbital complications as well as the consequences of inducing a granulomatous reaction. CONCLUSION: The value of frontal sinus stenting is still a subject of debate. Complications of frontal sinus stenting are not uncommon and thus necessitate regular follow-up.