Approach to Sudden Hearing Loss Among Primary Care Physicians in Riyadh, Saudi Arabia.

INTRODUCTION: A medical emergency known as sudden sensorineural hearing loss (SSNHL) affects the ears suddenly, has a considerable probability of negative cognitive and functional outcomes, and can influence the patient's quality of life. Primary care physicians play a crucial role in diagnosing SSNHL and initiating prompt and efficient management since they are the ones who would likely encounter it initially. This study aims to evaluate the present knowledge, diagnostic, and management perspective of SSNHL among primary care physicians in Riyadh, Saudi Arabia. METHODS: A self-generated questionnaire with 17 questions was developed, and a link to the online survey was delivered to primary care physicians (PHPs) in Riyadh, Saudi Arabia, concerning the management of SSNHL. RESULTS: The knowledge level regarding SSNHL was evaluated, in which 21 (25%) of the participants had a low knowledge level, 34 (40.5%) had moderate knowledge, and 29 (34.5%) had a high knowledge level. Among 84 participants, 20 (23.8%) were confident in their ability to administer and understand the findings of tuning fork tests (TFT) to differentiate between sensorineural hearing loss and conductive hearing loss, whereas 64 (76.2%) were unsure about it. In addition, to distinguish between sensorineural hearing loss and conductive hearing loss, 62 (73.8%) participants were confident, and 22 (26.2%) participants were skeptical about their ability to interpret a formal audiogram. CONCLUSION: Considering SSNHL as a medical emergency, in our survey, many family doctors would make proper referral and treatment decisions. However, TFTs were underutilized for guiding management decisions compared to other ways to distinguish between conductive and sensorineural hearing loss.

Assessment of Knowledge, Attitude, and Practice of First Aid Management of Choking Among Primary School Teachers in Riyadh, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Understanding first aid is crucial for immediate intervention during health emergencies, with choking representing a significant danger, particularly for young children. Obstructed airways commonly lead to choking incidents, carrying substantial risks if not swiftly dealt with. This research endeavors to evaluate the comprehension, perspectives, and implementation of first aid measures for choking incidents among primary school teachers in Riyadh, Saudi Arabia, an area of paramount importance with minimal existing research within this particular demographic. METHODOLOGY: This was a cross-sectional study conducted from the beginning of July till the end of October 2023, among 447 primary school teachers in Riyadh, Saudi Arabia. Data collection was carried out by administering a questionnaire through an online platform. The questionnaire included demographic information, knowledge about signs and symptoms of choking, the attitude of participants, participant's practice, and the relationship between the knowledge level about choking and practice. The data collected were reviewed, coded, and then fed into IBM SPSS Statistics for Windows, Version 29 (Released 2023; IBM Corp., Armonk, New York, United States).  Results: Our study on first aid management of choking among primary school teachers highlighted significant findings. Participants demonstrated high awareness of choking signs with 386 (86.3%) recognizing universal signs and 330 (73.8%) claiming proficiency in first aid. Attitudes favored the importance of immediate treatment in 394 participants (88.1%) and the necessity of first aid knowledge for teachers (92.2%). One-hundred and fifty-one participants (33.8%) reported performing choking first aid with 328 (73.4%) opting for the Heimlich maneuver for a six-year-old. Significantly, higher knowledge correlated with increased first aid performance (p < 0.001) and support for mandatory training (p < 0.001). CONCLUSION: Our study indicates a higher knowledge level in primary school teachers with positive attitudes and practices regarding choking first aid management. It underscores the importance of enhancing first aid training among primary school teachers, emphasizing its positive impact on choking management and the necessity of immediate intervention in such cases.

Guidelines for cochlear implantation in Saudi Arabia.

This study aim to establish unified clinical practice guidelines (CPGs) for adults and pediatric cochlear implantation (CI) for the Ministry of Health specialist hospitals in the Kingdom of Saudi Arabia. A comprehensive literature review was carried out by a task force group. Guidelines were based on evidence-based medicine including institutions and individuals' experiences. Bilateral CI is recommended for adults and pediatrics with bilateral severe/profound hearing loss. The minimum age of implantation for children is recommended at 9 months. This study provides a safe framework for the multidisciplinary team to select appropriate CI candidates. It is important to establish a comprehensive multidisciplinary team covering different aspects of health care providers.

Malignant Otitis Externa in a 20-Year-Old Male Patient With Erdheim-Chester Disease: A Case Report.

Malignant otitis externa (MOE) is an uncommon, potentially life-threatening, invasive infection of the external auditory canal and lateral skull base. It is mainly seen in older adults with diabetes or immunocompromised patients and rarely seen in children. Erdheim-Chester disease (ECD) is a rare, non-Langerhans histiocytosis disorder. It is a multisystem disease with a poorly understood etiology. It commonly affects the skeletal system, central nervous system (CNS), cardiovascular system, lungs, retroperitoneum, kidneys, and skin. CNS involvement confers poor prognosis and reduced response to treatment. Cardiovascular involvement is another indicator of poor prognosis. This report describes the case of a 20-year-old male with ECD who had bilateral malignant otitis externa/skull base osteomyelitis and hearing loss. The patient was not responding well to treatment. He was on intravenous antibiotics, underwent left mastoidectomy, received targeted immunotherapy, and had four rounds of chemotherapy. The patient died after six months from the diagnosis and targeted treatment, which indicates the aggressiveness of the disease. MOE should be suspected in any patient presenting with intractable otalgia with otorrhea that is not responsive to local treatment for uncomplicated otitis externa or otalgia with temporomandibular joint (TMJ) pain aggravated by chewing. This is the first report of malignant otitis externa in a young patient with ECD to the best of the author's knowledge. This case emphasizes the importance of suspecting MOE in young patients, especially if the risk factors of the disease are present because early diagnosis can prevent or minimize life-threatening complications.