Factors affecting graft healing in laryngotracheal reconstruction: a retrospective single-center experience.

PURPOSE: To examine the factors that affect graft healing after laryngotracheal reconstruction (LTR). METHODS: We conducted a retrospective chart review at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between January-2008 and October-2023. We included all patients who underwent LTR and required anterior and/or posterior graft placement, while those who underwent procedures without graft placement and those with incomplete information were excluded. RESULTS: Forty-nine patients were analyzed. Most patients were pediatric (65.3%), male (65.3%), had no coexisting comorbidities (55.1%), and harbored grade 3-4 stenosis (59.2%). Thirty patients (61.2%) underwent open surgery. Various graft complications occurred including infection (n = 1, 2%), dehiscence (n = 3, 6.1%), scar (n = 6, 12.2%), and granulation (n = 29, 59.2%). Only 15 patients (30.65%) achieved the composite status of "healthy" graft. Among 43 patients who had postoperative cultures, positive results for Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were observed in 10 and four patients, respectively. Open surgery and double-stage procedure were significantly associated with higher rates of granulation tissue formation. Pediatric-age group had significantly higher rate of complete epithelization compared to adult-age group. A significantly greater proportion of patients who had unhealthy grafts had open surgery. The rate of double-stage LTR was significantly higher in unhealthy grafts compared to healthy grafts. Prolonged stent duration was linked to various graft-related complications. Multivariate logistic regression analyses showed no statistically significant correlations between various factors and postoperative graft-related complications. CONCLUSION: Open surgery, double-stage procedure, pediatric age group, and stent duration were not significant risk factors associated with postoperative graft-related complications during LTR in multivariate analysis.

Clinical evaluation of pediatric patients with recurrent respiratory papillomatosis.: A longitudinal study at a Saudi Arabian tertiary care center.

OBJECTIVES: To study the clinical evaluation of recurrent respiratory papillomatosis (RRP) patients and the factors associated with the improvement in the Derkay's score as a measure of disease severity. METHODS: A retrospective cohort that included all juvenile RRP patients who were admitted to King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between September 2015 and June 2022 and underwent surgical debulking. RESULTS: A total of 16 patients were eligible to join our study. Among them, 7 patients were males. Hoarseness of voice was the most frequent symptom. The median period of the follow-up was 56 months. Complete remission was achieved in 31.3%. The univariate linear regression model revealed that the cidofovir-treated patients had a significant reduction in the change value of Derkay's score compared to those without treatment (regression coefficient= -5.83, 95% confidence interval [CI]: [-11.5 to -0.143], p=0.045). Also, the increased first Derkay's score decreased the change value and subsequently increased the improvement chance of the disease (regression coefficient= -0.424, 95% CI: [-0.764 to -0.083], p=0.018). However, in the multivariate regression model, both variables showed non-significant results. CONCLUSION: cidofovir treatment and higher Derkay's scores affected the disease improvement.

Spirometry in laryngotracheal stenosis: a systematic review and meta-analysis.

PURPOSE: This study aimed to assess the changes in spirometry parameters or indices after relieving laryngotracheal stenosis (LTS) in adult patients. METHODS: A systematic review and meta-analysis of studies from PubMed, Scopus, Web of Science, Cochrane Library, and EBSCO databases was conducted for assessing changes in spirometry values after endoscopic balloon dilatation of LTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant data, such as changes in mean spirometry values between preoperative and postoperative interventions, and findings of receiver operating characteristic curve analyses for predicting the need for surgical intervention, were extracted. RESULTS: Ten studies including 330 patients overall met the inclusion criteria. Significant improvements were observed from preoperative to postoperative mean values of different spirometry parameters and indices. The overall mean differences in peak expiratory flow (ΔPEF), expiratory disproportion index (ΔEDI), and peak inspiratory flow (ΔPIF) were 2.26 L/s (95% CI 2.14-2.38), 27.94 s (95% CI 26.36-29.52), and 1.21 L/s (95% CI 0.95-1.47), respectively. ΔPEF and ΔPIF values increased, while ΔEDI decreased. In predicting the need for surgical intervention, EDI had the highest sensitivity (88%), and forced expiratory volume per second/forced vital capacity had the highest specificity (85%). CONCLUSION: Spirometry is a valuable tool for assessing patients with LTS. PEF, EDI, and PIF were the most commonly reported spirometry parameters that significantly improved after airway stenosis was relieved.

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.

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.

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.

Intraparotid Recurrence of Papillary Thyroid Carcinoma After Thyroidectomy Coincident With Declining Thyroglobulin Levels: A Case Report and Review of the Literature.

Papillary thyroid carcinoma (PTC) is the most frequent thyroid malignancy. Intraparotid recurrence of PTC is, however, rare. Most parotid malignancies are either primary or metastatic from cancer outside the head and neck. We report a case of a 71-year-old man who had undergone lobectomy and completion thyroidectomy for PTC and presented to our clinic with an insidious intraparotid recurrence, for which he underwent a superficial parotidectomy and radioactive iodine therapy. We also present a review of the literature on similar cases. Intraparotid metastasis of PTC should be considered in the differential diagnosis of a parotid mass.

A Case-Control Study of Titanium and Fluoroplastic Ventilation Tubes.

Background Tympanostomy ventilation tube (VT) insertion is one of the most common procedures performed in otorhinolaryngology. VTs have been proven to effectively manage otitis media (OM) with effusion (OME) and to improve the quality of life of children postoperatively. Although there are multiple types of VT shapes, materials, and sizes, few studies have investigated and compared the effects of titanium VT with those of VTs made of other materials. This study aimed to compare titanium VTs and the more commonly used fluoroplastic VTs in a retrospective, age-matched, case-control study. We studied the postoperative outcomes and rates of extrusion, infection, otorrhea, tube obstruction, and residual perforation. Methodology Medical records of patients who underwent myringotomy with VT insertion from January 2018 to December 2020 were reviewed. A total of 34 patients met the inclusion criteria, of whom 17 had undergone titanium VT insertion bilaterally (titanium group) and 17 had undergone fluoroplastic VT insertion bilaterally (control group). Both groups were followed up with regular postoperative examinations for 18 months. Results Postoperative complications were categorized as early and late complications. The most common early postoperative complication was early extrusion of VT (six months or less after insertion) (67.6%); this was documented most often in the titanium group. Other early postoperative complications included transient otorrhea (14.7%), tube blockage (8.8%), and recurrent acute otitis media (AOM) (occurring within one month from completion of therapy of AOM episode) (5.9%); these rates were similar in both groups. Late complications were not significantly variable between groups. Tympanic membrane retraction was the most common late complication (8.8%). Conclusions VT insertion is associated with the risk of complications with varying degrees. Although factors affecting the VT complication rates are multiple and various, these rates were not different between groups in this study. However, further studies including larger population samples are needed to statistically confirm these results and their generalizability.

Patients With Nasal Fracture.

Nasal fractures are the most common type of facial bone fracture. Studies conducted globally have shown that nasal fractures represent a significant liability on the health care system due to the frequency of its occurrence among most populations. This study aimed to describe the frequency, etiology, and demographics of nasal fractures in patients presenting to King Fahad General Hospital, Jeddah, Saudi Arabia.This study was a cross-sectional questionnaire-based study and included all patients with a nasal fracture who were referred from the emergency department to the ENT unit of King Fahad General Hospital over a four-month period (December 2018 to March 2019).A total of 130 patients with nasal fracture were included in the present study; most of the included patients were males (83.1%). The mean age of the patients was 28.5 years. The most frequent cause of nasal fracture was physical assault (54.6%), followed by road traffic accidents (20%). Most patients had epistaxis and presented with either active epistaxis at the time of assessment or epistaxis that spontaneously resolved after injury. Patients who had lacerations on the nose were more likely to have a displaced nasal bone (P = 0.016). Isolated nasal bone fractures were more commonly noted in victims of physical assault, whereas combined facial bone fractures were commonly noted in patients involved in road traffic accidents (P < 0.001).Most of the injuries occurred in the city, particularly among foreigners and young adults. Physical assault was reported to be the leading cause of nasal fractures.

Hoarseness of Voice as a Rare Presentation of Tuberculosis: A Case Report Study.

BACKGROUND: Having hoarseness of voice as the first clinical manifestation of tuberculosis is rare. This atypical presentation causes some confusion since other more common conditions, such as laryngeal carcinoma, present similarly and might require more invasive tests to confirm the diagnosis. CASE PRESENTATION: A 38-year-old male presented to the otorhinolaryngology clinic with a four-month history of change in voice. Laryngoscopy demonstrated a right glottic mass, raising suspicion of laryngeal cancer. The computed tomography showed a mass and incidental finding of opacities in lung apices. Chest x-ray demonstrated findings suggestive of tuberculosis. Polymerase chain reaction and culture of sputum samples confirmed the diagnosis and the patient was started on anti-tuberculosis treatment. CONCLUSION: Despite accounting for only 1% of pulmonary tuberculosis cases and having a similar presentation to laryngeal carcinoma, we recommend considering laryngeal tuberculosis when evaluating hoarseness of voice in endemic areas.