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Objective: This study aimed to analyse the computed tomography parameters for effective ventilation in patients with adhesive otitis media. Methods: Twenty-six patients with unilateral adhesive otitis media were included in the study. The patients' temporal bone computed tomography images were retrospectively reviewed. Eustachian tube length and diameter were measured. Mastoid pneumatisation and middle-ear size were evaluated by measuring petroclival and Eustachian tube–tympanic cavity ventilation angles. Results: The average Eustachian tube length was 38.4 mm and 38.9 mm in adhesive otitis media and healthy ears, respectively. The Eustachian tube diameter of the adhesive otitis media ears (1.47 mm) was significantly narrower than that of the healthy ears (1.83 mm). There were no significant differences in the angles between adhesive otitis media and healthy ears. Conclusion: A narrow Eustachian tube diameter was associated with developing adhesive otitis media. Measuring Eustachian tube diameter is simple and can be routinely performed when examining temporal bone computed tomography images for Eustachian tube function evaluation. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinitis is when the nasal passages become inflamed and irritated, causing symptoms like nasal congestion, runny nose, sneezing, and postnasal drip that last for at least 12 weeks. While various medical treatments are available for chronic rhinitis, studies have shown that patients often do not comply with the treatment or report that it is ineffective. Cryotherapy for the nasal mucosa is a surgical option that has shown promise for these patients, with acceptable side effects., Aim: Our goal is to evaluate the existing literature regarding the effectiveness and safety of cryotherapy as a treatment for chronic rhinitis., Methods: We searched four electronic databases for relevant studies. Data were extracted from the included studies after screening procedures. Using the random effect model, we calculated the pooled mean difference (MD) for our continuous outcomes and pooled proportions for categorical outcomes. The I 2 test was used to detect heterogenicity. Randomized controlled trials (RCTs) were assessed for methodological quality using the Cochrane risk of bias assessment tool 2, while observational studies and single-arm studies were assessed using the National Institutes of Health's tools., Results: Our study comprised 21 studies; eighteen were eligible for analysis, with 1663 patients with chronic rhinitis. All of our assessed outcomes showed improvement with cryotherapy from their baseline status. Our pooled MDs for Total Nasal Symptom Score (rTNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and Nasal Obstruction Symptom Evaluation (NOSE) scores were as follows: ( - 3.58, 95% CI [ - 3.80,  - 3.37], p < 0.001), ( - 1.48, 95% CI [ - 1.68,  - 1.27], p < 0.001), and ( - 26.65, 95% CI [ - 33.98,  - 19.31], p < 0.001), respectively. Regarding nasal obstruction and rhinorrhea, cryotherapy showed effectiveness in 61% and 52% of patients in the complete relief subgroup and 26% and 34% in the < 50%-relief subgroup, respectively., Conclusion: We observed significant improvement in our measured outcomes as rTNSS, RQLQ, and NOSE scores compared to the baseline state, demonstrating the cryotherapy's efficacy. This improvement was consistent in all subsequent follow-up periods. However, we need more high-quality RCTs for stronger evidence to be generalized., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Leukotrienes play a significant role in the pathogenesis of adenoid hypertrophy (A.H.). Therefore, we aimed to analyse the role of montelukast, a leukotriene receptor antagonist, alone or in combination with mometasone, a potent local intranasal steroid, for the treatment of A.H., Methods: Participants were children with A.H. were treated with montelukast alone or montelukast and mometasone furoate. The main outcome measures were effect of montelukast on clinical symptoms of A.H. A literature review was conducted using online search engines, Cochrane Library, PubMed, Web of Science and Scopus, for randomized clinical trials assessing children with A.H. treated with montelukast alone or montelukast and mometasone furoate. Seven randomized clinical trials (RCTs) were included with 742 children., Results: Our study reveals that montelukast alone or in combination with intranasal mometasone furoate significantly improves clinical symptoms of adenoid hypertrophy such as snoring, sleeping disturbance, mouth breathing and A/N ratio. Montelukast was superior to placebo in decreasing snoring (SMD = -1.00, 95% CI [-1.52, -0.49]), sleep discomfort (SMD = -1.26, 95% CI [-1.60, -0.93]), A/N ratio (MD = -0.11, 95% CI [-0.14, -0.09]) and mouth breathing (SMD = -1.36, 95% CI [-1.70, -1.02]). No difference was detected between montelukast and mometasone versus mometasone alone in snoring (SMD = -0.21, 95%CI [-0.69, 0.27]); however, the combination group was superior to the mometasone alone in mouth breathing (SMD = -0.46, 95% CI [-0.73, -0.19])., Conclusions: The limitation of studies included a small sample size, with an overall low to medium quality. Thus, further larger, higher-quality RCTs are recommended to provide more substantial evidence., (© 2024 John Wiley & Sons Ltd.)

Pneumocephalus refers to air inside the cranium; however, otogenic pneumocephalus is rarely reported in the literature. The neurological presentations of pneumocephalus include headache, lethargy, confusion, disorientation, and seizure. Here, we have reported a case of a 42-year-old woman with extensive pneumocephalus and cerebrospinal fluid leak secondary to petrous bone cholesteatoma. She presented to the emergency department with sudden headache and left ear discharge. Physical examination revealed watery otorrhea through a hole in the tympanic membrane. Radiological studies demonstrated extensive soft tissue in the left middle ear and mastoid extending to the internal auditory canal. Free intracranial air was observed, and bony destruction was seen in the cochlea, vestibule, and semicircular canals. The patient was managed surgically via the transotic approach and fully recovered. Although otogenic pneumocephalus is rarely encountered in clinical practice, early diagnosis and urgent management are important to prevent fatal complications., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Granulomatosis with polyangiitis (GPA) is a vasculitis that affects respiratory and kidney vessels. It primarily involves the nose and sinuses but can progress systemically. Granulomatosis with polyangiitis causes severe nasal deformities, impacting aesthetics and breathing. Literature focuses on rhinoplasty for saddle nose deformities in non-GPA patients, but its suitability for GPA patients remains uncertain., Aim: Our study aims to assess the effectiveness and safety of rhinoplasty in GPA patients by analyzing the existing literature., Methods: Four databases were searched; 2 reviewers independently screened the retrieved references, then relevant data for our study were extracted. Categorical outcomes were analyzed using pooled proportions and 95% CI. Statistical heterogeneity was assessed using the I2 statistics χ 2 test with a P -value lower than 0.1 indicating heterogeneity., Results: In our systematic review and meta-analysis, we incorporated 16 studies encompassing 136 patients who underwent nasal reconstruction as part of their treatment for GPA. The collective findings indicate a favorable success rate for rhinoplasty, with a pooled ratio of 89% (95% CI: 84%, 95%). The rate of revision surgeries was relatively low, with a pooled rate of 19% (95% CI: 12%, 26%). Furthermore, rhinoplasty demonstrated comparatively lower rates of recurrence (pooled rate: 22%, 95% CI: 3%, 42%) and complications (pooled rate: 12%, 95% CI: 7%, 18%)., Conclusion: Rhinoplasty benefits GPA patients with saddle nose deformity and septal perforation with high success rates and low recurrence, revision, and complication outcomes. However, more research is needed for validation and refinement., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Objectives: Nasal septal deviation is a common health issue that can significantly impact the quality of life. Although nasal septoplasty is commonly performed in Otolaryngology practice, its effectiveness has been questioned. This was the first study to assess disease-specific quality of life in patients undergoing nasal septoplasty with or without turbinoplasty in Saudi Arabia., Methods: This was a prospective observational study of patients undergoing nasal septoplasty with or without turbinoplasty for nasal obstruction due to septal deviation with or without inferior turbinate hypertrophy. Nasal Obstruction Symptom Evaluation (NOSE) scores were collected preoperatively and 3 months postoperatively and were compared with controls., Results: This study involved 200 subjects, including 40 patients in the case group and 160 individuals in the control group. The mean preoperative and 3-month postoperative NOSE scores of the case group were (58.4±23.7 and 15.0±18.6, P <0.001), respectively. However, the postoperatively NOSE score did not reach NOSE score in control group (13.28±8.13, P =0.377). All nasal symptoms statistically and clinically improved postoperatively. There were no significant differences in NOSE score changes among cases preoperatively and postoperatively according to age, sex, or the presence of allergic rhinitis or asthma., Conclusions: Nasal septoplasty with or without turbinoplasty leads to improvements in disease-specific quality of life as assessed by NOSE scores and significantly improved nasal symptoms 3 months after surgery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD.)

Background:  Epistaxis is an acute episode of nasal bleeding commonly caused in children by traumatic injuries in a school setting. It is one of the common ear, nose, and throat emergencies, which should be managed with first-aid measures. To the best of our knowledge, no studies have been conducted among school teachers in the Qassim region of Saudi Arabia regarding this information. This study thus aimed to assess levels of knowledge about first-aid management and control of epistaxis among school teachers in the Qassim region, Saudi Arabia., Materials and Methods:  A cross-sectional study using a validated online questionnaire was distributed via social media platforms. Information was collected regarding sociodemographic characteristics, and eight items assessed participants' knowledge about epistaxis and its management. Univariate, bivariate, and multivariable analyses were conducted to assess the factors associated with good levels of knowledge., Results:  The study had a total of 1,152 participants, of which 69.7% were female. The mean of knowledge was 3.29 (SD=1.39, range: 0-7). Only 19.4% of participants had a good level of knowledge. In multivariate analysis, females and those who had received information on first aid to stop nose-bleeds were significantly associated with good knowledge levels (adjusted odds ratio {AOR}: 1.72, 95% CI: 1.18-2.51, p=0.005; and AOR: 3.38, 95% CI: 2.47-4.64, p<0.001, respectively)., Conclusion:  Less than one-quarter of participants had good knowledge levels. Health education sessions for teachers are highly recommended and should specifically target male teachers., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alanazy et al.)

Introduction: Tracheostomy-related tracheal tear is a serious complication that may follow surgical or percutaneous tracheostomy. Pediatric populations carry a higher risk because of anatomical differences. The aim of this article is to review this condition and to help in its diagnosis and management with the assistance of clinical and radiological findings., Materials and Methods: An English literature review was done using the terms pediatric, tracheostomy, tracheal tear and tracheostomy tube., Result: Two cases reported in the literature met the criteria to be included in the review., Discussion: Tracheostomy-related tracheal tear needs immediate diagnosis as it may lead to life-threatening outcomes, such as pneumothorax, respiratory distress, extensive subcutaneous emphysema and pneumomediastinum. Symptoms and complications of the tear may occur intraoperatively or postoperatively. Gold standard methods for diagnosis include flexible or rigid tracheobronchoscopy, which helps in determining the management plan. The treatment choices for iatrogenic tracheal tears depend on the tear site, size, and extension of the tear and patient's hemodynamic status. Conservative management is sufficient for stable patients with small tears, whereas surgical management is essential for unstable patients and those with large or complicated tears., Conclusion: Tracheostomy-related tracheal tear is a serious rare complication. The pediatric age group carries a higher risk of the condition and its management, either conservative or surgical, depends on airway endoscopy findings and patient's hemodynamic status., Competing Interests: The authors declare no conflict of interest, financial or otherwise., (© 2022 Alenezi et al.)

Introduction: developing and developed countries have a high prevalence of allergic rhinitis (AR). Severe AR has negative impacts on sleep, quality of life, and work performance. The study aimed to identify the patterns of AR among patients attending the ears nose and throat Unit (ENT) clinic at King Saud Hospital, Qassim, Saudi Arabia., Methods: this study was a cross-sectional study conducted at the ENT clinic of King Saudi Hospital, Unaizah City, Qassim region, Saudi Arabia. We examined outpatients diagnosed with AR using an interview questionnaire and clinical examination., Results: the sample included 455 patients. Of these, 23.7% were 21-30 years old, 65.7% had a family history of AR, 57.8% had no general symptoms, 75.6% reported runny nose as the most common nasal symptom, and 35.4% reported no complications. Dust was the most common trigger of AR (82.4%), 49.2% reported allergic symptoms in all seasons, 96% of patients have inferior turbinate hypertrophy, and oral histamine was the most commonly used treatment (33.2%)., Conclusion: perineal AR and inferior turbinate hypertrophy were very common findings comparing to previous studies, further studies to assess the risk factors are highly recommended., Competing Interests: The authors declare no competing interests., (Copyright: Sultan Alanazy et al.)

Objective: To increase awareness and the index of suspicion regarding Grisel's syndrome among otolaryngologists after otolaryngology procedures., Method: We conducted a search of MEDLINE/PubMed for articles published through January 2020 utilizing the following terms: Grisel's syndrome, Grisel syndrome, and atlantoaxial subluxation alone and in combination with other terms like ENT, otolaryngology, head & neck, tonsillectomy, adenoidectomy, adenotonsillectomy, mastoidectomy, tympanoplasty, and tympanomastoidectomy. We included English-language cases that occurred after surgical procedures and contained the following data: age, onset, common presenting symptoms, diagnostic approach, management options, and the presence of complications., Result: We found 39 papers that met our criteria. Most cases occurred after adenotonsillectomy with or without ventilation tube insertion (55.6%). The majority of the affected population was the pediatric age group, and the main presenting symptom was torticollis that presents as early-onset. In regard to management, most of the cases were treated with medical therapy with or without adjunctive measures (e.g., a cervical collar). No neurological complications were recorded except in one case that was treated with no long term sequel., Conclusion: Grisel's syndrome is a rare complication that occurs after otolaryngology procedures and can result in serious neurological complications and death. A high index of suspicion is an important factor for early diagnosis and management to prevent such complications. In most cases, conservative management is successful with a good prognosis., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Nasolabial cysts are rare, non-odontogenic, soft-tissue cysts that develop between the upper lip and nasal vestibule with an overall incidence of 0.7% out of all maxillofacial cysts. The predominant presentation of a nasolabial cyst is a painless localized swelling with varying degrees of nasal obstruction. Several treatment modalities have described in the management of the nasolabial cyst. In this paper, we present a case of a nasolabial cyst in a 44 years old man with discussions of the treatment modalities in the lights of the literature., Case Presentation: We present a case of a nasolabial cyst in a 44-year-old man that slowly increased in size through a period of 3 years, with associated mild pain and nasal obstruction. It had caused a mass effect upon the maxilla, resulting in scalloping. The cyst was excised entirely with no evidence of recurrence at the two months follow up., Conclusions: The nasolabial cyst is a rare soft-tissue cyst. Complete surgical excision using an open approach performed to our case, which considered with the complete endoscopic removal of the best treatment for the nasolabial cysts with a rare recurrence rate.

Phlebectasia describes an anomalous, fusiform dilatation of a vein. In the neck region, the internal and external jugular veins are mostly affected. To our knowledge, this is the first case in Saudi Arabia of internal jugular phlebectasia affecting an adult female. We describe a 61-year-old female with complaints of a neck swelling she noticed 4 years ago. Initially, the swelling increased in size and reached a stable level. It was asymptomatic and only enlarged during Valsalva maneuver. Flexible nasolaryngoscopy and computerized tomography scan showed unremarkable examination. Follow-up after 1 year with US Doppler showed no progression. Internal jugular phlebectasia is a rare disorder which is often diagnosed during childhood. More often than not, it does not cause any significant morbidity. Since it is a benign condition, observation is advised with regular monitoring. For asymptomatic lesions, surgical intervention is recommended if cosmetic or psychologic concerns are present., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Congenital subglottic stenosis (C-SGS) is the third most common congenital anomaly of the larynx. It necessitates tracheotomy in newborns if it causes severe airway obstruction. When the negative impact of tracheostomy cannot be tolerated, as in presence of congenital heart disease requiring further surgical intervention, other alternative procedures are required. This case report is the first of its kind reporting airway expansion in a neonate in the first few hours after birth., Case Report: A 38-week-fetus male was born with multiple congenital heart anomalies and C-SGS of grade III. Single-stage laryngotracheoplasty (SS-LTP) with anterior thyroid alar cartilage (TAC) grafting was performed. Our team was fully aware of all potential risks during SS-LTP procedure in such debilitated patient., Discussion: Treatment of C-SGS in premature neonates is tracheostomy to avoid prolonged intubation. In some cases, tracheostomy is not a good option as in presence of congenital heart disease necessitating urgent further surgical interventions. Among all surgical procedures to augment the airway without tracheostomy, SS-LTP with placement of anterior TAC graft was our choice., Conclusion: This case report demonstrated that SS-LTP with anterior TAC graft can be performed in a newborn with severe C-SGS and congenital heart disease. It can alleviate the need for tracheostomy and avoid unnecessary delay for subsequent cardiac interventions. However, further study is likely needed to make a definitive statement of its safety and efficacy., (© The Author(s) 2015.)