initial symptoms and signs of RPH in these patients, and the airway management that was used to t... more initial symptoms and signs of RPH in these patients, and the airway management that was used to treat the patients. There are less than 100 cases reported in the literature. 1 Case Report. A 63-year-old man known with atrial fibrillation on anticoagulation therapy was presented to the emergency department with progressive dysphagia and odynophagia. On physical examination, his temperature was 37 0 C, oxygen saturation was 93% on 2 liters of oxygen, and other vital signs were normal. Examination of the neck revealed diffuse swelling, bruising, and tenderness all over. Flexible laryngoscopy revealed large lateral and posterior pharyngeal wall swelling. His initial blood investigations showed normal complete blood count (CBC) and international normalized ratio (INR) of 9.8. X-ray revealed a soft tissue of the neck that demonstrated a retropharyngeal swelling compromising the airway (Figure 1). The patient was then had fiber optic awake oral intubation and gradual reversal of the coagulopathy was achieved with fresh frozen plasma and vitamin-K after being transferred to the intensive care unit. Subsequently, the patient had a tracheostomy after he failed extubation, 3 weeks later the hematoma completely resolved and the patient sent home in good condition after he was been successfully decanualted.
Background: Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstructio... more Background: Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstruction. Essentially there are two approaches: external and endoscopic. Several modalities are used in endoscopic DCR; all aiming to improve success rate, reduce complications, and shorten operative time. Both kerrison punch and drill are widely used in endoscopic DCR with non-conclusive knowledge about differences in operative details as well as on the outcome. The aim of this study is to compare between powered (drill) and non-powered (kerrison punch) DCR to clarify the superiority of one over the other. Methods: A retrospective chart review of 59 patients who underwent endoscopic DCR procedure at our institution from June 2013 until July 2014 (34 kerrison punch and 32 powered drill). Operative details, surgical outcome and complications were compared between both groups.
Parathyroidectomy is considered the definitive cure for primary hyperparathyroidism due to a sing... more 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.
Background: Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstructio... more Background: Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstruction. Essentially there are two approaches: external and endoscopic. Several modalities are used in endoscopic DCR; all aiming to improve success rate, reduce complications, and shorten operative time. Both kerrison punch and drill are widely used in endoscopic DCR with non-conclusive knowledge about differences in operative details as well as on the outcome. The aim of this study is to compare between powered (drill) and non-powered (kerrison punch) DCR to clarify the superiority of one over the other. Methods: A retrospective chart review of 59 patients who underwent endoscopic DCR procedure at our institution from June 2013 until July 2014 (34 kerrison punch and 32 powered drill). Operative details, surgical outcome and complications were compared between both groups.
Objectives: An Otolaryngology—Head and Neck Surgery clinic is an integral part of any modern tert... more Objectives: An Otolaryngology—Head and Neck Surgery clinic is an integral part of any modern tertiary center outpatient department. The objective of this article is to present our experience in developing a local electronic Makkah Otolaryngology—Head and Neck DATABASE (MO-HND) and provide a roadmap for the development of Otolaryngology—Head and Neck Surgery clinics in other tertiary centers. Methods: This is a prospective audit of all patients attending our clinic over 3 months period (July to September 2014). The data were recorded using our MO-HND. Results: A total of 1178 patients were included. The mean age was 27.7 ± 6.7 years. Participants included 586 males (49.7%) and 592 females (50.3%). There were 1139 (96.6%) Saudi and 39 (3.4%) non-Saudi patients. The specialist clinic undertook most of the workload (66%). The majority of surgery bookings (94%) were carried out through a consultant clinic. Of all participants, 80% were diagnosed with general ENT conditions, 21% underwent a procedure in the clinic, and 29% required further investigations. The surgical conversion rate was 16.3%. Conclusion: Electronic DATABASES have become important tools for improving medical services. Primary and secondary level medical centers and hospitals should increase their role in alleviating pressure from tertiary and qua-ternary level hospitals. In turn, a model concentrated on subspecialty clinics and services should be developed.
Background: The congregation of so many people during Umrah and Hajj seasons from different parts... more Background: The congregation of so many people during Umrah and Hajj seasons from different parts of the world in unavoidably overcrowded conditions within a confined area for a defined period of time presents many public health challenges, and health risks are greatly increased with potential for both local and international consequences. The human nasopharynx and nares are densely colonized by a broad variety of microorganisms including commensal bacteria as well as potentially pathogenic bacteria (PPB) mainly: Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Neisseria meningitidis, Moraxella catarrhalis and Haemophilus influenzae. Aims of the study: determination of the prevalence of Staphylococcus aureus nasal carriage in Umrah visitors and Pilgrims before and after performing Umrah and Hajj, determination the antibiotic resistance patterns of Staphylococcus aureus isolates before and after Umrah and Hajj seasons and determination of the prevalence of (MR...
To examine the possible implications of the 2009 H1N1 influenza A (pandemic flu, pH1N1) on this r... more To examine the possible implications of the 2009 H1N1 influenza A (pandemic flu, pH1N1) on this religious gathering and provide a response plan for the Otolaryngology, Head and Neck (ENT) clinic during the Hajj pilgrimage. This study was conducted between November and December 2009. All patients presenting to the ENT clinic at Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia were recorded. Descriptive statistics were used to analyze the data. A total of 3087 patients were included (mean age 35+/-7.8 years), of which, 2114 were males (68.5%), and 973 females (31.5%, male to female gender ratio=2.17:1). Among them, 1467 patients (47.5%) were Hajji and 1620 patients (52.5%) were non-Hajji. Saudi patients comprised 1602 (51.8%), while non-Saudi's comprised 1485 (48.2%). Upper respiratory tract infections (URTI) including the diagnosis of pharyngitis, viral URTI, pH1N1, and tonsillitis represented (92%) of total diagnoses. Of these, only 77 suspected pH1N1 cases (2.5%) we...
To present our experience in the development of our own local electronic Makkah Ear, Nose, and Th... more To present our experience in the development of our own local electronic Makkah Ear, Nose, and Throat (ENT) - Hajj Database, and provide a road map for the ENT Clinic during Hajj. This prospective cohort study was conducted between November 28 and December 10, 2008 (1429 Hijri Hajj season). All patients presenting to the ENT Clinic at Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia were recorded. A total of 1047 patients were included. The mean age was 26 +/- 6.4 years. There were 663 males (63.3%), and 384 females (36.7%). Among them, 361 patients (34.5%) were Hajjis, and 686 patients (65.5%) were non-Hajji. The total number of Saudi patients were 716 (68.4%), and non-Saudi's were 331 (31.6%). A total of 78.5% of the patients presented during the 12 hours shift (12 PM-12 AM). Upper respiratory tract infections (URTI) including the diagnosis of pharyngitis, viral URTI, and tonsillitis represented 85.2% of the total diagnosis. Twenty-four patients were admitted, with...
Retropharyngeal hematomas (RPH) are relatively rare. They are clinically important because of the... more Retropharyngeal hematomas (RPH) are relatively rare. They are clinically important because of the close proximity to the upper airway, which can be life threatening and requires immediate intervention. We report one patient who presented with RPH due to anticoagulation that resulted in airway obstruction and subsequent intubations. We outline the normal anatomy of the retropharyngeal space, the pathogenesis and treatment of RPH, with related literature review.
Parathyroidectomy is considered the definitive cure for primary hyperparathyroidism due to a sing... more 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.
To develop a valid and reliable assessment tool for endoscopic sinus surgery (ESS). Data were col... more To develop a valid and reliable assessment tool for endoscopic sinus surgery (ESS). Data were collected prospectively in an observational study through evaluations at two tertiary academic institutions, i.e. St. Paul's Sinus Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada, and King Fahd Medical City, Riyadh, Saudi Arabia, from December 2006 to December 2009. A 2-page evaluation form was developed in conjunction with the Objective Assessment of Technical Skills Surgery (OSATS) evaluation form developed by Reznick et al in Toronto to assess residents' surgical skills. A Likert scale (1-5 where 5 = excellent) was used for evaluations. The Global Rating of Endoscopic Surgical Skills (GRESS) evaluation instrument was designed with input from academic otolaryngologists, fellowship-trained rhinologists, and experts in medical education. The experts' comments were incorporated, establishing face and content validity. Residents from various levels of training...
To evaluate the efficacy of suction drainage in preventing postoperative hematoma formation in th... more To evaluate the efficacy of suction drainage in preventing postoperative hematoma formation in thyroid surgery. We conducted a meta-analysis using only randomized controlled trials in which the incidence of post-thyroidectomy hematoma was compared directly in patients with and without suction drains (eight studies since 1980; N = 944). The odds ratio (OR) with respective confidence intervals (CIs) using the fixed effects model was reported. We used an OR < 1.0 as being in favour of treatment (ie, the use of suction drains). In our meta-analysis, there was no statistically significant difference between the rates of post-thyroidectomy hematoma whether or not suction drains were used when the results were combined using a fixed effects model (OR 1.04, 95% CI-1.93), with p = .90. In this comparison, a fixed effects model was used rather than a random effects model because there was no statistically significant heterogeneity (chi2 = 6.26, p = .28). We conclude that the use of suction...
Tuberculosis (TB) of the paraspinal muscles is a rare clinical entity. We present a case of an 18... more Tuberculosis (TB) of the paraspinal muscles is a rare clinical entity. We present a case of an 18-year-old, Saudi male patient presenting with the clinical picture of a paraspinal mass that turned out to be paraspinal TB. It originated from the paraspinal tissues and muscles, and invaded the C6 and C7 vertebrae. Initially, it was highly suspicious for malignancy. A biopsy confirmed the diagnosis of TB, and the patient was treated successfully with anti-TB therapy. It is important to be aware that paraspinal TB can mimic malignancy.
initial symptoms and signs of RPH in these patients, and the airway management that was used to t... more initial symptoms and signs of RPH in these patients, and the airway management that was used to treat the patients. There are less than 100 cases reported in the literature. 1 Case Report. A 63-year-old man known with atrial fibrillation on anticoagulation therapy was presented to the emergency department with progressive dysphagia and odynophagia. On physical examination, his temperature was 37 0 C, oxygen saturation was 93% on 2 liters of oxygen, and other vital signs were normal. Examination of the neck revealed diffuse swelling, bruising, and tenderness all over. Flexible laryngoscopy revealed large lateral and posterior pharyngeal wall swelling. His initial blood investigations showed normal complete blood count (CBC) and international normalized ratio (INR) of 9.8. X-ray revealed a soft tissue of the neck that demonstrated a retropharyngeal swelling compromising the airway (Figure 1). The patient was then had fiber optic awake oral intubation and gradual reversal of the coagulopathy was achieved with fresh frozen plasma and vitamin-K after being transferred to the intensive care unit. Subsequently, the patient had a tracheostomy after he failed extubation, 3 weeks later the hematoma completely resolved and the patient sent home in good condition after he was been successfully decanualted.
Background: Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstructio... more Background: Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstruction. Essentially there are two approaches: external and endoscopic. Several modalities are used in endoscopic DCR; all aiming to improve success rate, reduce complications, and shorten operative time. Both kerrison punch and drill are widely used in endoscopic DCR with non-conclusive knowledge about differences in operative details as well as on the outcome. The aim of this study is to compare between powered (drill) and non-powered (kerrison punch) DCR to clarify the superiority of one over the other. Methods: A retrospective chart review of 59 patients who underwent endoscopic DCR procedure at our institution from June 2013 until July 2014 (34 kerrison punch and 32 powered drill). Operative details, surgical outcome and complications were compared between both groups.
Parathyroidectomy is considered the definitive cure for primary hyperparathyroidism due to a sing... more 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.
Background: Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstructio... more Background: Dacrocystorhinostomy (DCR) is an operation used to treat nasolacrimal duct obstruction. Essentially there are two approaches: external and endoscopic. Several modalities are used in endoscopic DCR; all aiming to improve success rate, reduce complications, and shorten operative time. Both kerrison punch and drill are widely used in endoscopic DCR with non-conclusive knowledge about differences in operative details as well as on the outcome. The aim of this study is to compare between powered (drill) and non-powered (kerrison punch) DCR to clarify the superiority of one over the other. Methods: A retrospective chart review of 59 patients who underwent endoscopic DCR procedure at our institution from June 2013 until July 2014 (34 kerrison punch and 32 powered drill). Operative details, surgical outcome and complications were compared between both groups.
Objectives: An Otolaryngology—Head and Neck Surgery clinic is an integral part of any modern tert... more Objectives: An Otolaryngology—Head and Neck Surgery clinic is an integral part of any modern tertiary center outpatient department. The objective of this article is to present our experience in developing a local electronic Makkah Otolaryngology—Head and Neck DATABASE (MO-HND) and provide a roadmap for the development of Otolaryngology—Head and Neck Surgery clinics in other tertiary centers. Methods: This is a prospective audit of all patients attending our clinic over 3 months period (July to September 2014). The data were recorded using our MO-HND. Results: A total of 1178 patients were included. The mean age was 27.7 ± 6.7 years. Participants included 586 males (49.7%) and 592 females (50.3%). There were 1139 (96.6%) Saudi and 39 (3.4%) non-Saudi patients. The specialist clinic undertook most of the workload (66%). The majority of surgery bookings (94%) were carried out through a consultant clinic. Of all participants, 80% were diagnosed with general ENT conditions, 21% underwent a procedure in the clinic, and 29% required further investigations. The surgical conversion rate was 16.3%. Conclusion: Electronic DATABASES have become important tools for improving medical services. Primary and secondary level medical centers and hospitals should increase their role in alleviating pressure from tertiary and qua-ternary level hospitals. In turn, a model concentrated on subspecialty clinics and services should be developed.
Background: The congregation of so many people during Umrah and Hajj seasons from different parts... more Background: The congregation of so many people during Umrah and Hajj seasons from different parts of the world in unavoidably overcrowded conditions within a confined area for a defined period of time presents many public health challenges, and health risks are greatly increased with potential for both local and international consequences. The human nasopharynx and nares are densely colonized by a broad variety of microorganisms including commensal bacteria as well as potentially pathogenic bacteria (PPB) mainly: Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Neisseria meningitidis, Moraxella catarrhalis and Haemophilus influenzae. Aims of the study: determination of the prevalence of Staphylococcus aureus nasal carriage in Umrah visitors and Pilgrims before and after performing Umrah and Hajj, determination the antibiotic resistance patterns of Staphylococcus aureus isolates before and after Umrah and Hajj seasons and determination of the prevalence of (MR...
To examine the possible implications of the 2009 H1N1 influenza A (pandemic flu, pH1N1) on this r... more To examine the possible implications of the 2009 H1N1 influenza A (pandemic flu, pH1N1) on this religious gathering and provide a response plan for the Otolaryngology, Head and Neck (ENT) clinic during the Hajj pilgrimage. This study was conducted between November and December 2009. All patients presenting to the ENT clinic at Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia were recorded. Descriptive statistics were used to analyze the data. A total of 3087 patients were included (mean age 35+/-7.8 years), of which, 2114 were males (68.5%), and 973 females (31.5%, male to female gender ratio=2.17:1). Among them, 1467 patients (47.5%) were Hajji and 1620 patients (52.5%) were non-Hajji. Saudi patients comprised 1602 (51.8%), while non-Saudi's comprised 1485 (48.2%). Upper respiratory tract infections (URTI) including the diagnosis of pharyngitis, viral URTI, pH1N1, and tonsillitis represented (92%) of total diagnoses. Of these, only 77 suspected pH1N1 cases (2.5%) we...
To present our experience in the development of our own local electronic Makkah Ear, Nose, and Th... more To present our experience in the development of our own local electronic Makkah Ear, Nose, and Throat (ENT) - Hajj Database, and provide a road map for the ENT Clinic during Hajj. This prospective cohort study was conducted between November 28 and December 10, 2008 (1429 Hijri Hajj season). All patients presenting to the ENT Clinic at Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia were recorded. A total of 1047 patients were included. The mean age was 26 +/- 6.4 years. There were 663 males (63.3%), and 384 females (36.7%). Among them, 361 patients (34.5%) were Hajjis, and 686 patients (65.5%) were non-Hajji. The total number of Saudi patients were 716 (68.4%), and non-Saudi's were 331 (31.6%). A total of 78.5% of the patients presented during the 12 hours shift (12 PM-12 AM). Upper respiratory tract infections (URTI) including the diagnosis of pharyngitis, viral URTI, and tonsillitis represented 85.2% of the total diagnosis. Twenty-four patients were admitted, with...
Retropharyngeal hematomas (RPH) are relatively rare. They are clinically important because of the... more Retropharyngeal hematomas (RPH) are relatively rare. They are clinically important because of the close proximity to the upper airway, which can be life threatening and requires immediate intervention. We report one patient who presented with RPH due to anticoagulation that resulted in airway obstruction and subsequent intubations. We outline the normal anatomy of the retropharyngeal space, the pathogenesis and treatment of RPH, with related literature review.
Parathyroidectomy is considered the definitive cure for primary hyperparathyroidism due to a sing... more 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.
To develop a valid and reliable assessment tool for endoscopic sinus surgery (ESS). Data were col... more To develop a valid and reliable assessment tool for endoscopic sinus surgery (ESS). Data were collected prospectively in an observational study through evaluations at two tertiary academic institutions, i.e. St. Paul's Sinus Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada, and King Fahd Medical City, Riyadh, Saudi Arabia, from December 2006 to December 2009. A 2-page evaluation form was developed in conjunction with the Objective Assessment of Technical Skills Surgery (OSATS) evaluation form developed by Reznick et al in Toronto to assess residents' surgical skills. A Likert scale (1-5 where 5 = excellent) was used for evaluations. The Global Rating of Endoscopic Surgical Skills (GRESS) evaluation instrument was designed with input from academic otolaryngologists, fellowship-trained rhinologists, and experts in medical education. The experts' comments were incorporated, establishing face and content validity. Residents from various levels of training...
To evaluate the efficacy of suction drainage in preventing postoperative hematoma formation in th... more To evaluate the efficacy of suction drainage in preventing postoperative hematoma formation in thyroid surgery. We conducted a meta-analysis using only randomized controlled trials in which the incidence of post-thyroidectomy hematoma was compared directly in patients with and without suction drains (eight studies since 1980; N = 944). The odds ratio (OR) with respective confidence intervals (CIs) using the fixed effects model was reported. We used an OR < 1.0 as being in favour of treatment (ie, the use of suction drains). In our meta-analysis, there was no statistically significant difference between the rates of post-thyroidectomy hematoma whether or not suction drains were used when the results were combined using a fixed effects model (OR 1.04, 95% CI-1.93), with p = .90. In this comparison, a fixed effects model was used rather than a random effects model because there was no statistically significant heterogeneity (chi2 = 6.26, p = .28). We conclude that the use of suction...
Tuberculosis (TB) of the paraspinal muscles is a rare clinical entity. We present a case of an 18... more Tuberculosis (TB) of the paraspinal muscles is a rare clinical entity. We present a case of an 18-year-old, Saudi male patient presenting with the clinical picture of a paraspinal mass that turned out to be paraspinal TB. It originated from the paraspinal tissues and muscles, and invaded the C6 and C7 vertebrae. Initially, it was highly suspicious for malignancy. A biopsy confirmed the diagnosis of TB, and the patient was treated successfully with anti-TB therapy. It is important to be aware that paraspinal TB can mimic malignancy.
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Papers by Ameen Alherabi