Objectives: To evaluate the diagnostic yield of skin prick test (SPT) and serum total immunoglobulin E (IgE) antibodies level in patients with allergic rhinitis (AR) and the role of nasal provocation test (NPT) for the determination of local allergic rhinitis (LAR) in patients with nonallergic rhinitis (NAR). Methodology: This multi-center study included 1230 patients with clinical manifestations for ≥2 years. Patients were classified according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) and scored according to the quantitative Score for Allergic Rhinitis (SFAR). The SPT and total IgE antibody levels were done for all patients. Patients gave negative SPT underwent NPT, and its result was interpreted using Lebel Symptom Score Scale. Results: The SPT was positive in 77.8% of patients, mostly for grass pollen and dust mites. All patients were sensitive to multiple allergens. Median serum IgE antibody level for total study population was 162 IU/ml. Forty-two patients (3.4%) with negative SPT showed a weak response to NPT, while 231 patients (18.7%) with negative SPT had a high response to NPT and were considered to have LAR. Conclusion: The SPT could discriminate between AR and NAR patients. The NPT could identify LAR in 84.6% of patients with rhinitis among those considered as NAR.

ObjectiveLanguage is almost always affected in fragile X syndrome (FXS), and a delay in language acquisition is one of the first characteristics. The aim of this work was to study the effect of recurrent middle ear infections on the language profile in boys with FXS. Study design: Prospective case series.SettingAcademic Medical Center.Subjects and MethodsThe present study was conducted on 30 males, ranging in age from 4–10 years. They were diagnosed as having a full mutation of DNA. The males were divided into two groups: Group A included 15 children with a history of recurrent middle ear infections more than four times per year during the first 4 years of life, and Group B did not have a history of recurrent middle ear infections during the first 4 years of life. Language assessments were done for all participants using the Standardized Arabic Language test.ResultsResults showed significant delays in language development in children with FXS. Relative strengths in semantics compared to syntax and pragmatics were observed in all boys. The recurrent ear infections of the boys played an important role in the language development delay. The mean of receptive, expressive, and total language age was better and higher among boys without a history of recurrent middle ear infections compared to boys with recurrent middle ear infections.ConclusionRecurrent otitis media in boys with FXS exacerbates the language problems that exist in this syndrome.

Objective:To study the benefit of surgery in different types of isolated concha bullosa.Design:Prospective case series.Setting:Academic Medical Center.Patients:Forty seven symptomatic patients complaining of nasal congestion and block, headache and facial pain having concha bullosa without any other sinonasal finding. Their conchae bullosa were classified as lamellar, bulbous and extensive concha bullosa. They were subjected to endoscopic operation.Main outcome measures:Subjective evaluation of postoperative improvement of sinonasal symptoms and objective pre- and postoperative measurement of total nasal resistance by rhinomanometry.Results:Two patients (25%) of lamellar type showed complete improvement, 5 patients (62.5%) showed partial improvement and 1 patient (12.5%) showed no improvement. Regarding bulbous type, 16 patients (72.72%) showed complete improvement, 6 patients (27.28%) showed partial improvement and no patient (0%) showed no improvement. Regarding extensive type, 15 (88.24%) patients showed complete improvement, 2 patients (11.76%) showed partial improvement and no patient (0%) showed no improvement. The total nasal resistance was 0.25 Pa/cm3 per second postoperatively compared with 0.37 Pa/cm3 per second preoperatively in patients having lamellar type; 0.28 Pa/cm3 per second postoperatively compared with 0.71 Pa/cm3 per second preoperatively in patients having bulbous type; and 0.27 Pa/cm3 per second postoperatively compared with 0.67 Pa/cm3 per second preoperatively in patients having extensive type.Conclusions:With proper patient selection, the operative management is of great value in relieving the sinonasal symptoms in patients having isolated Concha bullosa. This will be more obvious in certain types as bulbous and extensive types especially of large sizes.

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Supracricoid laryngectomy is effective for managing laryngeal cancer. Modification of the technique to permit resection of both arytenoids is possible in select patients.