Context:Invasive sinonasal aspergillosis is a silently progressive disease that, left untreated, may invade the adjacent intracranial and intra-orbital compartments incurring serious morbidity.Aim:To evaluate our results of a collaborative surgical management plans for patients with invasive sinonasal aspergillosis with orbitocranial extension.Setting and Design:Retrospective study.Materials and Methods:Between the years 2000 and 2012, 12 patients with Aspergillus sinusitis with orbitocranial extension were treated at our institution. Preoperative CT and MRI scans were done in all cases and cerebral angiography in two patients with subarachnoid hemorrhage (SAH). Surgical combined transcranial and endonasal approaches to the skull base were considered in all patients. Adjuvant antifungals were administered postoperatively with regular clinical and radiologic follow up.Results:All cases had a long history of headache and nasal obstruction (n = 12). Five presented with unilateral proptosis, one with meningitis, one with epilepsy, two with SAH, and one patient presented with trigeminal neuralgia. Craniotomy alone was chosen for the patients with isolated sphenoiditis (n = 2) while a combined cranial and endonasal approach was elected for the other patients (n = 10). Adjuvant antifungal therapy was used for 3-12 months. Patients were followed up clinically and radiologically for an average 36-month period (range = 12-50 months) with disease eradication achieved in eight patients (67%). Two died as consequence to SAH. Follow up also showed that three patients (25%) had sinunasal recurrence requiring evacuation through an endonasal approach.Conclusions:Surgical intervention, with adjuvant antifungal therapy, aiming for safe total removal of the fungal burden, whenever feasible, has a major role in the management of invasive sinonasal aspergillosis with orbitocranial extension with minimal morbidity and good outcomes.

Background: Knowledge of ear health and hearing loss is essential for early intervention and treatment, but the state of public knowledge of such in Jeddah, Saudi Arabia, remains unknown.Objectives: To measure public knowledge of ear health and hearing loss.Method: This cross-sectional study was conducted during August 2018 in Jeddah, Saudi Arabia. An electronic survey questionnaire was distributed to 2372 residents of various districts in Jeddah. The survey was created in 2013 by adopting previously published World Health Organization material, designed to assess knowledge and perception of ear health. All males and females aged 10 years or older living in Jeddah had the chance to participate in this study. A total of 2372 people participated. Percentages mean ± standard deviation, one-way analysis of variance (ANOVAs) and independent t-tests were applied to determine the significant difference. p-values of 0.05 or less were considered significant.Results: The overall mean number of correct responses on the survey’s true/false questionnaire was 10.66 ± 1.92 out of 14. Female participants gave a higher mean number of correct answers than did male participants (10.73 ± 2.03 vs. 10.54 ± 2.03, respectively). Participants with a family history of hearing loss gave a higher mean number of correct answers compared with participants who reported a negative family history (10.89 ± 1.82 vs. 10.53 ± 1.97, respectively).Conclusion: Overall awareness of ear health and hearing loss management is fair. However, the results indicate a need for more integrated educational materials to be made available both to the general population as well as to hearing loss individuals and their families.

Patient: Male, 52Final Diagnosis: Spindle-cell carcinoma of the maxillary sinusSymptoms: —Medication:—Clinical Procedure: Functional endoscopic sinus surgery • total maxillectomySpecialty: OtolaryngologyObjective:Rare diseaseBackground:Carcinosarcomas, also known as spindle cell carcinomas, are rare and highly aggressive tumors characterized by dual histologic differentiation of squamous cell and mesenchymal cell tumors. Occurrence of carcinosarcoma in maxillary sinus is very rare, with only 11 cases reported since 1957. The small number of reported cases creates an obstacle to the increased understanding of the behavior, prognosis, and therapeutic management of this tumor.Case Report:A 52-year-old man presented with a 2-month history of right nasal obstruction. Computed tomography (CT) and magnetic resonance imaging (MRI) showed opacified right frontal, sphenoid, ethmoid, and maxillary sinuses with soft tissue density and expansion of the mass with erosion of the right lateral maxillary wall. Functional endoscopic sinus surgery (FESS) was done and histopathology revealed multiple fragments of nasal mucosa lined by stratified hyperplastic squamous epithelium with an increased degree of dysplasia and pleomorphism and a second spindle cell high-grade neoplastic growth with bizarre giant cells and abnormal mitotic figures. Consistent with carcinosarcoma, immunohistochemistry showed strong positive staining for vimentin in the spindle cell component and strong positive staining for cytokeratin markers in the epithelial cell component. The patient underwent right total maxillectomy with postoperative chemoradiation therapy and survived for 1 year.Conclusions:Carcinosarcoma of the maxillary sinus is a rare disease with non-specific symptoms; it usually presents in the advance stage and is associated with poor patient prognosis. This case indicates that surgical intervention with postoperative chemoradiotherapy improves patient prognosis and should be considered as the standard therapeutic modality.

Abstract.[Purpose] The aim of this clinical study was to determine whether the deep head hanging maneuver (DH maneuver) is an efficacious treatment maneuver for anterior canalithiasis. [Subjects and Methods] Twenty-two adult patients were recruited. Their ages ranged from 41-63 years, with an average age of 53 years. Ten patients were male, and twelve were female. Patients were judged to be "clear" of anterior canalithiasis when there was no nystagmus or subjective vertigo elicited by diagnostic positioning at a follow-up appointment. This study method was supported by other research using the same method.[Results] The results indicated that 77.3% of the twentytwo patients were clear of anterior canalithiasis after one treatment session, with another 18.1% clear after a second treatment session. The remaining 4.5% required a third treatment session.[Conclusion] The deep head hanging maneuver was demonstrated to be a useful treatment in patients presenting with possible anterior canalithiasis. Approximately 95% of the patients were clear after one or two deep head hanging maneuver sessions.