Background: Incidental parathyroidectomy with subsequent hypoparathyroidism and postoperative hypocalcemia is thought to be one of the common complications of thyroidectomy. Current literature reports wide discrepancy in incidence and risk factors. Objectives: The aim of our study was to evaluate the incidence and risk factors of incidental parathyroidectomy in thyroid surgery. Methods: A retrospective study included 270 patients who had thyroid surgery that was performed over two years from January 2017 to December 2018 in two tertiary care hospitals. Preoperative and postoperative records were assessed. Factors such as gender, diagnosis, type of surgery, and usage of surgical loupes during the procedure were evaluated and were compared to find the association with incidental parathyroidectomy in thyroid surgery. Results: Incidental parathyroidectomy was noticed in 62 (23%) surgical specimens during histopathologic examination. There was no significant association between incidental parathyroidectomy and sex of patient, use of surgical loupes, pathology of thyroid disease, or neck dissection. Conclusion: Although the risk of incidental parathyroidectomy is inevitable, careful dissection and meticulous intraoperative identification of parathyroid gland during thyroidectomy can reduce the incidence of incidental parathyroidectomy, thereby minimizing the risk of postoperative hypoparathyroidism and hypocalcemia.

We present a case of spontaneous cervical, retropharyngeal, and mediastinal emphysema occurring in a previously healthy young male, which is the first described case in Saudi Arabia. The patient was admitted to the ward for observation, monitoring of vital signs, analgesia, and prophylactic antibiotics. The patient was kept under observation for 8 days. During that time, neck pain improved gradually with no episodes of oxygen desaturation or vital sign deterioration. The patient was later discharged with very mild persistent pain. Two weeks after discharge, patient was seen in outpatient clinic and was free of symptoms. Spontaneous subcutaneous emphysema remains a rare presentation encountered in emergency department. The investigations and treatment required for such patients has no consensus between authors. Although most of the reported cases described an uncomplicated course, there is a need for clear guidelines on management protocol.

Objective. This study systematically evaluated and analysed existing evidence regarding the effectiveness of tinnitus retraining therapy (TRT) in treating tinnitus at different follow-up periods and the factors that influence the choice of treatment. Databases reviewed. Medline, OpenAIRE, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Springer Nature Journals, Science Citation Index Expanded, and PubMed. Methods. Data were collected from multiple sources. Studies on adults with tinnitus, experiencing stable, bothersome, and chronic symptoms were included. Participants with significant comorbid conditions potentially influencing TRT outcomes and traumatic injuries were excluded. Results and discussion. A total of 18 articles were included in the qualitative assessment. The studies included encompassed various geographical locations and study settings, with a total of 1712 participants, of whom 1011 underwent TRT and 701 were in the comparison group who were receiving alternative treatments. Gender distribution among participants revealed 1097 males and 596 females. The analysis consistently demonstrated improvements in tinnitus severity and quality of life following TRT, as assessed by Tinnitus Handicap Index, Tinnitus Questionnaire, and Visual Analogue Scale. The meta-analysis revealed significant heterogeneity among studies; however, sensitivity analyses demonstrated consistent results. Additionally, publication bias assessment indicated no systematic bias in effect sizes across studies. Conclusions. These findings suggest that TRT holds promise as an effective intervention for managing tinnitus. Further well-designed randomised controlled trials are warranted to confirm these findings and advance our understanding of TRT’s efficacy in treating tinnitus.