BACKGROUND AND OBJECTIVES: Despite the known benefits of support during chilbirth, most hospitals in Saudi Arabia do not allow a companion during labor. This can be due to cultural beliefs among pr...

Cochlear implants (CIs) are typically activated four weeks after the implantation surgery. This delay between device implantation and activation lengthens the implant process and consequently induces personal and financial burdens for some patients who travel from remote regions to receive the surgery. However, fitting the speech processor and eliminating the waiting period could decrease the indirect cost associated with cochlear implantation. The objective of this study was to assess the impact of an early CI fitting on the overall cost paid by patients and their families aiming to improve future care strategies for patients receiving CIs. This retrospective study was conducted in a tertiary referral center. All patients who received any kind of CI with early fitting of the speech processor were included. The total financial benefit for the patients and their families over the standard activation visit was investigated by assessing the cost of the non-medical expense for one hospital visit. Our results showed that the non-medical cost for each hospital visit associated with cochlear implantation was higher for those who traveled from remote areas: 81 USD for each patient within 200 km of the implantation center and 748.56 USD for each patient farther than 200 km from the implantation center. Using the early fitting approach, some of the financial burden associated with implantation could be alleviated.

Background: The COVID-19 pandemic has had a devastating effect on people across the globe. Its impact on medical students’ education has also been profound. Here, we aimed to comprehensively determine the nature of this impact on their choice of specialty. Method: A cross-sectional study was conducted among medical students in Saudi Arabia during the pandemic from May to June 2021. Data collected from 1984 medical students were analyzed. Results: Of the total sample, 810 (40.8%) respondents reported that the pandemic could affect their choice of specialty, with the majority being in the third year (n = 235). Across all class-years, the most common reason chosen was the inability to explore specialties of interest (n = 539, 66.5%). Another reason cited was the inability to support residency application (n = 175, 21.6%). A majority expressed concerns regarding enrollment in research activities. As high as 17.9% (n = 356) of the respondents admitted that they were trying to avoid specialty with frontline exposure to COVID-19, while 353 students (17.8%) were considering local training programs only. While examining certainty levels, of the 1174 (59.2%) students who reported not being affected by the pandemic, 924 (78.7%) had a weak certainty level. The majority were in the third (54.8%, n = 342) and fourth years (44.8%, n = 212). Conclusions: This study is the first attempt to thoroughly examine the effect of COVID-19 on medical students’ choice of specialty. This effect unfurled in 4 out of 10 surveyed students. Many students reported concerns regarding the inability to explore medical specialties and the inadequacy of obtained clinical knowledge. However, a subsidiary effect was observed among students who were assertive about their choice of specialty. These findings shed new light on the exigency of establishing a career counseling framework designed to meet individual learner needs, thereby galvanizing their morale. Further research could explore the long-term implications of the Saudi Commission for Health Specialties Matching System.

Objective: To evaluate cochlear implantation in Vogt-Koyanagi-Harada syndrome with regard to surgical difficulties and hearing outcomes. Patients: Single case report. Intervention(s): Therapeutic complete electrode insertion during surgery despite evident intra-cochlear fibrosis. Main Outcome Measure(s): Postoperative speech audiometry, categories of auditory performance, and speech intelligibility rating. Results: Vogt-Koyanagi-Harada syndrome is a multisystem autoimmune disease that affects tissues containing melanin. It is characterized by bilateral uveitis with auditory, vestibular, and dermatologic manifestations. Standard treatment comprises aggressive administration of systemic corticosteroids. This report describes the use of bilateral cochlear implants in a 30-year-old Saudi woman who presented with uveitis and was diagnosed with Vogt-Koyanagi-Harada syndrome. She had progressive hearing loss in both ears and experienced minimal improvement with hearing aids. The patient underwent sequential cochlear implantation, which was challenging because it was difficult to insert the electrode in the right ear due to intra-cochlear fibrosis. After more than 5 years of follow-up, she has good hearing in both ears, despite the advancement of ocular disease and recurring visual complaints. Conclusion: This study suggests that patients with Vogt-Koyanagi-Harada syndrome could develop intra-cochlear fibrosis during cochlear implantation due to the autoimmune nature of disease. Moreover, cochlear implantation becomes more difficult with disease advancement. Therefore, it is essential that healthcare professionals consider early detection and prompt treatment of hearing loss in patients with this syndrome.

To evaluate the feasibility and outcomes of cochlear implantation (CI) in infancy. All infants who underwent CI from January 2011 to October 2018 at a tertiary referral center in the Kingdom of Saudi Arabia were retrospectively reviewed. Demographic data, factors associated with early detection, and any surgical difficulties or postoperative complications were extracted from the medical records. The outcome of CI was determined by a speech pathologist. Fifteen patients underwent CI during the study period (9 bilateral and performed simultaneously, 6 unilateral). The round window was difficult to identify in 5 cases. Incomplete electrode insertion because of cochlear ossification secondary to meningitis was documented in one patient. No major postoperative complications were encountered. The average auditory performance score was 7 and the speech intelligibility rating was 5. This study represents the largest national cohort of pediatric patients undergoing CI in infancy. In this series, the surgery was safe and the speech outcome was good. With implementation of the neonatal screening program in the Kingdom of Saudi Arabia, the number of infants undergoing CI is likely to increase in the near future, paving the way for more research in infant CI.