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Identification of Nasal Irrigation Bottle Contamination in Post Sinonasal Surgery

Zahedi FD, Asmi NH, Husain S, Gendeh BS

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1837-1842.
PMID: 31763256 DOI: 10.1007/s12070-017-1219-x

Nasal irrigation is an effective and cheap method in managing post sinonasal surgery patients. It works by improving ciliary clearance and performing mechanical debridement of the thick crust, decreasing mucosal edema and reducing the inflammatory mediators. Presence of nasal irrigation bottle contamination and its effect on patients have been studied. The aim of this study is to prospectively identify the risk of contamination in the nasal irrigation bottle, fluid from the bottle and to correlate with endoscopic findings from the patients who had underwent sinonasal surgery. Swabs will be taken from the nasal irrigation bottle and patient's middle meatus before the surgery and at each post surgery visits (2 and 4 weeks). Patients will be advised to irrigate their nose three times per day post sinonasal surgery. During endoscopic examination of the patient's nasal cavity at 2 and 4 weeks, any evidence of infection will be noted and documented. Additionally, a swab of fluid irrigated from the nasal cavity collected during the clinic follow-ups will also be taken. The specimens will be sent to the Microbiology laboratory for standard culture and sensitivity test. A total of 27 patients completed the study and were divided into case (n = 15) and control (n = 12) groups. The CFU (colony-forming unit) value of the bacteria cultured from the nasal cavity and the nasal irrigation bottle was statistically significantly (P = 0.00) increased from the baseline to the second week follow-up in both groups but not from the second week to the fourth week follow-up. The majority of the swabs from the nasal cavity of the patients and the nasal irrigation bottles were positively cultured for Pseudomonas sp. group. Other groups of bacteria that were cultured were Enterobacter sp., Coagulase Negative Staphylococcus (CONS) and Klebsiella sp. Endoscopically, there was no clinical evidence of infection found in the nasal cavity of the patients. The nasal irrigation bottle that was used in the post sinonasal surgery treatment and for alleviation of symptoms of sinonasal diseases was found to have bacterial contamination from the swabs taken from the bottle. However, despite this finding there was not clinical evidence of infection noted from the nasal endoscopic examination. A simple and effective method of cleaning the bottle would be helpful to reduce the bacterial contamination for this useful treatment method.
Fulltext Functional outcome evaluation of septorhinoplasty for nasal obstruction

Zahedi FD, Husain S, Gendeh BS

Indian J Otolaryngol Head Neck Surg, 2016 Jun;68(2):218-23.
PMID: 27340641 DOI: 10.1007/s12070-015-0899-3

A prospective single blinded interventional study was held in Otorhinolaryngology Clinic, Universiti Kebangsaan Malaysia Medical Centre in August 2010 until November 2012 to evaluate the functional outcome of septorhinoplasty objectively and subjectively. Objective assessment was done using rhinomanometry and subjective assessment using Nasal Obstruction Symptoms Evaluation (NOSE) scale and Health-Related Quality of Life Questionnaires (HRQOL) in Rhino Surgery. All measurements were taken preoperatively and 3 months postoperatively. A total of 29 patients were enrolled and completed the study. Septorhinoplasty was commonly performed in Malays and Indians and rare amongst Chinese, with age ranged from 18 to 54 years. Majority had no history of trauma. Twisted nose was the most common external nose abnormality followed by crooked and saddle nose. All patients had internal valve insufficiency. There were significant improvement of the total and of all the parameters in the NOSE scale post septorhinoplasty (p 0.05). Significant correlations were noted in the improvement between the two subjective assessments (NOSE scale and HRQOL score). However, there was no significant correlation in the improvement between the subjective (NOSE scale and HRQOL score) with objective (rhinomanometry score) assessments. Septorhinoplasty improves the nasal airflow and quality of life of patients with nasal obstruction.
Study site: Otorhinolaryngology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fulltext Ectopic Esthesioneuroblastoma of the Sphenoclivus: A Rare Entity

Zahedi FD, Gendeh BS, Husain S, Kumar R, Kew TY

Indian J Otolaryngol Head Neck Surg, 2017 Mar;69(1):125-129.
PMID: 28239593 DOI: 10.1007/s12070-016-0978-0

Esthesioneuroblastoma is a rare malignant neoplasm of oflactory neuroepithelium and usually located at the olfactory cleft at superior nasal cavity. Ectopic localization of esthesioneuroblastoma is even rarer and usually posed with a diagnostic dilemma and delay in the diagnosis and management, We report a rare case of ectopic esthesioneuroblastoma of the sphenoclivus with the presentation of intermittent unilateral epistaxis, intermittent intractable headache without anosmia. Nasal endoscopy findings showed a pulsatile mass at the anterior face of the sphenoid sinus with extension posteriorly towards the clivus region and occupying the floor of the sphenoid sinus. Endonasal transclival endoscopic excision of tumour was performed which involved otorhinolaryngology surgeon and neurosurgeon with intraoperative navigation imaging and frozen section. The histopathological findings was esthesioneuroblastoma. Due to its rarity and unusual presentation, the diagnosis of ectopic esthesioneuroblastoma is difficult and can be misdiagnosed with the other type of malignancy. Therefore, the histopathological result is important in confirming the type of tumour and can lead to the next step of management.
A review of smell and taste dysfunction in COVID-19 patients

Wong DKC, Gendeh HS, Thong HK, Lum SG, Gendeh BS, Saim A, et al.

Med J Malaysia, 2020 09;75(5):574-581.
PMID: 32918429

INTRODUCTION: Multiple anecdotal reports suggest that smell and taste loss were early subclinical symptoms of COVID-19 patients. The objective of this review was to identify the incidence of smell and taste dysfunction in COVID-19, determine the onset of their symptoms and the risk factors of anosmia, hyposmia, ageusia or dysgeusia for COVID-19 infection.
METHODS: We searched the PubMed and Google Scholar on 15th May 2020, with search terms including SARS-COV-2, coronavirus, COVID-19, hyposmia, anosmia, ageusia and dysgeusia. The articles included were cross sectional studies, observational studies and retrospective or prospective audits, letters to editor and short communications that included a study of a cohort of patients. Case reports, case-series and interventional studies were excluded.
DISCUSSION: A total of 16 studies were selected. Incidence of smell and taste dysfunction was higher in Europe (34 to 86%), North America (19 to 71%) and the Middle East (36 to 98%) when compared to the Asian cohorts (11 to 15%) in COVID-19 positive patients. Incidence of smell and taste dysfunction in COVID-19 negative patients was low in comparison (12 to 27%). Total incidence of smell and taste dysfunction from COVID-19 positive and negative patients from seven studies was 20% and 10% respectively. Symptoms may appear just before, concomitantly, or immediately after the onset of the usual symptoms. Occurs predominantly in females. When occurring immediately after the onset of the usual symptoms, the median time of onset was 3.3 to 4.4 days. Symptoms persist for a period of seven to 14 days. Patients with smell and taste dysfunction were reported to have a six to ten-fold odds of having COVID-19.
CONCLUSION: Smell and taste dysfunction has a high incidence in Europe, North America, and the Middle East. The incidence was lower in the Asia region. It is a strong risk factor for COVID-19. It may be the only symptom and should be added to the list of symptoms when screening for COVID- 19.
Fulltext Skin prick test reactivity to common airborne pollens and molds in allergic rhinitis patients

Wan Ishlah L, Gendeh BS

Med J Malaysia, 2005 Jun;60(2):194-200.
PMID: 16114160 MyJurnal

Allergic rhinitis is the single most common chronic allergic disease affecting an estimated four million people in Malaysia. House dust mites, grass pollens and fungal spores play has been identified to play a major role in the pathogenesis of allergic rhinitis. However, sensitization to pollen and spores in Malaysia is not well documented. On the basis of the results of an aerobiological survey of the common mold spores and pollens in the Klang Valley, twelve local extracts of molds and two local extracts of grass pollens were prepared by the Institute for Medical Research for this study. The study evaluated the prevalence of skin prick test (SPT) reactivity to the extracts of those airborne molds and pollens in allergic rhinitis patients in the Klang Valley. A total of 85 allergic rhinitis patients were recruited. All molds and grass pollens extracts tested, elicited positive response to SPT. Among the molds extracts, Fusarium was observed to have the highest prevalence of SPT reactivity (23.5%), followed by Aspergillus flavum (21.2%), Dreselera orysae (18.8%), Alternaria sp (17.6%), Curvularis eragrostidis (17.6%), Penicillium oxa (16.5%), Pestolotriopsis gtuepini (16.5%), Rhizopphus arrhi (16.5%), Aspergilluls nigus (15.3%). Penicillium choy (12.9%), Aspergillus fumigatus (11.8%), and Cladosporium sp (4.7%). In the grass pollen, the SPT reactivity to Ischaemum and Enilia is 14.1% and 5.9% respectively. However, the prevalence of SPT reactivity was not influenced by the age, sex, ethnicity, symptomatology and concurrent allergic condition. We have documented the prevalence of skin prick test reactivity to common molds and grass pollens in the Klang valley, which is comparable to the neighboring countries. Its prevalence in our allergic rhinitis patients suggests that it has a role in pathogenesis of allergic diseases. A larger representative sample involving multi-centric centers in Malaysia should be encouraged in the near future.

Study site: ENT
Department, Pusat Perubatan University Kebangsaan Malaysia
(PPUKM)
Fulltext The association of concha bullosa and deviated nasal septum with chronic rhinosinusitis in functional endoscopic sinus surgery patients

Vincent TE, Gendeh BS

Med J Malaysia, 2010 Jun;65(2):108-11.
PMID: 23756792 MyJurnal

Chronic rhinosinusitis (CRS) remains a prevalent disease and a major cause of morbidity for many patients and functional endoscopic sinus surgery (FESS) is the gold standard for the treatment of CRS. Many factors contribute to the development of CRS, among others nasal anatomic variation. The authors aim to study the association of concha bullosa and deviated nasal septum with CRS patients requiring FESS amongst the diversified multiethnic Malaysian race. The records of 137 patients with CRS who had undergone FESS between March 2002 and October 2006 at the Department of Otorhinolaryngology, Head and Neck Surgery of the Hospital Universiti Kebangsaan Malaysia (HUKM), Kuala Lumpur were retrospectively reviewed. The data revealed that deviated nasal septum (DNS) and concha bullosa (CB) were the two commonest anatomical variations in the nasal cavity. In this study, CB was statistically significant amongst the females and in the Chinese and Indian ethnic groups. DNS is also prevalent but has no significant statistical relationship with sex, age, ethnic group in the local context. CB and DNS are coincidental variations and this study disprove that DNS is associated with CB in its development and pathogenesis of CRS. The mere presence of both these conditions also does not predispose the patients to CRS in the adjacent paranasal sinuses.
Fulltext Sino-nasal hemangiopericytoma--a rare tumor

Vikneswaran T, Gendeh BS, Tan VES, Phang KS, Saravanan K

Med J Malaysia, 2005 Oct;60(4):485-8.
PMID: 16570712

Hemangiopericytoma is a very rare angiogenic tumor. In the nasal cavity, it can be considered malignant. It occurs in various parts of the body but those in the nasal cavity account for only 5% of total cases. Less than 200 cases have been reported worldwide involving the nose and paranasal sinuses. Due to its rarity a proper line of management has not been established to tackle this tumour. This article highlights two cases of hemangiopericytoma (HPC), one in an adult and the other in a child, presenting as an intranasal mass.
Fulltext Late Temporal Lobe Extensive Osteoradionecrosis Post Radiation for Nasopharyngeal Carcinoma: Case Series

Tang CL, Kumar R, Toh CJ, Azura S, Tan GC, Gendeh BS

Indian J Otolaryngol Head Neck Surg, 2017 Sep;69(3):409-414.
PMID: 28929077 DOI: 10.1007/s12070-015-0909-5

Osteoradionecrosis is one of the most serious complications of radiotherapy for nasopharyngeal carcinoma. We report three cases of osteoradionecrosis in temporal lobe who presented differently few years after completion of radiotherapy. Cranial magnetic resonance image showed lesions in temporal lobe either unilateral or bilateral with mass effect. One of the cases even showed disease progression few years after the initial diagnosis of osteoradionecrosis. Diagnosis of osteoradionecrosis for all three patients was confirmed by biopsy.
The Nasal Hemangioma

Tan SN, Gendeh HS, Gendeh BS, Ramzisham AR

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1683-1686.
PMID: 31763224 DOI: 10.1007/s12070-015-0918-4

Hemangioma is a disease of head and neck commonly, but its presence in the nasal cavity or sinus is rare. It is a form of benign tumour of vascular origin consisting of predominantly blood vessels. It can be categorized into capillary, cavernous and mixed type in accordance to its histopathology features. Retrospectively, we reviewed five cases of nasal hemangioma presenting at University Kebangsaan Malaysia Medical Center (UKMMC) between September 2007 and May 2015. Information on the patients age, gender, ethnicity, clinical symptoms, imaging findings (if available), treatment modalities were collected retrospectively for analysis. Five patients were analysed. Females were more affected than male with ratio of 4:1. All patients presented with unilateral lobular capillary hemangioma of the nasal cavity with 60 % (3/5) of the lesions on the right side and 40 % (2/5) on the left side. The common symptoms at presentation were epitaxis and nasal obstruction (5/5, 100 %), followed by rhinorrhea (3/5, 60 %) and facial pain (1/5, 20 %). All the patients underwent a surgical excision of the hemangioma. The five patients had no recurrence on subsequent follow ups. Computed tomography of paranasal sinuses can be performed to exclude bony erosions. Endoscopic sinus haemangioma excision provide good visualisation and better outcomes. In conclusion, nasal hemangioma should always be differential diagnosis for nasal lesions and surgical excision is still the preferred first line treatment.
Follicular thyroid cancer with sternal metastasis - challenges and outcomes

Syazni MA, Gendeh HS, Kosai NR, Ramzisham AR, Gendeh BS, Basiron NH, et al.

Med J Malaysia, 2017 02;72(1):80-82.
PMID: 28255152 MyJurnal

Sternal metastasis from differentiated thyroid carcinoma (DTC) is rare and presents a conundrum for surgeons. We present a lady diagnosed with follicular thyroid carcinoma and sternal metastasis who underwent thyroidectomy, sternectomy and sternoplasty with titanium mesh and acrylic plate. She developed a surgical site infection, of which multiple conservative approaches were attempted. She eventually required removal of the implant. Closure of sternal defect was completed with bilateral pectoralis major advancement flaps. This article highlights a series of complications faced during the course of treatment and how they were managed in a tertiary healthcare centre.
Fulltext A ten year retrospective review of orbital complications secondary to acute sinusitis in children

Suhaili DN, Goh BS, Gendeh BS

Med J Malaysia, 2010 Mar;65(1):49-52.
PMID: 21265249 MyJurnal

Acute sinusitis is most often a mild self-limiting disease. However, it may progress into severe and life threatening complications. One of the commonest being orbital complication of which visual loss is a direct consequence. In this 10 year retrospective study, the nature of orbital complication, clinical presentation and treatment modalities and outcome seen in children with acute sinusitis in a tertiary referral institute were reviewed. Of six patients, there was a case of preseptal cellulitis, 4 cases of subperiosteal abscess and one case of orbital abscess. Periorbital swelling was a common presenting feature. In 5 cases this was associated with proptosis with one case of impending optic nerve compression. The value of computed tomography and opthalmological examination as a component in the management plan is highlighted. All patients were treated with intravenous antibiotics but evidence of abscess collection warranted urgent surgical drainage in 5 patients, 3 being endoscopic drainage while external approach was done for the remaining 2 patients. Thus a child exhibiting orbital complication of acute sinusitis, prompt diagnosis and treatment is essential in obtaining the best outcome for the child.
Fulltext Correlation of computed tomography and nasal endoscopic findings in chronic rhinosinusitis

Shahizon AM, Suraya A, Rozmnan Z, Aini AA, Gendeh BS

Med J Malaysia, 2008 Aug;63(3):211-5.
PMID: 19248692 MyJurnal

This is a cross sectional study of 40 patients diagnosed with chronic rhinosinusitis using the Lanza Kennedy diagnostic criteria based on nasal endoscopy (NE), and on computer tomography (CT) of the paranasal sinuses. The purpose of the study is to demonstrate the effectiveness and limitations of CT, and NE in the assessment of chronic rhinosinusitis. This study shows that CT was superior in detecting OMC involvement, presence of concha bullosa, paradoxical turbinate and nasal septal deviation. NE was better at detecting polyps.
Fulltext Endonasal endoscopic transsphenoidal pituitary surgery for pituitary adenoma: a retrospective analysis of surgical outcome

Sand MS, Gendeh BS, Husain S

Med J Malaysia, 2011 Dec;66(5):443-6.
PMID: 22390098 MyJurnal

The purpose of this retrospective joint rhino-neurosurgical study from January 1998 until September 2009 is to document the demographic data, clinical presentations, radiological findings, approaches and incidence of residual tumour. Forty-seven patients with pituitary adenoma underwent trans-sphenoidal hypophysectomy of which 25 patients with complete medical and radiological data were included in the study. The medical and radiological data were analyzed. There were 12 males and 13 females with age ranging from 17 to 76 years old (mean 49.2). Fourteen of the patients were Chinese, eight Malays and three Indians. Twelve of the patients had functioning tumour of which five each presented with acromegaly and Cushing disease respectively and two with amenorrhoea. The rest of 13 patients had non functioning tumour presenting with visual disturbances. Sixteen of the patients had pituitary macroadenomas and the rest 9 microadenomas. Eighteen patients had undergone transcollumellar trans-sphenoidal hypophysectomy and the rest 7 patients had undergone transnasal transsphenoidal hypophysectomy. About 68.8% of pituitary macroadenomas had residual tumour, compared to only 22.2% of patient with pituitary microadenomas. Radiologically, about 45.5% of residual macroadenoma had suprasellar extension and the majority had spread to suprasellar cistern and carvenous sinus (54.5%). About 16.6% of patients had undergone post operative radiotherapy. In conclusion, this study showed that patient with pituitary macroadenomas had higher incidence of residual tumour compared to pituitary microadenomas.
Fulltext Nasal NK/T cell lymphoma mimicking an latrogenic lateral nasal wall infection: a diagnostic dilemma

Saleh KA, Razif, Gendeh BS

Med J Malaysia, 2011 Jun;66(2):160-1.
PMID: 22106705

Extra nodal NK/T cell lymphoma, 'nasal type' is a rare clinicopathological entity. The prevalence of nasal lymphoma is estimated at 0.17-1.5% for all non -Hodgkin's lymphomas (NHL), of which 45% originate from the NK/T cell. It is more commonly encountered in Asian countries. The main clinical features are nasal congestion and epistaxis due to local aggressive destruction. It has a distinct immunophenotypic profile of CD2+, CD56+ and CD3-. The tumor often shows polymorphic lymphoreticular infiltrates and necrosis. We present a case of a 50-year-old male who presented with lateral nasal wall infection following endoscopic sinonasal surgery and later proven to be extranodal NK/T cell 'nasal type' lymphoma with immunophenotypic features.
Fulltext Cultural Adaptation of Sniffin' Sticks Smell Identification Test: The Malaysian Version

Sai-Guan L, Husain S, Zahedi FD, Ahmad N, Gendeh BS

Iran J Otorhinolaryngol, 2020 Jul;32(111):213-222.
PMID: 32850509 DOI: 10.22038/ijorl.2019.34346.2138

Introduction: Sniffin' Sticks smell identification test is a tool used for evaluation of olfactory function but the results are culture-dependent. It relies on the subject's familiarity to the odorant and descriptors. This study aims to develop the Malaysian version of Sniffin' Sticks smell identification test suitable for local population usage.
Materials and Methods: The odorant descriptors and distractors of the original version of Sniffin' Sticks were translated into Malay language. It was then tested for familiarity and identifiability in 30 normosmic subjects. The descriptors were replaced until the familiarity of all descriptors and identification rates of odorants achieved ≥ 70%. The validity of the new cultural-adapted version was tested in 60 hypo-anosmic subjects and 60 normosmic subjects with Student t-test. The test-retest reliability was evaluated after two weeks with interclass correlation.
Results: Two odorant descriptors and nine distractors achieved familiarity <70% (13.3% - 66.7%) and were replaced. Another three culturally inappropriate distractors were also replaced. The mean score among the healthy subjects was significantly higher than the subject with smell dysfunction [13.7 (1.12) and 7.3 (3.42); t = 7.24 (df = 34.23), P<0.001]. The coefficient of correlation (r) between test and retest scores was 0.93 (P<0.001).
Conclusion: The cultural adapted Malaysian version of Sniffin' Sticks smell identification test is valid and has high test-retest reliability. This is the first smell identification test validated in Malaysia. It is effective for evaluation of olfactory function in local population.
Fulltext Evaluation with acoustic rhinometry of patients undergoing sinonasal surgery

Raja Ahmad RLA, Gendeh BS

Med J Malaysia, 2003 Dec;58(5):723-8.
PMID: 15190659

The purpose of this study is to evaluate the use of acoustic rhinometry in assessing surgical outcomes in sinonasal surgery. This prospective study was carried out from January till December 2001. A group of 44 patients who presented with nasal obstruction due to various rhinologic abnormality were examined with acoustic rhinometry pre and post-operatively. They were examined with acoustic rhinometry pre and post decongestion with cocaine and adrenaline. A highly significant correlation existed between minimal cross sectional area (MCA) and the subjective feeling of nasal problem, pre and post surgery. Thus MCA is a valuable parameter to express objectively the nasal patency. The mucovascular component of the nasal cavity plays a major role in the nasal patency as determined in the pre and post-decongestion acoustic rhinometry measurement. Acoustic rhinometry is a good tool to evaluate the nasal patency in cases where sinonasal surgery is considered in correcting the abnormality as well as for the post-operative evaluation.
Fulltext Challenges in the treatment of sinonasal undifferentiated carcinoma: a ray of hope

Norleza AN, Gendeh BS

Med J Malaysia, 2005 Aug;60(3):281-5.
PMID: 16379180 MyJurnal

We studied nine cases of SNUCs presented to the Department of Otorhinolaryngology, Hospital University Kebangsaan Malaysia from 1999 to 2003. There were 8 males and 1 female with ages ranging from 24 to 78 years (mean 46.5y). The racial distribution consisted of 5 Chinese (55.5%), 3 Malays (33.3%) and 1 Indian (11.1%). Three patients were Kadish B (33.3%) and six were Kadish C (66.6%) by classification. In our series 2 years survival was 26.3% and median survival time was 14.2 months.
Sinonasal hybrid tumour involving the anterior skull base

Mazita A, Gendeh BS, Zainal AI

J Laryngol Otol, 2008 Aug;122(8):861-3.
PMID: 17625030

We report a rare case of sinonasal hybrid tumour within an inverted papilloma.
Fulltext Acquired nasal posterior choanal atresia: postradiotherapy

Marina MB, Gendeh BS

Med J Malaysia, 2006 Mar;61(1):94-6.
PMID: 16708742

Reported cases of acquired posterior choanal atresia are very few in the English literature. A case of acquired posterior choanal atresia post radiotherapy is reported which was treated by endonasal endoscopic repair using microdebrider with untoward effect.
Fulltext Bilateral maxillary sinus cholesterol granuloma: a rare entity

Marina MB, Gendeh BS

Med J Malaysia, 2006 Jun;61(2):226-8.
PMID: 16898317

Cholesterol granuloma in the paranasal sinuses is rare. It is more common in the mastoid antrum and temporal bone air cells in chronic middle ear disease. A case of bilateral maxillary sinus cholesterol granuloma that mimics chronic maxillary sinusitis is reported. This is the first reported case of cholesterol granuloma of the maxillary sinus in the Malaysian Literature.

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