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Tuberculous Otomastoiditis: A Diagnostic Dilemma

Yee PM, Othman IA

Cureus, 2024 Oct;16(10):e71307.
PMID: 39529760 DOI: 10.7759/cureus.71307

Where tuberculous (TB) infection is prevalent, the diagnosis of TB otomastoiditis (TOM) should be considered in a chronically discharging ear that does not respond to standard medical treatment. We are reporting a case of TB otomastoiditis with an adjacent deep neck abscess in a healthy 18-year-old male. He presented with a five five-month history of right otorrhea with hearing loss and a concurrent right level two neck swelling, without any signs of acute infection. Aural polyp was seen occupying the external ear canal (EAC) obscuring the tympanic membrane. There was no clinical improvement despite oral, topical, and intravenous antimicrobial therapy. The audiogram showed right moderate to severe mixed hearing loss. Erythrocyte sedimentation rate (ESR) and Mantoux were positive; however, initial pus swab culture yielded Pseudomonas aeruginosa and was negative for acid-fast Bacilli (AFB). High-resolution computed tomography (HRCT) of the temporal bone showed multifocal bony erosion with soft tissue density occupying the EAC, middle ear, and mastoid air cells. Bezold and Citelli abscesses were also noted adjacent to the mastoid tip with an eroded outer cortex. The patient underwent mastoid exploration to obtain tissue for diagnosis and to clear the disease. The diagnosis of TB otomastoiditis was made based on intraoperative findings of caseous necrosis, which was culture positive for Mycobacterium tuberculosis but negative on AFB stain. Complete resolution of the disease was seen after three months of anti-TB treatment. His right hearing remains poor, thus he was counseled for a bone conduction hearing amplification device. High clinical suspicion and early HRCT will expedite the delivery of treatment for suspected TB otomastoiditis. In some cases, surgical intervention is needed to obtain tissue for diagnosis, remove the sequestrum, and when there is clinical evidence of complications.
Fulltext A Case of Medialized Lateral Maxillary Sinus Wall: A Pillar of Support

Othman IA, Hashim ND, Nazimi AJ

Case Rep Med, 2018;2018:4053531.
PMID: 29861735 DOI: 10.1155/2018/4053531

The number of maxillofacial trauma (MFT) cases attended in the Emergency Department is progressively increasing in trend, owing to the rising statistics of motor-vehicle accidents (MVAs) and urban assaults in addition to occupational-related injuries. Prompt and thorough assessment is important for accurate diagnosis and paramount treatment plans. We will be discussing a case of unusual presentation of an orbital floor fracture post-MVA which was treated conservatively based on the clinical assessments during follow-ups, supported by radiological findings. We will also briefly discuss the different radiological modalities available in assessing MFT and late presentation of enophthalmos.
Fulltext Base of Skull Metastatic Adenocarcinoma from the Breast 23 Years after the Primary Diagnosis

Othman IA, Zahedi FD, Husain S

Case Rep Med, 2020;2020:2610597.
PMID: 32802078 DOI: 10.1155/2020/2610597

Breast cancer metastases to the base of the skull with concomitant infiltration into the paranasal sinuses and nasopharynx are exceptionally rare with only small numbers of reported literatures. Greenberg et al. in 1981 described five clinical syndromes with regards to the base of skull metastases and the clinical presentation of each syndrome related to its anatomical location. Often, metastases to the base of the skull remain asymptomatic until the lesion has increased to a considerable size causing bony destruction and impingement to the surrounding structures. When involving the paranasal sinuses or nasopharynx, the most common presenting symptoms mimic those of rhinosinusitis and, hence, may delay the accurate diagnosis. We are reporting a case of base of skull metastasis from breast carcinoma, 23 years after the primary diagnosis. To the best of our knowledge, our case is the first case to report latent metastasis of more than 20 years.
Fulltext Painless Giant Submandibular Gland Sialolith: A Case Report

Thong HK, Othman IA, Ramli R, Sabir Husin Athar PP

Cureus, 2021 Nov;13(11):e19429.
PMID: 34926020 DOI: 10.7759/cureus.19429

Sialolithiasis is one of the most common diseases involving the salivary glands. It is a condition that occurs due to an obstruction in a salivary gland or its duct due to a calculus. The formation of a salivary stone is believed to be secondary to the deposition of mineral salts around a nidus, which is frequently associated with a recurrent bacterial infection. Patients with submandibular sialolithiasis usually present with acute swelling over the neck associated with pain, fever, and purulent intraoral discharge. The size of the calculus varies from <1 mm to a few centimeters. The frequency of sialolithiasis is relatively common. It is estimated to affect 12 in 1000 of the adult population. However, the occurrence of giant sialoliths, >15 mm in any diameter, is rare. Here, we describe our experience with a case of giant submandibular sialolithiasis measuring 25 mm presenting as a painless submandibular mass. The patient underwent submandibular gland excision followed by a full recovery.
Fulltext Auditory Performance in Early Implanted Children with Cochleovestibular Malformation and Cochlear Nerve Deficiency

Othman IA, Abdullah A, See GB, Umat C, Tyler RS

J Int Adv Otol, 2020 Dec;16(3):297-302.
PMID: 33136006 DOI: 10.5152/iao.2020.8563

OBJECTIVES: This study aimed to report the auditory performance in children with cochleovestibular malformation (CVM)/cochlear nerve deficiency (CND) who were implanted early at the Universiti Kebangsaan Malaysia Medical Centre, using Categorical Auditory Performance (CAP)-II score and Speech Intelligibility Rating (SIR) scales, and to compare the outcome of their matched counterparts.
MATERIALS AND METHODS: A total of 14 children with CVM/CND with unilateral cochlear implant (CI) implanted before the age of 4 years old were matched and compared with 14 children with normal inner ear structures. Their improvement in auditory performance was evaluated twice using CAP-II score and SIR scales at 6-month intervals, with the baseline evaluation done at least 6 months after implantation.
RESULTS: The average age of implantation was 31±8 and 33±7 months for the control group and the case (CVM/CND) group, respectively. Overall, there were no significant differences in outcome when comparing the entire cohort of case subjects and their matched control subjects in this study. However, the improvement in CAP-II scores and SIR scales among the case subjects in between the first and second evaluations was statistically significant (p=0.040 and p=0.034, respectively). With longer duration of CI usage, children with CVM/CND showed significant speech perception outcome evident by their SIR scales (p=0.011).
CONCLUSION: Children with radiographically malformed inner ear structures who were implanted before the age of 4 years have comparable performance to their matched counterparts, evident by their similar improvement of CAP-II scores and SIR scales over time. Hence, this group of children benefited from cochlear implantation.