MyMedR

'Trachealised oesophagus' feature of late onset atopic march

Saniasiaya J

Postgrad Med J, 2020 12;96(1142):793.

PMID: 32376775 DOI: 10.1136/postgradmedj-2020-137856

A Rare Cause of Dysphonia

Saniasiaya J

Oman Med J, 2021 May;36(3):e274.

PMID: 34164160 DOI: 10.5001/omj.2021.52

Fulltext A Rare Differential Diagnosis of a Solitary Anterior Neck Mass

Saniasiaya J, Mohamad I

Oman Med J, 2016 Sep;31(5):384-6.

PMID: 27602195 DOI: 10.5001/omj.2016.76

Patients with anterior neck masses commonly present to otorhinolaryngology clinics, but there are limited differential diagnoses for such lesions. Common ones include thyroid nodule and thyroglossal duct cyst. In an elderly patient, a differentiated thyroid carcinoma should be suspected especially if it moves with swallowing. We encountered a typical presentation of a solitary thyroid nodule-like mass with the exception of pulsation in a 65-year-old female. Further investigation, using neck ultrasonography, revealed that it was a variant of right common carotid artery arising from the left common carotid artery. Knowledge of such variants is of great importance as ignorance of such a variation may lead to inadvertent surgical complications during procedures.

Fulltext A Rare Manifestation of Cervical Yolk Sac Tumor in an Unfortunate Infant

Saniasiaya J, Hamid SSA, Mohamad H, Wahab WNNWA, Zawawi N

Turk Arch Otorhinolaryngol, 2019 Sep;57(3):157-160.

PMID: 31620699 DOI: 10.5152/tao.2019.3900

Paediatric germ cell tumor is composed of various neoplasms which exhibit capricious clinical presentation and histological features depending on the age and the area of presentation. Yolk sac tumor is an extremely rare malignant tumor of embryonic origin which usually arises from the gonads. Its manifestation in the head and neck region is extremely rare. Here, we report a rare case of the malignant transformation of mature teratoma into yolk sac tumor of the neck in an infant. Diagnosis was confirmed following histopathological examination of the neck mass along with marked increase of the serum alpha-fetoprotein. The child unfortunately succumbed prior to chemotherapy. We highlight the challenge we faced in diagnosing and managing this rare entity. We would also like to recommend serial monitoring of serum alpha-fetoprotein in all patients with mature teratoma to detect malignant transformation early.

Fulltext A Throat that Clicks

Ramasamy K, Saniasiaya J

Iran J Otorhinolaryngol, 2021 Jul;33(117):249-251.

PMID: 34395326 DOI: 10.22038/ijorl.2021.51303.2752

Introduction: Clicking larynx syndrome is a rare condition that may be intriguing to the attending clinician. Patients typically present with clicking sensations in the neck, often obvious during head movement or swallowing. Due to the scarce presentation of such cases, clicking larynx syndrome harbors a high propensity to be an overlooked diagnosis, resulting in a clinical stalemate.

Case Report: Herein, we present a case of clicking larynx in a young girl followed by an overview of the latest literature on the aetiology and treatment options. This case aims to reinforce the presence of this entity further and subsequently increase its awareness among clinicians.

Conclusion: Expeditious diagnosis is imperative not just for the eventual treatment but also for timely relief to the anxious patients who would have been perplexed by the strange clicking in the throat.

A hard left supraclavicular mass in a young boy-is it cancer?

Ramasamy K, Saniasiaya J, Gani NA

Malays Fam Physician, 2020;15(2):53-55.

PMID: 32843947

Acute labyrinthitis: a manifestation of COVID-19 in a teenager

Saniasiaya J, Kulasegarah J

BMJ Case Rep, 2023 Dec 28;16(12).

PMID: 38154869 DOI: 10.1136/bcr-2023-258290

Audiovestibular symptoms following COVID-19 have been long acknowledged, especially in adults. However, acute labyrinthitis presenting as an early manifestation of COVID-19 has not been reported in children. We report COVID-19-induced acute labyrinthitis in a teenager. We report on a boy in his early adolescence with a sudden onset of spinning sensation, imbalance and unilateral hearing loss with a positive SARS-CoV-2 test. Vestibular investigations point towards right labyrinthine hypofunction, and an audiometry test revealed right-sided severe hearing loss. Symptoms improved gradually with steroids and vestibular rehabilitation therapy. However, the long-term repercussions of post-COVID-19 acute labyrinthitis are unknown and must be followed up closely. To our knowledge, this is the first reported case of acute labyrinthitis secondary to COVID-19 in paediatrics. Additionally, we conducted a literature search to elucidate the outcome of COVID-19-induced acute vestibular syndrome in children.

Fulltext An Unexpected Midline Neck Swelling in a Young Female

Lee JPH, Saniasiaya J

Oman Med J, 2024 Jan;39(1):e601.

PMID: 38370333 DOI: 10.5001/omj.2024.45

An Unusual Presentation of Midline Lethal Granuloma

Chin EW, Saniasiaya J, Hitam S, Hassan E, Kah Wai N

Indian J Otolaryngol Head Neck Surg, 2024 Apr;76(2):2137-2140.

PMID: 38566723 DOI: 10.1007/s12070-023-04466-x

Extranodal natural killer T-cell lymphoma, nasal type (ENKTCL), is a rare form of non-Hodgkin lymphoma that is strongly related to Epstein-Barr Virus (EBV) infection and commonly presents as "midline lethal granuloma." Herein, we report a middle-aged lady who presented with a two-week history of fever, sore throat and constitutional symptoms. Intraoral examination revealed a lacerated soft palate with an ulcerated uvula. A diagnosis of ENKTCL was confirmed through deep biopsies under general anaesthesia supplemented with a positive serum EBV genome. Unfortunately, she succumbed due to disease progression with left frontal brain metastasis with concurrent pulmonary tuberculosis before treatment was completed. The recommended treatment is multimodality with L-asparaginase-containing regimes chemotherapy in an advanced stage, relapsed, or refractory ENKTCL for better outcomes. The quantification of circulating plasma EBV deoxyribonucleic acid (DNA) is helpful as the baseline of tumour load and a biomarker for monitoring treatment response and prognostication. We advocate repeated and deeper core tissue biopsies.

Fulltext Auditory Cinchonism in COVID Era

Saniasiaya J, Kulasegarah J

Ear Nose Throat J, 2020 Nov;99(9):597-598.

PMID: 32744901 DOI: 10.1177/0145561320947255

Fulltext Aural polyp with facial asymmetry in an unfortunate infant

Zubir FS, Saniasiaya J, Abdul Gani H

Malays Fam Physician, 2021 Mar 25;16(1):133-135.

PMID: 33948154 DOI: 10.51866/cr1070

Temporal bone rhabdomyosarcoma is an aggressive entity that simulates chronic otitis ear infection. It is the most common soft tissue sarcoma amongst pediatric patients. Herein, we would like to report a case of temporal bone rhabdomyosarcoma involving a 2-year-old boy who presented with a one-month history of otorrhea with facial asymmetry. Early treatment led to remission of this severe neoplasm.

Basaloid Nasopharyngeal Carcinoma: An Entity That Remains Oblivious

Ganeson SK, Saniasiaya J, Mohamad I, Abdul Gani N

Gulf J Oncolog, 2020 Sep;1(34):83-86.

PMID: 33431368

INTRODUCTION: Basaloid squamous cell carcinoma of the nasopharynx is a rare entity with only scarce cases reported in the English Literature. It is a histological variant of squamous cell carcinoma with aggressive nature and comprises of both basal cell carcinoma and squamous cell carcinoma.

CASE PRESENTATION: Herein, we report on a middleaged male who presented with left-sided spontaneous epistaxis and aural fullness with no neck node which turned out to be basaloid cell carcinoma of nasopharynx.

DISCUSSION AND CONCLUSION: We highlight high clinical suspicion of rare variant of nasopharyngeal carcinoma although no palpable node was evident upon presentation.

Fulltext Carcinoma Ex Pleomorphic Adenoma Presented as a Gigantic Tumor: Treatment and Diagnostic Challenges

Maruthamuthu T, Saniasiaya J, Mohamad I, Nadarajah S, Lazim NM, Wan Abdul Rahman WF

Oman Med J, 2018 Jul;33(4):342-345.

PMID: 30038735 DOI: 10.5001/omj.2018.62

Parotid gland surgery can be challenging due to intricate relationship between the gland and facial nerve. Besides complete removal of the lesion, the main focus of surgery is centered on the facial nerve. Surgery can be technically demanding especially when the tumor is large or involves the deep lobe. We report a patient with a 30-year history of gigantic parotid mass, which initial fine-needle aspiration cytology reported as pleomorphic adenoma. The tumor, weighing 1.3 kg, was successfully resected with facial nerve preservation. Histopathological examination of the excised mass confirmed as carcinoma ex pleomorphic adenoma (CaExPA) of adenocarcinoma, not otherwise specified type. We describe the specific surgical and reconstruction techniques for successful removal of large parotid tumors with facial nerve preservation. To our knowledge, this is the heaviest CaExPA of the parotid gland in South-East Asian region.

Cervical bronchogenic cyst in a toddler

Ooi KM, Saniasiaya J, Kulasegarah J, Ong DL

BMJ Case Rep, 2024 Jan 12;17(1).

PMID: 38216171 DOI: 10.1136/bcr-2023-256699

Bronchogenic cyst is a congenital abnormality arising from the tracheobronchial system. Localisation of such cysts in the head and neck region is rare. We report a girl in her early childhood with a painless enlarging right lateral neck mass diagnosed with a branchial cleft cyst based on clinical and radiological MRI findings. An incidental finding of a cervical bronchogenic cyst was made on the final histopathological specimen. Although rare, bronchogenic cysts should be considered as differential diagnoses for paediatric patients' lateral and midline cervical masses.

Cervical tuberculous lymphadenitis

Karleen C, Saniasiaya J

BMJ Case Rep, 2021 May 06;14(5).

PMID: 33958365 DOI: 10.1136/bcr-2021-241807

Characteristics and diagnostic approach of vestibular migraine in children and adolescents: A systematic review

Saniasiaya J, Salim R

Auris Nasus Larynx, 2023 Apr;50(2):218-227.

PMID: 35843849 DOI: 10.1016/j.anl.2022.06.007

OBJECTIVE: Vestibular migraine (VM) is the most common cause of episodic vertigo afflicts 1% of the general population. The complexity of VM is owing to the migrainous, and vestibular components and much knowledge have been gained in recent years on VM in the adult population. Akin to that, numerous studies focusing on VM in children and adolescent has emerged. We reviewed the literature to understand the characteristics and diagnostic approach of VM in children and adolescents.

METHODS: A literature search was conducted over a period of one month (April 2022).

RESULTS: 16 articles were selected based on our objective and selection criteria. A total of patients was included, with a median age of 10.9 years. 11 studies diagnosed VM based on diagnostic criteria. Caloric test and electro/videonystagmography are the most favoured investigation used (50%). Imaging was performed in 56.2% of included studies.

CONCLUSION: Deciphering the ideal diagnostic approach for VM is prudent to ensure children and adolescents suffering from VM are treated earlier. VM can be diagnosed using the established diagnostic criteria, which requires thorough and meticulous history taking. The available oto-neurological examination aims to exclude other disorders as its significance in diagnosing VM is still debatable.

Fulltext Commonly Misdiagnosed Facial Lesion: Pilomatricoma

Xin TY, Saniasiaya J, Kulasegarah J, Fan CS

Acta Medica (Hradec Kralove), 2023;66(4):158-160.

PMID: 38588394 DOI: 10.14712/18059694.2024.11

Pilomatricoma, also known as Pilamatrixoma or Malherbe's calcifying epithelioma, is a benign skin tumour with a bimodal age distribution between the paediatric and elderly age groups. Although it was previously thought to be rare, recent studies have revealed that it is quite common. Typically, pilomatricoma is diagnosed following histopathological examination of the lesion as it is frequently misdiagnosed with other types of skin pathology. In our case, the child presented with painless swelling of the left infraauricular region. The initial cytology and imaging were unable to provide a definite diagnosis. An excision biopsy was done, and a histopathological examination was suggestive of Pilomatricoma. Therefore, Pilomatricoma ought to be considered in the differential diagnosis of head and neck lesions in hopes of providing a better understanding on this pathological lesion.

Congenital inferior turbinate hypertrophy: an overlooked entity in newborns and review of the literature

C A Rahim NA, Saniasiaya J, Kulasegarah J

J Laryngol Otol, 2021 Oct 15.

PMID: 34649637 DOI: 10.1017/S0022215121002905

BACKGROUND: Neonatal nasal obstruction may result in respiratory distress, feeding difficulties, sleep apnoea and failure to thrive; hence, it requires thorough evaluation and prompt intervention. Congenital inferior turbinate hypertrophy is relatively uncommon, and its presentation can mimic other congenital nasal anomalies.

RELEVANCE: This paper reports two cases of congenital inferior turbinate hypertrophy in neonates that resulted in significant respiratory distress, feeding difficulties and sleep disturbance. Both patients were successfully treated surgically by endoscopic nasal dilatation and stenting. A literature search was performed to identify articles on congenital inferior turbinate hypertrophy in neonates and its management.

CONCLUSION: Albeit rare, congenital inferior turbinate hypertrophy should be considered a differential diagnosis in newborns presenting with respiratory distress at birth.

Correlation between subjective and objective voice analysis pre- and post-shift among teleoperators in a tertiary hospital

Rahman M, Saniasiaya J, Abu Bakar MZ

J Laryngol Otol, 2023 Jul;137(7):789-793.

PMID: 36444560 DOI: 10.1017/S0022215122002493

OBJECTIVE: Teachers and singers have been extensively studied and are shown to have a greater tendency to voice disorders. This study aimed to investigate the correlation between subjective and objective voice analysis pre- and post-shift among teleoperators in a tertiary hospital.

METHODS: This was a prospective cohort study. Each patient underwent pre- and post-shift voice analysis.

RESULTS: Among 42 teleoperators, 28 patients (66.7 per cent) completed all the tests. Female predominance (62 per cent) was noted, with a mean age of 40 years. Voice changes during working were reported by 48.1 per cent. Pre- and post-shift maximum phonation time (p < 0.018) and Voice Handicap Index-10 (p < 0.011) showed significant results with no correlation noted between subjective and objective assessment.

CONCLUSION: Maximum phonation time and Voice Handicap Index-10 are good voice assessment tools. The quality of evidence is inadequate to recommend 'gold standard' voice assessment until a better-quality study has been completed.

Could Cultural and Background Resilience be the Main Culprit for Neglected Vestibular Dysfunction in Children?

Saniasiaya J

Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):4114-4115.

PMID: 37974752 DOI: 10.1007/s12070-023-03873-4

Vestibular dysfunction in children and adolescents has recently gained tremendous attention, with more child-friendly investigations and rehabilitation protocols emerging.Reports have shown that children with vestibular impairment tend to develop speech and language acquisition delay, fine and gross motor delay, which in the long-termresults in an overall poor quality of life. In an extreme situation, vestibular dysfunction can lead to dissociative syndromes such as depersonalisation/derealisation symptomsthat occur following a mismatch between the vestibular signals and other sensory inputs, which may, in turn, lead to suicidal thoughts and behaviour 1. Whilst measuresto incorporate vestibular assessment as a part of routine practice in paediatric patients have been carried out in most centres, pediatric vestibular medicine appears to beunfathomed in some parts of the world, notably the South-East Asian region.

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