MyMedR

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.

Fulltext Dual retrotympanic aural mass

Che Ab Rahim NA, Saniasiaya J, Kulasegarah J

BMJ Case Rep, 2021 Apr 12;14(4).

PMID: 33846192 DOI: 10.1136/bcr-2021-241591

High-riding jugular bulb (HRJB), although rare, may pose a challenge as it may be mistaken for other non-alarming condition, such as middle ear effusion. Patients with HRJB classically present with pulsatile tinnitus. We report a unique case of a 26-year-old patient with underlying beta thalassaemia who presented with a 2-month history of intermittent epistaxis and rhinorrhoea. Otoscopic examinations revealed a pulsatile bluish mass behind the right tympanic membrane and a dull left tympanic membrane. Imaging performed revealed a finding of dual retrotympanic pathology, which consisted of a right dehiscent HRJB and left cholesterol granuloma. We highlight a rare case of dual retrotympanic mass as well as its management.

Distraction Breathing Exercise in Managing Inducible Laryngeal Obstruction in a Female Patient

Che Ab Rahim NA, Saniasiaya J, Narayanan P

Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):5169-5171.

PMID: 36742856 DOI: 10.1007/s12070-022-03083-4

Inducible laryngeal obstruction (ILO) describes as inappropriate, episodic, reversible laryngeal closure during inspiration, occurring at the glottic and/or supraglottic level, in response to external triggers causing exertional breathing difficulties. We describe a case of a female patient with an underlying major depressive disorder who presented with sudden onset of stridor and tachypnoea, whereby the external trigger was psychogenic in origin. Bedside flexible nasopharyngolaryngoscopy (FNPLS) showed characteristic findings of paradoxical adduction of vocal cords during inspiration. Arterial blood gas analysis, routine blood tests, chest radiography, and computed tomography (CT) scan of brain, neck, and thorax excluded neurological or airway abnormality. Bedside distraction breathing exercise alleviated the stridor and tachypnoea. The patient was managed by supportive psychotherapy, speech therapy, and anti-reflux medication and was discharged well with resolution of her respiratory distress. We would like to highlight that meticulous history along with physical examinations are imperative especially amongst Otorhinolaryngologists as emergent airway management tracheostomy would have been unnecessary and cause more stress and burden to the patient as well as family members.

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 X-Linked Gusher Disease DFNX2 in Children, a Rare Inner Ear Dysplasia with Mixed Hearing and Vestibular Loss

Dasgupta S, Hong J, Morris R, Iqbal J, Lennox-Bowley A, Saniasiaya J

Audiol Res, 2023 Aug 04;13(4):600-614.

PMID: 37622928 DOI: 10.3390/audiolres13040052

Conductive hearing losses are typically present in disorders of the external/middle ear. However, there is a rare group of inner ear conditions called third windows that can also generate a conductive hearing loss. This is due to an abnormal connection between the middle and the inner ear or between the inner ear and the cranial cavity. X-linked gusher disorder is an extremely rare congenital inner ear dysplastic syndrome with an abnormal connection due to a characteristic incomplete cochlear partition type III and an incomplete internal auditory meatus fundus. The disorder is inherited in an X-linked fashion due to the mutation of the POU3F4 gene. We present two siblings diagnosed with the condition and their long-term follow-ups. They both presented audiovestibular symptoms and showed progressive mixed losses and bilateral vestibular weakness. They were treated with cochlear implant, digital amplification and with vestibular rehabilitation. Significant others around them were involved in their journey with the medical team, and in both, a very favourable outcome was achieved. This is the first time that we have reported evolving audiovestibular function with vestibular quantification in X-linked gusher disorder and emphasize on the multidisciplinary holistic approach to manage these children effectively.

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.

Cervical tuberculous lymphadenitis

Karleen C, Saniasiaya J

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

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

Fulltext Topical gentamicin-induced acute vestibulopathy: A case report

Lau TB, Saniasiaya J, Govindaraju R

Malays Fam Physician, 2023;18:23.

PMID: 37292223 DOI: 10.51866/cr.266

Evidence suggests that otologic injury from ototopical aminoglycoside preparations is infrequent when used to treat ear infections with an intact tympanic membrane. Meanwhile, parenteral administration of aminoglycosides, is well known to be associated with a significant incidence of cochlear and vestibular damage. The discrepancy between topical and parenteral ototoxic effects is thought to result from a combination of factors, including the protective function of debris overlying the round window membrane, low antibiotic concentrations of topical antibiotic preparations, length of exposure and inability to detect subtle hearing or vestibular changes. Herein, we present a case of acute vestibulopathy following a 2-week course of topical gentamicin otic drops. Awareness of vestibulotoxicity following topical gentamicin therapy is prudent as vestibulopathic symptoms can be severely debilitating.

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

Fulltext Croup and COVID-19 in a child: a case report and literature review

Lim CC, Saniasiaya J, Kulasegarah J

BMJ Case Rep, 2021 Sep 14;14(9).

PMID: 34521741 DOI: 10.1136/bcr-2021-244769

Croup (laryngotracheitis) is frequently encountered in the emergency department in a young child presenting with stridor. We describe a rare case of croup secondary to SARS-CoV-2 in an 18-month-old child who presented with stridor and respiratory distress and required urgent intubation. Subsequently, the child developed multisystem inflammatory syndrome in children (MIS-C). The child was monitored in paediatric intensive care unit. We would like to highlight that COVID-19 croup in children may be an indicator for MIS-C, and close monitoring is warranted as MIS-C is a life-threatening condition. Our limited experience suggests that COVID-19 croup especially if associated with MIS-C has an underlying more severe pathology and may require prolonged treatment in comparison with the typical croup or even COVID-19 croup. It is important to recognise this clinical entity during a time when most countries are in a third wave of COVID-19 pandemic.

Fulltext Postauricular swelling secondary to salmonella extradural abscess in a toddler: a near miss condition

Lim CC, Saniasiaya J, Kulasegarah J

BMJ Case Rep, 2021 Jul 01;14(7).

PMID: 34210704 DOI: 10.1136/bcr-2021-243412

Postauricular swelling is usually encountered in an emergency setting in otorhinolaryngology, resulting from complication of acute or chronic suppurative otitis media. Besides that, postauricular swelling may occur secondary to various other conditions including infectious disease, tumour, vascular malformation, granulomatous condition and even trauma. Children less than 2 years old are prone to fall and up to 10% sustain traumatic brain injury without any obvious signs of neurological deficit. We describe a rare case of a postauricular swelling in a toddler which turned out to be salmonella extradural abscess from an infected traumatic haematoma. The importance of high clinical suspicion especially in a child with a history of fall cannot be emphasised more because a missed brain abscess could lead to potentially life-threatening problems. We would like to highlight that meticulous history taking along with prompt assessment and intervention is prudent for a better prognosis and recovery.

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.

Fulltext Valsalva manoeuvre to detect isolated hyoid bone fracture

Mohd Hamdan MH, Saniasiaya J, Narayanan P

BMJ Case Rep, 2021 Jul 13;14(7).

PMID: 34257127 DOI: 10.1136/bcr-2021-243756

The hyoid bone fracture has traditionally been attributed to strangulation and hanging. Although rare, ensuing its vague presentation, hyoid bone fracture is oftentimes overlooked and missed, leading to delayed complications. Herein, we are reporting an overlooked hyoid bone fracture in a man who attempted suicide by strangulating himself, whereby Valsalva manoeuvre performed during bedside flexible nasopharyngolaryngoscopy revealed the fractured segment. As the patient was stable and asymptomatic, he was successfully managed conservatively. We would like to highlight the awareness of the Valsalva manoeuvre, which could elicit hyoid bone fracture as missing or overlooking the fracture may lead to devastating complications which may ensue, such as respiratory distress.

Recurrent stridor in an infant

Ngu CYV, Saniasiaya J, Kulasegarah J

BMJ Case Rep, 2021 Sep 07;14(9).

PMID: 34493558 DOI: 10.1136/bcr-2021-244012

Paediatric upper airway obstruction is an emergency that requires immediate intervention. Among the myriad factors that leads to upper airway obstruction in paediatric age group, bilateral vocal cord palsy is not commonly encountered in clinical practice. The underlying cause of bilateral vocal cord palsy requires thorough investigation prior to deciding on the appropriate intervention. Herein, we report a 4-month-old baby boy who presented with recurrent inspiratory stridor with bilateral vocal cord palsy secondary to Arnold Chiari II malformation. Immediate intervention to drain the hydrocephalous resulted in complete resolution of stridor without having to perform a tracheostomy. We highlight the importance of meticulous and thorough investigations especially in children, as emergent airway intervention such as tracheostomy may result in detrimental effect to speech, swallowing as well as quality of life.

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.

Something is crawling in my ears

Ponnuvelu K, Saniasiaya J, Abdul Gani N

Eur Ann Otorhinolaryngol Head Neck Dis, 2021 Dec;138(6):505-507.

PMID: 33712397 DOI: 10.1016/j.anorl.2020.09.015

Fulltext Intriguing aural foreign body and algorithm of management of foreign body

Ponnuvelu K, Saniasiaya J, Abdul Gani N

BMJ Case Rep, 2021 Aug 16;14(8).

PMID: 34400422 DOI: 10.1136/bcr-2021-242122

Foreign body (FB) in the external auditory canal is more common among the paediatric age group compared with adult patients and it may be deposited in various ways. An accidental animate aural FB is reported to be commonly encountered in adults whereas inanimate FBs are likely to be found among adult patients with learning disability. An elderly man presented with accidental penetration of rattan tree stem into his ear while gardening. Removal of a FB from the external auditory canal requires expertise as deep penetration of a FB into the middle and inner ear may lead grave complications, especially when overzealous removal is attempted by nonear, nose and throat (ENT) personnel. This case emphasises on the importance of awareness of meticulous removal of a FB under proper visualisation so as to avoid unnecessary complications. Additionally, we propose an algorithm for proper removal of aural FB in an acute care setting.

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.

Olfactory and Gustatory Dysfunctions as a Clinical Manifestation of Coronavirus Disease 2019 in a Malaysian Tertiary Center

Ramasamy K, Saniasiaya J, Abdul Gani N

Ann Otol Rhinol Laryngol, 2021 May;130(5):513-519.

PMID: 33025798 DOI: 10.1177/0003489420963165

OBJECTIVE: To investigate the prevalence of olfactory and gustatory dysfunction among patients with COVID-19 infection and the recovery rate.

METHODS: Adult patients (≥18 years) tested positive for COVID-19 via reverse transcription-polymerase chain reaction (RT-PCR) and admitted in Hospital Tuanku Ja'afar Seremban, Malaysia, were recruited in this study. Patients completed a questionnaire via telephone interview comprising the following details: age, sex, ethnicity, comorbidities, general and otorhinolaryngological symptoms, onset and duration of olfactory and gustatory dysfunction. Patients with persistent olfactory and gustatory dysfunction at the time of the initial interview were followed-up every 3 to 5 days till resolution.

RESULTS: A total of 145 patients were included in our study. The mean age of patients was 43.0 ± 17.7 (range: 18-86). Fever (44.1%) and cough (39.3%) were the most prevalent general symptoms. Thirty-one patients (21.4%) reported olfactory dysfunction and 34 (23.4%) reported dysgeusia. There was a significant association between both olfactory and gustatory dysfunction (P

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

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