MyMedR

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.

Primary endoscopic endonasal dacryocystorhinostomy for pediatric nasolacrimal duct obstruction: A systematic review

Saniasiaya J, Abdullah B, Husain S, Wang Y, Wan Mohammad Z

Am J Rhinol Allergy, 2017 Sep 01;31(5):328-333.

PMID: 28859711 DOI: 10.2500/ajra.2017.31.4464

BACKGROUND: Epiphora secondary to nasolacrimal duct obstruction is common in the pediatric age group. The mainstay treatment among these young patients has been conservative. Once epiphora becomes recalcitrant, however, an external or an endonasal approach is considered.

OBJECTIVE: Endoscopic dacryocystorhinostomy (EDCR) entails creating an opening from the lacrimal sac directly into the nasal cavity to counteract nasolacrimal duct obstruction. We reviewed the literature to determine the effectiveness and the safety of primary EDCR to treat pediatric nasolacrimal duct obstruction.

METHOD: A literature search was conducted by using a number of medical literature data bases for the period from 1995 to 2016. The following search words were used either individually or in combination: epiphora, nasolacrimal duct obstruction, endoscopic dacryocystorhinostomy, powered endoscopic dacryocystorhinostomy, laser-assisted endoscopic dacryocystorhinostomy, children, congenital, acquired, presaccal obstruction, and postsaccal obstruction. In addition, a few articles were identified based on the experience and information provided by the senior authors (B.A., S.H., D.Y.W.). The search was conducted over a 1-month period (January 2017). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed when possible.

RESULTS: Only 10 original clinical research articles were selected based on our objectives and selection criteria. All the studies were at level of evidence III: nonrandomized and noncomparative prospective or retrospective case series. Altogether, 313 patients with ages that ranged from 4 months to 18 years were enrolled. A total of 352 EDCRs were performed that were either single sided (n = 313) or bilateral (n = 39). The most common causes of the obstruction were classified as congenital, followed by idiopathic, and then acquired. A meta-analysis was not performed because of the heterogeneity of the patient groups and variability of the methods used to measure outcomes.

CONCLUSION: Analysis of the results indicated that EDCR was an effective, safe therapeutic approach to treating nasolacrimal duct obstruction in pediatric patients. It should be considered as an alternative procedure to external dacryocystorhinostomy after a failed conservative treatment.

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.

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.

Cervical tuberculous lymphadenitis

Karleen C, Saniasiaya J

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

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

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 Traumatic septal swelling

Tuang GJ, Saniasiaya J

BMJ Case Rep, 2021 Feb 09;14(2).

PMID: 33563681 DOI: 10.1136/bcr-2020-241172

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.

Fulltext Hyphae in external auditory canal

Saniasiaya J, Narayanan P

BMJ Case Rep, 2021 Jul 26;14(7).

PMID: 34312145 DOI: 10.1136/bcr-2021-245388

Fulltext Vestibular migraine: a manifestation of long COVID syndrome in children

Saniasiaya J

BMJ Case Rep, 2023 May 22;16(5).

PMID: 37217233 DOI: 10.1136/bcr-2023-255734

Long COVID-19 syndrome has been reported among children and adolescents following COVID-19 recovery. Among them, notable symptoms include myalgia, insomnia, loss of smell and headache. Yet, novel manifestations are being discovered daily. Herein, we report two cases of vestibular migraine post-COVID-19 involving two children who presented with vestibular migraine symptoms following COVID-19 infection and their management. Children post-COVID-19 should be thoroughly evaluated for vestibular migraine symptoms so they can be managed promptly. This is the first article to report vestibular migraine as a manifestation of long COVID-19 syndrome.

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.

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.

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.

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.

Intermittent unilateral neck bulge on Valsalva manoeuvre in an adolescent

Saniasiaya J

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

PMID: 38154861 DOI: 10.1136/bcr-2023-255231

Fulltext Mediastinal lymphoma presenting with asymmetrical chest wall

Saniasiaya J

BMJ Case Rep, 2022 Jan 07;15(1).

PMID: 34996771 DOI: 10.1136/bcr-2021-246953

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 Keratosis obturans complicated with facial nerve palsy: a diagnostic dilemma

Saniasiaya J, Nik Othman NA, Mohamad Pakarul Razy NH

Braz J Otorhinolaryngol, 2016 05 24;86(1):130-132.

PMID: 27269254 DOI: 10.1016/j.bjorl.2016.04.012

Fulltext Infantile wryneck: report of 2 cases

Saniasiaya J, Mohamad I, Abdul Rahman SK

Braz J Otorhinolaryngol, 2016 06 22;86(3):389-392.

PMID: 27388958 DOI: 10.1016/j.bjorl.2016.05.011

Displaying publications 1 - 20 of 70 in total