MyMedR

Zulkarnaen M, Tang IP, Wong SL

Malays J Pathol, 2012 Jun;34(1):53-5.

We present a case of a papillary tumour at the cerebellopontine angle in a 41-year-old man. He presented with left-sided facial and ear pain associated with dizziness, nystagmus and hearing loss. CT scan of the temporal bone showed a destructive tumour at the left cerebellopontine angle. Surgical excision was performed and the diagnosis of the endolymphatic sac tumour was made. Endolymphatic tumour is a low grade adenocarcinoma that originates from the endolymphatic sac. The definitive diagnosis requires a combination of clinical features, radiological finding and pathological correlation.

Fulltext Unilateral pulmonary vein atresia presenting with recurrent haemoptysis in a child: a case report

Wong MNL, Tang IP, Chor YK, Lau KS, John AR, Hii KC, et al.

BMC Pediatr, 2020 09 24;20(1):448.

PMID: 32972390 DOI: 10.1186/s12887-020-02348-7

BACKGROUND: Haemoptysis is an uncommon presenting symptom in children and is usually caused by acute lower respiratory tract infection or foreign body aspiration. We report a rare case of right unilateral pulmonary vein atresia (PVA) as the underlying aetiology of recurrent haemoptysis in a child.

CASE PRESENTATION: A 4 years old girl presented with history of recurrent haemoptysis. Bronchoscopic evaluation excluded a foreign body aspiration but revealed right bronchial mucosal hyperaemia and varices. Diagnosis of right unilateral PVA was suspected on transthoracic echocardiography which demonstrated hypoplastic right pulmonary artery and non-visualization of right pulmonary veins. Final diagnosis was confirmed on cardiac CT angiography. A conservative treatment approach was opted with consideration for pneumonectomy in future when she is older.

CONCLUSION: Rarer causes should be considered when investigating for recurrent haemoptysis in children. Bronchoscopy and cardiac imaging are useful tools to establish the diagnosis of unilateral PVA in our case.

A new modified speculum guided single nostril technique for endoscopic transnasal transsphenoidal surgery: an analysis of nasal complications

Waran V, Tang IP, Karuppiah R, Abd Kadir KA, Chandran H, Muthusamy KA, et al.

Br J Neurosurg, 2013 Dec;27(6):742-6.

PMID: 23647078 DOI: 10.3109/02688697.2013.791667

Abstract The endoscopic transnasal, transsphenoidal surgical technique for pituitary tumour excision has generally been regarded as a less invasive technique, ranging from single nostril to dual nostril techniques. We propose a single nostril technique using a modified nasal speculum as a preferred technique. We initially reviewed 25 patients who underwent pituitary tumour excision, via endoscopic transnasal transsphenoidal surgery, using this new modified speculum-guided single nostril technique. The results show shorter operation time with reduced intra- and post-operative nasal soft tissue injuries and complications.

Fulltext Optimal size AMBU® laryngeal mask airway among Asian adult population

Tang MY, Tang IP, Wang CY

Med J Malaysia, 2014 Aug;69(4):151-5.

PMID: 25500841 MyJurnal

AIM: This was a randomized single blinded study to determine optimal size for Ambu®LMA (ALMA) among Malaysian adult population.

METHODS: One hundred and twenty six non-paralyzed anaesthetized adult patients were block randomized into size 3, 4 and 5 Ambu®LMA. Optimal size is defined primarily by oropharyngeal pressure (OLP). Pharyngeal injury and ease of insertion are also taken into consideration.

RESULTS: Mean OLP was significantly higher for Size 4 and 5 compared to size 3 (p<0.001) but similar between size 4 and 5. Number of insertion attempts and insertion time were similar between sizes. Size 5 required more manipulations during insertion (p<0.005) and had higher pharyngeal injury (p=0.001) compared to size 3 and 4.

DISCUSSION: We recommend size 4 ALMA as the optimal size for Malaysian adults in view of the higher OLP compared to size 3, yet less pharyngeal injury than size 5 in spontaneously breathing patients.

Bilateral nontuberculous mycobacterial middle ear infection: a rare case

Tang IP, Singh S, Rajagopalan R

Ear Nose Throat J, 2014 Sep;93(9):390-4.

PMID: 25255345

Nontuberculous Mycobacterium (NTM) middle ear infection is a rare cause of chronic bilateral intermittent otorrhea. We report a rare case of bilateral NTM middle ear infection in which a 55-year-old woman presented with intermittent otorrhea of 40 years' duration. The patient was treated medically with success. We conclude that NTM is a rare but probably under-recognized cause of chronic otitis media. A high index of suspicion is needed for the diagnosis to avoid prolonged morbidity. Treatment includes surgical clearance of infected tissue with appropriate antimycobacterial drugs, which are selected based on culture and sensitivity.

Geniculate neuralgia: a systematic review

Tang IP, Freeman SR, Kontorinis G, Tang MY, Rutherford SA, King AT, et al.

J Laryngol Otol, 2014 May;128(5):394-9.

PMID: 24819337 DOI: 10.1017/S0022215114000802

To systematically summarise the peer-reviewed literature relating to the aetiology, clinical presentation, investigation and treatment of geniculate neuralgia.

Surgical outcomes in cystic vestibular schwannoma versus solid vestibular schwannoma

Tang IP, Freeman SR, Rutherford SA, King AT, Ramsden RT, Lloyd SK

Otol Neurotol, 2014 Aug;35(7):1266-70.

PMID: 24841920 DOI: 10.1097/MAO.0000000000000435

To review the postoperative surgical outcomes of cystic vestibular schwannomas (CVSs), especially facial nerve outcomes, and compare these results with those from matched solid vestibular schwannomas (SVS) resected during the same period at a tertiary referral center.

Intrasellar pituitary mucocele: diagnostic dilemma

Tang IP, Chai CK, Kumar G, Prepageran N, Waran V

Br J Neurosurg, 2014 Jun;28(3):390-2.

PMID: 23875880 DOI: 10.3109/02688697.2013.817535

Isolated intrasellar pituitary mucocele following transsphenoidal sinus surgery is extremely rare. The clinical features resemble a pituitary tumor, therefore careful radiological interpretation is crucial to reach the correct diagnosis. We report a case of intrasellar mucocele who had transsphenoidal sinus surgery performed 15 years prior.

Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses: a rare case

Tang IP, Singh S, Krishnan G, Looi LM

J Laryngol Otol, 2012 Dec;126(12):1284-6.

PMID: 23084156 DOI: 10.1017/S0022215112002435

We report a rare case of small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses with intracranial extension, and discuss the management of this rare tumour.

Diagnostic challenges in tuberculous otitis media

Tang IP, Prepageran N, Ong CA, Puraviappan P

J Laryngol Otol, 2010 Aug;124(8):913-5.

PMID: 20426886 DOI: 10.1017/S0022215110000265

To demonstrate the different clinical presentations of tuberculous otitis media and the management of selected cases.

A recurrent nasopharyngeal carcinoma with lacrimal sac involvement: a case report

Tang IP, Periyannan P, Prepageran N, Shashinder S, Singh A, Bhagubhai PN

Eur J Cancer Care (Engl), 2011 Jan;20(1):93-5.

PMID: 20088917 DOI: 10.1111/j.1365-2354.2009.01147.x

We report a very rare case of recurrent nasopharyngeal carcinoma with local involvement of lacrimal sac. The patient was treated with chemotherapy and there was no recurrence noted after 1 year of follow-up.

Fulltext Outcome of patients presenting with idiopathic facial nerve paralysis (Bell's palsy) in a tertiary centre--a five year experience

Tang IP, Lee SC, Shashinder S, Raman R

Med J Malaysia, 2009 Jun;64(2):155-8.

PMID: 20058577

This is a retrospective study. The objective of this study is to review the factors influencing the outcome of treatment for the patients presented with idiopathic facial nerve paralysis. The demographic data, clinical presentation and management of 84 patients with idiopathic facial nerve paralysis (Bell's palsy) were collected from the medical record office, reviewed and analyzed from 2000 to 2005. Thirty-four (72.3%) out of 47 patients who were treated with oral prednisolone alone, fully recovered from Bell's palsy meanwhile 36 (97%) out of 37 patients who were treated with combination of oral prednisolone and acyclovir fully recovered. The difference was statistically significant. 42 (93.3%) out of 45 patients who presented within three days to our clinic, fully recovered while 28 (71.8%) out of 39 patients presented later then three days had full recovery from Bell's palsy. The difference was statistically significant. The outcome of full recovery is better with the patients treated with combined acyclovir and prednisolone compared with prednisolone alone. The patients who were treated after three days of clinical presentation, who were more than 50 years of age, who had concurrent chronic medical illness and facial nerve paralysis HB Grade IV to VI during initial presentation have reduced chance of full recovery of facial nerve paralysis.

Epithelial migration in the atelectatic tympanic membrane

Tang IP, Prepageran N, Raman R, Sharizhal T

J Laryngol Otol, 2009 Dec;123(12):1321-4.

PMID: 19835642 DOI: 10.1017/S0022215109990806

To determine whether epithelial migration in the atelectatic tympanic membrane (secondary to any pathology) occurs in a similar fashion to that in the normal (non-pathological) tympanic membrane, by calculating and comparing the epithelial migration rate and pattern.

Fulltext Endoscopic orbital decompression for optic neuropathy in thyroid ophthalmopathy

Tang IP, Prepageran N, Subrayan V, Tajunisah I

Med J Malaysia, 2008 Oct;63(4):337-8.

PMID: 19385499 MyJurnal

Optic neuropathy, an uncommon manifestation occurs in 5% of patients with Graves' ophthalmopathy. Its outcome is good if early and proper treatment given. We reported a 49 years old male patient of Graves' disease with bilateral optic neuropathy. He underwent bilateral transnasal endoscopic orbital decompression with marked improvement of visual acuity bilaterally. The preoperative visual acuity was 6/36 in his right eye and 6/60 in his left eye. Two days after operation, his visual acuity was 6/12 in his right eye and 6/24 in his left eye. Transnasal endoscopic orbital decompression is a choice of treatment in optic neuropathy in thyroid ophthalmopathy after trial of corticosteroids.

Fulltext Endoscopic orbital decompression for Graves' ophthalmopathy

Tang IP, Prepageran N, Shashinder S

Med J Malaysia, 2008 Mar;63(1):67-8.

PMID: 18935740

We report a male patient of Graves' Disease with bilateral exophthalmos who had undergone bilateral transnasal endoscopic orbital decompression with subsequent improvement of 3 mm in orbital proptosis bilaterally without any complications. Transnasal endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques especially for purely cosmetic reasons.

Fulltext Extensive benign sinonasal squamous papilloma

Tang IP, Prepageran N

Med J Malaysia, 2007 Oct;62(4):337-8.

PMID: 18551941 MyJurnal

We reported a patient with an extensive benign sinonasal squamous papilloma in the right nasal cavity with involvement of right sphenoid, ethmoid, maxillary sinuses and intracranial extension. This tumour is rare with very few reported cases in the literature of such extensive in nature. The tumour is excised completely with combined endoscopic transnasal and transcranial approaches. The patient remains disease free at a year interval of follow-up.

Migrating foreign body into the common carotid artery and internal jugular vein--a rare case

Tang IP, Singh S, Shoba N, Rahmat O, Shivalingam S, Gopala KG, et al.

Auris Nasus Larynx, 2009 Jun;36(3):380-2.

PMID: 19019597 DOI: 10.1016/j.anl.2008.08.003

Ingested foreign bodies are a fairly common otorhinolaryngological emergencies encountered in Malaysia. The vast majority of these foreign bodies are fish bones which most commonly are impacted at the level of the cricopharynx. Rarely, however, a foreign body may migrate extraluminally and may even extrude subcutaneously. We report a rare occurrence where a fish bone not only migrated extraluminally, it was found to have migrated into the common carotid artery and the internal jugular vein and required surgical removal.

Fulltext Outcome of patients presenting with preauricular sinus in a tertiary centre--a five year experience

Tang IP, Shashinder S, Kuljit S, Gopala KG

Med J Malaysia, 2007 Mar;62(1):53-5.

PMID: 17682572

We reviewed the recurrence rate and possible factors influencing recurrence of preauricular sinus after excision. Seventy-one patients with 73 preauricular sinuses seen at our centre from year 2000 to 2005 were reviewed in this study. The overall recurrence rate was 14.1%. Twelve sinuses needed to be drained for an abscess prior to a definitive surgery. Different modalities used in demonstrating the sinus tract between methylene blue alone and probing together with methylene blue, showed different outcomes, which were statistically significant with a p value of < 0.05(chi-square test). A preauricular sinus with a previous history of infection or actively infected during the definitive surgery may have a higher tendency of recurrence. Meanwhile demonstrating the sinus tract by probing with lacrimal probe/sinus probe followed by injection of methylene blue reduces the recurrence rate (p < 0.05 with chi-square test).

Evaluation and treatment of isolated sphenoid sinus diseases

Tang IP, Brand Y, Prepageran N

Curr Opin Otolaryngol Head Neck Surg, 2016 Feb;24(1):43-9.

PMID: 26575516 DOI: 10.1097/MOO.0000000000000218

To review cause, clinical evaluation, medical and surgical management of isolated sphenoid sinus diseases.

A 4-year review of surgical and oncological outcomes of endoscopic endonasal transpterygoid nasopharyngectomy in salvaging locally recurrent nasopharyngeal carcinoma

Tang IP, Ngui LX, Ramachandran K, Lim LY, Voon PJ, Yu KL, et al.

Eur Arch Otorhinolaryngol, 2019 Sep;276(9):2475-2482.

PMID: 31227870 DOI: 10.1007/s00405-019-05522-5

PURPOSE: To study the surgical and oncological outcomes of endoscopic endonasal transpterygoid nasopharyngectomy (EETN) in salvaging locally recurrent nasopharyngeal carcinoma (NPC).

METHOD: This was a retrospective clinical record review study carried out at a tertiary centre from June 2013 until May 2017. A total of 55 locally recurrent NPC patients (rT1-rT4) underwent EETN performed by single skull base surgeon with curative intention with postoperative adjuvant chemotherapy but without postoperative radiotherapy.

RESULTS: There were 44 (80.0%) males and 11 (20.0%) females, with mean age of 52.5 years. The mean operating time was 180 min (range 150-280 min). 85% (47/55) of patients achieved en bloc tumour resection. 93% (51/55) of patients obtained negative microscopic margin based on postoperative histopathological evaluation. Intraoperatively, one (1.8%) patient had internal carotid artery injury which was successfully stented and had recovered fully without neurological deficit. There were no major postoperative complications reported. During a mean follow-up period of 18-month (range 12-48 months) postsurgery, five patients (9.1%) had residual or recurrence at the primary site. All five patients underwent re-surgery. One patient at rT3 passed away 6 months after re-surgery due to distant metastasis complicated with septicaemia. The 1-year local disease-free rate was 93% and the 1-year overall survival rate was 98%.

CONCLUSIONS: EETN is emerging treatment options for locally recurrent NPC, with relatively low morbidity and encouraging short-term outcome. Long-term outcome is yet to be determined with longer follow-up and bigger cohort study. However, a successful surgical outcome required a very experienced team and highly specialised equipment.

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