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.

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.

Fulltext Using Patient Profiles To Guide The Choice Of Antihistamines In The Primary Care Setting In Malaysia: Expert Consensus And Recommendations

Baharudin A, Abdul Latiff AH, Woo K, Yap FB, Tang IP, Leong KF, et al.

Ther Clin Risk Manag, 2019;15:1267-1275.

PMID: 31802877 DOI: 10.2147/TCRM.S221059

H1-antihistamines are recognized to be effective for conditions such as allergic rhinitis and chronic spontaneous urticaria. However, management of such conditions in the real-world primary care setting may be challenging due to diverse patient-specific considerations, the wide range of antihistamines available, choice of other treatment modalities, and the complexity of interpreting specialist treatment algorithms. Despite regular updates to international guidelines, regional/national surveys of healthcare professionals show a clear gap between guidelines and real-world practice, particularly at the primary care level. This article thus presents the consensus opinion of experts from relevant specialties in Malaysia - allergology, pediatrics, otorhinolaryngology, and dermtology - on harmonizing the use and choice of antihistamines in primary care. Patient profiling is recommended as a tool to guide primary care practitioners in prescribing the appropriate antihistamine for each patient. Patient profiling is a three-step approach that involves 1) identifying the individual's needs; 2) reviewing patient-specific considerations; and 3) monitoring treatment response and referral to specialists in more severe or difficult-to-treat cases. Concurrently, guidelct 3ines should be reviewed and updated periodically to include recommendations that are easily actionable for primary care practitioners.

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.

Fulltext Kimura's Disease: Diagnostic Challenge and Treatment Modalities

Sia KJ, Kong CK, Tan TY, Tang IP

Med J Malaysia, 2014 Dec;69(6):281-3.

PMID: 25934961

CASE REPORT: Five cases of Kimura's disease had been treated in our centre from year 2003 to 2010. All cases were presented with head and neck mass with cervical lymphadenopathy. Surgical excision was performed for all cases. Definite diagnosis was made by histopathological examination of the resected specimens. One out of five cases developed tumour recurrence four years after resection.

CONCLUSION: Surgical excision is our choice of treatment because the outcome is immediate and definite tissue diagnosis is feasible after resection. Oral corticosteroid could be considered as an option in advanced disease. However, tumour recurrence is common after cessation of steroid therapy.

Fulltext Sinonasal angioleiomyoma

Lau YW, Tharumalingam V, Tan TY, Tang IP

Med J Malaysia, 2016 Jun;71(3):154-5.

PMID: 27495895 MyJurnal

Angioleiomyoma of the nasal cavity is an extremely rare benign neoplasm. It usually occurs in the lower extremities. Up to date, only few cases of angioleiomyoma have been reported. First case of angioleiomyoma of nasal cavity was reported in 1966. We report a rare case of angioleiomyoma arising from the right maxillary sinus.

Cavernous sinus fungal infection: a rare case

Ng BHK, Kho GS, Sim SK, Liew DNS, Tang IP

Br J Neurosurg, 2017 Jun 09.

PMID: 28597698 DOI: 10.1080/02688697.2017.1335857

Intracranial fungal infection of the cavernous sinus is a condition that usually affects immunocompromised individuals and is rarely seen in immunocompetent individuals. It is a potentially life threatening condition which requires prompt treatment. Here we present a case of an immunocompetent patient with a fungal infection of the cavernous sinus.

Bonebridge transcutaneous bone conduction implant in children with congenital aural atresia: surgical and audiological outcomes

Ngui LX, Tang IP

J Laryngol Otol, 2018 Aug;132(8):693-697.

PMID: 30008276 DOI: 10.1017/S0022215118001123

OBJECTIVES: To investigate the surgical and audiological outcomes of the Bonebridge transcutaneous bone conduction hearing implant among children with congenital aural atresia.

METHODS: Six children were recruited and underwent Bonebridge transcutaneous bone conduction implant surgery. The patients' audiometric thresholds for air conduction, bone conduction and sound-field tests were assessed pre-operatively and at six months post-operatively. Patients' satisfaction was assessed at six months post-operatively with the Hearing Device Satisfaction Scale.

RESULTS: No major complications were reported. Mean aided sound-field thresholds improved post-operatively by more than 30 dB for 0.5-4 kHz (p 0.05). All patients were satisfied (scores were over 90 per cent) with the implant in terms of functional outcome and cosmetic appearance.

CONCLUSION: Bonebridge transcutaneous bone conduction implant surgery is safe and effective among children with congenital aural atresia with conductive hearing loss.

Temporal bone squamous cell carcinoma: A change in treatment

Ngu CYV, Mohd Saad MS, Tang IP

Med J Malaysia, 2021 09;76(5):725-730.

PMID: 34508382

Temporal bone squamous cell carcinoma (TBSCC) is a rare head and neck malignancy with the incidence 0.8 -1.0 cases in 1 million population. We are reporting a case series on the TBSCC cases that were operated on at Sarawak General Hospital, Malaysia. Ten patients were identified and collected with the presentation and type of surgery performed. It has been challenging for us to manage with recorded 2 years surviving in 6 out of 10 patients operated within this period. An adequate management with proper surgical resection of tumour and radiotherapy can extend the life expectancy for TBSCC patients.

Fulltext Adenoid Cystic Carcinoma of the Nasopharynx: A Case Series

Ng BHK, Tang IP

Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):731-733.

PMID: 31742052 DOI: 10.1007/s12070-018-1523-0

Adenoid cystic carcinomas are tumors that are more commonly seen in the salivary glands than in the nasopharynx. Nasopharyngeal adenoid cystic carcinomas are rare and cases that are reported in the literatures are few. Treatment is mainly by surgical resection. Here, we report 2 cases of nasopharyngeal adenoid cystic carcinoma.

Fulltext Challenges in Managing Intractable Epistaxis in a Post-nasal Surgery and Radiated Cancer Patient: A Case Report and Literature Review

Goh SP, Wilfred R, Husain S, Tang IP

Indian J Otolaryngol Head Neck Surg, 2023 Apr;75(Suppl 1):1096-1100.

PMID: 37206815 DOI: 10.1007/s12070-023-03625-4

Recurrent epistaxis represents an alarming sign that may suggest a sinister aetiology, especially in patients with previous head and neck malignancy. The recognition of certain potentially life-threatening conditions, namely pseudoaneurysm or tumour recurrence, remains prudence to avoid disastrous repercussion. Nasal endoscopy has become an essential tool in otolaryngology. It can aid identify the underlying cause of epistasis and facilitate therapeutic management. On the other hand, radio imaging is highly sensitive in detecting vascular lesions, besides providing a pre-operative mapping if surgical intervention is planned. This paper reported a patient with sphenoidal sinus squamous cell carcinoma in remission presented with torrential epistaxis not relieved with nasal packing. Despite a repeated angiogram and magnetic resonance image, the identification of the source of bleeding remained futile, culminating in an examination under general anaesthesia. The diagnosis of carotid blowout syndrome was made intraoperatively, and the bleeding was temporarily secured with a muscular patch, preceded by the insertion of a vascular stent. The authors wish to highlight the importance of examination under general anaesthesia if radio imaging does not correlate to the clinical findings. Management options for carotid blowout should be tailored to the patients' medical conditions.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-023-03625-4.

Fulltext A Rare Case of Cerebrospinal Fluid Rhinorrhea from Canal of Stenberg

Ngu CYV, Lee TH, Ramachandran K, Liew DNS, Tang IP

Indian J Otolaryngol Head Neck Surg, 2023 Apr;75(Suppl 1):764-767.

PMID: 37206705 DOI: 10.1007/s12070-022-03347-z

Background: A spontaneous cerebrospinal leak from Sternberg's canal with meningoencephalocele is a very rare clinical entity. Endoscopic repair of the defect is challenging and crucial in identifying the defect. The aim of this case report is to highlight the presence and management with endoscopic surgery in repairing Sternberg canal. Case: 40-year-old woman presents with spontaneous CSF rhinorrhea with no predisposing factors. CT imaging and MRI showed osteodural defect in the lateral recess of sphenoid with meningoencephalocoele lateral to the foramen rotundum. Endoscopic transethmoidal - transphenoidal - transpterygoid approach was used to repair the defect, and patient is well post-operative with least complication from the intervention surgery. Conclusion: Endoscopic approach proved to be the best and safest method in localizing the defect and closure of the leak. Angled scopes and image guided system were used to identify the precise location of the leak.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-022-03347-z.

A Rare Case and Literature Review of Endoscopic Endonasal

Rajoo TS, Ng BHK, Abdullah B, Tang IP

Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):996-999.

PMID: 37275000 DOI: 10.1007/s12070-022-03212-z

We report a rare case of localized anterior clinoid mucocele (ACM) with acute visual loss and a literature review of the endoscopic endonasal surgery. We advocate that endoscopic endonasal approach is the best choice. To our knowledge there a limited report on localized ACM that treated via endoscopic endonasal approach.

Pharyngeal Lipoma-A Potentially Life Threatening Presentation

Mohd Nor SNA, Ng BHK, Othman N, Tang IP

Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):5478-5481.

PMID: 36742515 DOI: 10.1007/s12070-021-02803-6

Pharyngeal lipoma of the upper aero-digestive system is extremely rare. It is typically benign, slow growing and symptoms would depend on its size and location. Surgical intervention is often needed especially for large tumour with impending airway obstruction. Here we present a case of potentially life threatening presentation of pharyngeal lipoma.

A Rare Case of Complicated Sinonasal Meliodosis Mimicking Sinonasal Lymphoproliferative Disease

Cheah Y, Jumastapha H, Tang IP

Indian J Otolaryngol Head Neck Surg, 2023 Sep;75(3):2564-2567.

PMID: 37636706 DOI: 10.1007/s12070-023-03792-4

Unilateral nasal obstruction with purulent nasal discharge is one of the presentations for sinonasal melioidosis. However, it may mimic nasal NK/T cell lymphoma. Both causing tissue destruction involving nasal septum, lateral nasal wall and palate. Here, we report a case of disseminated melioidosis involving sinonasal mimicking nasal lymphoma in a 32-year-old immunocompetent lady. She presented with prolonged fever, unilateral nasal blockage, painful facial swelling and knee pain. Clinical findings revealed extensive necrotic tissue and crusting involving right lateral wall of nasal cavity. Tissue and blood culture and sensitivity (C + S) grew Burkholderia pseudomallei. Recovery was complete after surgery and antibiotics.

Fulltext Primary lacrimal sac lymphoma with recurrence: a case report

Chai CK, Tang IP, Tan TY

Med J Malaysia, 2013 Jun;68(3):269-70.

PMID: 23749022 MyJurnal

Primary lacrimal sac lymphoma is rare. The common clinical features are epiphora and medial canthal swelling which mimic nasolacrimal duct obstruction. Histological examination is therefore important to avoid delay in diagnosis and treatment. We report a case of primary lacrimal sac lymphoma in a 72-year-old female who developed a metachronous tumour at the hard palate one year after excision of the lacrimal sac tumour.

Nasolacrimal relapse of nasopharyngeal carcinoma

Sia KJ, Tang IP, Kong CK, Tan TY

J Laryngol Otol, 2012 Aug;126(8):847-50.

PMID: 22804860 DOI: 10.1017/S0022215112001272

To describe three rare cases of nasolacrimal relapse of nasopharyngeal carcinoma, and to discuss the route of tumour spread from nasopharynx to lacrimal system as well as the relevant computed tomography findings.

Multiple symmetrical lipomatosis: case report and literature review

Sia KJ, Tang IP, Tan TY

J Laryngol Otol, 2012 Jul;126(7):756-8.

PMID: 22583757 DOI: 10.1017/S0022215112000709

To discuss the pathophysiology and various treatment methods of multiple symmetrical lipomatosis.

Fulltext Head and neck cancer: possible causes for delay in diagnosis and treatment

Lee SC, Tang IP, Avatar SP, Ahmad N, Selva KS, Tay KK, et al.

Med J Malaysia, 2011 Jun;66(2):101-4.

PMID: 22106686 MyJurnal

To explore the possible causes for delay in diagnosis and treatment of head and neck cancer at Sarawak General Hospital (SGH).

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.

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