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  1. Fulltext A Single Institution Cadaveric Study on Anatomical Variation of the Sublingual Gland Duct
    Ab Rahim NAC, Liew YT, Ghauth S, Narayanan P, Abu Bakar Z
    Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):347-351.
    PMID: 36406798 DOI: 10.1007/s12070-022-03261-4
    The purpose of this study was to conduct a cadaveric dissection study on the anatomical variation of the sublingual (SLG) excretory ducts and dictate an improved understanding of the anatomical communication between the SLG duct and submandibular (SMG) ducts. This study is carried out by standardized dissection of anterior floor of mouth in 6 formalin-fixed adult cadavers in Silent Mentor Workshop University Malaya in August 2020. The cadavers had no trace of scars, adhesions, signs of trauma or operation. SMG duct opening was identified lateral to the lingual frenulum through a papilla in the floor of mouth behind the lower incisor tooth. A horizontal incision line was done over floor of mouth just lateral to the opening. SMG duct and SLG was traced and skeletonized. Any presence of major duct arising from the SLG and its communication with SMG duct were investigated. We found there are 3 patterns of SLG excretory duct variants; (1) One major (Bartholin's) duct which open independently at its own orifice adjacent to the orifice of the Wharton's duct of SMG. (2) One major (Bartholin's) duct which joined into the Wharton's duct of SMG. (3) Absent of a major duct arising from SLG. The overall mean diameter of SLG ducts were 1.3 ± 0.41 and the mean length of SLG ducts were 18.5 ± 6.55. The overall mean diameter of SMG ducts was 2.6 ± 0.74 and the mean length of SMG ducts were 46.5 ± 6.57. Excretory ductal system of SLG showed great variations, not only between the different cadavers but also within the different sides of the same cadaver. Awareness of potential anatomical variations can aid in the accurate diagnosis and treatment of patients with salivary gland pathology as well as help surgeons reveal potential risk factor and avoid complications during surgical procedures in the floor of mouth.
  2. Fulltext A Review of Tracheal Bronchus in Universiti Kebangsaan Malaysia Medical Centre (UKMMC)
    Abdul Rahim F, Goh BS
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):2666-2669.
    PMID: 36452671 DOI: 10.1007/s12070-020-02358-y
    Tracheal bronchus (TB) is a rare congenital anomaly described as a abnormal bronchus that originates directly from the trachea above the carina directed towards the upper lung lobe. We analysed all paediatric rigid endoscopies of the airway from January 2015 until August 2020 to determine the incidence and characteristic of TB. In total, 68 rigid endoscopic airway examination record from children aged 0 to 12 years were analyzed. Endoscopic examination was performed from supraglottic region to carina using a 0 degree Hopkins rod lens telescope. Patients with a TB were identified and the site of TB origin was noted. Data of the identified patients was reviewed for the presence of preoperative airway findings such as stridor, upper lobe pneumonia, other congenital anomalies, intraoperative findings and complications and postoperative general condition outcome. TB was detected in 8 (11.8%) of 68 airway endoscopic examinations. 6 children (75%) were syndromic. 5 patients (62.5%) has congenital malacic airway and 2 patients (25%) has congenital tracheal stenosis. All TB originated from the right lateral wall of the trachea. All children had stridor unrelated to TB as presentation and 4 (50%) of children had preoperative upper lobe pneumonia. Tracheal bronchus is not a rare finding and is highly associated with syndromes and other airway anomalies. Although children with TB can be asymptomatic, upper lobe pneumonia is a common presentation. TB should be included in the differential diagnosis in patients with recurrent right upper lobe pneumonia or collapse and patients with unexplained oxygenation problem during endotracheal intubation, particularly in children with syndromes or other congenital anomalies.
  3. Nasal Irrigation as Treatment in Sinonasal Symptoms Relief: A Review of Its Efficacy and Clinical Applications
    Abdullah B, Periasamy C, Ismail R
    Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1718-1726.
    PMID: 31763232 DOI: 10.1007/s12070-017-1070-0
    Nasal irrigations have been used for centuries without any scientific data to determine its efficacy. Despite their widespread use, much confusion exist about the mechanism of action, preparation, indications and therapeutic advantage of nasal irrigations. Anecdotal evidence and poorly controlled studies add to the confusion. Recent evidence provides strong scientific justification of the benefits and advantages of using nasal irrigations in sinonasal symptoms relief. The present review of the evidence based literature highlights its efficacy and clinical applications.
  4. Supraglottic Schwannoma: Dilemma and Challenges in Management
    Al-Yahya SN, Saifudin N, Rahim NA, Mansor M, Din S, Bakar NS
    Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):5172-5176.
    PMID: 36742766 DOI: 10.1007/s12070-021-03027-4
    Laryngeal schwannomas are rare lesions that represent less than 1.5% of all benign laryngeal tumors. Its slow and submucosal growth may cause a delay in consultation and management. Herein, a case of right supraglottic schwannoma is diagnosed in a 34-year-old lady who was unconcerned about hoarseness for 10 years. She was referred to otorhinolaryngology clinic for assessment when hoarseness was detected during consultation for a gynecology surgery. Apart from hoarseness, there were no noisy breathing, shortness of breath or aspiration symptoms. Flexible nasopharyngolaryngoscopy showed a submucosal bulge at the right vestibular fold obscuring the vocal fold causing an airway concern. Computer tomography scan of the neck revealed a heterogenous enhancing mass centered at the right supraglottis measuring 2.6 × 2.7 × 2.7 cm. There were no erosions of the adjacent thyroid and arytenoid cartilages. Subsequently, complete excision of the lesion was done endoscopically. Definitive diagnosis of schwannoma was obtained via histopathology examination. This paper presents our approach and operative steps in the excision of this lesion using microlaryngoscopy with cold instruments.
  5. Fulltext Predictors of Surgical Outcomes After Functional Endoscopic Sinus Surgery in Chronic Rhinosinusitis
    Anne J, Sreedharan S, Dosemane D, Shenoy V, Kamath PM, Zubair SM
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):835-841.
    PMID: 36452725 DOI: 10.1007/s12070-020-01855-4
    Chronic rhinosinusitis has an incidence of 15% in India. Functional endoscopic sinus surgery (FESS), in case of failed medical management, is the current treatment protocol in Chronic rhinosinusitis. This study aims to assess the outcome of FESS as measured by subjective quality of life indices; Rhinosinusitis Disability Index (RSDI) and Sinonasal Outcome Test (SNOT-22. It also assesses the predictive factors which influence the outcome after FESS. The study was conducted among 100 patients with Chronic Rhinosinusitis who underwent FESS, after failure of medical management. Immunocompromised or pregnant patients and patients with history of previous sinus surgery or malignancy were excluded from the study. The evaluation was done using Lund Kennedy endoscopy scores, Lund Mackay CT scan scores and RSDI and SNOT-22 questionnaires (baseline and 3 months post-op). Statistical analysis was done using Wilcoxon signed-rank test, Kruskall Wallis test, Mann Whitney test and Chi-square test. p 
  6. Fulltext "High frequency presbycusis"-is there an earlier onset?
    Arvin B, Prepageran N, Raman R
    Indian J Otolaryngol Head Neck Surg, 2013 Dec;65(Suppl 3):480-4.
    PMID: 24427701 DOI: 10.1007/s12070-011-0356-x
    The objective of this study is to determine whether presbycusis occurs much earlier than previously believed if the high frequency (above 8 kHz) are included. Tertiary referral center (a teaching University). This is a cross-sectional observational study. Healthy adults from 20 to 49 years of age who had essentially normal hearing were included into the study. They were subjected to high frequency pure tone audiometry (until 16 kHz). Participants were grouped based on age ranges of 10 years (e.g., 20-29, 30-39, and 40-49) and the presence of symmetrical high frequency sensor neural hearing loss were documented. There is a significant presence of symmetrical high frequency sensor neural hearing loss (not attributed to any known risk factors) as early as from the age group of 40 to 49 years. Seven of 43 participants (16%) from age group of 20 to 29 years and 12 of 24 participants (50%) from age group of 30 to 39 years had significant high frequency hearing loss. High frequency hearing loss (high frequency Presbycusis) may occur much earlier than previously believed.
  7. Fulltext The Correlation Between Pre and Postoperative Hearing Level with High Resolution Computed Tomography (HRCT) Findings in Congenital Canal Atresia (CAA) Patients
    Asma A, Abdul Fatah AW, Hamzaini AH, Mazita A
    Indian J Otolaryngol Head Neck Surg, 2013 Dec;65(Suppl 3):526-31.
    PMID: 24427708 DOI: 10.1007/s12070-011-0438-9
    In managing patient with congenital congenital aural atresia (CAA), preoperative high resolution computed tomography (HRCT) scan and hearing assessment are important. A grading system based on HRCT findings was first introduced by Jahrsdoefer in order to select appropriate candidates for operation and to predict the postoperative hearing outcome in CAA patients. The score of eight and more was considered as a good prognostic factor for hearing reconstruction surgery. However previously in our center this score was not used as the criteria for surgical procedure. This study was conducted at Center A to evaluate the correlation between pre and postoperative hearing level with HRCT based on a Jahrsdoefer grading system in patients with CAA. All records and HRCT films with CAA from January 1997 until December 2007 at Center A were evaluated. The demographic data, operative records, pre and post operative hearing levels and HRCT findings were analyzed. Hearing level in this study was based on a pure tone average of air-bone gap at 500 Hz, 1 kHz and 2 kHz or hearing level obtained from auditory brainstem response eudiometry. This study was approved by Research Ethics Committee (code number, FF-197-2008). Thirty-two ears were retrospectively evaluated. The postoperative hearing level of 30 dB and less was considered as successful hearing result postoperatively. Of the six ears which underwent canalplasty, three had achieved successful hearing result. However, there was no significant correlation between preoperative hearing level (HL) with HRCT score and postoperative HL with HRCT score at 0.05 significant levels (correlation coefficient = -0.292, P = 0.105 and correlation coefficient = -0.127, P = 0.810) respectively. Hearing evaluation and HRCT temporal bone are two independent evaluations for the patients with CAA before going for hearing reconstructive surgery.
  8. Fulltext Surgical outcome of bone anchored hearing aid (baha) implant surgery: a 10 years experience
    Asma A, Ubaidah MA, Hasan SS, Wan Fazlina WH, Lim BY, Saim L, et al.
    Indian J Otolaryngol Head Neck Surg, 2013 Jul;65(3):251-4.
    PMID: 24427576 DOI: 10.1007/s12070-013-0621-2
    Bone anchored hearing aid (Baha) implant is an option for patient with canal atresia, single sided deafness(SSD) and chronically discharging ears despite treatments. This retrospective study was conducted from 2001 to 2011 to evaluate the surgical outcome of Baha implant surgery. Thirty-three patients were identified during this study period. Their age at implantation ranged from 5 to 40 years. Of 33 patients, 29 (87.9 %) patients had bilateral microtia and canal atresia, 3 (9.1 %) patients had unilateral microtia and canal atresia and 1 (3.0 %) patients have SSD following labyrinthitis. One patient (3.2 %) had major complication which is lost of implant due to failure of osseointegration. Soft tissue reactions were seen 7 patients (21.1 %). Of these 7 patients, 4 patients required 3-4 procedures as day care operation for excision of the skin overgrowth surrounding the abutment. Recurrent antibiotic treatment was required in 3 patients (9.7 %). None of our patient had history of intraoperative or peri-operative complication following Baha surgery. The commonest complications are local infection and inflammation at the implant site. None of our patient had history of intraoperative or peri-operative complication following Baha implant surgery.
  9. Fulltext A Single Blinded Randomized Controlled Study of the Effect of Conventional Oral Hypoglycemic Agents Versus Intensive Short-Term Insulin Therapy on Pure Tone Audiometry in Type II Diabetes Mellitus
    Asma A, Azmi MN, Mazita A, Marina MB, Salina H, Norlaila M
    Indian J Otolaryngol Head Neck Surg, 2011 Apr;63(2):114-8.
    PMID: 22468245 DOI: 10.1007/s12070-011-0132-y
    Neuropathy is frequently a late complication of diabetes mellitus. Auditory neuropathy and microangiopathy of inner ear are the possible causes of hearing loss in diabetics. To study the correlation between glycaemic control and hearing threshold in patients with type 2 diabetes mellitus and to determine the differences of hearing threshold between groups treated with different modality. This single blind randomized controlled study was performed at the Department of Medicine and Department of Otorhinolaryngology, Hospital Universiti Kebangsaan Malaysia (UKM) between 1st May 2003 and 31st September 2004. This study was approved by Research Ethics Committee (code number FF-137). Subjects were randomized into two groups. Group 1 were patients treated with conventional oral hypoglycemic agents. The patients in group 2 were those treated with insulin injection. The subjects were seen 4 weekly for 3 months. Audiometric test were performed in all subjects at each visit. Blood were taken for fasting blood glucose, Hb1Ac, and fructosamine at every visit to determine the glycaemic controls of the subject. They were 11 patients (22 ears) treated with oral hypoglycemic agents and 17 patients treated (34 ears) with subcutaneous insulin. There is no significant difference between mean pure tone threshold before and after treatment at all frequencies in both groups. There is also no significance different in fasting glucose level and fructosamine. However, there is significant difference HbA1c levels between the two groups after treatment (P 
  10. Fulltext Development and Evaluation of an Interprofessional Collaborative Practice Module for the Tracheostomy Procedure for Improved Patient Care
    Bhargava A, Sahoo S, Mahdi F, Ali Mohammed C, Dandekar S, Rege N, et al.
    Indian J Otolaryngol Head Neck Surg, 2022 Jun;74(2):225-233.
    PMID: 35813773 DOI: 10.1007/s12070-021-03041-6
    The Interprofesional collaborative practice (IPCP) is the need of the hour for improved patient care. The procedure of tracheotomy is a life saving procedure and the implementation of the Interprofessional collaborative practice module for the same comprising of the ENT surgeon, Physiotherapist, Nursing staff, OT and Trauma technician decreases the number of complications. This study was carried out to develop and evaluate the Interprofessional collaborative practice module for Tracheostomy. The project has been carried out as a prospective before and after study with the departments of ENT, nursing and Allied health sciences. The facilitators were from the above departments.They were sensitized and developed the Interprofessional education (IPE team),which then collaborated to develop the IPCP module.This IPE team after faculty meetings developed the module with learning objectives, teaching learning methods and methods of assessment. Standardized Readiness scale for Interprofessional Learning Scale (RIPLS), was adopted for the module. The questionnaires for assessment and the module were structured and validated.The template of reflection was compiled for the execution of the module. The students training comprised of the demonstration session, baseline Team OSCE, practice sessions and the final Team OSCE. The baseline and final Team OSCE scores,reflections and RIPLS scores were compared. Team OSCE scores baseline vs Final for IPCP competencies i.e. Competency 1-Values and Ethics for Interprofessional Practice, Competency 2-Roles and Responsibilities, Competency 3-Interprofessional Communication, Competency 4-Teams and Teamwork during Pretracheostomy (PreT),Tracheostomy(T) and PostTracheostomy (PostT) were calculated. Faculty observations: TOSCE scores (pre T/T/postT) significantly improved for all the four IPCP competencies (p 
  11. Fulltext Visual analog scale in hearing loss
    Bokari S, Prepageran N, Raman R
    Indian J Otolaryngol Head Neck Surg, 2010 Jan;62(1):40-3.
    PMID: 23120679 DOI: 10.1007/s12070-010-0004-x
    OBJECTIVE: To determine if visual analog scale (VAS) that has been used to measure magnitude of internal states such as pain, mood and various functional capabilities can be applied for patients with hearing loss.

    MATERIALS AND METHODS: One hundred and sixty patients, aged 12-80 years with unilateral hearing loss were studied using a VAS (1-10) and pure tone audiometry (PTA) of responses to 500, 1,000 and 2,000 Hz to determine degree and type of hearing loss. The results of both were compared to determine if VAS can be used in measuring hearing loss.

    RESULTS: Patients with mild, moderate hearing loss correlate well with corresponding VAS but other degrees of hearing loss (severe and profound) have poor correlation. The best correlation between PTA and VAS were found in conductive type of hearing loss.

    CONCLUSION: This study suggest that there may be a role for VAS in mild and moderate hearing loss. This may be more applicable in rural setting as a screening procedure when audiometry is not available and can enhance clinical hearing assessment especially in mild-to-moderate conductive hearing loss.

  12. 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.
  13. Rhinoplasty Surgical Technique for Nasal Dermoid Cyst Removal in Adult: Case Report
    Che Mohd Razali SS, Narayanan MS, Mohamad A, Ramli RR
    Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):3815-3817.
    PMID: 37974762 DOI: 10.1007/s12070-023-03822-1
    Nasal dermoid cyst is a rare benign lesion. The mainstay of treatment for a nasal dermoid cyst is surgical excision, which aims to remove the cyst and associated structures to prevent recurrence. We report a case of a 30-year-old man with nasal dermoid cyst, without intranasal or intracranial extension. The patient underwent open rhinoplasty technique for dermoid cyst excision. He had an uneventful postoperative recovery and was discharged well. The cyst and associated structure were successfully removed. There was no evidence of recurrence and complications postoperatively after 2 years of follow-up.
  14. Reliability of the 'M-Line' in the Prediction of the Facial Nerve Position in Patients with Parotid Neoplasms
    Cheah PF, Punithamalar K, Kong LSS, Goh LC, Yeoh AG, Mohd Razif MY
    Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):6032-6038.
    PMID: 36742789 DOI: 10.1007/s12070-021-02680-z
    Preoperative radiological assessment of parotid tumours represents a crucial step in the planning of a parotidectomy in order to avoid post-operative facial nerve paralysis. The purpose of this study is to determine the reliability of the novel 'M-line' in predicting the facial nerve position and compare it to various radiological methods in the same context. 66 patients whom had underwent parotidectomy for parotid tumours from January 2012 to February 2021 were analyzed. Parotid tumour location were identified using the retromandibular vein, facial nerve line, Conn's arc, Utrecht line and the 'M'-line were compared to the intraoperative location of parotid tumours.The 'M'-line is a novel hypothetical line (drawn between the lateral surface of the mandible to the lateral border of the mastoid process) used to identify the location of the facial nerve radiologically. The 'M-Line' and other methods of radiological assessments were associated with statistical significance in predicting if the parotid tumours were superficial or deep to the facial nerve (p-value 
  15. A Rare Cause of Acute Dyspnoea: Reinke Oedema
    Cheah SC, Yee LW, Kok WL, Nazri Zamri FI, Baki MM
    Indian J Otolaryngol Head Neck Surg, 2023 Sep;75(3):2420-2422.
    PMID: 37636736 DOI: 10.1007/s12070-023-03714-4
    Reinke oedema is a benign condition due to fluid collection within subepithelial space of the true vocal fold. This phenomenon is predisposed by chronic smoking, alcohol consumption and contribution of laryngopharyngeal reflux. Although benign, it may be life threatening when bilateral vocal folds are affected causing airway obstruction. In this report, awake tracheostomy was performed for a 65- year- old lady with stridor secondary to severe Reinke oedema. The importance of establishing a definitive airway is highlighted here in securing a difficult airway.

    SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12070-023-03714-4.

  16. 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.
  17. Fulltext The Trend of the Burden of Allergic Rhinitis Pre- and Post-COVID-19 Pandemic in the Urban Population of Perak, Malaysia
    Chew CC, Lim XJ, Narayanan MS, Letchumanan P, Rajan P, Chong CP
    Indian J Otolaryngol Head Neck Surg, 2023 May 30.
    PMID: 37362103 DOI: 10.1007/s12070-023-03896-x
    AIMS: This study aims to determine the trend of allergic rhinitis (AR) prevalence in a tertiary hospital between 2017 and 2022, and to compare its prevalence pre- and post-COVID-19 pandemic.

    METHODS: This was a cross-sectional study involving the extraction of all Malaysian patients' medical records who were diagnosed with AR and attended the otorhinolaryngology outpatient clinic of a government-funded tertiary hospital in Malaysia between 2017 and 2022.

    RESULTS: 3,744 cases out of the 57,968 first-encounter outpatient visits to the otorhinolaryngology clinic were extracted for analysis. Overall, the prevalence of AR cases ranged from 1.83 to 9.23% between 2017 and 2022. There was a significant drop of 21.38 to 70.22% between the pre- and post-COVID-19 pandemic (p 

  18. 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.
  19. Keratosis Obturans: A Disease of the Tropics?
    Chong AW, Raman R
    Indian J Otolaryngol Head Neck Surg, 2017 Sep;69(3):291-295.
    PMID: 28929057 DOI: 10.1007/s12070-017-1071-z
    Keratosis obturans appears to be an obscure and relatively uncommon entity, even in literature search of journals and reference texts, so much so that there is not even any prevalence or incidence statistics available. However, the condition did not appear to be as uncommon based on our clinical observations. We have managed to obtain 64 patients representing 67 ears with keratosis obturans in our study period of about 18 months with a pattern of occurrence during this period. Humid weather seemed to play a role in the frequency of its appearance during certain period in our observation. There also appears to be a correlation between the severity of symptoms (predominantly pain and hearing loss) and the presenting appearance of the condition, i.e., presence or absence of granulation tissue, as well as that the degree of difficulty in exenteration of the keratosis obturans (matrix and content) depending on the expansion of the bony canal. Our figures showed the majority of the patients are females and young individuals, the majority of them occur unilaterally. The condition also appear to stop short of involving the tympanic membrane with only the bony canal being expanded with the surrounding oedema creating an apparent "canal stenosis".
  20. Fulltext A Timely Burst: Tuberculous Retropharyngeal Abscess
    Chong W, Loh ST, Kulasegarah J, Loh TL, Tengku Kamalden TMIB
    Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1800-1802.
    PMID: 36452768 DOI: 10.1007/s12070-020-01809-w
    Tuberculous retropharyngeal abscess is a rare form of extrapulmonary tuberculosis. We describe an immunocompetent teenager who has her tuberculous retropharyngeal abscess ruptured and then diagnosis confirmed by the presence of acid-fast bacilli from the gastric lavage.
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