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Fulltext Congenital cholesteatoma: Different clinical presentation in two cases

Abdul Jalil S, Md Daud MK

Malays Fam Physician, 2016;11(2-3):30-32.
PMID: 28461856

INTRODUCTION: Congenital cholesteatoma (CC) of the middle ear is a rare entity that may be undiagnosed for years. The lesion can grow undetected until it produces symptoms such as reduced hearing or otalgia.

METHOD: Case report.

RESULTS: We report two cases of young ladies with CC who presented with different otological symptoms. The first case complained of recurrent unilateral ear pain while the second case presented with unilateral reduced hearing. Examination of both cases revealed a whitish mass seen behind an intact tympanic membrane. Both cases underwent surgery and histopathological examinations; findings were consistent with cholesteatoma.

CONCLUSION: There are varieties of clinical presentations of CC and the diagnosis is based on clinical findings.

Matched MeSH terms: Ear, Middle
Ball-bearing in ear

Abdul Wahab A

Br Med J, 1955;2:439.

I would like to report the case of a Chinese boy of 5 years old who came to see me with a ball-bearing in one of his ears. Repeated attempts were made to extricate it under general anaesthesia by means of several kinds of aural apparatus, but they all failed. While about to give up hope and hand him over to a specialist, I managed to borrow a pair of magnetic forceps from a radio mechanic. The ball-bearing was immediately attracted to the point of the forceps and drawn out with ease. It would not be a bad idea to design a magnetic aural (or nasal) forceps based upon the above principles with a view to avoiding unnecessary pain and misery to the young victims.

Matched MeSH terms: Ear Diseases
Fulltext Clinical and audiological profiles in children with chronic otitis media with effusion requiring surgical intervention

Abdullah B, Hassan S, Sidek D

Malays J Med Sci, 2007 Jul;14(2):22-7.
PMID: 22993488 MyJurnal

To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles and the intraoperative findings of children with chronic otitis media with effusion who required surgical intervention. A prospective cross sectional study was undertaken in the otorhinolaryngology clinic of USM Hospital (HUSM) involving 25 cases (50 ears) of children with chronic otitis media with effusion requiring surgical intervention from June 1999 to September 2001. Their ages ranged from 3 to 12 years old. The gender distribution included males at 72 % and females at 28 %. The presenting symptoms noted were hearing impairment (52%), otalgia (18%), ear block (16%) and tinnitus (14%). The otoscopic findings were fluid in the middle ear (40%), dullness (32%) and retraction of the tympanic membrane (28%). On audiometry, 24 ears had moderate deafness (48%), 16 ears had mild deafness (32%) while 4 ears had severe deafness (8%). With tympanometry, 42 ears out of the total 50 had a flat type B curve (84%) while 6 ears had type As curve (12%). During myringotomy, middle ear secretion was seen in 38 ears (76%) out of the 50 ears; 22 ears had mucoid secretion while 16 ears had serous secretion. Clinically, the commonest presenting symptom was hearing impairment (52%) while the most common otoscopic finding was fluid in the middle ear (40%). Audiologically, most patients had moderate conductive hearing loss (48%) and a type B curve (84%) on tympanometry. On myringotomy middle ear fluid was found in 76 % of the ears.
Study site: otorhinolaryngology clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Matched MeSH terms: Ear, Middle; Middle Ear Ventilation
Fulltext Cochlear implantation in children with labyrinthitis ossificans

Abdullah, A., Shaharudin, M.H., Amin, M., Marhaban, J.A., Awang, M.A., Zulfiqar, M.A., et al.

Medicine & Health, 2006;1(1):61-66.
MyJurnal

Evidence of ossification was previously considered a relative contraindication to cochlear implantation. It was considered difficult or impossible to achieve safe electrode insertion because of bony obstruction. Either the electrodes or the inner ear structures could be damaged. Moreover, obstructed scala tympani could limit the number of electrodes that can be inserted. The efficacy of the electrical stimulation was also questioned, as a higher current would be needed on an ossified cochlea. Finally, the neural survival in ossified cochlea is unknown. This may complicate the surgical procedure and affect the long-term outcome. However, depending on the experience of the surgeon, cochlear implantation has been attempted even in grossly ossified cochlea. Here we illustrate that cochlear implantation is safe in labyrinthitis ossificans.

Matched MeSH terms: Ear, Inner
Public Knowledge and Attitudes Regarding the Use of Antibiotics and Resistance: Findings from a Cross-Sectional Study Among Palestinian Adults

Abu Taha A, Abu-Zaydeh AH, Ardah RA, Al-Jabi SW, Sweileh WM, Awang R, et al.

Zoonoses Public Health, 2016 09;63(6):449-57.
PMID: 26752329 DOI: 10.1111/zph.12249

Antibiotics are considered to be among the most commonly sold drug classes in Palestine. Resistance to antibiotics has increased for reasons relating to the use and misuse of antibiotics. The aim of this study was to evaluate the knowledge, and attitudes regarding antibiotic use and awareness about resistance among adults visiting the emergency departments at hospitals in North Palestine. A self-administered cross-sectional questionnaire survey involving participants aged 18 or over was conducted from June 2012 to February 2013. Adults who visited the emergency departments at hospitals in North Palestine were included. Demographic characteristics, knowledge and attitudes towards antibiotic use were included in the questionnaire. Poor and good knowledge were defined as a total knowledge score of 0-7 and 8-15 of 15 questions, respectively. Attitude scores of 0-3 and 4-7 of 7 questions were considered poor and good, respectively. A total of 375 questionnaires were included in the study. A response rate of 83.3% was attained. About 55.0% of the participants had a good knowledge and 56.5% had a good attitude towards rational antibiotic use. A significant positive correlation was shown between participants' knowledge scores and participants' attitude scores towards antibiotic use (R = 0.344, P = 0.001. Participants with a high family income were more likely to be aware of appropriate antibiotic use than participants with a low family income (P-value <0.001). Participants with a higher educational level (university) had a good attitude towards rational antibiotic use than those with a lower education level (P-value <0.001). This study has documented important knowledge and attitude gaps in antibiotic use. These findings will help health policymakers in Palestine to implement intervention programmes to rationalize antibiotic use. Continuing medical education, professional development and training workshops for healthcare professionals regarding rational use of antibiotics and health risks associated with the spread of antibiotic resistance are needed. In addition, minimizing non-prescription use of antibiotics and increasing the public awareness about the health and economic hazards of antibiotic resistance are also required.

Matched MeSH terms: Ear/abnormalities; Ear Diseases
Fulltext Bilateral Carotid Body Tumours

Amran, A.R., Jayaram, G., Kumar, G.

International Medical Journal Malaysia, 2006;5(1):1-6.
MyJurnal

Paragangliomas are slow growing hypervascular tumour arising from neural crest cell derivatives throughout the body. In the head and neck region, the major paraganglial cells are located at the carotid bifurcation (carotid body), along the ganglia of the vagus nerve and along the nerves supplying the middle ear and jugular bulb. Less common locations include the larynx, orbit, nose and the aortic arch. Carotid body tumours are very rare neoplasms constituting less than 0.5% of all tumours. The true nature of the tumour is established at the time of attempted biopsy or surgical resection, sometimes with disastrous consequences. Only a few of the more than 500 cases reported in the literature have been studied and diagnosed preoperatively. These tumours must be considered in the evaluation of any lateral neck mass, even one located far from the carotid bifurcation. We report a case of bilateral carotid body tumours detected using 16-slice MDHCT in a patient who presented with pulsatile neck swelling for two years. This tumour is rarely malignant; however it produces serious problems by its progressive enlargement and impairment of adjacent structures in the neck. The treatment of choice is surgical resection; preferably to excise this lesion when it is small, because large, very vascular tumours are intimately attached to the carotid vessels and make surgical resection more hazardous. Pre-operative embolization can be performed in large tumours, as to facilitates surgery and reduce complication. In most of the cases, there is strong attachment of the tumour to the carotid arteries. When this is the situation, removal of the tumour means complete excision of both great arteries as well, and the mortality rate is 40 to 45 %. When surgical removal is not feasible, radiotherapy may help to control the tumour growth, although the results have not been encouraging. As it is very slow growing tumour with the growth rate of less than 5 mm per year tumours in old patients with significant risk factors for surgical intervention can be managed by observation alone.

Matched MeSH terms: Ear, Middle
Fulltext Superglue accidentally used as ear drops

Anusha B, Purushotman R, Lina LC, Avatar S

Med J Malaysia, 2012 Apr;67(2):212-3.
PMID: 22822647 MyJurnal

Superglue in the ear as a foreign body is an uncommon presentation. We report the case of a lady who accidentally instilled superglue directly onto her tympanic membrane and presented five days later. We successfully removed the glue with acetone and managed to preserve the integrity of the tympanic membrane.

Matched MeSH terms: Ear Canal*
Fulltext Bilateral microtia, canal atresia and aplasia of cochleovestibular nerve

Asma A, Roslenda AR, Fadzilah I, Mazita A, Marina MB, Ab Aziz A

Med J Malaysia, 2017 04;72(2):135-137.
PMID: 28473682 MyJurnal

A six-month-old baby with congenital patent ductus arteriosus (PDA), bilateral microtia and canal atresia was referred for hearing assessment. The audiology assessment revealed bilateral profound hearing loss, which is atypical for a case of pure canal atresia. Imaging was performed much earlier than usual and, as suspected, the patient also had bilateral severe inner ear anomaly. It is extremely rare for a person to have both external and inner ear anomaly because of the different embryological origin. The only suitable hearing rehabilitation option for this kind of patients is brainstem implant. However, the parents had opted for sign language as a form of communication.

Matched MeSH terms: Ear Canal/abnormalities*
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.

Matched MeSH terms: Ear; Hearing; Hearing Tests; Ethics Committees, Research
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.

Matched MeSH terms: Ear Diseases
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

Matched MeSH terms: Ear, Inner
Primary middle ear tuberculosis mimicking cholesteatoma

Aziz A, Md Daud MK

Malays Fam Physician, 2020;15(1):44-46.
PMID: 32284804

Tuberculous granuloma in the middle ear is an unusual entity. Herein, we report a case with short presentation of otitis media with mastoid abscess but with a CT scan showing widespread bone destruction. The cause was determined to be middle ear tuberculosis. Awareness of this entity is important, as it may cause a delay in referral to an otorhinolaryngology specialist and, subsequently, a delay in initiating treatment. Therefore, it should be considered in the differential diagnosis, especially when the usual treatment fails to produce the desired result.

Matched MeSH terms: Ear, Middle
Otological outcome in cleft lip and palate children with middle ear effusion

Azman A, Manuel AM

Int J Pediatr Otorhinolaryngol, 2020 Nov;138:110274.
PMID: 32836138 DOI: 10.1016/j.ijporl.2020.110274

OBJECTIVE: To evaluate the factors contributing to middle ear pathology, hearing and speech development among cleft palate children treated for middle ear effusion.
METHOD: A prospective cross-sectional otoscopic and audiological analysis was conducted on 102 cleft palate children (204 ears) aged 1-18 years old who were treated for middle ear effusion at our centre. Retrospective chart review was done to determine patient characteristics and prior patient management. The aim was to assess the effect of ventilation tube insertion (VTI) on hearing, speech and chronic otitis media; comparing the timing and number of ventilation tubes per ear and determining other factors affecting the short-term and long-term outcome.
RESULTS: 68 children or 130 ears (63% of all cases) were selectively treated with ventilation tube insertion. Repeat procedures (more than 2) were performed in 41 ears. Among children with VTI performed, the incidence of chronic otitis media in children after the age of 4 was 17%. Overall, abnormal tympanic membrane findings and hearing loss were detected in nearly half the cases who were previously treated with VTI. Early ventilation tube insertion at less than 1 year of age, resulted in a better middle ear and hearing outcome in children less than 4 years old (p

Matched MeSH terms: Middle Ear Ventilation
Fulltext The translabyrinthine approach for acoustic neuroma and its common complications

Azmi MN, Lokman BS, Ishlah L

Med J Malaysia, 2006 Mar;61(1):72-5.
PMID: 16708737 MyJurnal

A retrospective analysis of 15 cases intracanalicular acoustic neuroma that undergone tumour excision by translabyrinthine approach spanning from August 1996 until December 2002 is presented. The main presenting complaints are unilateral hearing loss (100%) and tinnitus (86.7%). The mean age of presentation was 48.5 years old. Magnetic resonance imaging is the most important investigation tool to diagnose acoustic neuroma. At six months post operatively, the facial nerve was normal or near normal (grade I and II) in 46.6%, grade III to IV in 46.6% and grade V to VI in 6.7% of the cases respectively. There were also four cases of post operative cerebrospinal fluid leak, which was successfully managed with conservative measures. The translabyrinthine approach is the most familiar surgical technique employed by otologist. It is the most direct route to the cerebellopontine angle and internal auditory canal. It requires minimum cerebellar retraction. However, it sacrifices any residual hearing in the operated ear.

Matched MeSH terms: Ear, Inner/surgery*
Fulltext Facial nerve palsy in otitis externa: A red flag?

Badaruddin A, Choo MM

Malays Fam Physician, 2021 Mar 25;16(1):117-120.
PMID: 33948150 DOI: 10.51866/cr1108

Otitis externa is an infection of the external auditory canal. It rarely results in facial palsy except in severe cases such as necrotizing otitis externa, which is a life-threatening invasive infection of the external auditory canal. Early recognition with prompt and appropriate treatment of necrotizing otitis externa is crucial to prevent more sinister complications. Here we report a case of an elderly gentleman who presented with otitis externa and developed facial palsy a month later. We identified possible problems that may have led to the complication so that such an occurrence can be prevented in the future.

Matched MeSH terms: Ear Canal
An anthropological study of the Malay and the Chinese of Malaysia

Chattopadhyay PK, Ganeson D

Ann Hum Biol, 1977 Jul;4(4):379-81.
PMID: 931362

Data for the ABO blood groups and for handclasping, arm folding, handedness, ear lobe types and camptodactyly are presented for 104 Malay and 57 Chinese males in the city of Alor Star, Kedah, Malaysia. The two groups exhibit marked differences in the frequencies of most of these attributes.

Matched MeSH terms: Ear/anatomy & histology
Fulltext Endaural approach of external auditory canal osteoma: report of two cases

Che Mohd Hilmi Che Mat1, Zulkiflee Salahuddin, Nik Azrizie Muhamed, Irfan Mohamad

Journal of Clinical and Health Sciences, 2021;6(1):53-57.
MyJurnal

Osteomas occur in all parts of the temporal bone, including the mastoid, squamous, middle
ear, styloid process, internal auditory canal and external auditory canal (EAC). The EAC has
been reported to be the most common site, followed by the mastoid and squamous parts.
Diagnosis is made based on history, clinical examination and radiological findings. Computed
tomography reveals a pedunculated hyperdense mass that usually arises from the
tympanosquamous suture. Surgical removal of EAC osteomas can be achieved using the
endaural or postauricular approaches. It can be performed with a drill or osteotome, either
endoscopically or by using microscopy. This report presents two patients with EAC osteomas
who underwent excision under microscopy using the endaural approach. Surgery is the gold
standard treatment, while close observation may be considered in asymptomatic patients.

Matched MeSH terms: Ear Canal; Ear Diseases
Bacteriology and antimicrobial susceptibility of ENT infections in a tropical hospital

Chew YK, Cheong JP, Ramesh N, Noorafidah MD, Brito-Mutunayagam S, Khir A, et al.

Ear Nose Throat J, 2014 Jun;93(6):E5-8.
PMID: 24932831

We conducted a retrospective observational study to determine the spectrum and antibiotic sensitivity pattern of organisms isolated in otorhinolaryngologic (ORL) infections. We reviewed the laboratory culture and sensitivity records of 4,909 patients-2,773 males (56.5%) and 2,136 females (43.5%), aged 2 to 90 years (mean: 45.3 ± 12.6)-who had been seen at two government hospitals in Malaysia. Of this group, 4,332 patients had a respiratory tract infection (88.2%), 206 had an ear infection (4.2%), 188 had a deep neck infection (3.8%), and 183 had an oropharyngeal infection (3.7%). The most common isolated organisms were Klebsiella spp, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, methicillin-susceptible S aureus, coagulase-negative S aureus, and Acinetobacter baumannii. We also identified the antimicrobial susceptibility of these organisms. We conclude that since the spectrum of causative pathogens in some infections differs between tropical and nontropical areas of the world, tropical hospitals should not completely adopt the antibiotic guidelines for ORL infections that have been recommended for hospitals in nontropical regions. We hope that our review and analysis of local data will help practitioners in Malaysia develop an appropriate prescribing policy with respect to ORL pathogens and antimicrobial susceptibility. The goal is to reduce the morbidity and mortality associated with these infections.

Matched MeSH terms: Ear Diseases/microbiology*
Fulltext Review of ear, nose and throat foreign bodies in Sarawak General Hospital. A five year experience

Chiun KC, Tang IP, Tan TY, Jong DE

Med J Malaysia, 2012 Feb;67(1):17-20.
PMID: 22582543

OBJECTIVE: Ear, nose and throat foreign bodies are common in ENT clinical practice. This study was designed to establish the local data of otorhinolaryngeal foreign bodies in term of prevalence among paediatric and adult groups, the clinical features, types of foreign body at different sites, and laterality of foreign bodies.
METHOD: This study was carried out at ENT department, Sarawak General Hospital, Malaysia, from 1st January 2005 to 31st December 2009. A total of 1084 cases were included and statistically analyzed.
RESULT: Ear foreign bodies showed the highest incidence which was consisted of 480 (44.3%) cases, followed by nose in 270 (24.9%) cases, pharynx in 251 (23.2%) cases, esophagus in 57 (5.3%) cases and laryngo-tracheobronchial tree in 26 (2.4%) cases. Otorhinolaryngeal foreign bodies occurred more frequently in 0-10 year old age group which constituted 651 (60.1%) cases. The descending order of frequency for foreign body sites in adult was pharynx (17.2%), ear (12.8%), esophagus (3.1%), nose (1.7%) and laryngo-tracheobronchial tree (1.1%). The type of foreign bodies varies with age group and site of foreign body lodgement. In general, common foreign bodies in both adult and children were food related, with the additional of small objects such as plastic toy in paediatric group.
CONCLUSION: Otorhinolaryngeal foreign bodies were found more frequently in children. The types of foreign body were different from age group and sites of foreign body lodgement. The local food constituted the highest incidence of ear, nose, and throat foreign bodies with additional of plastic toys in paediatric group.
Study site: ENT clinic, Sarawak General Hospital, Kuching, Sarawak, Malaysia

Matched MeSH terms: Ear*
Syringomyelia / bulbia presenting as anhidrosis

Choy, Yew Sing, Sinniah, D.

Malaysian Journal of Child Health, 1992;4(1):6-12.
MyJurnal

Reported is the first case of syringomyelia and syringobulbia associated with Arnold Chiari I malformation in a Malaysian child. The initial complaint was that of unilateral anhidrosis of the face. The chief presenting features were dissociated sensory loss, asymmetrical weakness of the left upper limb associated with subluxation of left shoulder and signs of upper motor neurone lesion in the left lower limb. One unusual feature was the presence of vesiculation followed by ulceration of the pinnae of both ears. Magnetic resonance imaging (MRI) of the posterior fossa and cervical and thoracic cord facilitated the diagnosis and was the most useful diagnostic procedure in this child.

Matched MeSH terms: Ear, External; Ear Auricle

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