MyMedR

Fulltext Management experience of subglottic stenosis by endoscopic bougie dilatation with mitomycin C and review of literature: case series

Liew YT, Yong DJ, Somasundran M, Lum CL

Indian J Otolaryngol Head Neck Surg, 2015 Mar;67(Suppl 1):129-33.

PMID: 25621268 DOI: 10.1007/s12070-014-0801-8

The aim of the study was to examine and analyze the epidemiology and outcome of treatment for paediatric acquired subglottic stenosis treated with endoscopic bougie dilatation and topical mitomycin C. There were 15 patients identified from 2008 until 2013. All of them had acquired subglottic stenosis due to history of intubation. Majority of the patients had grade III stenosis, with the total of seven. Three patients had grade IV; three were grade II and two were grade I. All of the patients with severe stenosis (grade III and IV) needed tracheostomy while only one in mild stenosis group (grade I and II) required it for prolonged ventilation rather than obstruction due to subglottic stenosis. All of them underwent direct laryngoscopy under general anesthesia followed by endoscopic dilatation with bougie and topical mitomycin C 0.4 mg/ml for 5 min. Aim of success in our study was decannulation of tracheostomy or absence of symptoms at exertion. We achieved 6 (60 %) successful decannulation out of 10 patients with tracheostomy (excluded the patient with tracheostomy in grade I stenosis due to prolonged ventilation). As for those without tracheostomy, 3 (75 %) out of 4 patients were asymptomatic even at exertion. Average number of dilatation was 3.1 times, with mean duration of 28 min. No complications were reported in our series. One patient with grade I stenosis passed away due to severe pneumonia unrelated to the stenosis or dilatation, and she did not have any dilatation before she passed away. Multiple related risk factors were identified such as intubation, prematurity, movement of endotracheal tube, respiratory infection, traumatic intubation and gastroesophageal reflux disease. Experience of open surgical method was very limited in our centre in Sabah in East Malaysia. Endoscopic technique plays an important role in treatment of subglottic stenosis with adjunct like mitomycin C possibly booster the successful rate.

Fulltext Late Temporal Lobe Extensive Osteoradionecrosis Post Radiation for Nasopharyngeal Carcinoma: Case Series

Tang CL, Kumar R, Toh CJ, Azura S, Tan GC, Gendeh BS

Indian J Otolaryngol Head Neck Surg, 2017 Sep;69(3):409-414.

PMID: 28929077 DOI: 10.1007/s12070-015-0909-5

Osteoradionecrosis is one of the most serious complications of radiotherapy for nasopharyngeal carcinoma. We report three cases of osteoradionecrosis in temporal lobe who presented differently few years after completion of radiotherapy. Cranial magnetic resonance image showed lesions in temporal lobe either unilateral or bilateral with mass effect. One of the cases even showed disease progression few years after the initial diagnosis of osteoradionecrosis. Diagnosis of osteoradionecrosis for all three patients was confirmed by biopsy.

Laryngeal Suction tube: A Novel Technique for Tracheal Ventilation in an Obstructed Airway in a Child with Respiratory Papillomatosis

Saniasiaya J, Lim SM, Kulasegarah J

Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):1274-1276.

PMID: 37276073 DOI: 10.1007/s12070-022-03411-8

BACKGROUND: Airway obstruction in a child requires expedite management in addition to comprehensive discussion between the Otolaryngology and Anaesthesiology team to formulate a treatment plan to ensure safe airway. Juvenile-onset recurrent respiratory papillomatosis (JORRP) is an exophytic benign laryngeal lesion which poses a great challenge when presented with respiratory distress.

OBJECTIVE: This paper presents a novel, safe and cost-effective approach to temporary tracheal ventilation of the obstructed airway in a child with juvenile-onset recurrent respiratory papillomatosis using the laryngeal suction tube connected to general anaesthetic (GA) machine.

RESULT AND CONCLUSION: Rigid laryngeal suction tube is placed through the side-port of Lindholm laryngoscope and connected to breathing circuit of GA machine. Manual bagging ventilation with 100% FiO2 achieved good oxygenation throughout the debulking of the papilloma without hindering the surgical field. Our technique utilizes the readily available equipment whilst enabling safe anaesthesia and providing good surgical field during excision of obstructive papillomatous airway lesion.

Fulltext Laryngeal Leiomyosarcoma: A Rare Case

Ng BHK, Tang IP, Suhashini G, Chai CK

Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):795-797.

PMID: 31742066 DOI: 10.1007/s12070-018-1553-7

Laryngeal leiomyosarcoma is a rare smooth muscle malignancy of the head and neck region. Diagnosis is based on immunohistochemistry. Here we present a case of laryngeal leiomyosarcoma that was diagnosed and treated in our center, focusing on the clinical features, histological diagnosis and management of this rare disease.

Langerhans Cell Histiocytosis in Paediatric Zygoma Swelling

Ng SW, Zakawi FA, Shanmuganathan J, Al-Yahya SN

Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):5905-5909.

PMID: 36742809 DOI: 10.1007/s12070-021-02480-5

Langerhans cell histiocytosis (LCH) is a rare neoplasm characterized by accumulation of histiocytes in various tissues. It has a wide clinical spectrum and its presentation may mimic clinical features of common diseases. High level of suspicion is required for early diagnosis. Here is a rare case of a rapidly aggressive LCH which first presented with right zygomatic swelling.

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".

Fulltext Keratinosis: a new entity in the tropics?

Raman R

Indian J Otolaryngol Head Neck Surg, 2014 Jan;66(1):106.

PMID: 24605312 DOI: 10.1007/s12070-012-0509-6

Inverted Follicular Keratosis: A Rare Presentation in External Ear Canal

Rashid KNA, Zainon IH, Othman NAN

Indian J Otolaryngol Head Neck Surg, 2024 Feb;76(1):1244-1246.

PMID: 38440449 DOI: 10.1007/s12070-023-04241-y

Inverted follicular keratosis is a benign skin lesion that typically presents as an asymptomatic, solitary nodule that may mimic malignant lesions, especially squamous cell carcinoma, both clinically and pathologically. It is developed from the hair follicle infundibulum and can be considered a variant of seborrheic dermatitis. We present a case of a 26-year-old gentleman with a soft tissue mass at the external auditory canal which was later confirmed as inverted follicular keratosis and was treated by endoscopic transcanal excision of the mass with temporalis fascia graft reconstruction. He is currently under surveillance follow-up with no symptoms and signs of recurrence.

Identification of Nasal Irrigation Bottle Contamination in Post Sinonasal Surgery

Zahedi FD, Asmi NH, Husain S, Gendeh BS

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1837-1842.

PMID: 31763256 DOI: 10.1007/s12070-017-1219-x

Nasal irrigation is an effective and cheap method in managing post sinonasal surgery patients. It works by improving ciliary clearance and performing mechanical debridement of the thick crust, decreasing mucosal edema and reducing the inflammatory mediators. Presence of nasal irrigation bottle contamination and its effect on patients have been studied. The aim of this study is to prospectively identify the risk of contamination in the nasal irrigation bottle, fluid from the bottle and to correlate with endoscopic findings from the patients who had underwent sinonasal surgery. Swabs will be taken from the nasal irrigation bottle and patient's middle meatus before the surgery and at each post surgery visits (2 and 4 weeks). Patients will be advised to irrigate their nose three times per day post sinonasal surgery. During endoscopic examination of the patient's nasal cavity at 2 and 4 weeks, any evidence of infection will be noted and documented. Additionally, a swab of fluid irrigated from the nasal cavity collected during the clinic follow-ups will also be taken. The specimens will be sent to the Microbiology laboratory for standard culture and sensitivity test. A total of 27 patients completed the study and were divided into case (n = 15) and control (n = 12) groups. The CFU (colony-forming unit) value of the bacteria cultured from the nasal cavity and the nasal irrigation bottle was statistically significantly (P = 0.00) increased from the baseline to the second week follow-up in both groups but not from the second week to the fourth week follow-up. The majority of the swabs from the nasal cavity of the patients and the nasal irrigation bottles were positively cultured for Pseudomonas sp. group. Other groups of bacteria that were cultured were Enterobacter sp., Coagulase Negative Staphylococcus (CONS) and Klebsiella sp. Endoscopically, there was no clinical evidence of infection found in the nasal cavity of the patients. The nasal irrigation bottle that was used in the post sinonasal surgery treatment and for alleviation of symptoms of sinonasal diseases was found to have bacterial contamination from the swabs taken from the bottle. However, despite this finding there was not clinical evidence of infection noted from the nasal endoscopic examination. A simple and effective method of cleaning the bottle would be helpful to reduce the bacterial contamination for this useful treatment method.

Fulltext Hypertensive retinopathy and sensorineural hearing loss

Tan TY, Rahmat O, Prepageran N, Fauzi A, Noran NH, Raman R

Indian J Otolaryngol Head Neck Surg, 2009 Dec;61(4):275-9.

PMID: 23120650 DOI: 10.1007/s12070-009-0082-9

To determine the correlation between hypertensive retinopathy (which is the end-organ damage of the vessels due to chronic hypertension) with sensorineural hearing loss.

Fulltext Huge Long Standing Staghorn Rhinolith in a Young Adult

Kumareysh VV, Kumarasamy G, Letchumanan P, Rajan P, Md Shukri N

Indian J Otolaryngol Head Neck Surg, 2023 Apr;75(Suppl 1):1053-1055.

PMID: 37206833 DOI: 10.1007/s12070-023-03611-w

Rhinolith is an uncommon condition that usually happens due to mineralisation of calcium and magnesium salts over a retained foreign body inside the nasal cavity for long period of time. Here we report one such case of a 33-year-old lady who presented to us with long standing intermittent epistaxis and on examination rhinolith was discovered.

Fulltext High-frequency hearing loss among mobile phone users

Velayutham P, Govindasamy GK, Raman R, Prepageran N, Ng KH

Indian J Otolaryngol Head Neck Surg, 2014 Jan;66(Suppl 1):169-72.

PMID: 24533378 DOI: 10.1007/s12070-011-0406-4

The objective of this study is to assess high frequency hearing (above 8 kHz) loss among prolonged mobile phone users is a tertiary Referral Center. Prospective single blinded study. This is the first study that used high-frequency audiometry. The wide usage of mobile phone is so profound that we were unable to find enough non-users as a control group. Therefore we compared the non-dominant ear to the dominant ear using audiometric measurements. The study was a blinded study wherein the audiologist did not know which was the dominant ear. A total of 100 subjects were studied. Of the subjects studied 53% were males and 47% females. Mean age was 27. The left ear was dominant in 63%, 22% were dominant in the right ear and 15% did not have a preference. This study showed that there is significant loss in the dominant ear compared to the non-dominant ear (P

High-Riding Inominate Artery: Challenge During Tracheostomy

Wannitta Wong ET, Saniasiaya J, Tharek A, Sallehuddin NS

Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):3878-3882.

PMID: 37974895 DOI: 10.1007/s12070-023-03944-6

An aberrant vessel presenting as a pulsatile neck mass poses a significant challenge intraoperatively if overlooked during the pre-operative period. We present a case of a high-riding innominate artery (HRIA) just above the suprasternal notch, with the right common carotid artery crossing the midline just inferior to the thyroid gland in a 72-year-old lady referred for tracheostomy. The surgeon operating on the anterior part of the neck must be aware of the HRIA and equipped with sufficient knowledge of interventions that may be adapted to prevent injury. We aim to highlight the importance of careful investigations of subtle signs which may lead to the diagnosis and treatment with a review of various interventions for this unusual condition.

Fulltext Functional outcome evaluation of septorhinoplasty for nasal obstruction

Zahedi FD, Husain S, Gendeh BS

Indian J Otolaryngol Head Neck Surg, 2016 Jun;68(2):218-23.

PMID: 27340641 DOI: 10.1007/s12070-015-0899-3

A prospective single blinded interventional study was held in Otorhinolaryngology Clinic, Universiti Kebangsaan Malaysia Medical Centre in August 2010 until November 2012 to evaluate the functional outcome of septorhinoplasty objectively and subjectively. Objective assessment was done using rhinomanometry and subjective assessment using Nasal Obstruction Symptoms Evaluation (NOSE) scale and Health-Related Quality of Life Questionnaires (HRQOL) in Rhino Surgery. All measurements were taken preoperatively and 3 months postoperatively. A total of 29 patients were enrolled and completed the study. Septorhinoplasty was commonly performed in Malays and Indians and rare amongst Chinese, with age ranged from 18 to 54 years. Majority had no history of trauma. Twisted nose was the most common external nose abnormality followed by crooked and saddle nose. All patients had internal valve insufficiency. There were significant improvement of the total and of all the parameters in the NOSE scale post septorhinoplasty (p 0.05). Significant correlations were noted in the improvement between the two subjective assessments (NOSE scale and HRQOL score). However, there was no significant correlation in the improvement between the subjective (NOSE scale and HRQOL score) with objective (rhinomanometry score) assessments. Septorhinoplasty improves the nasal airflow and quality of life of patients with nasal obstruction.
Study site: Otorhinolaryngology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Fulltext Fourth Branchial Pouch Sinus: A Rare, Often Misdiagnosed Congenital Anomaly

Lim RCA, Loh TL, Yahaya Z, Wan Hamizan AK

Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1964-1966.

PMID: 36452519 DOI: 10.1007/s12070-020-01941-7

Pathologies of the branchial apparatus originate from abnormal embryological development and frequently affects the second branchial cleft. Fourth branchial cleft lesions are exceptionally few and existing literature on it is scarce. We present a case of a fourth branchial pouch sinus, masquerading as a recurrent neck abscess.

Floor of Mouth Squamous Cell Carcinoma Presenting as an Abscess

Mohd Afandi MF, Liew YT

Indian J Otolaryngol Head Neck Surg, 2023 Jun;75(2):902-904.

PMID: 37274978 DOI: 10.1007/s12070-022-03128-8

Oral squamous cell carcinoma (OSCC) is the most common malignancy encountered in oral cavity. Etiology is often multifactorial but strongly associated with chronic tobacco smoking, excessive alcohol consumption and tobacco chewing. Factors such as poor oral hygiene, ill-fitting dentures causing chronic mucosal irritation can also contribute to the cancer development. In recent years, studies shown association of HPV infections, especially subtypes 16 and 18 in malignant transformation of head and neck squamous cell carcinoma, as it present may change prognosis, outcomes and management strategies from HPV-negative OSCC. OSCC have variable presentation, and most of the patients tend to seek treatment at later stage of disease. The lesion may present as leukoplakia or erythroplakia and may be ulcerated with indurated base and rolled out edges. We describe an uncommon presentation of floor of mouth squamous cell carcinoma which presented as localized abscess.

Fulltext Extended applications of endoscopic sinus surgery and its reference to cranial base and pituitary fossa

Gendeh BS

Indian J Otolaryngol Head Neck Surg, 2010 Sep;62(3):264-76.

PMID: 23120724 DOI: 10.1007/s12070-010-0077-6

Sinus surgery has the potential of allowing ENT surgeons to encroach the boundaries of our colleagues in ophthalmology and neurosurgery. The advent of nasal endoscope and lately powered instrumentation and computer-assisted navigational systems has avoided the use of the conventional and more radical approaches by the ENT surgeon for the treatment of inflammatory pathology or tumors of the orbit and skull base. As rhinologists have gained more experience in endoscopic surgery, more areas related to the orbit and the anterior skull base are accessible and surgery is safer.

Fulltext Experience with 2D Exoscope System for Bilateral Simultaneous Cochlear Implant Surgery in the Era of the COVID-19 Pandemic

Tan SH, Kulasegarah J, Prepageran N

Indian J Otolaryngol Head Neck Surg, 2023 Apr;75(Suppl 1):416-418.

PMID: 36777926 DOI: 10.1007/s12070-023-03505-x

We report the first case series utilizing the exoscope exclusively for bilateral simultaneous cochlear implant surgery and discuss the advantages, disadvantages, as well as surgical outcomes in the Covid-19 era. The VITOM® 2D is compatible with enhanced PPE and draping techniques which can improve safety while providing comparable surgical outcomes.

Fulltext Ex Utero Intrapartum Treatment (EXIT) Into the World: A Multidisciplinary Approach and Outcomes in a Malaysia Tertiary Centre

Oon A, Zulkifli S, Foong YK, Azhar AS, Abdul Ghafar MH, Soo MY

Indian J Otolaryngol Head Neck Surg, 2022 Jun;74(2):190-195.

PMID: 35813785 DOI: 10.1007/s12070-021-02851-y

Fetal airway obstruction that present during birth are challenging to manage. Cervical and thoracic mass may cause significant airway compression that leads to irreversible fetal morbidity and mortality. With the current advancement in prenatal diagnosis and assessment for surgical planning, EXIT has become an accepted, recognized and preferred option for safe delivery in complex head and neck masses. Ex utero intrapartum treatment (EXIT) is a life-saving procedure that provides time to establish an airway while maintaining uteroplacental circulation. It requires flawless coordination amongst multidisciplinary team to ensure immediate and safe baby deliveries. Retrospective review of EXIT procedures performed from the initial establishment of pediatric otolaryngology service in this centre starting from January 2019 to December 2020. Based on the prenatal diagnosis, five EXIT cases were performed in this centre within 2 years. 4 cases were diagnosed as lymphatic malformation and 1 immature teratoma with cervical and thoracic compression. 4 babies successfully delivered to airway without any complications with 1 death resulting from disseminated intravascular coagulopathy after EXIT. This review of five EXIT procedures aims to bring forth the different outcomes, preoperative planning and sharing our experience as a tertiary and newly established centre. Early prenatal diagnosis, good collaboration and experience among multidisciplinary team ensures good long term outcomes.

Fulltext Endoscopic septoplasty: The open book method

Prepageran N, Lingham OR

Indian J Otolaryngol Head Neck Surg, 2010 Sep;62(3):310-2.

PMID: 23120731 DOI: 10.1007/s12070-010-0090-9

The advent of endoscopes has revolutionized rhinology and the traditional headlight based surgeries have largely been replaced by endoscopes. Septoplasty for deviated nasal septum or Sluder's neuralgia have been conventionally performed with the aid of headlight. This can be technically challenging as visualization of the nasal cavity, particularly the posterior portion is rather limited as the procedure is performed via the nostrils. In addition, with headlights for illumination, teaching this procedure can be difficult as only the surgeon who is wearing the headlights has direct vision of the surgical field.Endoscopic septoplasty is an accepted alternative to traditional headlight approach to septoplasty. This approach provides a direct-targeted route to the anatomic deformity, improved visualization, and magnification of the surgical field. Our experience in endoscopic septoplasty is highlighted in this paper, excluding septoplasties performed as part of exposure to the sinuses. We use the open book method that to best of our knowledge has not been described in literature before.

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