MyMedR

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.

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

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 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

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 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.

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.

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.

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

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".

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.

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.

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 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.

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 Management of a Rare Lymphoepithelial Carcinoma of the Submandibular Gland in Elderly

Sairin ME, Yahya N, Kuan CY, Yunus MRM, Abdullah MK

Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):18-20.

PMID: 31741921 DOI: 10.1007/s12070-015-0940-6

Lymphoepithelial carcinoma (LEC) of salivary glands is a rare malignant salivary gland tumour and demonstrates genetic and regional distribution. It commonly occurs in major salivary gland especially parotid gland. We report a case of LEC of submandibular gland occurring in a 70 year-old lady.

Mastoid Cyst in a Child

Lee MJ, Lim CC, Ling SW, Devesayaham PR

Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):4020-4023.

PMID: 37974688 DOI: 10.1007/s12070-023-04047-y

Mastoid cysts are a rare condition that occurs either congenitally or secondary to chronic otological diseases with poor ventilation of the middle ear and mastoid cavity. In this presenting case, the authors report a case of secondary mastoid cyst with evidence of bony destruction and fistulous tract formation into adjacent structures. Concurrently, we reviewed other similar cases reported in the literature. A 12-year-old Malay boy with partially controlled allergic rhinitis presented with right-sided postauricular swelling and intermittent fever for three months. Examination revealed a non-tender bony swelling over the mastoid area. High-resolution computed tomography of the temporal bone revealed a large bony lytic lesion at the inferior aspect of the mastoid bone. Multidirectional fistulous tracts towards the splenius capitis muscle were seen extending from the lesion. Right mastoid exploration was done and revealed an infected mastoid cyst. Complete removal of the cyst wall and saucerization of the mastoid cavity were performed. Our patient showcases the potential of mastoid cysts to cause bony erosion, fistulation and abscess formation. Complete removal of mastoid cysts is therefore advocated to prevent its potential complications and unwarranted recurrence.

Myeloid Sarcoma of Temporal Bone: A Rare Manifestation of Relapse Acute Myeloid Leukemia

Goh BS, Tang CL, Tan GC

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 2):1023-1026.

PMID: 31750119 DOI: 10.1007/s12070-015-0930-8

Myeloid sarcoma is a rare malignant extramedullary neoplasm of myeloid precursor cells. This disorder may occur in concomitance with or precede development of acute or chronic myeloid leukemia. Sometimes, it is the initial manifestation of relapse in a previously treated acute myeloid leukemia. We report a case of 11 years old boy with acute myeloid leukemia in remission state, presented with short history of right otalgia associated with facial nerve palsy. Diagnosis of right acute mastoiditis with facial nerve palsy as complication of acute otitis media was made initially. Patient underwent simple cortical mastoidectomy but histopathology from soft tissue that was sent revealed diagnosis of myeloid sarcoma. A leukemic relapse was confirmed by paediatric oncologist through bone marrow biopsy. Chemotherapy was commenced but patient responded poorly to the treatment.

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.

Nasal NK/T-cell Lymphoma Presenting as Acute Inflammation of Nasal Vestibule

Vasiwala R, Mohamad I, Venkateswaran SP, Hamzah SZ

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1986-1989.

PMID: 31763280 DOI: 10.1007/s12070-018-1402-8

Extra nodal nasal NK/T cell lymphoma is relatively a rare type of non-Hodgkin lymphoma. Variable clinical presentation with rapidly progressive necrosis of the cartilaginous and bony wall of the nose and upper respiratory passages leads to delayed diagnosis and treatment. A 43-years-old patient presented with right nasal pain and furuncle-like swelling. The swelling progressed rapidly to cellulitis to the face up to the right eye. Within 2 months, it had advanced to necrosis of the lateral vestibular cartilage, medial maxillary wall, turbinate and nasal septal cartilage. Biopsy reported as non-Hodgkin diffuse T cell (angiocentric T cell) lymphoma.

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