MyMedR

Fulltext Pneumatization of Mastoid Air Cells, Temporal Bone, Ethmoid and Sphenoid Sinuses. Any Correlation?

Hindi K, Alazzawi S, Raman R, Prepageran N, Rahmat K

Indian J Otolaryngol Head Neck Surg, 2014 Dec;66(4):429-36.

PMID: 26396957 DOI: 10.1007/s12070-014-0745-z

The aim of this study is to assess the pneumatization of the paranasal sinuses (PNS) and other parts of temporal bone such as mastoid air cells and to investigate if there was any association between the aeration of these structures among the three major ethnic groups in Malaysia (Malay, Chinese, Indian) as this would be representative of Asia. A retrospective review of 150 computed tomography (CT) scans of PNS and temporal bones was done and analysed. The pneumatization of each area was obtained and compared using statistical analysis. Patients with a history of previous medical or surgical problems in the intended areas were excluded from the study. The pneumatization of the mastoid air cells and other temporal bone parts were noted to be symmetrical in more than 75 %. There was a positive correlation between the pneumatization of mastoid air cells and that of the sphenoid sinus. The prevalence of Agger nasi, Haller's and Onodi cells was observed to be significantly higher in the Chinese group. Preoperative assessment of the temporal bone and PNS with CT scan may be helpful in the evaluation of their anatomical landmark and decrease the possibility of surgical complications related to 3D structures.

Fulltext Anterior external bony ear canal bulge

Rajagopalan R

Indian J Otolaryngol Head Neck Surg, 2010 Jan;62(1):90-1.

PMID: 23120691 DOI: 10.1007/s12070-010-0001-0

To study the prevalence of anterior external bony ear canal bulge.

Fulltext Radiological Study of the Ethmoidal Arteries in the Nasal Cavity and Its Pertinence to the Endoscopic Surgeon

Kho JPY, Tang IP, Tan KS, Koa AJ, Prepageran N, Rajagopalan R

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1994-1999.

PMID: 31763282 DOI: 10.1007/s12070-018-1415-3

We studied the ethmoidal arteries using preexisting computer tomography of the paranasal sinuses (CT PNS) and statistically scrutinized data obtained between genders. A descriptive study from 77 CT PNS dated January 2016-December 2016 were collected and reviewed by two radiologists. A total of 54 (108 sides) CT PNS were studied of patients aged 18-77 years. 37 are male, 17 are female; with Bumiputera Sarawak predominance of 25 patients, 12 Malays, 16 Chinese and one Indian. Rate of identification are as follows: anterior ethmoidal artery (AEA)-100%, middle ethmoidal artery (MEA)-30%, posterior ethmoidal artery (PEA)-86%. The average distance from AEA-MEA is 8.1 ± 1.52 mm, MEA-PEA is 5.5 ± 1.29 mm and AEA-PEA is 12.9 ± 1.27 mm. The mean distance from PEA-the anterior wall of sphenoid is 7.7 ± 3.96 mm, and PEA-optic canal is 8.5 ± 3.1 mm with no statistical difference when compared between gender. AEA frequently presented with a long mesentery 57.4%, while 87.1% of PEA was hidden in a bony canal. The vertical distance of the AEA-skull base ranges from 0 to 12.5 mm whilst PEA-skull base is 0-4.7 mm. There is no statistical difference in distances of AEA, MEA nor PEA to skull base when analyzed between genders; t(82) = 1.663, p > 0.05, t(32) = 0.403, p > 0.05 and t(75) = 1.333, p > 0.05 respectively. We newly discovered, that 50% of MEA is hidden in a bony canal, and its distance to skull base ranged 0-5.3 mm. MEA and PEA less commonly have a short or long mesentery. Knowledge on the ethmoidal arteries especially in our unstudied population of diverse ethnicity, gains to assist surgeons worldwide, when embarking in endoscopic transnasal surgeries.

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.

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.

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 Annular bony spur

Raman R

Indian J Otolaryngol Head Neck Surg, 2000 Jul;52(3):318.

PMID: 23119711 DOI: 10.1007/BF03006219

A micro anatomical feature in the ear useful in surgery is described.

Fulltext Post stapedotomy hyperacousis-A mechanical explanation

Raman R

Indian J Otolaryngol Head Neck Surg, 2000 Apr;52(2):188.

PMID: 23119671 DOI: 10.1007/BF03000350

Mechanical explanation for the hyperacousis that sometimes occurs after stapedectomy or stapedotomy is presented.

Fulltext Post stapedotomy hyperacousis - a mechanical explanation

Raman R

Indian J Otolaryngol Head Neck Surg, 1999 Apr;51(2):64-5.

PMID: 23119520 DOI: 10.1007/BF02997994

A mechanical explanation for the hyperacousis that sometimes occurs after stapedectomy or stapedotomy is offered.

Fulltext An alternate approach to the mastoid antrum

Raman R

Indian J Otolaryngol Head Neck Surg, 1998 Apr;50(2):193.

PMID: 23119414 DOI: 10.1007/BF02991691

An alternate approach to the mastoid antrum for acellular mastoid is presented.

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 The role of sensation in subjective and objective evaluation of nasal patency

Dipak S, Prepageran N, Haslinda S, Atiya A, Raman R

Indian J Otolaryngol Head Neck Surg, 2011 Jan;63(1):10-4.

PMID: 22319710 DOI: 10.1007/s12070-010-0067-8

To assess if sensation of nasal mucosa affect the subjective sensation of nasal patency. This is a case control study with 50 patients, using 2% lignocaine as the active drug and normal saline as the placebo (2 groups of 25 patients each). Each subject had 2 ml of solution sprayed into the test nose. These subjects had no prior nasal symptoms, allergy or surgery. They were evaluated subjectively using Likert scale and objectively by acoustic rhinometry before and after lignocaine or normal saline. The patients in both normal saline and lignocaine groups demonstrated no significant change based upon Likert scale. The study also demonstrated the mean cross sectional area 1 (CSA1), mean cross sectional area 2 (CSA2), with mean Volume 1 and mean Volume 2, these results did not vary significantly in both groups with Acoustic Rhinometry. The analysis thus shows that the use of topical anesthetic spray on nasal mucosa produces no objective effect on nasal resistance or subjective sensation of altered nasal patency. Thus the study concludes that, tactile sensation of nasal mucosa does not play a role in the sensation of nasal obstruction.

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

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.

The Nasal Hemangioma

Tan SN, Gendeh HS, Gendeh BS, Ramzisham AR

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 3):1683-1686.

PMID: 31763224 DOI: 10.1007/s12070-015-0918-4

Hemangioma is a disease of head and neck commonly, but its presence in the nasal cavity or sinus is rare. It is a form of benign tumour of vascular origin consisting of predominantly blood vessels. It can be categorized into capillary, cavernous and mixed type in accordance to its histopathology features. Retrospectively, we reviewed five cases of nasal hemangioma presenting at University Kebangsaan Malaysia Medical Center (UKMMC) between September 2007 and May 2015. Information on the patients age, gender, ethnicity, clinical symptoms, imaging findings (if available), treatment modalities were collected retrospectively for analysis. Five patients were analysed. Females were more affected than male with ratio of 4:1. All patients presented with unilateral lobular capillary hemangioma of the nasal cavity with 60 % (3/5) of the lesions on the right side and 40 % (2/5) on the left side. The common symptoms at presentation were epitaxis and nasal obstruction (5/5, 100 %), followed by rhinorrhea (3/5, 60 %) and facial pain (1/5, 20 %). All the patients underwent a surgical excision of the hemangioma. The five patients had no recurrence on subsequent follow ups. Computed tomography of paranasal sinuses can be performed to exclude bony erosions. Endoscopic sinus haemangioma excision provide good visualisation and better outcomes. In conclusion, nasal hemangioma should always be differential diagnosis for nasal lesions and surgical excision is still the preferred first line treatment.

Total Transcanal Endoscopic Approach for Selective Facial Nerve Decompression in Traumatic Facial Nerve Palsy

Sim L, Othman NAN, Hoe KC, Saad MSM

Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):3819-3823.

PMID: 36742613 DOI: 10.1007/s12070-021-02662-1

Facial nerve palsy is one of the complications of temporal bone fracture. Several approaches can be used for facial nerve decompression which include the middle cranial fossa approach, transmastoid approach and translabyrinthine approach. When the site of injury is identified at the tympanic segment and perigeniculate area, total transcanal endoscopic approach (TTEA) is an excellent surgical option. This approach is safe and less invasive avoiding external incision and mastoid drilling. Our patient showed recovery to House-Brackmann grade II facial function and reduction of the air-bone gap 6 months after the surgery.

Bilateral Vestibular Atelectasis with Tullio's Phenomenon

Roy S, Kumarasamy G, Salim R

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 2):1599-1602.

PMID: 31750223 DOI: 10.1007/s12070-019-01685-z

Vestibular dehiscence or atelectasis is a rarity known to cause vertigo. This pathology poses many challenges especially in diagnosis and treatment simply due to the scarcity of reported cases. The etiologic factors, disease pathophysiology and complications remain unclear. We report a young adult female who presented with unsteadiness for 2 years associated with headache. Tullio's phenomenon was observed which led to a finding of bilateral vestibular dehiscence involving the medial walls on high resolution computed tomography.

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.

Role of Video Head Impulse Test to Assess Noise Exposure

Saniasiaya J

Indian J Otolaryngol Head Neck Surg, 2024 Feb;76(1):1461-1463.

PMID: 38440558 DOI: 10.1007/s12070-023-04244-9

Noise exposure has been reported to exert numerous detrimental effects on the human population, although most research has centred around hearing damage. Vestibular and balance loss have been demonstrated among industrial workers, although reports on this are still scarce. Vestibular loss increases the risk of falls, especially among industrial workers who are at constant risk. Nonetheless, the ideal investigation tool to investigate vestibular function remains unknown. We aim to review the available literature to elucidate the effect of noise exposure on semicircular canals using a video head impulse test (vHIT). A literature search identified only three studies involving 137 patients (mean age: 44.4). Semicircular canal deficit was found in 50.4% of the included participants, with lateral canal predominantly affected (71%). We highlight the importance of assessing the effect of noise exposure on vestibular function, especially among those prone to occupation-related vestibular loss.

Could Cultural and Background Resilience be the Main Culprit for Neglected Vestibular Dysfunction in Children?

Saniasiaya J

Indian J Otolaryngol Head Neck Surg, 2023 Dec;75(4):4114-4115.

PMID: 37974752 DOI: 10.1007/s12070-023-03873-4

Vestibular dysfunction in children and adolescents has recently gained tremendous attention, with more child-friendly investigations and rehabilitation protocols emerging.Reports have shown that children with vestibular impairment tend to develop speech and language acquisition delay, fine and gross motor delay, which in the long-termresults in an overall poor quality of life. In an extreme situation, vestibular dysfunction can lead to dissociative syndromes such as depersonalisation/derealisation symptomsthat occur following a mismatch between the vestibular signals and other sensory inputs, which may, in turn, lead to suicidal thoughts and behaviour 1. Whilst measuresto incorporate vestibular assessment as a part of routine practice in paediatric patients have been carried out in most centres, pediatric vestibular medicine appears to beunfathomed in some parts of the world, notably the South-East Asian region.

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