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Fulltext Postcricoid haemangioma with laryngomalacia in infancy

Khamalrudin N, Goh BS

BMJ Case Rep, 2021 Apr 19;14(4).
PMID: 33875496 DOI: 10.1136/bcr-2020-235936

Infantile haemangioma represents a congenital vascular anomaly commonly observed in the head and neck region. Such an occurrence over the postcricoid region, however, is rather unusual. Herein, the authors report a case of a synchronous postcricoid haemangioma in a 7-week-old newborn diagnosed with severe laryngomalacia. In addition to the floppy redundant arytenoid mucosa, flexible laryngoscopy revealed a lobulated bluish mass at the postcricoid. The lesion was hyperintense on T1-weighted sequence and was enhanced with contrast, supporting the diagnosis of a haemangioma. She underwent surgical excision of the haemangioma with intralesional steroid injection. Surveillance at 6-month postoperation did not show disease recurrence.
Fulltext Retrospective review of surgical management of foreign body ingestion

Shaariyah MM, Goh BS

Med J Malaysia, 2009 Dec;64(4):307-10.
PMID: 20954556 MyJurnal

Endoscopic examination and removal of foreign body under general anaesthesia are recommended for persistent symptomatic patient with or without significant findings on radiological examination. This report evaluates the management outcome of surgical removal of foreign body ingestion in upper gastrointestinal tract. A total of 70 cases with full documentation were reviewed retrospectively from June 1998 until December 2007. There were 32 male and 38 female with age range from 6 months to 87 years old (mean: 36.9 years). Sixty five patients (93%) were adults and 15 (7%) were below 13 years. Fish bones were the most common foreign body found (44.3%). Radiologically, foreign bodies were highly suspicious in 51 cases (76.1%). Intraoperatively, thirty six cases (70.6%) were positive. From 16 cases (23.9%) with normal radiograph, 10 cases (62.5%) were found to have foreign bodies. Therefore the plain radiograph is helpful, but clinical presentation is more reliable to determine surgical removal under general anaesthesia.
Parotid abscess: a five-year review--clinical presentation, diagnosis and management

Tan VE, Goh BS

J Laryngol Otol, 2007 Sep;121(9):872-9.
PMID: 17112392

Parotid abscess is an uncommon complication of suppurative infection of the parotid gland parenchyma, commonly bacterial or viral. Ductal ectasis, primary parenchymal involvement, or infection of the intraparotid or periparotid lymph nodes can result in abscess formation. Parotid abscess may arise from ductal ectasis, primary parenchymal involvement, or infection of the subcapsular lymph nodes. The operative records for all the patients who underwent surgeries in the Department of Otorhinolaryngology, Head and Neck Surgery of the National University Hospital, Kuala Lumpur, Malaysia between January 2001 and December 2005 were retrospectively reviewed. Our case series comprises 15 patients, with 10 males and five females with a median age at presentation of 51 years old. Diabetes mellitus is a significant comorbid factor, with six patients being diabetics. Among the diabetics, two patients presented with facial nerve palsy and one of them also died due to overwhelming septicaemia. Here, we discuss the presenting symptoms, predisposing factors, investigations, microbiology and complications of this condition.
Fulltext A Toddler with Rhabdomyosarcoma Presenting as Acute Otitis Media with Mastoid Abscess

Ng SY, Goh BS

Chin Med J (Engl), 2016 May 20;129(10):1249-1250.
PMID: 27174338 DOI: 10.4103/0366-6999.181973
Fulltext Prevalence of allergic rhinitis in children with otitis media with effusion

Norhafizah S, Salina H, Goh BS

Eur Ann Allergy Clin Immunol, 2020 05;52(3):121-130.
PMID: 31668057 DOI: 10.23822/EurAnnACI.1764-1489.119

Summary: Introduction.The prevalence of allergic rhinitis in children with persistent otitis media with effusion in different countries varies between 82% to 93%. Many risk factors of otitis media with effusion has been studied and proven. However, its association with allergic rhinitis remains controversial. Objective. The main objective of this study is to determine the prevalence of allergic rhinitis in children with persistent otitis media with effusion. This study is also aimed to identify the risk factors of otitis media with effusion, common allergens associated with allergic rhinitis and determine the hearing threshold of children with otitis media with effusion. Methods.A hundred and thirty children were recruited. History taking, physical examination and hearing assessment were done in the first visit. Those with allergic rhinitis underwent skin prick test and treated with intranasal corticosteroid and antihistamine. A second examination and hearing assessment were then repeated after 3 months. Results.The prevalence of allergic rhinitis in children with persistent otitis media with effusion in this study was noted to be 80.3%. Among these children, dust mites appeared to be the most common allergen (87.7%). Another risk factor appeared to be families with more than 4 members per-household (96%). It is noted that that otitis media with effusion caused a hearing loss up to 33 dB. However, there was a statistically significant improvement of the hearing threshold during second visit after commencement of allergy treatment. It was also noted that the hearing threshold in allergic rhinitis group was significantly impaired compared to the non-allergic rhinitis group. Conclusions.Allergic rhinitis and larger family household appeared to be common risk factors in children with persistent otitis media with effusion. There is significant hearing loss noted in children suffering from otitis media with effusion and allergic rhinitis. The hearing threshold improved remarkably with medical therapy. This study hence clarifies the controversy on the association between allergic rhinitis and otitis media with effusion.
Long-term status of middle-ear aeration post canal wall down mastoidectomy

Ezulia T, Goh BS, Saim L

J Laryngol Otol, 2019 Aug;133(8):662-667.
PMID: 31267884 DOI: 10.1017/S0022215119001385

BACKGROUND: Retraction pocket theory is the most acceptable theory for cholesteatoma formation. Canal wall down mastoidectomy is widely performed for cholesteatoma removal. Post-operatively, each patient with canal wall down mastoidectomy has an exteriorised mastoid cavity, exteriorised attic, neo-tympanic membrane and shallow neo-middle ear.
OBJECTIVE: This study aimed to clinically assess the status of the neo-tympanic membrane and the exteriorised attic following canal wall down mastoidectomy.
METHODS: All post canal wall down mastoidectomy patients were recruited and otoendoscopy was performed to assess the neo-tympanic membrane. A clinical classification of the overall status of middle-ear aeration following canal wall down mastoidectomy was formulated.
RESULTS: Twenty-five ears were included in the study. Ninety-two per cent of cases showed some degree of neo-tympanic membrane retraction, ranging from mild to very severe.
CONCLUSION: After more than six months following canal wall down mastoidectomy, the degree of retracted neo-tympanic membranes and exteriorised attics was significant. Eustachian tube dysfunction leading to negative middle-ear aeration was present even after the canal wall down procedure. However, there was no development of cholesteatoma, despite persistent retraction.
Case series of tuberculous otitis media: Spectrum of clinical presentation and outcome

Te BC, Goh BS

Acta Otorrinolaringol Esp (Engl Ed), 2021 Jan 13.
PMID: 33454087 DOI: 10.1016/j.otorri.2020.09.007

OBJECTIVE: Tuberculous otitis media (TB OM) is a rare disease. We present here our experience of TB OM on its clinical presentation, investigation and treatment outcome.
METHODS: A retrospective observational study was performed and clinical data of patients in whom TB OM was diagnosed at our center between 2008 and 2019 was analyzed.
RESULTS: Five cases of TB OM were identified. Otorrhoea was the most consistent presenting chief complaint while one of the cases presented with right post-auricular swelling. All the cases were successfully treated with anti-tuberculous medication with outcome of dry middle ear but only one case achieved full recovery of hearing loss.
CONCLUSION: Due to the disparity of presentations in all our patients, we would like to emphasize the high index of suspicion of TB OM in acute or chronic cases of otitis media with unusual presentation or poor response to standard treatment.
Fulltext Paediatric Adenotonsillectomy: Its Safety and Outcome in a Malaysian Tertiary Medical Center

Lokman FL, Goh BS

Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1050-1055.
PMID: 36452792 DOI: 10.1007/s12070-020-02099-y

Adenotonsillectomy is the commonest otorhinolaryngology surgery for paediatrics. The purpose of this study was to determine the safety and outcome of adenotonsillectomy in a tertiary center in Malaysia. This was achieved by studying the demographics, indications, co-morbidities of patients and its association with the complications of the procedure. This retrospective study was conducted from November 2011 until October 2016. Medical records of patients aged 2-12 years old who had adenotonsillectomy done in our center were retrieved for data collection. A total of 143 patients who fulfilled the inclusion and exclusion criteria were recruited. Median age was 7.52 (± 2.98 SD) years old. Allergic rhinitis was the commonest co-morbidity (40%). Recurrent tonsillitis was the main indication (60%), followed by sleep disordered breathing (SDB) without apnea (29%), obstructive sleep apnea (OSA) (7%) and other indications (4%). Post-operative paediatric intensive care unit (PICU) admission was very low (1.4%) and was reserved for those with severe OSA with complications. None of the patients admitted to PICU post-operative had respiratory complications. The prevalence of post-tonsillectomy bleeding was only 2.1%. There was no significant association between patient's co-morbidity with operative complications (p = 0.269). Adenotonsillectomy is indicated for children with recurrent tonsillitis and paediatric SDB. The two most severe complications, namely post-tonsillectomy haemorrhage and respiratory complications occurred but incidence was low. Criteria of post-operative PICU or paediatric high dependency unit admission for paediatric SDB has to be based on multiple clinical and logistics factors and not only patients co-morbidity and indication of surgery.
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.
Quality of life assessment in patients with moderate to severe allergic rhinitis treated with montelukast and/or intranasal steroids: a randomised, double-blind, placebo-controlled study

Goh BS, Ismail MI, Husain S

J Laryngol Otol, 2014 Mar;128(3):242-8.
PMID: 24618303 DOI: 10.1017/S002221511400036X

This study investigated improvements in quality of life associated with eight weeks of montelukast and/or intranasal steroid treatment for moderate to severe allergic rhinitis.
The role of proton pump inhibitors in adenoid hypertrophy in children

Iqbal FR, Goh BS, Mazita A

Otolaryngol Head Neck Surg, 2012 Aug;147(2):329-34.
PMID: 22496101 DOI: 10.1177/0194599812444528

To establish the efficacy of proton pump inhibitors (PPI) in the treatment of adenoid hypertrophy in children.
Fulltext Supraglottoplasty for laryngomalacia: who will benefit?

Zainal A, Goh BS, Mohamed AS

Asian J Surg, 2011 Apr;34(2):92-6.
PMID: 21723473 DOI: 10.1016/S1015-9584(11)60026-2

Laryngomalacia is the most common cause of neonatal and infantile stridor. The aim of this study was to assess the outcome of surgical intervention in children with laryngomalacia.
Fulltext A ten year retrospective review of orbital complications secondary to acute sinusitis in children

Suhaili DN, Goh BS, Gendeh BS

Med J Malaysia, 2010 Mar;65(1):49-52.
PMID: 21265249 MyJurnal

Acute sinusitis is most often a mild self-limiting disease. However, it may progress into severe and life threatening complications. One of the commonest being orbital complication of which visual loss is a direct consequence. In this 10 year retrospective study, the nature of orbital complication, clinical presentation and treatment modalities and outcome seen in children with acute sinusitis in a tertiary referral institute were reviewed. Of six patients, there was a case of preseptal cellulitis, 4 cases of subperiosteal abscess and one case of orbital abscess. Periorbital swelling was a common presenting feature. In 5 cases this was associated with proptosis with one case of impending optic nerve compression. The value of computed tomography and opthalmological examination as a component in the management plan is highlighted. All patients were treated with intravenous antibiotics but evidence of abscess collection warranted urgent surgical drainage in 5 patients, 3 being endoscopic drainage while external approach was done for the remaining 2 patients. Thus a child exhibiting orbital complication of acute sinusitis, prompt diagnosis and treatment is essential in obtaining the best outcome for the child.
Unilateral tongue angioedema caused by angiotensin-converting enzyme inhibitor

Ee YS, Sow AJ, Goh BS

J Laryngol Otol, 2010 Dec;124(12):1337-9.
PMID: 20529395 DOI: 10.1017/S002221511000143X

We report a case of an elderly man receiving treatment with perindopril, who presented with angioedema of the left side of the tongue, floor of the mouth and upper neck. This affected his speech and swallowing, and occurred one day after a burr hole and evacuation procedure undertaken to treat a subdural haematoma. The patient was kept under close observation and treated with intravenous hydrocortisone. The angioedema resolved completely in two days. This is the third reported case of unilateral tongue angioedema occurring secondary to angiotensin-converting enzyme inhibitor use.
Fulltext Intermittent Suprasternal Neck Mass Caused by Herniation of Ectopic Thymus: Report of Two Cases

Tey KJ, Goh BS, Mohd-Zaki F

Iran J Otorhinolaryngol, 2020 Nov;32(113):391-395.
PMID: 33282788 DOI: 10.22038/ijorl.2020.45727.2501

Introduction: Ectopic thymus is an uncommon cause of neck masses in children that frequently present as lateral cervical swelling especially on the right side.
Case Report: We report two cases with atypical clinical presentation of ectopic thymus and superior herniation of normal thymus. Both of the patients manifested as intermittent midline mass at the suprasternal region during Valsalva manuevre. Unique ultrasound features with the location along the thymic descent together with dynamic assessment of the organ movement were essential to reach the correct diagnosis. Conservative approach was considered in these patients considering the necessity of thymus in the process of puberty.
Conclusion: High index of suspicion is of utmost importance when encounter patient with similar clinical manifestation to avoid unnecessary diagnostic modalities and surgeries. Accurate diagnosis will also alleviate parents' anxiety.
Fulltext The Mysterious Whistling Breath: Foreign Body Aspiration

Chandran S, Gan BC, Goh BS

Cureus, 2023 Jan;15(1):e34267.
PMID: 36855495 DOI: 10.7759/cureus.34267

Foreign body aspiration is commonly seen in the pediatric age group and can be a life-threatening condition. Typical presentations include coughing, wheezing, and choking and can often masquerade as asthma causing misdiagnosis and treatment delay. Most of the time, the actual aspiration event is unnoticed, and patients may remain asymptomatic until they present with recurrent infections with or without positive radiological findings. Aspirated objects tend to migrate distally, and organic objects may induce edema and inflammation. Diagnosis is crucial as near-total or total obstruction of the airway may cause asphyxia and, subsequently, death if no immediate intervention is taken.
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.
Fulltext The Prevalence of Sensorineural Hearing Loss in β-thalassaemia patient treated with Desferrioxamine

Kong MH, Goh BS, Hamidah A, Zarina AL

Med J Malaysia, 2014 Feb;69(1):9-12.
PMID: 24814621 MyJurnal

OBJECTIVE: This study aimed to evaluate the prevalence of sensorineural hearing loss (SNHL) in β-thalassaemia patients treated with Desferrioxamine (DFO) and determine the correlation of SNHL with average daily DFO dosage, serum ferritin level and Therapeutic index (T.I).

METHODS: This is a cross sectional descriptive study carried out for a period of 14 months and 54 patients were recruited. The recruited patients are transfusion dependant β- thalassaemia patient aged 3 years and above treated with DFO. An interview, clinical examination and hearing assessment, which included tympanogram, and Pure Tone Audiometry (PTA) or behaviour alaudiometry were performed. The data on age started on DFO, average daily DFO, duration of DFO intake, serum ferritin past 1 year and Therapeutic Index (T.I) were obtained from patients' case notes.

RESULTS: The prevalence of SNHL was 57.4% and majority has mild hearing loss (93.6%). Fourteen patients (25.9%) have bilateral ear involvement and as many as 17 patients (31.5%) have SNHL in either ear. A total of 23 patients (42.6%) have normal hearing level. Although the prevalence of SNHL was 57.4%, only a small percentage of the patient noticed and complained of hearing loss (11.1%). There is no association between age started on DFO, average daily DFO and duration of DFO intake with normal hearing group and those patients with SNHL. Positive correlation was seen between average daily DFO with 2000 and 4000Hz on PTA in the left ear and between serum ferritin level past 1 year with 4000 and 8000Hz in the right ear and 8000Hz in the left ear. No significant correlation was seen between T.I on PTA.

CONCLUSION: The prevalence of SNHL from hearing assessment is high in β-thalassaemia patients in this study. However, it is manifested clinically in a smaller percentage. We suggest a baseline hearing assessment should be carried on all β-thalassaemia patients prior to DFO chelation therapy.
Fulltext Partial Cricotracheal Resection (PCTR), a Rewarding Outcome for Paediatric Subglottic Stenosis: An Early Experience

Goh BS, Roopesh S, Marina MB, Abdullah SM

Med J Malaysia, 2014 Feb;69(1):13-5.
PMID: 24814622

This is a retrospective study examining the outcome of paediatric patients with subglottic stenosis who underwent partial cricotracheal resection (PCTR) as a primary open procedure from 2004 to 2012. There were 5 patients identified aged from 3 to 18 years old. All the subglottic stenosis were acquired type. All of them were secondary to prolonged intubation. Three patients were classified as Myer-Cotton grade III and the other two were Myer-Cotton grade IV. Two of the patients had concomitant bilateral vocal cord immobility. All patients underwent two staged PCTR . All patients underwent two staged PCTR, and one patient underwent posterior cordectomy apart from partial CTR at different setting. All patients were successfully decannulated at various durations postoperatively. Although this is an early experience in our institution, PCTR has shown to be effective and safe procedure in patients with subglottic stenosis especially those with Myer-Cotton grade III and IV.
Fulltext Primary clear cell carcinoma of minor salivary gland of the soft palate: a case report

Saleh KA, Nurishmah MI, Firouzeh GN, Goh BS

Med J Malaysia, 2012 Jun;67(3):335-6.
PMID: 23082431 MyJurnal

Clear cells can be found in numerous salivary and non-salivary tumors in the head and neck region, including metastatic lesions. They are rare low-grade tumors accounting for less than 1% of all salivary gland tumors and occur almost exclusively in the intra-oral minor salivary glands. Hyalinizing clear cell carcinoma (HCCC) is an extremely rare and recently described neoplasm predominantly affecting the oral cavity. Histologically, it is characterized by nests of glycogen-rich monomorphic clear cells within a hyaline stroma. HCCC often follows an indolent course with a limited metastatic potential. It is therefore important to differentiate this entity from other more aggressive clear cell tumors including metastatic tumors such as renal cell carcinoma. We hereby report a case of HCCC localized in minor salivary glands specifically in soft palate for its rarity, as well as to discuss the role of immunohistochemical stains, essential for its definitive diagnosis.

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