PATIENTS: A young girl who complained of pulsatile tinnitus and an elderly man who presented with ear bleeding. Otoendoscopy examination revealed a pulsatile reddish mass protruding through the tympanic membrane in both patients.
INTERVENTIONS: A combination of clinical assessments and imaging supported the diagnosis of aberrant ICA in the middle ear. Transcanal endoscopic reinforcement of the artery was performed; tragal cartilage was used as a shield to strengthen the carotid canal defect.
RESULTS: Assisted by fine endoscopic instruments, the protruding arteries were separated without damage to the surrounding structures and reinforced using tragal cartilage. Both patients' symptoms improved postoperatively; they reported tinnitus relief and hearing improvement.
CONCLUSION: To prevent catastrophic events, diagnosis of aberrant ICA is important before any surgical intervention. With appropriate management, surgical intervention using transcanal endoscopic ear surgery offers a clear view of the surgical field and is an excellent choice for management of aberrant ICA.
MATERIALS AND METHODS: Sixty patients who underwent IBCT were allocated to Group I (n = 30; microscopic IBCT) and Group II (n = 30; endoscopic IBCT) by the dates of their visits. Anatomical success was defined as an intact, repaired tympanic membrane; functional success was defined as a significant decrease in the air-bone gap. Postoperative discomfort was analyzed using a visual analog scale (VAS). Thirteen trainees completed structured questionnaires exploring anatomical identification and the surgical steps.
RESULTS: The surgical success rates were 96.7% in Group I and 100% in Group II. We found no between-group differences in the mean decrease in the air-bone gap or the extent of postoperative discomfort. Significant postoperative hearing improvements were evident in both groups. The mean operative time was shorter when the microscopic approach was chosen (17.7±4.53 vs. 26.13±9.94 min). The two approaches significantly differed in terms of the identification of external and middle ear anatomical features by the trainees, and their understanding of the surgical steps.
CONCLUSION: Both endoscopic and microscopic IBCT were associated with good success rates. The endoscopic approach facilitates visualization, and a better understanding of the middle ear anatomy and the required surgical steps and thus is of greater educational utility.
METHOD: A cross sectional study was carried out where caretakers of cleft lip and/or palate were asked to complete the translated Malay language version of Strength Difficulties Questionnaire. The hearing status of the children was analyzed based on recent pure tone audiometric and tympanogram results. The patients' age, gender, type of cleft pathology, age of palatal surgery and behavioural patterns were examined for their potential relationship with hearing status.
RESULTS: A total of 74 children (148 ears) aged between 7 and 17 years with cleft lip and/or palate were recruited. The result showed 37 ears (25.0%) had hearing loss with majority suffered from mild conductive hearing loss. There were 16 ears (10.8%) that had persistent middle ear effusion. Hearing improvement occurred when palatal repair was performed at the age of less than 1 year old. (p = 0.015) There was no significant relationship between patients' gender, age, type of cleft and history of myringotomy with their hearing status. In terms of behavioural patterns, 16.3% were abnormal for total behavioural score, 39.2% for peer problem and 17.6% for conduct problem. For prosocial behaviour, 16.3% were rated low and very low. There was fair correlation between age and hyperactivity problems (r = 0.44). Patients' gender, type of cleft pathology, had been teased apart and hearing status was found not related to behavioural problems.
CONCLUSION: Cleft lip and/or palate patients have a good longterm hearing outcome. Majority had normal hearing and if there is hearing impairment, it is only a mild loss. Early palatal repair surgery before the age of 1 year can significantly reduce the risk of hearing loss. Cleft lip and/or palate patients experienced peer problems. There was no significant correlation between behavioural difficulty and hearing status among school-aged children with cleft lip and palate.
METHODS: Canalplasty or meatoplasty was performed under general anesthesia via the posterior auricular transcanal approach. The EAC diameter and length were measured and a non-fenestrated uncuffed TT of suitable size was fitted into the ear canal. The TT was then modified during fitting, to fit onto the concha. Patients were advised on the importance of compliance. The adequacy of the size of the EAC after the surgery was assessed during follow-ups.
RESULTS: A total of 3 patients (4 ears) were included in our study. Various sizes of TTs were fitted into their EAC following canalplasty or meatoplasty. All of them showed excellent postoperative outcome on follow up 2 years after the surgery, with no evidence of postoperative EAC stenosis.
CONCLUSION: Modified TT stent after canalplasty or meatoplasty is proposed as an excellent alternative in preventing restenosis of EAC in centers with limited resources.
METHODS: This study has two phases: Phase I involves the translation of the NCIQ from English to Malay, followed by internal consistency and test-retest reliability assessment of the final version of NCIQ-M. Phase II involves QOL assessment of post-lingual deafness using NCIQ-M.
RESULTS: Twenty CI users and 20 non-CI users answered the NCIQ-M. Test-retest reliability analysis of the NCIQ-M was performed using an intraclass correlation coefficient, achieving scores of more than 0.85. Internal consistency was analysed with Cronbach α of more than 0.70 in all subdomains. Scores between the two groups of subjects were analyzed using an independent sample t-test. Good internal consistency, intraclass correlation, and test-retest reliability were obtained. Scores in all six subdomains of the NCIQ-M are significantly higher in the CI user group than in the non-CI user group.
CONCLUSIONS: The NCIQ-M is a consistent and reliable subjective questionnaire to determine the QOL of CI users concerning physical, psychological, and social functioning.
METHODS: The prospective clinical study was conducted at Selayang Hospital (SH) and Hospital Canselor Tuanku Muhriz (HCTM) within one year. A total of 38 children ranging from 3 to 18 years old underwent hearing evaluation using ABR tests and MSSR under sedation. The duration of both tests were then compared.
RESULTS: The estimated hearing threshold of frequency specific chirp MSSR showed good correlation with ABR especially in higher frequencies such as 2000 Hz and 4000Hz with the value of cronbach alpha of 0.890, 0.933, 0.970 and 0.969 on 500Hz, 1000Hz, 2000Hz and 4000Hz. The sensitivity of MSSR is 0.786, 0.75, 0.957 and 0.889 and specificity is 0.85, 0.882, 0.979 and 0.966 over 500Hz, 1000Hz, 2000Hz and 4000Hz. The duration of MSSR tests were shorter than ABR tests in normal hearing children with an average of 35.3 minutes for MSSR tests and 46.4 minutes for ABR tests. This can also be seen in children with hearing loss where the average duration for MSSR tests is 40.0 minutes and 52.0 minutes for ABR tests.
CONCLUSION: MSSR showed good correlation and reliability in comparison with ABR especially on higher frequencies. Hence, MSSR is a good clinical test to diagnose children with hearing loss.