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Fulltext Congenital mastoid cholesteatoma presenting as a mass obstructing external auditory canal

Khairunnisak M, Mohd Khairi MD

Med J Malaysia, 2014 Dec;69(6):277-8.
PMID: 25934960 MyJurnal

We describe the clinical presentation, investigation and management of an eventually fatal case of hypercalcemic crisis due to primary hyperparathyridism (PHPT). A 60 year-old lady with history of urolithiasis presented with worsening generalized bone pain, spinal scoliosis and a limp. Laboratory data showed hypercalcemia and raised alkaline phosphatase. Left hip x-ray revealed a subcapital femoral neck fracture. Intact parathyroid hormone was elevated, 187.6 pmol/L (1.6 - 6.9) and ultrasound showed an enlarged right parathyroid gland. Despite initial reduction of serum calcium with saline infusion and multiple doses of intravenous pamidronate, her calcium increased to 4.14 mmol/L a week following application of Buck's traction for persistent left hip pain. She succumbed eventually with serum calcium peaking at 6.28 mmol/L despite multiple therapeutic interventions.
Comparison study of the MRI shoulder PROPELLER technique with differential image quality by variation of shoulder coils

Khairi M, Zakaria F, Supar R, Mohd Z

Med J Malaysia, 2024 Mar;79(Suppl 1):74-81.
PMID: 38555889

INTRODUCTION: Motion and pulsation artifacts are the most prominent types of artifacts in Magnetic Resonance Imaging (MRI) of the shoulder. Therefore, this study examined the Periodically Rotating Overlapping Parallel Lines with Enhanced Reconstruction (PROPELLER) technique with small flex coil (SFC) and dedicated shoulder coil (DSC) for the reduction of motion and pulsation artifacts. The signalto- noise ratio (SNR) and contrast-to-noise ratio (CNR) of the standard proton density fat saturation (PDFS) pulse sequence and the PROPELLER proton density fat saturation (PROPELLER PDFS) pulse sequence were also evaluated.
MATERIALS AND METHODS: Eighteen (18) participants who met the inclusion and exclusion criteria were scanned using a standard non-contrast MRI shoulder protocol including the PDFS pulse sequence and the PROPELLER PDFS pulse sequence using a small flex coil and a dedicated shoulder coil. Two experienced musculoskeletal (MSK) radiologists evaluated and graded the presence of artifacts on the MR images and the SNR and CNR were measured quantitatively.
RESULTS: The non-parametric Wilcoxon Signed Rank test revealed a significant reduction in motion and pulsation artifacts between the PROPELLER PDFS pulse sequence and the standard PDFS pulse sequence. In addition, the nonparametric Mann-Whitney U test revealed that the mean rank of SNR for the standard sequence was statistically significant when compared to the PROPELLER sequence for both coil types. The CNR of the PROPELLER sequence was statistically significant between fat-fluid, bone-fluid, bonetendon, bone-muscle, and muscle-fluid when using SFC and DSC.
CONCLUSION: This study proved that the PROPELLER-PDFS pulse sequence effectively eliminates motion and pulsation artifacts, regardless of the coils utilised. The PROPELLERPDFS pulse sequence can therefore be implemented into the standard MRI shoulder procedure.
Fulltext Unilateral foul smelly nasal discharge in an adult

Irfan M, Hasme Zam H, Mohd Khairi M

Malays Fam Physician, 2012;7(1):28-30.
PMID: 25606242 MyJurnal

The incidence of rhinolith is by far very low compared to the nasal foreign bodies, especially in adult. Foreign body (FB) in the nostril will lead to unilateral nasal symptom which can start with nasal obstruction or discomfort. In younger children, they may miss to report the problem to the parents but, later on, the FB will manifest itself with unilateral nasal discharge, which at most of the time fouls smells. We report a case of a healthy adult female who presented with unilateral foul smelly nasal discharge which later was diagnosed as rhinolith, with rubber-tip pencil eraser as the nidus of calcification.
Fulltext Clinical characteristic of vertigo in children

Rosdan S, Basheer L, Mohd Khairi MD

Med J Malaysia, 2015 Aug;70(4):220-3.
PMID: 26358017 MyJurnal

Objective: To review the clinical characteristic of vertigo in children.
Method: A retrospective observational study was done on children who presented to a specialised vertigo clinic over period of six years. The patients’ case notes were retrieved from the medical record unit and reviewed. All patients were seen by an otologist who thoroughly took down history, completed ear, nose, throat and neurological examination.
Result: Seven different causes were identified in 21 patients (86%) while no diagnosis was reached in three patients (12.5%). The most common cause of giddiness was childhood paroxysmal vertigo (33%) followed by benign paroxysmal positional vertigo (16.6%) and sensorineural hearing loss (12.5%). Other causes include chronic suppurative otitis media and anxiety disorder each accounting for 8.3%, one case of cholesteatoma and another case of ear wax each accounting for 4.1%.
Conclusion: It is not uncommon for the children to be affected by vertigo. Management of vertigo in children should include a detailed history, clinical examination, audiological and neurological evaluation. Imaging should be performed in selected patients. The main cause of vertigo in our series is CPV. The outcome of most of the patients is good.
Fulltext Coblation tonsillectomy versus dissection tonsillectomy: a comparison of intraoperative time, intraoperative blood loss and post-operative pain

Izny Hafiz Z, Rosdan S, Mohd Khairi MD

Med J Malaysia, 2014 Apr;69(2):74-8.
PMID: 25241816 MyJurnal

The objective of this study was to compare the intraoperative time, intraoperative blood loss and post operative pain between coblation tonsillectomy and cold tonsillectomy in the same patient. A prospective single blind control trial was carried out on 34 patients whom underwent tonsillectomy. The patients with known bleeding disorder, history of unilateral peritonsillar abscess and unilateral tonsillar hypertrophy were excluded. Operations were done by a single surgeon using cold dissection tonsillectomy in one side while coblation tonsillectomy in the other. Intraoperative time, intraoperative blood loss and post operative pain during the first 3 days were compared between the two methods. Results showed that the intraoperative time was significantly shorter (p<0.001) and intraoperative blood loss was significantly lesser (p<0.001) in coblation tonsillectomy as compared to cold tonsillectomy. Post operative pain score was significantly less at 6 hours post operation (p<0.001) in coblation tonsillectomy as compared to cold tonsillectomy. However, there were no differences in the post operative pain scores on day 1, 2 and 3. In conclusion, coblation tonsillectomy does have superiority in improving intraoperative efficiency in term of intraoperative time and bleeding compared to cold dissection tonsillectomy. The patient will benefit with minimal post operative pain in the immediate post surgery duration.
Hearing screening of infants in Neonatal Unit, Hospital Universiti Sains Malaysia using transient evoked otoacoustic emissions

Khairi MD, Din S, Shahid H, Normastura AR

J Laryngol Otol, 2005 Sep;119(9):678-83.
PMID: 16156907

The objective of this prospective study was to report on the prevalence of hearing impairment in the neonatal unit population. From 15 February 2000 to 15 March 2000 and from 15 February 2001 to 15 May 2001, 401 neonates were screened using transient evoked otoacoustic emissions (TEOAE) followed by second-stage screening of those infants who failed the initial test. Eight (2 per cent) infants failed one ear and 23 (5.74 per cent) infants failed both ears, adding up to 7.74 per cent planned for second-stage screening. Five out of 22 infants who came for the follow up failed the screening, resulting in a prevalence of hearing impairment of 1 per cent (95 per cent confidence interval [95% CI]: 0.0-2.0). Craniofacial malformations, very low birth weight, ototoxic medication, stigmata/syndromes associated with hearing loss and hyperbilirubinaemia at the level of exchange tranfusion were identified to be independent significant risk factors for hearing impairment, while poor Apgar scores and mechanical ventilation of more than five days were not. In conclusion, hearing screening in high-risk neonates revealed a total of 1 per cent with hearing loss. The changes in the risk profile indicate improved perinatal handling in a neonatal population at risk for hearing disorders.
Fulltext Myxoid Neurofibromas of the External Ear Canal: A Case Report

Maryam YK, Mohd Khairi MD, Asmah Hanim H

Med J Malaysia, 2015 Apr;70(2):102-3.
PMID: 26162387 MyJurnal

Myxoid neurofibroma is benign tumours of perineural cell origin that arise from elements in the peripheral nervous system. We report a case of a 60-year-old female patient presented with history of right ear mass which was slowly growing. Her primary complaint was cosmetic deformity but hearing loss was also present. The mass was excised and histologically revealed a myxoid neurofibroma. To the authors' knowledge, this is the first time that a myxoid neurofibroma arising from external auditory canal is reported. It should be included in the differential diagnosis of a mass originating from this location.
Keywords: Kelantan, Hospital Universiti Sains Malaysia
Light-harvesting complexes in photosystem II regulate glutathione-induced sensitivity of Arabidopsis guard cells to abscisic acid

Jahan MS, Nozulaidi M, Khairi M, Mat N

J Plant Physiol, 2016 May 20;195:1-8.
PMID: 26970687 DOI: 10.1016/j.jplph.2016.03.002

Light-harvesting complexes (LHCs) in photosystem II (PSII) regulate glutathione (GSH) functions in plants. To investigate whether LHCs control GSH biosynthesis that modifies guard cell abscisic acid (ABA) sensitivity, we evaluated GSH content, stomatal aperture, reactive oxygen species (ROS), weight loss and plant growth using a ch1-1 mutant that was defective of LHCs and compared this with wild-type (WT) Arabidopsis thaliana plants. Glutathione monoethyl ester (GSHmee) increased but 1-chloro-2,4 dinitrobenzene (CDNB) decreased the GSH content in the guard cells. The guard cells of the ch1-1 mutants accumulated significantly less GSH than the WT plants. The guard cells of the ch1-1 mutants also showed higher sensitivity to ABA than the WT plants. The CDNB treatment increased but the GSHmee treatment decreased the ABA sensitivity of the guard cells without affecting ABA-induced ROS production. Dark and light treatments altered the GSH content and stomatal aperture of the guard cells of ch1-1 and WT plants, irrespective of CDNB and GSHmee. The ch1-1 mutant contained fewer guard cells and displayed poor growth, late flowering and stumpy weight loss compared with the WT plants. This study suggests that defective LHCs reduced the GSH content in the guard cells and increased sensitivity to ABA, resulting in stomatal closure.
Fulltext Dural tear post mastoidectomy repaired with Dura Gen

Wong CY, Khairi MD, Mohamed SA, Irfan M

Med J Malaysia, 2010 Dec;65(4):307-8.
PMID: 21901952

Dural exposure may occur during the course of thinning the tegmen tympani and tegmen mastoideum in mastoid procedure. If large area of dura is exposed or lacerated, cerebrospinal fluid and brain herniation may enter the mastoid cavity. We report a case of a patient with injured dura mater and tegmen mastoideum during mastoidectomy for chronic suppurative otitis media with cholesteatoma managed by using DuraGen. The dura mater and tegmen defect healed totally showing the success of the procedure. A collagen matrix like DuraGen is an option for repairing dural tear in mastoid region.
Fulltext Speech disorders in operated cleft lip and palate children in Northeast Malaysia

Normastura AR, Mohd Khairi MD, Azizah Y, Nizam A, Samsuddin AR, Naing L

Med J Malaysia, 2008 Mar;63(1):21-5.
PMID: 18935726

The aim of this study was to determine the prevalence and association of speech disorders among operated cleft lip and palate children (CLP) in Northeast Malaysia. A comparative cross sectional study was performed on 98 operated CLP and 109 non-cleft subjects that aged between 3- 12-years-old. Data collection was done clinically and also by recording speech samples of each subject from both groups using a portable cassette recorder. Results showed that the prevalence of speech abnormality was 61.2% (95% CI: 51.41-71.04) and the risk of having speech abnormality was 174.5 times (95% CI: 23.04, 1320.67; P value < 0.001) in CLP children compared to non-cleft children. Therefore it was found that children with appropriately repaired CLP in Northeast Malaysia failed to have normal speech.
The association of allergy and chronic suppurative otitis media: A study in a tropical country

Mohd Khairi MD, Shahrjerdi B, Ramiza RR, Normastura R

Med J Malaysia, 2019 Jun;74(3):205-208.
PMID: 31256174

OBJECTIVE: Chronic suppurative otitis media (CSOM) usually begins as a spontaneous perforation of tympanic membrane due to an acute infection of the middle ear. This study was aimed to evaluate the association between allergy and CSOM.
METHODS: A case-control study was carried out among patients with CSOM (cases) and controls were those with no ear pathology. The presence of CSOM was made through a medical history and otoscopic examination. Allergen testing was done by the skin prick test.
RESULTS: In all 124 subjects were recruited in this study with equal number of the cases and controls. The commonest positive reaction in the skin prick test in both groups was to house dust mites. Among CSOM cases, half (50%) of them had an allergy to Blomia tropicalis and 48.4% to Dermatophagoides while in the control group, 27.4% to Dermatophagoides and 25.8% to B. tropicalis. There were significant associations between CSOM and allergy to B. tropicalis (p=0.005), Dermatophagoides (p=0.016) and Felis domesticus (p=0.040). The prevalence of allergy at 95% confidence interval (95%CI) in CSOM and control groups were demonstrated as 59.7% (95%CI: 47.5, 71.9) and 30.6 % (95%CI: 19.1, 42.1) respectively. There was a significant association between allergy and CSOM (p=0.001).
CONCLUSION: Indoor allergens are the most prevalent in our environment and therefore good control may difficult to achieve. The hypersensitivity states of the subject are likely to have a role in the pathogenesis of CSOM especially in the tropical countries where allergy occurs perennially.
Fulltext Auditory neuropathy: three cases among a group with sensorineural hearing loss

Mohd Khairi MD, Normastura AR, Wan Zaharah AW

Singapore Med J, 2009 Sep;50(9):e324-5.
PMID: 19787161

The prevalence of auditory neuropathy is not known, although the majority of cases are felt to lie within the population of neonatal intensive care unit graduates. We report three cases of auditory neuropathy, out of 211 children with sensorineural hearing loss, seen at our audiology clinic from April 1, 1999 to December 31, 2003. Two patients did not have a risk factor for hearing impairment. Screening policies based solely on transient evoked otoacoustic emissions testing will not detect auditory neuropathy effectively, and may falsely reassure parents and professionals unaware of this condition.
Study site: Audiology clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Screening for gap junction protein beta-2 gene mutations in Malays with autosomal recessive, non-syndromic hearing loss, using denaturing high performance liquid chromatography

Aishah ZS, Khairi MD, Normastura AR, Zafarina Z, Zilfalil BA

J Laryngol Otol, 2008 Dec;122(12):1284-8.
PMID: 18353197 DOI: 10.1017/S0022215108002041

To determine the frequency and type of gap junction protein beta-2 gene mutations in Malay patients with autosomal recessive, non-syndromic hearing loss.
Intradermal Naevi of External Auditory Canal: Unusual location with a unique presentation

Yatiee SL, Mohd Khairi MD, Md Salzihan MS, Ikmal HB

Med J Malaysia, 2018 04;73(2):121-122.
PMID: 29703880 MyJurnal

The incidence of intradermal nevus in the external auditory canal is uncommon. We herein are describing a case of 60-year-old lady who presented with foreign body sensation in the right external ear canal (EAC) with mild discomfort and ear bleed during ear picking. Otoscopic examination revealed hyperpigmented mass on the floor of the outer two third of EAC. Complete excisional biopsy of the mass resulted in histopathology findings of intradermal nevus. Despite the fact that the disease is not alarming, the possibilities of benign melanocytic nevi transformation into malignant lesions such as melanoma need to be ruled out.

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