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Endoscopic ear surgery during COVID-19 pandemic

Tengku Kamalden TMI, Misron K

Med J Malaysia, 2021 08;76(Suppl 4):42-44.
PMID: 34558558

Similar to other surgical fraternities, endoscopic ear surgery (EES) faced great challenges during the COVID-19 pandemic. Many elective operations involving EES needed to be postponed, resulting in accumulated cases. Throughout one year during COVID-19, Hospital Sultan Ismail, Johor, Malaysia continued to perform various EES procedures. Although EES is an aerosol-generating procedure, it has become evidence that this minimallyinvasive surgical approach offers lesser bony drilling and shorter operative time as compared to open mastoidectomy. Thus, this reduced the risk of viral transmission to the surgeons and operating staffs.
Fulltext Bilateral Sudden Sensorineural Hearing Loss Following Head Trauma

Misron K, Tengku Kamalden TMI, Mohammad N

Oman Med J, 2021 Jul;36(1):e280.
PMID: 34367684 DOI: 10.5001/omj.2021.42
Endoscopic intracanalicular vestibular schwannoma excision via middle ear corridors a surgical options

Tengku Kamalden TMI, Misron K, Arumugam PA

Acta Otolaryngol, 2021 Jul;141(7):678-683.
PMID: 33908813 DOI: 10.1080/00016489.2021.1916074

BACKGROUND: With more intracanalicular vestibular schwannoma (ICVS) diagnosed, treatment options are limited either to wait-and-see or surgery. The transpromontorial and infrapromontorial approaches allow direct route to the fundus of internal auditory canal with certain advantages in preserving facial nerve and even cochlear nerve.
OBJECTIVES: To describe the middle ear corridor approach for ICVS excision.
METHODOLOGY: All transpromontorial and infrapromontorial approaches for ICVS excision were recruited. The surgeries were performed at an otologic center by a single experienced otologist.
RESULTS: Three cases of ICVS Koos Type I were included in this review. Two cases were operated with exclusive endoscopic transcanal transpromontorial approach excision of tumor. One case underwent concurrent transcanal excision of ICVS through infrapromontorial approach with cochlear implantation. Two of them developed facial nerve paresis. The last patient recovered fully with viable cochlear nerve enabling hearing restoration with cochlear implant.
CONCLUSION: The potential of surgery in ICVS via middle ear approach is a safe and direct route with promising outcome. This approach offers removal of the ICVS without interrupting facial and cochlear nerves. Hence, the preservation of facial function and hearing are possible.
Infratemporal Fossa Synovial Sarcoma In A 3-Month-Old Infant: An Extremely Rare Tumour In Infancy

Lamry NA, Misron K, Tengku Kamalden TMI, Mohamad S

Gulf J Oncolog, 2021 Sep;1(37):91-94.
PMID: 35152201

Soft tissue sarcoma, especially synovial sarcoma is extremely rare in infancy. Only few cases were reported, and challenges lies in disease eradication and subsequent adjuvant therapy. Due to particularly small size of head and neck region with important structures are in intimate location with each other, surgical resection is very challenging, in order to ensure total disease resection as well as maintaining function and cosmetic outcome post-operatively. We present an uncommon case of synovial sarcoma of infratemporal fossa diagnosed in a 3-month-old infant. Due to extreme age, it poses difficulty to the managing team with regards to surgical intervention and oncological regimes. Keywords : Synovial sarcoma; infratemporal fossa; infant.
Fulltext A Rare Case Report of Unilateral Maxillary Mass from Adrenal Neuroblastoma

Mohamad Yusof AN, Saifudin N, Tengku Kamalden TMI

Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1408-1411.
PMID: 36452747 DOI: 10.1007/s12070-021-02560-6

Neuroblastoma is the most common extracranial neoplasm among paediatric patients, which arises from ectodermal neural crest cells. The most frequent primary site of neuroblastoma arises from retroperitoneum, specifically in the adrenal medulla. We present a rare case of adrenal neuroblastoma metastasis to maxillary sinus in a 20 month-old boy presenting with right maxillary swelling for the past 2 months. Computed tomography (CT) scan of paranasal sinus demonstrated right maxillary mass. A biopsy performed via a sublabial approach, surprisingly revealed neuroblastoma. Subsequent further workup depicted a huge right adrenal tumour. He was diagnosed with adrenal neuroblastoma stage 4 and treated with chemotherapy and surgical resection.
Fulltext Recurrent Submandibular Sialolithiasis in a Child

Thong HK, Mohamad Mahbob H, Sabir Husin Athar PP, Tengku Kamalden TMI

Cureus, 2020 Dec 19;12(12):e12163.
PMID: 33489575 DOI: 10.7759/cureus.12163

Sialolithiasis is a commonly encountered disease of the salivary glands, reported to represent up to 30% of all salivary gland diseases. However, the condition is rarely encountered in the pediatric population. The formation of a salivary stone is believed to be secondary to the deposition of calcium salts around a nidus. The formation of a nidus is commonly associated with desquamated epithelial or sloughing from a recent bacterial infection. Patients with submandibular sialolithiasis usually present with acute swelling over the neck associated with pain, fever, and purulent intraoral discharge. Neglected and poorly treated acute infection may progress to life-threatening abscess formation. Here we are describing our encounter with a 10-year-old boy with recurrent submandibular sialolithiasis. He was initially treated with conservative measures and antibiotics regimen. Failure of medical treatment and recurring symptoms led to submandibular gland excision followed by a full recovery.
Long-term maintenance costs incurred by the families of pediatric cochlear implant recipients in Malaysia

Misron K, Tengku Kamalden TMI, Misron LH, Devesahayam PR, Misron SNF

Cochlear Implants Int, 2021 09;22(5):291-295.
PMID: 33794747 DOI: 10.1080/14670100.2021.1905975

INTRODUCTION: Cochlear implant (CI) requires lifelong financial commitments to ensure that the devices always operate optimally.
OBJECTIVE: We estimated the long-term maintenance costs of CI including repair of speech processors, replacement of damaged parts, and battery requirements.
RESULTS: Forty-one parents of children who received CIs in Malaysian government hospitals were enrolled. The first 2 years of CI usage were covered by warranty. The cost increased three-fold from by 4 years of CI usage and then doubled by 8 years of usage. About 75% of parents commented that the costs were burdensome.
CONCLUSION: Our findings will be useful for parents whose children receive CI and will allow medical personnel to counsel the parents about the costs.
Fulltext Synchronous Occurrence of Bilateral Malignant Otitis Externa: Report of a Rare Case

Lamry NA, Misron K, Tengku Kamalden TMI, Aziz A, Salim R

Korean J Fam Med, 2021 Nov;42(6):483-486.
PMID: 32456405 DOI: 10.4082/kjfm.20.0071

Malignant otitis externa (MOE) is a rare and potentially life-threatening disease of the ear and temporal bone. Bilateral simultaneous MOE is extremely rare. Due to bilaterally symmetrical facial nerve palsy, it can easily be missed at the initial presentation, causing delay in management. Here, we report a case of bilateral MOE managed aggressively with regular ear toileting, ear packing with a ribbon gauze soaked with topical antimicrobials, and long-term intravenous and oral antibiotics. The patient showed good improvement in pain control, facial nerve status, and ear findings.
Fulltext Endoscope-Assisted Cochlear Implantation in Atretic Round Window

Musa MSH, Misron K, Hashim ND, Tengku Kamalden TMI

Cureus, 2024 Feb;16(2):e54360.
PMID: 38500948 DOI: 10.7759/cureus.54360

Different techniques have been proposed for cochlear implant (CI) from its conventional transmastoid posterior tympanotomy approach. Endoscopy role in the otologic field is still relatively new, but it provides a better surgical view with improved image clarity, especially in the challenging anatomical visualization of the critical structures in CI surgery. A 3-year-old girl with bilateral progressive profound hearing loss was scheduled for left cochlear implant surgery. The pre-operative high-resolution computed tomography (HRCT) of the temporal bone and magnetic resonance (MR) of internal acoustic meatus reported no significant abnormality of the middle and inner ears structures bilaterally. The standard left postauricular cortical mastoidectomy and posterior tympanotomy were performed. However, the microscopic view could not visualize the round window (RW) niche despite a widened extended posterior tympanotomy and surgical field manipulation. Transfacial recess endoscopic examination was done and was able to identify the possibly atretic RW. With endoscopic guidance, CI electrodes were inserted via cochleostomy, and intraoperative impedance measurement and neural response telemetry were obtained both during surgery and the postoperative phase. No intra- and postoperative complications were observed in this case. Following activation, the CI was functioning well. In conclusion, atretic RW is a rare anomaly found intraoperatively during CI surgery. Endoscope-assisted electrode insertion offers excellent visualization of targeted middle ear structures, especially in limited or abnormal anatomy of RW, which could minimize the risk of surgical complications.
Fulltext Self-reported symptom study of COVID-19 chemosensory dysfunction in Malaysia

Lee SH, Yeoh ZX, Sachlin IS, Gazali N, Soelar SA, Foo CY, et al.

Sci Rep, 2022 02 08;12(1):2111.
PMID: 35136124 DOI: 10.1038/s41598-022-06029-6

Alterations in the three chemosensory modalities-smell, taste, and chemesthesis-have been implicated in Coronavirus Disease 2019 (COVID-19), yet emerging data suggest a wide geographic and ethnic variation in the prevalence of these symptoms. Studies on chemosensory disorders in COVID-19 have predominantly focused on Caucasian populations whereas Asians remain understudied. We conducted a nationwide, multicentre cross-sectional study using an online questionnaire on a cohort of RT-PCR-confirmed adult COVID-19 patients in Malaysia between 6 June and 30 November 2020. The aim of our study was to investigate their presenting symptoms and assess their chemosensory function using self-ratings of perceived smell, taste, chemesthesis, and nasal blockage. In this cohort of 498 patients, 41.4% reported smell and/or taste loss when diagnosed with COVID-19, which was the commonest symptom. Blocked nose, loss of appetite, and gastrointestinal disturbances were independent predictors of smell and/or taste loss on multivariate analysis. Self-ratings of chemosensory function revealed a reduction in smell, taste, and chemesthesis across the entire cohort of patients that was more profound among those reporting smell and/or taste loss as their presenting symptom. Perceived nasal obstruction accounted for only a small proportion of changes in smell and taste, but not for chemesthesis, supporting viral disruption of sensorineural mechanisms as the dominant aetiology of chemosensory dysfunction. Our study suggests that chemosensory dysfunction in COVID-19 is more widespread than previously reported among Asians and may be related to the infectivity of viral strains.Study Registration: NMRR-20-934-54803 and NCT04390165.