Displaying all 12 publications

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  1. Santhi K, Prepageran N, Tang IP, Raman R
    Otol Neurotol, 2015 Feb;36(2):318-22.
    PMID: 24751743 DOI: 10.1097/MAO.0000000000000378
    The objectives of this study were to determine the presence of epithelial migration in patients with postirradiated nasopharyngeal carcinoma (NPC) and to compare the rate of epithelial migration in the tympanic membrane (TM) and the bony external auditory canal (EAC) of postirradiated NPC ears with normal ears by means of the ink dot method.
  2. Tang IP, Freeman SR, Rutherford SA, King AT, Ramsden RT, Lloyd SK
    Otol Neurotol, 2014 Aug;35(7):1266-70.
    PMID: 24841920 DOI: 10.1097/MAO.0000000000000435
    To review the postoperative surgical outcomes of cystic vestibular schwannomas (CVSs), especially facial nerve outcomes, and compare these results with those from matched solid vestibular schwannomas (SVS) resected during the same period at a tertiary referral center.
  3. Revadi G, Prepageran N, Raman R, Sharizal TA
    Otol Neurotol, 2011 Apr;32(3):504-7.
    PMID: 21307812 DOI: 10.1097/MAO.0b013e31820d97e2
    HYPOTHESIS: Epithelial migration on the external auditory canal (EAC) wall is abnormal in ears with keratosis obturans (KO).
    BACKGROUND: Earlier studies of epithelial migration have focused on the tympanic membrane with scattered information available for epithelial migration on canal walls. This study was undertaken to observe the epithelial migration on the EAC wall in normal ears and in ears with KO.
    METHODS: Twenty-five subjects with normal ears and 4 with KO were recruited for the study. Colored ink dots were placed around the tympanic annulus at the 12, 3, 6, and 9 o'clock positions. Migration patterns and the rate of travel of these ink dots were examined and photographed until the ink dots reached the bony cartilaginous junction.
    RESULTS: Fifteen healthy subjects and 1 with bilateral KO completed the study. The ink dots migrated laterally, with a rate of migration in normal ears between 42 and 205 μm/d. The mean rates for each quadrant, measured clockwise from the 12 o'clock position, were 104.93, 89.80, 72.67, and 109.93 μm/d, respectively. The pathologic ears exhibited a rate between 88 and 140 μm/d, and at approximately 4 to 12 weeks after ink application, areas of abnormal desquamation were apparent at the inferior quadrant, leading to a halt in the migration of the ink dot once it reached these sites.
    CONCLUSION: Epithelial migration occurred in an almost linear pattern in all quadrants, but the speed of migration was relatively slower in the anterior and inferior quadrants of a normal EAC. In the single KO patient, there were areas of normal migration and areas of abnormal keratin resurfacing at the inferior quadrant, which interfered with the migration of ink dots.
  4. Sivarajasingam M, Rajan P
    Otol Neurotol, 2007 Sep;28(6):869-70.
    PMID: 17435522
  5. Deong KK, Prepageran N, Raman R
    Otol Neurotol, 2006 Sep;27(6):855-8.
    PMID: 16936572
    To determine whether the postmyringoplasty tympanic membrane (TM) behaves in a similar way compared with a healthy nonoperated eardrum by calculating and comparing the epithelial migration rate and pattern.
  6. Aziz A, Md Daud MK, Nik Othman NA, Abd Rahman N
    Otol Neurotol, 2020 09;41(8):e989-e992.
    PMID: 32472918 DOI: 10.1097/MAO.0000000000002725
    BACKGROUND: Presbycusis is an age-related sensorineural hearing loss and it may reduce quality of life. We conducted a study to establish the prevalence of high-frequency presbycusis in normal hearing individuals and to validate the role of extended high-frequency distortion product otoacoustic emission (DPOAE) in the screening.

    METHOD: A cross-sectional study was conducted among 205 normal hearing adult participants with an age range between 25 and 54 years old. Hearing analysis with extended high-frequency pure-tone audiometry (PTA) and high-frequency DPOAE was carried out for all eligible participants. High-frequency presbycusis was considered to be present when the impairment of more than 25 dB occurs at higher than 8 kHz frequencies on both ears.

    RESULTS: Prevalence of high-frequency presbycusis using extended PTA was 31.7 (95% CI: 25.3, 38.1) and using high-frequency DPOAE was 57.4 (95% CI: 50.7, 64.4). The sensitivity and specificity of high-frequency DPOAE in detecting high-frequency presbycusis were 72.3 and 49.3% respectively with positive predictive value of 39.8% and negative predictive value of 79.3%. The association between age and high-frequency presbycusis was significant based on high-frequency DPOAE (p = 0.029).

    CONCLUSIONS: The prevalence of high-frequency hearing loss is higher with increasing in age. High-frequency DPOAE may be used as a screening tool followed by confirmation using extended PTA. The early detection of presbycusis is important so that measures can be taken to prevent more severe problems developing.

  7. Misron K, Mfuko G, Hur YK, Moon IS
    Otol Neurotol, 2021 06 01;42(5):e631-e634.
    PMID: 33741816 DOI: 10.1097/MAO.0000000000003132
    INTRODUCTION: Restoration of hearing in patients with vestibular schwannoma (VS) and poor hearing poses a great challenge. Simultaneous cochlear implantation during surgery for VS removal offers favorable hearing outcome if the cochlear nerve remains intact. Recent refinement of surgical techniques using the endoscope has made it possible to simultaneously restore the hearing and remove the tumor.

    CASE DESCRIPTION: A 62-year-old male had left severe sensorineural hearing loss and a 4 mm intracanalicular VS. We performed simultaneous nonmastoidectomy infrapromontorial VS removal and cochlear implantation in this patient to achieve minimal invasiveness and to provide maximal hearing restoration. The tumor was removed via this corridor while maintaining the integrity of cochlear as well as facial nerves with full insertion of a medium length cochlear implant electrode. After surgery, the patient showed good hearing rehabilitation.

    CONCLUSION: Simultaneous infrapromontorial VS removal and nonmastoidectomy cochlear implantation serves as an option for hearing restoration with minimal invasiveness in small VS removal.

  8. Prayuenyong P, Kasbekar AV, Hall DA, Hennig I, Anand A, Baguley DM
    Otol Neurotol, 2021 07 01;42(6):e730-e734.
    PMID: 33606465 DOI: 10.1097/MAO.0000000000003079
    OBJECTIVE: This study investigated balance problems and vestibular function in adult cancer survivors who had completed cisplatin chemotherapy treatment.

    STUDY DESIGN: Observational cross-sectional study.

    SETTING: Tertiary care center.

    PATIENTS: Adult survivors of cancer who had completed cisplatin treatment.

    MAIN OUTCOME MEASURES: Patient-reported balance symptoms were evaluated by a semistructured clinical interview. Patients underwent bedside clinical tests including Dynamic Visual Acuity test, Modified Clinical Testing of Sensory Interaction and Balance (CTSIB-m), and vibration sense testing to detect peripheral neuropathy. The video Head Impulse Test (vHIT) of all semicircular canals was performed.

    RESULTS: Eleven of 65 patients (17%) reported some balance symptoms after cisplatin therapy, including vertigo, dizziness, unsteadiness, and falls. Vertigo was the most common balance symptom, reported by six patients (9.2%), and the clinical histories of these patients were consistent with benign paroxysmal positional vertigo. Three patients (5%) had abnormal results of the CTSIB-m test, and they were the same patients who reported falls. There was a significant association of peripheral neuropathy detected by vibration test and balance symptoms. All patients had normal vHIT results in all semicircular canals.

    CONCLUSIONS: Balance symptoms after cisplatin treatment occurred in 17% of adult cancer survivors. Patients with peripheral neuropathy were more likely to have balance symptoms. The CTSIB-m test is a useful bedside physical examination to identify patients with a high risk of fall. Though there was no vestibular dysfunction detected by the vHIT in cancer survivors after cisplatin therapy, benign paroxysmal positional vertigo was relatively prevalent in this group of patients.

  9. Teh CS, Mah MC, Rahmat K, Prepageran N
    Otol Neurotol, 2022 Jan 01;43(1):12-22.
    PMID: 34669685 DOI: 10.1097/MAO.0000000000003389
    OBJECTIVES: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder that may have normal physical examination, clinical laboratory testing and vestibular evaluation. However, advances in neuroimaging have provided new insights in brain functional connectivity and structure in patients with PPPD. This systematic review was aimed at identifying significant structural or alterations in functional connectivity in patients with PPPD.

    DATABASES REVIEWED: Science Direct, Pubmed, Embase via Ovid databases, and Cochrane library.

    METHODS: This review following the guidelines of PRISMA, systematically and independently examined papers published up to March 2021 which fulfilled the predetermined criteria. PROSPERO Registration (CRD42020222334).

    RESULTS: A total of 15 studies were included (MRI = 4, SPECT = 1, resting state fMRI = 4, task-based fMRI = 5, task-based fMRI + MRI = 1). Significant changes in the gray matter volume, cortical folding, blood flow, and connectivity were seen at different brain regions involved in vestibular, visual, emotion, and motor processing.

    CONCLUSION: There is a multisensory dimension to the impairment resulting in chronic compensatory changes in PPPD that is evident by the significant alterations in multiple networks involved in maintaining balance. These changes observed offer some explanation for the symptoms that a PPPD patient may experience.Systematic Review Registration: This study is registered with PROSPERO (CRD42020222334).

  10. Wong ZY, Park YS, Mann GS
    Otol Neurotol, 2023 Aug 01;44(7):643-650.
    PMID: 37400232 DOI: 10.1097/MAO.0000000000003940
    OBJECTIVES: To compare postoperative tympanoplasty outcomes between active versus inactive otitis media (OM) patients with tympanic membrane perforation.

    DATABASES REVIEWED: Medline via PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar for studies published from inception to March 1, 2023.

    METHODS: Studies of 15- to 60-year-old patients undergoing microscopic/endoscopic myringoplasty using underlay/overlay technique with reported postoperative mean hearing gain and graft uptake were included. Studies requiring simultaneous surgical procedures, reporting patients with comorbidities and with non-English full text articles were excluded. Articles were independently screened by two researchers with data extracted according to a predetermined proforma in Microsoft Excel. Cochrane risk-of-bias assessment was used for risk of bias evaluation of randomized studies and Risk of Bias in Nonrandomized Studies of Interventions for nonrandomized studies. Similar studies were pooled for meta-analysis using the inverse variance random effects model to calculate the mean difference and corresponding 95% confidence interval (CI) for mean hearing gain and DerSimonian and Laird random effects model for graft uptake.

    RESULTS: Thirty-three studies comprising 2,373 patients met the inclusion/exclusion criteria, seven were pooled for meta-analysis. Included articles showed inactive OM patients have higher average postoperative mean hearing gain of 10.84 dB and graft uptake of 88.7% compared to active OM patients (9.15 dB and 84.2%). Meta-analysis of mean hearing gain (MD, -0.76 dB; 95% CI, -2.11 to 0.60; p = 0.27, moderate certainty) and graft uptake (OD, 0.61; 95% CI, 0.34-1.09; p = 0.10, moderate certainty) have an overall p value >0.05.

    CONCLUSION: There were no statistically significant differences in postoperative mean hearing gain and graft uptake between active and inactive OM patients undergoing tympanoplasty. Hence, tympanoplasty procedures should not be postponed solely because of patients' preoperative ear discharge status.

  11. Hashim ND, Jang SH, Moon IS
    Otol Neurotol, 2021 Jan;42(1):e82-e85.
    PMID: 33156236 DOI: 10.1097/MAO.0000000000002865
    OBJECTIVE: To describe surgical management for transcanal endoscopic ear surgery (TEES) in two patients with aberrant internal carotid artery (ICA) in the middle ear.

    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.

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