INTRODUCTIONWe report a case of successful rehabilitation of hearing with a cochlear implant in a patient with nasopharyngeal carcinoma who developed post-irradiation hearing loss following treatment.

CLINICAL PICTUREA 55-year-old Chinese lady suffered from radiation-induced sensorineural hearing loss due to treatment for nasopharyngeal carcinoma. Audiological tests and imaging studies showed an intact retrocochlear pathway.

TREATMENTCochlear implantation.

OUTCOMECochlear implant was done with successful rehabilitation of hearing until the time of this report.

CONCLUSIONSIf functionally active auditory fibres survive with no recurrent tumour, successful rehabilitation of post-irradiation induced sensorineural hearing loss is possible with a cochlear implant in a patient with nasopharyngeal carcinoma.

Audiometry, Evoked Response ; Cochlear Implants ; Female ; Hearing Loss ; etiology ; rehabilitation ; Hearing Loss, Sensorineural ; etiology ; rehabilitation ; Humans ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy

INTRODUCTIONThis study aims to review the results of hearing screens in newborns with cleft deformities.

MATERIALS AND METHODSA retrospective audit of 123 newborns with cleft deformities, born between 1 April 2002 and 1 December 2008, was conducted. Data on the results of universal newborn hearing screens (UNHS) and high-risk hearing screens, age at diagnosis, severity/type of hearing loss and mode of intervention were obtained from a prospectively maintained hearing database.

RESULTSThirty-one of 123 newborns (25.2%) failed the first automated auditory brainstem response (AABR). Seventy percent of infants (56 out of 80) who passed the UNHS failed the high-risk hearing screens which was conducted at 3 to 6 months of age. Otolaryngology referral rate was 67.5% (83/123); 90.3% of 31 newborns who failed the first AABR eventually required otolaryngology referrals. Incidence of hearing loss was 24.4% (30/123; 25 conductive, 2 mixed and 3 sensorineural), significantly higher than the hospital incidence of 0.3% (OR: 124.9, 95% CI, 81.1 to 192.4, P <0.01). In terms of severity, 8 were mild, 15 moderate, 5 severe, 2 profound. Eighteen out of 30 infants (60%) were detected from the high-risk hearing screens after passing the first AABR.

CONCLUSIONThese newborns had a higher risk of failing the UNHS and high-risk hearing screen. There was a higher incidence of hearing loss which was mainly conductive. Failure of the first AABR was an accurate predictor of an eventual otolaryngology referral, suggesting that a second AABR may be unnecessary. High-risk hearing screens helped to identify hearing loss which might have been missed out early on in life or which might have evolved later in infancy.

Cleft Lip ; complications ; Cleft Palate ; complications ; Hearing Loss ; complications ; Humans ; Infant, Newborn ; Neonatal Screening ; Retrospective Studies

INTRODUCTIONThe development of secondary tumours as a result of radiation therapy is a rare but serious complication.

CLINICAL PICTUREThis is a case report of a 45-year-old Chinese male who developed postirradiation sarcoma of the sphenoid bone in less than 5 years after radiation therapy for Stage T3N1M0 nasopharyngeal carcinoma.

DISCUSSIONIn the literature, the only case of postirradiation osteosarcoma of the sphenoid bone was after radiation therapy for craniopharyngioma. There was no previously reported case of postirradiation sarcoma of the sphenoid bone after radiation therapy for nasopharyngeal carcinoma.

CONCLUSIONThis is the first case of postirradiation malignant fibrous histiocytoma of the sphenoid to be reported. Of about 3000 patients treated with radiotherapy for nasopharyngeal carcinoma over a 10-year period in Singapore, only 1 patient developed postirradiation tumour of the sphenoid bone.

Bone Neoplasms ; etiology ; secondary ; Fatal Outcome ; Histiocytoma, Malignant Fibrous ; etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; radiotherapy ; Neoplasms, Radiation-Induced ; etiology ; Sphenoid Bone ; pathology ; Spinal Neoplasms ; radiotherapy ; secondary

Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.