Adenotonsillectomy for Paediatric Sleep Disordered Breathing – Post Surgery Placement and Outcome Adenotonsillectomy (AT) is the treatment of choice for children with sleep disordered breathing (SDB) caused by adenotonsillar hypertrophy. However, there is an increased risk of post operative complications among those with identified risk factors. Therefore, they are electively admitted to critical care wards after surgery. Unfortunately, due to limited resources and availability of beds in critical care wards, the cancellation rate for AT can be significant at some hospitals. It is becoming more difficult to satisfy the heightened demand for close monitoring post AT due to the increasing number of obese children and surge of SDB cases. Delaying surgery may indirectly worsen the child’s co-morbidities. Thus, it is vital to have a flowchart for post AT placement, which can be practical to many centres facing similar logistics concerns. This retrospective chart review done over 6 months included all paediatric patients who had AT for SDB at our centre. The objectives of this review were to identify factors contributing to elective admission to the paediatric intensive care unit (PICU)/paediatric high dependency unit (PHDU) following AT among patients with paediatric SDB, recognize association between obesity and PICU/PHDU admission as well as find the association between severity of allergic rhinitis with outcome post AT. We aim to have a flow chart for preoperative planning of post-surgery nursing placement among patients with SDB who are managed with AT at this centre. Obese patients without significant co-morbidities can be nursed in the general ward, the real admission rate to PHDU/PICU is lesser compared to that was planned pre-operatively and children with moderate- severe AR tend to have residual snoring post AT. A flow chart for preoperative planning of post-surgery nursing placement among patients with SDB can help to reduce unnecessary booking and admission to critical care wards, decreasing the waiting time for AT and backlog of cases at public hospitals.

A 1-year-10-month-old child developed left-sided Ramsay Hunt syndrome (RHS) without vesicles 1 month after an episode of varicella zoster infection. No ear symptoms, including hearing loss, tinnitus, or imbalance, were reported. The external ear and otoscopic examinations were unremarkable. He achieved adequate recovery with corticosteroid treatment. This case report discusses the unusual presentation of RHS without vesicles, the diagnostic dilemma in young children, varicella zoster virus hepatitis, treatment modalities, and the role of vaccination in its prevention.
Varicella Zoster Virus Infection ; Herpes Zoster Oticus ; Zoster Sine Herpete ; Chickenpox Vaccine

Abscess ; pathology ; Acute Disease ; Female ; Humans ; Infant ; Mastoid ; pathology ; Otitis Media ; diagnosis ; Rhabdomyosarcoma ; diagnosis

Objective: This study aimed to evaluate the prevalence of sensorineural hearing loss (SNHL) in β-thalassaemia patients treated with Desferrioxamine (DFO) and determine the correlation of SNHL with average daily DFO dosage, serum ferritin level and Therapeutic index (T.I). Methods: This is a cross sectional descriptive study carried out for a period of 14 months and 54 patients were recruited. The recruited patients are transfusion dependant β- thalassaemia patient aged 3 years and above treated with DFO. An interview, clinical examination and hearing assessment, which included tympanogram, and Pure Tone Audiometry (PTA) or behaviour alaudiometry were performed. The data on age started on DFO, average daily DFO, duration of DFO intake, serum ferritin past 1 year and Therapeutic Index (T.I) were obtained from patients’ case notes. Results: The prevalence of SNHL was 57.4% and majority has mild hearing loss (93.6%). Fourteen patients (25.9%) have bilateral ear involvement and as many as 17 patients (31.5%) have SNHL in either ear. A total of 23 patients (42.6%) have normal hearing level. Although the prevalence of SNHL was 57.4%, only a small percentage of the patient noticed and complained of hearing loss (11.1%). There is no association between age started on DFO, average daily DFO and duration of DFO intake with normal hearing group and those patients with SNHL. Positive correlation was seen between average daily DFO with 2000 and 4000Hz on PTA in the left ear and between serum ferritin level past 1 year with 4000 and 8000Hz in the right ear and 8000Hz in the left ear. No significant correlation was seen between T.I on PTA. Conclusion: The prevalence of SNHL from hearing assessment is high in β-thalassaemia patients in this study. However, it is manifested clinically in a smaller percentage. We suggest a baseline hearing assessment should be carried on all β-thalassaemia patients prior to DFO chelation therapy.

This is a retrospective study examining the outcome of paediatric patients with subglottic stenosis who underwent partial cricotracheal resection (PCTR) as a primary open procedure from 2004 to 2012. There were 5 patients identified aged from 3 to 18 years old. All the subglottic stenosis were acquired type. All of them were secondary to prolonged intubation. Three patients were classified as Myer-Cotton grade III and the other two were Myer-Cotton grade IV. Two of the patients had concomitant bilateral vocal cord immobility. All patients underwent two staged PCTR . All patients underwent two staged PCTR, and one patient underwent posterior cordectomy apart from partial CTR at different setting. All patients were successfully decannulated at various durations postoperatively. Although this is an early experience in our institution, PCTR has shown to be effective and safe procedure in patients with subglottic stenosis especially those with Myer-Cotton grade III and IV.

Diagnosis and treatment of the nasal type of Natural Killer (NK)/T-Cell Lymphoma can be challenging. NK/T-Cell lymphoma of the nasal type is very aggressive and invasive and may present with non-specific symptoms. This usually leads to delay in diagnosis and initiation of treatment. Lymphomatous lesions show areas of necrosis and hence multiple biopsies are usually needed for histopathological diagnosis with the aid of immunochemistry. We report the case of nasal type NK/T-Cell lymphoma in a middle aged lady who presented with unilateral nasal blockage, constitutional symptoms and soft palate perforating ulcer with delay in diagnosis.

Sinonasal tract malignancies are usually slow growing tumours with non-specific unilateral symptoms (occasionally bilateral) normal to the site of origin. They comprise a wide spectrum of pathological features. We report the case of a low grade non-intestinal sinonasal adenocarcinoma (SNAC) in a 38-year-old man who presented with a-six month history of right sided nasal blockage that was associated with occasional purulent rhinorrhoea and a month history of epistaxis.

Introduction: Cholesteatoma is an aggressive disease and its management poses a greater challenge in children than in adults. This study reviews the experience of Universiti Kebangsaan Malaysia Medical Centre in the clinical presentation and management outcome of acquired cholesteatoma in paediatrics that required surgical interventions. Materials and Methods: A retrospective review of case records of patients below 18 years old who underwent surgery from 1999 to 2010. Results: A total of 46 patients presented with 53 cases of cholesteatoma in which seven patients had bilateral disease. The age of presentation ranged from four to 18 years old with a mean age of 12 years. Male and female patients were 65% and 35% respectively. Otorrhoea or previous history of otorrhoea on presentation was found in 94% and 96% of them had hearing impairment. Cerebellopontine angle abscess, sigmoid sinus thrombosis and mastoiditis were among the complications. Tympanic membrane was retracted in 64% while 47% having had attic retraction and 53% had total atelectasis. A majority (85%) underwent canal wall down surgery with or without tympanoplasty. Post-operatively, 71% had improvement or preserved hearing level. The duration of follow up ranged from one month to 13 years and a quarter had recurrent disease and underwent revision surgeries. Conclusion Majority of the cholesteatoma patients suffered from hearing loss and otorrhoea. Tympanic membrane retraction remained the most common clinical finding. Hence, children with persistent otorrhoea after adequate treatment may represent cholesteatoma. Surgical options of canal wall up and canal wall down procedures have equal risk of recurrence.
Cholesteatoma ; Hearing Loss ; Recurrence

Neurologic and airway compromise as a result of traumatic vascular injuries to the neck region often lead to more severe complications and thus require special consideration. Furthermore, these cases pose diagnostic and therapeutic challenges to healthcare providers. Here, we report a case of a 28-year-old motorcyclist presenting with progressively enlarged Zone 2 neck swelling on the left side following a high impact collision. There were no symptoms or signs suggesting neurologic or laryngeal injury. Computed tomography angiogram of the neck revealed signs of an active arterial bleed. The apparent vascular injury was managed by close observation for signs of airway compromise, urgent angiogram, and selective catheter embolisation of the left lingual artery. The patient subsequently recovered without further operative exploration of the neck. At 6 months post-trauma, the neck swelling fully subsided with no complications from angioembolisation. This case illustrates the individualised treatment and multidisciplinary approach in managing such cases. We review our rationale for this diagnostic and therapeutic approach.

OBJECTIVE/strong: To present a case of middle ear carcinoma masquerading as an aural polyp and describe our experience with the clinical presentation, management and outcome of an elderly patient with this pathology. br /br /strongMETHODS/strong:br /strongDesign/strong: Case Reportbr /strongSetting/strong: Tertiary Public Hospital br /strongPatient/strong: Onebr /br /strongRESULTS/strong: A 63-year-old female presented with an aural polyp and preceding symptoms of inner ear disturbances followed by otorrhea and otalgia. CT scans revealed an erosive lesion occupying the entire middle ear cleft, external ear canal and mastoid cavity with involvement of inner structures. A repeat biopsy subsequently revealed malignancy leading to a diagnosis of middle ear carcinoma. The patient was offered surgical treatment but opted for radiotherapy and subsequently defaulted follow-up.br /br /strongCONCLUSION/strong: Middle ear carcinoma is rare and can masquerade as a benign aural polyp. Symptoms of severe otalgia and inner ear disturbances are indicators of possible malignancy, as are recent-onset symptoms of otitis media developing over a relatively short course later in life. A high index of suspicion is needed to avoid late diagnosis. Repeat deeper aural tissue biopsy is needed to exclude malignancy. Computed tomography imaging is indispensable in delineating tumor extent and aids in tumor staging as well as prognostication. Surgical resection with clear tumor margins, followed by postoperative radiotherapy, is the preferred choice of treatment. Sole radiotherapy is reserved for tumors of small volume as well as in cases where surgery is not feasible./p
Human ; Female ; Middle Aged ; Ear, Middle ; Carcinoma-diagnosis,radiotherapy ; Treatment Outcome ; polyps-diagnosis ; Ear ; Temporal Bone ; earache ; ear diseases ; Tomography Scanners, X-Ray Computed ; Biopsy ; General Surgery ; Radiotherapy ; Otitis Media