Newborn hearing screening: experience in a Malaysian hospital.

INTRODUCTION: This study aims to determine the prevalence of hearing loss among newborns delivered at Hospital Universiti Kebangsaan Malaysia and to evaluate the usefulness of our hearing screening protocol. METHODS: All infants born in the hospital over a nine-month period, between April to December 2003, were screened for hearing loss with a portable otoacoustic emission (OAE) before discharge. At the age of two months, a second OAE test was repeated on newborns who failed the initial test. Those who failed the second test were re-tested at three months of age. When these infants failed the third OAE test, a brainstem evoked response (BSER) test was performed. RESULTS: During the study period, 4,219 infants were born in the hospital, and 3,762 (89.2 percent) underwent OAE screening. 620 (19.7 percent) of them failed the first screening test, and 506 (81.6 percent) of them came for a second stage-screening test. In the third stage screening at three months of age, only 39 (65 percent) patients turned up. Of these, ten infants passed the OAE test and 29 failed. However, when these infants underwent BSER, 13 had normal BSER and 16 have abnormal BSER. The prevalence of hearing loss in this study was 0.42 percent (16/3,762). CONCLUSION: The large number of defaulters and false-positive results in this study suggest that this pilot hearing-screen programme requires fine-tuning to minimise these problems.

Neck abscess: five year retrospective review of Hospital University Kebangsaan Malaysia experience.

The most commonly involved space was the parapharyngeal and superficial anterior triangle followed by submandibular, retropharyngeal, posterior triangle and submental spaces respectively. Thirty-three percent of patients had diabetes mellitus as a predisposing factor. More than half of them had no known aetiological cause for the neck abscess. We encountered one mortality in an elderly patient with diabetes who succumbed to overwhelming septicaemia despite early abscess drainage and intensive medical treatment.

Paediatric tracheostomy in Hospital University Kebangsaan Malaysia - a changing trend.

Indication for pediatric tracheostomy has changed. Upper airway obstruction secondary to infectious disorders is no longer the commonest indication. The aim of this study was to establish data on indications, outcome and complications of pediatric tracheostomy. A retrospective analysis of pediatric tracheostomies carried out between March 2002 to March 2004 was done. Eighteen patients were identified. The commonest indication was prolonged ventilation (94.5%) followed by pulmonary toilet (5.5%). None was performed for upper airway obstruction. Postoperative complications were encountered in six patients (33.3%), the commonest being accidental decannulation notably in children less than six years of age. Twelve patients (66.6%) were successfully decannulated. The mortality rate was 16.6%. All death were non tracheostomy related. The commonest indication for tracheostomy was prolonged ventilation and tracheostomy in children is relatively safe despite complications.

Maxillary sinus tumours--a review of twenty-nine patients treated by maxillectomy approach.

A retrospective data of 29 patients who underwent various types of maxillectomy from January 1998 till January 2004 in UKM hospital were reviewed. There were 21 males (72%) and 8 females (28%) with mean age of 42 years. Malays were the majority of patients 17 (59%), Chinese 11 (38%) and Indian 1 (3%). Seventeen patients (59%) presented with malignant tumours while 12 patients (41%) with benign tumours. Inverted papilloma (50%) was the commonest benign tumour and squamous cell carcinoma (36%) was the commonest malignancy. Medial maxillectomy was performed in ten patients (35%), total maxillectomy in seven patients (24%), three patients (10%) had near total, three patients (10%) had partial maxillectomy and six patients (21%) underwent inferior maxillectomy.

Sinonasal inverted papilloma with malignant transformation in the middle ear: a multicentric origin?

Inverted papilloma is a rare, benign tumour representing only 0.5 to 4 per cent of all sinonasal neoplasms; its involvement of the middle ear is extremely rare. We present a case of multicentric inverted papilloma in the sinonasal region and middle ear in a 54-year-old man. The patient later developed neck metastasis secondary to malignant transformation of the inverted papilloma in the middle ear.