Effects of background noise on recording of portable transient-evoked otoacoustic emission in newborn hearing screening.

Transient-evoked otoacoustic emission (TEOAE) is a well-established screening tool for universal newborn hearing screening. The aims of this study are to measure the effects of background noise on recording of TEOAE and the duration required to complete the test at various noise levels. This study is a prospective study from June 2006 until May 2007. The study population were newborns from postnatal wards who were delivered at term pregnancy. Newborns who were more than 8-h old and passed a hearing screening testing using screening auditory brainstem response (SABRe) were further tested with TEOAE in four different test environments [isolation room in the ward during non-peak hour (E1), isolation room in the ward during peak hour (E2), maternal bedside in the ward during non-peak hour (E3) and maternal bedside in the ward during peak hour (E4)]. This study showed that test environment significantly influenced the time required to complete testing in both ears with F [534.23] = 0.945; P < 0.001 on the right ear and F [636.54] = 0.954; P < 0.001 on the left. Our study revealed that TEOAE testing was efficient in defining the presence of normal hearing in our postnatal wards at maternal bedside during non-peak hour with a specificity of 96.8%. Our study concludes that background noise levels for acceptable and accurate TEOAE recording in newborns should not exceed 65 dB A. In addition, when using TEOAE assessment in noisy environments, the time taken to obtain accurate results will greatly increase.

Nasal Angiomyolipoma (AML) Mimicking Juvenile Nasopharyngeal Angiofibroma.

INTRODUCTION: Angiomyolipoma (AML), a benign mesenchymal tumor that commonly arises from the kidney, may be associated with tuberous sclerosis complex and perivascular epithelioid cell tumors (PEComas). Nasal angiomyolipoma is very rare and usually occurs in elderly individuals with epistaxis and nasal obstruction. CASE REPORT: We report a rare case of nasal angiomyolipoma in a young male. To the best of our knowledge, this is the first documented case of angiomyolipoma originating from the posterior end of the inferior turbinate, clinically mimicking juvenile nasopharyngeal angiofibroma (JNA). The tumor was removed completely via coblator-assisted endoscopic sinus surgery. The patient was asymptomatic at a 2-year follow-up. CONCLUSION: Nasal AML located in the posterior nasal cavity in a male patient can mimic the presentation of JNA. A computed tomography scan of the paranasal sinuses played an important role in differentiating nasal AML from JNA. The coblator-assisted endoscopic technique is useful in controlling intraoperative hemostasis in the removal of a suspicious vascular tumor.

A review of smell and taste dysfunction in COVID-19 patients

@#and taste loss were early subclinical symptoms of COVID-19patients. The objective of this review was to identify theincidence of smell and taste dysfunction in COVID-19,determine the onset of their symptoms and the risk factorsof anosmia, hyposmia, ageusia or dysgeusia for COVID-19infection.Methods: We searched the PubMed and Google Scholar on15th May 2020, with search terms including SARS-COV-2,coronavirus, COVID-19, hyposmia, anosmia, ageusia anddysgeusia. The articles included were cross sectionalstudies, observational studies and retrospective orprospective audits, letters to editor and shortcommunications that included a study of a cohort ofpatients. Case reports, case-series and interventionalstudies were excluded. Discussion: A total of 16 studies were selected. Incidence ofsmell and taste dysfunction was higher in Europe (34 to86%), North America (19 to 71%) and the Middle East (36 to98%) when compared to the Asian cohorts (11 to 15%) inCOVID-19 positive patients. Incidence of smell and tastedysfunction in COVID-19 negative patients was low incomparison (12 to 27%). Total incidence of smell and tastedysfunction from COVID-19 positive and negative patientsfrom seven studies was 20% and 10% respectively.Symptoms may appear just before, concomitantly, orimmediately after the onset of the usual symptoms. Occurspredominantly in females. When occurring immediately afterthe onset of the usual symptoms, the median time of onsetwas 3.3 to 4.4 days. Symptoms persist for a period of sevento 14 days. Patients with smell and taste dysfunction werereported to have a six to ten-fold odds of having COVID-19.Conclusion: Smell and taste dysfunction has a highincidence in Europe, North America, and the Middle East.The incidence was lower in the Asia region. It is a strong riskfactor for COVID-19. It may be the only symptom and shouldbe added to the list of symptoms when screening for COVID-19.KEYW

Nasal vestibule schwannoma: report of a rare case.

Schwannomas of the nasal cavity and paranasal sinuses are quite rare, especially in the nasal vestibule. We report the case of a 61-year-old woman who presented with a 2-month history of progressively worsening right-sided epistaxis and nasal blockage. Rigid nasoendoscopy showed a mobile, smooth, globular mass occupying the right nasal vestibule. The mass arose from the lateral nasal wall and impinged on the anterior part of the middle turbinate posteriorly. Computed tomography of the paranasal sinuses showed a 3.8 × 1.7-cm enhancing mass in the right nostril. The mass obliterated the nasal cavity and caused mild deviation of the septum. The preoperative histopathologic examination showed positivity for vimentin and S-100 protein, suggesting a diagnosis of schwannoma. The patient underwent an intranasal laser-assisted excision biopsy. The histopathologic examination confirmed the diagnosis of schwannoma. Postoperative recovery was uneventful, and no recurrence was seen in the follow-up period.

Five cases of iatrogenic cerebrospinal fluid (CSF) rhinorrhoea: Early management is crucial

Endoscopic sinus surgery (ESS) is a standard treatment forrhinosinusitis, which failed optimum medical therapy.Iatrogenic cerebrospinal fluid (CSF) rhinorrhoea can occurduring ESS warrants early repair of the leakage. Thecommon sites for CSF leakage are cribriform plate, foveaethmoidalis, and anterior ethmoid sinuses. We present fivecases of iatrogenic CSF rhinorrhoea due to ESS and itsmanagement.

Quality of life and recurrence of disease in patients with eosinophilic and non-eosinophilic chronic rhinosinusitis with nasal polyposis

Objective: To assess the quality of life (QoL) and recurrenceof disease in patients with eosinophilic (ECRSwNP) andnon-eosinophilic chronic rhinosinusitis with nasal polyposis(non-ECRSwNP) post endoscopic sinus surgery (ESS).Methodology: A cross-sectional comparative study wascarried out in the Otorhinolaryngology – HNS Department,Universiti Kebangsaan Malaysia Medical Center (UKMMC).Subjective assessments of nasal symptoms and quality oflife (QoL) using SNOT-22 and Visual Analogue Scale (VAS)and objective endoscopic assessment was undertakenusing a modified Hadley endoscopic examination.Results: There was no significant statistical difference in thequality of life between the ECRSwNP and non-ECRSwNPgroups as evidenced by the SNOT-22 score and the VAScomparison (p>0.05). However, there was a significantdifference in terms of recurrence of disease with thepresence of nasal polyps on endoscopic examination. (p =0.016)Conclusion: In conclusion, we found that there is nosignificant difference in QoL between ECRSwNP and nonECRSwNP.There is higher frequency of recurrence of nasalpolyps amongst ECRSwNP.

Migration of foreign body from postcricoid region to the subcutaneous tissue of the neck.

Migration of a foreign body from the hypopharynx to the subcutaneous tissue of the neck is a rare event. We report a case of a 48-year-old male who accidentally swallowed a fish bone which was not identified intraoperatively. The patient then presented with migration of the bone to the soft tissue of the neck. We conclude that careful assessment of the patient with a foreign body in the throat is crucial to avoid fatal complications.

Sensitisation to common allergens in children with allergic rhinitis

Introduction: Allergic rhinitis is common in otorhinolaryngology practice. According to ‘Allergy Rhinitis and its Impact on Asthma (ARIA), Clinical and Experimental Allergy Reviews’ guidelines, the management of allergic rhinitis includes allergen avoidance. Therefore, it is important to know the allergens to which the patient is sensitised. This study was carried out to determine the prevalence of sensitisation to common allergens among children with allergic rhinitis seen in a tertiary referral centre in Malaysia. Materials and Methods: All children aged five to 12 years who had been referred to Otorhinolaryngology clinic Universiti Kebangsaan Malaysia Medical Center (UKMMC) from 2005 to 2010 with symptoms consistent with allergic rhinitis and had a skin prick test (SPT) were included in the study. The common allergens that had been used in the SPT were aeroallergens, food allergens and contact allergens. The database of SPT results was collected and reviewed. Results: A total number of 580 children were included in this study with 69.3% showing positive SPT. From the positive SPT results, a total of 1,515 sensitisations were observed with 60.9% sensitised to aeroallergens, 38.6% sensitised to food allergens and 0.6% sensitised to contact allergens. Among the aeroallergens, the house dust mite accounted for more than half of the sensitisations: Dermatophagoides pteronyssinus (27.9%), Dermatophagoides farinae (26.4%), Blomia tropicalis (26.0%). The most common food allergen sensitisation was seafood – crab (18.5%), prawn (18.0%) and squid (8.7%). Each of the other food allergens tested accounted for less than five percent of the positive SPT result. The contact allergen tested in this study was latex. Conclusion: This data represents a common allergen sensitisation in children with rhinitis symptoms residing in urban areas with house dust mites being the most common allergen sensitised in these children.

Endonasal Endoscopic Transsphenoidal Pituitary Surgery for Pituitary Adenoma: A retrospective Analysis Of Surgical Outcome

The purpose of this retrospective joint rhino-neurosurgical study from January 1998 until September 2009 is to document the demographic data, clinical presentations, radiological findings, approaches and incidence of residual tumour. Forty-seven patients with pituitary adenoma underwent trans-sphenoidal hypophysectomy of which 25 patients with complete medical and radiological data were included in the study. The medical and radiological data were analyzed. There were 12 males and 13 females with age ranging from 17 to 76 years old (mean 49.2). Fourteen of the patients were Chinese, eight Malays and three Indians. Twelve of the patients had functioning tumour of which five each presented with acromegaly and Cushing disease respectively and two with amenorrhoea. The rest of 13 patients had non functioning tumour presenting with visual disturbances. Sixteen of the patients had pituitary macroadenomas and the rest 9 microadenomas. Eighteen patients had undergone transcollumellar trans-sphenoidal hypophysectomy and the rest 7 patients had undergone transnasal transsphenoidal hypophysectomy. About 68.8% of pituitary macroadenomas had residual tumour, compared to only 22.2% of patient with pituitary microadenomas. Radiologically, about 45.5% of residual macroadenoma had suprasellar extension and the majority had spread to suprasellar cistern and carvenous sinus (54.5%). About 16.6% of patients had undergone post operative radiotherapy. In conclusion, this study showed that patient with pituitary macroadenomas had higher incidence of residual tumour compared to pituitary microadenomas

Respiratory epithelial adenomatoid hamartoma of the nasal septum

Objective@#Hamartomas are relatively uncommon, non-neoplastic malformations indigenous to the involved anatomic site. Respiratory epithelial adenomatoid hamartoma (REAH) is a subset of hamartoma characterized by prominent glandular proliferation lined by ciliated epithelium originating from the surface epithelium. Their location in the nasal cavity is rare and when present, mostly associated with the posterior nasal septum. We present such a case arising from the anterior nasal septum. @*Methods@#Design: Case report Setting: Tertiary University Referral Center Patient: One @*Results@#A 32-year-old lady who presented with a long-standing nasal block was found to have a broad-based nasal mass arising from the left anterior nasal septum. The lesion was histologically diagnosed as respiratory epithelial adenomatoid hamartoma following surgical excision. @*Conclusion@#Respiratory epithelial adenomatoid hamartoma although rare must be taken into consideration in the differential diagnosis of nasal lesions.

Primary malignant parotid lymphoma: Two case reports with different disease progression and treatment

Objective@#To describe our experience in managing two cases of primary malignant parotid lymphoma. @*Methods@#Design: Case Report Setting: Tertiary University Referral Center Patients: Two @*Results@#Both patients underwent superficial parotidectomy. Despite recurrence in one, the disease was controlled with conservative management. However, the disease was more aggressive in the other, requiring additional chemo-radiotherapy.@*Conclusion@#Malignant parotid lymphoma may present with varying stages, grades and clinical courses, requiring different management approaches. The treatment options are based on grading and staging at diagnosis and should be implemented depending on individual case.

Nonkeratinizing carcinoma of the sinonasal tract: A diagnosis of confusing nomenclature

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To describe a rare case of nonkeratinizing carcinoma of the sinonasal tract and review the literature on the nomenclature of its many synonyms.<br /><br /><strong>METHODS</strong>: <br /><strong>Design</strong>: Case Report<br /><strong>Setting</strong>: Tertiary Referral Center<br /><strong>Patient</strong>: One<br /><br /><strong>RESULTS</strong>: A 45-year-old female presented with a 6-month history of left nasal obstruction associated with epistaxis. Computed tomography revealed a mass expanding the left nasal cavity with the epicenter arising from the anterior ethmoidal air cells. Endoscopic resection of the tumor was carried out but as there was residual tumor, she then underwent endoscopic-assisted medial maxillectomy via a lateral rhinotomy. A subsequent computed tomography scan showed residual tumor adhering to the ipsilateral periorbita. The patient has so far declined intensity modulated radiotherapy that was advised though she is still under regular follow-up.<br /><br /><strong>CONCLUSION</strong>: Nonkeratinizing carcinoma of the sinonasal tract is a rare entity and there are very few reports concerning this type of malignancy. This may be partly due to its many synonyms, such as cylindrical cell carcinoma, Schneiderian carcinoma and transitional cell carcinoma. Nomenclature of this tumor should be standardized to avoid confusion and misdocumentation.</p>