Neck Space Infection: A Retrospective Study of 40 Cases at a Tertiary Care Center in Sibu, Malaysia.

This study is intended to explore the relationship of etiologies of neck space infection (NSI) and its prevalent microorganisms of NSI and to compare the treatments and its clinical outcomes with other studies. A retrospective study of 1 year duration from April 2022-April 2023 at ENT department Hospital Sibu includes total 40 NSI patients. 30 male and 10 female patients, with a male-to-female ratio of 3 were studied, with a mean age of 35.07 (± 18.25) years. Diabetes mellitus still constituted a high risk factor (27.3%), while patients with biohazard status (Hepatitis B and C) contributes 15.1%. There were 18 cases (45%) which etiology remained unknown, followed by odontogenic infection (27.5%), then upper respiratory tract infection (7.5%). 9 out of 40 patients required intensive care unit (ICU) care, with a median of 2.5 days ICU admission. Among the complications developed, airway obstruction (9 patients; 42.9%) was the most common. The most common infected neck space in our study was the submandibular space 18.1%; then the parapharyngeal space 13.3% and peritonsillar space 10.8%. The most common microorganism isolated was Streptococci Viridans (6 cases, 15%), followed by streptococcus pyogenes Group A (5 cases, 12.5%), then Klebsiella pneumoniae (4 cases, 10%). Interestingly, 62.5% of the neck infection cases were caused by single bacteria, while only 7.5% cases were infected by polymicrobial cause. Augmentin (amoxicillin and clavulanic acid) constitutes the highest proportion (40.4%) of first line antibiotics, while unasyn (ampicillin-sulbactam) was be a second substitute (13.5%). The duration of hospitalization ranged from 1 to 8 weeks, with a mean stay of 1.54 ± 1.49 weeks days. We achieved a high recovery rate of 97.5% with 1 patient died due to extensive small bowel ischemia.

A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery.

Keros and Gera classifications are widely used to assess the risk of skull base injury during endoscopic sinus surgery. Although, both classifications are useful preoperatively to stratify risk of patients going for surgery, it is not practical to measure the respective lengths during surgery. In this study, we aimed to propose a new radiological classification (Thailand-Malaysia-Singapore (TMS)) to assess the anatomical risk of anterior skull base injury using the orbital floor (OF) as a reference. A total of 150 computed tomography images of paranasal sinuses (300 sides) were reviewed. The TMS classification was categorized into 3 types by measuring OF to cribriform plate and OF to ethmoid roof. Most patients were classified as TMS type 1, Keros type 2 and Gera class II, followed by patients classified as TMS type 3, Keros type 1 and Gera class 1. TMS has significant correlation with Keros classification (p < 0.05). There was no significant correlation between Keros and Gera classifications (p = 0.33) and between TMS and Gera classifications (p = 0.80). The TMS classification has potential to be used for risk assessment of skull base injury among patients undergoing ESS. It serves as an additional assessment besides the Keros and Gera classifications.

The efficacy of intratympanic steroid injection for the treatment of idiopathic sudden sensorineural hearing loss

@#Objective: A systemic steroid is known to have a potential to recover hearing after idiopathic sudden sensorineural hearing loss (ISSHL). However, lately many centres have introduced the use of intratympanic (IT) steroid therapy as an option. We reviewed our experience in the treatment of patients with ISSHL looking at the overall success of using systemic steroid, IT steroid injections as salvage therapy and primary IT steroid injection. Methods: A retrospective study was conducted on 20 patients who had suffered from ISSHL from January 1, 2012, to December 31, 2017. ISSHL is defined as a rapid decline in hearing over three days or less affecting three or more frequencies by 30dB or greater. Comparison between the mode of steroid therapies and improvement in patients was done. At least 15dB improvement in pure tone audiogram (PTA) was considered as successful therapeutic intervention. Results: Twenty male and female patients who fit the inclusion and exclusion criteria were included. The mean age of the patients was 41.4 years with a range from 13 to 72 years. Ninety percent patients presented with unilateral ISSHL involvement. Eight ears of patients who received systemic steroid therapy alone had improved hearings (75%). Out of seven ears from six patients who received salvage therapy, four ears (57.1 %) had improvement in PTA. Seven ears showed improvement in PTA from a total of eight patients who primarily received IT injections. Conclusions: IT steroid therapy promises a favourable outcome in the improvement of the hearing, as compared to systemic steroid administration. Its usage is recommended not only for salvage therapy but should be used as primary treatment especially in those with co- morbiditie

Relapse of B-cell acute lymphoblastic leukaemia presenting as right aural polyp with facial and mandibular nerves palsy

A patient presenting with an ear polyp is a common finding in otorhinolaryngology practice. The common causes include chronic otitis media and cholesteatoma. We report an adult female patient with a history of acute leukaemia presenting with chronic otitis media symptoms and right ear polyp. She was subsequently diagnosed as relapse of B-cell acute lymphoblastic leukaemia based on histopathological examination. The presentation may be similar to an inflammatory pathology of the middle ear, making it misleading.