Post-traumatic Pseudoaneurysm of a Branch of Facial Artery

@#Pseudoaneurysm which is also known as a false aneurysm is caused by extravasation of blood from the injured vessel wall which is contained by the surrounding soft tissue. It does not contain any layer of the vessel wall and can expand as more and more blood collects. We are reporting a case of an 18-year-old Indian gentleman who presented with complaint of left neck swelling after being involved in a motor vehicle accident. Examination showed a softly pulsating swelling at the angle of the left mandible. CT angiogram revealed a pseudoaneurysm of a branch of the left facial artery. The pseudoaneurysm was embolized by using histoacryl glue. Pseudoaneurysm should be considered as a differential diagnosis in patients with a pulsatile mass after trauma.

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

Primary middle ear tuberculosis mimicking cholesteatoma

@#Tuberculous granuloma in the middle ear is an unusual entity. Herein, we report a case with short presentation of otitis media with mastoid abscess but with a CT scan showing widespread bone destruction. Te cause was determined to be middle ear tuberculosis. Awareness of this entity is important, as it may cause a delay in referral to an otorhinolaryngology specialist and, subsequently, a delay in initiating treatment. Terefore, it should be considered in the diferential diagnosis, especially when the usual treatment fails to produce the desired result.

The association of allergy and chronic suppurative otitis media: A study in a tropical country

@#Objective: Chronic suppurative otitis media (CSOM) usually begins as a spontaneous perforation of tympanic membrane due to an acute infection of the middle ear. This study was aimed to evaluate the association between allergy and CSOM. Methods: A case-control study was carried out among patients with CSOM (cases) and controls were those with no ear pathology. The presence of CSOM was made through a medical history and otoscopic examination. Allergen testing was done by the skin prick test. Results: In all 124 subjects were recruited in this study with equal number of the cases and controls. The commonest positive reaction in the skin prick test in both groups was to house dust mites. Among CSOM cases, half (50%) of them had an allergy to Blomia tropicalis and 48.4% to Dermatophagoides while in the control group, 27.4% to Dermatophagoides and 25.8% to B. tropicalis. There were significant associations between CSOM and allergy to B. tropicalis (p=0.005), Dermatophagoides (p=0.016) and Felis domesticus (p=0.040). The prevalence of allergy at 95% confidence interval (95%CI) in CSOM and control groups were demonstrated as 59.7% (95%CI: 47.5, 71.9) and 30.6 % (95%CI: 19.1, 42.1) respectively. There was a significant association between allergy and CSOM (p=0.001). Conclusion: Indoor allergens are the most prevalent in our environment and therefore good control may difficult to achieve. The hypersensitivity states of the subject are likely to have a role in the pathogenesis of CSOM especially in the tropical countries where allergy occurs perennially.

Intradermal Naevi of External Auditory Canal: Unusual location with a unique presentation

The incidence of intradermal nevus in the externalauditory canal is uncommon. We herein are describing acase of 60-year-old lady who presented with foreign bodysensation in the right external ear canal (EAC) with milddiscomfort and ear bleed during ear picking. Otoscopicexamination revealed hyperpigmented mass on the floorof the outer two third of EAC. Complete excisional biopsyof the mass resulted in histopathology findings ofintradermal nevus. Despite the fact that the disease is notalarming, the possibilities of benign melanocytic nevitransformation into malignant lesions such as melanomaneed to be ruled out.

Effect of oral health education programme on oral health awareness and plaque maturity status among hearing-impaired children

@#Many studies have indicated that hearing-impaired (HI) children have poor oral hygiene mainly contributed by difficulties in communication. The objectives of the study were to assess the difficulties experienced by HI children during dental visit and the effectiveness of “Oral Health Care for the Hearing-Impaired” (OCHI) programme in improving the oral health knowledge and practice, and reducing the dental plaque maturity scores among HI children. A community intervention study was conducted and training of trainers (TOT) was done to train the teachers in delivering oral health education (OHE) and practices by using developed booklet and video. The difficulties faced by the HI children during dental visit, and the oral health knowledge and practice (OHKP) were assessed by face-to -face interview with HI children whilst the dental plaque maturity was assessed using GC Tri Plaque ID Gel™ (TPID) during pre-intervention, post-intervention-1 and post-intervention-2. Data were analysed using SPSS version 22. Among the teachers, there was an increase in the mean (SD) total knowledge and attitude score during post-TOT compared to pre-TOT, 46.1 (2.44) and 43.7 (4.01); (p<0.001) and 16.7 (2.11) and 14.3 (2.38); (p<0.001) respectively. For the oral health practice, there were positive changes in practice among teachers during post-TOT compared to pre-TOT. There were also significant changes in mean knowledge scores of HI children with time (p=0.003) and the plaque maturity scores were significantly reduced during post-intervention-1 and post-intervention-2. Thus, the OCHI programme was effective in improving oral hygiene among HI children. However, the inconsistent pattern was observed for their oral health practices that need further research..

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.

Salivary parameters, dental caries experience and treatment needs of hearing-impaired children in a special school for deaf in Kelantan, Malaysia

Dental caries is the main oral health problem in hearing-impaired (HI) children and remains the most neglected need. The present study aimed to determine caries prevalence and treatment needs in HI children and the association with salivary parameters. A cross-sectional study was conducted on 63 HI children aged between 7-14 years who attended a special school for the deaf. Clinical oral examination was done and salivary parameters (resting flow rate and resting pH) were measured. Caries experience was charted using the index of decay-filled teeth (dft) and Decay-Missing-Filled Teeth (DMFT) for primary and permanent dentition respectively. Data were analysed using SPSS version 12.0. The mean age was 11.5 (SD 2.39) years and 53.8% were female. Dental caries prevalence was 88.0% (95% Cl: 73.0, 100.0) in primary dentition and 85.0% (95% Cl: 73.0, 96.0) in permanent dentition. The mean dft was 6.1 (SD 4.14) and the mean DMFT was 4.9 (SD 3.28). The mean resting flow rate was 0.14 (SD 0.08) ml/min while mean pH was 6.8 (SD 0.79). Both pit and fissure sealants and restorations were the highest (83.1%) treatment needs. Only 3.1% of the children did not require any treatment. There were no significant association between both salivary flow rate and salivary pH with caries experience in the primary (p=0.342, p=0.610 respectively) and permanent (p= 0.99, p=0.70 respectively) teeth. In conclusion, children with HI have high caries prevalence and unmet need for dental treatments. Salivary pH and resting flow rate of the children were not associated with their caries experience.

Myxoid Neurofibromas of the External Ear Canal: A Case Report

Myxoid neurofibroma is benign tumours of perineural cell origin that arise from elements in the peripheral nervous system. We report a case of a 60-year-old female patient presented with history of right ear mass which was slowly growing. Her primary complaint was cosmetic deformity but hearing loss was also present. The mass was excised and histologically revealed a myxoid neurofibroma. To the authors’ knowledge, this is the first time that a myxoid neurofibroma arising from external auditory canal is reported. It should be included in the differential diagnosis of a mass originating from this location.

Clinical Characteristic of Vertigo in Children

Objective: To review the clinical characteristic of vertigo in children Method: A retrospective observational study was done on children who presented to a specialised vertigo clinic over period of six years. The patients’ case notes were retrieved from the medical record unit and reviewed. All patients were seen by an otologist who thoroughly took down history, completed ear, nose, throat and neurological examination. Result: Seven different causes were identified in 21 patients (86%) while no diagnosis was reached in three patients (12.5%). The most common cause of giddiness was childhood paroxysmal vertigo (33%) followed by benign paroxysmal positional vertigo (16.6%) and sensorineural hearing loss (12.5%). Other causes include chronic suppurative otitis media and anxiety disorder each accounting for 8.3%, one case of cholesteatoma and another case of ear wax each accounting for 4.1%. Conclusion: It is not uncommon for the children to be affected by vertigo. Management of vertigo in children should include a detailed history, clinical examination, audiological and neurological evaluation. Imaging should be performed in selected patients. The main cause of vertigo in our series is CPV. The outcome of most of the patients is good.

Hamartomatous polyp of the tonsil: a case report

Hamartomatous polyps of the tonsil are very rare. They have been described using various terms such as a lymphangiomatous polyp, lymphangiectatic fibrous polyp, lipomatous polyp or pedunculated tonsil, thus the actual incidence is difficult to be quantified. We present a case of hamartomatous polyp of the palatine tonsil in a 30-year-old female presented with recurent tonsillitis. Histopathological examination of the resected tonsils showed features of chronic tonsilitis with incidental finding of hamartomatous polyp characterized by a polypoidal tissue covered by stratified squamous epithelium and composed of thin-walled blood vessels, lymphatic channels, fibrofatty tissues, seromucinous glands and striated muscle fibres. An unusual incidental histopathological finding of a rare condition has been discussed along with the review of literature.

Congenital Mastoid Cholesteatoma Presenting as a Mass

Cholesteatoma is one of the common disorders encountered by the otorhinolaryngologist. However, there are few cases with an atypical clinical presentation and computed tomography scan findings which make cholesteatoma difficult to diagnose. We report a rare case of congenital mastoid cholesteatoma that presented as a mass obstructing the external auditory canal. The disease was successfully treated with a mastoidectomy and histopathological examination confirmed the diagnosis of cholesteatoma. Clinicians should consider congenital mastoid cholesteatoma in the differential diagnosis of patients with a mass in the external auditory canal. The diagnosis is likely to be made based on surgical and histopathological findings.

Gradual Recovery from Bilateral Severe Sensorineural Hearing Loss post Motor Vehicle Accident

Sensorineural hearing loss following trauma is a common finding in daily clinical practice and usually associated with a poor prognosis. Our case illustrates a patient who was involved in motor vehicle accident sustaining bilateral severe to profound sensorineural hearing loss but subsequently recovered fully after two years. Unless there is clear trauma to the cochlea or auditory nerve, a substantial duration of follow up is needed in the treatment of such cases.

Cholesteatoma manisfesting as an external auditory canal polyp

Cholesteatoma is a serious disease of the ear. It is defined as a benign skin lesion that grows in the middle ear cleft. The most commonly affected sites are the middle ear cavity and mastoid bone. It can also develop in the petrous apex. It can manifest with a wide range of symptoms ranging from persistent ear discharge to hearing loss. The treatment is almost always surgical excision. We report a rare case of middle ear cholesteatoma that presented as an aural polyp arising from the posterior wall of the external auditory canal.