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.

Prevalence of Eosinophilic/Non Eosinophillic Nasal Polyps and Analysis of Their Presentation in Hospital Universiti Sains Malaysia Kelantan, Malaysia

This study is aimed to examine the predominant inflammatory cells in nasal polyps (NP) in the local community and its correlation to the clinical presentations. Materials and Methods: The study was done retrospectively looking at patients who had undergone functional endoscopic sinus surgery (FESS) in Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia with a histopathological diagnosis of nasal polyposis (NP), between the years 2004 to 2008. Sixty two patients between the ages of 18 years to 60 years old were selected and data relevant to the study were collected from the patient’s folders using a specially created form prepared for the study. The NP histopathology report from each patient underwent FESS were analysed and the patients were divided into eosinophilic and non eosinophilic dominant group. Clinical presentations from each patient were also gathered and analysed according to the NP group. Results: In HUSM, there were a higher number of eosinophilic types NP as compared to the neutrophilic type NP which is contrary to other study conducted on Asian populations. The clinical symptom correlations between either eosinophilic or non-eosinophilic type of NP have not shown any significant associations. Conclusion: The study showed that the incidence of histological subtypes of nasal polyp in HUSM is almost the same as that found in other parts of the world (Europe and North America) which will reduce the possibility of racial or geographical influence on the pathogenesis of the nasal polyp. Clinical symptoms and presentation alone are not enough to differentiate the type of the nasal polyp without the histological study.

A Study of Single Nucleotide Polymorphisms of Tumour Necrosis Factor α-1031 And Tumour Necrosis Factor β+ 252 in Chronic Rhinosinusitis

OBJECTIVES: This case-controlled study aimed to identify the association of tumor necrosis factor (TNF)α-1031 and TNFβ+ 252 gene polymorphisms between chronic rhinosinusitis (CRS) and healthy controls. Another purpose of this study was to investigate the associations of these gene polymorphisms with factors related to CRS. METHODS: All deoxyribonucleic acid (DNA) samples were genotyped for TNFα-1031 and TNFβ+252 genes by mean of polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RFLP). The statistical analysis were carried out using chi-square test or Fisher exact test to determine the associations of these gene polymorphisms in CRS. Multiple logistic regression was performed to evaluate the associations of these gene polymorphisms in CRS and its related risk factors. RESULTS: The genotype and allele frequencies of TNFα-1031 and TNFβ+252 gene did not show any significant associations between CRS and healthy controls. However, a significantly statistical difference of TNFα-1031 was observed in CRS participants with atopy (P-value, 0.045; odds ratio, 3.66) but not in CRS with asthma or aspirin intolerance. CONCLUSION: Although the presence of TNFα-1031 and TNFβ+252 gene polymorphisms did not render any significant associations between CRS and healthy control, this study suggests that TNFα-1031 gene polymorphisms in CRS patients with atopy may be associated with increase susceptibility towards CRS.

Outcome of neck dissections in a rural tertiary University Hospital in Malaysia

To determine the outcome of neck dissection among our head and neck cancer patients in the setting of a rural Universitiy Sains Malaysia Hospital. Neck dissection procedures were reviewed from 2004 to 2008. The medical folders of each patient were traced and the data collected includes diagnosis, type of operative procedure and outcome on follow-up. A total of fourteen patients had undergone neck dissection as a combined procedure with the'primary tumor surgical removal. There were five radical neck and one modified type two radical neck dissections. The rest were eight selective neck dissections [three anterior and five supraomohyoid]. Twelve patients underwent unilateral neck dissections and two patients underwent bilateral neck dissections. The average duration of hospital stay was seventeen days, the longest stay was two months and the shortest stay was four days. One patient died secondary to complication of the primary tumor and one had to undergo exploration due to chylous leak post operation. Neck dissection is a surgical procedure to control neck lymph nodes metastasis from primary carcinoma of the head and neck. The extent of the cervical nodes involvement determines the type of neck dissections and their outcomes

Endoscopic removal of an extensive sinonasal schwannoma

Schwannoma is a rare, benign and slow-growing tumour which arises exclusively from Schwann cells. Essentially this tumour can be found in any part of the body. In the paranasal sinuses and nasal cavity, this tumour originates mostly from the ophthalmic and maxillary branches of the trigeminal nerve. The most common clinical presentation is unilateral nasal obstruction. Histological examination is crucial for diagnosis. The main modality of treatment is surgical excision. The type of surgery will depend on the location and extent of the tumour. Even though it is generally considered a benign tumour, there have been reports of potential malignant transformation. We report a case of a 52-year-old man with an extensive nasal mass which was removed endoscopically and histologically confirmed as schwannoma.