Fishing Out a Bone From the Neck.

Foreign body ingestion is a common medical issue in Asian populations. Fish bones are the most commonly ingested foreign bodies due to the practice of cooking fish whole with bones intact, unlike in Western countries where fish are typically prepared as fillets or patties. Patients who have swallowed fish bones usually present with foreign body sensations, odynophagia, and pricking sensations during deglutination. Fish bones can generally be removed in an outpatient setting, but in some cases, patients must be placed under general anesthesia, where rigid esophagoscopy is performed. In some cases, neck exploration is required to extricate the bone. Here, we report the case of a 71-year-old man who underwent neck exploration for a 2.1 cm fish bone lateral to his thyroid cartilage, penetrating the left thyroid lobe.

Effect of Growth Factor Supplementation on the Hair Cell Specific Markers of Cells Harvested from Basilar Membrane.

OBJECTIVE: Loss of auditory hair cells is a major cause of deafness. The presence of auditory progenitor cells in the inner ear raises the hope for mammalian inner ear cell regeneration. In this study, we aimed to investigate the effect of growth factor supplementations, namely a combination of epidermal growth factor (EGF), insulin-like growth factor (IGF), and beta (ß)-fibroblast growth factor (ßFGF), on the expression of hair cell-specific markers by cells harvested from the cochlear membrane. This would provide an insight into the capability of these cells to differentiate into hair cells. MATERIALS AND METHODS: EGF, IGF, and ßFGF were supplemented into the culture medium. The cells were evaluated by morphology, growth kinetic, gene expression, and protein expression. RESULTS: The cultured cells of mouse basilar membrane were spindle shaped. Growth factors-enriched medium promotes a significantly higher proliferative activity than the basic culture medium but did not alter the cell morphology. Growth factors-enriched medium did not show any significant differences in the protein expression of the hair cell-specific markers myosin VIIa and calretinin and the stem-cell marker nestin. Gene expression analysis showed that the expression of the hair cell-specific genes myosin VIIa and calretinin as well as the stem cell genes nestin, Rex1, and Sox2 was reduced after the cells were passaged in the growth factor-supplemented medium. Cells in the basic medium expressed a significantly higher level of hair cell-specific genes at certain passages. CONCLUSION: Growth factor supplementation could not maintain the expression of hair cell-specific markers by cells obtained from the cochlear membrane.

Stomal recurrence after total laryngectomy: a 10-year review in Universiti Kebangsaan Malaysia Medical Center.

OBJECTIVE: To determine the frequency of stomal recurrence in patients following total laryngectomy in our center and to compare the frequency of previously reported risk factors such as preoperative tracheostomy, subglottic invasion and the level of lymph node metastases, with the rest of the world. METHODS: Clinical records of patients with carcinoma of the larynx who presented to Universiti Kebangsaan Malaysia (UKMMC) Otorhinolaryngology and Oncology clinics between January 1998 and December 2007 were reviewed. RESULTS: A total of all 18 male patients who underwent total laryngectomy for carcinoma of the larynx within this 10 year period. The youngest patient was 49 years old and the eldest was 79 years old with mean age of 63 +/- 8 years. Twelve of them had a tracheostomy prior to surgery. Median duration from tracheostomy to definitive surgery was 28.5 days. Only 1 patient developed stomal recurrence. CONCLUSION: The duration from tracheostomy and total laryngectomy was longer than what is accomplished in the developed countries but the frequency of stomal recurrence was still comparable to the rest of the world. The frequency of other previously reported risk factors namely subglottic invasion and lymph nodes metastases were comparably low.

Obstructive sleep apnea among express bus drivers in Malaysia: important indicators for screening.

OBJECTIVES: Obstructive sleep apnea (OSA) has been identified as one of the significant risk factors for motor vehicle crashes (MVCs). In the interest of public safety, this study was conducted to determine the prevalence of OSA and its associated factors among express bus drivers in Malaysia. Identifying factors or conditions related with OSA is very important because they can be used as indicators to subject a person to a confirmatory diagnosis using polysomnography testing. METHODS: Two hundred eighty-nine randomly selected express bus drivers from 5 express bus companies participated in the study. Information on demography, medical history, clinical symptoms, and signs of OSA were collected by a designated medical officer and the diagnosis of OSA was done based on the Apnea Hypopnoea Index (AHI) from polysomnography testing. RESULTS: Based on AHI, 128 (44.3%) subjects were diagnosed as having OSA with 83 (28.7%), 26 (9.0%), and 26 (6.6%) classified as mild, moderate, and severe OSA, respectively. Multiple logistic regression analysis results showed that age (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.01-1.09), snoring (OR = 3.54, 95% CI 1.91-6.57), body mass index (BMI; OR = 1.17, 95% CI 1.09-1.25), hypertension (OR = 1.87, 95% CI 1.02-3.40), and neck circumference (OR = 1.31, 95% CI 1.18-1.46) were significantly associated with OSA status. CONCLUSIONS: The results supported the need for identifying the risk group for OSA among express bus drivers and the need to diagnose them early for an early intervention.

Mastoid abscess in acute and chronic otitis media.

BACKGROUND: Mastoid abscess remains a recognised complication of otitis media despite the advent of antibiotics. The objectives of this study were to describe the risk factors in patients with mastoid abscess following acute and chronic otitis media and discuss the management of this infection. METHOD: A retrospective analysis was done on all patients who underwent mastoidectomy for mastoid abscess from January 2002 to December 2007. Data on the patients' presentation, associated complications, management, and follow-up were analysed. RESULTS: A total of 12 patients were enrolled in this study population. Group A consisted of patients with mastoid abscess preceded by acute otitis media, while Group B consisted of patients with mastoid abscess and chronic otitis media. In Group A (n = 7), 4 patients had a pre-morbid immunocompromised condition, but they did not have cholesteatoma. None of the patients in Group B (n = 5) had any pre-morbid illnesses. Out of 12 patients, 7 patients had associated extracranial complications, and 1 patient had intracranial complications. Most patients recovered well after mastoidectomy. Recurrence was noted in 1 patient who had acute lymphoblastic leukaemia. CONCLUSION: Mastoid abscess is still a recognised complication of acute otitis media, especially in patients who are immunocompromised. Immunocompetent patients may also develop mastoid abscess following chronic otitis media associated with cholesteatoma. Thus, early treatment of otitis media and close vigilant follow-up are advocated to ensure prompt detection of mastoid abscess complications.

Synovial sarcoma: a rare presentation of parapharyngeal mass / 癌症

Synovial sarcoma is a rare soft tissue sarcoma of the head and neck region involving the parapharyngeal space. The diagnosis of synovial sarcoma can be very challenging to the pathologists. We present a rare case of parapharyngeal synovial sarcoma in a young female patient who had a two-month history of left cervical intumescent mass at level II. The fine needle aspiration cytology of the mass was proved inconclusive. Transcervical excision of the mass was performed and the first case of parapharyngeal sarcoma was identified in our center by fluorescence in situ hybridization (FISH) technique. Repeat imaging revealed residual tumor. The patient successfully underwent a second excision of the residual tumor and received adjuvant radiotherapy.

Necrotizing Fasciitis of the Head and Neck: Surgical Outcomes in Three Cases

Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.

The lower cheek flap combined with neurosurgical approach for infratemporal fossa tumour

p style=text-align: justify;strongOBJECTIVE:/strong To describe our experience in performing the lower cheek flap for access to the infratemporal fossa combined with the neurosurgical approach. br /br /strongMETHODS:/strongbr /strongDesign:/strong Case report br /strongSetting:/strong Tertiary Referral Center br /strongPatients:/strong Two br /br /strongRESULTS:/strong Two unusual tumours involving the infratemporal and middle cranial fossa were excised using this combined appoach. The infratemporal fossa tumour was accessed via the lower cheek flap while the intracranial portion was resected from above via craniotomy.br /br /strongCONCLUSION:/strong The lower cheek flap in combination with the neurosurgical approach allows optimal exposure to tumours involving the infratemporal and middle cranial fossae. It has less complications and better aesthetic outcome compared to other approaches./p

Acute Tonsillitis With Concurrent Kikuchi's Disease as a Cause of Persistent Lymphadenopathy.

We present a young adult female with symptoms of acute tonsillitis and tender cervical lymphadenopathy. Despite a full course of oral antibiotics, she had persistent left lower cervical lymphadenopathy measuring 2.0 x 1.5 cm at 2 weeks post-treatment. Rigid and flexible scope examinations did not reveal any abnormalities in the nasopharynx, oropharynx or hypopharynx. Tuberculosis tests were negative and blood index results were normal. Fine needle aspiration cytology revealed a non-specific granulomatous inflammatory process. Excisional lymph node biopsy was performed, and the patient was diagnosed as having Kikuchi's Disease (KD). We would like to highlight the diagnostic challenges in detecting this condition and the importance of differentiating KD from tuberculosis and malignant lymphoma, the latter of which requires aggressive treatment.

Relation of distortion product otoacoustic emission with tinnitus.

OBJECTIVE: To investigate cochlear outer hair cell function based on distortion product otoacoustic emission (DPOAE) in patients with tinnitus. STUDY DESIGN: This is a case control study. SUBJECTS AND METHODS: The subjects are patients who attended the Otorhinolaryngology Clinic in Hospital Universiti Kebangsaan Malaysia over a period of 19 months from April 2005 until October 2006. All patients underwent a full ENT assessment and had tympanometry, pure tone audiometry, and DPOAE tests. The UKM Research and Ethics Committee reviewed and approved the study proposal prior to commencement of this study. RESULTS: The study population included 49 patients. They consisted of 16 patients (32 ears) with tinnitus and reduced hearing, 13 patients (26 ears) with tinnitus and normal hearing, 7 patients (13 ears) without tinnitus with reduced hearing, and 13 patients (26 ears) without tinnitus with normal hearing. Statistical analysis showed significant differences (P = .00) of mean DPOAE levels between the four groups of patients. CONCLUSION: Our results suggest that reduced outer hair cell activity, as detected by reduced DPOAE levels, may manifest as tinnitus even before there is a shift on hearing threshold. We also postulate that further reduction of cochlear outer hair cell activity, as shown by further reduced DPOAE levels, may actually terminate the source of tinnitus.