Migrated guidewire: an unusual cause for recurrent aural polyps

Aural polyps are secondary to multiple ear pathologies, most commonly inflammatory or cholesteatoma related. Here, we present a rare case of recurrent aural polyps caused by guidewire migration into the middle ear with serious systemic complications and our attempts at removal

The Role of Occlusion of the External Ear Canal in Hearing Loss

Objective:The objectives are to determine and compare the degrees of hearing loss upon occlusion of the cartilaginous and the bony portion of the external ear canal (EAC).Methods:There were 20 healthy participants with normal ears, and all gave an informed consent. After an otoscopy, a baseline pure tone audiogram (PTA) was conducted. If the PTA of the participant was normal, aqueous cream was applied with a syringe via an 18 G cannula, from the tympanic membrane up to the isthmus which corresponds to the bony ear canal. A second PTA was conducted, and subsequently the cream was removed via suction under microscope guidance. The procedure was then repeated with the cream applied from the isthmus to the aperture of the external ear canal using the same cannula followed by a PTA and removal of cream under microscope.Results:The mean threshold difference of occlusion at both portions of the ear canal were compared and analyzed. The mean threshold difference of hearing loss upon occlusion at the cartilaginous EAC was 37.5 to 48 dB. The mean threshold difference of hearing loss upon occlusion at the bony EAC was less, with a range of 21 to 24.95dB. There was a statistical difference (p<0.05) in the hearing loss between the blockage of the cartilaginous canal versus the blockage of the bony canal with a maximum difference at 2kHz.Conclusion:Cartilaginous block of the external ear canal causes more hearing loss than block of the bony ear canal. This correlates with the concept and properties of sound waves, resonance and impedance

Atypical Isolated Infections of the Infratemporal Fossa: A Diagnostic Challenge

Abstract Introduction: Atypical infratemporal fossa infections are rare and potentially fatal

Pulmonary hypertension and echocardiogram parameters in obstructive sleep apnea

Obstructive sleep apnea (OSA) is a growing health hazard in the United States and worldwide. OSA is now recognized as a disorder with systemic manifestations and its association with obesity and adverse cardiovascular consequences. There is increasing evidence that OSA may be associated with systemic hypertension and an increased incidence of stroke, heart failure, myocardial infarction, and arrhythmias. Less information is available about the association between OSA and pulmonary hypertension (PH). We therefore conduct this study to look at the prevalence of the pulmonary hypertension in obstructive sleep apnea patient and to identify risk factors leading to pulmonary hypertension among OSA patient. We studied and analyzed all OSA patient confirmed by polysomnograph in the year 2015. Twenty-five patients with OSA were included in this study with prevalence of pulmonary hypertension of 16%. Univariate analysis of various factors revealed a statistically significant association between having the lowest SpO2 of <70% and pulmonary hypertension (p = 0.016). There were no statistically significant associations between age, gender, smoking status, hypertension, body mass index (BMI), or apnea–hypopnea index (AHI) with occurrence of pulmonary hypertension. AHI is not a good predictor for pulmonary hypertension. The real value of using AHI to predict the health risk of OSA is doubtful. We recommend routine echocardiogram among OSA patient. The objective information in the echocardiogram provides evidence for counseling of patient with disease of OSA and hence hopefully can improve compliance of patient to treatment especially usage of CPAP

Atypical Isolated Infections of the Infratemporal Fossa: A Diagnostic Challenge

Introduction: Atypical infratemporal fossa infections are rare and potentially fatal.   Case Report: A case of an aspergillosis localized in the infratemporal fossa and another case of tuberculosis of the infratemporal fossa originating from the maxillary sinus, is described. The first patient was immunocompromised and showed symptoms of facial numbness; whereas the other was an immunocompetent man who complained of trigeminal neuralgia type pain. It was difficult to differentiate between infection and tumour despite the utilization of computed tomography scans and magnetic resonance imaging.   Conclusion:  These cases illustrate the need for a high index of suspicion; in addition to endoscopic confirmation and histopathology to establish precise diagnosis and early intervention

Is Daycare Tonsillectomy Safe?

Introduction: Tonsillectomy is one of the most common procedures performed by Ear, Nose, and Throat surgeon.  Usually, the procedure is carried out as an inpatient surgery. With the increasing need to reduce healthcare costs, spare precious hospital beds, and shorten elective surgery lists, there is currently a trend towards performing tonsillectomy on a daycare basis.  Materials and Methods: A prospective review of all tonsillectomies performed at the University Malaya Medical Center was undertaken for the year 2013. Demographic details, qualifying indications, and complication rates were evaluated.  Results: There was no incidence of primary hemorrhage among the 96 tonsillectomies performed. There was no significant correlation in terms of secondary hemorrhage between inpatient and day-case tonsillectomy (P=0.54). Only two patients required revision surgery to stop post-tonsillectomy bleeding. None of the patients required blood transfusion, and there were no mortalities.  Conclusion:  Daycare tonsillectomy is safe as long as the patient is carefully selected. Both medical and social aspects should be taken into consideration. A post-operative observation period of at least 6 to 8 hours is important. The surgeon should personally review the patient post-operatively and decides if he or she should be hospitalized for observation, or safe for discharge

Basaloid Squamous Cell Carcinoma: An Unusual Ball-Valve Laryngeal Obstruction

Introduction: A rare case of basaloid squamous cell carcinoma (BSCC) of the larynx, which has not been previously reported, is described. Case Report: A 60-year-old man was presented to the Otolaryngology Department with progressive dyspnoea and dysphagia to solids for over a period of 1 week. Direct laryngoscopy revealed a tumour at the laryngeal aspect of the epiglottis, which prolapsed into the laryngeal inlet each time the patient inspired. This resulted in an inspiratory stridor despite adequate glottic opening and normal mobility of the vocal cords.   Conclusion:  Therefore, in cases where a ball-valve lesion causes intermittent life-threatening airway obstruction, BSCC of the larynx, though rare, must be considered as a differential diagnosis