Early detection of hearing loss in tuberculosis patient using streptomycin by high frequency distortion product otoacoustic emissions (dpoae) and pure tone audiometry

Combination of Streptomycin, Isoniazid, Rifampicin and Pyrazinamide (SHRZ) are treatment of choice for tuberculosis. Streptomycin is known to cause ototoxicity, nephrotoxicity and neurotoxicity. Distortion product otoacoustic emission (DPOAE) is thought to be more sensitive for early detection of ototoxicity compare to pure tone audiometry (PTA). The aim of this study was to compare these two methods in newly diagnosed tuberculosis patients on streptomycin for early detection of ototoxicity. Ninety six newly diagnosed tuberculosis patients on streptomycin were screened and 50 patients finally included in this study. High frequency DPOAE and PTA were performed at several intervals. The incidence of ototoxicity in this study after completion two months ofiM Streptomycin (15 mglkg daily) is 29.2% (14 patients) using PTA (0.25- 8kHz). While using high frequency DPOAE detected ototoxicity in 77.1 % (37 patients). There was an association between ototoxicity with sex (P =0.011) and age ( P=0.003). There was no association between ototoxicity with other medications taken (P=0.621), pre treatment illness (P=0.140) and urea level (P=l.O). High Frequency (DPOAE) is a good monitoring tool for early detection of ototoxicity in tuberculosis patient on streptomycin compare to PTA

Tongue Paraesthesia and Dysgeusia Post Suspension Laryngoscopy

Suspension laryngoscopy is a common laryngeal procedure in Endolaryngeal microsurgery (ELMS). Oral mucosa and dental injuries are the known complications of the procedure. Nerve injury however is an infrequent encounter. We report a rare complication of lingual nerve injury which manifested as tongue numbness and altered taste following Endolaryngeal microsurgery procedure. The condition improved completely after few months of conservative management

A Rare Manifestation of Cervical Yolk Sac Tumor in an Unfortunate Infant

Paediatric germ cell tumor is composed of various neoplasms which exhibit capricious clinical presentation and histological features depending on the age and the area of presentation. Yolk sac tumor is an extremely rare malignant tumor of embryonic origin which usually arises from the gonads. Its manifestation in the head and neck region is extremely rare. Here, we report a rare case of the malignant transformation of mature teratoma into yolk sac tumor of the neck in an infant. Diagnosis was confirmed following histopathological examination of the neck mass along with marked increase of the serum alpha-fetoprotein. The child unfortunately succumbed prior to chemotherapy. We highlight the challenge we faced in diagnosing and managing this rare entity. We would also like to recommend serial monitoring of serum alpha-fetoprotein in all patients with mature teratoma to detect malignant transformation early

Epilepsy and obstructive sleep apnea syndrome

frequently coexist. Epilepsy patients were found to be drowsier when compared with general population using the Epworth Sleepiness Scale. The aim is to study obstructive sleep apnea syndrome (OSAS) in epilepsy patients, as well as the prevalence of obstructive sleep apnea and the predictors of sleepiness among epileptics. This was a prospective cross sectional study in HUSM on patients already diagnosed and treated with epilepsy. The study was conducted from Nove1nber 2008 to April 20 I 0. The consented participants who fulfilled the criterias were interviewed using questionnaire regarding demographic data. symptoms of obstruct!ve sleep apnea and Epsworth Sleepiness Scale, followed by full ear, nose and throat examination and overnight polysomnography (PSG). Five of sixty participants (8.3o/o) were diagnosed with OSA and four of them were males. OSA was mild in one patient, moderate in two patients and severe in the other two. Age, neck circumference, ESS score and BMI were significantly associated with OSA (p value <0.05). Epilepsy-related risks (type of seizures, duration and type of AED) have no significant association with OSA. Forty- nine percent of the abnormal physical findings found in OSA group were related to deviated nasal septu1n and inferior turbinate hypertrophy. The prevalence of OSA among epilepsy patients is 8.3%. The use of Malay version of ESS scale is appropriate and effective in screening patients for OSAS. Future role of PSG as part of assessment in high risks epileptics is recommended. Trc~1tinent of OSAS improves the quality of life of epilepsy patients

Tongue Paraesthesia and Dysgeusia Post Suspension Laryngoscopy

Suspension laryngoscopy is a common laryngeal procedure in Endolaryngeal microsurgery (ELMS). Oral mucosa and dental injuries are the known complications of the procedure. Nerve injury however is an infrequent encounter. We report a rare complication of lingual nerve injury which manifested as tongue numbness and altered taste following Endolaryngeal microsurgery procedure. The condition improved completely after few months of conservative management

A boy with bluish neck swelling on screaming

A 5-year-old Malay boy was presented with a history of swelling on the right side of the neck for 6-month duration. It was noticeable everytime when the child screamed (Figures 1 and 2). There was no other associated symptom

Laser Posterior Cordectomy for Bilateral Abductor Vocal Cord Palsy : A Case Report

Bilateral abductor vocal cord palsy is comparatively a rare vocal cord lesion, especially in a patient with no history of neck mass, previous surgery or trauma. Many patients are not stridulous. A patient presenting with stridor may need emergency airway management before the other treatment is commenced. We report a case of bilateral abductor palsy which required an emergency tracheostomy and subsequently a laser posterior cordectomy

Shattered thyroid gland in a young boy after a blunt neck trauma

Blunt thyroid injury in motor vehicle accident in paediatric patient is relatively rare. The symptoms are often barely anterior neck swelling which gradually increases in size and may or may not compromise the airway, and it can be fatal if missed to be identified. We described the case of a 15-year-old boy who involved in an accident and sustained a shattered thyroid gland despite no open wound in the neck. The management issues were outlined

Congenital mandibular epulis – A rare oral lesion in a newborn

Introduction: Congenital epulis or congenital granular cell tumour is a rare benign lesion arising from alveolar mucosa of neonates which can cause respiratory and feeding problems. It is also known as Neumann’s tumour. Females are affected 10 times more frequent. Method: A review of medical record was performed. Result: A newborn presented with lesion over left lower gum which was seen during antenatal abdominal ultrasonography scan by Obstetrics team at 35-week of gestation. The case was referred for ex utero intrapartum treatment procedure in view of anticipating upper airway obstruction. Upon delivery via Caesarean section, patient had no obstructive symptoms however was immediately intubated few hours of life to secure airway. Computed tomography scan confirmed a soft tissue mass arising from either lower alveolus or tip of tongue. The lesion was excised and histopathological examination reported as congenital epulis. Conclusion: Even though it is a rare case, congenital epulis should be considered as one of differential diagnosis of an oral mass. A multi-disciplinary team management is important in view of possibility of upper airway obstruction post delivery