Imaging profile of the ear in hearing loss patients in Hospital Universiti Sains Malaysia

Introduction: Hearing impairment is a major disability. The otologic assessments together with high-resolution CT images were able to obtain precise diagnostic profile of ear malformations. These details are essential for further management of patients. Objective: This study was conducted to investigate the detailed anatomical profile of the ears in hearing loss patient in Hospital Universiti Sains Malaysia by highresolution CT scan of the temporal bone. Methodology: This was a cross-sectional study of high resolution CT scans of temporal bone from 1st January 2008 to 31st May 2014 in HUSM. The study sample consisted of all patients with hearing loss who had undergone HRCT in HUSM and fulfilled the study criteria. Results: In this study, which consisted of 55 patients, 40% of patients showed some form of abnormality on the HRCT temporal bone with 36.4% with outer ear abnormality, 9.0% had middle ear abnormality, 40.1% noted to have inner ear abnormality and 13.6% with multiple areas of abnormality. In term of laterality, 54.5% were observed to have bilateral diseases, 27.3% on right ear and the remaining 18.2% had it on the left ear. The mean vestibular aqueduct diameter was 0.08 ± 0.09 cm (R) and 0.06 ± 0.04 cm (L), lateral semicircular canal diameter 0.10 ± 0.03 cm (R) and 0.10 ± 0.02 cm (L), vestibule diameter 0.30 ± 0.06 cm (R) and 0.31 ± 0.05 cm (L), bone width between the lateral vestibular wall and the inner wall of the lateral semicircular canal diameter 0.35 ± 0.07 cm (R) and (L) and internal acoustic meatus diameter 0.40 ± 0.08 cm (R) and 0.41 ± 0.08 cm (L). Patients with external ear abnormality were observed to have normal to severe hearing loss, patients with middle ear abnormality had mild to severe hearing loss and patients with inner ear abnormality had normal to profound hearing loss. The most common inner ear abnormalities in this study were enlarged vestibular aqueduct and cochlear ossifications. Conclusion: This study showed that HRCT temporal bone could detect ear abnormality up to 40% of patients with hearing loss and most common abnormality would be enlarged vestibular aqueduct and cochlear ossification. The severity of hearing loss was higher in patients with inner ear abnormality

Imaging Profile of the Ear in Hearing Loss Patients in Hospital Universiti Sains Malaysia: 5 year Cross Sectional Analysis at a Tertiary Otologic Centre

BACKGROUND: Hearing impairment is a major disability. The otologic assessment together with high-resolution CT images is an important step to obtain precise diagnostic profile of ear malformations. This study was conducted to obtain the detailed anatomy and objective assessment of the ear in patients presenting with hearing loss in a tertiary care otologic center using high-resolution CT scan. METHODS: A cross-sectional study of 55 patients with hearing loss who had undergone high-resolution CT scans at Hospital Universiti Sains Malaysia from 1st January 2008 until 31st May 2014. Patients with temporal bone fractures, malignancy, post-operative ear and cholesteatoma were excluded. RESULTS: Nine patients noted to have external ear anomaly on right ear and 7 patients on left ear. Middle ear abnormality in both ears was seen in 2 patients. Patients noted to have cochlear anomaly on the right ear (R) were 8 and left ear (L) were 4. Measurements of vestibular aqueduct diameter were 0.08 ± 0.09 cm (R) and 0.06 ± 0.04 cm (L), lateral semicircular canal diameter 0.10 ± 0.03 cm (R) and 0.10 ± 0.02 cm (L), vestibule diameter 0.30 ± 0.06 cm (R) and 0.31 ± 0.05 cm (L), bone width between the lateral vestibular wall and the inner wall of the lateral semicircular canal diameter 0.35 ± 0.07 cm (R) and (L) and internal acoustic meatus diameter 0.40 ± 0.08 cm (R) and 0.41 ± 0.08 cm (L). One patient had cochlear aplasia and common cavity deformity, 2 patients had lateral semicircular dehiscence and internal acoustic meatus stenosis, 4 patients had cochlear ossification and 5 patients were noted to have enlarged vestibular aqueduct. CONCLUSION: High-resolution CT scan image is a good single imaging modality to obtain an objective measurement of the ear as well as to detect subtle or underestimated ear anomalie

Angiofibroma of the maxillary sinus mimicking mucocele: a diagnostic challenge

Abstract Background Angiofibroma is a rare, histologically benign but locally aggressive vascular tumour that typically arises within the nasopharynx. Angiofibroma in sites other than the nasopharynx is extremely uncommon. Despite the histological similarities, the clinical features of this tumour are very much different from the typical nasopharyngeal angiofibroma and pose a diagnostic challenge, hence emphasizing the importance of a thorough evaluation and high index of suspicion in establishing the correct diagnosis. Case presentation A 25-year-old gentleman presented with progressive right nasal blockage and intermittent nasal discharge for 3 years duration. He was clinically and radiologically diagnosed as a mucocele. Surgical excision was done via endoscopic medial maxillectomy with complete relief of all the symptoms. Conclusion Although uncommon, angiofibroma can occur outside the nasopharynx. Therefore, thorough evaluation and a high index of suspicion are crucial in establishing the correct diagnosis

Case report: a grievous tale of a rare primary thyroid leiomyosarcoma

Abstract Background Primary thyroid leiomysosarcoma is a rare and aggressive disease which represents 0.014% of primary thyroid cancers. It confers a diagnostic conundrum, due to difficulty to make a preoperative diagnosis of thyroid leiomyosarcoma and to differentiate it from anaplastic thyroid carcinoma. Case presentation We herein report a rare case of primary thyroid leiomyosarcoma. A 48-year-old male presented with history of anterior neck swelling for the past 2 months. Computed tomography (CT) neck showed hypodense nodule at the right thyroid lobe with calcification causing tracheal deviation, with intratracheal extension at 1st and 2nd tracheal rings and presence of lung metastases. The histopathology analysis yield high grade spindle cell neoplasm suggestive of sarcoma. Immunohistochemistry showed that neoplastic spindle cells were positive for smooth muscle actin, vimentin, caldesmon while no reactivity was reported for thyroglobulin, calcitonin, thyroid transcription factor-1, S-100, CD45, CD 5, and cytokeratins. Patient had undergone tracheostomy and chemotherapy but he succumbed to death 1 month after completion of chemotherapy. Conclusion Primary thyroid leiomyoarcoma is a very rare and aggressive disease. The treatment ranging from surgery, adjuvant radiotherapy and chemotherapy, with high recurrence rates