Prolong placement of tracheostomy tube causing unusual complication

Tracheostomy can be associated with numerous complications. Here, we present a case of large hypertrophic skin of tracheostoma with tracheal granulation tissue causing malpositioning of tracheostomy tube and airway obstruction, secondary to prolong placement of a cuff tracheostomy tube due to improper tracheostomy care. This case illustrates that awareness and knowledge of proper tracheostomy tube care among medical personnel are very important to avoid any mismanagement that can cause life-threatening complications

Primary Laryngeal Tuberculosis Manifesting as Irregular Vocal Fold Lesion

Laryngeal tuberculosis is rare despite its close anatomical and physiological proximity to the lungs. It constitutes less than 1% of extrapulmonary tuberculosis. The symptoms of laryngeal tuberculosis are non-specific and mimic other laryngeal pathologies. The recent evolving and atypical endoscopic laryngeal features cause a diagnostic dilemma and delay in treatment. In this report, we presented three patients with distinct age and medical history, and hoarseness. Flexible videolaryngoscopy showed similar findings in the three cases, with irregular mucosa involving the entire length of the vocal fold, unilaterally in two cases and bilaterally in one. Mucosal waves were typically absent on laryngostroboscopy examination. The routine workup for pulmonary tuberculosis was unremarkable. The usage of Mycobacterium tuberculosis complex (MTBC) and rifampicin resistance (Xpert MTB/RIF) assay that detects Mycobacterium tuberculosis in the tissue biopsy specimens has helped in the rapid diagnosis of primary laryngeal tuberculosis and timely commencement of anti-tuberculous therapy. The clinical course and response to treatment were diverse in which two cases showed good response whilst the third developed disseminated tuberculosis despite optimal therapy

Challenging Removal of Embedded Fishbone in Tongue: Multimodal Technique, Surgical Approach and Consideration of Migration

Fishbone ingestion is a common occurrence and patients present with various symptoms, posing challenges to the attending physicians. Here, we present two unique cases of patients with an unexpected rapidly migrating fishbone in the tongue. The first patient was operated transorally because of a foreign body embedded in the genioglossus muscle. In the second patient, CT scan located a fishbone embedded in the left hyoglossus muscle; however, the fishbone had to be relocated intraoperatively using bedside ultrasound guidance and was eventually found embedded within the mylohyoid muscle. The fishbone was successfully removed via transcervical approach following a failed transoral approach

Air leakage and adherence to continuous positive airway pressure therapy in patients with moderate to severe obstruction sleep apnoea : a cross sectional study

This multicentre study aimed to evaluate the air leakage following a palatal surgery and its effect on CPAP adherence in OSA patients. The data on air leakage and adherence were objectively obtained and evaluated from the recorded CPAP therapy data. Forty patients were divided into two groups: surgery (18 patients) and non-surgery (22 patients). The mean air leakage level was 7.62±8.14% and 12.62±13.81% and mean adherence was 51.44±35.27% and 60.03±27.04% for surgery and non-surgery, respectively. There was no significant difference in CPAP adherence (p=0.389) but for mean air leakage it was significantly higher in non-surgery (p<0.01). The occurrence of significant air leakage during CPAP therapy was not associated with surgery (p=0.436). There was no association between poor CPAP adherence and surgery (p=0.622). In terms of impact of palatal surgery, it did not cause significant leakage with no significant association to poor adherence

High intraocular pressure : a comparative study between Obstructive Sleep Apnea (OSA) and non-OSA subjects

Obstructive Sleep Apnoea (OSA) affects 2-5% of the middle-aged population and is a potentially life-threatening condition. Previous studies on OSA and glaucoma have reported mixed findings. This was a cross-sectional comparative study with a study duration of one year to compare the incidence of high intraocular pressure among OSA subjects and non-OSA subjects. This study took place in a tertiary hospital where a total of 50 subjects with OSA and 50 non-OSA subjects were recruited. The average age was 37 years (19,65) in a multiethnic study population (76% (Malay), 18% (Chinese) and 6% (Indian)). All patients underwent a full night computer-assisted polysomnogram (SOMNOCheck Effort Weinmann, Hamburg, Germany), Epworth Sleepiness Scale (ESS), Mullers manouevre (MM) to assess the level of obstruction and tonometry. The incidence of high Intra Ocular Pressure (IOP) among OSA subject was 52% with a significant difference between non-OSA and OSA subjects. Correlation between ESS and IOP were significant (p<0.05) for both eyes. There was a significant difference in mean IOP between non-OSA and OSA subjects for both eyes (p<0.05). A significant association was found between the presence of collapse at retropalatal and retrolingual region with high IOP (p<0.05). The incidence of high IOP among OSA patient (52%) provides a new insight in the management of patients with OSA. Significant associations exist between OSA parameters (ESS and presence of collapse on Mullers manouevre) and high IOP. We strongly recommend periodic ophthalmic assessment of intraocular pressure in patients with OSA

Early Transthyrohyoid Injection Laryngoplasty Under Local Anaesthesia in a Single Tertiary Center of Southeast Asia: Multidimensional Voice Outcomes

Objective:To study the effectiveness of early percutaneous transthyrohyoid injection laryngoplasty under local anesthesia in improving voice quality in unilateral vocal fold paralysis (UVFP) patients.Methods:Longitudinal data of 29 UVFP patients who underwent injection laryngoplasty within six months from the onset of the symptoms were studied. The injectate (0.5–1 mL) was hyaluronic acid-based material (Juvéderm ULTRA XC; Allergan Industrie, France) that was delivered under local anesthesia with transthyrohyoid approach using a double-bend 21G needle. Multidimensional voice outcomes employing: 1) Malay-Voice-Handicap Index-10 (mVHI-10); 2) maximum phonation time (MPT); and 3) acoustic analysis [jitter%, shimmer% and noise-harmonic ratio (NHR)] were used to assess the treatment progress. The voice parameters were measured at baseline (2 weeks pre-injection), and at the first and third months post-injection.Results:The mean age of the 29 patients was 44.69 years, with a female-to-male ratio of 3.14:1. The voice outcomes measured at different time points were evaluated with repeated measures ANOVA. Significant improvement was observed from baseline to three months post injection laryngoplasty for mVHI-10, jitter, and NHR (p<0.001), shimmer (p=0.005) and MPT (p=0.018). Following the procedure, none of the patients developed any major complications.Conclusion:Office setting early transthyrohyoid injection laryngoplasty using a double-bend needle is a safe and effective procedure in patients with UVFP with evidence of significant improvement in voice and life quality

Does laryngeal reinnervation or type I thyroplasty give better voice results for patients with unilateral vocal fold paralysis (VOCALIST):Study protocol for a feasibility randomised controlled trial

Introduction: A functioning voice is essential for normal human communication. A good voice requires two moving vocal folds; if one fold is paralysed (unilateral vocal fold paralysis (UVFP)) people suffer from a breathy, weak voice that tires easily and is unable to function normally. UVFP can also result in choking and breathlessness. Current treatment for adults with UVFP is speech therapy to stimulate recovery of vocal fold (VF) motion or function and/or injection of the paralysed VF with a material to move it into a more favourable position for the functioning VF to close against. When these therapies are unsuccessful, or only provide temporary relief, surgery is offered. Two available surgical techniques are: (1) surgical medialisation; placing an implant near the paralysed VF to move it to the middle (thyroplasty) and/or repositioning the cartilage (arytenoid adduction) or (2) restoring the nerve supply to the VF (laryngeal reinnervation). Currently there is limited evidence to determine which surgery should be offered to adults with UVFP. Methods and analysis: A feasibility study to test the practicality of running a multicentre, randomised clinical trial of surgery for UVFP, including: (1) a qualitative study to understand the recruitment process and how it operates in clinical centres and (2) a small randomised trial of 30 participants recruited at 3 UK sites comparing non-selective laryngeal reinnervation to type I thyroplasty. Participants will be followed up for 12 months. The primary outcome focuses on recruitment and retention, with secondary outcomes covering voice, swallowing and quality of life. Ethics and dissemination: Ethical approval was received from National Research Ethics Service—Committee Bromley (reference 11/LO/0583). In addition to dissemination of results through presentation and publication of peer-reviewed articles, results will be shared with key clinician and patient groups required to develop the future large-scale randomised controlled trial. Trial registration number ISRCTN90201732; 16 December 2015

Facial Nerve Paralysis: A Rare Complication of Parotid Abscess

Benign parotid neoplasm and inflammatory processes of the parotid resulting in facial paralysis are extremely rare. We report a 72-year-old Malay female with poorly-controlled diabetes mellitus who presented with a painful right parotid swelling associated with right facial nerve palsy. The paralysis (Grade VI, House and Brackmann classification) remained after six months