Irfan Mohamad

Outcome of a newborn hearing screening program in a tertiary hospital in Malaysia: the first five years.

Background and Objective : Universal newborn hearing screening (UNHS) was started in the Hospital Universiti Sains Malaysia (HUSM) in January 2003. To comply with international standards, we determined the outcome of the newborn hearing screening program for the first 5 years of its implementation, from January 2003 to December 2007. Methods : The program screened all infants who were delivered in HUSM. In a retrospective review, the outcomes in terms of coverage, prevalence of hearing impairment, referral rate for each screening, age at detection of hearing impairment and at hearing aid-fitting were analyzed. Results : Ninety-eight percent of newborns were screened. The study included 16 100 randomly selected newborns. The initial screening referral rate was 25.5%. The prevalence of default for second and third screening was 33.9% and 40.7%, respectively. The mean (SD) age at detection of hearing impairment was 3.3 months (0.86). The mean (SD) age at fitting of a hearing aid was 13.6 (4.8) months.The prevalence of hearing impairment was 0.09%. Conclusion : A newborn hearing screening program is an important tool for early diagnosis and treatment. Even though the prevalence of hearing impairment may be low, the problem needs to be addressed early as the development of infants requires normal hearing.

Aeroplane headache and sinus barotrauma: Any missing link?

I read with great interest the article about aeroplane headache (AH) published recently in Cephalalgia. AH is described as a stereotypical frontal pain which appears exclusively in relation to airplane flights, in particular during the landing phase (1). Sinus barotraumas may affect any paranasal sinus (frontal, ethmoid, sphenoid or maxillary). Maxillary sinus barotraumas, for example, will lead to cheek pain and occasionally epistaxis. As the headache is described at the frontal location and it is unilateral, frontal sinus barotrauma is the most likely condition. As precisely illustrated by the author’s personal experience, sinus barotraumas are not readily relieved by maneuvers to open the Eustachian tube (2). This is because the obstructed ostia of the sinuses, particularly the frontals and ethmoids, which the authors are referring to, are not related to the Eustachian tube. Such maneuvers, for example, the Valsalva technique, are beneficial for otitic barotraumas. AH is not related to the distance of travel and occurs almost exclusively during descent, because its pathophysiology is pressure changes. A similar clinical condition can be seen in scuba diving (3). Themore sudden the pressure change, the more pain the patient will suffer. Sinus barotrauma is closely related to the degree of patency of the sinus opening (ostium). The blocked ostium will disturb the pressure equalization mechanism between the sinus cavity and the external environment. Thus, the prevention of sinus barotrauma is accomplished by relieving the obstruction, by either medical or surgical intervention. Nasal allergy, chronic rhinosinusitis, as well as early polypoidal changes of the nasal mucosa can be treated with oral or intranasal medications. Structural obstruction, for example, severe deviated nasal septum or well-formed nasal polyp, will benefit from nasal surgery.

Bilateral vocal cord palsy post thyroidectomy: lessons learnt

Bilateral vocal cord paralysis is a known possible complication following thyroid surgery. It owes to the close relationship between the recurrent laryngeal nerve and the thyroid gland. The most feared complication of bilateral vocal cord paralysis is airway compromise. We report the case of a 39-year-old woman who underwent total thyroidectomy for multinodular goitre. The surgery was uneventful. However she developed stridor in the recovery bay needing intubation. We postulate that the cause was attributed to bilateral vocal cord paresis due to the use of the intraoperative nerve monitoring (IONM) whose high setting throughout the surgery was overlooked. She made a complete recovery without the need of a tracheostomy. We share our lessons learnt from this case.

Antifungal Effect of Malaysian Aloe vera Leaf Extract on Selected Fungal Species of Pathogenic Otomycosis Species in In Vitro Culture Medium.

OBJECTIVES Aloe barbadensis miller or Aloe vera has been used for therapeutic purposes since ancient times with antifungal activity known to be amongst its medicinal properties. We conducted a pilot study to determine the antifungal properties of Malaysian Aloe vera leaf extract on otomycosis species including Aspergillus niger and Candida albicans. METHODS This laboratory-controlled prospective study was conducted at the Universiti Sains Malaysia. Extracts of Malaysian Aloe vera leaf was prepared in ethanol and solutions via the Soxhlet extraction method. Sabouraud dextrose agar cultured with the two fungal isolates were inoculated with the five different concentrations of each extract (50 g/mL, 25 g/mL, 12.5 g/mL, 6.25 g/mL, and 3.125 g/mL) using the well-diffusion method. Zone of inhibition was measured followed by minimum inhibitory concentration (MIC). RESULTS For A. niger, a zone of inhibition for alcohol and aqueous extract was seen for all concentrations except 3.125 g/mL. There was no zone of inhibition for both alcohol and aqueous extracts of Aloe vera leaf for C. albicans. The MIC values of aqueous and alcohol extracts were 5.1 g/mL and 4.4 g/mL for A. niger and since no zone of inhibition was obtained for C. albicans the MIC was not determined. CONCLUSIONS The antifungal effect of alcohol extracts of Malaysian Aloe vera leaf is better than the aqueous extract for A. niger (p < 0.001). Malaysian Aloe vera has a significant antifungal effect towards A. niger.

Image-guided system endoscopic drainage of orbital abscess caused by methicillin-resistant Staphylococcus aureus in an infant.

Highlights • Orbital abscess in infant requires prompt treatment.• MRSA is an increasingly common organism causing orbital abscess in infants.• Surgical drainage of orbital abscess is indicated when presence of persistent infection clinically or radiologically despite systemic antimicrobial therapy.• Image-guided endoscopic drainage of orbital abscess in infant provides a safer surgical technique.

Migrating fish bone piercing the common carotid artery, thyroid gland and causing deep neck abscess

Foreign body (FB) ingestion is very common in Malaysian population. The most commonly ingested FB is fish bone. Common presenting symptoms include FB sensation, odynophagia and or sharp pricking pain during swallowing. A careful history and physical examination is very important. Despite negative laryngoscopy and rigid esophagoscopy, persistent symptoms warrants further radiographic imaging studies. The FB can migrate extraluminally and involve other important adjacent structures of the neck and along the digestive tract. We report 3 cases of extraluminal migration of fish bone and their complications, which were successfully managed. One case with vascular complication which involve common carotid artery and the other two cases with neck abscess formation involving thyroid gland, retropharyngeal and parapharyngeal abscess.

A Rare Differential Diagnosis of a Solitary Anterior Neck Mass.

Patients with anterior neck masses commonly present to otorhinolaryngology clinics, but there are limited differential diagnoses for such lesions. Common ones include thyroid nodule and thyroglossal duct cyst. In an elderly patient, a differentiated thyroid carcinoma should be suspected especially if it moves with swallowing. We encountered a typical presentation of a solitary thyroid nodule-like mass with the exception of pulsation in a 65-year-old female. Further investigation, using neck ultrasonography, revealed that it was a variant of right common carotid artery arising from the left common carotid artery. Knowledge of such variants is of great importance as ignorance of such a variation may lead to inadvertent surgical complications during procedures.

Reversibility of a Vocal Cord Palsy Following Fine Needle Aspiration Cytology of a Clinically Impalpable Thyroid Nodule

Reversibility of a Vocal Cord Palsy Following Fine Needle Aspiration Cytology of a Clinically Impalpable Thyroid Nodule Vocal cord paralysis due to benign thyroid lesions, though very rare can also cause vocal cord palsy. Surgical intervention to the lesion is usually needed to release the pressure. We report a rare case of a vocal cord palsy caused by benign thyroid nodule that was detected only on computed tomography scan. Reversibility of vocal cord palsy was noted at two months after ultrasound-guided fine needle aspiration for cytology of the deep-seated thyroid nodule.

Extensive dural sinus thrombosis and bilateral lateral rectus palsy as an uncommon complication of chronic suppurative otitis media

Dural venous sinus thrombosis, especially of the sigmoid sinus, is a known but uncommon intracranial extradural complication of chronic suppurative otitis media. Even rarer is the simultaneous occurrence of bilateral abducens palsy in the same patient. We report the case of an adolescent male who presented with signs of raised intracranial pressure, diplopia and bilateral lateral rectus palsy associated with a history of left ear discharge and neck swelling. Extensive dural sinus thrombosis extending right up to the left internal jugular vein was confirmed on CT imaging. The patient was successfully treated with thrombolytic agents and antibiotic therapy. The pathophysiology of the concurrent complications is discussed.

Undiagnosed chicken meat aspiration as a cause of difficult-to-ventilate in a boy with traumatic brain injury

Introduction Bronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist. Discussion The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes. Case presentation We present a case of a 12-year-old boy who had a difficult-to-ventilate scenario post transferring and immediately connected to ventilator in operation theatre (OT) from portable ventilator from the emergency department. She was successfully managed by bronchoscopy. Conclusion Special attention should be given to the difficult-to-ventilate scenario post intubation of traumatic brain injury patient prior to operation. Prompt diagnosis and bronchoscope-assisted removal of foreign body was found to be a successful to reduce morbidity and mortality.