Marina Mat Baki

Obstructive sleep apnea among express bus drivers in Malaysia: Important indicators for screening

Objectives: Obstructive sleep apnea (OSA) has been identified as one of the significant risk factors for motor vehicle crashes (MVCs). In the interest of public safety, this study was conducted to determine the prevalence of OSA and its associated factors among express bus drivers in Malaysia. Identifying factors or conditions related with OSA is very important because they can be used as indicators to subject a person to a confirmatory diagnosis using polysomnography testing. Methods: Two hundred eighty-nine randomly selected express bus drivers from 5 express bus companies participated in the study. Information on demography, medical history, clinical symptoms, and signs of OSA were collected by a designated medical officer and the diagnosis of OSA was done based on the Apnea Hypopnoea Index (AHI) from polysomnography testing. Results: Based on AHI, 128 (44.3%) subjects were diagnosed as having OSA with 83 (28.7%), 26 (9.0%), and 26 (6.6%) classified as mild, moderate, and severe OSA, respectively. Multiple logistic regression analysis results showed that age (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.01–1.09), snoring (OR = 3.54, 95% CI 1.91–6.57), body mass index (BMI; OR = 1.17, 95% CI 1.09–1.25), hypertension (OR = 1.87, 95% CI 1.02–3.40), and neck circumference (OR = 1.31, 95% CI 1.18–1.46) were significantly associated with OSA status. Conclusions: The results supported the need for identifying the risk group for OSA among express bus drivers and the need to diagnose them early for an early intervention.

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.

Feasibility of vocal fold abduction and adduction assessment using cine-MRI.

AbstractObjectiveDetermine feasibility of vocal fold (VF) abduction and adduction assessment by cine magnetic resonance imaging (cine-MRI)MethodsCine-MRI of the VF was performed on five healthy and nine unilateral VF paralysis (UVFP) participants using an axial gradient echo acquisition with temporal resolution of 0.7 s. VFs were continuously imaged with cine-MRI during a 10-s period of quiet respiration and phonation. Scanning was repeated twice within an individual session and then once again at a 1-week interval. Asymmetry of VF position during phonation (VF phonation asymmetry, VFPa) and respiration (VF respiration asymmetry, VFRa) was determined. Percentage reduction in total glottal area between respiration and phonation (VF abduction potential, VFAP) was derived to measure overall mobility. An un-paired t-test was used to compare differences between groups. Intra-session, inter-session and inter-reader repeatability of the quantitative metrics was evaluated using intraclass correlation coefficient (ICC).ResultsVF position asymmetry (VFPa and VFRa) was greater (p=0.012; p=0.001) and overall mobility (VFAP) was lower (p=0.008) in UVFP patients compared with healthy participants. ICC of repeatability of all metrics was good, ranged from 0.82 to 0.95 except for the inter-session VFPa (0.44).ConclusionCine-MRI is feasible for assessing VF abduction and adduction. Derived quantitative metrics have good repeatability.Key points• Cine-MRI is used to assess vocal folds (VFs) mobility: abduction and adduction. • New quantitative metrics are derived from VF position and abduction potential. • Cine-MRI able to depict the difference between normal and abnormal VF mobility. • Cine-MRI derived quantitative metrics have good repeatability.

Laryngopyocele: report of a rare case and systematic review.

A 59-year-old man with a background of chronic obstructive pulmonary disease was diagnosed with a large mixed laryngopyocele that was successfully drained and marsupialized endoscopically using suction diathermy without requiring tracheostomy. Because of the rareness of the case, we performed a systematic review. Of 61 papers published between 1952 and 2015, we reviewed 23 cases written in English that described the number of cases, surgical approaches, resort to tracheostomy, complications, and outcomes. Four cases of laryngopyoceles were managed endoscopically using a cold instrument, microdebrider, or laser. Eighteen cases were operated on via an external approach, and 1 case applied both approaches. One of 4 endoscopic and 10 of 18 external approaches involved tracheostomy. Management using suction diathermy for excision and marsupialization of a laryngopyocele has never been reported and can be recommended as a feasible method due to its widespread availability. In the presence of a large laryngopyocele impeding the airway, tracheostomy may be averted in a controlled setting.

Comparison between OperaVOX™ and MDVP: Preliminary Results

Objectives: Objective evaluation of voice, such as acoustic analysis, provides additional evidence in treatment monitoring. Currently, it is only possible in voice laboratories in hospitals. OperaVOX™ (On Person RApid VOice eXaminer), a portable voice analysis running on an Apple™ iPod, iPhone, and iPad, was developed to enable remote voice assessment. Our goal was to evaluate the agreement between OperaVOX™ and Multidimensional Voice Program (MDVP, KayPentax, NJ, USA). Methods: A group of 16 healthy volunteers without voice complaints were recruited from the University College London Hospital NHS Trust from December 2012 until January 2013. Supervised recordings were performed in a quiet room. A five-second recording of a sustained vowel /a/ was used to measure fundamental frequency (F0), jitter, shimmer, and noise-to-harmonic ratio (NHR). The audio files recorded using OperaVOX™ were also analyzed using the MDVP. 95% limit of agreement (LOA) between software was analyzed using the Bland Altman method. Results: The mean difference (SD) of F0, jitter, shimmer, and NHR between OperaVOX™ and MDVP measurements was -0.14 (1.28 ) Hz, -0.06 (0.32)%, -0.26 (0.67)%, and 0.12 (0.02) respectively. The 95% LOA of OperaVOX™„ to MDVP for F0 was -2.67Hz to +2.39Hz; jitter was -0.57% to +0.68%; shimmer was -1.6% to +1.09%; and NHR was +0.08 to +0.12 compared to MDVP. Conclusions: OperaVOX™ at this stage has been shown to be a promising portable voice analysis tool for measuring the F0, jitter, and shimmer of voice since the 95% LOA were within clinically acceptable levels. Agreement with PRAAT is currently being tested.

Validity and Reliability Study of Bahasa Malaysia Version of Voice Handicap Index-10

OBJECTIVES This study aimed to determine the validity and reliability of Bahasa Malaysia version of Voice Handicap Index-10 (mVHI-10). MATERIALS AND METHODS This cross-sectional study was carried out in the Otorhinolaryngology, Head and Neck Surgery Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from June 2015 to May 2016. The mVHI-10 was produced following a rigorous forward and backward translation. One hundred participants, including 50 healthy volunteers (17 male, 33 female) and 50 patients with voice disorders (26 male, 24 female), were recruited to complete the mVHI-10 before flexible laryngoscopic examinations and acoustic analysis. The mVHI-10 was repeated in 2 weeks via telephone interview or clinic visit. Its reliability and validity were assessed using interclass correlation. RESULTS The test-retest reliability for total mVHI-10 and each item score was high, with the Cronbach alpha of >0.90. The total mVHI-10 score and domain scores were significantly higher (P < 0.001) in the pathology groups (20.92 ± 8.74) than healthy volunteers (1.54 ± 1.97), depicting excellent discriminant validity. The Kaiser-Meyer-Olkin measure was 0.92, which depicted excellent construct validity. There was a significant positive correlation between the mVHI-10 score and jitter and shimmer result (P < 0.001). CONCLUSIONS The present study showed good reliability and validity of the mVHI-10 when applied to both healthy volunteers and patients with voice disorders. We recommend the use of the mVHI-10 in daily clinical practice among Bahasa Malaysia-speaking population.

A bizarre case of accessory larynx in an infant with OEIS syndrome

We report a bizarre case of accessory larynx in an infant with OEIS syndrome (omphalocele, cloacal exstrophy, imperforated anus & spinal defects). This is the first reported case in literature of a duplicate accessory larynx which is a mirror image of the true larynx. A congenital duplication of the larynx is a rare anomaly and can present in various forms. In this case, the infant presented with recurrent lung infection and inability to wean off oxygen. Scope revealed severe laryngomalacia in addition to the accessory larynx. Hence, supraglottoplasty was done with aim to resolve the lung and airway problem.

Chronic large non healing ulcer: Non-tuberculous mycobacterial infection of the laryngopharynx

We describe a case of non-tuberculous mycobacterial infection of the larynx in a previously well, immunocompetent young woman. Laryngeal mycobacterial infection is rare and currently accounts for less than 1% of all cases. A diagnostic dilemma often occurs because it may mimic laryngeal carcinoma, chronic laryngitis, or laryngeal candidiasis. This case highlights the importance of considering non-tuberculous mycobacterial infection in the differential diagnosis of laryngeal lesions.

Unusual Presentation of Myasthenia Crisis Following Thymectomy and Thyroidectomy

Respiratory distress after thyroidectomy and thymectomy can be challenging. We encountered a 70-year-old lady with a long-standing goiter with concomitant thymoma. She underwent the surgery and developed respiratory distress upon extubation with loss of laryngeal sensation causing severe aspiration. She was diagnosed myasthenia gravis and symptoms resolved with MG treatments.

A Rare Case of Basal Cell Adenocarcinoma of Parotid Gland with Intracranial Extension

Basal cell adenocarcinoma (BCAC) is a rare tumour entity. Despite its tendency to be infiltrative and destructive tumour with propensity to recur, it rarely metastasizes and long-term outcome following surgery is favourable. This paper presents a 42-year-old male with residual BCAC of parotid gland that had extended into infratemporal fossa and intracranial. The important aspect of this case is the rarity occurrence of BCAC of parotid with intracranial extension and its surgical approaches to achieve tumour clearance.