Prepageran Narayanan

Nasal allergies in the Asian-Pacific population : results from the Allergies in Asia-Pacific Survey

Background The Allergies in Asia–Pacific Survey describes the symptoms, impact, and treatment of allergic rhinitis (AR) across Australia, China, Hong Kong, Malaysia, Singapore, Taiwan, Vietnam, and the Philippines. The Allergies in Asia–Pacific Survey was undertaken to further clarify the prevalence of physician-diagnosed nasal allergies (NAs), impact on quality-of-life (QOL), existing treatment paradigms and gaps, and NA medications currently used in treatment. Methods Thirty-three thousand three hundred seventy-eight households were screened for individuals, ≥4 years old, with a physician diagnosis of AR or NA and either symptoms or treatment in the past 12 months. Standardized questionnaires were used to make comparisons across regions. A total of 1043 adults and 192 children were included in the survey. Results Nine percent of participants were diagnosed with AR with two of three responding that their NAs were seasonal in nature. Nasal congestion was the most common and bothersome symptom of AR. Most participants reported that AR impacted their QOL with nearly one-half citing impairments in school/work performance/productivity. Sleep disturbances, secondary to AR, were also shown to be appreciable. Two-thirds of patients took medication for their AR. Less than one-quarter of survey respondents reported taking an intranasal corticosteroid and the satisfaction rate was similar to that of over-the-counter medications. The most common reasons cited for dissatisfaction were related to inadequate efficacy and bothersome side effects. Conclusion AR appears to be extremely common across Asia–Pacific nations. Many individuals with AR suffer from symptoms that reduce QOL and treatment gaps exist with current therapies. Through identification of disease impact and highlighting treatment gaps, clinicians may better understand and treat AR, leading to improvements in overall patient satisfaction and QOL.BACKGROUND The Allergies in Asia-Pacific Survey describes the symptoms, impact, and treatment of allergic rhinitis (AR) across Australia, China, Hong Kong, Malaysia, Singapore, Taiwan, Vietnam, and the Philippines. The Allergies in Asia-Pacific Survey was undertaken to further clarify the prevalence of physician-diagnosed nasal allergies (NAs), impact on quality-of-life (QOL), existing treatment paradigms and gaps, and NA medications currently used in treatment. METHODS Thirty-three thousand three hundred seventy-eight households were screened for individuals, ≥ 4 years old, with a physician diagnosis of AR or NA and either symptoms or treatment in the past 12 months. Standardized questionnaires were used to make comparisons across regions. A total of 1043 adults and 192 children were included in the survey. RESULTS Nine percent of participants were diagnosed with AR with two of three responding that their NAs were seasonal in nature. Nasal congestion was the most common and bothersome symptom of AR. Most participants reported that AR impacted their QOL with nearly one-half citing impairments in school/work performance/productivity. Sleep disturbances, secondary to AR, were also shown to be appreciable. Two-thirds of patients took medication for their AR. Less than one-quarter of survey respondents reported taking an intranasal corticosteroid and the satisfaction rate was similar to that of over-the-counter medications. The most common reasons cited for dissatisfaction were related to inadequate efficacy and bothersome side effects. CONCLUSION AR appears to be extremely common across Asia-Pacific nations. Many individuals with AR suffer from symptoms that reduce QOL and treatment gaps exist with current therapies. Through identification of disease impact and highlighting treatment gaps, clinicians may better understand and treat AR, leading to improvements in overall patient satisfaction and QOL.

Endoscopic skull base training using 3D printed models with pre-existing pathology.

Endoscopic base of skull surgery has been growing in acceptance in the recent past due to improvements in visualisation and micro instrumentation as well as the surgical maturing of early endoscopic skull base practitioners. Unfortunately, these demanding procedures have a steep learning curve. A physical simulation that is able to reproduce the complex anatomy of the anterior skull base provides very useful means of learning the necessary skills in a safe and effective environment. This paper aims to assess the ease of learning endoscopic skull base exposure and drilling techniques using an anatomically accurate physical model with a pre-existing pathology (i.e., basilar invagination) created from actual patient data. Five models of a patient with platy-basia and basilar invagination were created from the original MRI and CT imaging data of a patient. The models were used as part of a training workshop for ENT surgeons with varying degrees of experience in endoscopic base of skull surgery, from trainees to experienced consultants. The surgeons were given a list of key steps to achieve in exposing and drilling the skull base using the simulation model. They were then asked to list the level of difficulty of learning these steps using the model. The participants found the models suitable for learning registration, navigation and skull base drilling techniques. All participants also found the deep structures to be accurately represented spatially as confirmed by the navigation system. These models allow structured simulation to be conducted in a workshop environment where surgeons and trainees can practice to perform complex procedures in a controlled fashion under the supervision of experts.

Velopharyngeal and choanal stenosis after radiotherapy for nasopharyngeal carcinoma

Choanal stenosis is a well recognized late complication of radiotherapy for nasopharyngeal carcinoma. However velopharyngeal stenosis post radiotherapy for nasopharyngeal carcinoma is rare. We present here a case of bilateral choanal stenosis and velopharyngeal stenosis in a patient treated with radiotherapy for nasopharyngeal carcinoma. A 58-year-old woman presented to our otolaryngology clinic with a one year history of nasal obstruction. She was diagnosed to have nasopharyngeal carcinoma 12 years ago for which she received radiotherapy. Clinical examination revealed bilateral choanal stenosis and velopharyngeal stenosis. Treatment of choanal stenosis and velopharyngeal stenosis is challenging due to high incidence of recurrence and patients frequently require multiple procedures. The patient underwent a transnasal endoscopic excision of velopharyngeal scar tissue and widening of posterior choana using Surgitron®, mitomycin-C applied topically to the surgical wound and bilateral stenting under general anesthesia. The stents were kept for two weeks, and 3 years post operation velopharyngeal aperture and posterior choana remained patent. As illustrated in this case velopharyngeal stenosis can occur after radiotheraphy and should not be overlooked. Combine modality of transnasal endoscopic excision of velopharyngeal scar tissue, widening of choanal stenosis with Surgitron® followed by the application of mitomycin-C and stenting has been shown to be an effective option.

A Haemostatic Agent Delivery System for Endoscopic Neurosurgical Procedures

In endoscopic neurosurgery problems with haemostasis due to poor access exist. We have developed a system which allows the delivery of a variety of haemostatic agents in a more efficacious manner. The system has been used successfully in endoscopic skull base surgery and endoscopic surgery within the parenchyma of the brain using tube systems.

Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis

Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management.

Endoscopic transnasal removal of an intraconal foreign body using an image-guided surgical system

Abstract Foreign bodies lodged in the intraconal space of the orbit pose a surgical challenge due to its deep location behind the globe. Image-guided endoscopic transnasal surgery facilitates the localization of the metallic foreign bodies and enables its safe removal with minimal surrounding tissue damage and optic nerve injury.

Endoscopic Transsphenoidal Resection of Craniopharyngioma

Objectives To demonstrate, step‐by‐step, the technique and efficacy of endoscopic transsphenoidal approach in resection of a suprasellar craniopharyngioma. Design The video shows a step‐by‐step approach to the resection, covering the exposure, access, resection, and confirmation of resection and reconstruction. Setting The surgery was performed in the University of Malaya Medical Centre, a tertiary referral center in the capital of Malaysia. Participants Surgery was performed jointly by Professor Prepageran from the department of otorhinolaryngology and Professor Vicknes Waran from the division of neurosurgery. Both surgeons are from the University of Malaya. Video compilation, editing, and voice narration was done by Dr. Kong Yew Liew. Main Outcome Measures Completeness of resection and avoidance of intra‐ and postoperative complications. Results Based on intraoperative views and MRI findings, the tumor was completely resected with the patient suffering only transient diabetes insipidus. Conclusion Central suprasellar tumors can be removed completely via an endoscopic transsphenoidal approach with minimal morbidity to the patient. The link to the video can be found at: https://youtu.be/ZNIHfk12cYg.

Neck stiffness in a post-irradiated nasopharyngeal carcinoma adult: An unusual diagnosis

Nasopharyngeal carcinoma is a neoplasm commonly found in population of South East Asia. The mainstay of treatment is high dose irradiation. Complications from radiotherapy are not uncommon especially to those nearby structures such as vertebrae and spinal cord. A 57 year-old gentleman with nasopharyngeal carcinoma (NPC) who was treated with chemo-radiation (total of 35 fractions,70Gy) presented to us 6 months post therapy with bilateral nasal discharge and progressive neck stiffness. Nasoendoscopy showed inflamed nasophayngeal mucosa and Computed Tomography (CT) brain and cervical spine showed retropharyngeal and anterior epidural collection with extension into atlantoaxial bone and spinal cord compression. Histopathological specimen revealed features of chronic inflammations with multiple actinomycetes colonies. Our patient suffered severe neck stiffness and loss of sensations on both upper limbs. He was treated conservatively with Halo vest and intravenous antibiotics for 8 weeks and recovered fully. Irradiation in NPC is known to cause devastating complications to cervical spine such as osteoradionecrosis, osteomyelitis. It also renders tissues hypoxic and risk of getting rare infection like actinomycosis. This report can represent a great diagnostic and therapeutic challenge with differentials of tumor recurrence, osteoradionecrosis or osteomyelitis. Patients must be regularly followed up to look for possible cervical complications as a result from irradiation, to prevent devastating outcome or prognosis.

A Questionnaire Survey: Knowledge in Upper Airway Infections among General Practitioners in Malaysia

Background: Upper respiratory tract infections (URTI) cases are one of the most frequently seen cases in the primary care setting. The causative agents are either bacteria or virus. It is not easy to differentiate among them. In term of treatment for both conditions, certain principles of treatment are advised to be followed.

Image-Based Case Studies in ENT and Head and Neck Surgery

Image - Based case studies in ENT and head & neck surgery , Image - Based case studies in ENT and head & neck surgery , کتابخانه دیجیتال جندی شاپور اهواز