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   Table of Contents - Current issue
October-December 2022
Volume 24 | Issue 4
Page Nos. 151-191

Online since Friday, December 30, 2022

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Effects of combination therapy in reduction of tinnitus functional index score for tinnitus patients in a Tertiary Hospital in Malaysia: A randomized pilot trial p. 151
Nur Asyiqin Kamarudin, Wan Syafira Ishak, Mohd Arif Nazri, Azmi Mohd Tamil, Asma Abdullah
Background: This trial aimed to study the effect of combination therapy and compare it with tinnitus counseling alone in the reduction of tinnitus functional index (TFI) score. Materials and Methods: This work is a two-arm pilot-controlled trial where Muslims aged more than 18 years and with primary chronic bothersome tinnitus and a TFI score of more than 24 were recruited. The exclusion criteria were subjects with pulsatile or objective tinnitus or those with poor cognitive functions and Meniere's disease. They were randomized into two groups by using block randomization. The first treatment group received a combination of Al Quran sound therapy and tinnitus counseling, and the second treatment group received tinnitus counseling only. The results of the TFI score before intervention and 1-month postintervention were recorded and analyzed. Results: A total of 25 patients were recruited and randomized. Among them, 10 received combination therapy and 15 received counseling treatment. Overall, 68% of the patients (17/25) had reduced global TFI scores. The mean decline in total TFI score in the combination group was higher (12.4, standard deviation [SD]: 18.5) than that in the counseling group (4.9, SD: 18.8). Clinically relevant improvement was also higher in the combination group (40%) than in the counseling group (26.7%). Both comparisons were not statistically significant. Among the TFI subscales, the mean scores of intrusiveness, sense of control, and emotion decreased significantly after the intervention within the combination group, with values of P = 0.036, 0.026, and 0.036, respectively. Conclusion: This study was unable to determine if combination therapy is better than counseling due to the small sample size. However, combination therapy improved the emotion, sense of control, and degree of intrusiveness of tinnitus.
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Are intravenous antibiotics routinely indicated in the management of secondary post tonsillectomy haemorrhage? p. 157
Andreea Nae, Mohammed Habibulah Khan, Colleen Bernadeth Heffernan, Ivan James Keogh
Objective: To review secondary posttonsillectomy hemorrhage (SPTH) patients in our unit, assess them for evidence of infection and make recommendations about the routine use of intravenous (iv) antibiotics. Methods: Retrospective review of our departmental tonsillectomy database over 3 consecutive years. Inflammatory markers, temperature, and throat swab results were analyzed. Results: 3160 tonsillectomies were performed; 1856 on children. The patient's age range 273 years. One hundred and twenty-three SPTH cases were recorded (3.9% rate), with a slight female preponderance (61%). All received broad-spectrum IV antibiotics. Twenty percent of SPTH presented on the 5th postoperative day (range days 227). Eighty-four-and-a-half percent of patients had no clinical or laboratory evidence of infection. Nineteen (15.5%) patients had elevated C reactive protein, white cell count, and neutrophils. Forty patients had throat swabs performed with no pathogens isolated. Conclusions: Clinical signs of infection are uncommon in SPTH. The decision to use iv antibiotics in SPTH should be on an individual basis, guided by clinical and laboratory findings.
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Knowledge, attitude, and practice of office-based laryngeal assessment among adult smokers in Saudi Arabia p. 163
Manal Ahmed Bukhari, Abdulhamid Qaed A. Alenezi, Faisal Hazaa Abohelaibah, Faisal Salahaddin Alfawaz, Riam Saleh Alkhamis, Hadeel Abdullah M. Ashour
Background: Voice change or dysphonia can be caused by many factors. Smoking is one significant risk factor that has been proven to impact voice quality significantly. The smoker's prevalence has increased recently in Saudi Arabia, mainly among men. In this study, we will assess the prevalence of Saudi smokers' knowledge and practice of visiting ENT clinics due to their voice change and the importance of laryngeal assessment. Methods: This descriptive cross-sectional study collected 448 adult smokers throughout the Kingdom of Saudi Arabia using a validated electronic questionnaire from March to September 2022. We interpret and assess the data of knowledge and demographic variables and ENT clinic visits. To determine the association between our variables, we analyzed the data using SPSS Statistics, version 25. Results: Most participants were between 18 and 34-year-old. The majority of the participants are males (81.5%). The vast majority have never undergone a laryngeal exam (71.4%), and 70.5% do not know about such an assessment. The knowledge questions found that most participants answered as “I do not know,” ranging from 27.7% to 71.2%. Only 123 (27.5%) participants noticed voice changes. Conclusion: Voice change is a common symptom frequently noticed by active smokers. It can be a warning sign of severe hidden pathology. Such a type of pathology can be spotted by simple laryngeal assessment. For early recognition of these lesions, it is crucial for smokers' to be aware of the efficacy and advantages of laryngeal assessment and its importance.
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Subcutaneous emphysema around the cochlear implant: Two distinct etiologies p. 168
Isra Aljazeeri, Fida Almuhawas, Abdulrahman Hagr
Subcutaneous emphysema is usually induced by trauma, infection with gas-forming organisms, or surgical interventions. Few cases have been reported with subcutaneous emphysema after cochlear implantation. Here, we present two cases of subcutaneous emphysema with two distinct etiologies. One case presented with recurrent, bilateral, self-limiting, and mild swelling around the internal receiver stimulator of the cochlear implant. In-depth history taking of this patient revealed that each episode of this swelling was preceded by an upper respiratory tract infection, associated with forceful sneezing and coughing. This patient was managed conservatively. The other case had a long history of otorrhea, for which he did not seek medical attention. The patient presented with painful swelling over the internal receiver stimulator. Moreover, the underlying cause of the subcutaneous emphysema was found to be a cholesteatoma. This patient was managed surgically with the preservation of the device.
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Extramedullary plasmacytoma of paranasal sinuses: Diagnostic and therapeutic aspects of six cases with literature review p. 172
Neha Thakur, Jagdeep Thakur, Trilok Chand Guleria, Dinesh K Sharma, Ramesh K Azad
Extramedullary plasmacytoma (EMP) of the head and neck is a rare malignant tumor that accounts for just 3% of all plasma cell tumors. The mucosa-associated lymphoid tissue of the upper airways is involved in around 80%–90% of EMP. Because there is no conventional treatment regimen for plasmacytoma of the paranasal sinuses (PNS), therapy might be difficult. In this article, we will discuss six cases of EMP PNS, as well as the problems we encountered throughout their treatment.
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Conservative management of a complicated pharyngeal perforation caused by oral blunt trauma p. 176
Nisreen Ghazi Albouq, Jumana K Alahmadi, Wala Felemban, Abdulrahman F Alraddadi, Rayan A Julaidan
In children, pharyngeal perforation is a very uncommon injury. Most of the time, it is caused by secondary instrumentation. Laceration of the pharyngeal wall poses a life-threatening risk if not detected and treated promptly. A high level of suspicion is required in such cases, so hospitalization is needed for observation until an accurate diagnosis can be made. Here, we described a case of pharyngeal perforation in a 5-year-old boy who had oral blunt trauma and developed pneumomediastinum, which we managed conservatively.
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Bilateral peritonsillar abscess-developed ruptured Meckel's diverticulum: A case report p. 179
Abdulaziz S Alenazi, Jarallah M AlBahlal, Fahad A AlObaid, Mohammed J AlMahdi, Abdullah K AlMarri
Peritonsillar abscess (PTA) is an accumulation of pus between the fibrous capsule of the palatine tonsils and the superior pharyngeal constrictor muscle. Bilateral PTA (BPTA) is a rare disease. Meckel's diverticulum (MD) is a congenital abnormality of the distal ileum associated with failed vitelline duct closure. Spontaneous MD rupture during the management of PTA never happened before. In this article, the authors present a case of BPTA-developed MD rupture. We present a case involving an 18-year-old male who presented to the emergency department (ED) for a 2-day history of worsening sore throat, trismus, fever, and odynophagia; a diagnosis of bilateral severe PTA was made. During the management of the BPTA, the patient developed severe acute abdominal pain which was diagnosed later as a case of MD rupture. In ED, the patient underwent computerized tomography (CT) scan of the neck that showed bilateral hypodense masses, consistent with BPTA. Conservative management was started on IV antibiotics, IV fluids, and IV analgesia at the time of diagnosis in the ED. The patient then underwent two attempts of needle aspiration using 18-gauge needles that showed evidence of aspirated pus. Later on, the patient developed severe abdominal pain, which is evaluated by the general surgery department (GS), and underwent ultrasonography (US) and CT scan; then, the diagnosis of rupture MD was made. The patient underwent diagnostic laparoscopy performed by the GS team and improved thereafter. In this article, the authors present a case of BPTA-developed MD rupture.
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Mediastinitis, Pericarditis, Empyema, and Bacteremia: An Infrequent Complicated Ludwig's Angina Case p. 182
Diyaa Hassan Bokhary, Abdulmoneim Ali Mustafa, Ghada Asad Merdad
Ludwig's angina is a life-threatening cellulitis of the submandibular, submental, and sublingual areas that originates mostly from odontogenic illnesses. It is associated with high morbidity and mortality rates. Its natural course, if not treated, leads to the rapid progression and development of complications, including airway compromise, necrotizing fasciitis, septic shock, pericarditis, and empyema. We report the case of a 40-year-old male who presented primarily with chest pain associated with cheek pain, sore throat, odynophagia, and subjective fever. The patient was diagnosed with Ludwig's angina secondary to a poor oral hygiene complicated by pericarditis, mediastinitis, and left-sided empyema. An immediate antibiotic administered, and subsequently neck dissection with left anterolateral thoracotomy was performed. In this case report, we highlight the importance of not only early recognition but also rapid intervention to prevent disease progression, including early empiric antibiotics, airway management, and surgical intervention, especially if the patient presents with an atypical or vague complaint.
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Sternocleidomastoid tumor in an older child p. 185
Agnik Saha, Anwesha Mondal, Rajib Sikder, Pankaj Halder
In newborns and infants with congenital space-occupying cervical lesions, sternocleidomastoid tumors represent a relatively uncommon differential diagnosis. With an early and prolonged manual stretching exercise, it does generally go away. Some may need to have the muscle surgically released to avoid plagiocephaly, facial asymmetry, and scoliosis. We report a case of a 6-year-old child with significant torticollis who required surgery for a favorable cosmetic and functional outcome.
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Primary Burkitt's lymphoma at the nasopharynx and skull base with unusual clinical presentations in a 13-year-old boy p. 188
Santosh Kumar Swain
Burkitt's lymphoma (BL) is a rare and aggressive neoplasm an uncommon at the nasopharynx and skull base area. BL is rapidly growing B-cell non-Hodgkin's lymphoma. It commonly affects the gastrointestinal tract, whereas the primary involvement of the anterior skull base and nasopharynx is uncommon. Histopathological and immunohistochemical examinations confirm the diagnosis. Here, we are presenting a case of a 13-year-old boy presenting with BL at the nasopharynx and anterior skull base with intracranial invasion. The objective for reporting of this case report is to describe the rarity of location, unusual clinical presentations, and management of the BL. As BL is an aggressive tumor and considered a serious clinical condition, so requires timely diagnosis for prompt and appropriate treatment.
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