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  1. Teh CSL, Raman R
    J Prim Care Community Health, 2012 Apr 1;3(2):80-2.
    PMID: 23803449 DOI: 10.1177/2150131911417185
    INTRODUCTION AND AIMS: Patients with sore throats are often treated with oral gargles or oral sprays. Some may rinse instead of gargle, leading to unsatisfactory outcome. The authors studied the efficacy of oral rinses, gargles, and sprays and the effect of Friedman palate position on the outcome.
    METHODS: Ten subjects used specially prepared solutions to rinse, gargle, and then spray their oral cavities at 2-hour intervals. The blue dye indicated the areas stained by the solution, which were scored.
    RESULTS: Although there was no difference in reaching the oropharynx between the gargles and sprays, they were both better than were the oral rinses (P < .001). The difference in Friedman palate position did not have an effect on the efficacy of the different modalities.
    CONCLUSION: Oral gargles and sprays have been shown to be significantly better than are oral rinses if the oropharynx is the targeted site, and the size of the oral airway does not impede their efficacy.
    KEYWORDS: Friedman palate position; drug administration; oropharynx
  2. Sobani Din, Fadzilah Ismail, Teh, Carren Sui Lin, Raudha Ezaty Ruslan, Shiraz Qamil Muhammad Abdul Kadar, Azuin Izzati Arshad
    MyJurnal
    The current COVID-19 pandemic has forced many clinical disciplines to evolve to function safely and still provide the necessary care. Otorhinolaryngology (ORL) is a field that has been greatly affected by this highly transmissible viral pathogen. Aerosolizing procedures, proximity examination and other common procedures must be revamped to suit current time. The usual norm ORL procedures need also be altered to incorporate safeguards to protect both patient and healthcare workers. This recommendation for current practices aims to give a practical approach to modify current practices to maintain safety during the pandemic. These recommendations are the consensus amongst ORL practitioners in Hospital Sungai Buloh which is the designated COVID-19 centre for Malaysia’s central region and is currently being practised.
  3. Teh CS, Noordiana SH, Shamini S, Prepageran N
    PMID: 34353133 DOI: 10.1177/00034894211037211
    INTRODUCTION: Vestibular paroxysmia (VP) is a condition with recurrent short bouts of vertigo and is thought to be part of a neurovascular compression syndrome caused by the vascular loop. However, this is still being debated as vascular loops are considered as normal variants with limited studies involving vertiginous patients.

    OBJECTIVES: The aim of this paper is to study the association between audiovestibular symptoms and the presence of vascular loops and to study the association between vestibular paroxysmia and vascular loops.

    DESIGN: This is a retrospective analysis of clinical, audiological and MRI findings of patients with and without vascular loops and vestibular paroxysmia from 2000 to 2020.

    RESULTS: A total of 470 MRI Internal Auditory Meatus scans were performed during the study period of which, 71 (15.1%) had vascular loops and 162 (34.5%) had normal MRI which were used as controls. From the 233 subjects recruited, there were 37 subjects with VP and 196 non VP subjects were used as controls. There was no association between the vascular loop and control groups in terms of co-morbidity and audiovestibular symptoms. The VP group had a significantly older mean age of 51.8 (SD ± 10.3) as compared to the non VP group with the mean age of 45.6 (SD ± 15.5). The VP group had higher number of patients presenting with hearing loss at 97.3% when compared with those without VP (80.1%) (P = .01). The odds of having a vascular loop giving rise to VP was not statistically significant at 0.82 (95% CI 0.3735-1.7989) P = .62.

    CONCLUSION: The vascular loop is a normal variant which may or may not give rise to audiovestibular symptoms or vestibular paroxysmia. Clinical assessment is still most important tool in deriving a diagnosis of VP and MRI may be useful to rule out other central causes.

  4. Teh CS, Mah MC, Rahmat K, Prepageran N
    Otol Neurotol, 2022 Jan 01;43(1):12-22.
    PMID: 34669685 DOI: 10.1097/MAO.0000000000003389
    OBJECTIVES: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder that may have normal physical examination, clinical laboratory testing and vestibular evaluation. However, advances in neuroimaging have provided new insights in brain functional connectivity and structure in patients with PPPD. This systematic review was aimed at identifying significant structural or alterations in functional connectivity in patients with PPPD.

    DATABASES REVIEWED: Science Direct, Pubmed, Embase via Ovid databases, and Cochrane library.

    METHODS: This review following the guidelines of PRISMA, systematically and independently examined papers published up to March 2021 which fulfilled the predetermined criteria. PROSPERO Registration (CRD42020222334).

    RESULTS: A total of 15 studies were included (MRI = 4, SPECT = 1, resting state fMRI = 4, task-based fMRI = 5, task-based fMRI + MRI = 1). Significant changes in the gray matter volume, cortical folding, blood flow, and connectivity were seen at different brain regions involved in vestibular, visual, emotion, and motor processing.

    CONCLUSION: There is a multisensory dimension to the impairment resulting in chronic compensatory changes in PPPD that is evident by the significant alterations in multiple networks involved in maintaining balance. These changes observed offer some explanation for the symptoms that a PPPD patient may experience.Systematic Review Registration: This study is registered with PROSPERO (CRD42020222334).

  5. Teh CS, Abdullah NA, Kamaruddin NR, Mohd Judi KB, Fadzilah I, Zainun Z, et al.
    Ann Otol Rhinol Laryngol, 2023 May;132(5):566-577.
    PMID: 35794811 DOI: 10.1177/00034894221111408
    INTRODUCTION: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder where there is persistent dizziness or unsteadiness occurring on most days for more than 3 months duration. Treatment recommendations for PPPD include vestibular rehabilitation therapy (VRT) with or without medications and/or cognitive behavioral therapy.

    OBJECTIVES: This paper is a pilot study designed to compare the effects of Bal Ex as a home-based VRT on the quality of life (EQ-5D), dizziness handicap (DHI) and mental health (DASS-21) against hospital-based VRT.

    DESIGN: This was an assessor-blinded, randomized controlled pilot study where PPPD patients were randomly selected to undergo Bal Ex, the home-based VRT (intervention group) or hospital-based (control group) VRT. The participants were reviewed at 4 weeks and 12 weeks after the start of therapy to assess the primary endpoints using the subjective improvement in symptoms as reported by patients, changes in DHI scores, DASS-21 scores and EQ5D VAS scores.

    RESULTS: Thirty PPPD patients successfully completed the study with 15 in each study group. Within 4 weeks, there were significant improvements in the total DHI scores as well as anxiety levels. By the end of 12 weeks, there were significant improvements in the DHI, DASS-21 and EQ5D. The degree of improvement between Bal Ex and the control was comparable.

    CONCLUSION: VRT is an effective modality in significantly improving quality of life, dizziness handicap, depression, and anxiety levels within 3 months in PPPD. Preliminary results show Bal Ex is as effective as hospital-based VRT and should be considered as a treatment option for PPPD.

  6. Gima E, Teh CSL, Nik Hassan NFH, Yaacob NM, Md Shukri N
    Malays J Med Sci, 2023 Dec;30(6):156-166.
    PMID: 38239243 DOI: 10.21315/mjms2023.30.6.15
    BACKGROUND: Olfactory disorders (OD) are an umbrella term for a diverse group of smell problems. Numerous tests and questionnaires have been formulated to identify and test the severity of smell impairment, which is not readily available or translated for the Malaysian population. This study aimed to translate the Questionnaire for Olfactory Disorders (QOD) and validate and test the reliability of the Malay Questionnaire for Olfactory Disorders (mQOD).

    METHODS: This cross-sectional study was conducted in two tertiary centres. A forward and backward translation was conducted for the QOD. The translated questionnaire was distributed to subjects with self-reported smell disorders on days 1 and 7. Internal consistency was analysed using Cronbach's alpha and test-retest reliability was tested with an intraclass correlation coefficient. Confirmatory factor analysis was performed to test construct validity.

    RESULTS: A total of 375 participants were recruited, 52 dropped out and 323 completed the questionnaire a second time. The Cronbach's alpha coefficient was 0.537 for parosmia (P), 0.892 for life quality (LQ), 0.637 for sincerity (S) and 0.865 for visual analogue score (VAS). The intraclass correlation coefficient (ICC) for domain scores was > 0.9, while the ICC for all items was good to excellent. A three-factor model for mQOD showed an acceptable fit with indices chi-square value (CMIN)/degree of freedom (DF) = 3.332, Tucker-Lewis fit index (TLI) = 0.923, comparative fit index (CFI) = 0.939, root mean square error of approximation (RMSEA) = 0.079 and standardised root mean square residual (SRMR) = 0.0574.

    CONCLUSION: The mQOD is a valid and reliable tool for assessing OD in patients.

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