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Fulltext Postcricoid haemangioma with laryngomalacia in infancy

Khamalrudin N, Goh BS

BMJ Case Rep, 2021 Apr 19;14(4).
PMID: 33875496 DOI: 10.1136/bcr-2020-235936

Infantile haemangioma represents a congenital vascular anomaly commonly observed in the head and neck region. Such an occurrence over the postcricoid region, however, is rather unusual. Herein, the authors report a case of a synchronous postcricoid haemangioma in a 7-week-old newborn diagnosed with severe laryngomalacia. In addition to the floppy redundant arytenoid mucosa, flexible laryngoscopy revealed a lobulated bluish mass at the postcricoid. The lesion was hyperintense on T1-weighted sequence and was enhanced with contrast, supporting the diagnosis of a haemangioma. She underwent surgical excision of the haemangioma with intralesional steroid injection. Surveillance at 6-month postoperation did not show disease recurrence.
Fulltext Retrospective review of surgical management of foreign body ingestion

Shaariyah MM, Goh BS

Med J Malaysia, 2009 Dec;64(4):307-10.
PMID: 20954556 MyJurnal

Endoscopic examination and removal of foreign body under general anaesthesia are recommended for persistent symptomatic patient with or without significant findings on radiological examination. This report evaluates the management outcome of surgical removal of foreign body ingestion in upper gastrointestinal tract. A total of 70 cases with full documentation were reviewed retrospectively from June 1998 until December 2007. There were 32 male and 38 female with age range from 6 months to 87 years old (mean: 36.9 years). Sixty five patients (93%) were adults and 15 (7%) were below 13 years. Fish bones were the most common foreign body found (44.3%). Radiologically, foreign bodies were highly suspicious in 51 cases (76.1%). Intraoperatively, thirty six cases (70.6%) were positive. From 16 cases (23.9%) with normal radiograph, 10 cases (62.5%) were found to have foreign bodies. Therefore the plain radiograph is helpful, but clinical presentation is more reliable to determine surgical removal under general anaesthesia.
Fulltext A Toddler with Rhabdomyosarcoma Presenting as Acute Otitis Media with Mastoid Abscess

Ng SY, Goh BS

Chin Med J (Engl), 2016 May 20;129(10):1249-1250.
PMID: 27174338 DOI: 10.4103/0366-6999.181973
Case series of tuberculous otitis media: Spectrum of clinical presentation and outcome

Te BC, Goh BS

Acta Otorrinolaringol Esp (Engl Ed), 2021 Jan 13.
PMID: 33454087 DOI: 10.1016/j.otorri.2020.09.007

OBJECTIVE: Tuberculous otitis media (TB OM) is a rare disease. We present here our experience of TB OM on its clinical presentation, investigation and treatment outcome.
METHODS: A retrospective observational study was performed and clinical data of patients in whom TB OM was diagnosed at our center between 2008 and 2019 was analyzed.
RESULTS: Five cases of TB OM were identified. Otorrhoea was the most consistent presenting chief complaint while one of the cases presented with right post-auricular swelling. All the cases were successfully treated with anti-tuberculous medication with outcome of dry middle ear but only one case achieved full recovery of hearing loss.
CONCLUSION: Due to the disparity of presentations in all our patients, we would like to emphasize the high index of suspicion of TB OM in acute or chronic cases of otitis media with unusual presentation or poor response to standard treatment.
Fulltext Paediatric Adenotonsillectomy: Its Safety and Outcome in a Malaysian Tertiary Medical Center

Lokman FL, Goh BS

Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):1050-1055.
PMID: 36452792 DOI: 10.1007/s12070-020-02099-y

Adenotonsillectomy is the commonest otorhinolaryngology surgery for paediatrics. The purpose of this study was to determine the safety and outcome of adenotonsillectomy in a tertiary center in Malaysia. This was achieved by studying the demographics, indications, co-morbidities of patients and its association with the complications of the procedure. This retrospective study was conducted from November 2011 until October 2016. Medical records of patients aged 2-12 years old who had adenotonsillectomy done in our center were retrieved for data collection. A total of 143 patients who fulfilled the inclusion and exclusion criteria were recruited. Median age was 7.52 (± 2.98 SD) years old. Allergic rhinitis was the commonest co-morbidity (40%). Recurrent tonsillitis was the main indication (60%), followed by sleep disordered breathing (SDB) without apnea (29%), obstructive sleep apnea (OSA) (7%) and other indications (4%). Post-operative paediatric intensive care unit (PICU) admission was very low (1.4%) and was reserved for those with severe OSA with complications. None of the patients admitted to PICU post-operative had respiratory complications. The prevalence of post-tonsillectomy bleeding was only 2.1%. There was no significant association between patient's co-morbidity with operative complications (p = 0.269). Adenotonsillectomy is indicated for children with recurrent tonsillitis and paediatric SDB. The two most severe complications, namely post-tonsillectomy haemorrhage and respiratory complications occurred but incidence was low. Criteria of post-operative PICU or paediatric high dependency unit admission for paediatric SDB has to be based on multiple clinical and logistics factors and not only patients co-morbidity and indication of surgery.
Fulltext A Review of Tracheal Bronchus in Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Abdul Rahim F, Goh BS

Indian J Otolaryngol Head Neck Surg, 2022 Oct;74(Suppl 2):2666-2669.
PMID: 36452671 DOI: 10.1007/s12070-020-02358-y

Tracheal bronchus (TB) is a rare congenital anomaly described as a abnormal bronchus that originates directly from the trachea above the carina directed towards the upper lung lobe. We analysed all paediatric rigid endoscopies of the airway from January 2015 until August 2020 to determine the incidence and characteristic of TB. In total, 68 rigid endoscopic airway examination record from children aged 0 to 12 years were analyzed. Endoscopic examination was performed from supraglottic region to carina using a 0 degree Hopkins rod lens telescope. Patients with a TB were identified and the site of TB origin was noted. Data of the identified patients was reviewed for the presence of preoperative airway findings such as stridor, upper lobe pneumonia, other congenital anomalies, intraoperative findings and complications and postoperative general condition outcome. TB was detected in 8 (11.8%) of 68 airway endoscopic examinations. 6 children (75%) were syndromic. 5 patients (62.5%) has congenital malacic airway and 2 patients (25%) has congenital tracheal stenosis. All TB originated from the right lateral wall of the trachea. All children had stridor unrelated to TB as presentation and 4 (50%) of children had preoperative upper lobe pneumonia. Tracheal bronchus is not a rare finding and is highly associated with syndromes and other airway anomalies. Although children with TB can be asymptomatic, upper lobe pneumonia is a common presentation. TB should be included in the differential diagnosis in patients with recurrent right upper lobe pneumonia or collapse and patients with unexplained oxygenation problem during endotracheal intubation, particularly in children with syndromes or other congenital anomalies.
The role of proton pump inhibitors in adenoid hypertrophy in children

Iqbal FR, Goh BS, Mazita A

Otolaryngol Head Neck Surg, 2012 Aug;147(2):329-34.
PMID: 22496101 DOI: 10.1177/0194599812444528

To establish the efficacy of proton pump inhibitors (PPI) in the treatment of adenoid hypertrophy in children.
Fulltext Supraglottoplasty for laryngomalacia: who will benefit?

Zainal A, Goh BS, Mohamed AS

Asian J Surg, 2011 Apr;34(2):92-6.
PMID: 21723473 DOI: 10.1016/S1015-9584(11)60026-2

Laryngomalacia is the most common cause of neonatal and infantile stridor. The aim of this study was to assess the outcome of surgical intervention in children with laryngomalacia.
Fulltext Intermittent Suprasternal Neck Mass Caused by Herniation of Ectopic Thymus: Report of Two Cases

Tey KJ, Goh BS, Mohd-Zaki F

Iran J Otorhinolaryngol, 2020 Nov;32(113):391-395.
PMID: 33282788 DOI: 10.22038/ijorl.2020.45727.2501

Introduction: Ectopic thymus is an uncommon cause of neck masses in children that frequently present as lateral cervical swelling especially on the right side.
Case Report: We report two cases with atypical clinical presentation of ectopic thymus and superior herniation of normal thymus. Both of the patients manifested as intermittent midline mass at the suprasternal region during Valsalva manuevre. Unique ultrasound features with the location along the thymic descent together with dynamic assessment of the organ movement were essential to reach the correct diagnosis. Conservative approach was considered in these patients considering the necessity of thymus in the process of puberty.
Conclusion: High index of suspicion is of utmost importance when encounter patient with similar clinical manifestation to avoid unnecessary diagnostic modalities and surgeries. Accurate diagnosis will also alleviate parents' anxiety.
Fulltext The Mysterious Whistling Breath: Foreign Body Aspiration

Chandran S, Gan BC, Goh BS

Cureus, 2023 Jan;15(1):e34267.
PMID: 36855495 DOI: 10.7759/cureus.34267

Foreign body aspiration is commonly seen in the pediatric age group and can be a life-threatening condition. Typical presentations include coughing, wheezing, and choking and can often masquerade as asthma causing misdiagnosis and treatment delay. Most of the time, the actual aspiration event is unnoticed, and patients may remain asymptomatic until they present with recurrent infections with or without positive radiological findings. Aspirated objects tend to migrate distally, and organic objects may induce edema and inflammation. Diagnosis is crucial as near-total or total obstruction of the airway may cause asphyxia and, subsequently, death if no immediate intervention is taken.
Myeloid Sarcoma of Temporal Bone: A Rare Manifestation of Relapse Acute Myeloid Leukemia

Goh BS, Tang CL, Tan GC

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 2):1023-1026.
PMID: 31750119 DOI: 10.1007/s12070-015-0930-8

Myeloid sarcoma is a rare malignant extramedullary neoplasm of myeloid precursor cells. This disorder may occur in concomitance with or precede development of acute or chronic myeloid leukemia. Sometimes, it is the initial manifestation of relapse in a previously treated acute myeloid leukemia. We report a case of 11 years old boy with acute myeloid leukemia in remission state, presented with short history of right otalgia associated with facial nerve palsy. Diagnosis of right acute mastoiditis with facial nerve palsy as complication of acute otitis media was made initially. Patient underwent simple cortical mastoidectomy but histopathology from soft tissue that was sent revealed diagnosis of myeloid sarcoma. A leukemic relapse was confirmed by paediatric oncologist through bone marrow biopsy. Chemotherapy was commenced but patient responded poorly to the treatment.
Intracranial Complications of Chronic Otitis Media: Why Does It Still Occur?

Gendeh HS, Abdullah AB, Goh BS, Hashim ND

Ear Nose Throat J, 2019 Aug;98(7):416-419.
PMID: 31018687 DOI: 10.1177/0145561319840166

Intracranial complications secondary to chronic otitis media (COM) include otogenic brain abscess and sinus thrombosis. Intravenous antibiotics and imaging have significantly reduced the incidence of intracranial complications secondary to COM. However, the same does not apply to a developing country like Malaysia, which still experiences persisting otogenic complications. This case series describes 3 patients with COM and intracranial complications. All 3 patients had COM with mastoiditis, with 1 of the 3 having a cholesteatoma. Postulated reasons for the continued occurrence include poor access to health care, poor compliance with medication, and the lack of pneumococcal vaccination during childhood. In conclusion, public awareness and a timely specialty referral can reduce the incidence of intracranial complications of COM.
Challenges faced by parents when seeking diagnosis for children with sensorineural hearing loss

Hamzah NFA, Umat C, Harithasan D, Goh BS

Int J Pediatr Otorhinolaryngol, 2021 Apr;143:110656.
PMID: 33662710 DOI: 10.1016/j.ijporl.2021.110656

INTRODUCTION: The Joint Committee of Infant Hearing (JCIH) recommended hearing screening by one month of age, diagnosis of hearing loss by three months of age, and intervention initiated by six months of age. In Malaysia however, the age of diagnosis of hearing loss in children is relatively late. This study aimed to identify the challenges faced by parents in seeking a diagnosis of hearing loss for their children.
METHOD: The study utilized a semi-structured interview with open-ended questions to obtain information about parents' experiences during the diagnosis period and their challenges when going through that process. In this study, a total of 16 parents of children who were diagnosed with moderate to profound sensorineural hearing loss and received intervention within three years at the time of the study participated. Ten of the children were cochlear implant users, and six were hearing aid users.
RESULTS: Thematic analysis was used to analyse themes generated from the data according to the study objective. Four main themes and 17 subthemes were identified from this study. The four main themes were 1) Parents' emotion; 2) Parental knowledge; 3) Others; 4) Profesional services. Challenges that parents faced often include emotional behaviours such as feeling guilty and devastated during the diagnosis, lack of information-sharing from healthcare givers, lack of knowledge on childhood hearing loss among parents, support from families, seek for a second opinion, worry about others' acceptance, longer time for diagnosis to confirm, late referral to other related profesionals and no priority for the appointment.
CONCLUSION: Emotion is identified as the biggest challenge faced by parents in the process of diagnosis for their children with hearing loss. Hence, management of parental emotion needs to be emphasized by health profesionals as it influences the acceptance of parents towards their child's diagnosis.
The outcomes of bilateral cochlear implant users in Universiti Kebangsaan Malaysia

Mohammad Azmi HH, Goh BS, Abdullah A, Umat C

Acta Otolaryngol, 2020 Oct;140(10):838-844.
PMID: 32564640 DOI: 10.1080/00016489.2020.1775887

INTRODUCTION: Bilateral cochlear implants are seen to improve hearing capabilities.
OBJECTIVE: To assess the auditory outcome of paediatric bilateral cochlear implant in Universiti Kebangsaan Malaysia.
MATERIALS AND METHODS: This was a cross-sectional and descriptive study single centre analysis. Categories of Auditory Performance (CAP-II) scale and Speech, Spatial and Qualities (SSQ) of Hearing questionnaire were used.
RESULTS: Forty-six patients were recruited. Majority of the children (30.4%) rated 7 and 23.9% scored perfectly (9) based on the CAP-II Scale. The least performing children were rated 5 (average). Children that were implanted sequentially within 24 months showed median CAP-II scale of 7. No significant correlation seen between CAP-II and the duration interval, use and age of 1st CI (p > .05). The speech domain of SSQ-P scale showed median value of 8 indicating good speech understanding. The spatial hearing domain had median value of 7, quality of hearing domain had median of 8. Significant correlation seen in hearing in noise with the duration of use of CI (p
Surgical management of cochlear implant in chronic otitis media patients: safe and sound

Goh BS, Marimuthu D, Wan Hashim WF, Abdullah A

Acta Otolaryngol, 2020 Nov;140(11):914-918.
PMID: 32692598 DOI: 10.1080/00016489.2020.1784463

INTRODUCTION: Cochlear implantation (CI) in cases with chronic otitis media (COM) was previously contraindicated but recent advances have made it possible.
OBJECTIVE: To review surgical and audiological outcomes of COM patients that underwent CI.
MATERIAL AND METHODS: Retrospective review of patients above 18 years old.
RESULTS: Ten patients with complete data were included. Patients were aged 24-69 years old. Tympanoplasty and mastoidectomy were performed before CI. Imaging was performed to rule out ossifications. Eight patients underwent a standard canal wall up with either cochleostomy or round window approach. One patient had additional canalplasty and tympanoplasty and another one had blind sac procedure respectively. Analysis of the hearing aided level with CI and hearing aid showed significant benefit provided by the CI (Z = 2.803, p = .005).
DISCUSSION: Creating a dry and safe ear is important prior to CI. Definite hearing improvement is seen in all our cases that helped them to become independent again in their daily life. Hearing aid usage pre-CI might not be important as the hearing aids may continue to cause discharging ears and the benefits of hearing aids in severe to profound hearing loss are very minimal.
CONCLUSIONS: Cochlear implant is safe and effective in COM patients.
Fulltext Numb chin syndrome: an ominous sign of mandibular metastasis

Razak A, Goh BS, Rajaran JR, Nazimi AJ

BMJ Case Rep, 2018 May 14;2018.
PMID: 29764822 DOI: 10.1136/bcr-2017-223586

A 51-year-old woman a known case of stage 2 breast carcinoma in 2006 and underwent left mastectomy performed in the same year presented with bilateral lower limb pain suggestive of spinal pathology, and left chin numbness, both of 2 weeks' duration. Examination revealed left mandibular hypoesthesia without any other sign or symptoms. Orthopantomogram was unremarkable apart from mild alveolar bone expansion at tooth 36 area, which was extracted 3 months earlier. Subsequently, a full-body positron emission tomography contrast enhanced computer tomography revealed hypermetabolic lesions of her axial (excluding skull) and appendicular skeleton. In the head and neck region, left mandibular foramen and oropharynx bilaterally showed increased metabolism suggestive of tumour metastasis. The diagnosis was numb chin syndrome secondary to mandibular metastasis. Apart from supportive treatment, she was started on palliative chemotherapy and radiotherapy. At the time of discharge, there were no active complaints other than the aforementioned hypoesthesia.
Fulltext Quality of life of parents and siblings of children with cochlear implants

Umat C, Abdul Wahat NH, Che Ross S, Goh BS

J Otol, 2019 Mar;14(1):17-21.
PMID: 30936897 DOI: 10.1016/j.joto.2018.11.004

Objectives: This study examined the quality of life (QoL) of the parents and siblings of hearing-impaired children with cochlear implants (CIs).
Design: This is a cross-sectional, questionnaire-based study. The questionnaire consists of three sub-domains - interaction, emotional well-being and support for the hearing-impaired child and the overall QoL -- and two open-ended questions for participants to provide comments and suggestions to enhance their family's QoL. A total of 63 questionnaires were e-mailed or mailed to families who met the inclusion criteria.
Setting: The study was conducted under the Center for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur.
Participants: A total of 79 parents and 23 siblings from 44 families of children with CI participated in this study.
Main outcome measures: The mean score for each of the sub-domain and the overall QoL for both subject groups were computed. The answers for the open-ended questions were listed and organized into themes.
Results: There were significant correlations between the overall QoL score and each of the test domains for the parents' group (p 
Long-term outcomes of Universiti Kebangsaan Malaysia Cochlear Implant Program among pediatric implantees

Goh BS, Fadzilah N, Abdullah A, Othman BF, Umat C

Int J Pediatr Otorhinolaryngol, 2018 Feb;105:27-32.
PMID: 29447813 DOI: 10.1016/j.ijporl.2017.11.024

OBJECTIVES: Cochlear implant (CI) greatly enhances auditory performance as compared to hearing aids and has dramatically affected the educational and communication outcomes for profoundly deaf children. Universiti Kebangsaan Malaysia (UKM) pioneered CI program in 1995 in the South East Asia. We would like to report the long-term outcomes of UKM paediatric cochlear implantation in terms of: the proportion of children who were implanted and still using the device, the children's modes of communication, their educational placements, and their functional auditory/oral performance. We also examined the factors that affected the outcomes measured.
STUDY DESIGN: This was a cross sectional observational study.
METHODS: Two sets of questionnaires were given to 126 parents or primary caregivers of the implantees. The first set of questionnaire contained questions to assess the children's usage of CI, their types of education placement, and their modes of communication. The second set of questionnaire was the Parent's Evaluation Of Aural/Oral Performance of Children (PEACH) to evaluate the children's auditory functionality.
RESULTS: Our study showed that among the implantees, 97.6% are still using their CI, 69.8% communicating orally, and 58.5% attending mainstream education. For implantees that use oral communication and attend mainstream education, their mean age of implantation is 38 months. This is significantly lower compared to the mean age of implantation of implantees that use non-oral communication and attend non-mainstream education. Simple logistic regression analysis shows age of implantation reliably predicts implantees (N = 126) would communicate using oral communication with odds ratio of 0.974, and also predict mainstream education (N = 118) with odds ratio of 0.967. The median score of PEACH rating scale is 87.5% in quiet, and this significantly correlates with an earlier age of implantation (r = -0.235 p = 0.048).
CONCLUSIONS: UKM Cochlear Implant Program has achieved reasonable success among the pediatric implantees, with better outcomes seen in those implanted at the age of less than 4 years old.
Fulltext Tracheal cartilaginous sleeve in Pfeiffer syndrome: lesson learnt from its rarity

Mahmud N, Abdul Latif H, Mohd Zaki F, Goh BS

BMJ Case Rep, 2021 Apr 02;14(4).
PMID: 33811090 DOI: 10.1136/bcr-2020-236888

Pfeiffer syndrome is a rare inherited craniofacial disorder. Upper airway obstruction is common among patients with Pfeiffer syndrome due to craniosynostosis. They may also present with lower respiratory tract obstruction due to a rare congenital airway malformation called tracheal cartilaginous sleeve (TCS). We report the case of a patient with Pfeiffer syndrome who presented with recurrent bronchopneumonia, discovered incidentally to have TCS via direct visualisation during tracheostomy. Relevant literature for this rare clinical condition are reviewed and discussed. Clinicians should be aware of TCS when encountering patients with craniosynostosis who present with recurrent lower respiratory tract infections. Careful and meticulous investigations should be performed to look for TCS, especially in patients with craniosynostosis.
Fulltext Isolated blunt lingual artery injury secondary to a road traffic accident: diagnostic and therapeutic approach

Mawaddah A, Goh BS, Kew TY, Rozman Z

Malays J Med Sci, 2012 Apr;19(2):77-81.
PMID: 22973141 MyJurnal

Neurologic and airway compromise as a result of traumatic vascular injuries to the neck region often lead to more severe complications and thus require special consideration. Furthermore, these cases pose diagnostic and therapeutic challenges to healthcare providers. Here, we report a case of a 28-year-old motorcyclist presenting with progressively enlarged Zone 2 neck swelling on the left side following a high impact collision. There were no symptoms or signs suggesting neurologic or laryngeal injury. Computed tomography angiogram of the neck revealed signs of an active arterial bleed. The apparent vascular injury was managed by close observation for signs of airway compromise, urgent angiogram, and selective catheter embolisation of the left lingual artery. The patient subsequently recovered without further operative exploration of the neck. At 6 months post-trauma, the neck swelling fully subsided with no complications from angioembolisation. This case illustrates the individualised treatment and multidisciplinary approach in managing such cases. We review our rationale for this diagnostic and therapeutic approach.

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