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We studied the ethmoidal arteries using preexisting computer tomography of the paranasal sinuses (CT PNS) and statistically scrutinized data obtained between genders. A descriptive study from 77 CT PNS dated January 2016–December 2016 were collected and reviewed by two radiologists. A total of 54 (108 sides) CT PNS were studied of patients aged 18–77 years. 37 are male, 17 are female; with Bumiputera Sarawak predominance of 25 patients, 12 Malays, 16 Chinese and one Indian. Rate of identification are as follows: anterior ethmoidal artery (AEA)-100%, middle ethmoidal artery (MEA)-30%, posterior ethmoidal artery (PEA)-86%. The average distance from AEA–MEA is 8.1 ± 1.52 mm, MEA–PEA is 5.5 ± 1.29 mm and AEA–PEA is 12.9 ± 1.27 mm. The mean distance from PEA-the anterior wall of sphenoid is 7.7 ± 3.96 mm, and PEA-optic canal is 8.5 ± 3.1 mm with no statistical difference when compared between gender. AEA frequently presented with a long mesentery 57.4%, while 87.1% of PEA was hidden in a bony canal. The vertical distance of the AEA-skull base ranges from 0 to 12.5 mm whilst PEA-skull base is 0–4.7 mm. There is no statistical difference in distances of AEA, MEA nor PEA to skull base when analyzed between genders; t(82) = 1.663, p > 0.05, t(32) = 0.403, p > 0.05 and t(75) = 1.333, p > 0.05 respectively. We newly discovered, that 50% of MEA is hidden in a bony canal, and its distance to skull base ranged 0–5.3 mm. MEA and PEA less commonly have a short or long mesentery. Knowledge on the ethmoidal arteries especially in our unstudied population of diverse ethnicity, gains to assist surgeons worldwide, when embarking in endoscopic transnasal surgeries.

Introduction: There are a few studies that compare the outcomes between primary and revision tympanoplasties. The purpose of the present study was to compare the results of type I tympanoplasty (i.e., synonymous to myringoplasty) and revision myringoplasty based on the closure of tympanic membrane perforation and hearing improvement. Materials and Methods: This prospective single-blind study was carried out on a total of 240 patients with tympanic membrane perforation at a tertiary referral center. The subjects underwent primary or revision myringoplasty. Grafting success rate and hearing results were measured and the comparison between the primary and revision groups was drawn. Results: Grafting success rate was reported as 96.6% (112 out of 116 cases) for myringoplasty, while in revision myringoplasty the success rate of 78.2% (97 out of 124 patients) was achieved (P=0.001). Speech reception threshold was 23.1±9.2 dB and 24.9±13.1 dB in the primary and revision groups, respectively (P>0.05). However, the percentage of air-bone gap on audiometry≤20 dB were 83.8% and 76% in the primary and revision groups, respectively (P=0.26). Conclusion: The findings of the present study have shown that although grafting success was reported significantly better in myringoplasty (tympanoplasty type 1), compared to that in revision myringoplasty, it did not reveal any superiority over revision tympanoplasty regarding the hearing outcomes. No consensus was achieved due to a great number of controversies in the literature.

Ortner’s syndrome is rare syndrome characterised by hoarseness of voice due to recurrent laryngeal nerve involvement in cardiovascular disease.

BACKGROUND Baro-otalgia is a common complaint among passengers in an aircraft, in particular those who had a recent upper respiratory tract infection. The underlying pathophysiology is secondary to unequal aeration of the middle ear cleft with the surrounding atmosphere and it can be explained using Boyle's Law. We describe an unusual presentation of baro-otalgia in a pilot secondary to cholesteatoma obstructing the aditus despite normal middle ear pressure equalization provided by a grommet in the ear. CASE REPORT A 26-yr-old pilot with a presenting complaint of conductive hearing loss was diagnosed and treated for congenital cholesteatoma. His hearing improved, but 4 yr later he developed ear pain during the cruising phase of flight at an altitude of 9144 m (30,000 ft) above sea level. This pain persisted until descent to 4876 m (16,000 ft). Despite insertion of a middle ear ventilating tube, he remained symptomatic, requiring further investigation. This led to the diagnosis of recurrent cholesteatoma obstructing the aditus to the mastoid cavity. Upon surgical removal of the cholesteatoma, symptoms resolved. DISCUSSION We hypothesize that the recurrent cholesteatoma caused obstruction to normal aeration of the mastoid air cells during the changing atmospheric air pressure, thus producing pain. This is akin to sinus barotrauma instead of the usual pathophysiology underlying barotitis.Govindaraju R, Adaikappan M, Rajagopalan R. Baro-otolagia secondary to cholesteatoma. Aerosp Med Hum Perform. 2017; 88(1):65-67.

High acoustic noise level is one of the unavoidable side effects of 3 T magnetic resonance imaging (MRI). A case of hearing loss after 3 T MRI has been reported in this institution and hence this study. The objective of this study was to determine whether temporary threshold shift (TTS) in high frequency hearing occurs in patients undergoing 3 T MRI scans of the head and neck. A total of 35 patients undergoing head and neck 3 T MRI for various clinical indications were tested with pure tone audiometry in different frequencies including high frequencies, before and after the MRI scan. Any threshold change from the recorded baseline of 10 dB was considered significant. All patients were fitted with foamed 3 M earplugs before the procedure following the safety guidelines for 3 T MRI. The mean time for MRI procedure was 1,672 s (range 1,040-2,810). The noise dose received by each patient amounted to an average of 3,906.29% (1,415-9,170%). The noise dose was derived from a normograph used by Occupational Noise Surveys. This was calculated using the nomograph of L eq, L EX, noise dose and time. There was no statistically significant difference between the hearing threshold before and after the MRI procedures for all the frequencies (paired t test, P > 0.05). For patients using 3 M foamed earplugs, noise level generated by 3 T MRI during routine clinical sequence did not cause any TTS in high frequency hearing.

Aim: The aim of this study is to determine the presence of fungi in the human external ear. Materials and Methods: A total of 84 specimens of skin scraping were taken from the external ear canals of 46 randomly selected adult ears with their consent. Patients were 15 males and 31 females, with a mean age of 51 years (22 years to 86 years). Of these, 38 patients were from both the ears, and 4 each from right or left ear, respectively, making it a total of 84. These samples were sent to the microbiology laboratory for potassium hydroxide staining for fungal elements and then cultured in sabouraud dextrose agar with olive oil. If fungus was detected on the agar after 2–4 weeks of incubation, the type of fungus was read and verified by a microbiologist. Results: Forty specimens were positive (47.6%) and 44 were negative for fungal culture. The positive culture was Malassezia furfur in 31 (77.5%) and other fungi (Candida albicans 1, Candida parapsilosis 6 and Aspergillus species 2) in 9 (22.5%). Conclusion: There are fungi as commensals in the external human ear, M. Furfur is the most common fungus.

Nontuberculous Mycobacterium (NTM) middle ear infection is a rare cause of chronic bilateral intermittent otorrhea. We report a rare case of bilateral NTM middle ear infection in which a 55-year-old woman presented with intermittent otorrhea of 40 years' duration. The patient was treated medically with success. We conclude that NTM is a rare but probably under-recognized cause of chronic otitis media. A high index of suspicion is needed for the diagnosis to avoid prolonged morbidity. Treatment includes surgical clearance of infected tissue with appropriate antimycobacterial drugs, which are selected based on culture and sensitivity.

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.

To assess the ability of honey to reduce pain and promote epithelialization on posttonsillectomy wounds. Materials and methods: A prospective randomized control study was conducted on 60 patients undergoing tonsillectomy from November 2007 to September 2008 at University Malaya Medical Centre. The test group received honey application on the tonsillar bed and the control group had placebo applied. The pain relief was analyzed along with the amount of analgesia consumed, and wound epithelialization was monitored and recorded accordingly. Results: Twenty-one patients from each group were finally analyzed after excluding patients that did not complete the study or fit the criteria. Pain relief and wound epithelialization were observed to be better in the honey-treated group compared to the placebo group. However, the difference was not statistically significant. Conclusion: This study shows that the rate of pain relief and early return to work and school were faster in both groups when compared to the current practice. However, there was no statistical significance seen in either the honey or placebo groups in terms of pain relief and wound epithelization, which could be due to improper choice of placebo. The potential use of honey in wound healing and pain relief should be further explored with more studies.

The saying ‘a picture is worth a thousand words’ exemplifies the great value of pictures in describing a scenario. Pictures convey spatial information in a compact form, allowing textual descriptions to concentrate on the non-spatial (henceforth, contextual) properties of objects. The difficult task in integrating text and diagrammatic input to a system is to establish coreference — matching object references in the text to objects in the diagram.

Mechanical explanation for the hyperacousis that sometimes occurs after stapedectomy or stapedotomy is presented.

The higher field strength magnetic resonance imaging (MRI) such as 3 Tesla (T) and above generates noise that has potential detrimental effects on the hearing. Temporary threshold shifts following MRI examination have been reported for MRI with lower field strength. Such effect, however, have not been reported so far for a 3T MRI. We report a case that exemplifies the possible detrimental effects of a 3 T MRI generated noise on the auditory system. Our patient underwent investigation of his chronic backache in a 3 T MRI unit and developed hearing loss and tinnitus post-MRI examination. Hearing assessment was done using pure tone audiogram, distortion product otoacoustic emission (DPOAE) and brainstem electrical response audiometry (BERA) which revealed a unilateral sensorineural hearing loss which recovered within 3 days. However the tinnitus persisted. This is possibly a case of temporary threshold shift following noise exposure. However a sudden sensorineural hearing loss remains the other possibility.

We report a rare case of laryngotracheal anomaly and its possible etiology and mode of presentation. A teenager presented with voice change and a neck lump. Investigations revealed a laryngeal anomaly in which the larynx was hyperdescended. It was accompanied by low lying thyroid gland and hyoid bone together with an absence of a cervical segment of the esophagus and trachea. The anomaly only became noticeable secondary to pubertal changes in the thyroid cartilage of the teenager. An embryological defect during the formation of the laryngotracheal tube and esophagus is a possible explanation of this anomaly. The present case probably represents the third reported of its kind.

✓Xanthoma formation is frequently seen over the subcutaneous tissue of extensor surfaces and tendons that have received minor trauma or friction in patients with hypercholesterolemia. However, temporal bone xanthomas with intracranial extension are uncommon. To the best of the authors' knowledge, this is the second report in the literature in which bilateral extension of a xanthoma is described. Xanthomas of the temporal bone are benign lesions, and complete or even partial removal is effective. The predisposing cause of the lesion should also be treated.

Metastases to the larynx from distant primaries are rare. We report a case of a laryngeal metastasis from a rectal carcinoma.

Radiotherapy is the accepted treatment for early laryngeal carcinomas with the advantage of voice preservation. It is however, not without complications. We report a case of bilateral vocal cord immobility 15 years after radiotherapy. This appears to be due to ankylosis of cricoarytenoid joint and fibrosis of the larynx.

Describes an ongoing project to develop a theory of qualitative spatial reasoning which merges a simple, intuitive description of the spatial extent, relative position, and orientation of objects with existing methods for qualitative reasoning about dynamically changing worlds. We are applying our theories within a system for problem solving about the magnetic fields domain. We describe methods for integrating diagram and test input to a problem solver, methods of abstraction for modeling the spatial extents of objects, and a method for modeling spatial relations between objects through inequalities on extremal points which directly allows reasoning about the effects of translational motion. >

We performed 15 cases of dacryocystorhinostomy endoscopically with an 86% success rate. Using a Hangman's knot, the bypass tubes were placed in a secure and lasting way.