The 9th Malaysian International Otorhinolaryngology – Head and Neck Surgery Congress is an annual local event to update latest knowledge in the field of otorhinolaryngology (ORL). It provides a platform for local and international participants to exchange information through various symposia, plenary sessions and panel discussions. Today at this event, the Ministry of Health launched the Clinical Practice Guidelines (CPGs) on Management of Rhinosinusitis in Adolescents and Adults, and Management of Nasopharyngeal Carcinoma.
Two commonly encountered ORL conditions are rhinosinusitis and nasopharyngeal carcinoma. They are being suspected/diagnosed, treated and follow-up in primary and secondary/tertiary health care in Malaysia.
Rhinosinusitis is a common health problem. The reported prevalances of both acute and chronic rhinosinusits worldwide range between 2 to 15%. Important risk factors for this ORL condition are exposure to cigarette smoke, positive family history, asthma and gastroesophageal reflux disease.
Although it is a common illness, rhinosinusitis presents a number of diagnostic and management challenges to the practicing clinicians. Thus, making a clinical diagnosis based on well-accepted criteria should be emphasised in order for appropriate treatment to be instituted. In primary care, anterior rhinoscopy is recommended as part of clinical assessment while nasal endoscopy must be performed in an ORL centre. Intranasal corticosteroids and nasal saline irrigation are the mainstay treatment. On the other hand, surgery is indicated in cases such as orbital/intracranial complications and failure of medical treatment.
On another note, nasopharyngeal carcinoma (NPC) is the fourth most common cancer in Malaysia. It is predominant among Chinese, followed by natives of Sabah and Sarawak (especially Bidayuh). Tobacco smoking is one of the important risk factors for the cancer.
NPC is usually diagnosed late due to trivial presentation of painless neck lump, blood-stained saliva or nasal secretion and unilateral mild ear block. This may lead to poor survival outcome. The optimal management of NPC involves a multidisciplinary team with the main challenge include early diagnosis to prompt access for treatment. The primary treatment for NPC is radiotherapy in which intensity modulated radiotherapy is the preferred radiation technique due to less side effects it has. For those with intermediate or advanced disease, the aim is to minimise treatment side effects without compromising the outcome.
The MOH hopes that this national evidence-based CPG will be well utilised by healthcare providers in the public and private sectors in their daily clinical practice in handling and managing the two clinical conditions.
DATUK DR. NOOR HISHAM ABDULLAH
DIRECTOR GENERAL OF HEALTH MALAYSIA
4th May 2017