bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravascular Lymphoma of the Inferior Turbinate: An Unusual Rhinologic Presentation of a Rare Neoplasm
Authors: Lingan Milabelle B. , Roasa Francis V.
Published: April 2019

Objective: To present a unique case of intravascular lymphoma of the inferior turbinate because of its rarity, unusual clinical presentation and difficulty in establishing a diagnosis.

Design:      Case Report

Setting:      A tertiary hospital

Patient:      A 66-year-old male admitted to the hospital due to intermittent high grade fever of six months duration.

Result:  The patient presented with fever of unknown origin, and exhaustive laboratory, ancillary procedures and biopsies to rule in/out infectious, autoimmune and oncologic causes were performed to arrive at a diagnosis. Nasal endoscopy revealed an enlarged, hypertrophied and violaceous right inferior turbinate with watery to mucoid discharge and septal deviation to the right confirmed by CT scans of the paranasal sinuses. Functional Endoscopic Sinus Surgery (FESS), septoplasty and turbinoplasty with biopsy revealed Intravascular Lymphoma. Chemotherapy was deferred due to the deteriorating medical condition and the patient expired 7 months after the initial onset of symptoms.

Conclusion:  Patients who present with fever of unknown origin should undergo a thorough otorhinolaryngologic examination to exclude primary ENT conditions and ensure proper management. Given its rarity and multiplicity of presentation, it is extremely difficult to make a diagnosis of intravascular lymphoma. A high index of suspicion of Intravascular Lymphoma is necessary so that timely acquisition of tissue biopsy of any lesion involved will make a definite diagnosis.

Keywords: Intravascular lymphoma, Fever, Fever of Unknown Origin
Total Parathyroidectomy: A Surgical Management for Uncontrolled Secondary Hyperparathyroidism in a Patient with End Stage Renal Disease
Authors: Madrid Jeanne O. , Ureta Celso V.
Published: April 2019

Objective:  To present the case of an adult patient with end stage renal disease who underwent total parathyroidectomy with autotransplantation for uncontrolled secondary hyperparathyroidism

Methods:

Design: Case Report

Setting: Tertiary Hospital

Patient: One

Result: Total parathyroidectomy with autotransplantation resulted in decrease in parathyroid hormone from a pre-operative value of 1,347pg/mL (15-65 pg/mL) to 28.05 pg/mL.  Pruritus disappeared two days after the surgery.  Phosphorus and calcium levels were within normal values four days and two months post-operatively, respectively. 

Conclusion: Total parathyroidectomy with autotransplantation may be a viable surgical option for controlling secondary hyperparathyroidism associated with end stage renal disease and may play an important role in reducing morbidity and mortality among patients with end-stage renal disease.

Keywords: Secondary hyperparathyroidism, parathyroidectomy, autotransplantation, end- stage renal disease, hungry bone syndrome, parathyroid hormone
A 41-year-old Female Presenting with Sicca Syndrome
Authors: Tan Laurence Ian , Lapeña José Florencio F.
Published: April 2019

Objective: To describe a case of Sicca syndrome, review the literature on and discuss the diagnostic criteria for Sjögren Syndrome.

Methods:

Design: Case report

Setting: Private Clinic 

Patients: One

Results: A 41-year-old female presenting with throat dryness, dry eyes, bilateral parotid enlargement, vaginal dryness and multiple joint pains previously seen by four specialists over three decades was finally diagnosed with Sjögren syndrome.

Conclusion:  Sjögren syndrome presents uncommonly. As the presentation and clinical course should be taken as a whole, and no single test can be considered as a gold standard for its diagnosis, the disease entity may actually be under diagnosed, misdiagnosed or frequently present as diagnostic dilemmas. A comprehensive history and physical examination beyond the usual focus of the otorhinolaryngologic evaluation is the key for the astute clinician. Our experience may indicate a need for further evaluation of the EU revised criteria for Sjögren syndrome classification in the local setting.

 

Keywords: sicca syndrome, sjogren syndrome, keratoconjunctivitis sicca, stomatitis sicca, xerostomia, dysparenuia
A Preliminary Study on the Efficacy of Plumeria acuminata (Kalachuchi) Bark Extract Ointment versus Clotrimazole Cream in the Treatment of Otomycosis
Authors: Boncalon Rhoda Mae V. , Arugay Marida Arend V. , Ramos Rachel Zita H.
Published: April 2019

Objective:  To compare the therapeutic efficacy of kalachuchi (Plumeria acuminata Ait.) bark extract ointment (KO) and clotrimazole cream 1% (CC) in the treatment of otomycosis.

Methods:

Design:  Randomized double blind controlled trial

Setting: Outpatient otorhinolaryngology clinic of a tertiary private hospital

Subjects: Patients aged 18-years-old and above diagnosed clinically to have otomycosis with a positive potassium hydroxide (KOH) smear were randomly assigned to kalachuchi (Plumeria acuminata Ait.) bark extract ointment or clotrimazole cream 1% in unlabeled containers.  Self-application thrice daily for two weeks followed initial detailed instructions and demonstration. Symptoms, physical findings and repeat KOH smears were recorded after the first and second weeks of treatment.

Results:  Eighteen patients with otomycosis were enrolled in the study.  There was one  dropout per treatment group with no intention to treat. There were no statistically significant differences between KO and CC, with 75% (n=8) and 87.5% (n=8) cure rates, respectively.  One subject in the KO arm reported severe ear pain.

Conclusion: Kalachuchi extract ointment may be a promising topical antifungal agent. Multicenter clinical trials to establish its efficacy and safety as an effective alternative in the management of otomycosis should be conducted.

Key words: Otomycosis, kalachuchi, Plumeria acuminata Ait., clotrimazole, clinical trial, herbal medicine
Videostroboscopic Evaluation of Neoglottis in Alaryngeal Patients after Tracheoesophageal Voice Reconstruction without Prosthesis
Authors: Madrid Jeanne O. , Ureta Celso V.
Published: April 2019

Objective:  To investigate by means of videostoboscopy the characteristics of the neoglottis after total laryngectomy with primary or secondary voice reconstruction using a non-prosthetic tracheoesophageal fistula technique

Methods:       

Design: Cross-Sectional Study

Setting: Tertiary Public Hospital       

Subjects: Twenty alaryngeal patients

Results:  Videostroboscopy enabled evaluation of the neoglottis in all but two patients with a pectoralis major myocutaneous flap reconstruction of the pharyngoesophageal segment. Pooling of saliva was present in the cranial neoglottic opening in all subjects, but obscured visualization in these two. A circular neoglottic shape was most commonly seen.  Vibration of the neoglottis was noted in 90% of all alaryngeal patients and was associated with a regular mucosal wave.  Pharyngoesophageal vibration was noted in two thirds of patients.  It was associated with a strong mucosal wave, regular vibration and a longer open phase.

Conclusion: Videostroboscopy confirmed that neoglottic vibration accompanies sound production while pharyngoesophageal vibration may reinforce and enhance voice production in alaryngeal patients with non-prosthetic TE voice reconstruction. 

 

Keywords:  larynx, total laryngectomy, voice reconstruction, tracheoesophageal (te) fistula speech, alaryngeal voice, alaryngeal speech, videostrobe
Extranasopharyngeal Angiofibroma of the Larynx
Authors: Trinidad Connie Angel J. , David Michael Joseph C. , Chua Antonio H.
Published: April 2019

Objective: To present a rare case of laryngeal extranasopharyngeal angiofibroma, discussing its diagnosis, treatment and differences from the more typical juvenile angiofibroma.

           

Methods:

Design: Case Report

Setting: Tertiary Government Hospital

Patient: One

 

Result: A 51-year-old male with a two-year history of hoarseness developed difficulty of breathing. Direct laryngoscopy showed a 2x2x1cm glistening, multinodular, pedunculated, firm, pink mass attached to the posterior half of the right true vocal fold obstructing the glottic opening and extending superiorly to the ventricle. Microlaryngeal excision was done. Histopathology showing numerous vascular channels surrounded by dense paucicellular fibrous tissue was consistent with angiofibroma. 

Conclusion: Primary extranasopharyngeal angiofibroma is rare, with only 4 previously reported cases occurring in the larynx. We presented what may possibly be the first locally reported case. Although histopathologically similar to the more common juvenile nasopharyngeal angiofibroma, this was atypically seen in the larynx of an older adult patient. Direct laryngoscopy provided excellent exposure for identification as well as complete surgical resection. Unlike the nasopharyngeal type, no massive bleeding was encountered. Prognosis for this extranasopharyngeal angiofibroma is excellent as recurrence is noted to be rare, however, long term follow-up is recommended.

Keywords: extranasopharyngeal angiofibroma, laryngeal angiofibroma
Postoperative Wound Complications in Modified Meatoplasty vs Z- Meatoplasty in Canal Wall Down Mastoidectomy at a Tertiary Hospital: A Randomized Controlled Trial
Authors: Gumban Ma. Theresa L. , Almazan Natividad A.
Published: April 2019

Objective: To compare the postoperative complications (narrowing of the enlarged canal and perichondritis) of a meatoplasty without conchal cartilage removal and more raw skin area (modified meatoplasty) versus a meatoplasty with conchal cartilage removal and less raw skin area (Z meatoplasty) including other sequelae (hyperemia, formation of granulation tissue and discharge from the cavity) which may lead to complications in canal wall down post-auricular mastoidectomy.

Methods:

Design:    Concealed, randomized controlled clinical trial

Setting:    Tertiary Public Hospital  

Patients: Twenty-one ears of 19 patients with chronic suppurative otitis media (CSOM) undergoing postauricular open mastoidectomy (radical or modified radical mastoidectomy) between February to July 2009 were randomly assigned to undergo modified meatoplasty (Group A: n=11 ) and  Z meatoplasty (Group B:n=10). Main outcome measures were postoperative rates of meatoplasty complications and mastoidectomy sequelae that may lead to complications, on weeks 1, 2 and 4.

Results: On the 1st postoperative week, the Z meatoplasty was associated with a higher incidence of hyperemia at the incision site [A: 36.4%, B: 90% (p <0.02)]. The specific complication of perichondritis or other sequelae (discharge from the cavity, granulation tissue) or were no different in both types of meatoplasty. On the second postoperative week, the modified meatoplasty was associated with a higher incidence of narrowing of the canal (73% vs 20%) P<0.02; [RR = 3.64 (CI:1.00,13.23)]  The only factor associated with this complication was  the modified meatoplasty procedure itself [RR = 3.64 (CI: 1.00, 13.23)]. Perichondritis, and the sequelae of mastoidectomy (discharge from the cavity, granulation tissue) were no different in both types of meatoplasty.

Conclusion: Among CSOM patients who underwent postauricular open mastoidectomy, the Z meatoplasty was associated with a greater risk of hyperemia at the incision site than the modified meatoplasty in the 1st    operative week. Compared to the Z meatoplasty, the modified meatoplasty was associated with greater risk of narrowing of the canal on the 2nd postoperative week.  

Keywords: meatoplasty; mastoidectomy; complications
Cervical Vagal Schwannoma
Authors: Yong Doh Jeing , Hailani Iskandar , Yunus Mohd Razif bin Mohamad
Published: April 2019

Objective: To present a case of cervical vagal schwannoma and describe our experience with the clinical presentation, surgical management and outcome of an elderly patient with this pathology.

Methods:

Design: Case Report

Setting: Tertiary Public Hospital

Patients: One

Result: A 65-year-old lady presented with a recently enlarging, pulsatile right sided neck mass that had been asymptomatic for 15 years. Contrast CT revealed a circumscribed non-enhancing heterogenous 4 x 4 x 7 cm mass splaying the right internal jugular vein and common carotid artery. A neurogenic tumour was considered, and the mass was excised from the vagus nerve with preservation of adjacent structures. Final histopathologic reading was schwannoma. However, the patient succumbed to complications following a second surgery for expanding hematoma.

Conclusion: Schwannomas are benign, slow growing tumours that arise from Schwann cells of the nerve sheath. Cervical schwannomas originating from the vagus nerve are rare, but should be considered in patients presenting with solitary neck masses. Surgical extirpation is still the treatment of choice for nerve sheath tumours and recurrence is uncommon.  Efforts should be made to preserve unaffected structures and patients should be counseled preoperatively on the possible high risk of morbidity especially in the elderly group where close follow up and aggressive rehabilitation should be instituted following surgery.

 

Keywords: Cervical schwannoma, vagus nerve, neurogenic tumour; parapharyngeal space
Accuracy of Siemens HearCheck™ Navigator as a Screening Tool for Hearing Loss
Authors: Abes Generoso T. , Reyes-Quintos Ma. Rina T. , Tantoco Ma. Leah S.
Published: April 2019

Objective: To calculate the accuracy, sensitivity, specificity and positive predictive values of the Siemens HearCheck™ Navigator in detecting hearing loss and to compare values of these parameters when the examination is done in a soundproof booth and in a quiet room.

 

Methods:

Design: Analytical, cross-sectional study

Setting: Tertiary Public University Hospital

Patients: Patients seen at the Ear Unit of a tertiary public university hospital from June 2009 to August 2010 were tested using the Siemens HearCheck™ Navigator and pure tone audiometry, inside a soundproof audiometry booth and in a quiet room with an ambient noise of 50dB, with a different investigator for each examination. Each ear was treated as a separate subject. Results obtained from the HearCheck™ Navigator were designated as observed values and were classified as “no hearing loss” for green light, and “with hearing loss” for yellow or red lights. Results were compared with pure tone air conduction averages designated as gold standard values. Normal hearing acuity (0-25 dB) was classified as no hearing loss. Pure tone air conduction averages of 26dB and above were classified as “with hearing loss” and were further stratified as mild hearing loss (26-40dB) and moderate or worse hearing loss (>41 dB). Observed and gold standard values were compared and tabulated in a 2x2 table for all levels of hearing loss, mild hearing loss, and moderate or worse hearing loss. Accuracy, sensitivity, specificity, positive and negative predictive values of the Siemens HearCheck™ Navigator inside a soundproof audiometry booth and in a quiet room were determined using pure tone audiometry as the gold standard.

 

Results: 100 patients (200 ears) were tested, with a median age of 43 years old (range 15-75), and an almost equal number of male and female participants (52 males, 48 females). Accuracy rate of the Siemens HearCheck™ Navigator inside the soundproof audiometry booth and in a quiet room were 82.5% and 84% respectively for all levels of hearing loss. Sensitivity, specificity, positive and negative predictive values were similar whether the examination was done inside the soundproof audiometry booth or in a quiet room. These values were notably higher in patients with moderate or worse hearing loss compared to patients with mild hearing loss.

 

Conclusion: The Siemens HearCheck™ Navigator shows potential as an accurate, portable, easy-to-use tool to screen for hearing loss, especially for cases of moderate or worse hearing loss, without the need for soundproof audiometry booths or special training. It is recommended that further studies be done to differentiate degrees of hearing loss, and to evaluate its usefulness in other target populations, including school children and the elderly.

 

Keywords: hearing screening, hearing screening tool, accuracy, hearingloss, HearCheck™ Navigator
Audiological Manifestations in Kabuki (Niikawa-Kuroki) Syndrome
Authors: Tobias Celina Ann M. , Gloria-Cruz Teresa Luisa , Chiong Charlotte M.
Published: April 2019

Objective: To describe the audiological profile, clinical features and briefly summarize the speech and language development of a child with Kabuki syndrome (KS). KS is a rare malformation syndrome that usually presents with mental retardation and multiple congenital anomalies including ear diseases and hearing loss.

 

Methods:

Design: Case report

Setting: Tertiary Public University Hospital

Subject: One patient

 

Results: A five-year-old female diagnosed with KS at age three presented with moderate to severe conductive hearing loss in the right ear with a drop at the high frequencies and moderate to severe conductive sloping hearing loss in the left ear. She also had fluctuating tympanometric findings. She was fit with binaural hearing aids.

 

Conclusion: Ear diseases and hearing loss should immediately be considered in patients diagnosed with KS. A comprehensive audiological and otolaryngological evaluation should also be performed when presented with a KS case.

 

Keywords: Kabuki syndrome, Niikawa-Kuroki syndrome, hearing loss, multiple anomalies
Complete Dislocation of the Lens of the Eye - Always Review the Complete Study
Authors: Bickle Ian C.
Published: April 2019

This 37 year-old male patient underwent high resolution CT imaging of the face including paranasal sinuses following trauma. Computed tomography (CT) has a well-established role in the assessment of the facial bones in the context of trauma, in particular for fractures involving the paranasal sinuses and orbit. High resolution imaging permits isotropic reconstruction in multiple planes. Its use in imaging the contents of orbit itself is more select, with both direct clinical examination and even orbital ultrasound used to assess the globe and lens of the eye.1

Traumatic dislocation of the lens of the eye may entail the partial or complete translocation of the lens from its normal position within the anterior aspect of the eye.2 The high attenuation lens ‘floats’, within the vitreous of the globe (Figures 1, 2 and 3).

Following trauma to the face the injuries may be multiple and cross sub-speciality boundaries, but one should be alert to all injuries. In reviewing CT images one should be forensic in the review of all the anatomy covered, even it is not related to the original clinical query or not pertinent to one’s own clinical speciality.

As an old mentor once told me, ‘Before you take the film down, have one last paranoid look.’

Learning Point: Always review the entirety of the imaging performed

despite the focus of one’s clinical or speciality interest.
The Recurrent Laryngeal Nerve in Relation to the Inferior Thyroid Artery in Adult Filipino Cadavers
Authors: Matubis Jacob S. , Dumlao Karen June P. , Carrillo Ryner Jose C.
Published: April 2019

Objective: To describe the anatomic relationship of the recurrent laryngeal nerve and the inferior thyroid artery in adult cadavers in the Philippines and to compare the proportions of these anatomic relationships with those reported in the foreign literature.

Methods:

Study design: Descriptive, cross-sectional

Setting: University of the Philippines College of Medicine Anatomy Laboratory

Subjects: Fifty-four (54)  preserved cadavers (108 sides) dissected within a period from June 2008 to Aug 2010. The anatomy and position of both  the right and the left recurrent laryngeal nerves (RLN) and inferior thyroid arteries (ITA) were noted. The RLN was further classified into 2 variations: non-branching or branching prior to insertion at the cricothyroid joint, under the inferior constrictor muscle.  The ITA was also classified into non-branching and branching.  The results were compared to two foreign studies using a Z-test for two proportions.

Results: Fifty four (54) cadavers (108) sides were dissected. Among the  cadavers, both the recurrent laryngeal nerves and inferior thyroid arteries had a maximum of two branches although both the RLNs and ITAs for both the right and left sides were mostly non-branching. The right side of one cadaver was noted to have both a branching RLN and a branching ITA. There were no non-recurrent laryngeal nerves seen among the 54 cadavers.

For both left and right sides, the RLN was mostly dorsal to the ITA. Branching RLNs was mostly dorsal to a non-branching ITAs. Most of the non-branching RLNs were dorsal to the ITAs. Non-branching RLNs were usually dorsal to the ITA.

 

            The local patterns of the course of the RLN in relation to the ITA approximates those of Chinese where there is predominance of the RLN dorsal to the ITA  but differs from those of Brazilians where the RLN is usually between ITA branches. 

 

Conclusion: There are multiple anatomical variations with regards to the relationship of the RLN and the ITA. The anatomic variation among Asians may be different from Brazilians. The surgeon’s knowledge of the possible various configurations of the RLN and ITA should be able to help in identification and preservation of the RLN and prevention of complications in thyroid surgery.

Keywords: recurrent laryngeal nerve, inferior thyroid  artery, thyroid surgery, Filipino cadavers, anatomical variations
Hoarseness Due to Cardiovascular Disease: Two Cases of Cardiovocal Syndrome
Authors: Anuar Khairullah , Baki Marina Mat , Sani Abdullah , Sabir Husin Athar Primuharsa Putra
Published: April 2019

Objective: To report two cases of Cardiovocal syndrome (or Ortner’s syndrome) due to cardiovascular disease.

Methods:

Study Design: Case Report

Setting: Tertiary University Hospital

Subjects: Two

Results: Two patients with cardiovocal syndrome, one due to an aortic saccular aneurysm and the other due to severe mitral stenosis underwent surgery to correct the underlying cardiovascular disease. Post-operatively, the hoarseness resolved completely in the patient with mitral stenosis but persisted in the patient with aortic saccular aneurysm.

Conclusion: Cardivascular disease should be considered as a differential diagnosis in a patient with hoarseness. A high index of suspicion is needed to make an early diagnosis, which can lead to surgical correction of the potentially life-threatening, underlying cardiovascular disease.

Keywords: Cardiovocal hoarseness, Ortner’s syndrome, cardiovascular disease, aortic aneurysm, mitral stenosis
Accuracy of Reflexive Behavioral (“Baah”) Test in the Screening for Hearing Impairment in Infants Six Months Old and Below
Authors: Garcia Marieflor Cristy M. , Chiong Charlotte M. , Abes Generoso T. , Carrillo Ryner Jose C.
Published: April 2019

Objective: To determine the prevalence of hearing loss among infants six months old and below sent for newborn hearing screening in our institution, and to measure the accuracy, sensitivity, specificity and positive predictive values of reflexive behavioral (“Baah”) test in detecting hearing loss in infants.Methods:     Design: Cross-sectional study     Setting: Ear Unit of a tertiary government hospital     Participants: Infants less than Six months old sent for newborn hearing screening at the Ear Unit of a tertiary government hospital from April to September, 2011 were recruited. All participants were tested with OAE for hearing screening. OAE was also used as the standard for evaluating hearing impairment. The reflexive behavioral (“Baah”) test was then done using the human voice as a loud sound stimulus, and the response recorded were auropalpebral, startle and blinking response to the sound. Thesensitivity, specificity, accuracy, positive and negative predictive value of the test was then measured.Results: From April to September 2011, a total of 101 patients were tested, with a male to female ratio of 1.1:1 (53 males, 48 females). The prevalence of hearing impairment in this study population was 6.9% (7 out of 101). The reflexive behavioral (“Baah”) test was found to have sensitivity of 71.4%, specificity of 95.7%, accuracy rate of 94%, positive predictive value of 55.6% and negative predictive value of 97.8%.Conclusion: The reflexive behavioral (“Baah”) test shows potential as an accurate, acceptable and cost-effective screening tool to identify infants that may be at higher risk for hearing impairment. This test may aid the health care providers, in areas without OAEs, in identifying infants who are in need further hearing diagnostic evaluation, with OAEs or other hearing tests. It is recommended that the “Baah” test be implemented in the community to test its reproducibility in a larger population and outside the hospital setting.Keywords: reflexive behavioral test, “Baah” test, otoacoustic emission, hearing screening
Respiratory Epithelial Adenomatoid Hamartoma of the Nasal Septum
Authors: Zulkepli Siti Zulaili , Husain Salina , Gendeh Balwant Singh
Published: April 2019

Objective: Hamartomas are relatively uncommon, non-neoplastic malformations indigenous to the involved anatomic site. Respiratory epithelial adenomatoid hamartoma (REAH) is a subsetof hamartoma characterized by prominent glandular proliferation lined by ciliated epithelium originating from the surface epithelium. Their location in the nasal cavity is rare and when present, mostly associated with the posterior nasal septum. We present such a case arising from the anterior nasal septum.Methods:     Design: Case report     Setting: Tertiary University Referral Center     Patient: OneResults: A 32-year-old lady who presented with a long-standing nasal block was found to have a broad-based nasal mass arising from the left anterior nasal septum. The lesion was histologicallydiagnosed as respiratory epithelial adenomatoid hamartoma following surgical excision.Conclusion: Respiratory epithelial adenomatoid hamartoma although rare must be taken intoconsideration in the differential diagnosis of nasal lesions.Keywords: respiratory epithelial adenomatoid hamartoma; anterior nasal septum; nasal block
Primary Thyroid Lymphoma
Authors: Musngi-Paras Claudine Ann , Salpin Ansarie P. , Veloso Januario D.
Published: April 2019

Eight cases of primary thyroid lymphoma were reported in a tertiary government hospital from January 2005 to August 2011. All patients presented with a diffuse enlargement of both thyroid lobes with associated obstructive symptoms. Five of these cases were extranodal marginal zone lymphoma and three were diffuse large B-cell lymphoma. Clinical features that would favor a thyroid lymphoma include tumor size of greater that 7cm, obstructive symptoms, clinical hypothyroidism or history of Hashimoto thyroiditis. Thus, these features must be considered in evaluating thyroid nodules during fine-needle aspiration biopsy. Histologically, extranodal marginal zone B-cell lymphoma shows vaguely nodular to diffuse infiltrates of small to intermediate size atypical lymphoid cells infiltrating the thyroid follicles, while diffuse large B-cell lymphoma shows sheets of large atypical lymphoid cells infiltrating the thyroid follicular epithelium.

Keywords: Primary Thyroid Lymphoma, Extranodal Marginal Zone B-cell Lymphoma, Diffuse Large B-cell Lymphoma.
Giant Cell Tumor of the Maxilla
Authors: Saha Somnath , Sen Sharmila , Saha V. Padmini , Pal Sudipta
Published: April 2019

Objective: To present a rare case of maxillary swelling; its investigation and management.

 

Methods:

Design: Case Report

 

Setting: Tertiary Rural Private Teaching Hospital

 

Patient: One

 

Results: A 45-year-old female presented with a right maxillary swelling of six months duration. Radiological investigation revealed a radiolucent lesion arising from the inferior aspect of the right maxilla with no areas of calcification. Incisional biopsy report was consistent with giant cell tumor. The mass was excised via a Weber Ferguson incision under general anesthesia.

Conclusion: Though rare, giant cell tumor should be considered as one of the differential diagnosis in cases of maxillary swelling. Adequate surgical excision with long-term follow-up should be the treatment of choice for managing a giant cell lesion of the maxilla.

 

Keywords: maxillary swelling, giant cell tumor
An Improvised Tracheotomy Speaking Valve
Authors: Delovino Kirt Areis E. , Lim William S.
Published: April 2019

Objective: To design and test an improvised tracheotomy speaking valve fabricated from recycled parts of an anesthesia airway breathing circuit.

Methods:

Design: Surgical Instrumentation

Setting: Tertiary Private Hospital

Subjects: Speaking valves fabricated from discarded anesthesia breathing circuit parts were pilot-tested on 3 patients: one with vocal fold paralysis, another with a supraglottic mass and one post hemi-laryngectomy.

Results:  The improvised tracheotomy speaking valve was inexpensive and relatively easy to assemble. All three patients tolerated speech well through the speaking valve and were pleased to reestablish their means of verbal communication. Maximum Phonation Time (MPT) averaged 8 seconds for all three subjects.

Conclusion:  In our local setting, improving the quality of life of tracheotomized patients should be accessible to all, hence the value of an improvised speaking valve. It provides a more affordable means of restoring speech and because it is made from recycled materials, it is eco-friendly. Our improvised speaking valve is also a cheaper but viable alternative to more expensive commercially available ones.  Clinical trials with standardized feedback questionnaires, multi-observer perceptual evaluation with a system such as the GRBAS and/or vocal acoustic measures in a speech laboratory should be made to assess long term use, efficiency and safety measures.

Keywords: tracheotomy, tracheostomy, speaking valve, speaking device
When is a Vestibular Aqueduct Enlarged?
Authors: Yang Nathaniel W.
Published: April 2019

A ten-year-old boy with bilateral moderate sensorineural hearing loss underwent computerized tomographic (CT) imaging (GE Brightspeed, Wisconsin, USA) of the temporal bone as part of the work-up to determine the etiology of his condition. The formal radiologic interpretation of the scan stated that the vestibular aqueducts were not enlarged. However, independent review of the axial CT images appeared to indicate the presence of enlarged vestibular aqueducts. (Figure 1) This can be   contrasted with a scan from another patient with no evidence of sensorineural hearing loss. (Figure 2)

What can explain the discrepancy between the two?

 

If simple visual inspection of the vestibular aqueduct (VA) can lead to conflicting interpretations, then what radiographic parameters can be used to resolve the issue? Is there a more objective means of determining the presence of a clinically significant vestibular aqueduct enlargement?

 

In 1978, Valvasorri and Clemis1 first described an association between congenital sensorineural hearing loss and an abnormality in vestibular aqueduct anatomy which they labelled as the “large vestibular aqueduct syndrome.” In this landmark study that utilized hypocycloidal polytomographic temporal bone studies, they proposed that a vestibular aqueduct is enlarged when its midpoint diameter is greater than 1.5 mm.  Although this parameter is generally considered to be the defining characteristic of the condition, one must realize that this measurement was based on less accurate imaging technology and measurement tools. Contemporary studies utilize high-resolution CT imaging with digital workstation measurement software to evaluate vestibular aqueduct anatomy. Currently, the two most commonly used radiographic parameters are the VA midpoint (MP) width and the VA opercular (OP) width. (Figure 3)

More recently, Boston et al.2 in 2007 published normative values for these parameters based on a study population of 73 children without known sensorineural hearing loss. They considered a vestibular aqueduct enlarged when one or both of the measured widths were above the 95th percentile of the normal study group measurements. On this basis, a VA midpoint width of >0.9 mm and/or a VA opercular width of >1.9 mm was the criteria established to define an enlarged vestibular aqueduct.

 

The patient’s measured vestibular aqueduct midpoint width on the right was 2.1 mm, while the vestibular aqueduct opercular width was 2.9 mm. (Figure 4) These measurements, when evaluated against either the original Valvassori criteria or the newer criteria of Boston et al., confirm what was visually apparent– the presence of a clinically significant enlargement of the vestibular aqueduct as the etiology of the patient’s sensorineural hearing loss.
Spindle Cell Carcinomas of the Upper Aerodigestive Tract
Authors: Carnate Jose M.
Published: April 2019

A 65-year-old male with a two-month history of cough and hoarseness underwent direct laryngoscopy which showed a 1.5 cm diameter polypoid glottic mass. A polypectomy was performed revealing spindle cell carcinoma.

 

The World Health Organization (2005) defines a spindle cell carcinoma as “a biphasic tumor composed of a squamous cell carcinoma, either in-situ and/or invasive, and a malignant spindle cell component with a mesenchymal appearance, but of epithelial origin.”1 Spindle cell carcinomas go by a variety of synonyms such as sarcomatoid carcinoma, spindle cell squamous carcinoma and carcinosarcoma.

 

The larynx is a preferred site of involvement where they often present as polypoid masses.1,3 Microscopic examination often shows predominance of the sarcomatoid, spindle-cell component, which can range from fairly bland, reactive-looking fibroblastic-proliferation-like processes, to cytologically malignant and mitotically active proliferations that mimic other spindle-cell sarcomas such as leiomyosarcoma, fibrosarcoma or malignant fibrous histiocytoma.1,2,3 (Figure 1, double arrows)  The squamous cell carcinoma component may be in the form of an overlying carcinoma-in-situ, or of a focal keratinizing invasive squamous cell carcinoma that requires multiple sections to disclose.1,2  (Figure 1, single arrow) Cytokeratin-reactivity in the spindle cells, which may be quite focal as in this case, points to their epithelial derivation.1,2,4 (Figure 2)

Favorable prognostic findings include polypoid morphology and, like conventional laryngeal squamous cell carcinomas, a low-stage and a glottic site of origin. Reported 5-year survival rates range from 65 – 95%.1
Ectopic Thyroid Tissue: A Case Series
Authors: Saha Somnath , Ghosh Anirban , Pal Sudipta , Saha V Padmini
Published: April 2019

Objective: To describe the clinical presentation and course of seven ectopic thyroid patients.

Methods:

Design: Retrospective Chart Review

Setting: Tertiary Government Teaching Hospital

Subjects: Seven patients

Results: Five patients were female and two were male (ratio of 5:2). Three belonged to the 20 to 30 year-old age group, whereas two were below 10 years of age. All seven were biochemically hypothyroid and ectopic thyroid was found to be the only functioning thyroid tissue.Three patients were managed medically with levothyroxine, while ectopic thyroid was excised in four.  Ectopic thyroid tissue was autotransplanted in two cases following excision.

Conclusion: The ages of presentation in the present series correspond with the increased physiological demand of thyroid hormone. Thyroid substitution therapy is a must in the presence of clinical and/or biochemical hypothyroidism. Surgical excision should be avoided as far as possible especially if the ectopic tissue is the only functioning thyroid in the body. Surgery is required in selected cases presenting with obstructive symptoms or hemorrhage which are unresponsive to substitution therapy. Auto transplantation of the ectopic thyroid may not provide significant benefit to the patient and more research is warranted in this aspect.

Keywords: ectopic thyroid, lingual thyroid, thyroid replacement therapy, ectopic thyroid surgery.
Vocal Cord Paralysis and Dysphagia as Sequelae of Gradenigo Syndrome
Authors: Macasaet Mary Ann V. , Cruz Emmanuel Tadeus S.
Published: April 2019

Objectives:     To present a case of vocal cord paralysis and dysphagia developing in Gradenigo syndrome and to discuss its clinical presentation, differential diagnosis and therapeutic approach.

 

Methods:

            Design: Case Report

            Setting:  Tertiary Government Hospital

            Patient: One

 

Results:  A 54-year-old lady was admitted with a six month history of left-sided otorrhea, cheek and jaw pain, three months otalgia, and recent-onset hoarseness, dysphagia and diplopia on a background of mastoidectomy at age 6. Otoscopy revealed granulation tissue and chlolesteatoma occupying the left external auditory canal. There was left vocal cord paralysis with pooling of saliva in the pyriform sinus, left lateral gaze paralysis, and left facial nerve paralysis. CT scan revealed sclerosis of the left petrous apex and leptomeningeal enhancement on the left temporal lobe. Chronic suppurative otitis media with cholesteatoma and Gradenigo syndrome was diagnosed, and canal wall down mastoidectomy was performed Postoperatively, the otalgia and pain over the left jaw diminished in intensity while hoarseness and left lateral gaze palsy remained.

 

Conclusion: Gradenigo syndrome is known for its triad of retro-orbital pain, lateral gaze paralysis, and chronic middle ear infection due to petrous apicitis. Although rare, vocal cord paralysis and dysphagia may develop when infection traverses and encroaches on the jugular foramen where cranial nerves IX, X, and XI are lodged.  Knowledge of the syndrome should not be limited or confined to the classic triad.  Practicing ear specialists should be vigilant and cognizant of the clinical manifestations and sequelae of chronic middle ear infection. Prompt surgical intervention is crucial while resolution of the disease may vary for different individuals.

 

Keywords: Chronic otitis media, Gradenigo syndrome, vocal cord paralysis, petrous apicitis
Tomas C. Carvajal, MD (1936 - 2013)
Authors: Carvajal Theodore M.
Published: April 2019

“My Mentor… My Inspiration… My Dad”

 

 “The righteous who walks in his integrity—blessed are his children after him! ”

Proverbs 20:7 

 

Dr. Tomas Carvajal at 76 years old, had practiced for over 40 years as an Emeritus Consultant at Our Lady of Lourdes Hospital in Sta. Mesa, Manila, where he started his Residency Training. Early on, he learned to love the ENT specialty and underwent preceptorship under the wing of Dr. Ariston Bautista. At that time, there was no training program in the Philippines.  He went abroad and was accepted to train in Berlin, Germany at the Rodolf Virchow Krankenhaus Department of Ear Nose and Throat under Professor Peffniz. After his training in Germany, to further hone his knowledge and skills, he underwent post graduate training at the Royal National Ear, Nose and Throat Hospital in London, England and Wakayama Medical Center in Osaka, Japan specializing in Nasal Allergy.

On returning to Manila, he was invited to be an Assistant Professor in Otorhinolaryngology at the Far Eastern University – College of Medicine and a Consultant at the FEU Hospital then in Morayta, Manila. He was also appointed Medical Specialist Examiner under the then Ministry of Health. Later, he became the first Chairman of the Department of Ear Nose Throat – Head and Neck Surgery (1986-1993) at the FEU Hospital. During the same time he was also Chairman at the Quirino Medical Center Department of Eye Ear Nose and Throat (EENT).

Since then he had helped a lot of people-- including colleagues, friends and neighbors, and he was thus invited by former President Erap Estrada and Senator Jinggoy Estrada to run for city councilor in San Juan City where he served for two consecutive terms (2000-2006).

My father lived a fruitful and blessed life. He was loved and praised by everyone. It was he who inspired me to become an ENT doctor, it was he who guided me, giving me pointers during my residency training, and it was he who taught me too about LIFE….

 “Thank you Dad!”
Effectivity of Guava leaves (Psidium guajava) as Mouthwash for Patients with Aphthous Ulcers
Authors: Guintu Ferdinand Z. , Chua Antonio H.
Published: April 2019

Objective: To determine whether Psidium guajava leaves mouthwash is effective in the management of patients with aphthous ulcers

Methods:

Study Design: Randomized prospective open label clinical study

Setting:           Tertiary Government Training Hospital

Subjects:         Thirty two patients diagnosed with aphthous ulcers were randomly divided into two groups, a treatment group using prepared guava leaves mouthwash, and a control group using isotonic sodium chloride solution mouthwash, given thrice a day for seven days. Patients were evaluated using a 10 point Visual Analog Scale. The sizes of the aphthous ulcers were measured using a caliper, and compared on day 1 and day 7 for both treatment and control groups. Results were subjected to statistical analysis using T-test, Mann-Whitney U test, and Fisher Exact test.

Results: Comparison of VAS scores of guava treatment and NSS control groups showed that there were no differences in pain experienced on days 1 and 2. However, the VAS scores from day 3 to 7 had p values ranging from 0.02 - 0.0001 which showed significant differences in resolution of pain. There was statistically significant marked improvement of pain symptoms as early as three days post-treatment among patients who were administered guava leaves mouthwash. Complete resolution of aphthous ulcers in 75% of the study group was observed on day 7. Mean ulcer size post-treatment with guava gargle was 0.25mm compared to 0.75mm for NSS gargle. The mean size difference at day 7 was 1.44mm for the guava treatment group and 0.88mm for the NSS control group. There was a statistically significant faster resolution of ulcer size on day 7 in 16/16 or 100 % of patients in the treatment group compared with only 10/16 or 62.5% of patients in the control group. Patients who were administered guava leaves mouthwash generally fared better than those administered isotonic sodium chloride solution.

Conclusion: Guava leaves mouthwash was effective for aphthous ulcers in terms of reduction of symptoms of pain and faster reduction of ulcer size. Further clinical trials comparing this mouthwash against other treatment options are recommended.

Keywords: Guava leaves (Psidium guajava), aphthous ulcers, mouthwash
Nasal Glial Heterotopia: Unsuspected Brain Tissue in the Nasopharynx
Authors: Daffon Dan Valeriano F. , Calderon Alberto F. , Victoria Francisco A.
Published: April 2019

Objective: To report a case of ectopic brain tissue in the nasopharynx; discuss the differential diagnoses for and management of, this unilateral nasal mass in a pediatric patient, and describe the diagnostic difficulties and eventual treatment.

Methods:

Study Design:      Case Report

Setting:                 Tertiary Government Hospital

Participant:                      One

 

Results:  A 13-year-old boy consulted with an obstructing mass in the nasopharynx and severe muscle wasting, weight below his age and concurrent anemia.  CT-scan revealed a soft-tissue mass occupying a maxillary sinus and nasopharynx consistent with an antrochoanal polyp.  Initial biopsy revealed a papilloma, but the clinical picture warranted preoperative preparations for a possible vascular tumor such as juvenile angiofibroma.  Transpalatal excision and final histopathology yielded nasal glial heterotopia. 

Conclusion: When confronted with a unilateral nasal mass in a pediatric patient, aside from the usual considerations, embryologic anomalies particularly those of the intracranial protrusion variety should be strongly considered. Scrupulous preoperative evaluation and sufficient diagnostic modalities must be pursued in order to arrive a correct diagnosis, treatment plan and prevent possible complications especially those related to intracranial communication.

Keywords: Nasal glioma, glial heterotopia, congenital nasal masses
Congenital Maxillomandibular Fusion: A Rare Case of Isolated True Bony Syngnathia
Authors: Aguiling Patrick O. , King-Chao Nikki Lorraine Y. , Veloro Lyra V.
Published: April 2019

Objective: To present a rare case of congenital maxillomandibular fusion or syngnathia.

Methods:

Study Design: Case report

Setting: Tertiary Private Teaching Hospital

Patient: One

Results: A 3-year-old girl with oral adhesion (syngnathia) caused by a mandibular to maxillary fibrous band underwent successful surgical division of maxillomandibular bony fusion. Subsequent monitoring and serial oral dilations were performed post operatively, resulting in mouth opening of 24mm over a period of 3 months. Currently, the patient is able to tolerate a general liquid diet.

Conclusion: Congenital maxillomandibular fusion is a very rare condition with few cases reported. We hope this report contributes to its diagnosis and management in other children.

Keywords: Congenital maxillomandibular fusion, syngnathia
A Rare Case of Vertebrobasilar Dolichoectasia Presenting with Ipsilateral Facial Paresis and Concomitant Severe Sensorineural Hearing Loss
Authors: Tang Mee Ling , Revadi Govindaraju , Rajagopalan Raman , Brito-Mutunayagam Sushil
Published: April 2019

Objective: To report a case of vertebrobasilar dolichoectasia presenting with ipsilateral facial nerve paresis and concomitant severe sensorineural hearing loss.

 

Methods:

               Design: Case Report

               Setting: Secondary Government Hospital

               Patient: One

 

Results:  We report a case of vertebrobasilar dolichoectasia with concomitant ipsilateral facial nerve paresis and severe sensorineural hearing loss in an elderly female.  She presented to us with left facial nerve palsy House-Brackmann Grade III with prior history of ipsilateral sensorineural hearing loss.  MRI of the brain showed normal inner ear structures, but revealed a dilated and tortuous basilar artery with compression on the left medulla and possible branches of anterior inferior cerebellar artery as it coursed superiorly, and possible partial thrombosis of proximal basilar artery. 

 

Conclusion:  Concommitant facial nerve paresis and sensorineural hearing loss can be the clinical presentations of this rare but important condition.  MRI is vital in diagnosing vertebrobasilar dolichoectasia.

 

Keywords: Vertebrobasilar dolichoectasia, facial nerve palsy, sensorineural hearing loss, basilar artery