bluuebunny/crossref_metadata_2025 huggingface dataset:
A Vocal Cord Polyp in a Pediatric Patient
Authors: Nalangan Ma. Joan N.
Published: April 2019

Objective: To present a case of vocal cord polyp in a pediatric patient and discuss its differential diagnosis, assessment and management.

 

            Methods:

            Study Design: Case Report

            Setting: Tertiary Public Hospital

            Participant: One

 

            Results: A seven-year-old girl presented with hoarseness and a benign, unilateral mass seen at the junction of anterior and middle third of the vocal cord. The hoarseness resolved after excision, and histopathology confirmed an inflammatory vocal cord pseudo polyp.

 

            Conclusion: Vocal cord polyps occur infrequently in children and adolescents. These cases are seldomly seen and reported and may arise from chronic abuse of the larynx, vocal cord trauma or phonotrauma. Hoarseness is the most common presenting symptom. Differential diagnoses include recurrent respiratory papillomatosis, laryngeal cyst and laryngeal nodule. The management of vocal cord polyps involves surgical removal followed by speech therapy.

            Keywords: hoarseness, phonotrauma, vocal cord polyp, recurrent respiratory papillomatosis, vocal cord nodule, vocal cord cyst, flexible laryngoscopy, speech therapy
Gap Arthroplasty of Bilateral Temporomandibular Joint Ankylosis
Authors: Guintu Ferdinand Z. , Laoag Alexander T. , David Joselito F.
Published: April 2019

Objective: To present a case of bilateral temporomandibular joint ankylosis that was managed successfully through gap arthroplasty.

Methods:

Design:   Case report

Setting:   Tertiary Government Hospital

Patient:   One

Results:

A 25-year-old man presented with inability to open his mouth for 18 years after direct trauma to his chin.  CT scan showed bilateral bony fusion of condyles to glenoid fossae, hypertrophic sclerosis and fusion of the condylar heads to the temporal bones. He underwent bilateral gap arthroplasty via preauricular approach with creation of a 15 mm space on the mandibular fossa. As of latest follow up, the patient maintained an inter-alveolar distance of 30 mm for 5 months postoperatively, through continuous aggressive mouth opening exercises.

Conclusion:    

 Gap arthroplasty may be an efficient procedure for temporomandibular joint ankylosis in achieving satisfactory post-operative inter-alveolar opening and articular function. Early and meticulous rehabilitation is required to prevent relapse. Long-term follow up is recommended to document possible recurrence.

 

Keywords: temporomandibular joint ankylosis, gap arthroplasty, TMJ ankylosis, ankylosis
Animated Demonstration of Selected ORLHNS Concepts and Surgeries: A Potential Adjunct to Learning
Authors: Agullo Edgar Jake A. , Samson Emmanuel S. , Victoria Francisco A.
Published: April 2019

Objective: To create visual animated demonstrations of certain otorhinolaryngologic concepts and surgeries that can aid learning of students and ORL residents.

Methods: Several otorhinolaryngologic surgical procedures and pathophysiologic concepts were represented through 2-dimensional images. For every concept or procedure, a series of images was drawn and manipulated using the software Adobe Photoshop CS4. The series of images were then put into animation using the software Morpheus Photo Animation Suite v3.15.

Result: The end results were demonstrations of otorhinolaryngologic concepts and surgical procedures in movie (.AVI) format.

Conclusion: Concepts and surgeries in the field of otorhinolaryngology are usually explained or documented using texts or simple images. The generated animated demonstration of these ideas can aid in the learning of the ORL specialist.

Keywords: animation, surgical procedure demonstration, pathophysiology animated presentation
An Experimental Study on Maximum Sound Output Capabilities and Preferred Listening Levels Using Different Earphone Types
Authors: Destriza Waynn-Nielsen C. , De Castro Roderick B. , Enriquez Howard M.
Published: April 2019

Objective: The study aims to compare the maximum sound output capabilities of different earphone types/music style combinations. The study also intends to assess the preferred listening levels (PLL) of test subjects using different earphone types with background noise accession. The study also seeks to determine the presence or absence of a threshold shift on headphone/music style combination PLL’s that exceed the recommended noise limit.

Methods

Study Design:            Experimental Study

Setting:                       Tertiary Government Hospital

Subjects: Thirty (30) hearing healthy volunteers were sampled from hospital staff aged 18-40 years, with no known history of ear pathology and/or use of any known ototoxic drugs, with normal otoscopy and audiograms of less than 20dB from 125Hz to 8000Hz, and no exposure to loud noise from any source within the previous 3 days.

The sound pressure levels (SPL) delivered by three (3) types of earphones (earbud type, in-ear type, supra-aural type) were measured at maximum volume setting of a personal media player (iPod, Apple Inc.), while playing different music genres. The test subjects were asked to listen at their preferred listening levels (PLL) using the different types of earphones at increasing background noise accession.

Results: The earbud type averaged the greatest SPL among the earphone types, and pop music averaged the greatest SPL among the music styles. Comparison of the maximum output capabilities revealed that there was a significant difference among different brands of earphones of the same type. However, no significant difference were found among songs of similar music style and across different music styles in all earphones except the in-ear type. PLL average was at 90.4dB in a silent environment with increasing intensity as background noise accentuated. Supra-aural earphones registered the least increase in PLL in a loud environment, due to its higher background noise-attenuating capabilities.

Conclusion: Having a significant difference among earphone types with regard their maximum output capabilities, it is recommended to check the specifications of the earphone type one intends to use. In using personal media players (PMP), the volume should be set at the lowest comfortable level. While choice of music style remains the discretion of the listener, the choice of music style should be considered for long periods of listening. Because the PLL of test subjects were alarmingly high, the authors recommend intervention in their listening habits. Background noise attenuating capabilities of earphones play a factor in reducing excessive sound energy from reaching the ear, reducing the PLL, and decreasing the risk for noise-induced hearing loss.

Keywords:     earphones, music styles, personal media players, preferred listening levels, recreational noise, noise-induced hearing loss
A Case Series of Tessier 3, 4, 7 and Combined 4,7 Craniofacial Clefts
Authors: Rances Karen Adiel D. , Cruz Emmanuel Tadeus S. , Pascual Arsenio L. , Tinaza Jomar S.
Published: April 2019

Objective: To report a case series of Tessier 3, 4, 7 and combined 4,7 craniofacial clefts, their clinical presentations, surgical approaches and outcomes in light of the current literature.

Methods:

            Study Design:            Case series                                                                                         

            Setting:                       Tertiary Government Hospital

            Subjects:                    5 patients

Results: Five patients aged 3 to 14-years-old with Tessier 3, 4 (2 cases), 7 and combined 4,7 were included in this study: Tessier 3 – medial orbitomaxillary cleft extending through the bony skeleton traversing obliquely across the lacrimal groove, Tessier 4 – median orbitomaxillary cleft traversing vertically thru the inferior eyelid, infraorbital rim and orbital floor extending to the lip between the philtral crest and the oral commissure  (2 cases), Tessier 7 - macrostomia and cleft oral commissure,  and combined Tessier 4 and 7, combining features described above. Four underwent 2- or 3-stage surgeries while 1 declined.

Conclusion: Five craniofacial clefts were presented. Because of the varying patterns of craniofacial deformities, a series of surgical procedures, tailor-made for each individual were performed on four. Otolaryngologists who perform maxillofacial and cosmetic surgery should have good background knowledge about craniofacial defects and be familiar with the surgical approaches at their disposal to yield favorable results that are appropriate to their local contexts.

Keywords: Tessier Clefts No. 3, 4 and 7, oculoplasty, commisuroplasty, alar transpositional flap, canthopexy
Epitheloid Hemangioendothelioma of the Submandibular Region
Authors: Ranjit Peter , Madhusudan Parekh Nayan , Suhaili Dayangku Norsuhazenah Pengiran , Bickle Ian Christopher
Published: April 2019

Objective: To present an uncommon cause for a submandibular mass and review of the literature.

Methods:

Design: Case Report

Setting: Tertiary Government Hospital

Patient: One

Results: A 25-year-old lady presented with a painless chronic submandibular swelling. Ultrasound identified a solid mass, following which an uncomplicated core biopsy was performed obtaining an accurate pre-operative histopathological diagnosis. Pre-operative arterial embolization of this vascular mass led to a relatively bloodless wide local excision. Radiological imaging for distant metastases was negative.

Conclusion: Epitheloid Hemangioendothelioma is an uncommon cause for a submandibular mass. A malignant vascular soft tissue tumor with morphologic characteristics similar to carcinomas, melanomas and epitheloid sarcomas, it has a high rate of metastasis and morbidity when it affects the soft tissues and viscera. Immunohistochemistry provides clues to differentiation, and recommended treatment consists of a surgical wide local excision with regional lymph node resection. As there are no established standard therapeutic protocols for this disease due to its rarity, an individual case-by-case approach and follow-up needs to be undertaken.

Keywords:  epitheloid hemangioendothelioma, malignant vascular tumor, submandibular mass
Unilateral Pedunculated Polyp of the Palatine Tonsil
Authors: Mendoza Daniel Jose C. , Chua Antonio H. , Castañeda Samantha S.
Published: April 2019

Objective: To report a benign tonsillar lesion presenting as a pedunculated polyp and discuss its diagnosis and management.

 

Methods:

Design: Case Report

Setting: Tertiary Government Hospital

Patient: One

 

Results: A 14-year-old lad presented with a seven-year history of an elongated right tonsillar mass without associated bleeding, pain, dysphagia or obstructive sleep apnea. Physical examination revealed a pedunculated mass about 2 x 1 x 0.5cm in size located in the superior pole. After unilateral tonsillectomy, histopathological examination revealed lymphangectatic lipomatous fibrotic polyp.

 

Conclusion:  Lymphangiomatous polyp of the palatine tonsils is an unusual benign lesion of the head and neck. These commonly present as unilateral, polypoidal mass that cannot be clinically differentiated from other benign tonsillar lesions. Tonsillectomy is the recommended surgical approach for both diagnostic and therapeutic purposes. Histopathological study must be done to confirm diagnosis.

 

Keywords: Palatine Tonsil, Pedunculated polyp, Hamartoma, Lymphangioma, Tonsillectomy
Value of the 6-Hour Postoperative Ionized Calcium Slope in Predicting Post- Thyroidectomy Occurrence of Hypocalcemia
Authors: Cabance Ryan E. , Cruz Emmanuel Tadeus S.
Published: April 2019

Objective: To determine the value of the 6-hour postoperative ionized Calcium (iCa) slope, versus 6-hour postoperative Calcium alone, in predicting the occurrence of hypocalcemia in patients who underwent thyroid surgery in a tertiary hospital in Metro Manila.

Methods:

Study Design:            Retrospective Cross-Sectional Study

Setting:                       Tertiary Private Hospital

Subjects:                    Pre-operative and 6-hour postoperative ionized calcium determinations were analyzed in 59 patients of the ENT-HNS department in a tertiary hospital in Metro Manila who underwent thyroid surgery from January 2009 to December 2013.

Results: The 6-hr postoperative iCa slope (difference between the pre-operative and 6-hour postoperative iCa levels) of ≥0.18 mmol/L correctly predicted 57.1% of patients who eventually developed hypocalcemia, with a specificity of 81.6%, and a positive predictive value of 63.2%. In contrast, the 6-hour postoperative iCa measurement identified only 23.8% (5 out of 21) patients who developed hypocalcemia.

Conclusion: The 6-hr postoperative iCa slope increased the probability of identifying patients who developed hypocalcemia from 23.8% to 57.1%. However, as a single determination, this may  not suffice to take the place of serial iCa measurements after thyroid surgery.

Keywords: ionized calcium (iCa), hypocalcemia, thyroidectomy
Extended Transpalatine Approach for Excision of Juvenile Angiofibroma
Authors: Hernandez Josefino G. , Cabungcal Arsenio A. , Carrillo Ryner Jose D.
Published: April 2019

Objective:  To describe the extended transpalatine approach (ETPA) with transection of the ipsilateral greater palatine artery and extension of the ipsilateral retromolar incision and its corresponding surgical outcomes and present it as an option in the excision of juvenile angiofibroma (JA).

Methods: 

Study Design: Descriptive Case Series

Setting: Tertiary Public University Hospital

Subjects: 13 JA cases undergoing ETPA

Results: Records of JA in a tertiary hospital from 2007 – 2013 were reviewed. Out of 35 JA patients, 13 underwent excision via extended transpalatine approach. Preoperative work-up included CT scan with contrast with or without preoperative embolization. In all patients, the wide field allowed easy tumor excision and facilitated inspection and hemostasis. There was only one recurrence in our series, compared to 1 each for 4 endoscopic and 18 transmaxillary approaches. Not one of the patients developed a fistula or hypernasal speech. All patients had minimal palatal scarring, symmetric alveolar growth and palatal function.

Conclusion: The ETPA is a robust technique. It provides good exposure of JA with minimal preoperative requirements and postoperative complications.

Keywords: juvenile angiofibroma, juvenile nasopharyngeal angiofibroma, transpalatine approach
Vocal Fold Paralysis with Intraoperative Recurrent Laryngeal Nerve Identification versus Non-identification of Recurrent Laryngeal Nerve in Total Thyroidectomy: A Retrospective Cohort Study
Authors: Formanez Andrie Jeremy
Published: April 2019

Objective: To determine the risk of vocal fold paralysis in patients who underwent total thyroidectomy with and without intraoperative recurrent laryngeal nerve identification.

Methods:

            Study design:             Retrospective cohort study

            Setting:                       Tertiary military hospital

            Population: 237 adult patients who underwent total thyroidectomy for benign lesions based on post-operative histopathology operated on by senior third or fourth year residents. Excluded were those who underwent lobectomy with isthmusectomy or reoperation/completion thyroidectomy, had intrathoracic goiters, confirmed malignancies based on post-operative histopathology, or cases wherein the RLN had to be sacrificed due to gross involvement of the nerve caused by malignancy.

Results: Group A, wherein intraoperative identification of RLN was done, had a temporary and permanent RLN injury incidence of 2.75% and 0.92% respectively. Group B, wherein intraoperative identification of RLN was not done, had a temporary and permanent RLN injury incidence of 17.19% and 12.5% respectively.  Through binary linear regression, the probability of having temporary paralysis increases almost two-fold if the nerve is not identified, and the probability of having permanent paralysis increases by almost nine-fold if the nerve is not identified.

Conclusion: We recommend routine intraoperative RLN identification, which has a lower risk for temporary and permanent vocal fold paralysis when compared to non-identification of the RLN.

Keywords: cranial nerve injuries/prevention and control, recurrent laryngeal nerve injuries, thyroid neoplasms/surgery, thyroidectomy/adverse effects, vocal cord paralysis/prevention control
Clinical Profile of Patients with Laryngotracheal Stenosis in a Tertiary Government Hospital
Authors: Arriola Anna Carlissa P. , Chua Antonio H.
Published: April 2019

Objective:  To describe the clinical profile of patients with laryngotracheal stenosis over a 7-year period and discuss strategies for its prevention.

Methods:      

Study Design: Retrospective Case Series

Setting: Tertiary Government Hospital

Participants: Patients with laryngotracheal stenosis confirmed by laryngoscopy and/or bronchoscopy

Results: Twenty-one patients were evaluated for laryngotracheal stenosis from January 2008 to June 2015, but only 13 with complete data were included in this study. Of the 13 patients, nine (69.2%) belonged to the pediatric age group. Ten (77%) were males and three (23%) were females. Laryngotracheal stenosis following endotracheal tube (ET) intubation was seen in 11 (84.6%) while 2 had thyroid masses and no history of prior ET intubation. Presenting symptoms or reasons for referral were wheezing (n=4), stridor (n=4), failure to decannulate the tracheostomy tube (n=3), and dyspnea (n=2). Duration of ET intubation was four to 60 days. The highest frequency of ET re-intubation was 5 times.  Among those intubated, stenosis was glottic in one, subglottic in five and tracheal in five patients. Three had Cotton-Myer grade I stenosis, two had grade II, three had grade III and three had grade IV stenosis. Those with thyroid masses had tracheal stenosis.

Conclusion: Strategies for prevention of laryngotracheal stenosis should include routine airway endoscopy for patients with longstanding neck masses and for those with prolonged ET intubation, for whom the option of early prophylactic tracheostomy is worth considering. Otherwise, immediate post-extubation endoscopy may facilitate documentation and appropriate intervention.

Keywords:  acquired laryngeal stenosis; tracheal stenosis; endoscopy; intubation, intratracheal; tracheostomy
An Initial Survey of Septorhinoplasty in Crooked Nose Deformities
Authors: Villafuerte Cesar V. , Dy Alexander Edward S. , Lapeña Jose Florencio F.
Published: April 2019

Objectives: Crooked nose deformity is a commonly seen reason for septorhinoplasty in the otolaryngology clinic. The purpose of this study is to initially determine the different etiologies of patients with crooked nose deformities who underwent septorhinoplasty, and to describe the different types of crooked nose by their level of deviation and surgical management in our institution.

 

Methods:

Study design:       Case Series

Setting:                 Tertiary Public University Hospital

Subjects: A chart review of all patients with a crooked nose deformity who were admitted at the otorhinolaryngology ward of the National University Hospital and underwent septorhinoplasty from January 2012 to January 2015 was conducted, and data consisting of age, sex, etiology of crooked nose deformity, level of deviation, cartilage source, and surgical intervention were obtained and analyzed.

 

Results: A total of 21 patients underwent septorhinoplasty for crooked nose deformity in the study period. The most common etiology for crooked nose was physical violence (13/21 or 62%), followed by sports injury (4/21 or 19%), vehicular accidents (2/21 or 9%), and accidental fall (1/21 or 5%). There were more upper and middle third deviations than lower third deviations. Sixteen out of 21 patients (76%) underwent open rhinoplasty, while the rest underwent an endonasal approach. Twelve (57%) underwent intervention on the nasal fracture after at least a year (old or neglected fracture) as compared to the 9 (43%) who had immediate intervention after less than two weeks. Thirteen used septal cartilage, while 4 used conchal cartilage, and 1 used tragal cartilage. The most common grafts used were spreader and camouflage, followed closely by dorsal onlay, and columellar strut grafts.  

 

Conclusions: The majority of crooked nose deformities that were subjected to septorhinoplasty in our department were secondary to old nasal bone fractures caused by physical violence. Upper and middle third level deviations were more common, and most underwent open rhinoplasty with autologous cartilage grafts. Future studies may increase our understanding of, and improve our techniques in septorhinoplasty for crooked nose deformities in Filipino noses in particular, and Asian noses in general.

 

 

Keywords: rhinoplasty, deviated nose, crooked nose, septorhinoplasty, nasal trauma
Mandibular Ameloblastoma with Lung Metastasis 10 Years after Resection
Authors: Siy Rabo Justin Iohanne , Carpela Allan B. , Guevara Eutrapio S. , Romualdez Joel A.
Published: April 2019

Objective:  To present a case of mandibular ameloblastoma with pulmonary metastasis after ten years and discuss the possible pathophysiology, diagnostic and therapeutic options.

Methods:

Study Design: Case Report

Setting:           Tertiary Private Hospital

Subject:          One

Conclusion: Though benign, ameloblastoma has a high propensity for local invasion and may metastasize. It is difficult to predict metastasis, even with adequate treatment of the primary lesion. There is no standard protocol to prevent or detect metastatic ameloblastoma, but regular and close follow up may ensure early diagnosis.

Keywords: ameloblastoma, metastatic ameloblastoma, lung metastasis, follicular type ameloblastoma, odontogenic tumor
Glomangiopericytoma: The Sinonasal Mimic Of Soft Tissue Hemangiopericytoma
Authors: Villanueva Emilio Q. , Carnate Jose M.
Published: April 2019

A 42-year old Filipino male with a 10-month history of progressive left nasal obstruction and rhinorrhea and a clinical impression of nasal polyposis underwent endoscopic sinus surgery with partial ethmoidectomy and polypectomy.

            We received several dark-brown, irregular, rubbery tissue fragments with an aggregate diameter of 3 cm. Histopathologic examination shows sheets of spindly tumor cells beneath the respiratory epithelial lining. These spindle cells are closely packed and arranged in short fascicles and storiform clusters surrounding hyalinized large vessels or thin-walled submucosal blood vessels. (Figures 1 and 2) There is no atypia or necrosis.  Immunohistochemical studies show strong immunoreactivity to muscle specific actin, and focal reactivity to S-100. (Figure 3) Stains for CD34, caldesmon, cytokeratin, and desmin, are negative. (Figure 4) Based on these features, we diagnosed the case as glomangiopericytoma.

            Glomangiopericytoma is a rare tumor arising from the pericytes surrounding capillaries, and accounts for less than 0.5% of all sinonasal tumors.1 It has a very slight female preponderance, with a peak incidence during the seventh decade of life. The most common symptom is nasal obstruction, or epistaxis, with accompanying difficulty breathing, sinusitis and headache. A mass, or polyp is the most common clinical finding.2

            Hematoxylin–eosin staining shows a well-delineated but unencapsulated cellular tumor underneath the normal respiratory epithelium that effaces or surrounds adjacent normal structures.2 The tumor is composed of closely packed, uniform, oval to spindle-shaped cells, in short fascicles and in storiform, whorled or palisaded patterns. The cells surround numerous branching thin-walled, blood vessels, thus the morphologic resemblance to soft tissue hemangiopericytoma/solitary fibrous tumor. However, in contrast to hemangiopericytoma, glomangiopericytoma shows diffuse reactivity to muscle actins, and non-reactivity to CD34, while hemangiopericytoma shows the reverse reactions. Desmin and caldesmon are likewise non-reactive, distinguishing the tumor from leiomyomas or leiomyosarcomas of the upper aerodigestive tract. Cytokeratin non-reactivity distinguishes it from spindle cell carcinoma. S100, although typically negative, can be focally and weakly positive in a small percentage of tumor.3 

            Glomangiopericytoma is categorized as a borderline low malignancy tumor with an overall survival of >90% in 5 years but which tends to recur in up to 30% of cases. Strict follow-up is thus required, especially if complete resection is not achieved.1
Granulation Tissue mimicking a Glomus Tumor in a Patient with Chronic Middle Ear Infection
Authors: Ong Kimberly Mae C. , Labra Patrick John P. , Ricalde Rosario R. , Manasan Criston Van C. , Carnate Jose M.
Published: April 2019

Objective: To present an unusual cause of pulsatile tinnitus, presenting in a young adult suffering from chronic recurrent foul-smelling discharge from the same ear.

Methods:

Study Design:            Case report

Setting:                       Tertiary National University Hospital

Patient:                       One

 

Results: A 24-year old woman presented with pulsatile tinnitus on a background of chronic recurrent foul-smelling discharge. Clinico-radiologic findings seemed consistent with a glomus tympanicum coexisting with chronic suppurative otitis media with cholesteatoma. She underwent tympanomastoidectomy with excision of the mass. Histopathologic evaluation revealed the mass to be granulation tissue.

Conclusion: Pulsatile tinnitus is rarely associated with chronic middle ear infection. Granulation tissue arising at the promontory may mimic glomus tumors when accompanied with this symptom. Despite this revelation, it would still be prudent to prepare for a possible glomus tumor intraoperatively, so that profuse bleeding and complications may be avoided.

Keywords: tinnitus, pulsatile; otitis media, suppurative; glomus tympanicum
A 15-Year Occult Foreign Body in the Subglottic Area of A 50-Year-Old Woman
Authors: Segocio Donnie Jan D. , Dayanghirang Christine D. , Cachuela Joseph E.
Published: April 2019

Objective:

To present a case of subglottic foreign body (FB) impaction in a 50-year-old woman diagnosed with bronchial asthma for 15 years.

Methods:

Design:           Case Report

Setting:           Tertiary Public Hospital

Patient:           One

Results: A 50-year-old woman with recurrent cough and dyspnea for 15 years that had been managed as bronchial asthma, developed stridor and halitosis in the last 5 years. Flexible laryngoscopy revealed a subglottic mass and CT scan confirmed a suspicious foreign body in the lumen of the subglottis. Signs and symptoms resolved after peroral endoscopic removal of the foreign body from the larynx.  Histopathology of the extracted material from the airway confirmed it to be “bone tissue.”

Conclusion: Foreign body aspiration can occur in adults without predisposing factors. Its diagnosis can be challenging as it can mimic respiratory disorders such as bronchial asthma.  Endoscopy and computed tomography are valuable for correct diagnosis and management. An incorrect initial diagnosis should be considered in the light of unresolved symptoms and prompt referral to an appropriate specialist may prevent undue suffering and dangerous complications.

Keywords: foreign body aspiration, occult airway foreign body
Medialization Thyroplasty Using the Pocket and Silicone Implant Technique
Authors: Taningco Maria Margarita F. , Ibay Emmanuel L.
Published: April 2019

Objective: To describe a new method of medialization thyroplasty using a modified preformed nasal silicone implant.

Methods:

Design:           Surgical Innovation

Setting:           Tertiary Private Hospital

Participants:   Four patients underwent medialization thyroplasty using a pocket and nasal implant technique performed by the senior co-author.  The indication for medialization thyroplasty for these patients was hoarseness secondary to unilateral vocal fold paralysis of more than 6 months duration, and documented by flexible fiberoptic laryngoscopy.  The outcomes were described with comparison of pre- and post-operative subjective voice assessment.

Results: Operative time was 15–30 minutes.  Post-operative subjective improvement of voice quality was evident.  Scars were minimal and aesthetically acceptable.  The procedure could be done on an outpatient basis. 

Conclusion: Medialization thyroplasty via a pocket and silicone implant technique is initially effective and may be a worthwhile alternative to the usual window technique.

Keywords: unilateral vocal cord paralysis; medialization thyroplasty; Isshiki thyroplasty; silicone implant
Bleeding Time using Moringa oleifera (Malunggay) Leaf Extract versus Saline Control in a Rabbit Epistaxis Model: A Randomized Controlled Trial
Authors: Caballero Paula Luz G. , Cachuela Joseph E.
Published: April 2019

Objective: To determine bleeding time using Moringa oleifera leaf extract versus saline control in an experimental epistaxis model.

Methods:

            Design:           Randomized controlled trial

            Setting:           Tertiary Government Training Hospital

            Subjects:        Ten adult male New Zealand White rabbits were acclimatized for 1 week in a standard environment. One-centimeter long, full-thickness mucosal wounds in the junction of the nasal floor and anterior part of the septum were treated randomly with topical Moringa oleifera extract or colored isotonic saline control in either right or left nasal cavity, one site at a time. The duration of bleeding – time bleeding started to time bleeding stopped -- was recorded in seconds. Data was subjected to a t-test for paired samples.

Results: The mean bleeding time for wounds treated with Moringa extract was 53 seconds (range 38-70 secs), versus 159 seconds (range 100-218 secs) for controls. The bleeding time in the former was significantly shorter than in the latter (p = .000019, t-stat = 8.139), with a mean difference of 106 seconds between the two groups.

Conclusion: Moringa oleifera leaf extract was associated with significantly shorter bleeding time than saline control in this experimental epistaxis model, and may be worth investigating further as a hemostatic agent for epistaxis.

Keywords: epistaxis, malunggay, Moringa oleifera extract, topical hemostatic agent
Tuberculosis of the Thyroid
Authors: Fabito Elmer F. , Tipayno-Lubos Mary Jane , Ayahao Felixberto D.
Published: April 2019

Objectives: To present a case of thyroid tuberculosis and to discuss its clinical presentation, differential diagnoses and management.

Methods:

                        Design: Case Report

                        Setting:  Tertiary Government Hospital

                        Patient: One

Results: A 55-year-old farmer presented with an 8-month progressively enlarging anterior neck mass, and fine needle aspiration biopsy yielded grossly turbid straw-colored aspirate admixed with blood with microscopy showing scattered inflammatory cells and macrophages set against a colloid background. After total thyroidectomy, hispathology revealed parenchymal infiltration by multiple aggregates of plump spindled to epitheloid cells forming granulomas with interspersed multinucleated giant cells, central caseation necrosis and surrounding fibrosis with chronic inflammatory infiltrates. The nodal masses also showed prominent germinal centers with interspersed epitheloid cells and foamy macrophages. Final diagnosis was chronic granulomatous inflammation consistent with tuberculosis.

Conclusion: Tuberculosis (TB) of the thyroid is a rare occurrence that can present as inflammation, infection or tumor formation of the thyroid gland. Diagnosis depends on identification of the tubercle from tissues and aspirates by acid fast staining and TB culture. Treatment consists of multiple drug therapy for tuberculosis but thyroidectomy may be an option if the thyroid gland is severely diseased.

Keywords: tuberculosis, endocrine; thyroid disease
Supernumerary Nostril in a 15-Year-Old Girl
Authors: Lluisma Ann Christie P.
Published: April 2019

Objective: To describe a rare case of a supernumerary nostril and its management, and to discuss the different theories pertaining to this type of deformity.

Methods:

            Design:           Case Report

            Setting:           Tertiary Government Hospital

            Patient:           One

Results: A 15-year-old girl was born with one extra nasal opening. Nasal endoscopy after 15 years revealed a mucosa-lined cavity that ended blindly. Computed tomography scan showed a small opening lateral to the right nasal ala which did not communicate with the right nasal cavity. A crescent incision was made along the inner circumference of the supernumerary nostril and the blind ending nasal tract was excised. A portion of the ala was removed and a Z-plasty repair was performed.

Conclusion: Treatment has to be tailored as to the presentation of a supernumerary nostril and any other associated deformity. Though various surgical interventions exist, the goal of repair is to create a functioning and normal-appearing nose.

Keywords: Supernumerary Nostril, Accessory Nostril
Prevalence and Reasons for Non-Follow-Up of Newborns with “Refer” Results on Initial Hearing Screening
Authors: Ong Kimberly Mae C. , Cruz Teresa Luisa G. , Grullo Precious Eunice R.
Published: April 2019

Objective: To determine the prevalence rate of follow-up among infants who had a “refer” result on initial newborn hearing screening and to identify reasons for default by parents or guardians.

 

Method:

Study Design:   Cross-sectional study

Setting:             Tertiary public university hospital

Participants:     79 parents or guardians whose newborns obtained a “refer” result on initial hearing screening were interviewed over the phone.

 

Results: Among those babies who had a “refer” result on initial hearing screening, 51% followed up for repeat testing. The most common reasons for non-follow up by parents or guardians include being busy, distance from the hospital and baby’s health condition.

 

Conclusions: The follow-up rate in this study is higher compared to previous figures (27%), but is still below target. The reasons for non-follow-up obtained suggest problems may exist on all levels of the healthcare system. Appropriate solutions to address these problems should be explored.

 

Keywords: neonatal screening, hearing loss, infant, newborn, hearing tests, otoacoustic emissions
Unilateral Horizontal Semicircular Canal Malformation Causing Recurrent Vertigo
Authors: Yang Nathaniel W.
Published: April 2019

A 62-year-old man consulted for recurrent episodes of vertigo lasting from seconds to several minutes. The vertigo was variably described as spinning, lateral swaying, and a feeling of being “unsure of his position in space.” These episodes were noted to have begun when the patient was still in his 20’s. Standard pure tone audiometry revealed a mild-to-moderate downsloping mixed hearing loss in the left ear. Bithermal caloric testing indicated the presence of a significant left-sided peripheral vestibular loss. Due to the fact that the vertigo episodes presented relatively early in life, the possibility of a congenital inner ear malformation was considered as a cause for his symptoms.  Computerized tomographic (CT) imaging of the temporal bone was performed. This clearly showed the left horizontal semicircular canal lacking a central bony island. (Figure 1 and 2) The cochlea, superior and posterior semicircular canals, vestibular and cochlear aqueducts, and ossicular chain were grossly normal.

A malformation of the horizontal or lateral semicircular canal is one of the most common inner ear malformations, as it is the last vestibular structure to be formed during inner ear embryogenesis. As such, it may occur in isolation or may be associated with other vestibular, cochlear, or middle ear malformations.1,2  Although vertigo and dizziness are symptoms to be expected in such a condition, existing data indicates that it may be totally asymptomatic, or it may also present as a sensorineural, conductive, or mixed type of hearing loss.1,3   Radiologic imaging is of prime importance in diagnosing such conditions, especially when auditory and/or vestibular symptoms manifest early in life. This case perfectly illustrates the need for such studies, as the patient went undiagnosed for more than forty years!

            No definitive statements can be gleaned from existing medical literature with respect to treatment. However, in patients with debilitating vestibular symptoms, management with modalities that selectively target the vestibular system, but spare the auditory system, such as vestibular neurectomy and trans-tympanic aminoglycoside therapy appear to be reasonable options.

 

References

 

Johnson J, Lalwani AK. Sensorineural and conductive hearing loss associated with lateral semicircular canal malformation. Laryngoscope 2000 Oct;110(10):1673–1679. DOI:10.1097/00005537-200010000-00019 PMID: 11037823

 

Casselman JW, Delanote J, Kuhweide R, van Dinther J, De Foer B, Offeciers EF. Congenital malformations of the temporal bone. In: Lemmerling M, De Foer B, editors. Temporal bone imaging. Berlin Heidelberg: Springer-Verlag; 2015, pp. 120-154.

 

Kim CH, Shin JE, Lee YJ, Park HJ. Clinical characteristics of 7 patients with lateral semicircular canal dysplasia. Res Vestib Sci 2012;11(2):64-68.
Posterior Nasal Neurectomy In Treatment of Intractable Rhinitis: A Preliminary Series
Authors: Vo Minh Cong , Pham Huu Kien , Nguyen Minh Hien
Published: April 2019

Objective: To evaluate the efficacy and safety of posterior nasal neurectomy on the treatment of nasal congestion, rhinorrhea, sneezing, and post-nasal discharge in intractable rhinitis patients.

Methods

Design:                       Preliminary case series  

Setting:                       Tertiary University Medical Center

Participants:              Ten (10) patients with intractable rhinitis underwent endoscopic posterior nasal neurectomy in both sides. Symptoms were compared pre- and post-operatively one month and one year after surgery using Visual Analog Scale (VAS) scores. Endoscopic pre- and one-month post-operative Lund-Mackay scores were also compared.

Results: All four mean nasal symptom scores were reduced significantly at 1-month follow-up for nasal congestion (1.5 ± 1.08 vs 4.1 ± 0.5687, p = .00001), rhinorrhea (0.7 ± 0.823 vs 3.4 ± 0.966, p = .00001) post-nasal discharge (0.9 ± 0.994 vs 2.4 ± 1.5, p = .03), and sneezing (1.1 ± 0.738 vs 3 ± 0.943, p = .02). Mean endoscopic scores were also reduced significantly at one month, from 12.9 ± 2.55 to 4.2 ± 3, p = 0.0001.In the 6 patients that followed up at 1-year, post-operative mean nasal symptoms were still significantly better for congestion (0.6667 ± 0.8165 vs 4 ± 0.632, p = 0.00001), rhinorrhea (0.6667 ± 0.5164 vs 3.67 ± 1.033, p = .001), post-nasal discharge (0.1667 ± 0.40825 vs 2.17 ± 1.835, p = .033), sneezing (0.5 ± 0.54772 vs 3.17 ± 0.983, p = 0.0001). Mean post-operative VAS nasal scores and endoscopic scores were well associated (Correlation Coefficient -.648, p = .048).

Conclusion: Posterior nasal neurectomy could be considered as a safety and effective way to treat intractable rhinitis patients in Vietnam.

Keywords: Posterior nasal neurectomy, vasomotor rhinitis, allergic rhinitis, vidian neurectomy
Evaluation of the Newborn Hearing Screening Program in The Medical City based on Joint Commission on Infant Hearing (JCIH) 2007 Position Statement Quality Indicators
Authors: Que Mary Harmony B. , Reyes-Quintos Maria Rina T.
Published: April 2019

Objective : The objective of this study is to evaluate the newborn hearing screening program in The Medical City based on the Joint Committee on Infant Hearing (JCIH) 2007 Position Statement Quality Indicators.

Methods:

Study Design: Cross - Sectional Survey

Setting:           Tertiary Private Hospital

Participants : All newborns who underwent newborn hearing screening in The Medical City for the year 2015.

Results: Of 2,010 patients delivered in the hospital in year 2015, 1,986 (98.8%) were screened.  Among the 59 babies with initial “refer” results, 15 (25.42%) “referred” a second time while 24 (40.68%) “passed” the rescreening. Twenty (33.89%) did not undergo rescreening (10 were classified as dropouts, while another 10 did not undergo rescreening for various reasons. Of those who “referred” during rescreening, only 9 (60%) had further evaluation done with ABR/ASSR. Among these, 4 (26.66%) had hearing loss and proceeded with the appropriate monitoring and management while 5 (33.33%) had normal hearing.

Conclusion : The current newborn hearing screening program in the Medical City was able to reach JCIH 2007 quality indicators for screening but not for confirmation of hearing Loss. All patients with hearing loss were managed with early rehabilitation.

Keywords: Newborn hearing screening, otoacoustic emission test, auditory brainstem response test, auditory steady state response test
Operative Time and Tympanic Membrane Integrity in Endoscopic Transcanal versus Microscopic Post-Auricular Tympanoplasty for Chronic Otitis Media
Authors: Escalderon Jenina Rachel D.J. , Lim William L.
Published: April 2019

Objective: To compare surgical outcomes (operative time and tympanic membrane integrity) obtained by endoscopic transcanal tympanoplasty (ET) and microscopic post-auricular tympanoplasty (MT) in patient with inactive chronic otitis media.

Methods:

            Design:            Retrospective Cohort

            Setting:           Multicenter study in 3 Private Tertiary Hospitals  

            Participants: 18 patients who underwent microscopic or endoscopic tympanoplasty for chronic otitis media.

Results: Each group had 9 patients, with median age of 43 (31-65 years) for the MT and 47 (29-59 years) for the ET group. There was no significant difference in median age of the two groups (Mann-Whitney U=17, P=.22).  Male: female ratio was (5:4) and (6:3) for the ET and MT group respectively, with no significant difference in gender distribution (c2= 0.90, P=.34). Mean operative time for the ET and MT group was 86.7 minutes and 140.6 minutes, respectively, with significantly lower mean operative time for the ET group (t= 3.57, P=.0025). There was complete tympanic membrane graft uptake in both groups.

 

Conclusion: Regardless of technique, tympanoplasty is an effective surgical treatment among patients with inactive chronic otitis media. Endoscopic tympanoplasty is an alternative to conventional microscopic tympanoplasty that may use less operative time, producing similarly complete graft uptake.

 

Keywords: chronic otitis media, tympanoplasty, endoscopic tympanoplasty, microscopic tympanoplasty, perforation, tympanic membrane
Recurrent Laryngeal Nerve Paralysis and Hypocalcemia in Superior to Inferior Compared to Inferior to Superior Dissection Approaches in Thyroidectomy
Authors: Yu Randel D.
Published: April 2019

Objective: To compare the incidence of recurrent laryngeal nerve injury and hypocalcemia in patients who underwent thyroidectomy using a superior-inferior versus an inferior to superior approach in identifying the recurrent laryngeal nerve in a tertiary government hospital between January 2012 to December 2016.

Methods

Design:           Retrospective Cohort Study

Setting:           Tertiary Government Hospital

Patients:         Records of two hundred forty-one (241) adult patients who underwent surgery for thyroid diseases in the department of Otorhinolaryngology – Head and Neck Surgery   between January 2012 and December 2016 were evaluated. Records of patients with postoperative hoarseness after total thyroidectomy or lobectomy with isthmusectomy and hypocalcemia after total thyroidectomy were reviewed, and operative techniques analyzed for the approaches to recurrent laryngeal nerve identification.

Results:           Records of 119 patients (aged 20-73; median 41-years-old) meeting inclusion and exclusion criteria were analyzed. Of 57 thyroidectomies using a superior-inferior approach, 42 were bilateral, totaling 99; of 62 using an inferior-superior approach, 40 were bilateral, totaling 102. There was a higher incidence of post-operative complications among those who underwent inferior-superior dissection than those who underwent superior-inferior dissection. Chi square test showed the former approach (versus the latter) had 4.86 times the relative risk (RR) of permanent RLN injury (1.9%, 0.0475 to 5.5914, p=.3058), 1.62 times the RR of transient RLN injury (5%, 0.3971 to 6.5889, p=.5021), 1.92 times the RR of permanent hypocalcemia (1.9%, 0.0.1806 to 21.2838, p=.5910), and 2.06 times the RR of transient hypocalcemia (17%, 0.9055 to 4.4333, P=.0738). However, there was no significant difference between the two approaches with regard to hoarseness (independent t test, t value 0.90; p = .367) or hypocalcemia (t=0.428; p= .796).

Conclusion:    There is no significant difference in the incidence of recurrent laryngeal nerve injury and hypocalcemia in patients who underwent thyroidectomy using a superior-inferior versus an inferior to superior approach in identifying the recurrent laryngeal nerve. Intraoperatively, surgeons may shift from one approach to the other as needed, and we recommend that they be well versed in both approaches and fully knowledgeable of the various anatomical courses of the recurrent laryngeal nerve and locations of parathyroid gland.

Keywords: recurrent laryngeal nerve injuries, thyroid neoplasms, thyroidectomy, vocal cord paralysis, hypoparathyroidism, hypocalcemia
Pathologic Laryngoscopic Findings, Number of Years in Teaching, and Related Factors among Secondary Public-School Teachers in Bacolod City, Negros Occidental
Authors: Mundo Nathalie P. , Vinco Von V.
Published: April 2019

Objective: To determine the presence or absence of gross laryngeal or vocal cord pathology during endoscopic examination and determine if there is a relationship between these findings, the number of years in teaching, and the presence of other risk factors among teachers in a public secondary school in Bacolod City.

 

Methods

Study Design:      Cross-sectional study

Setting:                 Secondary public school in Bacolod City, Philippines          

Participants:        A total of 50 school teachers participated in the study, conducted from July 2016 to May 2017. They completed a questionnaire on demographic data, professional profile, and lifestyle profile and underwent laryngoscopic examination.

 

Results: The most common pathologic laryngoscopic findings were vocal fold nodule (12%), swollen arytenoids (10%), paretic vocal cords (6%) and epiglottic mass (6%). There was no significant relationship between laryngoscopic findings and number of years teaching (X2 = 0.103, df = 1, p = .748. However, there was a significant relationship between laryngoscopic findings, smoking (X2 = 6.419, df = 1, p = .011) and daily water intake (X2 = 10.208, df = 2, p =.006).

 

Conclusions: Results of this study suggest that in terms of voice care, public school teachers may benefit from avoidance of smoking and increased water intake.

 

Keywords:  teachers, vocal cord, hoarseness, voice, laryngoscopy, videostroboscopy