bluuebunny/crossref_metadata_2025_split huggingface dataset:
Augmentation Rhinoplasty with Rib Cartilage Graft
Authors: Lagura Elaine Marie A. , Yap Eduardo C. , Garcia Anna Victoria G. 
Published: April 2019

Objective: To investigate the outcome and complications of augmentation rhinoplasty with rib cartilage grafts

Methods:
Study Design: Retrospective study
Setting: Tertiary Government Hospital
Participants: Patients who underwent dorsal nasal augmentation with autologous rib cartilage grafts between June 2008 and October 2012.

Results: A total of 12 patients (3 male, 9 female) were included in the study. Mean age was 29 years. Seven were cases of primary simple rhinoplasty with 4 cases of revision (previously using alloplastic materials) and one case of trauma. Indications for the procedure were all cosmetic. There was no incidence of infection, both in the donor and recipient sites, warping of the graft, graft extrusion, resorption, pneumothorax, chest wall deformity or prolonged edema. Post-operative pain in the donor site was relieved by oral pain medications. No revision surgery was required.

Conclusion: Costal cartilage is a good option for structural support of the nose. In our experience patients have become wary of the complication of allografts and have opted to use autografts. The surgeon’s knowledge of the nasal anatomy as well as his or her experience with autologous grafts plays a major role in avoiding post-operative morbidity.
Keywords: Rhinoplasty, rib graft, costal cartilage graft, Southeast Asian nose
Hyalinizing Trabecular Tumor of the Thyroid Gland
Authors: Te Vincent G. , Carnate Jose M. 
Published: April 2019

A 34-year-old woman with a 4-year history of a slowly enlarging thyroid gland underwent a total thyroidectomy. Histologic sections showed multinodular colloid goiter. In addition, a 1.2 centimeter diameter discrete mass with a solid white cut surface was noted within the left lobe.
Sections from the left lobe mass show a well-demarcated tumor whose cells are arranged in trabecular and nested growth patterns. (Figure 1) The cells are polygonal to spindly and have ample eosinophilic, slightly granular cytoplasm and oval to angular nuclei that are often grooved. (Figure 2) Hyaline material and a delicate fibrovascular stroma surround the nests and trabeculae, and occasional psammoma bodies are seen. (Figure 3) These features led us to a diagnosis of hyalinizing trabecular tumor.
Hyalinizing trabecular tumor (HTT) is a rare thyroid neoplasm of follicular cell derivation.1, 2 The tumor occurs in adults with a wide age range (4th – 7th decades) and a mean age of 47 years. It is more common in females.1 The classic histologic findings are of a solid circumscribed epithelial neoplasm with or without a thin capsule composed of medium to large-sized polygonal to fusiform cells that are arranged in alveolar, trabecular and nested groups. The cells have finely granular, acidophilic, amphophilic or clear cytoplasm. Nuclei often have prominent grooves and small nucleoli. Calcospherites (psammoma bodies) may be present. Colloid is scant or absent. 1, 2, 3

Because of overlapping nuclear features, a follicular variant of papillary thyroid carcinoma is a differential diagnosis. Histologic features are usually sufficient to distinguish the entities as a nested-alveolar architecture is rarely a prominent feature of a papillary carcinoma.2 Immunohistochemistry may be of aid in this distinction especially in difficult cases with limited material. Cytokeratin 19 and HBME1 are negative in HTT and are usually positive in papillary thyroid carcinomas.4, 5, 6 Neuroendocrine markers are also negative in HTT and are positive in medullary thyroid carcinomas and paragangliomas.2

HTT is of uncertain malignant potential, and a 2008 review of 119 HTTs has shown only one case progressing to malignancy.3 The majority of cases have behaved in a benign fashion and thus may be treated conservatively.1
Descending Necrotizing Mediastinitis, a Dreaded Complication of Acute Tonsillitis
Authors: Go Ma. Stephanie C. , Cruz Emmanuel Tadeus S. 
Published: April 2019

Objective: To report a case of acute tonsillitis that subsequently developed descending necrotizing mediastinitis, and to discuss the signs and symptoms, differential diagnosis, pathophysiology, diagnostic criteria, ancillary procedures and management.

Methods:
Design: Case Report
Setting: Tertiary private and government hospital
Patient: One

Results: A 36-year-old woman was admitted with a 2-day history of sore throat and a diagnosis of acute exudative tonsillitis. She complained of sore throat accompanied by dyspnea, neck and chest pain which rapidly progressed to mediastinitis. She was transferred to a tertiary government hospital where video assisted thoracoscopic surgery with bilateral deloculation, mediastinoscopy and bronchoscopy revealed purulent discharge from the right main stem bronchus with multiloculated effusion in the left lung and posterolateral loculated effusion in the right lung. Her condition improved and she was discharged after a month of antibiotic therapy.

Conclusion: Acute tonsillitis seldom leads to a life-threatening complication such as mediastinitis. Descending necrotizing mediastinitis develops when acute tonsillar infection progresses and descends to the mediastinum. It is a surgical emergency which requires mediastinal drainage, thoracotomy and long-term antimicrobials. Clinicians who manage oropharyngeal infections should be aware of this rare but lethal complication which may occur even in non-immunocompromised individuals.

Keywords: Acute tonsillophraryngitis, tonsillitis, mediastinitis, descending necrotizing mediastinitis.
Primary Laryngeal Aspergillosis in a Postpartum Patient
Authors: Villanueva Jose Carlo R. , Opulencia Alejandro P. , Calavera Kenneth Z. , Lim William L. 
Published: April 2019

Objective: To present a rare case of primary laryngeal aspergillosis manifesting with hoarseness in a seemingly healthy, immunocompetent, postpartum patient and discuss the probable contributing factors leading to this unusual disease process.
Methods:
Study Design: Case Report
Setting: Tertiary Private University Hospital
Subjects: One (1)
Results: A 28-year-old previously healthy post-partum woman presented with hoarseness of a few weeks duration and recent intake of antibiotics and steroids. Videolaryngoscopy revealed a creamy, exophytic mass overlying both vocal folds. Microscopic examination revealed septated, dichotomously branching hyphae with acute angles characteristic of Aspergillus sp. The patient recovered with anti fungal medications.
Conclusion: The clinical presentation of laryngeal aspergillosis can be very non-specific and should not be disregarded merely on the basis of immune competence. It should be considered, together with other host and environmental factors when a patient responds poorly to conventional treatment. There is a need for quick and accurate diagnosis as the disease responds quite rapidly with appropriate anti fungal medications.

Keywords: Aspergillosis, hoarseness, larynx, postpartum, immunosupression
A Myringotomy and Ventilating Tube Applicator: New Look at a Five-Century-Old Procedure
Authors: Amable Jay Pee M. , Sia-Vargas Lily L. 
Published: April 2019

Objective: To fabricate a single instrument that can be used to perform myringotomy and insert a pressure equalizing tube at almost the same time.

Methods:
Study Design: Surgical Instrumentation
Setting: Tertiary Private Hospital
Subject: A chicken egg membrane was used as a tympanic membrane model

Result: The fabricated instrument was able to perforate the egg membrane and apply the modified polyethylene pressure equalizing tube in less than one minute without complications.

Conclusion: The prototype applicator can facilitate myringotomy and pressure equalizing (PE) tube insertion at only a fraction of the time it usually takes to do the standard myringotomy and subsequent ventilating tube insertion.

Keywords: Myringotomy, pressure equalizing tube, ventilating tube, acute otitis media, otitis media with effusion, polyethylene tube
Effects of Dexamethasone versus Saline-Impregnated Nasal Packing on the Postoperative Outcome of Patients with Chronic Rhinosinusitis and Nasal Polyps after Endoscopic Sinus Surgery: A Randomized Controlled Trial
Authors: Promentilla Shella May A. 
Published: April 2019

Objective: To evaluate the effects of Dexamethasone-impregnated absorbable nasal pack versus saline-impregnated nasal packing on postoperative outcome of nasal cavities after endoscopic sinus surgery using the Perioperative Sinus Evaluation Scoring System (POSE) and Lund and Kennedy Endoscopic Scoring System.
Methods:
Study Design: Prospective, randomized, double blinded, placebo-controlled trial
Setting: Single Center Tertiary Government Hospital
Population: Nineteen patients aged 15 years old and above, diagnosed with chronic rhinosinusitis, with nasal polyposis grade 3, who underwent endoscopic sinus surgery from January 2015 to August 2015
Results: Nasal cavities that received postoperative dexamethasone-impregnated nasal packs showed significantly lower POSE scores than placebo on post-op Days 14 (p value 0.0022; 95% CI: -2.113 to -0.5116) as well as lower Lund-Kennedy Scores on post-op day 14 (p value of 0.0180; 95% CI: -2.493 to – 0.2571) and day 28 (p value of 0.007; 95% CI: -1.56275 to -0.2832)
Conclusion: Dexamethasone-impregnated absorbable nasal packing affords better postoperative outcomes: less edema, crusting, secretions, and synechiae, than saline-impregnated absorbable packing in later postoperative days.
Keywords: Dexamethasone, endoscopy, nasal polyp, nasal cavity, intranasal absorption
Congenital Oval Window Aplasia: An Unusual Cause of Conductive Hearing Loss in an Adult
Authors: Chiong Charlotte M. , Mercado-Evasco Rachel T. , Chiong Alessandra E. , Perez Mary Ellen C. , Abes Franco Louie L. , Chan Abner L. 
Published: April 2019

Objective: To report a case of congenital oval window aplasia (COWA) in a Filipino adult presenting with unilateral maximal conductive hearing loss and discuss the diagnostic considerations, pathophysiology and management.
Methods:
Study Design: Case report
Subjects: One (1)
Setting: Tertiary Public Referral Center
Results: Audiometric evaluation showed a maximal unilateral left conductive hearing loss. High resolution temporal bone CT showed absence of the oval window on the left along with facial and stapes abnormalities. Exploratory tympanotomy showed an aberrant facial nerve, monopodal and abnormally located stapes and absent oval window. Postoperative hearing gain achieved after a neo-oval window and Schuknecht piston wire prosthesis remained stable over two years.
Conclusion: A congenital minor ear anomaly classified as Cremers Class 4a in which a congenital oval window aplasia was associated with an aberrant facial nerve anomaly and a monopodal stapes is reported. Recent literature supported the view that congenital oval window aplasia can in selected cases be amenable to various surgical approaches and a stable postoperative hearing gain is achievable in the long term.
Keywords: oval window absence, Cremers classification, congenital middle ear
Recurrent Epistaxis from a Post-Traumatic Infraorbital Artery Pseudoaneurysm
Authors: Pascual Ma. Victoria P. , Alonzo Daniel M. 
Published: April 2019

Objective: To present a rare case of post-traumatic recurrent epistaxis in an elderly woman.
Methods
Design: Case Report
Setting: Tertiary Private Hospital
Participants: One
Results: A 93-year-old woman had multiple admissions for recurrent life threatening nose-bleeding that was not controlled until a post-traumatic pseudoaneurysm of the infraorbital artery was diagnosed and embolized.
Conclusion: The diagnosis of pseudoaneurysm should be considered in such cases, and treatment involving surgeons and interventional radiologists should be initiated to minimize morbidity and mortality.

Keywords: recurrent epistaxis, post-traumatic pseudoaneurysm, right infraorbital artery, right internal maxillary artery, embolization
Association of the Laterality of Chronic Suppurative Otitis Media with the Laterality of Sinonasal Disease Based on Temporal Bone CT - Scan Results and Lund Mackay Scoring System
Authors: Adan Walfrido C. , Cruz Emmanuel Tadeus S. 
Published: April 2019

Objective: To determine the association between the laterality of chronic suppurative otitis media (CSOM) and the laterality of sinonasal disease, based on temporal bone ct-scan results and Lund-Mackay Scoring system, among patients admitted for ear surgery in a tertiary government hospital in Metro Manila.
Method:
Design: Retrospective review of records
Setting: Tertiary Government Hospital
Patients: Ninety-eight patients diagnosed with chronic suppurative otitis media admitted for otologic surgery in the Department of Otorhinolaryngology – Head and Neck Surgery from January 2011 to June 2014 were considered for inclusion. Hospital charts and temporal bone ct-scan results were retrieved and analyzed for ear and sinonasal radiographic abnormalities and laterality. Excluded were those without CT-scan plates, who underwent temporal bone surgery for reasons other than chronic suppurative otitis media, and those with incomplete records. The Lund-Mackay Scoring System was used to grade sinonasal findings which were compared to CSOM complications. Data was analyzed using t-test, ANOVA for homogenous numerical data, Kruskal-Wallis for heterogenous numerical data, and chi-square test for nominal type of data.
Results: Of the 64 patients included in the study, 12 or 18.75% had radiographic sinonasal abnormalities. There was no significant association between the laterality of ear disease and the laterality of sinonasal pathology as there was no significant difference in the proportion of subjects with sinonasal disease according to laterality of CSOM (p=.32). When site of nose pathology was compared to Lund-Mackay graded scores, it was found that bilateral nose pathology generally had a higher Lund-Mackay score of 8.60 ± 5.60. However, there was no significant difference in the Lund-Mackay score according to the nose pathology site (p=.20). An association was seen between total LMS and patients with ear pathologies, but no significant difference was noted (p=.44). Although patients with ear complications had higher LM scores, this was not statistically significant.
Conclusion: Laterality of ear disease was not associated with the laterality of sinonasal disease, although CSOM complications were associated with high Lund-Mackay scores. Future, better-designed studies may shed more light on these associations.
Keywords: chronic suppurative otitis media, sinonasal disease, Lund-Mackay, Temporal Bone CT-Scan
Relapsing Polychondritis Initially Presenting with Hoarseness and Difficulty Breathing in a 21-Year-Old Male
Authors: Padua Paula Francezca , Lim William L. 
Published: April 2019

Objective: To present a case of relapsing polychondritis initially presenting with hoarseness and difficulty breathing and to discuss the diagnostic criteria and typical CT scan findings of relapsing polychondritis.
Design: Case Report
Setting: Tertiary Private Hospital in Metro Manila
Case Report: A 21-year-old man who was initially managed as a case of bronchial asthma for persistent hoarseness and recurrent difficulty breathing was found to have severe laryngeal edema on endoscopy, and soft tissue expansion of the cricoid cartilage with calcifications and irregular first tracheal ring on CT scan. He also had recurrent eye redness and developed bilateral aural inflammation, and was subsequently diagnosed to have relapsing polychondritis.
Conclusion: Relapsing polychondritis is a rare autoimmune disease characterized by recurrent inflammation and eventual destruction of cartilage throughout the body. Typical manifestations may not always be present, causing a delay in diagnosis. It should be considered in patients with intractable respiratory symptoms not responsive to treatment for upper respiratory tract infections or asthma. A CT scan may reveal signs of cartilage destruction and help in diagnosis.
Keywords: Polychondritis, Relapsing; airway involvement; imaging
Traumatic Perforation of the Tympanic Membrane: Etiologies and Risk Factors for Healing and Intervention
Authors: Sannigrahi Rajarshi , Ghosh Debangshu , Saha Jayanta , Basu Sumit Kumar 
Published: April 2019

Objective: To study various etiologies of traumatic tympanic membrane perforation; evaluate the factors involved in healing of traumatic tympanic membrane perforation; and identify patients with perforations unlikely to benefit from conservative management.
Methods
Study Design: Prospective observational study
Setting: Tertiary Government Medical College and Hospital
Subjects: 64 consecutive cases of traumatic tympanic membrane perforation seen over one year were followed for 3 months. Perforations were assessed in terms of size, etiology, condition of edge and other associated factors or combinations of factors with regards to spontaneous healing, using descriptive statistics and chi-square tests.
Results: Of the 64 cases, 51 perforations healed while 13 did not. There were significant associations between tympanic membrane condition after 3 months and explosive mode of injury (χ2 = 23.30; p=.00001) as well as with size of perforation ((χ2 = 25.75; p=.00001). The risk of persistence of a tympanic membrane perforation was 34.57 times more among patients with a perforation size >50% compared to those with perforation size ≤50% [OR-34.57 (6.28, 190.14); p= .00001]. Combined, explosive etiology and perforation size >50% were significantly associated with non-healing ((χ2 = 37.60; p = .00001). There were no significant associations with the condition of the edge of the perforation and upper respiratory tract infection.
Conclusions: An explosive etiology and tympanic membrane perforation size >50% may be significant risk factors predicting non-healing of the perforation. Risk stratification of patients having one or both of these risk factors, with early intervention for those with both, and close monitoring for those with any one of these may lessen unnecessary morbidity. Bigger multicenter future studies are necessary to confirm these initial findings.
Keywords: tympanic membrane perforation, tympanic membrane, risk factors, wound healing, early intervention
Optical Myringotomy Knife
Authors: De Leon Rozelle O. , Amable Jay Pee M. 
Published: April 2019

Objective: To describe an improvised optical myringotomy knife essential in creation of an incision in a myringotomy simulator.
Methods:
Study Design: Instrumental Innovation
Setting: Tertiary Private Hospital
Subject: None
Results: The optical myringotomy knife was able to create incisions on mock membranes made up of polyethylene film (Cling Wrap) in a myringotomy simulator. The incisions measured approximately 2 mm with sharp edges indicating that the myringotomy knife was able to penetrate the mock membrane with ease. It provided good control in performing myringotomy incisions under endoscopic visualization of the tympanic membrane.
Conclusion: Our initial experience with this optical myringotomy knife for tympanostomy tube insertion suggests that it may greatly improve the performance of myringotomy especially among less experienced surgeons. Further studies may establish its accuracy and replicability in vitro, after which formal in vivo trials can be attempted.

Keywords: tympanostomy, middle ear ventilation, endoscopy, instrumentation
Ehretia Microphylla (Tsaang Gubat) versus Loratadine as Treatment for Allergic Rhinitis: A Randomized Controlled Trial
Authors: Umali Fatima Angela C. , Chua Antonio H. 
Published: April 2019

Objective: To determine if Ehretia microphylla (Tsaang Gubat) decoction tea and placebo can improve the symptoms of mild intermittent allergic rhinitis in comparison to loratadine and control tea.

Methods:
Study Design: Double blind, Randomized Controlled Trial
Setting: Tertiary Government Training Hospital
Subjects: Twenty-four patients diagnosed with mild intermittent allergic rhinitis from October 2015 to July 2016 were randomly divided into a treatment group given Ehretia microphylla (Tsaang Gubat) decoction tea and placebo, and a control group given control tea and loratadine, both taken for 7 days. Patients underwent pre– and post–intervention evaluation by anterior rhinoscopy, Sino-nasal Outcome Test 22 (SNOT 22) Questionnaire and 10-point Visual Analog Scale (VAS). Data were encoded and subjected to statistical analysis using Mann Whitney U test, and Wilcoxon Signed Rank test.

Results: Age and gender of the treatment and control group participants were comparable. Prior to intervention, no differences in symptoms were noted between both groups on SNOT 22 and VAS scores. After intervention, no differences in symptoms were noted between the 2 groups on SNOT 22 and VAS scores either. Comparison of pre- (30.4 ± 17.3) and post- (7.2 ± 6.5) intervention mean SNOT 22 scores of the loratadine control group with pre- (32.5 ± 23.7) and post- (7.8 ± 10.4) intervention mean SNOT 22 scores of the Ehretia Microphylla treatment group showed significant improvement of symptoms in both groups. Likewise, comparison of pre- and post-intervention mean VAS scores of the loratadine control group and pre- and post-intervention mean VAS scores of the Ehretia Microphylla treatment group based on symptoms of sneezing, rhinorrhea, nasal congestion and pruritus showed significant improvement of symptoms in both groups (p-values of < .001).

Conclusion: Ehretia microphylla (Tsaang Gubat) decoction tea may improve symptoms of allergic rhinitis (sneezing, rhinorrhea, pruritus, and nasal congestion) and be taken as an alternative to loratadine in patients with mild intermittent allergic rhinitis. Further clinical trials with more participants may provide stronger evidence for this conclusion.

Keywords: Allergic rhinitis, tsaang gubat, ehretia microphylla, loratadine