Clinical profile of patients with laryngotracheal stenosis in a tertiary government hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the clinical profile of patients with laryngotracheal stenosis over a 7-year period and discuss strategies for its prevention.<br /><strong>METHODS:</strong><br /><strong>    Design:</strong> Retrospective Case Series<br /><strong>    Setting:</strong> Tertiary Government Hospital<br /><strong>  Participants:</strong> Thirteen (13) patients with laryngotracheal stenosis confirmed by laryngoscopy and/or bronchoscopy.<br /><strong>RESULTS:</strong> 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.<br /><strong>CONCLUSION:</strong> 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<br />intervention.</p>

Transcanal resection of a type 1 glomus tympanicum

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To present a case of type 1 glomus tympanicum, its clinical presentations, surgical management and outcome.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 44-year-old woman with pulsatile tinnitus, vertigo, headache, ear fullness and decreased hearing on the right had a pulsatile reddish mass behind the tympanic membrane and Brown sign. Weber test lateralized to the right with mild conductive hearing loss on pure tone audiometry. Contrast CT scan demonstrated a 5x6 mm well-defined enhancing mass in the meso- and hypotympanum. Internal auditory canal MRI showed an avidly enhancing 5x3x4 mm nodule within the right middle ear adjacent to the cochlear promontory and anterior to the lateral semicircular canal. Impression was glomus tympanicum, type 1. The mass was excised via transcanal approach with post-operative resolution of tinnitus, headache, vertigo and improvement of hearing. Final histopathology was consistent with glomus tumor.<br /><strong>CONCLUSION:</strong> Glomus tympanicum tumors are rare, benign middle ear paragangliomas that arise from Jacobson's nerve are slow-growing and locally destructive. CT scan and MRI may detect involvement of other structures. Surgical resection is the primary treatment modality. Type 1 glomus tympanicum tumors are small and limited to the promontory and a less-invasive transcanal approach may be employed.</p>

Otorhinolaryngologic manifestations of human immunodeficiency virus infection in Manila, the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the prevalence of otorhinolaryngologic (ENT) manifestations in people living with Human Immunodeficiency Virus (HIV) infection seen in our institutions and to determine the association of these manifestations with age, sex, CD4 count and antiretroviral treatment.<br /><br /><strong>METHODS:</strong><br /><strong>Study Design:</strong> Cross-sectional study<br /><br /><strong>Setting:</strong> Two Tertiary Government Hospitals<br /><strong><br />Subjects:</strong> Adult patients (>19 years old) confirmed to be HIV- infected  were seen at Jose R. Reyes Memorial Medical Center and San Lazaro Hospital from February to July 2014. A data sheet regarding ENT manifestations was filled upon examination. Age, sex, CD4 count and antiretroviral treatment data were recorded. Independent samples t-test was used to determine age association with manifestations. Fischer's exact test was used to determine association of sex and manifestations. Chi-square test of independence was used to determine association of CD4 count and antiretroviral treatment with manifestations. Association was considered statistically significant if p< 0.05.<br /><br /><strong>RESULTS:</strong> Three hundred one (301) patients participated with 287 males (95.3%) and 14 females (4.7%). The mean age was 31.7 ± 8. One hundred ninety seven (197 or 65.4%) had ENT manifestations. The most common areas of manifestations came from the oral cavity-oropharyngeal area (n=104, 37%), nasal cavity-nasopharyngeal area (n=73, 26%) and ear (n=43, 15%). The most frequent manifestations were cervical lymphadenopathy, aphthous stomatitis and acute rhinitis. There was no significant difference in the age (p=0.31) and sex (p=0.15) of patients with and without manifestations. However, there was a direct association of manifestations with low CD4 count (p<0.001) and inverse association with antiretroviral treatment (p=0.036).</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> Our findings emphasize the importance of screening for ENT manifestations, regular CD4 monitoring and enrollment to antiretroviral therapy in persons with HIV. Baseline otorhinolaryngologic examination upon HIV diagnosis and prior to initiating treatment should be followed by regular surveillance. Conversely, physicians should also be aware that patients with ENT manifestation may have HIV infection.</p>