Factors predisposing to post thyroidectomy vocal cord paralysis at Ospital ng Maynila Medical Center

Objective@#To determine the prevalence of vocal cord paralysis among post thyroidectomy patients based on severity and laterality, and explore possible associations with age, sex, diagnosis and type of thyroid lesion and surgical procedure.@*Methods@#Design: Cross-sectional study. Setting: Tertiary Government Training Hospital. Participants: Records of patients who underwent thyroidectomy under the Department of Otorhinolaryngology – Head and Neck Surgery of the Ospital ng Maynila Medical Center from January 1, 2014 to June 30, 2021. @*Results@#There were strong associations between the type of lesion and the presence of recurrent laryngeal nerve injury (V=.211, p=.001) and the diagnosis and the presence of RLNI (V=.245, p=.006). There were no significant associations between patient’s sex, age, diagnosis, type of thyroid lesion, surgical procedure with laterality and severity of RLNI. It was notable that all cases of bilateral recurrent laryngeal nerve injury were due to carcinoma only. Patients with malignant tumors were 2.8x (95% CI: 1.48-5.29) as likely to develop post surgical RLNI than those with benign tumors (p=.0015).@*Conclusion@#The factors that had a strong association with the presence of vocal cord paralysis among post-thyroidectomy patients were the diagnosis and type of thyroid lesion. Malignant thyroid lesions (specifically thyroid carcinoma) had a higher incidence of recurrent laryngeal nerve injury compared to benign thyroid lesions. More data from different institutions and including other predisposing factors may confirm our findings.

Tied to the Top: A Case Report on an Isolated Ankyloglossia Superior

@#<p><strong>Objective:</strong> To report a case of isolated ankyloglossia superior in a one-month-old boy.</p><p><strong>Methods:</strong></p><p style="text-align: left; padding-left: 30px;"><strong>Design:</strong> Case Report</p><p style="padding-left: 30px;"><strong>Setting:</strong> Tertiary Government Training Hospital </p><p style="padding-left: 30px;"><strong>Patient:</strong> One</p><p><strong>Results:</strong> A one-month-old boy with failure to thrive, feeding difficulties and a palatoglossal band that limited mouth opening and anterior posturing of the tongue was diagnosed to have non-syndromic ankyloglossia superior and underwent surgical transection of the fibrous ankylosis under intravenous sedation due to difficulty of insinuating an endotracheal tube orally. Direct latch breastfeeding was successfully adapted from the second to tenth postoperative day before they were lost to follow up.</p><p><strong>Conclusion:</strong> Despite a complicated pediatric airway, coordinated surgical and anesthesia management successfully restored tongue function and mouth opening to allow effective feeding.</p>

Animated demonstration of selected ORLHNS concepts and surgeries: A potential adjunct to learning

@#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 two 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.

Assessment of the ototoxic effects of amikacin and meropenem among neonates in a tertiary government hospital

@#OBJECTIVE: Using pre- and post-treatment otoacoustic emission (OAE) tests, this study aimed to assess the ototoxic effect of meropenem, amikacin and meropenem plus amikacin among neonates treated for sepsis neonatorum in a neonatal intensive care unit versus untreated outpatient controls.METHODS: Design: Prospective Quasi-Experimental Controlled Clinical Trial Setting: Tertiary Government Hospital Subjects: Neonates treated for sepsis neonatorum in the Neonatal Intensive Care Unit between August to October 2012 who met inclusion criteria were included in this study. Controls were neonates born in the same institution who were not admitted and did not receive any antibiotic treatment. Excluded were those with APGAR < 5 at first minute, birth weight < 1000 grams, clinically evident congenital anomalies and initial "refer" results on OAE. Neonates were subjected to OAE testing before and after seven days treatment with amikacin, meropenem or a combination of both drugs. Results were analysed using chi-square test. Maternal drug intake, family history of hearing impairment and clinical outcomes (whether expired or discharged improved) were not included in this study. Assessment of ototoxic effects were limited to OAE alone and not confirmed by ABR.RESULTS: OAE "refer" rates were as follows: no amikacin and no meropenem, 0% (0/42); amikacin only, 33.3% (3/9); meropenem only, 25% (2/8) and amikacin and meropenem, 50% (10/20). Statistical analysis showed that hearing loss was dependent on treatment (c2 =23.741, p = < 0.001). Overall, statistical analysis showed that there is an increased risk of hearing loss when treated with amikacin and/or meropenem as compared to no treatment.CONCLUSION: There is an increased risk of ototoxicity when amikacin, meropenem or a combination of both drugs is administered to neonates. While the ototoxic effects of amikacin have been elucidated, further studies involving meropenem and its potential ototoxic effect are recommended.