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.

Nasal glial heterotopia: Unsuspected brain tissue in the nasopharynx

@#<p><strong>OBJECTIVE: </strong>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 diagnosis difficulties and eventual treatment.</p> <p><strong>METHODS: <br />Study Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Participant:</strong> One <br /><br /><strong>RESULTS</strong>: 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.<br /><br /><strong>CONCLUSION:</strong> When confronted with 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 at a correct diagnosis, treatment plan and prevent possible complications especially those related to intracranial communication.</p>

Glottal function index and GRBAS scale of patients undergoing vocal cord medialization: A series of five patients

@#<p><strong>OBJECTIVE: </strong>Vocal cord paralysis or immobility is debilitating condition that may result from neural or mechanical fixation of the vocal cord (VC). When permanent, therapy is aimed at improving closure by modifying the position of the vocal cord. Whatever surgical intervention is chosen, pre-and post-operative voice evaluation is important. This study aimed to investigate the usefulness of the Glottal Function Index (GFI) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) Scale in the evaluation of treatment outcomes in patients with unilateral vocal cord paralysis (UVCP) who underwent medialization thyroplasty type 1 with a modified lock-in soft silicone implant.<br /><br /><strong>METHODS:<br />Design:</strong> Descriptive Case Series<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> Five<br /><br /><strong>RESULTS:</strong> Five patients (3 females, 2 males) consulted due to hoarness underwent rigid endoscopy. Four (2 right, 2 left) had unilateral paramedian VC paralysis while one had bilateral paresis with bowing of the left vocal cord. One of those with left VC paralysis was diagnosed as idiopathic; the four were iatrogenic (3 form thyroid surgery, 1 from multiple surgical procedures). All patients underwent medialization thyroplasty type 1 using locked-in soft silicone implant. The GFI and GRBAS scale were utilized for pre-operative and post-operative perceptual evaluation of voice. The GFI showed severe glottic insufficiency among all five patients prior to surgery with improvement of the subjective symptoms one day and one week post-surgery in four patients. Likewise, the Hirano GRBAS scale showed improvement of voice quality and correlated the improvement of the patient's subjective symptoms from the from GFI scores. However, 5 cases with bilateral vocal cord paresis, showed no improvement of voice quality despite recovery from subjective symptoms.<br /><br /><strong>CONCLUSIONS:</strong> For glottal insufficiency, perceptual voice evaluation using self-administered GFI and GRBAS scale assessment are important parameters in determining the quality of life among patients with glottal insufficiency undergoing medialization laryngoplasty.</p>

Surgical management of chronic suppurative otitis media with intracranial complications

@#Intracranial abscess is a serious, life-threatening condition with a dire prognosis. Although the advent of the antibiotic era has drastically reduced the incidence of the disease, predisposing factors such as untreated ear infections, poor personal hygiene, significant trauma with violation of the sterile cranial environment as well as existing co-morbidities such as an immunocompromised state make intracranial abscess a horrifying reality. Ear infections, in particular, are notorious for being the origin of roughly 50% of cerebellar abscesses.1 Chronic suppurative otitis media (CSOM) is one of the leading causes of brain abscess. Shaw and Russell2 reviewed 47 cases of cerebellar abscess and showed that 93% were caused by CSOM; the most common mechanism of entry into the brain parenchyma being direct extension. Chronic infection in the middle ear space could erode through the tegmen tympani and into the temporal lobe or through the tegmen mastoidei into the cerebellum. Neurological symptoms may be delayed as the abscess ‘grows’ in areas around the cerebellum that are regarded as ‘silent’, until vital areas such as those responsible for coordination and balance are violated. We describe a case of cerebellar abscess secondary to CSOM and discuss the possibility of performing ear surgery with simultaneous drainage of a contiguous abscess through a transmastoid approach in cases of chronic suppurative otitis media with intracranial complications.

The dimensions of the nasal septal cartilage: A preliminary study in adult Filipino Malay cadavers

@#<p style="text-align: justify;"><strong>OBJECTIVES</strong>: This study aimed to measure the dimensions of the nasal septal cartilage in adult Filipino Malay cadavers and calculate the cartilage area as well as the amount of graft material that can be harvested from the septal cartilage.<br /><br /><strong>METHODS</strong>:<br /><strong>Design</strong>: Descriptive, cross-sectional<br /><strong>Setting</strong>: Pamantasan ng Lungsod ng Maynila College of Medicine Anatomy Laboratory<br /><strong>Subjects</strong>: Ten preserved adult cadavers dissected within a period from September 2010 to October 2010. The septal cartilages were harvested and the lengths of the cephalic margin, dorsal margin, caudal margin and ventral margin were measured. From these measurements, the total area of the cartilage and the amount of graft material that can be harvested were calculated.<br /><br /><strong>RESULTS</strong>: The mean length of each margin of the septal cartilage was 25.9mm (cephalic edge), 22.3 mm (dorsal edge), 21.4mm (caudal edge) and 33.1 mm (ventral edge). The area of the septal cartilage had a mean value of 652.5 mm². The amount of septal cartilage which can be harvested had a mean area of 403mm².<br /><br /><strong>CONCLUSION</strong>: This study showed a slight decrease in septal cartilage area to 652.5 mm² and in available graft material to 403 mm². While this decrease may reflect the apparently smaller noses of native Southeast Asians compared to East Asians and South Asians, the difference in values can also be due to the difference in the number of subjects or in methods of measurement and further studies are recommended to determine the extent of inter-racial variability.</p>

Cavernous hemangioma of the mandible

Objective: To report a case of hemangioma arising from the mandible and its clinical presentation; describe the similarities with which mandibular hemangioma may mimic odontogenic and non-odontogenic lesions; and identify diagnostic and treatment modalities employed in these patients. Methods: Design: Case Report Setting: Tertiary Public Hospital Patient: One Results: A 12-year-old male with intractable gum bleeding exacerbated by intraoperative manipulation of a loose first premolar and uncontrolled by left external carotid ligation, underwent segmental mandibulectomy. The resected segment revealed multiple porosities and a hollow blood-filled cavity. Histopathology confirmed the diagnosis of cavernous hemangioma. Conclusion: Though rare, mandibular hemangiomas should be considered in lesions involving the mandible. Diagnosis is difficult with an array of lesions that may appear clinically and radiographically similar. The non-specific signs and symptoms of mandibular hemangioma could lead to exsanguinating hemorrhage if not attended to promptly.