Advanced laryngotracheal stenosis patients in a tertiary provincial government hospital: A prospective case series

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the clinical profiles, interventions, and surgical outcomes of patients with advanced (grade III and IV) laryngotracheal stenosis prospectively seen over a 2-year period.  </p><p style="text-align: justify;"><strong>METHODS:</strong></p><p style="text-align: justify;">           <strong>Design:</strong>           Prospective Case Series</p><p style="text-align: justify;">          <strong>Setting:</strong>           Tertiary Provincial Government Hospital</p><p style="text-align: justify;"><strong>          Participants:</strong>  Five (5) patients with advanced laryngotracheal stenosis confirmed by laryngoscopy and/or tracheoscopy.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Five (5) patients (4 males, 1 female), aged 23 to 31years (mean 27-years-old) diagnosed with advanced laryngotracheal stenosis between June 2016 to June 2018 were included in this series. Four resulted from prolonged intubation (14 - 60 days) while one had a prolonged tracheotomy (13 years). Presentations of stenosis included dyspnea on extubation attempt (n=3), failure to extubate (n=1) and failure to decannulate tracheotomy (n=1). Stenosis length was 3 cm in two, and 1.5 cm in three. Of the five (5) patients, three had grade IV stenosis while two had grade III stenosis based on the Cotton-Myer Classification System. Two of those with grade IV stenosis and both patients with grade III stenosis had undergone prolonged intubation. The stenosis involved the subglottis in three, and combined subglottic and tracheal stenosis in two. Prolonged intubation was present in all three with subglottic stenosis, and in one of the two with combined subglottic and tracheal stenosis. Two patients underwent open surgical approaches while three underwent endoscopic dilatation procedures. Four patients were successfully decannulated while one is still on tracheostomy. None of them had post-operative complications.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong>  Advanced laryngotracheal stenosis is a challenging entity that results from heterogenous causes. Categorizing stenosis and measuring stenosis length may help in treatment planning and predicting surgical outcome.</p><p style="text-align: justify;"> </p>

PHONETOVOX: A novel prototype device for alaryngeal speech

Objective@#To describe a prototype improvised hand held device for alaryngeal speech.@*Methods@#Design: Instrument Innovation. Setting: Tertiary Private Hospital. Participants: Four listeners with normal hearing, were native Tagalog-speakers and had no previous experience with alaryngeal speech types participated in initial trials.@*Results@#The prototype PHONETOVOX was fabricated using a soundproofed cellphone casing with an intra-oral sound port attachment and a cellphone was loaded with Pocket Talkbox v. 1.4.0 software. The device was tested for its ability to produce intelligible speech by using the cellphone as a substitute for the larynx using oral cavity resonators and articulators, producing a synthesized sound mimicking the human voice. The PHONETOVOX produced intelligible words. Initial testing using a C-V-C Tagalog Word List had 4 listeners identify 34, 35, 47, and 54 out of 93 words (37 to 58%), with an overall average intelligibility of 46%.@*Conclusion@#Despite its restrictions in articulation and the wide range of results from the four listeners, our initial results may suggest the potential of PHONETOVOX as another modality for alaryngeal speech comparable to the 36 – 38 % intelligibility of commercially-available devices. Further trials with actual laryngectomees are needed to further establish intelligibility and acceptability.

Diagnostic value of computerized dynamic posturography in the assessment of peripheral vestibular disorders

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aims to determine the sensitivity, specificity, positive predictive value and negative  predictive  value  of  Computerized  Dynamic  Posturography  (CDP)  in  properly  labeling patients with peripheral vestibular disorders by Videonystagmography (VNG) as having vestibular dysfunction.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case - Control Study<br /><strong>Setting:</strong> Tertiary Private Hospital<br /><strong>Subjects:</strong> Twenty-three (23) patients aged 18 and above with no history of hypertension or cardiovascular disease and no intake of anti-vertigo medications for at least 48 hours prior to testing and with complete VNG and CDP results obtained on the same day or at least  two  days  apart  were  included  in  the  study. Cases were defined as those  diagnosed with a peripheral  vestibular  disorder  by VNG  while  controls  were  defined as those with  normal VNG results.  Sensitivity, specificity, positive predictive value and negative  predictive value of CDP in labeling those with peripheral vestibular disorders as vestibular were determined using VNG as gold standard.<br /><strong>RESULTS:</strong> There were 11 cases  (4  males, 7 females) and 12 controls (8  males,  4  females).  Using VNG  as  the  gold  standard  for  diagnosing  peripheral  vestibular  disorders,  CDP  had  a  sensitivity of 45.45% and specificity of 66.67% with Positive Predictive Value(PPV) of 55.56% and Negative Predictive Value(NPV) of 57.14%  in  assessing  peripheral vestibular disorders among the adults tested.  Interestingly, 33.33% of patients with normal VNG may actually have had a vestibular dysfunction that could be detected by CDP.<br /><strong>CONCLUSION:</strong> Prospective studies with larger sample sizes utilizing VNG and CDP are recommended in order to verify our findings.</p>

Calcifications in thyroid ultrasonography and thyroid carcinoma

@#BACKGROUND: Thyroid nodules are a common disease entity occurring in 5-10% of the general population and increasing with age. Their detection on ultrasonography ranges from 13% to 67%. Calcifications on ultrasound may occur in both benign and malignant diseases but have been cited for increased risk of thyroid carcinoma.OBJECTIVE: To determine the association of calcifications found on thyroid ultrasonography and the different types of calcifications with thyroid carcinoma.METHODS: Design: Retrospective Study Setting: Tertiary Private Hospital Participants: 126 patients with pre-operative thyroid or neck ultrasonography who subsequently underwent thyroidectomy (total or subtotal, with or without frozen section) were selected from a database covering a one-year period from January to December 2012. The presence and type of calcification on ultrasonography was correlated with the final histopathologic report for a diagnosis of thyroid carcinoma. Sensitivity, specificity, positive and negative predictive values were obtained.RESULTS: 51 out of 126 studies (40%) were observed to have calcifications of any description in both histologically benign (41%) and malignant (59%) nodules. Calcifications seen in malignancy arose from papillary carcinoma (86%). Follicular carcinoma and others (Plasmacytoma and Lymphoma) accounted for 7% each. The peripheral type of calcification was most prevalent accounting for 37% (11 out of 30). The sensitivity of detecting calcifications on ultrasonography is 58.82%, specificity 81.33%, positive predictive value 68.18% and negative predictive value 74.38%. Chi square test computed was 21.54 (P <0.05).CONCLUSION: There was an association between calcification found on ultrasonography and thyroid carcinoma and 86% of the calcifications were peripheral patterns mostly found in papillary thyroid carcinomas. Ultrasonography alone is not sufficient in diagnosing thyroid carcinoma but may increase the suspicion of malignancy depending on the type of calcification.