Unilateral tonsilar hypertrophy in a 4-year-old girl with focal dermal hypoplasia (Goltz syndrome)

OBJECTIVE: To report a case of unilateral tonsillar hypertrophy resulting in severe Obstructive Sleep Apnea in a 4-year-old girl with focal dermal hypoplasia (FDH, Goltz or Goltz-Gorlin) Syndrome.METHODS:Design: Case ReportSetting: Tertiary Private Teaching HospitalPatient: OneRESULTS: A 4-year-old girl with Goltz Syndrome (classical features of cutaneous and osteopathic disorders since birth) and unilateral tonsillar hypertrophy manifested with snoring and apneic episodes at two years of age. Polysomnography revealed severe Obstructive Sleep Apnea and Arterial Blood Gases revealed metabolic acidosis with hypoxemia. A tonsillectomy and adenoidectomy improved breathing, appetite and sleep with resolution of snoring and apneic spells and final tonsil histopathology revealed lymphoepithelial polyp.CONCLUSION: A 4-year-old child with Goltz syndrome who developed severe obstructive sleep apnea due to tonsillar hypertrophy was presented. Otolaryngologists should be aware of this syndrome which may manifest with oral and mucosal lesions. Although rare, Goltz syndrome may be considered in the differential diagnosis of tonsillar hypertrophy especially in the presence of the inherent clinical features. Physicians should educate patients and address the co-morbidities associated with it through individualized treatment.

Quality of life after FESS among patients with nasal polyps using the NOSE questionnaire translated in Filipino (NOSE-Ph)

@#<p><strong>OBJECTIVE:</strong> To evaluate the quality of life before, and after Functional Endoscopic Sinus Surgery (FESS) among patients with nasal obstruction due to nasal polyposis using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire translated in Filipino (NOSE-Ph) in a tertiary government hospital in Metro Manila.</p> <p><strong>METHODS:</strong></p> <p><strong>Design:</strong>Cross-Sectional QOL Study</p> <p><strong>Setting:</strong>Tertiary Government Hospital</p> <p><strong>Participants:</strong>  40 patients with nasal polyposis who underwent FESS from April 2014 to June 2015 were included in the study. Patients who underwent FESS due to other nasal tumors other than nasal polyp were excluded. The subjects answered the previously-validated NOSE-Ph questionnaire pre- and post-operatively and the scores were gathered and analyzed.</p> <p><strong>RESULTS:</strong>Based on the pre and post-operative scores, there was a statistically significant improvement in all 5 parameters (1. nasal congestion, 2. nasal obstruction, 3. trouble breathing, 4.  trouble sleeping, and 5. inability to get enough air through the nose during exercise).</p> <p><strong>CONCLUSION:</strong>There was a statistically significant improvement in the quality of life of patients who underwent FESS based on the pre and post-operative scores using the NOSE-Ph questionnaire translated in Filipino.  </p>

Association of the laterality of chronic suppurative otitis media and sinonasal disease based on temporal bone CT scans and Lund Mackay scoring system

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> 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.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective review of records<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Participants:</strong> Ninety-eight (98) 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.<br /><strong>RESULTS:</strong> 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.<br /><strong>CONCLUSION:</strong> 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.<br /><br /> </p>

Descending necrotizing mediastinitis, a dreaded complication of acute tonsillitis

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> 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.<br /><br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report</p> <p><strong>Setting:</strong> Tertiary Private and Government Hospital</p> <p><strong>Patient:</strong> One</p> <p style="text-align: justify;"><strong>RESULTS:</strong>  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.<br /><br /><strong>CONCLUSION: </strong>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.</p>

Value of the 6-hour postoperative ionized calcium slope in predicting post- thyroidectomy occurrence of hypocalcemia

@#<p style="text-align: justify;"><strong>OBJECTIVE: </strong>To determine the value of the 6-hour postoperative ionized Calcium (iCa) slope, versus 6-hour postoperative Calcium alone in predicting the occurrence of hypocalcemia in patients who underwent thyroid surgery in a tertiary hospital in Metro Manila.<br /><br /><strong>METHODS:</strong><br /><strong>Design: </strong>Retrospective cross-sectional study<br /><br /><strong>Setting: </strong>Tertiary Private Hospital<br /><br /><strong>Subjects: </strong>Pre-operative and 6-hour postoperative ionized calcium determinations were analyzed in 59 patients of the ENT-HNS Department in a tertiary hospital in Metro Manila who underwent thyroid surgery from January 2009 to December 2013.<br /><br /><strong>RESULTS:</strong> The 6-hour postoperative iCa slope (difference between the pre-operative and 6-hour postoperative iCa levels) of ?0.18 mmol/L correctly predicted 57.1% of patients who eventually developed hypocalcemia, with a specificity of 81.6% and a positive predictive value of 63.2%. In contrast, the 6-hour postoperative iCa measurement identified only 23.8% (5 out of 21) patients who developed hypocalcemia.<br /><br /><strong>CONCLUSION:</strong> The 6-hr postoperative iCa slope increased the probability of identifying patients who developed hypocalcemia from 23.8% to 57.1%. However, as a single determination, this may  not suffice to take the place of serial iCa measurements after thyroid surgery.</p>

A case series of Tessier 3, 4, 7 and combined 4, 7 craniofacial clefts

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To report a case series of Tessier 3, 4, 7 and combined 4,7 craniofacial clefts, their clinical presentations, surgical approaches and outcomes in light of the current literature.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case series<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Subjects:</strong> Five patients<br /><strong>RESULTS:</strong> Five  patients aged 3 to 14-years-old with Tessier 3, 4 (2  cases), 7  and combined 4,7 were included in this study: Tessier 3 - medial orbitomaxillary cleft extending through the bony skeleton traversing obliquely across the lacrimal groove, Tessier 4 - median orbitomaxillary cleft traversing  vertically  through  the  inferior  eyelid,  infraorbital rim and  orbital  floor extending  to the lip between the philtral crest and the oral commissure  (2 cases), Tessier 7 - macrostomia and cleft oral commissure and combined Tessier 4 and 7, combining features described above. Four underwent 2- or 3-stage surgeries while one declined.<br /><strong>CONCLUSION:</strong> Five  craniofacial  clefts  were  presented.  Because  of  the  varying  patterns of craniofacial  deformities,  a  series of surgical  procedures,  tailor-made  for  each  individual  were performed  on  four. Otolaryngologists who perform maxillofacial and cosmetic surgery  should have good background knowledge about craniofacial defects and be familiar with the  surgical approaches at their disposal to yield favorable results that are appropriate to their local contexts.</p>

Vocal cord paralysis and dysphagia as sequelae of Gradenigo syndrome

@#<p><strong>OBJECTIVES:</strong> To present a case of vocal cord paralysis and dysphagia developing in Gradenigo syndrome and to discuss its clinical presentation, differential diagnosis and therapeutic approach. <strong><br /><br />METHODS:<br />Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><br /><strong>RESULTS:</strong> A 54-year-old lady was admitted with a six-month history of left-sided otorrhea, cheek and jaw pain, three months otalgia, and recent-onset hoarseness, dysphagia and diplopia on a background of mastoidectomy at age six. Otoscopy revealed granulation tissue and chlolesteatoma occupying the left external auditory canal. There was left vocal cord paralysis with pooling of saliva in the pyriform sinus, left lateral gaze paralysis and left facial nerve paralysis. CT scan revealed sclerosis of the left petrous apex and leptomeningeal enhancement on the left temporal lobe. Chronic suppurative otitis media with cholesteatoma and Gradenigo syndrome was diagnosed, and canal wall down mastoidectomy was performed. Postoperatively, the otalgia and pain over the left jaw diminished in intensity while hoarseness and left lateral gaze palsy remained.<br /><br /><strong>CONCLUSION:</strong> Gradenigo syndrome is known for its triad of retro-orbital pain, lateral gaze paralysis, and chronic middle ear infection due to petrous apicitis. Although rare, vocal cord paralysis and dysphagia may develop when infection traverses and encroaches on the jugular foramen where cranial nerves IX, X, and XI are lodged. Knowledge of the syndrome should not be limited or confined to the classic triad. Practicing ear specialists should be vigilant and cognizant of the clinical manifestations and sequelae of chronic middle ear infection. Prompt surgical intervention is crucial while resolution of the disease may vary for different individuals.</p>