Quality of life among SARS-CoV-2 (COVID-19) positive patients with anosmia using the short version questionnaire of olfactory disorders - Negative statements translated in Filipino (sQOD-NS Ph)

@#<p><strong>Objective:</strong> To determine the quality of life among SARS-CoV-2 (COVID-19) positive patients with anosmia using the Short Version Questionnaire of Olfactory Disorders - Negative Statements translated in Filipino (sQOD-NS Ph).</p><p><strong>Methods: </strong><strong>Design:</strong> Cross-Sectional Study</p><p><strong>                 Setting:</strong> Tertiary Government Training Hospital</p><p><strong>                 Participants:</strong> SARS-CoV-2 (COVID-19) RT-PCR positive patients aged 18 years old and above with COVID-19 symptoms and anosmia in a tertiary government hospital who consulted from March 2020 to August 2021 answered the short version of sQOD-NS Ph.</p><p><strong>Results:</strong> Out of 108 participants with positive SARS-CoV-2 (COVID-19) RT-PCR test, 72 (66%) presented with anosmia, and sQOD-NS Ph scores ranged from 1 to 21 with a mean of 14.78. Thirty two (44%) encountered problems in eating while 21 (29%) had feelings of isolation due to loss of smell. There was an inverse correlation of -0.478 between recovery time of olfaction and QoL score, hence the longer the recovery time, the lower the QoL score, while the shorter the recovery time, the higher the QoL score (p < .0001).</p><p><strong>Conclusion:</strong> Majority of COVID-19 patients with anosmia had mild or negligible impairment, while a small percentage had impaired quality of life. The low percentage may be due to high number of patients who may have recovered their sense of smell along the course of the disease.</p>

Fatal otitic hydrocephalus due to sinus thrombosis: A case report

Objective@#To report a case of chronic suppurative otitis media with complications of lateral sinus thrombosis and otitic hydrocephalus and to discuss its clinical manifestations, clinical course, ancillary procedures and management.@*Methods@#Study Design: Case Report. Setting: Tertiary Government Training Hospital. Patient: One. @*Results@#A 35-year-old man was admitted due to intermittent right otorrhea for 20 years and headache for a month. The Glasgow Coma Scale (GCS) score was 12, and mastoidectomy performed on the second hospital day showed cholesteatoma with erosion of the bony covering of the sigmoid sinus with scanty purulent discharge. The GCS improved to 15 few hours post- operatively, however, 24 hours post-operatively, GCS decreased from 15 to 10 and a CT scan showed dilatation of cerebral ventricles and lateral sinus thrombosis which persisted on subsequent imaging studies. His condition deteriorated irreversibly despite a ventriculostomy, and he eventually expired after 3 weeks in the ward. @*Conclusion@#Otitic hydrocephalus due to lateral sinus thrombosis is a serious complication of chronic suppurative otitis media seldom encountered nowadays. In this case, otitic hydrocephalus developed and progressed despite broad spectrum antibiotics, mastoidectomy and a ventricular shunt. This case report underscores the importance of early recognition of warning signs of intracranial complications to institute prompt management.

Association of Anosmia and Positive SARS-CoV-2 (COVID-19) RT-PCR Test Results Among Patients in the Quezon City General Hospital

AbstractObjective: To determine the association of anosmia and positive SARS-CoV-2 (COVID-19) RT-PCR test results among patients in a tertiary government hospital in Metro Manila.Methods: Design: Cross-SectionalStudy Setting: Tertiary Government Training HospitalParticipants: Patients aged 18 years old and above who consulted or were admitted with COVID-19 symptoms at the Quezon City General Hospital in the Philippines from July to September 2020 answered an offline version of the American Academy of Otolaryngology - Head and Neck Surgery AAO-HNS COVID-19 Anosmia Reporting Tool prior to undergoing (COVID-19) RT-PCR testing.Results: Out of 172 participants, 63 (36.6%) presented with anosmia. Sixty (95.2%) out of 63 of those with anosmia had a positive COVID-19 RT-PCR test result. Forty-one (65%) participants reported anosmia as the first symptom while the most common associated symptoms were fever (59%), cough (50%), and rhinorrhea (31%). There was a significant association between anosmia and positive SARS-CoV-2 (COVID-19) RT-PCR tests (X2 =33.85, df=1, pConclusion: Anosmia was associated with a positive SARS-CoV-2 (COVID-19) RT-PCR test in more than 95% of those who reported the symptom. Anosmia should be considered as a red flag sign which should be included in the screening of persons suspected of being infected with COVID-19 to help mitigate further spread of the virus.Keywords: anosmia; olfactory dysfunction; loss of sense of smell; coronavirus; SARS-CoV-2; pandemic; 2019-NCoV; COVID-19

Association of anosmia and positive SARS-CoV-2 (COVID-19) RT-PCR Test results among patients in the Quezon City General Hospital

Objective@#To determine the association of anosmia and positive SARS-CoV-2 (COVID-19) RT-PCR test results among patients in a tertiary government hospital in Metro Manila.@*Methods@#Design: Cross-Sectional Study. Setting: Tertiary Government Hospital. Participants: Patients aged 18 years old and above who consulted or were admitted with COVID-19 symptoms at the Quezon City General Hospital in the Philippines from July to September 2020 answered an offline version of the American Academy of Otolaryngology-Head and Neck Surgery AAO-HNS COVID-19 Anosmia Reporting Tool prior to undergoing (COVID-19) RT-PCR testing.@*Results@#Out of 172 participants, 63 (36.6%) presented with anosmia. Sixty (95.2%) out of 63 of those with anosmia had a positive COVID-19 RT-PCR test result. Forty-one (65%) participants reported anosmia as the first symptom while the most common associated symptoms were fever (59%), cough (50%), and rhinorrhea (31%). There was a significant association between anosmia and positive SARS-CoV-2 (COVID-19) RT-PCR tests (X2 =33.85, df=1, p<.0001). @*Conclusion@#Anosmia was associated with a positive SARS-CoV-2 (COVID-19) RT-PCR test in more than 95% of those who reported the symptom. Anosmia should be considered as a red flag sign which should be included in the screening of persons suspected of being infected with COVID-19 to help mitigate further spread of the virus.

Bilateral Facial Nerve (Bell's) Palsy in a 24-Year-Old Woman: A Case Report

@#<p><strong>OBJECTIVE:</strong> To report a case of acute bilateral facial nerve palsy in a 24-year-old woman and to present the differential diagnoses, pathophysiology, management and prognosis.</p><p><strong>METHODS:</strong></p><p><strong> Design:</strong> Case study</p><p><strong>Setting:</strong> Tertiary Private Hospital</p><p><strong>Patient:</strong> One (1)</p><p><strong>RESULT:</strong> A 24-year-old woman with fever, joint pains, cough, chest pain, difficulty ambulating and progressive facial muscle weakness was diagnosed with rheumatic fever. Bilateral facial nerve paralysis was noted, and Electromyography-Nerve Conduction Velocity (EMG-NCV) testing with special facial nerve study revealed abnormal facial nerve and blink reflex studies while EMG-NCV of the upper and lower limbs were normal. Audiometry and MRI of the brain and facial nerve were normal while Schirmer's Test showed decreased tearing in both eyes. The rheumatic fever resolved within 5 days of antibiotics, while Prednisone and physiotherapy resulted in improvement of facial paralysis from House Brackmann V to House Brackmann II-III over a period of 6 months.</p><p><strong>CONCLUSION:</strong> Idiopathic facial paralysis or Bell's Palsy is the most common cause of acute unilateral facial paralysis while bilateral facial nerve paralysis is a rare condition. Patients with facial palsy should undergo appropriate diagnostics to determine the underlying condition and to facilitate prompt management.</p>

Efficacy of Carragelose® Nasal Spray Impregnated Versus Mupirocin Ointment Impregnated Nasal Packs on Mucosal Healing after Endoscopic Sinus Surgery: A Double-Blind, Non-Randomized, Right-Left Side Comparison

@#Objective: To determine the efficacy of carragelose® nasal spray versus mupirocin ointment impregnated nasal packs on postoperative mucosal healing among chronic rhinosinusitis with nasal polyposis (CRSwNP) patients after endoscopic sinus surgery (ESS). Methods: Design: Double-Blind, Non-Randomized, Right-Left Side Comparison Setting: Tertiary Government Training Hospital Participants: Fifteen (15) patients diagnosed with chronic rhinosinusitis with nasal polyposis (CRSwNP) who had ESS were included in the study. Nasal packs (Netcell®) impregnated with carragelose® nasal spray or mupirocin ointment were respectively applied in right and left nostrils. Postoperative mucosal healing was graded by a blinded consultant using the Lund-Kennedy Endoscopic Scoring System and Perioperative Sinus Endoscopy (POSE) scoring system. Results: Six patients (12 nasal sides) completed the study. Comparing nasal packs impregnated with carragelose® nasal spray mupirocin ointment, the carragelose® group had lower Lund- Kennedy median scores than the mupirocin group on the 7th post-operative day; and this was statistically significant (p = .027). There were no significant differences in Lund-Kennedy postoperative scores on days 4 (p = .217), 14 (p = .171) and 28 (p = .151). Conclusion: Carragelose® nasal spray impregnated nasal packs may be comparable with, and may be an alternative to mupirocin ointment impregnated nasal packs in terms of postoperative mucosal healing among ESS patients with CRSwNP.

Autologous Fat Transfer to Improve Aesthetic Appearance in Facial Asymmetry from Parry-Romberg Syndrome: A Case Report

@#<p><strong>OBJECTIVE: </strong>To present a case of progressive hemifacial atrophy in a young woman with Parry-Romberg Syndrome and the role of autologous fat transfer to improve her aesthetic appearance and lessen facial asymmetry.</p><p><strong>METHODS:</strong></p><p><strong>Design:</strong>           Case Report</p><p><strong>Setting:</strong>           Tertiary Government Training Hospital</p><p><strong>Patient:</strong>           One</p><p><strong>RESULTS: </strong>A 20-year old woman consulted because of drooping of the right eyelid and gradual thinning of right cheek muscles since age 16.  On examination, the right facial muscles were hypoplastic with prominent facial bony ridges. An MRI scan showed atrophy of the right medial pterygoid and masseter. She underwent autologous fat transfer on the right side of the face to augment the cheek, improve cosmetic appearance and lessen facial asymmetry.  </p><p><strong>Conclusion: </strong>Our patient is satisfied and happy with the outcome and cosmetic appearance of her autologous fat transfer and is ready to undergo the same procedure if the need arises in the future. Although no definite cure exists for Parry Romberg syndrome, our report illustrates the role of autologous fat transfer as an inexpensive, easily harvested and biocompatible material to improve facial asymmetry. The procedure yielded encouraging results, although long-term benefits remain uncertain.</p><p> </p><p><strong>Keywords:</strong> Parry-Romberg syndrome; progressive hemifacial atrophy; autologous transplantation</p>

Association of ultrasonographic findings and thyroid malignancy: A cross-sectional study

@#<p><strong>OBJECTIVE: </strong>To determine the association of thyroid malignancy and the following ultrasonographic findings: presence of solid hypoechoic nodule, irregular margins (infiltrative, microlobulated, or speculated), microcalcifications or disrupted rim calcifications with small extrusive hypoechoic soft tissue component, taller than wide shape of the thyroid nodule, and evidence of extrathyroidal extension.</p><p><strong>METHODS:</strong></p><p><strong>Design:           </strong>Cross-Sectional Study</p><p><strong>Setting:           </strong>Tertiary Government Training Hospital</p><p><strong>Participants: </strong>Records of patients admitted to the Otorhinolaryngology- Head and Neck Surgery ward with a diagnosis of nodular non-toxic goiter, multinodular non-toxic goiter, and thyroid malignancy who underwent thyroid surgery between January 2017 and June 2018 were considered for inclusion.</p><p><strong>RESULTS: </strong>A total of 33 patients, 7 males and 26 females, were included in this study. Patients' age ranged from 26 to 69 years with an average of 46 years. Thirteen (39.4%) had malignant while 20 (60.6%) had benign histopathologic results. There was a significant association between presence of solid hypoechoic nodule (Fisher exact, n = 33, p = .0047), irregular margins and microcalcifications with malignant histopathology results (X2 (df = 1, N = 33) = 8.57, p = .003). No significant difference was noted in the proportion of subjects with malignancy according to taller than wide nodules (Fisher exact, n = 33, p = 1.000) or presence of extrathyroidal extension nodules or presence of extrathyroidal extension (Fisher exact, n = 33, p = .276). On multivariate analysis using logistic regression, only microcalcification was found to be a significant predictor of malignancy (OR = 8.96, 95% CI:  1.02 - 87.19, p = .05).</p><p><strong>Conclusion: </strong>There was a significant association between presence of solid hypoechoic nodule, margins and microcalcifications with thyroid carcinoma. Only microcalcification was found to be a significant predictor of thyroid malignancy on ultrasound, although our confidence interval was broad.</p><p><strong>KEYWORDS:</strong> calcifications; thyroid; thyroid carcinoma; thyroid nodule; ultrasonography</p>

Bilateral cricoarytenoid joint ankylosis with a perplexing etiology

@#Immobility, fixation, or paralysis of the vocal folds is an ominous sign when encountered in the clinics. This may be due to a variety of diseases, lesions, injuries, or vascular compromise which may affect the integrity and physiologic mechanism of the vocal folds. The common etiologies include infectious processes such as laryngeal or pulmonary tuberculosis (PTB), malignancy or neoplasms, central problems such as cerebrovascular accidents (CVA), stroke and others.1,2,3 The problem should be addressed immediately because this potentially life threatening and imminent narrowing of the glottic opening may lead to respiratory distress. Vocal fold paralysis due to compression of the recurrent laryngeal nerve from PTB and laryngeal cancer are perennially seen in clinical practice, but immobility of the vocal folds due to cricoarytenoid joint fixation or ankylosis is seldom seen and appreciated. Hence, we present a case of bilateral cricoarytenoid joint ankylosis and discuss its etiology, pathophysiology, differential diagnoses, ancillary procedures, and management.

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

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

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>

An improvised tracheostoma button fabricated from disposable plastic syringe

Objective: To design inexpensive, easily fabricated stoma buttons for post-laryngectomy patients with stomal stenosis and patients who require prolonged tracheotomy. Methods: Design: Surgical Instrumentation Setting: Tertiary Government Hospital Subjects: Tracheostoma buttons fabricated from 3 or 5 cc disposable plastic syringe were tested on two post-laryngectomy patients with stomal stenosis and a tracheotomized patient with bilateral vocal cord paralysis. Results: The tracheostoma buttons were inexpensive and relatively easy to fabricate. They were easily inserted and well tolerated by all three patients, compared to previously-used commerciallyavailable tracheotomy tubes. Conclusion: In a developing country setting, improvised tracheostoma buttons made from disposable plastic syringes may be viable alternatives to commercially-available stoma buttons or tracheotomy tubes. Clinical trials on more subjects should be conducted to assess parameters for use and long-term efficacy and safety issues.