Hearing loss from S. Suis meningitis in a middle-aged couple

@#Streptococcus suis is a bacterial pathogen causing a wide range of infections including meningitis, lung infections, arthritis, sepsis and endocarditis.1 Over the years, an increasing number of cases have been reported among humans especially in countries in Southeast Asia specifically in Vietnam and Thailand where pig-rearing is common.2 One of the prominent symptoms of S. suis infection is hearing loss that may be present during the onset or a few days after.1 We report two cases of adult S. suis meningitis presenting with bilateral hearing loss.

Pneumococcal conjugate vaccine (Non-Typeable Haemophilus influenzae (NTHi) protein D, diphtheria or tetanus toxoid conjugates) in prevention of acute otitis media in children: A cohort study

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the incidence of acute otitis media among children aged 2 to 6 months old in Sampaloc, Manila who were previously given 3 doses of pneumococcal conjugate vaccine (Non-Typeable Haemophilus influenzae (NTHi) protein D, diphtheria or tetanus toxoid conjugates) and those who did not receive the vaccine over a period of one year.<br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Cohort Study<br /><strong>Setting:</strong> Primary Health Center in Sampaloc, Manila, Philippines<br /><strong>Participants:</strong> Medical records of well children aged 2 to 6 months were reviewed for inclusion. Participants were categorized into vaccinated and unvaccinated groups. Both groups underwent baseline history and physical examination including otoscopy and any signs and symptoms of active ear infection were noted. Subjects were followed up for a period of one year on a monthly basis for signs or symptoms of acute otitis media. <br /><strong>RESULTS:</strong> A total of 176 subjects participated in the study. The overall incidence of AOM among participants was 5.11% (9 out of 176). An AOM incidence of 3.75% (3 out of 80) and 6.25% (6 out of 96) was found among the exposed and unexposed groups, respectively. Fisher's exact test (one-tailed) p value= .34, relative risk (RR) .6 (95% Cl 0.155, 2.323).<br /><strong>CONCLUSION:</strong> The results of this study showed no difference in the development of AOM in the two groups. However, based on the relative risk, Pneumococcal conjugate vaccine is still beneficial in preventing AOM in children.</p>

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>

Undifferentiated nasopharyngeal malignancy with immunohistochemical features of diffuse large B cell lymphoma and undifferentiated carcinoma: A collision tumor?

@#p style=text-align: justify;strongOBJECTIVE:/strong To describe an unusual presentation of undifferentiated nasopharyngeal malignancy with immunohistochemical features of both diffuse B-cell lymphoma and undifferentiated carcinomastrong./strongbr /br /strongMETHODS:/strongbr /strongDesign:/strong Case Reportbr /strongSetting/strong: Tertiary Private University Hospital br /strongPatient:/strong Onebr /br /strongRESULTS:/strong A 49-year-old female whose initial nasopharyngeal biopsy interpretation was diffuse large B-cell lymphoma underwent three cycles of Rituximab, Cyclophosphamide, Hydroxydaunomycin, Oncovin and Prednisone (R-CHOP). Post-chemotherapy Computed Tomography (CT) scan of the nasopharynx revealed no change in tumor size or appearance. Repeat nasopharyngeal (NP) biopsy findings suggested an epithelial tumor lineage or post-chemotherapy reactive mucosal epithelial cells. No residual lymphoma was noted and immunostaining was positive for cytokeratin. The patient underwent 35 fractions of radiotherapy. Re-evaluation by Magnetic Resonance Imaging (MRI) with contrast after four months showed significant tumor shrinkage. Repeat NP biopsy revealed necrotic tissues with foci of high-grade squamous cell carcinoma. Two months after the biopsy, repeat MRI with contrast of the nasopharynx and neck showed increase in the bulk of the nasopharyngeal tumor with inferior extension to the level of the orophaynx and possible contralateral involvement. A nasopharyngectomy via left maxillary swing was performed and the final histopathology was undifferentiated carcinoma.br /br /strongCONCLUSION:/strong Undifferentiated malignancies of the nasopharynx may contain lymphoma or carcinoma and rarely, both lineages in coexistence. In such cases, the possibility of a collision tumor should be considered. Immunohistochemical distinction is important for treatment and prognostication./p

Inflammatory pseudotumor of an orbito-maxillary mass masquerading as a malignancy

Objective: To present a case of a benign orbito-maxillary tumor behaving as an invasive, expansive malignancy. Design: Case report Setting: A tertiary care hospital in Metro Manila Patient: A 4 1/2-year-old boy with a seven month history of right orbito-maxillary mass, proptosis and epiphora. Result: A series of biopsies were done before a definite diagnosis was made due to inconsistencies in the histopathologic findings, clinical picture, and the radiologic presentation of the case. After diagnosis, appropriate intervention resulted in a dramatic decrease in the size of the mass. At present, the patient is disease-free and asymptomatic. Conclusion: Histopathologic diagnosis of Inflammatory Pseudotumor is difficult and differentiating it from malignant tumors is often a concern for otolaryngologists and pathologists. In spite of an initial malignant biopsy result, the combination of clinical signs and symptoms and radiologic findings of an infiltrative mass lesion, should not discount the possibility of a benign entity such as Inflammatory Pseudotumor for which treatment is conservative. (Author)

In the face of a compromised airway

OBJECTIVES: This case report aims to (1) Present the differential diagnosis of chronic cough without neglecting uncommon causes (2) Increase awareness of diagnostic challenges that may arise in the face of a compromised airway (3) Elucidate the therapeutic complexity of airway management; (4) Emphasize the value of a multi-disciplinary team approach in such cases; Illustrate the vital role otolaryngologists play in the diagnosis and management of airway problems DESIGN: Case Report SETTING: Tertiary Care Hospital in Quezon City, Philippines PATIENTS: One Patient RESULTS: This is the case of an eleven-year old male that presented with chronic cough that was refractory to conventional empiric medical therapy. As his symptoms progressed, further evaluation revealed a mass that was obstructing a large portion of the airway. Timely and methodical investigation and intervention proved to be life-saving. CONCLUSION: A working knowledge of the differential diagnoses of chronic cough is crucial in the diagnosis and management of the compromised airway. A high index of suspicion, systematic and thorough investigation and a multi-disciplinary approach are vital components of the treatment plan. Bronchoscopy in the hands of a skilled practitioner is still a diagnostic and therapeutic mainstay. (Author)