Sinonasal anatomy variations on CT scans of a sample of Filipino adults with chronic rhinosinusitis

Objective@#To determine the prevalence of sinonasal anatomic variations seen on paranasal sinus (PNS) CT scans of a sample of Filipino adults with chronic rhinosinusitis.@*Methods@#Design: Cross-sectional study Setting: Tertiary Government Training Hospital Participants: The PNS CT scans of 51 Filipino patients with chronic rhinosinusitis with and without nasal polyposis diagnosed at our outpatien Department of Otorhinolaryngology-Head and Neck Surgery between October 2015 to December 2020 were reviewed for the presence of sinonasal anatomic variants. The prevalence of the identified variants was calculated.@*Results@#The CT scans of 51 patients, 41 (80.4%) men and 10 (19.6%) women, were included. The median age was 48 years (Q25: 35, Q75: 56, IQR:21). The median Lund Mackay Score (LMS) was 15 (Q25: 12, Q75: 20, IQR:8). Majority (94%) had an LMS of ≥5. The most common anatomic variant in the study population was agger nasi (n=46/51, 90.2% present bilaterally) followed by uncinate process attachment to the lamina papyracea (n=90/102, 88.24%). The third to sixth most common findings were Keros type II classification (n=76/102, 74.51%), nasal septal deviation (n=35/51, 68.62%), optic nerve canal type 1 (n=67/102, 65.69%) and anterior ethmoid artery grade 1 (n=46/102, 45.1%), respectively. Less common variants were Onodi cell (n=13/51, 25.49% unilateral and n=10/51, 19.61% bilateral), Haller cell (n=8/51, 15.69% unilateral and n=1/51, 1.96% bilateral), supraorbital cell (n=4/51, 7.84% unilateral and n=4/51, 7.84% bilateral), middle turbinate concha bullosa (n=3/51, 5.88% unilateral and n=6/51, 11.76% bilateral), superior turbinate concha bullosa (n=2/51, 3.92% unilateral and n=1/51, 1.96% bilateral), pneumatized crista galli (n=2/51, 3.92%) and optic nerve dehiscence (n=1/51, 1.96% bilateral). @*Conclusion@#In the adult Filipino population with CRS sampled in this study, the six most common sinonasal anatomic variants were agger nasi, superior attachment of the uncinate process to the lamina papyracea, Keros type II classification, septal deviation, optic nerve canal type 1 and anterior ethmoid artery grade 1. Pre-operatively, the PNS CT scan of every patient must be meticulously evaluated for the sinonasal anatomic variants to avoid surgical complications.

Predominant endotype of nasal polyps in a sample of Filipinos following endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis

Objective@#To determine the prevalence of eosinophilic and non-eosinophilic nasal polyps in Filipino patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) who underwent endoscopic sinus surgery. @*Methods@#Design: Retrospective Chart Review. Setting: Tertiary Government Training Hospital. Participants: A consecutive sample of adult patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis at the Rizal Medical Center from 2015-2019.@*Results@#Out of 66 patients who underwent endoscopic sinus surgery during the study period, 36 (54.55%) had an eosinophilic endotype while 30 (45.45%) had a non-eosinophilic endotype. @*Conclusion@#The slight predominance of eosinophilic nasal polyps found in our sample may suggest a contrasting trend compared to our Asian neighbors, who have a predominantly non[1]eosinophilic endotype – Indonesia (90.47%), Thailand (81.9%), South Korea (66.7%) and China (53.6%). However, this predominance is still lower than the 78-88% eosinophilia reported among Caucasians. Larger series may confirm these preliminary findings

Otorhinolaryngology Out-Patient Practice in the “Post”-COVID-19 Era: Ensuring a Balance Between Service and Safety

Objective@#To review available resources and provide evidence-based recommendations that may optimize otorhinolaryngologic out-patient health care delivery in the “post”-COVID-19 era while ensuring the safety of our patients, healthcare workers and staff.@*Data Sources@#Relevant peer-reviewed journal articles; task force, organizational and institutional, government and non-government organization recommendations; published guidelines from medical, health-related, and scientific organizations.@*Methods@#A comprehensive review of the literature on the COVID-19 pandemic as it pertained to “post”-COVID 19 out-patient otorhinolaryngologic practice was obtained from peer-reviewed articles, guidelines, recommendations, and statements that were identified through a structured search of the data sources for relevant literature utilizing MEDLINE (through PubMed and PubMed Central PMC), Google (and Google Scholar), HERDIN Plus, the World Health Organization (WHO) Global Health Library, and grey literature including social media (blogs, Twitter, LinkedIn, Facebook). In-patient management (including ORL surgical procedures such as tracheostomy) were excluded. Retrieved material was critically appraised and organized according to five discussion themes: physical office set-up, patient processing, personal protection, procedures, and prevention and health-promotion.@*Conclusion@#These recommendations are consistent with the best available evidence to date, and are globally acceptable while being locally applicable. They address the concerns of otorhinolaryngologists and related specialists about resuming office practice during the “post”-COVID-19 period when strict quarantines are gradually lifted and a transition to the “new” normal is made despite the unavailability of a specific vaccine for SARS-CoV-2. While they target practice settings in the Philippines, they should be useful to ENT (ear, nose & throat) surgeons in other countries in ensuring a balance between service and safety as we continue to serve our patients during these challenging times.

Reliability and validity of the Filipino Sino-Nasal Outcome Test (SNOT) 22

Objective@#To translate the Sino-Nasal Outcome Test (SNOT) 22 into Filipino, and establish the validity and reliability of the Filipino version of the Sino-Nasal Outcome Test (SNOT) 22. @*Methods@#Design: Prospective Cohort. Setting: Tertiary Government Training Hospital. Participants: Twenty one (21) patients with rhinosinusitis with or without nasal polyposis were administered the Filipino SNOT 22 to determine reliability. Sixty three (63) patients with rhinosinusitis with or without nasal polyps and forty eight (48) controls were recruited for the validity study.@*Results@#The Filipino SNOT 22 had a Pearson correlation of 0.618 significant at the 0.01 level and a Cronbach’s alpha of 0.76. The calculated Z-Score was 7.21 with p-value < .00001 significant at p < .05. The value of U was 300 with a critical U value at 1512.@*Conclusion@#The self administered Filipino SNOT 22 is a reliable and valid tool for measuring QOL among Filipino patients with rhinosinusitis.

Laryngeal cancer neck node metastasis: Patterns of spread

OBJECTIVE: To determine the patterns of neck node metastases of patients with laryngeal carcinoma in our institution.METHODS:Design:            Chart Review Setting:            Tertiary Public HospitalSubjects:         Records of thirty-eight (38) laryngeal cancer patients who underwent laryngectomy with neck dissection from January 2010 to January 2017 were considered.RESULTS: Records of 34 laryngeal cancer patients with ages ranging from 45-72 years old were included. The most common subsite was the glottis, with 19 (55.88%) patients. The distribution of neck node metastases for all subsites were 0/64 (0%) for level I, 22/64 (34.37%) for level II, 12/64 (18.75%) for level III, 7/64 (10.93%) for level IV, 0/64 (0%) for level V, and 1/64 (1.56%) for level VI. Distributions of lymph nodes per subsite for supraglottic SCCA were 0 (0%) for level I, 3/22 (13.63%) for level II, 2/12 (16.66%) for level III, 1/7 (14.28%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI. For glottic SCCA, they were 0 (0%) for level I, 12/22 (54.54%) for level II, 8/12 (66.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 1/1 (100%) for level VI; and for transglottic SCCA, they were 0 (0%) for level I, 7/22 (31.81%) for level II, 5/12 (41.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI. CONCLUSION: Our findings show that neck node levels II, III, and IV are most frequently affected in laryngeal carcinoma patients in our sample, and may guide recommendations for neck dissection in our institution.

Laryngeal cancer neck node metastases: Patterns of spread

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the patterns of neck node metastases of patients with laryngeal carcinoma in our institution.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Chart Review<br /><strong>Setting:</strong> Tertiary Public Hospital<br /><strong>Participants:</strong> Records of thirty-eight (38) laryngeal cancer patients who underwent laryngectomy with neck dissection from January 2010 to January 2017 were considered.<br /><strong>RESULTS:</strong> Records of 34 laryngeal cancer patients with ages ranging from 45-72 years old were included. The most common subsite was the glottis with 19 (55.88%) patients. The distribution of neck node metastases for all subsites were 0/64 (0%) for level I, 22/64 (34.37%) for level II, 12/64 (18.75%) for level III, 7/64 (10.93%) for level IV, 0/64 (0%) for level V, and 1/64 (1.56%) for level VI. Distributions of lymph nodes per subsite for supraglottic SCCA were 0 (0%) for level I, 3/22 (13.63%) for level II, 2/12 (16.66%) for level III, 1/7 (14.28%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI. For glottic SCCA, they were 0 (0%) for level I, 12/22 (54.54%) for level II, 8/12 (66.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 1/1 (100%) for level VI; and for transglottic SCCA, they were 0 (0%) for level I, 7/22 (31.81%) for level II, 5/12 (41.66%) for level III, 3/7 (42.85%) for level IV, 0 (0%) for level V, and 0/1 (0%) for level VI.<br /><strong>CONCLUSION:</strong> Our findings show that neck node levels II, III and IV are most frequently affected in laryngeal carcinoma patients in our sample and may guide recommendations for neck dissection in our institution.</p>

Accuracy of fine needle aspiration biopsy in diagnosing parotid gland malignancy

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of FNAB in detecting parotid malignancies in our institution.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Restrospective Chart Review<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Participants:</strong> Postoperative records of seventy six (76) patients with tumors of the parotid gland preoperatively diagnosed by FNAB. <br /><strong>RESULTS:</strong> The sensitivity of FNAB was 46%. The specificity and positive predictive value were both 100% and negative predictive value was 90%. Overall accuracy in diagnosing malignant parotid tumor was 91%.<br /><strong>CONCLUSION:</strong> FNAB in this institution is a poor predictor of malignancy, having a sensitivity rate of only 46%. While this may serve as a basis for not recommending pre-operative FNAB for patients with parotid tumors in the interim, other factors should also be considered, including concerns with the actual performance and interpretation of FNAB in our institution.<br /><br /> </p>

Chemodectoma and tetralogy of fallot

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To describe a rare case of chemodectoma, its clinical features and management, and to discuss its relationship chronic hypoxia from Tetralogy of Fallot.<br /><br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><br /><strong>Setting:</strong> Tertiary Government Hospital<br /><br /><strong>Patient:</strong> One<br /><br /><strong>RESULTS:</strong> A 23-year-old woman presented with a painless, slow growing, movable right submandibular mass, initially diagnosed as a lipoma by fine needle aspiration biopsy.  Computed tomography scan showed a solid nodule with ill-defined margins from the angle of the mandible to the level of the hyoid bone along the carotid sheath. There was also an incidental finding of patent ductus arteriosus and Tetralogy of Fallot on pre-operative clearance. Excision of the mass under general anesthesia revealed adherence to the posterior portion of the carotid trunk enveloping both the internal & external carotid artery. Final histopathological diagnosis was chemodectoma.<br /><br /><strong>CONCLUSION:</strong> Although rare, chemodectoma should be considered as one of the differentials in a patient with a submandibular mass. Hyperplastic chemodectoma may result from chronic hypoxia due to Tetralogy of Fallot.  Surgical excision is the treatment of choice.</p>

Otoscopic and audiologic findings in an ati community in Boracay

Background: Certain indigenous populations have been noted by the World Health Organization (WHO) to havethe highest prevalence ratesforchronicsuppurativeotitis media (CSOM), including the Australian Aborigines (28-43%), Greenlanders (2-10%) and Alaskan Eskimos (2-10%). Objectives: To determine the prevalence of common ear problems, particularly CSOM, among the indigenous Ati or Aeta community in Bolabog, Boracay, and to determine their hearing sensitivity using screening audiometry. Methods: Study Design - Descriptive cross-sectional study. Setting - A small Ati community in Bolabog, Boracay. Population - A total of 63 adults and children underwent medical interview and otoscopy. Additionally 24 had their hearing screened by audiometry. Results: About a quarter of the population participated in the study, including 41 children (40 percent of all children) and 22 adults (18 percent of all adults). Forty-six percent of children and 23 percent of adults who were examined had previous history of ear discharge, while 22 percent of children and 45 percent of adults who were examined had history of hearing loss. Seventeen percent of children had history of hearing loss in the family. CSOM was found in 18 (43.90 percent) children and 8 (36.36 percent) adults. Impacted cerumen was found in 17.1 percent of children. Eleven female children underwent screening audiometry. Of these, eight had normal hearing and three had abnormal findings. Thirteen adults were also tested, five of whom were male and had normal hearing bilaterally. Four of eight female adults had abnormal hearing, of which three were unilateral. Conclusions: The Ati population in Bolabog, Boracay belongs to a group with the highest prevalence rates for CSOM (27.0 percent). A bigger sample for screening audiometry is required for proper estimation of hearing loss prevalence. Both environmental and genetic factors may have increased the prevalence of CSOM in the Ati population of Boracay. (Author)

The Philippine National Ear Institute: Patient and audilogic profiles

Background: The Philippine National Ear Institute (PNEI) was created to promote health of hearing and balance among Filipinos. Over the years, it has provided audiologic services to thousands of patients annually and has published relevant hearing and balance research. Objective: To describe the patients served by the PNEI in terms of age, region of origin, occupation, pretest diagnosis, and audiologic results. Methods: Study Design - Cross-sectional study Setting - National tertiary care center Population - All records of patients referred for audiologic testing at PNEI in 2006 were reviewed and encoded into analyzable format. Results: A total of 1,756 patients had audiologic records for review. Median age was 32.5 years, with the age distribution presented according to sex, type of tests done including common reasons for referral, and median threshold levels by frequency. Coverage was national in scope, with most patients coming from the National Capital Region and from Regions III and IVa. Occupation was indicated in 37.8 percent of the working age group, most of whom were unemployed. The most common pretest diagnosis was chronic otitis media (26.6 percent), followed by hearing loss of unknown etiology (13.0 percent) and tinnitus (9.3 percent). Severity of hearing impairment based on pure tone audiometry was variable, and was presented according to common diagnoses. About 39 percent of hearing impairment cases were sensorineural, 36 percent conductive and 25 percent due to mixed defect. Bilateral Type A ears were found in 45.4 percent of patients by tympanometry, while 29.3 percent were bilateral Type B. For otoacoustic emissions, 69.0 percent were labeled as "refer" in at least one ear. Conclusion: The PNEI is a major national referral center for audiology that holds much promise in developing programs for national surveillance of the hearing status of different sectors in Philippine society. (Author)

Embryonal rhabdomyosarcoma of the mandible

Objectives: 1] To describe a case of an embryonal rhabdomyosarcoma presenting as al radiolucent mandibular mass in a 3-year-old child. 2] To review existing literature on the clinical picture and pathophysiology of intraosseous rhabdomyosarcoma. 3] To identify learning points in the diagnosis of intraosseous rhabdomyosarcoma. Design: Case report. Setting: A tertiary referral hospital. Patients: One (1) Results: A case of a 3-year-old child with a radiolucent mandibular mass is described. Thel final histopathologic report turned out to be embryonal rhabdomyosarcoma. Intraosseous rhabdomyosarcomas are rare occurrences (3.5 percent in one review), and clinically present in younger age groups, with a non-tender, enlarging, firm-hard mass over a specific area. A review of the available literature on intraosseous rhabdomyosarcomas, and its proposed pathogenesis, is presented. Conclusion: A case of a radiolucent mandibular mass in a 3-year-old child is presented. Intraosseous rhabdomyosarcomas of the mandible are rare occurrences that pose challenges to the otorhinolaryngologist. Taken separately, the presentation, patient characteristics, clinical course, ancillary laboratories and imaging modalities may lead even the most astute otorhinolaryngologist astray. The whole clinical picture should be taken together so that the correct diagnosis will not be missed despite the rare presentation. (Author)