High risk human papilloma virus (HPV) oropharyngeal squamous cell carcinoma in a private tertiary care setting in the Philippines: Prevalence, clinical characteristics and testing

Objective@#To determine the prevalence and describe the clinical characteristics of high risk HPV mong patients with oropharyngeal squamous cell carcinomas in our institution utilizing p16 and HPV DNA in-situ hybridization testing and to determine the factors associated with high risk HPV positivity.@*Methods@# Design: Retrospective Cohort Review Setting: Tertiary Private Training Hospital Participants: 29 @*Results@#A total of 29 primary oropharyngeal squamous cell carcinomas were diagnosed during the 11-year study period (January 2010 to December 2021). Based on the HPV in-situ hybridization status, the prevalence of high risk HPV oropharyngeal squamous cell carcinoma in our institution was 52%. Majority of these cases were males (87.5%) with a median age of ≤55 years old (60%) who are non-smokers (88.2%) and non-drinkers of alcoholic beverages (80%). There was no statistically significant association between age group, sex, smoking status, alcohol intake, lymph node status and high risk HPV infection. The most common tumor site involved in HPV-positive oropharyngeal squamous cell carcinoma was the tonsil (87%). Majority demonstrated a nonkeratinizing histology (73%) with positive lymph node status (67%) upon clinical presentation. Fifteen (83%) of the 18 p16 positive squamous cell carcinomas were positive for high risk HPVDNA. Of note, 3 (17%) out of the 18 p16 positive squamous cell carcinomas turned out to have negative HPV DNA-ISH status.@*Conclusion@#Although no statistically significant correlation between any clinical characteristic with viral status was established, HPV-mediated oropharyngeal squamous cell carcinoma in this institution was commonly seen among males aged 54 years old and below who are nonsmokers and non-drinkers of alcoholic beverages with the palatine tonsil as the most common site presenting with a non-keratinizing histology. In terms of testing, p16 staining correlates well with high risk HPV status. Future studies utilizing a larger patient population may aid in elucidating statistically significant clinical associations in our local population

Operative time and tympanic membrane graft uptake in endoscopic transcanal versus microscopic post-auricular tympanoplasty for chronic otitis media

Objective@#To compare surgical outcomes (operative time and tympanic membrane integrity) obtained by endoscopic transcanal tympanoplasty (ET) and microscopic post-auricular tympanoplasty (MT) in patient with inactive chronic otitis media. @*Methods@# Design: Retrospective Cohort Setting: Multicenter study in 3 Private Tertiary Hospitals Participants: 18 patients who underwent microscopic or endoscopic tympanoplasty for chronic otitis media. @*Results@#Each group had 9 patients, with median age of 43 (31-65 years) for the MT and 47 (29-59 years) for the ET group. There was no significant difference in median age of the two groups (Mann-Whitney U=17, P=.22). Male: female ratio was (5:4) and (6:3) for the ET and MT group respectively, with no significant difference in gender distribution (c2= 0.90, P=.34). Mean operative time for the ET and MT group was 86.7 minutes and 140.6 minutes, respectively, with significantly lower mean operative time for the ET group (t= 3.57, P=.0025). There was complete tympanic membrane graft uptake in both groups. @*Conclusion@#Regardless of technique, tympanoplasty is an effective surgical treatment among patients with inactive chronic otitis media. Endoscopic tympanoplasty is an alternative to conventional microscopic tympanoplasty that may use less operative time, producing similarly complete graft uptake.

Relapsing polychondritis initially presenting with hoarseness and difficulty breathing in a 21-year-old male

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present a case of relapsing polychondritis initially presenting with hoarseness and difficulty breathing and to discuss the diagnostic criteria and typical CT scan findings of relapsing polychondritis. <br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Private Hospital in Metro Manila<br /><strong>Patient:</strong> One<br /><strong>RESULT:</strong> A 21-year-old man who was initially managed as a case of bronchial asthma for persistent hoarseness and recurrent difficulty breathing was found to have severe laryngeal edema on endoscopy, and soft tissue expansion of the cricoid cartilage with calcifications and irregular first tracheal ring on CT scan. He also had recurrent eye redness and developed bilateral aural inflammation, and was subsequently diagnosed to have relapsing polychondritis.<br /><strong>CONCLUSION:</strong> Relapsing polychondritis is a rare autoimmune disease characterized by recurrent inflammation and eventual destruction of cartilage throughout the body. Typical manifestations may not always be present, causing a delay in diagnosis. It should be considered in patients with intractable respiratory symptoms not responsive to treatment for upper respiratory tract infections or asthma. A CT scan may reveal signs of cartilage destruction and help in diagnosis.                  </p>

Primary laryngeal aspergillosis in a postpartum patient

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To present a rare case of primary laryngeal aspergillosis manifesting with hoarseness in a seemingly healthy, immunocompetent, postpartum patient and discuss the probable contributing factors leading to this unusual disease process.</p> <p style="text-align: justify;"><strong>METHODS</strong><br /><strong>Design:</strong> Case Report<br /><br /><strong>Setting:</strong> Tertiary Private University Hospital<br /><br /><strong>Subjects:</strong>  One<br /><br /><strong>RESULTS:</strong> A 28-year-old previously healthy postpartum woman presented with hoarseness of a few weeks duration and recent intake of antibiotics and steroids. Videolaryngoscopy revealed a creamy, exophytic mass overlying both vocal folds. Microscopic examination revealed septated, dichotomously branching hyphae with acute angles characteristic of Aspergillus sp. The patient recovered with anti fungal medications.<br /><br /><strong>CONCLUSION:</strong> The clinical presentation of laryngeal aspergillosis can be very non-specific and should not be disregarded merely on the basis of immune competence. It should be considered, together with other host and environmental factors when a patient responds poorly to conventional treatment. There is a need for quick and accurate diagnosis as the disease responds quite rapidly with appropriate anti fungal medications.</p>

Congenital bilateral vocal fold paralysis in a two-year-old girl

@#Vocal fold paralysis is an otolaryngologic disorder that is more prevalent in the adult population. Its occurrence in children has been documented in the literature. We report a case of congenital bilateral vocal fold paralysis and discuss the issues surrounding its ultimate diagnosis and management.