A comparison between penlight and otoscopic examination of the ear canal and tympanic membrane among grade 1 students

BACKGROUND@#In the Philippines, screening for ear problems especially in children at entry to school is usually undertaken by school nurses and teachers who typically do not have specialized instrumentation. The penlight has recently been employed as screening method in determing the possibilities of ear problems in public school communities. This study attempts to determine the accuracy of the penlight as an alternative method for screening to assess the common external ear abnormalities among Grade 1 students in an elementary school.@*OBJECTIVES@#1. To compare the result of otologic examination using the penlight versus otoscopy in determining of common pediatric ear problems. 2. To determine the sensitivity, specificity and predictive values of penlight examination in the screening of ear canal and tympanic membrane for abnormal conditions among Grade 1 students.@*METHODS@#Otologic examination with the use of a penlight was carried out by the tranined nurse in ears of Grade 1 students and the results compared with those obtained from otoscopy done by an otolaryngologist. Presence of ear conditions such as cerumen, discharge, foreign body, tympanic membrane visualization, and an overall assessment were recorded in an Excel file. The examiners were both blinded with the findings.@*RESULTS@#Ninety-four students (188 test ears) with a median age of 6 years, ranging from 5 to 10 years, and a 1:1 sex distribution were included in the study. The result showed an excellent agreement (P<.001) between the penlight and otoscopic examination. The sensitivity and specificity were of 98.6% and 100%, respectively. The PPV is nearly 100% and NPV of 95.2% and and overall accuracy of 98.94%.@*CONCLUSIONS@#There is an excellent agreement between the nurse‘s findings and otolaryngologist‘s findings in examining the ear canal and tympanic membrane. The penlight has on overall accuracy of 98.94%, in identifying cerumen, discharge, foreign body and visualizing the tympanic membrane. Thus, this study shows that with trained nurse in otologic examination, the penlight is an effective screening in identifying common ear problem among children.

Aeroallergen sensitization and associated comorbid diseases of an adult Filipino population with allergic rhinitis

BACKGROUND: There is a large global variation in sensitization patterns to aeroallergens due to differences in climate, urbanization, and lifestyle. Knowledge of the most common inhalant allergens is important for appropriate prevention and management of allergic rhinitis (AR). OBJECTIVE: This study aims to provide data on aeroallergen sensitization patterns and associated comorbid diseases of adult Filipinos with AR. METHODS: Medical records of adult Filipinos seen in an Otolaryngology-Allergy Clinic from January 2011 to 2016 were reviewed. Inclusion criteria used was presence of clinically defined AR and positive skin test to at least one aeroallergen in the test panel. Demographics, comorbid conditions, and results of skin prick test were determined. Standard descriptive statistics were used for analysis. RESULTS: One hundred ninety-one adult patients were included in this study. Mean age was 38.8 years, and majority lived in an urban area (71.2%). Most patients exhibited polysensitization (97.4%). All exhibited sensitization to indoor and 86.9% to outdoor allergens. The most common indoor allergens were Dermatophagoides pteronyssinus (97.4%), Dermatophagoides farinae, (95.8%), cockroach (80.1%), and molds (72.8%). Bermuda (67%), Johnson grass (58.7%), and Acacia (58.2%) were the most common outdoor allergens. Urticaria (18.8%), dermatitis (16.8%), and asthma (11.5%) were the most common associated comorbid disease. Twelve percent of patients had more than one associated comorbid disease. Asthma + urticaria followed by asthma + dermatitis were the most common co-morbid combinations. One patient had three comorbid diseases: asthma + urticaria + rhinosinusitis. CONCLUSION: Compared to earlier studies, aeroallergen sensitization patterns of Filipinos remain unchanged. This study also identifies for the first time, the associated comorbid diseases of AR in this population. Understanding these factors can guide treatment strategies to reduce disease burden.

Double ectopic thyroid gland in a 10-year-old Filipino boy

Objective@#To present a case of a double ectopic thyroid gland in a 10-year old boy and discuss the pros and cons of the different management options that were available. @*Methods@# Design: Case Report. Setting: Tertiary Hospital in Metro Manila. Subject: One (1). @*Results@#A 10-year-old boy presented with hoarseness and easy fatigability for 6 years. Rigid endoscopy and CT scan showed an infraglottic mass originating from the anterior tracheal wall causing obstruction. Biopsy revealed thyroid tissue with atypia. Thyroid scintigraphy showed uptake in the submental and midline anterior neck. Thyroid hormone levels were consistent with hypothyroidism. Levothyroxine returned hormone levels to normal and resulted in complete regression of the mass with no symptoms of dyspnea, stridor or bleeding.@*Conclusion@#The management of ectopic thyroid presents a challenge as there are no guidelines for optimal treatment. Thyroid hormone insufficiency is a frequent occurrence, and emphasis must be given to its monitoring. Surgery in a critical airway lesion such as this may be reserved for cases where the patient experiences dyspnea and stridor or lack of response to thyroid hormone treatment.

Clinical and Histopathological Profile Of BRAF V600E Mutation In Conventional Papillary Thyroid Carcinoma in A Filipino Population

BRAF V600E is a possible biomarker for risk stratification and prognostication in papillary thyroid carcinoma. Studies on its association with aggressive clinicopathological features among East Asian populations are limited. This study examines the clinical and histopathological features of this mutation in Filipinos with conventional papillary thyroid carcinoma. Methods: Formalin-fixed, paraffin embedded thyroid tissue blocks of papillary carcinoma for the study period January 2010 to December 2012 were retrieved. Slides were reviewed and described according to tumour size, variant type, sclerosis, multifocality, subcapsular location, extra-thyroidal extension, nodal metastasis, and nodal extracapsular spread. Medical records were reviewed for patient demographics and characteristics. Mutation status was determined using realtime polymerase chain reaction and sequencing. Results: Sixty-five patients were included in this study. BRAF V600E mutation prevalence was 38.46%. The mutation positive group was predominantly female, young (mean age 36 years), with tumour size less than 4 cm, and late-stage disease. Extra-thyroidal extension (60%), significant sclerosis (96%), and subcapsular tumour location (72%) were the most frequent findings. Eighty-three percent of patients with nodal metastasis had extracapsular spread. Conclusions: Compared to some Asian populations, this study of Filipino patients shows a lower prevalence of BRAF V600E mutation. The clinical and histopathological features of mutation positive patients raise important issues regarding extent of surgical excision and appropriate management of neck metastasis for this group.

Attitudes, practices on allergic rhinitis of three socioeconomic classes of Filipinos in the National Capital Region

BACKGROUND: Healthcare access and usage may vary according to socioeconomic class (SEC). Knowing this variable's effect on patient attitudes, practices, and health seeking behavior allows better understanding of compliance, adherence to treatment, and educational needs on allergic rhinitis (AR). OBJECTIVE: This study seeks to assess the attitudes and practices on AR of Filipinos in the National Capital Region. METHODS: A cross sectional survey of 301 Filipinos, stratified into socioeconomic groups ABC1, C2, and DE, was conducted from December 2014 to February 2015. A previously validated and pilot tested questionnaire on AR was administered via structured face to face interviews. RESULTS: Most respondents attributed their symptoms to "colds" (ABC1 77%, C2 79%, DE 78%); most did not consult a physician for their symptoms. Only 26% of all respondents were aware of AR. Only the ABC1 group had respondents who specifically used the term AR. Most respondents' symptoms fulfilled criteria for moderate to severe disease. Sleep was the activity most affected by AR (62%). For symptom relief, over the counter antihistamine-decongestants were the most preferred drug preparations (ABC1 30%, C2 38%, DE 34%). Groups ABC1 and C2 cited family, television, and Internet as the top primary sources of health information; DE cited family, television, and friends. CONCLUSION: Regardless of SEC, Filipinos are not aware of AR. Lack of awareness and gaps in knowledge can result to an underestimation of the condition, decrease in health seeking behavior, unmet patient needs, and undertreatment of disease.

Attitudes, practices on allergic rhinitis of generalists and specialists in Philippine National Capital Region

BACKGROUND: Treatment of allergic rhinitis (AR) consistent with consensus guidelines is reported to result in better patient outcomes. However, physicians may manage patients independently of guidelines. Asian data on physician perspectives regarding AR diagnosis and management is limited. OBJECTIVE: The study objective is to assess attitudes and practices on AR of Filipino specialists and generalists. METHODS: A cross sectional survey of 100 specialists and 100 generalists was conducted from November 2014 to January 2015. A previously validated and pilot tested questionnaire was administered via structured face to face interviews. RESULTS: Specialists reported greater adequate knowledge of AR (specialists, 58%; generalists, 39%) and adherence to guidelines (specialists, 84%; generalists, 54%). Diagnostic tests were not routinely used (specialists, 81%; generalists, 92%). Monotherapy, specifically antihistamines, was preferred for mild AR. For moderate-severe AR, preference for monotherapy versus combination therapy (specialists, 49% vs. 51%; generalists, 44% vs. 56%) was similar. Both groups preferred intranasal corticosteroid spray (INCS) for monotherapy and antileukotrienes, antihistamines, INCS for combination therapy. For adjuvant therapy, specialists (82%) preferred nasal irrigation/douche. Primary consideration for choice of therapy was efficacy. Cost was the perceived reason for patients' noncompliance with treatment. CONCLUSION: Despite differences in awareness of and adherence to guidelines, prescribing patterns on management of mild and moderate-severe AR are similar among Filipino specialists and generalists. This can be attributed to a shared perception of efficacy and cost as drivers for therapeutic choices.