Clinical spectrum of Tuberculosis Otitis Media (TBOM) and management outcomes

Objectives@#To determine the initial clinical diagnoses of patients with tuberculous otitis media (TBOM), to determine the value of PCR test, biopsy, and ancillary diagnostic procedures in detecting middle ear TB infection, and to establish the differences in treatment outcomes. @*Methods@#The clinical records of twenty-eight patients identified with middle ear TB infection by PCR test and biopsy, from January 2010 to December 2016, were reviewed to determine their initial clinical diagnoses. The positivity rates of PCR test and biopsy were compared. The records of 12 patients included in a previous publication were revisited and included in the present study population. The combined cases were classified according to clinical diagnosis to constitute a summary of demographic characteristics, clinical diagnoses, laboratory tests, and treatment outcomes. Results of diagnostic and surgical procedures were reviewed and analyzed. Clinical findings and hearing test results before and after treatment were compared. @*Results@#Of the 28 patients, eight different clinical diagnoses of patients confirmed with middle ear TB were determined. PCR test diagnosed most cases belonging to the early and chronic stages of the disease process. Biopsy diagnosed mostly the chronic cases but failed to diagnose acute cases and late cases with diagnosis of chronic suppurative otitis media with cholesteatoma. By including the twelve cases that were published in 2011, the range of clinical diagnoses was expanded and an outcome of eleven clinical diagnoses confirmed with TB infection was established. Analysis of treatment outcomes showed that the clinical and hearing outcomes were better for patients managed at the early stage of the disease than for those presenting at the late stages of the disease process who underwent more complicated surgical procedures. @*Conclusion@#Our study supports the concept of tuberculous otitis media (TBOM) clinical spectrum, implying a paradigm shift in the established thinking that TBOM presents only as a chronic disease. The combined use of PCR and biopsy is a potential diagnostic tool to improve case detection rate, further broaden the scope of the clinical spectrum, and develop better control and preventive strategies for TBOM.

Effect of proton pump inhibitors on Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in patients with laryngopharyngeal reflux: A systematic review and meta-analysis

Objectives@#The purpose of this study was to determine the efficacy of proton pump inhibitor (PPI) therapy in treating the symptoms and laryngeal findings of laryngopharyngeal reflux (LPR). @*Methods@#Placebo-controlled, randomized clinical trials published after June 2001 to January 2021 which used PPI as the sole intervention and the RSI or RFS as outcome measures were eligible for inclusion. Studies that were published prior to June 2001, those which only made use of questionnaires other than the RSI or RFS, those which used PPI in combination with other treatments, or those with unavailable full-text manuscripts were excluded. These studies were identified from MEDLINE, Scopus, Cochrane Library, Embase, and HERDIN Plus databases which were searched from May 21 to 26, 2020. The primary outcome was the mean difference between baseline/pre-treatment and post-treatment RSI scores for both PPI and placebo groups. The secondary outcome was the mean difference between pre-treatment and post-treatment RFS scores for PPI and placebo groups. Aggregate results of these outcomes were analyzed using forest plots. Heterogeneity was determined through prediction intervals. Risk of bias of individual studies was assessed using the Cochrane Collaboration’s Tool in Assessing Risk of Bias. @*Results@#Nine randomized control trials were included with a total of 737 patients randomized and 595 patients analyzed – 294 from the PPI group and 301 from the placebo group. There were notable variations among the studies in terms of choice of PPI, dosage and frequency. Out of nine studies, four used both RSI and RFS in their analysis. Two studies used RSI alone and three used the RFS in combination with symptom questionnaires other than the RSI. There was a significant decrease in the RSI of the PPI group versus the placebo group with a mean difference of -2.83 (95% CI, -5.13 to -0.53, p = .02). However, there was no significant decrease in the RFS between PPI and placebo groups with a mean difference of -0.84 (95% CI, -2.66 to 0.98, p = .37). For two clinical trials which only reported post-treatment RFS, there was also no significant difference between the two treatment groups with a mean difference of 1.27 (95% CI, -0.22 to 2.76, p = .10). @*Conclusion@#This meta-analysis found that, although a statistically significant benefit in RSI was noted with PPI therapy, this difference may not translate to a clinically significant change in symptoms; therefore, there is insufficient evidence to recommend for or against the treatment of LPR with PPIs.

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) for thyroid nodules: A series of the first 10 patients in a single institution

Objective@#To present the perioperative data of patients with solitary or multinodular goiter and/ or papillary thyroid carcinoma who underwent Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in a single tertiary medical center. @*Methods@#Design: Case series. Setting: Tertiary Government Hospital. Participants: Records of 10 patients who underwent TOETVA from June 2018 to July 2019 (9 thyroid lobectomies, 1 total thyroidectomy) were reviewed. Outcomes and measures included conversion to open surgery, operative time, intraoperative blood loss, size of the thyroid gland, postoperative hospital stay, visual analogue pain scores (VAS), and postoperative complications.@*Results@#None of the 10 patients were converted to an open procedure. The average preoperative thyroid size was 4.73 cm in widest diameter using thyroid ultrasound (±1.88 cm, range 3.6 to 6.5 cm). Mean operative time for thyroid lobectomy and total thyroidectomy was 4 hours and 29 minutes and 4 hours and 15 minutes, respectively. Mean intraoperative blood loss was 140 ml (±47.96 ml, range 80 to 200 ml) for thyroid lobectomy and 100 ml for total thyroidectomy. The average intraoperative size of the thyroid gland measured in widest diameter (larger lobe for total thyroidectomy) was 4.48 cm (±0.919 cm, range 3 to 5.5 cm). Median postoperative hospital stay was 2 days (±1.55 days, range 2 to 12 days). Mean VAS pain scores for postoperative days 1, 2, 3, and 7 were 5, 3, 2, and 0, respectively. Transient recurrent laryngeal nerve injury (of 3 months duration) occurred in 1 patient. Two cases had surgical site infection, 2 had wound dehiscence, 1 had seroma and 1 had skin burn as a complication. None had hypocalcemia or mental nerve injury in the series. @*Conclusions@#TOETVA was replicated in the local setting and a presentation of the perioperative data of all the patients who underwent this novel technique, the indications, as well as surgical and patient outcomes, were described.

Agreement between human voice (“Baah”) Test and Otoacoustic Emissions in Screening of infants for Binaural Hearing Loss

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the agreement between Otoacoustic Emission and "Baah" tests for detecting binaural hearing loss in infants referred for hearing evaluation in a local community setting.<br /><strong>METHOD:</strong> This is a retrospective review done in a Private Community-based Secondary Specialty Hospital. Bilateral hearing test results of 788 neonates and infants obtained between September 2011 and January 2013 using human voice "BAAH" test and OAE were reviewed from January 2014 to September 2015.<br /><strong>RESULTS:</strong> There were 432 males and 356 females (male: female ratio 1.2:1) with a mean age of 11.17 days (range of 0-143 days). Of the 780 infants with bilateral "Pass" using OAE, all were screened as "with response" by "Baah" tests. Five infants with bilateral "refer" results using OAE yielded "no response" on "Baah" test. Sensitivity of 'Baah' test was 100%, specificity was 99.5%, with positive predictive value of 62.5%, and negative predictive value of 100%. There was good agreement noted between OAE and "Baah" (kappa=.77, p<.001).<br /><strong>CONCLUSION:</strong> The "Baah" test is a possible alternative to OAE in initially detecting binaural hearing loss in areas where equipment and personnel are limited. Although "Baah" test could only detect 62% of infants with binaural hearing loss and could not detect unilateral hearing loss, infants detected with binaural hearing loss can be immediately referred to centers with more sophisticated equipment.</p>

Extramedullary plasmacytoma in the maxillary sinus

Objective:To describe an intranasal mass initially diagnosed and treated as benign that eventually turned out to be a malignant extramedullary plasmacytoma of the maxillary sinus and to review the literature on its presenting signs and symptoms, diagnosis, management and pathophysiology. Methods: Design: Case Report Setting: Tertiary Public Hospital Patient: One Results: A 45-year-old male with persistent nasal obstruction and intermittent epistaxis underwent several biopsies of a mass shown on computed tomography scans as heterogeneously enhancing, expansile, occupying the left maxillary sinus with extension into the left nasal cavity with areas of erosion. Immunohistochemical staining was negative for cytokeratin (CK) and leukocyte common antigen (LCA). Complete excision yielded a final histopathologic interpretation of plasmacytoma. Laboratory examinations excluded multiple myeloma. The final diagnosis was extramedullary plasmacytoma and he was treated with post-operative adjuvant radiotherapy. Conclusion: Plasmacytoma may present in the sinu-nasal region and be part of a systemic disease like multiple myeloma. A high index of suspicion and thorough initial histopathological work-up may help in establishing a definitive diagnosis and providing optimum treatment.