Philippine Journal of Otolaryngology Head and Neck Surgery

Congenital Internal Auditory Canal Stenosis

Nathaniel Yang — 2024-11-21

A 3-year-old boy underwent evaluation for possible cochlear implantation. He had failed a neonatal otoacoustic emission (OAE) hearing screen. A combined auditory brainstem response/auditory steady-state response (ABR/ASSR) test battery confirmed the presence of a severe hearing loss on the right and a profound hearing loss on the left. No Joint Committee on Infant Hearing (JCIH) risk factors for early childhood hearing loss1 were identified. Rehabilitation via hearing aid amplification and auditory-verbal speech therapy was unsuccessful. Computerized tomographic (CT) imaging of the temporal bone was performed to identify the presence of any inner ear abnormalities. No abnormalities of the cochlea, vestibule and semicircular canals on both sides were identified by the radiologist. The internal auditory canals were described as “fairly symmetrical without widening”, and the study was officially reported as an “unremarkable study of the temporal bones”.

Independent review of the CT imaging revealed the presence of seemingly narrow internal auditory canals (IAC) on both sides. (Figure1A) The width of the IACs on the axial plane were measured by drawing a perpendicular line starting from the posterior wall of the IAC, 2 mm inside the posterior lip of the internal auditory meatus, and ending on the anterior canal wall, as described by McClay et al.² Measurements taken utilizing the length measurement tool in the DICOM imaging software (RadiAnt DICOM Viewer, Version 2024.1, Medixant) indicated an IAC width of 1.78 mm on the right (with severe hearing loss) and 1.37 mm on the left (with profound hearing loss). (Figure 1B) These measurements confirmed the presence of bilateral internal auditory canal stenosis, a diagnosis defined by a canal of 2 mm or less on high
resolution CT.³

Adenoid Cystic Carcinoma of the External Ear Canal: A Case Report

Sarah Eunice Caluma — 2024-11-21

Objective: To present a rare case of Adenoid Cystic Carcinoma of the external ear canal in a 73-year-old man, including its diagnosis and surgical management.

Methods:
Design: Case Report
Setting: Tertiary Government Training Hospital
Patient: One

Results: A 73-year-old man who consulted due to decreased hearing on the right ear had a 4-year history of gradually enlarging mass occupying the right external auditory canal. Wide en bloc resection of the external auditory canal mass and superficial parotidectomy with facial nerve preservation was performed with final histopathology results of adenoid cystic carcinoma. Follow-up at 2 years has shown no signs or symptoms or recurrence.

Conclusion: Adenoid cystic carcinoma of the external ear canal is a very rare disease that can present similarly to other otologic infections. Early identification of symptoms, performance of necessary imaging, and timely biopsy are key to reducing misdiagnosis and improving the survival rate. Complete resection of the tumor with adequate margins is the recommended treatment due to its high rates for recurrence.

Primary Melanoma of the Palatine Tonsil in an Adult Filipino Patient: A Case Report

Katrin Louise Cabatana — 2024-11-21

ABSTRACT

Objectives: To discuss a case of primary melanoma of the palatine tonsil in a 57-year-old man presented with a dark, pigmented tonsillar mass initially managed as a case of arterio-venous malformation, and review the literature on its presentation, diagnosis, management and outcomes.

Methods:

Design: Case Report

Setting: Tertiary Government Training Hospital

Patient: One

Results: A 57-year-old man presented with a pigmented, bluish-black mass (7.2 cm) on the right tonsillar area with dysphagia and odynophagia. A CT scan interpretation considered large tonsillar malignancy, right with infiltrations of the soft palate, lingual tonsils and pre-epiglottic space. The initial impression was an arteriovenous malformation and preoperative arterial embolization was followed by a tonsillectomy. The final biopsy result was mucosal melanoma. Refusing further treatment, he expired nine months later in the emergency room, after presenting with decreasing sensorium and desaturations, jaundice and abdominal distension.

Conclusion: To the best of our knowledge, this is the first reported case of tonsillar melanoma in the Philippines. Primary tonsillar melanoma is rare but its diagnosis is still possible (although it is usually diagnosed in advanced stages). Despite improvement in surgical techniques and adjuvant therapies, its prognosis remains poor. Regular oral cavity screening may help in early detection.

Nikolo Ariel M. Ansaldo, MD (1983-2024)

Chris Robinson Laganao — 2024-11-21

It is my great honor to share my experiences as we celebrate the life of Dr. Nikolo Ariel Ansaldo. Cole was not just a trusted colleague, he was a good friend and a remarkable individual who has left an indelible mark on all who knew him. His warmth, generosity and unwavering positivity were among the traits I sincerely admire about him. Please allow me to share three important life lessons I learned from him.

Lesson 1: The Value of Kindness
I first met Cole when applying for residency training in Otorhinolaryngology – Head and Neck Surgery at the Southern Philippines Medical Center in October 2011. He was a dependable partner during the highs and lows of residency training and helped me get through all those tasks, sanctions, and difficult surgeries. He was the king of small talk and was incredibly warm to anyone he met. You felt at ease talking to him because of his humorous banter and amusing anecdotes. Throughout his medical career, he helped many patients and did not hesitate to extend his assistance to anyone who needed it. Cole showed us that no act of kindness is ever too small or inconsequential.

Lesson 2: The Power of Resilience
After we passed the diplomate board exams in 2016, we wanted to contribute more to the department by pursuing fellowship training. He ended up doing his Otology fellowship at the University of Santo Tomas Hospital which he completed in 2018 then came back to help improve the audiology services of our department and the surgical competencies of our residents. He did these while pursuing his private practice and giving lectures to national and international medical students of his alma mater, Davao Medical School Foundation.

Life was not always easy for Cole, especially with his physical health, but he faced every challenge with courage and a positive disposition. Cole faced those struggles head-on, never losing hope or his sense of humor. He made it a point to be present during his clinic duties and the weekly department conferences even when he could barely walk. He taught us that resilience is about finding strength in our vulnerabilities and courage in our fears. I hope that we also learn to find our strengths and overcome our toughest obstacles by staying positive and true to ourselves.

Lesson 3: The Relevance of Essentialism
Cole lived his life with an envious amount of energy and enthusiasm which was truly inspiring. He embraced every moment with joy and gratitude whether it was attending a soccer game with Mason, going to pediatric visits with Mari, or spending an adventurous weekend with Christie and their families. I know that he was making the most of every experience as he always shared those stories with us with fondness. He taught us to cherish the present, to find beauty in the everyday, and to never take a single moment for granted. In his memory, let us strive to live our lives with the same passion and appreciation for the here and now.

Let us celebrate the memories we have with Cole. Each memory brings to mind the impact he had on our lives. His untimely passing allows us not only to reflect on our own mortality but also to decide on what to do with the time that is given to us.

I truly regret not knowing him more because his life was cut painfully short, but the memories I had with him during our time together during residency training, in the operating room, and outside the confines of the hospital will be cherished for many years. Rest with God, dear Cole, and please know you will be missed by the many people who loved and admired you.

Paul Christian P. Pacquing, MD (1986-2024)

Michael Ryan Abuan — 2024-11-20

It is an honor to write this tribute to Dr. Paul Christian Pacquing, though I never imagined doing this for him. Given this opportunity to pay my last respects to a dear friend and colleague, I will try my best to recount and share the last 11 years of his life with you.

Pax played a myriad of roles. He was a husband, a father, a son, a friend and a physician. Whichever role he played; he was exemplary at it.

I first met Pax during pre-residency for the ORL-HNS program at the East Avenue Medical Center. He was cordial to everyone, even to his fellow pre residents, despite us being competitors.

During residency, he stood out as Mr. Congeniality. He had an immensely infectious smile, and was literally friends with everyone in the hospital. He always had an amicable demeanor towards his patients. He would call patients like, "Mommy dear! Kumusta ka na?" Sometimes, proceeding to innocently and warmly hug our patients.

He had a knack for handling conflicts and toxicities with his laid back nature. He would utter: "Chill. Relax lang tayo pare." Surprisingly, this worked and we would surmount our challenges unscathed most of the time.

We had our sleep medicine and surgery fellowship training together in the same year at Chang Gung Medical Center. He excelled even in a foreign land and training institution. As a Fellow, he was sharp, studious and valued the time and experience there. Our mentors acknowledged his brilliance and he finished training with much approval.

Back home, he established his practice in Isabela, Cagayan and Manila. However, due to the limited mobility brought about by the pandemic, he opted to stay in his hometown of Isabela and share his medical expertise there.

As a physician, he was charitable and compassionate. Sharing a clinic together, our secretary would frequently tell me the incidents where Pax would treat financially-constrained patients for free. He would incessantly discuss his dream of establishing and providing sleep disorder services in the North to cater to his fellow Ilocanos.

As a family man, he was affectionate, responsible and thoughtful. He loved his wife and was committed, despite numerous challenges. Our chats never ended without him talking about his daughter, the time they spent together and the dreams he had for her. Even during his last days, he only thought of his daughter and that he was determined to fight on so that he could see her grow up.

In March 2023, after attending our annual PSSM convention, he was diagnosed with a rare type of B- lymphoblastic leukemia. This was extremely difficult and sad news to process by everyone close to Pax. How could a fit, sporty and healthy young man have leukemia?

He underwent numerous grueling sessions of chemotherapy, but despite this, in a typical Pax manner of managing things, he remained calm, positive and relaxed. Never was there a negative word during the entirety of his treatment. Even in pictures where he was bedridden and attached to IV lines, he was still smiling.

On the morning of September 4, 2024, the day prior to the first phase of his bone marrow transplant treatment, he asked for prayers and told me the next time I see him will be during recovery. Four days after, I received news from his wife that he was in critical condition with signs of multiple organ failure. Even prior to intubation, he was seen smiling and waving to his wife and brother and gesturing a thumbs up. Only a brave man would be capable of doing this while feeling the inevitable end nearing. Pax joined our Creator the following day.

Paul Christian’s early passing remains a mystery and nagging question to family and friends. Why was this energetic, young and vibrant soul extinguished so early? Perhaps God has a plan. As mere humans, maybe we are not supposed to know the answers to the whys and whens of life and existence.

To Pax: "Paalam, kapatid." We will miss you.
I know you are smiling down at us from the heavens.

Contents Vol. 39 No. 2 July-December 2024

Philip J Otolaryngol Head Neck Surg — 2024-11-21

EDITORIAL

Original Research: Descriptive or Analytical, Either-Or or Both-And?
Lapeña JFF

SPECIAL ANNOUNCEMENT

Sydney Declaration on Predatory or Pseudo Journals and Publishers APAME WPRIM IMSEAR

ORIGINAL ARTICLES

Association of Treatment Delays with Survival for Patients with Head and Neck Cancer Undergoing Surgery and Radiotherapy at the Philippine General Hospital
Sacayan-Quitay ND, De Guzman SPC, Cañal JPA, Villafuerte CV III L

Diagnostic Accuracy and Safety of Endoscopic – Guided Office-Based Biopsies for Laryngeal and Pharyngeal Lesions
at St. Luke’s Medical Center
Fernandez DR, Soriano RG

Determining the Severity of Symptoms Among Patients with Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis
Versus Non-Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis at the Veterans Memorial Medical Center
Hizon GJS, Espanto JP, Rodriguez-Labrador KM

Regression Analysis of Preoperative Chest Radiographs to Predict Intraoperative Location of Esophageal Foreign Body
(Coin) in Pediatric Patients
Balite ADM, Roldan FCA

Olfactory Dysfunction, Dysgeusia, and Clinical Outcomes in COVID-19 Patients: An Observational Study in a Tertiary
COVID Referral Center in the Philippines
Tirol CJR, Fullante PB

Otorhinolaryngologic Manifestations of Long COVID-19 Infection Among Patients at the Quezon City General Hospital
Sison MNK, Cruz ETS

Telemedicine for ENT: Quality of Care During the COVID-19 Pandemic at the Jose R. Reyes Memorial Medical Center in 2022
Castro JMC, Chua RU

CASE REPORTS

Adenoid Cystic Carcinoma of the External Ear Canal: A Case Report
Caluma SEC, De Ramos JSM

Primary Melanoma of the Palatine Tonsil in an Adult Filipino Patient: A Case Report
Cabataña KLD, Salud DL

SURGICAL INNOVATIONS AND INSTRUMENTATION

A Novel Technique: Scored Conchal Cartilage to Simulate Natural Dome of Lower Lateral Cartilage in the Asian Nose
King-Chao NLY, Yap EC

FEATURED GRAND ROUNDS

A Case Report on Maxillary Ameloblastic Fibroma in a 55-Year-Old Man
Mendoza MEF, Altura IC.

FROM THE VIEWBOX

Congenital Internal Auditory Canal Stenosis
Yang NW

UNDER THE MICROSCOPE

Non-Invasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features – An Illustrative Case
Mirhan CVL, Rivera JP, Carnate JM.

PASSAGES

Nikolo Ariel M. Ansaldo, MD (1983-2024)
Laganao CRD

Paul Christian P. Pacquing, MD (1986 - 2024)
Abuan MRA

CAPTOONS

DokNet’s World
Billones WU

A Case Report on Maxillary Ameloblastic Fibroma in a 55-Year-Old Man

Ma. Elline Faye Mendoza — 2024-11-21

Ameloblastic Fibroma (AF) accounts for only 2% of all odontogenic tumors.¹ It has been
shown to be more common in males than females.² A malignant transformation of this tumor is known as ameloblastic fibrosarcoma. To the best of our knowledge, there are no published reports on AF in the Philippines, with only one report of its malignant counterpart, ameloblastic fibrosarcoma.³ We present a rare case of AF with an unusual presentation and discuss its rarity, pathogenesis, histologic features and management.

CASE REPORT
A 55-year-old Filipino man consulted at our tertiary government hospital for a one-year history of a gradually enlarging maxillary alveolar ridge mass extending to the hard palate. Upon first noticing the mass a year prior, he consulted with a local dentist and an intraoral examination revealed a smooth swelling on the right maxillary alveolar ridge between the first and second maxillary premolar, approximately measuring 2 cm x 2 cm x 1 cm. The mass was noted to extend to the hard palate. (Figure 1A) He was advised consultation with an ENT surgeon for further
evaluation and management but he did not comply.

In the interim, the mass gradually enlarged. Upon first consultation at ITRMC, intraoral examination revealed a 6 cm x 4 cm x 2 cm soft, non-friable, ulcerative mass with irregular borders on the right maxillary alveolar ridge extending to the hard palate. (Figure 1B) The mass was malodorous, easily bled on manipulation and had violaceous areas. A punch biopsy revealed AF. Past medical history was unremarkable. A contrast-enhanced computed tomography (CECT) scan of the paranasal sinuses (PNS) revealed a 6.7 cm x 8.7 cm x 6.7 cm expansile, lobulated, mixed attenuating, heterogeneously enhancing mass in the midface. The bulk of the mass involved the right maxilla but extended to involve the entire hard palate and most of the left maxillary sinus. (Figure 2) The lesion was associated with osteolytic destruction and abutted the floor of the right orbit and bilateral zygomaticomaxillary buttresses. The inferior and posterior portions of the nasal septum were also eroded. (Figure 3) Given the clinical and radiographic features, odontogenic myxoma and ameloblastoma were considered as differential diagnoses as they may present as a painless, slow-growing, multiloculated mass with bony expansions.^4,5 Oral cavity squamous cell carcinoma was also considered. The mass was excised via a right subtotal maxillectomy and left inferior maxillectomy using a Weber-Ferguson approach (Figure 4) and a temporary surgical obturator was fitted. Post-operative recovery was unremarkable and the patient was discharged after five days. Once the surgical site healed he was fitted with an acrylic surgical obturator. Final histopathological report was AF, compatible with the pre-operative biopsy result. (Figure 5) On follow up three months post-surgery, the patient was able to eat and speak with ease and no tumor recurrence was observed. One year and three weeks later, there was still no recurrence noted on inspection of the surgical defect, his speech was hypernasal but understandable, and he had no difficulty communicating and eating.

Sydney Declaration on Predatory or Pseudo Journals and Publishers

APAME — 2024-11-21

We, the participants in the Joint Meeting of the Asia Pacific Association of Medical Journal Editors (APAME), the Western Pacific
Region Index Medicus (WPRIM), and Index Medicus of the South-East Asia Region (IMSEAR), held in Newcastle, New South Wales, Australia from August 28 to 30, 2024:

CONSIDERING
That predatory (or pseudo) journals and publishers offer open access publication in exchange for fees without robust editorial or publishing services; these include “fake” or “scam” journals or publishers who send phishing emails which promise quick review;

That the articles collected by predatory (or pseudo) journals or publishers may never be published, or often are published with poor quality or accessibility, irrespective of any attempts by authors to withdraw them, resulting in such research effectively being lost;

CONFIRM
Our commitment to uphold the quality and integrity of our individual journals and their respective submission, editing and review processes, in opposition to predatory (or pseudo) journal practices;

Our commitment to exercise vigilance and safeguard the quality and integrity of our respective publishers against predatory (or pseudo) publication processes;

Our commitment to ensure that member journals of the Asia Pacific Association of Medical Journal Editors (including those indexed in the Western Pacific Region Index Medicus and Index Medicus of the South East Asia Region) and their publishers do not engage in predatory (or pseudo) journal or publication practices;

CALL ON
Member States of and governments in the World Health Organization (WHO) Western Pacific and South-East Asia Regions, in collaboration with stakeholders from the nongovernmental and private sectors, to formulate and implement procedures and processes for identifying and dealing with predatory (and pseudo) journals and publishers, and for guiding new and existing journals away from engaging in predatory (and pseudo) journal and publisher practices;

Stakeholders from the public and private sectors, national and international organizations, universities and academic societies to support WPRIM, IMSEAR, the Global Index Medicus of WHO, in ensuring the availability of high quality health information for all that is not marred by predatory (and pseudo) journal and publication practices;

Non-Invasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features – An Illustrative Case

Clarisse Veronica Mirhan — 2024-11-21

A 54-year-old woman underwent total thyroidectomy for a one-year history of anterior neck mass. The specimen was a 29.88–gram thyroid gland that on sectioning showed a single 2.0 x 1.5 x 1.5 cm encapsulated nodule with tan-brown solid cut surfaces noted on the right thyroid lobe. No gross lesions were noted on sectioning of the isthmus and left thyroid lobe.

Microscopic examination showed a thinly encapsulated nodule composed of tightly-packed follicles. (Figure 1) Examination of the entire capsule did not show capsular or vascular invasion. The follicles were lined by follicular cells that had crowded and enlarged nuclei with pale chromatin and some nuclear membrane irregularities such as grooving. (Figure 2) There were no papillae, psammoma bodies, necrosis, mitotic figures and solid or trabecular architecture seen. Based on these features, the diagnosis rendered was non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).

NIFTP is a term adopted in 2016 to replace the nomenclature of a thyroid tumor previously termed “non-invasive encapsulated follicular variant of papillary thyroid carcinoma (FVPTC)”.¹In the most recent edition of the World Health Organization (WHO) Classification of Tumors, NITFP is considered a low-risk follicular cell-derived neoplasm whose definition also reflects the diagnostic criteria of this tumor.²

A Novel Technique: Scored Conchal Cartilage to Simulate Natural Dome of Lower Lateral Cartilage in the Asian Nose

Nikki Lorraine King-Chao — 2024-11-21

Objective: To introduce a novel technique for tip grafting, using scored conchal cartilage with a curled morphology and provide an alternative approach to tip refinement procedures.

Methods:
Design: Surgical Innovation
Setting: Ambulatory Aesthetic Surgical Center
Participants: 12 private patients

Results: This technique produces a natural looking tip with aesthetically pleasing projection and definition. The simulation of the natural curvature of the lower lateral cartilage (LLC) by curling the SCC gives a more lobular and softer looking tip. The corners of the graft are also hidden underneath the SSTE providing camouflage of irregularities. There were no complications or sequelae (e.g. palpable cartilage and cartilage visibility) observed with the use of this technique.

Conclusion: This simple yet novel technique can be applied to Asian patients for a natural looking tip. This technique is applicable to patients with thin skin and gives surgeons an alternative option as they perform tip surgeries. This technique together with other approaches in rhinoplasty may help surgeons achieve a more balanced look for Asian patients.

Original Research: Descriptive or Analytical, Either-Or or Both-And?

José Florencio Lapeña — 2024-11-21

descriptive (adj.)
“serving or aiming to describe,” 1751, from Late Latin descriptivus, from descript-, past-participle stem of describere “to write down, copy; sketch, represent,” from de “down” (see de-) + scribere “to write” (from PIE root *skribh- “to cut”). Related: Descriptively; descriptiveness.

¹Online Etymology Dictionary
https://www.etymonline.com/word/descriptive
© 2001-2024 Douglas Harper

analytical (adj.)
“employing analytic methods,” 1520s, with -al (1) + Medieval Latin analyticus, from analyticus, from Greek analytikos “analytical,” from analytos “dissolved,” from analyein “unloose, release, set free,” from ana “up, back, throughout” (see ana) + lysis “a loosening,” from lyein “to unfasten” (from PIE root *leu- “to loosen, divide, cut apart”).

²Online Etymology Dictionary
https://www.etymonline.com/word/analytical
© 2001-2024 Douglas Harper

DokNet’s World

William Billones — 2024-11-21

Staff Box; Notice to Readers and Contributors

Philipp J Otolarygol Head Neck Surg — 2025-01-27

Association of Treatment Delays with Survival for Patients with Head and Neck Cancer Undergoing Surgery and Radiotherapy at the Philippine General Hospital

Nicole Sacayan-Quitay — 2024-11-21

Objective: To identify in what phases in the treatment of head and neck cancer do delays
happen at a tertiary hospital and to determine the association between the length of treatment
delays and the oncologic outcomes (disease-free survival and overall survival) for patients with
head and neck cancer.

Methods:
Design: Retrospective Cohort Study
Setting: Tertiary National University Hospital
Participants: Sixty-eight (68) patients who had surgery and adjuvant radiotherapy for invasive head and neck cancer at the Philippine General Hospital during the 5-year period of January 2014 to December 2019 were included in the initial consideration. Only 15 had survival data and were thus eligible for inclusion in this study.

Results: The median treatment package time for head and neck cancers in our institution was 27.6 weeks or 193 days. The treatment package time statistically correlated with both overall survival, F(1,13)=12.952, p<0.005, R2=0.499, and disease-free survival, F(1-13)=12.823, p<0.005, R2= 0.497. However, the independent effects of other predictors such as time interval between first consult to histopathologic diagnosis, diagnosis to surgery, and surgery to post-operative radiotherapy, showed no statistically significant association with overall survival and disease free survival.

Conclusion: All study patients experienced treatment delays from diagnosis to surgery, and surgery to adjuvant radiation therapy, and in their total treatment package time. The positive correlation among treatment package time, and disease-free and overall survival in this study must be further investigated in order to elucidate the true effect of delays across time intervals in the treatment of head and neck cancer in the Philippine General Hospital. Every effort should be made towards timely management of these patients.

Diagnostic Accuracy and Safety of Endoscopic – Guided Office-Based Biopsies for Laryngeal and Pharyngeal Lesions at St. Luke’s Medical Center

Diana Fernandez — 2024-11-21

Objective: To determine the sensitivity, specificity, positive predictive value, negative predictive value and safety of endoscopic guided office-based biopsies (OBB) in diagnosing laryngeal and pharyngeal neoplasms at the St. Luke’s Medical Center in Quezon City and Global City.

Methods:
Design: Diagnostic Accuracy Study
Setting: Two Tertiary Private Training Hospitals
Participants: Records of patients with pharyngeal and laryngeal lesions who underwent endoscopic-guided OBB were included in the study describing safety. Only patients with subsequent operative biopsies were included in assessing diagnostic accuracy.

Results: Thirty-six (36) patients were included: 28 (77.78%) males and 8 (22.22%) females, with median age of 61.5 (IQR 52-73 years). Nearly half (16/36; 44.44%) of the office-based biopsies yielded malignant histopathology results, 19.44% had high grade dysplasia while 36.11% had benign findings. Of 10 patients with operative biopsy for definitive diagnosis, 8 were correctly diagnosed with carcinoma while one had a change in diagnosis from benign to malignant. Office based biopsy was well tolerated and had no complications reported. Overall, the sensitivity of OBB in predicting malignancy was 88.89%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 50%.

Conclusion: Office-based biopsy is an accurate, reliable and safe modality for screening suspicious pharyngeal and laryngeal neoplasms, and may be part of routine screening during initial endoscopy among selected patients with suspicious pharyngeal and laryngeal neoplasms. Further investigation and larger population studies may provide more robust insights on effectiveness and safety of office-based biopsy in diagnosis of pharyngeal and laryngeal neoplasms.

Determining the Severity of Symptoms Among Patients with Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis Versus Non - Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis at the Veterans Memorial Medical Center

Geoffrey John Hizon — 2024-11-21

Objective: To compare the severity of symptoms of patients diagnosed with Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis (eCRSwNP) versus Non - Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis (non-eCRSwNP) using the Filipino Sinonasal Outcome Test (Filipino SNOT 22) and determine the most common symptoms experienced by patients with eCRSwNP versus non-eCRSwNP.

Methods:
Design: Cross-Sectional Study
Setting: Tertiary Government Training Hospital
Participants: A total of 68 patients diagnosed with Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) from November 7, 2018 to August 31, 2022 were included in the study.

Results: Of the 68 patients included in the study, 33 (48.5%) had non-eCRSwNP while 35 (51.5%) had eCRSwNP. The age of the patients with non-eCRSwNP group was 50.6 + 18.45 and those with eCRSwNP was 52.9 + 16.6 years old. Non-eCRSwNP patients had a lower mean Filipino SNOT 22 score of 39.7 ± 16.1 compared with eCRSwNP with a score of 62.7± 13.5. The non-eCRSwNP patients had symptom severity classified as mild in 2 (6.1%), moderate in 25 (75.8%) and severe in 6 (18.2%) based on Filipino SNOT-22. Among the eCRSwNP group, majority of the patients, 29 (82.9%) were classified as severe, 6 (17.1%) as moderate, and none with mild severity. Using the Filipino SNOT 22, the most common symptoms of patients with eCRSwNP were item 2 (baradong ilong; nasal blockage) at 28.6%, then item 7 (malapot na sipon; thick nasal discharge) at 25.7%, Item 8 (pagbabara ng tenga; ear fullness) and item 12 (pagkawala/ pagkabawas ng panlasa/ pang amoy; decreased sense of smell/taste) were tied at 14.3%, item 13 (hirap sa pagtulog; difficulty falling asleep) at 25.7%, and item 17 (pagkapagod; fatigue during the day) at 31.4% while patients with no-eCRSwNP were noted with item 2 (baradong ilong; nasal blockage) at 48.5%, followed by item 4 (hindi tumitigil na pagtulo ng sipon; runny nose) at 21.2%, item 11 (pananakit ng mukha; facial pain) at 33.3%, Item 7 (malapot na sipon; thick nasal discharge) at 18.2%, and item 20 (pagiging irritable/pagkainis; irritability) at 21.2%.

Conclusion: Our present study suggests that the higher the SNOT 22 score, the more likely it is to be eosinophilic chronic rhinosinusitis. Although nasal blockage was the most common symptom found in
both patients with eCRSwNP and non-eCRSwNP, patients with thick nasal discharge, decreased sense of smell/taste and ear fullness were more likely to be suffering from eCRSwNP, while patients with runny nose, facial pain and thick nasal discharge were more likely to have non-eCRSwNP.

Regression Analysis of Preoperative Chest Radiographs to Predict Intraoperative Location of Esophageal Foreign Body (Coin) in Pediatric Patients

Angelika Doreen Martinez — 2024-11-21

Objectives: To provide a guide to estimate the location of coins within the esophagus based on the pre-operative radiographic image among pediatric patients seen at the East Avenue Medical Center Department of Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) between January 2018 and December 2020.

Methods:

Design: Retrospective Case Series

Setting:Tertiary Government Training Hospital

Participants: The records of 99 pediatric patients aged 6 months to 13 years who were diagnosed with esophageal foreign body (coin) impaction and underwent rigid esophagoscopy from January 2018 to December 2020 were retrospectively reviewed.

Results: A predictive model was derived from the data using linear regression analysis. The model shows that we can predict the intraoperative location of coin within the esophagus if provided with the patient’s age and vertebral level of the coin on chest radiograph. Prediction values were reported for patients in three age categories (less than 3 years old, 3 to 7 years old, 8 to 13 years old), at 10 radiographic locations (C2, C4, C5, C6, C7, T1, T2, T3, T7, T8), except for these (C1, C3, T4-T6) because of lack of data. For example, the table predicts that a coin will be located 13 cm (or between 11.4cm to 14.8cm) from the central maxillary incisors (CMI) intraoperatively if the coin was located at level C6 vertebrae on chest radiograph, for patients less than 3 years old.

Conclusion:This study provides a novel guide that may serve as a practical tool for ENT surgeons to estimate the intraoperative location of coin foreign bodies in the esophagus of pediatric patients based on preoperative radiographic imaging.

Olfactory Dysfunction, Dysgeusia, and Clinical Outcomes in COVID-19 Patients: An Observational Study in a Tertiary COVID Referral Center in the Philippines

Chantel Jacqueline Tirol — 2024-11-21

Objective: To describe the prevalence, onset, associated symptoms, and clinical characteristics of COVID-19 in-patients with olfactory and gustatory dysfunction at the Philippine General Hospital from March 2021 to January 2022 and determine the number of patients with olfactory dysfunction/dysgeusia who recovered or expired.

Methods:
Design: Prospective Cohort Study
Setting: COVID-19 Referral Hospital (Tertiary National University Hospital)
Participants: COVID-19 RT-PCR positive in-patients, ages 19 and older

Results: A total of 207 patients were included. Sixty-four (64) patients reported olfactory dysfunction and 79 reported dysgeusia. Olfactory and gustatory dysfunction were observed early in the course of infection, before day 6 of illness. The average length of hospital stay was 20.36 days; those with olfactory dysfunction stayed for 17.53 days, dysgeusia for 19.92 days, and 21.09 days for those who noted neither. For those subsequently intubated, 0 had olfactory dysfunction, three reported dysgeusia, three had both and six had neither. Thirteen (13) patients in the study expired. Among them, none reported olfactory dysfunction and two had dysgeusia.

Conclusions: Our results corroborate existing literature that olfactory and gustatory dysfunction as key indicators of COVID-19 with 42.5% of participants reporting these symptoms early, often before day 6 of illness. Ninety-two percent (92%) of those affected recovered and had shorter hospital stays, emphasizing the importance of recognizing these dysfunctions for improved disease detection and outcomes.

Otorhinolaryngologic Manifestations of Long COVID-19 Infection Among Patients at the Quezon City General Hospital

Ma. Nina Kristine Sison — 2024-11-21

Objective: To determine the otorhinolaryngologic manifestations of long COVID-19 infection among patients consulting at the Quezon City General Hospital.

Methods:

Design: Cross-Sectional Study

Setting: Tertiary Government Hospital

Participants:Patients aged 18 years old and above, who previously tested positive for the SARS-COV-2 Test, and consulted with otolaryngologic problems at the Outpatient department, Emergency Room, or were dmitted, or referred from other services to the Department of Otorhinolaryngology Head and Neck Surgery, from October 2022 to January 2023 were considered for inclusion.

Results: Out of 150 participants, 127 (84.67%) reported having otorhinolaryngologic symptoms. Five percent (5%) had ongoing symptomatic COVID-19 (4 to 12 weeks) and 11% had post COVID-19 syndrome (>12 weeks). Patients with long COVID-19 had rhinorrhea (54.51%), hyposmia (51.47%), dysgeusia (48.9%), anosmia (48.53%), sore throat (47.8%), ageusia (29.78%), tinnitus (23.53%), ear pain (23.53%), phantosmia (21.33%), and dizziness (11.76%). Out of 25 patients with long COVID, only 2 had pneumonia and 1 was hospitalized and eventually recovered.

Conclusion: This study showed a prevalence rate of 16% of long COVID-19 with rhinorrhea as the most prominent symptom. Long-term monitoring is essential and patients who had COVID should be advised to report any lingering illness which may subsequently develop. Physicians should be vigilant and aware of the clinical manifestations of long COVID in order to institute proper intervention.

Telemedicine for ENT: Quality of Care During the COVID-19 Pandemic at the Jose R. Reyes Memorial Medical Center in 2022

Janella Mara Castro — 2024-11-21

Objective: To assess the quality of care of telemedicine consultation during the COVID-19 pandemic at the Jose R. Reyes Memorial Medical Center in 2022
Methods:
Design: Cross-Sectional Study
Setting: Tertiary Government Training Hospital
Participants: 210 patients

Results: Majority of the respondents were female, less than 40 years of age, unemployed, consulted for the first time, lived < 25km distance from the hospital, consulted because of an
ear problem, consulted without symptoms suggestive of COVID-19 and had higher outcomes of face-to-face consultation. The overall satisfaction with teleconsultation was good with majority of patients satisfied and very satisfied with teleconsultation (4.29±1.083). Occupational status, technical problems encountered in the teleconsultation, and those who were bothered by the absence of clinical examination were associated with the perceived quality of care of the ENT teleconsultation (p < .05). Among the population who were satisfied to ENT teleconsultation, 82 (43%) were from the working population (OR 2.2 [1.1-4.7]), 158 (95%) were satisfied with quality of response (OR 23.7 [9.4-59.8]) and 154 (93%) were satisfied with image quality (OR 16.9 [7.3-39.0]).

Conclusion: Teleconsultation for ENT has proven useful in terms of satisfying the urgent concerns of patients in a pandemic setting.

Message

Christine Joy Arquiza — 2024-11-21

Happy Holidays!
The Philippine Society of Otolaryngology-Head and Neck Surgery (PSO HNS) Board of Trustees congratulates the Editorial Board of the Philippine Journal of Otolaryngology – Head and Neck Surgery (PJO-HNS), headed by Dr. Jose Florencio Lapeña, Jr., on the publication of this issue. Dr. Lapeña has been the editor-in-chief of the PJO-HNS for the past 18 years, and it has grown in scope and stature under his leadership.

It is through the PJO-HNS that we achieve some of the objectives codified in our articles of incorporation. These articles state that the primary purpose of the PSO-HNS is to engage in the promotion of the welfare, training, and scientific advancement of ORL-HNS in the Philippines, particularly (among many other objectives), to develop programs to promote the exchange of scientific information among members, and to encourage, support and institute publication of scientific ORL-HNS literature for national and international consumption.

This year, we will be proposing a new Vision for the PSO-HNS: To be a globally recognized society in ORL-HNS, driving innovation, collaboration, and excellence through an engaged community of Fellows and stakeholders by 2027. Part of the reason for the change was to facilitate recall of the vision statement. We want every Fellow of the Society to remember the vision so that individually and corporately, we can put this vision at the forefront of our plans and projects to ensure success. Part of the proposed Mission of the PSO-HNS is advancing innovation in ENT care by promoting research and development. The PJO-HNS will play an important role in achieving global recognition for the society by continuing its tradition of innovation and excellence in vetting, improving and publishing research papers from all over the world.

Knowing our Vision and Mission is but the start of continuing our growth as a Society. To be truly relevant, we must look at the current situation of our nation and identify ways to improve the lot of the Filipino people, not just in terms of ENT care, but in all aspects of life that we can touch. The Society has increasingly focused on advocacies such as care for the environment, cancer consciousness, hearing health, road safety and the like. We have supported movements and statements for social justice, government accountability and PhilHealth reform. Let us continue to use our strength as a Society towards a better Philippines.

I would like to share with you my life verse for this year. From the letter of Paul to the Galatians: “Let us not become weary in doing good, for at the proper time we will reap a harvest if we do not give up.” Let us continue doing good for each Fellow, for the PSO-HNS as a whole, and for the Filipino people who need our care.

His Blessings!