Tufted angioma (TA) is a rare, benign, vascular neoplasm of the skin. The diagnosis of this condition is infrequent due to its rare occurrence. Only 158 cases have been described as of 2015. The treatment reported in the literature is very limited with no clear guidelines on its management. Currently, there are no reported cases in the Philippines of TA treated with aspirin. This is a case of a 1-year-old Filipino boy presenting with multiple dusky red papules and plaques on the left side of the cheek, pre- and postauricular areas, parieto-occipital areas, chest, and upper back. His lesions started at 2 months of age, noted to increase in size, number, and thickness over time. Dermoscopy revealed homogenous erythematous background with perifollicular lacunae separated by thin septa. Histopathology revealed dilated vessels in the papillary dermis with proliferation of endothelial cells in lobules, surrounded by dilated crescent-shaped vascular channels in the dermis. The patient was treated with low-dose aspirin (5 mg/kg/day) once a day for 1 month with improvement. After 4 months from treatment, no new lesions, no increase in size, nor symptoms were noted. Low-dose aspirin is an effective and safe option for monotherapy of TA in pediatric patients.

Leukocytoclastic vasculitis (LCV) is a histopathologic descriptor for a prevalent type of small-vessel vasculitis (SVV) that affects arterioles, capillaries, and postcapillary venules. Although the association between vasculitis and malignancy only accounts for <5% of vasculitis cases, it has been recognized as a true paraneoplastic syndrome in several studies. A 57-year-old Filipino male presented with erythematous, nonblanching macules on his lower extremities, which rapidly progressed to violaceous lesions on his trunk, buttocks, and lower extremities. He also reported significant weight loss, decreased appetite, and vomiting. A skin biopsy confirmed LCV. Initially treated for meningococcemia, his condition did not improve. Abdominal imaging revealed an enlarged heterogeneous liver with retroperitoneal lymphadenopathy and a parenchymal nodule. He was eventually diagnosed with vasculitis secondary to an underlying hepatic malignancy and expired later from multiorgan failure.

Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) is a variant of chronic inflammatory demyelinating polyneuropathy (CIDP). It presents as a chronic, asymmetrical sensory-motor polyneuropathy with features of demyelination on nerve conduction studies. Management options include intravenous immunoglobulin and corticosteroid infusions. Prognosis is generally favorable but there have been reports of variable response to treatment. This condition is rare and local data on CIDP and its variants is limited, hence we report a case of a 64-year-old male presenting with 3 year history of progressive asymmetric numbness and weakness of all limbs. Sensory deficits began on the left hand and had progressed to involve the distal portions of all limbs, eventually developing weakness as well. The patient underwent multiple nerve-conduction studies, all of which showed findings congruent with MADSAM. He was given intravenous high dose methylprednisolone and was maintained on mycophenolate mofetil.

We report a 39-year-old male who had generalized tonic-clonic seizure with loss of awareness. Investigations led to a diagnosis of a left temporal lobe tumor. He underwent resection of the mass with consequent loss of brain tissue in the temporal lobe and was found to have a complete right homonymous hemianopia in the immediate postoperative period. Macular ganglion cell analysis on optical coherence tomography (OCT) showed homonymous thinning affecting the inferonasal sector in the right eye and inferotemporal sector in the left eye. This case demonstrates transsynaptic retrograde degeneration through the interruption of the inferior optic radiation, and its corresponding effect on the structure and function of the affected retinal field. Temporal lobe lesions may cause not only a homonymous visual f ield defect contralateral to the side of the lesion but also result to homonymous sectoral thinning of the macular ganglion cell complexes in both eyes located ipsilateral to the side of the lesion.

Objective: To report a case of lingual thyroglossal duct cyst in an elderly man, excised via combined Trotter procedure and hyoid osteotomy.

Methods:
Design: Case Report
Setting: Tertiary Government Training Hospital
Participant: An elderly retired male office worker with dysphagia

Results: The cyst was completely excised via median labiomandibular glossotomy, with hyoid osteotomy providing additional exposure. Our patient was discharged in two weeks after decannulation and remains asymptomatic.

Conclusion: The Trotter procedure with hyoid osteotomy may be a viable alternative to the Sistrunk procedure for large lingual TGDCs.

Otorrheacan result from middle ear discharge with tympanic membrane perforation, external ear canal pathology, skull injury and other serious diseases in trauma and immunocompromised patients.1Thorough investigation is warranted in cases without improvement after treatment. We present a case where fibrous dysplasia was the underlying cause and discuss its treatment.

CASE REPORT
A 41-year-old farmer man consulted at our ENT Outpatient Clinic with a 1-year history of clear, non-foul-smelling discharge from his left ear, associated with intermittent pounding ear pain. A hard immobile nontender prominence was noted over the patient’s left temporal area. (Figure 1) He was initially treated for chronic suppurative otitis media for 3 months. Severe ear pain was noted,
10/10 on pain scale, squeezing in character, radiating to the left temporal and parietal area associated with progressive hearing loss and ear fullness. Plain CT scans revealed a combined lytic and ground glass expansile lesion involving the left occipital, mastoid, and petrous temporal bone and portion of the parietal bone obliterating the external auditory canal and middle ear. (Figure 2)

On physical examination, a hard immobile nontender prominence was noted over the patient’s left temporo-parietal area. No facial asymmetry or numbness was noted. On otoscopy, there was a skin-colored round smooth hard immobile nontender mass in the external auditory canal with non-foul smelling whitish to yellowish purulent discharge. A Weber tuning fork test lateralized to the left and a Rinne test revealed air conduction < bone conduction on the left, and air conduction > bone conduction on the right.

The patient was admitted with an impression of chronic suppurative otitis media, left; to consider fibrous dysplasia vs. tuberculosis. Aerobic culture of ear discharge revealed no growth. Canal down mastoidectomy was done. Intraoperative findings revealed granulomatous and cartilaginous lesions on the mastoid and temporal bone. (Figure 3) There were aural polyps and cholesteatoma with the ossicles apparently eroded by the lesion. (Figure 4) Temporal bone fluid was sent for GeneXpert MTB/RIF while the surgical specimen was sent for histopathology. GeneXpert MTB/RIF revealed negative results for tuberculosis. Final histopathology results showed fibrous dysplasia.

A 52-year-oldintellectually disabled man who had previously undergone a left canal wall down mastoidectomy with cartilage graft tympanoplasty for cholesteatoma 20 years ago presented with new-onset discharge in the contralateral ear. He did not have any symptoms, particularly recurrent discharge, in the post-operative ear, despite infrequent and irregular clinic follow-up for periodic cleaning of the cavity. Clinical examination of the post-operative ear revealed the presence of retained cerumen which was easily removed. The mastoid cavity was noted to have a healthy skin lining, an intact neotympanum, and a smooth bowl-like appearance with no areas that could not be adequately visualized through the surgically widened external auditory meatus. He underwent computerized tomographic imaging of the temporal bone to evaluate the nature and cause of the new-onset discharge in the contralateral ear. This imaging study provided the opportunity to present and describe key post-operative radiologic features of a symptom-free canal-wall down mastoidectomy with tympanoplasty.

A canal-wall down mastoidectomy is a more extensive type of mastoidectomy which, in addition to the resection of the mastoid cortex, all mastoid air cells and Körner septum, is characterized by the resection of the posterior wall of the external auditory canal and scutum. Among the most common causes of failure following this type of surgery are incomplete removal of tegmental air cells and incomplete lowering of the facial ridge.1These two factors can and should be purposefully assessed in a post-operative imaging study.

Adequacy of bone removal in the epitympanum to address the issue of tegmental air cell disease is evaluated on axial CT images at the level of the malleus head-incus body complex and the proximal portion of the tympanic segment of the facial nerve. (Figure 1) All of the bone lateral to the ossicles, especially that overlying the malleus head and anterior epitympanic recess, should have been surgically removed.

On coronal CT images, this same adequacy is demonstrated by the surgical removal of all bone lateral to the epitympanum, from the scutum to the outer cortex, such that there is a clear line of sight from the external auditory meatus to the epitympanum. This helps ensure that there are no pockets of soft tissue medial to any bony ridges; soft tissue that may represent residual or recurrent disease. (Figure 2)

Objective:To determine the association of demographic profiles and clinical characteristics of patients with aural foreign bodies seen at the Emergency Room (ER) of the East Avenue Medical Center with clinical outcomes

Methods:
Design:Cross-Sectional Study
Setting:Tertiary Government Training Hospital
Participants:A total of 143 aural foreign body cases seen at the ER from January to December 2022 under the Department of Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) of East Avenue Medical Center were included in the study.

Results: Of the 143 patients, majority (84; 58.74%) were males. Mean age was 21.92 years old with two peak incidences noted at ages 1-12 years old and 18-65 years old. Most of the patients were right-handed (134; 93.71%). Majority of the foreign bodies were animate (76; 53.15%) and were frequently found to be lodged on the right ear (86; 60.14%) with duration from lodgment to
extraction commonly within less than 24 hours (119; 83.22%). One hundred forty two (99.30%) patients had successful foreign body extraction, 60 (41.96%) had complications, specifically involving the external auditory canal (51; 35.66%) and tympanic membrane (6; 4.20%). Significant associations were found between age and type of foreign body [χ2 (3, N =143) = 31.24, p < .01] with a higher proportion of animate foreign bodies in adults and inanimate foreign bodies in children; sex and presence of complications [χ²(1, N = 143) = 5.41, p < .05] with males experiencing more complications than females; type and duration of foreign body [, χ²(2, N = 143) = 16.33, p < .01] with animate foreign bodies generally having a shorter duration of less than 24 hours compared to inanimate foreign bodies; and the duration of foreign body and presence of TM complications [χ²(4, N = 143) = 14.21, p < .01] with shorter durations (less than 24 hours) showing fewer TM complications. Males had higher odds of developing complications compared to females (OR = 2.315, 95% CI [1.105, 4.851])

Objective:To determine the effectiveness of a one-stage hearing screening protocol in detecting hearing loss in high risk newborns at the Neonatal Intensive Care Unit of the Jose R. Reyes Memorial Medical Center.

Methods:
Design:Cross-Sectional Study
Setting:Tertiary Government Training Hospital
Population:High-risk newborns admitted at the Neonatal Intensive Care Unit of the Jose R. Reyes Memorial Medical Center from March to December 2023 underwent a one stage universal newborn hearing screening protocol. Excluded from the study were patients who were admitted for less than 48 hours, without consent from their parents or guardians and babies who were not cleared medically to undergo testing, and those who presented with aural atresia and/or any physical anomaly of the head and the external ear.

Results:A total of 169 babies were initially seen with 16 babies lost to follow up resulting in a final total of 153 babies (or 306 ears) tested. The refer and false positive rates were 9.8% and 8.92%, respectively, on average comparable to or even better than the two-step protocol in most studies. Sensitivity was determined to be 100% while specificity was 91.08%. The incidence of hearing loss in the study population was 19.8/1000, consistent with various study outcomes for high risk newborns. There was no reported incidence of auditory neuropathy in this study. The primary risk factors that were present in babies with hearing loss were: low birth weight, prematurity, neonatal intensive care unit admission of more than 5 days and exposure to ototoxic medications.

Conclusion:The one-staged Automated Auditory Brainstem Response (AABR) is an effective and efficient newborn hearing screening protocol for high-risk newborns in the Neonatal Intensive Care Unit (NICU) setting and eventually, may be considered as an alternative hearing screening technique whenever available in this cohort. More studies about improving newborn hearing screening, cost-analysis, diagnostics and interventions of hearing loss should be pursued in implementation of the Universal Hearing Screening Law in the Philippines.

Leukemoid reaction refers to reactive and excessive leukocytosis with a white blood cell count of more than 50,000 cells/mm3 in the absence of myeloproliferative neoplasm and has usually been described in response to inflammation, severe infection, malignancies, hemorrhage, acute hemolysis, or bone marrow stimulants. In contrast, urothelial cell carcinoma is rarely associated with leukemoid reaction, with few cases reported over the past few years. Here, we report a case of an invasive Urothelial carcinoma of a 63 year old patient presenting with terminal dysuria and excessively elevated and persisting leukocytosis accompanied by rapid tumor progression and deteriorating clinical status. For urothelial cell carcinoma patients exhibiting a leukemoid reaction, removal of the inciting tumor is the definitive treatment. Though placing of urethral catheter and resection of the bladder tumor alleviated the worsening renal status and terminal dysuria on the index patient, the patient still had multiple persistent febrile episodes throughout the course, accompanied by leukocytosis with predominant mature looking neutrophils, and a left shift. Extremely persistent leukocytosis appears to be associated with poor prognosis even after surgical resection and extensive medical management.