OBJECTIVE: The aim of the study was to describe the diagnosissurgical management and outcomes of eight patients with bone paraganglioma.

PATIENTS: A series of 8 patients with temporal bone paraganglioma were seen over a 10-year period and operated n by the senior author.

RESULTS: The majority of patients presented with hearing loss and pulsatile tinnitus. Other symptoms were facial numbness, facial asymmetry, dizziness, hoarseness, and dysphagia. All patients had pre-operative high resolution computed temography (HRCT) scan and/or magnetic resonance imaging. Pre-operative angiography and embolization facilitated the excision of these tumors in all but one case. There was reversal of pre-existent cranial nerve neuropathy in 3 of 8 cases. Unique to this series were the management of a patient who previously underwent gamma knife radiosurgery, one case in whom the glomus tumor grew from the better hearing ear thus posing the surgical management challenges and a complicated case of postoperative necrosis that required latissimus dorsi flap reconstruction. Other complications were described including post-operative facial paresis which eventually resolved in all patients.

CONCLUSION: In our setting, it is possible to achieve good result with acceptable morbidity with surgery with or without postoperative radiotherapy.

Human ; Tinnitus ; Dizziness ; Glomus Tumor ; Facial Paralysis ; Hypesthesia ; Hoarseness ; Hearing ; Hearing Loss ; Temporal Bone ; Paraganglioma ; Angiography ; Cranial Nerves

OBJECTIVES: The objectives of this study are to describe the experience on cochlear implantation among patients with chronic otitis media (COM) and to describe the management of patients with otitis media before and after cochlear implantation (CI).

METHODS: The records of one hundred five consecutive patients who have undergone cochlear implantation were reviewed and the patients with chronic otitis media either before or after surgery were included in the study. Data such as age at implantation, etiology of deafness, laterality of otitis media, radiologic studies, medications and intraoperative findings in these patients were reviewed then recorded in a separate database file. Outcomes in terms of complications during or after surgery were likewise noted.

RESULTS: Of 105 patients who had cochlear implantation, twelve patients had history of chronic otitis media or recurrent acute otitis media. There were three patients, 2 adults with bilateral COM as the cause for deafness and one child with bilateral COM and middle ear foreign body mimicking a cholesteatoma. All three had to undergo mastoidectomy and tympanoplasty for the surgical management of active suppurative chronic otitis media. No further episodes of otitis media were noted and all were otitis free subsequently at the time of cochlear implantation. Five prelingually deaf children had otitis media following cochlear implantation (one week to 4 months), two of whom had to undergo revision cochlear implant surgery without explantation for definitive management. Four additional patients had episodes of recurrent otitis media prior to and after cochlear implantation which required only medical management with broad spectrum.antibiotics.

CONCLUSION: Despite high prevalence of otitis media in the Philippines, our data supports literature reports that cochlear implantation is a safe and effective procedure in patients with bilateral profound hearing loss both in the pediatric and adult.

Human ; Male ; Female ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Cochlear Implantation ; Cochlear Implants ; Tympanoplasty ; Anti-bacterial Agents ; Otitis Media ; Hearing Loss, Bilateral ; Cholesteatoma

Objective: This report aims to determine the clinical manifestations and management of patients with superior semicircular canal dehiscence syndrome (SSCDS). Methods: Design: Case series Setting: Tertiary hospitals and private clinics Participants: Out of 30 patients with vestibular vertigo or otologic symptoms, 14 patients were diagnosed with SSCDS based on high resolution computed tomographic scan (HRCT). The demographic features, incidence of specific signs and symptoms and management of these patients were described, including the audiograms, vestibular evoked myogenic potential (VEMP) responses and ancillary tests. Results: Vertigo was the most common vestibular symptom of SSCDS. Tullio phenomenon was elicited in 50% of patients with confirmed dehiscence on HRCT scan. Low frequency (250 Hz and 500 Hz) air-bone gap was noted in 21.4% of patients. Lowered VEMP responses were also noted in 66.7% of patients with confirmed SSCDS. Severity of symptoms may determine its management. Conclusion: The diagnosis of SSCDS does not conform to a specific clinical presentation or audiologic result and good clinical correlation is needed in order to raise suspicion of the disease and prompt the clinician to order confirmatory imaging by computed tomographic scan or magnetic resonance imaging. The presence of this syndrome in a proportion of children that is greater than previously reported needs further study as these children may be genetically predisposed to have thinned out superior semicircular canals that eventually become dehisced albeit at an earlier age.

OBJECTIVE: The prevalence of congenital bilateral permanent profound hearing loss in the Philippines is 1.3 per 1000 live births. The prevalence increases to 22 per 1000 live births for unilateral mild to moderate hearing loss. This study was conducted to determine the cost of establishing a universal newborn hearing screening (UNHS) program. Local prevalence data and current costs of screening, diagnostics and intervention strategies for bilateral permanent hearing loss were utilized to estimate the costs of implementing the program.

METHODS: Both short-term and long-term costs for hearing screening centers and for families caring for hearing-impaired children were determined using a societal perspective. Calculations included cost of hearing loss and the effectiveness of testing strategies. In this study the societal cost was considered although some of the costs pertained to costs borne by individual patients or their families since none of the screening, diagnostic and intervention strategies are paid for by insurance companies. An exception is the partial subsidy for cochlear implantation that is reimbursable with the Philippine Health Insurance Corporation.

RESULTS: Using published data on the prevalence of hearing loss and experience from a pilot universal newborn hearing screening project at a national tertiary hospital (Philippine General Hospital), the long-term benefits and savings from UNHS on a national scale greatly outweigh the immediate costs of testing and intervention.

CONCLUSION: The cost benefit of UNHS program at a national level outweighs the financial burden of hearing impaired individuals and their families.

Human ; Male ; Female ; Child ; Infant Newborn ; Cochlear Implantation ; Cost-benefit Analysis ; Hospitals, General ; Hearing Loss ; Hearing Loss, Bilateral ; Persons With Hearing Impairments

OBJECTIVES: This paper aims to determine the length of time before a cochlear implantee would reach aided hearing threshold of < 45 dBHL at 5 frequencies (target threshold) and whether there is a difference depending on age of implantation and sex.
METHODS: From January 2009 to February 2011, the aided earing thresholds of 41 prelingually deaf children with cochlear implants after switch on were reviewed.
RESULTS: There were 21 males and 20 females. Majority of children 7 years old reached it at < 1 month. The probability that a female would reach the target threshold on or before 6 months was 90% but this was not statistically significant.
CONCLUSION: Sixty-six percent of the children with cochlear nplants reached the target threshold within the first 3 months post fitting and 80% within the first 6 months post fitting. More of the older children reached target threshold earlier than the younger children. There was a trend that more females reached the target threshold earlier than the males but this was not statistically significant.

Human ; Male ; Female ; Child ; Child Preschool ; Infant ; Infant Newborn ; Cochlear Implants ; Cochlear Implantation ; Hearing Aids ; Cochlea

Objectives: 1) To present a technique for implanting the Med-EI Combi 40+™ using a small incision with minimal access. 2) To describe the short term postsurgical outcomes in these patients. Methods: Two patients (1 child and 1 adult) underwent a novel small incision technique for implantation of the Med-EI Combi 40+™ cochlear implant device. The short term outcomes in these two patients were described and compared with previous experience using the standard implantation technique citing advantages and possible limitations. As these two patients had bilateral implantation utilizing different techniques on the two sides interesting comparisons could be made on the same individuals. Results: The preliminary experience with a novel small incision technique for the Med-EI Combi 40+™ implantation shows encouraging results in terms of healing and initial performance of these patients. Conclusion: This small incision technique may be offered to patients especially to those who wish to have bilateral implantations as this allows a less invasive approach, good cosmesis without sacrificing the safety and performance outcomes at least in the short term. (Author)
COCHLEAR IMPLANTATION SURGERY OTOLOGIC SURGICAL PROCEDURES

Background: Certain indigenous populations have been noted by the World Health Organization (WHO) to havethe highest prevalence ratesforchronicsuppurativeotitis media (CSOM), including the Australian Aborigines (28-43%), Greenlanders (2-10%) and Alaskan Eskimos (2-10%). Objectives: To determine the prevalence of common ear problems, particularly CSOM, among the indigenous Ati or Aeta community in Bolabog, Boracay, and to determine their hearing sensitivity using screening audiometry. Methods: Study Design - Descriptive cross-sectional study. Setting - A small Ati community in Bolabog, Boracay. Population - A total of 63 adults and children underwent medical interview and otoscopy. Additionally 24 had their hearing screened by audiometry. Results: About a quarter of the population participated in the study, including 41 children (40 percent of all children) and 22 adults (18 percent of all adults). Forty-six percent of children and 23 percent of adults who were examined had previous history of ear discharge, while 22 percent of children and 45 percent of adults who were examined had history of hearing loss. Seventeen percent of children had history of hearing loss in the family. CSOM was found in 18 (43.90 percent) children and 8 (36.36 percent) adults. Impacted cerumen was found in 17.1 percent of children. Eleven female children underwent screening audiometry. Of these, eight had normal hearing and three had abnormal findings. Thirteen adults were also tested, five of whom were male and had normal hearing bilaterally. Four of eight female adults had abnormal hearing, of which three were unilateral. Conclusions: The Ati population in Bolabog, Boracay belongs to a group with the highest prevalence rates for CSOM (27.0 percent). A bigger sample for screening audiometry is required for proper estimation of hearing loss prevalence. Both environmental and genetic factors may have increased the prevalence of CSOM in the Ati population of Boracay. (Author)
HEARING LOSS OTITIS MEDIA OTITIS MEDIA ; SUPPURATIVE

OBJECTIVES:To determine the agreement between 1) ear examination findings of the otorhinolaryngologist using an otoscope and trained elementary school nurses using a penlight, 2) hearing screening findings of the otorhinolaryngologist and elementary school nurses, both using the Philippine National Ear Institute (PNEI) Method of 512 Hz Tuning Fork Test (TFT) and 3) PNEI Method of 512 Hz TFT findings and screening audiometry findings.
METHODS:In this continuing study, nurses residing in the venue of the study, and previously trained in ear examination using a penlight and hearing screening using the PNEI 512 Hz TFT, conducted these in school children who attended the hearing screening and medical mission. Otoscopy, PNEI Method of 512 Hz TFT, and screening audiometry were then conducted on the children by the otolaryngologist. The nurses and the otolaryngologist performed independent and blinded assessments.
RESULTS:Eighteen nurses and ninety children participated in the study. Data subjected to Kappa statistics showed good agreement between nurses and otorhinolaryngologist's findings in the examination of the external canal and tympanic membrane and in PNEI Method of 512 Hz TFTs, and between the PNEI Method of 512 Hz TFT and screening audiometry.
CONCLUSION:PNEI methods of penlight ear examination and 512 Hz TFT may be effective tools for early detection of common ear conditions and hearing screening in Filipino school children. These may be conducted in the school setting not only by otorhinolaryngologists but also by adequately trained school nurses.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Diagnosis ; Nurses ; Hearing ; Audiometry ; Child ; Ear Diseases ; Early Diagnosis ; Humans ; Otolaryngologists ; Otoscopes ; Otoscopy ; Philippines ; Religious Missions ; Schools ; Tympanic Membrane ; Hearing Tests

OBJECTIVE: To explore the effects of pesticide exposure on the auditory system, specifically on hearing status based on auditory brainstem responses.

METHODS: A cohort of pregnant women was identified in several communities in a rural area from April 2002 to February 2003 and followed up until delivery. Mother-infant dyads were assessed for exposure to pesticides. Maternal and fetal exposures to environmental toxic products were determined by measuring levels in maternal hair and blood, and infant cord blood, hair, and meconium, respectively. Hearing status was measured using otoacoustic emissions (OAE) and confirmed by diagnostic auditory brainstem responses (ABR) measured at 80, 60, and 40 decibels. Waves I, III, V were identified and absolute latencies measured, including inter-peak latencies from waves 11III, I-V, and III-V. Pesticide exposure was then correlated with latencies of Waves I, III, V, and interpeak latencies of waves I-III, IIV, and III-V. Hearing loss and pesticide exposures were correlated with Griffiths Mental Development Scores (GMDS).

RESULTS: Significant delays in the ABR wave latencies were noted in the group with exposure to pesticides. Propoxur was the most common toxic product detected in infants and meconium the best substrate for its detection. There was a 1.4% risk of hearing loss with exposure to propoxur (RR=0.52 (0.12-2.30), p = 0.06), a 6.25% risk with cypermethrin exposure (RR= 4.53 (0.61133.64), P = 0.10) and 6.25% risk with pretilachlor exposure (3.13 (0.44-22.30), p = 0.07). Griffith's Mental Developmental Scale scores (GMDS- hearing and speech subscale and general quotient scores) were not significantly different between exposed and unexposed groups. However, three infants with positive exposures and hearing loss had below average, or low to average scores using this scale.

CONCLUSION: Maternal exposure to environmental toxic products may affect the auditory pathway in infants at birth. Pregnant women should limit their exposure to such toxic products in order to avoid neurodevelopmental effects particularly on hearing because this is very important in the critical stage of language and speech development.

Human ; Male ; Female ; Infant Newborn ; Auditory Pathways ; Maternal Exposure ; Meconium ; Speech ; Otoacoustic Emissions, Spontaneous ; Hearing Loss ; Deafness ; Hearing Tests ; Acetanilides ; Pesticides ; Hair

Background: The Philippine National Ear Institute (PNEI) was created to promote health of hearing and balance among Filipinos. Over the years, it has provided audiologic services to thousands of patients annually and has published relevant hearing and balance research. Objective: To describe the patients served by the PNEI in terms of age, region of origin, occupation, pretest diagnosis, and audiologic results. Methods: Study Design - Cross-sectional study Setting - National tertiary care center Population - All records of patients referred for audiologic testing at PNEI in 2006 were reviewed and encoded into analyzable format. Results: A total of 1,756 patients had audiologic records for review. Median age was 32.5 years, with the age distribution presented according to sex, type of tests done including common reasons for referral, and median threshold levels by frequency. Coverage was national in scope, with most patients coming from the National Capital Region and from Regions III and IVa. Occupation was indicated in 37.8 percent of the working age group, most of whom were unemployed. The most common pretest diagnosis was chronic otitis media (26.6 percent), followed by hearing loss of unknown etiology (13.0 percent) and tinnitus (9.3 percent). Severity of hearing impairment based on pure tone audiometry was variable, and was presented according to common diagnoses. About 39 percent of hearing impairment cases were sensorineural, 36 percent conductive and 25 percent due to mixed defect. Bilateral Type A ears were found in 45.4 percent of patients by tympanometry, while 29.3 percent were bilateral Type B. For otoacoustic emissions, 69.0 percent were labeled as "refer" in at least one ear. Conclusion: The PNEI is a major national referral center for audiology that holds much promise in developing programs for national surveillance of the hearing status of different sectors in Philippine society. (Author)
HEARING AUDIOLOGY ACOUSTIC IMPEDANCE TESTS OTITIS MEDIA