OBJECTIVE: To determine the prevalence rate of follow-up among infants who had a "refer" result on initial newborn hearing screening and to identify reasons for default by parents or guardians.
METHODS:
Design: Cross-Sectional Study
Setting: Tertiary National University Hospital
Participants: 79 parents or guardians whose newborns obtained a "refer" result on initial hearing screening were interviewed over the phone.
RESULTS: Among those babies who had a "refer" result on initial hearing screening, 51% followed up for repeat testing. The most common reasons for non-follow up by parents or guardians include being busy, distance from the hospital and baby's health condition.
CONCLUSIONS: The follow-up rate in this study is higher compared to previous figures (27%), but is still below target. The reasons for non-follow-up obtained suggest problems may exist on all levels of the healthcare system. Appropriate solutions to address these problems should be explored.

Human ; Male ; Female ; Infant Newborn ; Hospitals, University ; Prevalence ; Hearing Tests ; Hearing ; Tertiary Care Centers ; Parents

Co-existence of multiple pathologies affecting a patient poses a challenge in the diagnosis and management. A rare combination of early tongue cancer, maxillary fungal rhinosinusitis, calcified thyroid nodule and primary hyperparathyroidism in a 70-year-old female is described. The evidences used for disease probabilities based on diagnostic results and effectivess of treatment modalities are presented. The decision-making process to come up with an individualized management is discussed.

Tongue Neoplasms ; Parathyroid Neoplasms

Objective: To determine the prevalence of sinonasal anatomic variations seen on paranasal sinus (PNS) CT scans of a sample of Filipino adults with chronic rhinosinusitis. Methods: Design: Cross-sectional study Setting: Tertiary Government Training Hospital Participants: The PNS CT scans of 51 Filipino patients with chronic rhinosinusitis with and without nasal polyposis diagnosed at our outpatien Department of Otorhinolaryngology-Head and Neck Surgery between October 2015 to December 2020 were reviewed for the presence of sinonasal anatomic variants. The prevalence of the identified variants was calculated. Results: The CT scans of 51 patients, 41 (80.4%) men and 10 (19.6%) women, were included. The median age was 48 years (Q25: 35, Q75: 56, IQR:21). The median Lund Mackay Score (LMS) was 15 (Q25: 12, Q75: 20, IQR:8). Majority (94%) had an LMS of ≥5. The most common anatomic variant in the study population was agger nasi (n=46/51, 90.2% present bilaterally) followed by uncinate process attachment to the lamina papyracea (n=90/102, 88.24%). The third to sixth most common findings were Keros type II classification (n=76/102, 74.51%), nasal septal deviation (n=35/51, 68.62%), optic nerve canal type 1 (n=67/102, 65.69%) and anterior ethmoid artery grade 1 (n=46/102, 45.1%), respectively. Less common variants were Onodi cell (n=13/51, 25.49% unilateral and n=10/51, 19.61% bilateral), Haller cell (n=8/51, 15.69% unilateral and n=1/51, 1.96% bilateral), supraorbital cell (n=4/51, 7.84% unilateral and n=4/51, 7.84% bilateral), middle turbinate concha bullosa (n=3/51, 5.88% unilateral and n=6/51, 11.76% bilateral), superior turbinate concha bullosa (n=2/51, 3.92% unilateral and n=1/51, 1.96% bilateral), pneumatized crista galli (n=2/51, 3.92%) and optic nerve dehiscence (n=1/51, 1.96% bilateral). Conclusion In the adult Filipino population with CRS sampled in this study, the six most common sinonasal anatomic variants were agger nasi, superior attachment of the uncinate process to the lamina papyracea, Keros type II classification, septal deviation, optic nerve canal type 1 and anterior ethmoid artery grade 1. Pre-operatively, the PNS CT scan of every patient must be meticulously evaluated for the sinonasal anatomic variants to avoid surgical complications.

OBJECTIVE: To identify risk factors associated with disease recurrence among Filipinos with papillary thyroid carcinoma (PTC).
METHODS:
Design: Retrospective Cohort Study
Setting: Tertiary National University Hospital
Participants: 76 patients diagnosed with papillary thyroid carcinoma, classified as low and low-to-intermediate risk (2015 ATA classification) that underwent total thyroidectomy with or without neck dissection from 2010-2014 and were followed up from 10 months to 5 years. Log rank and Cox regression analyses were used to determine significant risk factors for recurrence.
RESULTS: 29 (38.15%) had recurrence. On univariate analysis, age, tumor size, multifocality, extrathyroidal extension, presence of lateral neck nodes and RAI therapy were statistically associated with recurrence. However, on multivariate analysis, no clinicopathologic factor was statistically associated with recurrence.
CONCLUSION: Age of >45 years, female sex, tumor size of >2 cm, multifocality, presence of microscopic extrathyroidal extension and lymph node metastasis might contribute to the recurrence of papillary thyroid cancer while post-operative radioactive ablation may have some protective effect. However, this study suggests that other factors must be included in the model to better understand the relationship between these factors and recurrence.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Thyroid Cancer, Papillary ; Neck Dissection ; Thyroidectomy ; Thyroid Neoplasms ; Lymphatic Metastasis ; Lymph Nodes ; Regression Analysis ; Factor Ix

Dear Editor, The tympanic membrane and the ossicular chain contribute roughly 28 dB in hearing gain. In chronic suppurative otitis media, loss of tympanic membrane and lysis of the ossicular chain are significant causes of hearing loss.1 Through the years, hearing impairment has been augmented using various devices such as ear trumpets, carbon hearing aids, vacuum tube and transistor hearing aids, bone anchored hearing aids, and cochlear implants.2 This case report describes how a cotton wick was used to amplify sound.
Human ; Male ; Hearing ; Hearing Loss

BACKGROUND: Sensorineural hearing loss (SNHL) is a form of diabetic neuropathy. Its prevalence rate varies from 21.7-73.3% among different populations. The association of this complication with long-term glycemic control has not been described extensively.
OBJECTIVES: The study aims to determine the prevalence of SNHL in Filipino patients with diabetes consulting in a tertiary hospital; and to determine the association of SNHL with the degree of blood sugar control as measured by the mean hemoglobin bA1c (HbA1c) for the last five years.
METHODOLOGY: A cross-sectional study of 128 patients in a tertiary hospital was done. Patients were recruited via stratified random sampling with the different clinics as the stratifying variable. They underwent physical examination and pure tone audiometry (PTA) to detect presence of SNHL and presence of distal peripheral neuropathy. Chart review was done to gather the HbA1c levels for the last five years, as well as data on the presence of retinopathy and nephropathy. The average HbA1c levels, and other clinical and demographic factors and their association with SNHL were analyzed using logistic regression.
RESULTS: The prevalence of SNHL among patients with diabetes is 45.31%. Glycemic control does not seem to be associated with SNHL (p value 0.451, OR 1.447). Age was found to be significantly associated with SNHL (p value=0.046, OR=1.035). Among patients age 60 years old and below, retinopathy was significantly associated with SNHL (p value 0.023, OR=3.564). Multivariate analysis did not show any significant predictor for SNHL. There was no observed difference in the proportion of patients with SNHL among males (48.94%) compared to females (43.21%), p value of 0.530. A more advanced age is associated with SNHL among males (p value 0.024, OR=1.095) and a family history of hearing loss is an independent predictor of SNHL (p value 0.047, OR=1.088).
CONCLUSION: There is a high prevalence rate of SNHL among Filipino patients with diabetes. SNHL does not seem to be associated with glycemic control. Screening for SNHL maybe warranted for patients with diabetes due to its high prevalence rate regardless of glycemic control. Hearing care, focusing on prevention of hearing loss, should be advocated for patients with diabetes mellitus

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Audiometry, Pure-tone ; Blood Glucose ; Deafness ; Diabetic Neuropathies ; Hearing Loss ; Hearing Loss, Sensorineural ; Diabetes Mellitus ; Patients

Objective: To report a case of thyroglossal duct carcinoma with concurrent papillary thyroid carcinoma Methods: Design: Case Report. Setting: Tertiary National University Hospital. Patient: One. Results: A 46-year-old woman was diagnosed with thyroglossal duct carcinoma after undergoing a Sistrunk procedure. Due to presence of thyroid nodules, the patient underwent second stage thyroidectomy with central neck dissection which revealed papillary thyroid carcinoma. Conclusion Thyroglossal duct carcinomas are rare entities and there is no current consensus regarding their management. Difficulties arise in the diagnosis of these tumors as they present similarly to benign thyroglossal duct cysts. Most cases are diagnosed postoperatively. Proper preoperative assessment including head and neck examination, biopsy, and radiologic imaging is necessary to recognize patients who could benefit from more aggressive management.
Thyroglossal Cyst ; Thyroid Cancer, Papillary

OBJECTIVE: The objective of the study is to describe the pattern of nodal metastasis in papillary thyroid carcinoma (PTC) among Filipinos and to determine the possible clinicopathologic factors associated with level V involvement.
METHODS: This study included patients >18 years old with PTC with clinically positive neck node (cN1b) who underwent total thyroidectomy with lateral neck dissection (levels II-IV) or posterolateral neck dissection (II-V) from 2011-2016 at the Department of Otorhinolaryngology-Head and Neck Surgery, Philippine General Hospital. Histopathology reports were reviewed for the presence of nodal metastasis per level, tumor size, tumor location, gross extrathyroidal involvement and subtype. Univariate analysis utilized Pearson Chi-square test or the Fischer exact test. Multivariate analysis utilized logistic regression.
RESULTS: Lymph node involvement in the lateral neck was highest in level III (87.04%), followed by level IV (81.48%), IIa (66.67%), V (60.00%) and IIb (42.59%). No clinicopathologic factor was found to be associated with level V involvement.
CONCLUSION: The pattern of lymph node metastasis among Filipinos is similar but higher than that reported in the literature. Level V involvement is high and thus, this study suggests including level II-V in the neck dissection among Filipinos with cN1b papillary thyroid carcinoma.

Thyroid Cancer, Papillary ; Neck Dissection

OBJECTIVE: This study aims to determine the prevalence and pattern of thyroid gland involvement in advanced laryngeal squamous cell carcinoma and to identify factors associated with its development.
METHOD: Records of 118 patients who underwent laryngectomy with thyroidectomy for advanced laryngeal squamous cell carcinoma in a tertiary government hospital from January 2010 to August 2015 were reviewed. Demographic, clinical and histopathology data were obtained. The relationship of the laterality of primary tumor bulk and lobe involvement was analyzed using Fischer's exact test. The association between thyroid gland invasion and other factors was analyzed using logistic regression.
RESULTS: Thyroid gland involvement was found in 11% of the patients via direct spread in 92.3%. Single lobe involvement accounted for 61.5% of cases. There is a tendency for laryngeal squamous cell carcinoma to invade the thyroid lobe ipsilateral to the primary tumor bulk. Extralaryngeal spread, tracheostomal involvement, and tracheal extension were associated with thyroid gland involvement.
CONCLUSION: Thyroid gland involvement in advanced laryngeal squamous cell carcinoma is rare; hence, indications for performing thyroidectomy in relation to the presence of thyroid gland involvement should be established to avoid unnecessary surgeries.

Laryngeal Neoplasms ; Thyroidectomy

Objective: To determine the accuracy, sensitivity, specificity, positive predictive values, and use of the Reflexive Behavioral “Baah” Test and NHSRC Level 1 and Level 2 Questionnaires in detecting hearing impairment in rural health communities. Methods: This was a prospective cross-sectional study conducted at the rural health unit of five municipalities. Infants less than six months old were screened for hearing impairments using the OAE device (standard), the Reflexive Behavioral “Baah” test, and the NHSRC Level 1 and Level 2 Questionnaires. The “Baah” test and the filling out of the NHSRC Level 1 and 2 Questionnaires were done by trained health workers while OAE was done by an audiologist. Results: A total of 103 babies, with a mean age of 41.9 days at the time of testing and a male to female ratio of 1.02:1 (52 males and 51 females) were tested. A hearing impairment prevalence of 4.9% (5 out of 103) was noted. The “Baah” test showed to have a sensitivity of 60%, specificity of 97.96% and an accuracy rate of 96.12%. The NHSRC Level 1 and Level 2 Questionnaires showed sensitivity, specificity, and accuracy rate of 40%, 67.35% and 66.02%, respectively for the former and 40%, 85.71% and 83.50%, respectively for the latter. Analysis of the complimentary use of the NHSRC Level 1 and Level 2 Questionnaires with the “Baah” test also showed no significant improvement to using the “Baah” test as a stand-alone screening tool with sensitivity, specificity, and accuracy of 60%, 67.35% and 66.99%, respectively for the “Baah” test and Level 1 Questionnaire, and 60%, 83.67% and 82.52%, respectively for the “Baah” test and Level 2 Questionnaire. Conclusion The Reflexive Behavioral “Baah” test is a potentially accurate, sensitive, specific, and acceptable standalone hearing screening test to identify infants with higher risk of hearing impairment in the rural health community setting. On the other hand, the use of the NHSRC Questionnaires as a stand-alone or complementary tool for “Baah” is unnecessary as it results to more false positive and false negative results.
Surveys and Questionnaires ; Infant, Newborn ; Audiometry ; Behavior Rating Scale