OBJECTIVE: To present a case of relapsing polychondritis initially presenting with hoarseness and difficulty breathing and to discuss the diagnostic criteria and typical CT scan findings of relapsing polychondritis.
METHODS:
Design: Case Report
Setting: Tertiary Private Hospital in Metro Manila
Patient: One
RESULT: A 21-year-old man who was initially managed as a case of bronchial asthma for persistent hoarseness and recurrent difficulty breathing was found to have severe laryngeal edema on endoscopy, and soft tissue expansion of the cricoid cartilage with calcifications and irregular first tracheal ring on CT scan. He also had recurrent eye redness and developed bilateral aural inflammation, and was subsequently diagnosed to have relapsing polychondritis.
CONCLUSION: Relapsing polychondritis is a rare autoimmune disease characterized by recurrent inflammation and eventual destruction of cartilage throughout the body. Typical manifestations may not always be present, causing a delay in diagnosis. It should be considered in patients with intractable respiratory symptoms not responsive to treatment for upper respiratory tract infections or asthma. A CT scan may reveal signs of cartilage destruction and help in diagnosis.                 

Human ; Male ; Young Adult ; Hoarseness ; Edema ; Asthma ; Laryngeal Edema

Vocal fold paralysis is an otolaryngologic disorder that is more prevalent in the adult population. Its occurrence in children has been documented in the literature. We report a case of congenital bilateral vocal fold paralysis and discuss the issues surrounding its ultimate diagnosis and management.
Human ; Female ; Child Preschool ; Vocal Cord Dysfunction ; Paralysis ; Tomography Scanners, X-Ray Computed ; Magnetic Resonance Imaging ; Electromyography ;

Objective: To compare surgical outcomes (operative time and tympanic membrane integrity) obtained by endoscopic transcanal tympanoplasty (ET) and microscopic post-auricular tympanoplasty (MT) in patient with inactive chronic otitis media. Methods: Design: Retrospective Cohort Setting: Multicenter study in 3 Private Tertiary Hospitals Participants: 18 patients who underwent microscopic or endoscopic tympanoplasty for chronic otitis media. Results: Each group had 9 patients, with median age of 43 (31-65 years) for the MT and 47 (29-59 years) for the ET group. There was no significant difference in median age of the two groups (Mann-Whitney U=17, P=.22). Male: female ratio was (5:4) and (6:3) for the ET and MT group respectively, with no significant difference in gender distribution (c2= 0.90, P=.34). Mean operative time for the ET and MT group was 86.7 minutes and 140.6 minutes, respectively, with significantly lower mean operative time for the ET group (t= 3.57, P=.0025). There was complete tympanic membrane graft uptake in both groups. Conclusion Regardless of technique, tympanoplasty is an effective surgical treatment among patients with inactive chronic otitis media. Endoscopic tympanoplasty is an alternative to conventional microscopic tympanoplasty that may use less operative time, producing similarly complete graft uptake.
Tympanoplasty ; Tympanic Membrane

Objective: To determine the prevalence and describe the clinical characteristics of high risk HPV mong patients with oropharyngeal squamous cell carcinomas in our institution utilizing p16 and HPV DNA in-situ hybridization testing and to determine the factors associated with high risk HPV positivity. Methods: Design: Retrospective Cohort Review Setting: Tertiary Private Training Hospital Participants: 29 Results: A total of 29 primary oropharyngeal squamous cell carcinomas were diagnosed during the 11-year study period (January 2010 to December 2021). Based on the HPV in-situ hybridization status, the prevalence of high risk HPV oropharyngeal squamous cell carcinoma in our institution was 52%. Majority of these cases were males (87.5%) with a median age of ≤55 years old (60%) who are non-smokers (88.2%) and non-drinkers of alcoholic beverages (80%). There was no statistically significant association between age group, sex, smoking status, alcohol intake, lymph node status and high risk HPV infection. The most common tumor site involved in HPV-positive oropharyngeal squamous cell carcinoma was the tonsil (87%). Majority demonstrated a nonkeratinizing histology (73%) with positive lymph node status (67%) upon clinical presentation. Fifteen (83%) of the 18 p16 positive squamous cell carcinomas were positive for high risk HPVDNA. Of note, 3 (17%) out of the 18 p16 positive squamous cell carcinomas turned out to have negative HPV DNA-ISH status. Conclusion Although no statistically significant correlation between any clinical characteristic with viral status was established, HPV-mediated oropharyngeal squamous cell carcinoma in this institution was commonly seen among males aged 54 years old and below who are nonsmokers and non-drinkers of alcoholic beverages with the palatine tonsil as the most common site presenting with a non-keratinizing histology. In terms of testing, p16 staining correlates well with high risk HPV status. Future studies utilizing a larger patient population may aid in elucidating statistically significant clinical associations in our local population
human papillomavirus ; oropharyngeal cancer ; p16

Neurology

PURPOSE: Obtaining brain tissue is critical to definite diagnosis and to furthering understanding of neurodegenerative diseases. The present authors have maintained the National Neuropathology Reference and Diagnostic Laboratories for Dementia in South Korea since 2016. We have built a nationwide brain bank network and are collecting brain tissues from patients with neurodegenerative diseases. We are aiming to facilitate analyses of clinic-pathological and image-pathological correlations of neurodegenerative disease and to broaden understanding thereof. MATERIALS AND METHODS: We recruited participants through two routes: from memory clinics and the community. As a baseline evaluation, clinical interviews, a neurological examination, laboratory tests, neuropsychological tests, and MRI were undertaken. Some patients also underwent amyloid PET. RESULTS: We recruited 105 participants, 70 from clinics and 35 from the community. Among them, 11 died and were autopsied. The clinical diagnoses of the autopsied patients included four with Alzheimer's disease (AD), two with subcortical vascular dementia, two with non-fluent variant primary progressive aphasia, one with leukoencephalopathy, one with frontotemporal dementia (FTD), and one with Creutzfeldt-Jakob disease (CJD). Five patients underwent amyloid PET: two with AD, one with mixed dementia, one with FTD, and one with CJD. CONCLUSION: The clinical and neuropathological information to be obtained from this cohort in the future will provide a deeper understanding of the neuropathological mechanisms of cognitive impairment in Asia, especially Korea.
Alzheimer Disease ; Amyloid ; Aphasia, Primary Progressive ; Asia ; Brain* ; Cognition Disorders ; Cohort Studies ; Creutzfeldt-Jakob Syndrome ; Dementia ; Dementia, Vascular ; Diagnosis ; Frontotemporal Dementia ; Humans ; Korea* ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Memory ; Neurodegenerative Diseases ; Neurologic Examination ; Neuropathology ; Neuropsychological Tests

OBJECTIVES: To present a rare case of primary laryngeal aspergillosis manifesting with hoarseness in a seemingly healthy, immunocompetent, postpartum patient and discuss the probable contributing factors leading to this unusual disease process.

METHODS
Design: Case Report

Setting: Tertiary Private University Hospital

Subjects:  One

RESULTS: A 28-year-old previously healthy postpartum woman presented with hoarseness of a few weeks duration and recent intake of antibiotics and steroids. Videolaryngoscopy revealed a creamy, exophytic mass overlying both vocal folds. Microscopic examination revealed septated, dichotomously branching hyphae with acute angles characteristic of Aspergillus sp. The patient recovered with anti fungal medications.

CONCLUSION: The clinical presentation of laryngeal aspergillosis can be very non-specific and should not be disregarded merely on the basis of immune competence. It should be considered, together with other host and environmental factors when a patient responds poorly to conventional treatment. There is a need for quick and accurate diagnosis as the disease responds quite rapidly with appropriate anti fungal medications.

Female ; Adult ; Aspergillosis ; Hoarseness ; Larynx ; Postpartum