OBJECTIVE: Using pre- and post-treatment otoacoustic emission (OAE) tests, this study aimed to assess the ototoxic effect of meropenem, amikacin and meropenem plus amikacin among neonates treated for sepsis neonatorum in a neonatal intensive care unit versus untreated outpatient controls.METHODS: Design: Prospective Quasi-Experimental Controlled Clinical Trial Setting: Tertiary Government Hospital Subjects: Neonates treated for sepsis neonatorum in the Neonatal Intensive Care Unit between August to October 2012 who met inclusion criteria were included in this study. Controls were neonates born in the same institution who were not admitted and did not receive any antibiotic treatment. Excluded were those with APGAR < 5 at first minute, birth weight < 1000 grams, clinically evident congenital anomalies and initial "refer" results on OAE. Neonates were subjected to OAE testing before and after seven days treatment with amikacin, meropenem or a combination of both drugs. Results were analysed using chi-square test. Maternal drug intake, family history of hearing impairment and clinical outcomes (whether expired or discharged improved) were not included in this study. Assessment of ototoxic effects were limited to OAE alone and not confirmed by ABR.RESULTS: OAE "refer" rates were as follows: no amikacin and no meropenem, 0% (0/42); amikacin only, 33.3% (3/9); meropenem only, 25% (2/8) and amikacin and meropenem, 50% (10/20). Statistical analysis showed that hearing loss was dependent on treatment (c2 =23.741, p = < 0.001). Overall, statistical analysis showed that there is an increased risk of hearing loss when treated with amikacin and/or meropenem as compared to no treatment.CONCLUSION: There is an increased risk of ototoxicity when amikacin, meropenem or a combination of both drugs is administered to neonates. While the ototoxic effects of amikacin have been elucidated, further studies involving meropenem and its potential ototoxic effect are recommended.
Human ; Male ; Female ; Infant Newborn ; amikacin ; meropenem ; hearing loss

What makes the majority of noses beautiful? It is the tip.1,2,3South East Asian noses are usually small and short with bulbous tip and thick skin and soft tissue envelope (SSTE).2 The tip is determined by the shape and strength of the lower cartilages.2,3,4The lower cartilages are usually soft and weak so there is a need for a strong support system for the attachment of the lower cartilages. Thus, the surgical term is called “Structural Rhinoplasty.”2,3The concept of the surgery involves re-structuring the tip to a new position for elongation and projection. Since the septum is the most stable structure, a central part of the septum is harvested and is used as extended septal support graft for fixation of the lower cartilage for a whole new tip position.2,3 The open approach is often used. The SSTE dissection is wide up to the pyriform aperture laterally, nasal spine inferiorly and glabella superiorly. Make certain that the dissection plane is below the superficial muscular aponeurotic system (SMAS) in the upper cartilage (UC) and lower cartilage (LC) and below the periosteum in the nasal bone.
Human ; Male ; Female ; Rhinoplasty

OBJECTIVES: To report a case of foreign lodged within the sphenoid sinus and its extraction.METHODS:Design: Case report Setting: Tertiary Government Hospital Patient: OneRESULTS: An 11-year-old girl was hit in the eye by an unknown object from an improvised slingshot. She had loss of vision of the left eye and headache without loss of consciousness. A plain craniofacial Computed Tomography (CT) scan showed a round opaque foreign body abutting the left sphenoid sinus, left posterior ethmoid cells and medial aspect of the left orbital region with adjacent soft tissue densities extending into the apparently ruptured, irregular left globe. The left posterior part of the lamina papyracea was not visualized probably fractured or ruptured. Transorbital enucleation of the left eye and endoscopy-assisted removal of the foreign body (a glass marble) were performed with no intra-operative and post - operative complications.CONCLUSION:Foreign body of the sphenoid sinus is a rare condition. Adequate imaging is important for localization and planning the optimal surgical approach. Endoscopic guidance may aid in extraction.
Human ; Female ; Child ; Sphenoid Sinus ; FOREIGN BODIES ; Tomography Scanners, X-Ray Computed

OBJECTIVES: To present a case of bilateral temporomandibular joint ankylosis that was managed successfully through gap arthroplasty. METHODS: Design: Case Report Setting: Tertiary Government Hospital Patient: One RESULTS:A 25-year-old man presented with inability to open his mouth for 18 years after direct trauma to his chin. CT scan showed bilateral bony fusion of condyles to glenoid fossae, hypertrophic sclerosis and fusion of the condylar heads to the temporal bones. He underwent bilateral gap arthroplasty via preauricular approach with creation of a 15 mm space on the mandibular fossa. As of latest follow up, the patient maintained an inter-alveolar distance of 30 mm for five months postoperatively through continuous aggressive mouth opening exercises. CONCLUSION:Gap arthroplasty may be an efficient procedure for temporomandibular joint ankylosis in achieving satisfactory post-operative inter-alveolar opening and articular function. Early and meticulous rehabilitation is required to prevent relapse. Long-term follow up is recommended to document possible recurrence.
Human ; Male ; Adult ; Temporomandibular ankylosis ; Ankylosis

OBJECTIVE: Determine the frequency-specific thresholds of auditory steady state response (ASSR) of Filipino children with absent auditory brainstem response (click-ABR) results.METHODS: This is a cross-sectional study analyzing the frequency-specific thresholds of auditory steady state response (ASSR) of Filipino children with absent auditory brainstem response (click-ABR) results. The study population comprised of 99 pediatric patients referred for hearing assessment using electrophysiologic techniques at the Ear Unit of the Philippine General Hospital. The subjects underwent hearing threshold evaluation using both evoked-potential techniques (click ABR and ASSR) within a one-month period from January 2009 to March 2014. The ASSR results of patients with absent click-ABR were collected and analyzed.RESULTS: There were 99 patients who underwent both ABR and ASSR. Of the 65 patients with absent ABR thresholds results, 13 patients had unilateral absent ABR while 52 had bilateral absent ABR results. The data of hearing tests from the combined 117 ears with absent ABR hearing tests were collected. The proportion of children with ASSR thresholds with absent ABR per frequency were -500 Hz- 45/117 (38.5%); -1000 Hz- 76/117 (64.0%); -2000 Hz- 63/117 (53.8%); and -4000 Hz- 41/117 (35.0%). The proportion of children with ASSR thresholds with absent ABR per number of frequencies were: -4 frequencies- 19/117 (16.2%); -3 frequencies- 32/117 (27.4%); -2 frequencies- 22/117 (18.8%); and -1 frequency- 44/117 (37.6%)CONCLUSION: In the absence of click- ABR response, ASSR may provide information about the levels of severe to profound hearing loss among children. The criteria of selection of candidates for intervention (hearing aids or cochlear implantation) should include results from hearing evaluation not only from behavioral and ABR thresholds but also from ASSR thresholds. This may ensure that exclusion of some children with severe and profound hearing loss who may benefit from the intervention will be minimized.
Human ; Male ; Female ; deafness ; Audiometry, Evoked Response ; hearing ;

OBJECTIVE: To present a case of vocal cord polyp in a pediatric patient and discuss its differential diagnosis, assessment and management. METHODS: Design: Case report Setting: Tertiary Public Hospital Patient: One RESULTS: A seven-year-old girl presented with hoarseness and a benign, unilateral mass seen at the junction of the anterior and middle third of the vocal cord. The hoarseness resolved after excision and histopathology confirmed an inflammatory vocal cord pseudo polyp. CONCLUSIONS: Vocal cord polyps occur infrequently in children and adolescents. These cases are seldomly seen and reported and may arise from chronic abuse of the larynx, vocal cord trauma or phonotrauma. Hoarseness is the most common presenting symptom. Differential diagnoses include recurrent respiratory papillomatosis, laryngeal cyst and laryngeal nodule. The management of vocal cord polyps involves surgical removal followed by speech therapy.
Human ; Female ; Child ; hoarseness ; Polyps ; Vocal Cords ; Recurrent respiratory papillomatosis ; Speech Therapy ; Laryngoscopy

OBJECTIVES: To present a case of Rosai-Dorfman disease in an individual with a 14-year history of recurrent nasal polyposis and discuss its clinical presentation, physical examination, radiologic findings, histopathologic characteristics and available treatment. METHODS: Design: Case Report Setting: Tertiary Government Hospital Patient: One RESULTS: A 26-year-old Filipino diagnosed and repeatedly treated medically and surgically for recurrent nasal polyposis underwent repeat endoscopic sinus surgery. A histopathologic impression of Rosai-Dorfman disease was confirmed by positive S-100 and CD1a negative immunochemistry in conjunction with the morphologic findings. CONCLUSION: Rosai-Dorfman disease is a rare entity which should be considered when dealing with recurrent nasal polyposis that is intractable to initial medical and surgical therapies. Histopathologic findings of emperipolesis and immunohistochemical S-100 stains play a key role in the diagnosis but there is yet no definite treatment for this disease.
Human ; Adult ; Histiocytosis, Sinus ; Emperipolesis

Objective: To determine whether Psidium guajava leaves mouthwash is effective in the management of patients with aphthous ulcers Methods: Study Design: Randomized prospective open label clinical study Setting: Tertiary Government Training Hospital Subjects: Thirty two patients diagnosed with aphthous ulcers were randomly divided into two groups, a treatment group using prepared guava leaves mouthwash, and a control group using isotonic sodium chloride solution mouthwash, given thrice a day for seven days. Patients were evaluated using a 10 point Visual Analog Scale. The sizes of the aphthous ulcers were measured using a caliper, and compared on day 1 and day 7 for both treatment and control groups. Results were subjected to statistical analysis using T-test, Mann-Whitney U test, and Fisher Exact test. Results: Comparison of VAS scores of guava treatment and NSS control groups showed that there were no differences in pain experienced on days 1 and 2. However, the VAS scores from day 3 to 7 had p values ranging from 0.02 - 0.0001 which showed significant differences in resolution of pain. There was statistically significant marked improvement of pain symptoms as early as three days post-treatment among patients who were administered guava leaves mouthwash. Complete resolution of aphthous ulcers in 75% of the study group was observed on day 7. Mean ulcer size post-treatment with guava gargle was 0.25mm compared to 0.75mm for NSS gargle. The mean size difference at day 7 was 1.44mm for the guava treatment group and 0.88mm for the NSS control group. There was a statistically significant faster resolution of ulcer size on day 7 in 16/16 or 100 % of patients in the treatment group compared with only 10/16 or 62.5% of patients in the control group. Patients who were administered guava leaves mouthwash generally fared better than those administered isotonic sodium chloride solution. Conclusion Guava leaves mouthwash was effective for aphthous ulcers in terms of reduction of symptoms of pain and faster reduction of ulcer size. Further clinical trials comparing this mouthwash against other treatment options are recommended.
Herbal Medicine ; Plants, Medicinal ; Stomatitis, Aphthous

OBJECTIVE: Vocal cord paralysis or immobility is debilitating condition that may result from neural or mechanical fixation of the vocal cord (VC). When permanent, therapy is aimed at improving closure by modifying the position of the vocal cord. Whatever surgical intervention is chosen, pre-and post-operative voice evaluation is important. This study aimed to investigate the usefulness of the Glottal Function Index (GFI) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) Scale in the evaluation of treatment outcomes in patients with unilateral vocal cord paralysis (UVCP) who underwent medialization thyroplasty type 1 with a modified lock-in soft silicone implant.

METHODS:
Design: Descriptive Case Series
Setting: Tertiary Government Hospital
Patient: Five

RESULTS: Five patients (3 females, 2 males) consulted due to hoarness underwent rigid endoscopy. Four (2 right, 2 left) had unilateral paramedian VC paralysis while one had bilateral paresis with bowing of the left vocal cord. One of those with left VC paralysis was diagnosed as idiopathic; the four were iatrogenic (3 form thyroid surgery, 1 from multiple surgical procedures). All patients underwent medialization thyroplasty type 1 using locked-in soft silicone implant. The GFI and GRBAS scale were utilized for pre-operative and post-operative perceptual evaluation of voice. The GFI showed severe glottic insufficiency among all five patients prior to surgery with improvement of the subjective symptoms one day and one week post-surgery in four patients. Likewise, the Hirano GRBAS scale showed improvement of voice quality and correlated the improvement of the patient's subjective symptoms from the from GFI scores. However, 5 cases with bilateral vocal cord paresis, showed no improvement of voice quality despite recovery from subjective symptoms.

CONCLUSIONS: For glottal insufficiency, perceptual voice evaluation using self-administered GFI and GRBAS scale assessment are important parameters in determining the quality of life among patients with glottal insufficiency undergoing medialization laryngoplasty.

OBJECTIVE: To report a case of ectopic brain tissue in the nasopharynx; discuss the differential diagnoses for and management of, this unilateral nasal mass in a pediatric patient, and describe the diagnosis difficulties and eventual treatment.

METHODS:
Study Design: Case Report
Setting: Tertiary Government Hospital
Participant: One

RESULTS: A 13-year-old boy consulted with an obstructing mass in the nasopharynx and severe muscle wasting, weight below his age and concurrent anemia. CT-scan revealed a soft-tissue mass occupying a maxillary sinus and nasopharynx consistent with an antrochoanal polyp. Initial biopsy revealed a papilloma, but the clinical picture warranted preoperative preparations for a possible vascular tumor such as juvenile angiofibroma. Transpalatal excision and final histopathology yielded nasal glial heterotopia.

CONCLUSION: When confronted with unilateral nasal mass in a pediatric patient, aside from the usual considerations, embryologic anomalies particularly those of the intracranial protrusion variety should be strongly considered. Scrupulous preoperative evaluation and sufficient diagnostic modalities must be pursued in order to arrive at a correct diagnosis, treatment plan and prevent possible complications especially those related to intracranial communication.