Background: Pure tone audiometry is routinely used to determine conductive and sensorineural hearing status. Ossicular discontinuity is usually assessed intra-operatively. If ossicular discontinuity can be predicted by pure tone audiometry, perhaps the operative procedure of choice and prognosis for hearing can also be anticipated. Objective: To determine the predictive value of preoperative pure tone audiometry on the presence of gross ossicular discontinuity in chronic otitis media. Methods: Records of 205 patients, 7 to 75 years of age undergoing their first operation for chronic otitis media were reviewed. Preoperative audiograms and operative records for tympanomastoidectomy were evaluated. A total of 162 patients meeting inclusion criteria were included in the study. Likelihood ratios for positive and negative ossicular discontinuity for frequency-specific air-bone gap cut-offs were determined. Multiple logistic regression analysis for pure tone audiometry and operative findings to predict ossicular discontinuity was performed and a model for predicting ossicular discontinuity using logistic regression obtained. Results and Conclusion: Frequency-specific air bone gap (ABG) cut-off values can predict ossicular discontinuity in chronic suppurative otitis media namely: < 20 dB ABG at 500 Hz predicts absence of ossicular discontinuity while > 50 dB ABG at 500 Hz, >30 dB ABG at 2 KHz, and > 50 dB ABG at 4 KHz best predict the presence of ossicular discontinuity in general. In the absence of cholesteatoma, the air bone gaps of <30 dB at 500 Hz and <20 dB at 1 KHz decrease probability of ossicular discontinuity from 32.97 percent to 2.54 percent. Combination of air bone gaps of >50 dB at 500 Hz, >20 dB at 2 KHz and >40 dB at 4 KHz increase the probability of ossicular discontinuity from 32.97 percent to 85.9 percent. These findings suggest that ossicular exploration may not be necessary for the former while an evaluation of the ossicular chain may be mandatory for the latter in the setting where cholesteatoma is not present or suspected. Presence of cholesteatoma, granulation tissue and size of tympanic membrane perforation are important factors to consider in predicting ossicular discontinuity. (Author)
AUDIOMETRY AUDIOMETRY ; PURE-TONE OTITIS MEDIA OTITIS MEDIA ; SUPPURATIVE LOGISTIC MODELS HEARING TESTS SUPPURATION

Objective: The goal of this work is the creation of word lists, in Ilocano, suitable for use in speech audiometry. Methods: First, estimates of the distribution of speech sounds and of the most common syllable structures in Ilocano were found from a phonetic transcription analysis of nearly 3000 words obtained from three magazine articles. Second, 372 two-syllable words were rated, for commonness, by fifteen native speakers of Ilocano who currently reside in Hawaii. Finally, various combinations of two-syllable words were made to produce 50-item lists. Results: First, an estimate of the distribution of speech sounds in Ilocano was found, with frequencies of occurrence ranging from 22.4 percent, for the speech sound /a/, to 0.007 percent, for the speech sound M. The syllable-structure analyses revealed that a very small number of distinct monosyllabic words were used very frequently. Two-syllable words were also used frequently, but were attributed to many distinct words. Second, from the rating results, approximately 70 percent of the two-syllable words in the rating survey were judged as common by 12 or more of the raters. Finally, four lists of 50 words each were constructed using only common two-syllable words with the most frequent two-syllable structures found in Ilocano. Each word list has a distribution of speech sounds that approximates that found from the phonetic analysis, and hence each list is roughly phonetically-balanced. Conclusions: These word lists may be of value to otolaryngologists and audiologists who work with native speakers of Ilocano. (Author)
AUDIOMETRY AUDIOMETRY ; SPEECH HEARING TESTS

Objectives: To identify the bacterial pathogens associated with chronic suppurative otitis media and their antimicrobial sensitivity and resistance. Study Design: Cross-sectional survey. Setting: The study was carried out from July 2004-July 2005 at the outpatient clinic of a government tertiary hospital. Number of subjects: A total of 32 patients (54 ears) with unilateral or bilateral active chronic suppurative otitis media. Results: Bacterial pathogens of 54 ear discharge samples from CSOM were studied. Among them, 42 (78 percent) were pure cultures and 9 (16.7 percent) were mixed, only 3 (5.6 percent) of the submitted samples had no growth. There were 42 pure isolates, the most common of which was Staphylococcus aureus 21 (50 percent), followed by Pseudomonas aeruginosa 14 (33.3 percent). Drug sensitivity pattern of Staphylococcus aureus showed that 61.9 percent were resistant to Penicillin while more than 90 percent were sensitive to Aminoglycosides and Clindamycin. Pseudomonas aeruginosa was resistant to penicillin in 64.3 percent of cases and Ciprofloxacin was active against pseudomonas in 85.7 percent. Conclusion: The most common bacterial pathogens from CSOM include Staphylococcus aureu and Pseudomonas aeruginosa. Majority of the isolates of Staphylococcus aureus were resistant to penicillin. Aminoglycosides, macrolides and quinolones were effective against most of the isolates of Staphylococcus aureus. (Author)
OTITIS MEDIA OTITIS MEDIA ; SUPPURATIVE TYMPANIC-MEMBRANE MASTOIDITIS CROSS-SECTIONAL STUDIES

Objectives: To determine the efficacy of a 7-day treatment of methylprednisolone 16mg in reducing the size of nasal polyps and on improvement of nasal symptoms. Methods: Design: Randomized double-blind placebo-controlled trial Setting: Out-patient department of the East Avenue Medical Center Patients: Patients 18 years old and above with nasal polyposis determined by history and endoscopic examination Results: There was a significant decrease in polyp size by an average of 16 percent (P < .05) among 12 out of the 23 patients (52.17 percent) in the steroid group versus placebo. The treatment group also exhibited an improvement in nasal symptoms of rhinorrhea, congestion and anosmia compared to the placebo. Conclusion: Medical treatment with oral methylprednisolone given at a low dose of 16 mg for one week resulted in reduction of the size of nasal polyps and improved the symptoms of rhinorrhea, nasal congestion and anosmia. Other associated symptoms like headache, epistaxis, sneezing, itchiness, epiphora, cough, postnasal drip, throat discomfort, facial pain, eyecomplaints and fever did not differ between the steroid and placebo groups. Recommendation: One week of oral steroids can be used to treat nasal polyps initially. If there is response, this mode of management can be combined with a long-term course of intranasal steroid sprays. Patients who do not respond may be referred for surgery. (Author)
NOSE DISEASES METHYLPREDNISOLONE OLFACTION DISORDERS POLYPS NASAL POLYPS

Objective: To determine the olfactory function and/or dysfunction of young adults who are cigarette smokers using a locally validated smell identification test. Design: Cross-sectional study Setting:Tertiary hospital in Metro Manila Patients: The volunteer study group was composed of 60 male and 21 female students and] employees of a tertiary hospital and its affiliated medical school (both in Quezon City). All subjects were young adults within the age range of 20-35 years with a mean age of 27.58 years (+/- 4.33). All the subjects were currently smoking cigarettes with no medical history of recent viral infection, nasal/sinus surgery, nasal/brain tumors, head trauma, radiotherapy, chronic rhinitides in exacerbation ortracheostomy. Olfactory function of each subject was evaluated using the Sto. Tomas Smell Identification Test (ST-SIT) which is a locally-validated test. Results: Majority of the subjects fell within the 24-27 age group with a mean age of 27.58 years (+/- 4.33). Males outnumbered females 74.1 percent as against 25.9 percent. An inverse relation between pack years and ST-SIT score was present indicating that there could be a dose-related effect off cigarette smoking on olfactory function. Among the 81 subjects, 15 (18.5 percent) turned out to be anosmic, 46 (56.7 percent) were hyposmic I and 20 (24.6 percent) had normal olfactory function. A mean ST-SIT score was computed at 81.183 (+/- 12.58), indicating that majority of the subjects had olfactory dysfunction, meaning they were hyposmic. Conclusion: Smoking cigarettes has become part of the lifestyle of a lot of people in spite of its hazards to health. In the present study, a majority of supposedly healthy young adults who currently smoked cigarettes were proven to suffer from olfactory impairment based on the scores of a locally-validated smell identification test. An inverse relation between ST-SIT scores and pack years was also noted which may indicate a dose-related effect of smoking on olfactory function. (Author)
CROSS-SECTIONAL STUDIES SMELL SMOKING OLFACTION DISORDERS ADULT

Objective: To present a case of a benign orbito-maxillary tumor behaving as an invasive, expansive malignancy. Design: Case report Setting: A tertiary care hospital in Metro Manila Patient: A 4 1/2-year-old boy with a seven month history of right orbito-maxillary mass, proptosis and epiphora. Result: A series of biopsies were done before a definite diagnosis was made due to inconsistencies in the histopathologic findings, clinical picture, and the radiologic presentation of the case. After diagnosis, appropriate intervention resulted in a dramatic decrease in the size of the mass. At present, the patient is disease-free and asymptomatic. Conclusion: Histopathologic diagnosis of Inflammatory Pseudotumor is difficult and differentiating it from malignant tumors is often a concern for otolaryngologists and pathologists. In spite of an initial malignant biopsy result, the combination of clinical signs and symptoms and radiologic findings of an infiltrative mass lesion, should not discount the possibility of a benign entity such as Inflammatory Pseudotumor for which treatment is conservative. (Author)
GRANULOMA ; PLASMA CELL GRANULOMA ; PLASMA CELL ; ORBITAL ORBITAL DISEASES

Objectives: 1] To describe a case of an embryonal rhabdomyosarcoma presenting as al radiolucent mandibular mass in a 3-year-old child. 2] To review existing literature on the clinical picture and pathophysiology of intraosseous rhabdomyosarcoma. 3] To identify learning points in the diagnosis of intraosseous rhabdomyosarcoma. Design: Case report. Setting: A tertiary referral hospital. Patients: One (1) Results: A case of a 3-year-old child with a radiolucent mandibular mass is described. Thel final histopathologic report turned out to be embryonal rhabdomyosarcoma. Intraosseous rhabdomyosarcomas are rare occurrences (3.5 percent in one review), and clinically present in younger age groups, with a non-tender, enlarging, firm-hard mass over a specific area. A review of the available literature on intraosseous rhabdomyosarcomas, and its proposed pathogenesis, is presented. Conclusion: A case of a radiolucent mandibular mass in a 3-year-old child is presented. Intraosseous rhabdomyosarcomas of the mandible are rare occurrences that pose challenges to the otorhinolaryngologist. Taken separately, the presentation, patient characteristics, clinical course, ancillary laboratories and imaging modalities may lead even the most astute otorhinolaryngologist astray. The whole clinical picture should be taken together so that the correct diagnosis will not be missed despite the rare presentation. (Author)
RHABDOMYOSARCOMA RHABDOMYOSARCOMA ; EMBRYONAL

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

OBJECTIVES: 1. To present a rare case of a true teratoma of the nasopharynx in a Filipino newborn. 2. To present a rational diagnostic and management approach to the case. DESIGN: Case report SETTING: Tertiary Government Hospital PATIENT: One female newborn RESULTS: A newborn presented with a congenital large naso-oropharyngeal mass. She did not present with signs of airway obstruction. The oral mass was found to be attached to the nasopharynx. The initial consideration was a teratoma. The patient also manifested with an incomplete cleft palate and dermoid cyst on the left eye. Contrast CT scan confirmed the attachment of the mass to the left nasopharyngeal wall. The mass was subsequently resected and delivered transorally. The final histopathology showed teratoma. Otorhinolaryngologic management of this case encompassed the following priorities: (1) ensuring vital & vegetative function (airway & feeding), (2) examination of the newborn for concomitant congenital anomalies, (3) resection of the mass after accurate delineation of its extent and dimensions and (4) planning for future repair of the palatal defect. CONCLUSION: True teratomas of the nasopharynx are rare lesions (originating from the 3 embryonic germ cell layers). Airway management is the first priority of the otorhinolaryngologist in these cases because of potential to cause upper airway obstruction. (Author)
CASE REPORTS [PUBLICATION TYPE] TERATOMA NASOPHARYNX NASOPHARYNGEAL NEOPLASMS

OBJECTIVES: 1. To present an unusual case of neurofibroma of the neck that does not meet the criteria for neurofibromatosis. 2. To describe the role of surgery in the treatment and reconstruction of a cosmetically unacceptable, disfiguring lesion. 3. To emphasize the importance of early detection and possibility of malignant transformation in neurofibroma. 4. To present the criteria in the diagnosis of neurofibromatosis. DESIGN: Case Report SETTING: Tertiary Hospital PATIENT: A 36 years old male with a huge bleeding neck mass. RESULT: Repeated incision biopsy of the lateral neck mass revealed neurofibroma. CT scan of the mass showed that it was superficial to the sternocleidomastoid muscle and was not adherent to the major vessels of the neck. A wide excision of the mass was done and the defect was reconstructed with a pectoralis major flap. CONCLUSION: Acase of neurofibroma that does not meet the criteria for von Recklinghausen's disease is presented. This may represent a distinct form of neurofibromatosis. In this kind of tumor, surgery remains the treatment of choice for resectable lesions. Early detection of the tumor is imperative for its successful treatment. (Author)
NEUROFIBROMA NECK NEUROFIBROMATOSES CASE REPORTS [PUBLICATION TYPE]