The World Health Organization Constitution "enshrines the highest attainable standard of health as a fundamental right of every human being. The right to health includes access to timely, acceptable, and affordable health care of appropriate quality ... as well as the underlying determinants of health, such as ... access to health-related education and information."1 On the other hand, "social determinants of health can themselves pose barriers to education ... and 'damaged brains and bodies' cannot learn optimally."2 While there are no clear-cut solutions to such multifactorial issues involving complex-systems, the sustainable developmental goals of the United Nations development agenda beyond 2015 address both health and education.3

Health research fundamentally underpins the key aspiration of the sustainable development goals to realize universal health coverage.3 It is the responsibility of researchers and publishers to make this research available and accessible to all those who need it, in order to assist policymakers and practitioners to progressively realize the right to health of every global citizen. It would seem that the speed and reach of present-day information and communication technology would have facilitated the dissemination of health information. "However, despite the promises of the information revolution, and some successful initiatives, there is little if any evidence that the majority of health professionals in the developing world are any better informed than they were 10 years ago."4 This observation made over a decade ago still holds true today.

How can we advance access to health information and publication in our current "glocal" situation? How can the health information produced by research conducted by our students, residents and fellows, be shared with all those who may need and use the information? The Philipp J Otolaryngol Head Neck Surg has been actively pursuing multiple means of ensuring the availability of our research and innovation through traditional means, including indexing on various Index Medici and databases. While our visibility has increased dramatically in the 10 years of my editorship, we need to explore new paradigms, trends and innovations, especially with regard the social media. This includes using Facebook, Twitter, LinkedIn and RSS feeds, to name a few. It also calls us to consider the transition to a full open access model and adopting Creative Commons licenses.

It is timely that the Asia Pacific Association of Medical Journal Editors (APAME) will explore this very theme of shifting paradigms, trends and innovations in advancing access to health information and publication in the forthcoming APAME2015 Annual Convention and Joint Meeting with the Western Pacific Region Index Medicus at the Sofitel Philippine Plaza and WHO Western Pacific Region Office from August 24-26 (http://apame2015.healthresearch.ph) in conjunction with the Global Health Forum 2015 at the Philippine International Convention Center (http://www.forum2015.org).

Close to a thousand editors, reviewers, authors, researchers, librarians, and publishers of medical journals from Asia Pacific states, local delegates representing various institutions and organizations, including the Department of Science and Technology - Philippine Council for Health Research and Development (PCHRD), Department of Health, University of the Philippines Manila, Medical and Health Librarians Association of the Philippines (MAHLAP), the Philippine Medical Association, the Philippine Nursing Association, the Philippine Dental Association and others will exchange ideas in three days of meetings, scientific sessions and workshops. At the same time, the over 70 conjoint Forum 2015 sessions across 2 tracks covering 6 themes will provide "a platform where several other thousand key global actors in health gather to learn, debate and shape the global agenda on research and innovation for health, to arrive at new solutions that are driving health equity and socio-economic development."

Whether you are a beginning researcher or a seasoned scientist, a novice trainee or senior subspecialist, a community-based health worker or health policy-maker, there will be something for you to learn and share at these meetings that recognize "people (are) at the center of health research and innovation." Medical and health professions students, ORL-HNS residents and consultants of all training and academic institutions are particularly enjoined to participate in this rare opportunity that will benefit us as well as the people we serve.

Meet me at the Forum!

Health Information

OBJECTIVE: To report a case series of Tessier 3, 4, 7 and combined 4,7 craniofacial clefts, their clinical presentations, surgical approaches and outcomes in light of the current literature.
METHODS:
Design: Case series
Setting: Tertiary Government Hospital
Subjects: Five patients
RESULTS: Five  patients aged 3 to 14-years-old with Tessier 3, 4 (2  cases), 7  and combined 4,7 were included in this study: Tessier 3 - medial orbitomaxillary cleft extending through the bony skeleton traversing obliquely across the lacrimal groove, Tessier 4 - median orbitomaxillary cleft traversing  vertically  through  the  inferior  eyelid,  infraorbital rim and  orbital  floor extending  to the lip between the philtral crest and the oral commissure  (2 cases), Tessier 7 - macrostomia and cleft oral commissure and combined Tessier 4 and 7, combining features described above. Four underwent 2- or 3-stage surgeries while one declined.
CONCLUSION: Five  craniofacial  clefts  were  presented.  Because  of  the  varying  patterns of craniofacial  deformities,  a  series of surgical  procedures,  tailor-made  for  each  individual  were performed  on  four. Otolaryngologists who perform maxillofacial and cosmetic surgery  should have good background knowledge about craniofacial defects and be familiar with the  surgical approaches at their disposal to yield favorable results that are appropriate to their local contexts.

Human ; Male ; Adolescent ; Child ; Child Preschool ; General Surgery ; Macrostomia ; Surgery, Plastic ; Lip ; Otolaryngologists ; Craniofacial Abnormalities ; Eyelids ; Orbit

OBJECTIVE: To investigate the outcome and complications of augmentation rhinoplasty with rib cartilage grafts.
METHODS:
Design: Retrospective study
Setting: Tertiary Government Hospital
Subjects: Patients who underwent dorsal nasal augmentation with autologous rib cartilage grafts between June 2008 and October 2012.
RESULTS: A total of 12 patients (3 male, 9 female) were included in the study. Mean age was 29 years. Seven were cases of primary simple rhinoplasty with four cases of revision (previously using alloplastic materials) and one case of trauma. Indications for the procedure were all cosmetic. There was no incidence of infection, both in the donor and recipient sites, warping of the graft, graft extrusion, resorption, pneumothorax, chest wall deformity or prolonged edema. Post-operative pain in the donor site was relieved by oral pain medications. No revision surgery was required.
CONCLUSION: Costal cartilage is a good option for structural support of the nose. In our experience patients have become wary of the complication of allografts and have opted to use autografts. The surgeon's knowledge of the nasal anatomy as well as his or her experience with autologous grafts plays a major role in avoiding post-operative morbidity.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Rhinoplasty ; Costal Cartilage ; Nose ; Autografts ; Thoracic Wall ; Pneumothorax ; Allografts ; Transplantation, Autologous ; Ribs ; Hyaline Cartilage ; Pain, Postoperative ; Edema

OBJECTIVE: As   a   guide   to   the   clinical   practice   of   infiltration   of   local   anesthesia   into   the pterygopalatine fossa via the greater palatine canal, this study sought to determine and record the  mean  CT  scan  measurements  of  the  following:  1)  palatal  mucosal  thickness,  2)  length  and width  of  greater  palatine  canal,  and  3)  length  and  width  of  pterygopalatine  fossa  among  adult patients in a private tertiary hospital in Quezon City.
METHODS:
Design: Retrospective, Descriptive Study
Setting: Tertiary Private Hospital
Subjects: Paranasal Sinus (PNS) CT Scans of 113 adult patients from January 2014 to May 2014 were reviewed and evaluated. Excluded were images with pathology that distorted the anatomy of the sinuses and surrounding structures.
RESULTS: Our study showed average CT scan measurements of 5.98 mm palatal mucosal thickness, 16.99  mm  greater  palatine  canal  length,  18.75  mm  pterygopalatine  fossa  length,  2.37  mm greater palatine canal width and 2.58 mm pterygopalatine fossa width. Comparison of average measurements  by  sex  was  not  statistically  significant.  There  was  statistical  significance  when comparing the right palatal mucosal thickness of 5.86 mm with the left which was 6.11 mm with p-value of 0.001. Comparison between the length of the right pterygopalatine fossa of 18.48 mm with the  left side at 19.01 mm showed statistical significance with p-value of 0.01.
CONCLUSION: As the average measurement of the mucosal palatal thickness combined with the length of the greater palatine canal was 22.97 mm, we recommend bending the needle 23 mm from  the  tip  in  a  45  degree  angle  for  adult  patients  who  will  undergo  sinus surgery,  control  of posterior epistaxis, trigeminal nerve block and minor oral cavity surgeries.

Human ; Male ; Female ; Adult ; Pterygopalatine Fossa ; Anesthesia, Local ; Needles ; Epistaxis ; Palate ; Paranasal Sinuses ; Mouth ; Trigeminal Nerve ; Palate ; Nose

OBJECTIVE: The  study  aims  to  compare  the  maximum  sound  output  capabilities  of  different earphone types/music style combinations. The study also intends to assess the preferred listening levels (PLL) of test subjects using different earphone types with background noise accession. The study also seeks to determine the presence or absence of a threshold shift on headphone/music style combination PLLs that exceed the recommended noise limit.
METHODS:
Design: Experimental Study
Setting: Tertiary Government Hospital
Subjects: Thirty (30) hearing healthy volunteers were sampled from hospital staff aged 18-40 years with no known history of ear pathology and/or use of any known ototoxic drugs, with normal otoscopy, audiograms of less than 20dB from 125Hz to 8000Hz and no exposure to loud noise from any source within the previous three days.The sound pressure levels (SPL) delivered by three (3) types of earphones (earbud type, in-ear  type,  supra-aural  type)  were  measured  at  maximum  volume  setting  of  a  personal  media player  (iPod,  Apple  Inc.),  while  playing  different  music  genres. The  test subjects  were  asked  to listen at their preferred listening levels (PLL) using the different types of earphones at increasing background noise accession.
RESULTS: The  earbud  type  averaged  the  greatest  SPL  among  the  earphone  types  and  pop music averaged the greatest SPL among the music styles. Comparison of the maximum output capabilities revealed that there was a significant difference among different brands of earphones of the same type. However, no significant difference were found among songs of similar music style and across different music styles in all earphones except the in-ear type. PLL average was at  90.4dB  in  a  silent  environment  with  increasing  intensity  as  background  noise accentuated. Supra-aural earphones registered the least increase in PLL in a loud environment due to its higher background noise-attenuating capabilities.
CONCLUSION: Having a significant difference among earphone types with regard their maximum output  capabilities,  it  is  recommended  to  check  the  specifications  of  the  earphone  type  one intends  to  use.  In  using  personal  media  players  (PMP),  the  volume  should  be  set  at  the  lowest comfortable  level. While  choice  of  music  style  remains  the  discretion  of  the  listener,  the  choice of  music  style  should  be considered  for  long  periods  of  listening.  Because  the  PLL  of  test subjects  were  alarmingly  high,  the  authors  recommend  intervention in  their  listening  habits.  Background  noise  attenuating  capabilities of earphones  play  a  factor  in  reducing  excessive  sound  energy  from reaching  the  ear  reducing  the  PLL  and  decreasing  the  risk  for  noise-induced hearing loss.

Human ; Male ; Female ; Adult ; Adolescent ; Mp3-player ; Hearing Loss, Noise-induced ; Noise ; Music ; Malus ; Otoscopy ; Healthy Volunteers ; Hearing Tests ; Hearing ; Auditory Perception ; Sound

OBJECTIVES: This study aims to determine the sensitivity, specificity, positive predictive value and negative  predictive  value  of  Computerized  Dynamic  Posturography  (CDP)  in  properly  labeling patients with peripheral vestibular disorders by Videonystagmography (VNG) as having vestibular dysfunction.
METHODS:
Design: Case - Control Study
Setting: Tertiary Private Hospital
Subjects: Twenty-three (23) patients aged 18 and above with no history of hypertension or cardiovascular disease and no intake of anti-vertigo medications for at least 48 hours prior to testing and with complete VNG and CDP results obtained on the same day or at least  two  days  apart  were  included  in  the  study. Cases were defined as those  diagnosed with a peripheral  vestibular  disorder  by VNG  while  controls  were  defined as those with  normal VNG results.  Sensitivity, specificity, positive predictive value and negative  predictive value of CDP in labeling those with peripheral vestibular disorders as vestibular were determined using VNG as gold standard.
RESULTS: There were 11 cases  (4  males, 7 females) and 12 controls (8  males,  4  females).  Using VNG  as  the  gold  standard  for  diagnosing  peripheral  vestibular  disorders,  CDP  had  a  sensitivity of 45.45% and specificity of 66.67% with Positive Predictive Value(PPV) of 55.56% and Negative Predictive Value(NPV) of 57.14%  in  assessing  peripheral vestibular disorders among the adults tested.  Interestingly, 33.33% of patients with normal VNG may actually have had a vestibular dysfunction that could be detected by CDP.
CONCLUSION: Prospective studies with larger sample sizes utilizing VNG and CDP are recommended in order to verify our findings.

Human ; Male ; Female ; Middle Aged ; Adult ; Adolescent ; Vertigo ; Vestibular Diseases ; Vestibule, Labyrinth ; Sensitivity And Specificity ; Cardiovascular Diseases ; Hypertension ; Hospitals, Private ; Cytidine Diphosphate

OBJECTIVE: To determine whether excessive daytime sleepiness (EDS) as assessed by the Epworth Sleepiness Scale (ESS) is significantly correlated with body mass index (BMI) and Apnea-Hypopnea Index (AHI) in patients suspected of OSAS and whether obesity as assessed by BMI is associated with AHI.
METHODS:
Design: Non-concurrent cohort study
Setting: Tertiary Private Hospital
Population: The charts of 389 patients suspected to have sleep disorders and referred for polysomnography (PSG) at the Center for Snoring and Sleep Disorders in year 2009 were reviewed. Inclusion criteria were patients aged 19 and above with complete data. A total of 238 patient charts were included in the study.
RESULTS: The study included a total of 238 patient charts. Results showed no significant association between ESS and AHI (p-value >0.05) even when correlated with the different severities of OSAS (p-value>0.05). Sensitivity and specificity of ESS was found to be 54% and 57%, respectively, indicating that ESS is not a sensitive and specific tool to predict the presence of OSAS. These findings suggest that ESS may not be able to significantly identify patients with OSAS. However, BMI showed a significant association with ESS (p-value<0.05) representing more patients with EDS belonging to the obese category. Conversely, obese patients were twice more likely to have EDS, represented by ESS scores of >=10. BMI was also significantly associated with AHI using one-way Anova test.
CONCLUSION: This report concludes that the ESS alone is insufficient to identify patients with OSAS. Nevertheless, questionnaires like the ESS supplement relevant history to help diagnose patients with sleep disorders particularly OSAS. On the other hand, the ESS showed a significant association with BMI representing more obese patients had excessive daytime sleepiness. The likelihood ratio of having excessive daytime sleepiness is two times more for obese patients. BMI was also significantly associated with AHI which confirms the well established relationship of obesity with OSAS, and shows that obese patients are at higher risk for severe OSAS.

Human ; Male ; Female ; Adult ; Adolescent ; Child ; Child Preschool ; Sleep ; Apnea ; Body Mass Index ; Sleep Apnea, Obstructive ; Syndrome ; Snoring ; Polysomnography ; Sleep Wake Disorders ; Obesity

OBJECTIVES: To present a case of type 1 glomus tympanicum, its clinical presentations, surgical management and outcome.
METHODS:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
RESULTS: A 44-year-old woman with pulsatile tinnitus, vertigo, headache, ear fullness and decreased hearing on the right had a pulsatile reddish mass behind the tympanic membrane and Brown sign. Weber test lateralized to the right with mild conductive hearing loss on pure tone audiometry. Contrast CT scan demonstrated a 5x6 mm well-defined enhancing mass in the meso- and hypotympanum. Internal auditory canal MRI showed an avidly enhancing 5x3x4 mm nodule within the right middle ear adjacent to the cochlear promontory and anterior to the lateral semicircular canal. Impression was glomus tympanicum, type 1. The mass was excised via transcanal approach with post-operative resolution of tinnitus, headache, vertigo and improvement of hearing. Final histopathology was consistent with glomus tumor.
CONCLUSION: Glomus tympanicum tumors are rare, benign middle ear paragangliomas that arise from Jacobson's nerve are slow-growing and locally destructive. CT scan and MRI may detect involvement of other structures. Surgical resection is the primary treatment modality. Type 1 glomus tympanicum tumors are small and limited to the promontory and a less-invasive transcanal approach may be employed.

Human ; Female ; Adult ; Glomus Tympanicum Tumor ; Tympanic Membrane ; Hearing Loss, Conductive ; Glomus Tumor ; Ear, Middle ; Hearing Loss ; Ear Neoplasms ; Vertigo

OBJECTIVE: To report a case of a large sinus Haller cell that presented with chronic rhinosinusitis and proptosis and its surgical management.
METHODS:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
RESULTS: A 34-year-old lady with proptosis and secondary sinusitis due to a giant infected Haller cell was successfully treated by lateral rhinotomy approach and clearance of all diseased mucosa therein into the nasal cavity.
CONCLUSION: Approach to diseased sinonasal structures via lateral rhinotomy is an alternative to endoscopic sinus surgery in the presence of an unusually large Haller cell.

Human ; Female ; Adult ; Nasal Cavity ; Paranasal Sinuses ; Sinusitis ; Endoscopy ; Nose ; Exophthalmos ; Mucous Membrane

OBJECTIVES: To  present  an  uncommon  cause  for  a  submandibular  mass  and  review  of  the literature.
METHODS:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
RESULTS: A  25-year-old  lady  presented  with  a  painless  chronic  submandibular  swelling. Ultrasound identified a solid mass following which an uncomplicated core biopsy was performed obtaining    an    accurate    pre-operative    histopathological    diagnosis.    Pre-operative    arterial embolization of this vascular mass led to a relatively bloodless wide local excision. Radiological imaging for distant metastases was negative.
CONCLUSION: Epitheloid  Hemangioendothelioma  is  an  uncommon  cause  for  a  submandibular mass.   A malignant   vascular   soft   tissue   tumor   with   morphologic   characteristics   similar   to carcinomas, melanomas and epitheloid sarcomas, it has a high rate of metastasis and morbidity when it affects the soft tissues and viscera. Immunohistochemistry provides clues to differentiation and recommended treatment consists of a surgical wide local excision with regional lymph node resection. As there are no established standard therapeutic protocols for this disease due to its rarity, an individual case-by-case approach and follow-up needs to be undertaken.

Human ; Female ; Adult ; Neoplasms ; Immunohistochemistry ; Viscera ; Melanoma ; Hemangioendothelioma ; Radiography ; Sarcoma ; Biopsy ; Lymph Nodes