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Association of treatment delays with survival for patients with head and neck cancer undergoing surgery and radiotherapy at the Philippine General Hospital

Nicole D. Sacayan-Quitay ; Sean Patrick C. De Guzman ; Johanna Patricia A. Cañ ; al ; Cesar Vincent L. Villafuerte, III

Philippine Journal of Otolaryngology Head and Neck Surgery.2024;39(2):7-11. doi:https://doi.org/10.32412/pjohns.v39i2.2177

Objective: To identify in what phases in the treatment of head and neck cancer do delays happen at a tertiary hospital and to determine the association between the length of treatment delays and the oncologic outcomes (disease-free survival and overall survival) for patients with head and neck cancer. : Methods Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Participants: Sixty-eight (68) patients who had surgery and adjuvant radiotherapy for invasive head and neck cancer at the Philippine General Hospital during the 5-year period of January 2014 to December 2019 were included in the initial consideration. Only 15 had survival data and were thus eligible for inclusion in this study. Results: The median treatment package time for head and neck cancers in our institution was 27.6 weeks or 193 days. The treatment package time statistically correlated with both overall survival, F(1,13)=12.952, p <0.005, R2=0.499, and disease-free survival, F(1-13)=12.823, p <0.005, R2= 0.497. However, the independent effects of other predictors such as time interval between first consult to histopathologic diagnosis, diagnosis to surgery, and surgery to post-operative radiotherapy, showed no statistically significant association with overall survival and disease free survival. Conclusion All study patients experienced treatment delays from diagnosis to surgery, and surgery to adjuvant radiation therapy, and in their total treatment package time. The positive correlation among treatment package time, and disease-free and overall survival in this study must be further investigated in order to elucidate the true effect of delays across time intervals in the treatment of head and neck cancer in the Philippine General Hospital. Every effort should be made towards timely management of these patients.
Head and Neck Neoplasms ; Radiotherapy ; Survival Rate ; Treatment Outcome ; Time-to-Treatment ; Surgery ; Disease-Free Survival ; Delayed Diagnosis ; Retrospective Studies ; Postoperative Care

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Diagnostic accuracy and safety of endoscopic – Guided office-based biopsies for laryngeal and pharyngeal lesions at St. Luke’s Medical Center

Diana R. Fernandez ; Ronaldo G. Soriano

Philippine Journal of Otolaryngology Head and Neck Surgery.2024;39(2):12-16. doi:https://doi.org/10.32412/pjohns.v39i2.2171

Objective: To determine the sensitivity, specificity, positive predictive value, negative predictive value and safety of endoscopic guided office-based biopsies (OBB) in diagnosing laryngeal and pharyngeal neoplasms at the St. Luke’s Medical Center in Quezon City and Global City. : Methods Design: Diagnostic Accuracy Study Setting: Two Tertiary Private Training Hospitals Participants: Records of patients with pharyngeal and laryngeal lesions who underwent endoscopic-guided OBB were included in the study describing safety. Only patients with subsequent operative biopsies were included in assessing diagnostic accuracy. Results: Thirty-six (36) patients were included: 28 (77.78%) males and 8 (22.22%) females, with median age of 61.5 (IQR 52-73 years). Nearly half (16/36; 44.44%) of the office-based biopsies yielded malignant histopathology results, 19.44% had high grade dysplasia while 36.11% had benign findings. Of 10 patients with operative biopsy for definitive diagnosis, 8 were correctly diagnosed with carcinoma while one had a change in diagnosis from benign to malignant. Office based biopsy was well tolerated and had no complications reported. Overall, the sensitivity of OBB in predicting malignancy was 88.89%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 50%. Conclusion Office-based biopsy is an accurate, reliable and safe modality for screening suspicious pharyngeal and laryngeal neoplasms, and may be part of routine screening during initial endoscopy among selected patients with suspicious pharyngeal and laryngeal neoplasms. Further investigation and larger population studies may provide more robust insights on effectiveness and safety of office-based biopsy in diagnosis of pharyngeal and laryngeal neoplasms.
Head and Neck Neoplasms ; Malignancy ; Neoplasms

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Determining the severity of symptoms among patients with eosinophilic chronic rhinosinusitis with nasal polyposis versus non-eosinophilic chronic rhinosinusitis with nasal polyposis at the Veterans Memorial Medical Center

Geoffrey John S. Hizon ; Jay P. Espanto ; Kathleen M. Rodriguez-Labrador

Philippine Journal of Otolaryngology Head and Neck Surgery.2024;39(2):17-20. doi:https://doi.org/10.32412/pjohns.v39i2.2173

Objective: To compare the severity of symptoms of patients diagnosed with Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis (eCRSwNP) versus Non - Eosinophilic Chronic Rhinosinusitis with Nasal Polyposis (non-eCRSwNP) using the Filipino Sinonasal Outcome Test (Filipino SNOT 22) and determine the most common symptoms experienced by patients with eCRSwNP versus non-eCRSwNP. : Methods Design: Cross-Sectional Study Setting: Tertiary Government Training Hospital Participants: A total of 68 patients diagnosed with Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP) from November 7, 2018 to August 31, 2022 were included in the study. Results: Of the 68 patients included in the study, 33 (48.5%) had non-eCRSwNP while 35 (51.5%) had eCRSwNP. The age of the patients with non-eCRSwNP group was 50.6 + 18.45 and those with eCRSwNP was 52.9 + 16.6 years old. Non-eCRSwNP patients had a lower mean Filipino SNOT 22 score of 39.7 ± 16.1 compared with eCRSwNP with a score of 62.7± 13.5. The non-eCRSwNP patients had symptom severity classified as mild in 2 (6.1%), moderate in 25 (75.8%) and severe in 6 (18.2%) based on Filipino SNOT-22. Among the eCRSwNP group, majority of the patients, 29 (82.9%) were classified as severe, 6 (17.1%) as moderate, and none with mild severity. Using the Filipino SNOT 22, the most common symptoms of patients with eCRSwNP were item 2 (baradong ilong; nasal blockage) at 28.6%, then item 7 (malapot na sipon; thick nasal discharge) at 25.7%, Item 8 (pagbabara ng tenga; ear fullness) and item 12 (pagkawala/ pagkabawas ng panlasa/ pang amoy; decreased sense of smell/taste) were tied at 14.3%, item 13 (hirap sa pagtulog; difficulty falling asleep) at 25.7%, and item 17 (pagkapagod; fatigue during the day) at 31.4% while patients with no-eCRSwNP were noted with item 2 (baradong ilong; nasal blockage) at 48.5%, followed by item 4 (hindi tumitigil na pagtulo ng sipon; runny nose) at 21.2%, item 11 (pananakit ng mukha; facial pain) at 33.3%, Item 7 (malapot na sipon; thick nasal discharge) at 18.2%, and item 20 (pagiging irritable/pagkainis; irritability) at 21.2%. Conclusion Our present study suggests that the higher the SNOT 22 score, the more likely it is to be eosinophilic chronic rhinosinusitis. Although nasal blockage was the most common symptom found in both patients with eCRSwNP and non-eCRSwNP, patients with thick nasal discharge, decreased sense of smell/taste and ear fullness were more likely to be suffering from eCRSwNP, while patients with runny nose, facial pain and thick nasal discharge were more likely to have non-eCRSwNP.
Sinusitis ; Endoscopic Surgical Procedure ; Endoscopy ; SNOT-22 ; Sino-Nasal Outcome Test ; Nasal Blockage ; Nasal Obstruction

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Regression analysis of preoperative chest radiographs to predict intraoperative location of esophageal foreign body (coin) in pediatric patients

Angelika Doreen M. Balite ; Fortuna Corazon A. Roldan

Philippine Journal of Otolaryngology Head and Neck Surgery.2024;39(2):21-25. doi:https://doi.org/10.32412/pjohns.v39i2.2165

Objectives: To provide a guide to estimate the location of coins within the esophagus based on the pre-operative radiographic image among pediatric patients seen at the East Avenue Medical Center Department of Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) between January 2018 and December 2020. : Methods Design: Retrospective Case Series Setting: Tertiary Government Training Hospital Participants: The records of 99 pediatric patients aged 6 months to 13 years who were diagnosed with esophageal foreign body (coin) impaction and underwent rigid esophagoscopy from January 2018 to December 2020 were retrospectively reviewed. Results: A predictive model was derived from the data using linear regression analysis. The model shows that we can predict the intraoperative location of coin within the esophagus if provided with the patient’s age and vertebral level of the coin on chest radiograph. Prediction values were reported for patients in three age categories (less than 3 years old, 3 to 7 years old, 8 to 13 years old), at 10 radiographic locations (C2, C4, C5, C6, C7, T1, T2, T3, T7, T8), except for these (C1, C3, T4-T6) because of lack of data. For example, the table predicts that a coin will be located 13 cm (or between 11.4cm to 14.8cm) from the central maxillary incisors (CMI) intraoperatively if the coin was located at level C6 vertebrae on chest radiograph, for patients less than 3 years old. Conclusion This study provides a novel guide that may serve as a practical tool for ENT surgeons to estimate the intraoperative location of coin foreign bodies in the esophagus of pediatric patients based on preoperative radiographic imaging.
Foreign Bodies ; Foreign Bodies ; Esophagus ; Esophagoscopes ; Esophagoscopic Surgery ; Esophagoscopic Surgical Procedures ; Esophagoscopy

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Olfactory dysfunction, dysgeusia, and clinical outcomes in COVID-19 patients: An observational study in a tertiary COVID referral center in the Philippines

Chantel Jacqueline R. Tirol ; Philip B. Fullante

Philippine Journal of Otolaryngology Head and Neck Surgery.2024;39(2):26-31. doi:https://doi.org/10.32412/pjohns.v39i2.2119

Objective: To describe the prevalence, onset, associated symptoms, and clinical characteristics of COVID-19 in-patients with olfactory and gustatory dysfunction at the Philippine General Hospital from March 2021 to January 2022 and determine the number of patients with olfactory dysfunction/dysgeusia who recovered or expired. : Methods Design: Prospective Cohort Study Setting: COVID-19 Referral Hospital (Tertiary National University Hospital) Participants: COVID-19 RT-PCR positive in-patients, ages 19 and older Results: A total of 207 patients were included. Sixty-four (64) patients reported olfactory dysfunction and 79 reported dysgeusia. Olfactory and gustatory dysfunction were observed early in the course of infection, before day 6 of illness. The average length of hospital stay was 20.36 days; those with olfactory dysfunction stayed for 17.53 days, dysgeusia for 19.92 days, and 21.09 days for those who noted neither. For those subsequently intubated, 0 had olfactory dysfunction, three reported dysgeusia, three had both and six had neither. Thirteen (13) patients in the study expired. Among them, none reported olfactory dysfunction and two had dysgeusia. Conclusions Our results corroborate existing literature that olfactory and gustatory dysfunction as key indicators of COVID-19 with 42.5% of participants reporting these symptoms early, often before day 6 of illness. Ninety-two percent (92%) of those affected recovered and had shorter hospital stays, emphasizing the importance of recognizing these dysfunctions for improved disease detection and outcomes.
Anosmia ; Dysgeusia ; COVID-19 ; Coronavirus

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Otorhinolaryngologic manifestations of long COVID-19 infection among patients at the Quezon City General Hospital

Ma. Nina Kristine C. Sison ; Emmanuel Tadeus S. Cruz

Philippine Journal of Otolaryngology Head and Neck Surgery.2024;39(2):32-36. doi:https://doi.org/10.32412/pjohns.v39i2.2167

Objective: To determine the otorhinolaryngologic manifestations of long COVID-19 infection among patients consulting at the Quezon City General Hospital. : Methods Design: Cross-Sectional Study Setting: Tertiary Government Hospital Participants: Patients aged 18 years old and above, who previously tested positive for the SARS-COV-2 Test, and consulted with otolaryngologic problems at the Outpatient department, Emergency Room, or were dmitted, or referred from other services to the Department of Otorhinolaryngology Head and Neck Surgery, from October 2022 to January 2023 were considered for inclusion. Results: Out of 150 participants, 127 (84.67%) reported having otorhinolaryngologic symptoms. Five percent (5%) had ongoing symptomatic COVID-19 (4 to 12 weeks) and 11% had post COVID-19 syndrome (>12 weeks). Patients with long COVID-19 had rhinorrhea (54.51%), hyposmia (51.47%), dysgeusia (48.9%), anosmia (48.53%), sore throat (47.8%), ageusia (29.78%), tinnitus (23.53%), ear pain (23.53%), phantosmia (21.33%), and dizziness (11.76%). Out of 25 patients with long COVID, only 2 had pneumonia and 1 was hospitalized and eventually recovered. Conclusion This study showed a prevalence rate of 16% of long COVID-19 with rhinorrhea as the most prominent symptom. Long-term monitoring is essential and patients who had COVID should be advised to report any lingering illness which may subsequently develop. Physicians should be vigilant and aware of the clinical manifestations of long COVID in order to institute proper intervention.
COVID-19 ; SARS-CoV-2 ; Long COVID ; Post-Acute COVID-19 Syndrome ; Long Haul COVID-19 ; Post-Acute COVID-19 Syndrome ; Rhinorrhea

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Telemedicine for ENT: Quality of care during the COVID-19 pandemic at the Jose R. Reyes Memorial Medical Center in 2022

Janella Mara C. Castro ; Ryan U. Chua

Philippine Journal of Otolaryngology Head and Neck Surgery.2024;39(2):37-40. doi:https://doi.org/10.32412/pjohns.v39i2.2169

Objective: To assess the quality of care of telemedicine consultation during the COVID-19 pandemic at the Jose R. Reyes Memorial Medical Center in 2022. : Methods Design: Cross-Sectional Study Setting: Tertiary Government Training Hospital Participants: 210 patients Results: Majority of the respondents were female, less than 40 years of age, unemployed, consulted for the first time, lived < 25km distance from the hospital, consulted because of an ear problem, consulted without symptoms suggestive of COVID-19 and had higher outcomes of face-to-face consultation. The overall satisfaction with teleconsultation was good with majority of patients satisfied and very satisfied with teleconsultation (4.29±1.083). Occupational status, technical problems encountered in the teleconsultation, and those who were bothered by the absence of clinical examination were associated with the perceived quality of care of the ENT teleconsultation (p < .05). Among the population who were satisfied to ENT teleconsultation, 82 (43%) were from the working population (OR 2.2 [1.1-4.7]), 158 (95%) were satisfied with quality of response (OR 23.7 [9.4-59.8]) and 154 (93%) were satisfied with image quality (OR 16.9 [7.3-39.0]). Conclusion Teleconsultation for ENT has proven useful in terms of satisfying the urgent concerns of patients in a pandemic setting.
Telemedicine

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Adenoid cystic carcinoma of the external ear canal: A case report

Sarah Eunice C. Caluma ; Joanne Sebastiana M. De Ramos

Philippine Journal of Otolaryngology Head and Neck Surgery.2024;39(2):41-44. doi:https://doi.org/10.32412/pjohns.v39i2.2083

Objective: To present a rare case of Adenoid Cystic Carcinoma of the external ear canal in a 73-year-old man, including its diagnosis and surgical management. : Methods Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A 73-year-old man who consulted due to decreased hearing on the right ear had a 4-year history of gradually enlarging mass occupying the right external auditory canal. Wide en bloc resection of the external auditory canal mass and superficial parotidectomy with facial nerve preservation was performed with final histopathology results of adenoid cystic carcinoma. Follow-up at 2 years has shown no signs or symptoms or recurrence. Conclusion Adenoid cystic carcinoma of the external ear canal is a very rare disease that can present similarly to other otologic infections. Early identification of symptoms, performance of necessary imaging, and timely biopsy are key to reducing misdiagnosis and improving the survival rate. Complete resection of the tumor with adequate margins is the recommended treatment due to its high rates for recurrence.
Carcinoma, Adenoid Cystic ; Ear Neoplasms

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Primary melanoma of the palatine tonsil in an adult Filipino patient: A case report

Katrin Louise D. Cabatañ ; a ; Duane L .Salud

Philippine Journal of Otolaryngology Head and Neck Surgery.2024;39(2):45-48. doi:https://doi.org/10.32412/pjohns.v39i2.1905

Objectives: To discuss a case of primary melanoma of the palatine tonsil in a 57-year-old man presented with a dark, pigmented tonsillar mass initially managed as a case of arterio-venous malformation, and review the literature on its presentation, diagnosis, management and outcomes. : Methods Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Results: A 57-year-old man presented with a pigmented, bluish-black mass (7.2 cm) on the right tonsillar area with dysphagia and odynophagia. A CT scan interpretation considered large tonsillar malignancy, right with infiltrations of the soft palate, lingual tonsils and pre-epiglottic space. The initial impression was an arteriovenous malformation and preoperative arterial embolization was followed by a tonsillectomy. The final biopsy result was mucosal melanoma. Refusing further treatment, he expired nine months later in the emergency room, after presenting with decreasing sensorium and desaturations, jaundice and abdominal distension. Conclusion To the best of our knowledge, this is the first reported case of tonsillar melanoma in the Philippines. Primary tonsillar melanoma is rare but its diagnosis is still possible (although it is usually diagnosed in advanced stages). Despite improvement in surgical techniques and adjuvant therapies, its prognosis remains poor. Regular oral cavity screening may help in early detection.
Palatine Tonsil ; Melanoma

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A novel technique: Scored conchal cartilage to simulate natural dome of lower lateral cartilage in the Asian nose

Nikki Lorraine Y. King-Chao ; Eduardo C. Yap

Philippine Journal of Otolaryngology Head and Neck Surgery.2024;39(2):49-53. doi:https://doi.org/10.32412/pjohns.v39i2.2443

Objective: To introduce a novel technique for tip grafting, using scored conchal cartilage with a curled morphology and provide an alternative approach to tip refinement procedures. : Methods Design: Surgical Innovation Setting: Ambulatory Aesthetic Surgical Center Participants: 12 private patients Results: This technique produces a natural looking tip with aesthetically pleasing projection and definition. The simulation of the natural curvature of the lower lateral cartilage (LLC) by curling the SCC gives a more lobular and softer looking tip. The corners of the graft are also hidden underneath the SSTE providing camouflage of irregularities. There were no complications or sequelae (e.g. palpable cartilage and cartilage visibility) observed with the use of this technique. Conclusion This simple yet novel technique can be applied to Asian patients for a natural looking tip. This technique is applicable to patients with thin skin and gives surgeons an alternative option as they perform tip surgeries. This technique together with other approaches in rhinoplasty may help surgeons achieve a more balanced look for Asian patients.
Rhinoplasty

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