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Philippine Journal of Otolaryngology Head and Neck Surgery

2002 (v1, n1) to Present ISSN: 1671-8925

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Otorhinolaryngology Out-Patient Practice in the “Post”-COVID-19 Era: Ensuring a Balance Between Service and Safety

José ; Florencio F. Lapeñ ; a, Jr. ; Franco Louie L. Abes ; Mark Anthony T. Gomez ; Cesar Vincent L. Villafuerte III ; Rodante A. Roldan ; Philip B. Fullante ; Ryner Jose C. Carrillo ; Justin Elfred Lan B. Paber ; Armando T. Isla Jr. ; Rose Alcances-Inocencio ; Jose Benedicto A. Cabazor ; Ruzanne M. Caro ; Ma. Fita P. Guzman

Philippine Journal of Otolaryngology Head and Neck Surgery.2020;35(1):6-29. doi:https://doi.org/10.32412/pjohns.v35i1.1249

Objective: To review available resources and provide evidence-based recommendations that may optimize otorhinolaryngologic out-patient health care delivery in the “post”-COVID-19 era while ensuring the safety of our patients, healthcare workers and staff. Data Sources: Relevant peer-reviewed journal articles; task force, organizational and institutional, government and non-government organization recommendations; published guidelines from medical, health-related, and scientific organizations. Methods: A comprehensive review of the literature on the COVID-19 pandemic as it pertained to “post”-COVID 19 out-patient otorhinolaryngologic practice was obtained from peer-reviewed articles, guidelines, recommendations, and statements that were identified through a structured search of the data sources for relevant literature utilizing MEDLINE (through PubMed and PubMed Central PMC), Google (and Google Scholar), HERDIN Plus, the World Health Organization (WHO) Global Health Library, and grey literature including social media (blogs, Twitter, LinkedIn, Facebook). In-patient management (including ORL surgical procedures such as tracheostomy) were excluded. Retrieved material was critically appraised and organized according to five discussion themes: physical office set-up, patient processing, personal protection, procedures, and prevention and health-promotion. Conclusion These recommendations are consistent with the best available evidence to date, and are globally acceptable while being locally applicable. They address the concerns of otorhinolaryngologists and related specialists about resuming office practice during the “post”-COVID-19 period when strict quarantines are gradually lifted and a transition to the “new” normal is made despite the unavailability of a specific vaccine for SARS-CoV-2. While they target practice settings in the Philippines, they should be useful to ENT (ear, nose & throat) surgeons in other countries in ensuring a balance between service and safety as we continue to serve our patients during these challenging times.

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Effectiveness of levodropropizine on post-operative sore throat after endotracheal intubation for head and neck surgery: A double-blind randomized controlled trial

Ivabelle M. Ducto ; Joseph E. Cachuela

Philippine Journal of Otolaryngology Head and Neck Surgery.2020;35(2):6-10. doi:10.32412/pjohns.v35i2.1501

Objective: To determine the effectiveness of levodropropizine in reducing the incidence of post-operative sore throat (POST) among ear, nose, throat, head and neck (ENT-HNS) patients undergoing general endotracheal anesthesia. Methods: Design: Double-Blind, Randomized, Placebo Controlled Trial Setting: Tertiary Government Training Hospital Participants: Sixty (60) ENT-HNS patients aged between 19 to 60 years old admitted to the Southern Philippines Medical Center from January to March 2019 for surgeries on benign thyroid tumors, benign submandibular gland tumors and tonsils requiring orotracheal intubation were randomized into control and treatment groups of 30 patients each. Results: There was a statistically significant difference (p=.0016) in the incidence of POST 6 hours after surgery between control (25/30; 83%) and treatment (16/30; 53.33%) groups. However, confounders such as length and type of surgery (more females and tonsillectomy cases in the control group) were not fully eliminated by randomization. Conclusion: Perioperative levodropropizine significantly decreases the incidence of moderate (as well as mild) postoperative sore throat. It was not shown to decrease the incidence of severe sore throat. A larger cohort (adjusted for other confounders) may better describe the benefit of this treatment.

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Efficacy of Carragelose® Nasal Spray Impregnated Versus Mupirocin Ointment Impregnated Nasal Packs on Mucosal Healing after Endoscopic Sinus Surgery: A Double-Blind, Non-Randomized, Right-Left Side Comparison

Joseph Bernard B. Lo ; Emmanuel Tadeus S. Cruz

Philippine Journal of Otolaryngology Head and Neck Surgery.2020;35(2):11-16. doi:10.32412/pjohns.v35i2.1503

Objective: To determine the efficacy of carragelose® nasal spray versus mupirocin ointment impregnated nasal packs on postoperative mucosal healing among chronic rhinosinusitis with nasal polyposis (CRSwNP) patients after endoscopic sinus surgery (ESS). Methods: Design: Double-Blind, Non-Randomized, Right-Left Side Comparison Setting: Tertiary Government Training Hospital Participants: Fifteen (15) patients diagnosed with chronic rhinosinusitis with nasal polyposis (CRSwNP) who had ESS were included in the study. Nasal packs (Netcell®) impregnated with carragelose® nasal spray or mupirocin ointment were respectively applied in right and left nostrils. Postoperative mucosal healing was graded by a blinded consultant using the Lund-Kennedy Endoscopic Scoring System and Perioperative Sinus Endoscopy (POSE) scoring system. Results: Six patients (12 nasal sides) completed the study. Comparing nasal packs impregnated with carragelose® nasal spray mupirocin ointment, the carragelose® group had lower Lund- Kennedy median scores than the mupirocin group on the 7th post-operative day; and this was statistically significant (p = .027). There were no significant differences in Lund-Kennedy postoperative scores on days 4 (p = .217), 14 (p = .171) and 28 (p = .151). Conclusion: Carragelose® nasal spray impregnated nasal packs may be comparable with, and may be an alternative to mupirocin ointment impregnated nasal packs in terms of postoperative mucosal healing among ESS patients with CRSwNP.

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The relationship of surgeon handedness and experience on operative duration and hearing improvement in ipsilateral and contralateral otologic surgeries

Gillian T. Barzaga

Philippine Journal of Otolaryngology Head and Neck Surgery.2020;35(2):17-21. doi:10.32412/pjohns.v35i2.1505

Objective: To determine the relationship of the surgeon handedness and operative site laterality on operative duration and hearing improvement in otologic surgery, and to further explore whether this relationship may be related to surgeon experience. Methods: Design: Retrospective Cohort Setting: Tertiary Private Teaching Hospital Participants: Seventy-three (73) patients aged 18 to 65 years old who underwent primary ear surgery under general anesthesia between January 2016 and December 2019 were retrospectively divided into two groups: 39 contralateral and 34 ipsilateral. The operative durations and hearing improvements were compared using independent t-tests, with consideration of surgeon experience in years further stratifying patients. Results: There was no significant difference in operative duration, t(71) = 1.14, p = .26, between the contralateral (M = 281.95 minutes, SD = 71.82) and ipsilateral (M = 261.15, SD = 79.26) groups. This same pattern was more pronounced among surgeons with 10+ years of experience although there was also no significant difference in operative time, t(33) = 1.31, p = .19 for both ipsilateral and contralateral surgeries There was no statistically significant difference, t(36) = -0.72, p = .47, in overall mean hearing gain among patients in the contralateral (M = +2.22 dB, SD = 10.54) and ipsilateral (M = +5.12 dB, SD = 14.26) groups. Although the difference was also not statistically significant, t(16) = -1.94, p = .07 for contralateral (M = 0.00, SD = 5.43) and ipsilateral (M = +7.95 dB, SD = 11.52) procedures performed by surgeons with experience of 10 years or more, a mean hearing gain of +7 dB in the ipsilateral group compared to 0 dB in the contralateral group was notable. Conclusion: This study did not prove that regardless of surgeon experience, right-handed surgeons operating on the right ear and left-handed surgeons operating on the left ear have better ear surgery outcomes of operative duration and hearing improvement compared to right- handed surgeons operating on the left ear and left-handed surgeons operating on the right ear. Future studies on larger samples with more complete data may yet demonstrate this effect.
Functional Laterality ; otologic surgical procedures ; hearing ; operative time

Functional Laterality ; otologic surgical procedures ; hearing ; operative time

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Assessment of nasal airflow and pain, safety and cost of an improvised nasal airway (nasogastric) tube after endoscopic sinus surgery

Josephine Grace C. Rojo ; Rachel Zita H. Ramos

Philippine Journal of Otolaryngology Head and Neck Surgery.2020;35(2):22-26. doi:10.32412/pjohns.v35i2.1509

Objective: To compare subjective nasal airflow and overall pain score (as well as safety and added cost of) using an improvised nasal airway tube (nasogastric tube) versus nasal packing after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods: Design: Quasi - Experimental Prospective Cohort Study Setting: Tertiary Government Training Hospital Participants: Twenty-six (26) consecutive patients aged 18 to 77 years old diagnosed with CRSwNP who underwent ESS were alternately assigned to an experimental group (A) of 13, where an improvised nasal airway (nasogastric) tube was placed in addition to the nasal pack or a control group (B) of 13 with nasal packing alone. Results: There was a significant difference in subjective nasal airflow between experimental (A) and control (B) groups during the immediate postoperative period where the mean subjective airflow was 8.07 and 0.00 over 10.00, respectively. No significant difference was noted between the groups in terms of age, gender, severity of polyposis and overall pain score. No complications such as bleeding, Toxic Shock Syndrome, vestibular or alar injury and septal necrosis were noted immediately post-op and after one week follow-up in both groups. An approximate cost of PhP 25 was added to group A. Conclusion: An improvised nasal airway using a nasogastric tube provides adequate airflow without additional pain in the immediate postoperative period. It is safe to use and an affordable option for patients in need of nasal airway stents residing in areas where a preformed nasal packing with incorporated tube stent is not available.
stents ; nasal obstruction ; nasal polyps ; sinusitis

stents ; nasal obstruction ; nasal polyps ; sinusitis

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Prevalence of diabetes mellitus and clinicodemographic profiles of patients with head and neck infections in a Philippine tertiary government hospital

Jesusa M. Santos

Philippine Journal of Otolaryngology Head and Neck Surgery.2020;35(2):27-31. doi:10.32412/pjohns.v35i2.1507

Objective: To determine the prevalence of diabetes mellitus among patients admitted for head and neck infections and describe their clinicodemographic features. Methods: Design: Retrospective Case Series Setting: Tertiary Government Training Hospital Participants: Forty-two (42) patients Results: Out of 211 adult patients admitted for head and neck infections during the study period, 42 (20%) were diagnosed to have concomitant diabetes mellitus (DM). Only 6 (14%) were known to have DM before admission while 28 (67%) were found to have DM only after admission. The most common site of infection was the neck (11; 26%). More than half of the patients (24; 57.1%) had infections in the head only, 17 (40.5%) had infections in the neck only, and 1 (2.4%) had infections in both the head and neck regions. Among these, 26 (61.9%) had infection in one site only, 15 (35.7%) had infections in two sites and one (2.4%) had infections in three sites. The majority (28; 66.7%) had an unknown etiology of infection with spontaneous appearance of redness and swelling in the involved area. Six (14.3%) were odontogenic, five (11.9%) were due to skin trauma, and three (7.1%) were due to nasal mucosal trauma. Available cultures in 14 patients revealed 12 (86%) with aerobic microorganisms and two (14%) with anaerobic growths. Half of the aerobic cultures grew K. pneumoniae. All patients were started on empiric intravenous antibiotics and over half of them (52.4%) needed surgical management. More than half (27; 64.3%) suffered from diabetic head and neck-associated complications, categorized into orbital (56%), organ/systemic (26%), local (11%), and neural (7%). Despite these complications, the majority (37, 86%) went home improved while five (12%) expired. Conclusion: This study found that 20% of patients admitted for head and neck infections during the study period had concurrent DM. Guided by known clinicodemographic haracteristics, patients admitted with suspicious head and neck infections must be promptly screened for concomitant DM and properly managed before substantial morbidity and death ensue. Otolaryngologists - head and neck surgeons, endocrinologists, general practitioners and patients alike must be cognizant of diabetic head and neck infections so that they can be prevented or managed early before complications set in.
Diabetes Mellitus ; Communicable Diseases

Diabetes Mellitus ; Communicable Diseases

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Head and neck symptoms as predictors of outcome in tetanus patients

Angeli C. Carlos-Hiceta ; Ryner Jose D. Carrillo ; Jose Florencio F. Lapeñ ; a

Philippine Journal of Otolaryngology Head and Neck Surgery.2020;35(2):32-36. doi:10.32412/pjohns.v35i2.1519

Objective: This study aims to investigate which, if any head and neck symptoms (trismus, dysphagia, alterations in speech or facial movements, and dyspnea) might be good predictors of outcomes (mortality, tracheostomy, discharged, decannulated) and prognosis of tetanus patients. Methods: Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Patients: Seventy-three (73) pediatric and adult patients diagnosed with tetanus and admitted at the emergency room of the Philippine General Hospital between January 1, 2013 and December 31, 2017. Demographic characteristics, incubation periods, periods of onset, routes of entry, head and neck symptoms, stage, and outcomes were retrieved from medical records and analyzed. Results: Of the 73 patients included, 53 (73%) were adults, while the remaining 20 (27%) were pediatric. The three most common head and neck symptoms were trismus (48; 66%), neck pain/ rigidity (35; 48%), and dysphagia to solids (31; 42%). Results of multivariate logistic regression analysis showed that only trismus (OR = 3.742, p = .015) and neck pain/ rigidity (OR = 4.135, p = .015) were significant predictors of decannulation. No dependent variable/symptoms had a significant effect in predicting discharge and mortality. Conclusion: Clinically diagnosed tetanus can be easily recognized and immediately treated. Most of the early complaints are head and neck symptoms that can help in early diagnosis and treatment resulting in better prognosis. In particular, trismus and neck pain/rigidity may predict the outcome of decannulation after early tracheotomy, but not of discharge and mortality.
tracheotomy ; tetanus ; trismus ; Neck Pain ; Muscle Rigidity

tracheotomy ; tetanus ; trismus ; Neck Pain ; Muscle Rigidity

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A linguistic validation study on the Filipino dizziness handicap inventory

Sherwin N. Agustin ; Celso V. Ureta ; Natividad A. Almazan

Philippine Journal of Otolaryngology Head and Neck Surgery.2020;35(2):37-40. doi:10.32412/pjohns.v35i2.1517

Objective: To determine the validity and reliability of the Filipino Dizziness Handicap Inventory (FDHI) questionnaire among geriatric patients with dizziness. Methods: Design: Linguistic Validation Setting: Tertiary Government Training Hospital Participants: Twenty-five (25) patients Results: The dizziness handicap inventory was translated into Filipino by a Filipino language specialist and an ENT specialist who are experts in their field. The translated version was easily understood by the 25 geriatric patients with Cronbach α scores of .957 overall [M = 2.16; SD = 1.93]. Sub-domain item-total correlation scores (physical M = 2.6, SD = 1.90, Cronbach α = .860; emotional M = 1.66, SD = 1.84, Cronbach α = .901; and functional M = 2.5, SD = 1.97, Cronbach α = .902) demonstrated validity of the respective subdomains. Conclusion: The Filipino Dizziness Handicap Inventory questionnaire is an internally valid tool for assessment of dizziness among geriatric patients. External validity and reliability can be evaluated in future studies employing corroborative measures and repeated testing.
dizziness

dizziness

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Blindness from fungal rhinosinusitis of the paranasal sinuses: A case report

Daniel Rico T. De Jesus ; Patrick Joseph L. Estolano

Philippine Journal of Otolaryngology Head and Neck Surgery.2020;35(2):41-43. doi:10.32412/pjohns.v35i2.1515

Objective: To present a unique case of blindness resulting from fungal rhinosinusitis involving multiple sinuses mimicking a malignant process in a pregnant patient. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Result: A 36-year-old pregnant woman developed unilateral blindness during her 20th week of gestation with a history of binocular diplopia, unilateral nasal obstruction and anosmia for 13 months during the pre-pregnancy period. Sphenoid sinus malignancy was suspected on imaging. The planned biopsy was intraoperatively shifted to endoscopic sinus surgery when clay-like materials were seen involving the left maxillary sinus and bilateral sphenoid and ethmoid sinuses. Histopathologic examination confirmed fungal growth. Postoperatively, nasal symptoms resolved but blindness of the left eye and blurring of vision of the right eye persisted. Conclusion: Fungal rhinosinusitis rarely occurs in multiple sinuses and is commonly misdiagnosed. It can afflict pregnant patients and mimic a malignant process. A high index of suspicion early on, especially in the presence of nasal congestion and diplopia may prevent potentially irreversible complications.
sinusitis ; sphenoid sinus ; maxillary sinus ; pregnancy

sinusitis ; sphenoid sinus ; maxillary sinus ; pregnancy

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Endoscopic management of a large tornwaldt cyst: A case report

Wenrol Z. Espinosa ; Michael Joseph C. David

Philippine Journal of Otolaryngology Head and Neck Surgery.2020;35(2):44-47. doi:10.32412/pjohns.v35i2.1513

Objective: To report successful marsupialization of a large Tornwaldt cyst using combined transnasal and transoral endoscopic surgery in a 7-year-old girl who presented with nasal obstruction. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Result: A 7-year-old girl presented with an 11-month history of recurrent yellowish nasal discharge gradually associated with nasal obstruction. Examination revealed a large, well encapsulated, broad-based cystic mass in the nasopharynx immediately adjacent to the posterior choanae, continuing posterior to the soft palate (pushing the uvula anteriorly) and extending inferiorly to the epiglottic area. Computerized Tomography (CT) demonstrated a well-circumscribed, midline hypodense mass with fluid attenuation obstructing the nasopharyngeal area extending inferiorly to the oropharyngeal area. Endoscopic marsupialization via transnasal and transoral approach was successful, and a respiratory epithelium-lined cyst consistent with a Tornwaldt cyst was confirmed by histopathologic examination Conclusion: Combined transnasal and transoral endoscopic marsupialization is possible a for a large symptomatic Tornwaldt cyst in a pediatric patient with relatively smaller and complex nasal cavities.
endoscopy ; cyst ; Nasopharynx ;

endoscopy ; cyst ; Nasopharynx ;

Country

Philippines

Publisher

Philippine Society of Otolaryngology-Head and Neck Surgery, Inc.

ElectronicLinks

https://pjohns.pso-hns.org/index.php/pjohns

Editor-in-chief

Jose Florencio F. Lapeña, Jr., MA, MD

E-mail

pjohns@pso-hns.org

Abbreviation

PJOHNS

Vernacular Journal Title

ISSN

1908-4889

EISSN

2094-1501

Year Approved

2008

Current Indexing Status

Currently Indexed

Start Year

1981

Description

The Philippine Journal of Otolaryngology Head and Neck Surgery (PJOHNS), official refereed journal of the Philippine Society of Otolaryngology Head and Neck Surgery, is a free and open-access journal that follows the “Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals” of the International Committee of Medical Journal Editors (www.icmje.org), and is listed as such: https://www.icmje.org/journals-following-the-icmje-recommendations/ - P Its academic editors are committed to fair and professional dealing in all aspects of our publishing operations. Their affiliations are listed on this website, and they additionally disclose other potential conflicts of interest when needed. Our role is to publish original work of value to the intellectual community in the best possible form and to the highest possible standards. We expect similar standards from our reviewers and authors. Honesty, originality and fair dealing on the part of authors, and fairness, objectivity and confidentiality on the part of editors and reviewers are among the critical values that enable us to achieve our aim. The PJOHNS endorses and behaves in accordance with the codes of conduct and international standards established by the Committee on Publication Ethics (COPE), Directory of Open Access Journals (DOAJ), Open Access Scholarly Publishers Association (OASPA), and World Association of Medical Editors (WAME) in their joint statement on the Principles of Transparency & Best Practice in Scholarly Publishing, available at https://doi.org/10.24318/cope.2019.1.12.

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