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Endoscopic sinus surgery perioperative outcomes after intravenous tranexamic acid:A double blind randomized controlled trial

Jenna Marie C. Quiroga ; Peter Simon R. Jarin

Philippine Journal of Otolaryngology Head and Neck Surgery.2018;33(1):6-11. doi:https://doi.org/10.32412/pjohns.v33i1.13

Objective: To determine the effect of a single intravenous dose of tranexamic acid on intraoperative bleeding, duration of surgery and surgical field visualization during endoscopic sinus surgery. Methods: Study Design: Double-blind, randomized, placebo-controlled trial. Setting: Tertiary Government Hospital in Quezon City Participants: 10 patients aged 18-75 years old diagnosed with chronic rhinosinusitis with or without nasal polyposis and unresponsive to medical treatment, who underwent endoscopic sinus surgery from September 2016 to August 2017, were randomly allocated to treatment group and control group respectively. The “odd” numbers were assigned to the treatment group (intravenous Tranexamic acid) given 1 dose of 100mg/ml (500mg tranexamic acid per 5 ml) tranexamic acid slow intravenous drip 1 hour prior to the procedure, while the “even” numbers assigned to the control group received the same amount of normal saline solution. Results: The mean duration of surgery of the tranexamic group was 185 minutes (standard deviation, SD 55.23) and the control group was 122.6 minutes (SD 42.03) showing no significant difference (p=.08). The mean blood loss of the tranexamic group was less at 240ml (SD 108.39) compared with the control group at 290ml (SD 74.16), although there was no statistically significant difference (p=.42). Intraoperative surgical field assessed by the surgeon based on the Boezart grading scale showed that 2 (40%) of the tranexamic group had higher bleeding score compared with the placebo group. However, this was not found to be statistically significant (p=.460). Due to the small sample size, a type II error occurred with alpha level of 0.05 and estimated power of 0.0885, with not enough basis to refute that a single dose of intravenous tranexamic acid has no effect in improving surgical field visualization during endoscopic sinus surgery. No drug side effects were noted after administration until after surgery. Conclusion Single dose intravenous tranexamic acid in functional endoscopic sinus surgery decreased mean intraoperative blood loss (but this was statistically insignificant), but its effect on surgical field visualization cannot totally be assessed due to small sample size. There was also no change in the observed duration of surgery. No untoward side effects associated were noted from administration of the drug until after the surgery finished.
Administration, Intravenous ; Tranexamic Acid ; Sinusitis

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Posterior nasal neurectomy in treatment of intractable rhinitis: A preliminary series

Minh Cong Vo ; Huu Kien Pham ; Minh Hien Nguyen

Philippine Journal of Otolaryngology Head and Neck Surgery.2018;33(1):12-16. doi:https://doi.org/10.32412/pjohns.v33i1.15

Objective: To evaluate the efficacy and safety of posterior nasal neurectomy on the treatment of nasal congestion, rhinorrhea, sneezing, and post-nasal discharge in intractable rhinitis patients. Methods: Design: Preliminary case series. Setting: Tertiary University Medical Center. Participant: Ten (10) patients with intractable rhinitis underwent endoscopic posterior nasal neurectomy in both sides. Symptoms were compared pre- and post-operatively one month and one year after surgery using Visual Analog Scale (VAS) scores. Endoscopic pre- and one-month post-operative Lund-Mackay scores were also compared. Results: All four mean nasal symptom scores were reduced significantly at 1-month follow-up for nasal congestion (1.5 ± 1.08 vs 4.1 ± 0.5687, p = .00001), rhinorrhea (0.7 ± 0.823 vs 3.4 ± 0.966, p = .00001) post-nasal discharge (0.9 ± 0.994 vs 2.4 ± 1.5, p = .03), and sneezing (1.1 ± 0.738 vs 3 ± 0.943, p = .02). Mean endoscopic scores were also reduced significantly at one month, from 12.9 ± 2.55 to 4.2 ± 3, p = 0.0001.In the 6 patients that followed up at 1-year, post-operative mean nasal symptoms were still significantly better for congestion (0.6667 ± 0.8165 vs 4 ± 0.632, p = 0.00001), rhinorrhea (0.6667 ± 0.5164 vs 3.67 ± 1.033, p = .001), post-nasal discharge (0.1667 ± 0.40825 vs 2.17 ± 1.835, p = .033), sneezing (0.5 ± 0.54772 vs 3.17 ± 0.983, p = 0.0001). Mean post-operative VAS nasal scores and endoscopic scores were well associated (Correlation Coefficient -.648, p = .048). Conclusion Posterior nasal neurectomy could be considered as a safety and effective way to treat intractable rhinitis patients in Vietnam.
Rhinitis, Vasomotor

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Reliability and validity of the Filipino Sino-Nasal Outcome Test (SNOT) 22

Christine Anne C. Maningding ; Rodante A. Roldan

Philippine Journal of Otolaryngology Head and Neck Surgery.2018;33(1):17-20. doi:https://doi.org/10.32412/pjohns.v33i1.51

Objective: To translate the Sino-Nasal Outcome Test (SNOT) 22 into Filipino, and establish the validity and reliability of the Filipino version of the Sino-Nasal Outcome Test (SNOT) 22. Methods: Design: Prospective Cohort. Setting: Tertiary Government Training Hospital. Participants: Twenty one (21) patients with rhinosinusitis with or without nasal polyposis were administered the Filipino SNOT 22 to determine reliability. Sixty three (63) patients with rhinosinusitis with or without nasal polyps and forty eight (48) controls were recruited for the validity study. Results: The Filipino SNOT 22 had a Pearson correlation of 0.618 significant at the 0.01 level and a Cronbach’s alpha of 0.76. The calculated Z-Score was 7.21 with p-value < .00001 significant at p < .05. The value of U was 300 with a critical U value at 1512. Conclusion The self administered Filipino SNOT 22 is a reliable and valid tool for measuring QOL among Filipino patients with rhinosinusitis.
Sinusitis ; Reproducibility of Results ; Quality of Life

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Evaluation of the newborn hearing screening program in The Medical City based on Joint Commission on Infant Hearing (JCIH) 2007 position statement quality indicators

Mary Harmony B. Que ; Maria Rina T. Reyes-Quintos

Philippine Journal of Otolaryngology Head and Neck Surgery.2018;33(1):21-24. doi:https://doi.org/10.32412/pjohns.v33i1.23

Objective: The objective of this study is to evaluate the newborn hearing screening program in The Medical City based on the Joint Committee on Infant Hearing (JCIH) 2007 Position Statement Quality Indicators. Methods: Study Design: Cross - Sectional Survey. Setting: Tertiary Private Hospital. Participants: All newborns who underwent newborn hearing screening in The Medical City for the year 2015. Results: Of 2,010 patients delivered in the hospital in year 2015, 1,986 (98.8%) were screened. Among the 59 babies with initial “refer” results, 15 (25.42%) “referred” a second time while 24 (40.68%) “passed” the rescreening. Twenty (33.89%) did not undergo rescreening (10 were classified as dropouts, while another 10 did not undergo rescreening for various reasons. Of those who “referred” during rescreening, only 9 (60%) had further evaluation done with ABR/ASSR. Among these, 4 (26.66%) had hearing loss and proceeded with the appropriate monitoring and management while 5 (33.33%) had normal hearing. Conclusion The current newborn hearing screening program in the Medical City was able to reach JCIH 2007 quality indicators for screening but not for confirmation of hearing Loss. All patients with hearing loss were managed with early rehabilitation.
Otoacoustic Emissions, Spontaneous ; Evoked Potentials, Auditory, Brain Stem

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Operative time and tympanic membrane graft uptake in endoscopic transcanal versus microscopic post-auricular tympanoplasty for chronic otitis media

Jenina Rachel D.J. Escalderon ; William L. Lim

Philippine Journal of Otolaryngology Head and Neck Surgery.2018;33(1):25-29. doi:https://doi.org/10.32412/pjohns.v33i1.25

Objective: To compare surgical outcomes (operative time and tympanic membrane integrity) obtained by endoscopic transcanal tympanoplasty (ET) and microscopic post-auricular tympanoplasty (MT) in patient with inactive chronic otitis media. Methods: Design: Retrospective Cohort Setting: Multicenter study in 3 Private Tertiary Hospitals Participants: 18 patients who underwent microscopic or endoscopic tympanoplasty for chronic otitis media. Results: Each group had 9 patients, with median age of 43 (31-65 years) for the MT and 47 (29-59 years) for the ET group. There was no significant difference in median age of the two groups (Mann-Whitney U=17, P=.22). Male: female ratio was (5:4) and (6:3) for the ET and MT group respectively, with no significant difference in gender distribution (c2= 0.90, P=.34). Mean operative time for the ET and MT group was 86.7 minutes and 140.6 minutes, respectively, with significantly lower mean operative time for the ET group (t= 3.57, P=.0025). There was complete tympanic membrane graft uptake in both groups. Conclusion Regardless of technique, tympanoplasty is an effective surgical treatment among patients with inactive chronic otitis media. Endoscopic tympanoplasty is an alternative to conventional microscopic tympanoplasty that may use less operative time, producing similarly complete graft uptake.
Tympanoplasty ; Tympanic Membrane

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Histopathologically positive regional neck node metastasis among patients with laryngeal squamous cell carcinoma

Efren Gerald L. Soliman ; Alfredo Quintin Y. Pontejos

Philippine Journal of Otolaryngology Head and Neck Surgery.2018;33(1):30-33. doi:https://doi.org/10.32412/pjohns.v33i1.27

Objective: To determine the patterns of regional neck node metastasis in laryngeal squamous cell carcinoma in Filipinos according to subsite and clinical stage, and to determine possible factors associated with level V involvement. Methods: Design: Retrospective Case Series. Setting: Tertiary National University Hospital. Participants: A chart review was conducted for patients diagnosed with laryngeal squamous cell carcinoma who underwent laryngectomy with neck dissection from January 2011 to April 2015. Medical information obtained included demographics, clinical parameters, and histopathologic reports of nodal involvement. The rate and location of positive neck nodes was recorded according to clinical stage and primary subsite. Fisher exact test was used to determine significant risk factors for level V cervical lymph node involvement. Results: Of 56 patients included, most were male with an average age of 61 years. Most patients had cancer originating from the glottic subsite, with the majority being staged III and IVA according to the TNM classification. Histopathologically positive neck nodes were centered at levels II to IV. No significant association was seen between level V involvement and the studied clinicopathologic factors (age, sex, tumor differentiation, subsite involvement, involvement of other neck node levels). Conclusion Cervical neck node levels II, III, and IV are the most commonly involved in neck dissection, with many being positive for nodal metastasis for these levels. Level V nodes may be removed when clinically positive, but elective neck dissection may exclude this level. The current practice of neck dissection appears to be appropriate in terms of selecting the most likely locations of metastatic spread. Further study is recommended, with a greater population and standardized levels of neck dissection.
Laryngeal Neoplasms ; Lymphatic Metastasis ; Neck Dissection ; Carcinoma, Squamous Cell

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Inverted papilloma of the middle ear presenting as an aural polyp

Dann Joel C. Caro

Philippine Journal of Otolaryngology Head and Neck Surgery.2018;33(1):34-38. doi:https://doi.org/10.32412/pjohns.v33i1.49

Objective: To present a rare case of inverted papilloma of the middle ear in a 77-year old man presenting with an external auditory canal polyp of the right ear. Methods:: Design: Case Report. Setting: Tertiary Private Hospital. Patient: One. Results: A 77-year-old man presenting with external auditory canal mass underwent tympanoplasty with canal wall down mastoidectomy. Histopathologic examination revealed inverted papilloma. Conclusion With only 30 cases reported in the literature, inverted papilloma of the middle ear is a rare disease entity that may mimic other benign conditions such as cholesteatoma. It requires further investigation to devise a rational approach to diagnosis and management. Regular post- operative monitoring is essential due to high recurrence and malignant transformation rate while post-operative radiotherapy remains controversial and requires further investigation
Papilloma, Inverted, Cholesteatoma ; Ear, Middle

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Extranasopharyngeal angiofibroma: A diagnostic dilemma

Nitin Gupta ; Arjun Dass ; Vaibhav Saini ; Shashikant Anil Pol ; Lovekesh Mittal

Philippine Journal of Otolaryngology Head and Neck Surgery.2018;33(1):39-42. doi:https://doi.org/10.32412/pjohns.v33i1.31

Objective: To report two cases of extranasopharyngeal angiofibroma, highlighting the diagnostic challenges involved. Methods: Design: Case Report. Setting: Tertiary Teaching Hospital and Medical School. Patients: Two (2). Results: A 13-year-old boy who presented with epistaxis and a vascular mass on the posterior nasal septum that enhanced on contrast-enhanced computed tomography (CECT), and a 3-year-old boy who presented with dysphagia and mild respiratory difficulty, with a large naso-oropharyngeal mass arising from the soft palate on physical and x-ray examination that could not be corroborated because stridor developed during sedation for CECT, both underwent endoscopic tumor excision. Conclusion As illustrated in these cases, atypical presentations of extranasopharyngeal angiofibromas can pose a considerable diagnostic and surgical challenge for clinicians.
Angiofibroma, Classification ; Diagnosis ; Diagnostic Imaging

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Multiple myeloma presenting as a parotid mass

Benedick B. Borbe ; Samantha S. Castaneda

Philippine Journal of Otolaryngology Head and Neck Surgery.2018;33(1):43-46. doi:https://doi.org/10.32412/pjohns.v33i1.33

Objective: To present the case of a patient with left facial swelling as the primary manifestation of Multiple Myeloma, and discuss the surgical management, diagnostic dilemma, and subsequent medical management done for this unusual presentation. Methods: Design: Case Report. Setting: Tertiary Government Hospital. Patient: One (1). Results: A 55-year old man with an enlarging left pre-auricular mass of one (1) year duration underwent superficial parotidectomy with facial nerve preservation and selective lymphadenectomy for pleomorphic adenoma based on initial clinical and cytologic findings. Histopathologic examination showed plasmacytoid proliferation, and subsequent work-ups finally revealed Multiple Myeloma. Conclusion Emphasized in this case report is the thorough work-up and targeted therapy needed for the timely diagnosis and treatment of a patient with Multiple Myeloma.
Multiple Myeloma ; Plasmacytoma ; Parotid Gland ; Adenoma, Pleomorphic

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Double ectopic thyroid gland in a 10-year-old Filipino boy

Tomas Joaquin C. Mendez ; Cecilia Gretchen Navarro Locsin

Philippine Journal of Otolaryngology Head and Neck Surgery.2018;33(1):47-50. doi:https://doi.org/10.32412/pjohns.v33i1.35

Objective: To present a case of a double ectopic thyroid gland in a 10-year old boy and discuss the pros and cons of the different management options that were available. Methods: Design: Case Report. Setting: Tertiary Hospital in Metro Manila. Subject: One (1). Results: A 10-year-old boy presented with hoarseness and easy fatigability for 6 years. Rigid endoscopy and CT scan showed an infraglottic mass originating from the anterior tracheal wall causing obstruction. Biopsy revealed thyroid tissue with atypia. Thyroid scintigraphy showed uptake in the submental and midline anterior neck. Thyroid hormone levels were consistent with hypothyroidism. Levothyroxine returned hormone levels to normal and resulted in complete regression of the mass with no symptoms of dyspnea, stridor or bleeding. Conclusion The management of ectopic thyroid presents a challenge as there are no guidelines for optimal treatment. Thyroid hormone insufficiency is a frequent occurrence, and emphasis must be given to its monitoring. Surgery in a critical airway lesion such as this may be reserved for cases where the patient experiences dyspnea and stridor or lack of response to thyroid hormone treatment.
Thyroid Dysgenesis ; Thyroid Hormones ; Thyroxine

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