Human ; Case Reports ; Publications

OBJECTIVES: •To present a case of an 8 month-old female who ingested a foreign body that impacted itself into the posterior pharyngeal wall resulting in a retropharyngeal sinus tract • To discuss the events leading to the diagnosis of the patient • To explain the reason behind the difficulty of locating the foreign body during rigid esophagoscopy • To discuss the use of endoscopic cauterization as management of the retropharyngeal sinus tract METHODS: Design: Case Report Setting: Tertiary Government Hospital Patient: One RESULTS: An 8 month-old female presented with repeated bouts of vomiting with associated refusal to eat. A chest radiograph showed a triangular radiopaque object at the level of Tl -T2. Emergency foreign body extraction via rigid esophagoscopy was done, however, no foreign body was seen in the esophagus. An intraoperative chest radiograph showed a foreign body at the previously described location. On repeat esophagoscopy, a linear wound with purulent discharge on the posterior pharyngeal wall was seen. This wound was explored using a 0° telescope revealing a retropharyngeal tract measuring 2.4 cm in length. At the end of the retropharyngeal tract, a glass shard was found and was extracted. This tract was monitored endoscopically 4, 18, 25, and 32 days postoperative, respectively for possible spontaneous closure of the tract. Eventually, after 32 days, noted to persist hence was debrided and was cauterized via electrocautery leading to its closure. Postop monitoring via flexible endoscopy and neck soft tissue lateral x-ray showed complete closure of the retropharyngeal sinus tract. CONCLUSION An 8 month-old female who ingested a glass shard was presented. The ingestion of pointed or sharp objects may be embedded into the retropharyngeal space and its further advancement may be caused by shearing forces caused by repetitive swallowing and vomiting. Immediate detection of these sharp foreign bodies may prevent formation of such tracts. Therefore, a high index of suspicion must be had in cases where foreign bodies that are not visualized by rigid esophagoscopy by careful inspection of the mucosal wall of the pharyngeal area with further guidance of radiographs. The innovation of endoscopic electrocautery as management of the sinus tract, inspired from the management of fourth branchial cleft sinus tracts, is an effective approach in management.

OBJECTIVE: To compare the efficacy of Clarithromycin versus Methylprednisolone in the treatment of non-eosinophilic nasal polyposis.

DESIGN: Randomized Controlled Trial

SETTING: Tertiary Government Training Hospital

PARTICIPANTS: Forty  two (42) patients with Chronic Rhinosinusitis with determination of eosinophil count.  Both groups were further randomized into a treatment arm given Clarithromycin (CLA) 500mg/ day and another arm given Methylprednisolone (METH) 32 mg/ day tampering to 8 mg/ day for 15 days. All participants underwent pre- and post-treatment evaluation via anterior rhinoscopy, Sino-Nasal Outcome Test (SNOT-22) and Endoscopic Appearance (EA) Scoring. Date were encoded and subjected to statistical analysis using Mann-Whitney U test.

RESULTS: For the 9 participants in the non-eosinophilic group, 4 were given CLA and 5 were given METH. The CLA arm showed significant improvement in SNOT-22 scores by the 15th day (p= .007). The METH arm did not demonstrate significant improvement by the 7th (p= .44) or 15th day (p= .22). Comparison in the improvement in SNOT-22 scores between the two arms showed that on both 7th and 15th days, CLA outperformed METH (p= 0.26 and p= .004, respectively). For the EA scoring, both the CLA and METH groups significantly improved by the 7th (p= .27 and p= 0.017, respectively) and 15th day (p= .013 and p= .027, respectively). Comparison in the improvement of EA scores between the two arms showed significant difference on the 15th day (p= .01) with the CLA performing better than METH. Overall, the results suggest that the CLA arm performed significantly better than METH arm in the treatment of non-eosinophilic patients.

Of the 33 eosinophilic patients, 17 were given CLA and 16 were given METH. The CLA arm showed significant improvement in SNOT-22 scores by the 15th day (p< .001) while the METH arm both on 7th (p= .033) and 15th day (p< .001). Comparison of the improvement in SNOT-22 results between the two arms showed no significant difference (7th day p= .494; 15th day p= .587). For the EA scoring, both treatment groups showed significant improvement by the 7th and 15th day (p< .001). Comparison on the improvement in EA scores between the two arms showed significant difference (p< .001) on both 7th and 15th day, suggesting that METH was more effective than CLA. Overall, the results showed that both CLA and METH were effective in the treatment of eosinophilic nasal polyps. However, METH was significantly better than CLA in terms of superior EA scores.

CONCLUSION: In terms of improving symptoms and well-being, as well as decreasing nasal polyp size and reducing discharge and edema as reflected in superios SNOT 22 and EA scores, Clarithromycin was significantly more effective than Methylprednisolone in the treatment of non-eosinophilic nasal polyps. While both Clarithromycin and Methylprednisolone were shown to be effective in the treatment of eosinophilic nasal polyps, Methylprednisolone was significantly better in that Clarithromycin in terms of EA scores. A biopsy for tissue eosinophilic cell count prior to treatment is recommended to establish the predominant inflammatory cell in nasal polyps in order to provide appropriate targeted treatment, i.e. Clarithromycin for non-eosinophilic nasal polyps and Methylprednisolone for eosinophilic polyps.

Human ; Male ; Female ; Macrolides ; Clarithromycin ; Methylprednisolone ; Nasal Polyps ; Eosinophils

Objective: To compare the efficacy of Clarithromycin versus Methylprednisolone in the treatment of non-eosinophilic and eosinophilic nasal polyposis.

Methods:

            Study Design: Randomized controlled trial

            Setting:           Tertiary Government Training Hospital

Subjects:         Forty two patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) were grouped into non-eosinophilic and eosinophilic groups after biopsy determination of eosinophil count. Both groups were further randomized into a treatment arm given Clarithromycin (CLA) 500 mg/ day and another arm given Methylprednisolone (METH) 32 mg/ day tapering to 8 mg/ day for 15 days. All participants underwent pre- and post-treatment evaluation via anterior rhinoscopy, Sino-Nasal Outcome Test (SNOT-22) and Endoscopic Appearance (EA) Scoring. Data were encoded and subjected to statistical analysis using Mann-Whitney U test.

Results: For the 9 participants in the non-eosinophilic group, 4 were given CLA and 5 were given METH. The CLA arm showed significant improvement in SNOT-22 scores by the 15th day (p= .007). The METH arm did not demonstrate significant improvement by the 7th (p= .44) or 15th day (p= .22). Comparison of the improvement in SNOT-22 scores between the two arms showed that on both 7th and 15th days, CLA outperformed METH (p= .026 and p= .004, respectively). For the EA scoring, both the CLA and METH groups significantly improved by the 7th (p= .027 and p= 0.017, respectively), and 15th day (p= .013 and p= .027, respectively). Comparison of the improvement in EA scores between the two arms showed significant difference on the 15th day (p= .01), with the CLA performing better than METH. Overall, the results suggest that the CLA arm performed significantly better than the METH arm in the treatment of non-eosinophilic patients.

          Of the 33 eosinophilic patients, 17 were given CLA and 16 were given METH. The CLA arm showed significant improvement in SNOT-22 scores by the 15th day (p < .001), while the METH arm on both 7th (p= .033) and 15th day (p< .001). Comparison of the improvement in SNOT-22 results between the two arms showed no significant differences (7th day p= .494; 15th day p= .587). For the EA scoring, both treatment groups showed significant improvement by the 7th and 15th day (p< .001). Comparison of the improvement in EA scores between the two arms showed significant differences (p< .001) on both 7th and 15th day, suggesting that METH was more effective than CLA. Overall, the results showed that both CLA and METH were effective in the treatment of eosinophilic nasal polyps. However, METH was significantly better than CLA in terms of superior EA scores.

Conclusion: In terms of improving symptoms and well-being, as well as decreasing nasal polyp size and reducing discharge and edema as reflected in superior SNOT-22 and EA scores, Clarithromycin was significantly more effective than Methylprednisolone in the treatment of non-eosinophilic nasal polyps. While both Clarithromycin and Methylprednisolone were shown to be effective in the treatment of eosinophilic nasal polyps, Methylprednisolone was significantly better than Clarithromycin in terms of superior EA scores. A biopsy for tissue eosinophil cell count prior to treatment is recommended to establish the predominant inflammatory cell in nasal polyps in order to provide appropriate targeted treatment, i.e. Clarithromycin for non-eosinophilic nasal polyps and Methylprednisolone for eosinophilic polyps.

Keywords: macrolides, clarithromycin, methylprednisolone, nasal polyps, eosinophils

Human ; Male ; Female ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Clarithromycin ; Macrolides ; Methylprednisolone ; Nasal Polyps ; Eosinophils

OBJECTIVE: To determine if Ehretia microphylla (Tsaang Gubat) decoction tea and placebo can improve the symptoms of mild intermittent allergic rhinitis in comparison to loratadine and control tea.
METHODS:
Design: Double-Blind, Randomized Controlled
Trial Setting: Tertiary-Government Training Hospital
Participants: Twenty-four patients diagnosed with mild intermittent allergic rhinitis from October 2015 to July 2016 were randomly divided into a treatment group given Ehretia microphylla (Tsaang Gubat) decoction tea and placebo, and a control group given control tea and loratadine, both taken for 7 days. Patients underwent pre- and post-intervention evaluation by anterior rhinoscopy, Sino-nasal Outcome Test 22 (SNOT 22) Questionnaire and 10-point Visual Analog Scale (VAS). Data were encoded and subjected to statistical analysis using Mann Whitney U test and Wilcoxon Signed Rank test.
RESULTS: Age and gender of the treatment and control group participants were comparable. Prior to intervention, no differences in symptoms were noted between both groups on SNOT 22 and VAS scores. After intervention, no differences in symptoms were noted between the 2 groups on SNOT 22 and VAS scores either. Comparison of pre- (30.4 ± 17.3) and post- (7.2 ± 6.5) intervention mean SNOT 22 scores of the loratadine control group with pre- (32.5 ± 23.7) and post- (7.8 ± 10.4) intervention mean SNOT 22 scores of the Ehretia Microphylla treatment group showed significant improvement of symptoms in both groups. Likewise, comparison of pre- and post-intervention mean VAS scores of the loratadine control group and pre- and post-intervention mean VAS scores of the Ehretia Microphylla treatment group based on symptoms of sneezing, rhinorrhea, nasal congestion and pruritus showed significant improvement of symptoms in both groups (p-values of < .001).
CONCLUSION: Ehretia microphylla (Tsaang Gubat) decoction tea may improve symptoms of allergic rhinitis (sneezing, rhinorrhea, pruritus and nasal congestion) and be taken as an alternative to loratadine in patients with mild intermittent allergic rhinitis. Further clinical trials with more participants may provide stronger evidence for this conclusion.

Human ; Male ; Female ; Middle Aged ; Adult ; Loratadine ; Sneezing ; Statistics, Nonparametric ; Rhinitis, Allergic ; Nose ; Isononanoyl Oxybenzene Sulfonate ; Benzenesulfonates ; Pruritus ; Boraginaceae

OBJECTIVE: To describe the clinical profile of patients with laryngotracheal stenosis over a 7-year period and discuss strategies for its prevention.
METHODS:
    Design: Retrospective Case Series
    Setting: Tertiary Government Hospital
  Participants: Thirteen (13) patients with laryngotracheal stenosis confirmed by laryngoscopy and/or bronchoscopy.
RESULTS: Twenty-one patients were evaluated for laryngotracheal stenosis from January 2008 to June  2015, but only 13 with complete data were included in this study. Of the 13 patients, nine (69.2%) belonged to the pediatric age group. Ten (77%) were males and three (23%) were females. Laryngotracheal  stenosis  following endotracheal  tube  (ET)  intubation  was  seen in 11 (84.6%) while 2 had thyroid masses and no  history  of  prior  ET  intubation.  Presenting symptoms or reasons for referral were wheezing (n=4), stridor (n=4), failure to decannulate the tracheostomy tube (n=3), and dyspnea (n=2). Duration of ET intubation was four to 60 days. The highest frequency of ET re-intubation was 5 times. Among those intubated, stenosis was glottic in one, subglottic in five and tracheal in five patients. Three had Cotton-Myer grade I stenosis, two had grade II, three had grade III and three had grade IV stenosis. Those with thyroid masses had tracheal stenosis.
CONCLUSION: Strategies  for  prevention  of  laryngotracheal  stenosis  should include  routine airway  endoscopy  for  patients  with  longstanding  neck  masses  and  for  those  with  prolonged ET  intubation,  for  whom  the  option  of  early  prophylactic  tracheostomy  is  worth  considering. Otherwise, immediate post-extubation endoscopy may facilitate documentation and appropriate
intervention.

Human ; Male ; Female ; Constriction, Pathologic ; Endoscopy ; Intubation ; Tracheostomy

OBJECTIVES: To report a benign tonsillar lesion presenting as a pedunculated polyp and discuss its diagnosis and management.
METHODS:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
RESULTS: A 14-year-old lad presented with a seven-year history of an elongated right tonsillar mass without  associated  bleeding, pain,  dysphagia or obstructive sleep  apnea.  Physical  examination revealed  a  pedunculated  mass  about  2  x  1  x  0.5cm  in  size  located  in  the  superior  pole.  After unilateral  tonsillectomy, histopathological  examination  revealed  lymphangectatic  lipomatous fibrotic polyp.
CONCLUSION: Lymphangiomatous polyp of the palatine tonsils  is  an  unusual benign lesion of the head and neck. These  are  commonly  present  as  unilateral,  polypoidal  mass  that  cannot be clinically  differentiated  from  other  benign  tonsillar  lesions. Tonsillectomy  is  the  recommended surgical  approach  for  both  diagnostic  and  therapeutic  purposes.  Histopathological  study  must be done to confirm diagnosis.

Human ; Male ; Adolescent ; Palatine Tonsil ; Hamartoma ; Tonsillectomy ; Lymphangioma ; Deglutition Disorders ; Neck ; Head ; Sleep Apnea, Obstructive ; Polyps ; Pain ; Physical Examination

OBJECTIVE: To determine the prevalence of otorhinolaryngologic (ENT) manifestations in people living with Human Immunodeficiency Virus (HIV) infection seen in our institutions and to determine the association of these manifestations with age, sex, CD4 count and antiretroviral treatment.

METHODS:
Study Design: Cross-sectional study

Setting: Two Tertiary Government Hospitals

Subjects: Adult patients (>19 years old) confirmed to be HIV- infected  were seen at Jose R. Reyes Memorial Medical Center and San Lazaro Hospital from February to July 2014. A data sheet regarding ENT manifestations was filled upon examination. Age, sex, CD4 count and antiretroviral treatment data were recorded. Independent samples t-test was used to determine age association with manifestations. Fischer's exact test was used to determine association of sex and manifestations. Chi-square test of independence was used to determine association of CD4 count and antiretroviral treatment with manifestations. Association was considered statistically significant if p< 0.05.

RESULTS: Three hundred one (301) patients participated with 287 males (95.3%) and 14 females (4.7%). The mean age was 31.7 ± 8. One hundred ninety seven (197 or 65.4%) had ENT manifestations. The most common areas of manifestations came from the oral cavity-oropharyngeal area (n=104, 37%), nasal cavity-nasopharyngeal area (n=73, 26%) and ear (n=43, 15%). The most frequent manifestations were cervical lymphadenopathy, aphthous stomatitis and acute rhinitis. There was no significant difference in the age (p=0.31) and sex (p=0.15) of patients with and without manifestations. However, there was a direct association of manifestations with low CD4 count (p<0.001) and inverse association with antiretroviral treatment (p=0.036).

CONCLUSION: Our findings emphasize the importance of screening for ENT manifestations, regular CD4 monitoring and enrollment to antiretroviral therapy in persons with HIV. Baseline otorhinolaryngologic examination upon HIV diagnosis and prior to initiating treatment should be followed by regular surveillance. Conversely, physicians should also be aware that patients with ENT manifestation may have HIV infection.

Human ; Male ; Female ; Adult ; HIV ; Otorhinolaryngologic Diseases ; CD4 Lymphocyte Count ; Anti-Retroviral Agents ; Stomatitis ; Rhinitis

OBJECTIVES: To determine the factors related to spontaneous passage of ingested coins in children.

METHODS:
Design: Retrospective study

Setting: Tertiary Government Hospital

Subjects: The records of 136 pediatric patients with a history of coin ingestion seen at the emergency room department of our institution between December  2012 and May 2014 were retrospectively reviewed. Demographic data such as age and gender of the patient were recorded, including the type of coin, location of coin in the esophagus, time of ingestion and time of spontaneous passage into the stomach (for those that passed spontaneously).

RESULTS: Spontaneous passage in 27 out of 136 pediatric patients with radiographic evidence of a round radio-opaque foreign body initially located in the esophagus eventually passed into the stomach or intestines, accounting for 20% of the total number of cases. Coin ingestion was more common in patients aged 5 to 6 years (33% of cases), with slight male predominance (58%). One peso coins were the most common type of coin ingested, however only 24% of these spontaneously passed. The rate of spontaneous passage was highest in smaller sized coins (5 and 25 centavo coin) compared to larger sized coins (5 peso). Proximally located coins, albeit more common than middle and distally located coins, were the least likely to spontaneously pass (12%). Average time interval from ingestion to passage of the coin was 12 hours.

CONCLUSION: Many factors are related to spontaneous passage of foreign bodies in the esophagus. The age of the patient, type of coin ingested, and initial location of the coin in the esophagus should be considered. Older patients, smaller sized coins, and distally located coins have the highest probability of spontaneous passage beyond the esophagus. A 12-hour observation period may be considered in patients with single esophageal coin ingestion.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Esophagus ; Esophagoscopy ; Eating

OBJECTIVES: To report a case of foreign lodged within the sphenoid sinus and its extraction.METHODS:Design: Case report Setting: Tertiary Government Hospital Patient: OneRESULTS: An 11-year-old girl was hit in the eye by an unknown object from an improvised slingshot. She had loss of vision of the left eye and headache without loss of consciousness. A plain craniofacial Computed Tomography (CT) scan showed a round opaque foreign body abutting the left sphenoid sinus, left posterior ethmoid cells and medial aspect of the left orbital region with adjacent soft tissue densities extending into the apparently ruptured, irregular left globe. The left posterior part of the lamina papyracea was not visualized probably fractured or ruptured. Transorbital enucleation of the left eye and endoscopy-assisted removal of the foreign body (a glass marble) were performed with no intra-operative and post - operative complications.CONCLUSION:Foreign body of the sphenoid sinus is a rare condition. Adequate imaging is important for localization and planning the optimal surgical approach. Endoscopic guidance may aid in extraction.
Human ; Female ; Child ; Sphenoid Sinus ; FOREIGN BODIES ; Tomography Scanners, X-Ray Computed