BACKGROUND

The National Cochlear Implant Program (NCIP) is a national program to address the increasing prevalence of hearing loss, especially in the pediatric population here in the Philippines. In its pilot implementation, it included three tertiary hospitals to represent Luzon, Visayas, and Mindanao and was able to enroll 20 patients who successfully underwent cochlear implantation.

OBJECTIVES

The aim of this study is to evaluate the auditory outcomes of the patients who underwent cochlear implantation under the NCIP using the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) Questionnaire and Categories of Auditory Performance (CAP) score questionnaire.

METHODS

The study included all recipients of the cochlear implants, under NCIP from December 2019 to December 2021, except 1 with incomplete data during the course of his followup. The outcomes measured included the PEACH Questionnaire score and CAP Questionnaire score and were compared on various factors which included patient's sex and age, parents'  socioeconomic status, duration of hearing aid use prior to CI, pre CI imaging findings and CI electrode placement using nonparametric statistical tests .

RESULTS

The mean PEACH score of the 19 patients was 53.59% ± 12.76% (range: 30% - 75%) while the mean CAP score was 3.16 ± 1.04 (range: 1 - 4.3). Parents of the included patients who have a higher educational background and those in which the electrode was located on the ideal location, scala tympani, have a statistically significant higher PEACH score (p-value of 0.017 and 0.012, respectively). In comparing the CAP scores, those who have unremarkable or normal preoperative imaging have a statistically significant higher score (p-value 0.013)

CONCLUSION

Patients who had normal preoperative imaging, proper placement of electrodes and those patients with parents belonging to a higher educational background had statistically significant better auditory outcomes after cochlear implantation. Patients who had the cochlear implantation before 36 months of age and hearing aid use of 7 to 18 months prior to cochlear implantation had higher PEACH and CAP scores, however these were not statistically significant. Further studies with a larger sample size is recommended.

Cochlear Implantation

Objectives: The purpose of this prospective case series was to describe the difference in cure rates between a 6-month and a 9-month anti-tuberculous treatment regimen in patients with newly diagnosed tuberculous cervical lymphadenitis. Methods: Thirty-eight consecutive participants were enrolled in the study. Thirty participants were ultimately analyzed at the end of six months, nine months, and 12 months using serial neck ultrasound to assess for the presence of lymphadenopathy. At the end of six months, participants with residual lymphadenopathy larger than 1 cm extended treatment to complete nine months of treatment. Results: Among the 30 participants who completed 6-month treatment, 63.3% (n=19) were cured while 36.7% (n=11) had residual lymphadenopathy and extended to 9-month treatment. At the end of 9-month treatment, 36.4% (n=4) were cured while 63.6% (n=7) had persistent lymphadenopathy greater than 1 cm on ultrasound. At 12 months, 15.8% (n=3) of those treated for six months and 45.5% (n=5) of those treated for nine months had recurrent/residual lymphadenopathy. There were no significant differences between cure rates for age, sex, concomitant pulmonary tuberculosis, the number of nodes, skin changes, TB-PCR results, and presence of paradoxical reaction whether at six or at 12 months. Conclusion Due to the low cure rates in this study, there was not enough evidence to support current recommendations of a 6-month treatment period for tuberculous cervical lymphadenitis or to claim its effectiveness over a longer treatment duration.
tuberculosis ; lymph node ; antibiotics ; Anti-Bacterial Agents

Background: The National Cochlear Implant Program (NCIP) is a national program to address the increasing prevalence of hearing loss, especially in the pediatric population here in the Philippines. In its pilot implementation, it included three tertiary hospitals to represent Luzon, Visayas, and Mindanao and was able to enroll 20 patients who successfully underwent cochlear implantation. Objectives: The aim of this study is to evaluate the auditory outcomes of the patients who underwent cochlear implantation under the NCIP using the Parents' Evaluation of Aural/Oral Performance of Children (PEACH) Questionnaire and Categories of Auditory Performance (CAP) score questionnaire. Methods: The study included all recipients of the cochlear implants, under NCIP from December 2019 to December 2021, except 1 with incomplete data during the course of his followup. The outcomes measured included the PEACH Questionnaire score and CAP Questionnaire score and were compared on various factors which included patient's sex and age, parents' socioeconomic status, duration of hearing aid use prior to CI, pre CI imaging findings and CI electrode placement using nonparametric statistical tests. Results: The mean PEACH score of the 19 patients was 53.59% ± 12.76% (range: 30% - 75%) while the mean CAP score was 3.16 ± 1.04 (range: 1 - 4.3). Parents of the included patients who have a higher educational background and those in which the electrode was located on the ideal location, scala tympani, have a statistically significant higher PEACH score (p-value of 0.017 and 0.012, respectively). In comparing the CAP scores, those who have unremarkable or normal preoperative imaging have a statistically significant higher score (p-value 0.013). Conclusion Patients who had normal preoperative imaging, proper placement of electrodes and those patients with parents belonging to a higher educational background had statistically significant better auditory outcomes after cochlear implantation. Patients who had the cochlear implantation before 36 months of age and hearing aid use of 7 to 18 months prior to cochlear implantation had higher PEACH and CAP scores, however these were not statistically significant. Further studies with a larger sample size is recommended.
cochlear implantation

Background: Universal newborn hearing screening is mandated in the Philippines through the Universal Newborn Hearing Screening and Intervention Act of 2009 (RA 9709). Newborn hearing screening (NBHS) centers are required to perform screening tests, compile and submit data on screened newborns, and advise parents on the subsequent steps after NBHS. Objective: The study aimed to conduct a survey of the implementation of the Universal Newborn Hearing Screening and Intervention Program (UNHSIP) in the different regions of the country; and assess the information technology (IT) capabilities of hearing centers. Methods: Fifty-one NBHS centers across twelve regions were surveyed through on-site inspections in 2016. Data was gathered on the centers’ testing capability, staffing, access to specialists, use of local protocols, connectivity, and IT capabilities. Results: All surveyed centers followed the recommended protocols of the Manual of Operations of the Universal Newborn Hearing Screening and Intervention Act of 2009 (RA 9709). Among the 12 regions visited, only five (41.67%) had Category C centers with confirmatory testing and early amplification services as recommended. Majority of facilities (96.1%) were staffed by trained and certified personnel. A small percentage had access to subspecialists such as clinical audiologists (39.2%) and speech-language pathologists (23.5%). All facilities had computer access, but only 58.8% had internet access. Majority (94.1%) of the centers visited were not using the recommended data submission methods, specifically the use of registry cards and the online registry. Only 27.5% of centers had data on newborns who underwent confirmatory testing or early intervention. Conclusion Facilities were found to be compliant to NBHS screening protocols and majority complied with certification requirements for staff; but were found to be non-compliant with use of registry cards or the online registry. Majority of centers were able to contact the parents of neonates who did not pass newborn screening, but had no system to track outcomes. Lack of confirmatory and early intervention services in identified areas emphasize the need for development of regional centers. It is recommended that measures to improve the utilization of the online registry are taken.
Neonatal Screening

Objectives: We present in this article the design and evaluation of a blended learning approach for training community healthcare providers in performing newborn hearing screening (NHS). Methods: We developed a blended learning course for training community healthcare providers on eHealth-enabled NHS, following Bloom’s revised taxonomy of educational objectives. The training involved three components: computer-based training (CBT), face-to-face (FTF) training, and on-site coaching. We used surveys and post-training interviews following Level 1 Kirkpatrick’s training evaluation model to get initial feedback on the training program. Results: Thirty-one community healthcare providers from five rural health units and a private hearing screening center, with a mean age of 42.2 ± 12.0 years, participated in the pilot. 93.5% of the participants agreed that the program content met stated objectives and was relevant to their practice. The length of the course was perceived to be adequate. Overall satisfaction with the program was rated at 8.5 ± 0.9 (with ten as the highest). The majority expressed that the CBT and FTF course were satisfactory at 93.5% and 100%, respectively. All participants agreed that the course enhanced their knowledge of newborn hearing screening and telehealth. Positive reviews were received from participants on the use of CBT to improve theoretical knowledge before FTF training. Participants declared that FTF training and on-site coaching helped improved NHS skills and implementation. Conclusion Competent community healthcare providers are critical to strengthening the performance of the health system, and advances in the education and technology sectors offer promising potential in upskilling local healthcare providers. The increasing access of Filipino healthcare providers to improved information and communications technology (ICT) is a significant catalyst for pedagogical innovation, like the use of blended learning in the continuous professional development of health practitioners. As ICTs gradually penetrate the health sector, the challenge we now face is not whether but how we can use innovations in education strategies to benefit healthcare providers.
Infant, Newborn ; Telemedicine

The authors report a case of post-tonsillectomy dysgeusia and discuss the pathogenesis, diagnostics, as well as treatment options done in several reported cases. A 37-year-old man who was diagnosed with recurrent tonsillitis underwent bilateral palatine tonsillectomy, and on the second post-operative day, post-tonsillectomy hemorrhage ensued which required emergency hemostasis at the operating room. Intra-operative findings include active bleeding on the left tongue base, wherein hemostasis was achieved via electrodissection. After the procedure, patient noted a disturbance to taste that persisted for several months. Dysgeusia is an unusual complication of tonsillectomy, occurring in 0.3% to 9% of cases.
Tonsillectomy ; dysgeusia

BACKGROUND: In 2000, the World Health Organization recommended implementation of universal hearing screening. The Philippines enacted this policy into law in 2009 as it was found to be cost-effective for the Philippines. The model at the time used a hospital-based approached to screening. This paper examines the cost-effectiveness and budget impact of implementing a community-based universal hearing screening program.
METHODS: A model was developed following a community-based hearing screening program. Parameters were obtained through literature review, secondary data analysis, and consultation with experts. Cost-effectiveness was assessed for a single birth cohort from a public payer and societal perspective.
RESULTS: A community-based universal hearing screening program was found to be cost-saving. One-way sensitivity analysis showed that results were sensitive only to treatment rate and follow-up rate. The program is also a high budget impact program.
CONCLUSION: A community-based hearing screening program is cost-saving for the Philippines. Ensuring treatment and good follow-up in testing will ensure cost-effectiveness.

Hearing Loss ; Cost-Effectiveness Analysis

OBJECTIVES: To discuss a rare case of temporal bone capillary hemangioma and its diagnosis and management.
METHODS:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One
RESULTS: A 44-year-old woman with a history of on-and-off right ear discharge, tinnitus and decreased hearing, and a pinkish, smooth-surfaced, non-friable, non-pulsating mass occluding the right external auditory canal, was initially treated for chronic suppurative otitis media with aural polyp. A punch biopsy due to persistence of disease despite medical treatment revealed capillary hemangioma. She underwent canal wall down mastoidectomy with obliteration to completely resect the tumor.
CONCLUSION: Capillary hemangiomas of the temporal bone are benign lesions that may lead to complications such as bone erosion, hearing loss, recurrent infection and bleeding if left untreated. Surgery remains the ideal treatment and recurrence is rare and the prognosis is good if resection is complete.

Human ; Female ; Middle Aged ; Ear Canal ; Otitis Media, Suppurative ; Tinnitus ; Hearing Loss ; Temporal Bone ; Deafness ; Mastoid ; Hemangioma, Capillary ; Prognosis ; Biopsy ; Polyps

BACKGROUND: Medication errors are preventable events that can cause or lead to inappropriate drug use. Knowing the prevalence and types of errors can help us institute corrective measures and avoid adverse drug events.
OBJECTIVE: This study determined the prevalence of medication errors and its specific types in the four main service wards of a tertiary government training medical center.
METHODS: This is a retrospective, descriptive chart review study. From the master list of admissions, systematic sampling was done to retrieve the required number of charts. Relevant pages such as order sheets, nurses' notes, therapeutic sheets were photographed. For prolonged admissions, only the first 7 days were reviewed. Each chart was evaluated by two people who then met and agreed on the errors identified.
RESULTS: The overall prevalence of medication errors is 97.8%. Pediatrics had the most (63.3/chart), followed by Medicine, OB-Gynecology, and Surgery (7.3/chart). The most common type of errors identified were prescribing, followed by compliance, then administration errors.
CONCLUSION: Medication errors are present in the four main wards in our hospital. We recommend orientation of all incoming first year residents on proper ordering and prescribing of drugs, as well as a prospective observational study to determine true prevalence of all types of medication errors.

Medication Errors

OBJECTIVE: To present an unusual cause of pulsatile tinnitus, presenting in a young adult suffering from chronic recurrent foul-smelling discharge from the same ear.
METHODS:
Design: Case Report
Setting: Tertiary National University Hospital
Patient: One
RESULTS: A 24 year-old woman presented with pulsatile tinnitus on a background of chronic recurrent foul-smelling discharge. Clinico-radiologic findings seemed consistent with a glomus tympanicum coexisting with chronic suppurative otitis media with cholesteatoma. She underwent tympanomastoidectomy with excision of the mass. Histopathologic evaluation revealed the mass to be granulation tissue.
CONCLUSION: Pulsatile tinnitus is rarely associated with chronic middle ear infection. Granulation tissue arising at the promontory may mimic glomus tumors when accompanied with this symptom. Despite this revelation, it would still be prudent to prepare for a possible glomus tumor intraoperatively so that profuse bleeding and complications may be avoided.

Human ; Female ; Young Adult ; Earache ; Headache ; Vertigo ; Glomus Tumor ; Cholesteatoma