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.

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.

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 .

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)

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.

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

Objective: To compare outcomes of COVID-19 positive and COVID-19 negative patients who underwent tracheostomy for prolonged intubation in terms of weaning duration, length of ICU and hospital stay, overall and 30-day mortality, and explore risk factors for particular outcomes (mortality, 30-day mortality and weaning duration post tracheostomy). Methods: Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Participants: Of 122 adult patients that underwent tracheotomy between March 30, 2020 and March 30, 2021; 76 adult patients underwent tracheostomy for prolonged intubation were analyzed. Results: Open tracheotomy was performed on 122 adult patients. Seventy six (62.3%) due to prolonged intubation and 46 (37.7%) for airway prophylaxis. Among the former, the mean age was 58.46±16.81 and 54 (71.05%) patients were female, 22 (28.95%) tested COVID-19 positive and 54 (71.05%) tested negative. Mean APACHE II score was 16.62±6.78. Average days of intubation prior to tracheostomy was 29.14±17.66 days. No statistically significant difference in outcomes (weaning days, length of stay, days discharge from ICU and hospital, 30-day mortality, days to death) were noted between COVID19 positive and negative patients who underwent tracheostomy for prolonged intubation. Mortality rates post tracheostomy in this institution appear to be higher than existing literature. On multiple linear regression analysis, days of intubation prior to tracheostomy was associated with increased weaning time post-tracheostomy (OR: 0.35 CI:0.18-0.51 95% p = <.001). This implies that for every additional day of intubation prior to tracheostomy, weaning days increase by 0.35 of a day. Conclusion Outcomes of COVID-19 compared to non-COVID-19 patients undergoing tracheostomy for prolonged intubation do not seem to be significantly different which is consistent with existing literature.
COVID-19 ; tracheostomy

Objectives: To develop our own qualitative fit test kit and protocol for respirators and validate this against the manufacturer-issued kit. Methods: This is a crossover study of 50 healthcare workers in a tertiary government hospital. Some healthcare workers were tested multiple times according to the number of respirators they want tested. Qualitative fit testing was done according to manufacturer protocol for the commercial kits or according to our own protocol for the novel kits. Results: A total of 63 fit tests were analyzed. This novel kit was determined to be noninferior to manufacturer-issued kits in detecting leaks among worn respirators (p=0.005). Conclusion A fit test kit can be successfully created from readily available household and hospital materials. Fit tests with these novel kits using our validated protocol are shown to be noninferior to commercial test kits. This can greatly aid in qualitative fit testing of respirators in a logistically constrained pandemic setting.
healthcare workers ; respirators ; SARS-CoV-2

ABSTRACT

Objectives: To determine the prevalence of dysphonia, defined as any perceived voice pathology, in conventional cigarette smokers and e-cigarette users and to quantify and compare the Filipino Voice Handicap Index (VHI) scores of the two groups based on the mean scores for each of the three domains of this tool, as well as the mean total score for each group.

Methods: 

Design: Cross-sectional study

Setting: Tertiary National University Hospital

Participants: 52 adults between the ages 18-65 with no previously known laryngeal illness or condition were divided into 26 conventional smokers and 26 e-cigarette users and completed the self-administered Filipino Voice Handicap Index.

Results: The prevalence of impairment in the sample using a total VHI score cut-off of 18 was 17.31% (9 out of 52, CI 8.23-30.32%) and the prevalence of dysphonic symptoms in the sample was 86.54% (45 out of 52, CI 74.21-94.41%). There were no significant differences between smokers and e-cigarette users for impairment using this cut-off (z: -1.36, p: .07) and dysphonic symptoms (z: 0.4063, p: .68). The prevalence of moderate impairment was 3.85% (1 out of 26, CI: 0.10-19.64%) among those using e-cigarettes; and 1.92% (1 out of 52, CI: 0.04-10.26%) among the entire sample population.

Conclusion: There appears to be no statistically significant difference between the Filipino VHI scores of conventional smokers and e-cigarette users. Further inquiry into the subject would benefit from a larger sample size, comparison with a control group, inclusion of other factors relevant to the development of dysphonia, and correlation with objective means for voice analysis.

Objective: To describe the initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis in our institution. Methods: Design: Case Series Setting: Tertiary National University Hospital Participants: 17 Patients Results: Seventeen (17) patients who underwent transoral posterior cordectomy and partial arytenoidectomy using carbon dioxide laser were included in the study consisting of 14 females and 3 males. Iatrogenic injury was the most common cause of bilateral vocal cord paralysis in this subset of patients. Five patients who tolerated decannulation and another six who had no preoperative tracheostomy all reported subjective improvement in breathing. All of them were also observed to have resolution of stridor and increased respiratory comfort compared to their preoperative condition. The most common postoperative complication was granuloma formation at the medial arytenoidectomy site occurring only in 4 patients. None of the patients complained of aspiration episodes or dysphagia during the postoperative period. Conclusion Our initial experience with transoral endoscopic posterior cordectomy and partial arytenoidectomy using carbon dioxide laser has good postoperative outcomes among patients with bilateral vocal cord paralysis.
Human ; Male ; Paralysis ; Vocal Cord Paralysis ; Vocal Cords ; Carbon Dioxide ; Tracheostomy ; Voice Quality

Objectives: The purpose of this study was to determine the efficacy of proton pump inhibitor (PPI) therapy in treating the symptoms and laryngeal findings of laryngopharyngeal reflux (LPR). Methods: Placebo-controlled, randomized clinical trials published after June 2001 to January 2021 which used PPI as the sole intervention and the RSI or RFS as outcome measures were eligible for inclusion. Studies that were published prior to June 2001, those which only made use of questionnaires other than the RSI or RFS, those which used PPI in combination with other treatments, or those with unavailable full-text manuscripts were excluded. These studies were identified from MEDLINE, Scopus, Cochrane Library, Embase, and HERDIN Plus databases which were searched from May 21 to 26, 2020. The primary outcome was the mean difference between baseline/pre-treatment and post-treatment RSI scores for both PPI and placebo groups. The secondary outcome was the mean difference between pre-treatment and post-treatment RFS scores for PPI and placebo groups. Aggregate results of these outcomes were analyzed using forest plots. Heterogeneity was determined through prediction intervals. Risk of bias of individual studies was assessed using the Cochrane Collaboration’s Tool in Assessing Risk of Bias. Results: Nine randomized control trials were included with a total of 737 patients randomized and 595 patients analyzed – 294 from the PPI group and 301 from the placebo group. There were notable variations among the studies in terms of choice of PPI, dosage and frequency. Out of nine studies, four used both RSI and RFS in their analysis. Two studies used RSI alone and three used the RFS in combination with symptom questionnaires other than the RSI. There was a significant decrease in the RSI of the PPI group versus the placebo group with a mean difference of -2.83 (95% CI, -5.13 to -0.53, p = .02). However, there was no significant decrease in the RFS between PPI and placebo groups with a mean difference of -0.84 (95% CI, -2.66 to 0.98, p = .37). For two clinical trials which only reported post-treatment RFS, there was also no significant difference between the two treatment groups with a mean difference of 1.27 (95% CI, -0.22 to 2.76, p = .10). Conclusion This meta-analysis found that, although a statistically significant benefit in RSI was noted with PPI therapy, this difference may not translate to a clinically significant change in symptoms; therefore, there is insufficient evidence to recommend for or against the treatment of LPR with PPIs.
Laryngopharyngeal Reflux ; Proton Pump Inhibitors ; Laryngitis ; Hoarseness

Objectives: To develop our own qualitative fit test kit and protocol for respirators and validate this against the manufacturer-issued kit. Methods: This is a crossover study of 50 healthcare workers in a tertiary government hospital. Some healthcare workers were tested multiple times according to the number of respirators they want tested. Qualitative fit testing was done according to manufacturer protocol for the commercial kits or according to our own protocol for the novel kits. Results: A total of 63 fit tests were analyzed. This novel kit was determined to be noninferior to manufacturer-issued kits in detecting leaks among worn respirators (p=0.005). Conclusion A fit test kit can be successfully created from readily available household and hospital materials. Fit tests with these novel kits using our validated protocol are shown to be noninferior to commercial test kits. This can greatly aid in qualitative fit testing of respirators in a logistically constrained pandemic setting.
Health Personnel ; Ventilators, Mechanical ; SARS-CoV-2