Objective: To report a case of lingual thyroglossal duct cyst in an elderly man, excised via combined Trotter procedure and hyoid osteotomy.

Methods:
Design: Case Report
Setting: Tertiary Government Training Hospital
Participant: An elderly retired male office worker with dysphagia

Results: The cyst was completely excised via median labiomandibular glossotomy, with hyoid osteotomy providing additional exposure. Our patient was discharged in two weeks after decannulation and remains asymptomatic.

Conclusion: The Trotter procedure with hyoid osteotomy may be a viable alternative to the Sistrunk procedure for large lingual TGDCs.

Objective:To report a case of retrograde cricopharyngeal dysfunction (R-CPD) and the use of
botulinum toxin injection for its diagnosis and therapy.

Methods:
Design:Case Report
Setting:Tertiary Private University Hospital
Patient:An 18-year-old female college student who presented with inability to burp, associated with awkward gurgling noises from the chest, abdominal discomfort and excessive flatulence.

Results:Our patient gained the ability to belch and the relief of associated excessive flatulence and awkward gurgling noises from the chest, after cricopharyngeal muscle Botulinum toxin injection.

Conclusion:Botulinum toxin injection may serve as both a diagnostic and therapeutic intervention for R-CPD.

The Philippine Journal of Otolaryngology Head and Neck Surgerypreviously co published two guest editorials, on “Reducing the Risks of Nuclear War— the Role of Health Professionals”¹and “Time to Treat the Climate and Nature Crisis as One Indivisible Global Health Emergency”²that addressed dual potentially catastrophic concerns that both place us “on the brink.”³

By co-publishing these guest editorials, the Philippine Journal of Otolaryngology Head and Neck Surgery joined the call for “health professional associations to inform their members worldwide about the threat to human survival and to join with the International Physicians for the Prevention of Nuclear War (IPPNW) to support efforts to reduce the near-term risks of nuclear war.”¹As enumerated in the editorial,¹we urged three immediate steps that should be taken by nuclear-armed states and their allies: 1) adopt a no first use policy;⁴2) take their nuclear weapons off hair-trigger alert; and 3) urge all states involved in current conflicts to pledge publicly and unequivocally that they will not use nuclear weapons in these conflicts.It is alarming that noprogress has been made on these measures.

Thus, on our 44th Anniversary, we join over 150 scholarly scientific journals worldwide in co-publishing another Guest Editorial on “Ending Nuclear Weapons, Before They End Us.”⁵We call on the World Health Assembly (WHA) to vote this May on re establishing a mandate for the World Health Organization (WHO) to address the consequences of nuclear weapons and war,6and urge health professionals and their associations (including otolaryngologists – head and neck surgeons, all surgeons and physicians, and the Philippine Society of Otolaryngology – Head and Neck Surgery, Philippine College of Surgeons, Philippine College of Physicians,
Philippine Academy of Family Physicians, Philippine Pediatric Society, Philippine Obstetrical and Gynecologic Society, Philippine Society of Anesthesiology, Philippine College of Radiology, Philippine Society of Pathologists, other specialty and subspecialty societies, and the Philippine Medical Association) to urge the Philippine Government to support such a mandate and support the new United Nations (UN) comprehensive study on the effects of nuclear war.⁷

Otorrheacan result from middle ear discharge with tympanic membrane perforation, external ear canal pathology, skull injury and other serious diseases in trauma and immunocompromised patients.1Thorough investigation is warranted in cases without improvement after treatment. We present a case where fibrous dysplasia was the underlying cause and discuss its treatment.

CASE REPORT
A 41-year-old farmer man consulted at our ENT Outpatient Clinic with a 1-year history of clear, non-foul-smelling discharge from his left ear, associated with intermittent pounding ear pain. A hard immobile nontender prominence was noted over the patient’s left temporal area. (Figure 1) He was initially treated for chronic suppurative otitis media for 3 months. Severe ear pain was noted,
10/10 on pain scale, squeezing in character, radiating to the left temporal and parietal area associated with progressive hearing loss and ear fullness. Plain CT scans revealed a combined lytic and ground glass expansile lesion involving the left occipital, mastoid, and petrous temporal bone and portion of the parietal bone obliterating the external auditory canal and middle ear. (Figure 2)

On physical examination, a hard immobile nontender prominence was noted over the patient’s left temporo-parietal area. No facial asymmetry or numbness was noted. On otoscopy, there was a skin-colored round smooth hard immobile nontender mass in the external auditory canal with non-foul smelling whitish to yellowish purulent discharge. A Weber tuning fork test lateralized to the left and a Rinne test revealed air conduction < bone conduction on the left, and air conduction > bone conduction on the right.

The patient was admitted with an impression of chronic suppurative otitis media, left; to consider fibrous dysplasia vs. tuberculosis. Aerobic culture of ear discharge revealed no growth. Canal down mastoidectomy was done. Intraoperative findings revealed granulomatous and cartilaginous lesions on the mastoid and temporal bone. (Figure 3) There were aural polyps and cholesteatoma with the ossicles apparently eroded by the lesion. (Figure 4) Temporal bone fluid was sent for GeneXpert MTB/RIF while the surgical specimen was sent for histopathology. GeneXpert MTB/RIF revealed negative results for tuberculosis. Final histopathology results showed fibrous dysplasia.

A 52-year-oldintellectually disabled man who had previously undergone a left canal wall down mastoidectomy with cartilage graft tympanoplasty for cholesteatoma 20 years ago presented with new-onset discharge in the contralateral ear. He did not have any symptoms, particularly recurrent discharge, in the post-operative ear, despite infrequent and irregular clinic follow-up for periodic cleaning of the cavity. Clinical examination of the post-operative ear revealed the presence of retained cerumen which was easily removed. The mastoid cavity was noted to have a healthy skin lining, an intact neotympanum, and a smooth bowl-like appearance with no areas that could not be adequately visualized through the surgically widened external auditory meatus. He underwent computerized tomographic imaging of the temporal bone to evaluate the nature and cause of the new-onset discharge in the contralateral ear. This imaging study provided the opportunity to present and describe key post-operative radiologic features of a symptom-free canal-wall down mastoidectomy with tympanoplasty.

A canal-wall down mastoidectomy is a more extensive type of mastoidectomy which, in addition to the resection of the mastoid cortex, all mastoid air cells and Körner septum, is characterized by the resection of the posterior wall of the external auditory canal and scutum. Among the most common causes of failure following this type of surgery are incomplete removal of tegmental air cells and incomplete lowering of the facial ridge.1These two factors can and should be purposefully assessed in a post-operative imaging study.

Adequacy of bone removal in the epitympanum to address the issue of tegmental air cell disease is evaluated on axial CT images at the level of the malleus head-incus body complex and the proximal portion of the tympanic segment of the facial nerve. (Figure 1) All of the bone lateral to the ossicles, especially that overlying the malleus head and anterior epitympanic recess, should have been surgically removed.

On coronal CT images, this same adequacy is demonstrated by the surgical removal of all bone lateral to the epitympanum, from the scutum to the outer cortex, such that there is a clear line of sight from the external auditory meatus to the epitympanum. This helps ensure that there are no pockets of soft tissue medial to any bony ridges; soft tissue that may represent residual or recurrent disease. (Figure 2)

Objective:To determine the association of demographic profiles and clinical characteristics of patients with aural foreign bodies seen at the Emergency Room (ER) of the East Avenue Medical Center with clinical outcomes

Methods:
Design:Cross-Sectional Study
Setting:Tertiary Government Training Hospital
Participants:A total of 143 aural foreign body cases seen at the ER from January to December 2022 under the Department of Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) of East Avenue Medical Center were included in the study.

Results: Of the 143 patients, majority (84; 58.74%) were males. Mean age was 21.92 years old with two peak incidences noted at ages 1-12 years old and 18-65 years old. Most of the patients were right-handed (134; 93.71%). Majority of the foreign bodies were animate (76; 53.15%) and were frequently found to be lodged on the right ear (86; 60.14%) with duration from lodgment to
extraction commonly within less than 24 hours (119; 83.22%). One hundred forty two (99.30%) patients had successful foreign body extraction, 60 (41.96%) had complications, specifically involving the external auditory canal (51; 35.66%) and tympanic membrane (6; 4.20%). Significant associations were found between age and type of foreign body [χ2 (3, N =143) = 31.24, p < .01] with a higher proportion of animate foreign bodies in adults and inanimate foreign bodies in children; sex and presence of complications [χ²(1, N = 143) = 5.41, p < .05] with males experiencing more complications than females; type and duration of foreign body [, χ²(2, N = 143) = 16.33, p < .01] with animate foreign bodies generally having a shorter duration of less than 24 hours compared to inanimate foreign bodies; and the duration of foreign body and presence of TM complications [χ²(4, N = 143) = 14.21, p < .01] with shorter durations (less than 24 hours) showing fewer TM complications. Males had higher odds of developing complications compared to females (OR = 2.315, 95% CI [1.105, 4.851])

Objective:To determine the sensitivity, specificity and positive predictive value of the STOP BANG questionnaire in diagnosing Obstructive Sleep Apnea (OSA) in adults admitted for polysomnography at the Rizal Medical Center from January 2019 to June 2024

Methods:
Design:Review of Records
Setting:Tertiary Government Training Hospital
Participants:166 adult patients

Results:A total of 166 patient records were included with an average age of 35.6 ± 12 years, BMI of 29.3 ± 6.44 and 67% were male. The STOP-BANG questionnaire had a sensitivity of 77% to screen for all (AHI ≥ 5), mild (AHI = 5-14.9), moderate (AHI = 15-19.9), and severe OSA (AHI > 30), respectively. The specificity was 62% and the area under the curve was 0.717 for all, mild, moderate and severe OSA

Conclusion:A STOP-BANG score of 3/8 can predict the presence of OSA with a sensitivity of 77% and specificity of 62% with AUC of 0.717. The increase in score does not predict the severity. Further research can be done to identify other co-morbidities associated with OSA.

Objective:To determine the effectiveness of a one-stage hearing screening protocol in detecting hearing loss in high risk newborns at the Neonatal Intensive Care Unit of the Jose R. Reyes Memorial Medical Center.

Methods:
Design:Cross-Sectional Study
Setting:Tertiary Government Training Hospital
Population:High-risk newborns admitted at the Neonatal Intensive Care Unit of the Jose R. Reyes Memorial Medical Center from March to December 2023 underwent a one stage universal newborn hearing screening protocol. Excluded from the study were patients who were admitted for less than 48 hours, without consent from their parents or guardians and babies who were not cleared medically to undergo testing, and those who presented with aural atresia and/or any physical anomaly of the head and the external ear.

Results:A total of 169 babies were initially seen with 16 babies lost to follow up resulting in a final total of 153 babies (or 306 ears) tested. The refer and false positive rates were 9.8% and 8.92%, respectively, on average comparable to or even better than the two-step protocol in most studies. Sensitivity was determined to be 100% while specificity was 91.08%. The incidence of hearing loss in the study population was 19.8/1000, consistent with various study outcomes for high risk newborns. There was no reported incidence of auditory neuropathy in this study. The primary risk factors that were present in babies with hearing loss were: low birth weight, prematurity, neonatal intensive care unit admission of more than 5 days and exposure to ototoxic medications.

Conclusion:The one-staged Automated Auditory Brainstem Response (AABR) is an effective and efficient newborn hearing screening protocol for high-risk newborns in the Neonatal Intensive Care Unit (NICU) setting and eventually, may be considered as an alternative hearing screening technique whenever available in this cohort. More studies about improving newborn hearing screening, cost-analysis, diagnostics and interventions of hearing loss should be pursued in implementation of the Universal Hearing Screening Law in the Philippines.

Objective:To describe a low-cost, reproducible phantom model for training medical practitioners in ultrasound-guided ethanol ablation (EA) of a cystic thyroid nodule.

Methods:The model of cyst contents was created using a mixture of coffee powder, cornstarch and water to mimic colloidal contents. This was injected into the finger of a cut surgical glove secured with transparent tape to serve as an inflatable capsule and placed inside a chicken breast. This setup allows practitioners to perform key ultrasound-guided ethanol ablation techniques including spinal needle insertion, cyst aspiration, saline flushing, re-aspiration and ethanol injection.

Results:The phantom model was assembled for PhP 150.30 per unit and took approximately 5 minutes to construct. This model was demonstrated to be a cost-effective and simple method for enabling specialists to practice and enhance their skills in ultrasound-guided ethanol ablation of a cystic thyroid nodule.

Conclusion:The described phantom model provides an accessible and practical training tool for healthcare providers to gain proficiency in ultrasound-guided ethanol ablation of a cystic thyroid nodule in a safe and controlled setting prior to actual patient handling.

Objective:To describe the radiologic dimensions of the Eustachian tube (pre-tympanic diameter, tubo-tympanic angle, and Eustachian tube angle) among normal ears, ears with chronic otitis media (COM) with and without cholesteatoma, in a sample of Filipino adults with COM; and to compare the dimensions of the three variables.

Methods:
Design:Retrospective Review of Records
Setting:Tertiary Government Training Hospital
Participants:The study included 69 CT scans of adults with COM, with images of 23 ears for each variable (normal ears, COM with and without cholesteatoma formation).

Results:In normal ears, the average pre-tympanic diameter was 3.976 ± 0.78 mm, the average tubo-tympanic angle was 41.529 ± 5.85 degrees, and the average Eustachian tube Angle (Reid Plane) was 27.077 ± 4.62 degrees. In patients with COM without cholesteatoma, the mean pre tympanic diameter was 4.002 ± 1.13 mm, the mean tubo-tympanic angle was 141.994 ± 6.30 degrees, and the mean measurement of the Reid plane was 24.649 ± 3.10 degrees. In ears with COM with cholesteatoma, the mean pre-tympanic diameter was 4.1993 ± 0.50mm, the mean tubo-tympanic angle was 138.789 ± 7.13 degrees, and the mean Reid plane was 26.483 ± 3.86 degrees. P-values for the pre-tympanic diameter, tubo-tympanic angle, and ET angle were .617, .198, and .098 respectively, indicating that there were no statistically significant differences in the ET dimensions of the ears with COM with cholesteatoma, without cholesteatoma and normal ears.

Conclusion:In our investigation, we found no statistically significant differences in Eustachian tube dimensions among individuals with normal ears and COM with or without cholesteatoma. This suggests that the Eustachian tube dimensions may not serve as a primary etiological factor for COM among our patients.