Objectives: To determine the initial clinical diagnoses of patients with tuberculous otitis media (TBOM), to determine the value of PCR test, biopsy, and ancillary diagnostic procedures in detecting middle ear TB infection, and to establish the differences in treatment outcomes. Methods: The clinical records of twenty-eight patients identified with middle ear TB infection by PCR test and biopsy, from January 2010 to December 2016, were reviewed to determine their initial clinical diagnoses. The positivity rates of PCR test and biopsy were compared. The records of 12 patients included in a previous publication were revisited and included in the present study population. The combined cases were classified according to clinical diagnosis to constitute a summary of demographic characteristics, clinical diagnoses, laboratory tests, and treatment outcomes. Results of diagnostic and surgical procedures were reviewed and analyzed. Clinical findings and hearing test results before and after treatment were compared. Results: Of the 28 patients, eight different clinical diagnoses of patients confirmed with middle ear TB were determined. PCR test diagnosed most cases belonging to the early and chronic stages of the disease process. Biopsy diagnosed mostly the chronic cases but failed to diagnose acute cases and late cases with diagnosis of chronic suppurative otitis media with cholesteatoma. By including the twelve cases that were published in 2011, the range of clinical diagnoses was expanded and an outcome of eleven clinical diagnoses confirmed with TB infection was established. Analysis of treatment outcomes showed that the clinical and hearing outcomes were better for patients managed at the early stage of the disease than for those presenting at the late stages of the disease process who underwent more complicated surgical procedures. Conclusion Our study supports the concept of tuberculous otitis media (TBOM) clinical spectrum, implying a paradigm shift in the established thinking that TBOM presents only as a chronic disease. The combined use of PCR and biopsy is a potential diagnostic tool to improve case detection rate, further broaden the scope of the clinical spectrum, and develop better control and preventive strategies for TBOM.
Otitis Media, Suppurative ; Polymerase Chain Reaction

Literature has reported the existence of cholesteatoma in chronic suppurative otitis media with tuberculosis. This report demonstrates that a cholesteatoma can be associated with an acute otitis media with tuberculosis. The importance of a high index of suspicion for tuberculous otitis media and its consequent meticulous management including diagnostic tests, medical and surgical procedures and monitoring are discussed.

Tuberculosis ; Cholesteatoma

OBJECTIVES: To determine the effect of age, ex and body index on selected static tests of balance and to generate referance normtive data among the different population groups.

METHODS: In this cross-sectional study, 100 asymptomatic normal adult Filipino volunteers, aged 20 to 69 years were tasked to perform selected static balance tests. These tests included classic Romberg (CR), Romberg with Jendrassik (RJ) maneuver, tandem Romberg (TR), standing on foam with feet apart (SOFFA), standing on foam with feet together (SOFFT) and standing on one leg (SOL). All tests were done with eyes opened (EO) followed by eyes closed (EC) for 30 seconds each. Volunteers were grouped into age groups by decades, normative values were obtained and effects of age, sex and body mass index, if any, on performance of the various tests were determined.

RESULTS: All volunteers were able to do the CR and RJ maneuver for 30 seconds. All were able to perform for 30 seconds the TREO, SOFFA EO and SOFFT EO procedures. Some volunteers were unable to complete the TREC, SOFFA EC, SOFFT EC, SOL EO and SOL EC procedures. The mean performance duration values for TREC, SOFFA EC, SOFFT EC, SOL EO AND SOL EC were significantly negatively correlated with age. Although majority of tests were negatively correlated with body mass index, the correlations were not statistically significant.

CONCLUSION: Age significantly affects selected static balance performance whereas sex and body mass index do not significantly affect selected static balance performance. The normative values generated in this study are inconclusive because of inadequate sample size, particularly in the older age group. The results, however, showed the potential value of the 5th percentile as a normative norm in systematically assessing the involvement of the vesticular, visual and proprioceptive organs i balance function.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Sample Size ; Body Mass Index ; Posture ; Foot ; Volunteers

OBJECTIVE: The purpose of this review is to improve the detection of TB otitis media cases and its treatment outcome by describing the varied clinical presentations, discussing the importance, limitations and frontiers of possible diagnostic tests and illustrating the roles of medical and surgical interventions

METHOD: A review of available literature was done. The search included published researches on TB Otitis Media and related articles on tuberculosis.

RESULTS: The review included aspects of the clinical presentation, diagnostic considerations, and treatment options, both medical and surgical, of tuberculous otitis media.

CONCLUSION: Tuberculous otitis media presents with a variety of clinical features so that a high index of suspicion is very important. Diagnostic examinations are available but are varied depending on the clinical presentation. Definitive treatment is mainly medical with anti- Koch's medications.

Diagnostic Tests, Routine ; Otitis Media ; Tuberculosis ; Treatment Outcome ; Research

OBJECTIVES. The goal of the study is to find a reasonable aIternative test that can be utilized in the Philippine setting to operationalize the Universal Newborn Hearing Screening Act. Thus the components of the Voice Test were studied. The objectives of the study are to determine: (1) which of the two words "Baah" and "Psst" is better for newborn hearing screening rocedure as far as their physical characteristics are concerned, ~) how do the two words "Baah" and Psst" differ between genders and distance from sound source, (3) to determine the proportion of the participants who could recite the words at intensity of 80db or louder.

METHODS. Frequency characteristics and sound intensity differences of two words "Baah" and "Psst" were determined and ompared.

RESULTS. The word "Baah" exhibited more favorable physical attributes over the word 'Psst" for purposes of being a screening tool for newborn hearing assessment.

CONCLUSION. This study reports the results of an initial step in the search for an inexpensive, feasible, and valid tool for neonatal earing screening. Correlation studies with speech developmental milestones may eventually enhance the usefulness of the voice test.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Neonatal Screening ; 1012-s-acetamide Adipic Hydrazide Sepharose 4b ; Benzodiazepines ; Sepharose

Objective: To determine the prevalence of hearing loss among infants six months old and below sent for newborn hearing screening in our institution, and to measure the accuracy, sensitivity, specificity and positive predictive values of reflexive behavioral (“Baah”) test in detecting hearing loss in infants. Methods: Design: Cross-sectional study Setting: Ear Unit of a tertiary government hospital Participants: Infants less than Six months old sent for newborn hearing screening at the Ear Unit of a tertiary government hospital from April to September, 2011 were recruited. All participants were tested with OAE for hearing screening. OAE was also used as the standard for evaluating hearing impairment. The reflexive behavioral (“Baah”) test was then done using the human voice as a loud sound stimulus, and the response recorded were auropalpebral, startle and blinking response to the sound. The sensitivity, specificity, accuracy, positive and negative predictive value of the test was then measured. Results: From April to September 2011, a total of 101 patients were tested, with a male to female ratio of 1.1:1 (53 males, 48 females). The prevalence of hearing impairment in this study population was 6.9% (7 out of 101). The reflexive behavioral (“Baah”) test was found to have sensitivity of 71.4%, specificity of 95.7%, accuracy rate of 94%, positive predictive value of 55.6% and negative predictive value of 97.8%. Conclusion The reflexive behavioral (“Baah”) test shows potential as an accurate, acceptable and cost-effective screening tool to identify infants that may be at higher risk for hearing impairment. This test may aid the health care providers, in areas without OAEs, in identifying infants who are in need further hearing diagnostic evaluation, with OAEs or other hearing tests. It is recommended that the “Baah” test be implemented in the community to test its reproducibility in a larger population and outside the hospital setting.

Objective: To calculate the accuracy, sensitivity, specificity and positive predictive values of the Siemens HearCheck™ Navigator in detecting hearing loss and to compare values of these parameters when the examination is done in a soundproof booth and in a quiet room. Methods: Design: Analytical, cross-sectional study Setting: Tertiary Public University Hospital Patients: Patients seen at the Ear Unit of a tertiary public university hospital from June 2009 to August 2010 were tested using the Siemens HearCheck™ Navigator and pure tone audiometry, inside a soundproof audiometry booth and in a quiet room with an ambient noise of 50dB, with a different investigator for each examination. Each ear was treated as a separate subject. Results obtained from the HearCheck™ Navigator were designated as observed values and were classified as “no hearing loss” for green light, and “with hearing loss” for yellow or red lights. Results were compared with pure tone air conduction averages designated as gold standard values. Normal hearing acuity (0-25 dB) was classified as no hearing loss. Pure tone air conduction averages of 26dB and above were classified as “with hearing loss” and were further stratified as mild hearing loss (26-40dB) and moderate or worse hearing loss (>41 dB). Observed and gold standard values were compared and tabulated in a 2x2 table for all levels of hearing loss, mild hearing loss, and moderate or worse hearing loss. Accuracy, sensitivity, specificity, positive and negative predictive values of the Siemens HearCheck™ Navigator inside a soundproof audiometry booth and in a quiet room were determined using pure tone audiometry as the gold standard. Results: 100 patients (200 ears) were tested, with a median age of 43 years old (range 15-75), and an almost equal number of male and female participants (52 males, 48 females). Accuracy rate of the Siemens HearCheck™ Navigator inside the soundproof audiometry booth and in a quiet room were 82.5% and 84% respectively for all levels of hearing loss. Sensitivity, specificity, positive and negative predictive values were similar whether the examination was done inside the soundproof audiometry booth or in a quiet room. These values were notably higher in patients with moderate or worse hearing loss compared to patients with mild hearing loss. Conclusion The Siemens HearCheck™ Navigator shows potential as an accurate, portable, easy-to-use tool to screen for hearing loss, especially for cases of moderate or worse hearing loss, without the need for soundproof audiometry booths or special training. It is recommended that further studies be done to differentiate degrees of hearing loss, and to evaluate its usefulness in other target populations, including school children and the elderly.
Hearing Loss

OBJECTIVES:To determine the agreement between 1) ear examination findings of the otorhinolaryngologist using an otoscope and trained elementary school nurses using a penlight, 2) hearing screening findings of the otorhinolaryngologist and elementary school nurses, both using the Philippine National Ear Institute (PNEI) Method of 512 Hz Tuning Fork Test (TFT) and 3) PNEI Method of 512 Hz TFT findings and screening audiometry findings.
METHODS:In this continuing study, nurses residing in the venue of the study, and previously trained in ear examination using a penlight and hearing screening using the PNEI 512 Hz TFT, conducted these in school children who attended the hearing screening and medical mission. Otoscopy, PNEI Method of 512 Hz TFT, and screening audiometry were then conducted on the children by the otolaryngologist. The nurses and the otolaryngologist performed independent and blinded assessments.
RESULTS:Eighteen nurses and ninety children participated in the study. Data subjected to Kappa statistics showed good agreement between nurses and otorhinolaryngologist's findings in the examination of the external canal and tympanic membrane and in PNEI Method of 512 Hz TFTs, and between the PNEI Method of 512 Hz TFT and screening audiometry.
CONCLUSION:PNEI methods of penlight ear examination and 512 Hz TFT may be effective tools for early detection of common ear conditions and hearing screening in Filipino school children. These may be conducted in the school setting not only by otorhinolaryngologists but also by adequately trained school nurses.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Diagnosis ; Nurses ; Hearing ; Audiometry ; Child ; Ear Diseases ; Early Diagnosis ; Humans ; Otolaryngologists ; Otoscopes ; Otoscopy ; Philippines ; Religious Missions ; Schools ; Tympanic Membrane ; Hearing Tests

Background: The Philippine National Ear Institute (PNEI) was created to promote health of hearing and balance among Filipinos. Over the years, it has provided audiologic services to thousands of patients annually and has published relevant hearing and balance research. Objective: To describe the patients served by the PNEI in terms of age, region of origin, occupation, pretest diagnosis, and audiologic results. Methods: Study Design - Cross-sectional study Setting - National tertiary care center Population - All records of patients referred for audiologic testing at PNEI in 2006 were reviewed and encoded into analyzable format. Results: A total of 1,756 patients had audiologic records for review. Median age was 32.5 years, with the age distribution presented according to sex, type of tests done including common reasons for referral, and median threshold levels by frequency. Coverage was national in scope, with most patients coming from the National Capital Region and from Regions III and IVa. Occupation was indicated in 37.8 percent of the working age group, most of whom were unemployed. The most common pretest diagnosis was chronic otitis media (26.6 percent), followed by hearing loss of unknown etiology (13.0 percent) and tinnitus (9.3 percent). Severity of hearing impairment based on pure tone audiometry was variable, and was presented according to common diagnoses. About 39 percent of hearing impairment cases were sensorineural, 36 percent conductive and 25 percent due to mixed defect. Bilateral Type A ears were found in 45.4 percent of patients by tympanometry, while 29.3 percent were bilateral Type B. For otoacoustic emissions, 69.0 percent were labeled as "refer" in at least one ear. Conclusion: The PNEI is a major national referral center for audiology that holds much promise in developing programs for national surveillance of the hearing status of different sectors in Philippine society. (Author)
HEARING AUDIOLOGY ACOUSTIC IMPEDANCE TESTS OTITIS MEDIA

Background: Certain indigenous populations have been noted by the World Health Organization (WHO) to havethe highest prevalence ratesforchronicsuppurativeotitis media (CSOM), including the Australian Aborigines (28-43%), Greenlanders (2-10%) and Alaskan Eskimos (2-10%). Objectives: To determine the prevalence of common ear problems, particularly CSOM, among the indigenous Ati or Aeta community in Bolabog, Boracay, and to determine their hearing sensitivity using screening audiometry. Methods: Study Design - Descriptive cross-sectional study. Setting - A small Ati community in Bolabog, Boracay. Population - A total of 63 adults and children underwent medical interview and otoscopy. Additionally 24 had their hearing screened by audiometry. Results: About a quarter of the population participated in the study, including 41 children (40 percent of all children) and 22 adults (18 percent of all adults). Forty-six percent of children and 23 percent of adults who were examined had previous history of ear discharge, while 22 percent of children and 45 percent of adults who were examined had history of hearing loss. Seventeen percent of children had history of hearing loss in the family. CSOM was found in 18 (43.90 percent) children and 8 (36.36 percent) adults. Impacted cerumen was found in 17.1 percent of children. Eleven female children underwent screening audiometry. Of these, eight had normal hearing and three had abnormal findings. Thirteen adults were also tested, five of whom were male and had normal hearing bilaterally. Four of eight female adults had abnormal hearing, of which three were unilateral. Conclusions: The Ati population in Bolabog, Boracay belongs to a group with the highest prevalence rates for CSOM (27.0 percent). A bigger sample for screening audiometry is required for proper estimation of hearing loss prevalence. Both environmental and genetic factors may have increased the prevalence of CSOM in the Ati population of Boracay. (Author)
HEARING LOSS OTITIS MEDIA OTITIS MEDIA ; SUPPURATIVE