Objective: To describe the cochlear anatomy among Filipinos through high resolution computed tomography (HRCT) imaging. Methods: Design: Retrospective Study Setting: Tertiary Private University Hospital Patients: Cochlear images retrospectively obtained from computed tomography (CT) scans of subjects who underwent cranial, facial, paranasal sinus and temporal bone computed tomography from October 2009 to July 2010 were reconstructed and analyzed. Results: 388 cochlear images were obtained from the scans of 194 subjects (101 males and 93 females, aged 1 to 90 years old, mean = 52 years) and reconstructed for analysis. The mean coiled cochlear height measured 4.36 mm on the right (A.D.) and 4.34 mm on the left (A.S.). Measurement from the oval window to the distal end of the basal turn (equivalent to the horizontal dimension of the cochlea or the mean length of the basal turn) was 7.55 mm A.D. and 7.60 mm A.S. The vertical and horizontal dimensions of right and left cochleas were identical in all subjects (S.D. = 0.35). The right and left cochlear turns were identical in each subject, exhibiting 2 ½ turns in 92.3% of subjects and 2 ¾ turns in 7.7% of subjects.The cochlear dimensions were similar in all subjects, regardless of age. No cochlear ossification or malformation was noted on any CT image. Conclusion: The 7.55 mm mean length of the cochlear basal turn among Filipinos in this study was 1.24 mm shorter than the average length of the basal turn of 8.81 mm reported elsewhere. Further studies of the cochlear dimensions in specific age groups and its correlation to audiometric status are recommended to determine other significant physiologic correlations. Keywords: cochlea, cochlear turn, high-resolution computed tomography (HRCT), magnetic resonance imaging (MRI)
Objectives: (1) Develop a task simulator for myringotomy and pressure equalizing tube insertion. (2) Develop a simulator that can be used to hone a participant’s micro surgical skills. Methods: Study conducted from October to November 2013. A design for a model head with a core made up of wood and polyester body filling was made. The external facial features were replicated using molding clay. The pinna and the external auditory canal were then made from carved wood. The external auditory canals were continuous with the core of the head model. Rubber fittings were used to attach the wooden pinna to the head in order to allow some degree of mobility to the pinnae. A port at the occipital portion of the head was made that would accommodate a middle ear cartridge. A solution bottle’s cap was used to fabricate the middle ear cartridge. The tympanic membrane was simulated using a single sheet of polyethelene film. Myringotomy, tube insertion, and evacuation of middle ear fluid was done several times. Results: We were able to construct a simulator for doing myringotomy, evacuation of middle ear fluid, and tympanostomy tube insertion. The simulator was sturdy, easy to use, and economical. Conclusions: Simulators allow constant practice and objective evaluation of skills without risks to the patient under the hands of the surgeon still on the learning curve. The creation of this simulator is a step towards the improvement of surgical training, evaluation of residents, better health economics, and patient safety.
Objective: To present a rare case of primary laryngeal aspergillosis manifesting with hoarseness in a seemingly healthy, immunocompetent, postpartum patient and discuss the probable contributing factors leading to this unusual disease process. Methods: Study Design: Case Report Setting: Tertiary Private University Hospital Subjects: One (1) Results: A 28-year-old previously healthy post-partum woman presented with hoarseness of a few weeks duration and recent intake of antibiotics and steroids. Videolaryngoscopy revealed a creamy, exophytic mass overlying both vocal folds. Microscopic examination revealed septated, dichotomously branching hyphae with acute angles characteristic of Aspergillus sp. The patient recovered with anti fungal medications. Conclusion: The clinical presentation of laryngeal aspergillosis can be very non-specific and should not be disregarded merely on the basis of immune competence. It should be considered, together with other host and environmental factors when a patient responds poorly to conventional treatment. There is a need for quick and accurate diagnosis as the disease responds quite rapidly with appropriate anti fungal medications. Keywords: Aspergillosis, hoarseness, larynx, postpartum, immunosupression
Objectives: Systemic multifocal fibrosclerosis is a syndrome characterized by the presence of fibrosis in various locations, most often retroperitoneal, mediastinal, and thyroid (Riedel thyroiditis). The fibrosis in the thyroid tissue can extend to the laryngeal cartilages and muscles, leading to respiratory distress. A thyroidectomy is, in these cases, an intervention to consider. Recognize potential "rare" causes of hoarseness following thyroid surgery.Method: Hoarseness case study. A 69 year old man presented to the ear, nose, and throat (ENT) consultation with a history of hoarseness and aspiration following total thyroidectomy for Riedel's thyroiditis. Physical examination revealed exuberant pharyngolaryngeal reflux with consequent edema and redundancy of arytenoid mucosa with simetric mobility of the vocal folds.Results: Worsening dysphonia after total thyroidectomy, particularly in the context of Riedel thyroiditis, leads to suspicion of iatrogenic vocal fold paresis. The vocal fold preserved mobility, associated with signs of exuberant pharyngolaryngeal reflux with extensive mucosal damage, reveals an unsuspected cause of hoarseness. The authors postulate that post-operatory changes in esophagic sphincter pressure may have triggered reflux.Conclusions: Rare causes of hoarseness following thyroid surgery should be considered in order to promptly establish a correct treatment plan.
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