Comparative Analysis of Temporal Bone Dimensions and Otolaryngological Procedures, Schemes and Mind Maps of Anatomy

Download Comparative Analysis of Temporal Bone Dimensions and Otolaryngological Procedures and more Schemes and Mind Maps Anatomy in PDF only on Docsity!

: Y ¢ _ : 6 33 - 27 83, 6 33 - 8344 , 092 _. 9 0 6- 6 6 52

T HE PH ILI PP I NE J OU RNA LOF OTOLAR Y NGOLOG Y

H E A D AND N EC K S U RGER Y

THE E DI T O R I ALSTAFF

Eusebio Llama s ,M.D. E d itor'in-Chief

Alfredo Pontejos,M.D. AssistantEditor

Carlos Reyes, M.D. Managing Editor

BOA R DOF EDI T ORS

Vicente Chiong,M.D Head & Neck Tumor Surgery

Manuel Lim, M.D. '!Otology

Mariano Caparas,M.D. ; MaxillofacialSurgery

Teodoro Llamanzares , M.D. iRhinopharyngology

Remigio Jarin, M.D. ,IReconstructive& Plastic Surgery

Milagros Lopez, M.D. 'Bronchoesophalogy& Laryngology

Carlos Reyes, M.D. Audiology& Neuro-Otology

A ll manuscriptsand other editorialmatter should be addressedto

E u s ebioLlamas, M.D., Editor-in-Chief,The PhilippineJournal of Oto-

laryng o l og y - Head and Neck Surgery, Department of Otolaryngol o gy, ,

S anto To ma s UniversityHo s pital,Suite 208.

II 1 I I I I I I I I

Editor ' s Note

Im m ortality in Print

Nine years ago, the m aiden issue of the Philippine Journal of Otolaryngolog y -

Head and Neck Surgery created a ripple in the country's circle of scientific publications.

For the first time in its twenty - five years of existence, the socie ty had the opportuni ty to

attain " i mm ortality in p ri nt. " Whereas interesting cases, researc h es, and experience s by

our m entors were more often than not lost to oblivion, the journal serves as a goldmine,

a reposito r y o f knowledge that c an be shared andpassed on to colleagues.

From its beginnings, the official publication of the socie ty has been nurtured and

cared for by the Father of the Philippine Journal of Otolaryngology - Head and Neck

Surgery, Dr. Angel Enriquez. Every year since 1981, I remember in awe as to how t h is

man would constantly re m ind the co ns ultants and residents to submit their papers for

public at ion. A nd when his " baby " finally came out fresh from t h e press, t h e editor - in -

chief, with fervent enthusi asm , trans f ormed into the ad vertiser, distributor, a n d newsboy

rolled into one.

In this ninth issue , we dedicate a nd pay tribute to the m an who had drea m ed

and envisioned the public at ion, for without which our residents and consultants m ay

never ex perience th is touch of rel at ive i m mortali ty. We salute and congratulate Dr.

Angel Enriquez and his staff for giving us nine y e ar s of worthwhile literature. We hope

that in the following publications we can at least equal, if not surpass , the works laid

down by the previo us editorial staff.

E us ebio Llam as , MD

....... = =, il I IIII I I I

TH E PI _ E S I _ E N T' S P AG E

In a relativ_y small and young society such as the Philippine Society of

Otola_yngol_gy _ Head and Neck Surgery, it is not really that difficult to get

into the top of the pinnacle. As one of our p_t president_ aptly remarked,

"Just stick around in all its f,Jnctions, show genuine concern for the welfare of

the society and i_ members, flavor it with a pinch of leadcrbhip and soon you

will get the mandate of your colleagues and of course a chance to inject your own

policies and ida. Perhaps even improve on the previou_ leadership not with-

standing the flawlessness the society was ran by the former preside_. In

short, to contradict the words of Sk_kespea_e, I wil_, as your new president,

attempt to "improve on a masterpiece."

Allow me to briefly observe with you th_ eveni_ the progress, pitfalls,

and heartach_ of our specialty, particularly in the local setting. Just like

any successful endeavor, it has ended t_e slings _nd arrows of professional

suspicions and jealousies from members of othe_ species whose interest is in

the same region of the human body as ours.

We are accused of sticking oar fingers into a_ _pects of head and neck

surgery by the very people who admi_ that they b_ generalists, a specia_

t_ning of a few more years are needed to become a _il ple_ed head and neck

surgeon.

Our knowledge of head and eck diseases and it management was not the

result of the ear, nose, and throat being in the regio_ but logically because of

the natural pathophysiology of the diseases particularly the biology of tumors in

this organ system. Just as we expect a heart suJ_gon to have mastered the

hemodynamics of the cardiopulmonary system whenever he operates on the heart so

too an otolaryngologist is expected to manage, lct'_ bay, an advance stage of

cancer of the larynx, its region_ spread, the options available to manage it,

and thg subsequent reconstruction of the defect his surgery might have created.

O_r specia_y therefore _ gone a long way since the time it was popularly

known as EENT whic_ _.emed more like a package deal offering to th¢ patient but

in reality is more o_h_halmologicexpertise rather than otolaryngologic knowledge_

A little knowledge is of course dangerous so much so that our national hero,

Dr. Jose Rizal, practiced good op_halmology but never touched otolaryngology.

So much so that the Founding Fathers o_. this soci_y, in its desire to start

competent ENT practice in the country, _ormed the nucleus of what is then known

as the Philippine Society of Otolaryngology and Bronehoesophagology, exactly 33

years ago this 17 February. They were known as the "Heroic 9 " for they were

brave enough to declare independence from a domineering mother society known as

the POOS. My major role as your new president therefore will be to get rid of

all these misconceptions about us.

The first step to be taken _ be a revision of ou_ By-l_ which unfortu-

nately did not go hand in hand with the progress of the organization. It stZZ

retai_ the old name - - Philippine Society of Otol_yngology and Bronchoesopha-

gology; has restricted membership to American Board certified and eligibles, and

has lagged behind the economic picture of the times so as to charge a measly _ 75

per member per year. But in revisin 9 t_e Co_titution we should not fall into

the same mistake which our American colleagues did two year_ ago when thet_

The _ j / _ , t. a _ and g e_eme n, _ not be e Lf - f u fl U._n g without Looking

back _ au_ a_ the accomplishment 6 of the previou_ pr_ident_ of both the

_o c iety nd the board. To D. _ C huRn Leh, _edi_te past prc_ident of the

_o c ie_y, c redit i 6 hereby given for an u npre c edented nR m ber of q,ali_y _entific

meeting_ and _gmpo_ia, seven in all in 1 9 88 alone. He had to pitch-in finan c ial -

Ly because we ran o_t of spon6or6." And to Dr. Nap E jcrcito, i mm ediate past

president of the board, c redit-i 6 like_e d_e for m aintaining the high standards

of otolaryngology pra c tice in the country through the t_adition_y but reason-

ably rigid board exa m inations. And to Dr. Angel E mtiq u ez, the outgoing

Editor - in-Chief of the only journal in E NT-head and ne c k surgery in the country,

your erudite edito_ have stimulated all the mc m be _ to c ontJt/bute ex c e//ent

art/ c /e_.

To the Founding F athcr_, the "Heroi c Nine", so m e of who m are here tonight to

honor the o cc asion, rest asscred tha_ the standa_d_ you ai m ed fo_ for the so c iety

33 years ago will not go to waste.

And finally to my fellow officers: the road to suc c _ in run_ng the

organization will be reali z ed only by i m ploring the h_p of the Almighty

Physician and by putting our a c ts together.

........ ] -- , m i HI I

PHILIPPINE SOCIETY OF O T OLARYNG OLO GY - HEAD A N D NECK SURGERY, INC.

OFFICERS 1 98 9-199 0

President: TEODORO LLAMANZARES, MD Vice-President: EDILBERTO JOSE, MD

Secretary: ALFREDO Q.Y. PONTEJOS, JR., MD Treasurer: ROBIE V. Z ANTUA, MD

PRO: JACOB S. MATUBIS, MD

Board of Directors: DOMINADOR ALMEDA, MD CARLOS DUMLAO, MD

SIU CHUAN LEH, MD LEONARDO MANGAHAS, JR., MD

FELIX NOLASCO, MD ANGEL ENRIQUEZ, MD (Ex - Officio

Il l l I I III I I • _ -- "'

PSO-HNS FINANCIAL REPORT

AS OF 7 DECEMBER 1988

Recei pts :

Beginning Cash ............................ P 896.

Annual Dues .......................... ..... 15,000.

Acc r editation Fees ........................ 2,500.

Share from 3rd ASEAN Congress ............. 12,775.

Interest inBank .......................... 142.

Total .................................... P 31,314.

Less Expenses:

Representation (meetings) ................. 4,784.

Secretary's Stipend (Jan-Sep) ............. 1,800.

Telegram .................................. 976.

Messengerial ..................... ......... 337.

Mail ........................... ; .......... 142.

Plaque .................................... 4,180.

Xerox ..................................... 264.

IFOS Annual Dues .......................... 1,555.

Supplies ................................... 91.

Bank Charges ................. ............. 138.

Miscellaneous ............................. 330.

Withholding Tax ........................... 16.

Total ................................... 14,616.

CASH AT END ................... P 16,698.

Submitted by: D._R / OB ' IE_V_UA

] Treas_

ii |m i i ll i

p _ h_ of b_ 1 _teral _ vocal which progr e ssed prompt Lng a & _ ss i o m. mi- p aralysi s. Sin c e the n , she has be e n n a tion re_eal bilateral mldlime v oc _ cord e _erti o _ dy s pnea which b e c a me s e v e re paralysis. Orotracheal intubatl o n wa s ck e acc o mp a ni e d by ir_piratory stridor o ne _ follo_d by tracheosto m y. A left e_do_l prior to ion. Em_ination r e v e a l e d arytm_idectomy wa s done on the third ho_tm a l b _ 1 - t e ral E[dl Ln e vo c o! cord paralysis, the day. lYach e ost o m y s r e _ v ed after I0 . d e Br e e of w h i c h w a s si_d1_r to that prior to the Wo o dB m pro cedu re. A left e n do a ryt e _ D i d e c t o y_s d on e. Trach e ostamy _ s COll e n t e r_mved aft e r I0 days. S h e has return to near n o mami llfe with a m adequateairway a nd a Given the choi c e betw e e n a n e d o fu n ctic_mlvoice , a nd _m e _t e r n alcervical a ppro a ch,the pa ti e nt readily chose the former.

Comm e n ts T e chniqu e Aft e r a f a iled lateraliz Ln g pro ce dur e thr o ugh a n externalapproach,the pati e nt cho s e After the pa ti e nt has be e n a e s fl_i ze d to undergo a less invasivesu r gi c a lproc e dure, through a pr e vi ou s tr_t o my, direct gdsc o pyis p e rfo usi__ Pilli n lg a v 0r s c e mw_horedwith a L_wy chest lary n _ o pe holder. An op e r a tingm e ro e cope with a 3 75 mm Ca s e No. 3 front l e n s is set up a nd fo c used _ the p os t e rior. A May o tabl e is F1 eed J.A., a 38 yr-old m a le, ms admitt e d in fr o nt of the s u rge o n to serve as elbo w r e st bec a use of dysp n ea. One year prior to duri n g the course of the procedure. An i n _ e ct- a d mission, tracheo s t o my s. do be of ion of epir_rine 1:200,000dilutionth a severe dyspnea. Pati e nt " h_as eaned from th e _ 25 spinal needle is d o ne. A tracheost o mytube after three m_ths. A year incisi o nIs mm d e ov er the ant e r cm al, p rtl o n later , p_tient again d e veloped _ q ere dy spn e a o f th e ary e piglottlcfold c e r l ylngth e I r yte- requiri n g a r e peat. traeh e o s t o _y..m n ati o _ _old cartil a g e. S oft tis s ues a re _t e d r e v e l e d immobile c ords with on e mm glottlc using s h a r p a nd blunt dissection ex p c _ the op e ni n g.• A l e ft e n d o lary a ryt e oid e et c y s u perioraspect of the aryte n oidswhich is h e ld s do n e a nd the t u b e w a s r e moved afte r I0 with a gr a s p i ng forc e ps. The cartil_e is days. S e ve n m_nths lat e r, air_y s still dissectedfree fr o m its so_ing p e rle- s u fficientm_d v olce w a s s l l g htlybreathy, noid tis_m s an d the attachm e nts c u t u sing l a ryngeal scissors until the cartil is delivered. Periaytemoidpoc k et is Comment s a nd the. mco s a / ed g e s tri m m e d end suture d u _z i .ng Vicry 15-0, He h a d probl e ms getti n g a job b ec _ t e of the e m ployer'sfear of his trachealstom a. Due to financ l c o n s tr_ts, he c o n se nt e d to a Di sa u s o _ less e x p e n si v esurgicalpr o cedure. Bilateral vocal cord paralysis u _ u ly r e sults fr o m surgi ca l inj u r y to the r e nt Case No. 4 laryr_al n e rve dur / ng'thyrold e cto. r y. It c s n ! al s o b e d to a ny _e_l e nt with _t_l

• F. D., a 46 yr-old f_ m le, _s _itt e d cervical tr amn , n_mtr o plc viru s e s , b_e of _ an d s trldor. Three years m_r c ¢_pr o ise s econ d a ry to m c _ bo lic prior to a dmissionthe p a tientw a s di a gnosed t o dise a s e s s uc h as c H - h er .s, c a z _ t d e _ rec- h a ve a left vocal cord paralys i s. One y_mr t my , Intr ac r a 1 c o m a, __ J in prior t o adm_i o n, she developed %olsy fixation, a nd idiopa t hicc au s e s. 2 ,,I0- , 14,| 6 breathi n g" a nd _ s tr e at e d as br o n c hial a sthma which di d not impro v eher c o ndition. One we e k Indirect _ c be perf o _ to prior to admissi o n, s he had dyspnea an d stridor as s ess l a ry m o v n t, _r, it _ not 1 0

allow for discrimi na tionb e tweem vocal cord the early ]__. u se d by Kirstein,

p a ralysis a nd a nkylosisof the cricoarytenoid. Y a nk a er, a nd o thers at the turn o f the T_w, direct laryngoscopyis deemed necess a ry c_mtury. Since the deve lo p m e ntof the wide in order to assess lary n geal neur bore l a _ with flberopticill u minati o n iflte g rity,evaluate m obility of the c rlcoary- for use with the operatingmicrosc o pe,mi c ro- t_nold joint, an d ev aluate the interaryte no ld scopic _ a nd micr_ry of the r e glonwith respectto t e theri n _fibrosis.I _ h a ve c o me of a g e. Microscopicl a zyng o - sc m py _ e_mdaqatl o nof the fine d etails of The t of patientswith bilat e ral the _ cords a nd a dj a centareas with blno- rec u rrmlt nerve paralysis has ah_ys been a cul a r visl c m. The resultl x depth of percept- c to the otol a ryngologists. 2 Thro u _ ion with incre a se e xpos u re an d a ddition a l the years, rum e ro u s procedures have been i]itmfl ma ti o na11 c s c s bimmmml ms_tion an d dev is ed _ o ff e r e d a c o n s iderable me asu r e of ex e c u tion o f mi cro s_i c al pr oce dmr e s. 11 suc c es s. 5 T her a p e mt_l c o pti o ns r e st o n th e principle o f i m p r o v i the air,my with little or no comprn, d e in the ability t o ph o nat e 8. The surgical corm e ctlon of bilateral These incl u de t s tomy, l a t e rall z i n g as rec m r, m _t nerve paralysis is a promp t S,re of mll as dy--_o p ro c _ires. La te r _lt_in g milli m eters. A careful, b loodless -, s u bpe t l- proced u res o f .th e par alyz e d cords m a y be _r-lml disse ct i o n o f the arytenoidcartil a g e

c a r ried out t h ro_a eith e r intr_l_ryng e a l o r p e fo ed t [ Kl e r dir e ct vi_zation t h ro_

ext_ s u rgical a p. These the operating m ic ro sc o p e will resul t in involve sur_. cal _ aim e d at sec d flhros_sIn the arytm_id bed and th e refore, a n the l a t e rall z atlonof the vocal - ,. ] A g m t s b y q_x_m e nt o f the a by a n a dditionalI or t e ri, th e laryr_ a nteriorly thro u gh a 2 ram. m_ d1_ne thyrotomy; posterlorly, behi n d the

m rgtn o f the thyroid cartll a _; and _ y , Tttis Increase :in size o f the glotti c

through a windowin th e thy_ld i_ a 2 , 6 ,S,13 a pe rtur e fo _ ] t e noide c to_ by th e

The declslon as to which of t h e p r oce d u r es t o m _x- ost w g i c al tedmlque occ u rs p ost e riorly in er ta ke t o secure a m adequ at e a _ t he Id bed. Ve ry li tt le l a teralizat_n be detez m inedby. t he p at ien t 'sindlv dm ,l _ of t he _ vocal cords develop a nd a s a m_d pref e r_ace a nd the ' s s 11 a nd r e salt, the voi c e remains 0od. A 2 t o 3 ,i, c onfid e nce, sp a ce b et_m the mm_r a nm vocal cords persists vh i c h preservesvocal ftmctlon a nd a n In 1948, Thornelld_scrlhed_n intral_Lryn- e a s t_te d 5 to 6 m m sp a ce is pres e nt in the

ge a l o pe ration here the _ r u m oi d s _ oolla pee d bed , whi c h p rovides m _ ad eq uat

through th e susp e nsion l a _.2,6, 7 . 2 , Ind_cat In c l u d e r_l tt a with o ut a c ervi ca l l o n and the inh e rent S c reeni n g o f c a ndl d atesf o r intra!l m or bl d lt y o f _ i nfec tion a n d p r o l n _ d a p p r oach L ,l v des la t eral neck ra t o h o spital con; diss a t isf a c t ionof the rule out tr a cheal ste n osls,p u dm o n a ryfuncti o n pati e nt wi t h t_t o my tu be a nd I n a deq u a c y stu d ies, a nd _ before t he definitive of the _ on the basis of __! p rocedure. e __rti1_e imm ob ility. 1 3

• C a se s e l ect ion is t mpo r t a m t. P a_ts C om p sr_ to Cc , with sig nlfl r. m t card d is e ase are not Intral_ a ry_id e ct_ more co_I s te_t- c_t e s f o r ary t eno l dec t omy _

lypreservesvoicequalitymadavoidst hem Jor proc e duredoes not _!1ow the respiratory

p_i- c ation of .. n Th e vo*ee q u alat _ _ is aecomp th ro ugh a

t o a mo re _t spe ring coa rs e t ype after t r a c heal stoma.!2 1 p_yd_logical

the proc e dmre - a c h a ng e preferred by a _ a lso infl u e n c e th e results. P m a tomlc r m J or ity of patients o ve r the _ r oo_l_l r atio n lm_ring _ .access to the u p wit h a t racheoeto_ ,be or c hroni c glo_tl c s_ti c l arynx c reates a te chn_al,dlffi- obstruction, c u lty. R edu c e d vlslbillty , restrlc t m of surgi c al m,l - tion, a.t dist2m from the 1_a)scopi c mmfl n ation m_t s ur -7 " o f the o pera ti t a -9_t c ombin e t o ma k e e nd ol_ _ _ hav e c om e a lo_ w_ m L uc e the e-- o f _teno td e c tomy mor e dif f _ e _,!t to _m p lish. 1 6

Bibli o graphy 14. Thornell,W. C. Transoral intral a ryn- geal approach for arytenoidectomyin bilateral i. Bailey, B.J., et al. Surgery _f the vocal cord paralysis with inadequate airway. larynx. W. B. SaunderCo. 1985. Trans. Am. Acad. Ophtalmol. and Otolaryngol. 53:631, 1949.

2. P e lmus, C. et al. Microsurgical thyrotomF and arytenoidectomy for bilateral 15. Ward, P., et al. Observations in curr_nt laryngeal nerve paralysis. Laryngo- so-en]]ed idiopathic vocal cord paralysis. scope 80:491-503,1970. Annals of Otology, Rhinology, Laryngology 91:558-562,1982.
3. Holinger, L. et al. Etiology of bil a teral abductor paralysis. Annals of 16. Whicker, J.H. et al. long term Otolaryngology85:428-435,1976. results of Thomell arytenoidectomy in the surgical treatment of bilateral vocal cord
4. Holinger, P. et al. Vocal cord paralysis. Laryng o scope82 : 1331-1335,1972. paralysis and psychopathology. Archives of Otolaryngology107:33-36, 1981. 17. Woodmn, D.G. Bilateral abductor m paralysis:A survey of 521 cases of arytenoi-
5. Kelly, J.D. Surgica] tre a tment of dectomy via the open approach. Archives of bilateral paralysis of the abductor muscles. Otolaryngo-logy 58:150-153, ] 953. Archivesof Otolaryngology33:293-304,1941.
6. Kirchner,F.R. Endoscopic lateraliza- tion of the vocal cord in abductorparalysisof the larynx. Laryngoscope89:1779-1783,1979.
7. Kirchner, F.R. Endoscopic rehabilita- tion of the airway in laryng e al paralysis. Annals of Otology, _Inology and l a ryngology 91:382-383,1982.
8. L e vy, R.B. et al. Validationof vocal cord lateralizationprocedure. Laryngoscope 92:697-6 9 9,1982.
9. Michike, A. Reh a bilit a tionof wcal cord paralysis. Archives of Otolaryngology 100:431-441,1974.

I0. Parnell, F.W., et al. Vocal cord paralysis:R e view of I00 cas e s. Laryngoscope 80:1036-1043,1970.

11. Strong,M.S. Microscopicl a ryngoscopy. l a ryng o scope 80 :[ 540-|552, 1970.
12. Strong,M.S., et al. Cardiac c o mplic a - tions of microsurgeryof the larynx: Etiology, incidence, and prevention. laryngoscope 84:908-919,1974.
13. Thornell,W.C. Intralaryngealapproach for arytemoidectomyin bilateral a bductorpara- lysis of the vocal cords. Archives of Otola- ryngology47 : 505-506,1948.

13

The P hil. Jour. the ter m '_ y p o pharyn g eal Syndr o m e " after of Oto. He a d & a nalysi n gseries of ciner a diogr a phy o f Inf e rior Neck Surgery ConstrictorSwallow.

I wish to present a case that proves all these allegationswrong.

GLOBUS HYSTERICUS , --

A JO KE N O MORE*

Rep o rt o f a Case

E. C. , a 36-yr old f_rsle,consultedat the E duard o C. Ya p ,M D** Ospital ng M a ynila for a "l u mp in the throat." Three years previously,she noticed an abnormal sensation in her throat better described as h mpy witho u t re a lly making her swillowing difficult. As her condition progressed-, swallowing noticeably became more and more difficult but always with improvementtowards the end of her meals. Ik_ever, the difficulty graduallybec a me worse but not'to a point where Intr od uc t i o n she cannot toleratesolids.

Scott Br o om's Disease of the F a r, Nose, A m o nth prior to admission,E.C. went down and Throat defines Globus Hystericus as ."a with a "flu" and at least on one occasion,the condition in which a patient, often a middle patient threw up at _tich time she said the a ged w_m a n, complair u _of the _ti o n of a sensation of^ a^ lump^ bec a me more^ obvious^ a nd l_np in the throatusually in the region of the notice a ble in her throat. At the s a ne time, thyroidcartilage. There may be other symptoms the patient also claimed that her breathing suggestive of a functional state, and the beca_e difficultbut the moment she swallowed, patient may admit tlmt a relative or a friend re s piration became easy. She immediately has recently ,llcctm_edto cancer of the sought c xm sultationto an EENT specialistand throat." C_orge A. Gates, on the other hand, was told that there was nothing wrong in her in his O_rre_t 'lherapyin Otolaryngologyq_qd throat. Truth 60 tell, this was not the first a nd Neck Surgery 1982-8.3considersall non-food time she sought consultationbut all previous related dysphagia s Clobus Hystericus. Gerald exami_zationsproved non-revealingand in. each M. English defines the conditionas "a lump in instance,her case was labelled as a case of the throatof psyd,oson_ticorig,]." "pharyngitis."

More recently,Ihkh a kbaet al believedthat At the time of admission, E.C. was c_ globus mechani.nis part of a normal bodily regular diet with no weight loss. On physical ft m ction,and tt u atthe symptom _ be pr_woked ex a mination, she appeared appreherLsive, as a r : esllltof strc%gemotionalmech a nism in ll - built, and fully cc_rative. Anmng "aht_stm person. L h ,dsay P. Gray junked the others, Ngr ex a minationsby four F / qTresidents term "Clobus _steric_s" and irk_teadsuggested proved nornml.

Es_hagogr a m obtained at the Pasay-Para- naque Hospital on 23 July 1987 shoed "Essen_ *3 r d P ri z e- S cien tificSy m p o siumo n Int e r es t i ngCase s h el don tiallyN o r ma l F_ophagogr a m." 1 1 September 1987 a t th e M a nil aGa rdenHot e l However,on account of her insisten f _tl_t Chi e f Resid e nt,Dep ar tm e nto f O t o l a ryng o l o gy, O hM - Ospit a ngl we take a look inside, the patient w as a d mitted M a yn i la for diagnostic es o phagosc o py.

N

2he R dl. Jour. and hardly portable. In the 1940's, becm,se of of Oto. Head & the reduction in size of the vacu u m tubes and Neck Surgery batteri e s, hearing aids ass u med the size of a cigarette pack.

Another signific a nt breakthrough oc_irr_l in 1950 with the development of the transistor, which replaced the vac u u m tube.

THE 4 0 1st OPTION *** As a cons e q u e nce, microm i n i aturiz a tion of aids bec a ne a reality in 1960.** Hearing aid sizes _re greatly reduced without sacrificing efficiency.

Finally, the 1970's witnessed the intro- Emmanuel S. Sa m s o **n, MD**** duction of very powerful wearable hearing a ids utilizing microchips, which we are using up to the present,

Ff_n the very crude instrument of P_tchi_son in 1900, the growth of hearing aid technology has been almost logarithmic. At present, about 300-400 models are offered for sale to suit each individual. Any instrument that brings sound to a listener's ear ma y he called a hearing aid. As In m a n's desire to achieve better hearing, far back as one can r, m a n._ h_q attempted a price, literally, has to be paid. It is to improve his hearing by placing his cupped high: a b o u t _3,000-@5,000. When patients go to h a nd against his pi n na. _is is prob a bly the goverment hospitals _ Ospital ng Mmynila earliest known hearing aid. It i n crude, but a nd Philippine General Hospital to obtain the very effective, best, but free ENT care, it is very discoura- ging to see patients who are hard of hearing, Man's search to further improve his hearing left unimproved bec_e they carmot afford the led to he ear trivet, which provided• i0 to 20 instrument. Therefore, better than giving th decibe l s increase in sou n d intensity, a n ear trumpet, but short of presenting the real device, the author looked back almost 40 In 1900, }tchinson introduced the first years when the tr a ns u qtorized hearing aid _ms electronic aid which bec a re the foreru n ner of still in its con c eption, and decided t o make the present aids. It consisted of a carbon one himself. microphone, batteries, and ear phones. It w a s more efficient, but carrying the whole set-up Thus, _ are presenting the poor, deaf required strength and determin a tion because it m a n, the 401st option: an efficient, port a ble, w a s big and heavy , and cheap hearing aid.

In the 1930's, with the invention of v a cu u m tubes, the carbon microphon e bec_me The instru m ent obsolete. B u t vac_ tube aids _ere still big A hearing aid consists basically of 3 parts: (i) a microphone which converts smmd energy to electical impulses; (2) an a_plifier, " 3rd Priz e -6thSci e ntific(Su r gicalInn o vation a nd Instr u ment whi ch int e n s ifies these electrical•• : _ pul ses; Design)ResearchConte s t i n Otola r yngologyheldat Ou e zon a nd (3) a receiver, which receives t he City S portsClub, 4 D ecemb e r 198 7 intensified e lectrical imp u lses and reconverts to sound en e rgy. In effect , a hearing afd is " *Junio r Res i d e nt,Depa rt me nt of Otola r yngology,P L M - Ospit a l nothing but a miniaturized P.A. system, or a ng Maynila m inus - o n e casette.

/ '

But a de a f m mn will never be i m pressed by spe c ifics llke SSPL 90's, harmonic distorti o ns, frequency response c urves, etc. The only thln_ t ha t is of p a r_ t i m por ta nce to him is the res t oration of his hearing at a price within hls me a ns.

Our ins t r u m e n t h a s proven its worth, alth_ in a very li m ited ._rL_e.

_nat a bou t l on g-term complica t ions? The a l t hor is very m u ch aw a re o f these, no ta bly aco u stic trmmm. We t herefore pl a n to do serial heari n g tests over long periods, an d only then c a n we m a ke concrete conclusions. We also pl a n to calibrate it to nmke it approxi- mate the qualities of preexisting models. L a stly, we might incorporate a ton e control to mak e frequency a_plifications more selective.

All of these we pl a n to accomplish witho u t defeating our nmin p u rpose: t o ma ke a hearing aid tha t is function a l as well as cheap.

We can see t hat t here are s t ill a lot of refi n emen t t o be made. Bu t none t heless, _ a t the Depar_ren t of ENT of Ospital ng Maynl ] _, with o_r very strong commitm e n t t o help t he poor, de a f ma n, strongly believe tha t i t c a n be done.

B ib l i o graphy

Cody, Robert, M. A. Hearing a ids Chap 6, Otol a - ryngology, Paparella a nd Sh_,-ick, 1980.

Mawson, S. and H. Im_msn. Part 2, Chap 5, Diseases of the ear: a textbook of otology, 4th ed. 1979.

Enriquez, Angel, M.D. Personal c c,, mlication.

Yap, F_uardo, _D. Person a/ comm u nication.

The Phil. of Oto. Head Jour. & Case Rep o rt

Neck Surgery A 37 yr old, female teac h er, w a s admitt e d o n J u ne 25, 198 7 at the S a nto Tom_s University Hospital Cli n ical Division becm_se of swelling of t he lef t h a lf of t he fa c e.

Abou t 4 month s prior t o confinement, t he pa t ien t noticed s_elll n g o f t he l ef t side of MALAR _ WELLING : A L O NG DISTANCE her face, her left eve sm a ll er t h a n u s ual a nd AFFAI R - displaced upward. There were no other accom- p a nying sig n s and ,symptoms. Towards the latter part of the m o nth she developed difficulty of

raisingbotharms.

Willi a m L. L i ra , MD** Two months prior to admission, the pati e nt c o nsulted a physici a n a nd was prescribed an,-eye dr o p whi c h afforded no relief of her c o ndi t ion.

A month a n d a h_If prior tO admission, she consulted an ophthal- mologist an d w a s given a n eye drop, Steroid, an d antibio t ics. A few days later, she developed swelling of t / ]e lo w er eyelid, dull pain o n tbe left cheek, and In tr o ducti o n difficu l ty in o pening h e r mouth.

Malar swelling, proptos£g, trlsmus, an d T weeks prior to admission, the patient c_mmosis will Jnvariably lead one to entertain developed left tesporal he a dache, proptosis, a prim a ry t u mor in the maxilla or perhaps in an d blurri n g of vision of the left eye, the orbit. Although, metastasis may enter into prompting consu l tation at the Ophthalmology the differenti_] diagnosis, the possibility is section of the Santo Tomas University Hospital often overlooked owing to its relative , rarity Clinicial Division. She was advised admission in parts where primary, neopl_ are more but she refused. l ikely to be encountered. The night prior to admission, the patient Paranasal simls and orbital metastases consulted at the'emergen C y room because of the from a distant primary foc u s are not frequently s a te complaints. She _s r e ferred to Neuro- enco u ntered in practice. Most articles on fogy and was subsequently admitted. these subjects have been J_1the rmture of c&se reports. In 1965, Rose found only 5] reported cases of orbital metastasis in his exterLsive survey of literature.! On the other _mnd,

there _re less than 70 c a ses of paran a sal Pertinent Physical Exami n at ion

simms l,etastatic Etmmrs reported in world literature 2 (_ admission, the patient _ conscious, coherent, anbulatory, and with stable vital A case report, probably the first in our signs. local literature of a metastatic tt_or to the orbit, r_]]a, infra-te_poral fossa, a nd F xa nination of the head and neck revealed fronto-epidural space is beiug presented, left malar s%elling, trisn_s, the left eye proptosed, chemotic, displaced superomedially, , and had limitation of mov a r e nt i n all gaze. 3r d P la c e- l nt er e s t i ng C a s e Pap e r Pr esentatio n h eld at t h e Visual ac u ity _s 20 / 25, OD and 20 / 200, OS. Manil a Garden Hotel, 198 7 Intra-ocx_ar pressure was elevated on the- left eye to 28 mm Hg. Plmdoscopy revealed blurred ***** "nqs i0 e nt , Dep art m e n t o f O t o r hin o l a ryn go l ogy , UST H os p ita l disc margin of the left eye.

2O