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Compartment syndrome has been defined as “a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space”.1 It is most commonly seen after injuries to the leg2-5 and forearm6-8 but may also occur in the arm,9 thigh,10 foot,11-13 buttock,14 hand15 and abdomen.16 It typically follows traumatic injury, but may also occur after ischaemic reperfusion injuries,17 burns,18 prolonged limb compression after drug overdose19 or poor positioning during surgery.20-24 Furthermore, subclinical compartment syndromes may explain the occurrence of a variety of postoperative disabilities which have been identified after the treatment of fractures of long bones using intramedullary nails.25 Approximately 40% of all acute compartment syndromes occur after fractures of the tibial shaft26 with an incidence in the range of 1% to 10%.26-30 A further 23% of compartment syndromes are caused by soft-tissue injuries with no fracture and fractures of the forearm account for 18%.26 Acute compartment syndrome is seen more commonly in younger patients, under 35 years of age31 and therefore leads to loss of function and long-term productivity in patients who would otherwise contribute to the country’s workforce for up to 40 years.

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 StudySetting: Tertiary Government Training HospitalPopulation: 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.

The review article presents the recommendations of professional associations: American Academies of Audiology, Pediatrics, and Otolaryngology-Head and Neck Surgery; the American Speech-Language-Hearing Association; the Council on Education of the Deaf; Directors of Speech and Hearing Programs in State Health and Welfare Agencies; and the Alexander Graham Bell Association for the Deaf and Hard of Hearing for screening and monitoring of hearing in infants and young children. Hearing loss in newborns was shown to develop due to defects in sound-conducting, neurosensory and mixed types. Conductive deafness is usually due to abnormalities of the outer or middle ear, limits the amount of sound that gets access to the inner ear; neurosensory hearing loss is caused by lesions of the cochlea or auditory analyzer - the most common cause of hearing loss in newborns. It was found that children who were hospitalized in the neonatal intensive care have a high risk of auditory neuropathy as compared to those who were taken to a regular room for the newborn. Mixed loss is a combination of conductive hearing loss with neurosensory deafness. The article presents the modern and effective electrophysiological techniques used for screening: auditory brainstem evoked potentials and oto-acoustic emissions. The peculiarities of the monitoring of infant hearing before discharge from obstetric department and risk factors for neurosensory deafness are presented: hospitalization in the neonatal intensive care unit, hereditary syndromes, family history of hearing loss, craniofacial abnormalities, congenital infections, bacterial meningitis, severe hyperbilirubinemia and blood transfusion. Current data of the efficacy of single-stage and two-stage screening protocols are presented. There are present an effective screening program steps of hearing loss in infants and young children: screening at least of 95 percent of infants before their discharge from the hospital; understanding that a relative number of false-positive findings (babies with a positive screening test who do not have hearing loss) was ≤ 3 percent and the number of referrals for audiologic testing after getting a positive screening result was ≤ 4 percent, and the relative number of false-negative findings (babies with significant impairment of hearing have not been detected by the screening test) was zero; the number of infants who remained under further observation, who were referred to audiologic examination and not tested by a screening test in the hospital (the parents did not refuse screening) was not less than 95 percent; rescreening infants who were re-admitted to hospital within the first month of life due to the conditions associated with potential hearing loss (eg, hyperbilirubinemia); an effective communication system that ensures the transfer of the results of a screening test from the hospital to the parents and responsible health professionals providing primary health care, as well as the referral of babies who did not pass a screening test for audiological examination. The recommendations and the steps of sending children to surdological comprehensive examination are presented. The author focused on the absence of documents regulating the screening and hearing monitoring since the neonatal period.

Hearing loss is considered the most common birth defect. The estimated prevalence of moderate and severe hearing loss in a normal newborn is 0.1%-0.3%, while the prevalence is 2%-4% in newborns admitted to the newborn intensive care unit. Neonatal hearing loss can be congenital (syndromic or non-syndromic) or acquired such as ototoxicity. In addition, the types of hearing loss can be conductive, sensorineural, or mixed. Hearing is vital for the acquisition of language and learning. Therefore, early detection and prompt treatment are of utmost importance in preventing the unwanted sequel of hearing loss. The hearing screening program is mandatory in many nations, especially for high-risk newborns. An automated auditory brainstem response test is used as a screening tool in newborns admitted to the newborn intensive care unit. Moreover, genetic testing and screening for cytomegalovirus in newborns are essential in identifying the cause of hearing loss, particularly, mild and delayed onset types of hearing loss. We aimed to update the knowledge on the various aspects of hearing loss in newborns with regard to the epidemiology, risk factors, causes, screening program, investigations, and different modalities of treatment.

Objective: 1) To share the experience in establishing the first province to set up the universal newborn hearing screening (UNHS) in Thailand. 2) To report the results of four consecutive years of UNHS in Trang. Materials and Methods: All newborns in Trang province, between October 2013 and September 2017, who received UNHS, were included in this study. The present study was a descriptive study. Results: There were three main obstacles to be solved to establish the program. There was no supported budget from the central government to run the UNHS. There was a lack of audiologists or trained personnel to run the UNHS. Finally, there was no province in Thailand that has done the project before. A budget for the Trang’s UNHS project was allocated, which was 3,100,000 baht from the Trang provincial administrative organization, to purchase hearing screening machines for every community hospital. The personnel to run the UNHS, which were nurses, were trained in every hospital. The protocols, referral, and follow-up programs were newly designed to establish the hospital network for the program. There were 28,254 newborns in Trang and 27,983 (99.04%) were screened. The high-risk newborns were 1,415 (5.1%). The low-risk group was 26,568 (94.9%). The referral rate of transient evoked otoacoustic emission (TEOAE) was 5.9%. In the low-risk past screening group, there was one newborn (0.005%) that presented later with delayed speech and profound hearing loss after 1½ years and the MRI showed bilateral IAC stenosis. There were two newborns with severe hearing loss, one was Mondini dysplasia, and the other was normal on imaging, in 169 unpassed low-risk newborns. In the high-risk group, 73 (5.2%) were unpassed. After diagnostic tests, 71 (97.2%) were normal, one had severe hearing loss with normal imaging, and the other had bilateral microtia. The incidence of bilateral severe SNHL in high-risk newborn was (1/1,415) 0.71:1,000 births. The incidence of bilateral severe SNHL in low-risk newborn was (3/26,568) 0.11:1,000 births. After two years of follow-up, there was no delayed speech due to hearing loss in all the present study newborns. Conclusion: The rate of congenital hearing loss is not as high as in the literature, but the UNHS is still important to the newborns and their parents. Keywords: UNHS in Trang, Province-based UNHS, Incidence of hearing loss in newborn

Editorial introductions

RUPTURE OF EXTENSOR TENDONS BY ATTRITION AT THE INFERIOR RADIO-ULNAR JOINT

High-resolution real-time sonography of the thyroid.

Anatomy, physiology, and genetics of paragangliomas

Universal Infant Hearing Screening Gains Momentum in States

Congenital aplasia and dysplasia of the tibia with intact fibula. Classification and management.

Greetings! This year marks the 64th year of the Philippine Society of Otolaryngology-Head and Neck Surgery. It is a defining year, marked by both national and international events that changed and will most likely continue to change medical practice, public health policy, socio-economic concepts and structures. The SARS-coronavirus-2 (COVID-19) pandemic crashed into the first quarter of 2020 unannounced and with great fury. This great unknown served as the impetus for a flurry of research into every aspect of the disease – its origins, biology, clinical course, and treatment. It initiated an unprecedented interest in research, not just among scientists and clinicians, but most especially amongst the general population. But what is RESEARCH? Re-search - to look again at the past with spectacles, to look at the past with new eyes, to look at the present with a microscope, and to look at the far distance with binoculars – all to better see & perhaps to find answers to our questions. Research fuels the evidence base of our understanding of diseases and the principles of our clinical and surgical practice. Our specialty of Otolaryngology, during this time of the pandemic, will be at the forefront of an exciting time for a renewed quest for knowledge. And what better vehicle to transport us into this new and uncharted world than the Philippine Journal of Otolaryngology Head and Neck Surgery? It is a testament to the unparalleled dedication of the editor-in-chief and editorial staff and the enthusiasm of the contributors, that every year the PJOHNS publishes interesting case reports, relevant descriptive and analytical studies, papers on surgical techniques & instrument innovations, and insightful commentaries. The journal is a platform for our questions and hypotheses. The journal is a venue for our discoveries. But most importantly, the journal is a celebration of our passion for Otolaryngology. Good reading to all! Cecilia Gretchen S. Navarro – Locsin, MD President Philippine Society of Otolaryngology – Head and Neck Surgery

Introduction: The first year of life is the key to normal speech and language development, as well as intellectual and emotional growth. Identification of risk factors for hearing loss is very important for early detection, early initiation of therapy, and assessing the baby's prognosis. This study aims to determine the risk factors for hearing loss in newborns. Methods: This research is a retrospective study with a case-control study design that was conducted from January to December 2021. The research sample was newborns with hearing loss at Prof. Dr. I.G.N.G. Ngoerah hospital. Hearing loss was assessed by Otoacoustic Emission (OAE). All data were analyzed with SPSS version 25. Results: This study got a total of 55 cases of newborns with hearing loss and 55 control groups without hearing loss. Based on multivariate analysis, the factor that significantly influenced hearing loss in newborns was premature birth (adjusted OR=7.120; 95% CI: 1.902-26.654; p=0.004). There was no significant relationship between length of stay, APGAR score, birth weight, family history, hyperbilirubinemia, mechanical ventilation, meningitis, congenital abnormalities, and ototoxic drugs with hearing loss in newborns. Conclusion: Prematurity is a risk factor for hearing loss in newborns. Premature babies should be screened for hearing to detect hearing loss early. Keywords: hearing loss, neonates, premature

Chinese Expert Consensus for Assessment of Vocal Function (2024): Guidelines of the Subspecialty Group of Voice, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association; Subspecialty Group of Laryngopharyngology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery.

Editorial introductions