18TH ASEAN ORL-HNS

CONGRESS
23 – 25 August 2019
Grand Copthorne Waterfront Hotel
Singapore

C ON G R ES S B O OK

Advancing ENT in ASEAN Together

www.aseanorl2019.org
Organised by
 CONTENTS

Message from the President, 2

ASEAN ORL-HNF

Message from the President, 3

ASEAN ORL-HNS Congress 2019

Message from the President, 5

Society of Otolaryngology Head & Neck
Surgery Singapore

Message from American Academy 7

of Otolaryngology-Head and Neck
Surgery/Foundation

Organising Committee 8

Congress Faculty a. International Faculty 9

b. Local Faculty 19

General Information 26

Programme Overview 27

Scientific Programme a. Day 1 31

b. Day 2
c. Day 3

List of Exhibitors 38

Exhibition Floor Plan 39

Sponsorship Acknowledgement 41

Oral & Poster Abstracts a. Oral 43

b. Poster

18TH ASEAN ORL-HNS CONGRESS 1

 MESSAGE FROM THE PRESIDENT,
The ASEAN ORL-HNS Federation

Prof Soe Tin

President
The ASEAN ORL-HNS Federation

Dear Colleagues, ASEAN community and all International friends

It is a great pride and privilege to have an opportunity to send a message

in this 18th ASEAN ORL-HNS Congress.

The ASEAN ORL-HNS Congress is done every two years among the ASEAN
member countries with different “Themes” of the Congress.

It is noted that in 16th ORL-HNS Congress the Theme was “ ASEAN ORL
HNS-Together we learn and share”; in 17th ASEAN ORL-HNS Congress
the Theme was “United and Concerted to move forward” and in this
18th Congress the Theme is “ Advancing ENT in ASEAN together”.

All the Themes are pointing towards ASEAN Culture, ASEAN Solidary and
unity sharing and advancing the knowledge of ORL HNS for all the members
of ASEAN Community.

Advancement and enhancement of the technology need international

cooperation and integration especially with the highly innovated and
research- orientated countries. I am glad to know that in this congress
many famous international faculties are involved to share their “State – of
– the Art technologies” with our ASEAN Community. This Congress will be
the best platform to learn, share and advance your knowledge in all facets
of ORL-HNS. I am sure that at the end of this Congress all the participants
will be overloaded with cutting-edge technologies to bring home with
pleasure.

Wish you all the best.

2 18TH ASEAN ORL-HNS CONGRESS

 MESSAGE FROM THE PRESIDENT,
18th ASEAN ORL-HNS Congress 2019

Dr Barrie Tan
President
18th ASEAN Otorhinolaryngology
Head & Neck Surgery Congress

Dear friends and colleagues

It gives me great pleasure to finally welcome you to Singapore for the

18th ASEAN ORL-HNS Congress. This biennial congress celebrates our ASEAN
unity and togetherness as we come together to pursue excellence in our
special discipline of Otorhinolaryngology Head and Neck Surgery. Indeed,
regional friendships have blossomed immensely in recent years with many
of us meeting regularly at instructional workshops organised in various
hospitals throughout ASEAN and when we meet each other overseas at
international conferences. The ASEAN ORL-HNS Congress builds on that
strong foundation, giving us a platform to reunite every 2 years and as our
congress motto says, to advance ENT in ASEAN together. It also serves to
introduce our younger colleagues and ENT Residents to this spirit of ASEAN
community that was first championed by our founders.

This year we honour the memories of 2 of our founders of the ASEAN

Federation of Oto-Rhino-Laryngology Head & Neck Societies (ORL-HNS)
Societies. Dr Mariano B. Caparas of Philippines and Dr N. Kunaratnam of
Singapore both sadly passed on within the last 2 years since the last edition
of the ASEAN ORL Congress held in Myanmar in 2017. We celebrate their
lives and remember fondly the deep impact they have had on the develop-
ment of ORL HNS in Philippines and Singapore. Join us for our opening cer-
emony where there will be a special showcase. We are deeply grateful to
their vision for having birthed the ASEAN ORL Federation in 1990 together
with Dr. Purnaman S. Pandi of Indonesia, Dr. Imran Gurbachan of Malaysia
and Dr. Suchitra Prasansuk of Thailand. Truly, we are all beneficiaries of
the legacy of friendship and collaboration that they forged in those early
years, blossoming now to a community of 10 ASEAN nations and ORL-HNS
Societies.
18TH ASEAN ORL-HNS CONGRESS 3
 MESSAGE FROM THE PRESIDENT,
18th ASEAN ORL-HNS Congress 2019

This year’s congress brings many of the best minds in the world across
7 subspecialties in ORL-HNS together with a dedicated full day symposium
program for Audiology. Over 200 invited teaching faculties from over 26
different countries congregate in Singapore over these 2 and a half days of
intense scientific sharing. Bolstering this robust conference are 10 instruc-
tional pre and post congress workshops. This congress is being hosted by the
Society of Otolaryngology Head & Neck Surgery Singapore (SOHNSS) and it
would not have been possible without the unwavering support provided
by all the various hospital ENT departments in Singapore. This congress is
testimony to the solidarity of the Singapore ENT fraternity with this being
a truly national effort. We also recognise the importance of how our nurses
and allied health professionals help our patients in their journey towards
optimum ENT Health. The Society for Audiology Professionals Singapore
(SAPS) and other Allied Health Professionals have partnered us immensely
in organising the scientific content of this congress and we are glad that we
can work together for the holistic good of our patients.

I would also like to take this opportunity to thank some of our other impor-
tant partners, collaborators and sponsors. This year’s congress is organised
as a joint meeting together with the American Academy of Otolaryngology-
Head and Neck Surgery/Foundation (AAO-HNS/F) and we highly value the
physical presence of numerous colleagues from the American Academy who
are joining us for this meeting. Much appreciation also goes to the Korean
Society of Otorhinolaryngology-Head and Neck Surgery who have sent a
delegation of their Key executive committee leaders and who will be running
a special Collaboration Symposium in Otology at our Congress. Such sup-
port shown by so many friends far and wide has been immensely moving
and we are grateful. We are also thankful for the many sponsors who have
come alongside us to make this congress a meaningful and successful one.

Finally, it leaves me to wish you all a wonderful visit to Singapore. This is an

especially good time to do so as we celebrate our bicentennial anniversary of
Singapore’s founding in 1819 by the British. Enjoy the sights, sounds, and
foods that make Singapore so colourful and vibrant. We are deeply hon-
oured that you have taken the time to come and be a part of the 18th ASEAN
ORL-HNS Congress and we wish you a fantastic time here with us!
4 18TH ASEAN ORL-HNS CONGRESS
 MESSAGE FROM THE PRESIDENT,
Society of Otolaryngology Head & Neck Surgery Singapore

Adj Asst Prof Lee Tee Sin

President, Society of Otolaryngology -
Head and Neck Surgery Singapore
Vice President, 18th ASEAN Otolaryngology -
Head and Neck Surgery Congress

Dear friends and colleagues

As President of the Society of Otolaryngology - Head & Neck Surgery

Singapore, I take great pride and pleasure in welcoming you to
Singapore and to the 18th ASEAN ORL-HNS Congress - Advancing ENT in
ASEAN Together.

This biennial event brings us together for both academic and social reasons.
It serves as a platform for all Otolaryngologists in ASEAN to come together
to share experiences and knowledge, and to educate the next generation,
while at the same time foster friendships and camaraderie. It has been
18 years since the last time Singapore hosted the Congress in 2001, and it is
an honour and privilege to be host once again.

This year, the Congress has been designed to provide an innovative and
comprehensive overview of the most recent advances in the field of
Otolaryngology. We have put together an impressive 2.5 days of scientific
programme consisting of 5 concurrent tracks featuring 7 subspecialties,
Otology, Rhinology, Laryngology, Head and Neck Surgery, Paediatric
Otolaryngology, Sleep Apnea Surgery, and Facial Plastic Surgery, with
renowned international and local teaching faculties. There are also Pre and
Post Congress Hands-on Workshops. We aim to showcase our capabilities
and expertise in Singapore, and at the same time enhance collaboration
amongst the ASEAN countries.

We will also be having the Gala Dinner which is a highlight of the Congress.
Representatives from each ASEAN countries will be putting up singing

18TH ASEAN ORL-HNS CONGRESS 5

 MESSAGE FROM THE PRESIDENT,
Society of Otolaryngology Head & Neck Surgery Singapore

and dancing performances to entertain the night away and for cultural
exchange. It is also the night when new friendships form and old
friendships rekindle. It will be a night to remember!

The Congress would not be possible without the collaboration and

participation of our industry partners and sponsors. I would like to thank
them for their immense support and generosity. I would also like to
take this opportunity to thank the teaching faculties and the organizing
committee for their time and tremendous effort in making this Congress
such a success.

Finally, I hope that you will have time to experience and immerse yourself
in the history and culture of Singapore, explore the great food and
shopping, and interact with the people. I believe by doing so, you will truly
enjoy the stay here in this beautiful Lion City. I sincerely hope that you will
enjoy the Congress and find it personally rewarding. Thank you!

6 18TH ASEAN ORL-HNS CONGRESS

MESSAGE FROM THE PRESIDENT, American Academy of
Otolaryngology-Head and Neck Surgery/Foundation

Albert L. Merati, MD
President, American Academy of
Otolaryngology - Head and Neck
Surgery/Foundation

On behalf of your colleagues and friends in the American Academy of

Otolaryngology–Head and Neck Surgery/Foundation, I congratulate the
18th ASEAN ORL-HNS Congress, its leadership and scientific program
organizing committee.

Central to the success and meaningful outcomes of collaboration is the

interconnectedness, trust, and ability to work together to advance the
specialty and patient care on a global scale. The ASEAN congress provides
an excellent platform for academic collaboration among neighbors and
“friends” in the region and around the world.

We congratulate you and wish you success as you gather in Singapore and
unite to improve the care and quality outcomes for our patients worldwide
through continued collaboration, friendship and outreach as our global
message continues to resonate around the world.

18TH ASEAN ORL-HNS CONGRESS 7

 ORGANISING COMMITTEE

Dr Barrie Tan Dr Lee Tee Sin Dr David Chin A/Prof Toh Song Tar
President Vice President Treasurer Scientific Chair (Overall)
Barrie Tan ENT Changi General Ascent Ear Nose Throat Singapore General Hospital
Head & Neck Surgery Hospital Specialist Group

Dr Sandeep Uppal Dr Lim Chwee Ming Dr Shalini d/o Dr Yuen Heng Wai
Scientific Committee Scientific Committee Arulanandam Scientific Committee
(Facial Plastics) (Head & Neck) Scientific Committee (Otology)
Khoo Teck Puat Hospital Singapore General Hospital (Laryngology) Changi General Hospital
Singapore General Hospital

Dr David Low A/Prof Loh Woei Dr Tay Sok Yan Dr Soma

Scientific Committee Shyang Scientific Committee Subramanian
(Otology) Scientific Committee (Paediatric) Scientific Committee
Changi General Hospital (Paediatric) National University Hospital​ (Rhinology)
National University Hospital​ Ng Teng Fong General
Hospital

Dr Chong Khai Beng Dr Annabelle Leong Dr Valerie Tay

Scientific Committee Social Co-Chair Social Co-Chair
(Sleep) The ENT Clinic, ​ Tan Tock Seng Hospital​
Tan Tock Seng Hospital​ Mount Elizabeth Novena
Hospital

8 18TH ASEAN ORL-HNS CONGRESS

 INTERNATIONAL FACULTY

Marcus Atlas Donella Chisari Georgina Harris Daniel Novakovic

Director Audiologist ENT Consultant ENT Surgeon,
Ear Science Institute ​Department of Audiology Department of Otolaryngology Medical Director
Australia and Speech Pathology Head and Neck Surgery Dr Liang Voice Program
Perth, Australia The University of Melbourne St Vincents Hospital Central Clinical School,
Melbourne, Australia Sydney, Australia University of Sydney
Sydney, Australia

Alkis Psaltis Narinder Singh Chris Brennan-Jones Ian Curthoys

Associate Professor A/Professor & Chairman Senior Research Fellow Professor
Department of Department of Telethon Kids Institute Department of Psychology
Otolaryngology Otolaryngology, University of Western University of Sydney
Head and Neck Surgery Head & Neck Surgery Australia Sydney, Australia
University of Adelaide Westmead Hospital, Perth, Australia
Adelaide, Australia University of Sydney
Sydney, Australia

Jafri Kuthubutheen Carsten Palme Debbie Phyland Dayse Távora-

Consultant Otology & Director of Head and Adjunct Associate Professor Vieira
Skull Base Surgeon, Neck Surgery Department of Surgery, Head of Department
Department of Chris O’Brien Lifehouse School Clinical Sciences Department of Audiology
Otolaryngology Comprehensive Monash Health Fiona Stanley Hospital
Head & Neck Surgery Cancer Centre Monash University Perth, Australia
Sir Charles Gairdner Australia Melbourne, Australia​
Hospital, Fiona Stanley &
Perth Children’s Hospital
Perth, Australia

18TH ASEAN ORL-HNS CONGRESS 9

 INTERNATIONAL FACULTY

Hermann Raunig Peter A Adamson Jonathan Irish Zhiyu Jia

Consultant of Department of Otolaryngology Professor Senior Consultant
Otolaryngology – Head and Neck Surgery, Department of OTL-Head and Department of Oral and
Spittal an der Drau, Division of Facial Plastic and Neck Surgery Maxillofacial Surgery
Carinthia Reconstructive Surgery University of Toronto The Second Hospital of
Austria University of Toronto, Canada Toronto, Canada Hebei Medical University
Shijiazhuang, China

Victor Abdullah Jason Chan Gordon Soo Atul Shah

Consultant, Chief of Service Assistant Professor The ENTific ® Centre Consultant
Department of Otorhinolaryn- Department of Otorhinolaryn- Hong Kong Plastic Surgery Department
gology, Head & Neck Surgery gology, Head and Neck Surgery Nanavati Super Specialty
United Christian Hospital / The Chinese University of Hospitals
Tseung Kwan O Hospital Hong Kong, Hong Kong Mumbai, India
Hong Kong

Deasi Anggraini Teti Madiadipoera Soekirman Soekin Ria Trimartini

MD, ORL-HNS Head of Subdivision of Allergy Otologist Doctor Division of Plastic and
(Consultant) and Rhinology, Coordinator of Department of Otology Reconstructive Surgery,
ENT Department Research and Development, Neurotology Skull Base Otorhinolaryngology
Persahabatan Hospital Department of Otolaryngology, Surgery Dr Cipto Mangunkusumo
Jakarta, Indonesia Hasan Sadikin Hospital - Proklamasi ENT-HNS lnstitute Hospital, University of
Faculty of Medicine, Padjadja- Jakarta, ​Indonesia Indonesia, Indonesia
ran University, ​Indonesia

10 18TH ASEAN ORL-HNS CONGRESS

 INTERNATIONAL FACULTY

Dini Widiarni Lina Lasminingrumi Rusdian Utamam Budi Sutikno

Widodo Consultant Roeslani Staff in Division of Rhinology​
Senior Consultant Department of ENT-HNS Senior Consultant Rhinology Division, Department
ENT Department Hasan Sadikin Hospital Director of Gandaria Sinus of Otorhinolaryngology
Dr Cipto Mangunkusumo Medical Faculty Universitas and Snoring Centre Faculty of Medicine,
Hospital- Faculty of Padjadjaran Gandaria Hospital Airlangga University /
Medicine Universitas Bandung, Indonesia​ Indonesia Dr Soetomo General
Jakarta, Indonesia Hospital, Surabaya, Indonesia

Retno S Wardani Gabi Arad Daniele Marchioni Claudio Vicini

Rhinology Consultant, Regional Sales ENT Department Professor
Department of Otorhino- Manager University of Verona Department of Head
laryngology Head & Neck Itamar Medical Ltd Verona, Italy & Neck
Surgery, ​Faculty of Medicine Israel University of Ferrara
Universitas Indonesia, ​ Italy
Dr. Cipto Mangunkusumo
Hospital, Jakarta, Indonesia

Shintaro Chiba Koichiro Saito

Secretary General of Department of
Japanese Society of Sleep Otolaryngology-Head
Research, President of and Neck Surgery
Japanese Surgical Sleep Kyorin University
Society, Department of ENT, School of Medicine
Associate Professor of Jikei ​Tokyo, Japan
University School of Medicine
/ Director of Ota Memorial
Sleep Center, Tokyo, Japan

18TH ASEAN ORL-HNS CONGRESS 11

 INTERNATIONAL FACULTY

Chung Hwan Baek Eun Chang Choi Yong-Ju Jang Ja-Won Koo
Professor President of Asian Society of Asan Medical Center Department of
Department of Otorhi- Head and Neck Oncology University of Ulsan Otorhinolaryngology
nolaryngology-Head and Department of College of Medicine Seoul National University
Neck Surgery Otorhinolaryngology South Korea Bundang Hospital
Samsung Medical Center Yonsei University College of Seongnam, Korea
Seoul, Korea Medicine, Seoul, Korea

Hyoung Jin Moon Park Chan Soon Yang-Sun Cho Ji Yun Choi
President Department of Professor Department of
​Beup Aesthetic Otorhinolaryngology - Department of ORL-HNS Otorhinolaryngology
Surgery Clinic Head and Neck Surgery Samsung Seoul Hospital School of Medicine
Korea St. Vincent’s Hospital, Seoul, Korea Chosun University
The Catholic University South Korea
of Korea, Medical
College, Suwon, Korea​

Jae Yun Jung Kang-Dae Lee Sung Wan Kim Kyung Tae
Chair of Department Professor Professor Professor
Department of Department of Department of Department of
Otolaryngology-Head & Otolaryngology-Head & Otorhinolaryngology- Otolaryngology-Head &
Neck Surgery Neck Surgery Head & Neck Surgery Neck Surgery
Dankook University Kosin University College Kyung Hee University Hanyang University
Choennan, Korea of Medicine Seoul, Korea Seoul, Korea
Busan, South Korea

12 18TH ASEAN ORL-HNS CONGRESS

 INTERNATIONAL FACULTY

Baharudin Abdullah Noor Hisham Abdullah Goh Bee See Prepageran N

Senior Consultant Director General of Health Senior ORL-HNS Consultant​ Senior Professor and
Department of Malaysia and Senior Consul- Department of Consultant, Department of
Otorhinolaryngology - Head tant Surgeon in Breast and Otorhinolaryngology Otorhinolaryngology,
and Neck Surgery Endocrine Surgery Universiti Head & Neck Surgery
Universiti Sains Malaysia Putrajaya Hospital Kebangsaan Malaysia Faculty of Medicine,
​Kubang Kerian, Kelantan, Ministry of Health Malaysia Malaysia University Malaya, Malaysia
Malaysia ​Putrajaya, Malaysia

Philip Rajan Lokman Saim Harvinder Singh Tang Ing Ping

Consultant Vice Chancellor & Dean Consultant Rhinologist Senior Consultant
Department of School of Medicine Department of ENT Department of ORL-HNS
Otorhinolaryngology KPJ Healthcare Hospital Raja Permaisuri University Malaysia
Hospital Raja Permaisuri University College Bainun Sarawak
Bainun Malaysia ​Ipoh, Malaysia Sarawak, Malaysia
Ipoh, Malaysia

Shifa Zulkifli Salina Husain Marina Mat Baki Tengku Izam

Paediatric Otolaryngology Senior Consultant, Professor of Laryngology Consultant Otologist
Consultant Rhinology Department of ORL Department
Department of Department of Otorhinolaryngology- Hospital Sultan Ismail
Otolaryngology Otorhinolaryngology- Head and Neck Surgery Johor Bahru, Malaysia
Woman Children’s Head And Neck Surgery Universiti Kebangsaan
Hospital Kuala Lumpur UKM Medical Centre Malaysia Medical Centre
Malaysia​ ​Malaysia Kuala Lumpur, Malaysia

18TH ASEAN ORL-HNS CONGRESS 13

 INTERNATIONAL FACULTY

Ramiza Ramza Ramli Abdullah Sani Avatar Singh Kuljit Singh

Senior Consultant Mohamed Consultant Consultant ENT Surgeon
Department of Senior Consultant ORL Department of ORL, Prince Court Medical Centre
Otorhinolaryngology – Surgeon Head-Neck Surgery Kuala Lumpur
Head and Neck Surgery Department of ORL HNS Taiping Hospital Malaysia
Universiti Sains Malaysia Universiti Kebangsaan Taiping, Malaysia
Kelantan, Malaysia Malaysia
Kuala Lumpur, Malaysia

Y Y Yap Khin Hla Hla Soe Tin Maung Maung Khaing

Consultant ENT Surgeon Professor President of ASEAN Professor/Head
Department of Department of ORL HNS Federation Department of
Otorhinolaryngology Otorhinolaryngology – Unit Head, High Tech Otorhinolaryngology
KPJ Johor Specialist Head & Neck Surgery ORL HNS One Stop University of Medicine (1)
Hospital University of Medicine (1) Solution Centre Yangon
Johor Bahru, Malaysia Yangon Victoria Hospital Yangon, Myanmar
Yangon, Myanmar Yangon, Myanmar

Ryner Carrillo Peter Jarin Alfredo Pontejos, Jr Joseph Amando

Consultant Consultant and Section Professor Jay Galvez
Department of Otorhinolar- Head of Rhinology Department of Galvez Clinic
yngology / Anatomy Department of Otolaryngol- Otolaryngology Philippines
Philippine General ogy-Head and Neck Surgery University of the Philippines
Hospital, University of the The Medical City Manila, Philippines
Philippines-Manila Metro Manila, Philipppines
Philippines

14 18TH ASEAN ORL-HNS CONGRESS

 INTERNATIONAL FACULTY

Erasmo Gonzalo Eduardo Yap Sameer Ali Bafaqeeh Kai-Ping Chang

Llanes Belo Medical Group College of Medicine, Chief & Professor
Clinical Associate Professor Philippines Otolaryngology Department Division of Head & Neck
Department of Otorhinolar- King Saud University Surgery, Department of
yngology Saudi Arabia Otolaryngology
University of the Philippines – Chang Gung Memorial
Philippine General Hospital Hospital
Manila, Philippines ​Taipei, Taiwan

Sheng-Po Hao Wei-Chung Hsu Hsueh-Yu Li Hsin-Ching Lin

Professor & Chairman Department of Professor MD, FACS
Department of Otolaryngol- Otolaryngology Department of Department of ​Otolar-
ogy Head and Neck Surgery National Taiwan University Otolaryngology yngology, Sleep Center,
Shin Kong Wu Ho-Su Hospital Chang Gung Memorial Robotic Surgery Center
Memorial Hospital, Taiwan Taipei, Taiwan Hospital Kaohsiung Chang Gung
Taipei, Taiwan Taiwan Memorial Hospital
Kaohsiung, Taiwan​

Chih-Wen Twu Feng-Yu Chiang Yu-Shu Huang Steve Kao

Department of Professor Department of Child Tri-Service General
Otolaryngology Department of Psychiatry and Sleep Center Hospital,
Taichung Veterans Otolaryngology – Chang Gung Memorial National Defense
General Hospital Head and Neck Surgery Hospital Medical Center
Taiwan Kaohsiung Medical Taipei, Taiwan Taiwan
University Hospital
​Kaohsiung, Taiwan

18TH ASEAN ORL-HNS CONGRESS 15

 INTERNATIONAL FACULTY

Clement CH Lin Shyh-Kuan Tai Wish Banhiran Choakchai

Assistant Professor Division Chief Chief of Sleep Medicine Metheetrairut
Department of Craniofacial Department of Division, Department of Department of
Center, Plastic and Otolaryngology OtoRhinoLaryngology Otorhinolaryngology
Reconstructive Surgery Taipei Veterans Faculty of Medicine Faculty of Medicine Siriraj
Chang Gung Memorial General Hospital Siriraj Hopsital, Hospital, Mahidol University
Hospital Taipei, Taiwan Mahidol University Bangkok, Thailand
Taoyuan, Taiwan Bangkok, Thailand

Kachorn Choladhis Napadon T Pongsakoran

Seresirikachorn Sinrachatanant Head of Division of Head Tantilipikorn
Consultant Teerapon Clinic and Neck Surgery Head of Center of Research
Department of Otolaryngol- Thailand Department of Excellent in Allergy & Immu-
ogy, Faculty of Medicine, Otolaryngology nology, Faculty of Medicine
Chulalongkorn University Chulalongkorn University Siriraj Hospital, Assistant
​Bangkok, Thailand Bangkok, Thailand President for Research &
Academic Affairs, Mahidol
University, Thailand

Pornthep Kasemsiri Phakdee Sannikorn Dhave Setabutr Kornkiat Snidvongs

Vice Chairman Department of Pediatric Otolaryngologist Associate Professor
Department of Otolaryngology Head Department of Department of
Otorhinolaryngology and Neck Surgery Otolaryngology Otolaryngology
Khon Kaen University Rajavithi Hospital, Chulabhorn International Chulalongkorn University
Khon Kaen, Thailand Ministry of Public Health College of Medicine, ​Bangkok, Thailand​
​Bangkok, Thailand Thammasat University
Hospital
Bangkok, Thailand

16 18TH ASEAN ORL-HNS CONGRESS

 INTERNATIONAL FACULTY

Archwin Sanguansak Ozcan Cakmak Anjana Haridas

Tanphaichitr Thanaviratananic FACEISTANBUL Spire Healthcare
Assistant Professor Department of Turkey United Kingdom
Department of Otorhi- Otorhinolaryngology
nolaryngology, Faculty of Faculty of Medicine,
Medicine, Siriraj Hospital, Khon Kaen University
Mahidol University ​Khon Kaen, Thailand​
Bangkok, Thailand

Hesham Saleh Samuel Leong Greg Davis Michael B Gluth

Charing Cross Hospital Lead Consultant, Liverpool MD, MPH Director, Comprehensive
United Kingdom Rhinology Fellowship Department of Ear & Hearing Center
Department of Otorhinolaryn- Otolaryngology – Department of
gology - Head & Neck Surgery Head And Neck Surgery Otolaryngology-Head &
Liverpool Head and University of Washington Neck Surgery
Neck Centre Seattle USA University of Chicago
Liverpool, United Kingdom Chicago, USA

Peter Hwang Kent Lam Zara M Patel Jivianne Lee

Department of Assistant Professor Associate Professor, Associate Professor
Otolaryngology-Head & Department of Director of Endoscopic Department of Head &
Neck Surgery Otolaryngology – Head Skull Base Surgery Neck Surgery
Stanford University & Neck Surgery, Eastern Department of University of California
Stanford, USA Virginia Medical School Otolaryngology – Los Angeles (UCLA)
Norfolk, Virginia, Head and Neck Surgery Los Angeles, USA
United States Stanford University School
of Medicine
Palo Alto, California, USA

18TH ASEAN ORL-HNS CONGRESS 17

 INTERNATIONAL FACULTY

Elizabeth Toh Pete Weber John M Joe Han

Vice Chairman Department of Delgaudio, MD Professor
Department of Otolaryngology Professor and Vice Chair Department of
Otolaryngology-Head Boston University Chief of Rhinology, Otolaryngology
and Neck Surgery Medical Center Department of Eastern Virginia
Lahey Hospital & Boston, USA Otolaryngology Medical School
Medical Center Emory University Norfolk, VA, USA
USA Atlanta, GA, USA

Stacey Ishman Teofilo Lee-Chiong Arturo Solares Eric W Wang

Professor Professor of Medicine Department of Associate Professor
Department of Otolaryngol- Department of Medicine Otolaryngology and Department of
ogy – Head and Neck Surgery National Jewish Health Neurosurgery Otolaryngology
and Pulmonary Medicine, Denver, USA ​Emory University University of Pittsburgh
Cincinnati Children’s Hospital Atlanta, GA, USA School of Medicine
Medical Center Pittsburgh, Pennsylvania,
Cincinnati, OH USA USA

Sarah K Wise Luan Tran Tran Phan Chung Thuy

Professor Associate Professor ​ irector of ENT Hospital
D
Department of and Chair ENT Hospital of
Otolaryngology-Head Department of Ho Chi Minh City
and Neck Surgery Otolaryngology - Associated Professor Head ENT
Emory University Head & Neck Surgery Department of Faculty of
Atlanta, Georgia USA Pham Ngoc Thach Medicine of Vietnam National
University of Medicine University HCMC
Ho Chi Minh City, ​Ho Chi Minh City, Vietnam
Vietnam

18 18TH ASEAN ORL-HNS CONGRESS

 LOCAL FACULTY

A Balakrishnan Chan Ching Yee Chao Siew Shuen Chew Fook Tim
Senior Consultant Consultant ENT and Sinus Centre Associate Professor, Vice
Department of Department of Gleneagles Medical Centre Dean (Faculty of Science)
Otolaryngology Otolaryngology Singapore Department of Biological
Singapore General Hospital KK Women’s and Sciences, National University
Singapore Children’s Hospital of Singapore
Singapore ​Singapore​

Chew Hui Sing Chong Khai Beng YawKhian Chong Chua Ai Ping
Associate Consultant Department of Senior Consultant Senior Consultant
Department of Otorhinolaryngology Department of Department of Medicine
Otorhinolaryngology Tan Tock Seng Hospital Otorhinolaryngology National University
Tan Tock Seng Hospital Singapore Tan Tock Seng Hospital Health System
Singapore Singapore Singapore

Dennis Chua Laura Chua Fung Chak Yuen Christopher Goh

Dr Dennis Chua - Principal Speech Therapist Consultant Senior Consultant
ENT Surgeons Medical Department of Speech Department of Novena ENT –
Centre Therapy Otorhinolaryngology Head & Neck Surgery
Singapore Singapore General Hospital (Ear, Nose and Throat) Specialist Centre
Singapore Tan Tock Seng Hospital ​Singapore
Singapore

18TH ASEAN ORL-HNS CONGRESS 19

 LOCAL FACULTY

Goh Yau Hong Han Hong Juan Harold Heah Rebecca Heywood
Consultant ENT Consultant ENT Surgeon Department of Consultant
Surgeon The ENT, Voice & Snoring Otolaryngology Department of ENT
Mount Elizabeth Clinic Singapore General (Ear, Nose & Throat) –
Medical Centre Singapore Hospital Head & Neck Surgery
Singapore Singapore Ng Teng Fong General
Hospital
Singapore

Ho Eu Chin Hsu Pon Pon Huang Xinyong Nikita Kamdar

Senior Consultant Assistant Chairman, Department of Auditory-Verbal Therapist
Department of Medical Board Otolaryngology - ENT Hearing Centre
Otorhinolaryngology Senior Consultant Surgeon Head & Neck Surgery Singapore General
(Ear, Nose and Throat) Department of Changi General Hospital Hospital
Tan Tock Seng Hospital Otorhinolaryngology Singapore Singapore
Singapore Changi General Hospital
Singapore

Lynn Koh Gopal Krishna David Lau Lau Hung Tuan

Consultant Senior Principal Audiologist David Lau ENT Centre Associate Consultant
Department of ENT Centre Singapore Department of
Otolaryngology Singapore General Hospital Otolaryngology (ENT) –
KK Women’s and ​Singapore Head & Neck Surgery
Children’s Hospital Khoo Teck Puat Hospital
Singapore Singapore

20 18TH ASEAN ORL-HNS CONGRESS

 LOCAL FACULTY

Dr Gary Lee Lee Phong Ching Lee Tee Sin Leem Pei Shan
Head Consultant Department of Principal Audiologist
Department of Department of Otolaryngology – Head ENT Centre
Audiology Endocrinology and Neck Surgery Singapore General Hospital
Ng Teng Fong General Singapore General Hospital Changi General Hospital Singapore
Hospital Singapore Singapore
Singapore

Leong Jern-Lin Leow Leong Chai Felix Li Lim Chwee Ming

Consultant ENT Consultant Lead Doctor Senior Consultant
Surgeon Department of Department of Aesthetics Department of
Ascent Ear Nose Throat Respiratory and Critical Thomson Wellth Otolaryngology
Specialist Group Care Medicine Aesthetics Clinic Singapore General
Singapore​​ Singapore General ​Singapore Hospital
Hospital Singapore
Singapore​

Francoise Lim Magdalene Lim Michael Lim Lim Ming Yann

Principal Speech Therapist​ Audiologist Senior Consultant Consultant
Department of ENT Department of Department of Paediatrics Department of
Tan Tock Seng Hospital Otolaryngology National University Hospital Otorhinolaryngology
Singapore National University Singapore (Ear, Nose and Throat)
Hospital Tan Tock Seng Hospital
Singapore Singapore

18TH ASEAN ORL-HNS CONGRESS 21

 LOCAL FACULTY

David Loh Ian Loh Shaun Loh Thomas Loh

Medical Director Consultant, Head of Service, Associate Consultant Department of
David Loh Surgery ​Facial Plastic & Singhealth Duke-NUS Sleep Otolaryngology -
Singapore Reconstructive Surgery Centre, Department of Head and Neck Surgery
Department of Otolaryngology National University
Otolaryngology Singapore General Hospital Hospital
Changi General Hospital Singapore Singapore
Singapore

Loh Woei Shyang Low Wong Kein Jenny Loo Mark Hon Wah
Head of Department Novena ENT - Head & Senior Principal Audiologist Ignatius
and Senior Consultant Neck Surgery Specialist Department of ENT, Head Consultant ENT Surgeon
Department of Centre & Neck Surgery Ascent Ear Nose Throat
Otolaryngology - Head Singapore National University Hospital Specialist Group
and Neck Surgery Singapore​ Singapore
National University
Hospital Singapore

Jennifer Martin William Hal Martin Paul Mok Ng Jing Hao

Senior Lecturer Programme Director My ENT Specialist National Dental Centre
Department of MSc Audiology Singapore Singapore
Otolaryngology Department of Singapore
National University of Otolaryngology
Singapore National University of
Singapore Singapore
Singapore

22 18TH ASEAN ORL-HNS CONGRESS

 LOCAL FACULTY

Ng Li Shia Ngiam Juzheng Ong Thun How Ong Yew Kwang

Consultant Medical Director Department of Respiratory Department of
Department of J Laser And Aesthetics Clinic and Critical Care Medicine Otolaryngology - Head &
Otolaryngology - Head Singapore Singapore General Hospital Neck Surgery (ENT)
and Neck Surgery Singapore National University Hospital
​National University Singapore
Hospital
Singapore

Kenny Pang Phua Chu Qin Raymond Seet Dharambir S Sethi

ENT Specialist Associate Consultant Senior Consultant Consultant ENT Surgeon
Asia Sleep Centre Department of ENT Department of Neurology Novena ENT - Head &
Paragon Medical Surgery National University Hospital Neck Surgery
Centre Sengkang General Singapore Specialist Centre
Singapore Hospital Singapore​
Singapore

Siow Jin Keat Gangahara Sundar Adeline Tan Alvin Tan

Clinical Associate Head, Orbit & Oculofacial Senior Consultant Department of
Professor of Surgery, Dept of Ophthal- Department of Otorhinolaryngology,
Otorhinolaryngology, mology, ​Adjunct Faculty, Respiratory Medicine Head & Neck Surgery
National University of Dept of Pediatrics, National Ng Teng Fong General Changi General
Singapore, University Hospital, ​ Hospital Hospital
Senior Consultant, National University of Singapore Singapore
Department of Singapore, Singapore
Otorhinolaryngology
(Ear, Nose and Throat),
Tan Tock Seng Hospital,
Singapore

18TH ASEAN ORL-HNS CONGRESS 23

 LOCAL FACULTY

Barrie Tan Jocelyn Tan Melissa Tan Terry Tan

Barrie Tan ENT Head Senior Speech Therapist Audiologist Consultant
& Neck Surgery Department of Department of ENT, Department of
Singapore Rehabilitation Audiology Otorhinolaryngology
National University Singapore General Khoo Teck Puat
Hospital Hospital Hospital
Singapore ​ Singapore Singapore

Vanessa Tan Tay Hin Ngan Tay Sok Yan Valerie Tay
Associate Consultant H N Tay ENT Head & Consultant Department of
Department of Neck Thyroid Sleep Department of Otolaryngology
Otolaryngology Robotic Surgery Otolaryngology - Tan Tock Seng Hospital
Singapore General Singapore Head & Neck Surgery Singapore
Hospital National University
Singapore Hospital
Singapore

Constance Teo Angeline Teo Yi Ling Neville Teo

Department of Research Associate/ Consultant
Otolaryngology Audiologist Department of
Singapore General Department of Otolaryngology
Hospital Otolaryngology Singapore General
Singapore National University of Hospital
Singapore Singapore
Singapore

24 18TH ASEAN ORL-HNS CONGRESS

 LOCAL FACULTY

Alex Tham Mark Thong Toh Song Tar Sandeep Uppal

Associate Consultant Senior Consultant Head, Singhealth Duke-NUS Senior Consultant,
Department of Department of Sleep Centre, Singhealth Otolaryngologist Trained in
Otolaryngology Otolaryngology - Head & Senior Consultant, Facial Plastic Surgery,
Tan Tock Seng Hospital Neck Surgery (ENT) Department of Khoo Teck Puat Hospital,
Singapore National University Hospital Otolaryngology, ​Singapore Singapore, Adjunct Assistant
Singapore General Hospital Professor, Yong Loo Lin
Singapore School of Medicine, National
University of Singapore

Wang De Yun Olivia Wee Wee Seng Kwee

Research Professor & ​ Senior Auditory-Verbal Senior Principal
Director of Research Therapist Physiotherapist
Department of Department of Centre for Advanced
Otolaryngology Otolaryngology Rehabilitation
National University Singapore General Therapeutics (CART)
of Singapore Hospital Tan Tock Seng Hospital
Singapore​ ​Singapore Singapore

Petrina Wong Grace Chao Edward Zhang

Consultant Regional Product Department of
Respiratory Medicine Audiologist Otolaryngology
Service, Department GN ReSound (Ear, Nose & Throat)
of Paediatrics Singapore Singapore General Hospital /
KK Women’s and Sengkang Health / SingHealth
Children’s Hospital Singapore
Singapore

18TH ASEAN ORL-HNS CONGRESS 25

 GENERAL INFORMATION

VENUE Refreshment and Lunch

Grand Copthorne Waterfront Hotel Refreshments and lunch will be
Level 4, Grand Ballroom provided daily according to the time
392 Havelock Road indicated in the programme.
Singapore 169663
Opening Ceremony
REGISTRATION DESK HOURS Registered participants are invited to
The registration desk will be located attend the Opening Ceremony on
in front of the ballroom, level 4 and 23 August 2019 at 1100hrs in the
will open as follows: Ballroom. Then followed by the
23 August 2019 0700 – 1800 hrs Opening of Exhibition and refresh-
24 August 2019 0700 – 1800 hrs ment. The Opening Ceremonies will
25 August 2019 0700 – 1330 hrs be followed immediately by the
Scientific Session.
EXHIBITION HOURS
The exhibition is located at the foyer MEET-THE-MASTER
of Level 3 & 4 and will be open as The welcome dinner will take place
follows: on 24 August 2019 at the Grand
23 - 24 August 2019 0900 – 1800 hrs Ballroom, Level 4 1800hrs. All
25 August 2019 0900 – 1300 hrs participants are invited to attend.

SCIENTIFIC PROGRAMME GALA Dinner

A full interactive Scientific Programme The Gala Dinner will take place on
is available on the Congress website. 24 August 2019 at 1900hrs at the
Grand Ballroom, Grand Copthorne
Certificate of Attendance Waterfront Hotel. All participants are
Please note that certificates of atten- invited to attend.
dance will not be printed onsite.
Certificate of Attendance will be issued
to all attendees electronically after
the congress. Certificate of Poster/Oral
Presentation will be issued upon
request after the congress.

26 18TH ASEAN ORL-HNS CONGRESS

 PRE / POST - CONGRESS WORKSHOP

PRE-CONGRESS WORKSHOP

POST-CONGRESS WORKSHOP

18TH ASEAN ORL-HNS CONGRESS 27

PROGRAMME OVERVIEW - DAY 1: FRIDAY, 23 AUGUST 2019

28 18TH ASEAN ORL-HNS CONGRESS

PROGRAMME OVERVIEW - DAY 2: SATURDAY, 24 AUGUST 2019

18TH ASEAN ORL-HNS CONGRESS 29

PROGRAMME OVERVIEW - DAY 3: SUNDAY, 24 AUGUST 2019

30 18TH ASEAN ORL-HNS CONGRESS

SCIENTIFIC PROGRAMME - DAY 1: FRIDAY, 23 AUGUST 2019

18TH ASEAN ORL-HNS CONGRESS 31

 SCIENTIFIC PROGRAMME - DAY 1 (continued)

32 18TH ASEAN ORL-HNS CONGRESS

SCIENTIFIC PROGRAMME - DAY 2: SATURDAY, 24 AUGUST 2019

18TH ASEAN ORL-HNS CONGRESS 33

SCIENTIFIC PROGRAMME - DAY 2 (continued)
 SCIENTIFIC PROGRAMME - DAY 2 (continued)

34 18TH ASEAN ORL-HNS CONGRESS

SCIENTIFIC PROGRAMME - DAY 2 (continued)

18TH ASEAN ORL-HNS CONGRESS 35

SCIENTIFIC PROGRAMME - DAY 3: SUNDAY, 25 AUGUST 2019

36 18TH ASEAN ORL-HNS CONGRESS

SCIENTIFIC PROGRAMME - DAY 3 (continued)

18TH ASEAN ORL-HNS CONGRESS 37

 LIST OF EXHIBITORS

LEVEL 4
Company Booth Number

A. Menarini Asia-Pacific Pte Ltd 16

Advanced Bionics 6
Carl Zeiss Pte Ltd 11
Cochlear Limited 8
GN Hearing Pte Ltd 7
KARL STORZ Endoscopy Asia Marketing Pte Ltd 5
Medel Pte Ltd 4
Medtronic International Ltd 17 - 18
Olympus Singapore Pte Ltd 15
Oticon Singapore Pte Ltd 12 - 13
Pentax Medical 1
Philips Healthcare 14
Sanofi-Aventis Singapore Pte Ltd 2
SurgiPro Pte Ltd 9 - 10
Ziwell Medical (S) Pte Ltd 3

LEVEL 3
Company Booth Number

Chengdu Mechan Electronic Technology Co. Ltd 8

Vorotek Pty Ltd 4
iNova Pharmaceuticals (Singapore) Pte Ltd 10
Johnson & Johnson Pte Ltd 3
Osteopore International Pte Ltd 5
Reckitt Benckiser (Singapore) Pte Ltd 7
SG Medical Pte Ltd 2
Smith & Nephew Pte Ltd 6
Stardust Sleep Labs 1
Zzenith Sleep & Respiratory, Medical & 9
Nursing Services Pte Ltd

38 18TH ASEAN ORL-HNS CONGRESS

EXHIBITION FLOOR PLAN - LEVEL 3

18TH ASEAN ORL-HNS CONGRESS 39

 EXHIBITION FLOOR PLAN - LEVEL 4

40 18TH ASEAN ORL-HNS CONGRESS

 SPONSORSHIP ACKNOWLEDGEMENT

The Organising Committee is deeply appreciative of the sponsorship

generously provided by the following companies.

PLATINUM SPONSOR

GOLD SPONSOR

SILVER SPONSORS

HOSPITALITY SUITE

LUNCH SYMPOSIUM SPONSORS

18TH ASEAN ORL-HNS CONGRESS 41

 SPONSORSHIP ACKNOWLEDGEMENT

The Organising Committee is deeply appreciative of the sponsorship

generously provided by the following companies.

WELCOME RECEPTION SPONSOR

BREAKFAST RECEPTION SPONSORS

PHILANTHROPIC SPONSOR

TABLE-TOP SPONSORS (MAIN CONGRESS + WORKSHOP)

TABLE-TOP SPONSORS (MAIN CONGRESS)

42 18TH ASEAN ORL-HNS CONGRESS

 18TH ASEAN ORL-HNS
CONGRESS

ABSTRACTS – ORAL

18TH ASEAN ORL-HNS CONGRESS 43

FP1_01

Head and Neck Oncology Linked to Poor Oral Health? A Systematic Review of the Evidence in the 21st
Century

TENG Ker Sheng [1]; John LOH Ser Pheng [2]

1 - Dental Officer, National Dental Centre, Singapore

2 - Consultant, Discipline of Oral & Maxillofacial Surgery, National University Centre for Oral Health,
Singapore

OBJECTIVES
The link between chronic inflammation and oral cancer is well known. Periodontal disease is a common
chronic inflammatory disease in the head and neck. Recently, several studies have indicated significant
association of periodontal disease with oral cancer. This review aims to evaluate current evidence for
the role of periodontal disease in carcinogenesis.

MATERIALS AND METHODS

A systematic search was carried out on PubMed and Embase using the PRISMA 2009 systematic review
guidelines. Keywords included: chemokines, periodontal disease, periodontitis, oral cancer, oral
carcinoma. The search generated 61 papers. Additional 14 manuscripts were hand-searched following
references from these manuscripts. Manuscripts were selected for full-text reading based on
predetermined criteria. Articles included were published in English between 2000 and 2019, including
reviews, prospective and retrospective studies, and original papers. Articles not in English, published
prior to 2000, animal studies, or retracted, as well as articles not related to cancer, were excluded.

RESULTS
After reviewing 75 abstracts, a total of 18 manuscripts were selected and reviewed. Evidence suggests
that mutual interaction between host cells and oral microbiota in chronic periodontitis provides a micro-
environment promoting carcinogenesis. Strong association between the poor oral health and oral cancer
was indicated, but the mechanisms explaining this link requires prospective research.

CONCLUSION
There is a clearly increased risk of oral cancer in patients with periodontal disease. Head and neck
professionals can advise patients that poor oral health carries increased risk of oral cancer. In this talk,
we propose a new workflow between dental and medical professionals in order to optimise patient risk
management.
FP1_02

HEAD AND NECK SCHWANNOMAS – AT TERTIARY CARE HOSPITAL, AND SYSTEMATIC REVIEW OF
LITERATURE

Dr KABEKKODU Sushmitha[1], Dr DOSEMANE Deviprasad[1], Dr JAIPURIA Bhagyashree[1], Dr

SREEDHARAN Suja[1], Dr M KAMATH Panduranga[1], Dr SHENOY Vijendra[1]
1-Department of Otorhinolaryngology, Kasturba Medical College, Manipal Academy of Higher Education,
Mangalore, India

OBJECTIVES
To describe the incidence, presenting clinical features, and management of head and neck extracranial
schwannomas.

MATERIALS AND METHODS

Patients who presented to the Department of Otorhinolaryngology at our tertiary care hospital with
head and neck schwannomas over the past 15 years were included in the study.

RESULTS
Out of 25 cases,19 presented initially as neck mass. Vagus was the commonest nerve of origin followed
by cervical sympathetic plexus. A rare presentation arising from brachial plexus C5 nerve root was also
encountered. There were few rare cases of schwannomas arising from nasal cavity, paranasal sinuses
and oral cavity. All underwent imaging studies (CT or MRI) preoperatively. Complete surgical excision
was the treatment in all cases.

CONCLUSION
Unilateral neck mass which was presenting for a long duration of time was the commonest presenting
complaint in head and neck schwannoma. The diagnosis is mainly by clinical features and investigations
such as imaging and fine-needle aspiration. Mostly, the diagnosis is confirmed on the histological study
after excision of the lesion. Mainstay of treatment is complete excision. Due to the proximity of the
tumour with the involved nerve, palsy may occur. Hence, a correct diagnosis of schwannoma is
essential.
FP1_03

JUVENILE NASOPHARYNGEAL ANGIOFIBROMA IN WEST JAVA INDONESIA

DEWI Yussy Afriani
Oncology Head and Neck Surgery Division of Faculty of Medicine Universitas Padjadjaran Bandung West
Java Indonesia

OBJECTIVES
Juvenile Nasopharyngeal Angiofibroma (JNA) is a benign, but locally aggressive because it has the ability
to have bone destruct and spread to surrounding tissue. This research to determine the profile of ANJ in
Hasan Sadikin Hospital which is the referral center hospital in West Java.

MATERIALS AND METHODS

This study is a descriptive retrospective to determine the profiles of JNA patients in Hasan Sadikin
Hospital Bandung West Java Indonesia at 2011-2018 period.

RESULTS
There was 98 cases of ANJ; 95 are man (97%) and 3 are woman (3%) patients in range of 10-20 years old
(97%). 68 patients (69%) with chief complain of epistaxis and others with nasal obstruction. The highest
stage of JNA was found for IIC-Redkoswki (58%). The surgical approach is done by trans palatal (82%)
and agents preoperative embolization was used PVA and Glue (84%). Preoperative embolization
procedure can reduce intraoperative blood loss until the total amount of intraoperative bleeding of 300
ml.

CONCLUSION
Juvenile Nasopharyngeal Angiofibroma occurs in male early adolescent. The surgical management of
ANB mostly done by embolization as perioperative stage and trans palatal approach. Preoperative
embolization such as PVA and Glue can reduced intraoperative blood loss significantly.
FP1_04

HOW ACCURATE IS CYTOLOGY IN EXCLUDING MALIGNANCY IN THYROID NODULES 4CM OR MORE?

Stephanie YEAP1, Jereme GAN1, LIM Chien Joo2, LI Hao1

Affiliations
1 Department of Otolaryngology, Tan Tock Seng Hospital, Singapore
2 Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore

BACKGROUND
Though fine-needle aspiration cytology (FNAC) is used as the gold standard for predicting malignancy in
thyroid nodules, its accuracy has been challenged in multiple studies that show that nodule sizes of
≥4cm are associated with higher risks of malignancy, with some articles recommending diagnostic
lobectomy of the thyroid regardless of cytology to rule out malignancy. Our study aims to determine the
false-negative rate of pre-operative FNAC in thyroid nodules ≥4cm, by looking for malignancy on post-
operative histology in cases where pre-operative FNAC was benign.

METHODS
We conducted a retrospective analysis of all thyroidectomies from 2010-2015 done at Tan
Tock Seng Hospital by collating data on pre-operative FNA cytology, nodule size on ultrasound,
ultrasound features, and post-operative histology.

RESULTS
517 records were retrieved, out of which 185 patients’ records with nodules ≥4cm and preoperative
FNAC results were selected. Benign cytology (Bethesda classes 1-3) accounted for
93.5% (N=173) of cases, of which 28 cases had malignant histology, thus giving a falsenegative
rate of 16.2%. Overall, FNAC had a low sensitivity to malignancy (24.3%) but high
specificity for benign diagnosis (98.4%) for thyroid nodules ≥4cm.

CONCLUSION
Approximately 3 in 20 cytologically benign thyroid nodules ≥4cm are histologically malignant,
suggesting cytology is insufficient to exclude cancer. A partial/total thyroidectomy is
recommended to exclude malignancy.
FP1_05

TIME BASED PROTOCOLS OF TRACHEOSTOMY CHANGES IN LONG TERM

TRACHEOSTOMISED PATIENTS ARE NOT INDICATED

KUMARASINGHE Dulitha [1, 2, 3]; SMITH Mark [1, 3], PALME Carsten [1, 3], RIFFAT
Faruque [1, 2, 3, 4, 5]
Affiliations: 1- School of Medicine, University of Sydney, Sydney, Australia; 2- School of
Medicine, Western Sydney University, Sydney, Australia; 3- Department of ENT, Westmead
Hospital, Sydney, Australia; 4- Department of ENT, Macquarie University Hospital, Sydney,
Australia; 5- Department of ENT, Chris O’Brien Lifehouse, Sydney, Australia

OBJECTIVES
Tracheostomy tube changes are a source of incredible psychological and physical
discomfort. Tubes are typically changed within 4-weeks post insertion and then every 4-
weeks to 3-monthly depending on clinical judgement. Changes are done for a variety of
reasons including the presumed increased risk of infection associated with biofilm formation.
Currently no evidence-based guidelines exist to guide tube changes and hence considerable
variability exists between institutions. This study aims to assess the rates of colonisation and
infection between tubes changed at different times.

MATERIALS AND METHODS

A prospective study of 65 adult tracheostomy patients’ part of one
of Australia’s largest tracheostomy services. Tracheostomy tubes were divided into
</=4weeks or >4weeks depending on their length of insertion and then tube samples sent for
brush cytology and MCS during changes. Data was collected over 18 months. Chi-square
tests were performed to compare culture results and other endpoints.

RESULTS
Chi squared analysis showed no significant difference in colonisation between
tubes changed </=4weeks vs >4weeks (65.0% vs 53.3%, p=0.38). There were also no
significant differences when comparing indication for insertion (Medical vs Surgical) or
the number of times the inner cannula was changed daily. Outpatients in the community had
significantly lower colonisation rates then inpatients (P<0.05).

CONCLUSIONS
The timing of tracheostomy tube changes may not affect colonisation and
infection rates amongst patients with tracheostomies. Tube changes pose significant risk
and discomfort to patients. Routine changes for the purpose of reducing infection risk may
not be indicated especially for long term tracheostomised patients unless clinically indicated.
FP1_06

COMPARISON OF OUTCOMES OF INTRAOPERATIVE NEUROMONITORING OF

RECURRENT LARYNGEAL NERVE VERSUS VISUALISATION ALONE DURING
THYROIDECTOMIES: A SINGAPORE EXPERIENCE
LEOW Yao Guang [1] ; LEE Caroline [1] ; GAN Jereme [1] ; HUANG Lilleen [1]
1 – ENT Department, Khoo Teck Puat Hospital, Singapore, Singapore

OBJECTIVES
Background: Although intraoperative nerve monitoring (IONM) has become commonly used
to identify the recurrent laryngeal nerve (RLN) during thyroid surgeries, its value in reducing
the incidence of RLN injury is still debatable. This study aimed to evaluate the outcomes of
thyroid surgery using IONM versus visualisation alone (VA).

MATERIALS AND METHODS

We conducted a retrospective analysis of all 271 open thyroidectomies performed by the
Otolaryngology Department in Khoo Teck Puat Hospital, Singapore, from 1 January 2014 –
31 December 2018. 10 patients were excluded from the RLN analysis as there was no postoperative
nasoendoscopy. Of the 261 remaining, 108 were using IONM and 153 with VA.
The primary outcome measure was the incidence of RLN injury and the secondary outcome
measure was operative duration. Possible risk factors for RLN injury were also analysed.

RESULTS
There were 31 patients with immediate post-op RLN injury, of which 6 had permanent (>6
months) injury. There was minor improvement in the respective rates of immediate and
permanent injury in the IONM group (9.3%, 0.9%) compared to the VA group (13.7%, 3.9%),
but it was not statistically significant by Fischer’s test (p=0.33, 0.41). There was no
significant difference using the Mann-Whitney U test in the operative duration of both
groups for hemi, total or repeat thyroidectomies. None of the analysed potential risk factors
for RLN injury proved to be statistically significant, although malignant histology had the
highest risk (RR=1.63, 95%CI 0.82-3.21).

CONCLUSION
This study suggests that IONM may not significantly reduce the risk of RLN injury or
operative duration in thyroid surgeries.
FP1_07

NARROW BAND IMAGING IN THE DETECTION OF ORAL AND OROPHARYNGEAL MALIGNANT LESIONS:
A SYSTEMATIC REVIEW AND META-ANALYSIS

WONG Eugene [1]; ANSARI Umair [1]; SMITH Murray [1]; SINGH Narinder [1]]; PALME Carsten [1];
SMITH Mark [1]; RIFFAT Faruque [1]
1 – Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital NSW 2145 Australia
BACKGROUND
This meta-analysis describes the validity of narrow band imaging (NBI) in the assessment of suspicious
oral lesions.

METHODS
Medline, EMBASE and Scopus were searched for trial studies comparing NBI with conventional
modalities in the oral cavity (OC) and oropharynx (OP) for the detection of dysplastic and malignant
change.

RESULTS
7 studies were found, and generally supported the utility of NBI in different clinical settings, although
there were exceptions. Pooled data from 5 studies of NBI validity demonstrated high summary
specificity and sensitivity for a wide range of suspicious lesions of the OC or OP (83.1% with 95% CI
74.9%-89.0% and 90.4% with 95% CI 82.1%-95.1%. respectively). Summary positive likelihood ratio (LR+)
was 8.7 (95%CI 4.7-16.1) and 0.2 (95%CI 0.13-0.27) respectively.

CONCLUSIONS
NBI is a promising diagnostic and surveillance tool for suspicious lesions in the OC or OP, however higher
powered studies will define precise NBI criterion and clinical recommendations.
FP2_01
ARYTENOID VERTICAL HEIGHT DISCREPANCY IN PREDICTING OUTCOMES AFTER UNILATERAL
VOCAL CORD MEDIALISATION
WONG Eugene [1]; SMITH Murray [1]; STONE Danielle [1]; PALME Carsten [1]; SMITH Mark [1];
RIFFAT Faruque [1]
1 – Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital NSW 2145 Australia
OBJECTIVES
Unilateral vocal fold paralysis is a structural abnormality that often occurs secondary to dysfunction
of the recurrent laryngeal nerve and typically presents as a breathy voice. Medialisation
laryngoplasty is a constellation of procedures that improves apposition of the vocal cords. Many
patients however fail to experience sufficient improvement in vocal quality post-operatively despite
apparent glottic closure on stroboscopy. This suggests that asymmetry in other cord characteristics
may also have acoustic consequences.
Our hypothesis is that arytenoid height symmetry may play a significant role in vocal quality. To our
knowledge there are no human observational studies examining this topic. We therefore aimed to
correlate asymmetry in arytenoid height and patient reported satisfaction in voice quality after
thyroplasty.

METHODS
A retrospective review of prospectively collected data on consecutive patients who underwent
medialisation thyroplasty at a tertiary Sydney Hospital was performed. Data collected included age,
sex, onset of symptoms, as well as well as preoperative, and 3 months postoperative Maximum
Phonation Time (MPT) and Voice Handicap Index (VHI). Pre-operative Computed tomography scans
were assessed for discrepancy of arytenoid vertical height discrepancy.

RESULTS
23 patients (56.5% female) with mean age 52.4+/-14.9 years were included. Most patients
underwent injection thyroplasty (78.3%,n=5) while the remaining underwent an open approach. A
statistically significant inverse correlation was found between increasing height discrepancy and VHI
improvement (r=-0.6, p=0.003.) Revision surgery was associated with increased height discrepancy.

CONCLUSION
Findings of this study may affect future recommendations to address height discrepancy in surgery
to treat unilateral vocal cord paralysis.
FP2_02
NARROW BAND IMAGING IN THE HISTOPATHOLOGICAL DIAGNOSIS OF
LARYNGEAL LESIONS
HO Joyce [1]; AHMADZADA Sejad [1]; TSEROS Evan [1]; SRITHARAN Niranjan [1];
PALME Carsten [1]; SMITH Mark [1]; RIFFAT Faruque [1]
1 – Department of Otolaryngology Head and Neck Surgery, Westmead Hospital,
Westmead, Australia

OBJECTIVES
Early mucosal abnormalities seen in early malignant laryngeal lesions are challenging to diagnose on
traditional white light endoscopy (WLE). Narrow band imaging (NBI) is a method of endoscopic
visualisation that uses a special filter to narrow the colours displayed to green and blue wavelengths.
The use of NBI allows clinicians to visualise the mucosal vascular patterns more precisely, allowing
for early detection of angiogenic changes. The aim of this study was to compare the sensitivity,
specificity, and accuracy of NBI in the diagnosis of vocal cord lesions.

MATERIALS AND METHODS

Patients with suspicious vocal cord lesions underwent traditional WLE followed by NBI. Images were
graded independently according to the Ni classification. A clinically indicated biopsy was obtained
and the histopathological diagnosis was compared against the NBI grade.

RESULTS
A total of 42 patients were recruited with 45 lesions biopsied. The male to female gender ratio was
3.5 to 1, with a mean age of 62 years. 30 of the 45 lesions were true positive and 1 was false
negative. There were no false positive results and 14 true negatives were found. This yielded a
sensitivity of 96.67% (p=0.01) and specificity of 100% (p=0.07). The accuracy was 97%.

CONCLUSION
NBI allows for improved visualisation of early changes in the mucosal microvasculature of the larynx
compared to traditional WLE. NBI can be used to detect early laryngeal neoplastic changes in the
clinic and operating theatre setting. This can result in early treatment and subsequent lower
morbidity and mortality.
FP2_03
HYALURONIC ACID INJECTION LARYNGOPLASY FOR MUSCLE TENSION DYSPHONIA: PRELIMINARY
RESULTS
NGUYEN Duy Duong [1]; MADILL Catherine [1]; CHACON Antonia [1]; NOVAKOVIC Daniel [1,2]
1 – Voice Research Laboratory, Faculty of Health Sciences, The University of Sydney, Sydney,
Australia; 2 – Central Clinical School, Faculty of Medicine and Health, The University of Sydney,
Sydney, Australia

OBJECTIVES
This study examined the efficacy of injection laryngoplasty (IL) using cross-linked hyaluronic acid
(HA) as an adjunct to voice therapy in treating muscle tension dysphonia (MTD) with and without
glottic insufficiency (GI).

MATERIALS AND METHODS

Thirty-four patients (17 male, 17 female) with MTD that did not respond to standard voice therapy
underwent IL using commercially available HA gel. Mean age of patients was 42.4 years; standard
deviation = 13.4; range = 23 - 71. Outcome measures included Voice Handicap Index-10 (VHI-10),
stroboscopic ratings of antero-posterior and lateral supraglottic constriction, maximal phonation
time (MPT), and acoustic measures of harmonics-to-noise ratio (HNR) and smoothed cepstral peak
prominence (CPPS) from vowel /a/, Rainbow Passage, and the third CAPE-V phrase. Data were
collected at baseline and 6-12 weeks after IL.

RESULTS
No patients underwent complications or adverse effects. VHI-10 statistically significantly dropped
after IL. Rating scores of supraglottic constriction also decreased significantly. Acoustic analyses of
28 patients with pre- and post-surgical voice recordings showed statistically significant increase in
HNR. Other acoustic measures did not show significant changes after IL. Post hoc analyses showed
that patients with GI showed improvement in both VHI-10 and HNR while non-GI patients only
showed improvement in VHI-10. Male patients showed improvement in VHI-10 only. Meanwhile,
female patients showed improvement in both VHI-10 and HNR.

CONCLUSION
HA IL can be used safely in combination with voice therapy to treat MTD effectively. The effects of
HA injection appeared to be more pronounced in female patients and in those with GI.
FP2_04
TREATMENT OUTCOMES OF PATIENTS WITH LARYNGOTRACHEAL STENOSIS: A 6-
YEAR EXPERIENCE IN A TERTIARY HOSPITAL IN THE PHILIPPINES
SARMIENTO Abigail [1]; DELA CRUZ, Anna Pamela [1]
1 - Department of Otorhinolaryngology, College of Medicine, University of the Philippines
Manila, Metro Manila, Philippines

OBJECTIVES:
To evaluate the treatment outcomes of open and endoscopic surgical techniques on patients
with laryngotracheal stenosis.

MATERIALS AND METHODS

This is a cross-sectional, retrospective study: a six-year review of patients with laryngotracheal
stenosis.

RESULTS
A total of 34 patients (21 adults and 13 pediatric patients) underwent surgery for airway stenosis
between 2013 to 2019. The mean age was 23 years old at time of first surgery. The most common
etiology for the stenosis was prolonged intubation (67%). Other etiologies include multiple
intubations (maximum of 8 times), external trauma such as strangulation injury, caustic ingestion
and flame burn. The most common site of stenosis is the subglottis (62%). Most patients had an
initial Cotton-Myer stage of 3 (63%). Ten out of the 34 patients (29%) were successfully
decannulated after the first surgery. Of the eight (8) patients who underwent open surgeries, six (6)
patients were successfully decannulated. Twenty patients underwent endoscopic repair; 7 were
successfully decannulated and 16 required multiple surgeries.

CONCLUSION
Patients with airway stenosis undergoing endoscopic surgery are more likely to receive further
surgery before successful decannulation.
FP2_05
SURGICAL MANAGEMENT OF NASOFRONTAL ANGLE IN RHINOPLASTY
Prof. Sameer Ali Bafaqeeh.
ABSTRACT
Profile refinement is one of the most common reasons patients seek consultation for rhinoplasty.
The radix is an essential component of the profile and is carefully assessed from the standpoint of
projection and position. Height and contour are evaluated at the radix, rhinion, and nasal tip. Each
component of the dorsal profile is individually classified as overprojected, underprojected, or of
appropriate height.
Radix has a special concern in rhinoplasty. Minimal changes in the position of nasofrontal angle can
produce a different image of nasal and midfacial length in the profile view. In a patient with deep
nasofrontal angle makes the illusion of a short nose. There are different techniques for radix surgical
correction, especially in the type of materials used in augmentation of the deep radix.
The purpose of my presentation is to evaluate the different materials used for radix augmentation
during primary and revision rhinoplasty: Skoog, crushed or diced septal cartilage wrapped in
temporalis fascia or facia Lata, rip cartilage, or crushed cartilage in fibrin glue, intact beveled edge
septal or rib cartilages covered by facia late, conchal cartilage and layers of fascia Lata.
Some patients undergoing crushed cartilage group showed irregularities during the postoperative
follow-up, but all autologous grafts represent acceptable graft material for radix augmentation.
My experience with radix augmentation during cosmetic rhinoplasty over a 25-years period using
both autologous and synthetic grafts provide me into maximizing success. I will discuss various
surgical considerations, patient selection, graft materials, complications and provide patient
examples.
FP2_06
FACIAL PROFILE OF FILIPINO YOUNG ADULTS USING MANUAL ANTHROPOMETRY

GUEVARA, Lemuel Ian [1] ; GALVEZ, Joseph Amado [1]

1 – Department of Ear, Nose, Throat, Head and Neck Surgery, Ospital ng Maynila Medical Center,
Manila, Philippines

OBJECTIVES
This study aims to establish baseline average measurements of the facial anthropometric profile of
young adult Filipinos.

Specific objectives include establishing the normal range of measurements of the craniofacial
complex among young adult Filipinos, the frequency of identical, smaller, or greater measurements
in relation to the normal range of North American Caucasians, and the identification of the regions
that contribute most to significant differences.

MATERIALS AND METHODS

The study was conducted using 65 male and 66 female healthy young adult Filipino subjects devoid
of any obvious facial deformity, with Class I occlusion and no history of previous maxillofacial trauma
or prior surgical treatment.

13 anthropometric measurements were performed using a digital sliding caliper according to

classical methods of physical anthropology. Obtained data was statistically analyzed and compared
versus previously established corresponding normal range of North American Caucasians using
independent sample t-test.

RESULTS
10 out of 13 anthropometric measurements were observed to be longer on average in Filipinos.
Compared to North American Caucasians, the male and female Filipino populations were also
observed to more frequently have greater than normal measurements of biocular width, eye fissure
length, morphological nose width, and mandible width. It was also observed that the Filipino
populations more frequently had lesser than normal measurement of face width.

CONCLUSION
The facial profile of the Filipino young adult has measurable differences as compared to the
standards for North American Caucasians. These morphological differences should be considered in
planning any facial aesthetic or reconstructive procedure.
FP2_07
MODIFIED ALA-SILL EXCISIONAL TECHNIQUE TO AVOID ALA-NOSTRIL SHAPE DEFORMITIES

JAVIER, Paula Sigma; GALVEZ, Joseph Amado

Facial Aesthetic Core of ENT Surgeons, Manila City, Philippines

ABSTRACT
OBJECTIVE
To describe a modified technique for alarplasty is described to avoid possible
deformities in Filipino noses

STUDY DESIGN
Descriptive Study

METHODOLOGY
We begin this approach by doing the pinch test to identify the ala-sill
junction. We then mark the sill resection, making sure that we retain 3mm of the sill. We
then identify the extent of alar resection, 1mm from the ala-sill junction, with a maximum
of 3mm tissue resection. The distance of the excised edge of the ala must be 3mm from
the nasolabial fold. Any further incision can be done to relax the area of excision for
cosmesis. Possible pitfalls include strangulation of the ala leading to an unnatural
curvature, and excessive excision, which may lead to a tear-dropped nostril
configuration.

RESULTS
Patients were reported to have more desirable results, and appear to have
more aesthetically pleasing outcomes. This approach has also helped in avoiding more
aggressive alar resection leading to a more obvious cosmetic alteration of Filipino noses.

CONCLUSION
This technique has been proven to create a more natural outcome, as well
as overall better satisfaction ratings in post Rhinoplasty Filipino patients.
FP3_01
TONGUE BASE REDUCATION IN CHILDREN WITH REFRACTORY OBSTRUCTIVE SLEEP APNOEA: THE
PERTH CHILDREN’s HOSPITAL EXPERIENCE

Authors:
ZHEN Emily (MBBS), VIJAYASEKARAN Shyan (MBBS, FRACS)
Department of Otolaryngology Head and Neck surgery, Perth Children’s Hospital, Perth, Western
Australia, Australia.

OBJECTIVES:
To determine the efficacy of midline posterior glossectomy (MPG) and lingual tonsillectomy (LT) in
the treatment of refractory obstructive sleep apnoea (OSA) in children and identify predictive factors
for positive outcomes.

MATERIALS AND METHODS:

A retrospective analysis of all MPG and LT cases was conducted at Perth Children’s Hospital over a
ten-year period, from 2007 to 2017. Eight cases were identified where the primary indication for
surgery was for refractory OSA, where patients have failed prior treatments such as
adentonsillectomy and/or positive airway pressure (PAP) therapy.

RESULTS:
Eight patients, 5 male and 3 female with age ranging between 1 to 13 years were included in the
study. Seven out of 8 children were syndromic, including 4 with trisomy 21, 1 with Rudenstein Taybi
syndrome and 1 with Beckwith-Wiedemann syndrome. Fifty percent of children had an elevated BMI
preoperatively. All had preoperative PSG demonstrating moderate to severe OSA after some form of
initial treatment. Four patients demonstrated significant improvement after tongue base reduction,
with no further requirement for PAP therapy. The remainder had residual symptoms and abnormal
PSG findings, most were referred back for PAP therapy. Children with normal BMI preoperatively
consistently improved after MPG and LT, irrespective of whether they had a diagnosed syndrome.

CONCLUSION:
Midline posterior glossectomy and LT appears to be more effective in treatment of refractory OSA in
in children with normal BMI preoperatively. This appears to be independent of their syndromic
diagnosis. Aggressive weight loss programs should be considered prior to surgery in this population.
FP3_02
EVALUATION OF PREFABRICATED ADJUSTABLE THERMOPLASTIC MANDIBULAR
ADVANCEMENT DEVICES(PAT-MADS) AS AN ADJUNCT FOR THE TREATMENT OF
OBSTRUCTIVE SLEEP APNOEA(OSA)
SOH Jie Min Leonard1, Yu Yue1, TAY Jade2, HAN Hong Juan1, TOH Song Tar1
1Department of Otolaryngology, Head & Neck Surgery, Singapore General Hospital,
Singapore
2Sleep Disorders Unit, Singapore General Hospital, Singapore

OBJECTIVE
To evaluate the use of direct to consumer Prefabricated adjustable thermoplastic mandibular
advancement devices(PAT-MADs) and its effectiveness in the treatment of OSA.

MATERIALS AND METHODS

32 patients with diagnosed mild-moderate OSA on formal polysomnography(PSG) were fitted
with a PAT-MAD(MyTAPTM, Airway Management Inc). Sleep indices: apnea-hypopnea
index(AHI), hypopnea index(HI), apnea index(AI), oxygen disturbance index(ODI), Lowest 02
saturation(Lsat) were measured with a Level 3 home sleep apnea test(HSAT) pre versus post
treatment. Quality of life(QOL) surveys of Epworth sleepiness scale(ESS), Pittsburg sleep
quality index(PSQI), Functional outcomes of sleep quality-10(FOSQ10) and satisfaction
surveys were administered.

RESULTS
Over a treatment duration of 3months, indices showed a trend to improvement. Results were
statistically significant when stratified into groups who achieved cure; Mean improvement in
AHI: -12.2 ±9.9, HI: -6.8±3.7, ODI: -11.1±9 for responders. Out of QOL surveys, ESS showed
a decrease of -1.41 [-2.52, -0.3] (p=.017) when corrected for age and BMI. Up to 60% of
patients found that the device was useful in alleviating snore symptoms.

CONCLUSION
PAT-MAD, with a titratable component is a direct to market, economical option
for the patient for trial use before proceeding with customized MADs. Potential applications
for its use in resolving subjective snore symptoms and sleep quality require further validation.
FP3_03
DRUG INDUCED SLEEP ENDOSCOPY: IS THERE A DIFFERENCE IN THE DEGREE OF
COLLAPSIBILITY AT DIFFERENT SEDATION LEVELS?
LEOW Yao Guang [1] ; LAU Hung Tuan [1] ; TAN Terry [1]
[1] – Department of Otolaryngology-Head and Neck Surgery, Khoo Teck Puat Hospital,
Singapore

OBJECTIVES
Drug Induced Sleep Endoscopy (DISE) is commonly used with the aim of identifying
obstructive sites that may contribute to Obstructive Sleep Apnoea (OSA). However, there is
still much variation in the conduct of the procedure. This study aimed to look at one of these
variables – sedation depth. We aimed to determine if variation in sedation depth (measured
using Bispectral Index [BIS]) affects the site(s) and severity of obstruction in OSA patients
undergoing DISE.

MATERIALS AND METHODS

We retrospectively reviewed the clinical and DISE data of 104 patients with moderate and
severe OSA (apnoea-hyponea index [AHI] ≥15). DISE was performed in the operating room,
using a target-controlled infusion of propofol to achieve steady states at two BIS levels: 60-70
and 71-80. The sites and severity of airway collapse were graded using the VOTE
classification, with a site being deemed to have significant obstruction when its VOTE
Obstruction Grade was ≥1.

RESULTS
At deeper sedation, 51% of patients had more obstructive sites. The proportion of patients
with significant obstruction also increased for each site, most prominently at the tongue base
(34% vs. 57%). There was no statistically significant correlation of increased collapsibility with
AHI, Body Mass Index, or Age.

CONCLUSION
This study revealed that a deeper sedation depth leads to an increase of both the number of
obstructive anatomical sites, and severity of obstruction in patients with moderate to severe
OSA, when examined by DISE. The site that appears to be most affected is the tongue base.
FP3_04
EFFICACY OF NASOALVEOLAR MOLDING AND NASAL CONFORMERS AS AN ADJUNCT TO ACHIEVE
NASAL SYMMETRY IN UNILATERAL CLEFT LIP

INTRODUCTION
Most of the primary cleft lip repair techniques result in stigmatizing the nasal outcomes such as
depression of ala, deviation of nasal septum, resulting in gross nasal asymmetry.

AIM
To assess the efficacy of various modalities employed to establish nasal symmetry in unilateral cleft
lip

METHODOLOGY
80 patients with complete unilateral cleft lip/palate, were operated for primary cheiloplasty with
modified Millard’s rotation and advancement technique. Subjects were divided into 4 groups of 20
each. Group 1 subjects operated employing modified Millard’s technique . In group 2, subjects
underwent NAM therapy followed by modified Millard’s repair. Group 3 subjects underwent
modified millard’s repair followed by placement of a nasal conformers for 12 months postoperative.
Group 4 patients were treated using NAM therapy followed by modified Millard’s repair and
placement of conformers. All patients were evaluated after 16 months for parameters like Alar
inclination angle, Nostril apex overhang, Nostril height and diameter, Columellar length and
deviation angle.

RESULTS
All 6 parameters were statistically significant in group 4 .

CONCLUSION
1. Maneuvers like NAM placement of nasal conformers have significant influence in
establishing nasal symmetry.
2. Findings of the study indicate that nasal conformers are effective as NAM in achieving nasal
symmetry.
FP3_05
ENDOSCOPIC EAR SURGERY FOR MIDDLE EAR CONGENITAL CHOLESTEATOMA IN CHLDREN
BUI The Anh [1]; NGUYEN Cong Thanh [1,2]; NGUYEN Thu Huong [1]; DOI Xuan An [1]; MAI Y Tho [1];
BIEN Van Hoan [1]. 1 – Pediatric ENT Department, National Otorhinolaryngology Hospital of
Vietnam, Ha Noi, Vietnam; 2 – ENT Department, Hanoi Medical University, Ha Noi, Vietnam.

OBJECTIVES:
To describe clinical and imaging characteristics of pediatric middle ear congenital cholesteatoma and
to evaluate the result of endoscopic ear surgery for pediatric middle ear congenital cholesteatoma.

MATERIALS AND METHODS:

Prospective study conducted on all children with diagnosis of middle ear congenital cholesteatoma
and treated in Pediatric ENT Department - National Otorhinolaryngology Hospital of Vietnam (the
main referral center for pediatric ENT care in Northern Vietnam) from February 2017 to February
2019.

RESULTS:
35 children with diagnosis of middle ear congenital cholesteatoma were included during the study
period. Mean age was 3.7 y.o. (ranging from 22 m.o. to 7 y.o.). There were 24 boys (68.6%) and 11
girls (31.4%). All but 1 patient had abnormal CT images with suspicion of cholesteatoma. When
Potsic's classification was applied: 21 patients were in stage I (60%); stages II, III, IV had 3; 7 and 4
patients, respectively. All patients were treated with surgery: there were 28 endoscopic transcanal
tympanoplasty and cholesteatoma removal; 3 antro-atticotomy with tympanoplasty and 4 canal-
wall-down mastoidectomy. There was no peri-operative complication and no recurrence after
follow-up (from 6 to 30 months, mean 15 months) in subgroup treated with endoscopic transcanal
tympanoplasty.

CONCLUSION:
Pediatric middle ear congenital cholesteatoma were seen commonly in Potsic stage I. Endoscopic
transcanal tympanoplasty with cholesteatoma removal proved to be an effective and safe surgical
treatment for early stages of pediatric middle ear congenital cholesteatoma.
FP3_06
A SYSTEMIC REVIEW OF DIAGNOSIS AND MANAGEMENT OF TYPE 1 LARYNGEAL
CLEFT
MEGOW Anna [1]; LOH Rachel [1]; PHUA Malvine [1]; SHAW Chi-Kee Leslie [1]
1 – Department of Otolaryngology Head and Neck Surgery, Modbury Hospital, South
Australia, Australia.

OBJECTIVES
A type 1 laryngeal cleft can be difficult to diagnose due to its non-specific or sometimes
silent clinical presentation. A range of different treatment modalities have been described in
the literature and currently there is no consensus on which is most appropriate. Our aim is to
provide guidance on diagnosis and best practice management.

MATERIALS AND METHODS

A systematic review of the literature was performed. Studies were sourced from Medline,
PubMed and Cochrane Library. Using a validated tool, a quality assessment of the included
studies was conducted. A meta-analysis was performed to assess the outcome of each
treatment modality using MedCalc software.

RESULTS
A total of 19 of 674 potential studies were included for analysis. Symptom resolution with
return to normal diet was seen in 52.3% (95% CI, 32.3–71.9%) of patients managed
conservatively. Of the patients treated with injection augmentation, 69.2% (95% CI, 59.1–
78.1%) had complete resolution of symptoms or on modified barium swallow (MBS). The
success rate of patients undergoing endoscopic surgical repair with complete resolution of
symptoms was 65.4% (95% CI, 49.1–80.1%). Based on research findings we present a
management algorithm.

CONCLUSION
An initial three-month trial of conservative management with thickened fluids and positional
strategies is recommended. In the presence of defined indications, endoscopic repair should
be considered. Injection augmentation can be considered prior to surgical repair in select
patients to assess for potential surgical outcome. Patients should be followed up with an
MBS six to eight weeks post-operatively.
FP3_07
ROUTINE USE OF TRANEXAMIC ACID IN MANAGEMENT OF SECONDARY POST-TONSILLECTOMY
BLEEDING – DOES IT MAKE A DIFFERENCE?

ZHEN Emily, LOCATELLI SMITH Alessandra, HASAN Zubair, VIJAYASEKARAN Shyan

Department of Otolarygnology and Head and Neck Surgery, Perth Children’s Hospital, Western
Australia, Australia

OBJECTIVES
Tranexamic acid (TXA) is a well known synthetic antifibrinolytic agent that has been shown to reduce
bleeding and transfusion in surgeries. Previous studies failed to show the prophylactic benefit of TXA
in reducing secondary post-tonsillectomy bleeding (PTB). The aim of our study was to evaluate the
therapeutic effect of TXA in reducing representation to theatres and blood transfusion in secondary
PTB.

MATERIALS AND METHODS

Retrospective analyses of all PTB admissions at Perth Children’s Hospital (PCH) emergency
department, who underwent adenotonsillectomy at PCH or in private sector between September
2017 and August 2018. All patients received TXA 10mg/kg and Amoxycillin 25mg/kg, IV, 8/hourly
once admitted. All children received TXA and Amoxycillin prescription for 5 days on discharge.
Admissions rate, representation to theatres and the need for transfusion were analysed and
compared to a group of historical controls from the same institution from 2012-2013 when TXA was
not routinely used in PTB.

RESULTS
2256 children (719 at PCH and 1537 in the private sector) underwent AT. The use of TXA reduced risk
of return to theatre by 49% but did not reduce the incidence of blood transfusions. No differences in
bleeding rates were observed between different surgical techniques. No complications resulting
from the use of TXA were found.

CONCLUSION
TXA for secondary bleeding significantly reduced the risk of reoperation in secondary PTB compared
to historical controls. This is the first study where TXA was used in a therapeutic manner for PTB.
Prospective trials are necessary to evaluate the effectiveness of TXA in the management of
secondary PTB.
FP4_01
THE ROLE OF DYNAMIC VISUAL ACUITY (DVA) TEST FOR ASSESSING BALANCE
DISORDER IN TUBERCULOSIS PATIENTS FOLLOWING STREPTOMYCIN THERAPY
BASHIRUDDIN Jenny [1]; ALVIANDI Widayat [1]; BRAMANTYO Brastho [1]; WIDAYANTI
Novra [1]; ANJANI Sonia Miyajima [2]; AULIA Nadira [2]
1 – ENT Department, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
2 – Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

OBJECTIVES
Balance disorder is the side effect of Streptomycin therapy in tuberculosis (TB) patients which
can cause decreased quality of life. One of the examinations that can be used to assess
impaired balance in primary healthcare is dynamic visual acuity (DVA). This study aims to
determine the role of DVA for assessing balance disorder in TB patients receiving Streptomycin
therapy.

MATERIALS AND METHODS

This study was a pre-experimental study intended to determine changes in vestibular function
using DVA test in a group of TB patients before and after 56 times administration of
Streptomycin, or when subjects complained of balance disorders. A total of 57 samples were
taken sequentially at ENT out-patient clinic, Cipto Mangunkusumo National General Hospital,
Jakarta, during April-October 2014. The data then analyzed using univariate and bivariate
analysis.

RESULT
There were 40 subjects that completed Streptomycin therapy for 56 days. The mean age was
38,13 ± 11,25 years. It was reported that 15 subjects had dizziness after receiving 41-50 grams
of Streptomycin. From 30 subjects (75%) that had bilateral peripheral vestibular impairment
(positive DVA examination), 28 of them complained of dizziness (p>0,05). The median value of
DVA line before therapy was 0 (minimum 0-maximum 2) line and then increasing to 3 (minimum
0-maximum 6) line, suggesting there was a significant change of DVA examination after
Streptomycin therapy (p<0,05).

CONCLUSION
Dynamic visual acuity can be used as one of alternative examination tools in primary healthcare
to assess balance disorder as the side effect of Streptomycin therapy in tuberculosis patients.
FP4_02
A RADIOLOGICAL STUDY ASSESSING THE PREVALENCE OF FRONTAL RECESS CELLS AND THE MOST
COMMON FRONTAL SINUS DRAINAGE PATHWAYS*

Luan V. Tran, MD, PhD 1,2, Ngoc H. Ngo, MD 1,2, Alkis J. Psaltis, MD, PhD, FRACS 3

ABSTRACT BACKGROUND
To date, there are numerous studies documenting the prevalence of frontal recess cells, but only I
study using the newly developed International Frontal Sinus Anatomical Classification (IFAC) system.
The identification of the frontal cells and their influence on the frontal drainage pathway plays an
important role in endoscopic frontal sinus surgery.

OBJECTIVE
The aim of this study is to document the radiological prevalence of various types of frontal cells, as
classified by IFAC and the most common frontal sinus drainage pathways based on its anatomic
relationships with these cells.

METHODS
Using a novel preoperative virtual planning software (Scopis Building Blocks), consecutive
computerized tomography scans of the sinuses of patients were analyzed for the prevalence of
frontal cells, as classified by the by IFAC, and the frontal sinus drainage pathways at the Ear Nose
Throat Hospital of Ho Chi Minh City, Vietnam.

RESULTS
In this study, 208 computed tomography scans of consecutively selected frontal sinuses of 114
patients were included for analysis. The agger nasi cell was present in 95.7% of reviewed scans. The
frontal cells prevalence was as follows: supra agger cell (SAC): 16.3%, supra agger frontal cell (SAFC):
13%, supra bulla cell (SBC): 46.2%, supra bulla frontal cell (SBFC): 4.3%, supra orbital ethmoid cell:
17.3%, and frontal septal cell: 10.6%. The most common frontal sinus pathway type in relation to
frontal cells was medial to SAC (70.6%), medial to SAFC (81.5%), anterior to SBC (88.5%), and
anterior to SBFC (100%). In cases that had 2 frontal cells group, the drainage pathway was medial to
SAC/SAFC and anterior to SBC/SBFC in most cases.

* The article has been published in American Journal of Rhinology and Allergy
1 Department of Otolaryngology, Head and Neck Surgery, Pham Ngoc
Thach University of Medicine, Ho Chi Minh City, Vietnam
2 Department of Rhinology, Ear Nose Throat Hospital of Ho Chi Minh City,
Ho Chi Minh City, Vietnam
3 Department of Otolaryngology, Head and Neck Surgery, Adelaide
University, Adelaide, Australia

CONCLUSION
This study documents the prevalence of frontal cells (classified by IFAC) using a novel preoperative
virtual planning software in the Vietnamese population. It demonstrates predominantly medial
anteromedial frontal drainage pathways as related to these frontal cells.

KEYWORDS
International Frontal Sinus Anatomical Classification, frontal sinus cells, supra agger cell, supra agger
frontal cell, supra bulla cell, supra bulla frontal cell, frontal septal cell, supra orbital ethmoid cell,
frontal sinus drainage pathway, preoperative virtual planning software.
FP4_03
THE EFFECT OF 1.25 DIHIDROXYVITAMIN D3 TOWARD IL-12, IL-10 AND TGF-β IN ALLERGIC RHINITIS
PATIENT WITH SUBCUTANEOUS IMMUNOTHERAPY
SUDIRO Melati [1], WAHYUDI [1], LESTARI Bony Wiem [2], MADIADIPOERA Teti [1], SETIABUDIAWAN
Budi [3], BOESOIRIE Thaufiq Siddiq [1]

1 − Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas

Padjadjaran, Bandung, Indonesia; 2 − Department of Public Health Universitas Padjadjaran, Bandung,
Indonesia; 3 − Department of Paediatric Faculty of Medicine, Universitas Padjadjaran, Bandung,
Indonesia

OBJECTIVES
The active form of vitamin D (1.25 Dihidroxyvitamin D3) shown the ability to inhibit both Th1 and
Th2 and supressing production of IL-12 generated IFN-γ, enhancing Treg production including anti-
inflammation cytokines. On the other side, subcutaneous allergen immunotherapy (SCIT) generally
inhibits allergen induced and corelated with increased IL-12 and IL-10 and TGF-β in skin macrophage.
We hypothesized that active form of vitamin D as adjuvant would be accelerate the onset of a
response immune tolerant increased proinflammatory and anti-inflammatory cytokines in allergic
rhinitis patient with SCIT.

MATERIALS AND METHODS

The study was an unpaired comparative analytic research with a randomized controlled trial design.
Thirty-six of moderate severe allergic rhinitis patients with vitamin D deficiency, age 18-49 years
received SCIT with Dermatophagoides pteronyssinus allergen extract for 15 weeks were divided into
two groups: SCIT along with calcitriol 0.5 Mcg/day and SCIT along with placebo. All subjects were
evaluated at baseline and week-15 for IL-12, IL-10 and TGF-β using ELISA. The Mann Whitney test
were used for analysis.

RESULTS
There was a significance different in increasing IL-12 level in SCIT+ Calcitriol group compare with
SCIT+placebo (p=0.045) in 15th weeks. There were no diffrences increasing IL-10 and TGF-β (p=0.728;
p= 0.155) in 15th weeks between two groups. The decrease in nasal symptoms score did not differ
significance between two groups (p>0.05).

CONCLUSIONS
1.25 Dihidroxyvitamin D3 can be used as a promising adjuvant for SCIT by increasing levels of IL-10
and TGF- earlier than IL-12 and accelerate immune tolerant.
FP4_04
CHANGES IN MUCOCILIARY CLEARANCE AND OLFACTION FOLLOWING ENDOSCOPIC SINUS SURGERY

KURIEN Regi; HEMA Vidya

Department of ENT, Christian Medical College, Vellore, Tamilnadu, India

OBJECTIVE:
Mucociliary clearance and olfaction are two main physiological properties of the nose affected by chronic
rhinosinusitis(CRS). However, CRS being a reversible disease. This study aimed to assess whether surgical
treatment with functional endoscopic sinus surgery(FESS) would help restore the mucociliary clearance and
olfactory function of nose.

MATERIALS AND METHODS:

This is a prospective observational study done on patients with CRS with or without nasal polyps undergoing
FESS in the department of ENT in a tertiary hospital over a period of seven months. All patients underwent
pre-operative measurement of mucociliary clearance time using saccharin and an assessment of olfactory
function using CCCRC test. Patients then underwent FESS. Postoperatively at three months, above tests were
repeated and changes in saccharine time and olfactory scores were calculated and analyzed.

RESULTS:
Of the 96 patients with CRS, 68 came back for follow up. 66% patients had polyposis and 80% underwent
primary surgery. There was a statistically significant reduction of 26% in mucociliary clearance time (p value
0.01) and 10% improvement of olfactory scores(p<0.05) at three months follow up. The improvement in
mucociliary time was more for patients with polyposis and for those who underwent revision surgery.
Majority of patients with anosmia improved to hyposmia although hyposmic patients did not have any
significant improvement.

CONCLUSION:
Our study showed a significant improvement in nasal mucociliary clearance and olfaction after endoscopic
sinus surgery. FESS apart from clearing the disease from sinuses, improves normal physiological functions of
nose that were impaired due to the chronic inflammatory process.
FP4_05
AMOXICILLIN/CLAVULANATE TABLET (625MG) PLUS AMOXICILLIN CAPSULE (500MG) IS NOT
INFERIOR TO AMOXICILLIN/CLAVULANATE TABLET (1000MG) FOR TREATING ACUTE BACTERIAL
RHINOSINUSITIS

CHIMCHUA Atidtaya [1,2] ; SUWANNAWONG Dussawan [1,2] ; SERESIRIKACHORN Kachon [1,2] ;

CHITSUTHIPAKORN Wirach [3,4] ; MONGKOLKUL Kittichai [3] ; AEUMJATURAPAT Songklot [1,2] ;
CHUSAKUL Supinda [1,2] ; KANJANAUMPORN Jesada [1,2] ; SNIDVONGS Kornkiat [1,2]

1-Department of Otolaryngology, Chulalongkorn University, Faculty of Medicine, Bangkok, Thailand

2-Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital,
Bangkok, Thailand
3-Department of Otolaryngology, Rajavithi Hospital, Bangkok, Thailand
4-Sawan Pracharak Hospital, Department of Otolaryngology, Nakhon Sawan, Thailand

OBJECTIVES
Drug-resistant Streptococcus pneumoniae requires the increased dose of amoxicillin up to 4 grams
per day. While dosage form of amoxicillin is a capsule, amoxicillin/clavulanate is a tablet. It is
unknown whether the addition of amoxicillin capsule to amoxicillin/clavulanate tablet is effective.
This study aimed to assess the effects of the addition of amoxicillin capsule to
amoxicillin/clavulanate tablet for treating acute bacterial rhinosinusitis.

MATERIALS AND METHODS

Patients diagnosed as acute bacterial rhinosinusitis were randomized to receive either
amoxicillin/clavulanate tablet (625 mg) plus amoxicillin capsule (500 mg) (AmClav625Am500) or
amoxicillin/clavulanate tablet (1000 mg) (AmClav1000) twice daily for 7 days. Outcome assessors
were blinded. Primary outcome was cure rate at one week. Secondary outcomes were symptoms,
22-item Sino-Nasal Outcome Test (SNOT-22) and adverse events.

RESULTS
Fifty-six patients (42.9% male, age 44.2±15.2 years) were enrolled. Cure rate of patients receiving
AmClav625Am500 at one week (78%) was comparable to AmClav1000 (75%), (odds ratio 1.2, 95%CI
0.4, 4.2, p=0.50). Mean symptoms score at the endpoint of AmClav625Am500 was not different from
AmClav1000 (3.0±2.9 vs 3.7±3.0, mean difference (MD) -0.64, 95%CI-2.2, 0.93, p=0.42). Mean SNOT-
22 and Mean SNOT-22-rhinosinusitis domain of AmClav625Am500 were not different from
AmClav1000 (0.9±0.6 vs 1.1±0.9, MD -0.2, 95%CI-0.6, 0.2, p=0.32 and 1.2±1.0 vs 1.6±1.2, MD -0.4,
95%CI-1.0, 0.2, p=0.15 respectively). Diarrhea and nausea were reported in 3 cases without
difference between groups, p=0.60.

CONCLUSION
The effects of the addition of amoxicillin capsule (500 mg) to amoxicillin/clavulanate tablet (625 mg)
for treating acute bacterial rhinosinusitis was comparable to amoxicillin/clavulanate tablet (1000
mg).
FP4_06
LARYNGOPHARYNGEAL REFLUX AS AN ASSOCIATED FACTOR CHRONIC RHINOSINUSITIS
RATUNANDA Sinta Sari [1,2] ; MADIADIPOERA Teti [1,2] ; ANGGRAENI Ratna [1,2], BOESOIRIE
Thaufiq [1,2] ; RUSLAMI Rovina [3,4]

1- ORL-HNS Department, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia ;2 – ORL-

HNS Department, Hasan Sadikin General Hospital, Bandung, Indonesia ;3 – Biomedical Sciences
Department, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia ;4 - Pharmacology and
Therapy Division, Hasan Sadikin General Hospital, Bandung, Indonesia.

OBJECTIVES
Chronic rhinosinusitis (CRS) is associated with multifactorial etiologies, making CRS often
uncontrolled. One of the factors thought to be associated with CRS is laryngopharyngeal reflux (LPR),
but the association is still unclear. The aim of this study is to find LPR as an associated factor CRS, by
measuring pepsin level as a direct pathway marker, and substance P level as an indirect pathway
marker; after proton pump inhibitor drug (PPI) administration.

MATERIALS AND METHODS

A randomized double-blind clinical trial study, parallel two group, was conducted in CRS with LPR
patients at the Rhinology-Allergy Clinic in Hasan Sadikin General Hospital Bandung, Indonesia, since
March until September 2018. A total of 72 subjects met the criteria, divided into Lansoprazole (PPI)
and placebo group for 28-days treatment, and 61 subjects attended to the end. Pepsin and
substance P levels were measured by ELISA method from nasal mucosa. The statistical analysis used
was the Mann Whitney test.

RESULTS
The decrease of pepsin level was greater in the treatment group (from baseline 0.11(0.04-
0.14)ng/ml to 0.06(0.01-0.08)ng/ml), than placebo (from baseline 0.03(0.01-0.11)ng/ml to 0.08(0.03-
0.14)ng/ml), with p value <0.001. But there was no difference in decrease of substance P level in
treatment group (from the baseline of 5.56(4-7.3)pg/ml to 5.62(4.11-6.97)pg/ml), compared to the
placebo (from baseline 6.19(4.42-8.0)pg/ml to 6.0(4.78-7.38)pg/ml), with p value > 0.05.

CONCLUSION
LPR is associated with CRS by direct pathway based on decrease of pepsin level in nasal mucosa, but
not proven yet by indirect pathway based on decrease of substance P level.
FP4_07
COMPARISON OF EOSINOPHILIC OTITIS MEDIA (EOM) AND EOSINOPHILIC GRANULOMATOSIS
WITH POLYANGIITIS (EGPA) WITH OTITIS MEDIA

FUKUDA Atsushi; MORITA Shinya; FUJIWARA Keishi; HOSHINO Kimiko; NAKAMARU Yuji;
HOMMA Akihiro

Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of
Medicine, Hokkaido University, Sapporo, Japan

OBJECTIVES
This study aimed to compare the clinical manifestations of eosinophilic otitis media (EOM) with
those of eosinophilic granulomatosis with polyangiitis (EGPA) with otitis media (OM).

MATERIALS AND METHODS

This retrospective study recruited 22 ears of 11 patients diagnosed with EOM (EOM group) and 20
ears of 12 patients with EGPA with OM (EGPA group). The endpoints were otorhinologic findings and
bronchial asthma (BA) status. Eosinophils in the peripheral blood and serum myeloperoxidase
(MPO)- and proteinase 3 (PR3)- antineutrophil cytoplasmic antibodies (ANCA) were measured. Pure-
tone audiograms were also compared.

RESULTS
No significant differences were found between the two groups in the incidence of BA, chronic
rhinosinusitis (CRS), and nasal polyp (NP) or age of onset of OM, BA, and CRS. The EGPA group had
significantly higher peripheral blood eosinophil counts than EOM group. A total of 6 patients (50%)
in the EGPA group were positive for MPO-ANCA, whereas none in the EOM group were positive for
MPO- or PR3-ANCA. At the latest visit, abnormal otologic findings, such as perforated tympanic
membrane, were more common in the EOM group. The average air conduction threshold and air-
bone gap were significantly higher in the EOM group than in EGPA one.

CONCLUSION
From an otorhinologic point of view alone, it is challenging to differentiate EOM from EGPA
preceded by OM. During treatment of EOM, monitoring peripheral blood eosinophils and serum
MPO- and PR3-ANCA as well as attention to the appearance of the characteristic systemic
manifestations of EGPA may contribute to early detection of EGPA.
FP4_08
IS CT NECESSARY FOR IMAGING PEDIATRIC CONGENITAL SENSORINEURAL HEARING LOSS?

CHIN Olivia [1]; DHARSONO Ferry [1]; KUTHUBUTHEEN Jafri [2]; THOMPSON Andrew [1]

1- Department of Medical Imaging, Perth Children’s Hospital, Perth, Australia

2- Department of Otolaryngology Head and Neck Surgery, Nedlands, Perth, Australia

OBJECTIVES
To determine if MRI alone is adequate for the pre-operative assessment of pediatric congenital
sensorineural hearing loss (SNHL).

MATERIAL AND METHODS

MRI and CT of the temporal bones conducted on the same day were analyzed retrospectively in 240
consecutive patients in a tertiary pediatric ENT service over 6 years for investigation of SNHL.
Children under the age of 5 years with no clinical syndrome or dysmorphic external ear anatomy
were included.

RESULTS
169 patients were included. MRI was able to detect nearly all instances of clinically relevant
anatomical variances. These were absent or hypoplastic cochlear nerves, large vestibular aqueduct
syndrome (LVAS), post-inflammatory cochlear obliteration, high riding jugular bulb and the presence
of otomastoid fluid. MRI detected cochleovestibular dysplasia in 32 out of 54 ears, with the majority
of the additional CT findings reflecting subtle cochlear dysplasia seen in the context of IP2. Of the 22
cases of dysplasia not evident on MRI, 13 patients (59%) also had LVAS, which would have prompted
evaluation with CT, due to the near universal co-existence of these entities. MRI could accurately
assess the extent of mastoid bone pneumatization bilaterally in 166 patients. 1 out of the 169
patients had an aberrant intratemporal facial nerve anatomy was occult on MRI and potentially
posed a surgical threat.

CONCLUSION
In a defined pediatric SNHL cohort, MRI alone has high utility and the addition of routine CT imaging
of the temporal bones has negligible additional yield or bearing on surgical outcomes.
FP4_09
ASSOCIATION BETWEEN HEARING LOSS AND COGNITIVE FUNCTION IN AN AGEING ETHNIC
CHINESE SINGAPOREAN POPULATION
HEYWOOD Rebecca [1,2]; JAYAKODY Dona [2]; EIKELBOOM Robert [2]; KOH Emily [3]; NICHOLAS
Sean [3]; TEO Nigel [3]; YAP Philip [4]; WEE Shiou Liang [3]; NG Tze Pin [5] 1 - Department of
Otolaryngology, Ng Teng Fong General Hospital, Singapore; 2 – Ear Science Institute Australia & Ear
Sciences Centre, Medical School, University of Western Australia; 3 - Geriatric Education and
Research Institute, Singapore; 4 - Department of Geriatric Medicine, Khoo Teck Puat Hospital,
Singapore; 5 - Department of Psychological Medicine, National University of Singapore, Singapore

OBJECTIVES
Hearing loss has been shown to be associated with cognitive impairment in epidemiological studies
of older persons in Western populations; however, (i) there has been limited study of the association
in Asian populations and (ii) most studies have utilized verbally administered cognition tests to
investigate this relationship and may therefore overestimate cognitive impairment. This study
investigated the association between untreated hearing loss and various cognitive functions using a
predominantly non-verbally administered cognitive test battery in a cohort of ageing ethnic Chinese
Singaporeans.

METHODS
227 participants (149 female, 77 male; mean age 71.3 +/- 5.7 years) completed pure tone
audiometry, a computerized, tablet-administered cognitive test battery, geriatric depression scale
and geriatric anxiety inventory in this baseline cross-sectional study. A pure tone average of
thresholds at 0.5, 1, 2 and 4kHz in the better hearing ear was used for data analysis. Multiple
regression analyses were performed, adjusted for age, education, gender, depression and anxiety.

RESULTS
Moderately-severe to profound hearing loss predicted paired associates learning (P<0.000), verbal
recognition memory (P=0.015) and delayed matching to sample (P=0.006). Geriatric anxiety
inventory score was a significant predictor of paired associates learning (P=0.000) and spatial
working memory (P=0.021).

CONCLUSION
Hearing loss is independently associated with poorer scores in several cognitive domains pertaining
to memory, including visual and verbal memory, new learning, attention and recognition, even when
verbally administered test stimuli are reduced to a minimum. The findings support those
documented in Western populations and have significant implications for the ageing Singaporean
population.
FP4_10
ROUND WINDOW BILATERAL SIMULTANEOUS COCHLEAR IMPLANTATION IN CHILDREN UNDER 12
MONTHS OF AGE – SURGICAL OUTCOMES AND CONSIDERATIONS

KUTHUBUTHEEN Jafri [1]; RODRIGUES Steven [1]; POLLAERS Katherine [1]; THOMPSON Andrew [2];
CHASE Carl [3]

1- Department of Otolaryngology Head and Neck Surgery, Perth Children’s Hospital, Perth,
Australia
2- Department of Medical Imaging, Perth Children’s Hospital, Perth, Australia
3- Department of Audiology, Perth Children’s Hospital, Perth, Australia

OBJECTIVES
To assess whether the round window (RW) approach is surgically feasible in children under 12
months of age undergoing cochlear implantation (CI)

MATERIALS and METHODS

All children undergoing bilateral simultaneous CI under 12 months of age at a tertiary paediatric
centre were reviewed. Routine preoperative workup included
auditory brainstem responses testing, tympanometry, otoacoustic emissions, cortical auditory
evoked potentials and 3T MRI scanning. Patients with syndromes or had abnormal temporal bone
anatomy were excluded. Intraoperative findings were assessed including the degree of mastoid
pneumatisation and RW accessibility to electrode insertion. Postoperative findings, complications
and implant performance including aided threshold and speech testing were assessed.

RESULTS
28 patients received a CI under 12 months of age. 12 patients were implanted at or below 7 months
of age. The mean age of implantation was 9 months. 90% of patients were deemed to have mastoid
pneumatisation conducive to allow surgical access to the facial recess. RW electrode insertion was
possible in 97% of ears. 2 patients had shallow ulceration over the magnet receiver site which
settled with a weaker magnet. 2 patients had nasopharyngeal blood postoperatively. All patients had
aided CI thresholds between 15-25dB from 250 to 8000Hz and Ling sound detection. There were no
facial nerve stimulations or anaesthetic complications.

CONCLUSION
The RW approach is a safe option even for children implanted under 12 months of age. This has
implications for expanding hearing and structure preservation to very young CI candidates to
minimise trauma to the ear for potential future regenerative therapies.
FP4_11
TRIGONA HONEY IN ALLERGIC RHINITIS PATIENTS: ITS EFFECTIVENESS AS AN ADJUNCT THERAPY
MD SHUKRI Norasnieda [1]; MAT SAUD Mohd Razi[1]; SALIM Rosdan [1]; HASSAN Norul Badriah
[2];CHE HUSSAIN Maraina[3]
1- Department Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, Universiti
Sains Malaysia, Kubang Kerian, Kelantan, Malaysia;
2- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang
Kerian, Kelantan, Malaysia;
3- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian,
Kelantan, Malaysia

OBJECTIVES
This study is to determine the effectiveness of Trigona Honey (TH) or also known as ‘Kelulut Honey’
from a stingless bee as an adjunct therapy for patients with moderate to severe allergic rhinitis using
clinical parameters; Total Nasal Symptom Score (TNSS) and Modified Lund-Kennedy naso-endoscopic
score. Total IgE in both control and study group is also measured and analysed.

MATERIALS AND METHODS

This was an open-label randomized controlled trial on 64 subjects recruited from
otorhinolaryngology clinic at two tertiary referral centres in the East Coast of Peninsular Malaysia
from July 2017 to February 2018. The control group received standard care of treatment while the
intervention group received standard care plus TH 189.33 mg/kg/day for 4 weeks duration. Total
nasal symptom score (TNSS), Sinonasal Outcome Test Score (SNOT-22), Modified Lund Kennedy
(MLK) were scored at start, week 4 and week 8 and analysed using repeated measure ANOVA.

RESULTS
There was significant improvement seen in time effect for TNSS and SNOT-22 in TH group at week 4
(p<0.001). There was significant different in treatment effect (p= 0.014) and time-treatment effect
(p<0.001) in TH group compared to control group which patients showed lower MLK score in TH
group. However, for total IgE level, there was no significant difference between the two groups.

CONCLUSIONS
Trigona Honey ingestion showed improvement in the symptoms of allergic rhinitis and endoscopy
findings, therefore it could serve as an adjunct therapy for allergic rhinitis patients.
FP4_12
EFFECT OF ROUND WINDOW OPENING SIZE ON RESIDUAL HEARING PRESERVATION IN COCHLEAR
IMPLANTATION
GOTAMCO Giselle [1,2] ; WU Hung-Pin [1,3]
1 - Department of Otolaryngology - Head and Neck Surgery, Taichung Tzu Chi General Hospital, The
Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; 2 - Section of Otorhinolaryngology - Head
and Neck Surgery, Department of Surgery, Cardinal Santos Medical Center, San Juan, Metro Manila,
Philippines; 3 - School of Medicine, Tzu Chi University, Hualien, Taiwan

OBJECTIVES
This study aims to compare the hearing preservation outcomes in cochlear implant surgery following
slit versus full opening of the round window membrane.

MATERIALS AND METHODS

Seventy patients (mean, 26.3 years; range, 2-69 years) who underwent cochlear implantation via
round window approach were included in the study. Thirty-five cases were prospectively enrolled
for cochlear implantation via the open round window approach between August 2018 and January
2019. Thirty-five patients who underwent cochlear implantation prior to August 2018 via the slit
round window opening were frequency matched by sex, age, and pure tone audiometry (PTA)
thresholds and were retrospectively enrolled. Preoperative and postoperative thresholds were
obtained. The percentage of hearing preservation was computed using the HEARRING Network
formula and classified into complete, partial, and minimal hearing preservation. The results
between the two groups were compared and analyzed.

RESULTS
The rate of complete hearing preservation in the open group was statistically significant (p=0.006) at
80% (n=28) compared to 48.6% (n=17) in the slit group.

CONCLUSION
The open round window technique results in significant residual hearing preservation compared to
the slit round window technique at 3 months postoperatively.
 18TH ASEAN ORL-HNS
CONGRESS

ABSTRACTS – POSTER
Audiology and Speech
POSTER # P-161
THE CORRELATION BETWEEN REACTIVE OXYGEN SPECIES WITH NOISE INDUCE HEARING LOSS IT
AUTOMOTIVE VOCATIONAL SCHOOL STUDENT

Vera Melyani1, Nyilo Purnami1, Dhany Arifianto2, Ainun Nadiroh2

1
Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas
Airlangga, Dr. Soetomo General Hospital, Surabaya. Indonesia
2
Department of Engineering Physics, Institut Teknologi Sepuluh Nopember, Surabaya. Indonesia

BACKGROUND
The used of machine practical in automotive students causes noise and threatens the students
auditory. Noisy causes hearing loss known noise induce hearing loss (NIHL) can be permanent, so
prevention efforts are very important. Noise exposure that over the threshold results in mechanical
damage and metabolic disorders causing changes in calcium homeostasis, cell oxidative stress and an
increase in free radical production known as Reactive Oxygen Species (ROS).

METHODS
This study is an observational research with approach cross sectional and analytical. This study held at
the ORL-HNS OPD Division of Neurotology, Clinical Pathology Installation and Central Installation of
Network Bank Biomaterials at Soetomo General Hospital Surabaya in May 2018.

RESULTS
The range of age population is 17-20 years, the measurement of ROS levels in plasma with NIHL
obtained a minimum value of 3.00 ng/ml and a maximum value of 9.70 ng/ml with a mean (SD) of
4.4894 ng/ml (1.7148). The value of ROS without GPAB obtained a minimum value of 0.86 ng/ml and a
maximum value of 2.81 ng/ml with a mean (SD) of 2.1047 ng/ml (0.5790). The results of Mann-
Whitney test demonstrated that significantly between plasma ROS levels and NIHL (p<0.05).

CONCLUSION
There is a correlation between plasma ROS levels and NIHL in automotive engineering vocational
school students, which means that ROS levels in students with NIHL are higher than ROS levels in
students without NIHL.
POSTER # P-162
THE CORRELATION BETWEEN TNF α VALUE WITH HEARING TRESHOLD AT 4000 HERTZ AFTER
EXPOSURE TO GUNFIRE OF NATIONAL POLICE SCHOOL IN EAST JAVA
Ismelia Fadlan1, Nyilo Purnami2
1
Department of Otorhinolaringology Head &Neck Surgery. Faculty of Medicine Jambi University.
Raden Mattaher Hospital.
2
Department of Otorhinolaringology Head &Neck Surgery. Faculty of Medicine Universitas Airlangga.
Dr. Soetomo Hospital

ABSTRACT
BACKGROUND:
The evidence in acoustic trauma after gunshot exposure in students of the National Police School are
prevalent. Prevention has been done by using the earplugs, but it was not effective so that other
methods are needed to prevent the occurrence of acoustic trauma. Tumor Necrotic Factor α (TNF α) is
chemotaxis factor with function to pull monocyte move to inflammation area and make inflammation
cell accumulation. This study aimed to show the correlation between levels of TNF α and hearing
threshold at 4000 Hz after the gunshot exposure.

METHODS:
This study is observational analytic with a retrospective cross sectional approach using secondary data
of medical records of the National Police School (NPS) students in east Java, batch 2017/2018. The
samples were selected by simple random sampling.

RESULT:
Out of the 50 students, the yongest was 18 years old and the oldest was 21 years with an average of
19.62 years. All research samples are male. Decresing the hearing threshold frequency at 4000 Hz
indicated as acoustic trauma was found in 28 students (56%), the minimum hearing threshold
frequency at 4000 Hz 5 dB and maximum of 65 dB with an average of 31.52 dB. The minimum value of
TNF α was 11,91 ng/ml and maximum was 407,87 ng/ml with an average of 164,74 ng/ml. Hearing loss
complaints were found in student (2%). Complaints of tinnitus and vertigo were not found. Statistical
tests with Pearson correlation between TNF α levels in serum with a hearing threshold value at 4000
Hz frequency showed that the SD 116,60 and p=0.17(p>0.05).

CONCLUSION:
There was no correlation between TNF α levels and the hearing threshold at 4000 Hz frequency after
gunshot exposure on East Java NPS students.
POSTER # P-163
ASSESSMENT OF HEARING IMPAIRMENT IN CHILDREN AT TERTIARY HOSPITAL, YANGON

THET Khin May [1,2]; HLA Hla Khin[3]

1 - Otorhinolaryngology and Head and Neck Specialist Hospital , Tarmwe, Yangon, Myanmar ;2 –
Otorhinolaryngology and Head and Neck Surgery Department, University of Medicine (1) , Yangon ;3 –
Otorhinolaryngology and Head and Neck Surgery Department, University of Medicine (1), Yangon

OBJECTIVE
To assess the hearing impairment in children who came to the tertiary hospital, tarmwe, yangon

MATERIALS AND METHODS

From September 2017 to December 2018, hospital based descriptive study was done in the children
who came to hospital by themselves or referred from health care centers or referred from
paediatricians to paediatric audiology unit, ORL-HNS hospital, Yangon. Study population included 889
children with or without hearing impairment. After detailed history and otological examination was
done, audiological assessment was done firstly screening with OAE, AABR, screening PTA and
tympanometry and confirmed by diagnostic ABR and ASSR according to age group A, group B, group C
and group D.

RESULTS
From this study, the prevalence of hearing impairment had 56% among 889 children who came to
hospital. Hearing impairment in gropu C and group D had 74.5% and 75.1% and 36.7% in group B and
11% in group A respectively. The most common type of hearing loss was sensorineural hearing loss
which is 37% and 29% was conductive hearing loss. All risk factors in this study except history of
ototoxic drugs were associated with hearing impairment. P-vale was <0.05 and it was significant. There
was no association between sex distribution and hearing impairment. After getting the diagnosis, for
sensorineural hearing loss, hearing aids were given for 68 children and cochlear implants was done for
17 children. The rest of patients who are not candidate for hearing aids and cochlear implants were
advised to go to school for deaf.

CONCLUSION
Neonatal hearing screening is the major role in early detection of hearing impairment. If hearing
impairment detected early, it can prevent the impairment of speech and language development. If the
risk factors related to hearing impairment are preventable, early awareness and assessment of hearing
in children should be done to get diagnosis in time. Late diagnosis may lead to delay in speech and
language and difficulty in communications, learning and social behaviours. So, from this data and
research, it was concluded that hearing impairment in children is a main issue to detect early and to
prevent communication disabilities.
POSTER # P-164
DEVELOPMENT OF INDONESIAN NATURAL SPEECH SYNTHESIS SYSTEM FOR CHILDREN WITH
DELAYED SPEECH

PURNAMI, Nyilo [1]; ANGGRAYNI, Elok [2]; ARIFIANTO, Dhany [2]; PUTRA, Agrista Prima Alditya [1]
1 – Faculty of Medicine, Airlangga University, Surabaya, Indoneia ;2 – Department of Engineering
Physics, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia

OBJECTIVES
As of today, about 16.8% of the total number of Indonesian has hearing impairment to profound
deafness, which most of them are children from 7 to 9 years old. Because of this, the children also
have delayed speech compared to normal hearing children. Furthermore, speech therapist currently
available are limited and insufficient to serve. These children who have hearing impairment cause the
delay in speaking ability. In this paper, we outlined the development of a multimedia tool for learning
the pronunciation of the children with delayed speech.

MATERIAL AND METHODS

Firstly, we constructed natural and expressive Indonesian speech corpus based on the phonetically
balanced in which contains speech database and its transcription. The sentences were selected from
colloquial conversations. We, then, hired ten professional radio news readers to utter the natural
speech corpus and four professional theater artists for the expressive speech corpus. As a result, the
Indonesian speech corpus consists of more than 18 hours audio, hand-labeled and segmented.

RESULTS
We used Hidden Markov Model (HMM) based to generate acoustical features of speech based on the
training data of fundamental frequency, mel-cepstrum and prosody. The generated speech utterances
were then evaluated subjectively and objectively to determine its naturalness. We do some variation
in the number of sentences and the type of sentences which used in the training part.

CONCLUSION
The training results showed that the new design of multimedia tool for learning of the children with
delayed speech patients was capable to use as the alternative for hospitals for the therapy of the delay
speech patients. In the on-going research, we keep monitoring the progress of the delayed speech
patients with speech therapists compared to our proposed Indonesian speech synthesis to measure
the effectiveness of the proposed system.
POSTER # P-165
SENSITIVITY AND SPECIFICITY OF THE HEARING HANDICAP INVENTORY FOR ELDERLY-SCREENING
THAI VERSION
Nattharee JUDEE, M.D.(1,2) ; Paninee CHARUSRIPAN, M.D.(1)
1- Department of Otolaryngology , Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand;
2- Relief and Community Health Bureau , The Thai Red Cross Society , Bangkok , Thailand

OBJECTIVE
To evaluate sensitivity and specificity of The Hearing Handicap Inventory for
Elderly-Screening (HHIE-S) Thai version

MATERIALS AND METHODS

Diagnostic study in Thai people aged 60 years or older who visited chulalongkorn hospital during 1
December 2016 – 30 November 2017. The Hearing Handicap Inventory for Elderly-Screening (HHIE-S)
Thai version individual questions was completed by paticipants themselves and then Pure-tone air-
conduction audiometry was conducted in a soundproof room and performed by certified audiologists.
pure-tone averages (PTA) threshold was calculated using pure-tone averages (PTA) of responses to
500, 1000 and 2000 Hz. a total HHIE-S score of 8 is defined as indicating the presence of hearing
handicap; therefore, we used this cutoff point to evaluate sensitivity and specificity of the HHIE-S Thai
version against pure-tone average ≥40 decibels hearing level (dBHL).

RESULTS
The 220 participants were included in this study which divided into 154(70%) females and 66(30%)
males with mean age of 69.24±7.21 years. For the detection of moderate or worse hearing loss (PTA
≥40 dB), the HHIE-S cut-point score of >8 had a sensitivity of 75.8% and a specificity of 68.5% with PPV
of 29.8% and NPV 94.1%

CONCLUSIONS
The HHIE-S Thai version is considered to be a reliable and valid screening tool to identify moderate
hearing loss in older adults in Thailand. The HHIE-S Thai version has the potential to be extended to a
large number of under-tested older adults in a country which is encourage that group of patients to
have proper diagnosis and intervention
POSTER # P-167
A COMPARISON OF THE HUMAN VOICE (“BAAH”) TEST AND THE AUTOMATED AUDITORY
BRAINSTEM RESPONSE IN DETECTING NEONATES WITH HEARING LOSS IN A COMMUNITY SETTING
CHIONG Alessandra Nadine MD [1] ; CHIONG Charlotte MD, PhD [1] ; LABRA, Patrick John MD ;
EVANGELISTA, Gienah MD [1]; GRULLO, Precious Eunice MD, MSc
1 – Department of Otorhinolarygology, Philippine General Hospital, Manila, Philippines

OBJECTIVES
To assess the usage of the Human Voice “Baah” Test compared to the AABR in detecting hearing loss
of neonates in the community setting.

MATERIALS AND METHODS

The study will be retrospective cross-sectional, the population consisting of newborns less than 1
month old screened by nurses at a testing facility in Malolos, Bulacan. Only infants who completed
both the Baah Test and the AABR at the time of testing will undergo review of records and be included
in the study.

RESULTS
For infants who passed hearing screening in at least one ear, 96% (193 infants) correlated with the
results of Baah testing. Only 1% (2 infants) had no observable response. For bilateral refer results on
the AABR, 4 out of 6 correlated with the Baah Test, while 2 out of 6 exhibited a response despite
bilateral refer results.

CONCLUSION
In this sample of trained health professionals administering the Baah Test and the AABR screening
test, 98% of infants showed consistent results between the two methods of screening.
 Facial Plastic
Reconstructive Surgery
POSTER # P-041
AVOIDING AND MANAGING UNFAVORABLE RHINOPLASTY RESULTS

Author’s name(s): Prof. SAMEER ALI BAFAQEEH, M.D.

Institution: KING SAUD UNIVERSITY, Otolaryngology Department, Chairman Facial Plastic Division,
PAAFPRS Vice President
Mailing Address: Riyadh 11411, Kingdom of SAUDI ARABIA
E-mail: prof.bafaqeeh@gmail.com Mobile phone: +966505256637

ABSTRACT TEXT
There is a high demand for rhinoplasty in almost all around the world. Although techniques used are
almost the same, results and acceptance of the results may vary in different cultures. Preoperative
evaluation is critical to understand the desires of the patient. Analysis of photos and computer image
editing before rhinoplasty may be helpful if done regularly.

The unfavorable outcome in rhinoplasty most frequently is the result of errors in surgical technique.
Many of our referral unhappy or dissatisfied revision cases have been to the plastic surgeon for their
primary assessment or their first surgery and referred to us for both functional and aesthetic
correction of their iatrogenic deformities after having had their primary surgery by the plastic surgeon.
Additionally, there are usually psychological issues that need to understand and deal with to achieve a
satisfactory outcome The nasal tip is the most prominent part of the face. It is both aesthetically and
functionally significant. So, it should be the primary goal of the surgeon to achieve a perfect tip. Many
sutures and grafts were described up to now. I aimed to discuss the advantages and disadvantages of
most famous techniques, Nasolabial angle is the point of interest of many patients so the surgeons
Targeting to adjusting it precisely. The dorsum is the second significant area in rhinoplasty. Various
vital aspects must be considered when improving the dorsum. Culture, personal desires and function
should be kept in mind while reforming the dorsum.

The external approach is applied for most revision cases, which offers several advantages: direct
visualization of underlying anatomic structures, adequate diagnosis of the existing deformity, and
exact placement of grafts and implants. The treatment is also multifactorial: Osteotomy and rasp
techniques are used to realign; (intact, crushed, diced, or morselized) cartilage grafts are used to fill in,
camouflage, smooth out, elevate, and contour different defects. The best form of treatment is
prevention. This requires an understanding of the complex anatomy and physiology of the nose

Outcome Objectives: Understanding the importance of preoperative evaluation and computer image
editing before rhinoplasty, Understanding the advantages and disadvantages of various tip sutures and
grafts, Learning the perfection of the dorsum.
POSTER # P-042
SUPRACLAVICULAR ARTERY ISLAND FLAP RECONSTRUCTION FOLLOWING
EXCISION OF A GIANT CAVERNOUS HEMANGIOMA OF THE FACE
DULNUAN Heather Grace [1]; CABUNGCAL Arsenio Claro [1]; LAHOZ Anna Claudine [1]
1 - Department of Otorhinolaryngology, University of the Philippines-Philippine General
Hospital, Manila, Philippines

OBJECTIVES
To present the use of a supraclavicular artery island flap as a viable option for the
reconstruction of a large cervicofacial defect following extirpation of a hemifacial cavernous
hemangioma.

MATERIALS AND METHODS

Design: Case Report
Setting: Tertiary National University Hospital
Patient: One

RESULTS
A 43 year-old female presented with a 11 x 15 cm cervicofacial defect following excision of a
large cavernous hemangioma. Pre-operative tumor embolization precluded the utilization of a
possible anterolateral thigh free tissue transfer to cover this defect. A supraclavicular artery
island flap was performed on this patient due to its ease of harvest, good color match, wide
arc of rotation, and minimal donor site morbidity. Post-operatively, the patient developed
multiple sites of dehiscence which were mostly managed conservatively. The patient also
presented with keloid scars 3 months post-operatively. Plans for secondary surgery with scar
revision, commissuroplasty, and intralesional steroid injections are currently being discussed
with the patient.

CONCLUSION
The supraclavicular artery island flap is a good alternative to free tissue transfer for
cervicofacial defects, especially in low-resource environments or in patient populations where
free tissue transfer is contraindicated. Advantages of the supraclavicular artery island flap
include its cost-effectiveness, good color match, wide arc of rotation, and ease of harvest.
POSTER # P-043
CONCHAL CARTILAGE: BEYOND TIP CONTOURING IN REVISION RHINOPLASTY
LAXAMANA, Shella May,
GALVEZ, Jose Amado
Department of Otorhinolaryngology Head and Neck Surgery
Ospital ng Maynila Medical Center
Manila, Philippines

INTRODUCTION
Alloplastic materials remain the primary choice in nasal dorsal augmentation but they are also
the most common cause of revision rhinoplasty. Autologous cartilage grafts are therefore
essential in safe and timely revision surgery. The complications and insufficiencies related
with septal and rib cartilage grafts often restricts their utility. Conchal cartilage grafts,
however, are safely obtained, readily available and easily contoured. We present the efficient
use of bilateral conchal cartilage grafts in
Asian revision rhinoplasty.

OBJECTIVE
To demonstrate the maximal use of bilateral conchal cartilage grafts and their harvest,
preparation intraoperative design and postoperative results in revision rhinoplasty of Asians
with mild to moderate nasal deformities.

METHODS
The 4 patients in the study conducted in a tertiary hospital in the Philippines (Ospitalng
Maynila Medical Center) underwent revision rhinoplasty using bilateral conchal cartilage
grafts. Cases were as follows: (1) iatrogenic saddle nose deformity after septorhinoplasty, (2)
silicon implant infection, (3) infected silicon oil injection (4) unsatisfactory primary
rhinoplasty. On follow up, there was no incidence of hematoma formation, infection, graft
resorption and displacement. All patients were satisfied with the aesthetic and functional
outcome.

CONCLUSION
The flexibility and tensile strength of conchal cartilage allows for correction of both nasal
dorsal structure and tip contour. With efficient harvesting and intraoperative application,
these grafts are sufficient for correction of mild to moderate saddle nose deformities, infected
silicon oil injections and alloplastic implant rejection. Bilateral conchal cartilage grafts provide
long term structural stability and favorable aesthetic outcomes in Asian revision rhinoplasty.
POSTER # P-044
MODIFIED MIDLINE REDUCTION GLOSSECTOMY FOR MACROGLOSSIA WITH MANDIBULAR TORI
CONGENITAL: A RARE CASE

MUTIA Dita [1] ; FARDIZZA Fauziah [1] ; BANGUN Kristaninta [2]

1 – Department of Otorhinolaringology Head and Neck Surgery, Faculty of Medicine Universitas
Indonesia – Cipto Mangungkusumo General Hospital, Jakarta, Indonesia
2 – Department of Plastic and Reconstructive Surgery, Faculty of Medicine Universitas Indonesia –
Cipto Mangungkusumo General Hospital, Jakarta, Indonesia

BACKGROUND
An enlarged tongue (macroglossia) in dentomusculoskeletal deformities creates masticatory, speech,
and airway management problems. Understanding the signs and symptoms of macroglossia will help
identify those patients who could benefit from a reduction glossectomy (reduction of tongue size) to
improve function, esthetics, and treatment stability. The aim of this poster is to report our case about
modified technique of midline reduction glossectomy in macroglossia with mandibular tori at
Maxillofacial Surgery Universitas Indonesia and then reporting the results.

MATERIALS AND METHODS

Reported rare case, five month old boy with congenital disorder macroglossia with mandibular tori,
that the syndrome still has not been found until now. Patient underwent primary tracheostomy
because of the upper airway obstruction, removal tori and midline reduction glossectomy with
modified kole technique that intended for volume reduction in oropharynx.

Kole proposed an anterior triangular wedge excision of the tongue. In our case, the initial anterior
wedge excision following the Kole technique provided adequate reduction in tongue length but width
reduction was unsatisfactory. Hence, we modified the technique by extending the apex of the anterior
triangular wedge to the posterior third midline providing additional and adequate reduction in tongue
width.

RESULTS
Our modification of the Kole technique proved to be viable as the postoperative results were
considered satisfactory. There was minimal blood loss. Tongue volume was uniformly reduced in both
length and width enabling mouth and jaw closure while tongue sensation and mobility were
preserved. Appearance, feeding, and speech intelligibility were markedly improved although the
follow up which was confirmed by FEES (Functional Endoscopic Evaluation of Swallowing) shows
hiposensitivity was still found, and it same as reported by Wang.

CONCLUSION
In management of reduction glossectomy can be modified accordance with the clinically condition for
each patient. Future application of this modification may demonstrate its usefulness.
POSTER # P-045
REVISION RHINOPLASTY: OUR EXPERIENCE

DUTTA Devi Prishni[1],KHANNA Swagata[1], DAS Anandita[2]

1-Swagat ENT Centre,2-Guwahati medical college,Assam,India

ABSTRACT
Rhinoplasty is one of the most difficult procedures of all cosmetic facial surgery. We present a series of
three cases in which revision rhinoplasty was done.The first case was a beautiful girl , following trauma
to her nose,silicone implantation was done by plastic surgeon. We planned for external rhinoplasty
approach to remove the implant which was found to be impinged with a screw at root of nasal
dorsum.The second case was crooked nose,with history of primary rhinoplasty done elsewhere with
no records,revision surgery was done abd patient was satisfied.3rd case was a Young female,with
maldeveloped nasal bone and maxillary bones ,she initially underwent dorsal augmentation and later
in revision surgery ,lateral osteotmies and further augmentation with diced rib cartilage wrapped in
temporalis fascia was done.All the three cases patients were well satisfied with the results. But
however as surgery is performed on scarred facial structure,it brings with itself a limitation in the
overall success,as these patients tends to often have unrealistic expectations, which sets the stage for
failure even when an acceptable result is achieved.

CONCLUSION
First attempt is always the best,hence no harm should be done to the patient while doing so.
POSTER # P-046
TROUBLE SLEEPING IN DEVIATED NOSE DEFORMITY – OUTCOME OF SEPTORHINOPLASTY
KALAKUNTLA Mounika [1,2] ; BELALDAVAR Basavaraj P [2]
1 – Department of Otorhinolaryngology & Head and Neck Surgery, Pristyn Care, Hyderabad, India
2 – Department of Otorhinolaryngology & Head and Neck Surgery, JNMC, KLE’s University, Belagavi,
India

OBJECTIVES
To evaluate outcome of septorhinoplasty in deviated nose deformity with trouble sleeping using Nasal
Obstructive Symptoms Evaluation (NOSE) scale

MATERIAL AND METHODS

A total of 40 patients who met the criteria of inclusion and exclusion were taken up in this study Study
design & period - One year crossectional study. During the study period, the patients were evaluated,
symptoms were noted and scored according to NOSE scale prior to septorhinoplasty and after a week
of postoperative period. Trouble sleeping score in NOSE scale and total NOSE scale score were
evaluated statistically by Mc Nemer test, Paired t test, Chi-square test and Independent t test.

RESULTS
In our study, the total NOSE score preoperative septorhinoplasty with mean score of 11.43±2.69 and
postoperative septorhinoplasty with mean score of 3.28±1.52. It was noted that NOSE score for
Trouble sleeping [P=0.001] and total NOSE score[P=0.001] preoperative septorhinoplasty in
comparison with postoperative septorhinoplasty shows their significance

CONCLUSION
Deviated nose deformity affects the quality of life of patients by causing nasal congestion, nasal
blockage, trouble in sleeping and aesthetic appearance. Quality-of-life (QOL) being in relation to health
of the nose. Our study assesses improvement in nasal symptoms and quality of life after
septorhinoplasty.
POSTER # P-048
SURGICAL MANAGEMENT OF GROSSLY DEFORMING VASCULAR LIP MASS USING
ULTRASONIC SCALPEL – A CASE SERIES

JOSEPHINE GRACE C. ROJO, MD; MICHAEL JOSEPH C. DAVID, MD, FPSO-HNS

Vascular malformations present as a common congenital anomaly that is aesthetically distinct
and can pose as a surgical challenge when seen in the lips. Of all vascular malformations, varix
or venous malformation is the most common. Management includes surgery with or without
embolization, sclerotherapy, medications and some advocates observation for small, infantile
hemangiomas. This case series will cover four patients with grossly deforming vascular
malformations of the lip that were not responsive to medical management who underwent
surgical excision using ultrasonic scalpel to lessen the risk of hemorrhage. For all four cases,
Lidocaine with Epinephrine in 1:100,000 dilution was used as local anesthesia and hemostasis.
To further lessen the risk of bleeding and to help maintain a clean surgical field especially for
those with large masses, tacking sutures on surrounding borders of the mass was used is Case
1, whereas Satinsky vascular clamps were used on Cases 2 and 4, with an addition of facial
artery ligation. For Case 3, mass was completely excised using the ultrasonic scalpel solely due
to its small size and favorable location. Only minimal bleeding were noted and none require
blood transfusion. All patients were discharged with improved condition with little to no
surgical marks on follow-up, and are satisfied with the cosmetic outcome of the procedure.
Ultrasonic scalpel proves to be satisfatory in the management of vascular lip masses aside
from its previously documented usefulness in thyroid and other head and neck surgeries.
Ultrasonic scalpel is a functional instrument in the surgical management of resectable
vascular lip mass. For large lesions, bleeding can be further decreased through different
hemostatic techniques such as Satinsky clamps and Tacking sutures surrounding the mass,
and ligation of the feeding vessel if feasible.
POSTER # P-049
SINGLE-STAGE AURICULAR RECONSTRUCTION USING POSTAURICULAR
PULL-THROUGH SUBCUTANEOUS FLAP
Khairunnisak MISRON and Tengku Mohamed Izam Tengku KAMALDEN
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital Sultan Ismail,
Jalan Persiaran Mutiara Emas Utama, Taman mount Austin, 81100 Johor Bahru,
Johor.

INTRODUCTION
Reconstruction of the auricle posses a great challenge in otologic field. It is owing to its 3-demensional
anatomical complexity. There are many surgical techniques used in reconstructing the auricular defect.
We will be describing a versatile technique in reconstructing defect at lateral surface of the auricle
following resection of basal cell carcinoma at middle third of auricle using postauricular pull-through
subcutaneous flap.

SURGICAL TECHNIQUE
The primary tumour was resected and frozen section was sent to ensure adequate margin clearance.
The size of the defect was drawn at the donor site at postauricular region. A window was created at
medial aspect of the primary tumour by removing a strip of conchal cartilage. The postauricular flap
was tunneled towards lateral surface of auricle through the created window. The flap was
accommodated the contour of the defect and closed with non-absorbable sutures. The donor site at
postauricular region was closed primarily by means of T-plasty.

OUTCOME
This patient had been followed up for 6 months postoperatively. The flap maintained the contour of
the auricle with good aesthetic results. The donor site wound healed well. Patient did not develop any
complications.

CONCLUSION
We propose postauricular pull-through subcutaneous flap to be considered in reconstructing defect at
middle of lateral surface of the auricle as it is done as a single-stage procedure, preserving the contour
of the auricle results in excellent cosmetic outcome, choice to reconstruct large defect and the donor
site can be closed primarily.
POSTER # P-050
FREE FLAP RECONSTRUCTION ON BASAL CELL CARCINOMA OF THE AURICLE

YULIANTI Dewi [1,2] ; FAJARIA Ratu [1,2] ; KARTIKA Dyah Ayu [1,2] ; FITRIANA Melysa [1,2]
1 - Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Public
Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia ; 2 - Otorhinolaryngology
Head and Neck Surgery Department, Dr. Sardjito Hospital, Yogyakarta, Indonesia

INTRODUCTION
Basal cell carcinoma (BCC) of the auricle is rare. BCC accounts for around 30-40% of auricle
cancer, which malignancy of auricle only reaches 6% of all cutaneous malignancies. BCC is a
locally invasive but It can cause significant local destruction with disfigurement if neglected or
treated inadequately. BCC of conchae is difficult to have an opperation and to applay suture
on that anatomical area, that it is an unusual location.

CASE REPORT
A 78 years old man with a black mass lower part of the left ear that has been grown
since 3 years ago. Initially, it was a small mass resembling corn seed and getting
bigger. It was extended from cavum of conchae to tragus with size 2 cm x 1 cm x 0.5
cm, irregular surface, hard consistency, immobile, well defined. Biopsy revealed BCC.
The patient was performed excision with margin 3-4 mm of the normal skin. The defect of skin
was reconstructed by using free flap from thigh skin. After one month the wound was clean,
there was no sign of flap tissue necrosis and relapse.

CONCLUSION
Basal cell carcinoma which is situated at the conchae auricle is an unusual condition. When it
is small in size, it is important to estabilish BCC early, before reaching large size enough to
disturtuct nearby structures, so that can make better prognosis. By using free flap
reconstruction from the thigh skin shows good result to close post excision skin defect.
POSTER # P-174
RECONSTRUCTION OF POST-BURN ANTERIOR NECK CONTRACTURES USING A BUTTERFLY DESIGN
FREE ANTEOLATERAL THIGH PERFORATOR FLAP

NG Zhi Yang [1,2]; LELLOUCH Alexandre [1,2,3]; POZZO Victor [3]; SUFFEE
Tabrez [3]; HIVELIN Mikaël [3]; LANTIERI Laurent [3]
1 – ENT, Ng Teng Feng General Hospital, Singapore; 2 – Plastic Surgery,
Massachusetts General Hospital, Harvard Medical School, Boston, USA; 3 – Service
de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance
Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France

OBJECTIVES
In order to optimize like-for-like reconstruction of the anterior neck, use of wide, thin and long flaps
such as the anterolateral thigh (ALT) perforator flap have been reported with promising results. Of
note, some patients appear to have a tendency towards severe scar contractures, which may be
contributed by the greater extent of inflammation during wound healing. We report our experience at
four years’ follow-up after secondary reconstruction of severe, anterior neck burn contractures in two
patients by harvesting the ALT flap with a butterfly design.

MATERIALS AND METHODS

The ALT is designed to match the post-resection defect with previously identified perforators located
in the middle of the flap. Because of the butterfly shape design of the ALT flap, the donor site can be
closed in V-Y fashion at both proximal and distal ends.

RESULTS
The patients presented with Grade 2 and 3 anterior cervical contracture (according to Makboul’s
classification system) following childhood burns involving 40 to 45% TBSA and both had post-excision
defect of burn scars resurfaced with butterfly ALT flap. At four years’ follow-up, neck extension had
improved from 83-900 pre-operatively up to 1200 without recurrence of scar contracture.

CONCLUSION
This technique not only provides adequate wound resurfacing of the burned neck and surrounding
areas but also, provides good neck extensibility by addressing both the anterior and lateral aspects of
the scar defect simultaneously. Moreover, such a flap design contributes to reduce tension on wound
edges and thus, the risk of contracture recurrence in neck burns reconstruction.
 Head & Neck Surgery

POSTER # P-003
METASTATIC PAPILLARY THYROID CARCINOMA PRESENTING AS FROZEN
SHOULDER: A CASE REPORT
ARCEO, Jovy Joy V [1]; FELIPE, Roy Raoul H [2]; GANSATAO, Fatima M [1]
1 – Department of Otorhinolaryngology, Head and Neck Surgery, East Avenue Medical
Center, Philippines; 2 – Section of Endocrinology, Department of Internal Medicine, East
Avenue Medical Center, Philippines

OBJECTIVES
To report and discuss a peculiar case of a 63-year old male who consulted for left shoulder
immobility and was diagnosed as a case of metastatic papillary thyroid carcinoma.

MATERIALS AND METHODS

The file record of the patient was reviewed. The clinical course, imaging, diagnostics, and
pathological findings were discussed as well as the pathophysiology of the disease and its
management.

RESULTS
The patient is a 63-year old male who presented with left shoulder immobility. Radiographic
examinations showed a lytic humeral mass and its biopsy revealed a well-differentiated
carcinoma consistent with a thyroid primary. The patient underwent total thyroidectomy with
central neck dissection, RAI, and then wide excision of humeral mass with application of
prosthesis. The official histopathology report for the thyroid and humeral mass showed
papillary thyroid carcinoma and metastatic carcinoma consistent with papillary thyroid
carcinoma, respectively.

CONCLUSION
Diagnosis of a thyroid carcinoma can be made despite no evidence of a primary tumor. It is
important to consider a primary thyroid malignancy in cases of new bone lesions where
there is no evident primary source of malignancy since differentiated thyroid carcinomas
have a propensity to metastasize to the bones. A multidisciplinary team of health care
professionals is needed to properly manage such cases.

POSTER # P-008
ASSOCIATION BETWEEN THE USE OF SMOKELESS TOBACCO AND CANCER OF GINGIVOBUCCAL
SULCUS
Sahni D.S.1, Bamania A.M.1, Ramsaha S.2, Thakar A.3, Sikka K.3, Sahoo R.K.4, Bhaskar S.4
1
M.B.B.S., All India Institute of Medical Sciences
2
ANDI Centre of Excellence for Biomedical and Biomaterials Research, CBBR, MSIRI, University of
Mauritius, Réduit, Republic of Mauritius.
3
Department of Otorhinolaryngology, All India Institute of Medical Sciences, India
4
Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, India

BACKGROUND
Although oral cancer accounts for 2.1% of all cancer cases globally, it is surfacing as a major public
threat in India. Oral cancer figures among three most common types of cancer in the Indian
subcontinent, with an incidence rate of 30%. The increased availability and use of smokeless tobacco
and betel‐quid in the recent years have further aggravated the situation. The scarcity of reports on the
contribution of such risk factors in oral cancer incidence remains a prime concern.In this
perspective,the association between smokeless tobacco and cancer of gingivobuccal sulcus was
investigated.

METHODOLOGY
The medical records of 249 patients with cancer of gingivobuccal sulcus, attending the BRAIRCH,
AIIMS, New Delhi, were retrospectively examined from 2009-2016. Demographic and clinical data
including history of addictions (smoking,smokeless tobacco) were collected and patients were staged
according to the 8th AJCC Cancer Staging (2017).

RESULTS
Smokeless forms of tobacco were more prevalent among the patients (50.7%), in contrast to smoked
tobacco (19.53%), while 29.77% were reported to consume both forms.A higher proportion of patients
with smokeless tobacco addiction were diagnosed with advanced stages of cancer (56.9% in Stage
III/IV). These rates were even higher (65.6%) in patients using both smokeless and smoked tobacco.

CONCLUSION
A strong association was observed between smokeless tobacco and gingivobuccal sulcus cancer,
particularly in patients who kept the tobacco in the buccal vestibule after chewing, to suck, sometimes
overnight. Elucidating the potential risk factors can be a key approach to design effective intervention
programs to combat the growing pandemic of oral cancer in India.

POSTER # P-009
REMOVAL OF AN EXTRALUMINAL OESOPHAGEAL FOREIGN BODY VIA THE
LATERAL PHARYNGOTOMY APPROACH: A CASE REPORT
PANG Khang Wen [1]; Vijayaraj THIRUNAVUKARASU [1]; Euan MURUGASU [1]
1 – Ear, Nose & Throat (ENT)-Head & Neck Surgery, Ng Teng Fong General Hospital,
Singapore

BACKGROUND
Fish bone impaction is one of the commonest ENT emergencies. The majority are partially intraluminal
which allows visualisation and removal of the fish bone with rigid or flexible oesophagoscopy. This also
depends on the site of impaction, configuration of the foreign body and surgeon’s preference. On the
contrary, extraluminal foreign bodies pose a challenge in diagnosing and retrieving them.

CASE PRESENTATION
This report reviews the history and clinical outcome of an 83 year old lady who presented with
odynophagia after eating fish. A non-contrast CT neck and mediastinum revealed a curvilinear foreign
body within the proximal oesophagus. She underwent rigid oesophagoscopy thrice with interval CT
scans but the foreign body could not be seen intraoperatively. The extraluminal, intramural foreign
body was finally removed via a transcervical left lateral pharyngotomy approach. The postoperative
course was complicated by laryngeal oedema that required re-intubation, swallowing dysfunction
requiring nasogastric tube feeding and left vocal cord palsy, both of which resolved completely within
6 months.

CONCLUSION
Preoperative CT is important to plan the surgical approach when extraluminal foreign
bodies are suspected. Extraluminal foreign bodies should be managed with extreme
caution due to the associated life threatening complications. Although open neck
exploration is challenging, it still remains the method of choice for removal of such
foreign bodies. The attendant risks and the post-operative course must be explained
in detail to the patient so that they can make an informed decision.

POSTER # P-010
TRANSORAL LASER MICROSURGERY IN EARLY-STAGE LARYNGEAL AND OROPHARYNGEAL CANCER
Tran Phan Chung Thuy MD. PhD, Nguyen Thanh Tuan MD.
Ho Chi Minh City ENT Hospital

BACKGROUND
For the treatment of laryngeal and oropharyngeal cancer, different treatment options, such as
transoral laser microsurgery, open surgical techniques, and primary radiotherapy, are under
discussion. In this context, the aim of the present study was to describe oncologic results and
complication rates of transoral laser microsurgery in treatment of early-stage laryngeal and
oropharyngeal cancer (T1/T2).

OBJECTIVE
The purpose of our study was to assess the efficacy and safety of TLM for the treatment of early
oropharyngeal carcinomas at Ho Chi Minh city ENT hospital.

MATERIALS AND METHODS

This is a prospective cohort study in Ho Chi Minh City Ear Nose Throat Hospital included early-stage
laryngeal and oropharyngeal cancer (T1/T2) patients scheduled to undergo transoral laser
microsurgery from January 2016 until Mars 2019. Data on demographics, site and extent of disease,
treatment, complication and early outcome were collected and analyzed.

RESULTS
120 patients of of early-staged laryngeal and oropharyngeal cancer (90 glottic carcinomas, 19 tongues,
5 soft palates, 4 tonsils and 2 posterior pharyngeal walls) A were included in this study. 89.2% patients
were male and 10.8% were female. The mean age was 54.8 years (± 10.6 years). 82.5% tumours are T1
and 17.5% T2. The bleeding complications occurred in 4 patients, 3 subcutaneus emphysemas. The
most frequent complication of TLM was bleeding (3.3%), the second is subcutaneus emphysemas
(2,5%). 30% of patients had normal voices and a further 62,5% had only mild or moderate voice
change. At their last followup, no patients had any difficulty in breathing or swallowing. During the
mean follow-up period of 8 months (range 1–18 months), 4 patients (3.3%) showed local recurrence,
and the laryngeal preservation rate is 100% for T1/T2 tumours

CONCLUSION
TLM is a safe, minimally invasive and effective method in the treatment for early laryngeal and
oropharyngeal cancer.

POSTER # P-011
CERVICAL OSTEORADIONECROSIS MIMICKING RECURRENCE OR METASTASIS OF NASOPHARYNGEAL
CARCINOMA AS A LATE COMPLICATION OF RADIOTHERAPY: A CASE REPORT
KURNIASARI Ratna [1]: WONG Howe Tung [2]
1 - ENT Department, Siloam Hospital Yogyakarta, Yogyakarta, Indonesia; 2 – ENT Department,
Timberland Medical Centre, Sarawak, Malaysia

INTRODUCTION
Nasopharyngeal carcinoma is a neoplasm commonly found in South-East Asia, and radiotherapy
remains the mainstay of treatment. A rare complication of this treatment is the development of
osteoradionecrosis, which involves the cervical spine. This case represents a diagnostic and
therapeutic challenge with differentials of tumor recurrence or osteoradionecrosis

CASE REPORT
We describe 57-years-old female with history of nasopharyngeal carcinoma. Patient was disease free
and remained well except for a small area of crust over the roof of nasopharynx for 20years post
radiotherapy when she started to develop progressive neck pain and weakness till she needed to be
fed via NG-tube and use wheel chair for a month prior to diagnosis. Nasoendoscopy showed extensive
crust and slough over the whole nasopharyngeal wall. MRI suggested nasopharyngeal enhancing
masses eroding clivus and extending around C1C2 likely recurrent tumour. PET-scan suggesting
metastatic lesion. CT-scan suspected osteoradionecrosis. The patient underwent extensive
desloughing and biopsy of nasopharynx exposing areas of the clivus and C1C2. The histological study
showed inflamed granulation tissue and necrosis. She was treated conservatively with pentoxifylline,
tocopherol, quinolone, and hyperbaric oxygen. After 2 months of conservative treatment there was
sign of healing by granulation and by 4 months only a very small area of bone remained exposed. The
pain slowly subsided. She gained strength and didn't need wheel chair anymore after 1,5 years.

CONCLUSION
Osteoradionecrosis progresses slowly and can be treated conservatively. Patient must be regularly
followed up to look for cervical complications as a result from irradiation, to prevent devastating
outcome.

POSTER # P-012
SUBMANDIBULAR CAVERNOUS HEMANGIOMA: DIFFERENTIAL DIAGNOSİS OF SUBMANDIBULAR
SIALOLITHIASIS

Sergül ULUS M.D*, Evren ERKUL M.D*, Mehtap TOPRAK M.D**, Engin ÇEKİN M.D*
*Department of Otolaryngology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul,
Turkey
**Department of Pathology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey

Cavernous hemangiomas are composed of dilated, blood-filled spaces lined by flattened endothelium
and calcification is common. Most cavernous hemangiomas require surgery since they do not show a
tendency to regress. So they needed surgery. A case of a 35 year old woman with cavernous
hemangioma affecting the submandibular region that clinically simulated sialolithiasis.

Key Words: cavernous hemangioma, sialolithiasis, submandibular region

INTRODUCTION
Although hemangioma is a relatively common lesion in the head and neck, it is rarely associated with
phlebolith in the submandibular region. Due to the rarity of these tumors and unfamiliar presentation,
inaccurate preoperative diagnosis and inappropriate treatment planning are common (1).

CASE REPORT
A 35-year-old female complaining of intermittent slightly painful swelling in her right neck for 6 years
applied to our clinic. She was suffering more often for 6 months. The swelling was the same during
eating but pain was increasing. On her physical examination we realized a 2 × 2-cm soft mass situated
in the right submandibular region. It had pain with palpation. The overlying skin was slightly elevated,
normal-colored. The wharton’s duct was healthy with palpation intraorally. Cervical ultrasound was
performed. Submandibular supurative lymphadenitis was suspected. Computed tomography (CT)
showed calcified foci within the enlarged right submandibular lymphadenitis / lymphadenopathy
(Figure 1) and histopathological sampling is recommended. The result of trucut biopsy was negative
for malignancy and reactive lymphoid cells.

The submandibular gland excision was planned. Comlete blood count and serum biochemistry were
performed for preoperative anesthesia approval. The results were within normal limits except HBs Ag.
HBs Ag was highly elevated.

Approximately 8 cm skin incision was made about 3 cm below the marginal mandible. When the area
was reached, 2 cm encapsulated view purple reddish colored mass was seen by superomedial side of
the gland and gland was healty. The mass was surgically removed. There wasn’t any unusual bleeding
during surgery. The specimen was sent for histopathologic examination. Microscopically, the lesion
showed large cystically dilated vessels with thin walls (Figure 2), endothelial cells immunoreactive with
CD 34 (Figure 3). Focal calcification was present. The lumina were filled with blood cells.
Figure 1. Axial contrast-enhanced computed tomography demonstrates calcified foci within the
enlarged right submandibular lymphadenitis / lymphadenopathy.

Figure 2. Microscopic views of the cavernous hemangioma large cystically dilated vessels with thin
walls (hematoxylin & eosin × 4)

Figure 3. Microscopic views of endothelial cells immunoreactive with CD 34 (CD 34 × 10)

DISCUSSION
Hemangiomas are benign vascular lesions and can occur in mesenchymal tissue in any part of the body
including skin, muscle, bone, orbit. Most hemangiomas are superficial lesions that have a predilection
for the head and neck region. There are many types of hemangiomas; cavernous hemangioma is the
most common type, followed by lobular capillary hemangioma, arteriovenous hemangioma, and
venous hemangioma. Most cavernous hemangiomas remain stable over time, and malignant
transformation does not ocur (2). Adult salivary gland hemangiomas are of the cavernous type, while
infantile hemangiomas are usually capillary (3).
Hemangiomas occur twice as often in females as in males. More than 90% of cases present before the
fourth decade of life (4). It is predominant in females and has an observed left-sided preference (5), in
our case the mass was on the right side.

Hemangiomas are the most common salivary gland masses in childhood. They occur predominantly in
the parotid gland, but they are rarely reported in the submandibular and sublingual glands (6). But in
our case the lesion was in submandibular area but easily separated from the submandibular gland.

Cavernous hemangioma should be included in the differential diagnosis of a swelling in the

submandibular region.
POSTER # P-013
TRANSORAL LASER SURGERY EXCISION OF SYNOVIAL SARCOMA OF THE HYPOPHARYNX

LIN Wei Lin [1] ; WU Hung Pin [1] ; LI Chi Ling [2] ; CHOU Yi Fan [1]
1 – Department of Otolaryngology Head and Neck Surgery, Taichung Tzu Chi General Hosipital,
Taichung, Taiwan; 2 – Department of Pathology, Taichung Tzu Chi General Hosipital, Taichung,
Taiwan

OBJECTIVES
Synovial carcinoma is a very rare and slow-growing malignant tumor which arises from mesenchymal
precursor stem cells. It is estimated to comprise about 3 to 9% of head and neck tumors and has an
even lower incidence in the larynx and hypopharynx. We present a case of a 15-year-old male
diagnosed with synovial sarcoma arising from the hypopharynx treated by surgical excision.

MATERIALS AND METHODS

The patient presented with dysphagia and hoarseness for more than 6 months. Physical examination
showed a cystic hypopharyngeal tumor on the left with concomitant ipsilateral arytenoid swelling.
Biopsy was done through direct laryngoscopy and microlaryngeal surgery. Histopathology showed
synovial sarcoma. He received partial laryngectomy via transoral LASER surgery and bilateral neck
dissection.

RESULTS
We reported a 15-year-old male diagnosed with hypopharyngeal synovial sarcoma, left, monophasic
spindle cell type, pT1bN0M0, stage I. He underwent thyroplasty two years after the initial surgery.
After 5 years of surveillance, the patient remains tumor free with no evidence of recurrence as seen by
flexible laryngoscopy and magnetic resonance imaging.

CONCLUSION
Synovial sarcoma of the head and neck is a rare but significant pathology. It presents multifaceted
challenges including (1) the lack of clinical features, (2) the preoperative histopathological diagnosis,
and (3) the postoperative modality of treatment. Clinical judgment should be exercised in its
management, especially in pediatric patients, in order to achieve tumor free margins and maximal
organ preservation. In our case, transoral LASER surgery resulted in complete tumor excision and good
functionality after surgery.
POSTER # P-014
SURGICAL APPROACH OF JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
ADHAM Marliinda (1) ; ANGELIKA Rut (1)
1 – Departement of Otorhinolaringology Head and Neck Surgery, Faculty of Medicine Universitas
Indonesia – Cipto Mangungkusumo General Hospital, Jakarta, Indonesia

OBJECTIVES
To investigate the surgical approaches regarding to the stage of juvenile nasopharyngeal angiofibroma
(JNA)

MATERIAL AND METHOD:

An evidence-based case report of a 13-year-old male patient with complaints of recurrent unilateral
epistaxis, unilateral nasal obstruction, and swelling of the cheek, diagnosed as JNA and underwent
extirpation surgery with Weber Ferguson approach. Literature were searched using “juvenile
nasopharyngeal angiofibroma”, “open surgery”, and “tumor recurrence” as the keywords. Therapeutic
studies with clear follow-up period to recurrence were included.

RESULTS
A retrospective cohort study conducted in 33 male patients with JNA. Twenty-five patients were
undergone surgery with lateral approaches and eight patients with other approaches. After following
up durations of one year, it is found that from five patients, three of them undergone lateral approach
intervention, had tumor recurrence. It can be concluded that the lateral approach decreases tumor
recurrence rates in patients with JNA compared to other approaches.

CONCLUSION
At advanced stage of JNA with a large tumor mass, surgical approach that can expose the entire mass
of the tumor is needed.
POSTER # P-015
THE SURVIVAL TIME OF SURGICAL MANAGEMENT OF THE ORBIT IN SINONASAL SQUAMOUS CELL
CARCINOMA
NARUEKON Jakkree[1,4]; KASEMSIRI Pornthep[1,4]; VATANASAPT Patravoot[1,4]; RATANAANEKCHAI
Teeraporn[1,4]; LAOHASIRIWONG Supawan[1,4]; TEERAMATWANICH Watchareeporn[1,4];
WIJAKKANALAN Pattaramon[1,4]; PHUTTHARAK Warinthorn[2]; KASEMSIRI Cattleya[3,4]
1- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Thailand; 2-
Department of Radiology, Faculty of Medicine, Khon Kaen University, Thailand; 3-Department of
Anesthesiology, Faculty of Medicine, Khon Kaen University, Thailand; 4 - Khon Kaen Head and Neck
Oncology Research, Khon Kaen, Thailand

OBJECTIVE
Aim to evaluate the survival time of sinonasal squamous cell carcinoma invading orbital patients who
underwent surgery with orbital preservation or exenteration.

MATERIALS AND METHODS

Medical recording charts of patients with paranasal sinus cancer were reviewed between January 1st,
2010 and December 31st, 2016. Clinical presentation, orbital invasion staging, treatment and survival
time were analyzed.

RESULTS
One hundred and twelve patients (73 males and 39 females) presented with sinonasal squamous cell
carcinoma. There were 41 patients with an orbital invasion that needed orbital surgical management.
Seven patients had periorbita involvements including 3 patients with visual acuity worse than 20/600
(poor VA) and 4 patients with visual acuity better than 20/600 (low VA). All of them were surgery with
preserved the orbits that allowed median survival time of 118 days and 694 in poor and low VA,
respectively (p<0.05). Regarding patients with tumor-involved periorbital content, orbital
exenterations were performed in patients with low VA (n=16) that provided median survival time
better than orbital preservations (n=10) (1262 days and 894 days ; p > 0.05). Furthermore, patients
with poor VA had exenterated the orbits (n =5) that yielded median survival time better than patients
had preserved the orbit (n=6) (425 days and 290 days ; p > 0.05).

CONCLUSION
Orbital exenteration seemed to provide better median survival time but it did not reach statistical
significance due to small sample size. However, the longer survival time allowed meaningful given in
clinical practice. Thus, orbital exenteration should be considered in patients with periorbital content
invasion although the patient has low visual acuity.
POSTER # P-017
BILATERAL ISCHAEMIC NECROSIS OF THE TONGUE - AN ATYPICAL PRESENTATION OF TEMPORAL
ARTERITIS

LIM Jason [1] ; MOORE Philip [1], MCKELVIE Penny [2], WILLIAMS Richard [2], MANN Halina [1]
1 – Department of Otolaryngology, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia ; 2-
Department of Anatomical Pathology, St Vincent’s Hospital, Melbourne, Australia

OBJECTIVES
Ischaemic necrosis of the tongue is rare. Current literature describes temporal arteritis as the most
common cause, which often affects the tongue unilaterally. We describe an 80-year-old woman who
developed bilateral tongue ischaemic necrosis in the context of an atypical presentation and delayed
diagnosis of temporal arteritis.
Through this report, we aim to highlight the importance and early recognition of this uncommon
presentation, which if delayed, can lead to worse outcomes and increased morbidities in those
affected.

MATERIALS AND METHODS

Consent was obtained from the patient for use of her de-identified medical information and images.
Clinical information including history, examination findings, investigation results and management
plans were collated and described.

RESULTS
The patient was initially managed by her general practitioner, after presenting with non-specific
symptoms of headache, throat pain and low-grade fever. She was later admitted to a rural hospital for
a suspected cerebrovascular event and treated for a misdiagnosed tongue fungal infection.
The patient then developed acute loss of vision in her right eye, prompting urgent transfer to the
Royal Victorian Eye and Ear Hospital. She received a final diagnosis of bilateral tongue ischaemic
necrosis secondary to temporal arteritis here. The patient experienced clinical improvement from a
prolonged course of steroid therapy.

CONCLUSION
This is the first Australian case report of bilateral lingual ischaemic necrosis secondary to temporal
arteritis. In the absence of typical symptoms of temporal arteritis, any patient with lingual pain and
evidence of tongue swelling or necrosis should be suspected for temporal arteritis, especially in
patients above the age of 50.
POSTER # P-018
DESCENDING NECROTIZING MEDIASTINITIS AS A COMPLICATION OF LUDWIG’S ANGINA SECONDARY
TO ODONTOGENIC INFECTION

KASILAG Raiza Michaella [1]; VICTORIA Francisco [1]

1 – Department of Otorhinolaryngology – Head and Neck Surgery, Ospital ng Maynila Medical Center,
Manila, Philippines

OBJECTIVES
To report a case of Ludwig’s Angina secondary to odontogenic infection leading to descending
necrotizing mediastinitis and to discuss its signs and symptoms, pathophysiology, diagnostic work-up
and management

MATERIALS AND METHODS

This is a case report from a tertiary government hospital.

RESULTS
Odontogenic infections rarely lead to life-threatening mediastinitis. Mortality rates from descending
necrotizing mediastinitis are high especially without prompt management. We report a case of a 29-
year-old male with a one-week history of toothache and gradual difficulty of swallowing. The patient
was admitted as a case of Ludwig’s Angina secondary to odontogenic infection and initially showed
clinical improvement after incision and drainage of the submental area and administration of
intravenous antibiotic therapy. The patient, however, later developed descending necrotizing
mediastinitis and empyema thoracis which was managed with an emergency neck exploration with
drainage of abscess, full thoracotomy, anterior mediastinotomy, decortication and bilateral chest tube
insertion. He was eventually discharged after a month of steady improvement on supportive
mechanical ventilation and antibiotic therapy.

CONCLUSION
Acute mediastinitis is a rare complication of infection from an odontogenic or pharyngeal focus.
Infection of the submandibular and submental space in Ludwig’s angina may progress to include deep
neck spaces and later cause descending necrotizing mediastinitis. It is a surgical emergency with a
high mortality rate necessitating thoracotomy, mediastinal drainage, and long-term antimicrobial
therapy. Clinicians managing oropharyngeal infections should be aware of this rare, but potentially
fatal complication which may occur even in immunocompetent individuals.
POSTER # P-019
CASE OF EWING’S SARCOMA OF THE MAXILLA

RAMOS Miguel Limbert [1]; SAMSON Emmanuel [1]

1 – Department of Otorhinolaryngology-Head and Neck Surgery, Ospital Ng Maynila Medical Center,
Manila, Philippines

OBJECTIVES
To report a case of Ewing’s Sarcoma (ES) of the maxilla: its symptomatology, course, diagnosis and
management.

MATERIALS AND METHODS

This is a case report of a 23-year-old female who initially presented with epistaxis from the right nostril
of six months duration that later developed into a mass in the right maxillary area. On biopsy and
immunohistochemistry (CD99), findings were consistent with Ewing’s Sarcoma. Patient underwent
wide resection of the mass, with preservation of the integrity of the adjacent structures, followed by
chemotherapy.

RESULTS
Ewing’s Sarcoma of sinonasal tract accounts to only 4-6% of all primary bone malignancy cases. Usually
found in the bones and soft tissues at different sites of the body, it only occurs 1-4% occurs in facial
bones and rarely involves the paranasal sinuses. Diagnosis was confirmed through biopsy and strong
reactivity to CD99. CT scan demonstrated the degree of bone damage and ruled out any involvement
of adjacent structures in the maxilla. Wide excision of the mass via a Weber-Ferguson Dieffenbach
incision provided good exposure that allowed adequate margins of resection to be achieved with
preservation of the orbital floor and palate.

CONCLUSION
Due to its rarity, Ewing Sarcoma of the maxilla requires skillful evaluation of the history, physical
examination, and ancillary procedures in order to recognize, diagnose and treat the disease in its early
stages.
POSTER # P-020
THE INCIDENCE OF STROKE AND MYOCARDIAL INFARCTION IN HEAD AND NECK CANCER PATIENTS
KWON Hyun-Keun [1]; HAN Kyungdo [2]; LEE Jin-Choon [1]
1 - Department of ORL-HNS, Pusan National University Yangsan Hospital, Yangsan, Korea ; 2 -
Department of biostatistics, College of medicine, The catholic university of Korea, Seoul, Korea

OBJECTIVES
This study was aimed to investigate the incidence and associated factors of stroke and myocardial
infarction(MI) after treatment of head and neck cancer(HNC) using population-based data.

MATERIALS AND METHODS

Based on the data of the Korean National Health Insurance Corporation, we obtained medical
information including socioeconomic information. From 2007 to 2013, a total of 22737 patients who
newly diagnosed with HNC were identified. A total of 68211 patients without HNC, stroke or MI were
identified for control group. The incidence of stroke or MI during the follow-up period was examined
in both groups.

RESULTS
The overall MI incidence was 1.3-fold higher in the HNC than in the control (4.42 vs 3.39 per 1000
person-years). Adjusted hazard ratio (HR) was 1.38. The overall stroke incidence was 1.38-fold higher
in the HNC than in the control (8.48 vs 6.16 per 1000 person-years). Adjunted HR was 1.48. Comparing
different site of cancer, hypopharyngeal cancer patients had the highest MI and stroke incidence rate
(3-fold and 2.63-fold higher). The incidence rate of MI and stroke was age dependent. Comparing
different therapeutic modalities, HNC patients receiving chemotherapy (CT) alone had the highest MI
risk (HR : 1.88), HNC patients receiving CT with surgery had the highest stroke risk (HR : 1.81).

CONCLUSION
There is an increased risk of MI and stroke in HNC patients, depending on age and those who received
CT alone and CT with surgery.
POSTER # P-021
OUTCOMES OF SUPERIORLY BASED STERNOCLEIDOMASTOID MUSCLE FLAP RECONSTRUCTION
DURING PAROTIDECTOMY
NAING Lin Htet
Otorhinolaryngology and Head and Neck Surgery Specialist Hospital, Yangon, Myanmar

OBJECTIVES
This study was aimed to assess the efficacy of superiorly based sternocleidomastoid muscle flap
reconstruction during parotidectomy in prevention of Frey’s syndrome and facial contour deformity
after parotidectomy.

MATERIALS AND METHODS

This prospective study included 29 patients with benign parotid tumours who underwent
parotidectomy with sternocleidomastoid muscle flap reconstruction, in ORL HNS Specialist Hospital
Yangon. Pre-operative Magnetic Resonance Imaging (MRI) of parotid region and FNAC assessment
were made in all patients to exclude malignant parotid tumours. Superficial or total parotidectomies
were done depending on tumour involvement and superiorly based sternocleidomastoid muscle flap
was reconstructed into operated parotid bed during single stage surgery. At one month and three
months periods after surgery, all patients were evaluated by Minor’s Starch Iodine Test to detect
Frey’s syndrome. And they were examined by Designed Visual Analog Score to determine facial
contour deformity. Moreover, patient’s satisfaction with facial contour and patient’s symptomatic
experience of gustatory sweating were recorded.

RESULTS
Among 29 patients, Minor’s Starch Iodine Test was positive in 5 patients (17%) and only 2 of them
(7%) subjectively complained of gustatory sweating. Visual analog scores completed by patients
themselves ranged from 0 to 3 , and the scores from the blinded examiners ranged from 1 to 3.

CONCLUSION
Superiorly based SCM flap reconstruction during either superficial or total parotidectomy is an
effective procedure for reducing the prevalence of Frey’s syndrome objectively and subjectively. And it
also provides better aesthetic outcome by improving the facial contour deformity.
POSTER # P-022
GORLIN SYNDROME: MULTIPLE FACIAL MASSES IN A 50-YEAR-OLD FEMALE

BORBE, Benedick [1]; ARTATES, Anne Margaux [1,2]

1 – Department of Otolaryngology – Head and Neck Surgery, Rizal Medical Center, Pasig, Philippines; 2
– Ateneo School of Medicine and Public Health, Pasig, Philippines

OBJECTIVES
To report a case of a patient with Gorlin Syndrome, its clinical presentations, diagnostic criteria, and
management

MATERIALS AND METHODS

Design: Case report
Setting: Tertiary government hospital
Patient: One

RESULTS
A 50-year-old female sought consult 29 years prior with gradually enlarging, coalescent multiple nevi
on the face. Excision biopsy performed one year later revealed findings consistent with Basal Cell
Carcinoma. With an uneventful post-operative course, the patient was discharged and was advised
active surveillance.

Recurrence was observed 1 year prior to consult at our center, with note of irregular, hyperpigmented,
rapidly enlarging, and disfiguring facial masses with foul-smelling discharge. Work-up done fulfilled the
criteria for Gorlin Syndrome. The patient underwent wide excision of the facial masses, with frozen
section, and reconstruction using split thickness skin graft. No recurrences were documented on
follow-up 6 months post-operation.

CONCLUSIONS
Nevoid Basal Cell Carcinoma Syndrome, or Gorlin Syndrome, is a rare autosomal dominant tumor-
predisposing condition. The patient had 3 major and 3 minor manifestations – fulfilling its clinical
criteria. Although the lesions are not usually life-threatening, its high recurrence rate warrants patient
education, further emphasizing prevention of its primary manifestation and the condition’s genetic
predilection. Remissions have been reported and disease surveillance is recommended in all
documented cases, including their relatives.
POSTER # P-023
PRETREATMENT MEAN CORPUSCULAR VOLUME AS A PROGNOSTIC FACTOR FOR HEAD AND NECK
CANCER

TSUSHIMA Nayuta, KANO Satoshi, SUZUKI Takayoshi, HOMMA Akihiro

Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate school of
Medicine, Hokkaido University, Hokkaido, Japan

OBJECTIVES
Pretreatment elevated mean corpuscular volume (MCV) was shown to be an independent risk factor
for patients with esophageal squamous cell carcinoma. To the best of our knowledge, no data exists
on the prognostic value of MCV for head and neck cancer. The objective of this study was to elucidate
the relationship between pretreatment elevated MCV and prognosis of patients with head and neck
cancer who underwent chemoradiotherapy.

MATERIALS AND METHODS

We assessed patients with oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma
who underwent chemoradiotherapy in our department between 2003 and 2012 and performed a
retrospective analysis. We excluded patients with previous treatments, palliative chemoradiotherapy,
unavailable pretreatment MCV, and distant metastasis at the initial visit. This study included 301
eligible patients. The number of patients with oropharyngeal, hypopharyngeal, and laryngeal cancer
were 118, 109, and 74, respectively. A median follow-up period was 5.1 years. Patients were divided
into two groups according to their MCV. The cut-off value for MCV was calculated by a receiver
operating characteristic curve. The primary endpoint of this study was overall survival rate.

RESULTS
Of all patients, 86 (29%) had high MCV (≥ 98.6 fL) and 215 (71%) had normal MCV (< 98.6 fL). There
was a significant difference in overall survival rate between the two groups (P=0.008). The five-year
overall survival rate of patients with high MCV and normal MCV were 55% and 76%, respectively.

CONCLUSIONS
Pretreatment elevated MCV predicted a worse survival outcome for patients with head and neck
cancer who were underwent chemoradiotherapy.
POSTER # P-024
CURRENT OUTCOME OF ADJUVANT PLATINUM-BASED CHEMOTHERAPY
FOR NASOPHARYNGEAL CARCINOMA : A SYSTEMATIC REVIEW
JELITA Namira Kesuma[1], ADHAM Marlinda[2]
1- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia 2- Oncology Division,
Otorhinolaryngology Head and Neck Surgery Department, University of Indonesia, Jakarta,
Indonesia

OBJECTIVES
To evaluate the current outcome of patient undergoing chemoradiotherapy with or without
adjuvant chemotherapy

MATERIAL AND METHODS

Search on online databases are performed, in Pubmed and Central, with keywords including
“nasopharyngeal carcinoma”, “chemotherapy”, “adjuvant” and “outcome” along with their
synonyms. Studies in english from 2014-2019 are included. Quality assessment were done
with Newcastle Ottawa Scale for Cohort studies and with CEBM for Randomized Controlled
Trial Studies. Risk of bias assessed using Cochrane Method.

RESULTS
From total of 179 study indentified, the title were screened for title and abstract. Twenty-one studies
eligible. Furthermore 5 duplicated studies were excluded, 1 study outcome was
differen, 1 study only available in abstract, and 1 study have no control group. A total of 7
studies were included in the final review with 1 RCT and 6 Cohort study. Most study have no
significancy in overall survival , progressive disease or distant metastasis free time. But differ
in high stage and high risk patient. Three studies included toxicity as an outcome with
adjuvant toxicity outweigh the need to add another round of chemotherapy.

CONCLUSION
Adjuvant chemotherapy believed to be necessary in eliminating residual cancer cells but
current studies shows little improvement in overall survival and sometimes unbearable
toxicities.
POSTER # P-025
PAPILLARY SUBTYPE OF NASOPHARYNGEAL CARCINOMA. AN ATYPICAL VARIANT PREVIOUSLY
UNREPORTED IN SOUTH EAST ASIA
KRISHNAMOORTHY Madhusudhan[1] ; KAMALUDIN Zaleha[2] ; MAT LAZIM Norhafiza[1] ; JAAFAR
Hasnan[2]
1-Department of Otorhinolaryngology and Head&Neck Surgery, Universiti Sains Malaysia, Kota Bharu,
Malaysia
2-Department of Pathology, Universiti Sains Malaysia, Kota Bharu, Malaysia

OBJECTIVES
To highlight the the various types of morphological patterns in nasopharyngeal carcinoma and to
showcase a rare variant type

MATERIALS AND METHOD

Biopsy material was composed of a fragment of tissue measuring 13mm in aggregate diameter
submitted in 1 block. The tissue was fixed in formalin and embedded in paraffin. Microscopic sections
were made and stained with Hematoxylin and Eosin. Immunohistochemistry staining was done and
the tumour was positive for p53 and negative for CK20.

RESULTS
Histopathology examination showed tumor cells arranged in papillary architecture and foci of sheets
and clusters. The papillary tumor was composed of hyalinized fibrovascular core lined by transitional
epithelium. In some areas , desmoplastic stroma reactions were observed, however no keratinization
was seen.

CONCLUSION
We wish to highlight a hitherto undescribed variant of non-keratinizing nasopharyngeal carcinoma
morphology. The treating physician and the reporting pathologist should always bear in mind such
entities especially when dealing with limited tissue samples. Ancillary studies like
immunohistochemistry are indispensable to diagnose such cases and differentiate it from other
possible malignancies.
POSTER # P-026
PROGNOSTIC EVALUATION OF EXTERNAL AUDITORY CANAL CANCER USING TWO DIFFERENT
STAGING SYSTEMS

MORITA Shinya; NAKAMARU Yuji; FUKUDA Atsushi; HOMMA Akihiro

Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of
Medicine, Hokkaido University, Sapporo, Japan

OBJECTIVES
The purpose was to compare survival differences between patients with external auditory canal (EAC)
cancer treated according to the University of Pittsburgh modified TNM staging system and those
treated in accordance with the 8th edition of the American Joint Committee on Cancer (AJCC) staging
manual on the TNM staging system for cutaneous cancers of the head and neck.

MATERIALS AND METHODS

We performed a retrospective, single-institution review of 60 patients with EAC cancer treated with
curative intent between September 2002 and March 2018. Survival outcomes were measured on the
basis of the two staging systems.

RESULTS
The C-index values for the overall survival (OS) rate revealed that the University of Pittsburgh staging
system had higher prognostic accuracy than the 8th edition of the AJCC staging system. Univariable and
multivariable analysis showed that T classification according to the University of Pittsburgh staging
system was an independent predictor of the OS rate (hazard ratio 5.25; 95% confidence interval 1.38-
24.9; p=0.015). Meanwhile, the AJCC staging system could not differentiate T2 from T3-4 cancers.

CONCLUSION
The University of Pittsburgh staging system for patients with EAC cancer is a valuable tool for use in
clinical decision-making and predicting survival outcome.
POSTER # P-027
CONCURRENCE OF LATE POST-TONSILLECTOMY HEMORRHAGE AND DENGUE FEVER IN A 17-YEAR
OLD: FIRST REPORTED CASE

OBJECTIVE
To present a case of a 17-year-old post-tonsillectomy child who was readmitted due
to dengue fever, hematemesis and late tonsillar bleeding three weeks after the surgery.

METHODS
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One

RESULTS
A 17-year-old previously healthy female underwent elective tonsillectomy in a tertiary
government hospital. Pre-, intra- and post-operative periods were unremarkable with no episode of
bleeding. The index case was advised to resume normal diet and activity at two weeks followup.
However, twenty days after tonsillectomy, the patient was brought to the emergency room due to
fever, massive hematemesis, worsening thrombocytopenia and unstable vital signs. She was admitted
in the pediatric intensive care unit as a case of severe dengue and was managed accordingly. However,
despite aggressive medical management, the patient deteriorated and eventually succumb to death at
post-operative day twenty one.

CONCLUSIONS
This could be the first reported case of a concurrent late post-tonsillectomy bleed
and dengue fever in a previously healthy young female. Practicing in a dengue-endemic area, it is
recommended to properly apprise all post-tonsillectomy as well as other post-surgery patients to do
preventive measures to avoid contacting dengue until the risk of post-operative site bleeding is
remote. Proper information dissemination on this risk can elicit health-seeking behavior among
patients when presented with persistent fever together with other dengue signs and symptoms
leading to prompt diagnosis, early management and better outcome.
POSTER # P-028
RADIATION-INDUCED MIDDLE EAR EFFUSION IN NASOPHARYNGEAL CARCINOMA PATIENTS. TO
TUBE OR NOT TO TUBE?
NG Ker Wei Isaac; LOH Kwok Seng Thomas; LIM Chwee Ming; GOH Xueying
Department of Otolaryngology (ENT) - Head & Neck Surgery, National University Hospital, Singapore

OBJECTIVES
To investigate the incidence of nasopharyngeal carcinoma(NPC)-related otitis media with
effusion(OME) and predisposing factors. To audit the efficacy and safety of myringotomy and tube
insertion(MT) in NPC-related OME.

MATERIALS AND METHODS

A retrospective cohort study of NPC patients treated in the National University Hospital of Singapore
from 2011 to 2016. Incidence and outcomes of NPC-related OME were analysed.

RESULTS
157 patients had complete data for analysis. The incidence of NPC-related OME is 31.2%(49/157
patients; 21.0%[66/314] ears).

OME is more likely in females(OR 2.570, 95%CI:1.257-5.254;p=0.009) and in patients with pre-
treatment OME(OR 3.361, 95%CI:1.249-9.044;p=0.013). There is no association between the presence
of OME and tumour stage, extent and treatment modality.

18.4% (9/49) of OME patients resolved spontaneously without MT(15.2%[10/66] of ears) after an
average of 150 days.

MT was performed on 20.4%(10/49) of the patients with NPC-related OME(21.2%[14/66] of ears with
OME). 71.4%(10/14) of ears had recurrence of OME after the first MT, 21.4%(3/14) had retained
tubes(average duration of tube: 740 days), and only 7%(1/14) had resolution of OME after the first
MT. Seven ears underwent repeated MT(average of 3 tubes/ear) and 2 had OME resolution with an
intact eardrum.

After MT insertion, only one patient reported intermittent otorrhea, none had chronic otorrhea.

CONCLUSION
NPC-related OME occurs in 31.2% of patients(21.0% of ears). 18.4% of them(15.2% of ears) resolves
spontaneously. NPC-related OME tends to recur after tube extrusion, necessitating repeated MT.
There is a low risk of troubling otorrhea after MT. MT insertion has a role in NPC-related OME.
POSTER # P-029
USEFULNESS OF SHOULDER ULTRASONOGRAPHY FOR EARLY DETECTION OF SHOULDER
DYSFUNCTION
FOLLOWING CERVICAL NECK DESSECTION
KIM Ji Won1, YANG Seoyon2, ROH Jong-Lyel3, CHOI Seung-Ho3, KIM Sang Yoon3, NAM Soon Yuhl3,*,
CHOI Kyoung Hyo2,*

1
Department of Otolaryngology, Inha University, College of Medicine, Incheon, South Korea
2
Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
3
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
South Korea

OBJECTIVE
Shoulder pain and dysfunction may occur following cervical neck dissection (ND). This study
investigated the usefulness of ultrasonography (USG) and the risk factors of shoulder dysfunction.

MATERIALS AND METHODS

A prospective observational study was conducted among the patients following cervical ND surgery.
USG evaluation and physical exam of the shoulder were performed at pre and post-operative
evaluation 3 months after ND. Visual analogue scale, EORTC-QLQ-C30, K-DASH (Korean version of the
disabilities of the arm, shoulder, and hand questionnaire) were also evaluated pre and post-
operatively. To confirm the spinal accessory neuropathy (SAN), electrodiagnostic study was performed
postoperatively. The prevalence of shoulder dysfunction was calculated according to physical
examination and USG finding.

RESULTS
A total of 92 patients enrolled including 17 patients who had bilateral ND (a total of 109 neck cases).
SAN and myofascial pain syndrome (MPS) developed in 56 (51.3%) and 61 (56.0%) cases, respectively.
Among 109 neck cases, 13 developed adhesive capsulitis (AC) (11.9%). The AC group showed
significant lower quality of life and shoulder function and higher pain score compared to the normal
contralateral side. Associating factors for AC were radiation therapy via multivariate analysis. There
were significant differences in MPS, △abduction, and QOL score according to SAN. Of total 109 neck
cases, 48 cases (44%) showed post-operative shoulder USG abnormal finding, and 35 cases (32.1%)
showed post-operative aggravation.

CONCLUSION
Shoulder dysfunction after ND is mainly due to a decrease in range of motion following AC, SAN, and
MPS, which could be early detected with shoulder USG.
POSTER # P-030
INTRAORAL MUCOEPIDERMOID CARCINOMA PRESENTING AS RETROMOLAR TRIONAL MASS; A CASE
REOPRT
KIM Seung Woo, MD
Department of Otolaryngology-Head and Neck Surgery, Veterans Health Service Medical Center, Seoul,
Korea

ABSTRACT
The salivary gland tumors account for about 5% of head and neck malignancies. Among these,
mucoepidermoid carcinoma (MEC) is the most common type of malignancy in major salivary glands.
Intraoral MEC may occur in various locations, and the predilection sites are palate, cheek, mandible,
lip and tongue etc. A very few cases of MEC are occurred in retromolar trigone. Recently, we
experienced a-65-year old woman with retromolar trigonal mass, and she was finally diagnosed as
MEC. We report the unique and rare disease entity with brief literature review.
POSTER # P-031
CORRELATION of BETHESDA SYSTEM for REPORTING THYROID CYTOPATHOLOGY and BRAF-V600E
GENE MUTATION in PATIENTS with PAPILLARY THYROID CARCINOMA

1
OZDAMAR Osman Ilkay, 1ACAR Gul Ozbilen, 2OZEN Filiz, 3ZENGINKINET Tulay.
1
Department of Otorhinolaryngology- Head and Neck Surgery, Istanbul Medeniyet University Goztepe
Training and Research Hospital, Istanbul, Turkey.
2
Department of Medical Genetics, Istanbul Medeniyet University Goztepe Training and Research
Hospital, Istanbul, Turkey.
3
Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital,
Istanbul, Turkey.

OBJECTIVES
The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) which was introduced firstly in
2007 for the aim of standardizing Thyroid FNA reports has been gained acceptance in tremendously
increasing number all over world. We aimed to investigate the correlation between the preoperative
TBSRTC results and postoperative histopathologic examination results for patients with Papillary
Thyroid Carcinoma (PTC) whether they had BRAF V600E gene mutation or not.

MATERIALS AND METHODS

We included 38 patients who underwent a total thyroidectomy between 2010 and 2019 in our tertiary
center. All of the patients diagnosed postoperatively as PTC. Nine-teen of these patients had BRAF
V600 gene mutation, and the other half had not BRAF V600E mutation to compare each group. All of
the patient’s preoperative TBSRTC results and postoperative histopathologic examination of the
thyroid specimen results were noted. These two parameters were compared between two groups in
which had BRAF V600E gene mutation (Group 1;n=19) and without mutation (Group 2;n=19).

RESULTS
There was only one patient with Bethesda IV (B-IV) in Group 1 but one patient with Bethesda III (B-III)
and 7 patients with Bethesda IV (B-IV) in group 2. Moreover, It was detected 3 patients with Bethesda
II (B-II; false negative) in group 2.

CONCLUSION
We detected a strong positive correlation between preoperative TBSRTC results and postoperative
correct PTC results in patients with BRAF V600E gene mutation. However, this correlation did not exist
in PTC patients without this gene mutation. This finding needs prospective studies with large samples
to verify.
POSTER # P-032
P16 PROFILE IN PATIENTS WITH OROPHARYNGEAL SQUAMOUS CELL CARCINOMA
ANGELIKA Rut (1) ; ADHAM Marlinda (1)
1 - Department of Otorhinolaringology Head and Neck Surgery, Faculty of Medicine Universitas
Indonesia – Cipto Mangunkusumo General Hospital, Jakarta, Indonesia

OBJECTIVES
To explain the role of protein status p16 in the diagnosis and management of oropharyngeal
squamous cell carcinoma (SCC) patients with HPV infection especially in response to radiation therapy.

MATERIALS AND METHODS

This literature review is compiled based on various sources obtained through online database
searches, such as Pubmed, Scopus, and EBSCOHost. Keywords used such as; "oropharyngeal squamous
cell carcinoma", "p16", and "radiation therapy". From the searching result, we found 65 articles those
are suitable with the theme.

RESULTS
This literature review showed that patients with oropharyngeal SCC positive p16 response better to
radiation than p16 negative. Patients with oropharyngeal SCC positive p16 have better prognosis and
higher survival rate.

CONCLUSION
Oropharynx SCC with positive p16 expression respond better to radiation therapy compared to
oropharyngeal SCC with negative p16 expression.
POSTER # P-033
USE OF CYANOACRYLATE TISSUE ADHESIVES FOR WOUND CLOSURE IN THE HEAD AND NECK
REGION: A 10-YEAR SYSTEMATIC REVIEW

RAJ Mary [1] ; RAJ Grace [2] ; LOH J S [3]

1 – Bedok polyclinic, Singhealth, Singapore; 2 – Tampines polyclinic, Singhealth, Singapore; 3 –
Discipline of Oral and Maxillofacial Surgery, National University Centre for Oral Health, National
University Health System, Singapore

OBJECTIVES
Wound closure in the head and neck region is challenging, primarily due to aesthetic concerns. This
study aims to compare the use of tissue adhesives (TAs) with other wound closure techniques, in the
head and neck region.

MATERIALS AND METHODS

Available literature in English, including RCTs and case reports over the past 10 years, was reviewed
from Pubmed and Google Scholar. Key terms used included “wound closure” and “tissue closure. Non
English literature was excluded. Main outcomes measured were wound cosmesis, infection rates and
dehiscence.

RESULTS
In the comparison of TAs and sutures, most studies reported no statistically significant difference in
terms of wound dehiscence, post-op pain, infection rates, patient/surgeon satisfaction and long-term
aesthetic outcome. Time taken for wound closure with TAs was substantially faster: 45s-1min for TAs
as opposed to 4-6mins for sutures. Another study also reported better hemostasis 1-2 days
postoperatively, when TAs were used. The comparison between TAs and staples showed a similar
result. However operating time was slightly shorter for staples.

CONCLUSION
Given the right indications, cyanoacrylate can be used as a good wound closure modality and can be
especially beneficial in the pediatric population. Recent literature has also published novel accounts of
the use of TAs for intra-oral wound closure, closure of post-parotidectomy salivary fistulas, treatment
of mucosal perforations during peroral endoscopic myotomy and even for closure of oroantral
communications. Further research is needed. We propose an algorithm of the indications and use of
TA in the head and neck region.
POSTER # P-034
MASSIVE CRANIOFACIAL BONE DESTRUCTION WITH UNILATERAL FACIAL PARALYSIS IN
GORHAM SYNDROME

SUNGA, Ann Bernadette [1]; CASTAÑEDA, Samantha [1,2]; FRANCO, Jose Jonathan [1,2]
1 – Department of ORL–HNS, Rizal Medical Center, Pasig City, Philippines; 2 – Ateneo School of
Medicine and Public Health, Pasig, Philippines

OBJECTIVES
To report a case of Gorham–Stout Syndrome (GSS), presenting with multiple facial masses and
unilateral right facial paralysis, its diagnostic criteria, and management

MATERIALS AND METHODS

Design: Case report
Setting: Tertiary government hospital
Patient: One

RESULTS
A 55-year old female presented with multiple masses in the frontal and temporal areas with
associated unilateral right facial nerve paralysis. Imaging showed massive osteolysis of the craniofacial
bones with sparing of the viscera. The histopathology result was consistent with connective tissue
disease – fibroma vs. sclerosing hemangioma with no atypia. There were absence of hereditary,
metabolic, infectious or malignant etiologies to explain the disease, thus we arrived at the diagnosis of
GSS. The patient presented at the late stage hence surgical resection was not an option. She
underwent radiotherapy and treatment for concomitant pneumonia and possible CNS infection. She
eventually succumbed to septic shock, completing only 3 fractions of radiotherapy and 17 days of
antibiotics.

CONCLUSIONS
GSS is an idiopathic condition that involves destruction of the osseous matrix of the bone with
accompanying angiomatosis. Symptoms vary depending on the site of the bones affected. The
rarity and idiopathic nature of this case makes it difficult to catch. A good correlation of the
clinical, histopathologic, and radiologic findings are essential in early detection of the disease
to achieve control and limit functional problems for these patients.
POSTER # P-035

A LARGE RECURRENT AMELOBLASTIC CARCINOMA IN A 60 YEAR-OLD FEMALE

DEALINO Maria Angela [1] ; ARQUIZA Christine Joy [1] ;

1 – Otorhinolaryngology Department, Philippine General Hospital, Manila, Philippines

OBJECTIVES
A surgico-pathologically confirmed case of a large recurrent ameloblastic carcinoma is described. The
existing literature on the epidemiology, presentation, pathogenesis, and management is reviewed.

MATERIALS AND METHODS

A single case report is detailed in this paper. Informed consent was secured prior to writing the
manuscript. Medical and operative records were extensively reviewed.

RESULTS
A 60 year-old female, previously managed as a case of odontogenic tumor of the maxilla, underwent
inferior maxillectomy. Frozen section and final histopathology confirmed ameloblastic carcinoma. Six
years after, she presented with a gradually enlarging mass in the postoperative site and came in after
three years had passed.

On physical examination there was a slightly movable predominantly firm mass approximately 17 x 17
x 15 cm with fluctuant areas, telangiectasias, and prominent vessels. There was no note of trismus and
the tongue remained fully mobile. On the left eye, there was diplopia on primary gaze and
hypertropia. Extraocular muscle movements were also limited on lateral and medial directions.

The craniofacial contrast-enhanced computed tomograph revealed a heterogeneously enhancing mass

arising from the left masticator space, measuring approximately 15.9 x 16.6 x 16.4 cm with non-
enhancing central areas of hypodensities and internal calcifications.
Metastatic workup raised suspicion for lung metastasis.

Palliative chemotherapy and radiotherapy was advised.

CONCLUSION
A high index of suspicion for ameloblastic carcinoma may warrant more aggressive management. Case
reports may help raise awareness as to the possible clinical course and poorer prognosis. Long-term
follow-up is a must in such cases.
POSTER # P-036

INFRATEMPORAL FOSSA MASS IN PEDIATRIC PATIENTS: AN UNUSUAL OCCURRENCE

Vannipa Vathanophas, M.D., Choakchai Metheetrairut, MD

Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok 10700, Thailand.

INFORMATION/BACKGROUND
The infratemporal fossa is anatomically situated in a deep location and is difficult to access. It
is formed by soft tissue. Regarding the important boundaries of this area, its anterior wall is
the posterior wall of maxillary sinus and posterior wall is a carotid sheath. Meanwhile,
medial is lateral pterygoid plate, and roof is ramus of mandible.

With some difficulty and many complications to access the area, zygomatic arch,
temporalis muscle, and ramus of mandible must be respectively removed.

Tumor of the infratemporal fossa may originate from the structures in this region, yet more
often is the result of extension from neighboring structures. Nonetheless, metastatic lesions
located in the region are rarely encountered.

Also, treatment of the infratemporal fossa tumor is hard to approach due to lots of
surrounding vital organs in this area. Particularly, it can affect facial structure growth in
children.

Hence, the best treatment outcome of this area is to save and protect structural
organ involvement as much as possible with the most ultimate cure.

CASE REPORT
A 2-year-old boy had painless left cheek mass
with rapid progress for 2 months (Fig.1).The
mass extended above the zygomatic arch and
pushed out in the left buccal area. Clinically,
only the asymmetry of cheekbone was
presented.
The intraoral examination showed a rubbery
firm submucosal cheek mass in front of the
retromolar triangle maxillary tuberosity, with
approximate size of 2*3 centimetres and no
sign of inflammation.

The CT scan revealed a well defined

homogeneous mass with mild enhancement
at left infratemporal space extended above
the zygomatic arch. Pressure effect to
mandible and posterolateral wall of left
maxillary sinus was noted with widening of
left pterygomaxillary fissure. The 3D bony
reconstruction showed the widening of
infratemporal fossa due to compression of
the mass at maxilla, zygomatic arch and both
body, and ramus of mandible, with small
bone erosion at maxilla (Fig.2).

The biopsy was done intraorally (Fig.3). The

infantile fibromatosis was then diagnosed.
The intervention procedure composed of left
gingivobuccal sulcus incision extended to
maxillary tuberosity and Gillies incision
(Fig.4). The incision was done and temporalis
muscle was elevated. The upper tumor at
zygomatic arch was dissected. The tumor was
successfully pulled down under zygomatic arch
and removed transorally.

Grossly, the lesion was an irregular non-

homogeneous tan grey and dark brown tissue
with rubbery consistency (Fig.5). No
postoperative complications were observed.
Two months follow-up showed no clinical
evidence of recurrence. MRI was done 3
months after surgery, with no recurrence
tumor found.

CONCLUSION
This is the first rare case of infantile
fibromatosis located in the intratemporal
fossa at Siriraj Hospital. The radiologic image
and pathology are, however, required for
diagnosis of the infratemporal fossa lesions.
Wide resection is the treatment of choice .
Nevertheless, it is crucially important to
preserve vital organs and cosmetics in facial
area, especially in pediatric patients. Close
follow-up is particularly needed to assess
tumor recurrence and the function of main
structures in this area.
POSTER # P-037

ACTINIC KERATOSIS PRESENTING AS A CUTANEOUS HORN

Thong HK1, Primuharsa Putra S H A2, Adillah Lamry3, Sandie Ewe3, Tengku Mohamed Izam T K3

1
KPJ Healthcare University College, Nilai, Negeri Sembilan, Malaysia

2
Ear, Nose & Throat-Head & Neck Consultant Clinic, KPJ Seremban Specialist Hopsital/ KPJ Healthcare
University College

Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Sultan Ismail, Johor Bahru,
Malaysia

INTRODUCTION
Cutaneous horns are usually found on skin with chronic sun exposure. It is a rare tumor presenting as a
conical, well-circumscribed mass, and is usually composed of dead keratin. Cutaneous horns may
originate from a wide spectrum of skin lesions including those that are benign, premalignant, or
malignant. In this case report we are reporting a unique case of cutaneous horn on the antihelix of the
left ear pinna.

CASE REPORT
A 55-year old Indian male presented to our outpatient clinic with a complaint of a slow-growing "horn-
like" structure over his left ear over the prior one year. Excision biopsy was performed and
histopathology revealed a completely excised lesion, which was diagnosed as cutaneous horn with
actinic keratosis at the base of the lesion.

CONCLUSION
A cutaneous horn is a rare clinical entity, with a bizarre horn-like growth commonly appearing at sun-
exposed areas of the head and neck region. However, such a lesion can also originate from a benign,
premalignant, or malignant condition; therefore, excision with histopathological studies is mandatory
in all cases.
POSTER # P-038

“STONES, BONES, ABDOMINAL GROANS, THRONES, PSYCHIC MOANS”: A CASE REPORT OF PRIMARY
HYPERPARATHYROIDISM.
SAMAGA Shailashree, RAMALINGAM Ravi, SINGH Sachender Pal
OTORHINOLARYNGOLOGY, KKR ENT Hospital and Research Institute, Chennai, India.

INTRODUCTION:
Primary hyperparathyroidism is seen in 1% of adult population. Etiology- autonomous production of
parathyroid hormone which results in hypercalcemia. In these cases mean calcium, parathyroid
hormone and alkaline phosphate levels are elevated while vitamin D levels are low. Hungry bone
syndrome is the common complication seen in immediate post-operative period.

CASE PRESENTATION:
68 year old male presented with swelling on right side of the neck, noticed since 6 months.Associated
with back ache, muscle ache and insomnia for 1-2 years.
1 month ago he presented withcomplaints of abdominal pain, vomiting and constipation for which he
was admitted at a tertiary hospital and was diagnosedasAcute pancreatitis, AKI with CKD,
Hypercalcemia and hypertension.
Then he was referred to us. On further evaluation USG neck indicatedrightParathyroid adenoma (1.6 x
2 cm).Nuclear Parathyroid Scintigraphy and SPECT-CTrevealed functioning parathyroid lesion
(adenoma) inferior to the lower pole of right lobe of thyroid gland. Parathyroid hormone level was
857.6pg/ml, S. Calcium persistently high (12.64 mg/dl), U.Calcium=452.5 mg/24 hrs, Vitamin D=25.8
mg/ml, S.ALP = 129, S. Phosphorous was normal.

DIAGNOSIS:
Primary Hyperparathyroidism

TREATMENT:
Right hemithyroidectomy with right inferior parathyroidectomy under GA.
Intra-operative PTH level was 57 pg/ml.

CONCLUSION:
As this case presented symptomatically, management was immediate. Post-operatively patient
presented with hungry bone syndrome which was medically managed. Nuclear Parathyroid
Scintigraphy and SPECT-CT have been fundamental tool to locate the pathologypre-operatively. Intra-
operative PTH level was useful test to confirm the complete removal of complete hyperfunctioning
parathyroid tissue.
POSTER # P-040

FACTORS ASSOCIATED WITH XEROSTOMIA IN NON-RADIATED PATIENTS

OBJECTIVE
To identify factors significantly associated with xerostomia in non-radiated patients.

METHODS
Patients who attended the outpatient otolaryngology clinic at Siriraj Hospital (Bangkok, Thailand) with
complaints of dry mouth were invited to join this study. Collected data included age, gender, body
mass index, smoking status, alcohol use, underlying disease, and previous medication and/or therapy.
Irradiated patients were excluded. Participants were classified into either the diseased or xerostomia
group by abnormal oral cavity examination and symptoms, or the no xerostomia group, which was
defined as dry mouth symptoms with no presence of abnormal physical findings.

RESULTS
Two hundred and two participants with a history of dry mouth were consecutively enrolled. There
were 86 patients with physical findings of xerostomia, and 116 symptomatic patients without
xerostomia. Multivariate analysis revealed age over 50 years (adjusted odds ratio [aOR]: 3.1, 95%
confidence interval [CI]: 1.3-7.9; p=0.012), analgesic and muscle relaxant intake (aOR: 3.6, 95% CI: 1.3-
9.7; p=0.012), psychotherapeutic medication (aOR: 7.8, 95% CI: 2.6-23.7; p<0.001), and radioactive
iodine therapy (aOR: 3.7, 95% CI: 1.2-11.8; p=0.015) to be independent predictors of xerostomia.

CONCLUSION
Xerostomia is a condition that can adversely affect quality of life. The results of this study revealed
older age (≥50 years), analgesics and muscle relaxants, psychotherapeutic medications, and
radioactive iodine therapy to be significantly associated with xerostomia. A thorough understanding of
the symptoms, diagnosis, relevant risk factors, and effective management is essential for improving
outcomes among patients with xerostomia.
POSTER # P-175

THE ELECTRO-CAPACITIVE CANCER THERAPY (ECCT) AS ADJUVANT THERAPY FOR ADVANCED STAGE
NASOPHARYNGEAL CARCINOMA

ROMDHONI Achmad Chusnu1, SAHUDI2, YUSUF Muhtarum1, MURTEDJO Urip3, SENSUSIATI Anggraini
Dwi4, KHAIRINA5, MACHIN Abdulloh6, HEDIANTO Tri1, RUMASTIKA Nindya Shinta1, FAUZI Fuad1, SELIM
Sabrina Izati1, KUSUMAWARDANI Eva Flourentina7

1
Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universitas
Airlangga, Surabaya, East Java, Indonesia
2
Department of Surgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
3
Palliative Installation, Dr. Soetomo Academic Medical Center - General Hospital
4
Department of Radiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
5
Department of Mental Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
6
Department of Neurology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
7
Program Magister of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya,
Indonesia
Email: romdhoni-a-c@fk.unair.ac.id

OBJECTIVES
The Electro-Capacitive Cancer Therapy (ECCT) is a low electric energy device which can be used as a
supporting modality to hold the growth of cancer cells. ECCT has been investigated and proven to be
able to kill cancer cells in vitro, but no single study about it in nasopharyngeal carcinoma (NPC). This
study was conducted to determine the safety and usefulness of ECCT as adjuvant therapy for advanced
NPC.

MATERIALS AND METHODS

The study was pre-post test with control group design. The sample was advanced stage of NPC patient
who came to ORLHNS OPD Dr. Soetomo Hospital, Surabaya, and fulfilled the inclusion criteria. They
were divided into 2 groups. The control group were given cisplatin based chemotherapy. The study
group were given chemotherapy and ECCT. In safety aspect, they were examined with ECG, EEG,
psychiatry test, and audiogram. Meanwhile, in usefulness they were examined the QoL and tumor
volume.

RESULTS
There were 8 respondents in the control group and 16 in the study group, which 7 patients excluded,
for different reason. In safety aspects there were no differences between groups pre and post
treatment, statistically. In usefulness aspects, there was significant difference in QoL between
respondents in the study group (p 0.027); in tumor volume there was difference between groups but
not significant (p 0.284).

CONCLUSION
The ECCT was safe to be administered to advanced NPC patients, but did not provide usefulness as
adjuvant therapy.
POSTER # P-176

DISPARITY IN GENDER AND SISTE PREVALENCE OF ORAL CANCER IN NORTH INDIA ( 2000-2017 )

INTRODUCTION
Oral cancer is a major problem in India and is among the top three types of cancers in the
country [1]. Incidence of oral cancer in India is 20 per 100,000 people and accounts for over
30% of al cancers in the country [2]. In the recent years, tobacco products have become popular
among younger Indians.[3]The aim of the study was to evaluate the site and gender specific
prevalence oral cancer from 2000-2017.

METHODS
A retrospective study of 3262 oral cancer patients was conducted from 2000 to 2017 in
B.R.Ambedkar Institute Rotary Cancer Hospital, A l India Institute Of Medical Sciences, New
Delhi. Data of patient’s age, gender and site of cancer was colected and analyzed by Non-
parametric trend test.

RESULTS
The proportion of oral cancer is higher in males (82%) as compared to females (18 %). Tongue
is the most common site of oral cancer occurence ( 37%)

CONCLUSIONS
In the North Indian population,the prevalence of Oral cancer is much higher among males as
compared to females,and tongue being the most common site.This can be attributed to the
difference in the prevalence of risk factors between India and the western world.
POSTER # P-196

DAYCARE TONSILLECTOMY
THURAIRAJU Ruthran; RAJAN Philip; MOHD SHARIN NASSRIDDI Mohd Sharin Fakhruzzaman;
MARNEL Zabarina.
ENT Department Hospital Raja Permaisuri Bainun Ipoh Perak Malaysia

OBJECTIVES
To evaluate day care tonsillectomies in a regional hospital since the establishment of a dedicated day
care centre in 2006 until 2017 at Hospital Raja Permaisuri Bainun.
To determine day care tonsillectomies according to
A. Indications for day care tonsillectomy
B. Number of complications
C. Type of complications
D. Age group prevalence

MATERIALS AND METHODS

This is a retrospective study on day care tonsillectomy using data collected from the
otorhinolaryngology department records. Patients with ASA 1 were included in the study while
patients with co-morbid, no caretaker those, stay more than 20 km from the hospital, obstructive
sleep apnoea, craniofacial abnormalities, cranio-facial abnormalities , developmental abnormalities,
developmental abnormalities , and problem with logistics were excluded.

RESULTS
There was a total of 499(58%) adult and 354(42%) paediatric patients. Recurrent tonsillitis was the
most common indication. The incidence of post tonsillectomy haemorrhage was 1.4 %( 12 cases) with
one case of bronchospasm . There were 7(58%) cases of secondary haemorrhage which occurred one
week after tonsillectomy. Another 5(42%) cases of primary haemorrhage were reported
intraoperatively and patients were admitted to the ward for observation post operatively. There were
no mortalities in our series.

CONCLUSION
Day care tonsillectomy is a safe procedure. The period of observation post the tonsillectomy
procedure in day care is sufficient within the six hours as any complications could be detected within
that time and secondary haemorrhage only occurred a week later
Laryngology
POSTER # P-051

OUTCOME OF SINGLE OPERATOR RIGID ESOPHAGOSCOPY IN

SWORD SWALLOWER'S POSITION TECHNIQUE FOR EXTRACTION OF
INGESTED FOREIGN BODIES

ROJO Josephine Grace [1] ; VINCO Von [1]

1- Department of Otorhinolaryngology - Head & Neck Surgery, Corazon Locsin Montelibano Memorial
Regional Hospital, Bacolod City, Philippines

OBJECTIVES
Esophagoscopy, both diagnostic and therapeutic, is traditionally done using Jackson’s High-Low
Technique wherein a second operator is needed to adjust the head and neck of the patient
while the main surgeon is manipulating the esophagoscope as it is introduced in the upper
gastrointestinal tract. Although widely practiced, limited data is available to support the safety
profile of rigid esophagoscopy done by a single operator. Thus, the objective of this study is to
evaluate the outcome of patients who underwent single-operator rigid esophagoscopy technique
for extraction of ingested foreign body with the patient in sword swallower’s position, also
known as Rose position.

MATERIALS AND METHODS

a. Study Design: Observational, Descriptive, Retrospective Study Design
b. Setting: Tertiary Government Hospital
c. Participants: Eighty-eight (88) Filipino subjects underwent single-operator rigid
esophagoscopy in sword swallower’s position technique for extraction of ingested foreign
body were included in a span of three years.

RESULTS
All patients regardless of age, sex, type of ingested foreign body an timing of intervention were
discharged with condition improved. Minimal postoperative dysphagia and odynophagia are only
apparent in 15%. Coin was the most common foreign body extracted among the pediatric age group,
and dentures, followed by food bolus among adults. No complications were noted.

CONCLUSIONS
Regardless of patient’s age, sex, and type of ingested foreign body, the single-operator rigid
esophagoscopy in sword swallower’s position technique is a safe and practical procedure for
removal of ingested foreign bodies, with low-risk for iatrogenic complications when done
properly.
POSTER # P-053

PIN NEEDLE AS TRACHEOBRONCHIAL FOREIGN BODY AT EMERGENCY ROOM (ER) OF DR. SOETOMO
GENERAL ACADEMIC HOSPITAL SURABAYA (2016 - 2018)
ERLANGGA Ariefian [1], HERAWATI Sri [2]
1 – Resident; 2 – Professor
Department of Otorhinolaryngology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General
Academic Hospital, Surabaya, Indonesia

OBJECTIVES: The purpose of this study was to describe patients with a pin needle as tracheobronchial
foreign body (FB) who went to Otorhinolaryngology's ER Unit in the period 2016-2018.

MATERIALS AND METHODS: Descriptive observations using retrospective data. The data taken from
medical records in the Broncho-Esophagology (BE) division of Otorhinolaryngology ER unit. The
patients were divided into two groups by age, namely group A (≥10 year old) and group B (≤10 year
old).

RESULTS: Among 40 tracheobronchial foreign bodies, there were 24 patients (60%) with pin needle
aspirations; consisting of five male (20.83%) and 19 female (79.17%). The youngest in group A was 2.5
year old (average 5.38 ± 3.25 years, median 4.5 years) and the oldest in group B was nineteen year old
(average 14.1 ± 2, 40 years, median fourteen years). All pin needle FB appear on the thorax X-ray
(100%). The initial management of all FB aspirations was extraction with rigid bronchoscopy. Most
patients lived outside Surabaya.

CONCLUSION: There was an increase in the incidence of pin needle aspiration over the last three
decades. Most of the patients were teenage girls. Thorax X-ray provided a good diagnostic imaging.
Rigid bronchoscopy extraction is the first choice treatment of aspirated tracheobronchial pin needle.
POSTER # P-054

TRANSORAL INJECTION AUGMENTATION OF VOCAL FOLD – HONG KONG EXPERIENCE

KWAN Ka Chung Peter [1] ; CHEUNG Amy Sonya Cheuk See [1] ; TONG Fu Man [1]
1 - Department of Ear, Nose and Throat, Pamela Youde Nethersole Eastern Hospital, Hong Kong

OBJECTIVES
Transoral injection augmentation of vocal fold under local anaesthesia is relatively unpopular in Hong
Kong and many other Asian countries. The benefit of this injection approach in Asian population was
not well established. We report our experience on this injection approach and determine its successful
rate, complication rate and effectiveness in our region.

MATERIALS AND METHODS

Retrospective review of patients who underwent injection augmentation of vocal fold by transoral
approach under local anaesthesia over a 25-month period was performed.

RESULTS
37 injections in 34 Hong Kong Chinese patients were performed. 36 injections were successful (97.3%)
and no significant complication occurred in all cases. Among the 31 cases of successful unilateral
injection for vocal fold paralysis, Voice Handicap Index – 10 (VHI-10) was reduced in 29 cases (93.5%)
and Maximum Phonation Time (MPT) was lengthened in 28 cases (90.3%). Bilateral injection was
performed in 5 cases of vocal fold atrophy and VHI-10 was reduced in 4 cases (80%).

CONCULSIONS
Transoral injection augmentation of vocal fold under local anaesthesia is a safe and effective approach
with high successful rate in treating Chinese patients with unilateral vocal fold paralysis and bilateral
vocal fold atrophy. This approach should be promoted and popularized in Asia.
POSTER # P-055

IMPROVEMENTS IN OUTCOMES USING A MULTIDISCIPLINARY TRACHEOSTOMY

TEAM
KUMARASINGHE Dulitha [1, 2, 3]; SMITH Mark [1, 3], PALME Carsten [1, 3], RIFFAT
Faruque [1, 2, 3, 4, 5]
Affiliations: 1- School of Medicine, University of Sydney, Sydney, Australia; 2- School of
Medicine, Western Sydney University, Sydney, Australia; 3- Department of ENT, Westmead
Hospital, Sydney, Australia; 4- Department of ENT, Macquarie University Hospital, Sydney,
Australia; 5- Department of ENT, Chris O’Brien Lifehouse, Sydney, Australia

OBJECTIVES
A tracheostomy tube is a significant cause of morbidity and mortality. Patients with
tracheostomies need specialised care with the involvement of a variety of medical, nursing
and allied health staff. Multidisciplinary team care is often considered the gold standard in
delivering a holistic care model. Consisting of a diverse selection of staff they can provide
specialised coordination, skills and education/training. This study aims to assess the
outcomes associated with a multidisciplinary tracheostomy service.

MATERIALS AND METHODS

A prospective cohort study of 65 adult tracheostomy patients’ part
of one of Australia’s largest multidisciplinary tracheostomy services. The service is
comprised of otolaryngologists, speech pathologists, specialised nursing staff and
physiotherapists with both inpatient, outpatient and community reach. Tracheostomy tube
samples were sent for brush cytology and MCS after initial insertion, 6-weeks and 3-months.
Data was collected over 18 months. Chi-square tests were performed to compare culture
results and other endpoints.

RESULTS
Perioperatively, patients’ part of the MDT were seen on a regular basis and
educated early on tracheostomy care. Chi squared analysis showed a significant difference
in bacterial colonisation of tracheostomy tubes between inpatients vs outpatients (73%v33%,
p=0.026). There was also a significant increase in nonsocomial multi-resistant infections in
inpatients (P<0.05).

CONCLUSION
Inpatients with tracheostomies are more prone to be colonised, in particular with
nonsocomial multi-resistant infections. A multidisciplinary tracheostomy service with
outpatient services providing more holistic care and education is able to reduce the amount
of time patients spend in hospital and thus their risk of developing hospital acquired
diseases.
POSTER # P-056

ASSESSING TRACHEOSTOMY TUBE COLONISATION AND INFECTION IN A

MULTIDISCIPLINARY TRACHEOSTOMY SERVICE
KUMARASINGHE Dulitha [1, 2, 3]; SMITH Mark [1, 3], PALME Carsten [1, 3], RIFFAT
Faruque [1, 2, 3, 4, 5]
Affiliations: 1- School of Medicine, University of Sydney, Sydney, Australia; 2- School of
Medicine, Western Sydney University, Sydney, Australia; 3- Department of ENT, Westmead
Hospital, Sydney, Australia; 4- Department of ENT, Macquarie University Hospital, Sydney,
Australia; 5- Department of ENT, Chris O’Brien Lifehouse, Sydney, Australia

OBJECTIVES
A tracheostomy tube is a significant cause of morbidity and mortality, particularly in
hospitalised patients. Biofilm formation and colonisation has been linked with in-dwelling
devices including tracheostomies and can lead to infections and sepsis. Colonisation of
objects can be affected by environmental and patient factors as well as their own design
including shape, size and material. This study aims to assess the colonisation of various
tracheostomy tubes.

MATERIALS AND METHODS

A prospective study of 65 adult tracheostomy patients’ part of one
of Australia’s largest multidisciplinary tracheostomy services. Tube samples were sent for
brush cytology and MCS after initial insertion, 4 weeks and 3 months. Data was collected
over 18 months. Chi-square tests were performed to compare culture results and other
endpoints.

RESULTS
Chi squared analysis showed a significant difference in colonisation when
comparing cuffed vs un-cuffed tubes (74%v27%, p=0.010). There were no statistically
significant differences when comparing tube diameter, material or the presence of
fenestrations. Pseudomonas-Aeruginosa and Staphylococcus-Aureus were the two most
common colonisers. Inpatients cultured significantly higher numbers of nosocomial multiresistant
bacteria (P<0.05).

CONCLUSIONS
Cuffed tracheostomy tubes are more prone to colonisation and infection then
uncuffed tubes. This is likely due to the cuff forming a physical barrier to innate immune
responses by inhibiting natural physiological mucociliary clearance. When safe to do so,
patients should be stepped down to uncuffed tubes sooner rather than later particularly in
the setting of long term tracheostomised patients. As expected, hospitalised patients are at
higher risk of colonising nosocomial multi-resistant bugs.
POSTER # P-057

USE OF TRANSORAL CARBON DIOXIDE LASER FOR SUPRAGLOTTIC WEB FROM CAUSTIC INGESTION
IN A 13 YEAR OLD

VELASCO Karen Joyce [1] ; CLAUDIO Emilio Raymund [1] ; HERNANDEZ Melfred [1]
1 – Department of Otorhinolaryngology, University of the Philippines – Philippine General
Hospital, Manila, Philippines

OBJECTIVES
This paper aims to report the surgical management of a supraglottic web from caustic
ingestion in a pediatric patient using transoral carbon dioxide laser.

MATERIALS AND METHODS

Setting: Tertiary Public University Hospital
Design: Case Report
Subjects: 1 patient

RESULTS
A pediatric patient who accidentally ingested sodium hydroxide was initially managed with
tracheostomy and tube gastrostomy. 13 years later, patient presented with inability to tolerate
decannulation. On nasopharyngolaryngoscopy, a circumferential supraglottic web with less than 1 mm
central opening was noted. Patient underwent transoral carbon dioxide laser excision. Patient was
successfully decannulated with good vocal output.

CONCLUSION
Supraglottic stenosis or web among the pediatric age group is rare and poses a challenge
among otorhinolaryngologists. It is important to know the extent of disease in order to create a sound
surgical plan. Transoral carbon dioxide laser can be an option for the treatment of supraglottic stenosis
among caustic ingestion patients presenting years after post injury.
POSTER # P-058

THE DANGERS OF BEATBOXING – SPONTANEOUS PNEUMOMEDIASTINUM AND

SUBCUTANEOUS EMPHYSEMA: A CASE REPORT
PANG Khang Wen [1]; Cherie NG Wei Qi [2]; Ranjit Gabriel MAGHERRA [1];
1 – Otolaryngology-Head and Neck Surgery, Ng Teng Fong General Hospital, Singapore
2 – Department of Diagnostic Imaging, National University Hospital, Singapore

BACKGROUND
Beatboxing is a complex form of vocal percussion, in which performers imitate drum sounds
using their entire vocal tract. We report the first known case of spontaneous
pneumomediastinum with subcutaneous emphysema occurring as a complication of
beatboxing.

CASE
A 20 year-old male presented with sudden onset of fever, neck tightness, sore throat and
hoarseness of voice after beatboxing earlier in the day. He had extensive subcutaneous
emphysema over his neck and upper chest. Plain radiographs and computed tomography
(CT) study of his neck and chest demonstrated subcutaneous emphysema and
pneumomediastinum, with no pneumothorax. Water-soluble contrast swallow and upper
gastrointestinal endoscopy were normal. He was managed conservatively. By Day 3 of
admission, his symptoms had resolved. The subcutaneous emphysema had improved and
he was discharged. At a 1 month-interval outpatient review, the subcutaneous emphysema
had completely resolved. A repeat chest radiograph was normal. He was advised against
beatboxing or other activities which may generate high intra-thoracic pressures.

CONCLUSION
Spontaneous pneumomediastinum with subcutaneous emphysema are possible
complications of beatboxing. We recommend a CT study of the thorax with oral and
intravenous contrast as the initial test of choice to exclude oesophageal rupture and other
life threatening conditions. The management is usually expectant unless the patient is
clinically unwell. Managing these cases as outpatients deserves further study.
POSTER # P-060

A CASE REPORT OF LARYNGEAL NEUROENDOCRINE CARCINOMA

WULANDARI Dian Paramita [1] ; DHARMA Hermawan Surya [1] ; RIZKI Syafiq Muhammad [1]
1 – Otorhinolaryngology-Head and Neck Surgery Department, Dr. Sardjito General Hospital / Faculty of
Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, Indonesia

INTRODUCTION
Neuroendocrine carcinoma is a rare type of tumor which have traits of both nerve and hormone-
producing cells. The tumor can develop anywhere in the body. It accounts for less than 1% of laryngeal
carcinoma.

OBJECTIVES
To describe a rare case of laryngeal neuroendocrine carcinoma.

CASE PRESENTATION
A 67-year-old man came to the outpatient clinic on February 2018 with a 2-month history of
hoarseness and dysphagia, accompanied by occasional shortness of breath. He used to smoke since he
was young until he quit smoking 2 years before. ENT examination was normal. Endoscopic
examination showed a vascular bluish mass in the supraglottic area, which partially obstructed the
view of laryngeal inlet and airway. The mass was pedunculated and moved with each inspiration and
expiration. The patient underwent direct laryngoscopy and biopsy. Further examination showed no
metastasis on another organ. The operation removed the tumor from its stalk on the right arytenoid.
In the post-operative healing process, only a small portion of the tumor stalk remained. The patient
received further treatment with chemoradiation and returned for post-treatment evaluation. Post-
treatment endoscopy showed a patent airway with no sign of the tumor. Evaluation by CT scan and
endoscopy was done periodically on 1, 3, and 6 months after. There was no recurrence during a
follow-up period of 15 months.

CONCLUSION
A rare case of laryngeal neuroendocrine carcinoma was diagnosed in endoscopy. The patient
underwent operative procedure and chemoradiation. Follow-up for 15 months showed no recurrence
of the tumor.
POSTER # P-061

HERPES SIMPLEX LARYNGITIS PRESENTING AS AIRWAY OBSTRUCTION IN

AN IMMUNOCOMPROMISED PATIENT.
PANG Jing-Yin [1,3] ; KOTSIOU George[2] ; NOVAKOVIC Daniel [3]
1 – Department of Otolaryngology, Khoo Teck Puat Hospital, Singapore, Singapore ;
2 – Microbiology Department, Royal North Shore Hospital, Sydney, Australia ;
3 – University of Sydney, Dr Liang Voice Program. Central Clinical School, Faculty of
Medicine and Health, Sydney, Australia

OBJECTIVES
We present a rare case of Herpes Simplex Virus (HSV) laryngitis resistant to
standard antiviral treatment and review acyclovir treatment in an
immunocompromised patient individual with HyperIgM Syndrome. He presented with
progressive laryngeal papillomatous disease (voice and airway symptoms) requiring
unplanned tracheostomy. Histopathology revealed ulcerative, inflamed mucosa in a
papilliform configuration with marked viral cytopathic effect and strong positive HSV
immunostaining, consistent with herpes. Disease progression occurred despite
acyclovir therapy and ultimately tracheostomy was required. The patient was treated
with foscarnet with good clinical response and was successfully decannulated.

MATERIALS AND METHODS

Case presentation and discussion of resistant HSV laryngitis and comprehensive
literature review of HSV laryngitis in adults.

RESULTS
From this case report and review of the literature, we advocate early biopsy of
unusual or poorly responsive laryngeal lesions for pathology, culture and virology
studies in order for proper treatment to be implemented. The diagnosis of HSV
laryngitis is difficult and can mimic neoplastic lesions like a malignancy or laryngeal
papillomatosis. In immunocompromised patients, HSV may be refractory to standard
antiherpetic therapy.

CONCLUSION
Herpetic viral infections seldom involve the larynx. Laryngeal disorders provoked by
the herpes virus are characterised by a large spectrum of presentations and
polymorphisms, and can simulate neoplastic lesions such as malignancies or
papillomatosis. Diagnosis requires discerning clinical consideration and confirmatory
testing. HSV laryngitis should be considered in immunocompromised patients with
nasoendoscopic findings of large, exudative and ulcerative masses. Early and
appropriate treatment initiation can possibly avoid the need for a tracheostomy.
POSTER # P-062

RAMSAY-HUNT SYNDROME PRESENTING TRUE VOCAL CORD PARALYSIS

HERNANDEZ Carlos Luis Alfonso [1] ; AMABLE Jay Pee [1] ; VILLANUEVA Jose Carlo [1]

1 - Department of Otorhinolaryngology – Head and Neck Surgery, University of the East – Ramon
Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines

OBJECTIVE
To present an unusual case of Ramsay-Hunt Syndrome initially presenting with vocal cord paralysis
originally treated as stroke in an elderly hypertensive woman. To discuss the probable contributing
factors leading to this unusual disease process.

METHODS AND METHODS

Design: Case Report
Setting: Private Tertiary, University Hospital
Subject: One

RESULTS
A 62-year-old elderly, hypertensive woman presented with hoarseness associated with odynophagia,
dysphagia, aspiration, left facial pain and left facial paralysis of three days duration. The patient was
initially treated as a case of stroke. However, the imaging study of the brain revealed a normal result.
Video laryngoscopy revealed left true vocal fold paralysis, with left arytenoid vesicular lesion. The
patient was treated as a case of Ramsay Hunt Syndrome involving the trigeminal nerve, facial nerve,
vagus nerve, glossopharyngeal nerve, and vestibulocochlear nerve, and recovered with anti-viral and
oral corticosteroids.

CONCLUSION
The presentation of Ramsay Hunt Syndrome can be atypical and should not be disregarded merely on
the basis of dysphagia. Consideration must be given to the possibility of multiple cranial nerve
involvement, particularly when swallowing and airway protection are compromised. Swift diagnosis
and treatment is crucial in the successful management of the disease.
POSTER # P-064

DENDRITIC FIBROMYXOLIPOMA OF LARYNX

RAZAK Siti Sarah 1, AZMAN Mawaddah 1, SANI Abdullah 1, RASUL HAMIDI Lizawati 2, WONG Yin Ping 2

1 Otorhinolaryngology, Head and Neck Surgery Department, Universiti Kebangsaan Malaysia Medical
Center, 56000 Kuala Lumpur, Malaysia.

2 Pathology Department, Universiti Kebangsaan Malaysia Medical Center, 56000 Kuala Lumpur,
Malaysia.

BACKGROUND
Dendritic fibromyxolipoma (DFML) is an uncommon, benign soft tissue tumour. It is seldom reported
in the hypopharynx. However, its endoscopic appearance may mimic an aggressive soft tissue
neoplasm hence the importance of its recognition.

CASE PRESENTATION
We discuss a rare case of dendritic fibromyxolipoma of the pyriform fossa in a 66-year-old male who
presented with hoarseness.

CONCLUSION
The best approach in managing this case will be discussed.
POSTER # P-065

CASE REPORT: LOCALIZED AMYLOIDOSIS OF LARYNX AS UNCOMMON CAUSE OF DYSPHONIA

WONG Bao Ling [1]; HENG Pek Ser [1]; TANG Chian Ling [1]; LEE Siew Ching[2]
1 – ENT Department, Hospital Sibu, Sarawak, Malaysia
2 – ENT Department, Rejang Medical Centre, Sarawak, Malaysia

OBJECTIVES
Amyloidosis defined as a group of diseases that result from the abnormal extracellular deposition of a
protein in various organs of the body. It can be localized or systemic involvement. Localized laryngeal
amyloidosis is a rare entity and accounts for 0.2% to 1.2% of all benign laryngeal tumours. We report
two cases of localized laryngeal amyloidosis.

CASE PRESENTATION
The first case presented with hoarseness for three months. Laryngoscope found irregular and
polypoidal growth over bilateral false cords which obscure the true cords. The second case complained
of dysphonia which worsening over two years. Laryngoscopy also showed irregular growth over the
supraglottic region. Both patients underwent endoscopic microlaryngeal surgery and debulking of
tumour done using cold method. The histopathological examination and Congo-red staining confirms
the diagnosis of amyloidosis. Otherwise, work out for systemic disease was negative.

RESULTS
At 12 months of review, the patient’s hoarseness and voice quality improved. Laryngoscope showed
stable post-operative changes with bulging over both false cords, mobile and symmetry vocal cords.
On the other hand, the other case had her symptoms remained at 2 months follow up.

CONCLUSION
Laryngeal amyloidosis is a rare though benign disease. However it could be life threatening condition if
airway compromise. The mainstay of treatment remains surgical debulking but is not curative as
complete margin resection is difficult. In addition, the treatment should be directed toward the
maintenance of the airway and improvement of the voice.
POSTER # P-066

CONCURRENT WELL-DIFFERENTIATED LIPOSARCOMA OF THE LARYNX AND DUCTAL CARCINOMA-IN-

SITU IN A YOUNG FEMALE: A POSSIBLE CASE OF GENETIC CANCER PRE-DISPOSITION

SALUD, Jacob Ephraim [1] ; CARRILLO, Ryner Jose [1]; MAGNO, Jose Pedrito [1]; AVILLA, Jose Maria [2];
ARANETA, Carlo [2]

1 – Department of Otorhinolaryngology, Philippine General Hospital, Manila, Philippines

2 – Department of Laboratories, Philippine General Hospital, Manila, Philippines
3 – Department of Surgery, Philippine General Hospital, Manila, Philippines

OBJECTIVES
Liposarcoma are rare malignant mesenchymal tumors that occur in the lower limbs, retroperitoneum
and upper extremities. Only 3-8% have been reported to originate in the head and neck. There have
been less than 40 confirmed cases of laryngeal liposarcoma reported in literature. As it is rare, these
may easily be mistaken for a benign lesion on outpatient endoscopy. A missed or delayed diagnosis
may consequently lead to poor outcomes for a disease that has otherwise good prognosis given timely
management.

MATERIALS AND METHODS

We report the case of a 39-year-old female with a left aryepiglottic fold mass presenting as a two-
month history of globus sensation. Flexible laryngoscopy with videostroboscopy revealed a fleshy,
smooth, non-pedunculated, benign-appearing mass with its bulk centered on the left aryepiglottic
fold.

RESULTS
Laser excision and subsequent biopsy revealed this to be a well-differentiated liposarcoma. Three
months post-excision, surveillance stroboscopy demonstrated normal vocal cord function and no
recurrence of masses at the surgical site. However, a left breast mass was detected, which was
revealed to be mammary carcinoma on ultrasound-guided aspiration. She underwent modified radical
mastectomy which yielded a histopathological diagnosis of ductal carcinoma in-situ.

CONCLUSION
Due to the indolent course and high tendency for local recurrence of liposarcoma, close post-operative
surveillance is necessary. Furthermore, concurrent malignancies in a young patient should alert the
clinician to the possibility of familial cancer predisposition syndromes that would warrant a more
proactive search for concurrent lesions on subsequent visits.
POSTER # P-067

COMPARISON OF ARYTENOID VERTICAL HEIGHT DISCREPANCY IN NORMAL VERSUS PATIENTS WITH

UNILATERAL VOCAL CORD PALSY

WONG Eugene [1]; SMITH Murray [1]; TJAHJONO Richard [1]; STONE Danielle [1]; SRITHARAN Niranjan
[1]; PALME Carsten [1]; SMITH Mark [1]; RIFFAT Faruque [1]
1 – Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital NSW 2145 Australia

AIM
Cadaveric experiments and more recently clinical data have demonstrated that patients with vertical
height discrepancy between their arytenoids experience poorer voice outcomes in patients with
unilateral vocal cord palsy (UVP) after medialisation laryngoplasty. However, the presence or severity
of height discrepancy in normal patients without UVP has not yet been clearly defined.
The aim of this study was to examine whether vertical height discrepancy was present in a normal
population without vocal cord pathology or concerns with their voice, in order to verify that
discrepancy truly carries acoustic consequences.

METHODS
A retrospective review of prospectively collected data was performed on consecutive patients who
underwent high resolution (1mm slices) computed tomography imaging of their neck. Patients were
excluded if they had any previous head and neck surgery or were known to have any vocal cord
pathology. Scans were assessed for discrepancy in arytenoid vertical height discrepancy and compared
to a cohort with known UVP.

RESULT
44 normal patients (50% female, mean age 57.6 ± 14.8 years) were compared to 23 patients with UVP
(43.4% female, mean age 52.3 ± 14.9 years.) Normal patients were found to have a smaller height
discrepancy compared to UVP patients (student’s t-test, 2.00mm ± 0.00 vs 2.39mm ± 0.72, p<0.001.)

CONCLUSION
This study appears to confirm that UVP may cause discrepancies in arytenoid vertical height. Normal
patients should not have a discrepancy of over 2mm. This study therefore suggests that discrepancy is
pathologic, and it is plausible that this results in acoustic consequences.
POSTER # P-069

WALLENBERG SYNDROME PRESENTING IN THE YOUNG AS ISOLATED DYSPHAGIA: CASE REPORT AND
REVIEW OF THE LITERATURE
TANANUCHITTIKUL Pornsek,1,2 SETABUTR Dhave, M.D.1-3

1
Department of Otolaryngology – Head & Neck Surgery, Thammasat University Hospital, Pathum
Thani, Thailand
2
Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
3
Chulabhorn International College of Medicine, Thammasat University, Pathum, Thani, Thailand

ABSTRACT
OBJECTIVE:
To present a unique case of dysphagia in a young healthy patient that would later by diagnosed as
Wallenberg syndrome

STUDY DESIGN:
Case report.

MATERIALS AND METHODS:

We present an interesting case of a very subtle presentation of Wallenberg syndrome that occurred in
an otherwise healthy 35-year-old Thai male. The patient initially complained of acute dysphagia over
six hours that later progressed to include mild dizziness, numbness of the left face, no dysarthria, and
no hoarseness, but evidence of true vocal cord paralysis. The patient had no other weakness or other
cerebellar signs. We follow by reviewing the literature regarding incidence and most common
presentation of this very rare entity in the young population. Literature analysis was performed
utilizing a PUBMED search of the following terms: "Wallenberg syndrome, young adult, dysphagia,
and dizziness." Results of the search were further investigated and presented.

SETTING:
Tertiary care medical center.

RESULTS:
A review of Wallenberg syndrome in the young adult population (19-44 years of age) remains rare and
typically presented as acute dysphagia or acute dizziness. Only six case reports have previously been
reported. The average reported age was 30 years (ranging from 32-40). The most common symptoms
were acute symptoms of vertigo, dysphagia, dysarthria, or numbness of the face. Few reported
spontaneous nystagmus or multiple cranial nerve involvement.

CONCLUSION:
The astute Otolaryngologist should be aware of the acute presentation of Wallenburg sydndrome in
young adults. Acute dysphagia, hoarseness, and dizziness should be thoroughly assessed. Prompt
diagnosis and neurology consultation are necessary for ideal treatment.
POSTER # P-190

CASE REPORT : SECONDARY LARYNGEAL TUBERCULOSIS IN PATIENT WITH ACTIVE PULMONARY

TUBERCULOSIS

TURUPADANG Lidya Allo Datu, RAHARDJO Sutji Pratiwi, and ALWI Rafidawaty
Departement of Otorhinolaryngology, Head and Neck Surgery
Medical Faculty of Hasanuddin University, dr.Wahidin Sudirohusodo Hospital, Makassar, Indonesia

BACKGROUND:
Secondary laryngeal tuberculosis is laryngeal infection caused by Mycobacterium Tuberculosis which is
accompanied with pulmonary tuberculosis. Laryngeal involvement was 15-37% in pulmonary
tuberculosis. Misdiagnose is a common problem and has become a major health problem.

CASE:
A 30 year-old female patient presented with a two-month history of hoarseness. The symptom
followed with odynophagia, 2-years history of coughing, episode of recurrent fever and 3 kg weight
loss. Based on laryngoscopy, the patient presented with multitude lesion on the larynx. Chest X-ray,
AFB sputum, expertMTB gene, and Sensitive Rifampicin Tests was conducted. The patient was given
first category of anti-tuberculosis drugs.

DISCUSSION:
Patient was diagnosed with laryngeal tuberculosis based on its clinical appearance and laryngoscopy
examination results. There are tubercles, ulcerative lesions, and “Mouse Bite” appearance on the
epiglottis. Chest X-ray revealed active tuberculosis, positive AFB Sputum Test, positive Sensitive
Rifampicin Test and expertMTBGen confirmed our diagnosis. The patient was given 1st category of
anti-tuberculosis drugs (2RHZE/ 4RH) for 6 months. At 5th month, follow-up was performed by
laryngoscopy, ulcerative lesions and tubercles no longer found. However, “Mouse Bite” appearance is
still found, this indicates the infection has hit the epiglottis cartilage. Hoarseness have decreased and
the patient's weight has risen 4 kg.

CONCLUSION:
Early laryngeal examination in patients with history of hoarseness is important to help detect laryngeal
tuberculosis and to prevent misdiagnose. Compliance of patients in taking medication gives good
results. Follow-up is needed to assess the effectiveness of treatment and prevent complications.
POSTER # P-191

A RARE CASE OF BLUE RUBBER BLEB NEVUS SYNDROME

ELEFANTE Shera
ENT HNS Department, Southern Philippines Medical Center, Davao City, Philippines

OBJECTIVES
This paper aims to present a rare case of a Blue Rubber Bleb Nevus Syndrome in a 35-year-old woman
who was initially diagnosed as Pharyngitis. This is to highlight the importance of thorough history
taking, physical examination and proper management of Head and Neck Tumors.

MATERIALS AND METHODS

Design: Case Report
Setting: Clinical Practice and Tertiary Government Hospital
Patient: One

RESULTS
A 35-year old female with Iron deficiency anemia who presented with globus sensation, had multiple
bluish soft, tender and compressible nodules at both arms, back and left leg. Flexible Fiberoptic
Nasopharyngeal endoscopy revealed a smooth, wide based, non-pulsatile, bluish mass at left
arytenoid partially obstructing the airway. Upper Gastrointestinal Endoscopy showed Tonsillar and
esophageal hemangioma, Hiatal Hernia and Erosive Gastritis. Colonoscopy revealed Internal
Hemorrhoids. Doppler Ultrasound of Lower Extremities showed venous malformations on the left
posterior proximal leg and medial malleolus. Patient was examined in Southern Philippines Medical
Center where a Multidisciplinary Tumor Board Conference decided to manage the case conservatively
with Iron Supplementation and frequent monitoring.

CONCLUSION
This is an interesting case of Blue Rubber Bleb Nevus Syndrome, a rare disease manifested by
distinctive cutaneous and gastrointestinal hemangiomatous lesions. The most common initial
presentation is iron deficiency anemia with multiple bluish cutaneous nodules. Rarely, laryngeal
involvement is present. Early detection will prevent misdiagnosis and over usage of inappropriate
tests. In this case, it is best to do conservative management if there is no immediate need for surgery.
Thus, improving patient’s quality of life and prevent further morbidity.
 Otology &
Neuro-Otology
POSTER # P-091

SQUAMOUS CELL CARCINOMA OF EXTERNAL AUDITORY CANAL-OPERATED CASE

Dr Lucian Lapusneanu
1.Lucian Lapusneanu-ENT Department, Emergency County Hospital, Braila, Romania
2.Daniele Mihalache-Pathological Anatomy Department, Emergency County Hospital, Braila, Romania
3.Dobre Mihai-Radiology Department, Emergency County Hospital, Braila, Romania

INTRODUCTION
Squamous carcinoma is the most frequent neoplasm in the external auditory canal (86%), about four
times more common than the basal carcinomas. These tumors have an aggressive nature and spread
among preformed vascular and neural pathways, invading adjacent structures. Most squamous cell
carcinomas (SCC) of the temporal bone occur in the fifth and sixth decades of life. Otorrhea is the
primary symptom, but otalgia, hearing loss, and bleeding may be frequent as well. Diagnosis is usually
delayed because of the similarity between symptoms of other benign otologic conditions such as
chronic suppurative otitis media and those of squamous carcinoma.

MATERIAL AND METHODS

An elderly patient with otorrhea and nearly permanent hearing loss in the right ear was misdiagnosed
and treated in a 9 month interval as for an otitis externa. At the time of the appointment with the
doctor, the patient presented otorrhea, hearing loss, and the otomicroscopic examination of distal 1/3
of the external auditory meatus revealed an infiltrative and vegetative formation with postero-inferior
insertion and distal channel obliteration. The MRI proved evidence of tympanic perforation with
erosion of the hammer handle. The resection en bloc of the neoplasm involving EAC and
tympanoplasty were the next steps taken. The postoperative examinations revealed a good
integration of the neotympanum and lack of relapse.

CONCLUSION
The early detection of the squamous cell carcinoma before its extensive spread into the middle ear
allows better treatment and prognosis. Therefore, it is of utmost importance to investigate this
disease and to make a proper differential diagnosis with other benign otologic pathologies. Diagnosed
on time, treated surgically correctly and then cured through radiotherapy, the malignant process did
not relapse, the pacient coming regulary to examination.
POSTER # P-092

THE ASSOCIATION BETWEEN SERUM VITAMIN D LEVELS AND BENIGN PAROXYSMAL

POSITIONAL VERTIGO

SARSITTHITHUM Kanokporn[1], KIATTHANABUMRUNG Sivaporn[1], WISUPAKAN

Todsapohn[1], JARIENGPRASERT Chanchai[1]
1 - Department of Otolaryngology, Ramathibodi Hospital of Mahidol University, Bangkok,
Thailand

INTRODUCTION
Recent studies have reported an association between benign paroxysmal positional vertigo (BPPV) and
osteopenia/osteoporosis. Because calcium is an important component of
otoconia, we hypothesize that impaired calcium metabolism as a result of reduced serum vitamin D
levels may be associated with BPPV.

OBJECTIVE
To evaluate the association between serum vitamin D levels and BPPV.

SUBJECTS AND METHODS

This study was designed as a case-control study comparing serum vitamin D levels in 57 BPPV
patients and 59 healthy controls whose age, gender, and BMI distributions were similar to those of the
BPPV group.

RESULTS
There were no significant demographic differences between case and control groups. The mean age of
BPPV patients, which comprised 49 (86%) women and 8 (14%) men, was 60.8 years. The data showed
that BPPV patients had significantly lower serum vitamin D levels than healthy controls (21.5 ng/ml vs
25.7 ng/ml). Within BPPV patients, however, we found no statistically significant differences in serum
vitamin D levels between recurrent and non-recurrent subgroups (22.0 ng/ml vs 20.7 ng/ml).

CONCLUSION
There was an association between low serum vitamin D levels and BPPV incidence in both recurrent
and non-recurrent group.
POSTER # P-093

ENDOSCOPIC TYMPANOPLASTY : A STUDY OF 50 CASES

DR KISHAN KUMAWAT, MS ENT – APOLLO ENT HOSPITAL BARMER,RAJASTHAN

ABSTRACT
• This study is aimed to evaluate the role of endoscope in the management of dry central
perforation of tympanic membrane.
• Total 50 patients underwent endoscopic
tympanoplasty, between the time period of January 2017 to December 2018, at APOLLO
ENT HOSPITAL BARMER RAJASTHAN.
• In this study , there was 96% Graft take up rate
with endoscopic approach.
• The endoscopic approach have following advantages over microscopic approach :-
• ↓ operationtime
• ↓ post operative pain level
• Better cosmetic results
• Better surgical view with minimal incision
• High success rate of graft take up
• Better post operative hearing improvement &
• Avoids end aural vertical and post auricular incisions.
• Thus endoscopic tympanoplasty can be a good alternative of microscopic tympanoplasty

INTRODUCTION
• Mer & colleagues introduced the middle ear endoscopy in 1967.
• An endoscope is an equipment used
successfully in several procedures of many medical specialties.
• The endoscope has practically replaced the
microscope for it offers
1. The excellent viewing of structures
2. Large angular image, viewing in several angles & magnification

METHODS
• This study was conducted at APOLLO ENT HOSPITAL BARMER, RAJASTHAN.
• Between January 2017 to December 2018.
• All 50 patients underwent preoperative assessment with proper history; otoscopic &
endoscopic examination; tuning fork test; pure tone audiometry (PTA); xylocaine sensitivity
test; X-ray mastoid & X- ray pns; routine blood investigations.
• The 50 patients were between 12 to 60 years with dry central perforation, small & medium in
size.
• Male to female ratio was 2:3
• According to PTA finding, 43 patients had pure conductive hearing loss (average35-40 db )
& 7 patients had mixed hearing loss (average 30-35 db).
• In 37 patients we used temporalis fascia & in remaining 13 patients tragal cartilage was
used as graft material

RESULTS
• From total of 50 cases with endoscopic approach, graft take up rate was 96 % with only 2 cases
of graft failure.
• Complete graft uptake rate was 97.29% &
92.38% for temporalis fascia graft & tragal cartilage graft respectively.
• The average time taken for each endoscope
assisted tympanoplasty was around 60-70 minutes
DISCUSSION

CONCLUSION
• The endoscopic approach has introduced a new perspective to ear surgery.
• Using this method, improved cosmetic outcomes & also, reduced postoperative morbidity.
• It can be performed & taught in academic institutions in the residency program in department
of Otorhinolaryngology.
POSTER # P-095

BILATERAL JUGULAR BULB DIVERTICULA – A RARE RADIOLOGICAL FINDING

LIM Jason [1] ; O’BRIEN Justin [1]
1 – Department of Otolaryngology, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia

OBJECTIVES
Jugular bulb diverticulum is a rare form of jugular bulb abnormality that often occurs unilaterally. This
may cause pulsatile tinnitus, hearing loss and vertigo. We describe a 67-year-old woman who
developed sensorineural hearing loss (SNHL) and pulsatile tinnitus with findings of bilateral jugular
bulb diverticula on computed tomography (CT) and magnetic resonance imaging (MRI). Through this
case report, we aim to explore the clinical presentation, investigations and management for this
uncommon vascular abnormality, which lacks current established guidelines.

MATERIALS AND METHODS

Consent was obtained from the patient for use of her de-identified medical information and images.
Clinical information including history, examination findings, investigation results and management
plans were collated.

RESULTS
The patient was referred to our institution by her audiologist for sudden left-sided SNHL and pulsatile
tinnitus. Her ear examination was normal and pure-tone audiogram demonstrated asymmetrical
moderate-severe left-sided SNHL.

Her MRI-Brain revealed a 6mm signal abnormality involving the left petrous temporal bone. A cone-
beam CT subsequently confirmed the presence of bilateral jugular diverticula. She was given a course
of high-dose oral prednisolone on initial encounter, with resolution of pulsatile tinnitus and
improvement in hearing on follow-up. She was decided for conservative management after a multi-
disciplinary meeting.

CONCLUSION
This is the first Australian case report of bilateral jugular bulb diverticula in a symptomatic patient. In a
normal ear examination, the presence of pulsatile tinnitus with vertigo or hearing loss should prompt
clinicians to exclude jugular bulb abnormalities or other vascular aetiologies on radiological
investigations. Management and follow-up duration should be determined on an individual basis.
POSTER # P-096

THE VESTIBULAR REHABILITATION THERAPY VERSUS HIGH DOSE BETAHISTINE FOR TREATMENT OF
THE ELDERLY WITH CHRONIC VESTIBULOPATHY : A RANDOMIZED CLINICAL TRIAL

Noor Dina HASHIM1, Mohamad Norkahfi RAZALI1, Asma ABDULLAH1, Nor Haniza ABDUL WAHAT2,
Norzie Nani mamat3

1
Department of Otorhinolaryngology- Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical
Centre, 56000 Kuala Lumpur, Malaysia.

2
Audiology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur,
Malaysia.

3
Physiotherapy Unit, Department of Medical Rehabilitation Services, Universiti Kebangsaan Malaysia
Medical Centre, 56000 Kuala Lumpur, Malaysia.

OBJECTIVE
To study the effectiveness of vestibular rehabilitation therapy (VRT) and high dose Betahistine in
treating elderly with chronic vestibulopathy (CV).

MATERIAL & METHODS

Fifty patients (14 males, 36 females) aged 55 years-old and above diagnosed with CV were recruited.
Patients were randomly assigned to either VRT or high dose Betahistine group. The VRT group would
attend therapy once a week for at least 4 sessions within 6 weeks while the other group, Betahistine
was prescribed at 48 mg three times daily for 6 weeks. The Vertigo Symptoms Scale (VSS) and Vertigo
Handicap Questionnaires (VHQ) were used as subjective assessments at pre-intervention, at 3 weeks
and after 6 weeks post-intervention while Video Head Impulse Test (vHIT) and Cervical Evoked
Myogenic Potential (cVEMP) were used as objective assessments at pre-intervention and after 6 weeks
post-intervention.

RESULTS
The mean scores of VSS and VHQ showed decreasing trends from baseline to 3 weeks and 6 weeks and
were statistically significant in both treatment groups. However, when comparing between groups,
there were no significant difference in scores indicating both treatments were equally effective.
cVEMP results showed no significant difference between pre and post-treatment in both groups.
Meanwhile some of vHIT components showed significant difference between pre and post treatment
in both groups.

CONCLUSIONS
Both treatment modalities are equally effective in treating elderly with CV. Variety of ages in elderly
makes no difference on therapy outcome. Elderly with CV now can be counselled on which treatment
options best suits their preferences.
POSTER # P-097

MANAGEMENT OF PARS TENSA RETRACTION POCKETS

Cheong Se Won, So young Kim, Chang Ho Lee, Hyoung-Mi Kim
Otorhinolaryngology Department
CHA Bundang Medical Center, CHA University

OBJECTIVE
In the present study, we investigated long-term outcomes after treatment for advanced retraction
pockets of pars tensa using a tympanostomy tube insertion combined with laser-assisted contraction-
lifting myringoplasty and radiologic considerations connected to the clinical findings.

METHOD
The patient with varying degree of retraction of the pars tensa according to Sade's classification
underwent CO2 laser myringoplasty combined with tympanostomy tube insertion. All patients were
followed for 5 years postoperatively. The mastoid pneumatization and eustachian tubes were
evaluated using temporal CT multiplanar reconstruction method.

RESULTS
If a successful outcome was defined as an intact tympanic membrane with no retraction or the
development of a stable, grade I mild retraction, the retractions had normalized or improved in most
of the patients by the end of the follow-up. The statistical analysis showed a significantly narrow
eustachian tube diameter in diseased ear side in adults rather than children. There were no
differences in mastoid pneumatisation in both ear for children while 21.4% of cases had a small
contracted mastoid in adults.

CONCLUSION
The present study suggests that different pathology may occur in the development of retraction
pockets in adults and children, which may supports adapting a more conservative flexible approaches
as the treatment for children with retraction pockets. Early recognition of eustachian tube dysfunction
and appropriate surgical intervention are the key to hearing preservation in the management of
retraction pockets.
POSTER # P-098

INTRAMUSCULAR STREPTOMYCIN INDUCED OSCILLOPSIA- A CASE REPORT

RAZAK Siti Sarah [1], ZAHEDI Farah Dayana [1], ABDULLAH Asma [1][2], MOTHAR Nadiah [3]

1 Department of Otorhinolaryngology, Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical
Centre, 56000 Kuala Lumpur, Malaysia.

2 Institute of Ear, Hearing and Speech (Institute-HEARS), Universiti Kebangsaan Malaysia, 56000 Kuala
Lumpur, Malaysia.

3 Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, 56000 Kuala Lumpur,
Malaysia.

BACKGROUND
Oscillopsia is an illusion of an unstable vision causing the perception of to-and-fro movement of the
environment. It is most commonly idiopathic. Aminoglycosides administration such as streptomycin
generating toxic metabolites can cause oscillopsia.

CASE PRESENTATION
We report a case of a 36 years old Malay female with positive Mycobacterium tuberculosis polymerase
chain reaction (PCR) who developed oscillopsia during the streptomycin administration.

CONCLUSION
We discussed the approach in managing this case.
POSTER # P-099

ANALYSIS OF AUDIOMETRIC DIFFERENCES IN NORMAL HEARING SUBJECTS: A

COMPARATIVE STUDY BASED ON GENDER AT CIPTO MANGUNKUSUMO NATIONAL
GENERAL HOSPITAL
AULIA Nadira [1]; BASHIRUDDIN Jenny [2], ALVIANDI Widayat [2], BRAMANTYO Brastho
[2], RIZKY Farisa [2]; ANJANI Sonia Miyajima [1]
1 – Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
2 – ENT Department, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia

OBJECTIVES
In evaluating hearing abilities, there are many studies reported in literature that summarized
audiological findings and their relation with subjects’ age. However, there are limited studies that have
attempted to delineate the gender differences in audiological findings. This study aims to explore the
differences between males and females in terms of audiological evaluation.

MATERIALS AND METHODS

This study is a cross sectional study on samples taken sequentially at ENT out-patient clinic,
Cipto Mangunkusumo National General Hospital, Jakarta, on January – April 2017. A total of
71 individuals with hearing within normal limits were selected for the study, including 28 males and 43
females. Pure tone audiometry, speech audiometry, and words in noise audiometry were used to
assess audiology findings. The results then analyzed by Mann-Whitney U test.

RESULTS
There was statistically significant difference (p< 0,05) between male and female at speech
recognition threshold (SRT) 50% assessed by words in noise audiometry. The median of SRT
50% on words in noise audiometry in male subjects was 66 dB, while the median in female
subjects was 67 dB.

CONCLUSION
We found that there was gender difference for word-recognition performance in the presence of
background noise in individuals with normal hearing threshold, where the females have poorer results
compared to males. However, well-controlled prospective studies with higher number of samples are
essential to confirm the results obtained and to identify the possible mechanisms underlying the
gender differences.
POSTER # P-100

QUALITY OF LIFE IN HEARING LOSS PATIENTS USING INDONESIAN VERSION OF HEARING HANDICAP
INVENTORY FOR ADULTS (HHIA)
ANJANI Sonia Miyajima [1]; BASHIRUDDIN Jenny [2]; ALVIANDI Widayat [2]; BRAMANTYO Brastho [2];
SARI Fatia Permata [2]; AULIA Nadira [1]
1 – Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
2 – ENT Department, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia

OBJECTIVES
Hearing loss can cause handicap that contribute to decrease quality of life (QoL). The Hearing
Handicap Inventory for Adults (HHIA) was used to assess the degree of handicap in adult patients with
hearing loss. This study is aimed to investigate QoL among hearing loss patients using Indonesian
version of HHIA questionnaire.

MATERIAL AND METHODS

We conduct a cross-sectional study at Cipto Mangunkusumo General Hospital, as tertiary national
referral hospital in Indonesia. Inclusion criteria was patient 18-60 years old with sensorineural hearing
loss and the exclusion criteria was middle ear abnormalities. QoL was classified as no handicap (0-16),
mild-to-moderate handicap (18-42), and severe handicap (>42).

RESULT
A total of 25 patients involved in this study. Mean age was 44,6 years and mean HHIA score was 39,92.
Nineteen subjects (70%) found to have handicap (36% and 40% have mild-to-moderate and severe
handicap, respectively). Seven subjects with severe handicap (37%) have no occupation. The worst
component of QoL are difficulty in understanding clients/colleagues (S7) on social scale and anxiety
(E12) on emotional scale. This Indonesian version of HHIA questionnaire is proven to be valid and
reliable and has been registered for patent in Ministry of Justice and Human Rights of Republik
Indonesia.

CONCLUSION
Most of Indonesian patients with hearing loss had impaired quality of life (QoL). This Indonesian
version of HHIA questionnaire would be useful for further evaluating QoL among hearing loss patients
in Indonesia.
POSTER # P-102

INTRATYMPANIC ADMINISTRATION OF ALPHA-LIPOIC ACID-LOADED PLURONIC F-127

NANOPARTICLES AMELIORATES ACUTE HEARING LOSS

So Young JUNG [1], Jihye YOO [2], Keum-Jin YANG [1], Gawon YI [2], Dong-Kee KIM [3], Heebeom Koo
[2,4],
1 – Clinical Research Institute, Daejeon St. Mary's Hospital, College of Medicine, The Catholic
University of Korea, Daejeon, Republic of Korea.
2 – Department of Medical Life Sciences, College of Medicine, The Catholic University of Korea, Seoul,
Republic of Korea.
3 – Department of Otolaryngology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic
University of Korea, Daejeon, Republic of Korea.
4 – Catholic Photomedicine Research Institute, College of Medicine, The Catholic University of Korea,
Seoul, Republic of Korea

OBJECTIVES
The purpose of sturdy was to develop a therapeutic drug for acute hearing loss using an antioxidant-
containing nanoparticle based on pluronic F127..

MATERIALS AND METHODS

We selected alpha lipoic-acid (ALA) as a drug to be loaded in nanoparticles through literature search.
The safety of nanoparticle in HEI-OC1 cells and the protective effect against aminoglycoside toxicity
were investigated. Then, we measured the intracellular levels of ROS and antioxidant proteins in
response to kanamycin with or without ALA-loaded nanoparticle. In mice, we treat the nanoparticles
by intratympanic injection 4h before ototoxicity induction and analyzed the therapeutic ability of the
nanoparticles in acute hearing loss.

RESULTS
The size of particles was about 109.1 nm, and in the analysis of drug release, about 28% of the drug
was released gradually from nanoparticle for 40 hours at room temperature. In vitro results showed
the nanoparticles were safe in MTT assay and provided protective effects at concentrations from 0.25
mg/ml to 2.5 mg/ml. It also showed an increase in antioxidant proteins such as Nrf2, HO-1, SOD-1 and
SOD-2. In animal study, the hearing of mice injected with the nanoparticles into the middle ear cavity
was significantly preserved after ototoxicity induction compared to the control group. The increase of
Nrf2 was also observed in cochlea of these animals, which indicated that the nanoparticles showed the
protective effect of hearing through the same antioxidant mechanism.

CONCLUSION
ALA-loaded Pluronic F127 nanoparticles showed effective hearing protection in acute hearing loss,
which could be mediated through the Nrf2 / HO-1 pathway. Considering the safety and sustained drug
release of the nanoparticles, it appears to be a potential new drug formulation for intratympanic
injections.
POSTER # P-103

DEGREE OF SPONTANEOUS NYSTAGMUS AFFECTS THE LENGTH OF HOSPITALIZATION IN VESTIBULAR

NEURITIS AT EARLY STAGE

Department of Otolaryngology-Head and Neck Surgery, Eulji University College of Medicine, Daejeon,
South Korea
Ho Yun Lee, Su Jin Kim

OBJECTIVES
We aimed to confirm the prognostic factors for predicting faster recovery of VN at early stage.

MATERIAL AND METHODS

We retrospectively reviewed patients’ medical charts who visited emergency department at a
university hospital diagnosed with VN and admitted to hospital for treatment between 2014 and 2018.
All the variables including bed-side examination and laboratory testings were collected as much as
possible. Bivariate analysis and stepwise regression analysis were performed with these variables.

RESULTS
A total of 56 patients’ individual data were retrospectively analyzed. Mean hospitalization day was
4.61.4 days. At initial bed-side examination, horizontal SN was observed in all patients and 80.3% of
these had positive head impulse test. Mean caloric weakness was 65.520.6%. For vHIT, both gain of
anterior and horizontal semicircular canal (SCC) between lesion side and intact side were statistically
different (p<0.001). Degree of SN (p=0.014), time constant measured by post-rotatory nystagmus in
the intact side (p=0.040), gain of posterior SCC in the lesion side (p=0.036) was correlated with
hospitalization period. Stepwise regression analysis revealed that degree of SN was independent
prognostic factors for predicting the length of hospitalization period (Beta=0.098, 95% CI=0.012-0.184,
p=0.027, R2=0.202). Others were not significant.

CONCLUSION
Degree of SN was independent prognostic factor for predicting early recovery of VN during
hospitalization period. Other laboratory findings were not related to prognosis.
POSTER # P-104

ADENOID CYSTIC CARCINOMA OF EXTERNAL AUDITORY CANAL: A RARE CASE

DESTIANTORO Moch Rizki [1,2] ; KRISTANTI Alberta Widya [1,2] ; DEWANTI Dyah Ayu Kartika [1,2] ;
CEMPAKA Rita [2,3]
1 - Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Public Health and
Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia ; 2 - Otorhinolaryngology Head and Neck
Surgery Department, Dr. Sardjito Hospital, Yogyakarta, Indonesia ; 3 - Pathology Anatomical
Department, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta,
Indonesia ; 4 - Pathology Anatomical Department, Dr. Sardjito Hospital, Yogyakarta, Indonesia

INTRODUCTION
Primary malignancies of the external auditory canal (EAC) are extremely rare with more than 80%
being squamous cell carcinomas and adenoid cystic carcinoma (ACC) accounting for approximately 5%.
These tumours are associated with a high risk of recurrence and significant morbidities from surgical
management and adjuvant radiotherapy.

CASE PRESENTATION
We reported 40 year old female patient with complaints of hearing loss in the right ear. There is a
lump in the right ear canal that has been felt for approximately 6 months. On the physical examination
of the right ear seen the mass covered the ear canal so that the tympanic membrane of the right ear
could not be assessed. The results of the tuning fork confirmed by audiometry showed that Auris
Dextra conductive hearing loss were moderate. The result of gustatorik test is decreasing senses of
salty and bitter senses, result for schimmer test is orbita dextra shorter 5mm than orbita sinistra and
result for sensory test is decreasing for mandibula dextra nerve. CT Scan results show bilateral
mastoiditis. The patient performed tympanoplasty and mass resection. The results of Anatomical
Pathology examination is adenoid cystic carcinoma.

CONCLUSION
Malignant tumours of the EAC are rare and most are squamous cell carcinomas. ACC arising in the EAC
is exceedingly rare. ACC has 3 main histological patterns: tubular, cribriform and solid. Tubular ACC has
the best prognosis, whereas solid ACC has the worst prognosis. Surgery treatment consisted of
excision of the EAC and the resulted for local eradication of the lesion.
POSTER # P-105

EFFECTS OF MULTIPLE SCLEROSIS ON MEDIOOLIVOCOHLEAR SYSTEM

ACAR Gul Ozbilen 1,ERTUGRUL Ozlem 2,TUYSUZ Ozan 1,ORHAN Asuman 3

Department of Otorhinolaryngology,Istanbul Medeniyet University, Goztepe Training and Research

Hospital,Istanbul Turkey 1
Department of Audiology,Istanbul Medeniyet University, Goztepe Training and Research
Hospital,Istanbul Turkey 2
Department of Neurology,Istanbul Medeniyet University, Goztepe Training and Research
Hospital,Istanbul Turkey 3

OBJECTIVES
The aim of this study was to investigate the effects of multiple sclerosis on the medialolivococlear
system, one of the olivococlear efferent systems.

MATERIALS AND METHODS

In this study, peripheral hearing was evaluated by pure tone audiometry test(PTA). MOC system was
evaluated by suppression testing with Trasientotoacoustic emission test (TEOAE) and contralateral
broad band noise . The MS group of 30 patients and the control group of 32 subjects underwent PTA
and TEOAE test at 1000-1500-2000-3000-4000 frequencies in the right and left ear, and TEOAE test
with contralateral suppression to observe the MOC reflex.

RESULTS
Otoacoustic emission values at all frequencies except 1500 Hz in right ear, and bilateral ears showed
significant reduced values between study and control groups (p <0.05). In addition, contralateral
suppression values at 4000 Hz showed a significant difference between the study and control groups
(p <0.05). A significant negative correlation was found between disease duration and age at 4000 Hz.
Accordingly, as the age and duration of the disease increased, the difference between 4000 Hz and
1000 Hz suppressed and non-suppressed measurement in the right ear decreased.

CONCLUSION
Otoacoustic emissions reflect cochlear functions, low emission responses obtained in MS can be
attributed to early subclinical involvement of outer hair cells on the auditory pathways.The decrease in
the suppression value especially at 4000 Hz in MS patients was affected by MOC system and as a result
it was seen that MS affected the medioolivococlear system which is the efferent system of auditory
pathways.
POSTER # P-107

PATTERN OF MIDDLE EAR CHOLESTEATOMA AND IMPLICATION ON SURGICAL APPROACH

PURPOSE
Understanding the pattern of involvement of middle ear cholesteatoma is important in achieving
complete eradication of disease and creation of a safe and dry ear. In recent years, this subject
becomes more pertinent with the rise of endoscopic ear surgery as surgeons decide on the optimal
approach to visualize and extirpate disease. With modification to the Attic-Tympanum-Mastoid
classification system proposed by Telmesani, this study aims to evaluate the commonest patterns of
involvement of middle ear cholesteatoma and its implication on surgical approach.

METHODS
This is a retrospective case series conducted in a single tertiary institution in Singapore. All patients
undergoing surgery for cholesteatoma between January 2012 and June 2015 were included. Staging of
cholesteatoma was assessed clinically and corroborated with radiological findings based primarily on
the grading system proposed by Telmesani, in which sites of cholesteatoma were divided into attic,
tympanic cavity and mastoid with a specific identification of the facial recess and/or sinus tympani
extension. In addition, the presence of an automastoidectomy cavity and other complications were
also noted.

RESULTS
53 patients (55 ears) were included. The majority of patients had cholesteatoma involving the attic
(98.2%). The cholesteatoma extended to the facial recess and/or sinus tympanum in 26 cases (47.3%).
The disease extended into the mastoid antrum and beyond in 43 cases (78.2%).

CONCLUSION
Our study shows that the majority of cholesteatomas present with extensive attic disease and
significant involvement of the mastoid. In these situations, endoscopes may be best suited for
adjunctive rather than exclusive use in surgery.
POSTER # P-109

3-TESLA MRI BRAIN SCANNING IN A MEDEL SYNCHRONY PAEDIATRIC COCHLEAR IMPLANT

RECIPIENT – FIRST REPORTED CASE, CLINICAL CONSIDERATIONS AND IMPLICATIONS FOR FUTURE
PRACTICE

ZHEN, Emily [1]; RODRIGUES, Steve [1]; KUTHUBUTHEEN, Jafri [1]; THOMSON, Andrew [2]
1 – Department of Otolaryngology Head and Neck Surgery, Perth Children’s Hospital, Perth, Australia;
2 – Department of Medical Imaging, Perth Children’s Hospital, Perth, Australia

OBJECTIVES
To demonstrate the safety and feasibility of the first reported case worldwide of a 3-Tesla MRI scan in
a pediatric MedEL Synchrony cochlear implant recipient under general anesthesia.

MATERIAL AND METHODS

A 3 year old child with a left optic pathway glioma managed with chemotherapy who received a
MedEL Synchrony cochlear implant on the right for sensorineural hearing loss was examined. The
Synchrony device was implanted due to its purported MRI compatibility in this patient. Following
informed consent and radiological approval, the child underwent an MRI scan to assess for growth of
the glioma. Concerns were initially raised about the inability of the child to report pain or symptoms
whilst under anesthesia, unlike adult patients in a similar situation.

RESULTS
The 3-Tesla MRI scan was performed without complication. There was expected artefact due to the
magnet of the receiver. There was no malfunction of the implant noted after the procedure and no
neurological or otological complications post MRI scanning. The child has subsequently had a further
three MRI scans in the same region with no reported complications or effects on the cochlear implant
or magnet. Meaningful staging information was obtained from the scan with regards to the tumour.

CONCLUSION
This is the first reported case of a child with a MedEL Synchrony cochlear implant undergoing a 3-Tesla
MRI scan under general anaesthesia and with repeated scanning. Provided manufacturer guidelines
are adhered to, 3-Tesla MRI scanning should not be contraindicated in pediatric CI recipients with a
compatible Synchrony cochlear implant.
POSTER # P-110

UNUSUAL PRESENTATION OF SKULL BASE OSTEOMYELITIS IN NONIMMUNOCOMPROMISED ELDERLY

PATIENTS – THE ESSENTIAL ROLE OF NUCLEAR
IMAGING IN DIAGNOSIS
MEGOW Anna [1]; LIM Rebecca SM [1]; SHAW Chi-Kee Leslie [1]
1 – Department of Otolaryngology Head and Neck Surgery, Modbury Hospital, South
Australia, Australia.

OBJECTIVES
Otogenic skull base osteomyelitis (SBO) is a life-threatening condition requiring timely
diagnosis and treatment. It is most commonly seen in the elderly diabetic or
immunocompromised patients. The role of nuclear medicine imaging in diagnosis of SBO
remains controversial.

MATERIALS AND METHODS

We present two unusual cases of otogenic SBO in elderly non-immunocompromised
patients without diabetes. A review of the relevant literature was performed in discussion of
these two patients.

RESULTS
Both patients presented with mild chronic otalgia and essentially normal inflammatory
markers. They were subsequently diagnosed with otogenic SBO based on nuclear medicine
imaging. Nuclear medicine imaging was essential for diagnosis and localization of SBO in
these patients as computed tomography (CT) and magnetic resonance imaging (MRI) either
failed to detect SBO or to accurately localize SBO.

CONCLUSION
We recommend a high index of suspicion as SBO can occur in non-immunocompromised
elderly patients without diabetes. CT and MRI scans are useful but not always reliable in the
diagnosis and accurate localization of SBO. Nuclear medicine imaging is essential in the
diagnostic workup.
POSTER # P-112

A RADIOLOGIC STUDY OF INNER EAR MALFORMATIONS IN COCHLEAR IMPLANT PATIENTS

DUONG Anh Vu [1], TRAN Viet Luan [2], LE Tran Quang Minh [3]
1 - Otoneurology Department, ENT Hospital of Ho Chi Minh City, Ho Chi Minh city, Vietnam
2 - Chairman of ORL-HNS, Pham Ngoc Thach University of Medicine, Ho Chi Minh city, Vietnam
3 - Vice Director, ENT Hospital of Ho Chi Minh City, Ho Chi Minh city, Vietnam

ABSTRACT
OBJECTIVE:
The aim of this study is to determine the preoperative radiologic prevalence of inner ear
malformations in cochlear implant patients according to Sennaroglu’s classification.

MATERIALS AND METHODS:

This was a retrospective study performed at Ear Nose Throat Hospital of Ho Chi Minh City between
January 2016 and October 2018. Inner ear malformations on temporal bone CT scan were identified
from all patients who have received cochlear implants during the study period.

RESULTS
12 patients with inner ear malformations were identified from a total of 158 cochlear implant patients,
represented a prevalence of 7.6%. Among them, there were 6 patients with incomplete partition type
II (50%), 3 patients with cochlear ossification (25%), 2 patients with cochlear hypoplasia type III
(16.7%), and 1 patient with incomplete partition type III (8.3%). Enlarged vestibular aqueduct
associated with incomplete partition type II was found in 2 cases (16.7%). Associated semicircular
canals anomalies were found in 5 cases including: cystic lateral semicircular canal (4 cases, 33.3%) and
semicircular canal aplasia (1 case, 8.3%).

CONCLUSION:
This study documents the prevalence of inner ear malformations in cochlear implant patients
(classified by Sennaroglu) in Vietnamese subjects. Understanding of such anomalies would significantly
help surgeons in making surgical strategy to obtain optimal outcomes.
POSTER # P-113

ENDOSCOPIC MANAGEMENT OF MIDDLE EAR / MASTOID CHOLESTEATOMA

EE Yuin Su [1]; SOW Aye Jane [2]

1 – ENT Department, Timberland Medical Centre, Kuching, Sarawak, Malaysia ; 2 – ENT Department,
Normah Specialist Medical Centre, Kuching, Sarawak, Malaysia

OBJECTIVES
To analyse the outcomes and complications of endoscopic transcanal / combined open mastoidectomy
ear surgeries for middle ear / mastoid cholesteatoma.

MATERIALS AND METHODS

Retrospective review of surgical notes, surgical video recordings, audiology outcomes and post-surgery
complications of endoscopic ear surgeries for cholesteatoma.

RESULTS
Eighteen patients underwent endoscopic transcanal ear / combined transmastoid surgeries for middle
ear / mastoid cholesteatoma from September 2013 till November 2018. Four cases of attic / antrum
cholesteatoma, underwent transcanal endoscopic atticoantrostomy and attic reconstruction.
Two cases of cholesteatoma involving attic and mastoid, with good pre-op hearing level, were treated
by combined cortical mastoidectomy and transcanal endoscopic surgery. Twelve endoscopic modified
radical mastoidectomy were performed. Two patients presented with facial nerve palsy, one with
dural sinus thrombosis, one with intracranial abscess, one with extradural abscess, two with
labyrinthine fistula, one congenital cholesteatoma and one recurrent cholesteatoma. The surgical time
ranged from 120-270 minutes. One patient (6.25%, n=16) have recurrence at 21st month, treated by
transcanal endoscopic cholesteatoma removal under local anaesthesia, and remain recurrence free
since then. One patient died due to pre-existing temporal abscess, 3 with small central perforations, 2
ears have attic perforations, 2 with sensorineural hearing loss and 2 with chorda tympani injury. There
were five transient complications. Most patients retained / had improved hearing (9/13).

CONCLUSION
Endoscopic ear surgery was found to be safe technique for removal of middle ear / mastoid
cholesteatoma with good result and good hearing preservation rate.
POSTER # P-114

PSEUDOMENINGOCELE OF THE EAR: A RARE CASE OF LATE POST-MASTOIDECTOMY COMPLICATION

BALATIBAT, Emilaine [1] ARTATES, Anne Margaux [1]
1 – ORL-HNS Department, Rizal Medical Center, Pasig City, Philippines

OBJECTIVE
To present a case of pseudomeningocele as a post-mastoidectomy complication and discuss its
diagnostic and surgical management.

METHODS
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One

RESULTS
A 31-year old male presented with right external ear canal mass with clear otorrhea ten years after a
mastoid surgery for chronic suppurative otitis media. The persistence of the mass, otorrhea with
episodic tonic-clonic seizures prompted consult. Temporal bone computer tomography (CT) and
cranial with internal auditory canal (IAC) magnetic resonance imaging (MRI) revealed a large tegmen
defect and a pseudomeningocele of the right ear with cerebrospinal fluid (CSF) leak. Transmastoid
extradural approach was employed to repair the tegmen defect using multilayer autografts and blind
sac closure.

CONCLUSION
Mastoid or middle ear surgery with tegmen defects may develop complications such as encephalocele,
meningocele or pseudomeningocele and can present years after surgery. High resolution temporal
bone CT scan and cranial MRI are complementary imaging necessary for diagnosis and surgical
planning. A multidisciplinary team approach comprised of Otology-Neurotology, Neurosurgery and
Neurology services was adapted in order to evaluate and manage the patient. Transmastoid extradural
approach was performed to repair the tegmen defect and involved using multiple autografts such as
conchal cartilage, temporalis muscle fascia, reinforced with temporalis muscle and abdominal fat graft
to obliterate the mastoid cavity.
POSTER # P-115

A COMMON LESION IN AN UNUSUAL LOCATION: LIPOMA IN THE CEREBELLOPONTINE

ANGLE
ASUNCION, Annabelle B. MD; DELA CRUZ, Emmanuel R. MD

Department of Otorhinolaryngology-Head and Neck Surgery Ilocos Training

and Regional Medical Center
San Fernando City, La Union, Philippines

OBJECTIVE:
To present a case of a lipoma in an unusual location in the cerebellopontine angle.

RESULTS:
An 11 year-old, female presented with hearing loss, left; with no associated signs and symptoms.
Gross physical examination of both ears were normal. Pure tone audiometry revealed moderate-
severe sensorineural hearing loss, AS, normal hearing threshold, AD. Further investigation with
Magnetic Resonance Imaging of the brain and internal auditory canal yielded a hyperintense focus on
pre-contrast T1 and T2-weighted imaging at the left cerebellopontine angle region, which has a
consistent signal dropout with T2 fat saturation sequence consistent with Lipoma.

CONCLUSIONS:
According to Boie’s, an acoustic schwannoma of the Cerebellopontine angle/internal auditory canal
(CPA/IAC) should always be considered unless proven otherwise in patient’s presenting with unilateral
sensorineural hearing loss.1

Moreover, a rare lipoma should also be considered as one of the differentials. A detailed history,
physical examination with the aid of pure tone audiometry and magnetic resonance imaging are vital
in establishing accurate diagnosis.

INTRODUCTION

Disabling hearing loss in children is a symptom frequently ignored by parents. It is a symptom often
disregarded apart from otalgia or otorrhea; until symptoms are severe enough to be a burden in
everyday life, moreover until it manifests with complications and even life- threatening conditions.
Hearing loss can be a cause of a disruption on the conduction and/or processing of sound from the
outer external ear to the inner ear to the brainstem. It is therefore concluded that it is a symptom of
vast diseases affecting the organs of hearing.

The most common clinically used classification of hearing loss help physicians to narrow down
impressions of its etiology. Basic topographic and functional distinction between conductive hearing
loss versus sensorineural hearing loss are at outmost help. Its laterality further narrows down our
impression. Bilateral Sensorineural Hearing loss have been well established with more than 50% cases
attributable to genetic causes; while more than 50% of children with unilateral hearing loss have no
identifiable cause.2 Although almost always an acoustic schwannoma should always be considered
unless proven otherwise in patient’s presenting with unilateral sensorineural hearing loss.1
CASE REPORT
An 11 year-old, female came in for a consult due to unilateral hearing loss, left; with no concomitant
otalgia, otorrhea, fever, tinnitus, facial asymmetry, headache, vertigo and problems with balance. She
was noted to have hearing loss at the age of 5 manifested by not responding to conversations,
instructions and commands given to her. The condition persisted to be more pronounced and
noticeable to be laterally isolated to the left ear. This prompted the parents to seek consult to an
otorhinolaryngologist.

The patient is a Grade 5 pupil, who gets above-average grades in school. Her developmental skills are
at par with her age. She seats most of the time in front of class to be able to hear her lessons.
Otherwise, she claims to have cope and adjusted to her condition.

The patient had an unremarkable feto-materal history. No previous history of ear infection. No history
of trauma, hospitalizations, and surgical procedures. No history of primary complex or intake of ototoxic
medications. She has no family history of hearing loss or malignancy.

During the initial consult, gross physical examination (Fig 1) and otoscopic findings revealed essentially
normal findings. (Fig 2) Rhinoscopy, Oral Cavity and Oropharyngeal and Neck Exams were unremarkable.
There were no noted facial asymmetry, House Brackmann Classification I. Cerebellar Function tests were
unremarkable. The rest of the neurologic examinations were unremarkable.

Tuning fork test revealed Weber Right and Rinne Positive. This is suggestive of Sensorineural Hearing
Loss, AS. Pure tone audiometry revealed Moderately Severe Sensorineural Hearing Loss, AS. Normal
hearing threshold, Auris Dextra (AD). (Fig 3) During this time, written and expressed consent were
instigated for the participation of the patient to a case report. (Fig. 4)

Further investigation with Magnetic Resonance Imaging revealed T1-T2 weighted with gadolinium
contrast of the brain and internal auditory canal. The imaging revealed: A hyperintense focus
approximately 0.4 x 0.6 x 0.7cm on pre- contrast T1 and T2-weighted imaging surrounding the facial and
vestibulocochlear nerve at the left cerebellopontine angle region, which has a consistent signal
dropout with T2 fat saturation sequence. There is no enhancement detected on the post contrast T1
fat saturation images. These radiographic features are consistent with Lipoma. (Fig 5)

In contrast with the most common vestibular schwannoma and meningioma. These lesions usually
demonstrate T1 isointensity with avid gadolinium uptake while epidermoids do not enhance with
contrast and are commonly hypointense on T1 and hyperintense on T2-weighted sequences. 3

The characteristic magnetic resonance images seen along with the detailed patient’s history and
physical examination. It is sufficient to diagnose our case as: Lipoma in the Cerebellopontine Angle, AS.
Owing to its benign symptomatology, radiographic characteristics, and high morbidity of biopsy or
microsurgery.

Definitive removal of the lesion is reserved for tumor enlargement and noted intractable symptoms
such as headache and facial asymmetry. The patient and her family members were counseled on the
red flags to watch-out as we continue to monitor her condition through frequent follow-up and series
of radiographic imaging.
CASE DISCUSSION
Internal Auditory Canal is a conduit for neurovascular structures such as vestibulocochlear nerve and
facial nerve from the skull base to the inner ear and terminal branches of the face. The
vestibulocochlear nerve leaves the brainstem as a homogenous nerve trunk and becomes visibly
separated in the internal auditory canal. The vestibular nerve is located posteriorly, while cochlear
nerve is located antero-inferiorly. The facial nerve is anatomically separated from the vestibulocochlear
nerve, however approaches intimately to the internal auditory canal antero-superiorly. (Fig 6) The
vestibulocochlear nerve predominantly contains afferent fibers for signal transduction from hair cells
to the brainstem, while the facial nerve provides both afferent and efferent fibers to the nervous
system.

Therefore, patients with lesions in the cerebellopontine angle/internal auditory canal (CPA/IAC) often
presents with sensorineural hearing loss, tinnitus, dysequilibrium, and facial hypesthesia. 4 These
symptoms are often nonspecific. In our case, intracranial lipomas may clinically mimic vestibular
schwannomas.7 Thus, the importance in implicating optimal imaging surveillance could not be
emphasize enough.

Magnetic Resonance Imaging (MRI) with Gadolinium Contrast Enhancement is the “gold standard” in
evaluating cerebellopontine angle and internal auditory canal mass (CPA/IAC)3 and is of vital
importance to establish diagnosis and differentiate one lesion from the other.

CPA/IAC mass comprises an approximately 10% of intracranial tumors; 5 an estimated 90% of these are
acoustic neuromas/vestibular schwanomas and the remainder accounts to 1 to 3% namely
meningomas, primary cholesteatomas, facial nerve schwannomas, and other less common lesions such
as lipomas and teratomas. 4

Lipomas are one of the most common benign mesenchymal tissue neoplasms in our body, however,
intracranially it occurs extremely rare which only accounts to 0.08%, 3 moreover only 0.15% of these
intracranial tumors are located in the CPA/IAC. 6

In contrast, Lipomas of the CPA/IAC are not considered true neoplasms rather lipomas are congenital
malformations that thought to may arise from abnormal differentiation of the meninx primitiva’’ (a
mesenchymal derivative of neural crest) into adipose tissue during the development of subarachnoid
cisterns. 3 This theory might explain why lipomas engulf coursing neurovascular structures, as oppose
to vestibular schwannomas and meningiomas, wherein neurovascular structures are pushed by the
tumor.

The characteristic radiographic feature of CPA/IAC lipoma are hyperdensity in T1-weighted images that
do not enhance with Gadolinum contrast administration. Hypo/isointense on T2-weighted images,
paralleling subcutaneous fat. And a distinguishing signal drop in fat-saturated MRI relative to
surrounding cerebrospinal fluid, orbital and subcutaneous fat.7 This is in contrast with other most
common CPA/IAC mass as summarized in Table 1.

Due to its rarity, there are no current standard recommendations in the management of CPA/IAC
lipomas. Lipomas feature of engulfing neovascular symptoms makes surgical removal unfavorable with
regard to functional outcome. Bigelow et. al. review of 52 patients who underwent microsurgery. 35
(67%) receiving subtotal and 17 (33%) gross total resection. 19% experienced improvement while 11%
claimed to have unchanged symptoms, and over 68% have new neurological deficits. This appears to be
a higher percentage than other CPA/IAC tumors. 3
Hence, microsurgery is reserved for decompressing cranial nerves and the brain stem to control
disabling neurologic symptoms symptoms such as vertigo, facial weakness, or hemifacial spasm. This
can be achieved by retrosigmoid approach, the middle fossa approach, and the translabyrinthine
approach.7 This is in contrast to vestibular schwannoma, which is more often addressed with surgery or
stereotactic radiation therapy. 4

Overall, majority of the literature suggest a conservative observation in addressing CPA/IAC lipoma. A
“watch and scan” policy is often advocated, since lipomas are relatively stable and lesion progression is
uncommon.3 In an analysis of the literatures, CPA/IAC lipomas showed no evidence of tumor growth
within a period of observation ranging from 12 months to 18 years. 7

Several studies suggest annual follow-up for adolescent patients and a single follow-up MRI scan
three to five years following diagnosis for adults. 8 The recommendations are reasonable since
CPA/ IAC lipomas might fluctuate with growth and percent body fat of young populations. No
studies have been done to associate body mass index and tumor behavior to come up with
definitive conclusions.3 Along with imaging, a clinical watchfulness should be
advocated to take into particular progression of neurootologic symptoms.

SUMMARY
Unilateral Sensorineural Hearing loss warrants a thorough investigation. More often than not, a CPA/IAC
mass should be considered and evaluated.

Lipoma of the cerebellopontine angle is treated conservatively with a “watch and scan” policy due to its
benign symptomatology and high morbidity following resection.
POSTER # P-116

EARLY INTERVENTION OF HEARING LOSS IN CHILDREN IS A NEUROLOGICAL EMERGENCY

INTRODUCTION
Hearing impairment is one of the most critical sensory impairments with significant social and
psychological consequences. Children with profound sensorineural hearing loss are at significant risk for
serious speech and language delays that can impact their communication, academic and social
development.

OBJECTIVE
The goal of early intervention is to minimize the adverse effects of non-amplified hearing loss.

DISCUSSION
Implementation of universal newborn hearing screening programs and advances in the technology
available to improve the hearing experience has led to an era of new possibilities. Over a decade
Cochlear implants have become widely accepted as an aid to exposing the deaf child’s auditory system
to a quality of sound experience not available with hearing aids alone. It is a known fact that cochlear
implantation under the age of 3 years, longer duration of implant use are the most important factors
that contribute to better speech and language outcomes. Failure to detect hearing loss early results in
lifelong deficits in speech and language acquisition, socio-personal and behavioural problems. Recent
studies have shown that early diagnosis and intervention of congenital deafness before the age of 6
months have better outcomes than those intervened after 6 months of age.

CONCLUSION
It’s not about hearing alone- it’s about brain development. Early intervention and referral are pivotal
to the development of speech and hearing skills in children with hearing loss before their auditory
system reaches neural plasticity. Each year lost to deafness significantly reduces the comprehension and
expressive skills.
Keywords: Congenital deafness, Universal newborn hearing screening, Cochlear implant.
POSTER # P-118

CASES OF INTRACTABLE MENIERE’S DISEASE: MANAGEMENT WITH MINIMALLY INVASIVE

RETROSIGMOID APPROACH (MIRA) TO VESTIBULAR NERVE SECTION - OUR EXPERIENCE.
SAMAGA Shailashree, RAMALINGAM Ravi, RAJAN Ravi.
OTORHINOLARYNGOLOGY, KKR ENT Hospital and Research Institute, Chennai, India.

INTRODUCTION:
Meniere’s disease classically affects middle aged adults and elderly with a triad of low frequency
unilateral nerve deafness, tinnitus and vertiginous attacks. Proposed and most accepted theory of
etiopathogenesis being endolymphatics hydrops which eventually leads to fibrosis of labyrinth.
Vertiginous episodes are due to rupture of endolymphatic sac membrane which causes mixing of
potassium rich endolymph with potassium poor perilymph. Influx of potassium causes depolarisation of
vestibular nerve end thereby causing vertigo and nystagmus.

CASE PRESENTATION:
Case 1: 60 year old female, known case of left Meniere’s disease for 3 years. No relief with medications.
Increased intensity of symptoms for past 1 year. Offered the option of vestibular nerve section, which
patient readily accepted.
Case 2: 70 years old male, known case of left Meniere’s disease. Had undergone endolymphatic sac
surgery 9 years ago. Post-operatively he was asymptomatic until last year following which he developed
incapacitating vertigo. Counselled for vestibular nerve section.

TREATMENT:
Left vestibular nerve section by minimally invasive retrosigmoid approach (MIRA) was done in both the
cases and completely recovered in 1 week post surgery.

CONCLUSION:
The main aim of vestibular nerve section is to relieve intractable and debilitating vestibular symptoms
while the hearing is preserved. Retrosigmoid approach provides a better exposure of VII and VIII nerve
complex in Cerebello Pontine Angle and lowers incidence of CSF leak. Considering high success rate,
excellent access and low complication rate this can be the best modality in treating intractable
Meniere’s disease in cases of failure of medical treatment.
POSTER # P-119

EFFICACY OF INTRATYMPANIC HIGH DOSE METHYLPREDNISOLONE COMPARED

TO INTRATYMPANIC HIGH DOSE DEXAMETHASONE IN TREATMENT OF IDIOPATHIC
SUDDEN SENSORINEURAL HEARING LOSS.

MEGOW Anna [1]; LI SUNG SANG Candice Chiew Yin [1]; ZHEN Emily [2]; SHAW Chi-Kee
Leslie [1]
1 – Department of Otolaryngology Head and Neck Surgery, Modbury Hospital, South
Australia, Australia; 2 – Department of Otolaryngology Head and Neck Surgery, Perth
Children’s Hospital, Western Australia, Australia.

OBJECTIVES
Determine the efficacy of high dose intratympanic methylprednisolone (ITM) compared to
intratympanic dexamethasone (ITD) in treatment of idiopathic sudden sensorineural hearing
loss (ISSNHL) utilised as either primary or salvage treatment.

MATERIALS AND METHODS

Prospective study of patients referred to our centre with new ISSNHL for primary or salvage
treatment following a 3-week course of systemic steroid therapy. Twenty patients were
recruited into ITD group and ten patients into the ITM group. Each patient had a ventilation
tube (VT) placed into the affected ear to facilitate intratympanic delivery of steroids. Four
doses of either 25 mg/mL dexamethasone or dose equivalent 125 mg/mL
methylprednisolone were administered through the VT weekly over 1 month. Response was
assessed with pure tone audiometry which was performed weekly during treatment and at 6-and 12-
months post treatment.

RESULTS
Hearing was completely restored within 10 dB of the unaffected ear in 20% of patients given
ITM. The remaining 37.5% of patients given ITM showed a partial recovery in hearing and
the rest showed modest or no improvement in hearing. Patients with low-moderate
frequency hearing loss who were administered ITM within 8 weeks delay of onset of
symptoms showed the most improvement. No side effects were noted. No significant
improvement in hearing was noted in the ITD group.

CONCLUSION
Our pilot study has shown patients with low-moderate frequency ISSNHL benefit from
salvage ITM, with a 20% complete recovery in hearing and remaining 37.5% partial recovery
in hearing when treated within 8 weeks delay of onset of symptoms.
POSTER # P-122

VALIDATING PCR QUANTIFICATION FOR PATHOGEN DETERMINATION IN CHRONIC

SUPPURATIVE OTITIS MEDIA WITH HIRA-TAN METHOD
DINA Alia [1,2] ; FERRY DWI Kurniawan [2] ; AZWAR Azwar [1] ; WILDA Mahdani [3] ; KOICHI
Hagiwara [4]
1 – ENT Department, Faculty of Medicine Universitas Syiah Kuala, Banda Aceh, Indonesia ; 2 –
Internal Medicine Department Comprehensive Medicine 1, Saitama Medical Centre Jichi Medical
University, Saitama, Japan ;3 – Microbiology Department, Faculty of Medicine Universitas Syiah
Kuala, Banda Aceh, Indonesia ;4 – Internal Medicine Department Division of Pulmonary Medicine,
Jichi Medical University, Tochigi, Japan

OBJECTIVES
Pathogen identification has been challenging in Chronic Suppurative Otitis Media (CSOM). The
recurrent nature, negative culture and misuse antibiotic in developing countries may conceal the
true pathogen. The pathogen identification by quantitative PCR with human cell as the internal
control (HIRA-TAN method) in Community Acquired Pneumonia can be similar applied. This study
objective was to preliminary investigate the utility of HIRA-TAN method in CSOM pathogen
identification.

MATERIALS AND METHODS

During December 2016 to January 2017, all CSOM patients in ENT outpatient clinic at dr. Zainoel
Abidin Hospital, Banda Aceh, Indonesia were enrolled. The otorrhea swab collection was managed
for microbiological culture and HIRA-TAN method. A multiplex TaqMan assay were performed
with 16 common pathogens. The cycle threshold difference between pathogen and human (Ct
pathogen) was the index for defining the pathogen. The ROC curve analyses was performed to
validate the cut-off values.

RESULTS
Thirty-nine patients ranging 1.7 to 62 years old were enrolled. The hearing impairment was found
different in children and adult (p<.005) by Fisher's exact test. The pathogen found by the culture in
14 samples (35.9%) culture were P. aeruginosa, K. pneumoniae, P. mirabilis, and M. morganii. The
Ct pathogencut-off for P. aeruginosa were 3.33 (90%, 100%); K. pneumoniae were 1.71 (85%,
100%); and Proteus sp. were 8.29 (90%, 100%). Multiple pathogen detected with negative culture
result were B. fragilis, A. baumanii, M. catarrhalis, and E. coli.

CONCLUSION
Current molecular technique enables to determine the pathogen by using the cut-off values for
certain pathogen. Multiple other pathogen detection and other cut-off values investigation
require further larger study.
POSTER # P-123

BALLOON DILATATION FOR EUSTACHIAN TUBE DYSFUNCTION IN WESTERN AUSTRALIA, A PILOT

STUDY

HENDRIKS Tom [1]; LING Shane [2]; KUTHUBUTHEEN Jafri [1,2]

1- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
2- Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth,
Australia

OBJECTIVES
There is emerging overseas evidence that balloon dilatation of the eustachian tube (ET) can be effective
treatment for eustachian tube dysfunction (ETD) as compared to medical therapy.1 Balloon dilatation
has not yet been performed in WA until now and we present the results of our pilot study.

MATERIALS AND METHODS

A prospective cohort study was conducted in Perth, WA. Thirteen adult patients were identified with a
clinical diagnosis of ETD and at least one symptom on the Eustachian Tube Dysfunction Questionnaire
(ETDQ), that had failed medical management of ETD. Primary outcomes included assessment of ETDQ
scores, tympanometry and pure tone audiometry (PTA). At the time of writing, eight patients had
undergone trans-nasal balloon dilatation with six-week follow-up results available.

RESULTS
Eight patients were included, the majority female (n=6) and the average age of the cohort 55 years. All
eight underwent balloon dilatation and demonstrated significant improvements in ETDQ scores at the
six-week follow up. The mean post-operative ETDQ score for all patients included was 1.9 compared to
4.9 pre-operatively (indicative of symptomatic relief). Tympanometry and PTA findings for all patients
were unchanged.

CONCLUSION
Our early experiences with balloon dilatation of the ET for ETD are encouraging demonstrating
significant symptomatic relief six weeks post-procedure, without any complications or side effects.
POSTER # P-124

TARGETED NEWBORN SCREENING FOR CONGENITAL CYTOMEGALOVIRUS-RELATED HEARING LOSS – A

PILOT PROJECT

REID Allison [1]; HAYLEY Herbert [1]; , CHASE, Carl [2]; BRENNAN-JONES, Chris [2]; BOWEN, Asha [3];
KUTHUBUTHEEN Jafri [1]

1- Department of Otolaryngology Head and Neck Surgery, Perth Children's Hospital, Perth,
Australia
2- Department of Audiology, Perth Children’s Hospital, Perth, Australia
3- Department of Infectious Diseases, Perth Children’s Hospital, Perth, Australia

OBJECTIVES
Congenital Cytomegalovirus infection (cCMV) is the most common cause of preventable sensorineural
hearing loss, occurring in 0.5% of all live births. Overall, it is estimated to cause of 8% of all hearing
losses and up to 20% of all idiopathic hearing loss. Despite this there is no screening for cCMV in most
countries. Treatments such as antiviral medications can potentially prevent permanent hearing loss
when given within 30 days of birth. This requires early screening before 3 weeks of age to accurately
diagnose cCMV. This study will review the Iiterature supporting the need for newborn cCMV screening
and introduce a landmark study we are about to undertake in Western Australia.

MATERIALS AND METHODS

This study will run over two years and enrol infants who fail their newborn hearing screen to undergo
cCMV saliva testing. Infants who test positive for the virus will be followed to determine the natural
history of their clinical progression and hearing loss. The study will also measure the incidence of cCMV
infection and to determine if early antiviral therapy is effective.

RESULTS
This study has the potential determine if routine early screening and therefore early treatment for cCMV
related hearing loss can improve outcomes. This could transform the management of congenital
sensorineural hearing loss in the region and contribute knowledge to this emerging field.

CONCLUSIONS
Newborn cCMV screening is a viable option and should be pursued in order to diagnose and potentially
treat the most common cause of preventable hearing loss. We urge other ASEAN countries to undertake
a similar study.
POSTER # P-125

THE INCIDENCE OF COCHLEAR NERVE ANOMALIES IN PAEDIATRIC SINGLE SIDED DEAFNESS

POLLAERS, Katherine [1]; THOMPSON, Andrew [2]; KUTHUBUTHEEN, Jafri [1]

1- Department of Otolaryngology Head and Neck Surgery, Perth Children’s Hospital, Perth,
Australia
2- Department of Medical Imaging, Perth Children’s Hospital, Perth, Australia

OBJECTIVES
Single sided deafness cochlear implantation is an emerging treatment option for children with
congenital hearing loss. The aim of this study is to describe the incidence of cochlear nerve anomalies in
patients with asymmetrical sensorineural hearing loss as part of the workup for cochlear implantation.

MATERIALS AND METHODS

This was a retrospective case series in a tertiary referral centre. Paediatric patients with bilateral or
unilateral sensorineural hearing loss, or unilateral deafness, who were investigated with Magnetic
Resonance Imaging (MRI) were examined retrospectively. The incidence of cochlear nerve hypoplasia or
aplasia were examined as well as the incidence of other anatomical abnormalities.

RESULTS
Of the 72 patients with unilateral sensorineural hearing loss, 39% (28 cases) had absent or hypoplastic
cochlear nerves on the affected side. 15% (11 cases) had other abnormal findings on MRI. 84 patients
had bilateral sensorineural hearing loss of which cochlear nerve hypoplasia or aplasia was identified only
in 5% (4 cases). Other abnormal findings were identified in 12 cases.

CONCLUSION
Paediatric patients with unilateral sensorineural hearing loss are more likely to have cochlear nerve
anomalies than those patients with bilateral sensorineural hearing loss. This has important implications
in the management of patients with congenital single sided deafness where cochlear implantation
requires the presence of a functioning cochlear nerve.
POSTER # P-126

FALSE POSITIVE DIFFUSION WEIGHTED MRI IN THE DETECTION OF CHOLESTEATOMA

ESMAILI A Aaron [1]; HASAN Zubair [1]; WITHERS Shannon [2]; KUTHUBUTHEEN Jafri [1,2]
1- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
2- Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth,
Australia

OBJECTIVES
Cholesteatoma is a common inflammatory middle ear process characterised by trapped keratinous
debris within a squamous epithelial sac exhibiting autonomous growth and bony erosion. Although the
diagnosis of cholesteatoma is predominantly made on clinical grounds, the utilisation of diffusion-
weighted imaging (DWI) on magnetic resonance imaging (MRI) has been increasingly utilised to detect
cholesteatoma with very high sensitivity and specificity in the diagnosis and follow up after
cholesteatoma surgery. However cases of false positive results have been poorly reported or identified.
The aim of this paper was to review a group of patients with confirmed false positive DWI and review
the various aetiologies and clinical presentation.

MATERIAL AND METHODS

A retrospective case based review of 12 identified patients was undertaken. Data on the clinical
features, imaging, and intraoperative samples obtained were collated. In all patients, the presence of
DWI positivity within the cohort was considered as a likely case of cholesteatoma in which surgical
treatment was then recommended. The supposed cholesteatoma tissue was collected for
histopathology.

RESULTS
There are various unique aetiologies identified which have been shown in our series to result in a for
false positive DWI, Some of these have never been reported in the literature including ceruminous
adenoma, cholesterol granuloma, ceruminous debris, chronic inflammatory tissue and inclusion
epidermoid. In all cases, the pre-clinical suspicion for cholesteatoma was intermediate

CONCLUSION
In assessing the MRI DWI scan results for cholesteatoma it is important to consider the possibility of a
false positive result.
POSTER # P-127

RADIOLOGICAL FINDINGS IN SPONTANEOUS CEREBROSPINAL FLUID (CSF) OTORRHOEA

HENDRIKS Tom [1]; BOEDDINGHAUS Rudolf [2]; THOMPSON Andrew [3]; KUTHUBUTHEEN Jafri [4]

1- Department of Otolaryngology Head and Neck Surgery, Fiona Stanley Hospital, Perth, Australia
2- Perth Radiological Clinic, Perth, Australia
3- Department of Medical Imaging, Perth Children’s Hospital, Perth, Australia
4- Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth,
Australia

OBJECTIVES
Spontaneous cerebrospinal fluid otorrhoea (sCSF) occurs in the absence of an identifiable cause. There
appears to be an increased incidence of sCSF possibly related to an obesity epidemic. Prompt and
accurate diagnosis is essential but remains difficult due to the subtle clinical presentation. Radiology is
often a key objective test, This study aims to describe the radiological findings in patients presenting
with sCSF.

MATERIALS AND METHODS

A retrospective cohort study was conducted in Western Australia with twenty-eight patients included
between 2013-2018. Baseline demographics and radiological features identified on CT and MRI were
collected. These included: tegmen defect sizes and locations, fluid within the middle ear or mastoid,
degree of mastoid development, and evidence of idiopathic intracranial hypertension (IIH).

RESULTS
There was a female predominance (n=17) with a mean age of 66 years. All patients underwent a CT
and/or MRI. Despite only two patients presenting with bilateral CSF leaks, bilateral defects were
identified in 26 patients. Anterior tegmen mastoideum defects were most common with an average size
of 2.6mm (range 1-9mm). Most patients had fluid present in the middle ear or mastoid but
cephalocoeles were rare (3.5%). Only three patients had strong evidence for IIH.

CONCLUSIONS
This study is in contrast to the literature in that only a minority of patients had radiological evidence of
IIH indicative that this pathology may contribute to but is not the sole cause of sCSF. Bilateral defects
were extremely common which is cause for concern given most patients presented with unilateral leaks.
POSTER # P-129

HEARING LOSS IN AGEING ETHNIC CHINESE SINGAPOREANS: A POPULATION BASED STUDY

PANG Khang Wen [1]; LEE Gary [1]; JAYAKODY Dona [2]; EIKELBOOM Robert [2]; KOH Emily [3];
NICHOLAS Sean [3]; TEO Nigel [3]; YAP Philip [4]; WEE Shiou Liang [3]; NG Tze Pin [5]; HEYWOOD
Rebecca [1,2]
1 – Department of Ear, Nose & Throat (ENT) – Head & Neck Surgery, Ng Teng Fong General Hospital,
Singapore; 2 – Ear Science Institute Australia & Ear Sciences Centre, Medical School, University of
Western Australia; 3 – Geriatric Education and Research Institute, Singapore; 4 – Department of
Geriatric Medicine, Khoo Teck Puat Hospital, Singapore; 5 – Department of Psychological Medicine,
National University of Singapore, Singapore

OBJECTIVES
This study investigated the prevalence and profile of hearing loss among participants in the Singapore
Longitudinal Ageing Study (SLAS), a population-based longitudinal study of ageing and health of
community-dwelling Singaporeans >55 years.

METHODS
244 subjects (160 female, 84 male; mean age 71.6 years) were included. Pure tone audiometry was
performed using an automated audiometer. First spoken language (L1) was recorded.

RESULTS
45.1% of participants had hearing loss. The degree of hearing loss based on better ear pure tone average
air conduction thresholds at 0.5, 1, 2 and 4kHz (4FA) was mild (26-40dB) in 35.3%, moderate (41-70dB)
in 9% and severe to profound (≥71dB) in 0.8%. Better ear 4FA ranged from 6 to 90dB. Asymmetry
between the better and worse ears (≥15dB) was present in 4.8%. Conductive hearing loss (4FA ABG
≥15dB) in at least one ear was present in 7.9%. Only 17% of the 10.9% of subjects with a disabling
hearing loss of >40dB 4FA wore a hearing aid. Univariate analysis demonstrated that 4FA was first
language dependent (English 4FA 26.5dB, SD 13.5; Mandarin 4FA 32.1dB, SD 15.9; Cantonese 4FA
36.2dB, SD 19.1; Teochew 4FA 37.0, SD 8.7; Hokkien 4FA 41.1dB, SD 20.8).

CONCLUSION
Audiological features that may indicate significant pathology were present in a minority of subjects.
Despite the prevalence of hearing loss in older Singaporeans, the uptake of hearing rehabilitation is
extremely low. Further studies of other risk factors for hearing loss among dialect speaking groups are
warranted.
POSTER # P-130

OSSICULOPLASTY WITH OSSICLE VS. CARTILAGE- FUNCTIONAL OUTCOMES ACHIEVED WITH DIFFERENT
METHODS OF OSSICULOPLASTY

SAMAGA Shailashree, RAMALINGAM Ravi, RAMAKRISHNAMA Raju, KHAN Wasim Syed.

Otorhinolaryngology, KKR ENT Hospital and Research Institute, Chennai, India.

OBJECTIVES:
To study:
-The hearing outcome.
-Factors affecting successful outcome of ossiculoplasty.
-Functional outcomes achieved with different methods of ossiculoplasty.

MATERIALS AND METHODS:

Fulfilling the inclusion criteria, Ossiculoplasty was performed on 100 patients suffering from CSOM, age
ranging from 5 to 75 years and conductive loss of ≥ 25 dB; obtaining ethical clearance from the
committee. Pre-operative assessment included: chief complaints, pre-operative audiogram, status of
ear; intra-operatively: type of ossicular defect and the disease, the surgery performed, ossicular-
reconstruction material and postoperative follow up after 4th month to assess hearing and functional
outcomes.

RESULTS:
All cases had eroded incus and stapes suprastructure was present in 62% cases. Mean pre-operative,
post-operative PTA was 49.02 and 32.62 respectively. Mean pre-operative, post-operative AB gap was
38.18 and 17.93 respectively. The gain in Air Conduction Threshold and in AB gap was 17 dB and 21 dB
respectively. Clinically, ossicular graft was superior to cartilage graft, statistically insignificant though.
Success rate in intact stapes supra structure was 53% but without stapes suprastructure exhibited 25%
success rate. No association was observed between the type of CSOM and the outcome post
ossiculoplasty. However, MSA had better outcome followed by myringostapedopexy and
myringoplatinopexy.

CONCLUSION:
The study shows significant hearing improvement with ossiculoplasty. Prognostic factors for successful
outcome were use of autologous ossicle, pure conductive hearing loss pre-operatively and intact stapes
suprastructure. Functional outcomes obtained were hearing gain ≥20 dB, with better results with MSA,
myringostapedopexy, myringoplainopexy in decreasing order; dry ear, no recurrence, and no extrusion
of the graft.
POSTER # P-177

FALSE POSITIVE DIFFUSION WEIGHTED MRI IN THE DETECTION OF CHOLESTEATOMA

Esmaili AA, Hasan Z, Withers S, Kuthubutheen J

Fiona Stanley Hospital, Western Australia Sir Charles Gardner Hospital, Western Australia

INFORMATION / BACKGROUND
• Cholesteatoma is a common inflammatory middle ear process characterised by trapped keratinous
debris within a squamous epithelial sac exhibiting autonomous growth and bony erosion. Although
the diagnosis of cholesteatoma is predominantly made on clinical grounds the utilisation diffusion-
weighted imaging (DWI) on magnetic resonance imaging (MRI) has been increasingly utilised to
detect cholesteatoma with very high sensitivity and specificity. However rare false positive cases
have been reported and identified.
• The aim of this study was to review a group of patients with confirmed false positive DWI with a
focus of identifying the various aetiologies and clinical characteristics.

MATERIALS AND METHODS

• A retrospective case based review of 13 patients was undertaken. Data on the clinical features,
imaging and post- operative histopathology was collated and presented.

RESULTS
• There are various unique aetiologies identified for false positive DWI, some of which have never
before been reported in the literature including ceruminous adenoma, cholesterol granuloma,
ceruminous debris and chronic inflammatory tissue (table 1 & figures)
• 8 of the 13 patients had history of previous otological surgery.

CONCLUSION
• In assessing MRI DWI for cholesteatoma, especially in the setting of previous surgery, it is important
to consider the possibility of false positive result.

TABLE 1
FIGURES
POSTER # P-178

BONEBRIDGE SURGERY IN YOUNG CHILDREN

KUTHUBUTHEEN Jafri [1]; HERBERT Hayley [1]; LEEMING Pia [2]; CLACK Rachel [2]; CHASE Carl [2]
1- Department of Otolaryngology Head and Neck Surgery, Perth Children’s Hospital, Perth,
Australia
2- Department of Audiology, Perth Children’s Hospital, Perth, Australia

OBJECTIVES
The Bonebridge bone conduction implant is approved for children as young as 5 years of age. Given the
size of the BC-FMT, there have been perceived limitations of its use in young children due to the
expected lower degree of mastoid pneumatisation. We present our experience with children implanted
with the device, including the youngest recipient of the device in Australia to date.

MATERIALS AND METHODS:

Eleven patients receiving the Bonebridge implant at our institution are presented between 4.5 years to
14 years of age. Three patients were aged between 4.5 and 5.5 years. The indications included single
sided deafness, chronic suppurative otitis media, microtia (including Goldenhar syndrome). In all
patients, potential sizing of the BC-FMT was assessed by comparing its size to the degree of mastoid air-
cells pneumatisation on temporal bone CT scanning.

RESULTS:
All patients including our youngest recipient were considered to have adequately pneumatised mastoids
to facilitate insertion. Most patients required a 1mm and 2mm lift kit to allow fitment to the temporal
bone curvature and in the majority, the sigmoid sinus and dura were identified and skeletonized. In a
10-year-old patient, the sigmoid sinus and middle cranial fossa were decompressed which surprisingly
was not required in our youngest patient. All patients had significant improvements in aided thresholds
and there were no surgical complications.

CONCLUSION
The Bonebridge implant can be used successfully in children just under the recommended age of
implantation. Mastoid air cell pneumatisation rather than age alone should be considered in
determining candidacy.
POSTER # P-184

FACTORS DETERMINING REGULAR HEARING AID USE IN THE ELDERLY

NG Janet Ho-yee [1] ; LOKE YUEN Alice [1]
1 – Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
SAR

OBJECTIVES
Presbycusis management with hearing aids involves a series of health behaviours including seeking
hearing assessments, acquiring hearing aid, and subsequent regular use. Since the introduction of the
International Classification of Functioning, Disability and Health, audiology practitioners have started to
consider presbycusis beyond the audiogram. This study aims at identifying factors determining regular
hearing aid use among elderly in Hong Kong.

MATERIALS AND METHODS

The cross-sectional study used a questionnaire to collect information on self-perceived hearing
handicap, attitudes towards hearing loss, hearing aid outcomes, satisfaction, and demographics.
Severity of hearing loss was assessed by pure tone audiometry. The study sample comprised 86 Chinese
aged 60 years or above, with sensorineural hearing loss, from private audiology clinics in Hong Kong.

RESULTS
The mean age of participants was 78 years old; with the majority (82.6%) had at least moderately severe
hearing loss. More than three-quarters (75.6%) of participants had behind-the-ear hearing aids and
binaural rate was 37.2%. Results of binary logistic regression analysis found that impact on others,
positive effects of amplification, severity of hearing loss, coupling with the suppression effect of morning
walk as daily activities, were significant factors determining longer daily hours of hearing aid use.

CONCLUSION
Perceived benefits associated with impact of presbycusis on others was found to be a strong factor
determining regular hearing aid use in elderly, alongside other factors. This novel finding has provided
audiology practitioners emergent evidence to consider the role of significant others in optimal
presbycusis management with hearing aids.
POSTER # P-185

CHRONIC SUPPURATIVE OTITIS MEDIA IN PATIENT WITH COCHLEAR IMPLANT; ONE-STEP SURGERY

WAHYUDIONO Ahmad Dian [1,3,5] ; PRIYONO Harim [2,4]

1 – ORL-HNS Department, Medical Faculty of Brawijaya University, Jakarta, Indonesia; 2 – ORL-HNS

Department, Medical Faculty of Indonesia University, Jakarta, Indonesia ; 3 - ORL-HNS Department, Dr
Saiful Anwar General Hospital, Malang, Indonesia ; 4 - ORL-HNS Department, Dr Cipto Mangunkusumo
National Center General Hospital, Jakarta, Indonesia ; 5 - Persada Hospital, Jakarta, Indonesia.

ABSTRACT
BACKGROUND.
Chronic suppurative otitis media (CSOM) in patients with cochlear implant were report in some cases.
The infection may spread along the main electrode into scala tympani.

OBJECTIVE.
This case report has purpose to discuss the management of CSOM in patient with cochlear implant.

CASE.
Female, 4 years old with unilateral implantation on the right ear in October 2015. At the time of surgery
was found middle ear effusion. In the middle year of 2017, there was recurrent infection and resolve
with antibiotic. Evaluation on August 2018 showed the main electrode has been exposed into ear canal.
The second white marker ring is clearly seen and the dacron mesh is positioned medial to the electrode.
CT scan shows the length of intra cochlear electrode is 21 mm. The first marker is at round window or
cochleostomy site and the second marker is at tympanic membrane level. The revision done in one-step.
The surgery begins with remove all infected tissue in mastoid cavity and middle ear followed by cartilage
tympanoplasty. Intra cochlear electrode explant and the new electrode implant directly. Evaluation after
surgery, tympanic membrane was intact and hearing evaluation after switch on show the same result
with the hearing before surgery.

CONCLUSION.
Middle ear effusion is the sign of risk of CSOM in patient with cochlear implant. One-stage operation for
explant and re implant the new electrode in patients cochlear implants with CSOM will reduce costs and
can provide the same hearing result.
POSTER # P-186

DETECTION OF HEARING IMPAIRMENT ASSOCIATED WITH POSITIVE RUBELLA ANTIBODY TEST IN

WAHIDIN SUDIROHUSODO HOSPITAL AMONG 2016 TO JUNE 2019

PUJIATI Rizke Ayu [1,2], SAVITRI Eka [1,2], DYAH Trining [2], WARTATI Sri [2]

1 - ENT Department, Wahidin Sudirohusodo Hospital, Makassar, Indonesia ; 2 - Otolaryngology

Department, Hasanuddin University Makassar, South Sulawesi, Indonesia ;

INTRODUCTION
Rubella infection can affect several organs and cause birth defects that are responsible for congenital
rubella syndrome (CRS). Infants with CRS often present with more than 1 sign or symptom consistent
with congenital rubella infection. However, infants may present with a single defect, with hearing
impairment being the most common single defect.

OBJECTIVE
To perform the screening of hearing impairment using OAE test and its correlation to rubella antibody
test IgG and IgM.

MATERIAL AND METHOD

The data were conducted using comprehensive search from medical record department in Wahidin
Sudirohusodo Hospital from January 2017 through June 2019. Inclusion criteria were those who tested
OAE and undergoing screening rubella antibody test.

RESULT
The total sample were 58 ears which consist the result by OAE test with 30 pass (51.7%) and 28 refer
(48.3%). Among these ears there were 5 pass and 17 refer with Rubella antibody IgG positive IgM
positive, 19 pass and 9 refer with Rubella antibody IgG positive IgM negative, 4 pass and 0 refer with
Rubella antibody IgG negative IgM negative, and 0 pass and 2 refer with Rubella antibody IgG negative
and IgM positive.

CONCLUSION
The results of the screening showed that patients who had hearing impairment according to the OAE
test results refer within Rubella antibody IgG positive, IgM positive as many as 17 out of 23 ears (77.3
%). For further examination should be perform BERA and ASSR to plan the using of hearing aid or
cochlear implant.
POSTER # P-187

OUTCOMES OF CARTILAGE GRAFT ENDOSCOPIC MYRINGOPLASTY; A RETROSPECTIVE REVIEW

THURAIRAJU Ruthran; RAJAN Philip; YIN Sze Ng; POSPANATHAN Pravina; NALATAMBY Siri Kavita
ORL department Hospital Raja Permaisuri Bainun Ipoh Perak Malaysia

OBJECTIVES
To investigate the outcome of endoscopic myringoplasty using tragal cartilage or a composite tragal
cartilage/perichondrium graft in the surgical management of inactive mucosal chronic otitis media.
Outcomes are measured in terms of surgical closure of the perforation and improvement of mean
audiometric air-bone gap.

METHODS AND MATERIALS

A retrospective study on transcanal endoscopic myringoplasty from 2016- 2019 in a tertiary health care
centre. Case records from the ORL clinic were reviewed. Data was collected and tabulated according to
size of perforation, graft type, underlay or overlay method and post-operative closure of perforation.
Pre and postoperative mean air-bone gap at 3 months measured at 500 Hz, 1 kHz and 2 kHz was
calculated.

RESULTS
Of the 73 number of patients 44 were females and 29 were males. Mean age was 39.6.In 73 ears 60 ears
achieved complete closure.12 were revision surgeries. The mean air bone gap pre- operatively was
26.06 dB. The average air bone gap post operatively was 17.15.The average improvement of air bone
gap was 8.91. 61 number of overlay method and 12 number of underlay method. The success rate was
82%.

CONCLUSION
Endoscopic myringoplasty with tragal cartilage success rate was 82% in this series. This is comparable to
conventional microscopic approach.
POSTER # P-188

PEDIATRIC LATERAL SINUS THROMBOSIS CAUSED BY ACUTE MASTOIDITIS

KRISHNAMOORTHY Madhusudhan[1] ; MOHAMAD Sakinah[1] ; MD DAUD Mohd Khairi [1]
1-Department of Otorhinolaryngology and Head&Neck Surgery, Universiti Sains Malaysia, Kota Bharu,
Malaysia

OBJECTIVES
To be wary of lateral sinus thrombosis as a rare complication of acute mastoiditis which can readily
occur in the younger pediatric age group.

MATERIALS AND METHOD

Computed tomography imaging features were suggestive of right sided mastoiditis. It was further
complicated with extensive venous thrombosis from the sigmoid – transverse sinus up to the right
internal jugular vein.

RESULTS
Radiologic examination showed long segment filling defect of the right internal jugular vein. The right
sternocleidomastoid appeared bulky and heterogenous. The right mastoid air cells were filled with fluid
and poorly aerated.

CONCLUSION
We wish to highlight a case of lateral sinus thrombosis as a result of mastoiditis. The treating physician
and the reporting radiologist should always bear in mind such entities especially when dealing with
limited history from an ill child.
POSTER # P-189

FACTORS RELATED TO QUALITY OF LIFE IN ELDERLY IN URBAN AREA SURAKARTA INDONESIA

VIAKHANE. Berlian Agusti, ANGGRAINI. Aulia Hervi, PRATIWI Dewi
Department of Otorhinolaryngology Head and Neck Surgery Faculty of Medicine Sebelas Maret
University, Surakarta, Indonesia.

OBJECTIVE:
Health problem and poor quality of life are biggest problems which become main focus in elderly, but
still be a neglected issues especially in developing countries. The association between quality of life and
its releated factors among elderly were investigated in this study.

MATERIAL AND METHODS:

This cross sectional study was conducted on 70 elderly in primary health care in Surakarta from June to
August 2019. Hearing impairment according to World Health Organization (WHO) was defined as a pure-
tone average of the thresholds at 0.5, 1, 2, and 4 kHz > 25 dB Hearing Level for the better ear.
Information concerning potential confounders including hypertension ,diabetes mellitus, visual
impairment and sleep disorder was obtained by interview. World Health Organization Quality of Life
Instruments (WHOQOL-BREF) used to measure QOL, consists of 4 domains , physical health ,
psychological , social relationships , and environment . Statistical analysis using Eta test and multiple
linear regresion analysis.

RESULTS:
Majority of the participants were male, mostly in 60-64 y.o age group, 47.1% had moderate hearing
impairment (mean 46.6 dB).Overall meant score of QOL was found to be average, with the lowest mean
score was physical domain and the highest was environment domain. Hypertension and visual
impairment were found to be significant factors in physical and social relationship domain of WHOQOL,
while only sleep disorder was found to be significant in psycological domain of WHOQOL. Hearing
impairment was significantly associated with environment domain of WHOQOL.

CONCLUSION:
Increasing health awareness in elderly by using hearing aid, wearing glasses, control of hipertension
and diabetes mellitus also giving intervention to improve sleep disorder will increase quality of life
among them
Paediatric ORL
POSTER # P-072

GILAL CHORISTOMA: AN UNUSUAL CASE OF A CONGENITAL TONGUE MASS IN A NEONATE

ZHEN, Emily (MBBS), BILISH Darin, (MB ChB, FRACS), THOMPSON, Andrew (MBBS, FRANZCR)
Department of Otolaryngology Head and Neck Surgery, Perth Children’s Hospital, Perth, Western
Australia, Australia.
Department of Radiology, Perth Children’s Hospital, Perth, Western Australia, Australia.

OBJECTIVES
To describe an unusual case of glial choristoma in a neonate who presented with a large congenital
lateral tongue lesion.

MATERIALS AND METHODS

This was a case report of a female neonate who presented at 3 weeks of life with a large mass at the
right lateral tongue. The mass was diagnosed when patient presented with feeding difficulties. On
examination, a large 1.5cm mass was noted arising from right lateral border of the tongue, sparing
tongue base and floor of mouth. The mass was firm, immobile and non-pulsatile. Overnight oximetry
revealed no desaturations. There was no airway compromise, however light snoring was noted during
admission. Patient underwent a MRI head and an incisional biopsy. Intraoperatively a fleshy, poorly
vascular lesion was noted. Histopathology examination found the mass to be a glial choristoma. Patient
is planned for elective complete excision of lesion.

RESULTS
Glial choristoma of the tongue is an extremely rare entity. Currently only a few case reports have
described this congenital malformation on the tongue. The clinical behavior of oral glial choristoma
varies depending on the age at onset as well as the location and size of the mass.

CONCLUSION
Glial choristoma is a rare and interesting diagnosis for congenital tongue lesions. It is benign in nature
but there is a risk of airway compromise and obstructive sleep apnoea in neonates and infants.
Physicians should be aware of it as a differential in congenital tongue lesions and its management
options.
POSTER # P-073

BACTERIOLOGY OF THE ADENOID AND ASSOCIATION WITH CLINICAL PRESENTATION IN PEDIATRIC

PATIENTS WITH ADENOID-RELATED DISEASES

UNGKANONT Kitirat [1] ; JOOTAKARN Sujeenun [1] ; TANPHAICHITR Archwin [1]; VATHANOPHAS
Vannipa [1]
1 – Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Thailand

OBJECTIVES
To study the bacterial culture of the adenoid, and to explore the relationship of adenoid bacteriology
with adenoid size and clinical presentation.

MATERIALS AND METHODS

Bacterial cultures of the adenoid obtained from adenoidectomy from August 2005 to December 2018
were reviewed. The adenoid sizes were measured in the lateral skull x-ray. Association between culture
results and the diagnosis, age group and adenoid-nasopharyngeal ratio were analysed.

RESULTS
We reviewed 407 pediatric cases who underwent adenoidectomy for otitis media, obstructive sleep
disorder and chronic sinusitis. Median age was 5.9 years and 60.9% of the patients were between 3 to 7
years old. Six most common pathogenic bacteria were Haemophilus inflenzae (26.2%), Staphylococcus
aureus (23.5%), Streptococcus pneumoniae (18.2%), Moraxella catarrhalis (12%) and Streptococcus
pyogenes (2.37%). Significant association was found between younger age group and higher prevalence
of Streptococcus pneumoniae (p<0.001). Moraxella catarrhalis was most prevalent in patients between
3-7 years old. Higher prevalence of Staphylococcus aureus was associated with increasing age (p=0.002).
Haemophilus inflenzae had similar prevalence in all age group. Streptococcus pyogenes was the only
bacteria that had significant association with adenoid size greater than 70% (p=0.017). Diagnosis of
adenoid-related diseases had no association with types of bacteria in the adenoid culture.

CONCLUSION
Pathogenic bacteria was found in the adenoid of children with adenoid-related diseases. The diagnosis
had no association with any particular bacteria from the culture. Age group had significant association
with Streptococcus pneumoniae and Staphylococcus aureus. Greater size of the adenoid had significant
association with Streptococcus pyogenes.
POSTER # P-074

THE TREND OF CLEFT CARE AT A CHILDREN’S REFERRAL CENTER IN THAILAND

Dhave Setabutr, MD,1,2 Thanakrit Sathavornmanee, B.S.2, Polpatt Jitpakdee,

B.S.2, Songphon Nudchawong, M.D.2, Penpak Krergmatukorn, M.D.3

1. Department of Otolaryngology, Queen Sirikit National Institutes of Health, Bangkok,

Thailand
2. Chulabhorn International College of Medicine, Thammasat University, Pathum Thani,
Thailand
3. Department of Plastic Surgery, Queen Sirikit National Institute of Children’s Health,
Bangkok, Thailand

OBJECTIVE
To investigate the trend in cleft care at a major children’s referral center in
Bangkok, Thailand.

STUDY DESIGN
Retrospective chart review.

SUBJECTS AND METHODS

A review of one-hundred twenty-nine patients under 18 years of
age who had underwent care by the Senior author for cleft treatment between January of
2015 to October of 2017 was done. The impact of varying factors on patient care was
analyzed. We compare our demographics and treatment timeline to that of previously
published literature in more developed countries.

SETTING
Tertiary care medical center.

RESULTS
One hundred and two patient charts were reviewed with 53% male patients.
Most patients had both cleft lip and palate, 44%. Cleft lips most commonly were
complete and occurred on the left side. 77.4 percent of cleft were non-syndromic. On
average, primary cleft lip surgery was performed before three months of age (2 months,
24 days). Sixteen percent of patients were treated with an obturator, while 11 patients
had NAM use. Hearing screenings occurred on average at around six months of age.
Abnormal tympanograms were evident in 32 percent of individuals. There was no
statistical significance in timing of surgery for patients who lived a distance greater than
30 kilometers from the hospital versus those from Bangkok. (p > 0.05)

CONCLUSION
Reviewing data from a high-volume referral center in Thailand reveals little
variance with regards to cleft care timing compared to published literature from the
developed world. Distance was found to not have an impact on delay to surgery for
patients living outside of the city.
POSTER # P-075

NECROTIZING FASCIITIS IN THE PEDIATRIC HEAD AND NECK: CASE REPORT AND REVIEW OF THE
LITERATURE
UPAPANT Vissuta [1] ; PRAMMANSAKUL Natasha [1] ; PLASEN Navamol [1,2] ; PRASERTTRAKUL Chulaluk
[3] ; SETABUTR Dhave [2,4]
1 – Faculty of Medicine, Thammasat University, Pathum Thani, Thailand ; 2 – Department of
Otolaryngology and Head & Neck Surgery, Thammasat University Hospital, Pathum Thani, Thailand ; 3 –
Department of Otolaryngology and Head & Neck Surgery, Lerdsin Hospital, Bangkok, Thailand ; 4 –
Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand

OBJECTIVE
To present an interesting case and review the literature regarding pediatric necrotizing fasciitis in the
head and neck.

MATERIALS AND METHODS

We discuss an interesting case of necrotizing fasciitis (NF) involving the parotid gland occurring in a four-
year old Burmese female secondary to Chromobacterium violaceum. The patient suffered from quick
deterioration leading to sepsis, and disseminated intravascular coagulation. Following appropriate
diagnosis, aggressive debridement, antibiotic treatment, and resuscitation led to successful treatment of
the infection. We follow by then reviewing the literature regarding incidence, common pathogens, and
appropriate treatment strategies for this rare entity. Literature analysis of case reports was performed.
PUBMED was searched for the terms "pediatric necrotizing fasciitis", and "necrotizing fasciitis in the
head and neck."

RESULTS
A review of NF in the pediatric population found only 25% presented in the head and neck. A total
number of 15 cases of pediatric necrotizing fasciitis in the head and neck region have been reported in
the English literature. We reviewed a total of 13 manuscripts, of which 12 were case reports. Nearly half
(41%) of cases reported Group A beta-hemolytic Streptococcus (GAS) as the causative organism. The
mortality rate from pediatric NF of the head and neck region is quoted as 17%. The average age of
patients with NF in the head and neck region was 4.5 years.

CONCLUSION
Pediatric necrotizing fasciitis remains a rare and deadly infection in the head and neck. Effective
management of the disease involves early and aggressive surgical debridement along with broad
spectrum antibiotics and nutritional support.
POSTER # P-076

DIAGNOSIS OF PEDIATRIC FEEDING DIFFICULTIES: A SERIAL CASE REPORT

ANATRIERA Raden Ayu1, TAMIN Susyana1, ZULKA Elvie1, WAHYUNI Luh Karunia2
1. Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine Universitas
Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
2. Department of Physical Rehabilitation, Faculty of Medicine Universitas Indonesia, Cipto
Mangunkusumo Hospital, Jakarta, Indonesia

OBJECTIVES
Swallowing is a complex sensorimotor process involving the mouth, tongue, pharynx, larynx, and
esophagus. Interference of this process results in feeding difficulties. In children, feeding difficulties
should be taken seriously because of the impact on child development, which could reduce their quality
of life. Disorders of feeding difficulties occur when children are unable or find it difficult to eat or drink
the quantities required to maintain an optimal nutritional status.

MATERIALS AND METHODS

We reported three cases of pediatric feeding difficulties influenced by various factors such as patient’s
condition, the delayed introduction of age-appropriate food consistencies by parents, and the
environment. The diagnosis were confirmed by history taking and fiberoptic endoscopic evaluation of
swallowing.

RESULTS
All three cases had demonstrated feeding difficulty in the oral phase but no abnormalities of the
pharyngeal phase. Two patients kept refusing to eat while other showed an uncooperative gesture with
tongue propulsion. All cases are managed by increasing parents’ awareness about eating habit, food
modification based on their age to attract the appetite. Oromotor exercises was performed when
medical issues are identified and controlled, and issues of postural alignment and support have been
addressed.

CONCLUSION
Evaluation swallowing function should be carried out which plays a role in diagnosing the case.
Combination of eating habit, oromotor exercise, and food modification to improve nutritional status are
the main goals of treatment.
POSTER # P-077

SURGICAL AND ANESTHETIC MANAGEMENT OF TRACHEOBRONCHIAL FOREIGN BODY REMOVAL :

CASE REPORT

WONG Bao Ling [1]; HENG Pek Ser[1]; TANG Chian Ling[1]; LIM Eng Haw[2]
1 – ENT Department, Hospital Sibu, Sarawak, Malaysia
2 – ENT Department, Hospital Miri, Sarawak, Malaysia

OBJECTIVES
Tracheobronchial foreign body (FB) is a common surgical emergency in childhood. It can result in serious
morbidity and mortality if management is delayed. One should raise the suspicion when there is
suggestive history of foreign body ingestion or aspiration.

CASE PRESENTATIONS
This 11 years old girl complained of foreign body ingestion and odynophagia but was suspected to have
aspirated the foreign body as foreign body was shown in the airway from the lateral view of neck X-ray.
Examination with flexible laryngoscope confirmed the foreign body lodged in the trachea. Rigid
bronchoscopy was performed under general anesthesia to remove the foreign body. After gas induction,
the foreign body was found dislodge further down to the right secondary bronchus. In this case,
inhalation and intravenous anesthesia with spontaneous ventilation were applied throughout the
procedure. The foreign body was successfully removed with optical forceps. Patient was discharged well
48 hours post-operation.

CONCLUSION
In cases of suspected foreign body aspiration, two views plain radiograph is the most cost-effective and
useful in aids of diagnosis. Rigid bronchoscopy is a challenging procedure which is remained as gold
standard technique for diagnostic purpose and removal of foreign body. In addition, the anesthesia in
managing airway foreign body is challenging as there is high risk of hypoxemia during the ‘shared
airway’ while performing bronchoscopy. Hence, communication between anesthesiologist and surgeon
is essential for optimal outcome.
POSTER # P-078

FOREIGN BODY ASPIRATION-OUR EXPERIENCE IN PAEDIATRIC POPULATION

INTRODUCTION
Foreign body airway is a common cause of morbidity and mortality in children. Virtual
bronchoscopy is a new investigative technique useful in locating non radiopaque FB missed
on plain radiography.

OBJECTIVES
To study the clinical profile of patients with suspected foreign body aspiration and
to evaluate the changing trends in the diagnosis and quicker management of foreign body
aspiration as a way of virtual bronchoscopy.

METHODS
This was a retrospective and prospective cross sectional study conducted in the
Department of otorhinolaryngology M.G.M.M.C &M.Y hospital Indore for a period of ten years. The
medical records of patients with foreign body aspiration, from august 2006 to September 2016 were
reviewed. Data was collected regarding their clinical presentation ,examination and chest x-ray, virtual
bronchoscopy, rigid bronchoscopy findings. Patients with suspected foreign body aspiration were
subjected to virtual bronchoscopy and rigid bronchoscopy was performed.

RESULTS
In the 150 subjects, we observed mean age group of presentation was 2.1 years, Male is to
female ratio was 4.1, 70% of the cases came from the rural areas,86% were vegetative foreign bodies,
and remaining non vegetative were aspirated mostly during the winter season. Betel nut was the most
common aspirated foreign body.63% had a positive history of foreign body aspiration, where as 37% had
a negative history .Right main bronchus was the most common site of lodgement. Breathlessness and
reduced air entry were the most common symptoms and signs. We also observed, that chest radiograph
were normal in as many as 40% cases. Hence negative chest radiographs does not rule out FB. In 150
patients with foreign body aspiration, which was detected by virtual bronchoscopy ,148 patients were
diagnosed to have foreign body on rigid bronchoscopy . This amounts to a positive predictive value of
97.3% which was similar to the positive predictive value of rigid bronchoscopy which was 99%.

CONCLUSION:
Virtual bronchoscopy is the only imaging modality which gives 99.9 % reassurance about the
presence or absence of a foreign body ,because of its high sensitivity and specificity ,hence
proves to be a life saving tool.
POSTER # P-079

PEDIATRIC ADENOID MEASUREMENT COMPARED AMONG LATERAL SKULL FILM, FLEXIBLE

ENDOSCOPY, AND INTRAOPERATIVE RIGID TELESCOPY
PISUTSIRI Nattha, MD; VATHANOPHAS Vannipa, MD
Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand

OBJECTIVE
To investigate the correlation among adenoid size measured by lateral skull film, flexible endoscopy, and
intraoperative rigid endoscopy.

MATERIALS AND METHODS

A cross-sectional study was conducted in 43 pediatric patients who presented for ENT surgery during
July 2017-December 2018. All patients underwent preoperative lateral skull film, flexible endoscopy, and
intraoperative rigid telescopy.

RESULTS
The average adenoidal-nasopharyngeal (A/N) ratio from lateral skull film, flexible endoscopy, and
intraoperative rigid endoscopy was 72.9, 79.5, and 81.6, respectively. There was a moderate correlation
between A/N ratio from lateral skull film and intraoperative rigid endoscopy (Pearson’s correlation:
0.567, p˂0.001). Whereas, the A/N ratio from flexible endoscopy compared to intraoperative rigid
endoscopy yielded a strong correlation (Pearson’s correlation: 0.791, p˂0.001). From linear regression
analysis, intraoperative adenoid measurement was estimated from the result of flexible endoscopy
(intraoperative nasal telescopy: 0.72 [flexible endoscopy] +24.47). Intraoperative adenoid size was also
estimated from lateral skull film (intraoperative nasal telescopy = 0.65 [lateral skull film] +34).

CONCLUSION
Flexible endoscopy is an accurate method for adenoid measurement and nasopharynx visualization with
no radiation exposure. Although less accurate, the benefits of lateral skull film include availability in
every hospital for general doctor, and our correlation in this study can be applied to obtain the actual
size measurement of adenoid gland.
POSTER # P-080

TONGUE TERATOMA IN A NEWBORN

CARLOS Angeli [1] ; PONTEJOS Alfredo Quintin Jr. [1] ; GRULLO Precious Eunice
1 – Department of Otorhinolaryngology, Philippine General Hospital, Manila, Philippines

OBJECTIVES
Oral cavity mass in a newborn can compromise the airway. Despite its benign characteristic, tongue
teratomas have a high death rate due to airway obstruction. This case aims to emphasize the
importance of a multidisciplinary team adept to manage such situations.

MATERIALS AND METHODS

A 2-day old male was referred to our institution for a tongue mass. He was born full term, appropriate
for gestational age to a then 27 year old G1P0, via low segment Cesarean section in a provincial hospital.
Upon delivery, there was an ~10 cm widest diameter mass attached to the tongue. There was no
respiratory distress noted, and the APGAR score was 9, 9. The patient was then transferred to our
institution.

RESULTS
At 6 days old, excision with primary closure was done. The mass measured 10 x 8 x 4 cm, multilobulated
with solid and cystic components. Final histopathologic result showed mature cystic teratoma.

CONCLUSION
A multidisciplinary team including an obstetrician, neonatologist, otorhinolaryngologist, and
anesthesiologist, must be formed immediately after the findings of such an anomaly. A possibility of
respiratory distress at birth should be anticipated, therefore a quick and well-executed life-saving
procedure to protect the airway, including intubation, tracheostomy, or ex utero intrapartum technique
(EXIT) must be ready. It is thru a multidisciplinary approach that we can carefully and appropriately plan,
manage, and ensure the safety and welfare of our patients, as well as convert a potentially fatal airway
obstruction into a more controlled setting for the delivery of the baby.
POSTER # P-081

A CASE REPORT ON A 4-MONTH OLD FEMALE WITH SUBGLOTTIC HEMANGIOMA

TREATED WITH PROPRANOLOL
SARMIENTO Abigail [1]; TUAZON, Rene [1]; LABRA Patrick John [1]; HERNANDEZ, Anna
Kristine [1]
1 - Department of Otorhinolaryngology, College of Medicine, University of the Philippines
Manila, Metro Manila, Philippines

OBJECTIVES
To describe the first reported case of infantile airway hemangioma successfully treated with
propranolol.

MATERIALS AND METHODS

This is a case report. The setting is a tertiary hospital in the Philippines.

RESULTS
The patient is a 4-month old female who initially presented with stridor at three weeks of life. The
patient eventually underwent tracheostomy for progressive difficulty of breathing. Direct laryngoscopy
revealed a smooth, reddish, soft, compressible submucosal bulge on the right subglottic area almost
completely obstructing the airway with a Cotton-Myer grade of 3. She was treated with propranolol with
an initial dose of 0.15mL/kg (0.6mg/kg) twice daily, eventually increased to 0.4mL/kg (1.7mg/kg) twice
daily. She underwent monthly follow ups and serial endoscopies. After 11 months of propranolol, repeat
endoscopy revealed a subglottic narrowing of < 50% (Cotton-Myer Gr. I). The patient was eventually
decannulated.

CONCLUSION
Airway hemangioma remains a challenging disease entity in the field of Otorhinolaryngology. The utility
of propranolol in treating infantile hemangioma has just been recently established. Its advantages over
other modalities include being non-invasive, of rapid onset, avoids tracheostomy, prolonged steroid
therapy, manipulation of subglottic tissues or prolonged periods of intubation. It is now considered a
safe and effective alternative treatment. In the future, propranolol may prove to be the best medical
treatment for subglottic hemangioma.
POSTER # P-192

BILATERAL CHOANAL ATRESIA IN A 14 YEAR OLD MALE: A CASE REPORT

MOYA Heidi Jesse ALMAZAN, Natividad

Department of Otorhinolaryngology – Head and Neck Surgery, East Avenue Medical Center, East
Avenue, Diliman, Quezon City, Philippines

OBJECTIVES
To present a case of a 14-year-old male with persistent bilateral nasal discharge, congestion and
hyponasal voice. Patient has no history of respiratory distress after birth but mother had difficulty in
feeding the infant. On physical examination, patient’s face is long and narrow, with prognathism and
open mouth. Lips are pursed and dry.

MATERIALS AND METHOD

Anterior rhinoscopy was done which showed a bilaterally discharging nostrils with congested turbinates.
Nasal endoscopy showed medial bowing of both lateral nasal wall, atretic bilateral choana, with
thickened posterior septum. Radiologic imaging revealed a thin membrane separating the nasal cavity
from the nasopharynx at the level of pterygoids and the vomer is thickened which confirmed the
diagnosis. Patient underwent Endoscopic Posterior Septectomy.

RESULTS
Repeat endoscopy was done one year post-op which showed a bilaterally patent choana. There was air
passage on both nostrils with absence of mucous discharge. Patient’s voice was still hyponasal but was
described to be improved.

CONCLUSION
Bilateral Choanal Atresia in an adolescent is a rare condition. It is diagnosed after birth since newborns
are obligate nasal breathers. Signs and symptoms include increased breathing efforts and chest
retractions, followed by cyanosis. The initial management in acute cases is endotracheal intubation.
They would present with adenoid facie, chronically congested nose with thick mucus discharge. Nasal
endoscopy coupled with CT scan must done to confirm the diagnosis. The definitive treatment is
surgery. Endoscopic sinus surgery is still the most common and successful method for repair of choanal
atresia.
POSTER # P-193

ACCURACY OF AIRWAY/NASOPHARYNGEAL RATIO (A/N RATIO) MEASUREMENT ON LATERAL NECK

RADIOGRAPHY IN DIAGNOSING PEDIATRIC ADENOID HYPERTROPHY: AN EVIDENCE-BASED CASE
REPORT
Primarani Made Ayundari*, Pratiwi Yasmin Diah*, Fardizza Fauziah**
* Intern at ENT Departement, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo
National General Hospital, Jakarta, Indonesia
** ENT Departement, Faculty of Medicine, Universitas Indonesia/ Cipto Mangunkusumo National
General Hospital, Jakarta, Indonesia

ABSTRACT
OBJECTIVES:
Adenoid hypertrophy is a common occurrence in paediatric otolaryngology, often causing nasal
obstruction, snoring, and mouth breathing. Complications may lead to impaired development in
children. Nasoendoscopy has been defined as the reference test for adenoid hypertrophy, but this
specific tool can hardly be found in rural health facilities of archipelago countries. Alternatively, A/N
ratio measurement on lateral neck radiography can be used to establish the confident diagnosis of
adenoid hypertrophy.

MATERIALS AND METHODS:

Literature searches in three databases (PubMed®, Cochrane® and EBSCO®) were accomplished using
“adenoid hypertrophy”, “radiography”, and their synonyms as keywords. Inclusion and exclusion criteria
were implemented to select the appropriate studies. The chosen studies were appraised using the VIA
(validity, importance, applicability) criteria to determine their qualities.

RESULTS:
Three primary studies with good validities revealed that A/N ratio of lateral neck radiography had
sensitivity value of 17% – 41% and specificity value of 86% – 98%. High specificity indicated that A/N
ratio measurement method is a decent tool to confirm the diagnosis in patients who were suspected of
having adenoid hypertrophy. Therefore, this tool can be utilized as an alternative of nasoendoscopy to
establish the diagnosis of adenoid hypertrophy, even though its diagnostic value would not be able to
replace nasoendoscopy as a reference test.

CONCLUSION:
This report has proven that A/N ratio measurement method can be easily applied by ENT specialists,
especially those working in rural health facilities where advanced equipments are rarely accessible, to
confirm the diagnosis of adenoid hypertrophy.
POSTER # P-194

A CASE REPORT OF TRACHEOSTOMAL MYIASIS (CHRYSOMYA BEZZANIA LARVAE) IN A 7-YEAR

OLD BOY

PORSUELO-ESPINO, Frances Vida

Department of ENT-HNS, Southern Philippines Medical Center, Davao City,
Philippines

INTRODUCTION
Myiasis is the infestation by dipterous larvae feeding on the host’s tissues. It can be attributed to
multiple factors, most importantly poor sanitation. This paper aims to present a case of a 7-year old
boy with tracheostomal infestation by Chrysomya bezziana larvae. There are only a few reported cases
of Tracheostomal myiasis. An article reviewing related literature from 1990-2015 only resulted 11
reported cases.

CASE PROTOCOL
A 7-year old boy was brought for consult due to foul odor from the tracheostoma. 3 years prior, he
underwent tracheostomy for prolonged intubation for gunshot injury to the head. Four days prior,
patient developed foul odor from the tracheostoma, with associated pain. During the consult, upon
close inspection of the tracheostoma, there was foul gray discharge, tenderness and erythema of the
surrounding skin, and multiple live maggots.

MANAGEMENT AND OUTCOMES

Patient underwent tracheostoma exploration, debridement, removal of foreign body, and change of
tracheostomy tube. A total of 143 maggots were removed. After 48 hours of antibiotics and
tracheostomy care, there was neither erythema nor discharges. Flexible fiberoptic endoscopy revealed
no more presence of foreign body, but glottic adhesions were noted. Future plans include
microlaryngeal surgical removal of glottis adhesions and decannulation.

CONCLUSION
Prognosis is good with total elimination of larvae and debridement. Tracheostomal care is of utmost
importance. Although extremely rare, otorhinolaryngologists must still be aware of myiasis. As a rare
case report, this paper will add more information regarding myiasis.
POSTER # P-195

NASAL HIRUDINIASIS: A RARE CASE OF RECURRENT EPISTAXIS IN A SEVEN YEAR OLD FEMALE
RUIZ Ma. Irka [1] ; CACHUELA Joseph [1] ; ISAGUIRRE Raul Jerry [2]

1 - ENT-HNS Department, Southern Philippines Medical Center, Davao City, Philippines ; 2 –

Department of ENT, Kidapawan Doctors Hospital; Kidapawan City, Philippines

ABSTRACT
OBJECTIVE:
To present an interesting case of Nasal Hirudiniasis in a 10-year old female with recurrent epistaxis. The
paper highlights and emphasizes thorough, proper history taking and physical examination that’s
essential in accurately diagnosing a disease. The need for an early referral to an Otorhinolaryngologist
and proper diagnostics for appropriate analysis and early intervention in preventing possible
complications.

METHODS:
Design: Case Report
Setting: Tertiary Government Hospital
Patient: One

RESULTS:
A 10-year-old female presented with a one-year history of daily, unprovoked epistaxis, accompanied by
nasal obstruction at nighttime and a sensation of a moving foreign body in the nasal cavity. Video
endoscopy revealed a moving dark colored entity at the middle meatus. Removal of the foreign body
revealed a leech in three separate occasions. Computer tomography of the paranasal sinuses done
after the second episode of leech removal, revealed a hypodensity on the left maxillary sinus. Patient
underwent nasal endoscopy with creation of left antral window and left maxillary sinus exploration
under general anesthesia, ruled out the presence of leech in the sinus. The fluids that were collected as
specimen for pathology verified the absence of leech eggs.

CONCLUSION
Nasal hirudianisis should be considered by Otorhinolaryngologist and must be included in the
differential diagnosis of patients presenting with recurrent unprovoked epistaxis with nasal congestion;
most especially with a history of intake and immersion in fresh bodies of water or lives near fresh
water springs. Early detection and removal of nasal hirudianisis is essential in preventing airway
compromise leading possibly to death.
Rhinology, Allergy &
Skull Base Surgery
POSTER # P-131

A STUDY TO ASSESS THE STRUCTURAL INTEGRITY OF THE NEILMED® SINUS RINSE™ BOTTLE
FOLLOWING REPEATED MICROWAVE DISINFECTION CYCLES.

LEONG Samuel C [1]; GUO Li [2]; ZHAO Yuyuan [2]

1 – Department of Otorhinolaryngology – Head and Neck Surgery, Aintree University Hospital NHS
Foundation Trust, Liverpool, United Kingdom
2 – Centre for Materials and Structures, School of Engineering, The University of Liverpool, United
Kingdom

OBJECTIVES
To assess the changes in the structural integrity of the NeilMed® Sinus Rinse™ following repeated
microwave cycles to inform on how frequently these bottles have to be changed.

METHODS
To mimic real-life conditions, the bottle was rinsed under running tap water. Excess water was shaken
off before being placed in a microwave. The bottles were subjected to either 90 or 120 seconds
microwave for 50, 100, 150, 200 and 250 cycles respectively. Tensile and compression testing was
undertaken at the end of each prescribed microwave duration and number of cycles. Tensile testing was
reported as yield strength (defined as the stress at which a material begins to deform plastically) while
compression testing was reported as stiffness (defined as the extent to which a material
resists deformation in response to an applied force).

RESULTS
Changes in yield strength was noted after 90 seconds,100 cycles and 120 seconds,50 cycles compared to
a non-microwaved bottle. The stiffness of the bottle gradually decreased with incremental microwave
cycles. After 250 microwave cycles at 90 seconds, stiffness was significantly lower compared to a non-
microwaved bottle. At 120 seconds, stiffness was significantly lower after 200 cycles.

CONCLUSION
Although changes thermoplastic properties were identified, it is unknown at what microwave cycle the
bottle loses its flexibility to generate sufficient volume and pressure head. Assuming patients rinse twice
daily and microwave decontaminate the bottles after each use, the data does not support any revisions
in the manufacturer’s recommendation to change the bottles every three months.
POSTER # P-132

THE RELATIONSHIP BETWEEN THE SINO-NASAL OUTCOME TEST (SNOT-22) AND NASAL OBSTRUCTION
SYMPTOM EVALUATION (NOSE) IN PATIENTS REQUIRING SEPTAL SURGERY FOR NASAL OBSTRUCTION

LEONG Samuel C; KHONG Grace C

Department of Otorhinolaryngology – Head and Neck Surgery
Aintree University Hospital NHS Foundation Trust
Liverpool, United Kingdom

OBJECTIVES
To assess the relationship between the Sino-Nasal Outcome Test (SNOT-22) and Nasal Obstruction
Symptom Evaluation (NOSE) scale in order to provide greater understanding of the quality-of-life
domains assessed by the SNOT-22 instrument.

METHODS
Patients on the waiting list for septoplasty with or without inferior turbinate surgery. Pre-operative
SNOT-22, NOSE, peak nasal inspiratory flow (PNIF) were evaluated

RESULTS
Sixty patients (male = 34), with the mean age of 39.3 years were included in this study. The mean NOSE
score was 84.0 (Standard deviation, SD 14.2) and SNOT-22 was 52.5 (SD 23.3). The mean PNIF was 85.3
L/min (SD 35). There was strong correlation (r = 0.72) between the total SNOT-22 and NOSE scores
(p<0.05). Both sleep dysfunction and psychological issues domains of the SNOT-22 had strong,
statistically significant correlation (r = 0.77 and 0.75 respectively) with the NOSE score. Although the
rhinologic symptoms domain correlated significantly with the NOSE score, this relationship was
moderate (r = 0.48). However, the correlation between the extranasal rhinologic domain and the NOSE
score was weak (r = 0.32, p<0.05). There was a weak and non-significant correlation (r = -0.27) between
SNOT-22 score and PNIF.

CONCLUSION
The routine use of both the NOSE and SNOT-22 is supported by this study. The total SNOT-22 score
correlated highly with the NOSE score although the rhinology specific domains of the SNOT-22 did not.
Other variables (sleep, psychological dysfunction) may also serve as key drivers for patients to seek
treatment.
POSTER # P-133

SINUS FUNGUS BALL IN THE KOREAN POPULATION: IMAGING CHARACTERISTICS OF 55 CASES

Inseon Ryoo1, Jae Min Shin2, Soo Chin Kim3, Hye Young Sun3, Hua Sun Kim3

1
Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
2
Department of Otorhinolaryngology, Korea University Guro Hospital, Korea University College of
Medicine, Seoul, Korea
3
Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul
National University College of Medicine, Seoul, Korea

BACKGROUND
Central dark-signal intensity with high-signal, hypertrophic mucosal wall of sinuses on T2-weighted
images is a characteristic MRI feature of sinonasal fungus ball. However this finding is usually
interpreted as non-fungal sinusitis with central sinus air. We evaluated the usefulness of T1-weighted
images for detecting fungus balls comparing with CT and T2-weighted MRI findings.

METHODS
Two reviewers assessed preoperative CT and MR images of 55 patients with pathologically confirmed
fungus balls. Reviewers evaluated the presence and patterns of calcifications on CT. Overall signals and
the presence and extent of certain signals of fungus balls on MRI were also assessed. The relationship
between calcifications and MRI signals was evaluated.

RESULTS
All patients had dark signal portions with high signal, hypertrophic mucosal walls on T2-weighted
images. Also, most patients showed iso- to hyper-intense overall signals on T1 weighted images and had
T1-weighted high signal portions on MRI. The presence, patterns, and location of calcifications had no
significant correlation with T1-weighted high-signal intensity portion.

CONCLUSIONS
Fungus ball can be suggested by the presence of the hyper-signal intensity portions in the fungal mass
on T1-weighted images in conjunction with dark-signal lesions surrounded by high-signal, hypertrophic
mucosal walls in paranasal sinuses on T2-weighted images.
POSTER # P-134

ACUTE UNILATERAL MAXILLARY ATELECTASIS FOLLOWING ENDOSCOPIC

PITUITARY SURGERY
HO Joyce [1,2]; ROM Darren [1]; WONG Eugene [1]; SINGH Narinder [1,2]
1 - Department of Otolaryngology Head and Neck Surgery, Westmead Hospital, Sydney,
Australia
2 - Sydney Medical School, The University of Sydney, Sydney, Australia

OBJECTIVES
Chronic maxillary atelectasis is traditionally described as a rare, acquired condition of
progressive antral wall collapse causing a reduction in maxillary sinus volume. This is
thought to be secondary to ostiomeatal obstruction and development of negative intra-sinus pressure
gradients. Maxillary atelectasis occurring rapidly after pituitary surgery, despite a normal pre-operative
CT scan, has not previously been described in the literature.

MATERIALS AND METHODS

We present a case of a 29-year-old male with facial pressure two months post endoscopic
transnasal, transsphenoidal excision of a Rathke’s cleft cyst. CT of the paranasal sinuses at
five months post-operatively demonstrated evidence of an atelectactic left maxillary sinus,
which was not present on pre-operative imaging. He underwent endoscopic uncinectomy
and middle meatal antrostomy with complete resolution of symptoms.

RESULTS
To our knowledge, this is the first case in the literature describing acute development of
maxillary atelectasis following pituitary surgery, where the maxillary sinus was not addressed during the
initial operation. While lateralisation of the middle turbinate causing ostiomeatal obstruction may lead
to sinus atelectasis, it is typically a slow process and seen in the context of chronic disease. Review of
the literature has demonstrated six cases of
documented rapid-onset atelectasis of maxillary sinuses.

CONCLUSION
This case represents the first in the literature of acute, post-operative unilateral maxillary
atelectasis following pituitary surgery. Acute maxillary atelectasis is a rare entity, which can
be successfully managed with minimally invasive sinus surgery. Consideration should be
made to incorporate acute cases into the classification system of maxillary atelectasis.
POSTER # P-136

OUTCOME OF ENDOSCOPIC SINUS SURGERY FOR THE TREATMENT OF INVERTED PAPILLOMA OF

NASAL CAVITY AND PARANASAL SINUS
Aung Khine SI, Maung Maung KHAING
Otorhinolaryngology-Head & Neck Surgery Hospital
Yangon, Myamar.

OBJECTIVE
The Objective of this study was to study the outcome of endoscopic sinus surgery for the treatment of
inverted papilloma of nasal cavity and paranasal sinus.

MATERIALS AND METHODS

Retrospective analysis of patients with inverted papilloma
operated at ORL-H&S Hospital, Yangon Myanmar in 2017 - 2018. Thirty patients suffering from inverted
papilloma of the nasal cavity and paranasal sinuses are included in this prospective study. In my study,
twenty-four patients undergone Functional Endoscopic Sinus Surgery (FESS) alone and six patients
undergone FESS in combined with medial maxillectomy.

RESULT
Five out of thirty patients were recurrent cases of inverted
papilloma. Apart from them, there were no recurrence of inverted papilloma during the study period.
Post-operative histology report revealed only inverted papilloma. Most commonly affected sinus is
maxillary sinus (60%) , ethmoid sinus (30%) and frontal sinus(10%). Both side are equally affected. Male
to female ratio is 1.3 : 1.

CONCLUSION
Endoscopic surgery has been proved to be successful even in the treatment of large lesions affecting the
posterior ethmoid sinus. This surgical technique which remains minimally invasive and thus retains the
paranasal bony framework, preserves unaffected mucosa, capable of rapid recovery, and prevents
damage to the patients` cosmetic appearances.
POSTER # P-137

CRANIOPHARYNGIOMA IN AN EXTREMELY RARE LOCATION: A CASE

REPORT
POLICINA Catherine [1]
1 - Department of Otolaryngology, Rizal Medical Center, Pasig City, Philippines

OBJECTIVE
To describe the occurrence of a purely infrasellar craniopharyngioma in the nasopharynx presenting as
nasal obstruction, epistaxis and headache in a 22 year old female

RESULTS
Rigid nasal endoscopy showed a fleshy, smooth, firm mass with prominent blood vessels in the right
nasal cavity extending from the middle turbinate to the nasopharynx. Contrast-enhanced CT scan of the
paranasal sinuses demonstrated a fairly-defined, heterogeneously enhancing nasopharyngeal mass with
calcifications extending to the sphenoid sinuses. Scope-guided punch biopsy of the nasopharyngeal
mass considered a salivary gland neoplasm (basaloid adenoma versus basaloid squamous cell
carcinoma). Another slide review indicated that the neoplastic cells seen cannot rule out ameloblastoma
and craniopharyngioma. Subsequently, the cranial MRI with contrast that was done revealed that the
nasopharyngeal mass had no intracranial extension. The neurohypophysis, sella and parasellar regions
were unremarkable. Endoscopic wide excision of the mass was performed. The final histopathology
report was craniopharyngioma.

CONCLUSION
This report highlights that in a case of nasal obstruction due to a nasopharyngeal mass without
neurologic deficits, differential diagnosis should include an infrasellar (e.g. nasopharyngeal)
craniopharyngioma. It is a rare tumor in an extremely rare location. To date, this is the 14th reported
case of a purely infrasellar craniopharygioma worldwide. Work up should include biopsy, paranasal sinus
CT scan, cranial MRI and endocrine studies if indicated. Complete excision is the accepted treatment at
present. Close post-operative surveillance with imaging studies is warranted due to the possibility of
recurrence. The prognosis and behavior of infrasellar craniopharyngiomas have yet to be identified.
POSTER # P-138

CASE REPORT ON LARGE FRONTOETHMOIDAL MUCOCELE: TREATMENT AND REVIEW

AUNG Naw Su Thanda, KHAING Maung Maung, AUNG Htein Lin
Otorhinolaryngology Head and Neck Surgery Hospital, Yangon, Myanmar

OBJECTIVES
The aim was to present our experience in treatment of frontoethmoidal mucocele and to
review the disease based on literature and our own experience.

MATERIALS AND METHODS

Case study of a patient with frontoethmoidal mucocele, operated at ORL-HNS hospital Yangon
in May 2019. In this case report we describe a 25-year-old man who presented with left sided
diplopia, eye pain and displacement of globe laterally and inferiorly for 3 years. Computed
tomography showed that bilateral frontal sinuses and left ethmoid sinuses are enlarged and
filled with enhancing soft tissue density causing widening of frontal ostium and frontal recess.
Left lamina papyracea was eroded by this soft tissue lesion which compresses the left orbit and
medial rectus muscle causing proptosis of left orbit. Endoscopic sinus surgery under general
anaesthesia was done.

RESULTS
Diplopia and left eye pain were resolved after endoscopic sinus surgery. There were no
perioperative and postoperative complications.

CONCLUSION
Frontoethmoidal mucoceles are benign lesion and prone to recurrence if not managed
adequately. The choice of the operative procedure for treatment of paranasal sinus mucocele
depends on the degree of extension. Surgery is the only effective treatment and functional
endoscopic sinus surgery is the standard of choice of frontoethmoidal mucoceles.
Keywords: Frontoethmoidal mucocele, Endoscopic sinus surgery
POSTER # P-139

CASE REPROTS ON JUVENILE NASOPHYRANGEAL ANGIOFIBROMA (JNA)

OO Zin Mar, KHAING Maung Maung, AUNG Htein Lin
Otorhinolaryngology- Head and Neck Surgery Department, University of Medicine (1) Yangon, Myanmar.

BACKGROUND
Juvenile Nasopharyngeal Angiofibroma (JNA) is a rare benign tumour in adolescent males. It may be
associated with significant morbidity because of its anatomical location and its locally destructive
growth pattern. Severe haemorrhage constitutes a high risk in JNA and its surgical management could
be complex.

OBJECTIVE
The aim was to present our experience in treatment of JNA, focusing on the type of surgical approaches
used and to review the disease based on literature and our own experiences.

STUDY DESIGN
Hospital based retrospective study.

STUDY PERIOD
1st January 2018 to 31st December 2018.

PARTICIPANTS
Total of 7 male patients.

METHOD
Retrospective analysis of patients with JNA, operated at ORL-HNS hospital Yangon in 2018. Total 7
patients , ages ranged from 17 to 35 years with JNA were included in this prospective study, who have
been underwent operation. Five of them had pre-operative embolization and five of them have been
operated with endoscopic approach, lateral rhinotomy approach in one patient and sub-labial (Caldwell-
lac) approach in one patient.

RESULT
One patient was a recurrent case of JNA. There were no recurrent of JNA during the study period. Post-
operative histology reports revealed only JNA.

CONCLUSION
Surgery is the treatment of choice for JNA. An endoscopic approach is feasible for early-stage lesions (
Fisch I and II) and conservative external approaches are still useful in advanced stages (Fisch III and IV) .
Pre-operative embolization, if possible is adjunctive in surgical treatment.
POSTER # P-140

BASE OF SKULL METASTATIC ADENOCARCINOMA FROM THE BREAST, THE LONGEST DORMANT AFTER
23 YEARS
ZAHEDI Farah Dayana [1]; OTHMAN Iylia Ajmal [1]; HUSAIN Salina [1]
1 – Department of Otorhinolaryngology-Head and Neck Surgery, Universiti Kebangsaan Malaysia
Medical Center, Kuala Lumpur, Malaysia

OBJECTIVE
We describe a case of a metastatic adenocarcinoma of the base of skull with concomitant paranasal
sinuses involvement after 23 years of breast carcinoma. This report also emphasized on the
presentation and the postulation of the delayed metastases.

METHODS
We reviewed a case note of a 67-year-old lady with history of left breast malignancy who underwent left
mastectomy and axillary clearance and completed her radiotherapy in 1992 presented with 3 months
history of total loss of vision on her left eye after 23 years. On nasoendoscopic examination showed
lobulated, well encapsulated mass occupying the midline postero-superior part of nasal cavity. The
histopathological examination of the mass revealed a metastatic adenocarcinoma of breast primary. She
was then referred to oncology for palliative treatment. She had completed 10 cycles of radiotherapy
(total of 30Gy) and 6 cycles of chemotherapy. She was subsequently started on Letrozole and calcium
supplement.

RESULTS
After 5 years of follow-up, she was clinically stable and the surveillance computed tomography scan
showed no significant changes in size and extension of tumour. Her clinical presentation remained the
same as the initial presentation.

CONCLUSION
Metastasis of the base of skull with concomitant paranasal sinuses involvement, as seen in our case, is
exclusively rare. The discernable feature of our case is the more than two decades asymptomatic
interval from the primary diagnosis of breast cancer. Therefore, latent metastasis to the base of skull
with concomitant infiltration to the paranasal sinuses should considered although the primary cancer
was diagnosed two decades back.
POSTER # P-141

EVALUATION OF RESPONSE TO TREATMENT IN NON-ALLERGIC RHINITIS PATIENTS USING NASAL PEAK

INSPIRATORY FLOW METER AND SINONASAL OUTCOME TEST-22
ZAHEDI Farah Dayana [1]; NIK HUSSIN Nik Roslina [2]; HUSAIN Salina [1]
1 – Department of Otorhinolaryngology-Head and Neck Surgery, Universiti Kebangsaan Malaysia
Medical Center, Kuala Lumpur, Malaysia; 2 – Department of Otorhinolaryngology, Hospital Selayang,
Selangor, Malaysia

OBJECTIVE
Non-Allergic Rhinitis (NAR) is a common condition worldwide with wide ranges of subtypes. The
condition may affect the patients’ the nasal function and quality of life. Therefore, patients’
improvements with the treatment given are important. The response towards treatment should be
assessed subjectively and objectively. We conducted this study to evaluate the treatment response in
NAR patient subjectively and objectively and to see the correlation between them.

METHODS
A Quasi-Experimental, One Group Pre-test Post-test Study was conducted in UKM Medical Center in 2
years duration. Nasal Peak Inspiratory Flow (NPIF) test and SNOT-22 questionnaires were used to assess
the treatment response in NAR patients objectively and subjectively. The measurements were taken
pre-treatment and 3 months post-treatment.

RESULTS
All of the 53 patients showed improvement in their symptoms and quality of life after 3 months of
treatment. The main symptoms complained by the patients are nasal obstruction, sneezing and runny
nose and need to blow nose. Forty-three percents were on medication that can induce rhinitis. There
was a significant improvement in the SNOT-22 score and Nasal Peak Inspiratory Flow test value after the
treatment. There was strong and significant correlation between the improvement of the SNOT-22 score
for nasal symptoms and quality of life and the increment of NPIF value for nasal function.

CONCLUSION
Medical treatment mainly by intranasal steroid is effective in treating NAR patients. This has been
proven by the improvement of the nasal function and quality of life of the patients.
POSTER # P-142

ONE WORLD BUT MILES APART: UNUSUAL PRESENTATION OF NASOPHARYNGEAL TUBERCULOSIS

WONG Bao Ling [1]; Shashi GOPALAN [1]; Muhammad Nasri ABU BAKAR [1]
1 – ENT Department, Hospital Sibu, Sarawak, Malaysia

OBJECTIVES
The occurrence of nasopharyngeal tuberculosis (NPTB) is rare even in endemic areas. NPTB can be
primary or secondary to a pulmonary or systemic TB. Although NPTB represents less than one percent of
all tuberculosis cases, the increase in cases reported recently may indicate an increase in the incidence.
We present a case series of primary nasopharyngeal tuberculosis.

MATERIALS AND METHODS

We described three cases of NPTB with different presentations, varied naso-endoscopic and radiological
findings. One case presented with multiple neck swelling without nasal symptoms. Nasoscope showed
normal nasopharynx but tissue biopsy was taken in view of suspicious of malignancy. Another patient
was a case of nasopharyngeal carcinoma who had completed radiotherapy, complained of persistent
yellowish discharge and nasoscope showed fullness over left nasopharynx. The third patient presented
with rhinitis symptoms for two months with adenoids hypertrophy. Radiological imaging may reveal a
normal finding versus an ill-defined enhancing soft tissue mass over the pharyngeal mucosa space where
a nasopharyngeal biopsy becomes helpful to obtain a diagnosis. All three cases were negative for
pulmonary tuberculosis and the diagnosis of nasopharyngeal tuberculosis was confirmed by
histopathological examination of nasopharyngeal tissue.

RESULTS
The patients responded well to antituberculous chemotherapy, evidenced by resolving nasal symptoms.

CONCLUSION
The variety of presenting symptoms is a challenge to diagnose NPTB because it commonly mimics other
pathologies. Granulomatous changes of nasopharynx post-radiotherapy also can be caused by
tuberculosis. Hence, high index of suspicion are important for early diagnosis of NPTB and initiation of
proper treatment.
POSTER # P-143

ENDOSCOPIC DACRYOCYSTORHINOSTOMY: A 10-YEAR EXPERIENCE

BACKGROUND
Nasolacrimal duct obstruction can be presenting with chronic epiphora and swelling of the lacrimal sac.
Dacryocystorhinostomy (DCR) is a surgical procedure which involves the diversion of lacrimal flow into
the nasal cavity by creating an opening at the level of lacrimal sac. This operation can be performed by
external or endoscopic endonasal approach.

OBJECTIVE
To study the outcome of endoscopic dacryocystorhinostomy in Universiti Kebangsaan Malaysia Medical
Centre over a 10 years period.

METHOD
A retrospective review of patients who underwent endoscopic dacryocystorhinostomy (EDCR) from
2007 to 2017 in Universiti Kebangsaan Malaysia Medical Center.

RESULT
A total of 20 patients were involved in the study. The demographic data, clinical presentations,
indication of surgery, investigations and post-operative outcome were analysed.

CONCLUSION
Our experience with EDCR concludes it to be an easy, efficient treatment for nasolacrimal duct
obstruction with minimal complications. The low recurrence rate in our patients suggests that
endoscopic DCR has good outcome.
POSTER # P-144

CLINICAL SIGNIFICANCE OF STERNBERG CANAL: A COMPREHENSIVE LITERATURE REVIEW

Nadia Syafeera NASERRUDIN [1] ; Salina HUSAIN [1] ; Farah Dayana ZAHEDI [1] ; Baharudin
ABDULLAH [2] ; Kornkiat SNIDVONGS [3] ; KEW Thean Yean [1]
1 - Department of Otorhinolaryngology - Head & Neck Surgery, Universiti Kebangsaan Malaysia
Medical Centre, Malaysia ; 2 - Department of Otorhinolaryngology- Head & Neck Surgery, School of
Medical Sciences, Universiti Sains Malaysia, Malaysia ; 3 - Department of Otolaryngology Head and
Neck Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial
Hospital, Bangkok, Thailand ; 4 - Department of Radiology, Universiti Kebangsaan Malaysia Medical
Centre, Malaysia

OBJECTIVE
Sternberg’s canal is a sphenoid skull base defect that can lead to cerebrospinal fluid leakage and
may lead to meningitis and meningoencephalocele. We reviewed the literature to see the
significance of Sternberg’s canal and the effectiveness of different surgical approaches in correcting
the defect.

MATERIALS AND METHODS

A literature search was conducted with following keywords: Sternberg’s canal; lateral
craniopharyngeal canal; cerebrospinal fluid leak; sphenoid sinus; meningocele; encephalocele.

RESULTS
Sternberg’s canal is rare. There are 15 original clinical research papers (level III). There are 55
patients (age 23 to 72 years old). Most of them are females.. All 39 patients with documented
presenting complaint have CSF rhinorrhoea. 14 out of 15 articles have cephalocele. There is no
laterality of affected sides to foramen rotundum. Most patients do not have previous neurosurgical
intervention or pre-existing medical illness. A total of 3 open surgeries, 49 endoscopic trans-nasal
surgery and 2 combined open with endoscopic surgery were performed. However, there are 6 cases
which developed recurrence of CSF leak.

CONCLUSION
The result shows that Sternberg’s canal is an adult onset disease; typically present with CSF
rhinorrhoea. The defect may occur either on medial or lateral to foramen rotundum. Endonasal
surgery favours over transcranial surgery in repairing the Sternberg’s canal defect as it is less
invasive and also able to reach the area due to the current advancement of surgical instruments.
Sternberg’s canal should be treated surgically due to its potential risks to develop intracranial
complication.
POSTER # P-145

A UNIQUE RHINOLOGIC MANIFESTATION OF MULTIPLE MYELOMA

SEAH Jun Jie [1,3] ; CHNG Wee Joo [2] ; THONG Kim Thye Mark [1]
1 – Department of Otolaryngology-Head & Neck Surgery (ENT), National University Hospital,
Singapore, Singapore; 2 – Department of Haematology-Oncology, National University
Cancer Institute, Singapore, Singapore; 3 – Yong Loo Lin School of Medicine, National
University of Singapore, Singapore, Singapore

OBJECTIVES
To describe unusual vascular lesions in the nasal mucosa of two patients with multiple
myeloma (MM), presenting with recurrent epistaxis.

MATERIALS AND METHODS

An extensive literature review was done to look for previous reports describing epistaxis
secondary to nasal mucosa abnormalities in patients diagnosed with MM. The medical
records of two patients, with unusual mucosal vascular lesions, were also reviewed.
Information regarding their presenting symptoms, medical history and nasoendoscopic
examination were reviewed. Nasoendoscopic images showing the change in the mucosal
vascular lesions, before and after treatment of MM, were obtained for comparison.

RESULTS
To date, there are no reports describing nasal vascular lesions of patients with MM. Both our patients
presented with similar-looking vascular lesions in their nasal mucosa, causing
recurrent bloodstained nasal secretions. Patient A went further to receive treatment with
chemotherapy and stem cell transplant for her MM, with subsequent resolution of her nasal
vascular lesions and epistaxis. Patient B is still currently followed-up.

CONCLUSION
While vascular lesions in MM have been described in other areas (eg. skin, retina), there are
no case reports describing any nasal lesions. Whether these lesions developed as part of
the natural disease progress of MM is unknown. Proposed mechanisms accounting for this
phenomenon include increased angiogenesis, amyloid accumulation in unusual sites, and
pathologic proteins interfering with plasma clotting factors causing precipitation of proteins
on walls of small blood vessels. Further research can consider the significance of such nasal
vascular lesions, both on the disease process, prognosis and ENT management of epistaxis.
POSTER # P-146

DISTRIBUTION OF EOSINOPHILS VERSUS NEUTROPHILS IN PATIENTS WITH BILATERAL NASAL POLYPS

OBJECTIVE
The aim of this study was to study the distribution of eosinophils versus neutrophils in patients with
bilateral nasal polyps.

DESIGN
Hospital based cross-sectional study

SETTING
Otorhinolaryngology + Head and Neck Specialist Hospital, Yangon

PARTICIPANTS
The study population comprised 96 patients (62 male and 34 female). Age ranged from 6 to 70 years.

RESULTS
Eosinophil dominated nasal polyp was seen in 19 cases, Neutrophil dominated nasal polyp was seen in
16 cases and non-eosinophil non-neutrophil dominated nasal polyp was seen in 61 cases. In this study, 7
cases give history of previous endoscopic polypectomy. Among 19 cases of eosinophil dominated nasal
polyps, 3 cases of nasal polyps associated with Bronchial Asthma. According to the histological result, 19
cases of eosinophil dominated nasal polyps, and among 67 cases, 16 cases of neutrophil dominated
nasal polys showed active chronic inflammatory nasal polyp.

CONCLUSION
This study suggests a strong relationship between presence of allergic symptoms and eosinophil
dominated nasal polyps. (P-value- 0.000) And there is strong evidence of association between presence
of infection and neutrophil dominated nasal polyps. (P-value- 000). There is strong relationship between
different types of biopsy result and eosinophil dominated nasal polyp versus neutrophil dominated nasal
polyp. In this study, eosinophil dominated and neutrophil dominated nasal polyp patients appear to be a
trend towards the higher grades of polyps. Even though the frequency of Asthma in the setting of nasal
polyp is between 30 and 70 %, only 18.6% of nasal polyp in eosinophil dominated patients are
associated with Asthma. Recurrence of bilateral nasal polyps are strong relationship with eosinophil
dominated nasal polyp.
POSTER # P-147

LEPROMATOUS RHINITIS AN UNUSUAL PRESENTATION OF HANSEN’S DISEASE

Thong HK1, Primuharsa Putra S H A2, B S Aminuddin 3,

1KPJ Healthcare University College, Nilai, Negeri Sembilan, Malaysia

2Ear, Nose & Throat-Head & Neck Consultant Clinic, KPJ Seremban Specialist Hopsital/ KPJ Healthcare
University College
3Ear, Nose & Throat-Head & Neck Consultant Clinic, KPJ Ampang Puteri Specilaist Hospital / KPJ
Healthcare University College

INTRODUCTION
Leprosy (Hansen’s disease) is a chronic granulomatous infection caused by the bacteria Mycobacterium
leprae. Classically leprosy affects the skin and peripheral nerves. The paranasal sinuses can also be
infected, and can serve as reservoirs for the reactivation of disease. We are highlighting a case of
lepromatous leprosy with an unusual nasal presentation of ozaena and nasal blockage as the primary
complaints.

CASE REPORT
A 31-year-old male patient, a private banker, presented to our ENT outpatient clinic with complaints of
nasal obstruction, foul-smelling nasal discharge (ozaena) and intermittent epistaxis for the past 1 month
associated with multiple cutaneous nodules over the bilateral ear pinnae. Biopsy of the nasal mucosa
revealed chronic granulomatous inflammation with multinucleated giant cells surrounded by abundant
bacilli consistent with histoid leprosy.

CONCLUSION
Leprosy remains a major public health hazard, as new cases are still being reported. The otolaryngologist
should remain vigilant and have high index of suspicion for leprosy in patients with chronic nasal
symptoms to prevent the potential morbidities that accompany this disease.
Keywords: Leprosy , lepromatous rhinitis , atrophic rhinitis , mycobacterium leprae , chronic
rhinosinusitis
POSTER # P-149

MANAGEMENT OF EPISTAXIS ON NOVEL ORAL ANTICOAGULATION

THERAPY
HO Joyce [1,2] ; RIFFAT Faruque [1,2]
1 – Department of Otolaryngology, Westmead Hospital, Westmead, Australia
2 – Sydney Medical School, University of Sydney, Camperdown, Australia

OBJECTIVES
Epistaxis is a common problem with a reported lifetime prevalence of 60%.
Individuals on anticoagulation therapy are at increased risk of bleeding. Novel oral
anticoagulants (NOAC) such as direct thrombin inhibitors and direct factor Xa
inhibitors offer some advantages over classic vitamin K-derived anticoagulation
therapy. However, there is a lack of available reversal agents for NOAC. We aim to
review the current literature on epistaxis in the context of NOAC use as well as
reversal agents to recommend guidelines on management.

MATERIALS AND METHODS

A comprehensive search of published literature was conducted using the following
Medline, Pre-Medline, PubMed, and Embase to identify all relevant articles up to
April 2019.

RESULTS
Patients on oral anticoagulation are over-represented in individuals with epistaxis.
Those on NOAC were more likely to relapse than patients on classic oral
anticoagulants or non-anticoagulated. The evidence regarding the severity of
epistaxis on NOAC is conflicting. Idarucizumab is an effective antidote for bleeding
associated with dabigatran use. There is a lack of high level of evidence for nonspecific
reversal agents. Recommendations for management of epistaxis on NOAC,
including first aid principles and use of reversal agents, are outlined.

CONCLUSION
Clinicians need to be aware of the potential severity of epistaxis and the increased
likelihood of recurrence. If reversal of anticoagulation is required, involvement of the
haematologist and cardiologist should be sought early. Further high-quality studies
are required to determine the efficacy and safety of andexanet alfa and ciraparatang
as well as non-specific reversal agents.
POSTER # P-150

THE ENDOSCOPIC SURGICAL MANAGEMENT OF FRONTAL SINUS OSTEOMAS

Nguyen Minh Hao Hon(*), Tran Phan Chung Thuy(*).

OBJECTIVES
Osteomas are the most common benign tumors of the paranasal sinuses (60%). Endonasal endoscopic
approach is chosen to remove osteomas of the frontal sinus and recess because its advantage of no
external scars. However, this approach is still limited by the conditions and the need for experienced
surgeons.

MATERIALS AND METHODS

This was a non-randomized trial study performed at ENT Hospital of Ho Chi Minh City. All adult patients
with osteomas of the frontal sinus and recess were indicated for surgery.

RESULTS
In 14 months (from January 2016 to August 2017), 34 adult patients were chosen in this study. 67.65%
osteomas was removed via endonasal endoscopic approach, in 32.35% of cases, a combine endoscopic
and external approach (Jacques incision). 88.24% osteomas was completely removed (52.95% by
elevators and 35.29% by drills), 11.76% osteomas was not completely removed. In 35.29% of cases, the
operation was navigation-assisted. 17.65% of cases had scarring and cicatrization of the frontal recess in
first 4 weeks post-op, 11.76% of them was repaired successfully in clinic, 5.89% of them necessitated
surgical revision. Intraoperatively, complication of injury to the lamina papyracea was observed in 1 case
(2.94%) and bleeding from the anterior ethmoidal artery was observed in 1 case (2.94%), both are
successfully controlled without severe consequences.

CONCLUSION
The endoscopic approach advantagous over external approaches in osteomas of the frontal sinus and
recess sinus that avoids external scars, loss of forehead sensation and makes the length of
hospitalization shorter. It should be noted that not all the osteomas should be removed completely by
endoscopic approach and the surgeon should stop at the right time. External approach is still helpful in
managing frontal sinus diseases.
POSTER # P-153

CHOANAL ATRESIA IN KARIADI GENERAL HOSPITAL SEMARANG

DEWI Anna Mailasari Kusuma 1, HARIYATI Riece 1

1 - Otorhinolaryngology Head and Neck Surgery Department Faculty of Medicine Diponegoro University
– dr Kariadi General Hospital Semarang

BACKGROUND
Choanal atresia is a rare congenital disorder, the incidence of 1 case in 5000 - 8000 births. Unilateral
choanal atresia causes unilateral chronic nasal drainage, while bilateral choanal atresia causes an
emergency at the time of inadequate birth of the nasal airway.

OBJECTIVE
This case was proposed to reports the insidens of various types of choanal atresia in Kariadi Hospital
Semarang

CASE
Three cases of different types of choanal atresia were reported from January 2017 – December 2018,
which had been performed operatively. The first case was an 18 days baby with bilateral type of
membranous choanal atresia, transnasal choanoplasty was performed by mucosal incision on the right
and left choana base. Application of naso gastric tube is done as a fixator in the choana hole. The second
case was an 18 years old child with unilateral type bony and membranous choanal atresia, performed
transnasal choanoplasty using drill and septal flap. The third case was a 7 years old child with bilateral
bony and membranous type choanal atresia, performed transnasal coanoplasty using drill and posterior
septectomy.

CONCLUSION
Choanal atresia can be late diagnosed especially if it occurs unilaterally. Several choanal atresia
operating techniques according to the type of membrane or bone, for the membrane type using incision
while the bone type needs to be made hole with a drill.
POSTER # P-154

INVASIVE FUNGAL RHINOSINUSITIS IN DR. CIPTO MANGUNKUSUMO GENERAL HOSPITAL: A

DESCRIPTIVE STUDY
RISSA Nieza Femini [1], WARDANI Retno S [1]
1 - Otorhinolaryngology Department, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia

OBJECTIVES
Invasive fungal Rhinosinusitis (IFRS) is a life threatening condition that typically affects
immunocompromised patients.

MATERIALS AND METHODS

This is a retrospective descriptive study to find characteristics of patients diagnosed by IFRS treated in
Dr. Cipto Mangunkusumo during 2014 – 2019 (6 years)

RESULTS
There were 12 cases of IFRS with 8 males predominantly to 4 females, with minimum age was 4 months
and maximum age was 59 years old. Four of them died because of the immunocompromised state they
had. The causes of death were sepsis, hemorrhagic stroke, NK T-Cell Lymphoma, and type 1 and 2
diabetes mellitus. The culture results were obtained in 11 patients consisting of Aspergillus spp. only and
Mucorales only in 2 cases each, Rhizopus, and Fusarium spp., Candida albicans and Fusarium spp.,
Candida tropicalis and Mucorales, Aspergillus flavus and Rhizopus, Aspergillus flavus and Fusarium, and
Aspergillus spp. and Mucorales, all of them were in one case each. Immunocompromised status were
found in 11 patients and immunocompetent status in 1 patient. IFRS treatments were carried out by
performing FESS surgery for debridement and various antifungal medication, such as Amphotericin B,
Fluconazole, Voriconazole, and Itraconazole. There were 3 patients underwent surgery first then
continued with antifungal medication. Whereas in 9 patients, antifungal treatment were given first. Four
patients died after antifungal treatment without debridement.

CONCLUSION
The immunocompromised state of the host is considered to be an important factor in the progression of
the disease.
POSTER # P-155

APPROACHES IN THE EARLY DETECTION AND MANAGEMENT OF MAXILLARY SINUSITIS FROM

ODONTOGENIC CAUSES: A 30 YEAR SYSTEMATIC REVIEW
RAJ Grace [1] ; RAJ Mary [2] ; LOH J S [3]
1 – Tampines polyclinic, Singhealth, Singapore; 2 – Bedok polyclinic, Singhealth, Singapore; 3 – Discipline
of Oral and Maxillofacial Surgery, National University Centre for Oral Health, National University Health
System, Singapore

OBJECTIVES
Odontogenic causes of maxillary sinusitis often go undiagnosed and overlooked, leading to persistent
infection and symptoms in patients. Early studies report an incidence of up to 10-12%, while newer
studies have reported an incidence as high as 40% of unilateral maxillary sinusitis. This study aims to
consolidate the emerging data regarding the pathophysiology, clinical symptoms, modern diagnostics
and treatment modalities of odontogenic maxillary sinusitis (MS).

MATERIALS AND METHODS

A search of all existing English literature including case reports was performed on Pubmed, Medline and
Scopus databases using the following keywords: “odontogenic sinusitis” and “maxillary sinusitis of
dental origin”. Non-English literature was excluded.

RESULTS
Complications of teeth extractions are common causes of MS. Symptoms include: nasal congestion and
rhinorrhea. It can be difficult to distinguish between odontogenic and non-odontogenic causes. Good
clinical acumen and the use of CBCT/CT imaging are important in diagnosing MS from odontogenic
causes. Availabilty of FESS in the armamentarium often proved invaluable. An intra-oral approach (sinus
lavage, buccal fat pad graft) with medical therapy (antibiotics, nasal decongestants) may also be offered
as a first line of treatment.

CONCLUSION
The management of MS involves treatment of both the sinusitis and the odontogenic cause. Thus, a
multidisciplinary approach involving otolaryngologists, oral maxillofacial surgeons and radiologists is
critical in ensuring optimal patient outcome. We propose a new algorithm of care for MS patients in this
review.
POSTER # P-156

PREDICTIVE FACTORS FOR INVASIVE FUNGAL RHINOSINUSITIS IN DIABETIC PATIENTS: DATA

REANALYSIS AND SYSTEMATIC REVIEW

KAN NYUNT Thwe Phyo , Snidvongs Kornkiat

Chulalongkorn University, Bangkok ,Thailand

OBJECTIVE
To identify likely prognostic factors which predict outcomes of diabetic patient with
invasive fungal rhino sinusitis ,this systematic review was done .

MATERIALS AND METHODS

A review was performed using Medline, EMBASE, and Cochrane database. The search was only on the
articles published in English language. Case series were excluded to prevent double input of data. Step
wise univariate analysis were done for each variables. The significant variables (P<0.10) were
incorporated (included) to multivariate model. Potential prognostic factors were identified using logistic
regression. Kaplan Meier curve was shown for survival.

RESULTS
Total 1103 journals are found but after excluding ,total 113 patients records
were included. Overall mortality was 28.32 % and male female ratio was 1.67:1. A wide
geographical distribution was seen , among them India is largest area of contribution.
Mucormycosis is account 67.26 percentage. In step wise univariate analysis on
radiological imaging, cavernous sinus , internal carotid and intracranial involvement
showed significant P value. Present of black materials and black esher was found to be
44 percentage of the patients , but not satisficatlly significant. For Glusoce level ,24
mmol/l is one of the point that further clinician need to pay attention on plasma glucose
level. There was limited resources for HbA1c.

CONCLUSION
Survival outcomes of invasive fungal sinusitis in diabetes patients, plasma glucose
level, total WBC count should be considered as independent predictors for high
mortality.
POSTER # P-157

VIDIAN NEURECTOMY – TECHNIQUE FEASIBILITY AND OUTCOMES

POSPANATHAN Pravina [1]; SINGH Harvinder [1]
1 –Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia

OBJECTIVES
Vidian Neurectomy has been advocated as a surgical option for rhinitis refractory to medical treatment.
The technique feasibility and surgical outcomes is described.

MATERIALS AND METHODS

Five consecutive patients (3 Females and 2 Males; mean age 42.5y; range 31-46y) who presented to the
ENT clinic with non-allergic rhinitis with persistent and disabling symptoms refractory to maximal
medical therapy is subjected to bilateral Vidian Neurectomy. A total of 10 procedures were performed
using a standardized surgical technique. Pre and post-operatively SNOT 20 scores, subjective complaints
and Schirmer’s Test was done for symptom evaluation.

RESULTS
A total of 10 procedures were done. All patients reported significant improvement in rhinorrhea, sleep
and psychological functions after 3 months of follow-up. Palatal numbness was the most subjective
complaint by the patients. However, it resolved after 3 months of follow-up. None of the patient’s
complaint of dry eyes. Schirmer’s test performed at 3 months showed mild to moderate dry eyes in
most patients. SNOT 20 scores showed significant reduction after 3 months of follow up.

CONCLUSION
Endoscopic Vidian Neurectomy does have a significant and important role in the
surgical management of refractory rhinitis. Endoscopic visualization of the vidian
nerve and better comprehension of the anatomy has enabled us to precisely locate and transect
the Vidian nerve. All of our patients had showed vast improvement in their rhinologic, sleep and
psychological symptoms.
POSTER # P-158

MYOEPITHELIAL CARCINOMA OF THE NASOPHARYNX

Nadia Syafeera NASERRUDIN [1] ; Farah Dayana ZAHEDI [1] ; Salina HUSAIN [1]
1 - Department of Otorhinolaryngology - Head & Neck Surgery, Universiti Kebangsaan Malaysia
Medical Centre, Malaysia

INTRODUCTION
Myoepithelial carcinoma (MECA) is a locally aggressive salivary gland tumour. Tso far, less than 10 cases
of nasopharyngeal MECA has been reported with majority reported to have nasal obstruction. Majority
of MECA are located in the parotid gland but it has previously been reported to occur in breast, lung and
orbit. The management of MECA of nasopharynx remain a challenge due to its rarity. Treatment involves
chemoradiotherapy and surgical excision but with high morbidity due to its close relation to intracranial.

CASE REPORT
A 70 year-old-Indian lady presented with blood stained saliva for past 1 month. She also complaint of
left ear blockage of same duration with reduced hearing. She has no epistaxis or nasal blockage. She has
no tuberculous symptom.

On examination, she was not cachectic. There was no neck node. Nasoendoscopy revealed a lobulated
mass arising from left fossa of Rossenmuller, obliterating the Eustachian tube. Biopsy revealed
myoepithelial malignant tumour.

CT and MRI of Neck showed 2.0x1.1x2.6cm homogenous enhancing nasopharyngeal mass filling the left
fossa of Rossenmuller and obstructing the Eustachian tube. Laterally it extended to parapharyngeal
space. Posterolaterally, it abutted the anterior wall of the left common carotid artery. Superiorly, the
tumour extended to the foramen lacerum. There were also vertebral metastases.

Patient underwent left extended nasopharyngectomy and planning for radiotherapy to her spine.

CONCLUSION
MECA is very rare and its management is challenging due to its rarity, its close proximity with skull base
and being locally aggressive. It should be identified early to achieve a complete tumour excision.
POSTER # P-159

THE EFFECTS OF THE MIDDLE TURBINATE ORIENTATION AND RESECTION ON SPHENOID SINUS
IRRIGATE PENETRATION FOLLOWING ENDOSCOPIC SINUS SURGERY.
1 MOGRE Dilesh; 2 KHONG Grace; 3 FLEMING Sarah;2 LEONG Samuel C
1 Department of Otorhinolaryngology-Head and Neck Surgery, B.K.L. Walawalkar Rural Medical College
and Hospital. Maharashtra, India.
2 The Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool,
United Kingdom.
3 Maxillofacial Prosthetics Laboratory, Aintree University Hospital NHS Foundation Trust. Liverpool,
United Kingdom.

OBJECTIVE
To determine how surgery on the middle turbinate (MT) may effect penetration of irrigation into the
sphenoid sinus.

MATERIALS AND METHODS

Two life-size 3-D printed sino-nasal models with video visualization ports drilled into the roof of the
sphenoid sinus were utilized in this study. Stepwise endoscopic sinus surgery was simulated on each side
of the models. Following each surgical step, the nasal cavities were irrigated with blue food colouring
mixed with water from a NeilMed® Sinus Rinse™ bottle. All irrigations were performed in a 45° head-
down position to mimic patients “bending over the sink”. Video recordings of these irrigation were
saved and single-blinded independent observers scored them according to a pre-defined scale.

RESULTS
When the middle turbinate was in the anatomical position, no changes in sphenoid sinus irrigate
penetration was observed before sphenoidotomy (natural ostium), 5mm sphenoidotomy and wide
sphenoidotomy. However, irrigate penetration improved significantly when the MT was medialized onto
the septum. A similar trend was observed when the MT was resected.

CONCLUSIONS
Middle turbinate medialisation, whether by suture conchopexy or controlled synechiae, is
recommended during endoscopic sinus surgery especially when sphenoidotomy is undertaken. Optimal
sinus dissection improves sphenoid irrigate penetration but wide antrostomy has a negative impact on
it.
POSTER # P-160

BILATERAL CHRONIC MAXILLARY ATELECTASIS WITH A UNILATERAL

ACCESSORY OSTIUM
HO Joyce [1,2]; WONG Eugene [1]; SINGH Narinder [1,2]
1 - Department of Otolaryngology Head and Neck Surgery, Westmead Hospital,
Sydney, Australia
2 - Sydney Medical School, The University of Sydney, Sydney, Australia

OBJECTIVES
Chronic maxillary atelectasis (CMA) is an underdiagnosed condition that can occur
bilaterally and may lead to significant complications. Its aetiology has not been
established. Accessory maxillary ostium (AMO) is a defect in the fontanelle and is
associated with maxillary sinus pathology. We aim to investigate the theories
regarding the aetiology of CMA using a case presentation with a literature review.

MATERIALS AND METHODS

We present a case of a 47-year-old man presented with sinonasal symptoms.
Nasendoscopy demonstrated bilateral lateralised uncinate processes. Radiological
findings were consistent with a diagnosis of bilateral stage II CMA, with the left side
less atelectatic than the right and only partially opacified. The patient proceeded with
bilateral uncinectomies and maxillary antrostomy. Intra-operatively, an AMO was
visualised on the left. We also performed a literature review regarding the aetiology
of CMA.

RESULTS
The main theory regarding the aetiology of CMA is sustained obstruction of the
ostiomeatal complex resulting in negative intra-sinus pressures and subsequent
atelectatic remodelling of the antrum. Our patient had an AMO on the left side, which
was also the side of lesser severity in symptoms and radiological findings. We
propose that the maxillary sinus pathology led to the development of the AMO, which
then halted progression of the CMA.

CONCLUSION
This case suggests that AMO can develop or enlarge and supports the notion that
CMA is caused by negative intra-sinus pressures. Further research is required to
establish the precise aetiology of CMA.
POSTER # P-171

QUALITY OF LIFE CHANGES FOLLOWING THREE-DIMENSIONAL PRINTING OF PROSTHESIS FOR LARGE

NASAL SEPTAL PERFORATIONS – OUR EXPERIENCE OF 13 PATIENTS

Authors:
1
Gaurav S Medikeri
1
Grace C Khong
1,2
Sarah Fleming
1,2
Taran Malhotra
1
Samuel C Leong
1
The Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust. Liverpool,
United Kingdom.
2
Maxillofacial Prosthetics Laboratory, Aintree University Hospital NHS Foundation Trust. Liverpool,
United Kingdom.

OBJECTIVE
To assess the clinical outcomes following large nasal septal perforation (NSP) closure using 3-D printing
technology for the fabrication of custom-made prosthesis.

MATERIALS AND METHODS

Design
Prospective cohort study
Setting
Rhinology clinics at a tertiary referral hospital in Liverpool, United Kingdom.
Participants
Patients diagnosed with nasal septal perforation.
Main outcome measures
Total SNOT-22, domain (rhinologic, ear/face symptoms, sleep and psychological function) scores and
pre- and post-insertion nasal symptoms specific to nasal septal perforation (crusting, epistaxis,
whistling) were evaluated.

RESULTS
The mean total SNOT-22 score improved significantly after insertion of the prosthesis. Although all the
domains had reduction in scores, the highest change was in perforation specific symptom reduction.

CONCLUSION
Accurate sizing and successful closure provided by 3-D printing technology for obturation of large nasal
septal perforations have resulted in significant improvement in quality of life scores as well as nasal
symptoms specific to perforations. Long-term retention rates of the prosthesis and temporal changes in
quality of life indices will require further evaluation.
POSTER # P-172

ADJUNCTIVE TECHNIQUES TO IMPROVE ACCESS OF THE ENDOSCOPIC PRELACRIMAL APPROACH TO

THE MAXILLARY SINUS, ORBITAL FLOOR AND INFRATEMPORAL FOSSA
LEONG Samuel [1] KHONG Grace [1] MEDIKERI Gaurav [1] TIERNEY Claire [2]
1-Department of Otorhinolaryngology – Head and Neck Surgery, Aintree University Hospital NHS
Foundation Trust, Liverpool, United Kingdom. 2-Human Anatomy Resource Centre, Faculty of Health and
Life Science, University of Liverpool, United Kingdom

OBJECTIVES
To determine adjunctive techniques could improve surgical access of the endoscopic prelacrimal
approach to the maxillary sinus and its anatomical boundaries thus enhancing the utility of the
technique.

MATERIALS AND METHODS

This study was approved by the Central University Research Ethics Committee of the University of
Liverpool (reference 4473). Twenty paranasal sinuses from 10 cadaveric heads were dissected using
pre-lacrimal and transseptal approach and canine fossa puncture. Anatomical areas of interest -
(palatine bone (PB), medial and lateral to infraorbital nerve (M-ION, L-ION), zygomatic recess (ZR),
alveolar recess (AR) and ramus of mandible (RM) were determined. Surgical accessibility was defined as
the successful placement of the distal tip of a 20-cm endonasal instrument on the specific anatomy of
interest. The Blakesley Rhinoforce® II straight nasal forceps and 45° upturned nasal forceps were used.
The forceps were held in its open position and centred in the middle of the endoscopic visual field.

RESULTS
Pre-lacrimal approach provides good access to PB and M-ION. Use of 450 instrument and transseptal
window significantly improved access to ZR and AR. Similarly, access to L-ION improved significantly
when 450 instrument was used through the pre lacrimal approach. Pre lacrimal approach provided
access to RM in 70% of the dissections and improved with angled instruments and/or a transseptal
window but with no statistical significance. Canine fossa puncture did not show any significant
improvement in accessibility of these anatomical areas.

CONCLUSION
Pre-lacrimal approach is useful for maxillary sinus and infratemporal fossa surgeries. Use of angled
instruments and transseptal window further increases its accessibility.
POSTER # P-173

CORRELATION OF SINONASAL SYMPTOMS WITH THE SIZE AND POSITION OF NASAL SEPTAL
PERFORATION – AN OBSERVATIONAL STUDY
LEONG Samuel [1] KHONG Grace [1]
1
Department of Otorhinolaryngology – Head and Neck Surgery, Aintree University Hospital NHS
Foundation Trust, Liverpool, United Kingdom

OBJECTIVES
To assess the correlation of sinonasal symptoms and quality of life with the size and position of nasal
septal perforation (NSP).

MATERIALS AND METHODS

This is a prospective observational study involving adult patients who presented with NSP. Sino-Nasal
Outcome Test-22 (SNOT-22) and its clinico-psychometric domains were analysed including additional
NSP-specific symptoms (nasal crusting, epistaxis and whistling noise during nasal breathing). Size of
perforation was measured radiologically by calculating the area in cm2 and antero-posterior (AP) length.
Position of the perforation was determined clinically by the distance from columella to the anterior edge
of the perforation.

RESULTS
Forty patients were included in this study (22 males) with the most common aetiology of iatrogenic
cause. No statistical correlation was observed between the total SNOT-22 score with either position or
size of NSP. As for NSP-specific symptoms, there was a statistically significant negative correlation with
the size of perforation (AP length) (r= -0.34, p= 0.03) and position of the perforation (r= -0.49, p=
0.0016), suggesting that these symptoms improved with posterior and larger perforations.

CONCLUSION
Reported SNOT-22 scores were comparable to patients with recalcitrant chronic rhinosinusitis although
the scores did not correlate with size and position of NSP. Sinonasal symptoms typically observed in NSP
improved with more posterior and larger perforations. This study provides insight into quality of life
impact of NSP and affirms clinical observation that anterior NSP are more symptomatic.
POSTER # P-180

PRELIMINARY RESULTS OF INTRANASAL PROBIOTIC USE AS PREVENTATIVE &/OR ADJUVANT

TREATMENT AGAINST RESPIRATORY TRACT INFECTIONS

Authors
Gaurav Medikeri1
Elissavet Nikolaou2
Ilinca Memelis2
Elysse Hendrick2
S.F.Plummer3
D.R.Michael3
J.Kerry-Smith3
A.A.Jack3
Daniela Ferreira2
Samuel C Leong1

1
Department of Otorhinolaryngology – Head and Neck Surgery, Aintree University Hospital NHS
Foundation Trust. Liverpool, United Kingdom.
2
Department of clinical sciences, Liverpool school of tropical medicine, Liverpool, United Kingdom
3
Cultech Ltd, Port Talbot, United Kingdom

OBJECTIVE
To investigate in vitro Adherence of Streptococcus pneumoniae (Spn) to Detroit Nasal epithelial cells
(NEC) in the presence and absence of probiotic consortia.

MATERIALS AND METHODS

The test consists of 2 arms – A control arm with NEC incubated with Spn for 3 hours & a test arm with
NEC incubated with Spn & probiotic consortia Lab4 & Lab 4b (5x106CFU/ml) separately. Adherence
assays were performed & cell colony counts were performed to assess the number of cells with Spn
adherence. Paired t test was applied to the mean values & statistical significance was obtained.
2 probiotic consortia developed by Cultech Ltd used
Lab4 – Lactobacillus-acidophilus, Bifidobacterium-bifidum and Bifidobacterium-animalis(subsp.-lactis)
Lab4b – Bifidobacterium-bifidum; Bifidobacterium-animalis(subsp.-lactis), Lactobacillus-salivarius and
Lactobacillus-paracasei

RESULTS
NEC tolerated viable/heat killed Lab4 & Lab4b up to 107CFU/mL irrespective of incubation time.
Probiotic adherence to NEC remained relatively stable over time (5.62% in1hr, 4.51% over 24hrs).
44.844% of cells in the control arm were free of cells with SPn adherence whereas 55.319% of cells in
the test arm with Lab4 were free of Spn adherence & 53.853 cells were free of adherence with Lab4b.

CONCLUSION
Preliminary data showed encouraging results of Lab4 & Lab4b regarding cell-viability, inflammatory-
mediator production & adherence. There is a reduction in the adherence of Streptococcus pneumoniae
to the NEC in the presence of probiotics. Lab4 has shown better results than Lab4b to reduce Spn
adherence to epithelial cells.
POSTER # P-181

PARANASAL SINUSES MUCOCELE : A SERIAL CASE

MOKOAGOW Subari [1], ZAKIAH Azmi Mir’ah [2], PERKASA Muh. Fadjar [3], PUNAGI Abdul Qadar [4].
1; 2; 3; 4 – Otorhinolaryngology Head and Neck Surgery Departement, Hasanuddin Medical Faculty
University, Wahidin Sudirohusodo Hospital, Makassar, Indonesia.

INTRODUCTION
Mucocele in paranasal sinuses is an accumulation of mucoid secretion and can be destructed. The major
etiology of mucocele is the obstruction of paranasal sinus drainage, most common site are the frontal
and ethmoid sinuses, mucocel in maxillary sinus is rare. Surgery is the first modality treatment for
paranasal sinus mucocele.

CASE
We present two cases of the mucocele. First case, 46 years old male, with chief complain mass on the
cheek and grew massively in last two years, nasal obstruction, slight facial pain on the right cheek. The
second case, 38 years old women, came with facial pain in the left forehead since 2 years ago and bulge
at right eyes, there was dyplopia but there was no vision impairment.

DISCUSSION
The first case, endoscopic medial maxillectomy approached with marsupialization technique has been
done to this patient, the thinning bone on anterior wall maxillaris sinus were fregmanted and fixated
with suture to prevent the skin and subcutaneous tissue collapse into the maxillary cavity. The second
case, we performed functional endoscopic sinus surgery aprroached with draf IIb, to maintain the
patency of frontal sinus drainage.

CONCLUSION
Functional sinus surgery endoscopic is always be the main choice therapy in paranasal sinus mucocele
and marsupialization technique has been done to maintain the drainage of sinuses.
POSTER # P-182

SERIAL CASE: PENETRATED FOREIGN BODY INJURY ON THE FACE (WOODEN AND IRON ARROW)
SARIRA Helta Tandi [1], PERKASA Muh. Fadjar [2], PUNAGI Abdul Qadar [3], ZAKIAH Azmi Mir’ah [4].
1;2;3;4 - Otorhinolaryngology Head and Neck Surgery Department, Hasanuddin Medical Faculty
University, Wahidin Sudirohusodo Hospital, Makassar, Indonesia.

INTRODUCTION
Foreign body penetrated injury into paranasal sinuses can be very destructed and life threatening.
Management of penetrated foreign body using endoscope to avoid further trauma to surrounding
tissue and to have a good visualization. The outcome after penetrated trauma sometimes causess
morbidity.

CASES
The first case: A 46-years-old male was referred to hospital due to penetration of foreign body
(wooden). The second case: A 34-years-old male came to hospital with chief complain of iron arrow
penetrated. Both of this case penetrated left site of the face.

DISCUSSION
From The first case, the foreign body (wooden) penetrated on the left orbital cavity, nasal cavity until to
nasopharynx. The second case shows foreign body (iron arrow) penetrated left orbital cavity, nasal
septum to nasopharynx, fracture of the left lamina papyracea extend to the left wall of ethmoid sinus.
Both of these cases were performed foreign body extraction, evacuation, and enucleation using
endoscopic procedure with opthalmologyst team.

CONCLUSION
Foreign body traumatic penetration of the face has always been affected several vital organ. An
immediate management should be ferformed to avoid infection morbidity and mortality.
POSTER # P-183

RAPIDLY PROGRESSING SUBPERIOSTEAL ORBITAL ABSCESS AND DEEP NECK ABSCESS

SIMULTANEOUSLY: A RARE COMPLICATION OF DENTAL INFECTION IN HEALTHY YOUNG PATIENT.
ANGGRAINI Aulia Hervi, FIRMANSYAH Andri, HENDRADEWI Sarwastuti.
Department of Otorhinolaryngology Head and Neck Surgery Faculty of Medicine Sebelas Maret
University, Surakarta, Indonesia.

BACKGROUND:
Subperiosteal orbital abscess secondary to rhinosinusitis recently reported the emergence of gram
negative extended spectrum beta lactamase (ESBL) bacteria which make it more complicated due to
antibiotics resistant. Deep neck abscess caused by dental infection is common case in spite of
widespread use of antibiotics. It can damage the adjacent vital structure thus still remain a life
threatening and challenging disease.

CASE REPORT:
A 38-year-old male, previously healthy, admitted with progressive left neck swelling and trismus since
10 days prior. History of recurrent left lower toothache lasted for a month, subsequently placed on
systemic antibiotics and analgesics. He also reported a year history of nasal blockage and facial pain,
symptoms worsened in last 7 days with left nasal mucopurulent foul smelling rhinorrhea, fever and
swollen on left eye and cheek. Management requires deep neck abscess surgical drainage,
odontectomy and functional endoscopic sinus surgery (FESS). Empiric antibiotic using ampicillin
sulbactam, intraoperative cultures of purulent drainage from sinus reveal Klebsiella pneumoniae with
positive ESBL and sensitive to meropenem while from deep neck abscess found Citrobacter koseri and
sensitive to ceftriaxone.

DISCUSSION:
Subperiosteal orbital abscess and deep neck abscess due to bacterial opportunistic infection is related
to the virulence of the causative agents and immunologic resistance of the host. CT scan is indicated to
evaluate the extension of the infection while the management depends on the cause and severity.
Impairment of vision, periorbital erythema, proptosis, and radiological findings indicated an immediate
surgical approach to avoid devastating morbidity. Similar with subperiosteal abscess, deep neck abscess
should be treated with intravenous antibiotics in addition to surgical drainage of abscesses

CONCLUSION:
This case highlighted the unexpected complication of dental infection which is very rare because it was
found simultaneously and the need of a prompt medical and surgical approach to achieve a good
prognosis
POSTER # P-197

PRIMARY CRANIOPHARYNGIOMA IN THE ETHMOID SINUS: AN UNUSUAL PRESENTATION

HO Joyce [1], WONG Eugene [1], SMITH Murray [1], SRITHARAN Niranjan [1] 1 - Department
of Otolaryngology Head and Neck Surgery, Westmead Hospital, Westmead, Australia

OBJECTIVES
Craniopharyngiomas are benign but aggressive epithelial tumours that arise from the Rathke’s
pouch. They are typically found within the sellar and suprasellar region.
Rarely it can be found in the infrasellar location, with involvement of the sphenoid sinus and
extension to the ethmoid. However, primary isolated ethmoid craniopharyngioma is extremely
rare and there have only been two other case reports of this in the literature. We describe the
third case of this rare condition.

MATERIALS AND METHODS

We present a case of a 31-year-old woman who was referred to an ENT specialist for nasal
obstruction, mouth breathing, and bruxism. On nasendoscopy, there was a right septal deviation
and bilateral turbinate hypertrophy with a left nasal cavity lesion. A CT of the paranasal sinuses
confirmed a deviated nasal septum, turbinate hypertrophy, and a left nasal cavity lesion. Surgical
intervention included a septoplasty, bilateral inferior turbinoplasty, and left endoscoic sinus
surgery with removal of the mass in the left ostiomeatal complex. Histopathology confirmed a left
ethmoidal adamantinomatous craniopharyngioma. She progressed well post- operatively and was
asymptomatic at 5 weeks follow-up.

RESULTS
Craniopharyngiomas are believed to originate from the squamous remnants of an
incompletely involuted craniopharyngeal duct, which also develops from Rathke’s pouch. Two
previous cases of primary ethmoidal craniopharyngiomas have been reported – both of whom
presented with epistaxis.

CONCLUSION
We report the third case of a primary extracranial ethmoidal craniopharyngioma. Clinicians
should be aware of the condition and consider it as a differential when assessing sinonasal
masses.
 Sleep & Related
Breathing Disorders
POSTER # P-086

RELATIONSHIP OF COLLAPSE OF THE UPPER AIRWAY WITH SEVERITY OF SLEEP APNOEA AND
SLEEPINESS
KURIEN Regi; VARGHESE Lalee
Department of ENT, Christian Medical College, Vellore, Tamilnadu, India

OBJECTIVE
Obstructive sleep apnoea is characterized by repeated episodes of collapse of the upper airway. The
symptoms experienced by the patient especially the degree of sleepiness is often variable. Many
patients with high levels of sleepiness do not have corresponding levels of Apnoea Hypopnea Index (AHI)
on polysomnography and vice versa. A review of literature shows very limited data on this with
conflicting results.

MATERIALS AND METHODS

This was a retrospective study including all patients with symptoms of obstructive sleep apnoea. All
patients underwent a complete history and Oto-laryngological examination, nasopharyngolaryngoscopy
with Muller’s manoeuvre, administration of the Epworth sleepiness scale (ESS) questionnaire and a full
night polysomnography. Correlation between the sites and degree of collapse at various sites, body
mass index(BMI), neck circumference (NC) with both the AHI and ESS were assessed. Correlation was
considered significant at p<0.05.

RESULTS
A total of 145 patients were included in the study. 98% had a collapse at Level I. 80% of the patients had
multisegmental collapse with 30% having collapse at all three levels. There was significant correlation
(p<0.001) between ESS and AHI. Collapse at Level I had the greatest impact on AHI scores. Statistically
significant variables with AHI were gender, NC; BMI and total score. No variables were significant with
ESS.

CONCLUSION
Cumulative scores of the severity of collapse irrespective of the number of sites involved had a greater
correlation with the AHI scores. This was seen more in the male gender and those with increased NC and
raised BMI.
POSTER # P-087

COMPARISON OF FATIGUE, STRESS, AND RESILIENCE IN PATIENTS WITH OR WITHOUT OBSTRUCTIVE

SLEEP APNEA.

Su Young Jung, MD, PhD1*, Jin-Young Min MD, PhD2, Sung Wan Kim MD, PhD2

OBJECTIVE
In this study, we compared the level of fatigue, stress, and resilience between patients with or without
obstructive sleep apnea (OSA). Furthermore, we identified whether surgery could decrease the level of
stress and fatigue in OSA patients.

STUDY DESIGN
A prospective clinical trial.

METHODS
We enrolled 100 patients who underwent surgery for OSA treatment (OSA group) and 50 patients who
had no snoring history (control group). Initial status of fatigue, stress, and resilience were evaluated in
both group by using Chalder Fatigue Scale (CFS), Daily Hassles Scale-revised (DHS-R), and Connor-
Davidson Resilience Scale (CD-RISC) questionnaire. Scores were compared between OSA and control
group. In addition, we compared status of fatigue, stress, and resilience in patients with OSA, before and
after three months of surgery.

RESULTS
The average age and BMI were not statistically significant between OSA and control group. However,
there were significant differences in CFS (OSA vs Control, 31.50±7.66 vs 24.38±4.61; p<0.001), DHS-R
(77.96±21.11 vs 67.50±16.09; p<0.001) and CD-RISC (64.91±16.05 vs 71.98±12.35; p=0.010) score
between OSA group and control group. Furthermore, CFS (preop vs postop, 31.50±7.66 vs 25.32±7.34;
p<0.001), DHS-R (77.96±21.11 vs 71.67±21.25; p=0.003) and CD-RISC (64.91±16.05 vs 68.14±19.41;
p=0.015) were improved after surgery compared to preoperative scores in OSA patients regardless of
BMI or severity of OSA.

CONCLUSION
Patients with OSA complain of more severe fatigue/stress and poor resilience compared to control
subjects. Furthermore, surgery might play a role in reducing the degree of stress and fatigue in OSA
patients.
POSTER # P-088

THAMMASAT – SIRIRAJ THAI PEDIATRIC SLEEP QUESTIONNAIRE: TRANSLATION

AND CROSS CULTURAL ADAPTATION
VIVATTANASARN Tipok [1] ; CHINDAHPORN Arisa [1] ; TANPHAICHITR Archwin [2] ;
SETABUTR Dhave [1,3]
1 – Chulabhorn International College of Medicine, Thammasat University Hospital, Pathum
Thani, Thailand ; 2 – Department of Otorhinolaryngology, Faculty of Medicine, Siriraj
Hospital, Mahidol University, Bangkok, Thailand ; 3 – Department of Otolaryngology,
Chulabhorn International College of Medicine, Thammasat University Hospital, Pathum
Thani, Thailand

OBJECTIVES
Pediatric Sleep Questionnaire (PSQ) has been deemed a useful tool in the assessment of
sleep disordered breathing. It is an inexpensive, less time-consuming and more accessible
analysis compared to gold standard polysomnography. The researchers aimed to translate
the PSQ into the Thai language and validate it for routine use in Thailand.

MATERIALS AND METHODS

The PSQ was translated into Thai using stages recommended by international guidelines
(Sagheri et al., 2010). Parents of children aged <18 years (n=70) completed the Thai PSQ
online twice within one month, with an interval of at least two weeks.

RESULTS
A total of 70 participants were enrolled, of which 53 were analyzed due to missing data (>
25%). Internal consistency analysis revealed an overall Cronbach ɑ of 0.757, validating the
questionnaire consistency. Test-retest reliability was evaluated using Kappa k, in which 19
out of 22 items yielded a significant value, and paired t-test, which showed a positive
correlation of 0.697 and no significant difference between the two sets of responses.

CONCLUSION
The current version of the Thammasat – Siriraj Thai PSQ has shown reasonable
consistency and validity results. The researchers aim to use the collected data to modify the
questionnaire and collect more data to further examine the usability of the questionnaire in
Thailand. The successful validation of the Thammasat – Siriraj Thai PSQ will allow Thai
physicians to have an inexpensive and fast method to screen children with sleep apnea.
POSTER # P-089

MAJORITY OF PRIMARY CARE PHYSICIANS DO NOT ROUTINELY ENQUIRE ABOUT SLEEP & RELATED
BREATHING DISORDERS.
CHUA Ai Ping1, RAJOO Geetha2, CHOOI Sue Ling2, TAN Renee2, CHIAM Qin Pei2, SOO Thomas3
1. Department of Medicine, JurongHealth Campus, National University Health System, Singapore.
2. Clinical Operations, JurongHealth Campus, National University Health System, Singapore.
3. Health & Wellness, JurongHealth Campus, National University Health System, Singapore.

OBJECTIVES
Sleep is important for health, and sleep & related breathing disorders are prevalent, albeit often under-
recognized and diagnosed. This could be related to healthcare providers not actively eliciting a sleep
history. We aim to investigate the prevalence of this and explore its reasons among primary care
physicians in Singapore.

MATERIALS AND METHODS

This is a cross-sectional self-administered survey conducted among primary care physicians in Singapore.
We recruited 144 physicians working in both private and public sectors from August 2017 to June 2018.

RESULTS
Mean age was 49 (SD ± 15) years old with male preponderance (59%). Majority (79%) worked full -time.
Among this cohort, only 8% routinely enquired about sleep & related breathing sleep disorders during
consultation; one-thirds rarely or never. This is in contrast to other lifestyle habits which were routinely
elicited (86%, smoking; 68%, alcohol ingestion; 70%, dietary intake; 74%, physical activity). The main
reasons for not enquiring about sleep were lack of initiation by patient (58%), lack of time (55%) and
perceived lack of awareness/knowledge (37%). Majority (79%) rated sleep as important, 81% rated their
awareness/knowledge in sleep and related breathing disorders as average or lower and 80% felt a need
to raise their competency in this area.

CONCLUSION
Although sleep is rated as important, majority of primary care physicians do not routinely enquire about
sleep & related breathing disorders during their consultation, Part of the reason is due to perceived lack
of awareness/ knowledge. More educational effort need to be put in place to raise sleep
awareness/knowledge in primary care.