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An antibiogram was constructed (Figures 3, 4 and Mackowiak (1978) cultured sinus tract drainage in 5) and it showed that for the three most common patients with chronic osteomyelitis and found that organisms, the quinolones are the most effective if the culture was positive for Staphylococcus aureuL antibiotics. This may be due to the fact that this there was good correlation with culture reports of. is a new drug and resistant strains have not yet the operative specimens. However, if the culture of developed. The use of ciprofloxacin has recently the sinus drainage was another organism,there was a been underscored in a study by Picirillo (1989), poor correlation. Assuming that the same pattern considering that the drug is effective in a wide range exists in the middle ear cleft since there is a similarity of both gram positive and gram negative organisms, in the organisms implicated, this might suggest However, the use of this ciprofloxacin is not recom- that the specimen obtained from the external auditory mended for chidren nor as a first line drug in the canal may not be the same as those from the middle management of COM. Gentamicin, which is corn- eardischargewiththosetakenintraoperativelyeg, bone, monly used otic solution, still has a good sensitivity cholesteatoma and granulation tissue. Computation (93.7%) for the organisms. The commonly prescribed of the predictive value of transcanal aspirates showed oral antibiotics ampicillin, trimethoprim, chlo- that there is good to excellent correlation for these ramphenicol and cephalexin showed a < 80% sensi- organisms using the rating of agreement by Kappa tivity pattern. This could probably be attributed statistics. This study specifically Shows that when to the administration of antibiotics intravenously or anyone of the three organisms is cultured, there is previous oral intake prior to the collection of a positive correlation in 90% of cases. This finding specimens, may be very imporant in the clinical setting as the antimicrobial treatment of COM can be fairly accu- The role of anaerobic organisms in COM has rately guided by doing transcanal aspiration of ear been the subject of intensive investigation and specu- discharge alone. lation. The metabolism of facultative species in mixed infections, by lowering the local concentration of oxygen and reduction in oxidation-reduction potential, TABLE 5. Correlation of Ear Aspirate with Operative provides a suitable environment for the anaerobic Specimen Culture. pathogens. Sugita (1981) elaborates that because of the obstruction of air around the cholesteatoma Earaspirate No.of Positive Negative Predictive there is a reduction of the partial pressureof oxygen Patients correlation correlation value with an inverse increase in cartoon dioxide thus favoring anaerobic growth. Synergy between the P.mlrabilis 29 29 0 100.0'/, negative bacilli particularly coliforms and Proteus and Bacteroidesspecieshave beenreported0ngham, 1977); P.vuloaris 13 11 2 84.6% In this study, there were four isolates of Bacteroides sp andin thesetwo B. melaninogenlcus was isolated P.asuroginosa 10 7 3 70.0% together with Proteus mirabilis. Previous studies have cited the importance of anaerobic organisms *Predictivevaluee.quahnumberoflmsitiveeorrelatianstimes100 in COM. The apparent low incidence of anaerobic dividedby total numberof patients. infection in this study maybe due to several factors, most impor't,3nt of which is the inherent difficulty SUMMARY in isolating the organism. A study of 30 patients with COM who underwent It is a common practice to treat COM empiri- radical mastoidectomy showed that the three most tally. However when confronted with patients re- common organisms were Proteus mirabilis, Proteus fractory to the usual medical management, as well vulgaris and Pseudomonas aeruginosa. The isolates as the significant potential for developing complies- obtained from the transcanal ear aspirate showed good tions in such cases, culture and sensitivity studies excellent correlation with the operative specimens from maybe necessary in the proper management of COM. the middle ear (bone, granulation tissue, cholestea- The question arises whether cultured, specimens toma). The transcanal ear aspirate cult'are maybe obtained from the external auditory canal would be valuable as a guide in the medicalmanagement of reflective of those taken directly from the middle ear. COM. 61
J BIBLIOGRAPHY Y MACKOWIAK, P.A., Jones, S.R. and Smith, J.W. Diagnostic value of sinus-tract cultures in chronic osteomyelitis. JAMA, 239-2772- ABES, G.T. and Jamir, J.C. Bacteriologic study 2775, 1978. of chronic ear discharge. Acta Medica Philippina, 14:28-31, 1978. OJALA, K., Son-i, M. Riihikangas, P. and Sipila, P. Comparison of pre and post-operative Annual Report, Department of Otorhinilaryngology, bacteriology of chronic ears. Journal of UP-PGH Medical Center, 1989. Laryngology and Otology, 95: 1023-1029, 1981. CHIONG, C.M., Chan, C.M., Yap, E.C., del Rosario, R.A., Pajarillo, P.R., Velmonte,M.A. et al. PICIRILLO, J.F. and Parnes, S.M. Ciprofloxacin for The microbiology of chronic otitis media, the treatment of chronic ear disease. La- Acta Medica Philippina, in press, 1990 ryngoseope, 99:510-513, 1989. INGHAM, H.R., Sison, P.R., Tharagonet, D., Selkon, Research'Protocol Guidelines for Physicians. Clinical J.B. and Codd, A.A. Inhibition of Phagocy- Epidimiolgy Unit, UP-PGH, 1988. tosis in vitro by obligate anaerobes. The __ Lancet, 2:1252-1254, 1977. SUGITA, R., Kawamura, S._ lchikawa, G., Goto, S. and Fujimaki, Y. Studies on anaerobic JOKIPII, A.M., Karma, P., Ojala, K. and Jokipii, L. bacteria in chronic otitis media. Laryngo- Anaerobic bacteria in chronic otits media, scope, 91: 816-821, 1981: Arch Otolaryngol, 103: 278-280, 1977. VIZON, C. and Tones, C. Bacteriology of chronic otitis media in children. Philippine Journal of Pediatrics, 18:46-49, 1969. 62
Page 2 and 3:
Iq4LIPl:qut=S TABLE OF CONTENTS NEC
Page 4 and 5:
HEAD AND NECK SURGERY - TO ADD OR N
Page 6 and 7:
PRESIDENT'S PAGE The years 1989-90
Page 8 and 9:
RIZAL MEDICAL CENTER DEPARTMENT OF
Page 10:
muscles. Again it is likely possibl
Page 15 and 16: area measuring 4.8 x 3.7 cm extendi
Page 17 and 18: tend to recur locally, even after p
Page 20 and 21: UNIVERSITY OF THE PHILIPPINES PHILI
Page 22 and 23: The majority of patients with hyper
Page 24 and 25: mass wa uttrasonograImy. Neck explo
Page 26 and 27: Figure 2 : Parathyroid Adcnoma vs.
Page 28 and 29: E.wa_ileMassonLe_Maxilla "salt& pep
Page 30 and 31: of some clinical features as well a
Page 34 and 35: MCU HOSPITAL DEPARTMENT OF OTOLARYN
Page 37 and 38: JOSE REYES MEMORIAL MEDICAL CENTER
Page 39 and 40: nonetheless stated: "We have the im
Page 41 and 42: to the diagnostic know-how of the c
Page 43 and 44: PATIENTS & METHODS: These signs and
Page 45 and 46: Most patients in group 1 complained
Page 47 and 48: DISCUSSION: and septal deviation mi
Page 49 and 50: OSPITAL NG MAYNILA DEPARTMENT OF OT
Page 51 and 52: ..temporary relief. According to Ha
Page 53 and 54: CASE REPORT phonuclear cells. The r
Page 55 and 56: TITLE:Cleft Lip Surgeryfor Rural Fi
Page 57 and 58: After intubation and the endoctrach
Page 59 and 60: BIBLIOGRAPHY Converse, J.M., Recons
Page 61 and 62: UNIVERSITY PHILIPPINE DEPARTMENT OF
Page 63: Table 3. Distribution of Organism b
Page 67 and 68: Figure 3. SENSITIVITY PATTERN OF Pr
Page 69 and 70: Figure 3. Percent SENSITIVITY PATTE
Page 71 and 72: loradatine 10 mg/tabletgiven once a
Page 73 and 74: 1. Severity of Symptoms 3. Comparis
Page 75 and 76: -J;r,ceiving 40 mg of loratadine da
Page 79 and 80: : ' : _ : ::::::: : : i : ::
Page 81 and 82: These patients are new patients see
Page 83 and 84: - Table Vl Baseline Signs and Sympt
Page 85 and 86: The following Table VII will show t
Page 87 and 88: • 14.Drowsiness: None 30 2 4 10 2
Page 89 and 90: Actifed's side effect of drowsiness
Page 91 and 92: " to be packed with one type of pac
Page 93 and 94: With regard to microbiology of nasa
Page 95 and 96: TABLE 6: MANNER OF CONTROL OF REBLE
Page 97 and 98: APPENDIX C MICROBIALGROWTH POTENTIA
Page 99 and 100: EAST AVENUE MEDICAL CENTER DEPARTME
Page 101 and 102: type (20%-30% of cases) varies from
Page 103 and 104: TABLE Ii HistologicalClassification
Page 105 and 106: THE LATERAL NASAL WALL IN FILIPINOS
Page 107 and 108: MIDDLE MEATUS: Diameter of ostium:
Page 109 and 110: .;4".,..:'.-" ............. '---.",
Page 111 and 112: Figure 4. Variation in the location
Page 113 and 114: This study presents variations with
Page 115:
ACKNOWLEDGMENT The authors would li
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