The Aesthetic Experts
Philippine Academy for Facial Plastic and Reconstructive Surgery
If there are specialists who would be known to bring solutions to facial and reconstructive surgery, they are the members of The Philippine Academy for Facial Plastic and Reconstructive Surgery or PAFPRS.
PAFPRS is a subspecialty group of the Philippine Society of Otolaryngology – Head and Neck Surgery (PSO-HNS) composed of bonafide ORL-HNS fellows who are enthusiasts in the field of facial aesthetic and reconstructive surgery.
It was founded in 2006 by Drs. Eutrapio Guevara Jr., Cesar Villafuerte Jr., Eduardo Yap, Joseph Amado Galvez, Alberto Calderon, Alexander Cabungcal, and Arsenio Pascual III. The primary aim was to promote facial aesthetic and reconstructive surgery through basic and advanced postgraduate courses and advocacy programs especially among otolaryngologists.
Since its inception, PAFPRS, together with PSOHNS and various training institutions, has conducted the annual basic facial plastic course fondly known as “pata course” for ORL-HNS residents all over the Philippines with the most recent one held in May 2017 in FEU-NRMF Hospital.
The PAFPRS two-year fellowship program, started in 2013, provides an avenue for further training of ORL-HNS fellows in the field of head and neck reconstructive and facial aesthetic surgery by further honing and fine-tuning their surgical techniques closely guided by experts both locally and abroad.
Annually and at times biannually held rhinoplasty and facial anatomy master classes have since evolved from didactic lectures and rhinoplasty implant carving workshops using erasers/silicone/e-PTFE blocks to live surgeries and fresh frozen cadaver dissection courses, aiding markedly in the hands-on learning experience of participants.
This year, these courses were held on February 18-21, 2017 at the East Avenue Medical Center and The Medical City and on September 8-9, 2017 at the UP-Philippine General Hospital. Thanks to our enthusiastic mentors, courses such as these have paved the way for otolaryngologists to be renowned experts in the field of rhinoplasty.
Quarterly held scientific meetings open to ORL-HNS residents and consultants have served as platforms for chosen experts to share their expertise in managing basic and complex cases, details not usually read in books or the internet. Topics that have been tackled include the ENT’s workhorse flap, the pectoralis major myocutaneous flap, by Dr. Armando Chiong Jr. and cleft lip and palate by Dr. Cesar Villafuerte Jr. On November 22, 2017, Dr. Eduardo Yap shared his experience in rhinoplasty.
Next year, 2018, PAFPRS plans to continue on serving its mother society, the PSO-HNS, by providing ORL-HNS residents, fellows and consultants’ access to facial aesthetic and reconstructive surgery–basic and advanced lecture series and cadaver workshops with live surgery demonstrations. Plans to broaden our audience base are in place by conducting some of these post-graduate courses outside of Metro Manila.
Victors of the Voice
Philippine Academy of Laryngobrochoesophagology and Phoniatrics
The Philippine Academy of Laryngobrochoesophagology and Phoniatrics (PALP) is composed of leading specialists who aid patients when it comes to their vocal problems and other concerns.
Its objectives are in line with PSO-HNS’ advocacy to further heighten awareness about vocal hygiene and other issues concerning the voice.
Early this year, PALP members with UST and East Avenue Medical Center ENT residents along with the Department of Education and the local ENTs belonging to the Central Luzon ENTs (CELENT), held in Olongapo National High School, the very first Vocal Health Caravan for teachers.
It’s intended to be a nationwide caravan for school teachers, educating them on proper vocal hygiene and practices. It includes Videolaryngoscopy of all the teachers who participated along with medical treatment after the screening. Follow up consults were seen gratis, courtesy of the local ENTs.
They also participated in a lay forum on Vocal Hygiene and Free Videolaryngoscopy for the participants at the St. Lukes Medical Center as well as in the Vocal hygiene and anti-smoking lecture at the East Avenue Medical Center. The lecture also provided free Videolaryngoscopywere
Head and Neck Experts
The Academy of Head and Neck Oncologists of the Philippines
In head and neck surgery, the subspecialty focus and scope as well as the treatment and management techniques have evolved with the changing technology, economic forces and the changing healthcare needs in the country.
The population is increasing and aging with a widening doctor-to-patient ratio. The therapeutic options are increasing with advancement in technology in a society with lack of health resources.
There is a trend towards a decline in the head and neck workforce services with the implementation of new health laws promoting shorter work hours, allowing physicians increased hours in their role as parents. The increased subspecialization in ENT adds to the problem of geographic maldistribution of ENT specialists in the Philippines.
The Academy of Head and Neck Oncologists of the Philippines (AHNOP) has been innovative in addressing the above-mentioned quandaries. The group is supportive of the increasing numbers of Cancer Centers being established nationwide by participating in head and neck grand rounds and encouraging new members to apply as active staff in these centers.
Annual activities like “Pasilip Ka” and the World Head and Neck Cancer Day is now celebrated nationwide including Baler, Lucena, Cebu, and hospitals in NCR. In a multidisciplinary management of head and neck cancer, AHNOP members have sacrificed part of their professional fees to lower the cost of the treatment. Philhealth has made surgery with postoperative concurrent chemo-radiotherapy for head and neck cancer surgery affordable.
AHNOP has engaged its corporate partners to be more patient-oriented in promoting prevention and awareness in head and neck cancer in the country.
AHNOP is changing with the healthcare delivery programs of the country by contributing ways and means towards the betterment and welfare of all our patients.
Heroes for the Ears
The Philippine Academy of Neurotology, Otology, and Related Sciences
It has been said that destiny is defined by the perfect alignment of stars. This has been the life-long arduous yet stimulating commitment of the Philippine Academy of Neurotology, Otology, and Related Sciences, or simply called PANORS. For when the stars align, a new order would have been achieved, ushering in the ultimate goal.
PANORS was established as a community of otolaryngologists dedicated to its ‘destiny’–the improvement of hearing health for all Filipinos through the promotion of the highest standards of practice and science of neuro-otology, otology, audiology & other related specialties guided by noble, nationalistic, and ethical principles.
For a decade of its existence, under the helms of current chair Dr. Norberto Martinez and ex-officio chair, Dr. Charlotte Chiong, the organization actively pushed for the advancement of hearing health among Filipinos, a dream evident with the ratification of the Universal Newborn Hearing Screening Act for the prevention, early diagnosis and intervention of hearing loss among babies.
In the near future, Filipino children (< 18 years old) with hearing impairment could also benefit from PhilHealth’s comprehensive evaluation and management packages, as a fruit of labor of this professional organization. Pilot studies are currently being done prior to the conferment of these benefit packages.
PANORS has always been in the forefront of hearing screening initiatives since its birthing years during the Collaboration on Newborn Hearing Screening Advocacy (CONHSCA).
As part of the present-day task of outcome measure and benchmark monitoring, a certification course for audiologists was held at the UST Faculty of Medicine and Surgery on April 22, in cooperation with the Association of Clinical Audiologists of the Philippines (ACAP).
The mission however, does not end with disease detection but proceeds further to intervention. Through several consultative meetings this year, PANORS has collaborated with government, other organizations, the academe, industries and the private sector for the provision of affordable hearing devices in the country.
Cognizant of the public hearing health concern and the goals of sustainable national development by 2022, PANORS, in collaboration with the Department of Health, Christoffel Blinden Mission and Better Hearing Philippines, spearheaded a consultative meeting on Ear and Hearing Health and Prevention of Hearing Disability last May 2 to 4 2017 in Clark Pampanga, which was attended by almost 60 stakeholders.
The attendees carefully mapped out the national hearing health agenda for the next years using the World Health Organization’s planning framework. The expert panels of this consultative assembly came up with concrete actions to ensure affordable, accessible, available, and quality services for the promotion of ear and hearing health among Filipinos, including prevention of hearing disability, and reducing by half all preventable causes of hearing impairment by the year 2025.
Advocating for patients’ right to a noise-free and a healthier hearing environment has been a significant part of PANORS activities. The International Ear Care Day celebration held last March 3, with the theme “Action for hearing loss: make a sound investment”, focused on the economic impact brought about by hearing loss. To this end, various educational materials were distributed by PANORS to inform the general public that prevention is the prime key for alleviating hearing loss, and its permanent effects on patients, their families, and the whole society.
The 22nd International Noise Awareness Day was also celebrated by the organization on April 26, with a minute of Peace and Quiet from 2:15 to 2:16 PM. During these two occasions, various accredited institutions offered free ear examination and hearing tests to patients. Some institutions organized lay fora and utilized the power of multimedia platform to champion the cause of patients with hearing loss, including those hearing individuals who are at risk.
From its inception, PANORS has committed itself to ORL resident training and research in the subspecialty, and has been a nurturing mother to existing otology fellowship programs in both the University of Santo Tomas and the East Avenue Medical Center (EAMC). Recently, fellows work in partnership with St. Luke’s Medical Center’s Hearing and Balance Disorders Laboratory to further hone their skills on audio-vestibular evaluation, cochlear implantation, and clinical research.
As part of PANORS commitment to academic pursuit this year, its members represented the country in international meetings. Dr. Martinezand Dra. Chiong were invited as faculties for some of these scientific activities. Conventions attended by the group included the IFOS congress held in Paris in June; the World Health Organization Meeting in Geneva in March and July; the Asia Pacific Symposium on Cochlear Implantation in Cyprus and the AAO-HNS congress in Chicago both held in September; the Coalition of Global Hearing Health meeting held in Florida on October, and the ASEAN ORL-HNS November meeting in Myanmar.
Members were also invited as resource speakers in various PSO-HNS certified courses – vestibular course and workshop with Professors Michel Lacour, Hermann Kingma, and Michael Strupp at the University of Santo Tomas: Basic ENT course at Makati Medical Center; Temporal Dissection course in EAMC; Philippine Pediatric Society convention and the 61st PSO-HNS annual convention, among others.
From March 1 to 3, 2018, the 10th International Academic Conference in Otology, Rhinology, and Laryngology (ORLIAC), organized by the University of the Philippines College of Medicine will be held at the Fairmont Hotel in Makati.
It has been a dynamic “aligning-the stars” 2017 for PANORS and it looks forward to more exciting years ahead of reaching its destiny — making sure that all Filipinos would have a global standard of hearing health with enough competent health providers, quality services, advocacy, training, and research. In retrospect, 2017 has taught PANORS that it is not the stars themselves that hold the destiny, but rather, the collaborative efforts of all members of the society making sure all resources are properly utilized and actions are in unison to achieve one particular goal, which align the stars perfectly.
Navigating Nasal Health
The Philippine Academy of Rhinology
According to the World Health Organization (WHO), there is an estimated 12.6 million deaths each year, or nearly 1 in 4 of total global deaths attributed to unhealthy environments, especially due to air pollution.
Chronic non-infectious rhinitis diseases (i.e. allergic, occupational, irritant rhinitis) are among those precipitated by air pollutants and it is rising in prevalence with approximately 400 million afflicted worldwide.
For the Philippine Academy of Rhinology (PAR), this means more work to achieve awareness among the lay public. But even before reaching the lay people, PAR members are down on equipping themselves with the current trends of the specialty.
For one, PAR had a busy year, it being at the forefront in the preparations for the 10th International Symposium on Recent Advances in Rhinosinusitis and Nasal Polyposis and the 61st Annual Convention of the PSO-HNS.
It was tedious work: balancing professional and clinical work with the demands of organizing an international meeting, against the backdrop of attending to family duties. Along with the rest of the Organizing Committee, we look forward to enjoying the fruits of our labor: seeing the smiles and nods of the attendees, as they enjoy three days of academic and social activities!
On the home front, PAR welcomed back two fellows from their overseas training: Dr. January Gelera finished her one-year Research Fellowship at Seoul National University Bundang Hospital under Prof. Chae-Seo Rhee, and Dr. Patrick Estolano concluded a one-month Clinical Observership at the University of North Carolina Chapel Hill under Prof. Brent Senior. Patrick’s next Fellowship Rotation will be in Seoul, Korea. Another young Fellow is Dr Joman Laxamana, presently undergoing a two-year Rhinology Fellowship at East Avenue Medical Center.
PAR continued to uphold its mission of providing continuing medical education with its monthly meetings. Residents join us as we discuss diagnostic dilemma, therapeutic controversies and research possibilities.
PAR also revived its Research Contest: this time with substantial prizes for the winners through the Cesar F. Villafuerte Sr. Research Contest which will be held during the annual convention.
On the international front, PAR members participated in various fora, including the ENT Summit in Kuala Lumpur, Malaysia and the Rhinology World Summit in Hong Kong.
Innovating Life Savers
Philippine Academy Of Craniomaxillofacial Surgery (PACMFS)
The year was marked by the Philippine Academy of Craniomaxillofacial Surgery’s (PACMFS) advocacy to promote education on the proper management of craniomaxillofacial (CMF) surgery and adherence to road safety laws among different training institutions and provincial Philippine Society of Otolaryngology-Head and Surgery (PSO-HNS) chapters.
The educational activities began with an AOCMF course entitled “Advances in Computer-aided Surgery in Craniomaxillofacial Reconstruction with Anatomic Specimens and Advanced Seminar on Osteotomies: Approach and Technical Innovation”was held last June 19-21, 2017 at the University of Santo Tomas and East Avenue Medical Center.Four International Faculty of the AOCMFand PACMFS members shared their experiences thru lectures and cadaver dissection workshop.
This was followed by an “In-house Craniomaxillofacial Workshop” at Makati Medical Center on September 28, 2017 hosted by the Makati Medical Center,Department of Otolaryngology-Head and NeckSurgery (MMC ORL-HNS).
In coordination with Bicol ENT-HNS Chapter another educational activity entitled “Maxillofacial Seminar and Workshop on Mandibular and Maxillary Fractures” was conducted at Bicol Medical Center last October 28, 2017. PACMFS members were thelecturers and workshop facilitators in both seminar-workshops.
An upcoming seminar-workshop at the East Avenue Medical Center (EAMC) Department of ORL-HNS “CMFAS Masterclass Manila III: Of Twists and Turns” is scheduled on November 23-24, 2017.
For the previous year,PACMFS had conducted educational lectures and lay forums for the promotion of adherence to road safety laws. This was in coordination with Central Luzon ENT-HNS Chapter (CELENT) and Baguio General Hospital and Medical Center (BGHMC) Department of ORLHNS.
The subspecialty study group has established a Fellowship Training Program in ORL Maxillofacial Surgery (consortium) with base hospital at the Jose R. Reyes Memorial Medical Center (JRRMMC) and is now accepting qualified fellows for 2018.
The year will come to a close with PACMFS’ presentation of its Clinical Practice Guideline on Management of Isolated Mandibular Body Fracture in Adults on the 61st Annual Convention of the Philippine Society of Otolaryngology-Head and Neck Surgery with an aim to be published early next year.
Chieftains for Hearing
The Philippine Academy of Audiology (PAAud)
The World Health Organization (WHO) estimates that 10 percent of the global population has some degree of hearing loss. Using these numbers, approximately 10 million Filipinos are hearing impaired. The Philippine Academy of Audiology (PAAud) is the specialty group designated by the Philippine Society of Otolaryngology-Head and Neck Surgery (PSO-HNS) to take care of this growing population of ours with hearing problems.
Founded in 2008, PAAud is composed of PSO-HNS fellows interested in the art and science of Audiology. Most of its members are active in their hospital’s Audiology section. Others are fellows who lead community based programs like the annual Deafness Awareness Week which is celebrated every 2nd week of November.
Other members are also into the sale and distribution of affordable yet good hearing aids and hearing instruments. Since 2008, PAAud has been headed by Dr. Howard Enriquez as President and Dr. Diosdado Uy as Vice President, both Otolaryngologists who have a degree in Clinical Audiology.
PAAud together with the Philippine Society of Audiology, a bigger group that includes non-ENTs who have special interest in audiology as well as those employed by the various hearing aid companies in the Philippines, conduct an Annual Audiology Convention. This November 25, 2017 it is slated to be held at the New World Manila Bay Hotel in Pedro Gil, Manila. This year’s theme is “Hearing Diagnosis and Intervention: Revisiting the Past, Embracing the Present, Shaping the Future”. Everyone is invited to attend.
The Sleep Specialists
The Philippine Academy of Sleep Surgery (PASS)
The Philippine Academy of Sleep Surgery (PASS) is the youngest subspecialty group of the PSO-HNS. Founded in 2011, the group was formed due to the increasing incidence and awareness on Obstructive sleep apnea (OSA). This condition affects more and more Filipinos manifesting as snoring, restless sleep and significant daytime sleepiness. It exists largely unrecognized until a bed partner complains or the individual experiences its consequences such as deterioration of health and work performance. At the time, physicians were also unlikely to even consider disturbing snoring as a potential medical condition.
Last year, the group helped in the creation of the Clinical Practice Guidelines for the Diagnosis and Management of Obstructive Sleep Apnea. This was a collaborative project with other societies and provided relevant information for physicians to understand how to approach a patient with OSA. This year, the group is finalizing release of the Clinical Practice Guideline on the Surgical Management of OSA. This document further clarifies the role of ENTs and surgery in treating OSA. These two publications are of national significance as they will be used as references by all Filipino physicians throughout the country.
Another important project is the “Adopt an ENT Training Institution and Chapter” program wherein a core member of PASS will be assigned to training institutions and chapters all over the country to help develop the practice of sleep surgery in their locale. Since OSA education remains vague to non-existent in medical schools, this project aims to spread awareness to ENT physicians all over the Philippines. The ultimate goal is to provide accessible care for Filipinos suffering from OSA wherever in the country they may be.
PASS has likewise worked on some community-relevant projects. Road safety is a major concern for the community. Sleepy motorists can cause accidents when they fall asleep on the wheel and harm not only themselves, but other unknowing motorists and pedestrians as well. Hence, another advocacy of the group the education of drivers on the hazards of driving while sleepy. The group has conducted lectures with LRT drivers and equipped their company doctors with the necessary screening tools for OSA. PASS is also working on screening bus drivers and educating them regarding the hazards of sleepy driving.
As the field of Sleep Medicine continues to evolve, the Philippine Academy of Sleep Medicine will continue to strive to fulfill its mission and respond to the needs of the PSO-HNS, our colleagues and Philippine people.
Foreign Body Busters
Philippine Academy of Pediatric Otolaryngology
Foreign body aspiration results in approximately 3000 deaths per year by asphyxiation, and these mostly occur before hospital intervention. More than 90 percent of deaths occur in children less than 5 years old, and 65 percent of deaths occur in infants. In 2000, foreign body aspiration in kids less than 14 years old led to 17,000 visits to the Emergency Department and 160 deaths.
Most airway foreign body aspirations occur in patients younger than 15 years of age. The condition tends to be twice as common as in boys. The highest incidence occurs between 1 and 3 years of age. Toddlers less than 3 years old account for 73 percent of cases. Up to 25 percent of patients are younger than 1 year.
Food and non-food objects commonly become lodged in the airway. Aspirated materials are more common with food than toys. Vegetative matter comprises approximately 70 percent to 80 percent of airway foreign bodies while plastic pieces comprise approximately 5 percent to 15 percent of airway foreign bodies.
Commonly aspirated foods are peanuts, raisins, seeds, pieces of meat (hot dogs and sausages), grapes and hard candies. Dried foods absorb water and swell with prolonged aspiration where some may even sprout. The percentage of aspirated metallic foreign bodies, especially safety pins, has decreased primarily because of the widespread use of disposable diapers.
Most toddler through preschool age children are susceptible to foreign body aspirations due to lack of molar teeth necessary for proper grinding of food, less-controlled coordination of swallowing, age-related tendency to explore the environment by placing objects in the mouth, or, often talking, laughing, running or playing while eating.
The quick diagnosis and management of foreign body aspiration in children is very critical, especially because time is of the essence. Sudden episode of coughing or choking while eating with subsequent wheezing (sometimes on one side) in an otherwise healthy child should prompt suspicion of FB aspiration. Typically, the choking period is witnessed. This acute phase may be followed by an asymptomatic phase where the foreign body becomes lodged and the reflexes are fatigued. Most patients who arrive at the hospital with airway FB have passed the acute phase and are no longer in respiratory distress. Uncommonly, tragic cases occur with total or neartotal occlusion of the airway leading to cyanosis and respiratory arrest. Complete airway obstruction resulting from a foreign body is an absolute emergency.
Without a witnessed event or history of aspiration, there can be a delay in management which may lead to complications. Most complications such as obstruction, erosion, or infection are the result of delayed diagnosis. Furthermore, foreign body aspiration may mimic conditions such as asthma, croup, or pneumonia which may contribute to late diagnosis. Suspected or known aspiration of foreign body should therefore require prompt endoscopy for removal of foreign bodies. Management is typically coordinated through the services of Pediatric otolaryngology, Pediatric anesthesiology, TCVS/General pediatric surgery, and Pediatric critical care. The team approach to management of children with foreign body aspiration through facilitation and coordination with other departments and specialties should be emphasized.
In summary, reduced mortality due to foreign body aspiration may be achieved with early recognition of the person in acute airway distress, availability of capable emergency personnel, and increased public awareness regarding the incidence and risk factors for foreign body aspiration.
Through its advocacy on ‘Preventing Foreign Body Accidents in Children’, the Philippine Academy of Pediatric Otolaryngology (PAPO) intends to achieve widespread attention to the problem of foreign body accidents and aims to reduce the number of infant and children morbidities and mortalities resulting from foreign body aspiration. The group is looking forward to continue promoting its advocacy in the succeeding years with the help of the PSO-HNS and local organizations.
December 2017 Health and Lifestyle