The Ear, Nose, Throat-Head and Neck Surgery Center is a facility which integrates specialized services such as The Center for Voice and Swallowing, Hearing and Dizziness Unit, and Prosthesis Laboratory.
The Center for Voice and Swallowing pioneered the first Voice Laboratory in the Philippines in 1997. It introduced the technology for stroboscopic evaluation and it has, since then, continued to be the premier referral center for diagnosing voice and swallowing disorders in the country. To date, the Center houses top-of-the-line equipment such as a High Definition Digital Laryngeal Strobe system and a Fiberoptic and Distal Chip Laryngoscope. These have allowed access to unsedated out-patient diagnostic and therapeutic procedures like Laryngeal Videoendostroboscopy (LVES) and TransnasalFlexible Laryngoscopy (TFL) with biopsy. Other procedures that are carried out are laryngeal electromyography (L-EMG) and injection laryngoplasty for vocal cord paralysis and endoscopic evaluation with sensory testing for patients with swallowing disorders. A certified Speech Language Pathologist is available in the Center to address the patients’ voice and swallowing concerns through Speaking Interventional Therapy.
The Hearing and Dizziness Center is equipped with modern facilities for hearing and balance tests both for children and adult patients. The center offers services from newborn hearing screening to amplification (hearing aids and cochlear implant). It is the first private hospital with a Cochlear Implant Program which started in 2014. This program covers early diagnosis, intervention and rehabilitation of children diagnosed with hearing loss. The center has the latest available technology for the evaluation of hearing and balance, including the complete hearing test battery (PuretoneAudiometery, Tympanometry and Speech audiometry), Auditory Brainstem Response (ABR), Auditory Steady State Response (ASSR), Videonystagmography (VNG), Vestibular Evoked Myogenic Potential (VEMP), Electrocochleography (EcochG), and the upcoming Video Head impulse test (VHit).
The Prosthesis Laboratory is the first in the country to have its own dedicated laboratory. Different types of fingers, toes, intraoral, and facial prosthesis, face and mouth guards, obturators, and speech aids are created here. The goal is to rebuild the patient’s self-esteem by ensuring aesthetic and functional restoration through these prosthetic devices.
CENTER FOR VOICE AND SWALLOWING
1. Laryngeal Videoendostroboscopy (LVES) – This is a minimally invasive endoscopic procedure of the larynx (voice box) and throat. A strobe or “blinking light” is delivered through a rigid or flexible scope to visualize the larynx, assess its vibration and the presence or absence of pathology.
2. Laryngeal Videoendoscopy (LVE) – This is an office-based diagnostic procedure that uses rigid laryngoscopes to examine the inside of the larynx, or vocal folds. LVE may be used in evaluating people with vocal fold tumors or paralysis of the vocal cords.
3. Transnasal Flexible Laryngoscopy (TFL) – An office-based diagnostic procedure, this makes use of Transnasal Flexible Laryngoscopes to examine the inside of the larynx, or vocal folds. TFL may be used in evaluating people with vocal fold tumors or paralysis of the vocal cords.
4. Transnasal Flexible Laryngoscopy with distal chip camera (TFL-DCC) – The visualization of the larynx is done using a flexible scope that is passed through the nose. Full-screen images of the larynx are produced and this enables optimal observation of the vocal folds.
5. Transnasal Flexible Laryngoscopy with Biopsy (TFL-B) – The flexible naso-pharyngo-laryngoscope has an instrument channel or port for the insertion of the biopsy forceps, injector and laser delivery that allow office-based therapeutic procedures that traditionally require sedation and general anesthesia.
6. Flexible Endoscopic Evaluation of Swallowing (FEES) – This is a standard technique that evaluates patients with swallowing problems. A flexible scope is passed trans-nasally to the patient’s hypopharynx to view laryngeal and pharyngeal structures. The clinician then observes the swallowing function by feeding the patient with various bolus consistencies and amounts of food. It provides real-time display of the swallowing function and is recorded for subsequent review.
7. Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEEST) – This is the only procedure that allows the monitoring of both the sensory and motor aspects of swallowing. A sheath with a port for air pulse delivery is slid into a flexible scope prior to its insertion into the nose. Calibrated air pulses are then delivered endoscopically to stimulate areas of the larynx. The sensory discriminating threshold is quantitatively measured while observing the laryngeal adductor (closure) reflex.
8. Laryngeal Electromyography (L-EMG) – This is a test performed to study muscle activities of the larynx. A fine needle similar to an acupuncture needle is inserted into the voice box and electrical potentials are measured. While this test can
be uncomfortable it lasts for only a few minutes and is not associated with any complications.
9. EMG (Electromyography) Guided botox injection for spastic dysphonia (BOTOX) –Patients suffering from focal dystonia of the larynx present with a strained voice quality called spastic dysphonia. This may be relieved with the injection of Botox to the laryngeal muscle (thyroarytenoid) to relax it. A small needle is used to deliver this substance and is injected to the anterior neck area. It is attached to a portable EMG unit to allow proper placement of the needle into the target muscle.
10. Kay’s Soft Image Processing (KSIP) – This was developed to complement the clinician’s subjective visual analysis of the stroboscopy examination. A series of digitalized images are analyzed with image processing algorithms representing vocal fold dynamics.
11. Electroglottography (EGG) – Electroglottographic waveforms can be displayed synchronously with a strobed vocal fold image. It can be used to confirm maximum adduction of the vocal folds and as an optional pitch triggering device.
12. Digital Strobe Voice Analysis Program (DSVAP) – This is a speech acquisition and analysis program that allows the clinician to collect acoustic measurements on the patient’s voice. These measurements are recorded for pre- and post-treatment comparisons. Hi-fidelity voice recordings are assessed through the Multi-Dimensional Voice Program.
13. Interventional therapy (Vocal Fitness/Rehabilitation Program) – Strategies to regain the voice that was lost due to vocal abuse, misuse or other medical conditions are carried out by speech language pathologists through interventional therapy.
14. Singing Interventional therapy (Vocal Coaching) – Individuals who wish to improve and correct their singing style may avail of the services of our in-house trainer
15. Speech and Language Rehabilitation Program – Patients with communication problems as a result of stroke or other neurological conditions can improve their receptive language skills through this program.
16. Swallowing Rehabilitation Program – Patients with swallowing problems as a result of stroke and other neurological conditions are given exercises for coordinating the swallowing muscles or re-stimulating the nerves that trigger the swallow reflex. Strategies to facilitate swallowing and safe feeding are also carried out.
HEARING AND DIZZINESS UNIT
1. Pure tone Audiometry – This is the key hearing test used to identify the hearing threshold levels of an individual, enabling the determination of the degree, type and configuration of a hearing loss.
2. Speech Audiometry – This test has become a fundamental tool in hearing-loss assessment. In conjunction with pure-tone audiometry, it can aid in determining the degree and type of hearing loss. Speech audiometry also provides information regarding discomfort or tolerance to speech stimuli and information on word recognition abilities.
3. Immittance Audiometry – This test generally consists of three separate tests –tympanometry, acoustic reflex thresholds, and reflex decay. Tympanometry is an objective test used to evaluate the movement of the eardrum and the status of the middle ear. In acoustic reflex testing, the audiologist measures slight changes in the eardrum because of two muscles in the middle ear (stapedius and tensor tympani muscle) that automatically contract to loud sounds. In the reflex decay test, a loud tone is presented for 10 seconds and the changes in the eardrum are again monitored during this period as the stapedius muscle contracts. The results of this test can allow the audiologist to determine if the hearing loss is related to problems in the cochlea or the acoustic nerve.
4. Visual Reinforcement Observation Audiometry (VROA) – This is a method to determine the minimum response level (MRL) of a child ages 6 months to 2 years old to sound. It may be done for older children if warranted. It employs the use of conditioning techniques so that the child will look at a toy or an interesting picture that moves/lights up when sound stimuli is presented.
5. Play Audiometry – This is a method of determining the hearing threshold of a child ages 2 to 4 years old. It may be done for older children if warranted. It makes use of conditioning techniques so that the child will perform a particular task when a sound stimulus is presented.
6. Otoacoustic Emissions Screening (OAE)/Newborn Hearing Screening Test – This is a simple, non-invasive, test for hearing defects in newborn babies and in children who are too young to cooperate in conventional hearing tests.
7. Auditory Brainstem Response (ABR) – Newborn infants will benefit the most with this screening test to monitor for hearing loss or deafness. It is a method employed to assess the functions of the ears, cranial nerves, and various brain functions of the lower part of the auditory system, prior to the child developing to the point of describing a possible hearing problem.
8. Auditory Steady State Response (ASSR) – is an objective test that helps evaluate the hearing ability of children after a newborn screen in the hospital indicates the possibility of hearing loss. This test can also be used to estimate the behavioral pure-tone audiogram which is important in the management of children with hearing loss. Pure tone audiogram is a hearing test used to determine the presence or absence of hearing loss. If hearing loss is present, the audiologist will be able to determine both type and degree of hearing loss.
9. Electrocochleography (ECochG) – This is an Important tool in assessing the function of the auditory system. It provides responses at the auditory periphery, whose source is the inner hair cells as well as neural responses from the auditory nerve. This is used to describe the synchronous electrical activity produced by the cochlea and auditory nerve, with electrodes placed in closed proximity with the source.
10. Video Head Impulse Test (Vhit) – This test utilizes a new technology that uses a high speed, lightweight video goggle to measure (left or right) eye velocity and record saccades and other abnormalities in patients with balance problems.
11. Videonystagmography (VNG) – It is a test used to evaluate patients experiencing dizziness. It makes use of video goggles with infrared cameras to allow video-image processing of eye movements particularly nystagmus (a vision condition in which the eyes make repetitive, uncontrolled movements) which is elicited or induced to determine the source of dizziness.
12. Vestibular Evoked Myogenic Potential (VEMP) – This neurophysiological assessment technique determines the function of the otolithic organs (utricle and saccule) of the inner ear. It complements the information provided by caloric testing and other forms of inner ear (vestibular apparatus) testing.
13. Epley Maneuveror Epley's exercise – This is a maneuver used to treat benign paroxysmal positional vertigo (BPPV). It is often performed by a doctor or a physical therapist, but can also be performed by the patient at home.
1. Feeding Plate or Obturator – This is an acrylic prosthesis for pediatric patients with cleft of the hard palate
2. Maxillary Obturator – This acrylic prosthesis is for adult patients with maxillary defects
3. Obturator with speech bulb – Adult patients with hypernasal speech will benefit from this prosthesis.
4. Surgical Obturator – This acrylic prosthesis is used intra-operatively for patients who will undergo the removal of their hard palate.
5. Interim Obturator – This acrylic prosthesis will be used by patients who underwent the removal of their hard palate as an interim prosthesis while waiting for the palatal defect to stabilize in size. This prosthesis does not have teeth.
6. Definitive Obturator – This acrylic prosthesis with teeth will be used by patients who underwent the removal of their hard palate after the palatal defect has stabilized. This prosthesis has teeth.
7. Occlusal Splint – This acrylic prosthesis is used intra-operatively to help the surgeon maintain the proper bite of the patient when there is a fracture of the jaw.
8. Mouth Guard – This is a customized silicone teeth protection for sports enthusiasts
9. Silicone Facial Prosthesis – This is a prosthesis of any part of the body made out of Silicone
a. Auricular prosthesis – ear prosthesis
b. Nasal prosthesis – prosthesis for the coverage of nasal defects
c. Composite prosthesis – prosthesis for the coverage of more than one part of the face
d. Digital prosthesis – prosthesis for the replacement of missing finger/toe
e. Orbital prosthesis – prosthesis for the coverage of orbital exenteration defect
10. Acrylic Facial Prosthesis – prosthesis of any part of the body made out of acrylic
Dr. Ma. Clarissa S. Fortuna – Consultant Director, ENT Center and Center for Voice and Swallowing
Dr. Patrick Henry S. Enriquez – Laryngologist
Nadine Sy, M.S., CCC-SLP – Speech Pathologist
Dr. Maria Rina Reyes-Quintos – Consultant Director, Hearing and Dizziness Unit
Dr. Nathaniel Yang – Neuro-Otologist
AmadonaLuistro, MClinAud – Audiologist
Dr. Samantha S. Castaneda – Consultant Director, Prosthesis Laboratory
Edmongino Camacho – Manager
Maria Teresita Gutierrez
The Medical City ENT Center
2/F Podium Bldg.
(632) 988-1000 / (632) 988-7000 local 6251
(632) 689-8201 (direct line)
Open daily from 8:00AM to 5:00PM except Sundays and Holidays