The Department of Otorhinolaryngology of the College of Medicine-Philippine General Hospital, University of the Philippines Manila continues to be a center of excellence in the field of Otorhinolaryngology and Head and Neck Surgery through service, teaching, training and research. It is comprised of the different sections/subspecialties, namely: Otology, Neuro-otology, Audiology and Lateral Skull base Surgery; Rhinology, Paranasal Sinus and Anterior Skull base Surgery; Laryngobronchoesophagology, Aerodigestive Tract, and Neck Surgery; Oral Cavity, Pharynx and Salivary Gland Surgery; and Craniomaxilllofacial, Plastic and Restorative Surgery.
Providing exemplary service and efficient health delivery has always been one of the priorities of the department. Weekly census of patients seen and admitted are presented to facilitate discussion and ensure proper and timely management of cases. Different subspecialty clinics in the outpatient department are conducted daily, further augmenting the number of new and follow-up patients seen. Surgeries are scheduled daily, both on an inpatient and outpatient basis to ensure fast turnover of patients. The department also strives to give the best service to the patients by acquiring state of the art equipment and further updating surgical skills. Additional services provided by the department are available through the Ear unit, Videostroboscopy unit and the Craniomaxillofacial Prosthesis unit. Participation in surgical and medical missions are also done to extend our services outside the hospital.
The department is committed to teaching, training and producing highly competent specialists. Its residency training program, which is a 4-year Philippine Board of Otolaryngology-Head and Neck Surgery accredited program, gives an in-depth exposure on the different subspecialties of Otorhinolaryngology. The department takes pride in consistently producing graduates who are already practicing and serving patients in the different regions of the country. Subspecialty training, through different fellowship programs are also available. The Head and Neck Oncologic Surgery fellowship gives a focused training on head and neck oncologic surgery with exposure to head and neck medical oncology, radiation oncology and radiology. Other programs offered include Craniomaxillofacial Prosthesis fellowship, Rotating fellowship in Facial Plastic Surgery in partnership with the Philippine Academy of Facial Plastic and Reconstructive Surgery (PAFPRS) and Masters in Clinical Audiology.
A two-track residency with an academic masteral program is also offered to select residents, one per year in the department. The academic track includes an additional year, with training activities modified to allow combined clinical activities of the regular track residency program while at the same time enrolling and fulfilling the academic requirements of the intended masteral graduate program.
Research is also one of the areas being focused in the department. Research updates and activities are done regularly to promote evidence-based learning. The research committee always ensures that residents adhere to the research requirements of the department and enjoins consultants to advise and give feedback to better improve their work. Residents of the department have always been encouraged to submit and present their papers and to actively participate in research fora, both locally and internationally.
The department will continue its commitment to maintaining competitive training, to ensuring up-to-date knowledge and skills in management, and to providing quality health care for all.
The Department of Otorhinolaryngology, University of the Philippines – Philippine General Hospital shall be an internationally recognized center of excellence in the field of Otorhinolaryngology – Head and Neck Surgery.
The health needs of the Filipino people shall be its prime consideration. It shall provide excellence and leadership in the field of Otorhinolaryngology – Head and Neck Surgery by teaching, providing exemplary clinical practice and dynamically pursuing relevant researches beneficial to the community in an environment guided by moral, ethical and spiritual values.
The specialty of Otorhinolaryngology has its beginning in the specialty formerly known as EENT – Eyes, Ears, Nose and Throat. The department was organized in May 1911 and was headed by Dr. Reinhert Rembe, a naturalized American of German ancestry. Within two years of its inception, the department began admitting resident physicians. When Dr. Rembe left the Philippines in 1914, Dr. Aristeo Rizal Ubaldo, assistant head, took over management of the department. Around the time of his chairmanship, Dr. Ubaldo toured famous eye, ear, nose and throat clinics of Europe and returned with an instrument called the Barraquer’s Erisophake. With this, Dr. Ubaldo introduced intracapsular cataract lens extraction in the country — a milestone in Philippine Ophthalmology. This was followed by other great achievements such as the first laryngectomy by Dr. Ubaldo and Dr. Antonio S. Fernando, Sr. in 1923 and the introduction of the first bronchoesophagology clinic by Dr. Vivencio C. Alcantara in 1932.
With rapid developments within the specialty of EENT, there was a call for its separation into two distinct specialties. In 1961, the University of the Philippines Board of Regents granted autonomy to the Department of Otorhinolaryngology, effectively separating it from the Department of Ophthalmology. Thereafter, the Department of Otorhinolaryngology (ORL) began its exodus into the specialty that it is today. Dr. Carlos Yambao was the department’s first chairman. He and his colleagues paved the way for further development of the field. He was followed by several great men who led and inspired the department to strive for great achievement.
At present, the department has been continuously soaring to improve facilities as it has continuously acquired new equipment such as the Zeiss microscope, CO2 and KTP A.R.C laser machine, the new Spies Rhinology tower, and complete and new microlaryngeal surgery and bronchoscopy sets. The residency training program has also been continuously adapting to the newly-recommended Outcome-Based Education (OBE) requirements of the Philippine Board of Otolaryngology, Head and Neck Surgery which has further increased the number of alternative teaching strategies, improved the quality of consultant supervision in operative procedures and outpatient clinics, and provided more objective and constructive assessment of residents’ performance.
Four-Year Accredited Residency Training Program
The residency training program of the Department of Otorhinolaryngology is a 4-year Philippine Board of Otolaryngology-Head and Neck Surgery accredited training program with subspecialties comprised by the different sections—the head of each is identified in the table that follows:
|Rhinology and Paranasal Sinus and Anterior Skull Base Surgery ("Rhino")||Ramon Antonio B. Lopa, MD|
|Craniomaxillofacial, Plastic, and Restorative Surgery ("Facial Plastic")||Roberto M. Pangan, DMD, MD, PhD|
|Oral Cavity, Pharynx, and Salivary Gland ("Oral Cavity")||Agnes T. Remulla, MD|
|Laryngobronchoesophagology and Head and Neck Surgery ("LBEN")||Ryner Jose C. Carrillo, MD, MSc (Clin Epi)|
|Otology, Neuro-otology, Audiology and Lateral Skull Base Surgery ("Otology"/ "Ear")||Nathaniel W. Yang, MD|
Residents are evaluated in four areas: 1) knowledge, 2) clinical and surgical skills, 3) attitude, and in 4) research output. Knowledge is measured by monthly in-house exams by the training officer and chief resident, residents are conducted during the last quarter of year. Clinical and surgical skills are evaluated by consultant’s assessment through appropriate grading materials, recommended by the PBO-HNS. Residents’ researches are likewise evaluated during various research activities (Interesting Case Contest, Descriptive Research Presentation, Analytical Research Presentation, regular research updates).
Head and Neck Oncology Surgery Fellowship Program
The head and neck surgical oncology fellowship program of the department is a 1-year high volume, clinical fellowship program geared towards producing subspecialists in the field of head and neck tumor/cancer treatment and care. The program aims to develop a head and neck surgeon who has a holistic grasp in the management of head and neck tumors/cancers with emphasis in training the fellow in performing difficult and complicated tumor surgeries in the head and neck. The fellowship program prides itself in elevating the treatment of head and neck cancers towards a multidisciplinary approach to involve other specialties to improve the outcomes of our patient care. Every Wednesday, for more than 20 years, this multidisciplinary team of specialists from Radiation Oncology, Medical Oncology, Pathology, Radiology, Psychiatry, Palliative and Hospice Care and our Head and Neck Surgical Oncology team meet and discuss the best treatment plans for our head and neck tumor/cancer patients as we see them, from initial care to post treatment surveillance. The program has produced numerous graduates who are now practicing in different parts of the country, operating and treating head and neck tumor/cancer patients in their localities.
Craniomaxillofacial Prosthesis Fellowship Program
The craniomaxillofacial fellowship program of the department is a two-year fellowship program that starts during the second year of residency for 2 residents interested in developing skills and the discipline in fabricating and providing prosthesis for patients suffering from post-operative head and neck defects. The fellows are trained to fabricate prosthesis that help patients regain their normal speech after surgical removal of the palate or fabricate a prosthetic nose for patients whose noses had to be removed because of cancer among others. Aside from these, the fellows also do a lot of prosthesis for cleft lip and palate patients to prepare and optimize these patients for their eventual definitive surgeries.
Philippine Academy of Facial Plastic and Reconstructive Surgery (PAFPRS), Rotating Fellow
The department, in partnership with the Philippine Academy of Facial Plastic and Reconstructive Surgery, allows its fellows to rotate in the department for several months to perform selected surgeries, observe in facial and reconstructive surgeries, and participate in the weekly ORL Facial Plastic rounds, tumor rounds and grand rounds. The fellow, in turn, presents a quarterly audit consisting of a census of cases seen and surgeries performed.
Master’s Program in Clinical Audiology
This program was started in 1998 and is offered every two years. Students spend their time in the Ear Unit for eight (8) hours a week to perform the different diagnostic tests on different patients, in addition to their classes. Faculty members come from the Department of Otorhinolaryngology University of the Philippines College of Medicine and the Department of Speech Pathology University of the Philippines College of Allied Medical Professions. Students are trained with full hands-on laboratory work, and the program allows integration of audiologic diagnosis and hearing aid analysis into the existing training program. The program also benefits from the upgraded Temporal Bone Dissection Laboratory and Vestibular Laboratory. Graduates of the Master of Clinical Audiology and ORL residency programs acquire skills for audiologic diagnosis and rehabilitation when they leave the hospital.
Post-graduate courses, lectures and seminars strengthen the residents’ understanding of the concepts essential to the specialty and provide much needed avenues to discuss management and treatment protocols with experts in the field. The basic thrust of the department has always been excellence in the field of Otorhinolaryngology – Head & Neck Surgery through teaching and training of both residents and medical students. Residents are involved in the teaching process and play a role in producing teaching aids such as the Self-Instructional Learning Modules for UP College of Medicine students.
Enumerated in the list that follows are the annual post-graduate courses conducted by the department and open to other trainees from other institutions:
- Annual Functional Endoscopic Sinus Surgery Course
- Annual Functional Rhinoplasty Course
- Images in ENT (Clinicoradiologic Correlation)- held every 2 years
- Basic Head and Neck Course- held every 2 years
- Annual In-house Temporal Bone Dissection Course
- Temporal Bone Dissection Course (open)- held every 2 years
Dr. Josefino G. Hernandez, Chair, and the present training officer, Dr. Arsenio Claro A. Cabungcal, along with all teaching consultants are diplomates of the Philippine Board of Otolaryngology- Head and Neck Surgery and Fellows of the Philippine Society of Otolaryngology- Head and Neck Surgery.
JOSEFINO G. HERNANDEZ., MD
JEANNETTE MARIE S. MATSUO, MD
Executive Officer and Vice Chair for Support Services
AGNES N. TIRONA-REMULLA, MD
Vice Chair for Undergraduate Training and Graduate Programs
ABNER L. CHAN, MD
Vice Chair for Postgraduate Training
RAMON ANTONIO B. LOPA, MD
Vice Chair for Patient Services
RYNER JOSE C. CARRILLO, MD, MSc (Clin Epi)
Vice Chair for Research
RAMON ANTONIO B. LOPA, MD
Head, Division of Otorhinolaryngology
JEANNETTE MARIE S. MATSUO, MD
Head, Division of Head and Neck Surgery
ARSENIO CLARO A. CABUNGCAL, MD
|Faculty Name||Degree||Rank||Email Address|
|1) Abes, Generoso T.||MD, MPH||Professor Emeritusemail@example.com|
|2) Arquiza, Christine Joy S.||MD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGHfirstname.lastname@example.org|
|3) Cabungcal, Arsenio Claro A.||MD||Assistant Associate Dean for Planning and Development, UP College of Medicine, Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGHemail@example.com|
|4) Calaquian, Christopher Malorre E||MD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGH Medical Specialist III, PGHfirstname.lastname@example.org|
|5) Carrillo, Ryner Jose D.||MD, MS (Clin Epi)||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGH Professor 4, Dept. of Anatomy, College of Medicineemail@example.com|
|6) Chan, Abner L.||MD||
College Secretary, UP College of Medicine. Professor 1, UP College of Medicine and Attending Otorhinolaryngologist, PGH
|7) Chiong, Armando Jr., M||MD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGH Medical Specialist III, PGHfirstname.lastname@example.org|
|8) Chiong, Charlotte M.||MD, PhD||Dean, UP College of Medicine, Clinical Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGH Research Professor 12, National Institutes of Health, UPMemail@example.com|
|9) Cruz, Teresa Luisa G.||MD, MHPEd||Associate Dean for PGIM, UP College of Medicine, Professor 1, UP College of Medicine and Attending Otorhinolaryngologist, PGHfirstname.lastname@example.org|
|10) Dela Cruz, Anna Pamela C., MD||MD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGHemail@example.com|
|11) Fellizar-Lopez, Kathleen Makrina R.||MD, MPH||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGHfirstname.lastname@example.org|
|12) Fullante, Philip B.||MD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGHemail@example.com|
|13) Hernandez, Josefino G.||MD||Professor 2, UP College of Medicine and Attending Otorhinolaryngologist, PGHfirstname.lastname@example.org|
|14) Hernandez, Melfred L.||MD, MHA||Associate Professor 4, UP College of Medicine and Attending Otorhinolaryngologist, PGHemail@example.com|
|15) Lapeña, Jose Florencio Jr., F.||MA, MD||Professor 12, UP College of Medicine and Attending Otorhinolaryngologist, PGHfirstname.lastname@example.org email@example.com|
|16) Llanes, Erasmo Gonzalo D.V.||MD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGHfirstname.lastname@example.org|
|17) Lopa, Ramon Antonio B.||MD||Associate Professor 3, UP College of Medicine and Attending Otorhinolaryngologist, PGHemail@example.com|
|18) Matsuo, Jeannette Marie S.||MD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGH Medical Specialist III, PGHfirstname.lastname@example.org|
|19)Pangan, Roberto M.||DMD, MD, PhD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGHemail@example.com|
|20) Reyes-Quintos, Maria Rina T.||MD, MClinAud, PhD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGH Research Professor 2, National Institutes of Health, UPMfirstname.lastname@example.org|
|21) Reyes, Ronaldo A.||MD, DMD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGHemail@example.com|
|22) Ricalde, Rosario R.||MD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGH Research Assistant Professor 2, National Institutes of Health, UPMfirstname.lastname@example.org|
|23) Tirona-Remulla, Agnes N.||MDemail@example.com|
|24) Villafuerte, Cesar Vincent III L.||MD||Clinical Associate Professor, UP College of Medicine and Attending Otorhinolaryngologist, PGHfirstname.lastname@example.org|
|25) Yang, Nathaniel W.||MD||Associate Professor 3, UP College of Medicine and Attending Otorhinolaryngologist, PGHemail@example.com|
|26) Hardillo, Jose Angelito U.||MD, PhD||Visiting Professor (consultant at the Department of Ear, Nose and Throat, Erasmus Medical Center Rotterdam, The Netherlandsfirstname.lastname@example.org|
|27) Cor Cremers||MD, PhD||Visiting Professor, Radboud University, Nijmegen, Netherlandsemail@example.com|
Craniomaxillofacial Prosthesis and Bioengineering Unit
The department has its own laboratory that fabricates cranio-maxillo-facial prosthetics. Prosthetic devices fabricated in the unit consists of feeding/ molding plates for cleft lip and palate patients; surgical, interim and permanent obturators for post-maxillectomy patients; occlusal splints, and lingual splints to name a few. Facial, nose and ear prostheses are also made here for patients who need these.
The Ear Unit is officially under the Philippine National Ear Institute. It functions as a service provider for the hospital in hearing examinations such as otoacoustic emission, auditory brainstem response, pure tone audiometry, speech testing, tympanometry and hearing aid fitting. It also offers tests for vertigo and balance which are only available in very few institutions, like the video head impulse test (VHIT) and cortical evoked potential. The Ear Unit likewise functions as a venue for training of the department’s residents and students of the Masters in Clinical Audiology of the UP College of Medicine in conducting the above-mentioned tests.
This unit is equipped with a laryngeal videostroboscopy machine and serves as a venue where patients can undergo videostroboscopic laryngeal examinations administered by subspecialty consultants. This allows us to visualize the vocal cords in detail and do voice analysis.
Cochlear Implantation and Bone Anchored Hearing Aids
The otology, neuro-otology section of the department is able to help qualified patients with hearing impairments by implanting advanced hearing apparatuses such as cochlear implants (CI) and bone anchored hearing aids (BAHA). The present Dean of the UPCM, Dean Charlotte Chiong, MD, PhD, pioneered cochlear implantation in the Philippines. Annually, the department does around 20 of these procedures.
CO2 Laser and KTP Laser Surgeries
Transoral laser microsurgery for benign and malignant conditions of the larynx has been one of the additional services provided by the department. It is an endoscopic approach to tumors with the use of either a CO2 or KTP laser to ablate or vaporize a lesion. It is minimally invasive and allows better surgical precision during resection. The laser has also been used in treatment of certain otologic conditions like glomus tympanicum and also has applications in the management of some vascular lesions.
Endoscopic Endonasal Approaches to the Skull Base
With the availability of the latest equipment for nasal endoscopy and skull base surgery such as HD endocameras, endoscopes, complete array of instrumentation and intraoperative surgical navigation systems, anterior skull base surgeries such as pituitary adenomas are done endoscopically through the nose in collaboration with Neurosurgery. The ORL rhinology service prepares a nasal corridor for the neurosurgeons to access and operate on lesions at the anterior skull base. These procedures are minimal access with virtually no visible scars.
Microvascular Reconstructive Surgery
Surgical resection of head and neck cancers and removal of large tumors may cause significant cosmetic and functional deformities among patients, thus requiring reconstruction to restore form and function. Aside from regional flaps, the department is also able to do reconstruction with free flaps through microvascular surgery. It has proven to be very reliable for repair of defects and has the advantages of allowing surgeons not to compromise resection margins, can be completed in a single stage and allows a two-team approach during surgery.
The department has a library of reading materials available for use in the callroom and in the department office. The department has a subscription to PJOHNS and foreign journals are accessible through the University of the Philippines Manila server (i.e. through search engine bodies like PubMed and ScienceDirect).
The Department’s Ward (Ward 10, second floor of the Philippine General Hospital) has a 42-bed capacity (39 adult beds and 3 pedia beds), divided into 5 major services.
|Oral Cavity||9 beds|
|Oral Cavity||9 beds|
|Facial Plastic||4 beds|
|Special beds/ ER beds/ Chief Resident||3 beds|
|Crib beds (any service)||3 beds|
The 39 adult beds are divided into male and female beds per service. The crib beds may accommodate any age-appropriate patient from any service. Each service has a team of residents-in-charge comprising 1 resident per year level.
The Department’s Outpatient Clinic is open 5 days a week from Monday to Friday. It is manned by the Service of the day and by all other available residents without specific posts (e.g. residents finishing early from the OR). Second year residents are in-charge of checking new patients seeking first consult, after being seen by medical students and resident rotators. First and third year residents check on the old and follow-up patients and those referred by other services. Fourth year residents oversee the entire OPD Clinic and receive referrals from junior residents.
Specialty Clinics are presided over by consultants of each service, as scheduled. Cases seen at these clinics are referred from the General Clinic for a specialized treatment plan of care by the consultant, fellow or service senior.
Major Operating Rooms
There are three (3) dedicated charity operating rooms (OR) for the department at the RCB OR complex during Tuesdays, Thursdays and Fridays. Additional rooms are being provided for pay cases—a total of 5 ORs on Mondays (2 pay rooms, 3 charity rooms) and 4 ORs on Wednesdays (1 pay room, 3 charity rooms). Each charity service is assigned three (3) OR days a week. Consultant and/or fellow supervision is mandatory for the more complicated cases and for teaching procedures.
The ORL section at the UP-PGH emergency room is equipped in handling ENT-HNS emergencies, such as foreign bodies (coin, beads, fish spine, etc) in the upper aerodigestive tract, and all upper airway emergencies among others. A resident, together with an intern and clerk, is on duty 24 hours at the E.R.
Consultants of the department hold key positions in the official journal of the PSO HNS. Dr. Jose Florencio F. Lapeña is the editor-in-chief of the Philippine Journal of Otolaryngology Head and Neck Surgery (PJOHNS). Dr. Christopher Malorre E. Calaquian, Dr. Ryner Jose C. Carrillo and Dr. Erasmo Gonzalo dV. Llanes are also associate editors of the said journal.
Research requirements for the residents have been closely monitored with regular research updates being conducted quarterly. Since 2015, a research consultant per year level has been assigned. One case report each for the 1st year residents (to be presented during their second year), one descriptive study each for the 2nd year residents, and one analytical/experimental study each for the 3rd year and 4th year residents have been required as the minimum research output. Each study group has been encouraged to produce research papers relevant to their subspecialty. The research committee is strict with EHRO approval prior to initiation of each research study.
Last year (2019), several trainees presented in both local and international venues. They presented in the midyear and annual conventions of the PSO-HNS, winning 3rd place in the Case Report category. The trainees also presented in various conferences all over the world including the Asian Society of Head and Neck Oncology (ASHNO) Congress in Seoul, Korea last March and the 4th European Otolaryngology-ENT Surgery Conference in Rome, Italy and the ASEAN ORL-Head and Neck Congress in Singapore last August.
The faculty and residents regulary publish their research in different local and international journals.
Department of Otorhinolaryngology
University of the Philippines College of Medicine –
2nd Floor, Main Building, Philippine General Hospital
Taft Avenue, Manila 1000
REPUBLIC OF THE PHILIPPINES
TELEPHONE: 8554-8400 loc. 2152/ 85548467
Because of the nature of our work, otolaryngologists are one of the more vulnerable subpopulation of healthcare workers during the COVID-19 pandemic. Despite this, the Department of Otorhinolaryngology has made efforts not only to ensure the safety of its trainees and faculty, but also to seek alternative means for the continuance of its services. Listed are some of the services the department has provided during the pandemic:
- The Department has provided 2 residents per week to go on duty in the COVID wards along with 1 safety officer.
- The Department has also sent 1-2 residents per week to go on duty as swabber in the Philippine General Hospital Health Service.
- We also developed an instructional video for naso-/oropharyngeal swabbing in our local language for dissemination to other local hospitals. The video outlined modifications in technique that were not done in other instructional videos.
- Outpatient consultation has shifted to telemedicine consultation. Old patients are given several online and offline options to reach out to us for specialist consultation.
- The trainees have done several emergent and urgent surgical procedures while wearing the appropriate level of personal protective equipment.
- Public health/primary care infographics are periodically released on online platforms to aid in lay education of common diseases of the head and neck.
- The Section of Laryngology, Bronchoesophagology and Neck Surgery (LBEN) created an evidence-based protocol on tracheostomy including indications and step-by-step technique.
- Several members of the faculty are engaged in development or adaptation of technologies useful during COVID-19
- Several members of the faculty have also contributed to the development of post-COVID outpatient clinical practice guidelines. This was recently published in Volume 35 of the Philippine Journal of Otolaryngology-Head and Neck Surgery.
- Trainees have realigned their research requirement to COVID-related research.
- The Department has temporarily shifted to online-based learning for its trainees in the form of online SGD and webinars. Self-directed learning is facilitated by coursework through Google Classroom platforms.
- Friday grand rounds and regular weekly consultant staff meeting were done via Zoom platform
|26||Arsenio Claro Cabungcal|
|64||Christine Joy Arquiza|
|69||Anna Pamela Dela Cruz|
|121||Jose Florencio Jr Lapena|