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Submitted by:
Kathleen Dy, CSP-PASP
Darla Florendo, CSP-PASP
Dennis Gascon, CSP-PASP
November 2019
Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
Acknowledgment
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
I. Introduction
Craniofacial anomalies are malformations that affect a child’s cranial and facial
bones (Center for Disease and Prevention, 2018). Typically acquired from birth and
more commonly seen among patients with syndromic conditions, craniofacial anomalies
bring about a multitude of possible concerns for a developing child. An epidemiologic
study conducted in 2003 to 2006 revealed that the most common craniofacial anomaly
in the Philippines was observed to be all forms of orofacial clefts, with an estimated
incidence of 1 in 1136 livebirths (Philippine Oral Cleft Registry, 2006). Considered to be
a local health burden, approximately 4,500 children are estimated to be born every year
with an orofacial cleft in the Philippines (Operation Smile, 2015).
Oral clefts can either be a cleft lip, a cleft palate, or a combination of both. Locally,
a combination type seems to be the most prevalent (WHO, 2006). Children with a cleft
palate will often have concerns feeding, speaking clearly, and are more likely to develop
ear infections that can lead to long-term hearing loss if left untreated (Center for Disease
and Prevention, 2018).
Given this, the Craniofacial Foundation of the Philippines was chosen as a study
site. As this foundation primarily caters to patients with craniofacial anomalies who are
considered to be at high risk for hearing loss, an existing protocol for the prevention,
identification, and management of hearing loss is therefore vital for this population.
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
Patient Demographics
According to the informants: (1) staff nurse, and (2) the supervising speech-
language pathologist, majority of CFFP’s patients are those with cleft lip and palate,
comprising of about 80% of the patient load. The remaining patients are further
subdivided into neurodevelopmental conditions (10%), other syndromic conditions
such as Down Syndrome (5%) and patients with isolated dental concerns (5%). For
the purpose of this case analysis, focus will be placed on one population alone, and
that is patients with craniofacial anomalies – the primary patients catered by the
center.
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
Service delivery
Since the foundation’s inception, CFFP has been closely working with other non-
government organizations such as Smile Train to provide services in far flung
areas in the Philippines. Through these outreach missions, access to the following
health services are made possible:
(1) Medical Missions: Through medical missions, free surgical operations and
dental services are provided. Made possible through the funding of
sponsors and partnerships with affiliated non-government organizations –
equipment, medications and aftercare kits are given to identified patients.
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
Procedure Description
Interview Assessment of indigence certificate, obtaining
basic demographic details and pertinent case
history
Physical Examination Obtaining height and weight of the patient
Visual Inspection Done for patients with craniofacial anomalies –
assessing oral and facial structures; identifying
location and size of cleft
Table 1. List of procedures done during Initial Assessment
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
Some rooms on the third floor, when not used by patients, are used by the speech
language pathology student interns as a therapy room.
Audiological Services
Upon interview, no existing protocols for the provision of audiological services
are currently in place at the foundation. Supported by statements from the center’s head
nurse and supervising speech-language pathologist, the foundation’s primary focus is
on the overall treatment and management of the cases being referred – hence, surgical
and rehabilitative services – with little resources allocated for prevention. Although
efforts in prevention of hearing loss among this population form part of the discussion
by speech-language pathologists during parent seminars, the supervising speech-
language pathologist feels that this may be inadequate, and consistent audiologic
monitoring is essential to ensure normal hearing acuity.
Given the lack of volunteer professionals within this health care area (i.e. ENTs
and Audiologists) and lack of available equipment (i.e. otoscopes, audiometers),
patients who are identified or suspected of having audiological concerns are usually
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
referred out to affiliated institutions. Unfortunately, most of patients referred out for
formal audiologic testing are lost to follow up.
Their recommendation is that children in this population are provided with the following
audiological services:
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
Children who have higher risk in developing middle ear infections are
highly encouraged to have their annual hearing tests for monitoring and prevent
further complications such as hearing loss.
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
patient. They also listed different syndromes and conditions which also require hearing
assessment.
Specific to patients with cleft palate who are at higher risk for conductive hearing
loss, the recommended practice algorithm is as follows:
Figure 3. Care Path for Patients with Cleft Palate (BC Children’s Hospital, 2012)
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
Given that children in this population mostly will have middle ear problems, most
specifically Otitis Media with Effusion (OME), the primary intervention for this is
grommets or tympanostomy tubes which is surgically placed in the eardrums of the
patient to equalize the pressure in the middle ear according to ASHA (2012).
Recommendations
Based on the analysis, the current practice of CFFP can be summarized as:
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
The following are our additional recommendations and plan of action with regards
to children with cleft/ cleft palate and craniofacial anomalies:
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
References
Apuzzo, M., & Yoshinaga-Itano, C. (1995). Early identification of infants with significant
hearing loss and the Minnesota Child Development Inventory. Seminars in Hearing,
16(2), 124–139.
Center for Disease Control and Prevention (2018). Facts about Cleft Lip and Palate.
National Center on Birth Defects and Developmental Disabilities.
David-Padilla, C. (2006). Profile of Oral Cleft Cases Reported in the Philippine Oral
Cleft Registry from May 2003 to December 2006. University of the Philippines, Manila.
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
Sharma, M., Bist, S. S., & Kumar, S. (2016). Age-Related Maturation of Wave V
Latency of Auditory Brainstem Response in Children. Journal of Audiology and
Otology, 20(2), 97–101. doi: 10.7874/jao.2016.20.2.97
Sood, M., & Kaushal, R. K. (2009). Importance of newborn hearing screening. Indian J
OtolaryngolyHead Neck Surgery, 61(2), 157–159. doi: doi: 10.1007/s12070-009-0058-
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Kellogg BC, ed. Cleft Palate With Cleft Lip (for Parents) - Nemours KidsHealth.
KidsHealth. https://kidshealth.org/en/parents/cleft-palate-cleft-lip.html. Published June
2019. Accessed November 28, 2019.
Gani, B., Kinshuck, A.J., Sharma, R. (2012). A Review of Hearing Loss in Cleft Palate
Patients Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299272/
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
APPENDIX I
Peer Evaluation and Grading
Florendo, Darla D.
Case Study Analysis of Population Based Practice: Patients with Cleft Palate and
Other Craniofacial Anomalies
For our case study, we decided to have the Craniofacial Foundation of the
Philippines (CFFP), a non-government and non-profit organization as our study site.
Last November 8, 2019, I went to CFFP located at Sta. Mesa, Manila to pass a letter
of request in behalf of my groupmates, Kathleen and Dennis. After obtaining
permission, Kathleen and Dennis conducted and interview on November 13 and 20. I
transcribed the recordings and identified themes for the completion of the paper. We
then divided our tasks equally for the research and paper writing. We all finalized our
case study together on a timely manner and made sure to consult each other
throughout the writing process.
PEER RATING:
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
Dy, Kathleen
Case Study Analysis of Population Based Practice: Patients with Cleft Palate and
Other Craniofacial Anomalies
For our case study, we decided to have the Craniofacial Foundation of the
Philippines (CFFP), a non-government and non-profit organization as our study site.
Last November 13 and 15, 2019, I went to CFFP located at Sta. Mesa, along with
Dennis Gascon, to interview the administrators, owners, and clinical supervisors
regarding their current protocols and practice. We then divided our tasks equally for
the research and paper writing. We all finalized our case study together on a timely
manner and made sure to consult each other throughout the writing process.
PEER RATING:
19
Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
Gascon, Dennis
Case Study Analysis of Population Based Practice: Patients with Cleft Palate and
Other Craniofacial Anomalies
For our case study, we decided to have the Craniofacial Foundation of the
Philippines (CFFP), a non-government and non-profit organization as our study site.
Last November 13 and 15, 2019, I went to CFFP located at Sta. Mesa, along with
Kathleen Dy, to interview the administrators, owners, and clinical supervisors
regarding their current protocols and practice. We then divided our tasks equally for
the research and paper writing. We all finalized our case study together on a timely
manner and made sure to consult each other throughout the writing process.
PEER RATING:
Dy, Kathleen (100%)
Florendo, Darla D. (100%)
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
APPENDIX II
Current Brochures of Craniofacial Foundation of the Philippines (CFFP)
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
APPENDIX III
Proposed Additional Brochure (Hearing Assessment)
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
APPENDIX IV
Proposed Additional Brochures
(Home Program, Proper Ear and Hearing Care)
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
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Case Study Analysis: Master of Clinical Audiology
Craniofacial Foundation University of Santo Tomas
of the Philippines (CFFP)
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