Objective: The study aimed to determine the role of low frequency ultrasound in patients with Chronic Rhinosinusitis with Nasal Polyposis (CRS-NP) and recovery after Endoscopic Sinus Surgery (ESS) using Sino Nasal Outcome Test 22 (SNOT-22) questionnaires, modified Lund MacKay endoscopic appearance, and histopathologic examination. Methods: Study design: Single Blinded Randomized Controlled Trial Setting: Tertiary government hospital Subjects: 42 adult Filipinos aged 19 to 76 years-old diagnosed with Chronic Rhinosinusitis with grade 2 and 3 Nasal Polyposis and failure of maximal medical management (3-month course of antibiotics, nasal douche, topical steroids and other modalities) between June 2013 to June 2015 were randomized into two groups of 21 participants each-- the ultrasound-treated group and control group. Specimens (nasal polyps) from both groups were obtained and processed with Hematoxylin-Eosin (H&E) and gram staining. Specimens from the ultrasound-treated group received low frequency ultrasound (1 MHz, 1.0 watt/cm2, 20% pulsed mode, for 5 minutes at 370C) post-extraction and prior to staining. In phase II, the ultrasound group also received the same ultrasound treatment while the control group underwent ultrasound at 0 MHz frequency, 0 watt/cm2, both twice a week for 3 weeks, beginning one (1) week post operatively. Both groups accomplished SNOT-22 forms and were evaluated via modified Lund MacKay endoscopic appearance at 1 week (week 0 of treatment), 2 weeks, 3 weeks, and 1 month post operatively (week 3 of treatment). Results: Paired T-test showed a statistically significant difference between control and treatment groups in epithelial thickness with a p-value of 2.29E-10 (average of 73.34um for controls and 31.1um for the treatment group) at 95% confidence interval. The inflammatory cell count also differed significantly between control and treatment groups (average 293.85 and 29.65 inflammatory cells per high-power field in 10 random microscopic fields, respectively), p-value of 1.05E-17 on paired T-test; CI 95%.  In phase II of the study, SNOT-22 results showed significant differences in improvement of symptoms in ultrasound-treated patients after Endoscopic Sinus Surgery (weekly mean scores of 38.05, 21, 11.3, and 10.45) and in modified Lund Mackay endoscopic appearance scores (weekly mean scores of 7.88, 4.35, 3.02, 2.08). Two-way analysis of variance showed significant differences between control and treatment groups for both SNOT-22 (p = 1.07E-80; 9.71E-119; CI 95%) and modified Lund Mackay endoscopic appearance scores (p = 3.89E-60; 1.85E-95; CI 95%). Conclusion: Low frequency therapeutic ultrasound demonstrated possible efficacy as an agent in disrupting epithelial architecture in patients with CRS-NP as well as in symptom improvement after endoscopic sinus surgery patients based on histopathologic evaluation, SNOT-22 and modified Lund MacKay endoscopic appearance scores. Low frequency ultrasound may be an adjuvant to conventional medical treatment in CRS-NP. Keywords: Biofilm, Sinusitis, Nasal Polyps, Chronic disease, Ultrasonic therapy

Objective: The study aims to compare the maximum sound output capabilities of different earphone types/music style combinations. The study also intends to assess the preferred listening levels (PLL) of test subjects using different earphone types with background noise accession. The study also seeks to determine the presence or absence of a threshold shift on headphone/music style combination PLL’s that exceed the recommended noise limit. Methods Study Design:            Experimental Study Setting:                       Tertiary Government Hospital Subjects: Thirty (30) hearing healthy volunteers were sampled from hospital staff aged 18-40 years, with no known history of ear pathology and/or use of any known ototoxic drugs, with normal otoscopy and audiograms of less than 20dB from 125Hz to 8000Hz, and no exposure to loud noise from any source within the previous 3 days. The sound pressure levels (SPL) delivered by three (3) types of earphones (earbud type, in-ear type, supra-aural type) were measured at maximum volume setting of a personal media player (iPod, Apple Inc.), while playing different music genres. The test subjects were asked to listen at their preferred listening levels (PLL) using the different types of earphones at increasing background noise accession. Results: The earbud type averaged the greatest SPL among the earphone types, and pop music averaged the greatest SPL among the music styles. Comparison of the maximum output capabilities revealed that there was a significant difference among different brands of earphones of the same type. However, no significant difference were found among songs of similar music style and across different music styles in all earphones except the in-ear type. PLL average was at 90.4dB in a silent environment with increasing intensity as background noise accentuated. Supra-aural earphones registered the least increase in PLL in a loud environment, due to its higher background noise-attenuating capabilities. Conclusion: Having a significant difference among earphone types with regard their maximum output capabilities, it is recommended to check the specifications of the earphone type one intends to use. In using personal media players (PMP), the volume should be set at the lowest comfortable level. While choice of music style remains the discretion of the listener, the choice of music style should be considered for long periods of listening. Because the PLL of test subjects were alarmingly high, the authors recommend intervention in their listening habits. Background noise attenuating capabilities of earphones play a factor in reducing excessive sound energy from reaching the ear, reducing the PLL, and decreasing the risk for noise-induced hearing loss. Keywords:     earphones, music styles, personal media players, preferred listening levels, recreational noise, noise-induced hearing loss