Oto Rhino Laryngologica Indonesiana

Correlation of Tympanomastoidectomy Pathological Findings With Hearing Loss In Chronic Suppurative Otitis Media Patients

2023-06-23T19:24:48+07:00

Background: Patients with chronic suppurative otitis media (CSOM) often experience hearing loss from mild to very severe degrees. In addition, patients with CSOM often have intraoperative pathological findings. Aims of this study is to determine the correlation between intraoperative tympanomastoidectomy pathological findings with the type and degree of hearing loss using pure tone audiogram images in CSOM patients.

Methods: This study is an analytic type study that uses a cross-sectional design. This research was conducted in three hospitals during October 2021 to December 2021. The sample size in this study was 37 patients who would undergo tympanomastodectomy surgery.

Results: The most common pathological finding was granulation in 36 patients (97.3%) and followed by sclerotic in 31 patients (83.8%). The average patient had more than 2 pathological findings. Most of patients (78.4%) had conductive hearing loss and most of patients had moderate degree of hearing loss in 25 patients (67.6%). Based on type of hearing loss, there were significant associations with several pathological findings, namely cholesteatoma (p=0.003), defect ossicles (p=0.009), ossicular defects (p=0.001), facial nerve defects (p=0.009). In terms of the number of pathological findings, there was a significant correlation with hearing loss (p=0.004, r=0.467) and the degree of hearing loss (p=0.029, r=0.360).

Conclusion: Among the pathological findings by type of hearing loss, a significant correlation was found.

Clinical analysis of the nose on Down syndrome patients in the Minangkabau tribe

2023-04-26T20:03:39+07:00

Background: Down's syndrome (DS) is a congenital disorder due to prenatal trisomy 21 which causes malformations of organs and body shape, including the nose. The variables measured are the points that determine the aesthetics of the nose. Purpose: This study aimed to describe primary data thus obtained from nose anthropometry of Down syndrome in the Minangkabau tribe can be used as a reference in nose reconstruction in patients with Down syndrome to restore physiological function and add aesthetic value. Methods: This research is a descriptive type study with a cross-sectional method using primary data as subjects. The sample of this study were people with Down syndrome who have Minangkabau ethnicity, totaling 22 samples with an age range of 13-25 years from special schools in Padang city. The study was conducted by observation and anthropometry of the nose using graphical images computerized by software called rhinobase software. Results: The results of this study showed that the nose width is 15.25 mm ± 2.07, the ala nasi width is 41.41 mm ± 3.47, the nasofrontal angle was 133.59° ± 5.89, the nasolabial angle was 109.24° ± 13.60 , the nose length is 32.16 mm ± 3.24. Conclusion: From this study, various results were found on the size of the aesthetic points of the nose of Down syndrome patients in the Minangkabau ethnic group when compared to DS patients in different race, ethnic, or non DS patients.

Analysis of bile acid in saliva of patients with laryngopharyngeal reflux and non-laryngopharyngeal reflux

2022-10-21T04:36:11+07:00

ABSTRACT — Background: Laryngopharyngeal reflux (LPR) is the backflow of gastric and or duodenal fluid into the larynx, pharynx, trachea, and bronchi. The prevalence of LPR is difficult to determine due to the limited gold standard and the large variety of LPR symptoms. Damage can occur due to the decrease in pH value and also because of exposure to harmful enzymes in reflux, including bile acid. Purpose : This study was conducted to analyze bile acid levels in the saliva of LPR patient and non LPR subject. Methods: This study is an observational study with a case-control design. The study was conducted in the ORL-HNS Department of Dr. M. Djamil Hospital, Padang, West Sumatra, Indonesia. The total sample size was 44 people. We enrolled 22 healthy subjects as the control group and 22 patients suspected of having LPR. Result: LPR patients are more common in women than in men, with 12 women and 10 men. Bile acid in the LPR group means of is 25.08±7.67µM, meanwhile, in the healthy group, the mean was 18.99±8.26 µM. There is a statistically significant in the incidence of LPR with the bile acids (p = 0.015) based on t- independent test. Conclusion: Our study confirmed that bile acids in saliva play a major role in diagnosing LPR.

Comparing Voice Related Quality of Life scores between fenestrated and speaking valve cannula users

2023-07-10T12:46:42+07:00

Background: Tracheostomy is a procedure that aims to maintain the airway so that air can enter the lungs and bypass the upper airway. Tracheostomy causes physiological changes, especially in terms of communication, which leads to reduced voice-related quality of life. Fenestrated tracheal cannula and speaking valve can assist patients in generating voice.

Objective: To compare the V-RQOL scores of the fenestrated tracheal cannula and speaking valve users.

Methods: Analytic observational study using a cross-sectional design. Data collection was done through interviews with the V-RQOL questionnaire guide. The study was conducted in September-December 2022 at the THTBKL Polyclinic of Dr. Mohammad Hoesin Hospital Palembang. Data were analyzed with IBM SPSS 26.

Results: 42 patients were using tracheal cannula, with 21 patients each with a fenestrated and speaking valve tracheal cannula. Patients with fenestrated tracheal cannula had lower quality of life in the physical, social, and total domains than those in the speaking valve group (poor QoL in the physical domain: 66.67% vs. 9.52%; social domain: 85.71% vs. 57.14%; total domain: 76.19% vs. 4.76%; p<0.001). From the multivariate analysis, the tracheal cannula type influenced the patient's quality of life was (p<0.001). The probability of someone with a fenestrated tracheal cannula will experience a poor QoL is 76.2%, while speaking valve is 4.7%.

Conclusion: The quality of life of patients with a fenestrated type of tracheal cannula is significantly lower than that of speaking valve tracheal cannula users in both the physical, social, and total domains as measured by the V-RQOL.

Validity-Reliability Test of Indonesian-translated MBD-MBS questionnaire as screening method for mouth breathers

2023-03-19T11:44:34+07:00

Introduction Mouth breathing, the process of air entry from the mouth to the lungs without passing through the nose, is an abnormal behaviour that may imply the presence of a comorbidity. Mouth breathing in children, teenagers, and adults leads to numerous pathological consequences, especially in children. There are several methods available to diagnose mouth breathing, one of them being the provision of questionnaires, however, there is yet any mouth breathing questionnaire that has been translated into Indonesian. Therefore, this research aims to translate the MBD-MBS questionnaire in Indonesian, and conduct a validity and reliability test for the translated questionnaire. Hence, this translated questionnaire may be used as a tool to diagnose the presence of mouth breathing. Methods This cross-sectional study was conducted to 33 parents of children in day-cares or preschools in Bandung city that fulfilled the inclusion and exclusion criteria. Translation of the questionnaire was conducted by a sworn translator after permission was granted by the original author through email. The questionnaire was then distributed to the subjects after being given consent. Afterwards, the validity and reliability test were then conducted using Spearman and Cronbach-α formulas respectively. Results All six questions in the Indonesian translated MBD-MBS questionnaire is validated (r_count > r_table, which is 0.355) and reliable (Cronbach’s Alpha 0.643 > 0.6). Conclusion Based on both validity and reliability tests, all questions in the Indonesian-translated MBD-MBS questionnaire are considered valid and reliable. Hence, this questionnaire is suitable to be utilized for further studies about mouth breathing.

Overview quality of life of deaf children in Government Special School II Banjarmasin

2022-07-28T10:41:23+07:00

Background: Hearing loss affects a person’s ability to communicate actively. In addition to social
barriers, non-interactive communication can affect a person’s emotional state. Early intervention at a
child’s age is very important to note. Purpose: To provide an overview of the quality of life (QoL) of deaf
children socially and emotionally, and to assess the use of hearing aids (HA) in their daily lives. Method:
Conducted using a cross-sectional method on 37 students aged 11-18 years, at the Government Special
School II Banjarmasin. The research media used was a Strength and Difficulties questionnaire. The data
was then processed using SPSS. Subjects were 19 male and 18 female, with the highest number being 13
years of age. Only 1 participant had anatomical abnormalities in the ear canal. All students had hearing
loss and did not know the cause of hearing loss. Result: As many as 50% of participants experienced
abnormalities in behaviour, 40% were borderline, and only 10% were normal. The relationship problems
in peer groups sub-scale experienced the most disruption. Almost all participants (97%) of the study did
not use their HA due to damaged (13%), or being left at home (65%). Conclusion: All children used
sign language as a way of communication, and never had speech therapy. Almost all deaf children had
behavioural disorders. Most participants (97%) did not wear their HA. This was one of the factors that
caused the quality of life of children with hearing impairment to decline.
Keywords: hearing loss, deaf, child, behavioural disorder, hearing aid, quality of life

Hypertonic saline nasal irrigation for chronic sinusitis: a systematic review and meta-analysis

2023-08-22T17:47:07+07:00

Background: Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses
characterized by persistent sinonasal symptoms. It is a prevalent chronic medical ailment worldwide,
impacting individuals of all ages and impairs patients’ quality of life. Recent findings in otorhinolaryngology reveal that hypertonic saline nasal irrigation is more effective than isotonic saline for addressing this condition. Hypertonic saline with higher osmotic pressure demonstrates superior efficacy in reducing mucosal edema.
Purpose: To study the efficacy of nasal irrigation with hypertonic saline on chronic
rhinosinusitis. Literature review: Conducted following the Preferred Reporting Items for Systematic
Review and Meta-Analysis (PRISMA) 2020 guidelines. The search strategy spanned prominent multiple
electronic databases (PubMed and SagePub), encompassing publications from 2015 to 2023. Duplicate
publications, review articles, and incomplete articles were excluded. A meta-analysis was planned to
analyze outcome of Visual Analog Scale (VAS) score. Result: The search results from the year 2015-
2023 yielded 35 articles from PubMed and 28 articles from SagePub. In the end, 4 eligible studies were
obtained. From these, hypertonic saline demonstrated enhanced symptomatic relief. However, only two
studies were eligible for meta-analysis, revealing no significant VAS difference between hypertonic and
normal saline (mean difference 2.40 [95% CI -2.85 – 7.65]; p 0.37).
Conclusion: Hypertonic saline nasal irrigation offered moderate side effects, improved nasal symptoms and ciliary activity more than isotonic saline, although there were no significant differences in radiological imaging or sense of smell. However, the meta-analysis did not find a significant difference in VAS scores.

Keywords: chronic rhinosinusitis, ciliary activity, nasal irrigation, hypertonic saline

Association between obstructive sleep apnea and sleep quality

2022-12-29T02:17:04+07:00

Background: Obstructive sleep apnea (OSA) is described as a disturbance of sleep presenting
repetitive (either total or partial) closure of the upper airway. Studies have demonstrated that OSA in
the middle-aged induces excessive daytime sleepiness; mood problems and poor quality of life. OSA
is characterized by repetitive narrowing or obstruction of the upper airway during sleep, resulting
in apnea or hypopnea. Patients with OSA have shown poor sleep quality. Purpose: To evaluate the
possible association between OSA and patients’ sleep quality. Literature review: OSA is a common
sleep disturbance classified by intermittent partial or total upper airway obstruction during sleep, causing intermittent hypoxemia, recurrent arousals, sleep fragmentation, and poor sleep quality. OSA is related to the quality of life, depression, and anxiety, but there were associations with acute stress which were reported by a few studies. Most of studies on OSA had collected data from moderate to severe sleep apnea in elderly patients and clinical settings. Continuous positive airway pressure (CPAP) therapy, which provides a mechanical pneumatic stent for the upper airway, is an effective treatment for OSA. As a rule, it is given via a nasal mask, and therefore patients should ideally keep their mouth closed during sleep. Conclusion: The literature review showed that there was a significant association between obstructive sleep apnea risk and sleep quality. The risk of increasing OSA among young people is associated with acute stress, and the relationship is mediated by sleep quality.

Keywords: sleep apnea, continuous positive airway pressure, upper airway obstruction

The role of locoregional radiotherapy in distant metastatic nasopharyngeal carcinoma cases

2023-10-02T16:24:55+07:00

Background: Nasopharyngeal carcinoma (NPC) is a highly metastatic head and neck cancer primarily
treated with platinum-based chemotherapy. The oligometastasis hypothesis proposed by Hellman and
Weichselbaum suggested that controlling the primary tumor through locoregional radiotherapy could
significantly improve prolonged disease-free survival. Purpose: To evaluate the effectiveness of combining locoregional radiotherapy with chemotherapy for metastatic NPC. Case series report: The first case involved a 57-year-old male with NPC at T4N3M1 (lungs) with partial response to chemotherapy, who then underwent concurrent chemoradiotherapy. However, his condition deteriorated after completing chemoradiation. The second case featured a 56-year-old male with NPC at T4N3M1 (liver), exhibiting partial response to chemotherapy and remaining at a stable condition after concurrent chemoradiotherapy. Method: Using specific keywords based on clinical questions in the PubMed, Cochrane, EBSCOhost, and Proquest databases. Inclusion criteria, exclusion criteria, and critical appraisal were carried out to find relevant studies. Result: Eleven articles were appraised critically based on the Oxford Centre for Evidence-based Medicine (CEBM) worksheet and include the validity, importance, and applicability in clinical scenarios. Conclusion: Metastatic NPC patients had better overall survival outcomes when treated with locoregional radiotherapy and systemic chemotherapy. Predictive factors influencing survival included oligometastasis, locoregional radiotherapy, chemotherapy response, lactate dehydrogenase, C-reactive protein, EBV DNA, total chemotherapy administration, Karnofsky performance score, number of metastatic lesions, and liver metastases. Platinum-based chemotherapy combined with locoregional radiotherapy could be considered as a management approach for cases of oligometastatic NPC.

Keywords: nasopharyngeal carcinoma, chemotherapy, metastasis, overall survival, radiotherapy

Coincidence of chronic rhinosinusitis with nasal polyps and neurofibroma

2023-05-30T07:53:35+07:00

Background: Nasal polyps are painless inflammatory lesions originated from around the middle
meatus or paranasal sinus cavity; while neurofibroma is benign peripheral nerve sheath tumor. Purpose:
To report a rare case of neurofibroma concurrently with nasal polyps in chronic rhinosinusitis. Case
report: A 64-year-old female with chief complaint congestion on the right nose cavity. There was a mass on both nasal cavities. Patient diagnosed with benign mass at right nasal cavity and chronic rhinosinusitis with nasal polyps at left nasal cavity; with a differential diagnosis of chronic rhinosinusitis with bilateral nasal polyps. Computer tomography scan results showed homogeneous isodense lesion in the right nasal cavity, and mucosal thickening in left nasal cavity and maxillary sinus. Patient was managed with total extirpation of the bilateral nasal cavity mass and functional endoscopic sinus surgery. Pathological examination revealed neurofibroma in the right nasal cavity and polyps in the left nasal cavity. Clinical question: “How to differentiate inflammation with tumor of nasal and paranasal sinuses? Is there a causal relationship?” Review method: Literature searching was performed with the keywords “nasal cavity neurofibroma”, AND “nasal polyps”, AND ”chronic rhinosinusitis” through database Google Scholar, PubMed, and hand searching/e-book. Result: There were 11 literatures published in the last 5 years, and 7 articles relevant with the subject. Conclusion: Chronic rhinosinusitis with nasal polyps, along with neurofibroma on nasal cavity is a rare co-incidence, and there was no correlation between those lesions. Pathological examination is a gold standard in differentiating a definite diagnosis of neurofibromas and polyps.

Keywords: nasal cavity neurofibroma, nasal polyps, chronic rhinosinusitis

Appropriate imaging in the management of first branchial cleft anomalies

2023-07-25T08:51:16+07:00

Background: First branchial cleft anomalies (FBCA) are rare clinical entities of the head and neck.
The low incidence and varied presentation often result in misdiagnosis and inappropriate treatment.
Correct diagnosis is essential for proper management, while an incorrect diagnosis will often lead to
inadequate treatment. A good understanding of the regional anatomy and embryology can lead to an
early diagnosis and thereby effective management of FBCA. Purpose: To present how to diagnose and
manage FBCA. Case report: A case of a 6-year-old female who had an FBCA with a history of swelling
and recurrent discharge from the fistula in the infra-auricular area. Complete excision of the tract was
performed without facial nerve complication. Clinical question: What is the appropriate imaging for
diagnosis FBCA? Review method: Scoping review was done to identify the scientific evidence about
imaging for diagnosis FBCA. Systemic searching in 4 databases (PubMed, Embase, Proquest, and Web
of Science) using keywords “first branchial cleft”, “anomaly”, and “imaging”. Result: Three article was
found relevant with the topic of imaging for diagnosis FBCA. Conclusion: Proper diagnosis of FBCA
can lead to proper management and good results. Imaging can provide an anatomical picture of each
branchial arch anomaly, which can be very helpful in preoperative planning to determine a definitive
surgical approach. Early management of FBCA can reduce the recurrence rate significantly.

Keywords: first branchial cleft, anomaly, children, imaging

Foreign body of fractured tracheal cannula in the bronchus after tracheostomy

2023-03-31T11:32:57+07:00

Background: Foreign body of fractured tracheal cannula in tracheobronchial tract is one of rare
complication of tracheostomy. Symptoms appear in the form of respiratory distress and if not properly
treated may threaten patient’s life. Objective: To know the causative factors, management, and preventionof tracheal cannula foreign body in tracheobronchial tract. Case report: A 3-year-old boy reported with a foreign body of fractured tracheal cannula in his bronchus after tracheostomy. Method: Review of evidence-based literatures with keywords ”foreign body” AND ”tracheal cannula” on Google Scholar. Result: Extraction of foreign body of fractured tracheal cannula was performed by rigid bronchoscopy via the stoma, under general anesthesia, in all of the case reports in the literatures. After the procedure, the respiratory distress improved and patients could be discharged from the hospital. Conclusion: The definitive management of foreign body of fractured tracheal cannula in tracheobronchial tract by using rigid bronchoscopy transtracheostomy under general anesthesia is effective. Education and knowledge about post-tracheostomy care and follow up, are the keys to prevent such incidents.

Keywords: foreign body, tracheal cannula, bronchoscopy