Oto Rhino Laryngologica Indonesiana

Subperiosteal and Citelli abscesses as rare complications of chronic suppurative otitis media

Edi Handoko, Selina Hans Sunanto — Fri, 27 Jun 2025 00:00:00 +0700

Background: Citelli abscess, is a rare extracranial complication of malignant chronic suppurative otitis media (CSOM), constitutes of a subperiosteal abscess extending from the mastoid medial aspect into the digastric fossa. Its infrequency often leads to underreporting, and delayed recognition can have severe consequences. Purpose: To present a case of malignant CSOM complicated by subperiosteal and Citelli abscesses. Case report: A 31-year-old male was diagnosed with left ear CSOM, with subsequent extracranial complications. Computed Tomography (CT) of the head and neck revealed cholesteatoma-associated ossicular damage, subperiosteal abscess, and Citelli abscess, extending intracranially to the extra-axial zone of the left temporal region. The patient underwent incision and drainage prior to receiving CT scan results, followed by a radical mastoidectomy and broad-spectrum antibiotic treatment. Clinical question: “In patients with CSOM, how does the prevalence of extracranial complications compared to intracranial complications in terms of frequency and associated clinical outcomes?” Method: A systematic search of PubMed, ProQuest, EBSCOhost, and Medline identified studies on extracranial and intracranial complications of CSOM published between 2019 and 2024. Result: Out of identified 84 articles, 6 met the inclusion criteria. Extracranial complications were more common, though regional variations emphasized the need for vigilance regarding intracranial complications due its severity. Conclusion: Subperiosteal abscesses, including Citelli abscesses, are rare but serious extracranial complications of CSOM. Prompt surgical intervention and targeted antibiotic therapy are crucial for favorable outcomes.

Prognostic factors for medicamentous and dental treatment failure in odontogenic sinusitis

Kartika Dwiyani, Eka Dian Safitri, Josua Manalu — Fri, 27 Jun 2025 00:00:00 +0700

Background: Odontogenic sinusitis refers to bacterial maxillary sinusitis caused by maxillary dental pathology, or complications from dental procedures. The therapeutic algorithm usually has two stages: conservative and surgical. If conservative therapy alone is successful in curing sinusitis, unnecessary sinus surgery can be avoided. But if conservative therapy fails, sinus surgery is usually required to remove the cause of the pathology. The effectiveness of conservative therapy varies in the range from 36 to 95%. Purpose: To investigate prognostic factors for medicamentous and dental treatment failure in odontogenic sinusitis. Case illustration: A 27 years old male with odontogenic sinusitis should undergo endoscopic sinus surgery although he had already received optimal conservative therapy. Clinical question: In patients with odontogenic sinusitis treated by conservative therapy, are smoking habits, high total Lund-Mackay score including osteomeatal complex (OMC) blockage, and history of dental procedure contribute as prognostic factors for medicamentosa and dental treatment failure? Method: Literature searching was performed through PubMed, Cochrane database and Hand-searching using keyword “odontogenic sinusitis”. Result: Three valid prognostic cohort articles were appraised for the validity, importance, and applicability in our clinical scenario. The precision prognostic factor is high total Lund-Mackay score with odd ratio (OR) 95%, and confidence interval (CI) 2.0, 1.04-3.79. Conclusion: High total Lund-Mackay score is an important prognostic factor for conservative therapy failure, so that the sinus surgery should be performed.

Endoscopy-assisted extraction of penetrating a wayer arrow in the ethmoid sinus

Christin Rony Nayoan, Lopo, C, Lopo WH, Rahma, IPFI White — Fri, 27 Jun 2025 00:00:00 +0700

Background: Using wayer arrows in attack activities carried out by a person, or a group of people is rife in Palu. Arrow injuries are classified as low velocity, but can be significantly life-threatening when the vital organs are affected. Endoscope-assisted surgery is one of the techniques of penetrating sinus injury management. Purpose: To describe the management of a unique case in otorhinolaryngology field. Case report: A 21-years old male patient was diagnosed with penetrating ethmoid sinus trauma caused by a wayer arrow. Extraction was performed to release the arrow using an endoscope. Clinical question: What kind of foreign bodies can penetrate into the paranasal sinuses? Is endoscope-based surgery approach, the correct technique for penetrating sinus injury management? Method: A literature search was performed on Pubmed and Google scholar using keywords “foreign body”, AND “sinus surgery”, AND “wayer arrow”. Result: The search obtained 19 articles, including 4 reports of wayer arrow penetrating paranasal sinus. Conclusion: The use of endoscopy for ethmoid sinus penetrating trauma gives good results.

The Management of retropharyngeal abscess in adult patient

Anak Agung Ayu Sri Vemi Hendrayani, Tince Sarlin Nalle — Fri, 27 Jun 2025 00:00:00 +0700

Background: Retropharyngeal abscess is an infection of the inner neck that mostly occurs in the pediatric population, although they can also arise in adults. While numerous resources discuss the diagnosis, treatment, and complications of retropharyngeal abscess in children, there is a scarcity of information available concerning its manifestation in adults. Purpose: To study the disease course, and management of retropharyngeal abscess in adults. Case report: A 41-year-old female patient came with chief complaints of difficulty of swallowing, snoring while sleeping, shortness of breath, and weight loss. These complaints had been going on for about 3 months. Clinical question: What is the management and overall disease course of retropharyngeal abscess in adult? Method: The literature search was conducted through Google Scholar, PubMed, and manual searches of e-books. Result: Thirteen articles concerning retropharyngeal abscess were found, but only 4 literatures were relevant to clinical question and inclusion criteria. Conclusion: Retropharyngeal abscess may present with a variety of symptoms. Management for retropharyngeal abscess in adult patient includes abscess incision and drainage, along with medication administration

Recurrent peritonsillar abscess in an active smoker patient

Dwi Khoirriyani, Adrian Benediktus — Fri, 27 Jun 2025 00:00:00 +0700

Background: Peritonsillar abscess is one of the most common conditions seen in healthcare settings. Serious complications such as airway obstruction may occur if peritonsillar abscess is not treated properly. There are several risk factors that contribute to the development of a peritonsillar abscess, one of which is smoking. Purpose: To analyze the association between the incidence of recurrent peritonsillar abscess in patients who were active smokers. Clinical question: How is recurrent peritonsillar abscess associated with active smoking? Case report: A case of a 43-year-old male patient with recurrent peritonsillar abscess and a history of active smoking, who was treated with drainage incision and was given antibiotics. Method: Evidence-based literature searches were conducted using PubMed, ScienceDirect, and ProQuest using ”peritonsillar abscess” AND ”smoker”. Result: Anatomical changes in the oral cavity and immunologic disorders in active smokers, both systemic and local, predisposed this population to higher risk factors for recurrent peritonsillar abscesses. Conclusion: Peritonsillar abscess could cause serious complications if not diagnosed and treated early. Smoking cessation might prevent recurrence of peritonsillar abscess.

Retrieval of a spherical foreign body in the right bronchus of a small child

Fri, 27 Jun 2025 00:00:00 +0700

Background: Bronchial foreign body aspiration can result in life-threatening obstruction of the airway, which makes it a serious emergency, particularly in children. Purpose: To report and discuss the challenges in extracting a spherical foreign body in right bronchus of a small child. Case report: A 3-year-old child, inadvertently inhaled a tiny, metallic ball, which resulted in respiratory distress. Diagnostic evaluation revealed high density opacity on chest X-ray, suggestive of a foreign body in the right main bronchus. The round metallic foreign body was successfully retrieved through bronchoscopy using optical forceps and magnetic forceps. Method: Literature search was conducted using keywords ”round foreign body in bronchus”, ”bronchial foreign body”, and ”bronchoscopy” in Medline and PubMed. Result: A total of 5 cases of round foreign bodies in the bronchus were published from 2003 to 2020. One case reported surgical removal of the foreign body, while 4 others were extracted via bronchoscopic intervention. Discussion: This case underscores the complexities in managing bronchial foreign body aspiration, particularly spherical shaped foreign body. The foreign body was round shaped and metallic, so it was difficult to be grasped, and the patient’s bronchus was very frail. Prompt diagnosis and appropriate interventions, guided by thorough clinical assessment and imaging, are crucial in ensuring favorable outcomes in such cases. Conclusion: In managing patients with foreign bodies in the bronchi, it is essential to select the appropriate instruments depending on the shape and type of foreign body, and surgical intervention should be considered as the last resort for foreign body extraction.

Post-cochlear implant surgery challenges: 15-years experience at Cipto Mangunkusumo National General Hospital

Semiramis Zizlavsky, Harim Priyono — Fri, 27 Jun 2025 00:00:00 +0700

Background: Hearing loss is a significant but often overlooked disability, particularly in developing countries as Indonesia, where access to specialized care is still limited. Purpose: To review the 15-years experience of cochlear implantation services at Cipto Mangunkusumo National General Hospital. Method: A retrospective study of children aged 0–18 years with profound hearing loss who underwent cochlear implant surgery between 2009 and 2023. Data were collected from medical records, including patient demographics, surgical outcomes, and complications. Result: A total of 255 patients (318 ears) received cochlear implants, with the majority aged 3–5 years (37.6%), and 54.5% male. Unilateral implants were predominant (75.3%). In 2020, a 92% decline in surgeries was noted due to the COVID-19 pandemic, which led to the postponement of elective and non-urgent cases. Post-surgical complications occurred in 4.3% of patients, with facial nerve stimulation being the most common side effects (36.4%). Conclusion: Despite expanding services, there still some obstacles remained, including high costs, limited access to specialized care, and unequal distribution of skilled professionals. Addressing these challenges is crucial to improving patient outcomes, and ensuring the sustainability of cochlear implant programs in Indonesia.

The relationship between IL-6 expression and ossicular destruction in CSOM with cholesteatoma

Fri, 27 Jun 2025 00:00:00 +0700

Background: Chronic suppurative otitis media (CSOM) is a disease that affects the middle ear, leading to perforation of the tympanic membrane. This condition involves chronic inflammation in the middle ear and mastoid cavity. A CT scan often reveals destruction to the ossicles and cholesteatoma. Purpose: To determine the relationship between increased IL-6 expression and ossicular destruction in CSOM patients with cholesteatoma. Method: This observational analytic study with a cross-sectional comparative design was conducted at the Anatomy Pathology Laboratory of Prof. Ngoerah General Hospital, Denpasar. The study used cholesteatoma tissue paraffin blocks from patients with the dangerous type of CSOM who had undergone tympanomastoidectomy from January 2022 to December 2023. Sampling was carried out through consecutive sampling, which included all cholesteatoma tissue paraffin blocks from patients with the dangerous type of CSOM that met the inclusion criteria, amounting to 17 blocks. Result: This study found a p-value >0.05, indicating no association in the bivariate analysis between the percentage, intensity, and overall score of IL-6 pathology results and ossicular destruction due to cholesteatoma, in CSOM patients. Conclusion: This study concluded that there was no significant relationship between IL-6 expression and hearing bone destruction caused by cholesteatoma in CSOM patients.

The saccharin test in chronic rhinosinusitis at Dr. Saiful Anwar General Hospital Malang

Iriana Maharani, Sarah Tamania Tallane — Fri, 27 Jun 2025 00:00:00 +0700

Background: The mucociliary system is the main defense mechanism in the respiratory tract as a protector from various particles, including bacteria. The mucociliary system will cause germs that enter to be expelled by coughing or swallowing. This system is greatly affected by many factors, such as respiratory tract infections, inflammation (rhinosinusitis), smoking habits, and pollutants. If the mucociliary system is not in good condition, the clearance time will be prolonged. Evaluation method to determine the function of the mucociliary system is the saccharin test, which is non-invasive, easily reproducible, low cost, and does not require special expertise to perform. Purpose: To know the timing of the saccharin test in chronic rhinosinusitis (CRS) patient. Method: Observational descriptive study with a cross-sectional design to find the timing of the saccharin test in CRS at ENT Department Dr. Saiful Anwar General Hospital from January-December 2023. Result: The most common finding was normal saccharin time in 46 patients (90%), and prolonged saccharin time in 5 patients (12%). The average saccharin time in chronic rhinosinusitis patients is 7.5±5.9. Most of patients were chronic rhinosinusitis without polyp (81%) with average saccharin test were 7.1±5.87, and majority were both non polyp and non-allergic rhinitis (43%) with average 8.2±6.1. Conclusion: Saccharin test could be abnormal in chronic rhinosinusitis, but overall patients with chronic rhinosinusitis had a normal average saccharin time, on both polyp and non-polyp rhinosinusitis. The results also showed that the saccharin test time was longer in chronic rhinosinusitis with polyps.

Correlation of changes in mean platelet volume with clinical stage of undifferentiated nasopharyngeal carcinoma

I Gede Wahyu Adi Raditya, I Ketut Suanda, Agus Rudi Asthuta, Jessica Filbertine — Fri, 27 Jun 2025 00:00:00 +0700

Background: The mean platelet volume (MPV) is known to serve as a platelet activation assessment system for cancer prognosis evaluation. However, its role in nasopharyngeal carcinoma (NPC) has not been studied. Purpose: To determine the correlation between MPV changes and stage progression, in undifferentiated-type NPC. Method: A retrospective cross-sectional study was conducted in Ear, Nose, Throat-Head and Neck Surgery (ENT-HNS) clinic of Sanglah General Hospital, Denpasar, from May to June 2020. Patients with undifferentiated-type NPC meeting inclusion and exclusion criteria were included. The mean MPV values were determined by calculating the difference in MPV from complete blood count tests after six chemotherapy sessions, compared to before chemotherapy. Changes in NPC staging were assessed using TNM classification pre- and post-chemotherapy. Logistic regression analysis was performed to examine the correlation between MPV changes and clinical stage changes, considering the confounding factors. Result: A total of 30 subjects were participated in this study, with mean age of 50.70±12.55 years. A significant correlation was observed between MPV changes and changes in clinical stages T (p=0.021, r=0.419), N (p=0.025, r=0.408), and M (p=0.048, r=0.364). Linear regression analysis showed a significant correlation between MPV changes and clinical stage T (p<0.001, r=0.268), clinical stage N (p=0.042, r=0.039), and clinical stage M (p=0.003, r=0.059) after adjusting for age and sex as confounding factors. Conclusion: There was a significant correlation between changes in MPV and clinical stage progression (T, N, M), in patients with undifferentiated-type nasopharyngeal carcinoma

Salivary pepsin detection for laryngopharyngeal reflux diagnosis: sensitivity and specificity comparison with scoring system

Putu Wijaya Kandhi, Rosauli Manurung, Pandu Wicaksono — Fri, 27 Jun 2025 00:00:00 +0700

Background: Laryngopharyngeal reflux (LPR) is characterized by the backflow of stomach contents into the larynx and pharynx. Gastroesophageal reflux disease (GERD) is a similar condition often mistaken for LPR. Detection of oral salivary pepsin has been developed as an alternative diagnostic modality for LPR. Additionally, there are diagnostic aids for LPR utilizing scoring systems, namely Reflux Symptoms Score (RSS) and Reflux Sign Assessment (RSA). Purpose: To assess the sensitivity and specificity of saliva pepsin testing compared to RSS and RSA in diagnosing LPR. Method: A prospective cross-sectional study involving 30 subjects with LPR symptoms was conducted to evaluate the diagnostic accuracy of saliva pepsin levels compared to RSS and RSA scores in LPR patients. Diagnostic tests performed included sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Result: The male-to-female ratio was 1:1.3. Saliva pepsin testing with a cutoff value of ≥16 ng/mL, demonstrated a sensitivity of 100%, specificity of 90%, PPV of 95.24%, and NPV of 100% against the RSS questionnaire. Meanwhile, when assessed against the RSA questionnaire, saliva pepsin testing showed a sensitivity of 95.24%, specificity of 88.89%, PPV of 95.24%, and NPV of 88.89%. The results indicated that saliva pepsin testing had good sensitivity and specificity, with values of 100% and 90%, respectively, against the RSS questionnaire; and 95.24% and 88.98%, respectively, against the RSA questionnaire. Conculsion: Saliva pepsin testing could be used as a primary diagnostic modality in the future due to its non-invasive nature, ease of administration, and good patient tolerance.

Management of ankyloglossia in children

Ivana Supit, Dini Widiarni Widodo — Fri, 27 Jun 2025 00:00:00 +0700

Background: Ankyloglossia, or tongue-tie, is a congenital oral anomaly characterized by an abnormally short, thick, or tight lingual frenulum that restricts tongue mobility. While mild cases may be asymptomatic, moderate to severe cases can impair essential functions such as breastfeeding, swallowing, mastication, speech articulation, and oral hygiene. In children, untreated ankyloglossia may also affect psychosocial development, including self-esteem and interpersonal communication. Purpose: To provide a comprehensive overview of ankyloglossia, emphasizing its anatomical and clinical aspects, classification systems, diagnostic tools, and current treatment options. Literature review: A narrative review was conducted using relevant literature from peer-reviewed journals and academic textbooks. The review covers various classification systems such as the Coryllos and Kotlow classifications, which assist clinicians in assessing severity, and determining management. Clinical manifestations vary with age and may include breastfeeding difficulties in infants, speech disturbances in children, and social or functional challenges in adults. Diagnostic approaches rely on clinical examination and standardized assessment tools like the Hazelbaker Assessment Tool for Lingual Frenulum Function (HATLFF). Management approaches include conservative methods or surgical intervention, with options such as frenotomy, frenectomy, or frenuloplasty, depending on the patient’s age and symptom severity. Conclusion: Ankyloglossia can significantly affect oral function and quality of life. Early recognition and appropriate intervention are essential for preventing long-term complications. Standardized diagnostic criteria and evidence-based treatment guidelines are needed to optimize care and ensure consistent clinical outcomes.