Oto Rhino Laryngologica Indonesiana

Squamous cell carcinoma of the external auditory canal with intracranial invasion

2026-03-31T11:09:31+07:00

Background: Squamous cell carcinoma (SCC) of the external auditory canal (EAC) is a rare and aggressive malignancy that may resemble chronic ear disease, causing delayed diagnosis and poor prognosis in advanced stages. Purpose: To report a case of SCC of the EAC with temporal bone and intracranial invasion. Case report: A 64-year-old male with chronic otorrhoea and previous mastoidectomy, presented with retroauricular ulcerative mass. Clinical examination found multiple ulcerative masses in the left retroauricular region. MRI showed temporal bone destruction with intracranial extension, and histopathology confirmed well-differentiated SCC, classified as stage IVA (T4N0M0). The patient underwent radical surgical excision, followed by adjuvant chemotherapy and radiotherapy; however, local recurrence occurred within six months. Clinical question: In advanced SCC of the EAC, how does multimodal therapy affect local control and outcomes? Method: A narrative evidence search was conducted through PubMed, Scopus, and Google Scholar for studies from 2016 to 2026 on SCC of the EAC, temporal bone invasion, intracranial extension, surgery, radiotherapy, chemoradiation, and multimodal therapy. Result: Evidences supported MRI for assessing tumor extension and guiding treatment. T4 disease with intracranial invasion remains associated with poor local control despite multimodal therapy. Conclusion: SCC of the EAC should be suspected in chronic otorrhea, non-healing ear lesions, or persistent symptoms after ear surgery. Early recognition, MRI-based staging, and multidisciplinary treatment are essential, although recurrence risk remains high in advanced T4 disease.

Sinonasal schwannoma in a patient with Eisenmenger syndrome

2026-02-10T11:12:59+07:00

Background: Sinonasal schwannoma is a rare tumor of the nasal cavity and paranasal sinuses, often presenting with recurrent epistaxis and nasal obstruction. Eisenmenger syndrome is a life-threatening cardiopulmonary condition resulting from uncorrected congenital heart disease. Purpose: To report a rare case of sinonasal schwannoma in a patient with Eisenmenger syndrome, and to explore therapeutic considerations. Case report: A 23-year-old male presented with recurrent nasal bleeding and progressive dyspnea. Imaging revealed a lobulated mass in the right nasal cavity. Histopathological evaluation confirmed sinonasal schwannoma. The patient also had an unrepaired secundum atrial septal defect with Eisenmenger physiology, rendering surgical excision high-risk. Clinical question: In patients with sinonasal schwannoma and Eisenmenger syndrome, when is surgical excision appropriate? Can conservative therapy provide adequate control in high-risk cases? Method: A literature search was conducted on PubMed, Medline, and Google Scholar using relevant keywords. Articles were selected based on the last 10 years of publication and full-text availability. Result: No studies specifically addressed this dual pathology. However, available literature emphasized the need for individualized management, with surgery being curative in healthy patients, and conservative observation preferred in high-risk cardiac cases. Conclusion: While surgical excision remains the “In patients with sinonasal hemangiopericytoma (HPC), conservative management may be justified in patients with Eisenmenger syndrome due to the prohibitive cardiopulmonary risks.

Image-based artificial intelligence for otitis media effusion diagnosis: a systematic review and meta-analysis

2026-01-28T10:58:51+07:00

Background: Otitis media with effusion (OME) is one of the most common ear conditions encountered in primary healthcare, particularly in facilities without supporting audiometry or tympanometry. OME is often misdiagnosed or delayed in treatment because it requires specialised skills to interpret otoscopic findings. Artificial Intelligence (AI) can help to simplify the diagnosis of OME so that appropriate management can be provided immediately. Purpose: To determine the performance of AI based on otoscope results in the diagnosis of OME. Method: A systematic review search based on the PRISMA flowchart was conducted in three databases (PubMed, Cochrane Library, ScienceDirect) until July 2024. Data extraction was performed to assess the sensitivity and specificity of AI for the diagnosis of OME. The risk of bias was assessed using QUADAS-2. All data were analyzed using Review Manager 5.4 and MetaDTA 2.0. Result: Twelve studies with 20,452 otoscope results were included in this review. The meta-analysis showed that AI based on otoscope results had a high sensitivity of 0.93 (95% CI; 0.87- 0.96), and a high specificity of 0.96 (95% CI; 0.94-0.98). In pediatric patients, this otoscope-based AI was also shown to diagnose OME with high sensitivity and specificity of 0.93 (95% CI; 0.64-0.99); 0.94 (95% CI; 0.86-0.97). Conclusion: AI demonstrates high sensitivity and specificity performance for the diagnosis of OME in both adult and pediatric patients. AI shows promising potential to help identify OME in primary care settings before referral for further management, and to avoid unnecessary antibiotic use. Further research is needed.

Assessment tools of olfactory dysfunction: a systematic review

2026-01-28T10:49:52+07:00

Background: The sense of smell plays a vital role in detecting odors and influences daily functioning and quality of life. Olfactory function can be assessed using subjective approaches, including self-reported questionnaires for individuals with olfactory disorders. Purpose: To summarize and categorize existing olfactory-related scales and questionnaires, based on previous research. Method: A systematic search was conducted following the PRISMA guidelines using ScienceDirect, ProQuest, and PubMed. Studies published between 2014 and 2024 were screened based on predefined criteria, and 10 eligible articles were included. Result: The instruments were classified into three categories: assessment of olfactory function and dysfunction; olfaction-related quality of life; and attitudes, emotional responses, and the perceived importance of smell. Reported reliability values ranged from acceptable to excellent, with Cronbach’s alpha coefficients between 0.65 and 0.98. Olfactory Disorders Questionnaire (ODQ) and the Taste and Smell Tool for Evaluation (TASTE) consist of more than 30 items, and may require longer completion time, which limiting routine clinical use, and provide limited evidence of predictive validity for evaluating the effectiveness of clinical interventions. Conclusion: This review highlighted a wide range of validated olfactory-related questionnaires, emphasizing the affective, emotional, and quality-of-life impacts of olfactory dysfunction. These instruments offer valuable subjective insights, which can complement objective olfactory testing in clinical practice and research

The influence of AI-driven robotics on medical education in head and neck surgery

2026-02-25T10:24:08+07:00

Background: Robotic surgery has become increasingly relevant in head and neck procedures, offering enhanced precision, improved access to anatomically complex regions, and favorable functional and cosmetic outcomes. Technological advances, including the integration of artificial intelligence (AI) and the emergence of novel platforms, have expanded the scope of minimally invasive surgery in Otolaryngology. However, disparities in access, training, and evidence quality, remain barriers to widespread adoption. Purpose: To evaluate the current impact of robotic surgery in head and neck surgery by synthesizing recent evidence on its clinical applications, technological development, training infrastructure, and future directions. Method: A narrative literature review was conducted using PubMed, Scopus, and Web of Science databases to identify peer-reviewed articles published between January 2010 and February 2025. Ten studies were selected based on relevance to robotic surgery in head and neck procedures. Data were extracted regarding study design, participants, intervention, outcomes, and thematic contributions. Result: The reviewed studies consistently demonstrated that robotic surgery was feasible and safe for transoral procedures, neck dissections, and pediatric cases. New platforms like Versius and KD-SR-01 showed potential for improved accessibility and usability. Key barriers included high cost, limited training availability, and lack of randomized controlled trials. AI applications remain largely theoretical with minimal clinical integration. Conclusion: Robotic surgery in head and neck practice is advancing with strong clinical promise. Future efforts must focus on cost-effectiveness, standardized training, and translational research to optimize access and impact, especially in under-resourced settings

Chromoendoscopic findings in diagnostic esophagoscopy

2026-01-28T16:07:01+07:00

Background: Patients with head and neck squamous cell carcinoma (HNSCC) carry a significant risk for potential spread of malignancy to the aerodigestive tract. Lugol chromoendoscopy is a well-established image-enhanced technique that increases the sensitivity for detecting early synchronous esophageal squamous cell neoplasms (ESCNs) by selectively staining normal glycogen-rich epithelium brown, leaving dysplastic or malignant areas unstained. Purpose: To describe the findings of chromoendoscopy during diagnostic esophagoscopy in three patients diagnosed with laryngeal carcinoma, who were scheduled for total laryngectomy as a follow-up treatment. Case reports: We presented three cases of male patients diagnosed with Stage III laryngeal carcinoma. Case 1 and case 2 were scheduled for primary total laryngectomy. Case 3 was scheduled for total laryngectomy following post-chemoradiotherapy recurrence. All patients underwent diagnostic esophagoscopy to evaluate potential esophageal extension. Clinical question: “Is chromoendoscopy highly sensitive in detecting malignant spread in patients with head and neck squamous cell carcinoma in the esophageal area?” Method: Literature search was conducted using key word “ chromoendoscopy” AND ”esophagoscopy” AND ”esophagus” AND ”therapy” in PubMed and Google Scholars. Exclusion criteria included articles published before the year 2000. Result: A total 30 articles relevant to this topic, and nine could be used as refferences. Conclusion: Chromoendoscopy is a highly effective diagnostic tool in the preoperative workup of laryngeal carcinoma patients. It significantly enhances the detection of both synchronous esophageal lesions and malignant extensions, enabling more precise surgical planning and comprehensive management, before major interventions such as total laryngectomy.

The Middle ear pepsin and IL-8 in active chronic suppurative otitis media with laryngopharyngeal reflux

2026-03-26T09:21:18+07:00

Background: Chronic suppurative otitis media (CSOM) is a chronic inflammatory condition of the middle ear, characterized by tympanic membrane perforation and persistent or recurrent ear discharge. The active phase of CSOM refers to a period of ongoing intense inflammation, marked by purulent exudate production, active infection, and heightened immune response. One of the contributing factors in CSOM pathogenesis is laryngopharyngeal reflux (LPR). Studies suggest that refluxed pepsin from LPR can reach the middle ear through the Eustachian tube, triggering local inflammation and exacerbating tissue damage during the active phase. Pepsin plays a role in upregulating pro-inflammatory cytokines, such as interleukin-8 (IL-8), thereby intensifying the inflammatory response and worsening CSOM symptoms in this stage. Purpose: To determine the correlation between pepsin and IL-8 levels in middle ear secretions of patients with active CSOM and LPR. Method: This cross-sectional study involved 32 patients with active CSOM and clinical signs of LPR. Middle ear secretions were analyzed for pepsin and IL-8 concentrations using enzyme-linked immunosorbent assay (ELISA). Pearson correlation was used to assess the relationship. Result: The study population was predominantly aged 36-45 years (28.12%) and female (59.4%). The mean pepsin concentration in middle ear secretions was 71.52±84.64 ng/mL, while the mean IL-8 level was 33.47±17.56 pg/mL. A strong and statistically significant positive correlation was observed between pepsin and IL-8 levels (r = 0.682; p = 0.001). Conclusion: Elevated pepsin levels due to LPR, strongly correlate with increased IL-8 expression, suggesting a reflux-mediated inflammatory mechanism in the pathogenesis of active CSOM.

Comparison sensitivity of 1% clotrimazole and 2% acetic acid to patient’s otomycosis isolates

2026-05-08T17:00:53+07:00

Background: Otomycosis is a challenge in the medical field, because it requires long-term treatment and follow-up and has a high recurrence rate. In the administration of otomycosis therapy, there are various problems, such as the occurrence of resistance, difficulty in drug application, and requires a long period of time for management. Therefore, choosing the right treatment regimen is very important, so as to reduce the level of resistance caused by the fungus that causes otomycosis. Purpose: To compare the sensitivity of 1% clotrimazole cream and 2% acetic acid solution to fungal isolates of otomycosis patients. Method: This study used true experimental design in vitro with post-test only control group design. Sampling was done by total sampling method during the August-November 20215. Eleven samples were obtained and tested on 3 treatment groups with repetition 3 times, so there was a total of 33 specimens studied. Result: The statistical calculations with the Kruskal-Wallis test from 11 samples tested, obtained a p value < 0.05 which indicated that there was a significant difference in the sensitivity of 1% clotrimazole cream and 2% acetic acid solution. Conclusion: The sensitivity of 1% clotrimazole cream and 2% acetic acid solution has a significant difference on fungal isolates of otomycosis patients

Association of IRF6 and rs22355371 polymorphism mutation with risk of non-syndromic orofacial cleft

2026-02-18T10:32:13+07:00

Background: Non-syndromic orofacial cleft (NSOFC) is a congenital abnormality characterized by incomplete division of the oral and nasal cavities, with no other abnormalities present. NSOFC is the result of disruptions in the normal biomolecular processes of craniofacial development. Many genes have been linked to NSOFC, one of them is IRF6 gene. Purpose: To investigate the association of IRF6 gene and incident of rs22355371 mutation, with the risk of developing NSOFC. Method: A cross-sectional comparative study, conducted in DR M Djamil General Hospital Padang Indonesia from September 2024 to November 2024 involving 13 lip or palate tissues from patient with NSOFC, and 13 maxillary crest from controls. Expression of IRF6 was examined with real time polymerase chain reaction (RT PCR) and the segment of rs22355371 was examined with Sanger sequencing. Result: IRF6 gene expression was shown to have a median value of 129.3 in NSOFC patients, and 252.5 in controls. This indicated that IRF6 gene expressions were lower in NSOFC patients. The Mann Whitney test was performed had it can be concluded that there is no statistically significant relation between IRF6 gene expression between NSOFC patients and controls with a p value = 0.174 (p > 0.05). Conclusion: Compared to controls, NSOFC patients had decreased levels of IRF6 gene expression and we found rs22355371 polymorphism either in NSOFC patient or controls.

The Auditory brainstem response latencies in children with global developmental delay at Dr. Cipto Mangunkusumo Hospital

2026-04-09T10:03:24+07:00

Background: Global developmental delay (GDD) affects multiple developmental domains and remains a major concern in early childhood. The auditory system plays a key role in language development, and the Auditory Brainstem Response (ABR) test provides an objective measure of auditory pathway maturation. However, data on ABR wave latencies among children with GDD who have normal predicted hearing thresholds are limited. Purpose: To describe absolute and interwave latencies of ABR waves I, III, and V, and to compare latencies of ABR waves across demographic and perinatal clinical characteristics in children with GDD. Method: A cross-sectional analytical study was conducted using medical record data from 70 children aged 6 months to 5 years with GDD at Dr. Cipto Mangunkusumo Hospital between January 2021 and May 2025. All subjects had normal predicted hearing thresholds (≤30dB) in ABR result and passed Distortion Product Otoacoustic Emission (DPOAE) screening. Comparations between risk factors (age, gender, gestational age, birth weight, NICU admission, asphyxia, and hyperbilirubinemia) and ABR latencies were analyzed using t-test or Mann–Whitney test. Result: Most subjects were male (71.4%) with a median age of 25 months. The language domain was most frequently affected (92.9%). Male subjects had a significantly longer absolute latency of wave V in the left ear compared to females (6.10±0.31 ms; p < 0.05). Conclusion: Male gender with normal predicted hearing threshold had significant difference in the left-ear wave V latency compared to female. ABR is a valuable tool for early detection of auditory pathway maturation delay in at-risk children.

A Demographic profile and clinical characteristics of patients with age related hearing loss

2026-02-11T12:38:16+07:00

Background: Age-Related Hearing Loss (ARHL), or presbycusis, is a progressive, bilateral sensorineural hearing loss associated with the aging process. It commonly occurs in individuals over 60 years of age and is often linked to metabolic and cardiovascular disorders. Oxidative stress is a key mechanism contributing to cochlear hair cell damage, thinning of the stria vascularis, and neuronal degeneration. Although ARHL is irreversible, controlling risk factors may help slow its progression. Purpose: To determine the demographic profile, clinical characteristics, and the relationship between comorbidities and types of ARHL in patients at Sardjito Hospital, Yogyakarta. Method: This retrospective descriptive study used secondary data from the Neurotology Clinic, Department of Otorhinolaryngology– Head and Neck Surgery, Sardjito Hospital, collected from January 2022 to December 2024. A total of 120 patients diagnosed with ARHL were collected. Bivariate analysis was performed using the Chi- Square test and Fisher’s Exact Test. Result: Among 120 respondents, most were male (57.5%) and aged 60–74 years (73.3%). The most common chief complaint was hearing loss (72.5%), followed by tinnitus (20.8%) and vertigo (6.7%). Audiogram findings showed that strial presbycusis was the most prevalent type (42.5%), followed by sensory (27.5%), neural (21.7%), and cochlear (8.3%) types. Most patients had moderate hearing loss (49.2%). Cardiovascular comorbidities were present in 51.7% of patients. A significant association was found between cardiovascular comorbidities and ARHL type (p < 0.05). Conclusion: Strial presbycusis was the most common type of ARHL, and had a correlation with cardiovascular comorbidities

Correlation of bacterial patterns with length of stay in deep neck abscess in Denpasar

2026-05-20T13:50:48+07:00

Background: Deep neck abscess is a potentially life-threatening disorder, if not managed appropriately. Identification of the causative bacterial and factors influencing the length of hospital stay (LOS), essential for optimizing treatment strategies. Purpose: To evaluate the correlation between bacterial patterns and LOS in patients with deep neck space abscesses at Prof. Ngoerah General Hospital, Denpasar. Method: Observational analytic study with a retrospective cross-sectional design design. Data were obtained from medical records of patients diagnosed with deep neck abscess between January 2021 and December 2023, who met the inclusion criteria. Variables collected included patient characteristics, bacterial pattern based on culture results, and duration of hospitalization. The Mann-Whitney U test was used to analyze differences in LOS between bacterial groups, as the data were not normally distributed. Result: A total of 44 patients met the inclusion criteria, consisting of 27 males (61.4%) and 17 females (38.6%), with a mean age of 45.86±15.89 years. The most common diagnosis was submandibular abscess (52.3%). The distribution of bacterial pattern nearly equal between Gram-positive (47.7%) and Gram-negative (52.3%) organisms. The mean LOS in patients with Gram-negative infections was 8.70±4.92 days, compared with 6.48±4.17 days in those with Gram-positive infections. The Mann-Whitney U test demonstrated a statistically significant difference between the two groups (p < 0.05). Conclusion: There was a significant association between bacterial pattern and LOS in patients with deep neck abscess in this research. Gram-negative bacteria tend to result in longer hospitalization compared to those caused by Gram-positif bacteria.