Oto Rhino Laryngologica Indonesiana

Balloon sinuplasty versus surgical therapy for chronic rhinosinusitis

Felicia Halim — 2025-12-27

Background: An inflammation of the nose and paranasal sinuses is known as rhinosinusitis, and should it persist for 12 weeks or longer, it becomes chronic rhinosinusitis (CRS). Compared to medical therapy, balloon dilatation has been shown to produce statistically significant improvements in symptoms, quality of life, nasal endoscopy scores, and Computed Tomography Paranasal Sinuses (CT-PNS) scores. The outcomes are comparable to those of Functional Endoscopic Sinus Surgery (FESS). Furthermore, it was discovered to be a method that was both safe and bearable. Purpose: To ascertain the role of balloon dilatation in the management of CRS, by comparing the result of Balloon Sinuplasty versus Functional Endoscopic Sinus Surgery. Literature review: A search of Google Scholar over the last 10 years found 375 results, and 14 could used as reference sources. Conclusion: Balloon sinuplasty is a useful method to overcome CRS. Balloon sinuplasty is minimally invasive, avoiding more aggresive and drastic procedures, for cases that are severe and unresponsive to medical treatment.

Autonomic dysfunction in allergic rhinitis assessed by heart rate variability

Nina Irawati — 2025-12-27

Background: Allergic rhinitis is a chronic inflammatory condition of the nose mediated by IgE, characterized by symptoms such as nasal congestion, rhinorrhea, repeated sneezing, and nasal itching. Autonomic nervous system dysfunction is a significant factor in the pathophysiology of allergic rhinitis. Purpose: To evaluate autonomic nervous system dysfunction in allergic rhinitis patients using heart rate variability. Case report: A 28-year-old woman with allergic rhinitis who underwent heart rate variability testing, revealed increased parasympathetic nervous system activity. Method: The study involved a literature search through PubMed, EBSCO, Scopus, and ScienceDirect, with screening based on inclusion and exclusion criteria. The selected literatures were critically reviewed using the Oxford Centre for Evidence-based Medicine’s criteria for Etiology Studies. Result: Two cross-sectional studies were identified that matched the case report’s PICO and eligibility criteria. Those studies showed patterns of autonomic nervous system dysfunction, marked by increased parasympathetic and decreased sympathetic activity in allergic rhinitis patients. Conclusion: The findings suggested that autonomic nervous system dysfunction played a role in the pathophysiology of allergic rhinitis, as evidenced by changes in heart rate variability.

Difficulties in the removal of whistle foreign body in the left bronchus

Ni Komang Tri Utami Handayani — 2025-12-27

Background: Tracheobronchial foreign bodies are one of the most common critical conditions in otorhinolaryngology. The mortality rate due to foreign body aspiration in children under 5 years old is quite high. The increased incidence of foreign body aspiration was triggered by the tendency of children to put everything in their mouths when crying, screaming, running, and playing. Purpose: To report difficulties in the management of a whistle foreign body in the left bronchus. Case report: A 9 years old boy, was brought to Prof. Ngoerah Hospital on December 19th, 2023, with a complaint of coughing for 2 days, because he accidentally choked on a whistle while playing. However, the results of thoracic X-ray and CTscan did not show a clear foreign body in the form of a whistle. Method: Literature search was conducted using keywords ”whistle foreign body in left bronchus” OR ”whistle foreign body” OR ”foreign body in left bronchus” AND ”bronchoscopy management” in Medline and PubMed from 2019– 2024. Result: A total of 21 literatures was found, and 12 could be used as references. Conclusion: The management of foreign body in the bronchus is challenging in diagnostic and bronchoscopy procedures.

Acute sialadenitis with acute myocarditis

Muhammad Dwijo Murdiyo — 2025-12-27

Background: Acute sialadenitis is an inflammation in the salivary glands that can be caused by various factors. This condition can also lead to complications beyond the head neck region, such as meningitis, pancreatitis, myocarditis, anemia hemolytic anemia, polyarthritis, and neck abscess. Purpose: To understand the clinical symptom, cause, and complications, that could occur in acute sialadenitis. Case report: A 65 years old man came to the hospital with swelling of the neck, chest pain, and salivary glands inflammation, along with findings suggestive of acute myocarditis. Clinical question: What complications can occur in sialadenitis? Method: A literature search was carried out on the Google Scholar site, in February-March 2022, with keywords “Sialadenitis” AND “Sialadenitis Complications” AND “Acute Myocarditis”. The inclusion criteria were publications in the last 20 years that were relevant to the topic, and had a full manuscript available. Result: There were 19 literatures obtained, and all could be used as a reference. Conclusion: The complications of sialadenitis were determined based on symptoms and comprehensive diagnostic tools, and the management needed multidemensional department collaboration.

Minimally invasive anterior approach otoplasty for children with prominent ears: case report and scoping review

Eva Tami Handari — 2025-12-27

Background: Prominent ears are one of the most common facial deformities in children. Although primarily a cosmetic issue, this condition can have significant social and psychological impacts on children, leading to the need for otoplasty at an early age. Otoplasty, a corrective surgical procedure, has undergone various innovations aimed at achieving satisfactory aesthetic outcomes, while minimizing complications. Purpose: To convey surgical techniques used in otoplasty for children with prominent ears. Case report: A 5-year-old patient presented with complaints of absent external auditory canals and prominent ears. The patient was diagnosed with bilateral auricular atresia, and prominent ears. The parents also reported speech delay in their child. Otoplasty was performed using the latest technique, with adjustments to the antihelical fold and reduction of conchal projection. Result: Following otoplasty using the newly introduced setback otoplasty technique described by Raunig, the patient demonstrated significant improvement in the aesthetic appearance of the ears with a more harmonious projection. Postoperative complications were minimal, with no signs of infection or residual deformity. The patient also continued postoperative speech therapy to address the speech delay. Conclusion: Advances in otoplasty with the New Concept Rauning technique had proven effective in correcting prominent ear deformities in children, yielding favorable aesthetic outcomes, with minimal complications. Early otoplasty can correct ear shape abnormalities and improve the child’s quality of life, both cosmetically and psychosocially.

Pathological tissue and perforation type causing conductive hearing loss in chronic suppurative otitis media

Aditya Shantika Putra — 2025-12-27

Background: Chronic Suppurative Otitis Media (CSOM) is an inflammatory middle ear condition that often leads to conductive hearing loss. Purpose: To analyse the correlation between pathological tissue and the type of perforation with conductive hearing loss, in patients with CSOM. Method: Cross-sectional study on medical records data of CSOM patients who visited the Ear, Nose, and Throat (ENT) outpatient clinic at Saiful Anwar General Hospital, between January 2019 and June 2022. The collected data included physical examination of the ear, audiometry results, and surgical findings during the operation. Comparative analysis was performed to compare audiometry results based on the pathological tissue diagnosis and the perforation type. Result: A total of 51 CSOM patients were included in the study. Moderate conductive hearing loss was the most common type (49% of cases). The comparative analysis showed no significant correlation between pathological tissue or the type of perforation with conductive hearing loss, in patients with CSOM. Conclusion: In this study, there were no significant corrrelation between pathological tissue and the type of perforation with conductive hearing loss in patients with CSOM.

Comparative study of anatomical findings in temporal bone dissections

I Gusti Ayu Putu Wahyu Widiantari — 2025-12-27

Background: Simple mastoidectomy is the most common approach to managing chronic suppurative otitis media (CSOM). This procedure aims to partially or completely remove mastoid cells, to overcome the infection in the middle ear. However, the mastoid bone pneumatization type may influence the result of simple mastoidectomy or temporal bone dissection. Purpose: To determine the difference in the anatomical findings of pneumatic and diploic mastoid types in the temporal bone dissections. Method: This cross-sectional study assesed on pneumatic and diploic types of mastoid bone, on temporal bone dissections findings. The mastoid bones used in this study were temporal bone of the Indonesian cadavers. Data were obtained from direct observation of the number of anatomical landmarks found during temporal bone dissections on each type of mastoid bone; and the maximal anatomical landmark found in each bone was seven. The number of anatomical landmarks between pneumatic and diploic mastoid bone was compared using the Mann-Whitney U test. Result: The mean of overall anatomical landmarks found during temporal bone dissection was 4.50±1.70. No significant difference in the number of anatomical landmarks was found between pneumatic and diploic mastoid bone (4.57±0.79 vs. 4.43±0.53; p=0.827). Conclusion: There was no significant difference in anatomical findings between pneumatic and diploic mastoid bone in temporal bone dissections. Broad knowledge is vital for successful mastoidectomy in all types of mastoid bone.

Cultural adaptation and normative data for olfactory testing in the Indonesia’s older adult population

Juvenius Martin — 2025-12-27

Background: The olfactory sense plays a vital role in well-being and cognitive health, particularly in the older adults. Olfactory dysfunction is linked to neurodegenerative diseases, and geriatric syndromes like frailty. Existing cognitive tests are education-biased, limiting their applicability. Cultural adaptation of olfactory tests enhances diagnostic accuracy, necessitating region-specific normative data for Indonesia. Purpose: To establish normative olfactory scores for Indonesia’s older adult population using a culturally adapted odor identification test. Method: A descriptive study was conducted on 205 healthy participants aged 60 and above, in Jakarta. Eight culturally familiar odors were used in a forced-choice identification test. Normative data were generated based on percentiles, with the 10th percentile serving as the cut off for hyposmia. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Result: Olfactory function was found to decline with age. Hyposmia thresholds were determined: individuals aged 60-64 years were considered hyposmic if they identified fewer than five odors, while those aged 80+ were hyposmic if they identified fewer than two odors. No significant differences were found between education levels, as both groups shared the same hyposmia thresholds. Conclusion: The study provided normative olfactory data specific to the Indonesia’s older adult population. These results supported the use of culturally adapted tests in clinical practice to detect olfactory dysfunction, which might indicate early cognitive decline. Further research should include longitudinal studies to capture changes over time.

The suitability of patient’s little finger diameter and middle finger lenght to the trachea diameter in predicting the tracheostomy cannula size

Sova Fitria — 2025-12-27

Background: A tracheostomy is a temporary or permanent opening of the trachea followed by a cannula insertion to secure the airway, a common life-saving procedure in otorhinolaryngology. However, tracheostomy cannula sizes vary significantly across manufacturers, with no standardized numbering system, complicating the selection of an appropriate size. The tracheal ring is made of cartilage, particularly in the fingers, is used as a marker for cartilage growth in the trachea. Purpose: This study aims to assess the suitability of little finger diameter and middle finger length to diameter of the trachea in order to predict the tracheostomy cannula size. Methode: This observational analytical study using a cross-sectional design, analyzing patients who underwent tracheostomy and met specific inclusion criteria. Measurements included the little finger diameter, middle finger length, and intraoperative anterolateral tracheal diameter. Data analysis was performed using Pearson and Spearman correlation tests. Result: Among 24 participants, adults accounted for 83.3% of cases, while children 16.7%, with a mean age of 54.5 years. The incidence of tracheostomy was more common in males (70.8%) and upper airway obstruction as the main indication (83,3%). The study identified a positive correlation between little finger diameter and tracheal internal diameter (r = 0.496, p < 0.05). Conversely, no significant correlation was observed between middle finger length and tracheal diameter (r = 0.318, p > 0.05). Conclusion: little finger diameter demonstrates potential as a predictor for tracheostomy cannula size, reflecting the internal tracheal diameter.

Keywords: Tracheal diameter, little finger diameter, middle finger length, Tracheostomy cannula.

Comparison of open and closed drainage in multiple deep neck abscesses

Lisa Apri Yanti — 2025-12-27

Background: Management of deep neck abscesses includes evacuation of pus from the abscess location, which can generally be divided into open drainage and closed drainage. Data regarding their comparison in deep neck abscesses are still inadequate. Purpose: To compare open and closed drainage in the management of patients with multiple deep neck abscesses. Method: Observational research using a cross-sectional design on 71 subjects diagnosed with multiple deep neck abscesses at RSUP Dr. Mohammad Hoesin Palembang who underwent drainage. Result: 37 subjects underwent open drainage (52.1%) and 34 underwent closed drainage (47.9%). A statistically significant difference between the open and closed drainage groups was observed in length of stay, duration until drain removal, days until the pus changed color and pus drained per day. Conclusion: Open drainage had more favorable outcomes compared to closed drainage. Comorbid factors were found to be affecting the efficacy of abscess drainage.

Procalcitonin thresholds and early mortality risk in deep neck abscess: a clinical perspective

Ade Asyari — 2025-12-27

Background: Procalcitonin (PCT) is widely used as an inflammatory marker in sepsis, but still controversial in deep neck abscesses. Purpose: To evaluate the usefulness of PCT as outcome predictor in deep neck abscess. Method: A prospective observational cohort study was conducted at Dr. M. Djamil Hospital, Padang, Indonesia (March 2022–May 2023). Patients with confirmed deep neck abscess by pus aspiration in the Emergency Department were included. Baseline laboratory and serum PCT tests were performed before surgical drainage. All patients received broad-spectrum antibiotics and standard postoperative care. Assessed outcomes were mortality, septic shock, organ failure, mediastinitis, empyema/ pleural effusion, necrotizing fasciitis, tracheostomy, pharyngocutaneous fistula, Intensive Care Unit >24 hours, and hospital stay. Result: Thirty-five patients met inclusion criteria. Multiple neck space involvement was found in 74.3%, and 93.4% underwent surgery. Mortality occurred in 28.6%, septic shock in 20%, mediastinitis in 14.3%, empyema/pleural effusion in 11.4%, necrotizing fasciitis in 8.6%, tracheostomy in 5.7%, fistula in 8.6%, and ICU stay >24 hours in 20%. Mean hospital stay was 9.03±7.90 days. Mean admission PCT was 0.313±0.677 ng/mL, with 17.1% having elevated PCT>0.5 ng/mL. No significant correlation was found between PCT and overall outcome. However, Receiver Operating Characteristic (ROC) analysis showed PCT≥0.14 ng/mL, predicted <5-day mortality (sensitivity 85.7%, specificity 78.4%), Area Under Curve (AUC) 0.773, p=0.027). Conclusion: Procalcitonin showed potential as an adjunctive marker in deep neck abscess. Although low initial levels are frequent, they do not exclude severe complications, highlighting its role in early risk stratification and clinical decisions.

Bioautography of dewandaru leaf ethanol extract thin-layer chromatography against Pseudomonas aeruginosa

I Wayan Lolik Lesmana — 2025-12-27

Background: Ear infections are a significant health concern due to their impact on hearing function. One ear infection that frequently occurs is Chronic Suppurative Otitis Media (CSOM), which is commonly caused by Pseudomonas aeruginosa. The development of therapies using natural ingredients appears to be a promising option for treating various infectious diseases. The potential of the Dewandaru leaves (Eugenia uniflora L.) has long been recognized, and several studies have demonstrated its antibacterial properties. Dewandaru leaves extract contains several active compounds with antibacterial activity, as evidenced by various in vitro studies. Purpose: To test the antibacterial activity of flavonoids, saponins, tannins, and terpenoids from Dewandaru leaves extract against American Type Culture Collection (ATCC) strain of Pseudomonas aeruginosa, ATCC 9027, as the most common cause of CSOM. Method: Antibacterial activity was assessed using the Thin-Layer Chromatography–Bioautography (TLC–bioautography) contact method using a clear area on the TLC plate. Result: Dewandaru leaf extract showed antibacterial activity against Pseudomonas aeruginosa with a significant zone of inhibition. The phytochemical substances in the extract that exhibit antibacterial activity were flavonoids. Conclusion: Dewandaru leaves had the potential to be a natural antibacterial agent against Pseudomonas aeruginosa.