Oto Rhino Laryngologica Indonesiana

Intralesional excision as a management strategy for keloids

Trmartani — 2024-06-30

Background: Several therapeutic modalities exist for keloids, but management them remains a challenge due to high recurrence rates. These case series discussed surgical therapy using intralesional excision. Purpose: To compare the effect of intralesional excision with extra-lesional excision followed by post-operative triamcinolone injection, on the recurrence rates of auricular keloids. Case reports: Three patients with keloids treated with intralesional excision were presented. The first patient, a 20-year- old male, had keloids on both ears, nose, hands, and feet following burnt injury. The second patient, a 19-year-old female, had a keloid lump on the left auricle. The patient had a history of bilateral microtia and had undergone stage 1 auriculoplasty with rib grafting on both ears. The third patient, a 36-year-old woman with complaints of a keloid appearing for 3 years in the helix of her right ear, and underwent surgical excision followed by triamcinolone injection. Clinical question: How does the recurrence in patients with auricular keloid undergoing intralesional excision and postoperative triamcinolone injection, compared to extra-lesional excision and triamcinolone injection? Method: A systematic literature search was conducted using PubMed, Cochrane Library, Scopus, and ClinicalKey with relevant keywords: “intralesional excision”, AND “keloid”. Result: A total of 192 articles were found, and 3 articles met the eligibility criteria. Conclusion: The literature search revealed no difference in the recurrence rates between intralesional and extra-lesional excision with triamcinolone injection. Further research on this topic is needed.

Keywords: intralesional excision, keloid, recurrence

Round window sealing with steroid-soaked sponge in sudden sensorineural hearing loss

Fikri Mirza Putranto — 2024-06-30

Background: A rescue treatment is needed in cases of Sudden Sensorineural Hearing Loss (SSNHL)which fail to obtain complete hearing restoration after conservative steroid therapy. In order to acquirebetter access of steroid to the cochlea, sealing the round window with a sponge soaked in steroid couldbe considered as an alternative delivery strategy.

Purpose: To review the evidence about the impact ofround window sealing in SSNHL patients whose hearing failed to recover completely after treated withsystemic and/or intratympanic steroid.

Cases: Seven patients with SSNHL, who had experienced either noor slight response to previous systemic and/or intratympanic steroid administration, underwent transcanalround window sealing with steroid-soaked sponge. Pure Tone Audiometry (PTA) results and symptoms(hearing loss, tinnitus, vertigo) were compared pre- and post-operatively. Five patients reported betterhearing and tinnitus symptom.

Method: A scoping review was made by conducting literature searchingat Cochrane, Pubmed, and Google Scholar using keywords “sudden sensorineural hearing loss”, AND“round window sealing”, and their relevant synonymous terms, employing Boolean operators.

Result: Atotal of 8 observational studies with 430 subjects met the inclusion criteria. Time measurement of hearingimprovement range from 6 days until 1 year. Most of the studies agreed that the procedure of sealingthe round window had a positive impact on hearing improvement.

Conclusion: This study revealed thatround window sealing with steroid-soaked sponged could be considered as an alternative approach forpatients with SSNHL who failed in conservative therapy.

Keywords: “round window sealing; sudden sensorineural hearing loss; transtympanic steroid”

Intraoperative Electrically Evoked Auditory Brainstem Response (eABR) examination in cochlear implant candidacy

Semiramis Zizlavsky — 2024-06-30

Background: Cochlear implantation is one of the most promising hearing habilitation methods for patients with profound sensorineural hearing loss (SNHL). One of the difficulties associated with the method is predicting the outcome of the surgery, especially in patients with cochlear nerve abnormalities. Purpose: To evaluate the intraoperative cochlear nerve response using Electrically Evoked Auditory Brainstem Response (eABR), and determine if cochlear implantation was required. Clinical question: How significant was intraoperative eABR in determining the outcome of cochlear implantation? Case report: This study considered two cases with profound bilateral SNHL that underwent intraoperative eABR. The first case involved 10-year-old girl who had used conventional hearing aids for eight years before surgery. She practiced lip reading for communication. The second case involved 4-year-old boy with delayed speech and a history of febrile seizure when he was two years old. He had used a conventional hearing aid for six months. Method: Evidence based literature was conducted through PubMed, Embase, and Wiley. Result: On the first case, eABR examination evoked no response in both ears and the parents decided not to carry on with the surgery. In the second case, eABR examination aroused a significant response in both ears, so the implantation was performed. Three months postoperative, the child was babbling and able to detect sound. Conclusion: eABR could give valuable input in identifying profound bilateral SNHL patients with cochlear nerve abnormality. The high cost of implant devices makes this examination beneficial for the patient’s family in deciding if implantation surgery is required.

Keywords: cochlear implant, cochlear nerve hypoplasia, eABR, hearing habilitation, profound sensorineural hearing loss

Steroid As Preventive Treatment For Transient Facial Nerve Palsy In Parotidectomy

Marlinda Adham — 2024-06-30

Background and Objective: One of the most reported complication of parotidectomy or other parotid surgery is facial nerve palsy. Steroids such as glucocorticoid have been known to help preserve nerve damage. But there’s lack of evidence that shows the use of steroids to help nerve recovery. So authors are determined to find the association between steroid intervention in parotidectomy patients to prevent or to help accelerate recovery rate in facial nerve palsy cases. Methods: This evidence-based case report used the PICO method for literature search in two databases (Ovid and PubMed). After selecting the article using inclusion and exclusion criteria, the author appraised the article using the Center of Evidence Based Medicine (CEBM) Oxford Appraisal Tools. Results: In total of 2 articles we found, we include all of them for analysis. Both of the articles shows that there’s no correlation between giving steroids to post-parotidectomy patients and faster recovery rate. In contrary, one study shows that placebo-treated groups had a faster facial nerve function recovery rate than steroid-treated patients. Conclusion: Giving steroids to post-parotidectomy patient won’t help accelerate the facial nerve function recovery rate. Prevention of facial nerve palsy in parotidectomy was preferred as treatment.

The The first transcanal endoscopic ear surgery in Udayana University General Hospital

I Gusti Ayu Mahaprani Danastri — 2024-06-30

Background: The conventional method for treating cholesteatoma involves using a microscopicapproach. However, over the years, endoscopy has evolved from being a supplementary tool alongside themicroscope to becoming the primary transcanal approach in different areas of ear surgery.

Purpose: Topresent a case of cholesteatoma in adult which was treated by the combination of transcanal endoscopicear surgery and mastoidectomy.

Case report: An adult patient with malignant type of chronic suppurativeotitis media underwent transcanal endoscopic ear surgery and mastoidectomy. Endoscopic surgery is amore intricate single-handed procedure that demands both experience and a comprehensive knowledge ofendoscopic ear anatomy. This is essential for navigating the anatomical space, dealing with the ossicularchain, and employing transcanal drilling techniques. The primary surgical focus for endoscopic earsurgery is the middle ear. When addressing cases where cholesteatoma extends beyond the posteriorepitympanum, the surgical approach relies on the surgeon’s expertise in performing extensive atticotomyor mastoidectomy, either with or without microscope assistance.

Clinical question: What is the role oftranscanal endoscopic ear surgery and mastoidectomy in adult patient with cholesteatoma?

Method:Literature searching was performed with the keywords: ”cholesteatoma”, AND ”transcanal endoscopicear surgery”, AND ”mastoidectomy” through database PubMed, Proquest, and hand searching/e-book.

Result: There were 3 articles relevant with the subject.

Conclusion: Transcanal endoscopic ear surgery isa minimally invasive and secure procedure characterized by its low rates of complications and recurrence

Keywords: transcanal endoscopic ear surgery, mastoidectomy, cholesteatoma, chronic suppurative otitis media.

Dysphagia after chemoradiation in nasopharyngeal carcinoma

Ika Dewi Mayangsari — 2024-06-30

Background: Dysphagia is one of the early and long-term consequences of nasopharyngeal carcinomamanagement. Chemotherapy with radiation may improve the local control and survival rate but also canlead to serious dysphagia caused by radiation damage, and chronic alteration of tissues leading to fibrosisthat can happen during or soon after the radiation therapy. Dysphagia can result in dehydration andmalnutrition, place people at risk of aspiration, and reduce the quality of life by increasing anxiety anddepression.

Purpose: Identifying causes, relevant factors, clinical presentation, and management of postchemoradiation dysphagia in nasopharyngeal cancer patients.

Literature review: Structures demonstratingpost-therapy changes were deemed as dysphagia aspiration-related structures (DARS). Management ofnasopharyngeal carcinoma is radiotherapy with fibrosis found in 38.2% of the nasopharyngeal carcinomapatients on at least one side of the neck post-treatment. The presence of fibrosis in the pharyngeal andlaryngeal muscles impacted hyoid bone anterior movement and upper esophageal sphincter relaxationcontributed to dysphagia. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is utilised to detectdysphagia in these patients. The treatment algorithm for dysphagia after chemoradiation consists of historytaking, clinical evaluation, instrumental examination, and management. The management options may bebehavioral, medical, surgical, or combination.

Conclusion: Identifying the cause, the components of thedeficit, and the relevant patient factors has prime importance in managing dysphagia besides consideringthe options and weighing the risks versus benefits.

Keywords: Dysphagia, chemoradiation, nasopharyngeal carcinoma, dysphagia aspiration-related structures, fiberoptic endoscopic evaluation of swallowing

In vitro activity of Manuka and Trigona honey on fibroblast and keratinocyte cultures

Harim Priyono — 2024-06-30

Background: Benefits of honey on wound healing is widely reported, but information about its
effect on the re-epithelialization of the tympanic membrane (TM) is limited. Purpose: To evaluate the
effect of Manuka honey (MHn) and Trigona honey (THn) from Indonesia, on TM re-epithelialization
through their potential action on proliferation of fibroblasts, keratinocytes, secretion of KFG and basic-
FGF. Method: This study was conducted at the YARSI University Laboratory. Fibroblast and keratinocyte cultures isolated from chronic suppurative otitis media patients were exposed to MHn and THn with three dilutions: 0.04%, 0.1%, and 0.25%. The cells were then subjected to proliferation assays, KGF and bFGF were also assessed and compared to the control. Result: MHn and THn did not increase the number of fibroblasts but shortened the doubling time duration. A significantly higher number of keratinocytes than control was observed in all MH groups and the 0.04% THn group. KGF secretion increased as the number of cells increased. On the 6th and 8th day, KGF secretion was observed to be higher in some intervention groups compared to the control group. Conversely, the level of bFGF secreted by fibroblasts and keratinocytes decreased as the number of cells increased. There was a positive correlation between the duration of both honey exposure and fibroblast proliferation. The duration of 0.04%, 0.1% MHn, and 0.04% THn exposure positively correlated with the number of keratinocytes. Conclusion: This research illustrated the positive effects of MHn and THn on fibroblasts and keratinocytes; thus, potential therapeutic properties could be further explored.

Effect of N-Acetylcysteine and vitamin D supplementation on interleukin-1β level in chronic suppurative otitis media

Pratiwi Dewi — 2024-06-30

Background: Chronic suppurative otitis media (CSOM) is a major health problem in many populations around the world, causing significant morbidity and mortality. It is characterized by transformation and hyperplasia of the middle ear mucosa following infiltration of numerous inflammatory cells. Recent researches showed a significant impact of the anti-inflammatory and anti-oxidant effects of N-Acetylcysteine (NAC) and vitamin D independently, but their role in the pathophysiology of CSOM was still unclear. Purpose: To evaluate the effect of NAC and vitamin D supplementation on vitamin D and interleukine-1β levels in CSOM. Method: The research was an experimental study with randomized controlled trial design, and was conducted at ENT polyclinic, Dr Moewardi Regional General Hospital Surakarta on May-October 2023. Blood serum examination of vitamin D and IL-1β levels was done at Biomedical Laboratory of Medical Faculty Sebelas Maret University. Result: There were 36 CSOM subjects without cholesteatoma who met the inclusion and exclusion criteria. The NAC+vitamin D group had the highest mean vitamin D level (30.82±5.35 ng/mL) and the lowest mean IL-1β level (23.81±7.13 pg/mL) compared to the control group and the group that received only NAC or vitamin D alone. (p<0.05). Conclusion: N-Acetylcysteine and vitamin D supplementation had a synergistic effect in reducing oxidative stress and inflammation in CSOM.

TNF-α expression in chronic rhinosinusitis with and without nasal polyps

Dolly Irfandy — 2024-06-30

Background: Chronic rhinosinusitis is an inflammatory disease of the nasal and paranasal sinusesmucosa, that is caused by multifactorial factors, and has a complex and influential etiology among variousmicroorganisms (bacteria, fungi, and viruses), environmental contamination (pollutants or cigarette smoke)and immune system instability. Tumor necrosis factor alpha (TNF-α) is one of the crucial cytokinesin the inflammatory process that plays a role in chronic rhinosinusitis. Purpose: To compare TNF-αgene expression levels in chronic rhinosinusitis patients with and without nasal polyps. Method: Thisquantitative study included a cross-sectional design comparative analysis of 24 samples obtained from theethmoid bulla of chronic rhinosinusitis patients. The patients were subjected to a Functional EndoscopicSinus Surgery (FESS) approach at the Rhinology Clinic of Dr. M. Djamil Regional Hospital, Padang.Patients were selected based on inclusion and exclusion criteria. The expression of TNF-α was measuredby using the Real-Time Polymerase Chain Reaction (RT-PCR). The data were analysed by SPSS witha p-value <0.05. Result: The average value of TNF-α expression in chronic rhinosinusitis with polypswas 4.89±12.65, while that of TNF-α expression in chronic rhinosinusitis patients without polyps was2.77±4.22. However, there was no statistical difference between the two groups of study (p-value >0.05).Conclusion: This study demonstrated the increased levels of TNF-α in chronic rhinosinusitis patientswith polyps compared to patients without polyps.

Correlation of LMP-1 expression with KRAS and Cyclin-D1 expressions in WHO type III NPC patients

Rizki Amelia Yurika Neri — 2024-06-30

Background: Nasopharyngeal carcinoma (NPC) is a malignancy with pathologically andepidemiologically unique characteristics. The risk factors that are often associated with NPC are chronicEBV infection, environmental factors, and epigenetic changes. EBV infection expresses Latent MembraneProtein-1 (LMP-1) in NPC. The role of LMP-1 is to activate signaling pathways, including KRAS-RAFMEK-ERK which induces transcription of cyclin D1 that contributes to cell proliferation.

Purpose: Todetermine the correlation between LMP-1 expression and KRAS expression, LMP-1 expression with cyclinD1 expression, and KRAS expression with cyclin D1 expression in nasopharyngeal tissue of WHO typeIII NPC patients.

Method: Analytical observational study with a cross-sectional approach involving 30paraffin blocks of biopsy tissue from NPC patients who had not received radiotherapy or chemotherapy.Expression of LMP-1, KRAS, and cyclin D1 was examined with immunohistochemical staining methodand calculated using manual counting by anatomical pathologists.

Result: Statistical analysis of LMP-1expression with KRAS expression showed an insignificant positive correlation (p=0.546) with a correlationcoefficient (ρ=0.115). The LMP-1 expression with cyclin D1 expression showed an insignificant positivecorrelation (p=0.305) with a correlation coefficient (ρ=0.194). The KRAS expression with cyclin D1expression showed an insignificant positive correlation (p=0.262) with a correlation coefficient (ρ=0.212).

Conclusion: In WHO type III NPC tissue in the proliferative process, an increase in LMP-1 expression(53.4%±27.35%,) was followed by an increase in KARS expression (49.83%±22.83%) and D1 expression(42.27%±31.94%) as well as an increase in KRAS expression (42.27%±31.94%) followed by an increasein cyclin D1 expression (42.27%±31.94%) although not significant.

Relationship of lowest oxygen saturation value with degree of obstructive sleep apnea on polysomnography

H.M Dwijo Murdiyo — 2024-06-30

Background: Obstructive sleep apnea (OSA) is a part of sleep disorder breathing syndrome.Symptoms of OSA often occur, but it is difficult to detect. Upon diagnosis, patients generally have hadsymptoms of OSA for years. If it is not treated properly, OSA can lead into complications involvingvarious other organ systems. The standard examination for diagnosing OSA is polysomnography. However,polysomnography examination during the era of Covid-19 pandemic could not be done.

Purpose: Todetermine the relationship between the lowest oxygen saturation (SaO2) value and the degree of obstructivesleep apnea on polysomnography examination.

Method: Observational analytic study with a crosssectional approach. The total sample was 59 subjects, consisted of 37 males and 22 females. The lowestSaO2 was assessed on polysomnography examination and compared with the degree of OSA.

Result:The lowest SaO2 relationship with the degree of OSA showed a significant negative result with a strongrelationship. In mild OSA, the Area Under Curve (AUC) value = 77.1%, and the cut off SaO2 value wasobtained at 90.5%. In moderate OSA, the AUC = 85% and the cut off SaO2 value was at 87.5%. In severeOSA, the AUC value was 94% and the cut off SaO2 value was obtained at 84.5%.

Conclusion: Therewas a significant relationship between the lowest oxygen saturation on polysomnography examinationand the degree of OSA.

OAE high noise examination result profile of tinnitus patients at the UGM Academic Hospital

Mahatma Sotya Bawono — 2024-06-30

Background: Tinnitus is a hearing disorder in the form of sound sensation without externalstimulation. It can affect a person’s quality of life. The number of patients with tinnitus is expected toincrease. Not many hospitals have a High Noise Otoacoustic Emission (OAE) device for examining tinnitusin patients. Tinnitus research is still limited in Indonesia, especially in Yogyakarta.

Purpose: This studyaimed to describe the results of the OAE High Noise examination in tinnitus patients at the ElectromedicalClinic of UGM Academic Hospital.

Method: A non-experimental study with a descriptive observationalapproach using secondary data. The sampling technique used was a total sampling technique of tinnituspatients who were examined for (OAE) High Noise from January 1st, 2019, to December 31st, 2021.

Result: Respondents who met the inclusion and exclusion criteria were 292 subjects. Most respondentswere more than 60 years old (27.05%), and female (51.71%). The OAE High Noise examination resultsshowed that most of them were abnormal (85.61%). Most of the respondents experienced bilateral tinnitusand experienced disturbances in more than six frequencies (46.60%). The primary diagnosis that had beenfound in the respondents was tinnitus (87.67%).

Conclusion: The OAE High Noise examination resultsat the Electromedical Clinic of UGM Academic Hospital were mainly abnormal.