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Management of otosclerosis with obliterated footplate and round window involvement Priyono, Harim; Sari, Anita Amalia; Zizlavsky, Semiramis; Alviandi, Widayat; Ranakusuma, Respati W.
Oto Rhino Laryngologica Indonesiana Vol. 52 No. 2 (2022): VOLUME 52, NO. 2 JULY - DECEMBER 2022
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v52i2.448

ABSTRACTBackground: Otosclerosis with obliterated footplate describes a condition with an overgrowth of bone so that the oval window is almost indistinguishable from the surrounding area. The occurence of round window obliteration is uncommon. In such cases, surgery is more difficult to perform and the results are often unsatisfactory. Purpose: To find out the management option for obliterative otosclerosis. Case report: A 35-year-old-man with suspected bilateral otosclerosis. The patient underwent transcanal endoscopic stapes surgery of the left ear with large fenestra stapedotomy procedure. Clinical question: In adult patients with obliterative otosclerosis, does stapes surgery improve hearing function and reduce complication? Review method: Using PubMed, EBSCOhost, Scopus and Proquest to search for the evidence of randomised control trial (RCT), cohort and case-control studies. Critical appraisal was conducted using critical appraisal tools from Center for Evidence Based Medicine (CEBM), Oxford University and qFAITH for systematic review/meta-analysis. Result: The literature searching used eligibility criteria based on keywords from clinical question found one study regarding the evaluation of intra-operative factors in otoslecrosis surgery outcomes, which was relevant to our clinical question. Conclusion: Large fenestra stapedotomy or stapedectomy is the preferred surgical technique for the management of obliterative otosclerosis. The involvement of round window caused a sensorineural hearing loss (SNHL) component and has a worse prognosis of hearing outcome post operatively. A further study is required to assess the best management for obliterative otosclerosis. ABSTRAKLatar belakang: Otosklerosis dengan obliterasi footplate menggambarkan suatu kondisi pertumbuhan tulang yang berlebihan sehingga tingkap lonjong hampir tidak dapat dibedakan dengan daerah sekitarnya. Obliterasi sampai ke tingkap bundar jarang terjadi. Hal tersebut menyebabkan operasi lebih sulit dilakukan dan hasilnya seringkali tidak memuaskan. Tujuan: Untuk mengetahui pilihan tatalaksana otosklerosis obliteratif. Laporan kasus: Laki-laki 35 tahun dengan suspek otosklerosis bilateral. Pasien menjalani operasi stapes telinga kiri dengan pendekatan endoskopi transkanal menggunakan prosedur stapedotomi fenestra besar. Pertanyaan klinis: Pada pasien dewasa dengan otosklerosis obliteratif, apakah operasi stapes dapat memulihkan fungsi pendengaran dan mengurangi komplikasi? Telaah literatur: Pencarian bukti melalui database PubMed, EBSCOhost, Scopus dan Proquest. Untuk uji coba kontrol acak, kohort dan studi kasus-kontrol, penilaian kritis dilakukan dengan menggunakan penilaian kritis dari CEBM, Oxford University dan qFAITH untuk tinjauan sistematis/meta-analisis. Hasil: Penelusuran literatur berdasarkan kriteria dari pertanyaan klinis, didapati satu artikel mengenai evaluasi faktor-faktor intraoperatif yang relevan dengan pertanyaan klinis. Kesimpulan: Stapedotomi fenestra besar atau stapedektomi adalah teknik bedah yang lebih dipilih untuk tatalaksana otosklerosis obliteratif. Keterlibatan tingkap bundar menyebabkan komponen gangguan pendengaran sensorineural, dan memiliki prognosis hasil pendengaran pasca operasi yang kurang baik. Dibutuhkan studi lebih lanjut untuk menilai tentang penatalaksanaan terbaik untuk kasus otosklerosis obliteratif.

Financing hearing aids for patients with congenital deafness in Indonesia Zachreini, Indra; Bashiruddin, Jenny; Zizlavsky, Semiramis; Tamin, Susyana; Priyono, Harim; Mayangsari, Ika Dwi; Alviandi, Widayat; Supartono, Natasha; Soetjipto, Damayanti; Ranakusuma, Respati; Damayanti, Heditya; Alia, Dina; Hajar Haryuna, Tengku Siti; Harahap, Juliandi; Warto, Nirza; Fitria, Hidayatul
Oto Rhino Laryngologica Indonesiana Vol. 52 No. 1 (2022): VOLUME 52, NO. 1 JANUARY - JUNE 2022
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v52i1.550

ABSTRACTBackground: The appropriate management of patients with congenital deafness is installing hearing aids, either external hearing aids or implanted in the ear (cochlear implant), aiming to reduce the medical and social burden, besides improving the quality of life of the sufferers. Objective: To ascertain the cost of hearing aids in patients with congenital deafness, in the form of external hearing aids or cochlear implants. Method: A descriptive study with cross-sectional design using questionnaires through interviews. The sample size was 535 mothers whose children had congenital deafness at 24 hospitals with facilities for establishing a diagnosis of congenital deafness in 17 provinces in Indonesia. Result: Most respondents were aged 30-39 years (55%), occupations were housewives (71.8%), and education level was high school (52.5%). The type of hearing aid used mostly was external (92.7%), with 45.9% paid by personal expense. The surgically planted hearing aids in 22 children was mostly cochlear implants (95.5%), which were financed by the Indonesian Healthcare and Social Security Agency (BPJS) plus personal costs (50%). Discussion: This study found that the most common type of hearing aid used by children with hearing impairments was external hearing aids (92.7%) through independent financing (45.9%). Only 7.3% of patients chose surgery in hearing habilitation, and 95.5% were cochlear implants. The small percentage of surgery were due to the high-priced of cochlear implants, and the government did not cover all financial expenses. Conclusion: Most external hearing aids were paid independently-out-of-pocket, while cochlear implant surgeries were funded by BPJS, plus extra costs independently. ABSTRAKLatar belakang: Penatalaksanaan terbaik untuk penderita tuli kongenital adalah pemasangan alat bantu dengar (ABD), baik berupa ABD eksternal maupun ABD yang ditanam dalam telinga (implan koklea), dengan tujuan untuk mengurangi beban medis dan sosial, serta meningkatkan kualitas hidup penderita. Tujuan: Untuk mengetahui seberapa besar biaya pemasangan ABD pada penderita tuli kongenital, baik berupa ABD eksternal maupun implan koklea. Metode: Penelitian deskriptif dengan rancangan cross sectional study menggunakan kuesioner melalui wawancara. Besar sampel 535 ibu yang anaknya menderita tuli kongenital pada 24 rumah sakit yang memiliki fasilitas penegakkan diagnosis tuli kongenital di 17 provinsi di Indonesia. Hasil: Sebagian besar responden berusia 30-39 tahun (55%), pekerjaan terbanyak adalah ibu rumah tangga (71.8%), dan tingkat pendidikan SMA (52.5%). Jenis ABD yang terbanyak adalah ABD eksternal (92,7%) dengan pembiayaan secara mandiri 45,9%. Pemasangan ABD dengan tindakan operasi dilakukan pada 22 anak, yang terbanyak adalah implan koklea (95,5%) yang dibiayai oleh Badan Penyelenggara Jaminan Sosial (BPJS) ditambah dengan biaya sendiri (50%). Diskusi: Penelitian ini mendapati bahwa ABD yang terbanyak digunakan oleh anak dengan gangguan pendengaran adalah ABD eksternal (92,7%) dengan biaya mandiri (45,9%). Habilitasi pendengaran dengan tindakan operasi hanya dilakukan pada 7,3% pasien, berupa implantasi koklea 95,5%. Kecilnya persentase habilitasi bedah dikarenakan tingginya harga implant koklea, dan bantuan dari BPJS tidak meliputi keseluruhan biaya. Kesimpulan: Sebagian besar pembiayaan alat bantu dengar eksternal secara mandiri, sedangkan operasi implan koklea menggunakan biaya BPJS ditambah biaya sendiri.

Filtration effectiveness of N95 medical mask exposed to repeated ultraviolet germicidal irradiation room Restuti, Ratna Dwi; Priyono, Harim; Mariska, Tara Candida; Cahyono, Arie; Bramantyo, Brastho; Soemarko, Dewi S.; Yusuf, Prasandhya Astagiri; Arman, Fitri; Prihartanto, Joedo
Oto Rhino Laryngologica Indonesiana Vol. 52 No. 2 (2022): VOLUME 52, NO. 2 JULY - DECEMBER 2022
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v52i2.581

ABSTRACTBackground: The global Coronavirus disease (COVID-19) pandemic has created shortages of personal protective equipment (PPE) including N95 respirator medical masks. Ultraviolet Germicidal Irradiation (UVGI) is an effective way for disinfection of N95 masks before reuse. The UVGI chamber is an effective method of disinfection against SARS-CoV-2, however its effect on the N95 medical masks filtration ability is still uncertain. Purpose: To evaluate filtration effectiveness of N95 mask after repeated UV-C irradiation in the UVGI chamber. Method: This was a parallel two-group experimental study to see the effect of repeated UVGI exposure on the filtration of 2 types of N95 medical masks (type 8210 and 1860), with 25 pieces each group, using an aerosol particle counter, after 10 cycles of repeated UVGI exposure in the UVGI chamber of the ORL-HNS Department Dr. Cipto Mangunkusumo Hospital. Result: There were no significant differences in the filtration effectiveness of N95 medical masks after repeated UVGI exposure up to 10 cycles for 2 types of N95 masks and there was no significant change in the filtration ability of the N95 medical masks after repeated UVGI exposure. Conclusion: The filtration of N95 medical masks type 8210 and 1860 filtration were maintained >95% after repeated UVGI exposure with cumulative dose of 10,126-16.200 mJ/cm2 in UVGI chamber of ORL-HNS Department, Dr. Cipto Mangunkusumo Hospital. ABSTRAKLatar belakang: Pandemi Coronavirus disease 2019 (COVID-19) menyebabkan keterbatasan tersedianya alat pelindung diri (APD) termasuk masker respirator N95. Ultraviolet Germicidal Irradiation (UVGI) merupakan salah satu cara desinfeksi yang menjanjikan dan efektif, sehingga masker N95 dapat digunakan kembali. Bilik UVGI merupakan metode yang efektif dalam disinfeksi terhadap SARS-CoV-2, namun efek paparan UVGI terhadap kemampuan filtrasi masker N95 belum diketahui. Tujuan: Untuk mengevaluasi efektivitas filtrasi masker N95 setelah paparan UV-C berulang di Bilik UVGI. Metode: Penelitian ini adalah studi ekperimental dua kelompok paralel untuk melihat efek paparan UVGI berulang terhadap filtrasi 2 tipe masker N95 (tipe 8210 dan 1860) sebanyak 25 masker di setiap grup, menggunakan aerosol particle counter setelah paparan UVGI berulang sebanyak 10 siklus di Bilik UVGI Departemen THT-KL RSCM. Hasil: Tidak didapatkan perbedaan bermakna pada masker N95 pasca-paparan UVGI berulang sebanyak 10 siklus dengan rerata filtrasi pada 2 tipe masker, serta tidak terdapat perubahan signifikan kemampuan filtrasi masker N95 pasca-paparan UVGI berulang. Kesimpulan: Filtrasi masker N95 pada penelitian ini dapat dipertahankan 95% pasca-paparan UVGI berulang hingga dosis kumulatif 10.126˗16.200 mJ/cm2 di bilik UVGI Departemen THT-KL RSCM.

Intraoperative Electrically Evoked Auditory Brainstem Response (eABR) examination in cochlear implant candidacy Zizlavsky, Semiramis; Saleh, Rangga Rayendra; Priyono, Harim
Oto Rhino Laryngologica Indonesiana Vol. 54 No. 1 (2024): VOLUME 54, NO. 1 JANUARY - JUNE 2024
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v54i1.664

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

Association between vitamin D deficiency and otitis media with effusion in children: a systematic review and meta-analysis Restuti, Ratna Dwi; Safitri, Eka Dian; Ranakusuma, Respati Wulansari; Sriyana, Ayu Astria; Priyono, Harim; Saleh, Rangga Rayendra; Marpaung, Dora A; Lazarus, Gilbert
Paediatrica Indonesiana Vol. 64 No. 5 (2024): September 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.5.2024.419-29

Background Vitamin D plays a crucial role in the regulation of inflammation. However, its effect on the development of otitis media effusion (OME), an inflammatory disease of the middle ear without signs of infection, remains largely unknown. Objective To assess the association between vitamin D deficiency and OME in children by systematic review and meta-analysis of the literature. Methods Eligible studies retrieved from PubMed, ProQuest, Embase, Cochrane databases and trial registries published up to 30 October 2022 were included in this review. The risk of bias of the included articles was assessed with the JBI Critical Appraisal Checklist for observational studies. The certainty of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation framework. Results We included eight studies (six case-control and two cross-sectional studies) involving 1,114 children, of which four studies were eligible for meta-analysis due to the significant clinical heterogeneity. We found that vitamin D deficiency (defined as vitamin D concentration of 20 ng/mL or less, i.e., ?50 nmol/L) might increase the odds of developing OME by 66.0% (n=514; OR 1.66; 95%CI 1.09 to 2.54; I2=20%), albeit with a very low certainty of evidence. Conclusion There is a very low quality of evidence indicating that vitamin D deficiency is associated with the development of OME in children. Further large, high-quality cohorts and adjusting for confounding factors are warranted to confirm our findings, ideally by exploring the dose-response relationship between vitamin D concentration and the development of OME.

Tantangan Pasca Operasi Implan Koklea: Pengalaman 15 Tahun di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Zizlavsky, Semiramis; Priyono, Harim
Oto Rhino Laryngologica Indonesiana Vol. 55 No. 1 (2025): VOLUME 55, NO. 1 JANUARY - JUNE 2025
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v55i1.701

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.

Efektivitas Kamar Ultraviolet Germicidal Irradiation (UVGI) Rumah Sakit Cipto Mangunkusumo untuk Disinfeksi Respirator N95 di Pandemi COVID-19: Studi Pendahuluan Restuti, Ratna Dwi; Priyono, Harim; Saleh, Rangga Rayendra; Sriyana, Ayu Astria; Yusuf, Prasandhya Astagiri; Airlangga, Tri Juda; Prayitno, Ari; Sitohang, Gortap; Arman, Fitri; Priyanto, Suko Dwi
Majalah Kedokteran Indonesia Vol 72 No 1 (2022): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.72.1-2022-583

Introduction: During the COVID-19 pandemic, where the disease might spread in a medical facility setting, the common problems found in every country is the shortage of personal protective equipment (PPE) for medical personnel – especially the disposable N95 respirators. Thus, a higher amplitude to disinfect and reuse N95 is urgently needed. In this study, we designed an effective and safe disinfection methods through an Ultraviolet Germicidal Irradiation (UVGI) chamber in Dr. Cipto Mangunkusumo Hospital to control the shortage of PPE by disinfecting and reusing disposable N95 respirators. Purpose: To evaluate the dosage and effectiveness of UV-C radiation for disposable N95 respirators disinfection in our designated UVGI chamber. Methods: This study used a cross-sectional design to determine the dose and the effectiveness of UV-C radiation in eradicating SARS-CoV 2 on disposable N95 respirators. Results: Using two different distances from the light source, we confirmed the inverse square law of UV-C radiation power. Irradiation for 2 hours with a radiation dose of 1080 mJ/cm2 resulted in undetected SARS-CoV-2 gene based on PCR examination in 10 out of 10 samples. Conclusion: This UVGI chamber is a potential solution for hospitals or medical facilities to overcome the limitations that occurred in the pandemic by disinfecting PPE.

Intraoperative Electrically Evoked Auditory Brainstem Response (eABR) examination in cochlear implant candidacy Zizlavsky, Semiramis; Saleh, Rangga Rayendra; Priyono, Harim
Oto Rhino Laryngologica Indonesiana Vol. 54 No. 1 (2024): VOLUME 54, NO. 1 JANUARY - JUNE 2024
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v54i1.664

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

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