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Oto Rhino Laryngologica Indonesiana

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Published by Perhimpunan Dokter Spesialis Telinga Hidung dan Tenggorok Bedah Kepala Leher Indonesia

ISSN : 02163667 EISSN : 25983970 DOI : -

Core Subject : Health,

Health Professions Medicine & Pharmacology

Journal Othorhinolaryngologica Indonesiana is a peer-reviewed and open access journal that focuses on promoting otorhinolaryngology-head and neck surgery that publishes research reports, case reports, and literature reviews, to increase knowledge and updating diagnostics procedurs on otorhinolaryngology-head and neck surgery.

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Articles 493 Documents

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Fungus ball paranasal sinuses: pattern of histopathology and culture characteristics Nugroho Suharsono
Oto Rhino Laryngologica Indonesiana Vol 49 (2019): Volume 49, No. 2 July - December 2019
Publisher : PERHATI-KL

Background: Fungal infection of the nose and paranasal sinuses is an uncommon condition which is now being increasingly recognized. The clinical presentation is not specific with various symptoms such as nasal obstruction, purulent nasal discharge, facial pain, and chronic cough. Only unilaterality may alert the clinician. Purpose: To find the morphological characteristics of the fungus in patients with paranasal sinus fungus ball. Methods: A retrospective study of 13 paranasal sinus fungus balls cases which underwent endoscopic sinus surgery at Department of Otorhinolaryngology Head and Neck Surgery St. Vincentius A Paulo Hospital Surabaya from March, 2012 until December, 2013. Age, sex, histopathology and fungal cultur were analysed. Histopathologic sections of all the patients were stained with hematoxylin and eosin (H&E), and Gomori methenamine silver (GMS). The specimens were then cultured on Sabouraud dextrose agar plates and incubated at 30°C for 1 month. At the end of the incubation period, the samples were evaluated microscopically to detect fungi and identify their species. Results: The age reported of the 13 patients, was ranging from 36 to 63 years old. There was a significant female predominance, 10 female patients (76.92%) and 3 male patients (23.08%). Histopathological examination showed that most causative agents were Aspergillus species 92.31% (12/13). Culture test was positive for 69.23% (9/13). Aspergillus niger (61.54%, 8/13) is the most frequent fungus reported to cause fungus balls. Conclusion: Pattern of histopathologic on HE and GMS is very helpful and sensitive to identify fungi. The most common isolated mould in our study was Aspergillus niger.Keywords: fungus ball, histopathology and culture, Aspergillus nigerABSTRAK Latar Belakang: Infeksi jamur di hidung dan sinus paranasal merupakan kondisi yang jarang terjadi, namun kini lebih sering ditemukan. Gejala klinisnya tidak spesifik dapat berupa obstruksi hidung, sekret dari hidung, nyeri wajah, dan batuk kronis. Bila terjadi unilateral, patut diwaspadai oleh para klinisi. Tujuan: Untuk mengetahui karakteristik morfologi fungus yang didapati pada pasien sinusitis jamur yang kami teliti. Metode: Dilakukan penelitian retrospektif pada 13 pasien sinusitis jamur yang menjalani bedah sinus endoskopi di Departemen Otorinolaringologi-Kepala Leher Rumah Sakit St. Vincentius A Paulo Surabaya dari bulan Maret 2012 sampai dengan Desember 2013. Dilakukan analisis usia, jenis kelamin, histopatologi dan kultur jamur. Pewarnaan preparat histopatologi menggunakan Hematoxylin dan eosin (H&E) dan Gomori Methenamine Silver (GMS). Kemudian spesimen diletakkan pada piring agar Sabouraud dextrose, dan dilakukan inkubasi pada suhu 30°C selama satu bulan. Pada akhir masa inkubasi, sampel dievaluasi dengan mikroskop untuk mendeteksi jamur dan spesiesnya. Hasil: Didapati usia 13 penderita berkisar dari 36-63 tahun. Wanita lebih dominan sebanyak 10 penderita (76,92 %) dan 3 penderita laki-laki (23,08%). Hasil pemeriksaan histopatologi menunjukkan spesies Aspergillus sebagai penyebab utama (92,31%) pada 12 penderita (12/13).Tes kultur positif pada 69,23% (9/13). Jamur yang paling sering menyebabkan bola jamur pada sinus adalah Aspergillus niger (61,54%, 8/13). Kesimpulan: Pewarnaan preparat histopatologi menggunakan Hematoxylin dan eosin (H&E) dan Gomori Methenamine Silver (GMS) sangat berguna dan sensitif dalam mendeteksi adanya jamur. Jenis jamur yang paling banyak ditemukan pada penelitian kami adalah Aspergillus niger.

PENANGANAN MIKROTIA BILATERAL: LAPORAN KASUS BERBASIS BUKTI Widodo, Dini Widiarni; Priyono, Harim; Suryati, Irma
Oto Rhino Laryngologica Indonesiana Vol 44, No 1 (2014): Volume 44, No. 1 January - June 2014
Publisher : PERHATI-KL

Latar Belakang: Mikrotia didefinisikan sebagai daun telinga berukuran kecil dengan insiden sekitar 1 dari 7000-8000 ribu kelahiran, dengan insiden pada satu telinga sekitar empat kali lipat lebih banyak dibanding dua telinga. Rekonstruksi mikrotia merupakan salah satu prosedur cukup sulit pada bidang plastik rekonstruksi. Saat ini, penggunaan tandur tulang rawan iga autologus masih menjadi baku emas untuk rekonstruksi mikrotia. Tujuan: mengingatkan kembali para ahli THT tentang pertimbangan pemilihan rekonstruksi bersamaan pada kasus mikrotia bilateral dengan pencarian literatur berbasis bukti. Kasus: dilaporkan satu kasus mikrotia bilateral derajat 3, dengan hantaran tulang telinga kanan 60 dB, dan hantaran tulang telinga kiri 72,5 dB. Dengan pertimbangan memilih rekonstruksi bersamaan atau bertahap pada kedua telinga dan mengetahui prediksi perbaikan fungsi pendengarannya. Penatalaksanaan: aurikuloplasti tahap 1 dilakukan bersamaan pada kedua telinga. Skor Jahrsdoefer kedua telinga masing-masing 3 dan karena keterbatasan ekonomi dianjurkan menggunakan alat bantu dengar bukan BAHA untuk mengatasi hambatan komunikasi. Kesimpulan: penatalaksanaan mikrotia bilateral di bidang THT tidak hanya mencakup aspek rekonstruksi bentuk namun menekankan fungsi telinga sebagai alat berkomunikasi yang optimal. Kata kunci: mikrotia bilateral, ambang pendengaran, aurikuloplasti. ABSTRACTBackground:Microtia is defined as small sized ear with incidence approximately 1 in 7000-8000 births, which incidents in one ear is 4 times more compared to bilateral ear. Microtia reconstruction is one of difficult procedures in plastic reconstruction field. Recently, the use of rib cartilage autograft is still the gold standard for ear reconstruction. Purpose: to inform otorhinolaryngologist concerning simultaneous ear reconstruction in bilateral microtia case with evidence based method. Case: a third grade bilateral microtia, with the result of bone conduction are 60 dB for right ear dan 72,5 dB for left ear, the consideration to reconstruct both ear simultaneously or gradually, and how to predict the hearing improvement Management: first step of auriculoplasty was done in both ears, with Jahrsdoefer score is 3 for each ear, BAHA is adviceable but due to economic limitation the patients chose hearing aids. Conclusion: Bilateral microtia management in otorhinolaryngology does not only emphasize on ear reconstruction aspects but also to restore ear function as a means of optimal communicating.Keywords: bilateral microtia, hearing thresholds, auriculoplasty.

Choristoma kartilaginosa pada lidah: kasus langka Zachreini, Indra; Faisal, F.; Lubis, Muhammad Najib Dahlan
Oto Rhino Laryngologica Indonesiana Vol 49 (2019): Volume 49, No. 2 July - December 2019
Publisher : PERHATI-KL

Latar belakang: Choristoma adalah suatu pertumbuhan jaringan normal di daerah yang tidak semestinya. Choristoma kartilaginosa pada lidah adalah pertumbuhan tulang rawan normal, yang berbentuk seperti tumor, terdapat pada lidah, pertumbuhan lambat, berbatas tegas, dan bersifat jinak, yang berkembang dari jaringan tulang rawan yang matang. Kelainan ini jarang ditemukan. Etiologi dan patogenesisnya sampai saat ini belum jelas namun diduga terjadi akibat malformasi perkembangan, atau reaksi pasca trauma. Tujuan: Melaporkan satu kasus choristoma kartilaginosa pada lidah, yang jarang ditemukan. Laporan Kasus: Kasus langka ini ditemukan pada seorang wanita berusia 39 tahun dengan keluhan terasa ada benjolan di pangkal lidah. Pada pemeriksaan tampak massa tumor di pangkal lidah, bertangkai, tidak nyeri dan tidak mudah berdarah. Penatalaksanaan berupa eksisi bedah secara lengkap. Pemeriksaan histopatologi didapati choristoma kartilaginosa pada lidah. Metode: Penelusuran bukti kepustakaan menghasilkan 11 jurnal dan hanya 3 jurnal yang relevan. Hasil: Dari hasil 3 jurnal yang relevan dengan kasus yang kami laporkan, mempunyai kesamaan dalam lokasi dan penatalaksanaannya. Kesimpulan: choristoma kartilaginosa pada lidah merupakan lesi jinak yang jarang ditemukan.Kata kunci: Choristoma kartilaginosa lidah, histopatologi, eksisiABSTRACT Background: Choristoma is a tumor-like growth of normal tissue in unusual location/site. Cartilaginous choristoma of the tongue is a normal cartilage growth which shaped like a tumor, located in the tongue, slow growing, well defined, benign, developed from mature cartilage tissue. This disorder is rarely found. Up till now, the etiology and pathogenesis is still unsure, but it is assumed to be the result of developmental malformations or post traumatic reactions. Purpose: To report a rare case of cartilaginous choristoma of the tongue. Case: A 39 years old woman came with a lump at the base of her tongue. Physical examination found a stalked tumor mass in the tongue, which was painless, and not easily bled. Management of this lesion was a complete excision. Histopathology examination found a cartilaginous choristoma of the tongue. Method: Searching for literature evidence produced 11 journals, and only 3 journals were relevant. Result: From the 3 relevant journals, there were similarities on location and case management with this reported case. Conclusion: Cartilaginous choristomas of the tongue is a benign lesion of the tongue that is rarely found.

Pengaruh pemberian vitamin E terhadap eosinofil mukosa hidung dan kualitas hidup penderita rinitis alergi Nanchy Christy; Rus Suheryanto; Mohammad Dwijo Murdiyo
Oto Rhino Laryngologica Indonesiana Vol 49 (2019): Volume 49, No. 2 July - December 2019
Publisher : PERHATI-KL

Latar belakang: Penyakit rinitis alergi (RA) banyak dijumpai dan memberi dampak negatif terhadap produktivitas, kualitas hidup, gangguan tidur, aktivitas di luar rumah, serta gangguan sekolah pada anak. Vitamin E bekerja sebagai antioksidan pada membran sel dan berikatan dengan radikal bebas dengan cara menghambat peroksidasi Poly Unsaturated Fatty Acid (PUFA). Tujuan: Mengetahui pengaruh vitamin E terhadap jumlah eosinofil mukosa hidung dan perbaikan klinis pada penderita rinitis alergi persisten sedang berat. Metode: Menggunakan Randomized Clinical Trial, double blind, pre and post control group dengan perlakuan pemberian terapi semprot hidung triamcinolone acetonide, cetirizine 10 mg, dan vitamin E 400IU selama 4 minggu. Dilakukan penilaian Visual Analogue Scale (VAS) dan Total Nasal Symptom Score (TNSS), serta pemeriksaan eosinofil mukosa hidung pada awal dan 4 minggu setelah perlakuan. Hasil: Didapatkan perbedaan bermakna antara jumlah eosinofil mukosa hidung sebelum dan sesudah pemberian vitamin E pada kelompok perlakuan (p=<0,001). Penurunan jumlah eosinofil mukosa hidung lebih besar dan bermakna pada kelompok perlakuan dibandingkan dengan kelompok kontrol (p=<0,001). Didapat perbaikan kualitas hidup berdasarkan perbaikan nilai VAS dan TNSS yang bermakna setelah perlakuan pada kelompok kontrol maupun perlakuan (p=<0,001), serta didapatkan perbaikan kualitas hidup berdasarkan nilai VAS dan TNSS pada kedua kelompok dengan selisih nilai perbaikan gejala yang lebih besar pada kelompok perlakuan, namun dari perhitungan statistik tidak didapatkan perbedaan yang bermakna. Kesimpulan: Vitamin E 400IU menurunkan jumlah eosinofil mukosa hidung secara bermakna pada pasien rinitis alergi persisten sedang berat. Perbaikan nilai TNSS pada penggunaan vitamin E 400IU lebih baik dibandingkan subjek yang mendapat plasebo, walaupun tidak berbeda secara bermakna.Kata kunci: rinitis alergi, Vitamin E, Total Nasal Symptom Score ABSTRACT Background: Allergic rhinitis (AR) is an allergic disease frequently found and has a negative impact on productivity, quality of life, sleep disorder, outdoors activities, and school disruption in children. Vitamin E works as an antioxidant in cell membranes through binding free radicals by inhibiting peroxidation of Poly Unsaturated Fatty Acids (PUFA). Purpose: To find out the effect of vitamin E administration on nasal mucosa eosinophil counts and the clinical improvement in patients with moderate severe persistent AR. Methods: A double blind randomized clinical trial, pre and post control group, given therapy of triamcinolone acetonide nasal spray, cetirizine 10 mg, and vitamin E 400 IU orally for 4 weeks. Evaluation by Visual Analogue Scale (VAS) and Total Nasal Symptom Score (TNSS), as well as nasal mucosal eosinophils count at baseline and 4 weeks after treatment. Results: There was a significant difference on the number of nasal mucosal eosinophils before and after vitamin E administration in the treatment group (p = <0.001). A greater and more significant decrease in the number of nasal mucosal eosinophils in the treatment group compared to control group (p = <0.001). Significant improvement of VAS and TNSS after treatment in the control and treatment groups (p = <0.001) and quality of life improvement based on VAS and TNSS values in both control and treatment groups, but the statistical calculations showed no significant differences between the two groups. Conclusion: Vitamin E 400IU significantly reduce the number of nasal mucosal eosinophils in patients with moderate severe persistent AR.

Management of Presbyphonia Fauziah Fardizza; Mirta Hediyati Reksodiputro
Oto Rhino Laryngologica Indonesiana Vol 50, No 1 (2020): Volume 50, No. 1 January - June 2020
Publisher : PERHATI-KL

Background: The proportion of individuals over 65 years of age in developed countries is increasing rapidly, due in large part to current and projected increases in life expectancy.Within the aging population, the incidence of vocal disorders is estimated to be between 12%-35%. Literature Review: Presbyphonia, or age-related dysphonia, is a diagnosis of exclusion. Patients’ other comorbidities must be evaluated completely. The complexity of presbyphonia involves the changes in the diverse tissues of the true vocal folds, musculature, and cartilage. Patients would get benefit from treatment of voice therapy or surgical laryngeal augmentation procedures. Purpose: The aim of this literature review is to describe presbyphonia and several kinds of its management. The primary treatment goal is to enhance glottal closure either by voice therapy or surgical interventions (phonosurgery) such as injection augmentation (IA) and bilateral thyroplasty surgery (BTS). Holistic physical evaluation had to be done to reach complete medical therapy. Conclusion: The best therapy for presbyphonia are voice therapy, or surgery followed by voice therapy and voice hygiene.Keywords: vocal disorder, presbyphonia, voice therapy, phonosurgery, management ABSTRAKLatar belakang: Prevalensi individu yang berusia diatas 65 tahun di negara maju semakin meningkat dengan cepat seiring dengan meningkatnya usia harapan hidup. Dalam populasi lanjut usia, angka kejadian gangguan fonasi diperkirakan antara 12%-35%. Tinjauan Pustaka: Presbifonia, atau disfonia terkait usia lanjut, membutuhkan evaluasi faktor komorbid secara lengkap. Kerumitan dari presbifonia adalah karena melibatkan perubahan jaringan, otot, dan tulang rawan di sekitar pita suara. Tatalaksana yang dilakukan adalah perawatan terapi suara dan prosedur bedah augmentasi pita suara. Tujuan: Untuk menggambarkan presbifonia serta berbagai jenis tatalaksananya. Keberhasilan utama penatalaksanaan presbifonia adalah meningkatnya penutupan glotis, baik dengan terapi suara atau intervensi bedah (phonosurgery) seperti injeksi augmentasi dan bedah tiroplasti bilateral. Dibutuhkan evaluasi fisik secara holistik untuk mencapai hasil terapi medis yang baik. Kesimpulan: Penatalaksanaan terbaik untuk presbifonia adalah terapi suara, atau pembedahan diikuti dengan terapi suara dan higiene suara.

Hearing status of children under five years old in Jatinangor district Wijana Wijana; Frino Abrianto; Shinta Fitri Boesoirie; Arif Dermawan
Oto Rhino Laryngologica Indonesiana Vol 50, No 1 (2020): Volume 50, No. 1 January - June 2020
Publisher : PERHATI-KL

Background: Hearing is one of the most influential factors in children developmental process. The critical period of hearing and speech development begins in the first 6 months of life and continues until the age of 3 years. World Health Organization estimates that one to three in a thousand births have sensorineural hearing loss (SNHL). Early detection of hearing loss is substantial so that the diagnosis can be established and appropriate intervention can be done earlier. Purpose: To determine the hearing status in children under five years of age in Jatinangor. Method: A cross-sectional observational study with 240 subjects under the age of five in 12 Integrated Healthcare Center (Posyandu) in Jatinangor. Examinations included parental interviews, Behavioral Observation Audiometry (BOA), Otoacoustic Emissions (OAE), and tympanometry tests. Result: One child (0.4%) had moderate conductive hearing lossin the left ear, 1 child (0.4%) had bilateralsevere SNHL, and 7 children (2.9%) had profound bilateral SNHL. Conclusion: The incidence of hearing loss in children under five in Jatinangor was 3.8%, with bilateral profound SNHL asthe highest number, and the most common cause were prenatal Toxoplasma, Rubella, Cytomegalovirus (CMV) dan Herpes simplex virus (TORCH) infections.Keywords: children under-five, early detection, hearing status ABSTRAKLatar belakang: Pendengaran merupakan salah satu faktor yang sangat berpengaruh dalam proses perkembangan anak. Periode kritis perkembangan pendengaran dan berbicara dimulai dalam 6 bulan pertama kehidupan dan terus berlanjut sampai usia 3 tahun. Badan kesehatan dunia memperkirakan satu sampai tiga dalam seribu kelahiran terdapat kejadian gangguan dengar jenis sensorineural. Deteksi dini gangguan dengar penting untuk dilakukan sehingga diagnosis dapat ditegakkan dan intervensi yang tepat dapat dilakukan sedini mungkin. Tujuan: Untuk mengetahui status pendengaran pada anak usia bawah lima tahun di kecamatan Jatinangor. Metode: Penelitian observasional potong lintang dengan subjek penelitian 240 anak usia bawah lima tahun di 12 Pos Pelayanan Terpadu (Posyandu) Kecamatan Jatinangor. Dilakukan pemeriksaan meliputi wawancara orangtua anak, tes Behavioral Observation Audiometry (BOA), tes Otoacoustic Emissions (OAE) dan tes timpanometri. Hasil: Didapatkan 1 anak (0,4%) mengalami gangguan dengar konduktif derajat sedang pada telinga kiri, 1 anak (0,4%) mengalami gangguan dengar sensorineural derajat berat bilateral, dan 7 anak (2,9%) mengalami gangguan dengar sensorineural derajat sangat berat bilateral. Kesimpulan: Angka kejadian gangguan dengar pada balita di kecamatan Jatinangor sebesar 3,8% dengan gangguan dengar terbanyak berupa sensorineural derajat sangat berat bilateral, dan latar belakang penyebab terbanyak adalah infeksi prenatal Toxoplasma, Rubella, Cytomegalovirus dan Herpes simplex virus (TORCH).

Comprehensive management of malignant otitis externa with tuberculosis and cranial nerve paresis in geriatrics Ratna Dwi Restuti
Oto Rhino Laryngologica Indonesiana Vol 50, No 1 (2020): Volume 50, No. 1 January - June 2020
Publisher : PERHATI-KL

Background: Malignant otitis externa is an inflammatory condition of the external ear which has the propensity to spread to the skull base. It can be a difficult entity to treat as clinical presentation varies and response to treatment differs between patients. Purpose: Evaluating the management of malignant otitis externa with complications in geriatric patients who had multiple comorbidities. Case: A 71 years old female with a diagnosis of left malignant otitis externa with complications of multiple cranial nerve palsies (N.VII, IX, X) and comorbidity in the form of diabetes mellitus and chronic kidney disease. The patient underwent subtotal temporal bone resection and petrosectomy. Clinical Question: “Could surgical management of malignant otitis externa with cranial nerve palsies complication in geriatric patients with multiple comorbidities achieve better result than conservative treatment?” Review Method: Literature search using keywords ’malignant otitis externa’ OR ’temporal bone osteomyelitis’ AND ’geriatric’ OR ’elderly’ AND ’multiple cranial nerve palsy’ AND ’diabetes mellitus’ AND ’tuberculosis’ AND ’surgery’ OR ’surgical’ was conducted through Cochrane, Pubmed, and Google Scholar. Result: The search obtained 11 articles published in the last 10 years. Selection based on inclusion and exclusion criteria, 2 studies were found relevant with the topic. Conclusion: Management of malignant otitis externa with complications in geriatric patients with multiple comorbidities requires a multidisciplinary approach to determine the need for surgery intervention.Keywords: malignant otitis externa, cranial nerve palsy, subtotal temporal bone resection, geriatric, diabetes mellitus ABSTRAK Latar belakang: Otitis eksterna maligna adalah suatu kondisi peradangan pada telinga luar yang memiliki kecenderungan untuk meluas hingga ke dasar tengkorak. Penyakit ini menjadi sulit ditangani karena manifestasi klinis yang bervariasi dan respons terhadap pengobatan yang berbeda antara pasien. Tujuan: Mengevaluasi tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri yang memiliki komorbiditas multipel. Kasus: Pasien perempuan 71 tahun dengan diagnosis otitis eksterna maligna telinga kiri dengan komplikasi paresis saraf kranial multipel (n.VII, IX, X) dan penyakit penyerta berupa diabetes melitus dan gagal ginjal kronik. Pasien menjalani operasi reseksi tulang temporal subtotal dan petrosektomi. Pertanyaan klinis: “Apakah tatalaksana pembedahan memberikan hasil yang lebih baik dibandingkan terapi konservatif pada pasien geriatri dengan otitis eksterna maligna disertai paresis saraf kranialis dengan komorbiditas multipel.” Telaah Literatur: Dilakukan menggunakan kata kunci ’malignant otitis externa’ ATAU ’temporal bone osteomyelitis’ DAN ’geriatric’ ATAU ’elderly’ DAN ’multiple cranial nerve palsy’ DAN ’diabetes melitus’ DAN ’tuberculosis’ DAN ’surgery’ ATAU ’surgical’ pada beberapa sumber data seperti Cochrane, Pubmed, dan Google Scholar. Hasil: Didapatkan 11 artikel publikasi 10 tahun terakhir. Berdasarkan kriteria inklusi dan eksklusi diperoleh 2 artikel yang relevan dengan topik. Kesimpulan: Tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri dengan komorbiditas multipel, membutuhkan pendekatan multidisiplin terutama untuk menentukan perlunya dilakukan tindakan pembedahan.

Analisis biaya implantasi koklea bilateral simultan dan sekuensial Ratna Dwi Restuti
Oto Rhino Laryngologica Indonesiana Vol 49 (2019): Volume 49, No. 2 July - December 2019
Publisher : PERHATI-KL

Latar belakang: Implantasi koklea merupakan tatalaksana pasien dengan ketulian sensorineural bilateral derajat berat atau sangat berat yang tidak terbantu dengan alat bantu dengar konvensional. Pemasangan implan dapat bersifat unilateral atau bilateral, baik secara simultan maupun sekuensial, dengan konsekuensi biaya yang berbeda. Di Indonesia pembiayaan implantasi koklea dapat dilakukan secara pribadi, atau jaminan kesehatan baik jaminan pemerintah (BPJS) maupun non pemerintah (swasta). Tujuan: Untuk mengetahui apakah biaya yang dibutuhkan untuk implantasi koklea simultan lebih efisien dibandingkan biaya implantasi secara sekuensial.Metode: Penelitian dilakukan secara retrospektif pada seluruh pasien yang dilakukan implantasi koklea dalam kurun waktu Januari 2015 hingga September 2019. Data rekam medis dan biaya perawatan dikumpulkan serta ditelaah dan dilakukan pengolahan data secara deskriptif dan analitik. Hasil: Pada penelitian ini didapatkan hasil bahwa pada operasi implantasi koklea secara simultan biayanya lebih efisien dibanding dengan operasi secara sekuensial. Sistem paket pasien BPJS tidak membedakan antara paket biaya pemasangan secara simultan maupun sekuensial. Kesimpulan: Berdasarkan perspektif biaya, pasien implantasi koklea secara simultan lebih efisien dibanding dengan pasien implantasi secara sekuensial.Kata kunci: ketulian sensorineural, implantasi koklea, bilateral simultan, bilateral sekuensial, biayaABSTRACT Background: Cochlear implantation is the management of patients with severe or profound bilateral sensorineural deafness whose hearing capacity does not improved by the assistance of conventional hearing aids. Implants can be unilateral or bilateral, either simultaneously or sequentially inserted with different cost consequences. In Indonesia cochlear implantation costs can be covered by private funding and health insurance, both government (BPJS) and non-government (private) insurance company. Purpose: To find out the more efficient cost between simultaneous and sequential cochlear implantation. Methods: The study was conducted retrospectively on all patients undergoing cochlear implantation in the period of January 2015 to September 2019. Medical record data and treatment costs were collected and reviewed, and data were processed descriptively and analytically. Result: This study revealed that simultaneous cochlear implantation surgery costs more efficient compared with sequential surgery, because the BPJS (government) patient package system does not differentiate between simultaneous and sequential package implantation costs. Conclusion: Based on financial perspective, the simultaneous cochlear implantation was more cost-effective than the sequential surgery.Keywords: sensorineural hearing loss, cochlear implantation, bilateral simultaneous, bilateral sequential, costs

The Dizziness Handicap Inventory questionnaire scores before-and-after vestibular rehabilitation therapy of presbyastasis patients Etty Sekardewi; Achmad Chusnu Romdhoni; Haris Mayagung Ekorini
Oto Rhino Laryngologica Indonesiana Vol 50, No 1 (2020): Volume 50, No. 1 January - June 2020
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v50i1.349

Background: Presbyastasis is multifactorial balance dysfunction that occurs in the elderly person. Presbyastasis can increase the risk of fall, anxiety, and decrease the quality of life. Vestibular rehabilitation therapy (VRT) has been proven effective to overcome balance disorders, and it is safe for the elderly. Several studies had reported the success of VRT for balance disorders. All this time, the accomplishment of VRT was assessed by using balance test, which had a risk of falling in elderly patients. Objective: To find out the outcome of Dizziness Handicap Inventory (DHI) questionnaire score in presbyastasis patients after VRT. Method: Ten presbyastasis patients in age range 60-75 years old who met the study criteria were taken by consecutive sampling. A longitudinal observational (pre and posttest) study by analyzing the DHI questionnaire scores. Assessment was performed twice, before and after VRT. The data was analyzed using paired T test and Wilcoxon signed rank test with outcome p<0.05. Result: The measurement of the emotional subscale DHI (DHI.E) showed the mean score before VRT was 4.00 (1.63), after therapy was 0.00 (0.63), p=0.004. The functional subscale (DHI.F) measurement showed the mean score before VRT was 10.40 (3.98), after therapy was 2.40 (2.07), p 0.00. The mean score of physical subscales (DHI.P) measurement before VRT was 9.00 (4.40), after therapy was 2.00 (1.58), p=0.008. The total DHI score (DHI.T) before VRT was 22.6 (7.67), after VRT was 4.20 (2.2) with p=0.000. Conclusion: There was an improvement in DHI questionnaire score before and after 6 weeks VRT.Keywords: Vestibular rehabilitation therapy (VRT), Dizziness Handicap Inventory (DHI), presbyastasis ABSTRAK Latar belakang: Presbiastasis dapat meningkatkan angka jatuh, kecemasan dan menurunkan kemandirian sehingga menurunkan kualitas hidup pada usia lanjut. Terapi rehabilitasi vestibuler (TRV) merupakan modal terapi yang terbukti dapat mengatasi gangguan keseimbangan, dan aman untuk usia lanjut. Beberapa penelitian melaporkan adanya keberhasilan TRV pada penderita gangguan keseimbangan. Keberhasilan dari TRV selama ini dinilai dengan menggunakan pemeriksaan keseimbangan yang memiliki risiko jatuh pada penderita usia lanjut. Tujuan: Membuktikan adanya perubahan skor kuesioner Dizziness Handicap Inventory (DHI) pada penderita presbiastasis sesudah TRV. Metode: Sepuluh penderita presbiastasis usia 60-75 tahun yang memenuhi kriteria penelitian diambil secara consecutive sampling. Studi observasi longitudinal (pre dan posttest) dengan menghitung dan menganalisis skor kuesioner DHI. Pengukuran dilakukan 2 kali yaitu sebelum TRV dan sesudah TRV. Analisis data dilakukan dengan paired T test dan Wilcoxon signed rank test, dengan hasil p<0,05. Hasil: Pengukuran skor kuesioner DHI subskala Emotional (DHI.E) sebelum TRV mempunyai mean 4,00 (1,63), 6 minggu sesudah TRV didapatkan mean 0,00 (0,63), p=0,004. Hasil subskala Functional (DHI.F) sebelum TRV didapatkan mean 10,40 (3,98), 6 minggu sesudah TRV, mean 2,40 (2,07), p=0,00. Pada subskala Physical (DHI.P) didapatkan mean 9,00 (4,40), dan 6 minggu sesudah TRV didapatkan mean 22,6 (7,67), sesudah TRV didapatkan mean 4,20 (2,2) dengan p=0,000. Kesimpulan: Terdapat perbaikan skor kuesioner DHI sesudah 6 minggu terapi rehabilitasi vestibuler (TRV).

Peran implanted electrically evoked auditory brainstem responses(Imp-eABR) pada pasien tuli kongenital Fikri Mirza Putranto; Jenny Bashiruddin; Semiramis Zizlavsky; Irawan Mangunatmadja; Jacub Pandelaki; Saptawati Bardosono; Wijana Hasansulama
Oto Rhino Laryngologica Indonesiana Vol 49 (2019): Volume 49, No. 2 July - December 2019
Publisher : PERHATI-KL

Latar belakang: Variasi performa pasca implan koklea menunjukkan adanya variasi patologi yang belum dapat dijelaskan melalui pemeriksaan standar pra-operasi. Untuk itu dibutuhkan pemeriksaan yang dapat menunjukkan variasi integritas jaras auditori sebagai petunjuk variasi potensi internal tiap individu. Tujuan: Mendapatkan variasi respons jaras auditori terhadap stimulus listrik pasca implan berdasarkan pemeriksaan Implanted Electrically evoked Auditory Brainstem Respons (Imp-eABR), serta korelasinya dengan faktor internal pra-implan lain berupa usia, luas area n. koklearis dan kemampuan komunikasi pra-operasi. Metode: Kriteria subjek penelitian adalah pasien operasi implan koklea berusia kurang dari 10 tahun, memiliki koklea dan n. koklearis normal, dan pada pasien berusia lebih dari 4 tahun sudah memakai alat bantu dengar minimal 1 tahun. Pemeriksaan Imp-eABR dilakukan terhadap 5 elektrode yang mewakili area apikal, medial dan basal koklea. Dicari hubungan respons dari stimulasi terhadap ketiga faktor internal.Hasil:Pemeriksaan Imp-eABR dilakukan terhadap 28 telinga dari 19 pasien yang dilakukan operasi secara unilateral dan bilateral. Rerata skor total respons Imp-eABR adalah 6,3 + 2,63; dengan 60,7% telinga memiliki skor total kurang dari 8. Uji regresi linear menunjukkan faktor usia, luas area n. koklearis dan kemampuan komunikasi berkorelasi secara bermakna dan dapat memprediksi variasi skor Imp-eABR sebanyak 49,2%. Kesimpulan:Variasi skor total Imp-eABR pada pasien dengan faktor internal pra-operasi menunjukkan adanya patogenesis lain yang mendasari kemampuan transmisi jaras pendengaran retrokoklea terhadap stimulasi listrik dari implan koklea. Faktor internal pra-operasi dapat menjelaskan kurang dari 50% variasi respons Imp-eABR. Kata kunci: Imp-eABR, luas area n. koklearis, implant koklea, integritas jaras auditori ABSTRACT Background:Variations in performance after cochlear implant indicates pathology variations that cannot be explained through standard preoperative examination. Therefore, an examination is needed to show variations in the integrity of auditory pathways as a guide to internal potential variations of each individual. Objectives: To show variations of auditory pathways responses to electrical stimulation from cochlear implant by performing Implanted Electrically evoked Auditory Brainstem Response (Imp-eABR) examination and to find its correlation to age, cochlear nerve area and preoperative communication skills. Methods: Subjects were cochlear implant patients with age less than 10 years, had normal cochlear and cochlear nerve,and patients over 4 years old with history of wearing hearing aids for at least 1 year. The Imp-eABR examination was performed to 5 electrodes representing the apical, medial and basal areas of the cochlea. Results:Imp-eABR examination was performed on 28 ears from 19 patients who underwent unilateral and bilateral surgery. The average total score of Imp-eABR responses was 6.3 + 2.63; with 60.7% of the ears having a total score of less than 8. Linear regression tests showed age,cochlear nerve area,andcommunicationabilitysignificantlycorrelate,it canexplain49.2%ofthevariationinthetotal Imp-eABR score. Conclusion: The variation in the total Imp-eABR score in patients with preoperative internal factors indicated that another pathogenesis also underlines the ability of transmission of the retrocochlear auditory pathway to electrical stimulation from the cochlear implant. Preoperative internal factors can only explain less than 50% of the variation of the Imp-eABR response.

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