Introduction: Mouth breathing is one of the earliest manifestations of obstructive sleep apnea (OSA). Despite the availability of validated screening tools for early detection, their use remains limited in Bandung, Indonesia. This study examined the use of the mouth breathing in the daytime-mouth breathing during sleep (MBD-MBS) questionnaire to identify mouth-breathing patterns and quantify OSA risk among children in Bandung, Indonesia. Methods: This cross-sectional study included 400 children in Bandung, Indonesia. Ethical approval was obtained before data collection. Based on responses to the MBD-MBS and Pediatric Sleep Questionnaire (PSQ), children were classified as complete nose breathers (CNB), complete mouth breathers (CMB), or partial mouth breathers (PMB). The prevalence of OSA and mouth-breathing patterns, and their associations, were analyzed. Results: Complete mouth breathers was the most prevalent mouth-breathing pattern (40.75%), particularly among children aged 6-9 years old. Moreover, OSA was more common in mouth breathers (CMB: 55.21%; PMB: 71.84%) than nose breathers (5.97%), with PMB showing the strongest association (71.8% screening positive). Conclusion: Using the MDB-MBS questionnaire, mouth breathing was identified as a strong predictor of OSA in children, supporting its utility as a practical and effective tool for early screening.

Background and Objectives: Acute Otitis Media (AOM) is a leading cause of morbidity in children, characterized by fever, otalgia, and hearing loss. If untreated, AOM may progress to chronic complications requiring surgical management. Globally, factors such as allergies, environmental tobacco smoke, and nutritional deficiencies are well-established risk factors, but in Indonesia, particularly rural areas like Bandung Regency, limited awareness and data exacerbate the burden of disease. Smoking prevalence and low immunization rates further increase risks for AOM. Materials and Methods: This case-control study, conducted between September 2019 and February 2020 in Bandung Regency, evaluated risk factors for AOM in children aged 24–59 months. Data were collected through structured questionnaires, anthropometric assessments, and ENT examinations. A total of 168 AOM-positive and 367 AOM-negative children were recruited from primary healthcare facilities. Results: Multivariable analysis identified significant associations with AOM: allergic rhinitis (AOR 1.92), cigarette smoke exposure (AOR 1.79), stunted growth (AOR 1.48), and incomplete basic immunizations (AOR 1.77). These findings highlight the importance of addressing modifiable factors such as nutrition and immunization to reduce AOM incidence. Conclusions: The rhinitis allergy and exposure to cigarette smoke are among the well-established risk factors that our results validate. Additional research is necessary to validate if our findings involving two modifiable risk factors, stunted children and insufficient basic vaccination, may increase the risk of AOM.

Introduction:Laryngeal carcinoma is a type of cancer that occurs in the laryngeal tissue with a high mortality rate. Fiber optic laryngoscopy examination with i-scan is a non-invasive technology used to visualize changes in the structure of the mucosa and blood vessels, aiding in better identification of malignancies. Despite its promising potential, the routine use of i-scan technology in examinations is not yet established in Indonesia, especially West Java. Objective:To compare endoscopic findings using i-scan with histopathological results in patients with laryngeal carcinoma. Methods:This study is an analytical prospective observational research with a cross-sectional design, followed by a concordance test analysis using accuracy tests and the kappa index. The data collected include information from all laryngeal tumor patients at the ORLHNS outpatient clinic at Dr. Hasan Sadikin General Hospital from July to December 2023. Results:This prospective observational study evaluated i-scan endoscopy's diagnostic accuracy versus histopathology in 29 laryngeal carcinoma patients, demonstrating 96% sensitivity (95% CI [80.4-99.3%]) and 100% specificity (95% CI [39.8-100%]) with substantial histopathological agreement (κ = 0.86, 95% CI [0.61-1.00]). The technology outperformed white light endoscopy (κ = 0.608) in detecting malignancies, correctly identifying vascular patterns in 24/25 malignant cases (eight poorly differentiated, six moderately differentiated, five well-differentiated squamous cell carcinomas) and all four benign lesions. One false-negative involved a well-differentiated carcinoma, potentially due to obscuring edema or tumor positioning. These findings underscore i-scan's utility for precise malignancy detection and biopsy guidance in laryngeal carcinoma evaluation. Conclusion:Our findings demonstrate concordance between i-scan endoscopic examination and histopathological results in laryngeal carcinoma evaluation. While this study provides preliminary evidence supporting the potential utility of i-scan technology for early lesion identification and biopsy targeting, further validation through larger-scale multicenter studies is warranted to confirm its clinical applicability.

Meningioma merupakan tumor yang muncul dari sel arachnoid yang menempel pada piamater dan bagian dalam lapisan arachnoid. Tumor ini merupakan tumor intrakranial, mewakili 12-25% dari neoplasma intrakranial. Meningioma intrakranial dapat menyebar secara ekstrakranial hingga melibatkan struktur di sekitarnya yang termasuk telinga dan tulang temporal. Meningioma ektopik, digambarkan sebagai meningioma primer tanpa keterlibatan intrakranial dan merupakan kasus yang jarang terjadi. Serial kasus ini menampilkan pasien dengan gambaran hiperostosis pada tulang temporal yang mengarah ke diagnosis meningioma intratemporal dan dilakukan tindakan mastoidektomi sebagai salah satu modalitas terapi. Ilustrasi Kasus 1: Seorang perempuan 53 tahun mengeluhkan penurunan pendengaran pada telinga kiri. pada pemeriksaan audiometri menunjukkan gangguan dengar tipe konduktif derajat berat 72,5 db. Hasil pemeriksaan ct scan menunjukkan gambaran hiperostosis disertai lesi sklerotik pada tulang temporal dan sphenoid. Pada pasien dilakukan tindakan operasi kanaloplasti dan mastoidektomi radikal. Ilustrasi Kasus 2: Seorang perempuan 50 tahun datang dengan keluhan telinga kiri mengeluarkan cairan kuning kehijauan yang sudah berlangsung sejak 3 tahun yang lalu dan hilang timbul, pada pemeriksaan audiometeri menunjukkan gambaran gangguan dengar tipe konduktif derajat berat 73,75 db. Hasil pemeriksaan ct scan menunjukkan hiperostosis disertai penebalan pada tulang temporal dan sphenoid wing kiri. Pada pasien dilakukan tindakan operasi kanaloplasti dan mastoidektomi radikal

Stunting is a chronic nutritional problem caused by many factors, including the condition of nutritional intake in infants. Malnutrition reduces body immunity so it is considered as a risk factor for inflammation in children. Allergic rhinitis is an inflammatory disease of the nasal mucosa caused by allergic reactions in patients. This study aims to determine the prevalence of allergic rhinitis in stunting patients in Kabupaten Bandung. This research is a descriptive study, data was taken by multistage cluster randomized sampling based on inclusion and exclusion criteria, in Kabupaten Bandung from the October 2019 to December 2019. The data obtained will be presented in the form of tables and diagrams. Result. From a total of 436 children age 2 – 5 years old with stunting, there were 188 children (43.11%) with allergic rhinitis and 245 children (58.6%) who did not suffer from allergic rhinitis. Most ages were in the range of 48-60 months as many as 77 children (40.95%), with the most sex being male as many as 100 children (53.19%), the most reported comorbidities were tonsillitis as many as 74 children (39.36%). Of the total 188 respondents, only 19 children (8.5%) had a history of atopy. In this study, the prevalence of allergic rhinitis in stunting children was 43.11%.

Background: Benefits of honey on wound healing is widely reported, but information about itseffect on the re-epithelialization of the tympanic membrane (TM) is limited. Purpose: To evaluate theeffect of Manuka honey (MHn) and Trigona honey (THn) from Indonesia, on TM re-epithelializationthrough 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.

Acute otitis media (AOM) is an infection of the middle ear and is the second most common pediatric diagnosis following upper respiratory infections.This article provides a review of the latest evidence on risk factors, diagnosis, management, and prevention of acute otitis media.Acute otitis media is a symptomatic disease with natural healing.Antibiotics should only be given in selective conditions.Myringotomy with the placement of ventilation tubes is the most common first-line surgical option for a child with recurrent or persistent AOM.

Background: Hearing loss and deafness are still an issue in Indonesia, especially in West Java, with a prevalence of 2.5% and 0.06%, respectively. Cochlear implants are intended for patients with severe sensorineural hearing loss to stimulate the remaining auditory nerves. Based on their competency standards, Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) Specialists are expected to be able to inform patients and families about the cochlear implantation procedures. This study aimed to explore the level of knowledge, attitudes, and behavior of ORL-HNS Specialists in West Java towards cochlear implants.Methods: This study was a descriptive study with a cross-sectional approach. Primary data were collected through a questionnaire filled out by ORL-HNS Specialists who were actively working in West Java in 2021–2022.Results: Data from 157 specialists showed that 41.4% (n=65) had good knowledge about cochlear implants, and 43.9% (n=69) had adequate knowledge, however, 62.4% (n=98) showed a negative attitude. In addition, 99.3% (n=156) showed good behavior.Conclusions: ORL-HNS Specialists in West Java have a sufficient level of knowledge, negative attitude, and good behavior towards cochlear Implants. The negative attitude of the specialists need to be bettered, updating their knowledge about how cochlear implants work and their effectiveness for patients with hearing impairments might give them a new perspective and hopefully change their attitude towards cochlear implants.

Langerhans Cell Histiocytosis (LCH) is one of the rare disease with atypical clinical manifestations. LCH must be watched out for and considered a differential diagnosis of the other otolaryngology diseases. A 2-years-10-months old boy with a crusted lump in the right ear canal accompanied by a lump behind the right ear that is expanding, bleeding for 3 months, and the patient experience loss of weight. Examination of the ear found a black mass covered with crusts with a firm, fixed consistency, filling the lateral one-third of the right external acoustic canal to the right auricle concha. A solid mass was obtained from the lateral one-third of the right external acoustic canal on a head CT scan, medially obliterating the external acoustic canal to the right internal acoustic canal. FNAB found nonspecific inflammation. Performed mass excision surgery and anatomical pathology examination. The patient was referred to the pediatric haemato-oncology division and underwent chemotherapy. Langerhans cell Histiocytosis in the temporal bone is a rare disease with atypical clinical manifestations, so it should be considered as one of the differential diagnoses if a mass is found in the external acoustic canal.

We report a case of a 5-year-old girl who came to Otolaryngology Outpatient Clinic of our hospital with the chief complaint of recurrent ear discharge which had started to appear since 3 years ago and had recurred every month despite repeated antibiotics and antifungals ear drops treatments, given by general practitioners and otolaryngologists. Gram staining, acid-fast staining and Mycobacterium tuberculosis culture examination from the discharge had never been conducted. There was a history of inadequate weight increment since she was 2 years old. Her uncle who often met her died about 6 months ago due to TB disease. She was initially diagnosed with otitis media from the previous clinicians before finally referred to our hospital due to the perforated tympanic membrane. Otoscope examination showed perforated tympanic membrane. CT scan showed right osteomastoiditis with cholesteatoma with destruction of right mastoid antrum and right ear bone. We did not find pale-looking granulomatous tissue or multiple perforated tympanic membrane. The patient was diagnosed with chronic suppurative otitis media (CSOM) of the right ear with right mastoiditis and right posterior auricle fistulae. Afterwards, canal wall up, canaloplasty, mastoid obliteration, tympanoplasty, and rotational flap right ear were performed. Histopathology examination revealed the presence of caseous necrosis and datia langhans cells. Based on her chronic illness supported by the histopathological findings, anti-tuberculosis therapy was commenced. No more ear discharge complained and her body weight started to increase after oral anti tuberculosis treatment.

Background: Benign Chronic Suppurative Otitis Media (CSOM) is a middle ear inflammation characterized by otorrhea with perforation in the central tympanic membrane. Topical ofloxacin as a standard therapy in this type of CSOM has limitations in reducing otorrhea score. Vitamin A supplementation could be given simultaneously with topical ofloxacin because of its property as a regulator of the local immune response in the middle ear. Objectives: This study aimed to analyse the effect of vitamin A supplementation on Tumor Necrosis Factor-α (TNF-α) and otorrhea score in benign CSOM patients. Materials and Methods: The pre-experimental method with post-test only control group approach was held from January to March 2020 at Rembang Regional Hospital, Central Java, Indonesia. The subjects of the study were benign CSOM patients aged 18-60 years who did not consume antibiotics or steroids for two weeks prior to the study. Subjects of the study were divided into two groups. The standard (control) group was given topical ofloxacin as standard therapy while the intervention group was given topical ofloxacin in combination with Vitamin A supplementation. The subjects consisted of 21 subjects in the standard group and 10 subjects in the intervention group. Results: The percentage of TNF-α expression in intervention group was 64.20 ± 36.18, while the percentage in the standard group was 91.10 ± 11.3. The result of the independent t-test showed that there was a significant difference between the two groups (P = 0.016; 95% CI = 9.41-44.37). There was a significant difference in the otorrhea score between the two groups (P = 0.003). Conclusion: There was a significant difference in TNF-α expression and the otorrhea score between the standard and the intervention group.

Aim: High expression of lytic enzymes and cytokines is related to cell proliferation in Otitis Media Chronic Suppurative (CSOM) with cholesteatoma. In addition, the process of inflammation healing and maintenance of homeostatic conditions requires Reactive Oxygen Species (ROS), which can cause significant damage to cells. To address this issue, secondary antioxidants such as Vitamins A and E are used to inhibit and neutralize the occurrence of oxidation reactions. These vitamins complement each other, with vitamin A working effectively at low concentrations of oxygen, while vitamin E functions in the opposite manner. Purpose: This study aims to investigate the roles of vitamin A and E levels in CSOM patients with Cholesteatoma. Patients and Methods: The study was conducted between July and December 2020, and the method used was an analytical observational approach with a case-control design. The sample population comprised 60 CSOM patients divided into 2 groups. These included those with and without cholesteatoma. Results: The results showed that there was no significant difference between these two groups in terms of the impact of vitamin A and E levels (respectively, p = 0.626, p = 0.864). Conclusion: Considering these results, it was discovered that vitamins A and E levels do not influence the occurrence of CSOM with or without cholesteatoma.

Background: Chronic suppurative otitis media (CSOM) is a case of ear infection which prevalence is still relatively high, especially in developing countries. Surgery is the definitive management for CSOM that aims to eradicate the infection and improve the hearing conduction system. The COVID-19 pandemic has put enormous pressure on the global health care system, including limitations on elective surgical procedure at most hospital at the beginning of the pandemic. Objective: This study aimed to assess the impact of the Covid-19 pandemic on the volume of chronic suppurative otitis media surgeries. Methods: A retrospective study on 236 chronic suppurative otitis media patients. The number of surgeries collected from April to December 2019 and 2020 was compared. Statistical analysis used the t-independence and linear regression test with p < 0.05. Results: The otologic surgeries decreased by 83.7% between 2019 and 2020. There were 203 surgeries (2019) vs 33 (2020). The average number of surgeries per month in 2019 and 2020 was 23 +/- 6 patients and 4 +/- 2 patients, respectively (t = 2.365; p < 0.001). All cases that underwent surgery in 2020 were cases with complications. Special consent and preparation must be completed before surgery. Conclusion: The number of otitis media surgeries significantly decreases during the COVID-19 pandemic.

Objectives: To investigate factors associated with time of diagnosis and habilitation of congenital hearing loss in Indonesia.Method: A retrospective cohort study was conducted from January to December 2020 by collecting data on patients with congenital hearing loss using validated questionnaires.Result: Among 535 children with congenital hearing loss, 2.7% had a family history of congenital hearing loss, 11.2% and 37.4% had a maternal history of ototoxic drugs and herbal medicine use during pregnancy, respectively, and 17.8% had prenatal exposure to TORCH infection. Lower maternal education level was shown to be associated with older age at diagnosis (p = 0.045), while older maternal age (p < 0.001), non-housewife mothers (p = 0.029), and out-of-pocket payment scheme (p = 0.027) were associated with a higher rate of habilitation.Conclusion: The present study showed that the presence of family history, the use of certain medications during pregnancy, and prenatal TORCH infection are prevalent in children with congenital hearing loss in Indonesia. Several factors such as maternal education level, age, occupation, and habilitation payment scheme may be associated with time of diagnosis and habilitation of congenital hearing loss.

Background: The prevalence of middle ear inflammation in West Java is still relatively high. General practitioners are at the forefront who see and treat the patients directly; thus, the number of cases can be reduced by increasing the competence of general practitioners. This study aimed to determine the level of knowledge, attitude, and practices of general practitioners in West Java towards middle ear inflammation, as an evaluation for improving health services in the community. Methods: This research was a descriptive study with a questionnaire conducted in August–December 2021 conducted online with a probability sampling technique of at least 368 general practitioners in West Java. The level of knowledge, attitude, and practices were calculated using the Guttman scale. The data were presented as a frequency distribution. Results: The results showed that the majority of the general practitioners still had poor knowledge of middle ear inflammation (n=325; 84.6%) as well as the attitude (n=333; 86.7%) and the level of practice (n=340; 88.5%). Conclusions: The level of knowledge, attitude, and practices of general practitioners in West Java towards middle ear inflammation is poor. Special interventions and approaches are needed to improve the competence of general practitioners in West Java based on the Standard Competency of Indonesian Doctors.

Cogan's syndrome is a rare autoimmune disorder with around 250 cases worldwide affecting young Caucasian adults in the third decade of life. This disease is characterized by audiovestibular disorders and inflammation in the eye. In this article, a case of Cogan's Syndrome was reported found in Dr. Hasan Sadikin Bandung ENT-HNS Clinic. Objective for this case report is as case study and knowledge because Cogan’s syndrome is a rare disease. Case: A 59-year-old woman with autoimmune disorders, interstitial keratitis in the eye and hearing loss in both ears, and without vestibular disorders. Audiogram examination revealed mild degree of sensorineural hearing loss in both ears. Patient is diagnosed with typical Cogan's Syndrome. Management of typical Cogan's Syndrome patients are the administration of methylprednisolone 48 mg per day; with a gradual reduction in dose; and prednisone eye drops, provides good response. Conclusion for this case report is Cogan’s syndrome are rare case and usually related with audiovestibular disorder and inflammation in the eye, management of Cogan's Syndrome with high doses of corticosteroids provides a good response.

Objective: To determine the validity and reliability of the Indonesian version of Patient Allergic Rhinitis Questionnaire as a screening tool for AR and the prevalence of AR in a class of 2018-2019 medical students of Universitas Padjadjaran, Indonesia.Methods: A cross-sectional descriptive study was performed during the period November-December 2021 on a class of 2018-2019 medical students of Padjadjaran University. The Indonesian version of the pre-validated Patient Allergic Rhinitis Questionnaire was distributed online. Allergic rhinitis was determined from history taking by identifying a history of a previous diagnosis of AR and/or 2 or more symptoms (watery runny nose, sneezing, nasal congestion, itching, or conjunctivitis) for more than 1 hour on most days.Results:. The validity of the Indonesian version of the Patient Allergic Rhinitis Questionnaire was good with a 0.895 Cronbach's Alpha coefficient, reflecting a reliable questionnaire. The prevalence of AR was 35.8% with most were female (69.2%). There were 59.9% of respondents who had a history of allergy in their parents. The most common symptom was nasal congestion (85.7%) and the moderate-severe persistent (49.2%) was the most common ARIA-WHO classification. Dusty places (92.1%) were the most common cause of symptoms. The most common comorbidity was rhinosinusitis (35%). The mean symptom severity score was 6.7.Conclusions: The Indonesian version of the Patient Allergic Rhinitis Questionnaire is valid and reliable as a screening tool for AR. The prevalence of AR in this study is quite high, with moderate-severe persistent as the most prominent classification.

Background: Chronic suppurative otitis media (CSOM) is the most common infectious disease in the world and the leading cause of hearing loss in children in developing countries. Iron deficiency anemia (IDA) is often found in children with CSOM. Objective: This study was conducted to determine the association between IDA and the incidence of CSOM in children. Method: This research is a case-control study using consecutive sampling. Participants were divided into case group which are children diagnosed with CSOM (n = 42) and control group which are children with normal ear (n = 42). All participants were examined for serum iron (FE), hemoglobin (Hb), total iron-binding capacity (TIBC), and ferritin levels. The analysis used in this study includes the chi-square test or fisher extract test and independence t-test or Man Whitney test with p < 0.05. Result: The measurement results obtained values of Hb (13.00 +/- 1.34 g/dL; p < 0.001), FE (95.13 +/- 40.84 g/dL; p < 0.001), TIBC (354.18 +/- 62.44 g/dL; p = 0.016), and ferritin levels (17.57 +/- 8.55 g/dL; p < 0.001). Participants who experienced IDA were 21.43% which in the case group was 31.0% and control group was 11.9% (OR = 3.32; p = 0.033). Conclusion: IDA can increase the incidence of CSOM in children.

ABSTRACT Introduction: Indonesia is one of the countries with the highest incidence of nasopharyngeal cancer (NPC), 6.2 out of 100,000 population/year. Radiotherapy is one of the main treatment options for NPC. Otitis media with effusion (OME) is the most common ear complication of radiotherapy for NPC patients. Objective: This study aimed to determine the association between the stage and histopathological type of NPC on the occurrence of OME. Method: This study used a cross-sectional method, data were taken retrospectively from medical records based on inclusion and exclusion criteria for the period January 2015–December 2019. Results: 131 patients met the inclusion and exclusion criteria. There were 87 men and 44 women, with the largest age range being 46–55 years (49%). Most (51%) had stage III NPC, followed by stage IV A by 28%. The histopathological type is mostly undifferentiated non-keratinized NPC in 90 patients (69%) and 34 patients with differentiated nonkeratinized types (26%). The association between stage (p 1 ) and histopathological type (p 2 ) of NPC with the incidence of OME after radiotherapy showed insignificant results (p 1 = 0.272 and p 2 = 0.101). Conclusion: Otitis media with effusion in post irradiated nasopharyngeal carcinoma patients occurred in 18.3%. Postirradiation OME generally occurs in men with the age range of 46–55 years, NPC stage III and non-keratinizing undifferentiated histopathological type. There was no significant association between stage and histopathological type of NPC with the occurrence of postirradiation OME. Highlights