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Abstrak :
Latar belakang : Gangguan penghidu saat ini lebih disadari oleh masyarakat akibat terjadinya pandemi COVID-19. Tatalaksana gangguan penghidu pasca-virus belum disepakati secara universal meskipun beberapa obat telah diuji coba. Tujuan: Penelitian ini bertujuan mengetahui gambaran jenis dan derajat gangguan penghidu pasca-virus serta efektifitas kombinasi latihan penghidu ortonasal (LPO) dan protokol terapi penghidu terhadap perbaikan fungsi penghidu pasca-virus. Metode: Penelitian dilakukan bulan Februari – Mei 2022 di poliklinik THT-KL RSCM. Desain penelitian yang digunakan uji kuasi eksperimental 1 grup pre dan post test dengan 12 subjek gangguan penghidu yang terjadi mendadak pasca infeksi virus. Subjek penelitian dilakukan penilaian fungsi penghidu dengan uji penghidu alkohol (UPA), uji penghidu intravena (UPI) dan sniffin stick test (SST). Subjek penelitian diberikan kombinasi LPO dan protokol terapi hidung yang terdiri dari irigasi hidung, steroid intranasal, dekongestan topikal, omega-3 dan oles balsam aromatik selama 6 minggu kemudian dilakukan penilaian statistik. Hasil: Didapatkan hiposmia 8 subjek dan ansomia 4 subjek. Pada subjek hiposmia terdapat 2 subjek pantosmia dan 3 subjek parosmia, sedangkan pada subjek anosmia didapatkan 1 subjek pantosmia. Pada penelitian ini didapatkan 9 subjek jenis sensorineural dan 3 subjek jenis konduksi. Setelah dilakukan terapi didapatkan hasil siginifikan berdasarkan pemeriksaan UPA, UPI, diskriminasi, identifikasi dan total ADI (p<0,05). Kesimpulan: Karakteristik gangguan penghidu pada penelitian ini sesuai dengan jenis gangguan penghidu sensorineural dan konduksi serta derajat anosmia dan hiposmia. Kombinasi LPO dan protokol terapi hidung selama 6 minggu terbukti efektif pada gangguan penghidu pasca-virus. ......Background: Postviral olfactory dysfunction is becoming more aware of the public due to the COVID-19 pandemic. The management of chronic postviral olfactory dysfunction is still unknown, although several drugs have been tried, but the treatment is not universally agreed yet. Objective: This study was conducted to describe the types and degrees of postviral olfactory dysfunction and the effectiveness of the combination of orthonasal olfactory training and nasal protocols therapy on the improvement of postviral olfactory function. Methode: The research was conducted from February to May 2022 at ENT outpatient clinic Dr. Cipto Mangunkusumo hospital. The research design used was a quasi-experimental test with 1 pre and post-test group with 12 subjects with olfactory dysfunction that occurred suddenly after viral infection. The research subjects will be assessed for olfactory function using the alcohol sniff test (AST), the intravenous olfactory test (IOT) and the sniffin stick test (SST). Subjects will be given a combination of orthonasal olfactory training and a nasal protocol therapy consisting of nasal irrigation, intranasal steroids, topical decongestants, omega-3 and aromatic balsam for 6 weeks then statistical analysis was performed. Results: There were 8 subjects with hyposmia and 4 subjects with ansomia. In hyposmic subjects there are 2 phantosmia subjects and 3 parosmia subjects, while in anosmia subjects there are 1 subject with phantosmia. The types of post-viral olfactory disorders in this study were 9 sensorineural subjects and 3 conductive subjects. The results of statistical calculations of olfactory function after therapy were found to be significant based on AST, IOT, discrimination, identification and TDI (p<0.05). Conclusion: The characteristics of the olfactory dysfunction in this study are sensorineural and conduction olfactory dysfunction. The combination of orthonasal olfactory training and nasal protocol therapy for 6 weeks has been shown to be effective in improving olfactory function in postviral olfactory dysfunction.

Abstrak :

Latar belakang: Angiofibroma nasofaring belia (ANB) adalah tumor fibrovaskular yang langka. Tingkat kekambuhan ANB diketahui memiliki angka yang tinggi. Kekambuhan tidak jarang dikaitkan dengan faktor genetik dan salah satunya adalah beta-catenin. Ekspresi beta-catenin telah diidentifikasi dapat memengaruhi pertumbuhan ANB, namun hubungannya dengan kekambuhan ANB masih perlu diteliti lebih lanjut. Metode: Penelitian ini merupakan studi analitik observasional dengan pendekatan kasus kontrol terhadap pasien ANB yang menjalani ekstirpasi tumor di RSUPN Dr. Cipto Mangunkusumo antara tahun 2013 dan 2022. Data mengenai demografi, karakteristik tumor, prosedur pre-ekstirpasi, pendekatan bedah, dan perdarahan intraoperatif dikumpulkan melalui rekam medis. Pemeriksaan imunohistokimia dilakukan untuk mengetahui ekspresi beta-catenin. Hasil: Didapatkan 33 pasien ANB (18 termasuk kelompok tidak kambuh dan 15 dalam kelompok kambuh). Seluruh pasien merupakan laki-laki berusia antara 9 hingga 28 tahun, dengan rata-rata usia 16,2 tahun. Kelompok usia ≤18 tahun memiliki risiko kekambuhan ANB 8,91 kali lebih tinggi dibandingkan dengan kelompok usia >18 tahun (p=0,046). Ekspresi beta-catenin tinggi (≥124,2) memiliki risiko yang lebih tinggi untuk menyebabkan kekambuhan dibandingkan dengan ekspresi beta-catenin rendah (<124,2) pada pasien ANB (p=0,000). Kesimpulan: Pasien ANB dengan ekspresi beta-catenin tinggi memiliki risiko kekambuhan yang lebih tinggi. ......Background: Juvenile nasopharyngeal angiofibroma (JNA) is a rare fibrovascular tumor known for its high recurrence rate. Recurrence is often linked to genetic factors such as beta-catenin. Although beta-catenin expression has been identified as influencing JNA growth, its relationship with JNA recurrence requires further investigation. Methods: This research employs an observational analytical study design with a case-control approach, focusing on JNA patients who underwent tumor extirpation at Cipto Mangunkusumo General Hospital between 2013 and 2022. Data on demographics, tumor characteristics, pre-extirpation procedures, surgical approaches, and intraoperative bleeding were collected from medical records. Immunohistochemical examination was conducted to determine beta-catenin expression. Results: Among the 33 JNA patients (18 were in the non-recurrent group and 15 were in the recurrent group). All patients were male, aged between 9 and 28 years, with an average age of 16.2 years. The age group ≤18 years had an 8.91 times higher risk of JNA recurrence compared to the age group >18 years (p=0.046). High beta-catenin expression (≥124.2) was associated with a higher risk of recurrence compared to low beta-catenin expression (<124.2) in ANB patients (p=0.000). Conclusion: JNA patients with high beta-catenin expression has a higher risk of recurrence.

Abstrak :
Latar belakang: Kelahiran hidup bayi prematur di Indonesia mencapai 675.700 kasus (15.5%) tiap tahun. Peningkatan insidens gangguan minum dan menelan pada bayi ditemukan terbanyak pada kelompok bayi prematur. Dampaknya akan meningkatkan komplikasi pasien berupa infeksi saluran napas, gangguan nutrisi, dan tumbuh kembang. Keadaan tersebut berisiko memperpanjang konversi pemberian makan per oral, perawatan, serta pembiayaan perawatan. Penelitian terdahulu belum melaporkan prevalensi dan karakteristik gangguan menelan serta gangguan koordinasi siklus isap-telan-napas (ITN) sebagai salah satu bentuk gangguan minum pada bayi prematur. Tujuan: Menilai prevalensi ganguan minum dan menelan pada bayi prematur, serta menilai karakteristik dan faktor risiko yang berpengaruh terhadap kemampuan minum dan menelan pada bayi prematur. Metode: Penelitian ini merupakan studi potong lintang pada bayi prematur dengan riwayat perawatan di NICU yang dilakukan Flexible Endoscopic Evaluation of Swallowing (FEES) di Klinik Disfagia Terpadu  Departemen THT-KL RSCM periode Oktober 2020-Oktober 2022. Parameter yang dinilai adalah faktor karakteristik kelahiran, karakteristik paska lahir, karakteristik oromotor dan tonus postural, serta karakteristik pemeriksaan FEES. Hasil: Prevalensi gangguan menelan sebesar 25% dengan karakteristik temuan disfagia fase oral mekanik, disfagia fase faring neurogenik, dan disfagia fase orofaring neurogenik. Prevalensi gangguan koordinasi siklus ITN sebesar 62,5%. Faktor risiko penyakit refluks gastro esofagus (PRGE) berhubungan dengan gangguan menelan pada bayi prematur (p=0,015) dengan menggunakan uji chi-square. Parameter lain seperti kelompok PMA, high arched palate, standing secretion, nutritive sucking, penetrasi dan aspirasi memiliki hubungan terhadap gangguan menelan pada bayi prematur (p<0,05). Kesimpulan: Karakteristik gangguan minum dan menelan pada bayi prematur ditemukan prevalensi gangguan koordinasi siklus ITN lebih banyak dibandingkan gangguan fungsi menelan (disfagia). Kelompok PMA, PRGE, high arched palate, standing secretion ditemukan sebagai faktor risiko yang berhubungan dengan gangguan menelan pada bayi prematur. Nutritive sucking, penetrasi, dan aspirasi  ditemukan sebagai faktor menentu diagnosis disfagia pada bayi prematur. ......Background: Preterm birth in Indonesia reaches 675,700 cases (15.5%) each year. This condition is the etiologic feeding difficulty and swallowing disorders in preterm babies. The impact will increase patient complications, such as respiratory tract infections, nutritional disorders, and growth and development. It precedes the risk of prolonging the conversion of oral feeding, and treatment, as well as a financial burden related to hospitalization. Previous studies have not reported the prevalence and characteristics of swallowing disorder or dysphagia and suck-swallow-breath (SSB) coordination disorder as a form of feeding difficulty in premature infants. Objective: To assess the prevalence of feeding difficulty and swallowing disorders in premature babies and analyzed characteristics and risk factors that affect the ability to feed and swallow in premature babies. Method: A cross-sectional study in preterm babies with a history of treatment in the NICU using a flexible endoscopic evaluation of swallowing (FEES) for swallowing evaluation at the Dysphagia outpatient clinics Department of ORL-HNS RSCM for the period October 2020-October 2022. The parameters assessed were birth characteristics, postnatal characteristics, oro-motor characteristics, and postural tone, as well as FEES examination characteristics. Results: The prevalence of swallowing disorders was 25% with characteristics of mechanical oral phase dysphagia, neurogenic pharyngeal phase dysphagia, and neurogenic oropharyngeal phase dysphagia. The prevalence of SSB cycle coordination disorders was 62.5%. The risk factor associated with dysphagia in preterm babies was gastroesophageal reflux disease (GERD) with a p-value = 0.015. Other parameters such as post-menstrual age (PMA) group, high arched palate, standing secretion, nutritive sucking, penetration, and aspiration have an association with swallowing disorders in premature infants (p<0.05). Conclusion: Characteristics of feeding difficulties and swallowing disorders in preterm babies were found to have more prevalence of SSB cycle coordination disorders than impaired swallowing function (dysphagia). The PMA, GERD, high-arched palate, and standing secretion group were found to be risk factors associated with swallowing disorders in premature infants. Nutritive sucking, penetration, and aspiration were found to be the erratic factors of dysphagia diagnosis in premature babies.

Abstrak :
Latar belakang: Nyeri kepala sekunder karena variasi anatomi pada mukosa hidung, konka, dan septum dikategorikan dalam lampiran pada International Classification of Headache Disorders – 3. Posisi ini berbeda dan lebih lemah dibanding dengan nyeri kepala sekunder akibat rinosinusitis akut atau eksaserbasi akut pada rinosinusitis kronik. Variasi anatomi pada rongga hidung dan sinus paranasal menjadi stimulasi mekanik berupa kompresi antar mukosa intranasal dan perubahan tekanan barometrik dalam rongga sinus. Studi ini bertujuan untuk mengetahui kecenderungan peran variasi anatomi septum deviasi, konka bulosa, dan sinus etmo-maksila (SEM) sebagai faktor risiko nyeri kepala rinogenik Metode: Penelitian ini dilakukan dengan menggunakan desain potong lintang pada pasien nyeri kepala rinogenik di Departemen THT RSUPN Dr. Cipto Mangunkusumo, RSUP Persahabatan dan RSUP Fatmawati periode Desember 2022 – Februari 2023. Parameter yang dinilai adalah skor NPRS, NOSE, dan ESS. Hasil: Proporsi variasi anatomi septum deviasi sebesar 73,8%, konka bulosa sebesar 52,3%, dan sinus etmomaksila sebesar 47,7% pada pasien nyeri kepala rinogenik di RSCM, RSF, dan RSP yang dievaluasi melalui tomografi komputer sinus paranasal. Terdapat perbedaan rerata yang bermakna antar kelompok derajat septum deviasi dan klasifikasi Mladina terhadap skor NPRS, NOSE, ESS (p<0,05). SEM tipe 2 memiliki rerata skor NPRS yang lebih tinggi dibanding SEM tipe 1 namun tidak bermakna secara statistik. Tipe SEM memiliki perbedaan rerata yang bermakna antar kelompok terhadap skor NOSE dan ESS (p<0,05). Jumlah variasi anatomi dan skor ESS memiliki kecenderungan hubungan yang bermakna terhadap skor NPRS (p<0,05). Odds ratio regresi logistik jumlah variasi anatomi dan skor ESS adalah 4,98E9. Kesimpulan: Proporsi variasi anatomi septum deviasi ditemukan paling banyak pada populasi nyeri kepala rinogenik. Derajat septum deviasi dan klasifikasi Mladina memiliki kecenderungan terhadap derajat nyeri kepala rinogenik. Tipe SEM memiliki kecenderungan hubungan dengan sumbatan hidung dan gangguan napas saat tidur. Jumlah variasi anatomi dan skor ESS menjadi faktor prediktor untuk derajat nyeri kepala rinogenik. ......Background: Secondary headaches due to anatomic variations in the nasal mucosa, turbinates, and septum are categorized in the appendix to the International Classification of Headache Disorders – 3. This position is different and weaker than secondary headaches due to acute rhinosinusitis or acute exacerbations of chronic rhinosinusitis. This study aims to determine the trend of the role of anatomical variations of septum deviation, concha bullosa, and ethmo-maxillary sinus (SEM) as risk factors for rhinogenic headache. Methods: This study was conducted using a cross-sectional design in rhinogenic headache patients at the ENT Department of RSUPN Dr. Cipto Mangunkusumo, Friendship Hospital and Fatmawati Hospital for the period December 2022 - February 2023. The parameters assessed were the NPRS, NOSE, and ESS scores. Results: ¬The proportion of anatomical variations of septum deviation was 73.8%, concha bullosa was 52.3%, and ethmomaxillary sinus was 47.7% in patients with rhinogenic headaches at RSCM, RSF, and RSP which were evaluated by computer tomography of the paranasal sinuses. There was a significant mean difference between the groups with the degree of septum deviation and the Mladina classification on the NPRS, NOSE, and ESS scores (p<0.05). SEM type 2 has a higher average NPRS score than SEM type 1 but it is not statistically significant. The SEM type had a significant difference between groups in the NOSE and ESS scores (p<0.05). The number of anatomic variations and the ESS score tended to have a significant relationship with the NPRS score (p<0.05). The logistic regression odds ratio for the number of anatomic variations and the ESS score is 4.98E9. Conclusion: The proportion of anatomical variations of septum deviation was found to be the highest in the rhinogenic headache population. The degree of septal deviation and the Mladina classification tend to the degree of rhinogenic headache. The SEM type tends to be associated with nasal obstruction and difficulty breathing during sleep. The amount of anatomic variation and ESS score are predictors for the degree of rhinogenic headache.