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Abstrak :
Manfaat madu untuk penyembuhan luka sudah banyak diteliti, namun informasi manfaatnya untuk penyembuhan luka timpanoplasti masih terbatas. Penelitian ini bertujuan mengevaluasi efek madu manuka (Mn) dan madu trigona (Tr) asli Indonesia pada re-epitelisasi membran timpani (MT) melalui potensi proliferasi fibroblas, keratinosit, sekresi KGF dan basic-FGF. Penelitian in vivo berupa uji klinis acak, tersamar ganda, pada 64 pasien dewasa otitis media supuratif kronik (OMSK) tipe aman tenang yang menjalani timpanoplasti di RSUPN dr. Cipto Mangunkusumo pada bulan Juni 2021–Agustus 2022. Pasien diacak dan disamarkan ke dalam dua kelompok, yaitu diberikan gelfoam plus gel Mn 100% medical grade (intervensi) atau hanya diberikan gelfoam (kontrol) di liang telinga saat timpanoplasti. Tampon telinga diangkat setelah dua minggu dan pasien diminta kontrol setiap minggu selama enam minggu. Penelitian in vitro dilakukan di Laboratorium Universitas YARSI. Kultur fibroblas dan keratinosit yang diisolasi dari pasien OMSK diberikan pajanan Mn dan Tr dengan tiga konsentrasi yaitu 0,04%, 0,1%, dan 0,25%, kemudian dilakukan uji proliferasi, KGF dan bFGF juga diukur dan dibandingkan dengan kelompok kontrol. Proporsi pengeringan luka pascatimpanoplasti kelompok intervensi lebih banyak secara bermakna dibandingkan kontrol pada minggu ke-3, ke-4, dan ke-6. Madu manuka dan Tr tidak meningkatkan jumlah sel kultur fibroblas, tetapi mempersingkat durasi doubling time. Jumlah sel kultur keratinosit lebih tinggi secara bermakna dibandingkan kontrol pada semua kelompok Mn dan Tr 0,04%. Sekresi KGF meningkat seiring pertambahan sel. Pada hari ke-6 dan hari ke-8, sekresi KGF lebih tinggi pada beberapa kelompok intervensi dibandingkan kontrol. Sebaliknya, kadar bFGF menurun seiring pertambahan sel. Terdapat korelasi positif antara lama pajanan kedua jenis madu dengan proliferasi fibroblas. Lama pajanan Mn 0,04%, 0,1%, dan Tr 0,04% berkorelasi positif dengan jumlah sel kultur keratinosit. Disimpulkan pemberian Mn saat timpanoplasti meningkatkan pencapaian re-epitelisasi MT sempurna melalui efeknya pada fibroblas dan keratinosit, serta berpotensi meningkatkan keberhasilan timpanoplasti. Penelitian ini juga menunjukkan efek positif Tr pada fibroblas dan keratinosit, sehingga potensi terapeutik madu ini dapat diteliti lebih lanjut ......Benefits of honey on wound healing have been widely reported, but information about its effect on the re-epithelialization of the tympanic membrane (TM) is limited. This study aims to evaluate the effect of manuka honey (MH) and trigona honey (TH) from Indonesia, on TM re-epithelization through their potential action on the proliferation of fibroblasts, keratinocytes, secretion of KFG and basic-FGF. The in vivo study was a randomized, controlled, double-blind clinical trial on 64 adult patients with mucosal type chronic suppurative otitis media (CSOM) undergoing tympanoplasty at Cipto Mangunkusumo General Hospital from June 2021–August 2022. Patients were randomized and blinded into two groups, receiving either gel foam soaked in 100% medical grade MH (intervention group) gel or only gel foam (control group) placed in the external auditory canal during tympanoplasty. The ear tampon was removed after two weeks, and patients were followed up weekly for six weeks. The in vitro study was conducted at the YARSI University Laboratory. Fibroblast and keratinocyte cultures isolated from CSOM patients were exposed to MH and TH 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 with the control group. The intervention group had a significantly higher proportion of dry tympanoplasty wounds than control at the 3rd, 4th, and 6th visit. Manuka honey and TH 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% TH group. KGF secretion increased as the number of cells increased. On day 6 and day 8, KGF secretion was higher in some of the intervention groups compared with the control group. In contrast, fibroblast bFGF secretion decreased as the number of cells increased. There was a positive correlation between the exposure time of all intervention groups and the number of cells in the fibroblast culture. Prolonged exposure time to 0.04% MH, 0.1% MH, and 0.04% TH were positively correlated with the number of keratinocytes. The application of MH during tympanoplasty increased complete TM re-epithelialization through its effect on fibroblasts and keratinocytes proliferation. MH has the potential to improve tympanoplasty outcomes. This present study also illustrated the positive effects of TH on fibroblasts and keratinocytes; thus, its potential therapeutic properties could be further explored.

Abstrak :
ABSTRAK Tesis ini membahas rinosinusitis kronik dan hubungannya dengan kelainan telinga tengah di poliklinik THT RSCM pada pasien dewasa. Penelitian ini bertujuan untuk mengetahui proporsi kelainan telinga tengah pada pasien rinosinusitis kronik dan hubungan antara rinosinusitis kronik dengan kelainan telinga tengah pada percontoh dengan keluhan hidung dan/atau keluhan telinga. Penelitian ini menggunakan metode potong lintang pada pasien usia 18-60 tahun dengan membran timpani intak yang datang ke poliklinik Umum THT RSCM dengan keluhan hidung dan/atau keluhan telinga yang kemudian menjalani rangkaian pemeriksaan nasoendoskopi, otomikroskopi, timpanometri dan uji cukit kulit. Hasil penelitian mendapatkan proporsi kelainan telinga tengah pada pasien rinosinusitis kronik sebanyak 14 percontoh (14/77=18,2%) dan hubungan antara rinosinusitis kronik dengan kelainan telinga tengah secara statistik tidak bermakna (p=0,75).

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ABSTRACT This study investigates chronic rhinosinusitis and its association with middle ear inflammation in adult patient at ENT oupatient clinic, Cipto Mangunkusumo Hospital. The aim of this study is to determine the proportion of the middle ear inflammation among the chronic rhinosinusitis patients and its association between chronic rhinosinusitis and middle ear inflammation in a population with ear and/or nose complaint. This is a cross sectional study in patients between the age of 18-60 years old with intact tympanic membrane who came to ENT outpatient clinic with ear and/or nose complaints and underwent nasoendoscopic, otomicroscopic, tympanometric examination and skin prick test. The results were proportion of the middle ear inflammation among the chronic rhinosinusitis patients was 14 samples (18,2%) and there was no significant association between chronic rhinosinusitis and middle ear inflammation statistically (p=0,75).

Abstrak :
ABSTRAK
Fragmen bilirubin yang tidak terkonjugasi dan tidak terikat albumin (bilirubin bebas) pada neonatus dapat menembus sawar darah otak sehingga terjadi kerusakan otak berupa ensefalopati bilirubin akut. Salah satu gejala ensefalopati bilirubin akut adalah tuli sensorineural. Penelitian sebelumnya menunjukkan bahwa bilirubin bebas mempunyai neurotoksisitas lebih besar dibandingkan dengan bilirubin total, namun pemeriksaan bilirubin bebas lebih sulit, rumit, mahal dan belum tersedia di klinik; sehingga perlu dicari pemeriksaan lain yang lebih praktis dan aplikatif. Salah satu pilihan untuk menentukan neurotoksisitas bilirubin adalah pengukuran rasio bilirubin total terhadap albumin (BT/A). Penelitian ini merupakan penelitian potong lintang berulang, bersifat observasional, longitudinal, dan prospektif berupa uji diagnostik untuk mengetahui proporsi tuli sensorineural yang diprediksi berdasarkan nilai rasio BT/A tertentu pada neonatus BBLR dengan hiperbilirubinemia. Penelitian ini dilakukan dalam periode bulan Agustus 2015 sampai dengan Maret 2016, dengan dua tahap pemeriksaan OAE dan BERA. Pemeriksaan pertama sebagai skrining pendengaran dilakukan saat subjek berumur ≥ 7β jam?1 minggu dan pemeriksaan kedua/diagnostik pada usia 3?6 bulan. Dari 131 subjek yang dilakukan skrining pendengaran dengan OAE dan BERA, terdapat 70 subjek dengan hasil refer dan 61 dengan hasil pass. Lima puluh satu subjek datang pada pemeriksaan kedua/diagnostik (response rate 38,9%). Hasil pemeriksaan diagnostik adalah 9 subjek tuli sensorineural (6,87%) yang terdiri dari 5 subjek tuli sensorineural bilateral, 2 subjek tuli sensorineural unilateral dan 2 subjek neuropati auditorik. Rasio BT/A berperan terhadap terjadinya tuli sensorineural dengan OR 16, p = 0,003, sensitivitas 89% dan spesifisitas 67%. Pada penelitian ini juga didapatkan angka rujukan bilirubin total dan rasio BT/A yang dapat menyebabkan tuli sensorineural pada neonatus BBLR hiperbilirubinemia yaitu 12,21 mg/dL dan 0,46. Rasio BT/A dapat digunakan sebagai prediktor tuli sensorineural pada neonatus BBLR dengan hiperbilirubinemia.

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ABSTRACT
In neonates, unconjugated unbound bilirubin (free bilirubin) can penetrate the blood brain barrier, causing brain damage in the form of acute bilirubin encephalopathy as one of the symptoms is sensorineural hearing loss. Previous research has demonstrated that free bilirubin neurotoxicity was more sensitive than total bilirubin, but the free bilirubin test is more difficult, complicated, expensive and not available in the clinic; thus it is necessary to find other tests which is more practical and applicable. One of the option to determine the bilirubin neurotoxicity is a measurement of the ratio of total bilirubin to albumin (BT/A). This is a repeated cross sectional study done in observational, longitudinal and prospective diagnostic tests to determine the proportion of sensorineural hearing loss predicted based on the value BT/A ratio in low birth weight (LBW) neonates with hyperbilirubinemia. The study was conducted from August 2015 until March 2016, with two-stage examination of the OAE and BERA, i.e. ≥ 7β hours?1 week and age of 3?6 months respectively. One hundred and thirty one subjects underwent hearing screening, and it revealed that 70 subjects diagnosed as refer and the rest (61 subjects) was pass. During the second examination/diagnostics with response rate at 38.9%, 9 from 51 subjects were diagnosed as sensorineural hearing loss (6.87%), i.e. five subjects with bilateral sensorineural hearing loss, two subjects with unilateral sensorineural hearing loss and two subjects with auditory neuropathy. The BT/A ratio contributes to the occurrence of sensorineural hearing loss with OR 16, p = 0.003, sensitivity 89% and specificity 67%. It also revealed in this study that the reference figure of bilirubin total and BT/A ratio were 12.21 mg/dL and 0.46 respectively. Those reference value can be used to predict sensorineural hearing loss in LBW neonatal with hyperbilirubinemia. Ratio of BT/A can be used as a predictor of sensorineural hearing loss in LBW neonates with hyperbilirubinemia.