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Metode biakan jaringan kolesteatoma pasien otitis media supuratif kronik tipe bahaya Restuti, Ratna Dwi
Oto Rhino Laryngologica Indonesiana Vol 43, No 1 (2013): Volume 43, No. 1 January - June 2013
Publisher : PERHATI-KL

Background: Tissue culture is a technique to multiply cells or tissue in vitro. With tissue culture cells can be studied as well as the nature of the application. Similarly, tissue culture methods can be applied also to cholesteatoma of chronic suppurative otitis media patients that can be used to study the nature of cholesteatomas to the cellular level. Purpose: The purpose of this study was to get tissue culture methods for cholesteatomas, so that the steps, techniques and specific tools for culturing cholesteatoma can be determined, also the number of cells that were planted, good environment in order to obtain cell viability and good culture results. Methods: This study consists of three phases: 1) Preliminary research phase aimed to determine the method of cell culture techniquesof cholesteatomas keratinocytes. 2) The stage of planting keratinocyte cells. 3) Phase keratinocytes cell harvest (harvest). Results: After this study, to get the optimal growth and viability, it would require the following methods: 1) Petri dish used for growing cholesteatomas keratinocyte cell is 1 cmdiameter petri dish; 2) The number of cells that were grown per cm2 of surface area of planting was 1-2 x 104cells per cm2; 3) The tripsinization time while harvesting cell was 30 seconds. Conclusion: Culture of cells was taken from the dispersion of certain organ which was done by enzymatic, mechanical and chemical disaggregation. Cultured keratinocytes had a short span of time and could be mixed with fibroblasts. Keratinocytes had a very limited replication half-life and there was a relationship between age and decline in the number of generations. This was associated with age, changes in the cell membrane and matrix components.Keywords: tissue culture, cholesteatoma, CSOM. ABSTRAKLatar belakang: Biakan jaringan merupakan suatu teknik memperbanyak sel atau jaringan secara in vitro. Dengan biakan jaringan dapat dipelajari berbagai sifat sel serta aplikasinya. Demikian juga jaringan kolesteatoma pasien otitis media supuratif kronik dapat digunakan metode biakan jaringan untuk mempelajari sifat jaringan kolesteatoma hingga tingkat sel. Tujuan: Tujuan penelitian ini adalah untuk mencari metode biakan jaringan kolesteatoma, sehingga didapatkan tahap-tahap biakan beserta teknik operasional baik alat spesifik yang digunakan, jumlah sel yang ditanam, lingkungan yang baik sehingga diperoleh viabilitas sel dan hasil biakan yang baik. Metode: Penelitian ini terdiri atas tiga tahap yaitu: 1) tahap penelitian pendahuluan yang bertujuan untuk menentukan metode teknik biakan sel keratosit kolesteatoma, 2) tahap menanam sel keratosit, 3) tahap memanen sel keratosit (harvest). Hasil: Setelah penelitian ini, untuk mendapatkan hasil pertumbuhan dan viabilitas yang optimal, maka diperlukan metode sebagai berikut: 1) petri yang digunakan untuk menanam sel keratinosit kolesteatoma adalah petri dengan diameter 1 cm, 2) jumlah sel yang ditanam per-cm2 luas permukaan bidang tanam adalah 1-2 x 104 sel per-cm2, 3) waktu tripsinisasi saat pengangkatan sel adalah 30 detik. Kesimpulan: Biakan sel adalah biakan yang diambil dari dispersi sel organ tertentu yang dilakukan dengan cara enzimatik, mekanik dan disagregasi secara kimiawi. Biakan keratinosit memiliki rentang waktu yang pendek dan hendaknya diwaspadai tercampur dengan fibroblas. Keratinosit memiliki waktu paruh replikasi yang sangat terbatas dan terdapat hubungan antara usia dengan penurunan jumlah generasi. Hal ini dikaitkan dengan usia, perubahan membran sel dan komponen matriks.Kata kunci: kultur jaringan, kolesteatoma, otitis media supuratif kronik.

Expression of Tumor Necrosis Factor - α (TNF-α) and Interleukin 1-β (IL1-β) in Chronic Tubotympanic Suppurative Otitis Media Anton Budhi Darmawan; Marsetyawan HNE Soesatyo; Ratna Dwi Restuti; Agus Surono
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 50, No 1 (2018): SUPPLEMENT
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Chronic Suppurative Otitis Media (CSOM) is a common public health problem worldwide and a major cause of hearing impairment. It is also one of the neglected disease especially in developing countries. Cytokines are a group of glycoproteins that play a role in strengthening the immune and inflammatory reactions in various diseases, including inflammation of the middle ear. Some of the important inflammatory mediators found in middle ear fluids are Tumor Necrosis Factor-α (TNF-α) and Interleukin-1β (IL-1β). Cytokines are thought to play a role in the ongoing inflammatory regulation. The aim of this study was to compare the expression of TNF-α and IL-1β in tubotympanic CSOM and in healthy control group. The mean of TNF-α serum level in tubotympanic CSOM was 0,553±1,59 pg/ ml, and 0,587±2,13 pg/ ml in control group. There was no statistically different of TNF-α between two groups (P > 0,05). Mean of IL-1β serum level in the tubotympanic CSOM and control group were 0,633±0,92 and 0,302±0,48, respectively. Although IL-1β levels were higher in the patient group, the difference was not statistically significant (P > 0,05).

TNF-α and TGF-β Contributes in Recurrent Otorrhea of Active Mucosal Chronic Otitis Media Dewi Pratiwi; Marisa Rizqiana; Adisetya Wicaksono; Defitaria Permatasari; Ratna Dwi Restuti; Tri Nugraha Susilawati; Sutarno Sutarno
The Indonesian Biomedical Journal Vol 14, No 1 (2022)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v14i1.1759

BACKGROUND: Active mucosal chronic otitis media (COM) is prevalent in lower-income countries and is associated with recurrent episodes of otorrhea due to chronic inflammation of the middle ear. Cytokines, which are well-known for their effects on the immune system, play an important role in the inflammatory response and tissue remodeling. The specific contributions of proinflammatory and immunoregulatory cytokines in the pathophysiology of active mucosal COM remain unclear. This study aimed to compare the levels of serum tumor necrosis factor (TNF)-α and transforming growth factor (TGF)-β in patients with active mucosal COM vs. healthy subjects.METHODS: Total 20 subjects with active mucosal COM and 20 healthy subjects participated in this study. The levels of serum TNF-α and TGF-β were measured using enzyme-linked immunosorbent assay (ELISA).RESULTS: The average level of serum TNF-α in subjects with active mucosal COM was significantly higher compare to the healthy subjects (46.373±41.76 pg/mL vs. 15.021±7.16 pg/mL; p=0.004). In contrast, the average level of serum TGF-β in subjects with active mucosal COM was lower compared to the healthy subjects, although the difference is not statistically significant (9.963±3.2 ng/mL vs. 11.78±8.48 ng/mL; p=0.552). Further analysis showed that in subjects with active mucosal COM, the levels of serum TNF-α had a medium positive correlation with the level of TGF-β (r=0.525; p=0.018).CONCLUSION: TNF-α and TGF-β, which are proinflammatory and immunoregulatory cytokines, may contribute to the pathogenesis of recurrent episodes of otorrhea in an active mucosal COM.KEYWORDS: tumor necrosis factor-α, transforming growth factor-β, active mucosal chronic otitis media

Posisi elektroda intrakoklea dan ECAP sebagai pedoman pemetaan pada tuli sensorineural dengan implan koklea Semiramis Zizlavsky; Ratna Dwi Restuti; Jacub Pandelaki; Muchtaruddin Mansyur; Bambang Hermani; Teguh Ranakusuma; Edrial Eddin; Sarwono Waspadji
Oto Rhino Laryngologica Indonesiana Vol 44, No 1 (2014): Volume 44, No. 1 January - June 2014
Publisher : PERHATI-KL

Latar belakang: Implan koklea merupakan pilihan utama untuk habilitasi pendengaran dan berbicara pada anak tuli sensorineural berat bilateral. Pengaturan comfortable dan threshold level berdasarkan nilai evoked compound action potential (ECAP) direkam dengan neural responses imaging (NRI) saat pemetaan. Tujuan: Memperoleh nilai ECAP sebagai acuan pemetaan berdasarkan jarak elektroda intrakoklea ke modiolus, jarak terpanjang elektroda nomor satu dengan elektroda berhadapan, jarak marker dengan lubang kokleostomi dan faktor lainnya. Metode: Anak tuli sensorineural usia 2-10 tahun, menggunakan implan koklea dengan desain contour atau straight terdiri dari 16 elektroda, 120 channel sebagai subjek penelitian. Subjek penelitian sebanyak 46 telinga (39 anak), terpasang implankoklea diperoleh secara konsekutif dengan desain potong lintang. Perekaman ECAP elektroda 3-5, 8-10, 13-15 mewakili daerah apeks, medial dan basal. Hasil tomografi komputer resolusi tinggi koklea dengan program OsiriX dilakukan rekonstruksi 3D untuk menilai posisi dan jarak elektroda. Analisis data diawali dengan univariat dan uji korelasi Spearman ‘s pada bivariat. Kandidat faktor yang berperan disertakan pada regresi ganda untuk mendapatkan faktor determinan ECAP. Comfortable zone untuk populasi diperoleh dari analisis area pada distribusi normal menggunakan comfortable level. Hasil: Diperoleh persamaan yaitu: (rerata ECAP)=-21,19+5,87 rerata jarak elektroda ke modiolus (mm)+1.31, rerata threshold level (cu)+0.48 lama penggunaan implan koklea (bulan). (R square=0.60). Comfortable zone diperoleh dengan ECAP yang berada pada variasi 84-87,5% comfortable level. Kesimpulan: Jarak elektroda ke modiolus, lama penggunaan implan koklea dan t level merupakan faktor determinan ECAP. Nilai ECAP dapat digunakan untuk mengidentifikasi penyimpangan jarak elektroda dan memperoleh comfortable zone.Kata kunci : ECAP, implan koklea, lokasi elektroda, tuli sensorineuralABSTRACT Background: Currently cochlear implant remains a preferred choice in hearing and speechhabilitation in children with bilateral profound SNHL. Comfortable and threshold level setting based on ECAP value is recorded by NRI during mapping. Purpose: To obtain ECAP value as mapping guidance based on the distance between electrode to modiolus, the longest distance between electrode number one with the ones it faces, the distance between marker and cochleostomy and other factors. Methods: Research subject were children with SNHL, between 2-10 years old using CI with 16 electrodes, 120 channels. There were 46 ears (39 children) with CI chosen consecutively by cross sectional design. Using NRI, ECAP was recorded on electrode 3-5, 8-10, 13-15 that represent the apex, medial and basal area. Their cochlears were examined with HRCT then 3D reconstruction with OsiriX programto determine the electrode position and calculate the distance. Data analysis started with univariat 1 and bivariat with Spearman’ correlation. Candidates’ factor were analysed with multiregression test to gain ECAP determinant factor. Comfortable zone for population was gained from area analysis in normal distribution using comfortable level. Results: The equation found were: y (average ECAP)=21.19+5.87 the average electrodes to modiolus distance (mm)+1.31, threshold level (cu)+0.48 CI length use (months). (R square=0.60).Comfortable zone was acquired with ECAP between 84-87,5% comfortable level variation. Conclusion: The electrode to modiolus distance, duration of CI use and t level are ECAP determinant factor. The value of ECAP can be used as guidance to identify electrode distance deviation and to gain comfortable zone.Keywords: cochlear implant, ECAP, electrode location, sensoryneural hearing loss

Coalescent mastioditis as a complication of acute otitis media Ratna Dwi Restuti; Harim Priyono; Dora A Marpaung; Ayu Astria Sriyana; Rangga Rayendra Saleh
Oto Rhino Laryngologica Indonesiana Vol 51, No 1 (2021): Volume 51, No. 1 January - June 2021
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v51i1.443

Background: Acute otitis media (AOM) is one of the most common infections in children. AOM disease can lead to complications such as coalescent mastoiditis. Mastoidectomy surgery in cases of coalescent mastoiditis in children is still a debate. Purpose: To convey the management of coalescent mastoiditis in pediatric patients as complication of AOM using an evidence-based literature search. Case Report: A 10-month old patient with a diagnosis of AOM and coalescent mastoiditis, who was given antibiotic therapy and abscess drainage incision. Clinical question: In a child with coalescent mastoiditis as a complication of otitis media, could the disease be cured with intravena antiobitic therapy only without mastoidectomy operation? Review methods: Evidence-based literature searches through Pubmed, Proquest and Cochrane were performed using the keywords mastoidectomy, antibiotics and coalescent mastoiditis. Result: The search resulted in 277 literatures, and 12 were relevant with the case, and two journals stating that in cases of uncomplicated coalescent mastoiditis, mastoidectomy operation could be postponed and intravenous antibiotic could be administered with monitoring of the patient’s condition for 48 hours. Conclusion: Intravenous antibiotic is the primary therapy in cases of coalescence mastoiditis accompanied by clinical monitoring for 48 hours. Additional mastoidectomy and other surgeries were performed in cases of clinical deterioration after intravenous antibiotic therapy, and in cases of intratemporal or intracranial complications. ABSTRAK Latar belakang: Otitis Media Akut (OMA) merupakan salah satu infeksi yang sering ditemukan pada anak. Penyakit OMA dapat mengakibatkan komplikasi seperti mastoiditis koalesens. Operasi telinga mastoidektomi untuk kasus mastoiditis koalesens anak masih merupakan perdebatan sampai saat ini. Tujuan: Mengulas tatalaksana mastoiditis koalesens akibat OMA pada pasien anak menggunakan pencarian literatur berbasis bukti. Laporan Kasus: Seorang pasien umur 10 bulan dengan OMA dan komplikasi mastoiditis koalesens. Dilakukan tatalaksana terapi antibiotik dan insisi drainase abses. Pertanyaan klinis: Pada kasus anak kecil dengan mastoiditis koalensens sebagai komplikasi otitis media akut, apakah penyakit ini dapat disembuhkan hanya dengan pemberian terapi antibiotik intravena tanpa operasi mastoidektomi? Telaah literatur: Telaah berbasis bukti dilakukan melalui Pubmed, Proquest dan Cochrane, dengan menggunakan kata kunci mastoidektomi, antibiotik dan mastoiditis koalesens. Hasil: Telaah berbasis bukti menghasilkan 277 literatur, 12 diantaranya relevan dengan kasus, dan dua literatur menyatakan bahwa pada kasus mastoiditis koalesens tanpa komplikasi, mastoidektomi bisa ditunda dan pemberian antibiotik intravena bisa diberikan dengan pemantauan kondisi pasien selama 48 jam. Kesimpulan: Pemberian antibiotik intravena merupakan terapi utama pada kasus mastoiditis koalesens disertai pemantauan klinis selama 48 jam. Terapi lanjutan berupa mastoidektomi dan operasi lainnya dilakukan pada kasus dengan perburukan klinis sesudah terapi antibiotik intravena, dan pada kasus komplikasi intratemporal atau intrakranial.Kata kunci: mastoiditis koalesens, otitis media akut, antibiotik, mastoidektomi

Labyrinthine fistula size as a prognostic factor for postoperative hearing deterioration Ratna Dwi Restuti; Harim Priyono; Ayu Astria Sriyana; Rangga Rayendra Saleh; Eka Dian Safitri
Oto Rhino Laryngologica Indonesiana Vol 51, No 2 (2021): VOLUME 51, NO. 2 JULY - DECEMBER 2021
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v51i2.497

ABSTRACTBackground: A labyrinthine fistula is an abnormal opening in the bony capsule of the inner ear, such as cochlea or semi-circular canals that may occur as a complication of chronic suppurative otitis media (CSOM) with cholesteatoma. Purpose: To find out the relation of the size of labyrinthine fistula as a prognostic factor of hearing deterioration after a complete cholesteatoma removal. Case report: Two cases of labyrinthine fistula in CSOM with cholesteatoma, along with preoperative and postoperative audiometry results. Clinical question: Does the labyrinthine fistula size in CSOM with cholesteatoma patients could serve as a prognostic factor in the postoperative hearing outcome? Review method: A structured, evidence-based literature search using Pubmed, Proquest and Cochrane to find studies of labyrinthine fistula as a complication of CSOM. The articles were selected based on eligibility criteria i.e. surgery procedure, labyrinthine fistula measurement, and postoperative evaluation of hearing function. The appraisal of each article used Oxford critical appraisal independently for prognostic study and systematic review. Result: Two studies met the inclusion criteria. One article used cohort retrospective method valid based on appraisal for prognostic studies. The other article used a systematic review method which had low validity. Conclusion: Fistula size is still debatable as a postoperative prognostic factor for hearing deterioration in CSOM with cholesteatoma. Larger sample size and better methods of study are necessary to resolve the clinical question.Keywords: chronic suppurative otitis media (CSOM), cholesteatoma, labyrinthine fistula, fistula sizeABSTRAKLatar belakang: Fistula labirin adalah terbukanya dinding tulang pada koklea atau kanalis semisirkularis yang merupakan suatu komplikasi dari otitis media supuratif kronik (OMSK) tipe bahaya. Tujuan: Untuk menjawab pertanyaan klinis terkait hubungan antara ukuran fistula labirin dengan prognosis penurunan pendengaran pasca operasi pengangkatan kolesteatoma. Laporan kasus: Dua kasus fistula labirin pada penderita OMSK tipe bahaya, disertai dengan hasil pemeriksaan audiometri pendengaran sebelum dan sesudah operasi. Pertanyaan klinis: Apakah ukuran fistula labirin pada kasus OMSK dengan kolesteatoma dapat menjadi faktor penentu prognosis untuk hasil pemeriksaan pendengaran pasca operasi? Telaah literatur: Pencarian literatur berbasis bukti menggunakan Pubmed, Proquest dan Cochrane terkait fistula labirin pada kasus OMSK. Kriteria inklusi studi berdasarkan teknik operasi, ukuran fistula dan evaluasi pendengaran pasca operasi. Metode Oxford critical appraisal digunakan untuk studi prognosis pada satu artikel, dan digunakan systematic review untuk artikel lainnya. Hasil: Dari pencarian literatur terdapat dua artikel yaitu studi kohort retrospektif, dan systematic review yang memenuhi kriteria inklusi. Hasil telaah literatur menunjukan bahwa study kohort retrospektif memiliki validitas cukup baik, sedangkan studi systematic review memiliki validitas yang kurang baik. Kedua artikel ini memiliki hasil yang berbeda dalam hubungan ukuran fistula labirin dengan prognosis penurunan pendengaran pasca operasi. Kesimpulan: Ukuran fistula sebagai faktor prognosis penurunan pendengaran pasca operasi pada kasus OMSK tipe bahaya masih memerlukan penelitian dengan sampel yang lebih banyak, dan metode yang lebih baik untuk dapat menjawab pertanyaan klinis.Kata kunci: otitis media supuratif kronik (OMSK), kolesteatoma, fistula labirin, ukuran fistula

Pengaruh deksametason terhadap proliferasi sel, kadar IL-α, dan TNF-α pada biakan kolesteatoma Ratna Dwi Restuti
Oto Rhino Laryngologica Indonesiana Vol 44, No 1 (2014): Volume 44, No. 1 January - June 2014
Publisher : PERHATI-KL

Latar belakang: Kolesteatoma merupakan suatu struktur berbentuk kantung, terdiri atas epitel gepeng berlapis yang selalu mengalami proses keratinisasi. Mengapa kolesteatoma bersifat invasif, hiperproliferatif, agresif, dan residif, hal ini perlu diselidiki. Deksametason merupakan salah satu kortikosteroid sintetik yang memiliki potensi tinggi sebagai preparat anti-inflamasi. Tujuan: Penelitian ini bertujuan untuk membuktikan bahwa pertumbuhan kolesteatoma dapat dihambat secara medikamentosa (dengan deksametason). Metode: Penelitian ini merupakan eksperimen yang dilakukan di laboratorium. Studi ini membandingkan 2 kelompok, yaitu kelompok biakan keratinosit kolesteatoma yang diberideksametason sebagai kelompok perlakuan dan kelompok biakan yang tidak diberi perlakuan. Hasil: Pada penghitungan sel setelah 48 jam kultur dan 24 jam ditambahkan deksametason, terdapat perbedaan bermakna antara kelompok kontrol dengan kelompok perlakuan yang dimulai dengan dosis 10 µg. Pemberian dosis tertinggi, yaitu 100 µg menyebabkan kelompok dosis tersebut berbeda bermakna dengan semua kelompok lainnya. Kesimpulan: Dibuktikan bahwa tingkat reduksi sel berhubungan dengan penambahan dosis deksametason (dose-dependent). Deksametason dapat menghambat proliferasi selpada biakan keratinosit kolesteatoma dengan dosis minimal 10 µg/mL. Kata kunci: kolesteatoma, keratinosit, proliferasi sel, interleukin-1α, tumor necrosis factor-α ABSTRACTBackground: Cholesteatoma is a sac-shaped structure, arise from stratified squamous epithelium which is constantly undergoing process of keratinization. Why the nature of cholesteatoma is invasive, hyperproliferative, aggressive, and recurrent need to be studied. Dexamethasone is a synthetic corticosteroid which has a high anti-inflammatory action. Objective: The aim of this study was to prove that cholesteatoma growth can be inhibited medically by dexamethasone. Methods: This study was conducted as a laboratory experiment. We compared two groups, the first one were cholesteatoma keratinocyte cultures given dexamethasone as the treatment group and the second group were untreated cultures. Results: In cells counting after 48 hours of culture and 24 hours of dexamethasone administration, there was a significant difference between the control group and the treatment group that was started at a dose of 10 µg. The highest dose given gorup, 100 µg caused significant difference with all other groups. Conclusion: The rate of reduction of cells associated with the addition of dexamethasone dose (dose-dependent). Dexametasone can inhibit cell proliferation in keratinocyte with minimal inhibitory dose of 10 µg/mL. Keywords: Cholesteatoma, keratinocyte, cell proliferation, interleukin-1α, tumor necrosis factor-α

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.

Komplikasi intratemporal dan intrakranial pada otitis media akut anak Harim Priyono; Ratna Dwi Restuti; Andre Iswara; Setyo Handryastuti
Oto Rhino Laryngologica Indonesiana Vol 41, No 1 (2011): Volume 41, No. 1 January - June 2011
Publisher : PERHATI-KL

Background: Acute otitis media (AOM) is an acute inflammation in the middle ear caused by various factors such as blockage of Eustachian tube, infection and allergy. Purpose: The case report is to forewarn general practitioners and ENT specialists concerning AOM potentially causes intratemporal and intracranial complications. Case: We report an eleven-years-old girl with acute otitis media with intratemporal complications (labirynthitis and sensorineural hearingloss) and intracranial complication (meningitis). Case management: The recent management of acute otitis media with complications includes empiric antibiotics, analgesic, anti-inflammatory drugs and miringotomy with ventilation tube insertion. Conclusion: The accuracy of diagnosing AOM with complication depends on the clinical symptomps such as vertigo, fever, seizure, meningism and unconsciousness. The pneumatic otoscopy examination is the gold standard in diagnosing AOM. Our patient was given antibiotics for 14 days, anti- inflamation and myringotomy with ventilation tube insertion procedure. Keywords: acute otitis media, intracranial complications, intratemporal complications Abstrak : Latar belakang: Otitis media akut (OMA) merupakan peradangan akut yang berlangsung di telinga tengah akibat berbagai faktor predisposisi seperti sumbatan tuba Eustachius, infeksi dan alergi.Tujuan: Kasus ini diajukan untuk mengingatkan dokter umum maupun spesialis THT mengenali gejala komplikasi OMA pada anak yang mempunyai potensi menimbulkan komplikasi intratemporal dan intrakranial. Kasus: Dilaporkan satu kasus OMA dengan komplikasi intratemporal (labirintitis dan tuli saraf) dan intrakranial (meningitis) pada anak perempuan usia 11 tahun.Penatalaksanaan: Penatalaksanaan otitis media akut dengan komplikasi intrakranial dan intratemporal mencakup pemberian antibiotik empiris, analgetik, anti-inflamasi dan tindakan miringotomi dengan pemasangan pipa ventilasi. Kesimpulan: Ketepatan dalam mendiagnosis OMA dengan komplikasi tergantung pada gejala klinis yang bisa dikenali seperti pusing berputar, demam, kejang, kaku kuduk dan penurunan kesadaran. Pemeriksaan otoskopi pneumatik merupakan gold standard dalam membantu diagnosis. Terapi untuk kasus ini terdiri atas antibiotik selama 14 hari, anti-inflamasi dan tindakan berupa miringotomi dengan pemasangan pipa ventilasi.Kata kunci: otitis media akut, komplikasi intrakranial, komplikasi temporal

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

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