Sriwijaya Journal of Otorhinolaryngology

Strategic Avoidance of General Anesthesia in Obstetric Trauma: Ear Ring Block for Auricular Reconstruction in a Second-Trimester Pregnancy

Purwoko — 2025-10-30

Background: Surgical interventions during pregnancy require balancing maternal physiological stability with fetal safety. Trauma necessitating ear reconstruction typically requires general anesthesia, which carries elevated risks of difficult airway management, aspiration, and fetal neurotoxicity. The “Ring Block” offers a regional alternative, yet evidence on its safety in second-trimester trauma remains limited.

Objective: To evaluate the safety, hemodynamic stability, and surgical efficacy of a landmark-based Ear Ring Block as an alternative to general anesthesia for extensive auricular trauma reconstruction in a high-risk, second-trimester parturient.

Case presentation: We present a 41-year-old multigravida at 14 weeks of gestation (ASA II) with a complex traumatic laceration of the right auricle following a motor vehicle accident. Owing to her advanced maternal age and the risks of general anesthesia, an awake ear reconstruction was planned using a landmark-based Ear Ring Block with 12 mL of 2% Lidocaine. Complete surgical anesthesia was achieved with a V-pattern and inverted V-pattern injection trajectory. Intraoperative monitoring revealed hemodynamic stability with no fluctuations in mean arterial pressure or fetal heart rate abnormalities. The patient reported a visual analog scale score of zero intraoperatively and was discharged 12 hours after surgery without complications.

Conclusion: The Ear Ring Block represents a superior anesthetic modality for auricular trauma in pregnant patients. It effectively mitigates the physiological risks of general anesthesia while providing profound analgesia and hemodynamic stability. This technique should be considered a primary anesthetic strategy for auricular reconstruction in the obstetric population.

Comparative Efficacy of Topical Antifungal and Antiseptic Agents for Otomycosis in Tropical and Subtropical Climates: A Systematic Review and Meta-Analysis

Rachmat Hidayat — 2026-07-23

Background: Otomycosis is a superficial fungal infection of the external auditory canal that is disproportionately prevalent in tropical and subtropical regions, yet the comparative efficacy of topical agents in this climatic and mycological context has not been quantitatively synthesised.

Objective: To compare complete-cure rates of topical antifungal and antiseptic agents for otomycosis using comparative studies from tropical and subtropical countries.

Methods: Following a registered protocol (PROSPERO CRD420261456091) and PRISMA 2020, we identified comparative studies reporting complete cure or mycological eradication. Ten studies (1,970 ears; eight countries) were included. The pre-specified primary comparison, povidone-iodine versus clotrimazole, was pooled as a risk ratio (RR) using a random-effects model with the Hartung–Knapp–Sidik–Jonkman correction, a 95% prediction interval and a leave-one-out analysis. Risk of bias used RoB 2 and ROBINS-I; certainty used GRADE.

Results: The random-effects pooled cure rate across 21 arms was 74.9% (95% CI 66.9–82.2; I² = 93%). For povidone-iodine versus clotrimazole (k = 4), the pooled RR was 0.86 (HKSJ 95% CI 0.53–1.39; prediction interval 0.29–2.58), indicating no significant difference while excluding neither agent's superiority. Between-study heterogeneity (I² = 79%) arose entirely from one non-randomised study; omitting it gave RR 0.95 (0.85–1.06) with I² = 0%. Certainty was low to very low.

Conclusion: Topical azoles and low-cost antiseptics such as povidone-iodine achieve broadly similar, moderate cure rates for otomycosis in tropical settings, but the evidence is too imprecise to establish equivalence, and potential ototoxicity means agent choice should remain individualised.

Spatiotemporal Trends and Attributable Risk Factors of Nasopharyngeal Carcinoma in Southeast Asia (1990–2023): An Ecological Analysis of the Global Burden of Disease Study with Projections to 2050

Linda Purnama — 2026-07-23

Background: Nasopharyngeal carcinoma (NPC) is an Epstein–Barr virus-associated epithelial malignancy with a strikingly uneven geography concentrated in Southeast Asia and southern China. Its region-specific burden, temporal dynamics and attributable risk factors have not been synthesised in a dedicated spatiotemporal ecological analysis.

Objective: To characterise NPC burden, trends and attributable risks across Southeast Asia.

Methods: We conducted an ecological analysis of Global Burden of Disease (GBD) estimates. Age-standardised incidence (ASIR), mortality (ASMR) and disability-adjusted life-year (DALY) rates for the GBD Southeast Asia region (1990–2021, GBD 2021) and constituent ASEAN countries (to 2023, GBD 2023) were compiled; temporal trends were summarised by the estimated annual percentage change (EAPC); attributable fractions for tobacco, alcohol and occupational carcinogens were obtained from GBD comparative risk assessment; and age-standardised rates were projected toward 2050.

Results: In 2021 the Southeast Asia region recorded the highest NPC mortality of any world region (ASMR 1.60 per 100,000). Age-standardised rates declined (EAPC: incidence −0.39, mortality −0.76, DALYs −0.84% per year), yet absolute incident cases more than doubled (6,209 to 13,661; +120%). National ASIR ranged from 1.3 (Cambodia) to 14.2 (Singapore); Indonesia carried the greatest absolute burden (5,163 cases; 4,306 deaths). Incidence rose in Indonesia (EAPC +0.8), Laos (+0.7) and Viet Nam (+0.6). Alcohol-attributable burden increased most steeply (Southeast Asia EAPC +2.27), against declining tobacco- and occupational-attributable rates.

Conclusion: Southeast Asia bears the world's heaviest NPC mortality; falling age-standardised rates mask a rising absolute burden and a growing alcohol-attributable component, underscoring the need for Epstein–Barr virus-informed early detection and region-tailored prevention.

Cross-Cohort Transcriptomic Analysis Identifies an ECM–CAF Stromal Program but Does Not Validate a Seven-Gene Prognostic Score in Head and Neck Squamous Cell Carcinoma

Reisha Notonegoro — 2026-07-24

Background: Head and neck squamous cell carcinoma (HNSCC) is biologically heterogeneous, and many public-data gene signatures lack cross-platform replication and unbiased evaluation.

Objective: We sought reproducible tumor–normal expression programs and tested the transportability of a derived seven-gene score.

Methods: TCGA-HNSC RNA-sequencing defined differentially expressed genes (DEGs) between 520 tumors and 44 normal tissues using TMM normalization and voom–limma, with paired sensitivity analysis. Concordant genes were replicated in 22 GSE6631 matched pairs and analyzed for GO and KEGG enrichment. A seven-gene overall-survival score was developed in event-stratified TCGA training data (n=361), evaluated in held-out TCGA (n=156), repeated nested resampling, and examined in GSE65858 (n=253). ESTIMATE and marker scores characterized tumor-microenvironment features.

Results: Among 5,657 TCGA and 168 GSE6631 DEGs, 151 replicated. Upregulated genes were enriched for extracellular-matrix organization, ECM–receptor interaction, integrin signaling, focal adhesion, and PI3K–Akt signaling. The score was associated with survival in training (HR per SD=1.68; C-index=0.642) but not held-out TCGA (HR=1.02; C-index=0.546) or unadjusted GSE65858 (HR=1.15; C-index=0.548). Median nested C-index was 0.564. HPV adjustment attenuated the GSE65858 association. The score correlated with CAF/fibroblast (ρ=0.269) and stromal scores (ρ=0.228).

Conclusion: Replicated expression changes support an ECM–CAF program, but the seven-gene score did not generalize and is not a validated prognostic model.

Genetically Proxied Circulating C-Reactive Protein and Selected Cytokines in Relation to Register-Defined Sensorineural Hearing Loss: A Two-Sample Mendelian Randomization Study

Rizky Ayu — 2026-07-24

Background: Circulating inflammatory biomarkers are associated with sensorineural hearing loss (SNHL), but observational studies cannot establish causality.

Objective: To evaluate whether genetically proxied C-reactive protein (CRP) and eight cytokines are associated with SNHL.

Methods: We used European-ancestry GWASs for CRP (N = 575,531) and eight cytokines (maximum N = 74,783), with FinnGen R13 outcomes of 48,388 SNHL cases and 432,132 controls; sudden idiopathic hearing loss (4,082 cases) was secondary. Variants were harmonized and pruned using 1000 Genomes Finnish linkage disequilibrium (r² < 0.001 within 10 Mb). Random-effects inverse-variance weighting or a Wald ratio was primary. Sensitivity analyses included MR-Egger, weighted median and mode, MR-RAPS, RadialMR, Steiger directionality, cis-only estimates, source-assay filters, and false-discovery-rate correction.

Results: Of 301 unique exposure rsIDs, 279 were retrieved and 276 exposure rows passed harmonization. Finnish LD pruning left 238 CRP instruments. CRP was compatible with the null (OR per unit increase in ln[CRP mg/L], 1.005; 95% CI, 0.948–1.065; p = 0.868), consistent with weighted median, MR-Egger, weighted mode, and MR-RAPS estimates. No cytokine survived FDR correction (all q ≥ 0.393), source-assay filtering yielded no supported association, and secondary-outcome estimates were null. Steiger analyses favored the exposure-to-outcome direction.

Conclusion: Results support no material effect of lifelong genetically proxied circulating CRP on register-defined SNHL. Cytokine evidence remains less definitive because instrument sets were small, predominantly trans acting, heterogeneous, and assay sensitive. The findings neither exclude acute or cochlea-specific inflammation nor evaluate corticosteroid effectiveness. Independent replication and cis-pQTL colocalization are required before therapeutic inference.