Sriwijaya Journal of Otorhinolaryngology

The Impact of the Middle Ear Microbiota on Otitis Media Outcomes: A Meta-Analysis of Longitudinal Studies

Isramilda, Sukma Sahreny — Thu, 31 Oct 2024 00:00:00 +0000

Introduction: Otitis media (OM), a prevalent middle ear inflammation, often involves microbial colonization. The composition of the middle ear microbiota may influence OM outcomes, including recurrence, persistence, and treatment response. This meta-analysis investigated the relationship between the middle ear microbiota and OM outcomes.

Methods: Longitudinal studies published from 2018 to 2024 that explored the middle ear microbiota and OM outcomes were systematically searched in PubMed, Embase, and Web of Science. Data on study design, participant characteristics, microbiota analysis, and OM outcomes were extracted. The risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects model was used to pool effect estimates.

Results: A total of 15 studies (n = 2,540 participants) met the inclusion criteria. The middle ear microbiota diversity was significantly lower in children with recurrent OM compared to those without (standardized mean difference [SMD] = -0.45, 95% confidence interval [CI] -0.62 to -0.28, p < 0.001). The presence of specific pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, was associated with an increased risk of OM recurrence (odds ratio [OR] 1.75, 95% CI 1.32 to 2.31, p < 0.001). Additionally, microbial dysbiosis was associated with delayed resolution of OM and increased antibiotic treatment failure.

Conclusion: The middle ear microbiota composition significantly impacts OM outcomes. Reduced diversity and specific pathogens are associated with increased OM recurrence. These findings highlight the potential for microbiota-targeted interventions in OM management.

A Simplified Scoring System for Diagnosing Allergic Rhinitis in Indonesian Primary Care Settings: A Cross-Sectional Study Comparing Accuracy to Specialist Diagnosis

Febria Suryani, Irna Nettles, Aisyah Andina Rasyid, Fifia Ardinanti — Thu, 13 Mar 2025 08:35:12 +0000

Introduction: Allergic rhinitis (AR) is a prevalent condition in Indonesia, yet often underdiagnosed and undertreated in primary care settings. Access to specialist otorhinolaryngologists is limited, particularly in rural areas. A simplified, accurate diagnostic tool for primary care physicians (PCPs) could significantly improve early diagnosis and management. This study aimed to develop and validate a simplified scoring system for AR diagnosis in Indonesian primary care, comparing its accuracy to the gold standard of specialist diagnosis.

Methods: A cross-sectional study was conducted in five major Indonesian cities (Medan, Palembang, Jakarta, Surabaya, and Makassar) across various primary care clinics. Patients presenting with nasal symptoms suggestive of AR were recruited. Each patient was assessed by a PCP using the newly developed "Indonesian Allergic Rhinitis Score" (IARS) and subsequently by a board-certified otorhinolaryngologist. The IARS included key symptoms and history elements weighted based on existing literature and expert consensus. The otorhinolaryngologist's diagnosis, based on a comprehensive history, physical examination (including nasal endoscopy when indicated), and allergy testing (skin prick test or specific IgE), served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and¹ area under the receiver operating characteristic curve (AUC)² were calculated to evaluate the IARS's diagnostic accuracy.

Results: A total of 1500 patients were included in the study (300 from each city). The mean age was 32.4 years (SD = 10.2), with a slight female predominance (58%). The IARS demonstrated a sensitivity of 85.3% (95% CI: 83.1-87.3%), specificity of 79.6% (95% CI: 76.8-82.2%), PPV of 82.5% (95% CI: 80.2-84.6%), and NPV of 83.0% (95% CI: 80.3-85.4%) for diagnosing AR. The AUC was 0.89 (95% CI: 0.87-0.91), indicating good diagnostic accuracy. The most common symptoms reported were nasal congestion (92%), rhinorrhea (88%), sneezing (85%), and itchy nose (79%).

Conclusion: The IARS provides a simple, accurate, and readily implementable tool for diagnosing AR in Indonesian primary care settings. Its high sensitivity and acceptable specificity suggest it can effectively identify individuals who require further evaluation and management for AR, improving access to care and potentially reducing the burden of undiagnosed allergic disease.

Development and Validation of a Novel Clinical Scoring System (INDO-TOS) for Predicting Post-Operative Outcomes in Indonesian Patients Undergoing Tonsillectomy/Adenoidectomy

Oliva Azalia Putri, Moon Kaeun, Aprilia Sari — Fri, 14 Mar 2025 03:24:56 +0000

Introduction: Tonsillectomy and adenoidectomy (T/A) are among the most common surgical procedures performed in Indonesia. While generally safe, post-operative complications can occur, impacting patient recovery and healthcare costs. Existing risk prediction models are often developed in Western populations and may not be directly applicable to the Indonesian context due to differences in genetics, healthcare access, and environmental factors. This study aimed to develop and validate a novel, culturally-tailored clinical scoring system (INDO-TOS) to predict post-operative outcomes in Indonesian children undergoing T/A.

Methods: A multi-center, prospective observational study was conducted across seven major cities in Indonesia (Medan, Palembang, Jakarta, Surabaya, Bali, Makassar, and Samarinda). Patients aged 2-18 years undergoing T/A for any indication were enrolled. Pre-operative data, including demographics, medical history, physical examination findings, and laboratory results, were collected. Potential risk factors were identified based on a literature review and expert consensus. The primary outcome was the occurrence of any post-operative complication within 30 days, including hemorrhage, infection, respiratory distress, dehydration, and prolonged pain. A logistic regression model was used to identify independent predictors of complications in a derivation cohort. A scoring system was developed based on the regression coefficients. The INDO-TOS was then validated in a separate, independent validation cohort. Model performance was assessed using receiver operating characteristic (ROC) curve analysis, calibration plots, and the Hosmer-Lemeshow goodness-of-fit test.

Results: A total of 1500 patients were enrolled (Derivation cohort: n=1000; Validation cohort: n=500). The overall complication rate was 12.5%. Multivariate analysis identified age <5 years (Odds Ratio [OR] = 1.8, 95% Confidence Interval [CI] 1.2-2.7), pre-existing comorbidities (OR = 2.5, 95% CI 1.6-3.9), history of recurrent acute tonsillitis (≥4 episodes/year) (OR = 1.9, 95% CI 1.3-2.8), high Mallampati score (III/IV) (OR = 2.1, 95% CI 1.4-3.2), and prolonged operative time (>60 minutes) (OR = 1.7, 95% CI 1.1-2.6) as significant independent predictors of post-operative complications. The INDO-TOS, incorporating these factors, demonstrated good discrimination in the derivation cohort (Area Under the Curve [AUC] = 0.78, 95% CI 0.74-0.82) and validation cohort (AUC = 0.75, 95% CI 0.70-0.80). Calibration was satisfactory in both cohorts.

Conclusion: The INDO-TOS is a novel, validated clinical scoring system that effectively predicts post-operative complications in Indonesian children undergoing T/A. It utilizes readily available clinical information and can be easily implemented in diverse healthcare settings across Indonesia. The INDO-TOS can aid clinicians in identifying high-risk patients, optimizing pre-operative care, and potentially reducing post-operative morbidity.

Development and Validation of the Indonesian Voice Handicap Index Adapted for Javanese and Sundanese Speakers (I-VHI-JS)

Hasrita Soleiman, Andhika Kurnianta Kusuma, Eduardo Michael Perez — Fri, 14 Mar 2025 08:28:56 +0000

Introduction: Voice disorders significantly impact quality of life. The Voice Handicap Index (VHI) is a widely used patient-reported outcome measure, but its applicability is limited by linguistic and cultural factors. Indonesia, with its diverse languages, requires culturally adapted versions. This study aimed to develop and validate the Indonesian Voice Handicap Index adapted for Javanese and Sundanese speakers (I-VHI-JS).

Methods: The original English VHI was translated into Indonesian, Javanese, and Sundanese using a rigorous forward-backward translation process. A cross-sectional study was conducted involving three groups: (1) individuals with voice disorders (n=150; Javanese speakers = 75, Sundanese speakers = 75), (2) age- and gender-matched vocally healthy controls (n=150; Javanese speakers = 75, Sundanese speakers = 75), and (3) a test-retest reliability group (n=50; Javanese speakers = 25, Sundanese speakers = 25) from the voice disorder group. Participants completed the appropriate I-VHI-JS version. Otolaryngological examination and acoustic voice analysis (jitter, shimmer, noise-to-harmonics ratio) were performed. Internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficient - ICC), construct validity (known-groups comparison), concurrent validity (correlation with acoustic parameters), and discriminant validity (receiver operating characteristic - ROC curve analysis) were assessed.

Results: The I-VHI-JS demonstrated excellent internal consistency (Cronbach's alpha > 0.90 for all versions) and test-retest reliability (ICC > 0.85 for all versions). Significant differences in I-VHI-JS scores were found between the voice disorder and control groups (p < 0.001) for all language versions, confirming construct validity. Moderate correlations were observed between I-VHI-JS scores and some acoustic parameters (e.g., jitter, r = 0.45, p < 0.01; shimmer, r = 0.40, p < 0.01). ROC curve analysis showed excellent discriminant ability (area under the curve - AUC > 0.80 for all versions).

Conclusion: The I-VHI-JS is a reliable and valid instrument for assessing voice-related handicaps in Indonesian, Javanese, and Sundanese speakers. It can be used in clinical practice and research to evaluate the impact of voice disorders and monitor treatment outcomes.

The Indonesian Otitis Media Severity Score (IOMSS): A Prospective Cohort Study Evaluating its Prognostic Value in Pediatric Patients

Fri, 21 Mar 2025 06:57:32 +0000

Introduction: Acute otitis media (AOM) and otitis media with effusion (OME) are common pediatric illnesses with varying clinical courses. A reliable prognostic tool to predict outcomes and guide treatment decisions in the Indonesian context is lacking. This study aimed to evaluate the prognostic value of the Indonesian Otitis Media Severity Score (IOMSS) in predicting treatment response and complications in pediatric patients with AOM and OME.

Methods: A prospective cohort study was conducted at five tertiary care hospitals in Indonesia (Medan, Jakarta, Samarinda, Makassar, and Denpasar) from January 2020 to December 2022. Children aged 6 months to 12 years diagnosed with AOM or OME were enrolled. The IOMSS, which incorporates clinical findings (otalgia, fever, otorrhea, tympanic membrane appearance, and hearing loss), was calculated at baseline. Patients were followed up for 6 months to assess treatment response (resolution of symptoms, tympanic membrane healing), and the development of complications (e.g., recurrent AOM, chronic suppurative otitis media (CSOM), mastoiditis, hearing loss). Statistical analyses, including Cox proportional hazards regression and receiver operating characteristic (ROC) curve analysis, were performed to evaluate the association between IOMSS and clinical outcomes.

Results: A total of 850 children (mean age 5.2 ± 2.8 years, 55% male) were included. Higher IOMSS scores at baseline were significantly associated with a lower probability of complete resolution of AOM/OME at 6 months (hazard ratio [HR] 0.85 per 1-point increase in IOMSS, 95% CI 0.80-0.90, p<0.001). The IOMSS also predicted the development of complications, with a higher score significantly increasing the risk of recurrent AOM (HR 1.20, 95% CI 1.10-1.31, p<0.001), CSOM (HR 1.35, 95% CI 1.18-1.54, p<0.001), and persistent hearing loss (HR 1.28, 95% CI 1.12-1.46, p<0.001). ROC curve analysis demonstrated good discriminatory ability of the IOMSS for predicting complications (AUC = 0.82, 95% CI 0.78-0.86).

Conclusion: The IOMSS is a valuable prognostic tool for predicting treatment outcomes and the risk of complications in Indonesian children with AOM and OME. Its use can aid clinicians in identifying high-risk patients who may benefit from more aggressive management and closer follow-up.