The effect of appropriate antibiotic use on the length of hospital stay in deep neck abscess (DNA) patients

Deep neck abscess (DNA) is an emergency in the otorhinolaryngology head and neck surgery field due to the formation of abscesses in the potential space between the deep neck fasciae. It is typically caused by the expansion of infection from various sources, including the teeth, mouth, throat, paranasal sinuses, middle ear, and neck. The increase of DNA cases needs for improvement of patient management especially when the patients have comorbidities which lead to an extended length of treatment. The study aimed to evaluate the appropriateness of empirical antibiotics given according to culture results and any comorbid factors that affect the length of hospital stay (LOHS). It was case-control observational study involving 44 cases of DNA patients who treated at Dr. Sardjito General Hospital Yogyakarta in the period of January 2018 to December 2020. The patients were divided into two groups with 22 patients in each group. The first group was the DNA patients with > 7 d LOHS and the second one was those with ≤ 7 d.  No significantly relationship was observed between variables evaluated included the appropriate antibiotic use  (p=0.546). However, dental caries (DC) was significantly related with the LOHS (p=0.015). In conclusion, there is no relationship between the appropriate antibiotic use and the LOHS. However, the DC is risk factor that influence the LOHS in patients with DNA

Evaluation of clinical pathway implementation and clinical practice guidelines in the management of deep neck abscess (DNA) at Dr. Sardjito, General Hospital Yogyakarta, Indonesia

Deep neck abscess (DNA) is an infectious condition categorized as anemergency case with high mortality and morbidity. The incidence decreasesover time due to extensive use of antibiotics, operative intervention, andimproved awareness of dental hygiene. Management of DNA must be carriedout appropriately and efficiently to prevent complications that may occur,such as jugular vein thrombosis, pericarditis, and pneumonia. Patients withDNA are often categorized as high-cost patients, because of the long durationof hospitalization, the need for special examinations, and complicatedmanagement. Clinical practice guidelines (CPG) and clinical pathways (CP)are a standard created for management, quality, and cost control. The studyaimed to evaluate the implementation of the CPG and CP in DNA patients atDr. Sardjito General Hospital, Yogyakarta. The study used medical recordsdata of DNA patients from January 2018 to December 2020 who met theinclusion and exclusion criteria. A total of 55 subjects were obtained, withcompliance to complete CPG filling of 98.3% and CP filling of 96.2%. There was100% completion in CPG filling categorized as good compliance, whilst thenumber of good compliances for CP was 92.7%. In conclusion, the diagnosisand management of DNA patients at Dr. Sardjito General Hospital has goodcompliance with CPG and CP available

The difference in biofilms formations on duration less than 90 d and more than 90 d of tracheotomy cannula usage

Currently, prevention of local and systemic infections caused by implantable devices is increasingly improved. Tracheostomy is a surgical action followed by an implantable device called tracheotomy cannula into a trachea to maintain upper airway patenting. The incidence of biofilm-related complications and infections is associated with the length of duration of the attached tracheostomy. The formation and spread of biofilms from distal cannula increase the infection incidence in stoma, tracheitis, and even peripheral pneumonia. However, until now there has been no consensus on when the tracheostomy replacement supposedly conducted. Some manufacturers recommend that cannula replacement supposedly conducted within 30 d, but the data are not yet in agreement and need further study. This study aimed to determine the difference in biofilms formations in a duration of less than 90 d and more than 90 d of tracheotomy cannula usage. It was a cross-sectional study involving patients who underwent a tracheostomy at the Department of Otorhinolaryngology of Dr. Sardjito General Hospital, Yogyakarta. Fisher exact test was applied to analyze the biofilms formations of the two different duration of tracheostomy cannula usage. A total of 20 patients were involved in this study.  Durations of more than 90 d had more biofilms formations compared to less than 90 d, although it was not significantly different (p>0.05). However, the PR value of 6 indicated that subjects who have attached cannula more than 90 d clinically have 6 times higher risk for developing biofilms formations than those less than 90. In conclusion, there is no significant differences in biofilms formations between the less than 90 d and more than 90 d of tracheostomy cannula usage. However, clinically subjects with longer duration of tracheostomy cannula usage have higher risk for developing biofilms formations

Prevalence Ratio of Otitis Media with Effusion in Laryngopharyngeal Reflux

Background. Otitis media with effusion (OME) in adults is less prevalent than in the pediatric population but still causes considerable morbidity. It has been suggested that laryngopharyngeal reflux (LPR) may have a role in the aetiology of adult OME. Reflux advances to the laryngopharynx and, subsequently, to other regions of the head and neck such as oral cavity, nasopharynx, nasal cavity, paranasal sinuses, and even middle ear with clinical manifestations being asthma, sinusitis, and otitis media. Objective. To determine the prevalence ratio of otitis media with effusion in laryngopharyngeal reflux. Methods. Observational analytic with cross sectional design. Result. 9 of 28 subjects experienced OME in LPR group, and 2 of 28 subjects in non-LPR group. Statistically there was significant difference between the two groups with p-value 0.02 and with 95% confidence interval range of 1.066-18.990. Conclusion. The prevalence ratio of otitis media with effusion in laryngopharyngeal reflux group is 4.5 times that in non-laryngopharyngeal reflux group

HUBUNGAN RINITIS ALERGI DENGAN PENURUNAN TEKANAN UDARA TELINGA TENGAH

Allergic rhinitis is a common case found in Ear Nose and Throat (ENT) practice, and can cause mild to severe complications. The prevalence of allergic rhinitis approximately 10-25% of population, which effects patient�s quality of life as well as health cost. ENT practitioner needs to know the possible complications that could happened from having allergic rhinitis. Prevention and management of allergic rhinitis are important to avoid complications. The aim of this study is to determine allergic rhinitis as a risk factor for decreased value on middle ear pressure. Study was commenced by doing tympanometri measurement to all patients in ENT outpatient unit of Dr. Sardjito Hospital, and dividing patients into rhinitis allergic group and non rhinitis allergic group. Skin prick test was carried out to all patients to determine the allergic status. Patients data were processed and analyzed with statistic measures to determine association between allergic rhinitis and decreased middle ear pressure. The study design was cross-sectional. Chi square and logistic regression are used in data statistical analysis. The result showed that from 40 allergic rhinitis patients, there were 33 patients (86,8 %) with decreased middle ear pressure and only 7 (16,7 %) allergic rhinitis patients without decreased middle ear pressure. Among 40 non allergic rhinitis patients, 35 patients (83,3 %) were not having decreased middle ear pressure, and only 5 patients (13,2 %) showed a decreased in middle ear pressure. Statistical analysis showed that there was a significant association between allergic rhinitis and decreased value in middle ear pressure (p<0,05). The prevalence ratio of allergic rhinitis to decreased middle ear pressure was 693:100 (87 %). Among allergic rhinitis patients, the major factor in decreasing middle ear pressure were the persistent moderate-severe allergic rhinitis, and persistent mild allergic rhinitis (p<0,05). Conclusion: Allergic rhinitis associated with decreased middle ear pressure