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 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

Risk factors of sensory hearing loss in nasopharyngeal carcinoma patients obtaining conventional radiotherapy

Previous studies proven that cochlear hair cells’ death plays an important role in sensorineural hearing loss due to radiation exposure. Other studies compared the differences between the impact of conventional radiotherapy (CRT) and intensity modulated radiation therapy (IMRT) on hearing loss in patients with nasopharyngeal carcinoma. Although, few differences found in some clinical manifestation, however no statistical analysis had been carried out. The aim of study was to evaluate the risk of sensory hearing loss in nasopharyngeal carcinoma patients who received CRT compared to IMRT.  A case control study was performed on nasopharyngeal carcinoma patients who received radiotherapy at Dr. Sardjito General Hospital, Yogyakarta. The result of DPOAE between NPC patients who received CRT and IMRT was compared in this study. Statistical analysis was performed using chi square test and multivariate analysis. The result showed that patients who received CRT significantly altered the risk for sensory hearing loss in the contralateral ear as much as 11.2 times according to the multivariate analysis (CI 95%: 2.2 – 56.6; p=0.004). In conclusion, the risk of sensory hearing loss in patients with nasopharyngeal carcinoma who received CRT is a greater compared to IMRT

The influence of tympanic membrane perforation site on the hearing level of conductive hearing loss in chronic suppurative otitis media

Chronic suppurative otitis media (CSOM) is an infection of the middle ear cavity both partially and totally. It is characterized by ear discharge through a tympanic membrane perforation for over a period of 2 to 6 weeks. Hearing loss is the most common complication of CSOM. One of the degrees of hearing loss in tympanic membrane perforation is depending on the site of perforation, but this premise is still debatable because of pros and contras by some researchers. This study aimed to assess the degree of hearing loss in relation to the site of tympanic membrane perforation. A cross-sectional prospective study design was performed involving 43 patients of safe type CSOM who came to the Department of Otolaryngology Head and Neck Surgery from the period January 2016 to November 2018. All subjects were divided into 4 groups based on the site of perforation. There was a perforation in the posteroinferior, the posterosuperior, the anteroinferior, and the anterosuperior. A statistical analysis using Anova along with multivariate analysis was conducted. Our result showed that the most common site of tympanic membrane perforation was at the anteroinferior (30 samples, 59.8%). The highest hearing threshold was seen at posteroinferior with a mean hearing level of 37.7±2.0 dB, anteroinferior with a mean hearing level of 31.7±0.7 dB, anterosuperior with a mean hearing level 30.7±1.4 dB, and posterosuperior mean hearing level 28.9±1.5 dB. The difference was found significant with p=0.004. Posteroinferior tympanic membrane perforation had a higher number of hearing loss compared to the other sites. In conclusion, the tympanic membrane perforation site has an important role in the hearing level of conductive hearing loss in CSOM