Search

Introduction: Congenital rubella syndrome (CRS) is associated with severe birth defects, that lead to disability in later life. Hence, early detection and intervention are needed to prevent permanent disability and mortality in children with CRS. We evaluated the time to diagnosis or correction intervention related to survival rate using survival analysis., Methodology: A retrospective cohort study was conducted to evaluate the follow-up of CRS-confirmed cases from 2011-2018 at a national referral hospital in Jakarta, Indonesia. Parents of eligible children who registered in the national CRS registry as laboratory-confirmed CRS cases were contacted through phone calls or home visits and interviewed about the current situation of their child's health. We also obtained clinical data from the medical records., Results: Fifty children, age 4 to 14 years, identified with laboratory-confirmed CRS were included in this study. Half (54%) of these children were female. All were born from mothers with no previous rubella vaccination history. Ophthalmic abnormalities such as congenital cataracts (88%) were the most common birth defect. Multiple congenital abnormalities including congenital heart disease, ocular abnormalities, and auditory defects were identified in 52% of the children. Based on Kaplan-Meier analysis, 50% of children were diagnosed at four months. Ophthalmic corrections such as cataract surgery were performed earlier than heart or auditory correction, with 50% of children undergoing eye correction one month after the diagnosis., Conclusions: There is a vital need to implement CRS surveillance in Indonesia to know the burden of CRS and reinforce the preventive actions, including vaccination against rubella., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2024 Nina D Putri, Mulya R Karyanti, Adhi Teguh P Iskandar, Najib Advani, Setyo Handryastuti, Irawan Mangunatmadja, Tri J Airlangga, Shindy C Aprianti, Meka M Rahman, Prillye D Octaviantie, Nabila M Salma, Hartono Gunardi, Rita S Sitorus, Hindra I Satari, Ari Prayitno.)

Introduction: This prospective cohort study aims to investigate the hearing dynamics and the changes in the central auditory pathways in infants with congenital cytomegalovirus (cCMV) infection., Materials and Methods: cCMV-infected neonates aged ≤3 weeks old were recruited and underwent clinical and laboratory tests to detect viremia and symptomatic infection, hearing examinations at three and six months of age, and radiological imaging of brain auditory pathways using diffusion tensor imaging., Results: From 26 eligible infants (52 ears), we detected symptomatic infection in nine (34.6%), viremia in 14 (14/25; 56.0%) and sensorineural hearing loss (SNHL) in 14 infants (53.8%). We observed 40 ears (76.9%) with unstable hearing thresholds, 17 (42.5%) of which fluctuated. Hearing fluctuation and progressivity were more common in symptomatic infection (66.7% vs. 14.7%, p<0.001; and 38.9% vs. 2.9%, p=0.002; respectively). A substantial proportion of ears had reduced fractional anisotropy (FA) in the medial geniculate body (59.1%), superior olivary nucleus (45.5%), trapezoid body (40.9%), auditory radiation (36.4%) and inferior colliculus (31.8%). Symptomatic infection was associated with an increased FA in the medial geniculate body (mean difference, MD: 0.12; 95% Confidence Intervals, 95%CI: 0.03, 0.22) and viremia in the inferior colliculus (MD: 0.09; 95%CI: 0.02, 0.16). An FA in the inferior colliculus of ≥0.404 had a sensitivity and specificity of 68.8% and 83.3% in predicting viremia (area under the curve 0.823; 95%CI: 0.633, 1.000, p=0.022)., Conclusion: SNHL along with its fluctuation and progression are common in cCMV-infected infants. cCMV infection may induce structural changes in the central auditory pathway.

Introduction: The role of immunodeficiency in the development of chronic suppurative otitis media (CSOM), especially in paediatric populations, have yet to be fully elucidated. The purposesof this study is to investigate the association between immunocompromised status and CSOM among paediatric population in a tertiary hospital in Indonesia., Materials and Methods: A cross-sectional study was performed by retrieving medical records of paediatric patients, with and without CSOM (age 0-18 years), visiting otorhinolaryngology (ENT-HNS) outpatient clinic in a tertiary hospital in Indonesia (2018-2020). We collected data on comorbidities causing immunosuppression such as HIV status, tuberculosis, and cancer., Results: Among the 1018 included patients (50 immunocompromised children), HIV infection was the most common cause of immunodeficiency in the CSOM group (24 patients, 60%), and cancer in the non-CSOM group (10 patients, 100%). We found a significant association between immunocompromised hosts and CSOM (odds ratio 19.5 [95% confidence interval: 9.5-39.9], p<0.001)., Conclusion: Immunocompromised children with HIV, tuberculosis, or cancer may be more vulnerable to CSOM. Further research is required to explore the association between other immunocompromised conditions and CSOM in paediatric populations.

Background: Electrode placement plays an important role in Brain Evoked Response Audiometry (BERA) recording. It is important to measure wave latency and amplitude accurately in determining hearing level. Young children usually have limited mastoid area, and in certain condition, it is often difficult to place the vibrator and electrodes coinciding on the mastoid. Therefore, earlobe electrode is considered as an alternative placement., Purpose: The aim was to correlate the wave V latency and amplitude on the mastoid and earlobe electrodes in BERA recording., Materials and Methods: Our study was a cross-sectional study conducted at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, between November 2020 and November 2021. Our subjects were infants and young children with normal hearing who underwent BERA examination. Electrodes were used to record BERA, and the electrodes were placed over the earlobes and mastoid area. Clicks at 20, 40, and 60 dB and tone burst at 500 Hz were used as stimuli for both ears., Result: Fifty subjects (100 ears) were included in the study. Our statistical analysis showed that there was a strong correlation between wave V latencies from mastoid and earlobe electrode. Moderate correlation was also found in wave V amplitude between both electrodes., Conclusion: Our study has demonstrated that placing electrodes on the earlobe area is reliable, particularly in certain condition when placing the electrodes on the mastoid area is not possible.

Hearing improvement represents one of the may valuable outcomes in microtia and aural atresia reconstruction surgery. Most patients with poor development in their hearing function have had a severe microtia. Conventional methods to improve hearing function are bone conduction and bone anchored hearing aids. Cartilage conduction hearing aids (CCHA) represents a new amplification method. This study assessed the outcomes and evaluated the impact and its safety in the patients with microtia and aural atresia whose hearing dysfunction did not improve after surgery for ear reconstruction in our hospital. Hearing functions were evaluated with pure tone audiometry or sound field testing by behavioral audiometry and speech audiometry before and after CCHA fitting. As a result, there was a significant difference between unaided and aided thresholds ( p < 0.001). Speech recognition threshold and speech discrimination level also significantly improved with CCHA. The average functional gains of 14 ears were 26.9 ± 2.3 dB. Almost all parents of the patients reported satisfaction with the performance of CCHA, and daily communication in children with hearing loss also became better than usual.