The COVID-19 pandemic presented unique challenges to the delivery of healthcare for patients with allergic rhinitis (AR) following its disruption and impact on the healthcare system with profound implications. Reliance on self-care for AR symptom management was substantial during the pandemic with many patients encouraged to only seek in-person medical care when necessary. The advantage of digital technology becomes apparent when patients and healthcare providers had to change and adapt their method of interaction from the regular physical face-to-face consultation to telehealth and mobile health in the provision of care. Despite the pandemic and the ever-evolving post pandemic situation, optimal management of AR remains paramount for both patients and healthcare professionals. A reshaping of the delivery of care is essential to accomplish this goal. In this paper, we present what we have learned about AR management during the COVID-19 pandemic, the role of digital technology in revolutionizing AR healthcare, screening assessment in the identification and differentiation of common upper respiratory conditions, and a framework to facilitate the management of AR in primary care.

Background: Olfactory neuroblastoma (ON) is a rare malignant tumor originating from the nasal cavity and/or skull base. Case presentation: A 53-year-old female complained of a runny nose mixed with blood on the left nasal cavity since 1 year ago. Histopathology result showed malignancy and immunohistochemistry showed ON supported by CT-Scan result. The patient underwent endoscopic endonasal approach resection with anterior septectomy followed by debulking with cautery and cutting instruments. The patient received 35 times of radiotherapy combined with 6 times chemotherapy subsequently. Discussion: Firstly, reported successful management of ON in Indonesia. Conclusion: An ON case of an Indonesian female was successfully resected without complication through a join operation of endoscopic endonasal approach four-hand technique with a neurosurgeon.

Background: Surgery on bilateral choanal atresia surgery is challenging and this case is rare in adults. In addition, stenosis issue postoperatively is commonly seen. Case presentation: Transnasal endoscopic neochoanal technique was performed on a 27 years old female with the detailed surgical procedure was described. Neither stent nor nasal tamponade was applied. Ten months follow-up revealed a patent-wide neochonae. Discussion: Transnasal endoscopic neochoanal technique without stent and nasal tamponade can be considered the procedure of choice in the management of CA cases. Conclusions: Transnasal endoscopic neochoanal technique is considered an effective surgical procedure on bilateral choanal atresia. Highlights:

Background: Allergic fungal rhinosinusitis (AFRS) is a rare case. Case presentation: A 63-year-old-man presented right nasal congestion one year ago. There was a polyp in the right nasal cavity supported CTScan showed a solid mass with central hyperattenuating of ±8.4 × 2.4 × 4.4 cm. Total IgE value was 1,227 IU/ml, while Aspergillus specific IgE and Mucorous specific IgE using the micro-Elisa technique were negative or less than 0.35 IU/ml. The skin prick test was positive on exposure to house dust, cotton, chicken meat, and cow's milk. Mucosal polypoid and allergic mucin were found during functional endoscopic sinus surgery (FESS). Histopathology showed inflammatory cells of eosinophils. Discussion: These results lead to a diagnosis of AFRS according to the Bent and Kuhn criteria. The highest incidence rate is in adolescents and young adults but it occurs in the elderly. So, some of the signs and symptoms of AFRS in adolescents and young adults do not appear. Conclusion: AFRS can only be diagnosed during FESS when mucins are found, this case appear in the elderly to be very interesting.

Link of Video https://youtu.be/wEp6PioGVqw Background: Hot saline irrigation and tranexamic acid are techniques used to control bleeding during functional endoscopic sinus surgery (FESS). Hot saline irrigation and tranexamic acid can help control bleeding originating from microvascular located in the nasal cavity and paranasal sinuses. This study aims to compare the efficacy of these two techniques on Boezaart score, intraoperative blood loss, and duration of surgery in functional endoscopic sinus surgery. Methods: This study is an intervention meta-analysis, the research formulated based on the population, intervention, comparison, outcome, and study design (PICOS). Articles were searched from five databases, including PubMed Central and publisher websites, Cochrane Library, ResearchGate, SAGE Journals, and Web of Science. There were no publication year or publication status restrictions on the selected research articles, and the date of the last search was up to February 2023. The efficacy of hot saline irrigation as a bleeding control method compared to tranexamic acid was assessed based on Boezaart surgical field score, intraoperative bleeding, and duration of surgery in functional endoscopic sinus surgery (FESS). Results: A total of 532 research articles were identified, and fifteen articles that met the inclusion and exclusion criteria were selected. Hot saline irrigation p-value p=0.0002 and for tranexamic acid p=<0.00001 based on Boezaart score. Hot saline irrigation p= 0.0001 and tranexamic acid had a p= 0.0002 based on the Intraoperative blood loss, but the standardized mean difference in the hot saline irrigation group was smaller compared to the tranexamic acid topical group. Hot saline irrigation p=0.06 and tranexamic acid p=0.13 for duration of surgery. Conclusion: This meta-analysis showed that the administration of tranexamic acid or hot saline irrigation could significantly reduce duration of surgery, intraoperative blood loss and improved surgical feld quality compared with room temperature saline irrigation. There is no statistically significant difference between tranexamic acid topical and hot saline irrigation.

Introduction: Hypothyroidism causes damage to the sensory morphology of the outer hair cell (OHC) and reduced microtubules in the supporting cells that can affect cochlear maturation, causing hearing loss. This study aimed to explain the relationship between thyroid-stimulating hormone (TSH) and free thyroxine levels with impaired OHC function in pediatric hypothyroid patients. Methods: This study was an observational analytic study with a cross-sectional design. This study was conducted in the Endocrinology Division of the Pediatric Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Otoacoustic Emission (OAE) examination was carried out in the Neurotology Division of the otolaryngology-head and neck surgery (ORL-HNS), for 2 months from August to September 2024. The sample size was taken consecutively, and as many as 30 patients met the inclusion and exclusion criteria. Baseline data, including gender, age at diagnosis, diagnosis of hypothyroidism, and duration of hypothyroid therapy, were obtained from medical records. The study subjects were anamnesis and underwent basic physical examination of ORL-HNS, then underwent tympanometry and OAE examination. The statistical test in this study used the Kruskal–Wallis test with a significance level of 0.05. Results: The 30 pediatric hypothyroid patients who had met the inclusion and exclusion criteria. Analysis of the relationship between FT4 levels and OHC function disorders in OAE frequency 2000 Hz obtained P = 0.029 (P > 0.05). The relationship between TSH levels and disorders at all OAE frequencies obtained (P > 0.05). Conclusion: This study concludes a significant relationship between FT4 levels and OHC function disorders in OAE frequency 2000 Hz.