Otomycosis is an infection of the outer ear caused by fungus. This disease often makes sufferers desperate because of the long time required for treatment and also the high recurrence rate if not treated properly and correctly. This disease is mainly found in tropical countries such as Indonesia. In countries with 4 seasons, this disease is often found along with the end of summer. Therefore, this disease is also known by other names, Tropical Ear or Hot Weather Ear . This disease is also associated with the absence of cerumen which has an important function because it is antibacterial, antimycotic and also repels insects. 1 The main causes of otomycosis that are most commonly found are fungi of the Aspergillus species and Candida species. The most common cause of otomycosis found is Aspergillus niger. Some triggering factors for the onset of this disease include the absence of earwax, the habit of digging the ears with dirty objects, and continuous exposure to water, for example when swimming and shampooing. Systemic diseases such as diabetes mellitus and chronic suppurative otitis media (CSOM) also cause recurrent otomycosis. 2 The initial symptoms of otomycosis that are often encountered are discomfort in the ear, itching, discharge, pain and a feeling of fullness in the ear. On examination ear will found reddish on hole ear, there is white mass and swelling of the ear canal. Hearing loss and ringing in the ears can also occur due to blockage of the ear canal caused by swelling of the ear canal and accumulation of secretions or white debris. 3,4 Generally, otomycosis can be cured if treated thoroughly by avoiding triggers, cleaning the fungus in the ear and administering local or systemic antifungals. Topical antifungals are better than systemic antifungals in cases of recurrent otomycosis. The use of systemic antifungals is chosen if there is no response to topical therapy and a fungal infection is suspected elsewhere. 2 Side effects of using systemic antifungals must be considered. For treatment, several visits to the doctor are usually required who will clean the fungus in the ear and provide antifungal cream. The use of topical antifungals requires special attention considering that if applied alone, there can be a buildup of cream and will cause discomfort. Antifungal ear drops are a good choice but the availability of antifungal ear drops is limited and difficult to find on the market. However, the risk of recurrence of this disease is very high, if the triggering factors that cause infection are not removed. 3,4 Therefore, it is important to know the management of otomycosis and the choice of antifungal therapy .

Olfactory disorders are defined as the loss, reduction or distortion of the ability to smell when a person is sniffing (orthonasal smell) or eating (retronasal smell) or changes in the perception of odors. 1 Olfactory disorders smell can differentiated become disturbance smell in a way quantitative (changes in the sense of smell in assessing an odorant) and qualitative (changes in the quality of odorants without affecting the sense of smell. Quantitative olfactory disorders are categorized into hyposmia (decreased sense of smell) and anosmia (loss of sense of smell) while qualitative olfactory disorders are disorders of odor identification (dysosmia) which include parosmia (misperception of odors that actually exist and phantosmia (feeling the presence of an odor when in fact the odor is not there). In a more specific form of dysosmia, some patients interpret all odors as unpleasant odors (cacosmia). 1-3 Prevalence hyposmia And anosmia on population in a way general is 20% and 5% respectively.3 As many as 2.7 million people (1.4% of the population in the United States) have experienced smell problems that last more than three months. Number incident the increase sharp along with increase age, and about 40% of people over the age of 65 have olfactory disorders. In a 2013 study in Korea, the prevalence of olfactory disorders was 4.5%. 4 The rate of spontaneous recovery in post-traumatic olfactory disorders occurs in a much lower percentage of patients, possibly due to post-traumatic scarring in the lamina cribrosa area , accompanied by intracranial lesions. 4 Disturbance smell own etiology Which diverse, estimated reach around 200 reason. Anosmia own prevalence around 5% from population General and physiological aging have significant contributions to olfactory disorders. However, excluding age-related olfactory disorders, approximately two-thirds of the causes of hyposmia are due to sinonasal disease, infection, or post-traumatic stress disorder. 3-4 According to study previously disturbance smell can impact negative impact on health, work, or quality of life in the past 12 months. Olfactory training is a therapeutic management that is a long-term odorant smelling exercise. This method was first discovered by Thomas Hummel in 2009. 4 Olfactory disorders still have a fairly high prevalence and can affect the quality of life of sufferers, as well as the low level of olfactory recovery after trauma. So that a deep understanding is needed, especially regarding the diagnosis and appropriate management of olfactory disorders. Based on this, the following case will be discussed with post-traumatic olfactory disorders that previously did not improve for 4 months. This is so that it can provide a deep understanding and appropriate management can be given to this patient according to the underlying etiology. So that it can to fix quality life And prevent complications Which more heavy in this disorder can be avoided. 3-4

For the past century, vocal fold paralysis (VFP) has been defined as the absence of movement or paralysis, resulting in loss of neural input. Electrophysiological investigations have shown that VFP is actually a heterogeneous clinical condition and is perhaps best thought of as a continuum of neurogenic dysfunction, encompassing partial denervation, complete denervation, variable degrees and patterns of reinnervation. It should not be surprising that paresis or incomplete paralysis in which some gross vocal fold mobility is retained has been considered alongside paralysis as a clinical entity 1 . VFP is decrease movement or paralysis Which happen on vocal cords. This condition has the impact that deep into quality life of the sufferer and this becomes an important problem in the field of Ear, Nose and Throat. This condition is a manifestation of a disease that occurs in the cranial cavity, larynx, thorax, and mediastinum which causes paralysis of the vagus nerve and recurrent laryngeal nerve. Unilateral vocal fold paralysis (UVFP) and also paralysis plika vocalist bilateral (VFPB) can bother physiological function larynx, that is breathing, protection channel breath, And phonation. PPV can occur due to mechanical fixation processes or due to neurogenic disorders 2 . Research conducted by Anil et al. stated that UVFP was more common, namely 82% compared to VFPB, which was 18%, with the presentation of PPV on the left (52%) being greater than the right (48%). Group age Which most Lots experience PPV, that is between 51-60 year (24%) and 61-70 years old (19%) with male gender (60%) more than Woman (40%) with comparison 3:2. They found that in patients with UVFP, the vocal folds were in the paramedian position in 78%, the intermedian position in 13%, and the median position in 9% 1 . Study Which done by Wang, et al. state that one hundred Ninety-four patients with PPV were identified, including 178 cases with UVFP and 16 with VFPB. Age average moment diagnosis is 61 year, with range from 16 until 94 year. For patient with PPV unilateral, PPV left diagnosed on 122 (69%) patient And tape voice right paralysed on 56 (31%) patient. One hundred thirteen (58%) patients were male and 81 (42%) were female. Surgery is reason most general from PPV, counted around 119 patients (61.3%) patients. Surgical procedures included thyroid surgery for 56 patients, throat surgery for 44 patients, thoracic surgery (lung and heart surgery) for 13 patients, and spine surgery for 3 patients 3 . The causes of UVFP have been widely reported over the past 40 years, including thyroid surgery, non-thyroid surgery, trauma, neurological disease, malignancy, intubation, infection, inflammation, and idiopathic causes. UVFP Which most Lots found moment This is consequence complications from surgical procedures. Based on research conducted by Misano and Merati, the risk of PPV due to surgical procedures that can injure the laryngeal nerves, namely thyroidectomy is 0.8-2.3%, heart/aortic surgery 2%, mediastinoscopy 0.2%-6%, esophagectomy 11%, and carotid endarterectomy 4% 3 . The symptoms that arise in PPV depend on the damage to the larynx that is affected and the symptoms that arise vary from mild to severe and can be damage unilateral or bilateral. Paralysis plika vocalist can happen in children or person mature 1 . Paralysis plika vocalist Alone until now is still a serious problem in the field of ENT. This is due to the damage that happen to his nerves nature permanent. Various action intervention even started developed For minimize damage Which happen. By Because Therefore, this Literature Review will discuss in detail the diagnosis and management of PPV.

Antrochoanal polyp is a benign polypoid lesion, originating from the inflamed and edematous mucosa of the maxillary antrum, consisting of a cystic part in the intra-antrum and a solid polypoid part in the intra-nasal region characterized by swelling of the mucosal mass. Which inflamed with stalk, Which Then go out from ostium sine and expand until to behind in area koana posterior. Most polyp originate from the osteomeatal cleft causing nasal obstruction. Polyps often grow in the ethmoidal and maxillary sinuses. These polyps are also known as Killian's polyps because they were first discovered by Killian in 1906. 1 Component congested from polyp antrochoanal can very big until filling the nasopharynx and oropharynx. Most antrochoanal polyps are unilateral, but in some cases bilateral ones have been found. Antrochoanal polyps occur in only about 3-6% of all types of polyps in the nose. Antrochoanal polyps are more common in non-atopic patients (4.7%) than in atopic rhinitis patients (1.5%). Polyps This often on children And teenager Which reach 23%, but can occurs in age more old. Polyp antrochoanal more Lots about man compared to women. 1-4 Turbinate hypertrophy is a term first introduced in 1800 which means enlargement of the inferior turbinate and this term is used until now. The causes of turbinate hypertrophy are allergic and non-allergic rhinitis (vasomotor rhinitis) and compensation of contralateral septal deviation. 5-6 Symptom main sufferer polyp antrochoanal And hypertrophy concha is nasal congestion and runny nose. Proper management in handling antrochoanal polyp cases is very important because of the high recurrence rate and predisposing factors that are difficult to control.

Nose is organ Which important in system breathing man. In addition to acting as an air inlet and outlet, the nose also plays a role in filtering incoming air, regulating air temperature and humidity, and participating in the process of smell. The structure of the nasal vestibule, which is the area at the front of the nose, plays an important role in maintaining the integrity and normal function of the nose. However, there are conditions that can disrupt the structure and function of the nasal vestibule, one of which is nasal vestibular stenosis. 1 Stenosis vestibular is a rare but serious condition. It occurs when there is a pathological narrowing of the nasal vestibule, either due to a congenital abnormality or due to injury, surgery, infection, or other medical procedures. This narrowing can block the flow of air into the nasal cavity, causing symptoms such as difficulty breathing, nasal obstruction, and discomfort in the individual. Which experience stenosis vestibular nose. Reason stenosis vestibule can vary, including congenital abnormalities, injury, infection, nasal surgery, or other medical procedures. This stenosis can be congenital or acquired. 2 Nasal vestibular stenosis is a rare condition. Statistics on the incidence of nasal vestibular stenosis specifically are not widely available, but the prevalence of the condition is believed to be relatively low. Nasal vestibular stenosis can occur in both children and adults. 2 For diagnose stenosis vestibular nose, can done physical examination that includes evaluation of the nasal vestibule and nasal cavity. Additional tests such as rhinoscopy, CT scan, or nasal endoscopy may also be needed to obtain a clearer picture of the nasal condition. Treatment for nasal vestibular stenosis may involve a conservative approach and also surgery, depends on level severity And causes of the condition. If nasal vestibular narrowing is more severe or is caused by significant structural abnormalities, surgery may be necessary. Surgery may involve reconstructive techniques or scar tissue extirpation to restore normal function of the nasal vestibule. 2

Cyst hygroma is one of the lymphangiomas or congenital disorders of the lymphatic drainage system in the form of a tumor filled with water. This cyst is also called obstructive jugular lymphatic and cystic hygroma colli which forms in the head, neck, clavicle, And area axillary. Around 75 until 80% is cyst hygroma colli (CHC) which occurs in the head and neck, 20% in the axilla, and 5% in the mediastinum and inguinal region. 1 The most common predilection The most common location of this cyst is in the posterior trigonum colli above the clavicle. This case is most often found in newborns or can be found during ultrasound prenatal Because is a congenital malformation, and is generally benign, soft and painless. 2 The incidence of hygroma colli cysts reaches one case per 6,000 to 16,000 births in the world, and 1 : 750 of them were spontaneous abortions. Data from the FASTER trial (Evaluation Risk Trimester First And Second) show prevalence of cysts hygroma in a way overall around 1 : 100, whereas cyst hygroma septate found in 1 : 285 fetuses in the first trimester. 3 Hygroma colli cysts can be found moment born (50 until 65%) in the form of swelling Which No painful, and most (80 to 90%) will settle before the age of two years. This case can occur in both boys and girls with a mortality rate of 2 to 6% which is usually secondary to pneumonia, bronchiectasis, And disturbance road breath consequence cyst Which size big 1 . These cysts have the potential to obstruct the airway depending on their anatomical location. Emphasis Which happen on structure surrounding like nerve, vessels blood, vessels lymph, including also emphasis on channel breathing And This digestion requires immediate treatment. 4 Ultrasonography, CT-scan, and MRI are modalities that can help distinguish the type of mass in the neck. 2.5 While the main therapeutic modality in this case is surgery, namely surgical extirpation by removing the cyst lesion. Although excision or surgical extirpation of the tumor is the treatment of choice, several other therapeutic methods have been studied such as local injection of bleomycin fat emulsion which can be an alternative therapy. 2.3 Given the large number of important structures around the area where the hygroma cyst develops and its potential to become an emergency case, it is important to learn more details about the diagnosis of hygroma cysts so that the appropriate management can be carried out. fast And appropriate can done. Based on background behind said, the author is interested For discuss more carry on about cyst hygroma, including diagnosis and management.

Microtia is a congenital hypoplastic malformation of the auricle that ranges in severity from a fully formed auricle with subunits Which A little more small until No existence leaf ear And lobule completely, known as anotia 4 .The global prevalence of microtia has shown significant geographic and ethnic variations. Microtia widely affects approximately 3-5 children in 10,000 live births. 3 Microtia has been associated with many syndromes and is thought to be caused by vascular or drug other Which used during time development embryology. Malformation or No existence ear outside can cause disturbance hearing conductive and psychosocial, thus affecting the quality of life of the child in the future. Collaboration between plastic surgeons, an ENT specialist in otology as well as an ENT specialist in reconstructive facial plastics is required when considering the timing of repair if these two conditions coexist 4 . Children born with craniofacial anomalies are at higher risk of developing decline flavor believe self (low self-esteem) And bullying. Historically, attempts have been made to restore normal form and function at school age to prevent such social stigma. Treatment options include observation, treating the hearing loss component with devices such as tool help hear, use ear prosthetic For repair cosmetic, and reconstructing the earlobe with alloplastic implantation or costal cartilage autografting.4 Ear lobe reconstruction is a challenging and involved procedure. with a number of complications surgery, ideally must done by experienced and high-volume teams. As surgical techniques have improved, particularly reconstruction with autologous costal cartilage, the physical and psychosocial impact of microtia can be minimized. 4 Therefore, the author is interested in conducting a literature review that discusses microtia. This literature review is expected to increase insight. latest for writer And reader about microtia, specifically for a specialist practicing in the field of reconstruction and otology.

Cyst gap branchial is Malformation congenital (MK) or disabled born change structure and function of the newborn's organ systems that occur in intrauterine life and are identified before, at or after birth. Birth defects can also be classified as major or minor anomalies depending on the magnitude of the structural and functional abnormalities and the need for medical support or care. Congenital malformations have become a major public health problem because of their significant contribution to newborn mortality and morbidity. birth and infants. The prevalence of MK varies from one area to the area others, but the global prevalence of MK is around 2%- 3%. 1– 3 The etiology of birth defects is documented to be multifactorial and includes genetic abnormalities, poor nutrition, TORCHES infections, alcohol consumption, and exposure to pollutants. environment like pesticide, use tobacco, disease sex maternal age, advanced maternal age, and maternal medical conditions. There is no consensus on the definition of advanced maternal age but it is generally accepted that pregnancy in mothers over 35 years is considered high risk. In addition, single gene defects (6%– 7%), chromosomal abnormalities (6%– 7%), interactions between genetic and environmental factors (20%– 25%), And exposure teratogen (6%– 7%) has involved as possibility causes of birth defects. It is important to note that approximately 50% of congenital malformations have no known cause. 2,4 Congenital malformations affect multiple organ systems and this depends on the stage of embryogenesis when the defect occurs. Some studies have reported central nervous system anomalies as the most predominant congenital malformation while others have reported digestive system abnormalities as the most common congenital malformation. 5 One type of congenital malformation is a branchial cleft cyst . Branchial cleft cyst also known as branchial cleft anomaly, is a congenital anomaly that arises from the first to fourth pharyngeal pouches. Anomaly This can appear as fistula, cyst, or channel sine, depends at the level of incomplete obliteration during embryogenesis. 6,7 The branchial arches represent the embryological precursors of the face, neck, and pharynx. Branchial arch anomalies are the second most common congenital lesions of the head and neck on children. Cyst branchial cleft is malformation congenital which arises from incomplete involution of the branchial remnants. Approximately 90% - 95% generally appear at the age of 20 to 40 years. 8 Branchial cleft cysts are believed to result from failure of fusion of the branchial arches. second, although some theory state that cystic degeneration from the first, second, and third branchial clefts or cystic degeneration of epithelial elements of the cervical lymph nodes can also lead to cyst formation. Branchial cysts more Possible attack woman than man And usually appear in the 3rd decade of life as a nontender swelling on the lateral side of the inferior neck mandible. They can increase big, especially after infection upper respiratory tract and sometimes show signs of inflammation and abscess formation such as pain, swelling and edema. Acute enlargement can cause obstructive symptoms such as respiratory distress or dysphagia. Sometimes the cyst is associated with a sinus or fistula associated with the sternocleidomastoid muscle. 9,10 In this case report we report a patient with a second branchial cleft cyst found at the Prof. dr. Central General Hospital. IG Denpasar .

In general epidemiology almost 85% of children have the fewest episodes of acute otitis media once in 3 years First life and 50% of children experienced 2 episodes or more . Children who suffer from otitis media in the year First , have increase risk of chronic otitis media or recurrent otitis media . Incident disease will tend decrease after age 6 years . In the United States , almost all child at 2 years old will experiencing otitis media, and approximately 17 percent child 6 months old has experienced 3 episodes or more . Frequent episodes repetitive result in improvement parents ' worries and anxieties , as well as costs health that must be covered . In developing countries common complications found is disturbance hearing , for That giving vaccination pneumococcus important For prevent otitis media and its complications . 5. Infection of the respiratory tract ear includes , infection channel ear external (otitis externa ), ear canal ear middle ear (otitis media), mastoid (mastoiditis) and ear part deep (labyrinthitis). Acute otitis media , a inflammation ear middle relate with effusion ear middle , which is accumulation fluid in the ear middle . Otorrhea is an ear discharge that can originate from tympanic membrane . Otitis media is classified based on symptom clinical , otoscopy , duration of illness and complications . Otitis media occurs Because aeration ear disturbed middle , usually due to Because impaired eustachian tube function . Correct diagnosis and management very much important , because otitis media is common diseases found and can cause complications distribution infection until to intracranial. 3