Mallory Weiss Syndrome (SMW) is a condition Which marked as is laceration mucosa superficial longitudinal (tear Mallory Weiss ) in upper gastrointestinal tract, especially at the gastroesophageal junction. Symptoms of SMW including painful stomach, hematemesis, and vomiting heavy. Blood often lumpy and coffee-ground-like, and the stool may be dark like tar (melena). In the United States, SMW accounts for one to 15% of upper gastrointestinal bleeding in adults and less than 5% in children. 1 According to a systematic review and meta-analysis, 37% of studies on SMW were from Asia. However, the review did not provide specific data on the incidence or prevalence of SMW in Asia, including Indonesia. 2 Mallory-Weiss syndrome (MSWS) has risk factors in the form of severe vomiting, which can associated with chronic alcoholism, but SMW also can happen consequence trauma critical on chest or stomach, hiccup chronic, lifting and straining, gastric or esophageal pleurisy, hiatal hernia, or cardiopulmonary resuscitation. Although most cases of Mallory-Weiss tears resolve spontaneously, patients with severe or recurrent bleeding episodes requiring intensive care therapy and interventional endoscopy have been reported. 1,2 Therefore, clinicians need to be familiar with the diagnosis and management of SMW in order to provide proper treatment for these cases.

Cyst duct thyroglossal is mass neck congenital Which most often found in children but can also be found in adults. 1,2 Disorders This happen by Because failure obliteration duct thyroglossal during embryonic period. 3,4 Malignant transformation is very rare, which is around 1% and is generally found in old age. 1 The clinical picture of the thyroglossal duct cyst is a cystic mass in the midline of the neck below the hyoid bone that moves upward when swallowing and protruding the tongue. 1.5 Generally has a diameter of 1 - 4 cm. 1 Treatment is by excision of the entire cyst and thyroglossal duct to the foramen cecum at the base of the tongue known as the Sistrunk technique. 1-5 Reported One case cyst duct thyroglossal on child man age 4 years and excision was performed using the Sistrunk technique with good healing results. Good.

. Trauma, inflammation, surgical scars, and burns can cause scars where if the healing of this wound occurs excessively it will cause keloid formation. Keloid is a pathological wound healing process due to the presence of abnormal cutaneous tissue fibroproliferative processes where fibroblastic proliferation is not balanced with the apoptosis process. Keloid marked with existence of network growing scar beyond the limits of the original wound area and this scar tissue rarely undergoes spontaneous regression. Although it does not cause mortality, keloids can affect the quality of life. life in a way significant Because influence cosmetics And cause a feeling uncomfortable due to taste painful or itchy that accompanies it. By Therefore, proper management of keloids is very important. 1,2 Until moment This treatment keloid auricle is a challenge Because Keloid tissue tends to recur after excision. There are various factors that are thought to influence this. severity and recurrence keloids, such as systemic factors (example influence factor immune And hormonal), local, And genetic (the influence of race and certain genes). Due to genetic influences, the prevalence of keloids is said to be more common in African, Asian, and Hispanic races. The incidence of keloids in the Asian population varies from 4.5% to 16%. 1.3 Area auricular is Wrong One location most frequent the occurrence keloids. Ear piercing is reason most frequent from keloid auricular. In addition factor systemic, and genetic factors, earring materials and the type of ear piercing procedure can contribute to the formation of keloids on the auricle. There are various choice keloid management auricle, like surgery, injection steroids, therapy pressure, silicone sheeting, cryotherapy, laser therapy, imiquimoid cream , and radiotherapy. However, until now there is no consensus regarding the therapeutic approach for auricular keloids. Keloid resection may be able to remove the keloid completely, but this treatment option has a fairly high recurrence rate (50-100%) so that various literature submit therapeutic approach combination for effective management of auricular keloids. Several studies have shown that the combination of surgical resection with radiation or postoperative steroid injection has a low recurrence rate. 3,4 In this case report, we report a 21-year-old male patient who own keloid on area lobe auricle consequence process piercing ear around 2 years earlier. Combination management approach resection surgery with postoperative corticosteroid injection showing good outcomes.

Inflammation of the nasal skin due to bacterial infection is a common case and can occur at any age, one of which is vestibulitis. Although there has been no research to date on the incidence or prevalence of nasal vestibulitis, in general nasal vestibulitis is suffered by many in old age. 1, 2 Nasal vestibulitis is inflammation of the nasal vestibule area, which is the skin-lined front part of the nostrils. This condition is generally caused by a bacterial infection, especially Staphylococcus aureus , but can also be triggered by physical or chemical irritation, as well as repeated trauma from habits such as excessive nose hair plucking or nose picking. 1-3 Small injuries to the nostrils can cause pimples at the base of the nose hairs and sometimes crusts around the nostrils. Repeated trauma to the vestibule when the nose is wiped And in clean by patient Alone become reason most often Apart from that, plucking or cutting nose hair can irritate the skin of the nasal vestibule, thereby triggering infection. The natural habitat of Staphylococcus aureus is humans are in the area skin, nose, mouth and large intestine, where in normal immune system conditions Staphylococcus aureus is not pathogenic. Nasal vestibulitis occurs when there is inflammation of the tissue around the entrance to the nose. 1,2,3 If not treated as early as possible, these inflammatory diseases can cause life-threatening complications. Ongoing infection can spread to the tissue layers under the skin, sometimes even involving the veins leading to the brain. This condition is often called cavernous sinus thrombosis . Therefore, it is important for ENT specialists to be able to diagnose correctly and provide appropriate therapy. 1-3

Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascular tumor located on part posterior nasopharynx And foramen sphenopalatine. JNA very much rare where incident tumor This only covering 0.05% until 0.5% from all over tumor head and neck. The prevalence of JNA in the United States is estimated at only 0.4 per million population. Although JNA can happen on all age, However incident JNA highest found in male patients aged 7 to 29 years old. 1.2 Therefore disease This quite rare, no data related to JNA epidemiology was found in Indonesia. Although nature benign, JNA can threaten life Because its nature Which very aggressive where 10-37% of cases involve cranial and orbital invasion. This cranial and orbital invasion can cause various morbidities, including nasal cavity obstruction, recurrent epistaxis, facial deformity, proptosis, blindness, and cranial nerve paralysis. In addition, this vascular mass is very easy to bleed where large JNA masses may even have more than one feeding artery so that the diagnosis and management of JNA becomes a challenge. 3,4 Biopsy is contraindicated in JNA cases and surgery or angiography-embolization is the only option that can be used to establish a definitive diagnosis and management in JNA cases. Therefore, careful clinical and radiological assessment will be very helpful in establishing a diagnosis. diagnosis and determination of appropriate surgical management. 5,6 By Due to the limited availability of literature related to JNA in Indonesia, the author aims to present diagnosis And Treatment from A case JNA on patient pediatrics aged 13 years at Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Bali, Indonesia.

According to the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020, rhinosinusitis is defined as inflammation of the nose and paranasal sinuses characterized by two or more symptoms, one of which includes nasal blockage or obstruction or congestion or nasal discharge (anterior or posterior nasal passages). or posterior nasal drip) accompanied by with pain face and or decreased olfactory sensitivity, if it occurs for ≤ 12 weeks it is said to be acute rhinosinusitis and if ≥ 12 weeks is said to be chronic rhinosinusitis. Rhinosinusitis is one of the common conditions that has been experienced by about 20% of individuals. According to estimates, the condition is projected to affect about 31 million people, which consists of about 4% of the adult population in the United States each year. According to surveys, 14.1% of adults have been diagnosed by a health professional with rhinosinusitis. In general historical, fungal etiology associated with 5-15% of chronic rhinosinusitis cases. After the statement of fungi as an etiological factor in most cases of chronic rhinosinusitis, the influence of fungal rhinosinusitis seems to be extraordinary lately. Fungal rhinosinusitis is known to cause prominent physical symptoms, causing a significant decrease in quality of life, and significant interference with daily activities. 1 Fungal rhinosinusitis is condition pathological on sine paranasal accompanied by inflammation sine Which caused by fungal infection. The etiology of fungal rhinosinusitis in Indonesia has not been widely documented. According to research conducted at the Haji Medan Hospital in 2014-2015, out of 74 cases of chronic rhinosinusitis that underwent fungal culture examination, there were 30 positive cases of fungi, most of which were found in the age range of 21-40 years, namely 60%. The distribution of fungi from the 30 cases that grew the most was Aspergilus fumigatus that is 15 sample (50%), Aspergillus sp as much as 7 sample (23.3%), Aspergillus niger 4 samples (13.3%), Candida sp as many as 3 samples (10%) and the least is Aspergillus versicolor only 1. 1,2 According to estimates made by Wahyuningsih et al. (2021) the prevalence of fungal rhinosinusitis in Indonesia is estimated at around 294,000 cases. 3 The diagnosis of fungal rhinosinusitis can be established through anamnesis, physical examination, and supporting examinations. The symptoms that arise vary depending on the patient's immune status. Supporting examinations can be used to help establish the diagnosis of fungal rhinosinusitis and provide important information to take appropriate action so that management becomes more precise and faster. Fungal rhinosinusitis produces a variety of patient prognoses, ranging from potentially good to fatal. Therefore, effective patient management plays an important role in improving the quality of life of patients. Therefore, the author conducted a literature review on the topic of fungal rhinosinusitis from the available literature. This literature review is expected to be a material to increase clinician insight, especially in terms of diagnosis and management of fungal rhinosinusitis.

Chondritis auricula often time due to by infection bacteria Which attacks the ear cartilage. Other risk factors include open wounds to the ear, medical procedures such as ear piercing, or autoimmune diseases. Inflammation is the main cause of chondritis, which can be caused by trauma to the leaf ear (auricle) consequence wound burn, surgery, piercing ear, or blunt or sharp trauma such as in wrestling matches or acupuncture. One of the complications of perichondritis that spreads deeper into the chondrium to become chondritis. . 1- 14 The earlobe or auricle is an organ that functions as a sound collector. 1,2 In several studies that have been reported, the ear can also cause auricular chondritis. Chondritis is an inflammation of the cartilage. Chondritis can occur in area Which own cartilage like ear, nose, larynx, trachea, and also the joint area. Auricular chondritis is an inflammation on cartilage leaf ear Which cause effusion serum or pussy in between the perichondrium layer and the outer ear cartilage. 1,2,3 Symptoms of auricular chondritis include redness, swelling, pain, and a burning sensation. on cartilage ear. Infection Which heavy can cause formation abscess or even necrosis of the cartilage. Both of these conditions require proper medical care, such as management of swelling, use of antibiotics in case of infection , And in a number of case, procedure surgery For overcome damage or deformity on ear. 3 The most common bacteria that cause perichondritis and auricular chondritis are similar to Pseudomonas aeruginosa and Staphylococcus aureus. If the treatment of chondritis with antibiotics fails, it can cause complications in the form of shrinking of the earlobe due to the destruction of the cartilage that forms the framework of the earlobe called cauliflower. 6,7 So that proper treatment is needed for earlobe infections to reduce damage and aesthetics of the ear.

Kartagener Syndrome (KS) is disease genetics recessive autosomal which accounts for about 50% of primary ciliary dyskinesia (PCD) cases. Because it is accompanied by various complications, PCD/KS greatly affects the quality patient's life. Syndrome This rare And First time described by Siewert on in 1904; however, Kartagener recognized the clinical syndrome in 1933. This syndrome includes the clinical triad of chronic sinusitis, bronchiectasis, and situs inversus. Camner et al. first suggested ciliary dyskinesia as the cause of this syndrome in 1975. In 1977, Eliasson et al. first coined the term "immotile cilia syndrome" to categorize infertility with chronic sinopulmonary infection. 1,2 Normal ciliary function is essential for respiratory host defense and sperm motility, as well as ensuring proper visceral orientation during embryogenesis. In Kartagener syndrome, mutations in the DNAI1 and DNAH5 genes cause impaired ciliary motility, which predisposes to recurrent sinopulmonary infections, infertility, and left-right body orientation errors. 1.2 Clinical manifestations the most common is bronchitis recurrent, pneumonia, and sinusitis. Situs inversus is present in 50% of patients with ciliary dyskinetic syndrome. The triad of this syndrome, namely situs inversus, chronic sinusitis, and bronchiectasis, is called Kartagener's syndrome. which is a subgroup of ciliary dyskinesia primary. The incident reported One from 20,000-40,000 person. Syndrome Dyskinetic cilia have also been associated with infertility in men and decreased fertility in women. Therapeutic approaches to PCD/KS aim to improve prevention, facilitate diagnosis definitive Which fast, avoid error diagnosis, maintain treatment active, control infection And delay the development of lesions. 2,3 Recurrent otitis media is a common manifestation of primary ciliary dyskinesia. Examination may reveal tympanic membrane retraction with mobility. Which bad or No There is And effusion ear middle. Testing more Advanced diagnosis usually shows flat tympanograms and bilateral conductive hearing loss due to thick middle ear effusions. Many patients undergo repeated tympanostomy tube placement, often complicated by chronic suppurative otitis media. Otologic disorders associated with primary ciliary dyskinesia include tympanosclerosis, cholesteatoma, and keratosis obturans. 1 Keratosis obturation is accumulation desquamation layer epidermis keratin in the external acoustic meatus (EAC), pearly white in color, can form lump And cause disturbance senses touch And hearing. This disease does not affect the MAE cartilage, usually these lesions are limited to the MAE, without causing decay bone. membrane The tympanic membrane appears normal, but is usually thick or retracted. 11,12 Keratosis obturans is a rare disease, whereas the incidence of cholesteatoma is MAE estimated The same with 1000 case otological new and every case There is Keratosis obturation is disease Which seldom occurs, while the frequency of MAE cholesteatoma is estimated to be equal to 1000 otological cases new And every case there is four or five case keratosis obturans. Keratosis obturans often occurs at a young age. 11,12 Etiology keratoses obturation No known, although can due to by chronic hyperemia that increases keratin desquamation and epidermal debris formation. Other theories may be caused by eczema, seborrheic dermatitis, furunculosis, and abnormal epithelial migration, sometimes even associated with chronic bronchiectasis and sinusitis. Keratosis obturans and MAE cholesteatoma are two different clinical conditions and pathological features in a way clinical. Treatment keratosis obturation is with MAE cleaning in a way regular And therapy topical, whereas cholesteatoma MAE generally require surgical intervention.12,13

Gentamicin ototoxicity can be defined as gentamicin which has the potential to cause toxic reactions in structures in the inner ear such as the cochlea. And vestibule. Damage on structures This Which due to by using the drug can cause symptoms such as hearing loss, tinnitus and disturbance balance. Ototoxicity defined as damage in the cochlear and/or vestibular structures in the ear due to exposure to chemicals 1. Damage to the inner ear caused by the use of certain drugs is often found in everyday medical practice. In developing countries, where drugs such as aminoglycosides are often used on disease like pneumonia, diarrhea And tuberculosis lungs, so that the incidence of ototoxicity is quite high. As a clinician, a doctor must know that ototoxic drugs can cause damage to the hearing and balance systems so that a doctor must recognize the types of drugs that are ototoxic 1 . Moment This agent pharmacological with effect side ototoxicity has are widely known and include aminoglycosides, platinum-based antineoplastic agents, salicylates, quinine, and diuretics 1 . Drugs that have the potential to cause toxic reactions to the structures of the inner ear, including the cochlea and vestibular are said to be ototoxic. to structure This is due to the influence of drugs that cause hearing loss, tinnitus, and balance disorders. Cases of ototoxicity became a major concern with the discovery of streptomycin in 1944 by Waxman . Streptomycin was useful in the therapy of tuberculosis, but some patients were later found to have dysfunction cochlear and vestibular irreversible. A few years later, analog from streptomycin that is dihydrostreptomycin used with hope its ototoxic effect is lower than streptomycin. However, in reality, dihydrostreptomycin Also own number incident toxicity to cochlea the high so that withdrawn from circulation 2 . Considering that cases of ototoxicity can be an emergency, the author considers important For learn more details regarding early diagnosis of ototoxicity induced by aminoglycosides so that rapid and appropriate management can be carried out to prevent more severe damage to the hearing and balance organs.

Clear cell carcinoma parotic in the head and neck area is a rare case. Clear cell carcinoma (CCC) can be found in almost all benign or malignant epithelial, mesenchymal, melanocytic or hematopoietic tumors. CCC occurs due to various factors including artifactual changes, impaired cell preservation and hydropic degeneration of organelles, or due to accumulation of glycogen, mucopolysaccharides, lipids, mucins, or phagocytosed foreign bodies in tumor cells. Clear cell changes in the tumor become more extensive as the tumor progresses or arise secondarily. All these factors make the diagnosis of clear cell difficult. Salivary gland tumors account for less than 7% of neoplasms involving the head and neck region. Intraosseous salivary gland tumors may arise from ectopic salivary glands, and may arise from neoplastic transformation of mucous cells found in the lining of dentigerous cysts, from embryonic submandibular glands found within the mandible, from bony entrapment of retromolar pad mucous cells during embryogenesis or theoretically, may also arise from salivary glands present within lingual cortical defects of the mandible. The most commonly reported intraosseous salivary gland tumor is mucoepidermoid carcinoma, followed by adenoid cystic carcinoma. Although Primary central CCC originating from the salivary glands is very rare, CCC still needs to be considered as a differential diagnosis of central clear cell tumor . Hyalinizing clear cell carcinoma (HCCC) was first discovered by Milchgrub et al. on year 1994 as carcinoma gland saliva minor rare Which consists of clear cells that form cords and nests within a hyalinized stroma. HCCC is now classified as ‘‘ clear cell adenocarcinoma’’ in the AFIP fascicle and ‘‘ clear cell carcinoma, not otherwise specified (NOS)’’ by the World Health Organization (WHO). 2 Clear cells are seen in a variety of benign and malignant salivary gland tumors, including benign mixed tumors, myoepithelioma/myoepithelial carcinoma, oncocytoma/oncocytic carcinoma, mucoepidermoid carcinoma, acinic cell carcinoma, polymorphic low-grade adenocarcinoma, and adenoid cystic carcinoma. In most cases, clear cells constitute only a small portion of the cellular content of these neoplasms and the diagnosis is based on identification of classic histomorphologic features and unique growth patterns. Differentiating primary salivary gland tumors from metastatic tumors with clear cell features is critical for diagnostic considerations and decision making.