Introduction: Undifferentiated nasopharyngeal carcinoma is the most common malignant tumor in nasopharynx, in which most patients come to a hospital in advanced stage. Cisplatin is one of the most effective widely used chemotherapy drugs for advanced stage undifferentiated nasopharyngeal carcinoma. Although it provides a successful outcome against cancer, there is serious side effect namely ototoxic hearing loss. Ginkgo biloba is a powerful antioxidant which may prevent ototoxic hearing loss. Objective: The study aims to determine the effect of ginkgo biloba against ototoxic hearing loss on advanced stage undifferentiated nasopharyngeal carcinoma receiving cisplatin chemotherapy. Methods: This study was double blind Randomized Control Trial with pre-post test design, was conducted in 22 patients with advanced stage undifferentiated nasopharyngeal carcinoma receiving cisplatin chemotherapy at the Department of Otorhinolaryngology Head and Neck Surgery dr. Moewardi Hospital Surakarta between June 1st and October 1st 2019. The subjects were allocated into control (plasebo) and treatment (80 mg Ginkgo biloba extract) groups. Hearing function was examined with pure tone audiometry, tympanometry and Distortion Product Otoacoustic Emission before and after the first, the second and the third cisplatin chemotherapy. The results of the examination of the two groups were tested using Friedman and Chi Square test. P value of <0.05 was considered significant. Results: The study subjects were mostly male (63.6%), with the age range of 40-59 years (90.9%). The baseline characteristics of the study subjects were homogeneous (p>0.05). There was a significant difference in the incidence of ototoxic hearing loss between control and treatment group after getting the second and the third chemotherapy (p=0.043 and p=0.033, respectively). Conclusion: There is a significant effect of ginkgo biloba in term of preventing ototoxic hearing loss on advanced stage undifferentiated nasopharyngeal carcinoma patients receiving cisplatin chemotherapy.

Cisplatin is widely used for the chemotherapy of head and neck cancer. However, it has a significant ototoxicity. Nigella sativa has been scientifically proven to have numerous benefits included to prevent adverse effect of a drug. This literature review aimed to evaluate the protective role of N. sativa oil against cisplatin-induced ototoxicity. Relevant publications were searched  from PubMed and Google Scholar databases within the last 10 years. Ototoxicity due to cisplatin can occur through the intrinsic and extrinsic pathways. Cisplatin causes endoplasmic reticulum stress, DNA damage, increased reactive oxygen species (ROS) and inflammatory processes, resulting in increased apoptosis of cochlear outer hair cells. The active constituents of N. sativa including flavonoids, phenolics and thymoquinone can prevent the cisplatin-induced ototoxicity. Examination of endogenous antioxidants, antiapoptotic, and proinflammatory could be used as primary approach to evaluate the protective role of N. sativa against cisplatin-induced ototoxicity.

Background: Obstructive sleep apnea syndrome is one of the obstructive sleep disorders, which has a high prevalence. The neuropsychological impact will affect daily life activities, social life, and reduce the quality of life in patients with obstructive sleep apnea syndrome. Purpose: To find out the effect of depression level against the quality of life (QOL) on patients with obstructive sleep apnea syndrome. Method: Analytical observational study with cross sectional approach. The study sample was 30 patients with high risk of obstructive sleep apnea syndrome who came to Otorhinolaryngology Head and Neck Surgery Department of Dr. Moewardi Hospital, from February to April 2019. The samples were determined using the Modified Berlin Questionnaire, and had fulfilled the inclusion and exclusion criteria. The variables studied were measured using questionnaires, including the level of depression (Beck’s Depression Inventory-II) and quality of life (Sleep Apnea Quality of Life Index). Result: From 30 samples, there were 20 patients (66.7%) with moderate depression and 10 patients (33.3%) with severe depression. The mean QOL of patients with obstructive sleep apnea syndrome with moderate depression was 4.085±0.369, while with severe depression was 3.040±0.241. The Independent Samples t-test showed a statistically and clinically significant correlation between the level of depression and QOL patients with obstructive sleep apnea syndrome (95% CI=0.78-1.31; p=0.000; t=8.097). Conclusion: There was a significant effect of depression level on the quality of life of patients with obstructive sleep apnea syndrome. ABSTRAKLatar belakang: Obstructive sleep apnea syndrome merupakan salah satu gangguan bernapas saat tidur tipe obstruktif, yang memiliki prevalensi cukup tinggi. Gangguan neuropsikologis yang ditimbulkannya dapat mempengaruhi aktivitas kehidupan sehari-hari, kehidupan sosial, dan akan menurunkan kualitas hidup pada pasien obstructive sleep apnea syndrome. Tujuan: Mengetahui pengaruh tingkat depresi terhadap kualitas hidup pasien dengan obstructive sleep apnea syndrome. Metode: Penelitian observasional analitik dengan pendekatan potong lintang, yang dilaksanakan pada 30 pasien dengan risiko tinggi obstructive sleep apnea syndrome di Bagian Telinga Hidung Tenggorok Bedah Kepala dan Leher RSUD dr. Moewardi Surakarta. Subjek penelitian diambil berdasarkan Modified Berlin Questionnaire, dan memenuhi kriteria inklusi dan eksklusi. Variabel yang diteliti diukur menggunakan kuesioner, meliputi tingkat depresi (Beck’s Depression Inventory-II) dan kualitas hidup (Sleep Apnea Quality of Life Index). Analisis data dilakukan uji normalitas dengan uji Saphiro- Wilk. Jika data terdistribusi normal, uji hipotesis yang digunakan adalah Independent Samples t-test. Apabila data tidak terdistribusi normal maka dilakukan uji Mann Whitney. Nilai p<0,05 menunjukkan hasil yang signifikan. Hasil: Dari 30 sampel didapatkan 20 pasien (66,7%) dengan depresi sedang dan 10 pasien (33,3%) dengan depresi berat. Nilai rerata kualitas hidup pasien obstructive sleep apnea syndrome dengan depresi sedang didapatkan 4,085±0,369, sedangkan dengan depresi berat 3,040±0,241. Uji Independent Samples t-test menunjukkan adanya hubungan yang signifikan antara tingkat depresi dengan kualitas hidup pasien obstructive sleep apnea syndrome (IK 95%=0,78-1,31; p=0,000; t=8,097). Kesimpulan: Terdapat pengaruh tingkat depresi terhadap kualitas hidup pasien obstructive sleep apnea syndrome.