Otitis externa (OE) is an external microbial Meatus acousticus (MAE) infection due to damage to the normal MAE serumen skin coat that protects and maintains MAE moisture and temperature. Living in the warm and humid tropics, a decrease in skin pH due to activity in the water including swimming, and excess cerumen cleaning are predisposing factors for OE. The use of antibiotics locally concentrated in OE can not only attack pathogenic microbes but also have an impact on normal flora so that it has the potential to cause resistant microbes. Honey has anti-bacterial properties without the risk of resistance and has even been shown to modulate immunity and inflammation. Various invivo and invitro studies prove that honey has broad spectrum anti-bacterial activity. Honey is proven invitro to modulate immunity by affecting the release of various inflammatory cytokines. This shows that honey has the potential for OE therapy. This article aims to discuss the potential of honey as a topical OE therapy in the hope that it can be an alternative choice of therapy in the management of OE in humans that is safe, effective, and efficient.

Highlights: Unusual CA in a 5-year-old boy with paranasal sinuses malformation in the ORL-HNS. Transnasal endoscopy posterior septectomy was successfully done. Abstract: Choanal atresia is a developmental failure of the nasal cavity to connect with the nasopharynx. The cause is either unilateral or bilateral nasal obstruction. Bilateral choanal atresia is a very rare condition and diagnosed soon after birth because neonates are obligate nasal breathers. Delayed diagnosis can cause death due to respiratory distress. The objective of this study was to report bilateral choanal atresia in 5-year-old boy who survived by breathing through his mouth using a simple tool made by his parent. It was a very rare condition because the posterior nasal cavity was covered by medial wall malformations of both maxillary sinuses which fused with the posterior nasal septum. The surgery method for this patient was posterior septectomy with transnasal endoscopic to create a neochoanae. The post-operative patient could breathe normally through his nose. Six weeks later, the nasal endoscopic evaluation indicated the patient’s patent neochoana.

Latar belakang: Rinitis alergi (RA) adalah inflamasi mukosa hidung yang diperantarai oleh IgE. Gejala dapat dinilai dengan Skor Gejala Hidung Total (SGHT). Patofisiologi dan manifestasi klinis RA dipengaruhi oleh berbagai sitokin diantaranya interleukin 33 (IL-33). Efektivitas propolis maupun flavonoid dalam menurunkan SGHT dan kadar IL-33 sekret hidung masih kontroversi. Tujuan: Membuktikan bahwa penambahan propolis pada terapi komplementer RA lebih efektif menurunkan SGHT dan kadar IL-33 sekret hidung. Metode: Penelitian double blind randomized clinical trial (RCT), dilakukan di Unit Rawat Jalan (URJ) Divisi Alergi Imunologi, Departemen Telinga Hidung Tenggorok-Bedah Kepala Leher (THT-KL) RSUD Dr. Soetomo, dan Institute of Tropical Disease, Universitas Airlangga, Surabaya pada bulan September 2018-Januari 2019. Pasien RA yang memenuhi kriteria inklusi diperiksa SGHT dan kadar IL-33 sekret hidung. Terapi diberikan selama 14 hari, evaluasi SGHT dan kadar IL-33 dilakukan hari ke-15. Hasil: Sepuluh sampel mendapat propolis dan terapi standar (kelompok A), sepuluh sampel mendapat terapi standar (kelompok B). Perbandingan SGHT antar kelompok setelah terapi rerata kelompok A=1,6 (SD 1,7), kelompok B=5,2 (SD 1,6). Uji Mann-Whitney satu arah p=0,001 menunjukkan SGHT antar kelompok setelah terapi berbeda signifikan (p<0,005). Rerata kadar IL-33 setelah terapi kelompok A=0,051 (SD 0,005), kelompok B=0,051 (SD 0,013). Uji t nilai p=0,881 menunjukkan kadar IL-33 sekret hidung antar kelompok setelah terapi berbeda tidak signifikan (p>0,005). Kesimpulan: Penambahan propolis sebagai terapi komplementer lebih efektif dalam menurunkan SGHT dibandingkan dengan terapi standar saja, namun tidak efektif dalam menurunkan kadar IL-33 sekret hidung penderita RA. Background: Allergic rhinitis (AR) is a nasal mucosa inflammation mediated by IgE. The symptoms severity is determined by total nasal symptom score (TNSS). The pathophysiology and clinical manifestations of AR are affected by several cytokines, one of which is interleukin 33 (IL-33). Efficacy of propolis or flavonoid in reducing TNSS and IL-33 level in nasal secretion is still a controversy. Purpose: To find out whether propolis addition to standard therapy could be more effective in reducing TNSS and IL-33 level of nasal secretion. Method: Double blind randomized clinical trial (RCT). The study was conducted at Outpatient unit of Department of Allergic and Immunology, Dr. Soetomo General Hospital, Surabaya and Institute of Tropical Disease (ITD) Universitas Airlangga. Allergic rhinitis patients who met inclusion criteria were examined for TNSS and IL-33 nasal secretion level. Therapy was given for 14 days, after which TNSS and IL-33 levels were evaluated on day 15th. Ten samples received propolis and standard therapy (group A), ten samples received standard therapy only (group B). Result: The comparison of TNSS groups after treatment: mean group A=1.6 (SD 1.7), and mean group B=5.2 (SD 1.6). One way Mann-Whitney test showed p=0.001 indicating the TNSS after treatment was significantly different (p<0.005). The comparison of IL-33: mean group A=0.051(SD=0.005) and mean group B=0.051(SD=0.013), t-test p=0.0881 indicating the IL-33 level of nasal secretion after treatment was not significantly different (p>0.005). Conclusion: Propolis as a complementary therapy was more effective reducing TNSS compared to standard therapy only, but it was not effective in reducing IL-33 level of nasal secretion.