Articles

Found 14 Documents
Search

PATTERN OF BACTERIA, ANTIBIOTIC USES AND SENSITIVITY AMONG EAR, NOSE, AND THROAT INFECTIOUS DISEASE IN OTOLARYNGOLOGY WARD IN TERTIARY HOSPITAL Agustina, Yolla Sri; Megantara, Imam; Dermawan, Arif
International Journal of Integrated Health Sciences Vol 7, No 1 (2019)
Publisher : International Journal of Integrated Health Sciences

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v7n1.1545

Abstract

Objective: To provide an overview of antibiotic use, bacterial patterns and sensitivity to antibiotics in the otolaryngology ward.Methods: This was a cross-sectional study, with total sampling method from medical record data of otolaryngology inpatients that use antibiotics for the period of January 1, 2016?June 30, 2016. Exclusion criteria are incomplete patient medical records and chemotherapy or radiotherapy patients. The variables studied were antibiotic use, bacterial pattern and susceptibility.Results: Among 276 subjects included in the inclusion criteria, the most widely used are single antibiotics (98.9%), generally used for 2?3 days (73.9%), via intravenous lines (92%), and with indications as empirical+prophylaxis (77.5%). Commonly used antibiotics are cefazolin (42.51%), ceftriaxone (29.54%), and cefotaxime (20.76%). The most common bacteria were E. coli (36.36%) and the most sensitive types of antibiotics were meropenem, amikacin, and tigecyclin, while the most resistant antibiotics were ampicillin, ciprofloxacin, and ceftriaxone.Conclusions: The majority of antibiotics used in the otolaryngology treatment room are cefazolin as prophylaxis. E. coli were the most found culture results and the most sensitive types of antibiotics, namely meropenem, amikacin, and tigecyclin, while the most resistant antibiotics were ampicillin, ciprofloxacin, and ceftriaxone.Keywords: Antibiotics, antibiotic sensitivity, bacterial pattern, ears, nose, throat
COMPARATIVE ANALYSIS OF GROUNDING RESISTANCE VALUE IN SOIL AND SEPTICTANK Syakur, Abdul; Juningtyastuti, Juningtyastuti; Dermawan, Arif
TEKNIK Volume 29, Nomor 3, Tahun 2008
Publisher : Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (202.007 KB) | DOI: 10.14710/teknik.v29i3.1942

Abstract

The aim of grounding system to protect of electrical equipment and instrumentation system and peopletogether. The lightning stroke near the strucutre of building can damage of equipment and instrumentationsystem. Therefore, it is very important to protect theese electrical and electronic equipment from lightningstrike uses lightning protection system and grounding system.This paper presents kind of grounding system at type of soil and place. The measurement of groundingresistance in soil and septictank have done. Types of soil for grounding resistance measuring aremarshland, clay and rockland.The measurement results of grounding resistance show that value of grounding resistance depend ondeepness of electrode and kind of soil and septictank. Grounding resistance value in septictank is morelower than soil.
Profile of Patients with Complicated Chronic Suppurative Otitis Media in Dr. Hasan Sadikin General Hospital Bandung, Indonesia January–December 2011 Desbassarie, Fitrie; Dermawan, Arif; Hadi, Soeseno
Althea Medical Journal Vol 2, No 1 (2015)
Publisher : Althea Medical Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (708.308 KB)

Abstract

  Background: The prevalence of chronic suppurative otitis media (CSOM) is still high in developing countries. According to the World Health Organization (WHO), the prevalence of CSOM is 2-4%. In 1994-1996, the prevalence of CSOM in various provinces in Indonesia is diverse, with general prevalence of 3.9%. Chronic suppurative otitis media can also lead to various complications. The objective of this study was to determine the profiles of CSOM patients with complications in Dr Hasan Sadikin General Hospital Bandung.Methods: Secondary data was obtained from 117 medical records of the period January-December 2011 in Dr Hasan Sadikin General Hospital Bandung. Out of 117 medical records, 43 medical records consisted of CSOM patients who had complications. Data of patients’demography, risk factor, chief and accompanying complaints, infected ears, pathological findings, complications, and treatments were collected and were analyzed with frequency distribution.Results: There was 36.75% CSOM patients with complications, 55.8% are male, 30.3% were 30-39 years old, 62.8% level of education of patients was primary education. Ear discharge (otorrhea) was the most common chief complaints (95.3%) and hearing loss was the most dominated accompanying symptom (53.5%), Upper Respiratory Tract Infection (URTI) was the most common risk factors. Most of the cases had unilateral complication (93%) and intratemporal (72%). Both intratemporal and extratemporal was only 26% cases. Granulation tissue was the most common intratemporal complication (32.5%). The most common procedure given was Mastoidectomy without tympanoplasty (51.2%) followed by pharmacotherapyConclusions: Percentage of CSOM with complication is still high in Dr. Hasan Sadikin General Hospital Bandung.Keywords: Chronic suppurative otitis media, complication, profile DOI: 10.15850/amj.v2n1.443 
KEEFEKTIFAN COLLABORATIVE LEARNING BERBASIS QUIZ EDUTAINMENT TERHADAP KETUNTASAN HASIL BELAJAR Dermawan, Arif
Chemistry in Education Vol 3 No 1 (2014): Terbit Bulan April 2014
Publisher : Chemistry in Education

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Strategi pembelajaran yang diterapkan pada kegiatan belajar mengajar harus disesuaikan dengan materi yang dipelajari. Teacher center kurang sesuai dengan output yang diharapkan dalam proses pembelajaran. Oleh karena itu terjadi perubahan paradigma pendidikan menjadi student center yang berdampak pada perubahan aktivitas guru dan siswa. Model collaborative learning melibatkan partisipasi aktif siswa dan meminimalisasi perbedaan antar individu. Penelitian ini bertujuan untuk mengetahui keefektifan penerapan model Collaborative Learning berbasis Quiz Edutainment pada pembelajaran kimia. Desain penelitian yang digunakan dalam penelitian ini adalah posttest-Only Control Design. Teknik sampling yang digunakan adalah cluster random sampling dengan kelas XI IPA 4 sebagai kelas eksperimen dan XI IPA 2 sebagai kelas kontrol. Berdasarkan analisis statistics student hasil penelitian menunjukan thitung sebesar 3,06 lebih dari t0,95(65) sebesar 1,7. Jadi dapat disimpulkan bahwa penerapan collaborative learning berbasis quiz edutainment terbukti efektif untuk pembelajaran kimia. Hal ini juga dibuktikan dengan hasil analisis uji ketuntasan hasil belajar yang menunjukan ketuntasan belajar siswa mencapai lebih dari 85%.
Distribution of Skin Prick Test Results in Rhinitis Allergic Patients at Dr. Hasan Sadikin General Hospital Bandung Antares, Gama; Dermawan, Arif; Permata, Yenti
Althea Medical Journal Vol 4, No 1 (2017)
Publisher : Althea Medical Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (559.723 KB)

Abstract

Background: Allergic Rhinitis (AR) is an inflammation condition in nasal mucous because of type 1 hypersensitivity. Skin prick test is one of the diagnostic tests to diagnose AR. Purpose of this study was to know the distribution of skin prick test in AR patients.Methods: This study used retrospective descriptive method as cross sectional design. This study was performed from 1 August to 31 October 2014. This study used medical record as secondary data at Department of Otorhinolaryngology–Head and Neck Surgery of Dr. Hasan Sadikin General Hospital. There were 175 cases which fulfilled the inclusion criteria of the study. The data were then analyzed using computer program.Results: Forty seven cases were positive for house dust (26.8%), 127 cases were positive for dust mite (72.5%), 85 cases were positive for rice pollen (48.5%), 62 cases were positive for maize pollen (35.5%), 56 cases were positive for mixed fungi (32%), 100 cases were positive for cockroach (57.1%), 63 cases were positive for horse dander (36%), 50 cases were positive for cat dander (28.5%), 93 cases were positive for dog dander (53.1%), and 38 cases were positive for chicken feather (21.9%).Conclusions: The most aeroallergen making positive result in skin prick test is dust mite. [AMJ.2017;4(1):129–32] DOI: 10.15850/amj.v4n1.1033
Effectiveness of Allergic Rhinitis Management Related to WHO Guideline on Allergic Rhinitis and Its Impact on Asthma (ARIA) Aziza, Atika; Dermawan, Arif; Kusumah Dewi, Vycke Yunivita
Althea Medical Journal Vol 3, No 4 (2016)
Publisher : Althea Medical Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (216.933 KB)

Abstract

Background: The standard procedure of Allergic Rhinitis (AR) Management in Indonesia is based on Allergic Rhinitis and Its Impact on Asthma (ARIA) World Health Organization (WHO) 2008 guideline; however, it needs some adjustment to get an effective use locally in Indonesia. The data related to the problem however did not exist in Indonesia. The study aimed to evaluate the effectiveness of AR patient management based on the ARIA WHO guideline in the Department of Otorhinolaryngology-Head and Neck Surgery Dr. Hasan Sadikin General Hospital Bandung.Methods: The study was conducted from September to October 2015 using quantitative descriptive design to observe the development of ARIA classification, total nasal symptom score (TNSS), and quality of life (QoL) during the first 6 months of therapy. The data were obtained from medical records of AR patients who visited the Rhinology-Allergy clinic Department of Otorhinolaryngology-Head and Neck Surgery Dr. Hasan Sadikin General Hospital within one year. Thirty three patients were included in the study using total sampling.Results: There was significant improvement (p<0.001) in ARIA classification, TNSS, and QoL between the initiation of therapy, the third, and the sixth month. In contrary, there was no significant difference in ARIA classification (p=0.109), TNSS (p=0.317), and QoL (p=1.000) between the third and the sixth month of therapy.Conclusions: Allergic rhinitis patient management based on the 2008 ARIA WHO guideline is effective. [AMJ.2016;3(4):538–44]Keywords: Allergic rhinitis, asthma, effectiveness, management DOI: 10.15850/amj.v3n4.651
Efektivitas imunoterapi terhadap gejala, temuan nasoendoskopik dan kualitas hidup pasien rinosinusitis alergi Pradana, Yuwan; Madiadipoera, Teti; Sudiro, Melati; Dermawan, Arif
Oto Rhino Laryngologica Indonesiana Vol 42, No 2 (2012): Volume 42, No. 2 July - December 2012
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (456.553 KB) | DOI: 10.32637/orli.v42i2.24

Abstract

Background: Rhinosinusitis is one of major health problems which increased the economic burden. With symptoms include nasal congestion, rhinorrhea, facial pain, and sometimes reduced or loss of smell, this condition may impair work productivity and quality of life (QOL). Rhinosinusitis is one of the comorbidity of allergic rhinitis. Allergen specific immunotherapy provides protection against the occurence of allergic symptoms and inflammatory reactions due to allergen exposure, that results in improvement  of QOL of allergic rhinosinusitis patients.   To assess the effectiveness of immunotherapy in the  severity of the disease, nasal symptoms, nasoendoscopic findings, drugs intake, and the QOL in allergic rhinosinusitis patients treated with specific immunotherapy. Methods: A retrospective descriptive study conducted at the Rhinology-Allergy Clinic of ORL-HNS Department, Dr.Hasan Sadikin General Hospital, Bandung, on January - December 2011, towards 25 patients, by anamnesis, severity of the disease using Visual Analogue Scale (VAS), nasal symptoms from Weeke, Davis and Okuda, nasoendoscopic findings from Lund-Kennedy, drug intake score, and QOL assesment using Rhinoconjuctivitis Quality of Life Questionaire. Results: There was a significant correlation (p<0,05) between specific immunotherapy for 1 year observed by reduced disease severity, reduced nasal symptoms, nasoendoscopic findings improvement, reduced drug intake, and increased Quality of Life which shows significant results from 3 months after immunotherapy using Wilcoxon differential test (p<0,001). Conclusion: Immunotherapy for 1 year was significantly reduced disease severity, reduced nasal symptoms, improved nasoendoscopic findings, reduced drug intake, and improvement of QOL in patients with allergic rhinosinusitis began from 3 months after immunotherapy and maintained afterwards. Key words: allergic rhinosinusitis, nasal symptoms, nasoendoscopy, specific immunotherapy, quality of life    Abstrak :  Latar belakang: Rinosinusitis merupakan salah satu masalah kesehatan yang semakin meningkat sehingga menjadi beban besar terhadap perekonomian masyarakat. Dengan gejala berupa hidung tersumbat, rinore, nyeri pada wajah dan dapat disertai berkurang atau hilangnya penciuman, kondisi ini dapat menurunkan produktivitas kerja dan kualitas hidup. Rinosinusitis merupakan salah satu komorbiditas dari rinitis alergi. Imunoterapi alergen spesifik bertujuan untuk memberikan perlindungan terhadap timbulnya gejala alergi dan reaksi inflamasi akibat pajanan alergen, sehingga dapat meningkatkan kualitas hidup pasien rinosinusitis. Tujuan: Membuktikan efektivitas imunoterapi terhadap tingkat beratnya penyakit, gejala hidung, nasoendoskopi, penggunaan obat dan kualitas hidup pasien rinosinusitis alergi yang diberikan pengobatan imunoterapi selama 3, 6, dan 12 bulan. Metode: Dilakukan penelitian deskriptif retrospektif, di Poliklinik Rinologi Alergi Ilmu Kesehatan THT-KL RSHS Bandung, dalam periode JanuariDesember 2011 pada 25 pasien, menggunakan anamnesis, tingkat berat penyakit berdasarkan Visual Analogue Scale (VAS), gejala hidung  berdasarkan Weeke, Davis dan Okuda, pemeriksaan nasoendoskopi berdasarkan Lund-Kennedy, penggunaan obat dan penilaian kualitas hidup dengan Rhinoconjuctivitis Quality of Life Questionaire. Hasil: Didapatkan hubungan bermakna berdasarkan uji chi-kuadrat-Friedman   antara imunoterapi selama 1 tahun (p<0,05) terhadap penurunan tingkat berat penyakit, penurunan gejala hidung, perbaikan temuan nasoendoskopi, penurunan penggunaan obat, serta peningkatan kualitas hidup. Didapat perbaikan secara bermakna sejak 3 bulan pasca imunoterapi (p<0,001) berdasarkan uji beda Wilcoxon. Kesimpulan: Imunoterapi selama 1 tahun efektif terhadap penurunan tingkat berat penyakit, penurunan gejala hidung, perbaikan temuan nasoendoskopi, penurunan penggunaan obat, serta peningkatan kualitas hidup pada pasien rinosinusitis alergi, dengan perbaikan sejak 3 bulan dan bertahan hingga 1 tahun pasca-imunoterapi. Kata kunci: rinosinusitis alergi, gejala hidung, nasoendoskopi, imunoterapi, kualitas hidup 
Pengaruh imunoterapi spesifik terhadap adenoid pada pasien rinitis alergi Pratita, Nindya; Madiadipoera, Teti; Ratunanda, Sinta Sari; Dermawan, Arif; Boesoirie, Shinta Fitri
Oto Rhino Laryngologica Indonesiana Vol 47, No 1 (2017): Volume 47, No. 1 January - June 2017
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (484.302 KB) | DOI: 10.32637/orli.v47i1.194

Abstract

Latar belakang: Rinitis alergi (RA) adalah suatu reaksi inflamasi hidung yang diperantarai oleh IgE, dengan gejala hidung tersumbat, rinore, bersin, dan rasa gatal, akibat mukosa hidung terpapar alergen.Hipertrofi adenoid (HA) dianggap sebagai salah satu komorbid dari RA, sehingga mungkin terdapathubungan antara RA dengan HA.Tujuan: Mengetahui pengaruh imunoterapi spesifik terhadap penurunanukuran adenoid pada pasien RA.Metode: Penelitian dilakukan dengan desain quasi-eksperimental,menggunakan anamnesis, nasoendoskopi, dan skin prick test (SPT). Pengukuran derajat adenoid dilakukanpada 32 sampel di Poliklinik Rinologi-Alergi Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala- Leher Rumah Sakit Dr. Hasan Sadikin Bandung selama Februari – Juni 2015. Penelitian ini dibagimenjadi dua kelompok yaitu kelompok pasien RA dengan HA sebagai komorbid yang mendapatkanpengobatan imunoterapi spesifik, dan kelompok yang mendapatkan terapi medikamentosa kombinasiberupa fluticasone furoate dengan cetirizine.Hasil: Pada kelompok yang diberikan imunoterapi spesifik,terjadi penurunan ukuran adenoid yang bermakna, dibandingkan dengan kelompok yang diberikan terapimedikamentosa kombinasi. Persentase penurunan untuk kelompok imunoterapi spesifik sebesar 80,4%,sedangkan pada kelompok pembanding sebesar 60,5%.Kesimpulan: Terdapat penurunan ukuran adenoidsecara signifikan pada kelompok yang mendapatkan pengobatan imunoterapi spesifik, yang lebih baikjika dibandingkan terapi medikamentosa kombinasi.Kata kunci: Rinitis alergi, hipertrofi adenoid, imunoterapi spesifik ABSTRACTBackground: Allergic rhinitis (AR) is an IgE-mediated inflammation reaction of the nosecharacterized by specific symptoms of nasal obstruction, rhinorrhea, sneezing, and nasal itching, whenthe nasal mucous membrane was exposed to allergen. Adenoid hyperthrophy (AH) is considered to beone of AR comorbid factor, and there might be a relationship between AR and AH. Purpose: To evaluatethe effect of specific immunotherapy in decreasing the size of AH in AR’s patients. Methods: This studydesign was a quasi-experimental. We used anamnesis, nasoendoscopic finding, and skin prick test.Measurement of adenoid had been conducted on 32 subjects in the Rhinology-Allergy Clinic of ORL-HNSDepartement of Dr. Hasan Sadikin General Hospital during February – June 2015. This study was dividedinto a group which was given specific immunotherapy, and a group which was given medical treatmentin the form of combination fluticasone furoate and cetirizine. Results: The group which was treated withspecific immunotherapy showed a significant decrease of the adenoid size compared to the group withcombination medication of fluticasone furoate and cetirizine. Specific immunotherapy decreased adenoidsize up to 80.4%, while in the other group was 60.5%.Conclusion: The study showed that the decreaseof adenoid size in the group treated with specific immunotherapy treatment was better than the grouptreated with combined medication treatment.Keywords: Allergic rhinitis, adenoid hyperthrophy, specific immunotherapy
Korelasi otitis media dengan temuan nasoendoskopi pada penderita rinosinusitis akut Anugrahani, Ariel; Madiadipoera, Teti; Dermawan, Arif
Oto Rhino Laryngologica Indonesiana Vol 45, No 2 (2015): Volume 45, No. 2 July - December 2015
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1134.015 KB) | DOI: 10.32637/orli.v45i2.114

Abstract

Latar belakang: Rinosinusitis akut adalah inflamasi pada hidung dan sinus paranasal yang berlangsung kurang dari 12 minggu. Adanya sumbatan pada hidung dapat menyebabkan sumbatan pada tuba Eustachius sehingga dapat terjadi gangguan ventilasi dan inflamasi yang dapat menimbulkan otitis media. Tujuan: Melihat adanya hubungan hidung tersumbat, nasal edema, dan rinore pada pasien rinosinusitis akut dengan otitis media. Metode: Penelitian dengan desain cross sectional study dan data diambil secara deskriptif retrospektif dari rekam medis, di Poliklinik Rinologi Alergi Ilmu Kesehatan THT-KL RSHS Bandung, dalam periode Januari 2013 - Juni 2014. Didapatkan jumlah sampel sebanyak 93 pasien yang terdiri dari 38 pasien dengan OMA, 27 pasien dengan OME, dan 28 pasien dengan OMSK, dengan usia 1 sampai 79 tahun, berdasarkan derajat berat penyakit menurut Visual Analogue Scale (VAS), gejala hidung berdasarkan Weeke, Davis dan Okuda, pemeriksaan nasoendoskopi berdasarkan Lund-Kennedy. Analisis data menggunakan uji Kruskal-Wallis, chi square (p<0,05), dan analisis korelasi Spearman. Hasil: Terdapat korelasi yang bermakna antara otitis media dengan temuan nasoendoskopi yaitu edema mukosa dan rinore. Kesimpulan: Terdapat hubungan antara peningkatan gejala obstruksi hidung dan edema mukosa serta rinore pada temuan nasoendoskopi pada penderita rinosinusitis akut dengan otitis media. Kata kunci: rinosinusitis akut, nasoendoskopi, otitis mediaABSTRACT Background: Acute rhinosinusitis is an inflammation of the nose and paranasal sinuses, which going on less than 12 weeks. If the Eustachian tube obstruction occurs, there will be ventilation and inflammatory disorders that can cause otitis media.rPurpose: This study aimed to find out the correlation of nasal obstruction, nasal edema, and rhinorrhea in acute rhinosinusitis patients with otitis media. Methods: The study was a cross sectional study which data were collected from retrospective descriptive study based on medical record at Rhinology-Allergy Clinic of ORL-HNS Department, Dr. Hasan Sadikin General Hospital, Bandung, from January 2013 to June 2014, involved 93 patients from 1 to 79 years old. Data were analyzed by using the Kruskal-Wallis, chi square, and Spearman statistical test based on anamnesis, severity of the disease using Visual Analogue Scale, nasal symptoms from Weeke, Davis and Okuda, nasoendoscopy findings from Lund-Kennedy. Results: There was a significant correlation between otitis media with mucosal edema and rhinorrhea from nasoendoscopy. Conclusion: There was a correlation between the increased symptoms of nasal obstruction,mucosal edema, and rhinorrhea in nasoendoscopy findings in patients with acute rhinosinusitis with the occurrence of otitis media. Key words: acute rhinosinusitis, nasoendoscopy, otitis media
Abses subgaleal sebagai komplikasi otitis media supuratif kronis Adriana, Riska; Mahdiani, Sally; Soeseno, Bogi; Dermawan, Arif
Oto Rhino Laryngologica Indonesiana Vol 45, No 1 (2015): Volume 45, No. 1 January - June 2015
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1545.434 KB) | DOI: 10.32637/orli.v45i1.107

Abstract

Latar belakang: Abses subgaleal merupakan salah satu komplikasi yang jarang dari otitis media supuratif kronis. Abses subgaleal ditemukan sekitar 32,4%, namun baru satu kasus mastoiditis dengankomplikasi abses subgaleal pada pasien dewasa yang pernah dilaporkan. Tujuan: Laporan kasus inidimaksudkan untuk mempresentasikan gambaran klinis dan diagnosis, serta penatalaksanaan dari otitismedia supuratif kronis dengan komplikasi abses subgaleal. Kasus: Satu kasus otitis media supuratifkronis dengan komplikasi mastoiditis dan terjadi perluasan infeksi ke ruang subgaleal pada seorang wanitaberumur 21 tahun, gravida 35 minggu. Penatalaksanaan: Dilakukan insisi drainase di temporoparietal,kemudian dilakukan mastoidektomi setelah tindakan terminasi kehamilan. Kesimpulan: Abses subgalealadalah salah satu komplikasi yang jarang terjadi akibat dari otitis media supuratif kronis. Diagnosis secaradini dan penatalaksanan yang tepat akan menentukan tingginya keberhasilan. Kata kunci: Otitis Media Supuratif Kronis, abses subgaleal, gravidaABSTRACT Background: Subgaleal abscess is a rare complication of chronic suppurative otitis media. Subgaleal abscess was found about 32,4%, but only one case of subgaleal abscess as a complication of mastoiditisin adult had been reported. Purpose: To present the clinical and diagnostic findings along with themanagement of subgaleal abscess with mastoidectomy. Case: A case of chronic suppurative otitis mediawith mastoiditis complication and extension into subgaleal space that was found in a 21 years old, 35weeks gravid woman. Management: Drainage incision at temporofacial region and later, mastoidectomyafter childbirth. Conclusion: Subgaleal abscess is one of the rare complications of chronic suppurativeotitis media. Early diagnosis and appropriate treatment will improve the outcome. Keywords: Chronic suppurative otitis media, subgaleal abscess, gravida