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Adanya kesenjangan wilayah antar kecamatan di Kabupaten Gunungkidul terlihat dari tingginya perbedaan angka kemiskinan dan nilai Produk Domestik Regional Bruto (PDRB) serta terkonsentrasinya kegiatan pada wilayah ibukota kabupaten. Untuk itu penentuan pusat-pusat pertumbuhan secara tersebar diperlukan di Kabupaten Gunungkidul untuk meminimalisir kesenjangan yang terjadi. Adapun tujuan penelitian ini adalah untuk menentukan kecamatan yang layak menjadi lokasi pusat-pusat pertumbuhan. Adapun tahapan analisis yaitu menganalisa calon lokasi berdasarkan sarana-prasarana dengan analisis scalogram dan menganalisa calon lokasi berdasarkan struktur pertumbuhan ekonomi dengan analisis tipologi klassen. Hasil analisis menunjukkan bahwa terdapat kecamatan yang layak dan tidak layak berdasarkan sarana prasarana dan juga berdasarkan struktur pertumbuhan ekonomi di masing-masing kecamatan. Adapun lokasi pusat-pusat pertumbuhan adalah Kecamatan Wonosari, Kecamatan Playen Kecamatan Semanu dan Kecamatan Karangmojo.

Objective: Idiopathic sudden sensorineural hearing loss may be accompanied by dizziness without true vertigo. This study used the video head impulse test to evaluate vestibular function in idiopathic sudden sensorineural hearing loss patients who described experiencing dizziness and not true vertigo., Methods: A prospective study was conducted of 30 consecutive patients diagnosed with idiopathic sudden sensorineural hearing loss with dizziness without true vertigo. A comparison of the video head impulse test results of the patients who complained of dizziness (symptomatic group) with a group of patients with idiopathic sudden sensorineural hearing loss and no dizziness (asymptomatic) was performed., Results: Nine patients (30 per cent) were symptomatic. Two of those patients had abnormal video head impulse test findings. Seven patients in the asymptomatic group (7 out of 21, 33 per cent) presented with abnormal video head impulse test results. No significant difference in vestibular function between the two groups was detected by the video head impulse test., Conclusion: The site of insult in patients with idiopathic sudden sensorineural hearing loss without true vertigo is usually limited to the cochlea or the cochlear nerve.

Objective: To evaluate the quality of leading Internet resources of information on sudden sensorineural hearing loss (SSNHL)., Study Design: Cross-sectional descriptive design., Settings: An online search by means of the Google search engine., Methods: An online search was conducted using terms related to SSNHL. We defined "quality" according to scaled readability measures (Flesch Reading Ease [FRE] and Flesch-Kincaid Grade-Level [FKGL]), as well as "understandability" and "actionability" (Patient Education Materials Assessment Tool), and Clinical Practice Guideline (CPG) adherence. Scoring was performed by two independent physicians., Results: The 10 most frequently encountered patient education websites were analyzed. The average FRE score was "fairly difficult" (mean 57.28, median 55.55, range 46.4-71.8) and the average FKGL score was "standard" (mean 9th grade, median 9th grade, range 5th-10th grade). Nine websites were understandable (mean 83%, median 84%, range 69-100%), and seven had good actionability scores (mean 73%, median 75%, range 50-100%). Most websites conformed with the CPG for patient education at a reasonable level (mean 5.6, median 5.5, range 3-7). Notably, all websites encouraged seeking medical help., Conclusion: Internet resources for patient education on SSNHL vary in quality and are generally understandable to the average layman. There is still much room for better, more comprehensive and easier-to-read information to improve patients' medical knowledge about their condition.Level of Evidence: 1., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)

Objectives/hypothesis: The aim of the study was to investigate the healing rates, the restoration of hearing, and the time for complete healing of paper patching versus watchful waiting for traumatic tympanic membrane perforations (TTMPs)., Study Design: Systematic review with meta analysis., Methods: Publications were selected by a search on "PubMed," "Embase," and "Web of Science." A meta-analysis of risk ratios for paper patching (intervention arm) and watchful waiting (control arm) was performed., Results: Five studies describing 393 TTMPs were included in the quantitative meta-analysis. TTMP healing rates ranged between 84.2% and 95.2% in the intervention arm and between 76.7% and 84.8% in the control arm. The pooled risk ratio of healed TTMPs was significantly higher in the intervention arm than in the control arm (risk ratio: 1.12, 95% confidence interval: 1.04-1.21)., Conclusions: TTMPs have high healing potential with and without intervention. The healing rate of paper patching was superior to that of watchful waiting alone., Level of Evidence: NA Laryngoscope, 131:2091-2097, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc..)

Objective: To compare the measured bone conduction threshold at 3 kHz with the calculated threshold in newly diagnosed sudden sensorineural hearing loss., Methods: A retrospective chart review was conducted of pure tone audiograms in confirmed sudden sensorineural hearing loss cases., Results: Of 157 patients with sudden sensorineural hearing loss, 144 had idiopathic hearing loss, 8 had vestibular schwannoma and 5 had Ménière's disease. The r value for the correlation between the two methods of 3 kHz assessment for all patients was 0.887 (p < 0.001). The mean difference between the measured and calculated 3 kHz thresholds was 0.76 ± 7.96 dB, 0.4 ± 8.08 dB and 1.5 ± 1.8 dB in the sudden sensorineural hearing loss, idiopathic and Ménière's disease groups, respectively. The mean difference between the measured and calculated 3 kHz thresholds was significantly greater in the vestibular schwannoma group (6.86 ± 4.38 dB) than in the idiopathic group (p = 0.013)., Conclusion: The 3 kHz frequency may encompass important audiometric information. A discrepancy between the measured and calculated bone conduction 3 kHz thresholds raises suspicion of an underlying vestibular schwannoma as an aetiology for sudden sensorineural hearing loss, and these thresholds should therefore be measured independently and routinely.

Objectives/hypothesis: To investigate the risk of residual tympanic membrane (TM) perforation after intratympanic (IT) steroidal treatment administered via transtympanic injection compared with trans-tympanostomy tube (TyT)., Study Design: Case series, systematic review and meta analysis., Methods: Data were retrieved from the medical files of an original cohort of all consecutive patients with sudden sensorineural hearing loss necessitating IT steroidal treatment in a tertiary medical center between January 1, 2016 and November 20, 2020. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" on comparable published cases was performed and meta-analysis was established., Results: Eighteen studies describing 818 ears were included in the quantitative meta-analysis in addition to a local cohort of 140 ears. The proportion of residual TM perforation was 1.11% and 1.14% (95% confidence interval: 0.01%-3.27% and 0.028%-2.38%) in the TyT and trans-tympanic groups, respectively, suggesting no significant difference in residual TM perforation risk between these techniques., Conclusion: IT steroid therapy via trans-TyT is not associated with more residual perforations than IT steroid therapy via transtympanic injections., Level of Evidence: NA Laryngoscope, 131:E2583-E2591, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc..)

Objective: To calculate the incidence of sensorineural hearing loss (SNHL; pure or as part of a mixed hearing loss, MHL) among bullous myringitis (BM) patients with a coexisting HL to assess whether steroidal treatment should be initiated even before the findings of a formal audiogram are available., Methods: Retrospective medical record review in a tertiary referral center and systematic review of the English literature., Results: The medical records of 81 patients with BM were retrieved among whom 50 patients (62%) had actually sustained a HL, although only 39/81 patients reported a HL when asked. Twenty-four patients had a MHL, 18 had a SNHL, and eight had a conductive HL (CHL). The systematic review included 106 ears: 17 had no HL, 53 had a MHL, 20 had a SNHL, and 16 had a CHL. The combined published and current results yielded a SNHL and MHL rates of 38/139 (27%) and 77/139 (55%), respectively of all BM patients with confirmed HL., Conclusion: BM is intuitively associated with a CHL resulting from the impeded function of the affected middle ear. Medical history and physical examination are not sufficient to exclude a SNHL in BM patients, and formal audiometry is mandatory for exclusion/confirmation in this setting. Nevertheless, steroidal treatment should not be delayed until the performance of formal audiometry because the actual rate of pure CHL in this setting is very low.Level of Evidence: 2., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)

Objective: Necrotising otitis externa is associated with high morbidity and mortality rates. This study investigated whether temporomandibular joint involvement had any prognostic effect on the course of necrotising otitis externa in patients who had undergone hyperbaric oxygen therapy after failed medical and sometimes surgical therapy., Methods: A retrospective case series was conducted of patients in whom antibiotic treatment and surgery had failed, who had been hospitalised for further treatment and hyperbaric oxygen therapy., Results: Twenty-three patients with necrotising otitis externa were identified. The temporomandibular joint was involved in four patients (17 per cent); these patients showed a constant gradual improvement in C-reactive protein and were eventually discharged free of disease, except one patient who was lost to follow up. Four patients (16 per cent) without temporomandibular joint involvement died within 90 days of discharge, while all patients with temporomandibular joint involvement were alive. Three patients (13 per cent) without temporomandibular joint involvement needed recurrent hospitalisation including further hyperbaric oxygen therapy; no patients with temporomandibular joint involvement required such treatment., Conclusion: Patients with temporomandibular joint involvement had lower rates of recurrent disease and no mortality. Therefore, we suggest considering temporomandibular joint involvement as a positive prognostic factor in necrotising otitis externa management.