BAHAN PEMICU 7

PENGINDERAAN
Ivan Buntara
405120049
 Learning Objectives
1. Menjelaskan faal pendengaran dan faal keseimbangan
2. Menjelaskan gangguan telinga bagian dalam :
• Gangguan pendengaran : tuli (perseptif, kongenital, konduktif), tinitus
(subjektif, objektif), presbiakusis, labirintitis
• Gangguan keseimbangan : motion sickness, vertigo, Meniere’s disease,
gangguan vestibuler (neuritis vestibuler, neuroma akustik)
3. Menjelaskan aliran getah bening kepala-leher
4. Menjelaskan keganasan THT-KL : NPC, angiofibroma nasofaring
juvenil, karsinoma laring
Silverthorn DU. Human physiology: an integrated approach. 6th
ed. Illinois: Pearson Education Inc.; 2013.
Human Physiology by Lauralee Sherwood ©2007 Brooks/Cole-
Thomson Learning.
Human Physiology by Lauralee Sherwood ©2007 Brooks/Cole-
Thomson Learning.
Human Physiology by Lauralee Sherwood ©2007 Brooks/Cole-
Thomson Learning.
 Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head
and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
Silverthorn DU. Human physiology: an integrated approach. 6th
ed. Illinois: Pearson Education Inc.; 2013.
Silverthorn DU. Human physiology: an integrated approach. 6th ed. Illinois: Pearson Education Inc.; 2013.
Guyton AC, Hall JE. Textbook of medical physiology. Philadelphia: Saunders Elsevier; 2006.
JALUR PROYEKSI
AUDITORI LANGSUNG

Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head

and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 3. London: Edward Arnold Ltd.; 2008.
 Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head
and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
 KORTEKS AUDITORI

Guyton AC, Hall JE. Textbook of medical physiology. Philadelphia: Saunders Elsevier; 2006.
Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 3. London: Edward Arnold Ltd.; 2008.
FUNGSI ORGAN VESTIBULER MANUSIA

Guyton AC, Hall JE. Textbook of medical physiology. Philadelphia: Saunders Elsevier; 2006.
Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 3. London: Edward Arnold Ltd.; 2008.
FUNGSI ORGAN VESTIBULER MANUSIA

Guyton AC, Hall JE. Textbook of medical physiology. Philadelphia: Saunders Elsevier; 2006.
Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 3. London: Edward Arnold Ltd.; 2008.
Silverthorn DU. Human physiology: an integrated approach. 6th
ed. Illinois: Pearson Education Inc.; 2013.
Silverthorn DU. Human physiology: an integrated approach. 6th
ed. Illinois: Pearson Education Inc.; 2013.
Human Physiology by Lauralee Sherwood ©2007 Brooks/Cole-
Thomson Learning.
Human Physiology by Lauralee Sherwood ©2007 Brooks/Cole-
Thomson Learning.
 Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head
and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
 SISTEM LIMFATIK SERVIKAL
• Superfisial
• Menembus fascia servikal
• Mengalir ke sistem limfatik yang lebih dalam
• Dalam
• Paling sering ditemukan di sekitar pembuluh darah, saraf, otot
• Menyalurkan mukosa mulut, orofaring, nasofaring, laring, dan hipofaring

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
SISTEM LIMFATIK SERVIKAL

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 KELOMPOK SUBMENTAL
• Terletak di midline, inferior terhadap os mandibula, dan diantara
ujung anterior M. digastricus
• Menyalurkan dasar mulut bagian anterior

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 KELOMPOK SUBMANDIBULAR
• Dibagi menjadi 6 kelompok → preglandular, prevaskular,
retrovaskular, retroglandular, intraglandular, nodus yang letaknya
lebih dalam
• Berhubungan dengan kelenjar submandibula dan pembuluh-
pembuluh fasial
• Keganasan pada dasar mulut, lidah, dan kavitas bukal → lebih sering
metastasis ke nodus perivaskular

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 RANTAI JUGULARIS
• 80% nodus limfe di leher → berhubungan dekat dengan V. jugularis
interna
• Saluran limfatik → di dalam jaringan areolar longgar
• Jaringan areolar longgar → di sekitar V. jugularis interna dan di dalam carotid
sheath
• Nodus limfe → di anterior, posterior, dan lateral dari vena
• Segmen paling superior dari vena → berjalan dari basis cranii s/d
setinggi bifurcatio A. carotis (pada level yang sama dengan cornu
mayor os hyoid menyilangi V. jugularis interna)

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 RANTAI JUGULARIS
• Tingkat yang paling superior dari vena → berjalan ke dalam M.
digastricus
• Nodus limfe yang ditemukan di sini → nodus jugulodigastricus
• Susunan nodus pertama yang mendrainase regio faucial posterior, terutama
tonsil palatina
• Diantara nodus jugularis superior dan media → nodus junctional
• Anastomosis limfatik dari nodus submandibular, nodus retrofaringeal, dan
nodus rantai jugularis

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 RANTAI JUGULARIS
• Nodus jugularis media → diantara bifurcatio A. carotis, setinggi
tendon M. omohyoid menyilangi V. jugularis interna
• Susunan nodus pertama untuk midhypopharynx larynx dan bagian superior
glandula tiroid
• Nodus jugularis inferior → diantara tendon M. omohyoid, turun
masuk ke rongga toraks. Kadang-kadang disebut kelompok nodus
preskalenus
• Membentuk pertemuan yang penting antara kelompok nodus mediastinal,
kelompok aksilaris, dan kelompok leher → alasan mengapa nodus di leher
dapat terlibat pada penyakit di luar leher

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 NODUS POSTERIOR
• Segitiga posterior → nodus limfe yang tersusun menjadi 2 kelompok :
di sepanjang N. XII dan yang berhubungan dengan pembuluh-
pembuluh tiroservikal
• Nodus di sepanjang N. XII → susunan pertama untuk nasofaring
• Susunan kedua untuk daerah yang didrainase nodus leher anterior →
berhubungan dengan pembuluh-pembuluh tiroservikal

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 LEVEL NODUS LIMFATIK

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 LEVEL NODUS LIMFATIK
• Dibuat oleh Memorial Sloan Kettering Hospital (NY) dan diadopsi oleh
American Academy of Otolaryngology Head and Neck Surgery
(AAOHNS) pada tahun 1991
• Membagi leher menjadi 6 level
• Level I – V : diapsangkan di lateral
• Level VI : nodus midline dari hyoid s/d sternal notch
• Head and Neck Cancer Committee of the American Academy of
Otolaryngology Head and Neck Surgery → memasukkan subzona

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 LEVEL I
• Nodus submental (subzona Ia) dan submandibular (subzona Ib)
• Mendrainase bibir, kavitas oral, dan lidah
• Subzona Ia → mendrainase dasar anterior dari mulut, bawah bibir,
dan lidah ventral
• Subzona Ib → mendrainase bagian lain dari kavitas oral

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 LEVEL II
• Membentuk kelompok nodus jugularis superior
• Mendrainase oropharynx, larynx, hypopharynx, dan parotis
• N. accessorius spinalis → membagi level ini menjadi 2 subzona :
anteroinferior terhadap N. accessorius spinalis (IIa) dan
posterosuperior terhadap N. accessorius spinalis / recessus
submuskular (IIb)
• Penyakit yang melibatkan level IIa → diseksi IIb
• Diseksi elektif untuk keganasan larynx dan hypopharynx → dapat
mengecualikan level IIb

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 LEVEL III
• Nodus jugularis media
• Mendrainase larynx dan pharynx
• Tidak dibagi menjadi subzona → paling besar pada level jugular dan
paling sedikit variasi daerah drainasenya

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 LEVEL IV
• Kelompok nodus jugularis inferior
• Daerah kecil, mendrainase larynx dan hypopharynx

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 LEVEL V
• Kelompok nodus segitiga posterior
• Mendrainase area limfatik lainnya di leher
• Subzona Va
• Bagian superior s/d inferior M. omohyoid
• Rantai nodus di sepanjang N. XII; mendrainase nasopharynx
• Subzona Vb
• Bagian inferior M. omohyoid
• Nodus berhubungan dengan truncus thyrocervicalis; mendrainase glandula
tiroid

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 LEVEL VI
• Kelompok nodus anterior / sentral → nodus paratrakeal, nodus
peritiroidal, dan nodus Delphian

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 LEVEL VII
• Jaringan mediastinal superior
• Tidak dikenal oleh kebanyakan teks di Amerika

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
ANGIOFIBROMA NASOFARING
JUVENIL
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
KARSINOMA NASOFARING (NPC)
 EPIDEMIOLOGI KARSINOMA NASOFARING
• Insiden tertinggi berdasarkan usia → populasi Cantonese (Cina
selatan)
• Prevalensi tinggi → ditemukan juga di Asia Tenggara (Malaysia,
Indonesia, Thailand, Vietnam, Filipina)
• Pria lebih sering terkena daripada wanita
• Usia onset → lebih muda dari keganasan lainnya (insiden ↑ pada
dekade ke-2, mencapai plateau pada dekade ke-5, kemudian ↓
seiring dengan bertambahnya usia)

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 KARSINOMA NASOFARING
Faktor genetik Infeksi laten EBV
dan reaktivasi

KARSINOMA
NASOFARING

Paparan
karsinogen
lingkungan
Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 MANIFESTASI KLINIS KARSINOMA
NASOFARING
• Stadium awal →
• Dapat asimtomatik
• Gejala telinga : tuli, tinitus, otalgia
• Gejala hidung : sekret hidung yang
mengandung darah, obstruksi nasal, post-
nasal drip, epistaksis unilateral
• Gejala telinga dan hidung
• Stadium lanjut
• Benjolan di bagian atas segitiga posterior
leher (limfadenopati servikal) → keluhan
tersering pasien yang datang
• Keterlibatan saraf kranial (terutama N. V
dan VI)
• Metastasis (jarang; pada tulang, paru,
hepar)

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones

NS, et al., editors. Scott-brown’s otorhinolaryngology, head and
neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.;
 DIAGNOSIS KARSINOMA NASOFARING
• Anamnesis → keluhan
• Pemeriksaan kepala-leher
• Pemeriksaan nasofaring → rinoskopi posterior, nasofaringoskopi retrograde
transoral, nasofaringoskopi antegrade, fiberskop fleksibel, endoskop rigid
• Biopsi pada lesi mencurigakan
• Serologi (untuk area endemis) : IgA anti-VCA (spesifisitas <<), IgA anti-EA
(spesifisitas >>)
• Sitologi
• Pewarnaan imunokimia (untuk yang terkait EBV)
• Radiologi (untuk penentuan stadium, rencana radioterapi, dan monitoring
pasca terapi) : CT, MRI, USG, PET, SPECT

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 DIAGNOSIS BANDING KARSINOMA
NASOFARING
• Karsinoma sinonasal tak terdiferensiasi
• Melanoma amelanotik

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
 TATALAKSANA KARSINOMA NASOFARING
• Radioterapi → megavoltage external radiotherapy (ERT), iradiasi leher
elektif
• Stadium I – II → radioterapi konvensional
• Stadium III – IVb → radioterapi konvensional + kemoterapi
Follow-up : minimal setiap 2 bulan pada tahun I, setiap 3 bulan pada tahun II
dan III, kemudian setiap 6 bulan setelahnya
• Salvage treatment

Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al., editors. Scott-brown’s
otorhinolaryngology, head and neck surgery. 7th ed. Volume 2. London: Edward Arnold Ltd.; 2008.
MENIERE’S DISEASE
 MENIERE’S DISEASE
• Kelainan otologi primer :
• Hilang pendengaran fluktuatif
• Vertigo episodik trias
• Tinitus
• Rasa penuh pada telinga
• Vertigo → spontan, rotasional, rekuren, berlangsung 20 menit – 24 jam,
tidak ada gejala neurologis
→ keluhan tersering
• Hilang pendengaran → tuli sensorineural frekuensi rendah, fluktuasi
(tercatat pada audiometri minimal 1x), unilateral
• Tinitus → low pitched, unilateral, volume ↑ saat serangan vertigo

Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head

and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
 EPIDEMIOLOGI MENIERE’S DISEASE
• Usia : 40 – 60 tahun
• Kebanyakan kasus : unilateral

Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head

and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
 Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head
and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
 DIAGNOSIS MENIERE’S DISEASE
• Anamnesis
• Audiometri
• Tes respon kalori → << / (-)
• Head thrust test → normal
• Elektrokokleografi

Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head

and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
 TATALAKSANA MENIERE’S DISEASE
• Farmakologi : diuresis, kortikosteroid PO dan atau injeksi
intratimpanik, injeksi gentamisin intratimpanik dosis rendah (kontrol
vertigo)
• Nonfarmakologi : restriksi garam, pembedahan pada kantung
endolimfatik, neurektomi vestibular selektif (pada pasien yang
resisten dengan terapi), labirintektomi

Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head

and neck surgery. 17th ed. Volume 1. Connecticut: BC Decker
Inc; 2009.
BENIGN PAROXYSMAL POSTURAL
VERTIGO (BPPV)
http://www.cmaj.ca/
http://vestibular.org/
http://capitolent.net/
 http://cfs10.blog.daum.net/
http://www.crushingnet.com/
 DAFTAR PUSTAKA
• Silverthorn DU. Human physiology: an integrated approach. 6th ed.
Illinois: Pearson Education Inc.; 2013.
• Human Physiology by Lauralee Sherwood ©2007 Brooks/Cole-
Thomson Learning.
• Guyton AC, Hall JE. Textbook of medical physiology. Philadelphia:
Saunders Elsevier; 2006.
 DAFTAR PUSTAKA
• Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al.,
editors. Scott-brown’s otorhinolaryngology, head and neck surgery. 7th ed.
Volume 1. London: Edward Arnold Ltd.; 2008.
• Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al.,
editors. Scott-brown’s otorhinolaryngology, head and neck surgery. 7th ed.
Volume 2. London: Edward Arnold Ltd.; 2008.
• Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al.,
editors. Scott-brown’s otorhinolaryngology, head and neck surgery. 7th ed.
Volume 3. London: Edward Arnold Ltd.; 2008.
• Snow JB, Wackym PA. Ballenger’s otorhinolaryngology head and neck
surgery. 17th ed. Volume 1. Connecticut: BC Decker Inc; 2009.