DATA

No Name Initials Age (yo) Gender Height (cm) Wight (kg)Medical History - Comorbidity

1 Rini Wahyuni RW 24 F 155 50 -

2 Ani Karniawati AK 37 F 155 66 -

3 Nuni Nuryani NN 30 F 156 74 -

4 Fajar Sidiq FS

Allergic Rhinology

5 Aan Kartini AA

6 Sari Arsih Tania SAT

7 Toriq Koswara TK

8 Faridah FR

9 Devi Mujiati DM

10 Yani Mulyani YM

11 SN

12 Novi Sarifah NS

13 FAS

14 Heny Yuniawati HY

Susi Nursyamsiah

Flora A. Situmorang

15 Suminar SM 20 F 160 46 _

16 II Kuswati II

17 RH

18 Agam Anduka AA

19 FF

Rahmat Hamdani

Fadhila Faturrachmi

20 Ubana UB

21

22

DATA

Medical History - Comorbidity Visit Sign & Symptom

No Date

+ - - -

1 19/6/2013 16/6/2013

2 26/6/2013 16/6/2013

3 10/7/2013 16/6/2013

- - - -

1 19/6/2013 17/6/2013

2 26/6/2013 17/6/2013

3 drop out

- - - -

1 20/6/2013 16/6/2013

2

3

1

2

3

Adenoid Hypertrophy

Posteromedial Deviated Septum

Concha Bullosa

Lateral deflected uncinate process

Date of onset

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

_ _ _ _

1 22/8/2013 21/8/2013

2 29/8/2013 21/8/2013

3 12/9/2013 21/8/2013

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

DATA

Sign & Symptom Physical Exam

Others Vital Sign

+ + + + - normal limit

+ + + + - normal limit

- + + - - normal limit

+ + + + - normal limit

+ + - - - normal limit

+ + + - - normal limit

Nasal Obstruction

Nasal Discharge

Facial Pain

Reduction/ Loss of smell

+ + - -

DATA

Physical ExamSinusitis Severity Score (SSS)

HeadacheGeneral State

4 0 1 3

3 0 0 0

2 1 0 0

4 2 2 3

2 1 1 2

Maxillary Pain

Maxillary Pain worsening on bending forward, percussion

or pressureNasal

Obstruction

Bilateral inferior turbinate hyperthrophy

Bilateral inferior turbinate hyperthrophy

Bilateral inferior turbinate hyperthrophy

Bilateral inferior turbinate hyperthrophy

Bilateral inferior turbinate hyperthrophy

Bilateral inferior turbinate hyperthrophy

Bilateral inferior turbinate hyperthrophy

Bilateral inferior turbinate hyperthrophy

DATA

Sinusitis Severity Score (SSS) Visual Analogue Score (VAS) (mm)

Total Score

2 2 12 75 60 20

1 1 5 30 40 10

0 0 3 0 10 10

2 3 16 65 35 35

1 1 8 50 20 0

0

0

0

0

0

0

Purulent Nasal

Secretion

Purulent Nasal Discharge visualized in the middle

meatus, or purulent PNDNasal

ObstructionNasal Discharge

(anterior/ posterior)

Facial Pain

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Visual Analogue Score (VAS) (mm) SNOT-20

2. Sneezing 4. Cough

55 4 4 4 3 3 4 2

10 2 2 2 0 0 0 0

0 0 1 0 0 1 1 0

35 2 3 3 2 4 3 4

30 2 2 1 1 1 0 0

Reduction/ Loss of Smell

1. Need to blow nose

3. Runny nose

5. Post Nasal discharge

6. Thick Nasal

Discharge7. Ear

fullness

SNOT-20

5 2 1 0 0 0 1 2

3 0 1 0 0 0 1 1

1 0 1 0 0 0 0 0

5 3 2 3 3 3 3 2

1 0 0 1 0 0 0 0

8. Dizziness

9. Ear Pain

10. Facial Pain /

Pressure11. Difficulty Falling asleep

12. Wake up at night

13. Lack of a good night's

sleep14. Wake up tired

15. Fatigue

SNOT-20

19. Sad Total

2 2 3 3 5 50 1,2,3,8,20

0 0 1 0 0 13 1,2,3,8

0 0 0 0 0 5 2,5,6,8,10

3 3 3 2 2 58 2,5,7,8,13

0 0 0 0 0 9 1,2

0

0

0

0

0

0

16. Reduced Productivity

17. Reduced Concentration

18. Frustated/ Restless/ Irritable

20. Embarrassed

Most Important

item

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

NasoendoscopyStep 1

Nasopharynx Ostium Tuba Eustachius Inferior Turbinate

Right Left Right Left Right Left

Opened Opened

Opened Opened enlargement enlargement

Opened Opened enlargement enlargement

PND (+) mucopurulent PND (+) mucopurulent Opened Opened

PND (-) PND(-) Opened Opened enlargement enlargement

PND (+) seromucoid, Adenoid hyperthrophy

25%

PND (+) seromucoid, Adenoid hyperthrophy

25%Hyperemic

enlargement Hyperemic

enlargement

PND (-), Adenoid hyperthrophy 25%

PND (-), Adenoid hyperthrophy 25%

PND (-), Adenoid hyperthrophy 25%

PND (-), Adenoid hyperthrophy 25%

Hyperemic enlargement

Hyperemic enlargement

NasoendoscopyStep 1 Step 2

Recessus Sphenoethmoidalis Ostium Sphenoid Sinus Middle Turbinate

Right Left Right Left Right Left

Normal Normal Normal Normal Normal Normal

Normal Normal Normal Normal Normal Normal

Normal Normal Normal Normal Normal Normal

Normal Normal Normal Normal Normal Normal

Normal Normal Normal Normal Normal Normal

NasoendoscopyStep 2

Meatus Media Uncinate Process Ethmoidal Bulla Deviated Septum

Right Left Right Left Right Left Right Left

Edema (+) Edema (+) + + - -

Edema (+) Edema (+) + + - -

Edema (-) Edema (-) + + - -

Edema (+) Edema (+) + + - -

Edema (+) Edema (+) + + - -

Opened, secret (-)

Narrowed, secret (-)

Opened, secret (-)

Narrowed, secret (-)

Opened, secret (-)

Opened, secret (-)

Narrowed, secret (+) mucopurulent

Narrowed, secret (+) mucopurulent

Opened, secret (-)

Opened, secret (-)

NasoendoscopyStep 3 Others

Recessus Frontalis Polyp DischargeOther

Right Left Right Left Right Left

Normal Normal - - Seromucoid Seromucoid Spur (+/+) 2

Normal Normal - - - - Spur (+/+) 1

Normal Normal - - - - Spur (+/+) 0

Normal Normal - - mucopurulent mucopurulent - 2

Normal Normal - - - - - 1

Score Nasoendoscopy (Lund-Kennedy Criteria)

Mucosal Edema

Radiography (Water's Positions)E3POS Criteria van Buchem

TotalAir Fluid Level NA 1 = Normal

Right Left Right Left Right Left Right Left Right

2 4 - - - + - + yes - - -

0 1

0 0 - - - - - - no - - +

2 4 - + - - - - Yes - - -

0 1

0

0

0

0

0

0

Score Nasoendoscopy (Lund-Kennedy Criteria)

Nasal Discharge

Mucosal Thickening ≤ 6 cm

Complete Opacification Conclusion

(yes/no)

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Radiography (Water's Positions)SPT

van Buchem

1 = Normal

Left Right Left Right Left Right Left Right Left

- - - - - - + + - yes 3x3

+ - - - - - - - - no

- - + - - - - - - Yes 4x4

2 = mucosal thickening ≤ 6 cm

3 = mucosal thickening ≥ 6 cm

4 = Complete Opacification

5 = Air Fluid Level Conclusion

(yes/no)Positive Control

SPT

D. Farinae Cockroach Cat Hair

0 0 0 0 0 0 0 Yes

Yes

0 2x2 0 0 0 0 0 Yes

Yes

Study Drug DispensingNegative

ControlD.

PteronyssinusDog

EpitheliaAspergillus Fumigatus

Yes No

Yes No 100 No

No - No

Yes No

Yes No 57,14

Diary Card Dispensing

Comcomitant Medications

Study Drugs Compliance (%)

Adverse Event (specify)

Yes, dyspnea since 5th day of

medication