Post on 06-Jul-2018
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Oleh:
Adya Arradikha, Teti Madiadipoera,
Arif Dermawan, Melati Sudiro
Hubungan antara unifed airway dengan obstruksi hidung pada pasien
rinitis alergi
Departemen Ilmu Kesehatan Telinga Hidung Tenggorok - Bedah Kepala Leher
Fakultas Kedokteran Universitas Padjadjaran – umah !akit Dr" Hasan !adikin
Bandung
#$%&
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PENDAHULUANRinitis alergi (RA) merupakan suatu gejala gangguan pada hidung
yang terjadi setelah pajanan alergen melalui proses inflamasi
diperantarai IgE pada mukosa hidung.Gejala RA: Obstruksi hidung bersin!bersin hidung berair gatal
hidung
"ous#uet $ %haltae& ' ru AA *enburg $ +okkens ,$ -ogias A et al. Allergi Rhinitis and its Impat on Asthma (ARIA) /001 update (in
ollaboration 2ith the ,orld 3ealth Organiation GA(/)4E' and AllerGen). Allergy. /0015 67 8uppl 16:1!960
"ous#uet $ %haltae& ' et.al. ,3O initiati&e allergi rhinitis and its impat on asthma (ARIA). 8uppl $ Allergy lin Immunol /0095901 : 89;!8/;0.
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PATOGENESIS RINITIS ALERGI
Sin *, To2ia! A5 "#&&5 Pathophy!iolo2y of aller2i6 and nonaller2i6 rhiniti!5 Pro6 Am Thora6 So65-
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Sin *, To2ia! A5 "#&&5 Pathophy!iolo2y of aller2i6 and nonaller2i6 rhiniti!5 Pro6 Am Thora6 So65
-
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UNIFIED AIRWAY
(Pawankar R. Overview on the pathomechanism of allergic rhinitis. Asian pac allergy.2011
inosinusitis
'titis (edia
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Management Rinitis Alergi menurut ARIA WHO
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#!j!an Penelitian
Hu)ungan unified airway dengan o)struksi
hidung
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Metode Penelitian
= Penelitian de!kriptif analitik retro!pektif den2an uBi6hi kuadrat
= Periode & anuari "#&)-=& De!em1er "#&)
= Poliklinik inolo2i-Aler2i Departemen 7lmuKe!ehatan THT-KL S Dr Ha!an Sadikin *andun2
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Metode Penelitian
= Su1Bek Penelitian:
Pa!ien den2an riniti! aler2i di!ertai den2an komor1id:
&5A!ma
"5ino!inu!iti!
=5Otiti! media
)5Hipertropi adenoid, dan
5Henti nafa! o1!truktif !aat tidur den2an 2eBalahidun2 ter!um1at
=. Dia2no!i! unifed airway dite2akan 1erda!arkan,anamne!i!, pemerik!aan >!ik, skin prick test ,pemerik!aan na!oendo!kopi
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VariabelObstruksi Hidung
Nilai P- C
& eni! Kelamin
Laki-laki &8&),=%9 @#8$,'%9 #,"#"
Perempuan ")8"#,@%9 @&8'@,&%9
" !ia
E"# tahun )8(,'%9 (8@=,=%9 #,#('
"#-"@ tahun &=8"%9 )8'%9
=#-=@ tahun $8"),"%9 "8',$%9
)#-)@ tahun 8&,"%9 "$8$),$%9
#-@ tahun )8&$,"%9 &$8$&,$%9
H*!IL D*+ DI!KU!I
arakteristik !ub"ek Penelitian #erdasarkan $dentitas Pasien
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KOMO*7D PAS7;. 7.7T7SAL;7
#%##%
##%&##%"###%"##%=###%
=##%)###%
=&$#5##%"@#5##%
&()#5##% &)#5##% #5##%
Menurut A7A 4HO riniti! aler2i dan a!ma menBadima!alah 1e!ar yan2 !erin2 ditemukan di 1er1a2ai 1elahan
duniaMenurut Krou!e =$% pa!ien riniti! aler2i memiliki a!ma
*ou!+uet , Khaltae ., /ru0 AA, Den1ur2 , 3okken! 4, To2ia! A, et al5 Aller2i6 hiniti! and it! 7mpa6t on
A!thma 8A7A9 "##$ update 8in 6olla1oration with the 4orld Health Or2ani0ation, A8"9L;. and Alleren95Aller2y5 "##$< (= Suppl $(:$-&(#
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"@%
")%
""%
"%
O1!truk!i hidun2
Hidun2 1erair
atal hidun2*er!in
e"ala Hidung Pada Pasien &ni'ed (ir)a*
A7A 4HO o1!truk!i hidun2 2eBala yan2 !erin2dikeluhkan yan2 dapat menurunkan kualita! hidup
*ou!+uet , Khaltae ., /ru0 AA, Den1ur2 , 3okken! 4, To2ia! A, et al5 Aller2i6 hiniti! and it! 7mpa6t on A!thma 8A7A9
"##$ update 8in 6olla1oration with the 4orld Health Or2ani0ation, A8"9L;. and Alleren95 Aller2y5 "##$< (= Suppl $(:$-&(#*ou!+uet , Khaltae ., et5al5 4HO initiatie aller2i6 rhiniti! and it! impa6t on a!thma 8A7A95 Suppl Aller2y /lin 7mmunol
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+,(( .$N$/$!(+.$
Obstruksi hidung
"ersin
3idung berair
Gatal hidung
'yeri 2ajah
'yeri kepala
'yeri telinga
0 60 ;0 10 ?0
1/.7
;9.1
61.6
67./
97.6
/7.6
9.>
7;./
olumn/
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VariabelObstruksi Hidung
P ValueC8nF&$&9
-8nF=@9
A!ma
C (= ' #,#)
- &&$ ="
ino!inu!iti!
C ) = #,##)
- &"' =(
Otiti! media
C ") &" #,##'
- &' "'
Hipertro> adenoid
C "' ' #,(=
- &) ="
Henti nafa! o1!truktif !aat tidur
Hasil Penelitian
Ket: .ilai p 1erda!arkan uBi 6hi !+uare
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Se6ara pato>!iolo2inya terdapat per!amaan antaraperadan2an pada !aluran nafa! ata! dan !aluran nafa!
1awahHi!tolo2i muko!a !aluran nafa! ata! dan 1awah
merupakan !uatu unit terinte2ra!i
Krou!e H, *rown 4, 3ineman SM et al5 A!thma and the uni>ed airway5 Ameri6an A6ademy of Otolaryn2olo2y-
Head and .e6k Sur2ery 3oundation5 "##'< &=(:S'-S(
initi! aler2i menim1ulkan in?ama!i padamem1ran muko!a hidun2, tu1a eu!ta6hiu!, telin2a
ten2ah, !inu! dan 1ronkhu!
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Unified
irway
Didapatkan
hu1un2an1ermakna antara
unifed airwayden2an o1!truk!i
hidun2
!$1P&(N
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!(.(N
initi! Aler2i haru! dio1ati
!e!uai den2an rekomenda!iA7A 4HO a2ar tidak terBadi
komor1idita!
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T;7MA KAS7H
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7n?ama!i pada muko!a hidun2 dan 1ronkhial mempunyaipro!e! in>ltra!i in?ama!i yan2 !ama, yaitu oleh adanya !el
eo!ino>l, !el ma!t, dan !el T-limfo!it5
Patogenesis *sma
immer , uhno 45 hiniti! and a!thma: uni>ed airway di!ea!e5 MA pra6ti6ee!!ential!-aller 5 "##(
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"&
Keru!akanepitel dan
!ilia
Pene1alanmuko!a,menin2kat
kan!um1atan
Penin2katan in?ama!i Barin2an
PenutupanO!tium
Penin2katan
pertum1uhan 1akteri
Sum1atanakiran
udara dan
draina!e
Sta2na!iSekret
Pen2entalan !e6ret,
peru1ahanpH
Peru1ahanMeta1oli!m
2a!muko!a
Krou!e H5 Aller2y and /hroni6 hino!inu!iti! Otolaryn2olo2i6 /lini6 of .orth Ameri6a5 ;l!eier Saunder5"##: p &"'-((
Patogenesis inosinusitis
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')struksi Tu)a
eusta,hiusIntraluminalRinitis Alergi
.traluminal
Adenoid 3ypertrophy
'asopharingeal tumor
Tekanan negati/
telinga tengah
/usi
Transudat ksudat '(
*'(
Patogenesis 'titis (edia
+ungsi Otot
-ensor @eli alatiniburuk
"" "luestone. /007. Eustahian -ube +untion and Allergy in Otitis 1
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initi!Aler2i
Patogenesis Henti Na2as Obstrukti2 !aat/idur
Hipertro>konka
Kon2e!tiHidun2
Henti nafa!o1!truktif !aat tidur
Soo!e 5 ole of aller2y in !leep di!ordered 1reathin25 Otolaryn2o 6lin n am5"#&& )):("-(=
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Patogenesis ObstruksiHidung
76himura K5 Me6hani!m of na!al o1!tru6tion in patient with aller2i6 rhiniti!5 /lini6al and ;Gperimental
Epidemiologi
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Epidemiologi
ARIA WHO rinitis alergi terjadi 5 j!ta orang di
sel!r!" d!nia
*andun2, riniti! aler2i den2an: a!ma "#,$% dan rino!inu!iti! &',&%
*ou!+uet , Khaltae ., /ru0 AA, Den1ur2 , 3okken! 4, To2ia! A, et al5 Aller2i6 hiniti! and it! 7mpa6t on A!thma 8A7A9"##$ update 8in 6olla1oration with the 4orld Health Or2ani0ation, A8"9L;. and Alleren95 Aller2y5 "##$< (= Suppl $(:$-&(#Ari>anto A, Madiadipoera T, Sudiro M, Dermawan A5 Karakteri!tik initi! Aler2i di Poliklinik Departemen 7lmu Ke!ehatan THT-KL S Dr5 Ha!an Sadikin *andun25 9th Jakarta International Functional Endoscopy Sinus Surgery : 3e1ruari "#&=Marple *35 Aller2i6 rhiniti! and in?ammatory airway di!ea!e: intera6tion! within the uni>ed air!pa6e5 Am hinol Aleer2y
-
$#%a!mamempunyai riniti!aler2i
(#%-$#%rino!inu!iti!mempunyai aler2i
#% OM;mempunyaialer2i
%-&)%riniti! aler2i
mempunyaia!ma
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arakteristik !ub"ek Penelitian #erdasarkan $dentitas Pasien
SHS prealen!i rhiniti! aler2i le1ih tin22i pada wanita di1andin2 pria
arakteristik ,umlah Persentase%
& eni! Kelamin
Laki-laki )','%
Perempuan && ",=%
" !ia
E"# tahun (# "',=%
"#-"@ tahun '" =",'%
=#-=@ tahun == &%
)#-)@ tahun == &%
#-@ tahun "" 0%
H*!IL D*+ DI!KU!I
Ari>anto A, Madiadipoera T, Sudiro M, Dermawan A5 Karakteri!tik initi! Aler2i di Poliklinik Departemen 7lmu Ke!ehatan THT-KL S Dr5 Ha!an Sadikin *andun25 9th Jakarta International Functional Endoscopy Sinus Surgery : 3e1ruari "#&=
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omorbid Pasien .initis (lergi
&ni'ed (ir)a* ,umlah Presentase %
A!ma '# =&,$%
ino!inu!iti! ' ",@%
Otiti! Media =( &(,)%
Hipertro> adenoid =) &,)%
Henti na2as obstrukti2 saattidur
"= 045%
Menurut A7A 4HO riniti! aler2i dan a!mamenBadi ma!alah 1e!ar yan2 !erin2 ditemukan di
1er1a2ai 1elahan dunia
*ou!+uet , Khaltae ., /ru0 AA, Den1ur2 , 3okken! 4, To2ia! A, et al5 Aller2i6 hiniti! and it! 7mpa6t on
A!thma 8A7A9 "##$ update 8in 6olla1oration with the 4orld Health Or2ani0ation, A8"9L;. and Alleren95Aller2y5 "##$< (= Suppl $(:$-&(#
Menurut Krou!e =$% pa!ien riniti! aler2i memilikia!ma
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e"ala Hidung Pada Pasien &ni'ed (ir)a*
No Variabel ,umlah Persentase%
& O1!truk!i hidun2 &$& $",=%
" Hidun2 *erair && ($,(%
= atal Hidun2 &=@ (=,"%
*er!in &$ 48%
A7A 4HO o1!truk!i hidun2 2eBala yan2 !erin2
dikeluhkan yan2 dapat menurunkan kualita! hidup
*ou!+uet , Khaltae ., /ru0 AA, Den1ur2 , 3okken! 4, To2ia! A, et al5 Aller2i6 hiniti! and it! 7mpa6t on A!thma 8A7A9
"##$ update 8in 6olla1oration with the 4orld Health Or2ani0ation, A8"9L;. and Alleren95 Aller2y5 "##$< (= Suppl $(:$-&(#*ou!+uet , Khaltae ., et5al5 4HO initiatie aller2i6 rhiniti! and it! impa6t on a!thma 8A7A95 Suppl Aller2y /lin 7mmunol
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Ha!il Penelitian
VariabelHidung berair
P ValueC8nF&&9
-8nF(@9
A!ma
C )@ "& #,'((
- " )$
ino!inu!iti!
C )= &) #,&@$
- $
Otiti! media
C "( #,(&"
- &" @
Hipertro> adenoid
C &$ &( #,#="
- &== =
Henti nafa! o1!truktif !aat tidurKet: .ilai p 1erda!arkan uBi 6hi !+uare
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Ha!il Penelitian
Variabelatal hidung
P ValueC8nF&=@9
-8nF$&9
A!ma
C )$ "" #,"$
- @& @
ino!inu!iti!
C "@ "$ #,#"
- & =
Otiti! media
C ") &= #,@"=
- &&( ($
Hipertro> adenoid
C &@ & #,=='
- &"# ((
Henti nafa! o1!truktif !aat tidurKet: .ilai p 1erda!arkan uBi 6hi !+uare
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Ha!il Penelitian
Variabel#ersin
P ValueC8nF&$9
-8nF("9
A!ma
C )( ") #,&(@
- &&" =$
ino!inu!iti!
C )# &' #,')@
- &&$ )
Otiti! media
C " && #,'"@
- &== &
Hipertro> adenoid
C "' ' #,"$)
- &=&
Henti nafa! o1!truktif !aat tidurKet: .ilai p 1erda!arkan uBi 6hi !+uare