tag:blogger.com,1999:blog-80318847770940168742024-03-14T14:48:01.457+08:00Telinga, Hidung, dan TenggorokanCatatan kuliah dokter muda Fakultas Kedokteran Universitas MataramTaufik Abidinhttp://www.blogger.com/profile/07690954313686984126noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-8031884777094016874.post-69917979211658113852009-02-27T11:11:00.004+08:002009-02-27T11:39:49.301+08:00MENELAN (DEGLUTASI) DAN GANGGUAN MENELAN oleh: Lalu W.J. Hardi
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mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt; text-align: justify; line-height: 150%;"><b><span lang="IN" style="font-family:Arial;">PENDAHULUAN</span></b><b style=""><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menurut kamus deglutasi atau deglutition diterjemahkan sebagai proses memasukkan makanan kedalam tubuh melalui <span style="">mulut<i> “<span style="color:black;">the process of taking food into the body through the mouth”</span></i></span><span style="color:black;">.</span><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Proses menelan merupakan suatu proses yang kompleks, yang memerlukan setiap organ yang berperan harus bekerja secara terintegrasi dan berkesinambungan. Dalam proses menelan ini diperlukan kerjasama yang baik dari <span style="">6 syaraf cranial</span>, <span style="">4 syaraf servikal</span> dan lebih dari <span style="">30 pasang otot menelan</span>.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Pada proses menelan terjadi pemindahan bolus makanan dari rongga mulut ke dalam lambung. Secara klinis terjadinya gangguan pada deglutasi disebut <span style="">disfagia</span> yaitu terjadi kegagalan memindahkan bolus makanan dari rongga mulut sampai ke lambung.</span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;">
<br /><span style=";font-family:Arial;color:black;" lang="IN"></span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt; text-align: justify; line-height: 150%;"><b><span lang="IN" style="font-family:Arial;">NEUROFISIOLOGI MENELAN<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" >Dalam proses menelan akan terjadi hal-hal seperti berikut : (1) pembentukan bolus makanan dengan bentuk dan konsistensi yang baik, (2) usaha sfingter mencegah terhamburnya bolus ini dalam fase-fase menelan, (3) kerja sama yang baik dari otot-otot di rongga mulut untuk mendorong bolus makanan ke arah lambung, (4) mencegah masuknya bolus makanan dan minuman ke dalam nasofaring dan laring, (5) mempercepat masuknya bolus makanan ke dalam faring pada saat respirasi, (6) usaha untuk membersihkan kembali esofagus. Proses menelan dapat dibagi dalam tiga fase yaitu : <o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 1cm; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Proses menelan dapat dibagi menjadi 3 fase yaitu fase oral, fase faringeal dan fase esophageal.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm; line-height: 150%;"><!--[if !supportLists]--><b style=""><span lang="IN" style="font-family:Arial;"><span style=""><span style=";font-family:";font-size:7;" > </span>1.<span style=";font-family:";font-size:7;" > </span></span></span></b><!--[endif]--><b style=""><u><span style=";font-family:Arial;color:black;" lang="IN">FASE ORAL</span></u></b><b style=""><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 1cm; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Pada fase oral ini akan terjadi proses pembentukan bolus makanan yang dilaksanakan oleh gigi geligi, lidah, palatum mole, otot-otot pipi dan saliva untuk menggiling dan membentuk bolus dengan konsistensi dan ukuran yang siap untuk ditelan. Proses ini berlangsung secara disadari.</span><span style=";font-family:Arial;color:black;" lang="IN"> </span><span style=";font-family:Arial;color:black;" ><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 1cm; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Peranan saraf kranial pada pembentukan bolus fase oral.</span><span style=";font-family:Arial;color:black;" ><o:p></o:p></span></p> <table class="MsoNormalTable" style="border: medium none ; margin-left: 5.4pt; border-collapse: collapse; width: 615px; height: 293px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 14.4pt;"> <td style="border: 1pt solid windowtext; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 92.85pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 14.4pt;" valign="top" width="124"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style=";font-family:Arial;color:black;" lang="IN">ORGAN</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> <td style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 133.95pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 14.4pt;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="179"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style=";font-family:Arial;color:black;" lang="IN">AFFEREN (sensorik)</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> <td style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 239.95pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 14.4pt;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="320"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style=";font-family:Arial;color:black;" lang="IN">EFFEREN (motorik)</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> </tr> <tr style="height: 16.5pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 92.85pt; height: 16.5pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="124"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Mandibula</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 133.95pt; height: 16.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="179"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n. V.2 (maksilaris)</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.95pt; height: 16.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="320"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" >n</span><span style=";font-family:Arial;color:black;" lang="IN">.V : m. Temporalis, m. maseter, m. pterigoid</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> </tr> <tr style="height: 61.2pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 92.85pt; height: 61.2pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="124"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Bibi</span><span style=";font-family:Arial;color:black;" >r</span><span style=";font-family:Arial;color:black;" lang="IN"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 133.95pt; height: 61.2pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="179"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n. V.2 (maksilaris)<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.95pt; height: 61.2pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="320"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n.VII : m.orbikularis oris, m. zigomatikum, m.levator labius oris, m.depresor labius oris, m. levator anguli oris, m. depressor anguli oris</span><span style=";font-family:Arial;color:black;" ><o:p></o:p></span></p> </td> </tr> <tr style="height: 16.5pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 92.85pt; height: 16.5pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="124"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Mulut & pipi<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 133.95pt; height: 16.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="179"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n.V.2 (maksilaris)</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.95pt; height: 16.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="320"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN"> n.VII: m. mentalis, m. risorius, m.businator<o:p></o:p></span></p> </td> </tr> <tr style="height: 20.8pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 92.85pt; height: 20.8pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="124"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Lidah<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 133.95pt; height: 20.8pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="179"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n.V.3 (lingualis)</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.95pt; height: 20.8pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="320"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN"> n.XII : m. hioglosus, m. mioglosus <o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" ><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Pada fase oral ini perpindahan bolus dari ronggal mulut ke faring segera terjadi, setelah otot-otot bibir dan pipi berkontraksi meletekkan bolus diatas lidah. Otot intrinsik lidah berkontraksi menyebabkan lidah terangkat mulai dari bagian anterior ke posterior. Bagian anterior lidah menekan palatum durum sehingga bolus terdorong ke faring.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Bolus menyentuh bagian arkus faring anterior, uvula dan dinding posterior faring sehingga menimbulkan <span style="">refleks faring</span>. Arkus faring terangkat ke atas akibat kontraksi m. palato faringeus (n. IX, n.X dan n.XII)</span><span style=";font-family:Arial;color:black;" >.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Peranan saraf kranial fase oral</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <table class="MsoNormalTable" style="border: medium none ; width: 573px; margin-left: 5.4pt; border-collapse: collapse; height: 373px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 12.75pt;"> <td style="border: 1pt solid windowtext; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 90.55pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 12.75pt;" valign="top" width="121"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style=";font-family:Arial;color:black;" lang="IN">ORGAN</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> <td style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 171.7pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 12.75pt;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="229"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style=";font-family:Arial;color:black;" lang="IN">AFFEREN (sensorik)</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> <td style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 203.95pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 12.75pt;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="272"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style=";font-family:Arial;color:black;" lang="IN">EFFEREN (motorik)</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> </tr> <tr style="height: 56.25pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 90.55pt; height: 56.25pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="121"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Bibir</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN"> </span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN"> </span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 171.7pt; height: 56.25pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="229"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n. V.2 (mandibularis), n.V.3 (lingualis)</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN"> </span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 203.95pt; height: 56.25pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="272"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n. VII : m.orbikularis oris, m.levator labius oris, m. depressor labius, m.mentalis</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> </tr> <tr style="height: 60.85pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 90.55pt; height: 60.85pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="121"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Mulut & pipi</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN"><o:p> </o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 171.7pt; height: 60.85pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="229"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n. V.2 (mandibularis)</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-family:Arial;"><o:p> </o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 203.95pt; height: 60.85pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="272"><p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%; text-align: left;"><span style=";font-family:Arial;color:black;" lang="IN">n.VII: m.zigomatikus,levator anguli oris, m.depressor anguli oris, m.risorius. m.businator<o:p></o:p></span></p> </td> </tr> <tr style="height: 25.6pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 90.55pt; height: 25.6pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="121"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Lidah<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 171.7pt; height: 25.6pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="229"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n.V.3 (lingualis)<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 203.95pt; height: 25.6pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="272"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n.IX,X,XI : m.palatoglosus<o:p></o:p></span></p> </td> </tr> <tr style="height: 21.05pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 90.55pt; height: 21.05pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="121"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">Uvula<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 171.7pt; height: 21.05pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="229"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n.V.2 (mandibularis)<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 203.95pt; height: 21.05pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="272"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN">n.IX,X,XI : m.uvulae,m.palatofaring <o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style=";font-family:Arial;color:black;" lang="IN"> </span><span style=";font-family:Arial;color:black;" ><span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Jadi pada fase oral ini secara garis besar bekerja saraf karanial n.V2 dan nV.3 sebagai serabut afferen (sensorik) dan n.V, nVII, n.IX, n.X, n.XI, n.XII sebagai serabut efferen (motorik).
<br /></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;">
<br /><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm; line-height: 150%;"><!--[if !supportLists]--><b style=""><span lang="IN" style="font-family:Arial;"><span style=""><span style=";font-family:";font-size:7;" > </span>2.<span style=";font-family:";font-size:7;" > </span></span></span></b><!--[endif]--><span lang="IN" style="font-family:Arial;"> <b style=""><u>FASE FARINGEAL</u><o:p></o:p></b></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Fase ini dimulai ketika bolus makanan menyentuh arkus faring anterior (arkus palatoglosus) dan <span style="">refleks menelan</span> segera timbul. Pada fase faringeal ini terjadi :<o:p></o:p></span></p> <ol style="margin-top: 0cm;" start="1" type="1"><li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">m. Tensor veli palatini (n.V) dan m. Levator veli palatini (n.IX, n.X dan n.XI) berkontraksi menyebabkan palatum mole terangkat, kemudian <span style="">uvula tertarik keatas</span> dan ke posterior sehingga menutup daerah nasofaring. <o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">m.genioglosus (n.XII, servikal 1), m ariepiglotika (n.IX,nX) m.krikoaritenoid lateralis (n.IX,n.X) berkontraksi menyebabkan <span style="">aduksi pita suara</span> sehingga laring tertutup. <o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Laring dan tulang hioid terangkat keatas ke arah dasar lidah karena kontraksi m.stilohioid, (n.VII), m. Geniohioid, m.tirohioid (n.XII dan n.servikal I). <o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Kontraksi m.konstriktor faring superior (n.IX, n.X, n.XI), m. Konstriktor faring inermedius (n.IX, n.X, n.XI) dan m.konstriktor faring inferior (n.X, n.XI) menyebabkan <span style="">faring tertekan kebawah</span> yang diikuti oleh relaksasi m. Kriko faring (n.X) <o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Pergerakan laring ke atas dan ke depan, relaksasi dari introitus esofagus dan dorongan otot-otot faring ke inferior menyebabkan <span style="">bolus makanan turun</span> ke bawah dan masuk ke dalam servikal esofagus. Proses ini hanya berlangsung sekitar satu detik untuk menelan cairan dan lebih lama bila menelan makanan padat. <o:p></o:p></span></li></ol> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Peranan saraf kranial pada fase faringeal<o:p></o:p></span></p> <div align="right"> <table class="MsoNormalTable" style="border: medium none ; margin-left: 17.7pt; border-collapse: collapse; width: 621px; height: 506px;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="border: 1pt solid windowtext; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 89.55pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial;" valign="top" width="119"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span lang="IN" style="font-family:Arial;">Organ</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> <td style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 121.55pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="162"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span lang="IN" style="font-family:Arial;">Afferen</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> <td style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 239.1pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="319"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span lang="IN" style="font-family:Arial;">Efferen</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> </tr> <tr style="height: 75.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 89.55pt; height: 75.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="119"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Lidah</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> </span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> </span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> </span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 121.55pt; height: 75.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="162"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.V.3</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> </span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> </span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> </span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.1pt; height: 75.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="319"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.V :m.milohyoid, m.digastrikus</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.VII : m.stilohyoid</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.XII,nC1 :m.geniohyoid, m.tirohyoid</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.XII :m.stiloglosus</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> </tr> <tr style="height: 40.9pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 89.55pt; height: 40.9pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="119"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Palatum</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> <o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 121.55pt; height: 40.9pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="162"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.V.2, n.V.3</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> <o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.1pt; height: 40.9pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="319"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.IX, n.X, n.XI :m.levator veli palatini</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.V :m.tensor veli palatini<o:p></o:p></span></p> </td> </tr> <tr style="height: 54.95pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 89.55pt; height: 54.95pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="119"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Hyoid</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> </span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> <o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 121.55pt; height: 54.95pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="162"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.Laringeus superior cab internus (n.X)</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> <o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.1pt; height: 54.95pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="319"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.V : m.milohyoid, m. Digastrikus</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.VII : m. Stilohioid</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.XII, n.C.1 :m.geniohioid, m.tirohioid<o:p></o:p></span></p> </td> </tr> <tr style="height: 20.45pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 89.55pt; height: 20.45pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="119"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Nasofaring <o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 121.55pt; height: 20.45pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="162"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.X <o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.1pt; height: 20.45pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="319"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.IX, n.X, n.XI : n.salfingofaringeus <o:p></o:p></span></p> </td> </tr> <tr style="height: 65.25pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 89.55pt; height: 65.25pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="119"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Faring </span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 121.55pt; height: 65.25pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="162"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.X </span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.1pt; height: 65.25pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="319"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.IX, n.X, n.XI : m. Palatofaring, m.konstriktor faring sup, m.konstriktor ffaring med.</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.X,n.XI : m.konstriktor faring inf.<o:p></o:p></span></p> </td> </tr> <tr style="height: 18.8pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 89.55pt; height: 18.8pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="119"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Laring<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 121.55pt; height: 18.8pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="162"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.rekuren (n.X)<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.1pt; height: 18.8pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="319"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.IX :m.stilofaring<o:p></o:p></span></p> </td> </tr> <tr style="height: 19.15pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 89.55pt; height: 19.15pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="119"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Esofagus <o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 121.55pt; height: 19.15pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="162"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.X<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 239.1pt; height: 19.15pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="319"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">n.X : m.krikofaring <o:p></o:p></span></p> </td> </tr> </tbody></table> </div> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Pada fase faringeal ini saraf yang bekerja saraf karanial n.V.2, n.V.3 dan n.X sebagai serabut afferen dan n.V, n.VII, n.IX, n.X, n.XI dan n.XII sebagai serabut efferen.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Bolus dengan viskositas yang tinggi akan memperlambat fase faringeal, meningkatkan waktu gelombang peristaltik dan memperpanjang waktu pembukaan sfingter esofagus bagian atas. Bertambahnya volume bolus menyebabkan lebih cepatnya waktu pergerakan pangkal lidah, pergerakan palatum mole dan pergerakan laring serta pembukaan sfingter esofagus bagian atas. Waktu <i>Pharyngeal transit</i> juga bertambah sesuai dengan umur.<o:p></o:p></span></p>
<br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5Ca%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C04%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; mso-font-alt:"Century Gothic"; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin-top:0cm; margin-right:0cm; margin-bottom:10.0pt; margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri; mso-fareast-font-family:Calibri; mso-bidi-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:1260142175; mso-list-template-ids:367816138;} @list l0:level1 {mso-level-tab-stop:36.0pt; mso-level-number-position:left; text-indent:-18.0pt;} ol {margin-bottom:0cm;} ul {margin-bottom:0cm;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Kecepatan gelombang peristaltik faring rata-rata 12 cm/detik. Mc.Connel dalam penelitiannya melihat adanya 2 sistem pompa yang bekerja yaitu :<o:p></o:p></span></p> <ol style="margin-top: 0cm;" start="1" type="1"><li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Oropharyngeal propulsion pomp (OOP) adalah tekanan yang ditimbulkan tenaga lidah 2/3 depan yang mendorong bolus ke orofaring yang disertai tenaga kontraksi dari m.konstriktor faring.</span></li><li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="line-height: 115%;font-family:Arial;font-size:11;" lang="IN"><span style="font-size:100%;">Hypopharyngeal suction pomp (HSP) adalah merupakan tekanan negatif akibat terangkatnya laring ke atas menjauhi dinding posterior faring, sehingga bolus terisap ke arah sfingter esofagus bagian atas. Sfingter esofagus bagian atas dibentuk oleh m.konstriktor faring inferior, m.krikofaring dan serabut otot longitudinal esofagus bagian superior.</span> </span></li></ol>
<br /><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_KYVIN7eqnmQ/Sadbe1JcpMI/AAAAAAAAACk/espvdznlrXo/s1600-h/menelan.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 388px; height: 242px;" src="http://1.bp.blogspot.com/_KYVIN7eqnmQ/Sadbe1JcpMI/AAAAAAAAACk/espvdznlrXo/s320/menelan.jpg" alt="" id="BLOGGER_PHOTO_ID_5307311271100327106" border="0" />gambar fase oral dan faringeal</a>
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mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 1cm; text-align: justify; text-indent: -1cm; line-height: 150%;"><!--[if !supportLists]--><b style=""><span lang="IN" style="font-family:Arial;"><span style=""><span style=";font-family:";font-size:7;" > </span>3.<span style=";font-family:";font-size:7;" > </span></span></span></b><!--[endif]--><b style=""><u><span lang="IN" style="font-family:Arial;">FASE ESOFAGEAL</span></u></b><b style=""><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Pada fase esofageal proses menelan berlangsung tanpa disadari. Bolus makanan turun lebih lambat dari fase faringeal yaitu 3-4 cm/ detik. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Fase ini terdiri dari beberapa tahapan :<o:p></o:p></span></p> <p class="ListParagraphCxSpFirst" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -36pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style=""><span style=";font-family:";font-size:7;" > </span>1.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span style="font-family:Arial;">D</span><span lang="IN" style="font-family:Arial;">imulai dengan terjadinya relaksasi m.kriko faring. <span style="">Gelombang peristaltik primer</span> terjadi akibat kontraksi otot longitudinal dan otot sirkuler dinding esofagus bagian proksimal. Gelombang peristaltik pertama ini akan diikuti oleh <span style="">gelombang peristaltik kedua</span> yang merupakan respons akibat regangan dinding esofagus.<o:p></o:p></span></p> <p class="ListParagraphCxSpLast" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -36pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style=""><span style=";font-family:";font-size:7;" > </span>2.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Gerakan <span style="">peristaltik tengah esofagus</span> dipengaruhi oleh serabut saraf pleksus mienterikus yang terletak diantara otot longitudinal dan otot sirkuler dinding esofagus dan gelombang ini bergerak seterusnya secara teratur menuju ke distal esofagus.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Cairan biasanya turun akibat gaya berat dan makanan padat turun karena gerak peristaltik dan berlangsung selama 8-20 detik. <i>Esophagal transit time</i> bertambah pada lansia akibat dari berkurangnya tonus otot-otot rongga mulut untuk merangsang gelombang peristaltik primer.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style=";font-family:Arial;color:black;" ><o:p> </o:p></span></p> <p class="ListParagraphCxSpFirst" style="margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; line-height: 150%;"><b><span style="font-family:Arial;"><o:p> </o:p></span></b></p><span style="font-weight: bold;">
<br /></span> <p class="ListParagraphCxSpLast" style="margin: 0cm 0cm 0.0001pt; text-align: justify; line-height: 150%;"><b><span lang="IN" style="font-family:Arial;">PERANAN SISTEM SARAF DALAM PROSES MENELAN<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Proses menelan diatur oleh sistem saraf yang dibagi dalam 3 tahap :<o:p></o:p></span></p> <ol style="margin-top: 0cm;" start="1" type="1"><li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Tahap afferen/sensoris dimana begitu ada makanan masuk ke dalam orofaring langsung akan berespons dan menyampaikan perintah. <o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Perintah diterima oleh pusat penelanan di Medula oblongata/batang otak (kedua sisi) pada trunkus solitarius di bag</span><span style="font-family:Arial;">ian d</span><span lang="IN" style="font-family:Arial;">orsal (berfungsi utuk mengatur fungsi motorik proses menelan) dan nukleus ambigius y</span><span style="font-family:Arial;">ang</span><span lang="IN" style="font-family:Arial;"> berfungsi mengatur distribusi impuls motorik ke motor neuron otot yang berhubungan dgn proses menelan. <o:p></o:p></span></li><li class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Tahap efferen/motorik yang menjalankan perintah</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></li></ol> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-family:Arial;"><o:p> </o:p></span></b></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-family:Arial;"><o:p>
<br /></o:p></span></b></p> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt; text-align: justify; line-height: 150%;"><b><span lang="IN" style="font-family:Arial;">GANGGUAN DEGLUTASI/MENELAN<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Secara medis gangguan pada peristiwa deglutasi disebut disfagia atau sulit menelan, yang merupakan masalah yang sering dikeluhkan baik oleh pasien dewasa, lansia ataupun anak-anak.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menurut catatan rata-rata manusia dalam sehari menelan sebanyak kurang lebih 2000 kali, sehingga masalah disfagia merupakan masalah yang sangat menggangu kualitas hidup seseorang.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Disfagia merupakan gejala kegagalan memindahkan bolus makanan dari rongga mulut sampai ke lambung.</span><span lang="IN" style="font-family:Arial;"> </span><span lang="IN" style="font-family:Arial;">Kegagalan dapat terj</span><span style="font-family:Arial;">a</span><span lang="IN" style="font-family:Arial;">di pada kelainan neuromuskular, sumbatan mekanik sepanjang saluran mulai dari rongga mulut sampai lambung serta gangguan emosi</span><span style="font-family:Arial;">. </span><span lang="IN" style="font-family:Arial;">Disfagia dapat disertai dengan rasa nyeri yang disebut odinofagia.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Berdasarkan d</span><span style="font-family:Arial;">e</span><span lang="IN" style="font-family:Arial;">finisi menurut para pakar (Mettew, Scott Brown dan Boeis) disfagia dibagi berdasarkan letak kelainannya yaitu di rongga mulut, orofaring, esofagus atau berdasarkan mekanismenya yaitu dapat menelan tetapi enggan, memang dapat menelan atau tidak dapat menelan sama sekali, atau baru dapat menelan jika minum segelas air, atau kelainannya hanya dilihat dari gangguan di esofagusnya.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-family:Arial;"><o:p> </o:p></span></b></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-family:Arial;"><o:p>
<br /></o:p></span></b></p> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt; text-align: justify; line-height: 150%;"><b><span lang="IN" style="font-family:Arial;">EVALUASI KLINIK DISFAGIA.<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 17.45pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Perlu diingat bahwa masalah disfagia dapat timbul kar</span><span style="font-family:Arial;">e</span><span lang="IN" style="font-family:Arial;">na :<o:p></o:p></span></p> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">A.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Berdasarkan proses mekanisme deglutasinya dapat dibagi :<o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">1.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Sumbatan mekanik/Disfagia</span><span lang="IN" style="font-family:Arial;"> </span><span lang="IN" style="font-family:Arial;">mekanik baik intraluminal atau ekstraluminal (penekanan dari luar lumen esofagus)</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">2.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Kelainan Neurologi/Disfagia</span><span lang="IN" style="font-family:Arial;"> </span><span lang="IN" style="font-family:Arial;">neurogenik/disfagia motorik mulai dari kelainan korteks serebri, pusat menelan di batang otak sampai neurosensori-muskular. <o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">3.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Kelainan emosi berat/ Disfagia psikogenik. <o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"><o:p> </o:p></span></p> <p class="ListParagraphCxSpFirst" style="margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">B.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Berdasar</span><span style="font-family:Arial;">kan</span><span lang="IN" style="font-family:Arial;"> proses mekanisme deglutasi diatas dibagi lagi menjadi :<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">1.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><i><span lang="IN" style="font-family:Arial;">Transfer dysphagia</span></i><span lang="IN" style="font-family:Arial;"> </span><span style="font-family:Arial;">bila</span><span lang="IN" style="font-family:Arial;"> kelainannya akibat kelainan neuromotor di fase oral dan faringeal.<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">2.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><i><span lang="IN" style="font-family:Arial;">Transit dysphagia</span></i><span lang="IN" style="font-family:Arial;"> bila disfagia disebabkan gangguan peristaltik baik primer/sekunder dan kurangnya relaksasi sfingter esofagus bagian bawah.<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">3.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><i><span lang="IN" style="font-family:Arial;">Obstructive dysphagia</span></i><span lang="IN" style="font-family:Arial;"> bila disebabkan penyempitan atau stenosis di faring dan esofagus</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"><o:p> </o:p></span></p> <p class="ListParagraphCxSpLast" style="margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">C.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Berdasarkan letak organ anatomi dapat dibagi menjadi :<o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 2cm; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">1.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Disfagia gangguan fase oral <o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 2cm; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">2.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Disfagia gangguan fase faringeal <o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 2cm; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">3.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Disfagia gangguan fase esofageal <o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;"><o:p> </o:p></span></p> <p class="ListParagraphCxSpFirst" style="margin: 0cm 0cm 0.0001pt 35.45pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">D.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Berdasarkan penyebab/etiologi dapat dibagi menjadi :<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">1.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Kelainan kongenital (K)<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">2.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Inflamasi/radang (R)<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">3.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Trauma (T)<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">4.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Benda asing (B)<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">5.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Neoplasma (N)<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">6.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Psikis (P)<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">7.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Kelainan endokrin (E) <o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">8.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Kelainan kardio vaskuler (KV)<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">9.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Kelainan neurologi/saraf (S)<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">10.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Penyakit degeneratif (D)<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; text-indent: -21pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">11.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Iatrogenik seperti akibat operasi, kemoterapi dan radiasi (I)<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin: 0cm 0cm 0.0001pt 2cm; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"><o:p> </o:p></span></p>
<br /><p class="ListParagraphCxSpLast" style="margin: 0cm 0cm 0.0001pt; text-align: justify; line-height: 150%;"><b><span lang="IN" style="font-family:Arial;">ANAMNESIS PENTING.<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">1.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Batasan keluhan disfagia (rongga mulut, orofaring, esofagus)</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">2.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Lama dan progresifitas keluhan disfagia</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">3.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Saat timbulnya keluhan disfagia dalam proses menelan (makan padat, cair, stress psikis dan fisik)</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">4.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">keluhan penyerta : odinofagi, BB turun cepat, demam, sesak nafas, batuk, perasaan mengganjal/menyumbat di tenggorokan. <o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">5.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Penyakit penyerta : eksplorasi neurologik degeneratif, autoimun, kardiovaskuler dll</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">6.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Penggunaan obat-obat yang mengganggu proses menelan (anastesi, muskulorelaksan pusat).<o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">7.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Evaluasi pola hidup, usia, hygiene mulut, pola makanan</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">8.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Riwayat operasi kepala dan leher sebelumnya</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-family:Arial;"><o:p> </o:p></span></b></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-family:Arial;"><o:p>
<br /></o:p></span></b></p> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt; text-align: justify; line-height: 150%;"><b><span lang="IN" style="font-family:Arial;">PEMERIKSAAN FISIK PENTING<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">1.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Keadaan umum pasien</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">2.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Pemeriksaan rongga mulut, evaluasi gerakan dan kekuatan otot mulut dan otot lidah. <o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">3.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Pemeriksaan orofaring, pergerakan palatum mole, sensibilitas orofaring dgn sentuhan spatel lidah, cari refleks muntah, refleks menelan, dan evaluasi suara (keterlibatan laring) <o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">4.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Pemeriksaan faring-laring : gerakan pangkal lidah, gerakan arkus faring, uvula, epiglotis, pita suara, plika ventrikularis dan sinus piriformis. <o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">5.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Pemeriksaan neurologi fungsi motorik dan sensorik saraf kranial</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 49.65pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">6.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Periksa posisi dan kelenturan leher/tulang servikal, evaluasi massa leher, pembesaran KGB leher dan trauma</span><span style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-family:Arial;"><o:p> </o:p></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-family:Arial;"><o:p>
<br /></o:p></span></p> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt; text-align: justify; line-height: 150%;"><b><span lang="IN" style="font-family:Arial;">PEMERIKSAAN PENUNJANG PENTING<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 1cm; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Pemeriksaan spesifik utk menilai adanya kelainan anatomi atau sumbatan mekanik :<o:p></o:p></span></p> <table class="MsoNormalTable" style="border: medium none ; margin-left: 5.4pt; border-collapse: collapse;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="border: 1pt solid windowtext; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 191.4pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial;" valign="top" width="255"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span lang="IN" style="font-family:Arial;">Penunjang</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> <td style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 276.4pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span lang="IN" style="font-family:Arial;">Kegunaan</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> </tr> <tr style="height: 56.25pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 191.4pt; height: 56.25pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="255"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Barium Swallow </span><span style="font-family:Arial;">(</span><span lang="IN" style="font-family:Arial;">Esofagogram)</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.4pt; height: 56.25pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menilai anatomi dan f</span><span style="font-family:Arial;">ung</span><span lang="IN" style="font-family:Arial;">s</span><span style="font-family:Arial;">i</span><span lang="IN" style="font-family:Arial;"> otot faring/esofagus, deteksi sumbatan o/k tumor, striktur,</span><span lang="IN" style="font-family:Arial;"> </span><span lang="IN" style="font-family:Arial;">web, akalasia, divertikulum</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> </tr> <tr style="height: 16.35pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 191.4pt; height: 16.35pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="255"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">CT Scan</span><span lang="IN" style="font-family:Arial;"> </span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.4pt; height: 16.35pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Kelainan anatomi di kepala, leher dan dada<o:p></o:p></span></p> </td> </tr> <tr style="height: 45pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 191.4pt; height: 45pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="255"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">MRI<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.4pt; height: 45pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Deteksi tumor, kalainan vaskuler/stroke, degeneratif proses diotak<o:p></o:p></span></p> </td> </tr> <tr style="height: 20.25pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 191.4pt; height: 20.25pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="255"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Laringoskopi direk</span><span lang="IN" style="font-family:Arial;"> </span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.4pt; height: 20.25pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menilai keadaan dan pergerakan otot laring<o:p></o:p></span></p> </td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 191.4pt; height: 13.5pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="255"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Esofagoskopi</span><span lang="IN" style="font-family:Arial;"> </span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.4pt; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menilai lumen esofagus, biopsi<o:p></o:p></span></p> </td> </tr> <tr style="height: 20.8pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 191.4pt; height: 20.8pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="255"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Endoskopi ultrasound<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.4pt; height: 20.8pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menilai lesi submukosa<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-family:Arial;"><o:p> </o:p></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-family:Arial;"><o:p>
<br /></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Pemeriksaan penunjang u</span><span style="font-family:Arial;">n</span><span lang="IN" style="font-family:Arial;">t</span><span style="font-family:Arial;">u</span><span lang="IN" style="font-family:Arial;">k menilai fungsi menelan :<o:p></o:p></span></p> <table class="MsoNormalTable" style="border: medium none ; margin-left: 5.4pt; border-collapse: collapse;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="border: 1pt solid windowtext; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 173.7pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial;" valign="top" width="232"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span lang="IN" style="font-family:Arial;">Penunjang</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> <td style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 276.5pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial;color:windowtext windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span lang="IN" style="font-family:Arial;">Kegunaan</span></b><b style=""><span style="font-family:Arial;"><o:p></o:p></span></b></p> </td> </tr> <tr style="height: 36.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 173.7pt; height: 36.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="232"> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 15.9pt; text-indent: -19.2pt; line-height: 150%;"><!--[if !supportLists]--><span style="font-family:Arial;"><span style="">1.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Modified barium swallow</span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 24.75pt; text-indent: -24.75pt; line-height: 150%;"><span style="font-family:Arial;"><o:p> </o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.5pt; height: 36.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menilai keadaan kedua sfingter esofagus, menganalisa <i>transfer dysphagia</i></span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> </tr> <tr style="height: 34.5pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 173.7pt; height: 34.5pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="232"> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 15.9pt; text-indent: -19.2pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">2.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Leksible fiber optic faringoskop<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.5pt; height: 34.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menilai pergerakan faring dan laring <o:p></o:p></span></p> </td> </tr> <tr style="height: 16.5pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 173.7pt; height: 16.5pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="232"> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 15.9pt; text-indent: -19.2pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">3.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Video floroscopy recording<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.5pt; height: 16.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menilai pergerakan faring dan laring <o:p></o:p></span></p> </td> </tr> <tr style="height: 74.25pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 173.7pt; height: 74.25pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="232"> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 15.9pt; text-indent: -19.2pt; line-height: 150%;"><!--[if !supportLists]--><span style="font-family:Arial;"><span style="">4.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Scintigraphy</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.5pt; height: 74.25pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menilai gangguan orofaring, esofagus, pengosongan lambung dan GERD (Gastroesophageal refluks disease)<o:p></o:p></span></p> </td> </tr> <tr style="height: 15.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 173.7pt; height: 15.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="232"> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 15.9pt; text-indent: -19.2pt; line-height: 150%;"><!--[if !supportLists]--><span style="font-family:Arial;"><span style="">5.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">EMG</span><span style="font-family:Arial;"><o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.5pt; height: 15.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menilai defisiensi fungsi saraf kranial<o:p></o:p></span></p> </td> </tr> <tr style="height: 16.5pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 173.7pt; height: 16.5pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="232"> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 15.9pt; text-indent: -19.2pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">6.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">Manometri<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.5pt; height: 16.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Menilai gangguan motilitas peristaltik<o:p></o:p></span></p> </td> </tr> <tr style="height: 18.1pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 173.7pt; height: 18.1pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="232"> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt 15.9pt; text-indent: -19.2pt; line-height: 150%;"><!--[if !supportLists]--><span lang="IN" style="font-family:Arial;"><span style="">7.<span style=";font-family:";font-size:7;" > </span></span></span><!--[endif]--><span lang="IN" style="font-family:Arial;">pHmetri 24 jam<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 276.5pt; height: 18.1pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="top" width="369"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Pemeriksaan fefluks esofagitis<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-family:Arial;"><o:p> </o:p></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-family:Arial;"><o:p>
<br /></o:p></span></p> <table class="MsoNormalTable" style="margin-left: 4.65pt; border-collapse: collapse;" border="0" cellpadding="0" cellspacing="0"> <tbody><tr style="height: 12.75pt;"> <td rowspan="3" style="border: 1pt solid windowtext; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 25.55pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 12.75pt;" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">No<o:p></o:p></span></b></p> </td> <td rowspan="3" style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 109.9pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 12.75pt;color:windowtext windowtext windowtext -moz-use-text-color;" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">Penyakit<o:p></o:p></span></b></p> </td> <td colspan="9" style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 240.95pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 12.75pt;color:windowtext windowtext windowtext -moz-use-text-color;" valign="bottom" width="321"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">Disfagia<o:p></o:p></span></b></p> </td> <td rowspan="3" style="border-style: solid solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 70.9pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 12.75pt;color:windowtext windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">Etiologi<o:p></o:p></span></b></p> </td> </tr> <tr style="height: 13.5pt;"> <td colspan="3" style="border-style: none solid double none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 70.85pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="94"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">Mekanik<o:p></o:p></span></b></p> </td> <td colspan="3" style="border-style: none solid double none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 3cm; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="113"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">Neurogenik<o:p></o:p></span></b></p> </td> <td colspan="3" style="border-style: none solid double none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 3cm; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="113"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">Psikogenik<o:p></o:p></span></b></p> </td> </tr> <tr style="height: 13.5pt;"> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 21.25pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">O<o:p></o:p></span></b></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 21.25pt; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">F<o:p></o:p></span></b></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 1cm; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">E<o:p></o:p></span></b></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 1cm; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">O<o:p></o:p></span></b></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 1cm; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">F<o:p></o:p></span></b></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 1cm; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">E<o:p></o:p></span></b></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 1cm; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">O<o:p></o:p></span></b></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 1cm; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">F<o:p></o:p></span></b></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; background: rgb(217, 217, 217) none repeat scroll 0% 0%; width: 1cm; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; height: 13.5pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family:Arial;">E<o:p></o:p></span></b></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">1<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Atresia <o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v/s<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">K<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">2<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Fistula trakeoesofagus<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v/s<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">K<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">3<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Stenosis/web<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v/s<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">K<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">4<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Divertikulum zenker<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">K<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">5<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Korpal<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">B<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">6<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Disfagia lusoria<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v/t<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">K<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">7<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Akalasia<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v/a<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">u/k<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">8<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Spasme difus esophagus<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v/s<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">P<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">9<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Striktur<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">T/R<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">10<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Esofagitis<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">R<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">11<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Karsinoma/tumor <o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">N<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">12<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Globus histerikus<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v/s<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">P<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">13<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">Serebral palsy<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">S<o:p></o:p></span></p> </td> </tr> <tr style="height: 12.75pt;"> <td style="border-style: none solid solid; padding: 0cm 5.4pt; width: 25.55pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext;" valign="top" width="34"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">14<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 109.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" valign="bottom" width="147"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; line-height: 150%;"><span style="font-family:Arial;">GERD<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 21.25pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="28"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">v<o:p></o:p></span></p> </td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 1cm; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="38"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;"><o:p> </o:p></span></p>
<br /></td> <td style="border-style: none solid solid none; padding: 0cm 5.4pt; width: 70.9pt; height: 12.75pt;color:-moz-use-text-color windowtext windowtext -moz-use-text-color;" width="95"> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><span style="font-family:Arial;">P<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> <o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span lang="IN" style="font-family:Arial;"> </span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;">
<br /><span lang="IN" style="font-family:Arial;"></span><span style="font-family:Arial;"><o:p></o:p></span></p> <p class="ListParagraph" style="margin: 0cm 0cm 0.0001pt; text-align: justify; line-height: 150%;"><b><span lang="IN" style="font-family:Arial;">DIET MODIFIKASI PADA PASIEN DENGAN GANGGUAN MENELAN<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt; line-height: 150%;"><span style="font-family:Arial;">Teknik modifikasi diet pada pasien </span><span lang="IN" style="font-family:Arial;">dengan</span><span style="font-family:Arial;"> gangguan menelan meliputi merubah bentuk dan suhu makanan berdasarkan pada hasil evaluasi makanan yang ditelan. <i>Liquid </i>dapat dikentalkan dengan produk komersial atau makanan lain. Penggunaan makanan lain seperti cereal bayi, tak berasa gelatin, atau tapioca bisa dirubah secara konsisten dengan pasien dysphagia yang diperlukan pasien sesuai kebutuhan untuk memenuhi nutrisi dan hidrasi mereka. Bila prinsip dasar penatalaksanaan gagal untuk menghasilkan kemajuan dalam dua sampai tiga minggu atau jika pasien mengalami kemunduran setelah pengembangan dibuat, pertimbangan harus diberikan untuk mengevaluasi kembali dan menyerahkan selanjutnya untuk intervensi medik.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b><span style="font-family:Arial;"><o:p>
<br /></o:p></span></b></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b><span style="font-family:Arial;"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;" align="center"><b><span lang="IN" style="font-family:Arial;">DAFTAR PUSTAKA</span></b><b><span style="font-family:Arial;"><o:p></o:p></span></b></p> <p class="ListParagraph" style="margin: 10pt 0cm 10pt 53.85pt; text-align: justify; text-indent: -36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Alper MC, Myers EN, Eibling DE. 2001</span><span style="font-family:Arial;">. </span><b style=""><i style=""><span lang="IN" style="font-family:Arial;">Dysphagia</span></i></b><span lang="IN" style="font-family:Arial;">. Decision making in ENT Disorders.;52:136-37<o:p></o:p></span></p> <p class="ListParagraph" style="margin: 10pt 0cm 10pt 53.85pt; text-align: justify; text-indent: -36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Bailey</span><span style="font-family:Arial;">,</span><span lang="IN" style="font-family:Arial;"> J Byron. 1998</span><span style="font-family:Arial;">. </span><b style=""><i style=""><span lang="IN" style="font-family:Arial;">Esophageal disorders</span></i></b><span lang="IN" style="font-family:Arial;">.</span><span lang="IN" style="font-family:Arial;"> </span><span lang="IN" style="font-family:Arial;">Head and neck surgery-Otolaringology.Vol.1.2.;56:781-801<o:p></o:p></span></p> <p class="ListParagraph" style="margin: 10pt 0cm 10pt 53.85pt; text-align: justify; text-indent: -36pt; line-height: 150%;"><span style="font-family:Arial;">Punagi,<span style=""> </span>Abdul Qadar. </span><span style="color: rgb(35, 31, 32);font-family:Arial;" >2006. </span><b><i style=""><span style="font-family:Arial;">Evaluasi Menelan Dengan Menggunakan Endoskop Fleksibel ( FEES ) dalam </span></i></b><b style=""><i style=""><span style="color: rgb(35, 31, 32);font-family:Arial;" >J Med Nus Vol. 27</span></i></b><span style="color: rgb(35, 31, 32);font-family:Arial;" >. </span><st1:place st="on"><span style="font-family:Arial;">Makassar</span></st1:place><span style="font-family:Arial;"> : Bagian THT-KL FKUH, RS. BLU. Dr. Wahidin Sudirohusodo.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="ListParagraph" style="margin: 10pt 0cm 10pt 53.85pt; text-align: justify; text-indent: -36pt; line-height: 150%;"><st1:place st="on"><st1:city st="on"><span style="font-family:Arial;">Paik</span></st1:city><span style="font-family:Arial;">, <st1:state st="on">NJ</st1:state></span></st1:place><span style="font-family:Arial;">. <b style=""><i style="">Dysphagia</i></b>. Available at http://www.emedicine.com. Accessed on February 15th 2006.</span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="ListParagraph" style="margin: 10pt 0cm 10pt 53.85pt; text-align: justify; text-indent: -36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Soepardi</span><span style="font-family:Arial;">,</span><span lang="IN" style="font-family:Arial;"> A Efianty. 2002</span><span style="font-family:Arial;">. </span><b style=""><i style=""><span lang="IN" style="font-family:Arial;">Penatalaksanaan disfagia secara komprehensif</span></i></b><span lang="IN" style="font-family:Arial;">. Acara ilmiah penglepasan purna</span><span style="font-family:Arial;">:</span><span lang="IN" style="font-family:Arial;"> tugas Prof Dr. Bambang.</span><span lang="IN" style="font-family:Arial;"> </span><span lang="IN" style="font-family:Arial;"><o:p></o:p></span></p> <p class="ListParagraph" style="margin: 10pt 0cm 10pt 53.85pt; text-align: justify; text-indent: -36pt; line-height: 150%;"><span lang="IN" style="font-family:Arial;">Thaller SR, Granick MS, Myers EN. 1993</span><span style="font-family:Arial;">. </span><b style=""><i style=""><span lang="IN" style="font-family:Arial;">Disfagia</span></i></b><span lang="IN" style="font-family:Arial;">. Diagram diagnostik peny</span><span style="font-family:Arial;">a</span><span lang="IN" style="font-family:Arial;">kit THT.EGC;13:105-11<o:p></o:p></span></p>
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<br /></div>Taufik Abidinhttp://www.blogger.com/profile/07690954313686984126noreply@blogger.com0tag:blogger.com,1999:blog-8031884777094016874.post-67825855939893401022009-02-27T11:02:00.002+08:002009-02-27T11:07:47.393+08:00Tumor Hidungoleh: <style> /* Font Definitions */ @font-face {font-family:Gautami; panose-1:2 0 5 0 0 0 0 0 0 0; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:2097155 0 0 0 1 0;} @font-face {font-family:"Arial Unicode MS"; panose-1:2 11 6 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-format:other; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--><b style=""><span style="font-family: Gautami;">Lalu W.J. 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font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="line-height: 150%;"><b style=""><span style="font-family: Gautami;" lang="IN">PENDAHULUAN<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family: Gautami;" lang="IN"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 54pt; line-height: 150%;"><span style="font-family: Gautami;">Tumor </span><span style="font-family: Gautami;" lang="IN">hidung</span><span style="font-family: Gautami;"> dan sinus paranasal pada umumnya jarang ditemukan, baik yang jinak maupun yang ganas. Di Indonesia dan di luar negeri, kekerapan jenis yang ganas hanya sekitar 1 % dari keganasan seluruh tubuh atau 3% dari seluruh keganasan di kepala dan leher<sup>5</sup>. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 54pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Hidung</span><span style="font-family: Gautami;"> dan sinus paranasal atau juga disebut sinonasal merupakan rongga yang dibatasi oleh tulang-tulang wajah yang merupakan daerah yang terlindung sehingga tumor yang timbul di daerah ini sulit diketahui secara dini. Asal tumor primer juga sulit ditentukan, apakah dari hidung atau sinus karena biasanya pasien berobat dalam keadaan penyakit telah lanjut dan tumor sudah memenuhi rongga hidung dan seluruh sinus<sup>5</sup>. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 54pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Data dari DEPKES RI tahun 2003 menyebutkan bahwa penyakit hidung dan sinus berada pada urutan ke-25 dari 50 pola penyakit peringkat utama atau sekitar 102.817 penderita rawat </span><span style="font-family: Gautami;" lang="IN">jalan</span><span style="font-family: Gautami;" lang="IN"> di rumah sakit</span><sup><span style="font-family: Gautami;">3</span></sup><span style="font-family: Gautami;" lang="IN">.</span><span style="font-family: Gautami;"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 54pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Survei Kesehatan Indera Penglihatan dan Pendengaran 1996 yang diadakan oleh Binkesmas bekerja sama dengan PERHATI dan Bagian THT RSCM mendapatkan data penyakit hidung dari 7 propinsi. </span><span style="font-family: Gautami;" lang="IN">Data dari Divisi Rinologi Departemen THT RSCM Januari-Agustus 2005 menyebutkan jumlah pasien rinologi pada kurun waktu tersebut adalah 435 pasien Dari jumlah tersebut 30% mempunyai indikasi operasi BSEF</span><sup><span style="font-family: Gautami;">1</span></sup><span style="font-family: Gautami;" lang="FI">.</span><span style="font-family: Gautami;" lang="FI"> </span><i style=""><sup><span style="font-family: Gautami;" lang="IN"><o:p></o:p></span></sup></i></p> <p class="MsoNormal" style="text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family: Gautami;"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><span style="font-family: Gautami;" lang="IN"><br /></span></b></p><p class="MsoNormal" style="line-height: 150%;"><b style=""><span style="font-family: Gautami;" lang="IN">TINJAUAN PUSTAKA<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family: Gautami;" lang="IN"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -1cm; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Pengertian <o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 54pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Tumor hidung adalah pertumbuhan ke</span><span style="font-family: Gautami;" lang="IN"> </span><span style="font-family: Gautami;" lang="IN">arah ganas yang mengenai hidung dan lesi yang menyerupai tumor pada rongga hidung, termasuk kulit dari hidung luar dan vestibulum nasi</span><sup><span style="font-family: Gautami;">2</span></sup><span style="font-family: Gautami;" lang="IN">.</span></p><p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 54pt; line-height: 150%;"><br /><span style="font-family: Gautami;" lang="IN"></span><span style="font-family: Gautami;"></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 54pt; line-height: 150%;"><span style="font-family: Gautami;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -1cm; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Epidemiologi dan etiologi<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Insiden tertinggi tumor ganas hidung dan sinus ditemukan di Jepang yaitu 2 per 10.000 penduduk pertahun. Di bagian THT FKUI-RSCM, keganasan ini ditemukan pada 10,1% dari seluruh tumor ganas THT. Rasio penderita laki-laki banding wanita sebesar 2:1</span><sup><span style="font-family: Gautami;">5</span></sup><span style="font-family: Gautami;" lang="IN">.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Etiologi tumor ganas hidung belum diketahui, tetapi diduga beberapa zat hasil industri merupakan penyebab antara lain nikel, debu kayu, kulit, formaldehid, kromium, minyak isopropyl dan lain-lain. Pekerja di bidang ini mendapat kemungkinan terjadi keganasan hidung dan sinus jauh lebih besar</span><sup><span style="font-family: Gautami;">5</span></sup><span style="font-family: Gautami;" lang="IN">.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;">Banyak laporan mengenai kasus adeno-karsinoma sinus etmoid pada pekerja-pekerja industri penggergajian kayu dan pembuatan mebel. Alkohol, asap rokok, makanan yang diasin </span><span style="font-family: Gautami;" lang="IN">atau</span><span style="font-family: Gautami;"> diasap diduga meningkatkan kemungkinan terjadi keganasan, sebaliknya buah-buahan dan sayuran mengurangi kemungkinan terjadi keganasan<sup>5</sup>. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Di Amerika Serikat, insidensi tumor hidung tiap tahun kurang dari 1:100.000 penduduk, yang menyumbang sekitar 3% kanker dari saluran pernapasan atas. Di Jepang dan Uganda, frekuensi tumor ini dua kali lebih tinggi dibandingkan dengan Amerika Serikat</span><sup><span style="font-family: Gautami;">6</span></sup><span style="font-family: Gautami;" lang="IN">.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Kecuali untuk tumor non-epitel, tumor hidung ganas hampir tidak ditemukan pada anak-anak. Prevalensi tumor hidung ganas meningkat sesuai umur yaitu 7:100.000 pada pasien dalam delapan dekade</span><sup><span style="font-family: Gautami;">6</span></sup><span style="font-family: Gautami;" lang="IN">.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Rousch (1999) memperkirakan bahwa di atas 80% dari semua tumor ganas pada manusia dihubungkan dengan lingkungan. Bagaimanapun perkiraan ini kemungkinan tinggi, bukti adanya penyebab lingkungan dari tumor hidung terutama pada pasien-pasien yang terpapar nikel, <i style="">chromium, hydrocarbon dan isopropyl oils</i></span><sup><span style="font-family: Gautami;">6</span></sup><span style="font-family: Gautami;" lang="IN">.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Risiko kanker meningkat pada tukang kayu, tukang sepatu dan boot, dan pembuat furniture. Karena kompleksnya paparan faktor lingkungan pada kelompok ini, agen yang berperan sulit diidentifikasi. Paparan hidrokarbon juga meningkatkan juga meningkatkan kanker hidung</span><sup><span style="font-family: Gautami;">6</span></sup><span style="font-family: Gautami;" lang="IN">.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Sekitar 55% tumor hidung dan sinus berasal dari sinus maxillary, 35% dari kavum nasi, 9% sinus ethmoid, dan 1% sinus frontal dan sphenoid dan septum. Untuk tumor yang besar, asal tumor sulit untuk diidentifikasi</span><sup><span style="font-family: Gautami;">6</span></sup><span style="font-family: Gautami;" lang="IN">.</span></p><p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><br /><span style="font-family: Gautami;" lang="IN"></span><span style="font-family: Gautami;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -1cm; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Jenis Histopatologi <o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;">Hampir </span><span style="font-family: Gautami;" lang="IN">seluruh</span><span style="font-family: Gautami;"> jenis histopatologi tumor jinak dan ganas dapat tumbuh di daerah sinonasal. Termasuk tumor jinak epitelial yaitu adenoma dan papiloma, yang non-epitelial yaitu fibroma, angiofibroma, hemangioma, neurilemomma, osteoma, displasia fibrosa dan lain-lain. Disamping itu ada tumor odontogenik misalnya ameloblastoma atau adamantinoma, kista tulang dan lain-lain<sup>5</sup>. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;">Tumor ganas epitelial adalah karsinoma sel skuamosa, kanker kelenjar liur, adenokarsinoma, karsinoma tanpa diferensiasi dan lain-lain. Jenis non epitelial ganas adalah hemangioperisitoma, bermacam-macam sarkoma termasuk rabdomiosarkoma dan osteogenik sarcoma ataupun keganasan limfoproliferatif seperti limfoma malignum, plasmasitoma atau pun polimorfik retikulosis sering juga ditemukan di daerah ini<sup>5</sup>. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;">Beberapa jenis tumor jinak ada yang mudah kambuh atau secara klinis bersifat ganas karena tumbuh agresif mendestruksi tulang, misalnya papiloma inverted, displasia fibrosa atau pun ameloblastoma. Pada jenis-jenis ini tindakan operasi harus radikal<sup>5</sup>.<br /></span></p><p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><br /><span style="font-family: Gautami;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -1cm; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">4.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Klasifikasi Tumor :<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 42.55pt; text-align: justify; text-indent: -14.2pt; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Tumor Jinak<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;">Tumor jinak tersering adalah papiloma skuamosa. Secara makroskopis mirip dengan </span><span style="font-family: Gautami;">polip, tetapi lebih vaskuler, padat dan tidak mengkilap. <st1:city w:st="on"><st1:place w:st="on">Ada</st1:place></st1:city> 2 jenis papiloma, pertama eksofitik atau fungiform dan yang kedua endofitik disebut papiloma inverted. Papiloma inverted ini bersifat sangat invasive, dapat merusak jaringan sekitarnya. Tumor ini sangat cenderung untuk residif dan dapat berubah menjadi ganas. Lebih sering dijumpai pada anak laki-laki usia tua. Terapi adalah bedah radikal misalnya rinotomi lateral atau maksilektomi media<sup>5</sup>.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;">Tumor jinak angiofibroma nasofaring sering bermanifestasi sebagai <st1:city w:st="on"><st1:place w:st="on">massa</st1:place></st1:city> yang mengisi rongga hidung bahkan juga mengisi seluruh rongga sinus paranasal dan mendorong bola mata ke anterior<sup>5</sup>.<br /></span></p><p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><br /><span style="font-family: Gautami;"><o:p></o:p></span></p> <ol style="margin-top: 0cm;" start="2" type="1"><li class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><span style="font-family: Gautami;" lang="IN">Tumor Ganas<o:p></o:p></span></b></li></ol> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;">Tumor ganas yang tersering adalah karsinoma sel skuamosa (70%), disusul oleh karsinoma yang berdeferensiasi dan tumor kelenjar<sup>5</sup>. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;">Sinus maksila adalah yang tersering terkena (65-80%), disusul sinus etmoid (15-25%), hidung sendiri (24%), sedangkan sinus sphenoid dan frontal jarang terkena<sup>5</sup>.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;">Metastasis ke kelenjar leher jarang terjadi (kurang dari 5%) karena rongga sinus sangat miskin dengan system limfa kecuali bila tumor sudah menginfiltrasi jaringan lunak hidung dan pipi yang kaya akan system limfatik<sup>5</sup>.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;">Metastasis jauh juga jarang ditemukan (kurang dari 10%) dan organ yang sering terkena metastasis jauh adalah hati dan paru<sup>5</sup>.</span></p><p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><br /><span style="font-family: Gautami;"></span><span style="font-family: Gautami;" lang="IN"><o:p></o:p></span></p> <ol style="margin-top: 0cm;" start="3" type="1"><li class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><span style="font-family: Gautami;" lang="IN">Invasi Sekunder<o:p></o:p></span></b></li></ol> <p class="MsoNormal" style="margin-left: 54pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span style="font-family: Gautami;" lang="IN"><span style="">a.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: Gautami;" lang="IN">Pituitary adenomas<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 54pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span style="font-family: Gautami;" lang="IN"><span style="">b.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: Gautami;" lang="IN">Chordomas<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 54pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span style="font-family: Gautami;" lang="IN"><span style="">c.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: Gautami;" lang="IN">Invasi sekunder lain (karsinoma nasofaring, meningioma, tumor odontogenik, neoplasma skeleton kraniofasial jinak dan ganas, tumor orbita dan apparatus lakrimal)</span><sup><span style="font-family: Gautami;" lang="IN"> </span></sup><sup><span style="font-family: Gautami;">2</span></sup><span style="font-family: Gautami;" lang="IN">.</span></p><p class="MsoNormal" style="margin-left: 54pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><br /><span style="font-family: Gautami;" lang="IN"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 54pt; text-align: justify; line-height: 150%;"><span style="font-family: Gautami;" lang="IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -1cm; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">5.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Pemeriksaan<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 42.55pt; text-align: justify; text-indent: -14.2pt; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Gejala dan tanda<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 27pt; line-height: 150%;"><b style=""><span style="font-family: Gautami;" lang="IN"><span style=""> </span></span></b><span style="font-family: Gautami;" lang="IN">Gejala tergantung dari asal primer tumor serta arah dan perluasannya. Tumor di dalam sinus maksila biasanya tanpa gejala. Gejala timbul setelah tumor besar, sehi</span><span style="font-family: Gautami;">n</span><span style="font-family: Gautami;" lang="IN">gga mendesak atau menembus dinding tulang meluas ke rongga hidung, rongga mulut, pipi, orbita atau intrakranial</span><sup><span style="font-family: Gautami;">5</span></sup><span style="font-family: Gautami;" lang="IN">. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 27pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Tergantung dari perluasan tumor, gejala dapat dikategorikan sebagai berikut</span><sup><span style="font-family: Gautami;">5</span></sup><span style="font-family: Gautami;" lang="IN">:<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 54pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span style="" lang="IN"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: Gautami;" lang="IN">Gejala nasal. Gejala nasal berupa obstruksi hidung unilateral dan rinorea. Sekretnya sering bercampur darah atau terjadi epistaksis. Tumor yang besar dapat mendesak tulang hidung sehingga terjadi deformitas hidung. Khas pada tumor ganas ingusnya berbau karena mengandung jaringan nekrotik.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 54pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span style="" lang="IN"><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: Gautami;" lang="IN">Gejala orbital. Perluasan tumor kearah orbita menimbulkan gejala diplopia, protosis atau penonjolan bola mata, oftalmoplegia, gangguan visus dan epifora. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 54pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span style="" lang="IN"><span style="">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: Gautami;" lang="IN">Gejala oral. Perluasan tumor ke rongga mulut menyebabkan penonjolan atau ulkus di palatum atau di prosesus alveolaris. Pasien megeluh gigi palsunya tidak pas lagi atau gigi geligi goyah. Seringkali pasien datang ke dokter gigi karena nyeri di gigi, tetapi tidak sembuh meskipun gigi yang sakit telah dicabut.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 54pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span style="" lang="IN"><span style="">4.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: Gautami;" lang="IN">Gejala fasial. Perluasan tumor ke depan akan menyebabkan penonjolan pipi. Disertai nyeri, anesthesia atau parestesia muka jika mengenai nervus trigeminus.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 54pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><!--[if !supportLists]--><span style="" lang="IN"><span style="">5.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: Gautami;" lang="IN">Gejala intrakranial. Perluasan tumor ke intrakranial menyebabkan sakit kepala hebat, oftalmoplegia dan gangguan visus. Dapat disertai likuorea, yaitu cairan otak yang keluar melalui hidung. Jika perluasan sampai ke fossa kranii media maka saraf otak lainnya bisa terkena. Jika tumor meluas ke belakang, terjadi trismus akibat terkenanya muskulus pterigoideus disertai anestesia dan parestesia daerah yang dipersarafi nervus maksilaris dan mandibularis.</span></p><p class="MsoNormal" style="margin-left: 54pt; text-align: justify; text-indent: -18pt; line-height: 150%;"><br /><span style="font-family: Gautami;" lang="IN"><o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><span style="font-family: Gautami;" lang="IN"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="margin-left: 42.55pt; text-align: justify; text-indent: -14.2pt; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Pemeriksaan Fisik<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 27pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Saat memeriksa pasien, pertama-tama perhatikan wajah pasien apakah terdapat asimetri atau tidak. Selanjutnya periksa dengan seksama kavum nasi dan nasofaring melalui rinoskopi anterior dan posterior. Permukaan yang licin merupakan pertanda tumor jinak sedangkan permukaan yang berbenjol-benjol, rapuh dan mudah berdarah merupakan pertanda tumor ganas. Jika dinding lateral kavum nasi terdorong ke medial berarti tumor berada di sinus maksila</span><sup><span style="font-family: Gautami;">5</span></sup><span style="font-family: Gautami;" lang="IN">. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 27pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN"><span style=""> </span>Pemeriksaan nasoendoskopi dan sinuskopi dapat membantu menemukan tumor pada stadium dini. Adanya pembesaran kelenjar leher juga perlu dicari meskipun tumor ini jarang bermetastasis ke kelenjar leher</span><sup><span style="font-family: Gautami;">5</span></sup><span style="font-family: Gautami;" lang="IN">.<br /></span></p><p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 27pt; line-height: 150%;"><br /><span style="font-family: Gautami;" lang="IN"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="font-family: Gautami;" lang="IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; text-align: justify; text-indent: -14.2pt; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Pemeriksaan Penunjang<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 27pt; line-height: 150%;"><b style=""><span style="font-family: Gautami;" lang="IN"><span style=""> </span></span></b><span style="font-family: Gautami;" lang="IN">Foto polos berfungsi sebagai diagnosis awal, terutama jika ada erosi tulang dan perselubungan padat unilateral, harus dicurigai keganasan dan </span><span style="font-family: Gautami;">di</span><span style="font-family: Gautami;" lang="IN">buat</span><span style="font-family: Gautami;"> suatu</span><span style="font-family: Gautami;" lang="IN"> tomogram atau TK. Pemeriksaan MRI dapat membedakan jaringan tumor dengan jaringan normal tetapi kurang begitu baik dalam memperlihatkan destruksi tulang.</span><span style="font-family: Gautami;" lang="IN"> </span><span style="font-family: Gautami;" lang="IN">Foto polos toraks diperlukan untuk melihat adanya metastasis tumor di paru</span><sup><span style="font-family: Gautami;">5</span></sup><span style="font-family: Gautami;" lang="IN">.</span></p><p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: 27pt; line-height: 150%;"><br /><span style="font-family: Gautami;" lang="IN"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="font-family: Gautami;" lang="IN"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 27pt; text-align: justify; text-indent: -27pt; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">6.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Diagnosis<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Diagnosis pasti ditegakkan berdasarkan pemeriksaan histopatologi. Jika tumor tampak di rongga hidung atau rongga mulut, maka biopsi mudah dan harus segera dilakukan. Biopsi tumor sinus maksila, dapat dilakukan melalui tindakan sinoskopi atau melalui operasi Caldwel-Luc yang insisinya melalui sulkus ginggivo-bukal</span><sup><span style="font-family: Gautami;">5</span></sup><span style="font-family: Gautami;" lang="IN">.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Jika dicurigai tumor vaskuler, misalnya angofibroma, jangan lakukan biopsi karena akan sangat sulit menghentikan perdarahan yang terjadi. Diagnosis adalah dengan angiografi</span><sup><span style="font-family: Gautami;">5</span></sup><span style="font-family: Gautami;">.</span></p><p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><br /><span style="font-family: Gautami;"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="font-family: Gautami;" lang="PT-BR"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -1cm; line-height: 150%;"><!--[if !supportLists]--><b style=""><span style="font-family: Gautami;" lang="IN"><span style="">7.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-family: Gautami;" lang="IN">Terapi Tumor Hidung dan Sinus Paranasal<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Bedah<b style=""> </b>tumor endonasal terdiri dari reseksi tumor dibawah kendali endoskop, diikuti dengan eksisi jaringan tumor dari jaringan sehat sekitarnya. Semua ini memerlukan diagnostik gambaran TK yang adekuat sebelum operasi, diagnostik histologi, dan instrumentasi operasi yang tepat. Sangat diperlukan seorang operator yang sangat menguasai anatomi lokal dan pengalaman yang komprehensif<span style=""> </span>dalam melakukan bedah endoskopik. Sebelumnya pasien harus diberi penjelasan tentang prosedur yang akan dijalankan dan telah<span style=""> </span>membuat <i style="">informed consent,</i> termasuk juga bila dibutuhkan perluasan pembedahan baik melalui rute bedah eksternal maupun transoral</span><sup><span style="font-family: Gautami;">4</span></sup><span style="font-family: Gautami;" lang="IN">.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Dalam memilih terapi bedah yang optimal, seorang ahli harus mempertimbangkan dengan seksama dalam memilih pendekatan endonasal daripada prosedur klasik yaitu melalui pendekatan transfasial, transoral, dan <i style="">midfacial degloving. </i>Pendekatan endonasal menghindari insisi eksternal dan internal serta mobilisasi jaringan, sehingga menghindari pembentukan parut yang tidak diinginkan, stenosis duktus lakrimalis, mukokel, dan neuralgia. Komplikasi dan gejala ikutan yang dapat merugikan pasien lebih rendah, sehingga metode ini dapat diterima dengan baik</span><sup><span style="font-family: Gautami;">4</span></sup><span style="font-family: Gautami;" lang="FI">.</span></p><p class="MsoNormal" style="margin-left: 18pt; text-align: justify; text-indent: 45pt; line-height: 150%;"><br /><span style="font-family: Gautami;" lang="FI"></span><sup><span style="font-family: Gautami;" lang="IN"><o:p></o:p></span></sup></p> <p class="MsoNormal" style="text-align: justify; text-indent: 36pt; line-height: 150%;"><span style="font-family: Gautami;"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 36pt; line-height: 150%;"><span style="font-family: Gautami;">Bermacam-macam klasifikasi untuk menentukan stadium yang digunakan di Indonesia adalah klasifikasi UICC dan AJCC yang hanya berlaku untuk karsinoma di sinus maksila, etmoid dan rongga hidung sedangkan untuk sinus sphenoid dan frontal tidak termasuk dalam klasifikasi ini karena sangat jarang ditemukan. Perlu diingat bahwa keganasan yang tumbuh seperti basalioma dan melanoma malignum di kulit sekitar hidung dan sinus paranasal tidak termasuk dalam klasifikasi tumor hidung dan sinus paranasal.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 36pt; line-height: 150%;"><span style="font-family: Gautami;">Perluasan tumor primer dikatagorikan dalam T1, T2, T3, dan T4. Paling ringan T1, tumor terbatas di mukosa sinus, paling berat T4, tumor meluas ke orbita, sinus sphenoid dan frontal dan atau rongga intracranial.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 36pt; line-height: 150%;"><span style="font-family: Gautami;">Metastasis kelenjar ke limfa leher regional dikatagorikan dengan N0 (tidak diketemukan metastasis ke kelenjar limfa leher regional), N1 (metastasis ke kelenjar limfa leher dengan ukuran diameter terbesar kurang atau sama dengan 3 centimeter (cm), N2 (diameter terbesar lebih dari 3 cm dan kurang dari 6 cm) dan N3 (diameter terbesar lebih dari 6 cm). metastasis jauh dikategorikan sebagai M0 (tidak ada metastasis) dan M1 (ada metastasis).<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">Pembagian sistem TNM menurut Simson sebagai berikut:<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">T <span style=""> </span>: Tumor.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">T—1 <span style=""> </span>: <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">a. Tumor pada dinding anterior antrum.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">b. Tumor pada dinding nasoantral inferior.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">c. Tumor pada palatum bagian anteromedial.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">T—2 <span style=""> </span>:<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">a. Invasi ke dinding lateral tanpa mengenai otot.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">b. Invasi ke dinding superior tanpa mengenai orbita.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">T—3 <span style=""> </span>: <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">a. Invasi ke m. pterigoid.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">b. Invasi ke orbita<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">c. Invasi ke selule etmoid anterior tanpa mengenai lamina kribrosa.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">d. Invasi ke dinding anterior dan kulit diatasnya.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">T—4 : <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">a. Invasi ke lamina kribrosa.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">b. Invasi ke fosa pterigoid.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">c. Invasi ke rongga hidung atau sinus maksila kontra<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">lateral.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">d. Invasi ke lamina pterigoid.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">e. Invasi ke selule etmoid posterior.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 42.55pt; line-height: 150%;"><span style="font-family: Gautami;">f. Ekstensi ke resesus etmo-sfenoid.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">N : Kelenjar getah bening regional.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">N—1<span style=""> </span>: Klinis teraba kelenjar, dapat digerakkan.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">N—2 <span style=""> </span>: Tidak dapat digerakkan.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">M : Metastasis.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">M—1 <span style=""> </span>: Stadium dini, tumor terbatas di sinus.<o:p></o:p></span></p> <p class="MsoNormal" style="line-height: 150%;"><span style="font-family: Gautami;">M—2 <span style=""> </span>: Stadium lanjut, tumor meluas ke struktur yang berdekatan.<b style=""><o:p></o:p></b></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 36pt; line-height: 150%;"><span style="font-family: Gautami;">Berdasarkan TNM ini dapat ditentukan stadium yaitu stadium dini (stadium 1 dan 2), stadium lanjut (stadium 3 dan 4). Lebih dari 90 % pasien datang dalam stadium lanjut dan sulit menentukan asal tumor primernya karena hampir seluruh hidung dan sinus paranasal sudah terkena tumor.<o:p></o:p></span></p> <br /><meta http-equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5Ca%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C04%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Gautami; panose-1:2 0 5 0 0 0 0 0 0 0; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:2097155 0 0 0 1 0;} @font-face {font-family:"Arial Unicode MS"; panose-1:2 11 6 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-format:other; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 90.0pt 72.0pt 90.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:2147233182; mso-list-type:hybrid; mso-list-template-ids:1809988628 701379548 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l0:level1 {mso-level-tab-stop:36.0pt; mso-level-number-position:left; text-indent:-18.0pt;} @list l0:level2 {mso-level-number-format:alpha-lower; mso-level-tab-stop:72.0pt; mso-level-number-position:left; text-indent:-18.0pt;} @list l0:level3 {mso-level-number-format:roman-lower; mso-level-tab-stop:108.0pt; mso-level-number-position:right; text-indent:-9.0pt;} ol {margin-bottom:0cm;} ul {margin-bottom:0cm;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family: Gautami;" lang="IN"><br /></span></b></p><p class="MsoNormal" style="text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family: Gautami;" lang="IN">DAFTAR PUSTAKA<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: center; line-height: 150%;" align="center"><b style=""><span style="font-family: Gautami;" lang="IN"><o:p> </o:p></span></b></p> <ol style="margin-top: 0cm;" start="1" type="1"><li class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="font-family: Gautami;" lang="FI">Anonim. 2006. <b style=""><i style="">Data Poli Rawat Jalan Sub Bagian Rinologi 2000-2005</i></b>. Jakarta:<i style=""> </i>Bagian THT FKUI – RSUPN Dr. Cipto Mangunkusumo.<o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Cody, DeSanto</span><span style="font-family: Gautami;"> et al. </span><span style="font-family: Gautami;" lang="IN">2000</span><span style="font-family: Gautami;">.</span><span style="font-family: Gautami;"> <b style=""><i style=""><span lang="IN">Neoplasma of the Nasal Cavity in </span></i></b></span><b style=""><i style=""><span style="font-family: Gautami;" lang="IN">in Cummings – Otolaryngology - Head Neck Surgery</span></i></b><b style=""><span style="font-family: Gautami;" lang="IN"> <i style="">3<sup>rd</sup> ed</i></span></b><span style="font-family: Gautami;">.</span><span style="font-family: Gautami;"> <span lang="IN">New York</span></span><span style="font-family: Gautami;">:</span><span style="font-family: Gautami;"> <span lang="IN">Maple Vail Book Manufacturing Group Mosby-Year Book.<o:p></o:p></span></span></li><li class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="font-family: Gautami;" lang="FI">Depkes RI. </span><span style="font-family: Gautami;" lang="IN">2003</span><span style="font-family: Gautami;">.</span><span style="font-family: Gautami;"> <b style=""><i style=""><span lang="FI">Pola Penyakit 50 Peringkat Utama Menurut DTD Pasien Rawat. </span></i></b><i style=""><span lang="FI"><span style=""> </span></span></i><span lang="FI">Jakarta: Jalan Di Rumah Sakit Indonesia Tahun 2003, Depkes RI. <o:p></o:p></span></span></li><li class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="font-family: Gautami;" lang="FI">Hosemann W. 2001. <b style=""><i style="">Role of Endoscopic Surgery in Tumor. In: Kennedy DW, Bolger WE, Zinreich SJ. Diseases of The Sinuses, Diagnosis and Management. </i></b><span style=""> </span>London: Hamilton.<o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Roezin</span><span style="font-family: Gautami;">,</span><span style="font-family: Gautami;" lang="IN"> A</span><span style="font-family: Gautami;">. et al. </span><span style="font-family: Gautami;" lang="IN">200</span><span style="font-family: Gautami;">7.</span><span style="font-family: Gautami;"> <b style=""><i style=""><span lang="IN">Tumor Hidung dalam : Soepardi E, Iskandar N, eds</span></i><span lang="IN">., <i style="">Buku Ajar Ilmu Kesehatan Telinga Hidung Tenggorok. Edisi ke-</i></span></b></span><b style=""><i style=""><span style="font-family: Gautami;">6.</span></i></b><span style="font-family: Gautami;"> <span lang="IN">Jakarta</span></span><span style="font-family: Gautami;">:</span><span style="font-family: Gautami;"> <span lang="IN">BP FK UI.<o:p></o:p></span></span></li><li class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="font-family: Gautami;" lang="IN">Rousch GC</span><span style="font-family: Gautami;">. </span><span style="font-family: Gautami;" lang="IN">1999</span><span style="font-family: Gautami;">.</span><span style="font-family: Gautami;"> <b style=""><i style=""><span lang="IN">Epidemiology of Cancer of The Nose and Paranasal Sinuses -Current Concepts</span></i><span lang="IN"> <i style="">in Cummings – Otolaryngology - Head Neck Surgery</i> <i style="">3<sup>rd</sup> ed</i></span></b></span><b style=""><i style=""><span style="font-family: Gautami;">.</span></i></b><span style="font-family: Gautami;"> <span lang="IN">New York</span></span><span style="font-family: Gautami;">:</span><span style="font-family: Gautami;"> <span lang="IN">Maple Vail Book Manufacturing Group Mosby-Year Book</span></span><span style="font-family: Gautami;">.</span><span style="font-family: Gautami;" lang="IN"> <o:p></o:p></span></li></ol> <br /> Taufik Abidinhttp://www.blogger.com/profile/07690954313686984126noreply@blogger.com0tag:blogger.com,1999:blog-8031884777094016874.post-4095105107969701702009-02-24T03:40:00.002+08:002009-02-24T03:44:49.944+08:00KOLESTEATOMA EKSTERNA<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><link rel="Edit-Time-Data" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_editdata.mso"><!--[if !mso]> <style> v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} </style> <![endif]--><font size="3"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype>oleh: Taufik Abidin<br /></font><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults ext="edit" spidmax="1027"> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout ext="edit"> <o:idmap ext="edit" data="1"> </o:shapelayout></xml><![endif]--><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><font style="line-height: 150%;" size="3" face="Arial">Kolesteatoma adalah suatu kista epiterial yang berisi deskuamasi epitel (keratin). Istilah kolesteatoma mulai diperkenalkan oleh Johanes Muller pada tahun 1838 karena disangka tumor yang ternyata bukan. Seluruh epitel kulit (keratinizing stratified squamous epithelium) pada tubuh kita berada pada lokasi yang terbuka/ terpapar ke dunia luar. Epitel kulit di liang telinga merupakan suatu daerah cul-de-sac sehingga apabila terdapat serumen padat di liang telinga dalam waktu yang lama, maka dari epitel kulit yang berada medial dari serumen tersebut seakan terperangkap sehingga membentuk kolesteatoma.</font></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><font style="line-height: 150%;" size="3" face="Arial"><br /></font></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_KYVIN7eqnmQ/SaL8aVRvdEI/AAAAAAAAACU/unXHesHY7IA/s1600-h/tutorial_4.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 300px; height: 238px;" src="http://1.bp.blogspot.com/_KYVIN7eqnmQ/SaL8aVRvdEI/AAAAAAAAACU/unXHesHY7IA/s320/tutorial_4.jpg" alt="" id="BLOGGER_PHOTO_ID_5306080840314221634" border="0"></a><br /><font style="line-height: 150%;" size="3" face="Arial"><o:p></o:p></font></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><font style="line-height: 150%;" size="3" face="Arial">Kolesteatoma diawali dengan penumpukan deskuamasi epidermis di liang telinga, sehingga membentuk gumpalan dan menimbulkan rasa penuh serta kurang dengar. Bila tidak ditanggulangi dengan baik akan terjadi erosi kulit dan bagian tulang liang telinga. Hal yang terakhir ini disebut sebagai kolesteatoma eksterna. Kolesteatoma eksterna disusun atas epitel gepeng & debris tumpukan pengelupasan keratin, sehingga akan lembab karena menyerap air sehingga mengundang infeksi. Kolesteatoma mengerosi tulang yang terkena baik akibat efek penekanan oleh penumpukan debris keratin maupun akibat aktifitas mediasi enzim osteoklas. Etiologinya belum diketahui, sering terjadi pada pasien dengan kelainan paru kronik, seperti bronkiektasis, juga pada pasien sinusitis. Namun kejadian kolesteatoma sangat jarang terjadi.<o:p></o:p></font></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><font style="line-height: 150%;" size="3" face="Arial">Kolesteatoma merupakan media yang baik untuk tempat tumbuhnya kuman, yang paling sering adalah Pseudomonas aeruginosa. Pembesaran kolesteatom menjadi lebih cepat apabila sudah disertai infeksi, kolesteatom ini akan menekan dan mendesak organ disekitarnya serta menimbulkan nekrosis terhadap tulang. Terjadinya proses nekrosis diperhebat oleh karena adanya pembentukan reaksi asam oleh pembusukan bakteri.<o:p></o:p></font></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><font style="line-height: 150%;" size="3" face="Arial">Kolesteatoma pada liang telinga biasanya unilateral. Pasien mengeluhkan nyeri tumpul sampai nyeri hebat akibat peradangan setempat dan otorea intermitten akibat erosi tulang dan infeksi sekunder. Kolesteatoma diduga sebagai akibat migrasi epitel yang salah & periostitis sirkumskripta. Erosi bagian tulang liang telinga dapat sangat progresif memasuki rongga mastoid dan kavum timpani. <o:p></o:p></font></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><font style="line-height: 150%;" size="3" face="Arial">Penyakit ini dapat dikontrol dengan melakukan pembersihan liang telinga secara periodic misalnya tiap tiga bulan. Pemberian obat tetes telinga dari campuran alcohol atau gliserin dalam perioksida 3%, tiga kali seminggu sering kali dapat menolong. Pada pasien yang telah mengalami erosi tulang liang telinga, seringkali diperlukan tindakan bedah dengan melakukan tandur jaringan ke bawah kulit untuk menghilangkan gaung di dinding liang telinga. Yang penting ialah membuat agar liang telinga berbentuk seperti corong, sehingga pembersihan liang telinga secara spontan lebih terjamin.<o:p></o:p></font></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><font style="line-height: 150%;" size="3" face="Arial"><o:p> </o:p></font></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><font style="line-height: 150%;" size="3" face="Arial"><o:p><br /></o:p></font></p> <p class="MsoNormal" style="text-align: center; line-height: 150%;" align="center"><font size="3"><b style=""><font style="line-height: 150%;" face="Arial">DAFTAR PUSTAKA<o:p></o:p></font></b></font></p> <p class="MsoNormal" style="margin-left: 45pt; text-align: justify; text-indent: -45pt; line-height: 150%;"><font style="line-height: 150%;" size="3" face="Arial">Sosialisman. Herman., 2006. <i style="">Keratosis Obliterans Dan Kolesteatoma Eksterna</i>. Dalam: Buku Ajar Ilmu Kesehatan THT edisi kelima hal. 47-48. Balai Penerbit FKUI, <st1:place st="on"><st1:city st="on">Jakarta</st1:city></st1:place>.<o:p></o:p></font></p> <p class="MsoNormal" style="margin-left: 45pt; text-align: justify; text-indent: -45pt; line-height: 150%;"><font style="line-height: 150%;" size="3" face="Arial">Djaafar, ZA. 2006. <i style="">Kolesteatoma.</i> Dalam: Buku Ajar Ilmu Kesehatan THT edisi kelima hal.55-56. Balai Penerbit FKUI, <st1:place st="on"><st1:city st="on">Jakarta</st1:city></st1:place>.<o:p></o:p></font></p> <p class="MsoNormal" style="margin-left: 45pt; text-align: justify; text-indent: -45pt; line-height: 150%;"><font size="3"><i style=""><font style="line-height: 150%;" face="Arial">http://www.marshfieldclinic.org/proxy/MC-cattails_2006_sepoct_cyst.1.jpg</font></i></font><font style="line-height: 150%;" size="3" face="Arial">.<o:p></o:p></font></p> Taufik Abidinhttp://www.blogger.com/profile/07690954313686984126noreply@blogger.com0tag:blogger.com,1999:blog-8031884777094016874.post-56106537008321270512009-02-24T03:30:00.004+08:002009-02-24T03:35:34.787+08:00ABSES PERITONSIL<span style="text-decoration: underline;">oleh: Taufik Abidin</span><br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="line-height: 150%;"><b style="">PENDAHULUAN<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Abses peritonsiler dapat terjadi pada umur 10-60 tahun, namun paling sering terjadi pada umur 20-40 tahun. Pada anak-anak jarang terjadi kecuali pada mereka yang menurun sistem immunnya, tapi infeksi bisa menyebabkan obstruksi jalan napas yang signifikan pada anak-anak. Infeksi ini memiliki proporsi yang sama antara laki-laki dan perempuan. Bukti menunjukkan bahwa tonsilitis kronik atau percobaan multipel penggunaan antibiotik oral untuk tonsilitis akut merupakan predisposisi pada orang untuk berkembangnya abses peritonsiler. Di Amerika insiden tersebut kadang-kadang berkisar 30 kasus per 100.000 orang per tahun, dipertimbangkan hampir 45.000 kasus setiap tahun<sup>4</sup>.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Abses leher dalam terbentuk dalam ruang potensial diantara fasia leher dalam sebagai akibat dari penjalaran infeksi dari berbagai sumber, seperti gigi, mulut, tenggorok, sinus paranasal, telinga tengah dan leher tergantung ruang mana yang terlibat. Gejala dan tanda klinik dapat berupa nyeri dan pembengkakan. Abses peritonsiler (Quinsy) merupakan salah satu dari Abses leher dalam dimana selain itu abses leher dalam dapat juga abses retrofaring, abses parafaring, abses submanidibula dan angina ludovici (Ludwig Angina) <sup>3</sup>.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Abses peritonsiler adalah penyakit infeksi yang paling sering terjadi pada bagian kepala dan leher. Gabungan dari bakteri aerobic dan anaerobic di daerah peritonsilar. Tempat yang bisa berpotensi terjadinya abses adalah adalah didaerah pillar tonsil anteroposterior, fossa piriform inferior, dan palatum superior<sup>4</sup>.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Abses peritonsil terbentuk oleh karena penyebaran organisme bakteri penginfeksi tenggorokan kesalah satu ruangan aereolar yang longgar disekitar faring menyebabkan pembentukan abses, dimana infeksi telah menembus kapsul tonsil tetapi tetap dalam batas otot konstriktor faring<sup>5</sup>.</p><div style="text-align: justify;"> <font style="" size="12" face="""><font style="font-family: times new roman;" size="3">Peritonsillar abscess (PTA) merupakan kumpulan/timbunan (accumulation) pus (nanah) yang terlokalisir/terbatas (localized) pada jaringan peritonsillar yang terbentuk sebagai hasil dari suppurative tonsillitis.</font></font><br /></div><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">ETIOLOGI<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Abses peritonsil terjadi sebagai akibat komplikasi tonsilitis akut atau infeksi yang bersumber dari kelenjar mucus Weber di kutub atas tonsil. Biasanya kuman penyebabnya sama dengan kuman penyebab tonsilitis. Biasanya unilateral dan lebih sering pada anak-anak yang lebih tua dan dewasa muda<sup>2</sup>.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Abses peritonsiler disebabkan oleh organisme yang bersifat aerob maupun yang bersifat anaerob. Organisme aerob yang paling sering menyebabkan abses peritonsiler adalah <i style="">Streptococcus pyogenes</i> (Group A Beta-hemolitik streptoccus), <i style="">Staphylococcus aureus</i>, dan <i style="">Haemophilus influenzae. </i>Sedangkan organisme anaerob yang berperan adalah <i style="">Fusobacterium</i>. <i style="">Prevotella, Porphyromonas, Fusobacterium, </i>dan<i style=""> Peptostreptococcus spp.</i> Untuk kebanyakan abses peritonsiler diduga disebabkan karena kombinasi antara organisme aerobik dan anaerobik<sup>6</sup>.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><font style=""> </font></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">PATOLOGI<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Patofisiologi PTA belum diketahui sepenuhnya. Namun, teori yang paling banyak diterima adalah kemajuan (progression) episode tonsillitis eksudatif pertama menjadi peritonsillitis dan kemudian terjadi pembentukan abses yang sebenarnya (frank abscess formation).</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Daerah superior dan lateral fosa tonsilaris merupakan jaringan ikat longgar, oleh karena itu infiltrasi supurasi ke ruang potensial peritonsil tersering menempati daerah ini, sehingga tampak palatum mole membengkak. Abses peritonsil juga dapat terbentuk di bagian inferior, namun jarang.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Pada stadium permulaan, (stadium infiltrat), selain pembengkakan tampak juga permukaan yang hiperemis. Bila proses berlanjut, daerah tersebut lebih lunak dan berwarna kekuning-kuningan. Tonsil terdorong ke tengah, depan, dan bawah, uvula bengkak dan terdorong ke sisi kontra lateral.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Bila proses terus berlanjut, peradangan jaringan di sekitarnya akan menyebabkan iritasi pada m.pterigoid interna, sehingga timbul trismus. Abses dapat pecah spontan, sehingga dapat terjadi aspirasi ke paru.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Selain itu, PTA terbukti dapat timbul de novo tanpa ada riwayat tonsillitis kronis atau berulang (recurrent) sebelumnya. PTA dapat juga merupakan suatu gambaran (presentation) dari infeksi virus Epstein-Barr (yaitu: mononucleosis).</p> <p class="MsoNormal" style="line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">GEJALA KLINIS DAN DIAGNOSIS<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Selain gejala dan tanda tonsilitis akut, terdapat juga odinofagia (nyeru menelan) yang hebat, biasanya pada sisi yang sama juga dan nyeri telinga (otalgia), muntah (regurgitasi), mulut berbau (foetor ex ore), banyak ludah (hipersalivasi), suara sengau (rinolalia), dan kadang-kadang sukar membuka mulut (trismus), serta pembengkakan kelenjar submandibula dengan nyeri tekan.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Bila ada nyeri di leher (neck pain) dan atau terbatasnya gerakan leher (limitation in neck mobility), maka ini dikarenakan lymphadenopathy dan peradangan otot tengkuk (cervical muscle inflammation)<sup>1</sup>.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Prosedur diagnosis dengan melakukan Aspirasi jarum (needle aspiration). Tempat aspiration dibius / dianestesi menggunakan lidocaine dengan epinephrine dan jarum besar (berukuran 16–18) yang biasa menempel pada syringe berukuran 10cc. Aspirasi material yang bernanah (purulent) merupakan tanda khas, dan material dapat dikirim untuk dibiakkan.</p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><br /></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_KYVIN7eqnmQ/SaL6ITWsctI/AAAAAAAAACM/vaCxD7us6ng/s1600-h/abses+peritonsil.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 320px; height: 202px;" src="http://2.bp.blogspot.com/_KYVIN7eqnmQ/SaL6ITWsctI/AAAAAAAAACM/vaCxD7us6ng/s320/abses+peritonsil.jpg" alt="" id="BLOGGER_PHOTO_ID_5306078331537224402" border="0"></a></p><br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:85660489; mso-list-type:hybrid; mso-list-template-ids:509124976 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l0:level1 {mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in;} @list l1 {mso-list-id:1672222191; mso-list-type:hybrid; mso-list-template-ids:1809205536 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l1:level1 {mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="line-height: 150%;">Pada penderita PTA perlu dilakukan pemeriksaan<sup>7</sup>:</p> <ol style="margin-top: 0in;" start="1" type="1"><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Hitung darah lengkap (complete blood count), pengukuran kadar elektrolit (electrolyte level measurement), dan kultur darah (blood cultures).</li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Tes Monospot (antibodi heterophile) perlu dilakukan pada pasien dengan tonsillitis dan bilateral cervical lymphadenopathy. Jika hasilnya positif, penderita memerlukan evaluasi/penilaian hepatosplenomegaly. Liver function tests perlu dilakukan pada penderita dengan hepatomegaly.</li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">“Throat culture” atau “throat swab and culture”: diperlukan untuk identifikasi organisme yang infeksius. Hasilnya dapat digunakan untuk pemilihan antibiotik yang tepat dan efektif, untuk mencegah timbulnya resistensi antibiotik. </li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Plain radiographs: pandangan jaringan lunak lateral (Lateral soft tissue views) dari nasopharynx dan oropharynx dapat membantu dokter dalam menyingkirkan diagnosis abses retropharyngeal. </li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Computerized tomography (CT scan): biasanya tampak kumpulan cairan hypodense di apex tonsil yang terinfeksi (the affected tonsil), dengan “peripheral rim enhancement”. </li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Ultrasound, contohnya: intraoral ultrasonography.</li></ol> <p class="MsoNormal" style="line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><o:p> </o:p></b></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><o:p> </o:p><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">KOMPLIKASI<o:p></o:p></b></p> <p class="MsoNormal" style="text-indent: 0.5in; line-height: 150%;">Komplikasi yang mungkin terjadi ialah<sup>2</sup>:</p> <ol style="margin-top: 0in;" start="1" type="1"><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Abses pecah spontan, mengakibatkan perdarahanm aspirasi paru, atau piema.</li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Penjalaran infeksi dan abses ke daerah parafaring, sehingga terjadi abses parafaring. Kemudian dapat terjadi penjalaran ke mediastinum menimbulkan mediastinitis.</li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Bila terjadi penjalaran ke daerah intracranial, dapat mengakibatkan thrombus sinus kavernosus, meningitis, dan abses otak.</li></ol> <p class="MsoNormal" style="text-indent: 0.5in; line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Sejumlah komplikasi klinis lainnya dapat terjadi jika diagnosis PTA diabaikan. Beratnya komplikasi tergantung dari kecepatan progression penyakit. Untuk itulah diperlukan penanganan dan intervensi sejak dini.</p> <p class="MsoNormal" style="text-indent: 0.5in; line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">DIAGNOSIS BANDING<o:p></o:p></b></p> <p class="MsoNormal" style="text-indent: 0.5in; line-height: 150%;">Infiltrat peritonsil, tumor, abses retrofaring, abses parafaring, aneurisma arteri karotis interna, infeksi mastoid, mononucleosis, infeksi kelenjar liur, infeksi gigi, dan adenitis tonsil<sup>2,8,9</sup>.</p> <p class="MsoNormal" style="line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">TERAPI<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Pada stadium infiltrasi, diberikan antibiotika dosis tinggi dan obat simtomatik. Juga perlu kumur-kumur dengan air hangat dan kompres dingin pada leher. Antibiotik yang diberikan ialah penisilin 600.000-1.200.000 unit atau ampisilin/amoksisilin 3-4 x 250-500 mg atau sefalosporin 3-4 x 250-500 mg, metronidazol 3-4 x 250-500 mg<sup>2</sup>.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Bila telah terbentuk abses, dilakukan pungsi pada daerah abses, kemudian diinsisi untuk mengeluarkan nanah. Tempat insisi ialah di daerah yang paling menonjol dan lunak, atau pada pertengahan garis yang menghubungkan dasar uvula dengan geraham atas terakhir. Intraoral incision dan drainase dilakukan dengan mengiris mukosa overlying abses, biasanya diletakkan di lipatan supratonsillar. Drainase atau aspirate yang sukses menyebabkan perbaikan segera gejala-gejala pasien.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Bila terdapat trismus, maka untuk mengatasi nyeri, diberikan analgesia lokal di ganglion sfenopalatum.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Kemudian pasien dinjurkan untuk operasi tonsilektomi “a” chaud. Bila tonsilektomi dilakukan 3-4 hari setelah drainase abses disebut tonsilektomi “a” tiede, dan bila tonsilektomi 4-6 minggu sesudah drainase abses disebut tonsilektomi “a” froid. Pada umumnya tonsilektomi dilakukan sesudah infeksi tenang, yaitu 2-3 minggu sesudah drainase abses<sup>2</sup>.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Tonsilektomi merupakan indikasi absolut pada orang yang menderita abses peritonsilaris berulang atau abses yang meluas pada ruang jaringan sekitarnya. Abses peritonsil mempunyai kecenderungan besar untuk kambuh. Sampai saat ini belum ada kesepakatan kapan tonsilektomi dilakukan pada abses peritonsil. Sebagian penulis menganjurkan tonsilektomi 6–8 minggu kemudian mengingat kemungkinan terjadi perdarahan atau sepsis, sedangkan sebagian lagi menganjurkan tonsilektomi segera<sup>10</sup>.</p><br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} p.MsoFooter, li.MsoFooter, div.MsoFooter {margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; tab-stops:center 3.0in right 6.0in; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:595.35pt 842.0pt; margin:85.05pt 85.05pt 85.05pt 113.4pt; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:509679615; mso-list-type:hybrid; mso-list-template-ids:-1310002598 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l0:level1 {mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Penggunaan steroids masih kontroversial. Penelitian terbaru yang dilakukan Ozbek mengungkapkan bahwa penambahan dosis tunggal intravenous dexamethasone pada antibiotik parenteral telah terbukti secara signifikan mengurangi waktu opname di rumah sakit (<i style="">hours hospitalized</i>), nyeri tenggorokan (<i style="">throat pain</i>), demam, dan trismus dibandingkan dengan kelompok yang hanya diberi antibiotik parenteral.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style="">PROGNOSIS<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Abses peritonsoler hampir selalu berulang bila tidak diikuti dengan tonsilektomi., maka difunda sampai 6 minggu berikutnya. Pada saat tersebut peradangan telah mereda, biasanya terdapat jeringan fibrosa dan granulasi pada saat oprasi.</p> <p class="MsoNormal" style="line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="">DAFTAR PUSTAKA<o:p></o:p></b></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><font style="">1.<font style="" size="7" face="""> </font></font><!--[endif]--><st1:place st="on">Adams</st1:place>, G.L. 1997. <i style="">Penyakit-Penyakit Nasofaring Dan Orofaring</i>. Dalam: Boies, Buku Ajar Penyakit THT, hal.333. EGC, <st1:place st="on"><st1:city st="on">Jakarta</st1:city></st1:place>.</p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><font style="">2.<font style="" size="7" face="""> </font></font><!--[endif]-->Fachruddin, darnila. 2006. <i style="">Abses Leher Dalam</i>. Dalam: Buku Ajar Ilmu Kesehatan, Telinga-Hidung-Tenggorokan, hal. 185. Balai Penerbit FKUI, <st1:place st="on"><st1:city st="on">Jakarta</st1:city></st1:place>.</p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><font style="">3.<font style="" size="7" face="""> </font></font><!--[endif]-->Soepardi,E.A, Iskandar, H.N, Abses Peritonsiler, Buku Ajar Ilmu Kesehatan Telinga, Hidung dan Tenggorokan, <st1:place st="on"><st1:city st="on">Jakarta</st1:city></st1:place>: FKUl, 2000; 185-89.</p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><font style="">4.<font style="" size="7" face="""> </font></font><!--[endif]-->Mehta, Ninfa. MD. Peritonsillar Abscess. Available from. www.emedicine.com. Accessed at Juli 2007.</p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><font style="">5.<font style="" size="7" face="""> </font></font><!--[endif]-->Adrianto, Petrus. 1986. Penyakit Telinga, Hidung dan Tenggorokan, 296, 308-09. EGC, <st1:place st="on"><st1:city st="on">Jakarta</st1:city></st1:place>.</p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><font style="">6.<font style="" size="7" face="""> </font></font><!--[endif]-->Bailey, Byron J, MD. <i style="">Tonsillitis, Tonsillectomy, and Adenoidectomy</i>. In : Head and Neck Surgey-Otolaryngology 2nd Edition. Lippincott_Raven Publisher. <st1:place st="on"><st1:city st="on">Philadelphia</st1:city></st1:place>. P :1224, 1233-34.</p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><font style="">7.<font style="" size="7" face="""> </font></font><!--[endif]-->Anurogo, Dito. 2008. <i style="">Tips Praktis Mengenali Abses Peritonsil</i>. Accessed: http://www.kabarindonesia.com/berita.php?pil=3&dn=20080125161248.</p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><font style="">8.<font style="" size="7" face="""> </font></font><!--[endif]--><st1:place st="on">Preston</st1:place>, M. 2008. <i style="">Peritonsillar Abscess (Quinsy)</i>. accessed: http://www.patient.co.uk/showdoc/40000961/.</p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><font style="">9.<font style="" size="7" face="""> </font></font><!--[endif]-->STEYER, T. E. 2002. <i style="">Peritonsillar Abscess: Diagnosis and Treatment</i>. accessed: http://www.aafp.org/afp/20020101/93.html.</p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><font style="">10.<font style="" size="7" face="""> </font></font><!--[endif]-->Hatmansjah. <i style="">Tonsilektomi</i>. Cermin Dunia Kedokteran Vol. 89, 1993. Fakultas Kedokteran Universitas <st1:place st="on"><st1:country-region st="on">Indonesia</st1:country-region></st1:place>, hal : 19-21.</p><br />Taufik Abidinhttp://www.blogger.com/profile/07690954313686984126noreply@blogger.com2tag:blogger.com,1999:blog-8031884777094016874.post-88687162958791054852009-02-24T03:21:00.002+08:002009-02-24T03:28:59.749+08:00DEVIASI SEPTUM NASAL (Pergeseran Dinding Hidung)<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-no-proof:yes;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="line-height: 150%;"><b style="">Oleh: Taufik Abidin</b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">Pendahuluan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Trauma hidung banyak terjadi akibat kecelakaan yang bersifat tumpul, sehingga beresiko mengakibatkan berbagai macam komplikasi misalnya infeksi, obstruksi hidung, jaringan parut dan fibrosis, deformitas sekunder, sinekia, hidung pelana, obstruksi duktus nasoolakrimalis, dan perforasi hidung. Berdasarkan waktu, trauma hidung terbagi atas trauma baru, dimana kalus belum terbentuk sempurna; dan trauma lama, bila kalus sudah mengeras. Berdasarkan hubungan dengan telinga luar, ada yang disebut trauma terbuka dan trauma tertutup. Arah trauma menentukan kerusakan yang terjadi, misalnya bila trauma datang dari lateral, akan terjadi fraktur tulang hidung ipsilateral jika ringan, sedangkan trauma yang berat akan menyebabkan deviasi septum nasi dan fraktur tulang hidung kontralateral.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Septum hidung merupakan bagian dari hidung yang membatasi rongga hidung kanan dan kiri. Septum nasi berfungsi sebagai penopang batang hidung (dorsum nasi). Septum nasi dibagi atas dua daerah anatomi antara lain bagian anterior, yang tersusun dari tulang rawan quadrangularis; dan bagian posterior, yang tersusun dari lamina perpendikularis os ethmoidalis dan vomer. </p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Dalam keadaan normal, septum nasi berada lurus di tengah tetapi pada orang dewasa biasanya septum nasi tidak lurus sempurna di garis tengah. Deviasi septum dapat menyebabkan obstruksi hidung jika deviasi yang terjadi berat. Kecelakaan pada wajah merupakan faktor penyebab deviasi septum terbesar pada orang dewasa. </p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Gejala yang paling sering timbul dari deviasi septum ialah kesulitan bernapas melalui hidung. Kesulitan bernapas biasanya pada satu hidung, kadang juga pada hidung yang berlawanan. Pada beberapa kasus, deviasi septum juga dapat mengakibatkan drainase sekret sinus terhambat sehingga dapat menyebabkan sinusitis. </p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Pada kasus di bawah ini, deviasi septum yang terjadi akibat trauma tumpul dan gejala yang dialami pasien masih ringan sehingga pengobatan yang diberikan hanya berupa simptomatik.</p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><br /></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><br /></p><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-no-proof:yes;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:1115634316; mso-list-type:hybrid; mso-list-template-ids:-2019898830 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l0:level1 {mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="line-height: 150%;"><b style="">Definisi<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Deviasi septum ialah suatu keadaan dimana terjadi peralihan posisi dari septum nasi dari letaknya yang berada di garis medial tubuh. </p> <p class="MsoNormal" style="line-height: 150%;">Deviasi septum dibagi atas beberapa klasifikasi berdasarkan letak deviasi, yaitu:</p> <ol style="margin-top: 0in;" start="1" type="1"><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Tipe I; benjolan unilateral yang belum mengganggu aliran udara.</li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Tipe II; benjolan unilateral yang sudah mengganggu aliran udara, namun masih belum menunjukkan gejala klinis yang bermakna.</li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Tipe III; deviasi pada konka media (area osteomeatal dan turbinasi tengah).</li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Tipe IV, “S” septum (posterior ke sisi lain, dan anterior ke sisi lainnya).</li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Tipe V; tonjolan besar unilateral pada dasar septum, sementara di sisi lain masih normal.</li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Tipe VI; tipe V ditambah sulkus unilateral dari kaudal-ventral, sehingga menunjukkan rongga yang asimetri.</li><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Tipe VII; kombinasi lebih dari satu tipe, yaitu tipe I-tipe VI.</li></ol><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_KYVIN7eqnmQ/SaL4sF-Id5I/AAAAAAAAACE/58YNmF2g968/s1600-h/deviasi+septum.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 282px; height: 320px;" src="http://1.bp.blogspot.com/_KYVIN7eqnmQ/SaL4sF-Id5I/AAAAAAAAACE/58YNmF2g968/s320/deviasi+septum.jpg" alt="" id="BLOGGER_PHOTO_ID_5306076747396577170" border="0"></a><br /><br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><link rel="Edit-Time-Data" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_editdata.mso"><!--[if !mso]> <style> v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} </style> <![endif]--><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-no-proof:yes;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults ext="edit" spidmax="1027"> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout ext="edit"> <o:idmap ext="edit" data="1"> </o:shapelayout></xml><![endif]--> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><!--[if gte vml 1]><v:shapetype id="_x0000_t75" coordsize="21600,21600" spt="75" preferrelative="t" path="m@4@5l@4@11@9@11@9@5xe" filled="f" stroked="f"> <v:stroke joinstyle="miter"> <v:formulas> <v:f eqn="if lineDrawn pixelLineWidth 0"> <v:f eqn="sum @0 1 0"> <v:f eqn="sum 0 0 @1"> <v:f eqn="prod @2 1 2"> <v:f eqn="prod @3 21600 pixelWidth"> <v:f eqn="prod @3 21600 pixelHeight"> <v:f eqn="sum @0 0 1"> <v:f eqn="prod @6 1 2"> <v:f eqn="prod @7 21600 pixelWidth"> <v:f eqn="sum @8 21600 0"> <v:f eqn="prod @7 21600 pixelHeight"> <v:f eqn="sum @10 21600 0"> </v:formulas> <v:path extrusionok="f" gradientshapeok="t" connecttype="rect"> <o:lock ext="edit" aspectratio="t"> </v:shapetype><v:shape id="_x0000_s1026" type="#_x0000_t75" style="'position:absolute;" wrapcoords="-59 0 -59 21548 21600 21548 21600 0 -59 0"> <v:imagedata src="file:///C:\DOCUME~1\ADMINI~1\LOCALS~1\Temp\msohtml1\01\clip_image001.png" title="027"> <w:wrap type="tight"> </v:shape><![endif]--><!--[if !vml]--><!--[endif]-->Bentuk-bentuk dari deformitas hidung ialah deviasi, biasanya berbentuk C atau S; dislokasi, bagian bawah kartilago septum ke luar dari krista maksila dan masuk ke dalam rongga hidung; penonjolan tulang atau tulang rawan septum, bila memanjang dari depan ke belakang disebut krista, dan bila sangat runcing dan pipih disebut spina; sinekia, bila deviasi atau krista septum bertemu dan melekat dengan konka dihadapannya.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><o:p> </o:p></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><o:p><br /></o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style="">Etiologi<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Penyebab deviasi septum nasi antara lain trauma langsung, <i style="">Birth Moulding Theory </i>(posisi yang abnormal ketika dalam rahim), kelainan kongenital, trauma sesudah lahir, trauma waktu lahir, dan perbedaan pertumbuhan antara septum dan palatum.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Faktor resiko deviasi septum lebih besar ketika persalinan. Setelah lahir, resiko terbesar ialah dari olahraga, misalnya olahraga kontak langsung (tinju, karate, judo) dan tidak menggunakan helm atau sabuk pengaman ketika berkendara.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><o:p> </o:p></p><p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><o:p><br /></o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style="">Diagnosis<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Deviasi septum biasanya sudah dapat dilihat melalui inspeksi langsung pada batang hidungnya. Namun, diperlukan juga pemeriksaan radiologi untuk memastikan diagnosisnya. Dari pemeriksaan rinoskopi anterior, dapat dilihat penonjolan septum ke arah deviasi jika terdapat deviasi berat, tapi pada deviasi ringan, hasil pemeriksaan bisa normal.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Deviasi septum yang ringan tidak akan mengganggu, akan tetapi bila deviasi itu cukup berat, menyebabkan penyempitan pada satu sisi hidung. Dengan demikian, dapat mengganggu fungsi hidung dan menyebabkan komplikasi.</p><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_KYVIN7eqnmQ/SaL4qPsZ3dI/AAAAAAAAAB8/aySCP00dxMw/s1600-h/sleep_septoplasty2.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 210px; height: 320px;" src="http://2.bp.blogspot.com/_KYVIN7eqnmQ/SaL4qPsZ3dI/AAAAAAAAAB8/aySCP00dxMw/s320/sleep_septoplasty2.jpg" alt="" id="BLOGGER_PHOTO_ID_5306076715646836178" border="0"></a><br /><br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; panose-1:5 0 0 0 0 0 0 0 0 0; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 268435456 0 0 -2147483648 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-no-proof:yes;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:995764928; mso-list-type:hybrid; mso-list-template-ids:-2068932356 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l0:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Symbol;} @list l0:level2 {mso-level-number-format:bullet; mso-level-text:o; mso-level-tab-stop:1.0in; mso-level-number-position:left; text-indent:-.25in; font-family:"Courier New";} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Gejala yang sering timbul biasanya adalah sumbatan hidung yang unilateral atau juga bilateral. Keluhan lain ialah rasa nyeri di kepala dan di sekitar mata. Selain itu, penciuman juga bisa terganggu apabila terdapat deviasi pada bagian atas septum.</p> <p class="MsoNormal" style="line-height: 150%;"><o:p> </o:p></p><p class="MsoNormal" style="line-height: 150%;"><o:p><br /></o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style="">Penatalaksanaan<o:p></o:p></b></p> <ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="line-height: 150%;">Analgesik. Digunakan untuk mengurangi rasa sakit.</li><li class="MsoNormal" style="line-height: 150%;">Dekongestan, digunakan untuk mengurangi sekresi cairan hidung.</li><li class="MsoNormal" style="line-height: 150%;">Pembedahan.</li><ul style="margin-top: 0in;" type="circle"><li class="MsoNormal" style="text-align: justify; line-height: 150%;">Septoplasti. </li><li class="MsoNormal" style="line-height: 150%;">SMR (Sub-Mucous Resection). </li></ul></ul> <p class="MsoNormal" style="line-height: 150%;"><o:p> </o:p></p><p class="MsoNormal" style="line-height: 150%;"><o:p><br /></o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style="">Komplikasi<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><font style="" lang="IN">Deviasi septum dapat menyumbat ostium sinus, sehingga merupakan faktor predisposisi terjadinya sinusitis. Selain itu, deviasi septum juga menyebabkan ruang hidung sempit, yang dapat membentuk polip.<o:p></o:p></font></p><br /><br /><meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype><!--[if gte mso 9]><xml> <w:worddocument> <w:view>Normal</w:View> <w:zoom>0</w:Zoom> <w:punctuationkerning/> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:snaptogridincell/> <w:wraptextwithpunct/> <w:useasianbreakrules/> <w:dontgrowautofit/> </w:Compatibility> <w:browserlevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id="ieooui"></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-no-proof:yes;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="text-align: center; line-height: 150%;" align="center"><b style="">DAFTAR PUSTAKA<o:p></o:p></b></p> <p class="MsoNormal" style="line-height: 150%;"><font style="" lang="IN"><o:p> </o:p></font></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.5in; line-height: 150%;">Balasubramanian, T. 2006. <i style="">Deviated Nasal Septum</i>. Accessed: <i style="">http://drtbalu.com/dns.html.</i> </p> <p class="MsoNormal" style="line-height: 150%;">Anonim. 2006. <i style="">http://www.obstructednose.com/nasal_treatment_deviated_septum.html</i>.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.5in; line-height: 150%;">Novak, V .J. 1995. <i style="">Pathogenesis and surgical treatment of neurovascular primary headaches</i>. The italian journal of Neurological Sciens. Accessed: <i style="">http://www.vj-novak.ch/images/novak1-1.jpg.</i></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.5in; line-height: 150%;">Mangunkusumo, Endang. Nizar, N.W. 2006. <i style="">Kelainan Septum</i>. Dalam: Buku Ajar Ilmu Telinga-Hidung-Tenggorokan, hal.99. Balai Penerbit FKUI. <st1:place st="on"><st1:city st="on">Jakarta</st1:city></st1:place>.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.5in; line-height: 150%;">Kartika, Henny.2007. <i style="">Anatomi Hidung dan Sinus Paranasal</i>. Accessed: http://hennykartika.wordpress.com/2007/12/29/anatomi-hidung-dan-sinus-paranasal.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.5in; line-height: 150%;">Chmielik, Lechosław P. 2006. <i style="">Nasal septum deviation and conductivity hearing loss in children</i>. Borgis - New Medicine 3/2006, p. 82-86. accessed: http://www.newmedicine.pl/show.php?ktory=22.</p><br /> Taufik Abidinhttp://www.blogger.com/profile/07690954313686984126noreply@blogger.com9tag:blogger.com,1999:blog-8031884777094016874.post-42198525006821089142009-02-24T03:17:00.001+08:002009-02-24T03:20:16.263+08:00OTITIS EKSTERNA (OE)<meta http-equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Wingdings; 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mso-level-text:; mso-level-tab-stop:none; mso-level-number-position:left; text-indent:-.25in; font-family:Symbol;} @list l1 {mso-list-id:1794786646; mso-list-type:hybrid; mso-list-template-ids:-1806821218 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l1:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:none; mso-level-number-position:left; text-indent:-.25in; font-family:Symbol;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b style=""><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Oleh: I Dewa Ayu Vanessa</span></b></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b style=""><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Pendahuluan<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Otitis eksterna adalah radang liang telinga akut maupun kronis disebabkan oleh bakteri dapat terlogalisir atau difus, telinga rasa sakit. Faktor ini penyebab timbulnya otitis eksterna ini, kelembaban, penyumbatan liang telinga, trauma local dan alergi. Faktor ini menyebabkan berkurangnya lapisan protektif yang menyebabkan edema dari epitel skuamosa. Keadaan ini menimbulkan trauma local yang mengakibatkan bakteri masuk melalui kulit, inflasi dan menimbulkan eksudat. Bakteri patogen pada otitis eksterna akut adalah pseudomonas (41 %), strepokokus (22%), stafilokokus aureus (15%) dan bakteroides (11%).<sup><span style="">1</span></sup><b> </b>Istilah otitis eksterna akut meliputi adanya kondisi inflasi kulit dari liang telinga bagian luar. <sup><span style="">2,3</span></sup><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Otitis eksterna ini merupakan suatu infeksi liang telinga bagian luar yang<b> </b>dapat menyebar ke pina, periaurikular, atau ke tulang temporal. Biasanya seluruh<b> </b>liang telinga terlibat, tetapi pada furunkel liang telinga luar dapat dianggap<b> </b>pembentukan lokal otitis eksterna. Otitis eksterna difusa merupakan tipe infeksi<b> </b>bakteri patogen yang paling umum disebabkan oleh pseudomonas, stafilokokus dan<b> </b>proteus, atau jamur.<sup>4</sup><b><o:p></o:p></b></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Penyakit ini sering diumpai pada daerah-daerah yang panas dan lembab dan jarang pada iklim-iklim sejuk dan kering.<b> </b>Patogenesis dari otitis eksterna sangat komplek dan sejak tahun 1844 banyak peneliti mengemukakan faktor pencetus dari penyakit ini seperti Branca (1953) mengatakan bahwa berenang merupakan penyebab dan menimbulkan kekambuhan. Senturia dkk (1984) menganggap bahwa keadaan panas, lembab dan trauma terhadap epitel dari liang telinga luar merupakan faktor penting untuk terjadinya otitis eksterna.<sup><span style=""> </span></sup>Howke dkk (1984) mengemukakan pemaparan terhadap air dan penggunaan lidi kapas dapat menyebabkan terjadi otitis eksterna baik yang akut maupun kronik.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><span style=""> </span>Penulis akan membahas tentang kasus otitis eksterna sinistra. Penyakit ini sering ditemukan pada pasien di bidang telinga, hidung dan tenggorokan. <span style="color: black;">Nan Sati CN dalam penelitiannya di RS.Sumber Waras/FK UNTAR Jakarta mulai 1 Januari 1980 sampai dengan 30 Desember 1980 mendapatkan 1.370 penderita baru dengan diagnosis otitis eksterna yang terdiri dari 633 pria dan 737wanita. Umumnya penderita datang ke Rumah Sakit dengan keluhan rasa sakit pada telinga, terutama bila daun telinga disentuh dan waktu mengunyah. Bila peradangan ini tidak diobati secara adekuat, maka keluhan-keluhan seperti rasa sakit, gatal dan mungkin sekret yang berbau akan menetap.<sup><span style="">2</span></sup><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><o:p> </o:p></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><o:p><br /></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b style=""><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Batasan</span></b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Otitis eksterna adalah radang merata kulit liang telinga yang disebabkan oleh kuman maupun jamur (otomikosis) dengan tanda-tanda khas yaitu rasa tidak enak di liang telinga, deskuamasi, sekret di liang telinga dan kecenderungan untuk kambuhan. Pengobatan amat sederhana tetapi membutuhkan kepatuhan penderita terutama dalam menjaga kebersihan liang telinga.<sup><span style="color: black;">8</span></sup><b style=""><o:p></o:p></b></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p> </o:p></span></b></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p><br /></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Etiologi</span></b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Swimmer’s ear (otitis eksterna) sering dijumpai, didapati 4 dari 1000 orang, kebanyakan pada usia remaja dan dewasa muda.Terdiri dari inflamasi, iritasi atau infeksi pada telinga bagian luar. Dijumpai riwayat pemaparan terhadap air, trauma mekanik dan goresan atau benda asing dalam liang telinga. Berenang dalam air yang tercemar merupakan salah satu cara terjadinya otitis eksterna (swimmer’s ear).<sup>3</sup> Bentuk yang paling umum adalah bentuk boil (Furunkulosis) salah satu dari satu kelenjar sebasea 1/3 liang telinga luar. Pada otitis eksterna difusa disini proses patologis membatasi kulit sebagian kartilago dari otitis liang telinga luar, konka daun telinga penyebabnya idiopatik, trauma, iritan, bakteri atau fungal, alergi dan lingkungan. Kebanyakan disebabkan alergi pemakaian topikal obat tetes telinga. Alergen yang paling sering adalah antibiotik, contohnya: neomycin, framycetyn, gentamicin, polimixin, anti bakteri (clioquinol, Holmes dkk, 1982) dan anti histamin. Sensitifitas poten lainnya adalah metal dan khususnya nikel yang sering muncul pada kertas dan klip rambut yang mungkin digunakan untuk mengorek telinga. Infeksi merupakan penyakit yang paling umum dari liang telinga luar seperti otitis eksterna difusa akut pada lingkungan yang lembab.<sup>2 </sup><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p> </o:p></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p><br /></o:p></span></p> <h3 style="margin: 0in 0in 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%;">Patofisiologi</span><span style="font-size: 12pt; line-height: 150%; font-weight: normal;"><o:p></o:p></span></h3> <p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;">Saluran telinga bisa membersihkan dirinya sendiri dengan cara membuang sel-sel kulit yang mati dari gendang telinga melalui saluran telinga. Membersihkan saluran telinga dengan <i style="">cotton bud</i> (kapas pembersih) bisa mengganggu mekanisme pembersihan ini dan bisa mendorong sel-sel kulit yang mati ke arah gendang telinga sehingga kotoran menumpuk disana. </p> <p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;">Penimbunan sel-sel kulit yang mati dan serumen akan menyebabkan penimbunan air yang masuk ke dalam saluran ketika mandi atau berenang. Kulit yang basah dan lembut pada saluran telinga lebih mudah terinfeksi oleh bakteri atau jamur. <sup><span style="color: black;">7</span></sup></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p> </o:p></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p><br /></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b style=""><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Klasifikasi Otitis Eksterna<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">4.1. Penyebab tidak diketahui :<o:p></o:p></span></p> <p class="ListParagraphCxSpFirst" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Malfungsi kulit : dermatitis seboroita, hiperseruminosis, asteotosis<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Eksema infantil : intertigo, dermatitis infantil.<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Otitis eksterna membranosa.<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Meningitis kronik idiopatik<o:p></o:p></span></p> <p class="ListParagraphCxSpLast" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Lupus erimatosus, psoriasis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">4.2. Penyebab infeksi<o:p></o:p></span></p> <p class="ListParagraphCxSpFirst" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Bakteri gram (+) : furunkulosis, impetigo, pioderma, ektima, sellulitis, erisipelas.<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Bakteri gram (-) : Otitis eksterna diffusa, otitis eksterna bullosa, otitis eksterna granulosa, perikondritis.<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Bakteri tahan asam : mikrobakterium TBC.<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Jamur dan ragi (otomikosis) : saprofit atau patogen.<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Meningitis bullosa, herpes simplek, herpes zoster, moluskum kontangiosum, variola dan varicella.<o:p></o:p></span></p> <p class="ListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Protozoa<o:p></o:p></span></p> <p class="ListParagraphCxSpLast" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol; color: black;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Parasit<o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 27pt; text-align: justify; text-indent: -27pt; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">4.3. Erupsi neurogenik : proritus simpek, neurodermatitis lokalisata/desiminata, ekskoriasi, neurogenik.<o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 27pt; text-align: justify; text-indent: -27pt; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">4.4. <span style=""> </span>Dermatitis alergika, dermatitis kontakta (venenat), dermatis atopik, erupsi karena obat, dermatitis eksamatoid infeksiosa, alergi fisik.<o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 27pt; text-align: justify; text-indent: -27pt; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">4.5. <span style=""> </span>Lesi traumatika : kontusio dan laserasi, insisi bedah, hemorhagi (hematom vesikel dan bulla), trauma (terbakar, frosbite, radiasi dan kimiawi).<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">4.6. <span style=""> </span>Perubahan senilitas.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">4.7. <span style=""> </span>Deskrasia vitamin<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">4.8. <span style=""> </span>Diskrasia endokrin.<sup>2</sup></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><br /></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><br /></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><meta http-equiv="Content-Type" content="text/html; 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mso-level-text:; mso-level-tab-stop:1.15in; mso-level-number-position:left; margin-left:1.2in; text-indent:-.45in; font-family:Symbol; color:windowtext;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> </p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><i style=""><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Otitis Eksterna Sirkumskripta (Furunkel/ bisul)<o:p></o:p></span></i></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><span style=""> </span></span></b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Otitis eksterna sirkumskripta adalah infeksi bermula dari folikel rambut di liang telinga yang disebabkan oleh bakteri stafilokokus dan menimbulkan furunkel di liang telinga di 1/3 luar. Sering timbul pada seseorang yang menderita diabetes.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><span style=""> </span>Gejala klinis otitis eksterna sirkumskripta berupa rasa sakit (biasanya dari ringan sampai berat, dapat sangat mengganggu, rasa nyeri makin hebat bila mengunyah makanan). Keluhan kurang pendengaran, bila furunkel menutup liang telinga. Rasa sakit bila daun telinga ketarik atau ditekan. Terdapat tanda infiltrat atau abses pada 1/3 luar liang telinga.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Penatalaksanaan otitis eksterna sirkumskripta : <sup><span style="color: black;">8</span><span style="color: red;"><o:p></o:p></span></sup></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.75in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Lokal : pada stadium infiltrat diberikan tampon yang dibasahi dengan 10% ichthamol dalam glycerine, diganti setiap hari. Pada stadium abses dilakukan insisi pada abses dan tampon larutan rivanol 0,1%.<o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.75in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Sistemik : Antibiotika diberikan dengan pertimbangan infeksi yang cukup berat. Diberikan pada orang dewasa ampisillin 250 mg qid, eritromisin 250 qid. Anak-anak diberikan dosis 40-50 mg per kg BB.<o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.75in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Analgetik : Parasetamol 500 mg qid (dewasa). Antalgin 500 mg qid (dewasa).<o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Pada kasus-kasus berulang tidak lupa untuk mencari faktor sistemik yaitu adanya penyakit diabetes melitus.<sup><span style="color: black;">8</span></sup><span style="color: black;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><o:p> </o:p></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><o:p><br /></o:p></span></p> <p style="margin: 0in 0in 0.0001pt; text-align: justify; line-height: 150%;"><i style="">Otitis Eksterna Difus<o:p></o:p></i></p> <p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;">Otitis eksterna difus adalah infeksi pada 2/3 dalam liang telinga akibat infeksi bakteri. Umumnya bakteri penyebab yaitu Pseudomonas. Bakteri penyebab lainnya yaitu Staphylococcus albus, Escheria coli, dan sebagainya. Kulit liang telinga terlihat hiperemis dan udem yang batasnya tidak jelas. Tidak terdapat furunkel (bisul). Gejalanya sama dengan gejala otitis eksterna sirkumskripta (furunkel = bisul). Kandang-kadang kita temukan sekret yang berbau namun tidak bercampur lendir (musin). Lendir (musin) merupakan sekret yang berasal dari kavum timpani dan kita temukan pada kasus otitis media. <sup><span style="color: black;">5</span></sup><span style="color: red;"><o:p></o:p></span></p> <p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="color: black;">Pengobatan </span>otitis eksterna difus ialah dengan memasukkan tampon yang mengandung antibiotik ke liang telinga supaya terdapat kontak yang baik antara obat dengan kulit yang meradang. Kadang-kadang diperlukan obat antibiotika sistemik. <sup><span style="color: black;">6</span></sup></p> <p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="color: black;"><o:p> </o:p></span></p><p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="color: black;"><o:p><br /></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><i style=""><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Otomikosis <o:p></o:p></span></i></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Infeksi jamur di liang telinga dipermudah oleh kelembaban yang tinggi di daerah tersebut. Yang tersering ialah jamur aspergilus. Kadang-kadang ditemukan juga kandida albikans atau jamur lain.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Gejalanya biasanya berupa rasa gatal dan rasa penuh di liang telinga, tetapi sering pula tanpa keluhan. Pengobatannya ialah dengan membersihkan liang telinga. Larutan asam asetat 2-5% dalam alkohol yang diteteskan ke liang telinga biasanya dapat menyembuhkan. Kadang-kadang diperlukan juga obat anti-jamur (sebagai salep) yang diberikan secara topikal. <sup>6</sup></span><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: red;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p> </o:p></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p><br /></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Gejala Klinis<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Rasa sakit </span></b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">di dalam telinga bisa bervariasi dari yang hanya berupa rasa tidak enak sedikit, perasaan penuh didalam telinga, perasaan seperti terbakar hingga rasa sakit yang hebat, serta berdenyut. Meskipun rasa sakit sering merupakan gejala yang dominan, keluhan ini juga sering merupakan gejala sering mengelirukan. Kehebatan rasa sakit bisa agaknya tidak sebanding dengan derajat peradangan yang ada. Ini diterangkan dengan kenyataan bahwa kulit dari liang telinga luar langsung berhubungan dengan periosteum dan perikondrium, sehingga edema dermis menekan serabut saraf yang mengakibatkan rasa sakit yang hebat. Lagi pula, kulit dan tulang rawan 1/3 luar liang telinga bersambung dengan kulit dan tulang rawan daun telinga sehingga gerakan yang sedikit saja dari daun telinga akan dihantarkan kekulit dan tulang rawan dari liang telinga luar dan mengkibatkan rasa sakit yang hebat dirasakan oleh penderita otitis eksterna.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Rasa penuh pada telinga </span></b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">merupakan keluhan yang umum pada tahap awal dari otitis eksterna difusa dan sering mendahului terjadinya rasa sakit dan nyeri tekan daun telinga.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Gatal </span></b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">merupakan gejala klinik yang sangat sering dan merupakan pendahulu rasa sakit yang berkaitan dengan otitis eksterna akut. Pada kebanyakan penderita rasa gatal disertai rasa penuh dan rasa tidak enak merupakan tanda permulaan peradangan suatu otitis eksterna akuta. Pada otitis eksterna kronik merupakan keluhan utama.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Kurang pendengaran </span></b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">mungkin terjadi pada akut dan kronik dari otitis eksterna akut. Edema kulit liang telinga, sekret yang sorous atau purulen, penebalan kulit yang progresif pada otitis eksterna yang lama, sering menyumbat lumen kanalis dan menyebabkan timbulnya tuli konduktif. Keratin yang deskuamasi, rambut, serumen, debris, dan obat-obatan yang digunakan kedalam telinga bisa menutup lumen yang mengakibatkan peredaman hantaran suara.<sup>2</sup><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p> </o:p></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><o:p><br /></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Tanda-Tanda Klinis<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Menurut MM. Carr secara klinik otitis eksterna terbagi : <sup>4</sup><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">1. Otitis Eksterna Ringan : kulit liang telinga hiperemis dan eksudat, liang telinga menyempit.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">2. Otitis Eksterna Sedang : liang telinga sempit, bengkak, kulit hiperemis dan eksudat positif<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">3. Otitis Eksterna Komplikas : Pina/Periaurikuler eritema dan bengkak<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">4. Otitis Eksterna Kronik : kulit liang telinga/pina menebal, keriput, eritema positif.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Menurut Senturia HB (1980) :<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Eritema kulit, sekret yang kehijau-hijauan dan edema kulit liang telinga merupakan tanda-tanda klasik dari otitis diffusa akuta. Bau busuk dari sekret tidak terjadi. Otitis eksterna diffusa dapat dibagi atas 3 stadium yaitu : <sup>2</sup><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">1. “Pre Inflammatory“<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">2. Peradangan akut (ringan/ sedang/ berat)<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">3. Radang kronik<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><o:p> </o:p></span></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><o:p><br /></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Diagnosis Banding<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Diagnosis banding dari keadaan yang serupa dengan otitis eksterna antara lain meliputi :<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">- Otitis eksterna nekrotik<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">- Otitis eksterna bullosa<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">- Otitis eksterna granulosa<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">- Perikondritis yang berulang<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">- Kondritis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">- Furunkulosis dan karbunkulosis<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">- dermatitis, seperti psoriasis dan dermatitis seboroika.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Karsinoma liang telinga luar yang mungkin tampak seperti infeksi stadium dini diragukan dengan proses infeksi, sering diobati kurang sempurna. Tumor ganas yang paling sering adalah squamous sel karsinoma, walaupun tumor primer seperti seruminoma, kista adenoid, metastase karsinoma mamma, karsinoma prostat, small (oat) cell“ dan karsinoma sel renal. Adanya rasa sakit pada daerah mastoid terutama dari tumor ganas dan dapat disingkirkan dengan melakukan pemeriksaan biopsi.<sup>2</sup><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b style=""><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><o:p> </o:p></span></b></p><p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; line-height: 150%;"><b style=""><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";"><o:p><br /></o:p></span></b></p> <p class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center; line-height: 150%;"><b style=""><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">DAFTAR PUSTAKA<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Oghalai, J.S. 2003. <i>Otitis Eksterna</i><span style="">. Available from : http://www. bcm.tme.edu/oto/grand/101295.htm. Accessed : 2008, March 28.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Abdullah, F. 2003. <i>Uji Banding Klinis Pemakaian Larutan Burruwi Saring dengan Salep Ichthyol (Ichthammol) pada Otitis Eksterna Akut</i>. Available from : <a href="http://www.usudigitallibrary.com/"><span style="color: black;">www.usudigitallibrary.com</span></a>. Accessed : 2008, March 28.<o:p></o:p></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><span style="">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Kotton, C. 2004. <i>Otitis Eksterna. </i><span style="">Available from : </span>http:sav-ondrugs. com/shop/templates/encyclopedia/ ENCY/ artcle/000622. asp. <span style="">Accessed : 2008, March 28.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><span style="">4.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Carr, MM. 2000. <i>Otitis Eksterna. </i><span style="">Available from : http://www. icarus.med.utoronto.ea/carr/manual/otitisexterna</span>. htm. <span style="">Accessed : 2008, March 28.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><span style="">5.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Fatih, M. 2007. <i><span style="color: black;">Otitis Eksterna. </span></i><span style="color: black;">Available from : </span><span style="color: black;"><a href="http://hennykartika.wordpress.com/2007/12/29/otitis-eksterna/"><span style="color: black;">http://hennykartika.wordpress.com/2007/12/29/otitis-eksterna/</span></a>.</span> <span style="color: black;">Accessed : 2008, March 27.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><span style="">6.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Sosialisman & Helmi. 2001. <i style="">Kelainan Telinga Luar</i> dalam <i style="">Buku Ajar Ilmu Kesehatan Telinga, Hidung, Tenggorok, Kepala & Leher</i>. Ed. ke-5. Fakultas Kedokteran Universitas <st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region>. <st1:place w:st="on"><st1:city w:st="on">Jakarta</st1:city></st1:place>.<span style="color: black;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><span style="">7.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman";">Anonim. 2006. <i><span style="color: black;">Otitis Eksterna.</span></i><span style="color: black;"> Available from :</span><b style=""> </b><span style="color: black;"><a href="http://www.kalbe.co.id/"><span style="color: black;">http://www.kalbe.co.id</span></a>.</span> <span style="color: black;">Accessed : 2008, March 27.<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><span style="">8.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;">Suardana, W. dkk. 1992. <i>Pedoman Diagnosis dan Terapi Ilmu Penyakit Telinga, Hidung dan Tenggorok RSUP Denpasar</i>. Lab/UPF Telinga Hidung dan Tenggorok FK Unud. Denpasar.<o:p></o:p></span></p> <br /><span style="font-size: 12pt; line-height: 150%; font-family: "Times New Roman"; color: black;"><sup><o:p></o:p></sup></span><p></p> Taufik Abidinhttp://www.blogger.com/profile/07690954313686984126noreply@blogger.com0tag:blogger.com,1999:blog-8031884777094016874.post-30917108705856736742009-02-24T02:47:00.005+08:002009-02-24T02:55:57.585+08:00Rinitis Atrofi (Ozaena)<meta http-equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:536902279 -2147483648 8 0 511 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} p {mso-margin-top-alt:auto; margin-right:0in; mso-margin-bottom-alt:auto; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} span.ft91 {mso-style-name:ft91; mso-ansi-font-size:10.0pt; mso-bidi-font-size:10.0pt; font-family:Times; mso-ascii-font-family:Times; mso-hansi-font-family:Times; mso-bidi-font-family:Times; color:black;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:36511288; mso-list-type:hybrid; mso-list-template-ids:1817377312 -1064152488 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l0:level1 {mso-level-number-format:roman-upper; mso-level-tab-stop:none; mso-level-number-position:left; margin-left:.75in; text-indent:-.5in;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft91"><b style=""><span style="line-height: 150%; font-family: "Times New Roman";">oleh: I Dewa Ayu Vanessa<br /></span></b></span></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft91"><b style=""><span style="line-height: 150%; font-family: "Times New Roman";">PENDAHULUAN<o:p></o:p></span></b></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Rinitis atrofi adalah penyakit infeksi hidung kronik, yang ditandai adanya atrofi progresif pada mukosa dan tulang konka dan pembentukan krusta. Disebut juga rhinitis chronica atrophicanscum foetida, sebab ada rhinitis chronica atrophican non</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">foetida. </span></span><span style=""> </span><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Secara klinis, mukosa hidung menghasilkan sekret yang kental dan cepat mengering, sehingga terbentuk krusta yang berbau busuk.</span></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Etiologi dan patogenesis rinitis atrofi sampai sekarang belum dapat diterangkan dengan memuaskan.</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Oleh karena etiologinya belum pasti, maka pengobatannya belum ada yang <st1:city w:st="on"><st1:place w:st="on">baku</st1:place></st1:city>. Pengobatan ditujukan untuk menghilangkan faktor penyebab dan untuk menghilangkan gejala.</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Pengobatan dapat diberikan secara konservatif atau jika tidak menolong, dilakukan operasi. Menurut pengalaman, untuk kepentingan klinis perlu ditetapkan derajat</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">ozaena sebelum diobati, yaitu ringan, sedang atau berat, oleh</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">karena ini sangat</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">menentukan terapi dan prognosisnya.</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Biasanya diagnosis ozaena secara klinis tidak sulit. Biasanya</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">discharge berbau, bilateral, terdapat crustae kuning kehijau-hijauan. </span></span>Keluhan subjektif yang sering ditemukan pada pasien biasanya napas berbau (sementara pasien sendiri menderita anosmia)<span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">.<sup>1,2,4</sup></span></span><span style=""> </span></p> <p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Menurut Boies frekwensi penderita rhinitis atrofi wanita : laki adalah 3 : 1. Penyakit ini lebih sering mengenai wanita,</span></span> <span style="" lang="EN">usia 1-35 tahun </span><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">terutama pada usia pubertas.</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Sering ditemukan pada masyarakat dengan tingkat sosial ekonomi rendah dan di lingkungan yang buruk</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">dan di negara sedang berkembang.</span></span><sup><span style="" lang="EN">1,2,3<o:p></o:p></span></sup></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="EN">Ozaena lebih umum di negara-negara sekitar Laut Tengah daripada di Amerika Serikat. Menurunnya insidens campak, <i style="">scarlet fever</i>, dan difteria di Eropa Selatan sejak perang dunia ke II tampaknya timbul bersaman dengan suatu penurunan tajam dalam insidens ozaena.<sup>5</sup><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><o:p> </o:p></p><p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><br /><o:p></o:p><b style=""><span style=""></span></b></p><p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><b style=""><span style=""><span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></b><!--[endif]--><b style="">TINJAUAN PUSTAKA<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><o:p> </o:p></b></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><o:p><br /></o:p></b></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style="">Batasan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Rinitis atrofi adalah penyakit infeksi hidung kronik, yang ditandai adanya atrofi progresif pada mukosa dan tulang konka dan pembentukan krusta. Disebut juga rhinitis chronica atrophicanscum foetida, sebab ada rhinitis chronica atrophican non</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">foetida. Karakteristiknya ialah adanya atropi mukosa dan</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">jaringan pengikat submukosa struktur fossa nasalis, disertai</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">adanya crustae yang berbau khas. Secara klinis, mukosa hidung menghasilkan sekret yang kental dan cepat mengering, sehingga terbentuk krusta yang berbau busuk.</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Penyakit ini lebih banyak menyerang wanita daripada pria, terutama pada umur sekitar pubertas.<sup>1,2,6</sup></span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><o:p> </o:p></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><o:p><br /></o:p></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style="">Kekerapan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Beberapa kepustakaan menuliskan bahwa rinitis atrofi lebih sering mengenai wanita,</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">terutama pada usia pubertas.</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Baser dkk mendapatkan 10 wanita dan 5 pria,</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">dan Jiang dkk mendapatkan 15 wanita dan 12 pria.</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Samiadi mendapatkan 4 penderita wanita dan 3 pria.</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Menurut Boies frekwensi penderita rhinitis atrofi wanita : laki adalah 3 : 1. Tetapi dari segi umur, beberapa penulis mendapatkan hasil yang berbeda. Baser dkk mendapatkan umur antara 26-50 tahun,</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Jiang dkk berkisar 13-68 tahun, Samiadi mendapatkan umur antara 15-49 tahun.</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Penyakit ini sering ditemukan di kalangan masyarakat dengan tingkat sosial ekonomi rendah dan lingkungan yang buruk</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">dan di negara sedang berkembang.</span></span> <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Di RS H. Adam Malik dari Januari 1999 sampai Desember 2000 ditemukan 6 penderita rinitis atrofi, 4 wanita dan 2 pria, umur berkisar dari 10-37 tahun.<sup>1,2</sup><o:p></o:p></span></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="EN">Ozaena lebih umum di negara-negara sekitar Laut Tengah daripada di Amerika Serikat. 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mso-list-template-ids:593289426 -486925308 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l11:level1 {mso-level-text:"%1\)"; mso-level-tab-stop:none; mso-level-number-position:left; text-indent:-.25in; color:black;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style="">Etiologi<o:p></o:p></b></p> <p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="EN">Penyebab rinitis atrofi (Ozaena) belum diketahui sampai sekarang. Terdapat berbagai teori mengenai penyebab rinitis atrofik dan penyakit degeneratif sejenis. Beberapa penulis menekankan faktor herediter.<sup>5,6</sup> Namun ada beberapa keadaan yang dianggap berhubungan dengan terjadinya rinitis atrofi (Ozaena), yaitu : <sup>1,3,5</sup><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Infeksi setempat/ kronik spesifik. Paling banyak disebabkan oleh <i style=""><span style="">Klebsiella Ozaena.</span></i> </span><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Kuman ini menghentikan aktifitas sillia normal pada mukosa hidung manusia. </span></span><span style="" lang="EN">Selain golongan Klebsiella, kuman spesifik penyebab lainnya antara lain Stafilokokus, Streptokokus, <i style="">Pseudomonas aeuruginosa</i>, </span><span class="ft71"><span style="line-height: 150%; font-family: "Times New Roman";">Kokobasilus,<i> Bacillus mucosus, Diphteroid bacilli,</i> <i>Cocobacillus foetidus ozaena</i><span style="">.</span></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Defisiensi. Defisiensi Fe dan vitamin A. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Infeksi sekunder. Sinusitis kronis. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Kelainan hormon. </span><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Ketidakseimbangan hormon estrogen.</span></span><span style="" lang="EN"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Penyakit kolagen. Penyakit kolagen yang termasuk penyakit autoimun. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Teori mekanik dari Zaufal.</span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">Ketidakseimbangan otonom.</span></span><span style=""> <span lang="EN">Terjadi perubahan neurovaskular seperti deteriorisasi pembuluh darah akibat gangguan sistem saraf otonom.</span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Variasi dari <i>Reflex Sympathetic Dystrophy Syndrome</i> (RSDS).</span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Herediter.</span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Supurasi di hidung dan sinus paranasal.</span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Golongan darah. </span></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Selain faktor-faktor di atas, rinitis atrofi juga bisa digolongkan atas : rinitis atrofi primer yang penyebabnya tidak diketahui</span></span> <span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">dan rinitis atrofi sekunder, akibat trauma hidung (operasi besar pada hidung atau radioterapi) dan infeksi hidung kronik yang disebabkan oleh sifilis, lepra, <i>midline granuloma</i>, rinoskleroma dan tbc. </span></span><span style="" lang="EN">Radiasi pada hidung umumnya segera merusak pembuluh darah dan kelenjar penghasil mukus dan hampir selalu menyebabkan rinitis atrofik. Berbagai infeksi seperti eksantema akut, <i style="">scarlet fever</i>, difteri dan infeksi kronik telah diimplikasikan sebagai penyebab cedera pembuluh darah submukosa. Penyebab dari lingkungan juga telah diajukan karena angka insiden yang lebih tinggi pada masyarakat sosio ekonomi rendah.</span><span class="ft92"><sup><span style="line-height: 150%; font-family: "Times New Roman";">1,5</span></sup></span><span style="" lang="EN"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; line-height: 150%;"><span style="" lang="EN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style="">Patologi dan Patogenesis<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Beberapa penulis menyatakan adanya metaplasi epitel kolumnar bersilia menjadi epitel skuamous atau atrofik,</span></span> <span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">dan fibrosis dari tunika propria. Terdapat pengurangan kelenjar alveolar baik dalam jumlah dan ukuran</span></span> <span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">dan adanya endarteritis dan periarteritis pada arteriole terminal.</span></span> <span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Oleh karena itu secara patologi, rinitis atrofi bisa dibagi menjadi dua : <sup>1</sup></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">a)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Tipe I : adanya endarteritis dan periarteritis pada arteriole terminal akibat infeksi kronik; membaik dengan efek vasodilator dari terapi estrogen. </span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">b)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Tipe II : terdapat vasodilatasi kapiler, yang bertambah jelek dengan terapi estrogen. </span></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";"><o:p> </o:p></span></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Sebagian besar kasus merupakan tipe I. Endarteritis di arteriole akan menyebabkan berkurangnya aliran darah ke mukosa. Juga akan ditemui infiltrasi sel bulat di submukosa. <st1:city w:st="on"><st1:place w:st="on">Taylor</st1:place></st1:city> dan Young mendapatkan sel endotel bereaksi positif dengan fosfatase alkali yang menunjukkan adanya absorbsi tulang yang aktif.</span></span> <span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Atrofi epitel bersilia dan kelenjar seromusinus menyebabkan pembentukan krusta tebal yang melekat.</span></span> <span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Atrofi konka menyebabkan saluran nafas jadi lapang.</span></span> <span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Ini juga dihubungkan dengan teori proses autoimun; Dobbie mendeteksi adanya antibodi yang berlawanan dengan surfaktan protein A. Defisiensi surfaktan merupakan penyebab utama menurunnya resistensi hidung terhadap infeksi. Fungsi surfaktan yang abnormal menyebabkan pengurangan efisiensi <i>mucus clearance</i> dan mempunyai pengaruh kurang baik terhadap frekuensi gerakan silia. Ini akan menyebabkan bertumpuknya lendir dan juga diperberat dengan keringnya mukosa hidung dan hilangnya silia. Mukus akan mengering bersamaan dengan terkelupasnya sel epitel, membentuk krusta yang merupakan medium yang sangat baik untuk pertumbuhan kuman.<sup>1</sup> </span></span><span style="" lang="EN">Perubahan histopatologi dalam hidung pada rinitis atrofi (Ozaena), yaitu : <sup>3</sup></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Mukosa hidung. Berubah menjadi lebih tipis. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Silia hidung. Silia akan menghilang. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Epitel hidung. Terjadi perubahan metaplasia dari epitel torak bersilia menjadi epitel kubik atau epitel gepeng berlapis. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Kelenjar hidung. Mengalami degenerasi, atrofi (bentuknya mengecil), atau jumlahnya berkurang. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style="">Gejala Klinis dan Pemeriksaan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Keluhan </span></span><span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">penderita</span></span><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";"> </span></span><span style="" lang="EN">rinitis atrofi (ozaena) </span><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">biasanya berupa hidung tersumbat, gangguan penciuman (anosmi), ingus kental berwarna hijau, adanya krusta (kerak) berwarna hijau, sakit kepala, epistaksis dan hidung terasa kering. </span></span>Keluhan subjektif lain yang sering ditemukan pada pasien biasanya napas berbau (sementara pasien sendiri menderita anosmia) <span class="ft91"><span style="line-height: 150%; font-family: "Times New Roman";">jadi penderita sendiri (-), orang lain (+) penciumannya</span></span><span style="" lang="EN">. Pasien mengeluh kehilangan indra pengecap dan tidak bisa tidur nyenyak ataupun tidak tahan udara dingin. Meskipun jalan napas jelas menjadi semakin lebar, pasien merasakan sumbatan yang makin progresif saat bernapas lewat hidung, terutama karena katup udara yang mengatur perubahan tekanan hidung dan menghantarkan impuls sensorik dari mukosa hidung ke sistem saraf pusat telah bergerak semakin jauh dari gambaran.<sup>1,2,4,5,6</sup><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="EN">Pemeriksaan THT pada kasus rinitis atrofi (ozaena) dapat ditemukan </span><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">rongga hidung dipenuhi krusta hijau, kadang-kadang kuning atau hitam; jika krusta diangkat, terlihat rongga hidung sangat lapang, atrofi konka (</span></span><span style="" lang="EN">konka nasi media dan konka nasi inferior mengalami hipotrofi atau atrofi)</span><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">, sekret purulen dan berwarna hijau, mukosa hidung tipis dan kering.<sup>1,3</sup> Bisa juga ditemui ulat/ telur larva (karena bau busuk yang timbul). Sutomo dan Samsudin membagi ozaena secara klinik dalam tiga tingkat</span></span> <span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">: <sup>1</sup></span></span><span style="" lang="EN"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">a)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Tingkat I : Atrofi mukosa hidung, mukosa tampak kemerahan dan berlendir, krusta sedikit. </span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">b)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Tingkat II : Atrofi mukosa hidung makin jelas, mukosa makin kering, warna makin pudar, krusta banyak, keluhan anosmia belum jelas. </span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman"; color: windowtext;"><span style="">c)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Tingkat III : Atrofi berat mukosa dan tulang sehingga konka tampak sebagai garis, rongga hidung tampak lebar sekali, dapat ditemukan krusta di nasofaring, terdapat anosmia yang jelas.</span></span><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman"; color: windowtext;"><o:p></o:p></span></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="EN">Perubahan kontinu pada kompleks penyakit degeneratif kronik ini mempunyai awitan yang timbul perlahan berupa atrofi hidung dini. Biasanya pertama mengenai mukosa hidung tampak beberapa daerah metaplasia yang kering dan tipis dimana epitel pernapasan telah kehilangan silia, dan terbentuk krusta kecil serta sekret yang kental. Dapat terjadi ulserasi ringan dan pendarahan.<sup>5</sup><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="EN">Atrofi sedang tidak hanya mempengaruhi daerah mukosa hidung yang lebih besar namun terutama melibatkan suplai darah epitel hidung, secara perlahan memperbesar rongga hidung ke segala jurusan dengan semakin tipisnya epitel. Kelenjar mukosa atrofi dan menghilang, sementara fibrosis jaringan subepitel perlahan-lahan menyeluruh. Jaringan disekitar mukosa hidung juga ikut terlibat, termasuk kartilago, otot, dan kerangka tulang hidung. Akhirnya kekeringan, pembentukan krusta dan iritasi mukosa hidung dapat meluas ke epitel nasofaring, hipofaring dan laring. Keadaan ini dapat mempengaruhi patensi tuba Eustachius, berakibat efusi telinga tengah kronik dan dapat menimbulkan perubahan yang tidak diharapkan pada apartus lakrimalis termasuk keratitis sicca.<o:p></o:p></span></p> <p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="EN">Pemeriksaan penunjang pada kasus rinitis atrofi (ozaena) yang dapat dilakukan antara lain : <sup>3,4</sup><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Transiluminasi. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Foto Rontgen. Foto sinus paranasalis. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Pemeriksaan mikroorganisme. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Uji resistensi kuman. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Pemeriksaan darah tepi. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Pemeriksaan Fe serum. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Pemeriksaan histopatologi. </span>Dari pemeriksaan histopatologi terlihat mukosa hidung menjadi tipis, silia hilang, metaplasia torak bersilia menjadi epitel kubik atau gepeng berlapis, kelenjar berdegenerasi atau atrofi, jumlahnya berkurang dan bentuknya mengecil.</p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-size: 10pt; line-height: 150%; font-family: Symbol;" lang="EN"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Pemeriksaan</span> serologi darah.<span style="" lang="EN"><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="" lang="EN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><span style="" lang="EN"><br /></span></b></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><span style="" lang="EN">Diagnosis <o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Diagnosis </span></span><span style="" lang="EN">rinitis atrofi (ozaena) </span><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">dapat ditegakkan berdasarkan anamnesis, pemeriksaan darah rutin, rontgen foto sinus paranasal, pemeriksaan Fe serum, Mantoux test, pemeriksaan histopatologi dan test serologi (VDRL test dan Wasserman test) untuk menyingkirkan sifilis.<sup>1</sup></span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft102"><span style="line-height: 150%; font-family: "Times New Roman";"><o:p> </o:p></span></span></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft102"><span style="line-height: 150%; font-family: "Times New Roman";"><o:p><br /></o:p></span></span></p> <span style="font-weight: bold;">Diagnosis Banding</span> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Diagnosis </span></span><span style="" lang="EN">rinitis atrofi (ozaena) antara lain :<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Rinitis kronik TBC<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";"><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">rinitis kronik lepra<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">rinitis kronik sifilis </span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">4.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">rinitis sika</span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><o:p> </o:p></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><font size="3"><span class="ft22"><b><span style="font-size: 4pt; line-height: 150%;"><br /></span></b></span></font></p><span style="font-weight: bold;"><br />Komplikasi</span> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Komplikasi </span></span><span style="" lang="EN">rinitis atrofi (ozaena) d</span><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">apat berupa :<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Perforasi septum<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";"><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Faringitis<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";"><span style="">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Sinusitis<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";"><span style="">4.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Miasis hidung<o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">5.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Hidung pelana</span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span style="" lang="EN"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><b style="">Penatalaksanaan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="EN">Hingga kini pengobatan medis terbaik rinitis atrofik hanya bersifat paliatif. Termasuk dengan irigasi dan membersihkan krusta yang terbentuk, terapi sistemik dan lokal dengan endokrin; steroid; dan antibiotik; vasodilator; pemakaian iritan jaringan lokal ringan seperti alkohol; dan salep pelumas. Penekanan terapi utama adalah pembedahan, yaitu usaha-usaha langsung mengecilkan rongga hidung, dan dengan demikian juga memperbaiki suplai darah mukosa hidung.<sup>5</sup> </span><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Tujuan pengobatan adalah menghilangkan faktor etiologi/ penyebab dan menghilangkan gejala. Pengobatan dapat diberikan secara konservatif atau kalau tidak menolong dilakukan operasi.<sup>1,3</sup><o:p></o:p></span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><o:p> </o:p></p> <br /><span style="font-weight: bold;">Konservatif</span> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Pengobatan</span></span><span style=""> </span><span class="ft22"><span style="font-size: 4pt; line-height: 150%;">konservatif ozaena m</span></span><span style="" lang="EN">eliputi pemberian antibiotik, obat cuci hidung, dan simptomatik. </span><b><span style="color: black;"><o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">1)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Antibiotik spektrum luas sesuai uji resistensi kuman, dengan dosis adekuat sampai tanda-tanda infeksi hilang.</span></span> <span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Qizilbash dan Darf melaporkan hasil yang baik pada pengobatan dengan Rifampicin oral 600 mg 1 x sehari selama 12 minggu.</span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">2)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Obat cuci hidung, untuk membersihkan rongga hidung dari krusta dan sekret dan menghilangkan bau. Antara lain : </span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">a. Betadin solution dalam 100 ml air hangat atau </span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">b. Campuran : </span></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">NaCl </span></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">NH<sub>4</sub>Cl </span></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">NaHCO<sub>3</sub> </span></span><span style="" lang="EN">aaa 9</span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Aqua ad 300 cc 1 sendok makan dicampur 9 sendok makan air hangat </span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">c. Larutan garam dapur </span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">d. Campuran : </span></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Na bikarbonat 28,4 g </span></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Na diborat 28,4 g </span></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="font-family: Symbol;"><span style="">·<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">NaCl 56,7 g dicampur 280 ml air hangat </span></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft92"><span style="line-height: 150%; font-family: "Times New Roman";">Larutan dihirup ke dalam rongga hidung dan dikeluarkan lagi dengan menghembuskan kuat-kuat, air yang masuk ke nasofaring dikeluarkan melalui mulut, dilakukan dua kali sehari. </span></span><span style="" lang="EN">Pemberian obat simptomatik pada rinitis atrofi (Ozaena) biasanya dengan pemberian preparat Fe.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><sup><span style="" lang="EN"><o:p> </o:p></span></sup></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">3)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">Obat tetes hidung , setelah krusta diangkat, diberi antara lain : glukosa 25% dalam gliserin untuk membasahi mukosa, oestradiol dalam minyak Arachis 10.000 U / ml, kemisetin anti ozaena <i>solution</i> dan streptomisin 1 g + NaCl 30 ml. diberikan tiga kali sehari masing-masing tiga tetes. </span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">4)<span style=""> </span>Vitamin A 3 x 10.000 U selama 2 minggu. </span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">5)<span style=""> </span>Preparat Fe. </span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">6)<span style=""> </span>Selain itu bila ada sinusitis, diobati sampai tuntas</span></span>. <span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">Sinha, Sardana dan Rjvanski melaporkan ekstrak plasenta manusia secara sistemik memberikan 80% perbaikan dalam 2 tahun dan injeksi ekstrak plasenta submukosa intranasal memberikan 93,3% perbaikan pada periode waktu yang sama.</span></span> <span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">Ini membantu regenerasi epitel dan jaringan kelenjar.</span></span> <span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">Samiadi dalam laporannya memberikan : trisulfa 3 x 2 tablet sehari selama 2 minggu, natrium bikarbonat, cuci hidung dengan Na Cl fisiologis 3 x sehari, kontrol darah dan urine seminggu sekali untuk melihat efek samping obat, pembersihan hidung di klinik tiap 2 minggu sekali, cuci hidung diteruskan sampai 2-3 bulan kemudian dan didapatkan hasil yang memuaskan pada 6 dari 7 penderita.</span></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft103"><span style="line-height: 150%; font-family: "Times New Roman";"><o:p> </o:p></span></span></p> <br /><span style="font-weight: bold;">Operasi</span> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">Tujuan operasi pada rhinitis atrofi (ozaena) antara lain untuk : menyempitkan rongga hidung yang lapang, mengurangi pengeringan dan pembentukan krusta dan mengistirahatkan mukosa sehingga memungkinkan terjadinya regenerasi.<sup>1</sup> </span></span><span style="" lang="EN">Teknik bedah dibedakan menjadi dua kategori utama : <sup>5</sup><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="" lang="EN"><span style="">1)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Implan dengan pendekatan intra atau ekstra nasal dan<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="" lang="EN"><span style="">2)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Operasi, seperti penyempitan lobulus hidung atau fraktur tulang hidung ke arah dalam.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">Beberapa teknik operasi yang dilakukan antara lain : <sup>1</sup></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="color: black;"><span style="">1)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft93"><i><span style="line-height: 150%; font-family: "Times New Roman";">Young's operation </span></i></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; line-height: 150%;"><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">Penutupan total rongga hidung dengan <i>flap</i>. Sinha melaporkan hasil yang baik dengan penutupan lubang hidung sebagian atau seluruhnya dengan menjahit salah satu hidung bergantian masing-masing selama periode tiga tahun. </span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="color: black;"><span style="">2)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft93"><i><span style="line-height: 150%; font-family: "Times New Roman";">Modified Young's operation </span></i></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.25in; line-height: 150%;"><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">Penutupan lubang<i> </i>hidung dengan meninggalkan 3 mm yang terbuka. </span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="color: black;"><span style="">3)<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft93"><i><span style="line-height: 150%; font-family: "Times New Roman";">Lautenschlager operation </span></i></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; line-height: 150%;"><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">Dengan memobilisasi dinding medial antrum dan bagian dari etmoid, kemudian dipindahkan ke lubang hidung. </span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">4)<span style=""> </span>Implantasi submukosa dengan tulang rawan, tulang, dermofit, bahan sintetis seperti Teflon, campuran <i>Triosite</i> dan </span></span><span class="ft73"><i><span style="font-size: 10pt; line-height: 150%;">Fibrin Glue</span></i></span><span class="ft73"><span style="font-size: 10pt; line-height: 150%;">. </span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">5) Transplantasi duktus parotis ke dalam sinus maksila (<i>Wittmack's operation</i>) dengan tujuan membasahi mukosa hidung.</span></span> <span class="ft93"><span style="line-height: 150%; font-family: "Times New Roman";">Mewengkang N melaporkan operasi penutupan koana menggunakan <i>flap</i> faring pada penderita ozaena anak berhasil dengan memuaskan.</span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Bila pengobatan konsevatif adekuat yang cukup lama tidak menunjukkan perbaikan, pasien dirujuk untuk dilakukan operasi penutupan lubang hidung. Prinsipnya mengistirahatkan mukosa hidung pada nares anterior atau koana sehingga menjadi normal kembali selama 2 tahun. Atau dapat dilakukan implantasi untuk menyempitkan rongga hidung.<sup>4</sup></p> <p class="MsoNormal" style="text-align: justify; line-height: 150%;"><o:p> </o:p></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><o:p><br /></o:p></p><p class="MsoNormal" style="text-align: justify; line-height: 150%;"><meta http-equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:Times; 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mso-list-type:hybrid; mso-list-template-ids:-365130828 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l0:level1 {mso-level-tab-stop:none; mso-level-number-position:left; margin-left:.75in; text-indent:-.25in;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> </p><p class="MsoNormal" style="text-align: center; line-height: 150%;"><b style=""><span style="" lang="EN">Daftar Pustaka<o:p></o:p></span></b></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span class="ft11"><span style="line-height: 150%; font-family: "Times New Roman";"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></span><!--[endif]--><span class="ft61"><span style="font-size: 10.5pt; line-height: 150%;">Asnir, A. R. 2004. <i style="">Rinitis Atrofi</i>. </span></span><span style="color: black;">Available from : </span><span style="color: black;"><a href="http://www.kalbe.co.id/"><span style="color: black;">http://www.kalbe.co.id</span></a>.</span> <span style="color: black;">Accessed : 2008, April 12.</span> Sumber :<span class="ft61"><span style="font-size: 10.5pt; line-height: 150%;"> </span></span><span class="ft73"><span style="font-size: 10pt; line-height: 150%;">Cermin Dunia Kedokteran No. 144, 2004</span></span><span class="ft11"><span style="line-height: 150%; font-family: "Times New Roman";">. <o:p></o:p></span></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="color: black;" lang="EN"><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span class="ft11"><span style="line-height: 150%; font-family: "Times New Roman";">Soedarjatni. 1977. </span></span><span class="ft31"><i style=""><span style="font-size: 10pt; line-height: 150%;">Foetor Ex Nasi</span></i></span><span class="ft31"><span style="font-size: 10pt; line-height: 150%;">. </span></span><span style="color: black;">Available from : </span><span style="color: black;"><a href="http://www.kalbe.co.id/"><span style="color: black;">http://www.kalbe.co.id</span></a></span>. <span style="color: black;">Accessed : 2008, April 12. Sumber : </span><span class="ft71"><span style="font-size: 10pt; line-height: 150%;">Cermin Dunia Kedokteran No. 9, 1977.</span></span><span style="color: black;" lang="EN"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span style="color: black;" lang="EN">Al-Fatih, M. 2007.<i style=""><span style=""> </span></i></span><span class="ft61"><i style=""><span style="font-size: 10.5pt; line-height: 150%;">Rinitis Atrofi</span></i></span><span class="ft61"><i style=""><span style="font-size: 10.5pt; line-height: 150%;"> </span></i></span><i style=""><span style="color: black;" lang="EN">(Ozaena)</span></i><span style="color: black;" lang="EN">.<span style=""> </span></span><span style="color: black;">Available from : </span><span style="color: black;"><a href="http://hennykartika.wordpress.com/2007/12/29/ozaena-rinitis-atrofi/"><span style="color: black;">http://hennykartika.wordpress.com</span></a>.<span style=""> Accessed : 2008, April 12. </span></span>Sumber : <span style="" lang="EN">Buku Ajar Ilmu Kesehatan Telinga, Hidung, Tenggorok, Kepala & Leher. Ed. ke-5. <st1:city w:st="on">Jakarta</st1:city> : Fakultas Kedokteran Universitas <st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region>. 2006.</span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="color: black;"><span style="">4.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="color: black;">Arif, M., et al. 2006. </span><span class="ft61"><i style=""><span style="font-size: 10.5pt; line-height: 150%;">Rinitis Atrofi </span></i></span><i style=""><span style="color: black;" lang="EN">(Ozaena)</span></i><span style="color: black;" lang="EN">. </span><span style="color: black;">Available from : </span><span style="color: black;"><a href="http://www.geocities.com/kliniktehate/penyakit-hidung/rinitis-atrofi.htm"><span style="color: black;">http://www.geocities.com.</span></a> <span style="">Accessed : 2008, April 12. </span></span>Sumber : Buku Kapita Selekta Kedokteran. Ed. III, cet. 2. <st1:city w:st="on"><st1:place w:st="on">Jakarta</st1:place></st1:city> : Media Aesculapius. 1999.<span style="color: black;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="color: black;"><span style="">5.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="color: black;">Adams, L. G. et al. 1997. <i>Boies Buku Ajar Penyakit THT</i>. Ed. ke-6. Penerbit Buku Kedokteran EGC. <st1:city w:st="on"><st1:place w:st="on">Jakarta</st1:place></st1:city>.<o:p></o:p></span></p> <p style="margin: 0in 0in 0.0001pt 0.25in; text-align: justify; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="" lang="EN"><span style="">6.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN">Endang, M. & Nusjirwan, R. 2006. <i style="">Rinorea, Infeksi Hidung dan Sinus</i> dalam <i style="">Buku Ajar Ilmu Kesehatan Telinga, Hidung, Tenggorok, Kepala & Leher</i>. Ed. ke-5. Fakultas Kedokteran Universitas <st1:country-region w:st="on"><st1:place w:st="on">Indonesia</st1:place></st1:country-region>. <st1:city w:st="on"><st1:place w:st="on">Jakarta</st1:place></st1:city>.<o:p></o:p></span></p> <p></p> Taufik Abidinhttp://www.blogger.com/profile/07690954313686984126noreply@blogger.com1tag:blogger.com,1999:blog-8031884777094016874.post-55309430046628477962009-02-24T02:28:00.000+08:002009-02-24T02:46:52.957+08:00OTITIS MEDIA AKUT (OMA)<meta http-equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-no-proof:yes;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="line-height: 150%;"><b style="">Pendahuluan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Otitis media peradangan sebagian atau seluruh mukosa telinga tengah, tuba eustachius, antrum mastoid, dan sel-sel mastoid. otitis media terbagi atas otitis media supuratif dan non-supuratif, dimana masing-masing memiliki bentuk akut dan kronis. Otitis media akut termasuk kedalam jenis otitis media supuratif. Selain itu, terdapat juga jenis otitis media spesifik, yaitu otitis media tuberkulosa, otitis media sifilitik, dan otitis media adhesiva.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Otitis media pada anak-anak sering kali disertai dengan infeksi pada saluran pernapasan atas. Pada penelitian terhadap 112 pasien ISPA (6-35 bulan), didapatkan 30% mengalami otitis media akut dan 8% sinusitis. Epidemiologi seluruh dunia terjadinya otitis media berusia 1 thn sekitar 62%, sedangkan anak-anak berusia 3 thn sekitar 83%. Di Amerika Serikat, diperkirakan 75% anak mengalami minimal satu episode otitis media sebelum usia 3 tahun dan hampir setengah dari mereka mengalaminya tiga kali atau lebih. Di Inggris setidaknya 25% anak mengalami minimal satu episode sebelum usia sepuluh tahun.</p> <span style="font-size: 12pt; font-family: "Times New Roman";">Resiko kekambuhan otitis media terjadi pada beberapa faktor, antara lain usia <5 thn, otitis prone (pasien yang mengalami otitis pertama kali pada usia <6 bln, 3 kali dalam 6 bln terakhir), infeksi pernapasan, perokok, dan laki-laki.<br /></span><meta http-equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-no-proof:yes;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline; text-underline:single;} p {mso-margin-top-alt:auto; margin-right:0in; mso-margin-bottom-alt:auto; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} span.normal {mso-style-name:normal;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:1542982253; mso-list-type:hybrid; mso-list-template-ids:1234597886 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l0:level1 {mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in;} @list l0:level2 {mso-level-number-format:alpha-lower; mso-level-tab-stop:1.0in; mso-level-number-position:left; text-indent:-.25in;} @list l1 {mso-list-id:1876966945; mso-list-type:hybrid; mso-list-template-ids:1722713594 67698703 67698713 67698715 67698703 67698713 67698715 67698703 67698713 67698715;} @list l1:level1 {mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">Definisi<o:p></o:p></b></p> <p class="MsoNormal" style="text-indent: 0.5in; line-height: 150%;">Otitis media akut ialah peradangan telinga tengah yang mengenai sebagian atau seluruh periosteum dan terjadi dalam waktu kurang dari 3 minggu.</p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><o:p> </o:p></b></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">Etiologi<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Sumbatan pada tuba eustachius merupakan penyebab utama dari otitis media. Pertahanan tubuh pada silia mukosa tuba eustachius terganggu, sehingga pencegahan invasi kuman ke dalam telinga tengah terganggu juga. Selain itu, ISPA juga merupakan salah satu faktor penyebab yang paling sering.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Kuman penyebab OMA adalah bakteri piogenik, seperti <i style="">Streptococcus hemoliticus</i>, <i style=""><a href="http://www.fpnotebook.com/Lung/Bacteria/HmphlsInflnz.htm"><span style="color: windowtext; text-decoration: none;">Haemophilus Influenzae</span></a></i> (27%), <i style="">Staphylococcus aureus</i> (2%), <i style=""><a href="http://www.fpnotebook.com/Lung/Bacteria/PnmclPnmn.htm"><span style="color: windowtext; text-decoration: none;">Streptococcus Pneumoniae</span></a></i> (38%), <i style="">Pneumococcus</i>. </p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Pada anak-anak, makin sering terserang ISPA, makin besar kemungkinan terjadinya otitis media akut (OMA). Pada bayi, OMA dipermudah karena tuba eustachiusnya pendek, lebar, dan letaknya agak horisontal.</p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><o:p> </o:p></b></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">Patogenesis<o:p></o:p></b></p> <p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="IN">Otitis media sering diawali dengan infeksi pada saluran napas seperti radang tenggorokan atau pilek yang menyebar ke telinga tengah lewat saluran Eustachius. Saat bakteri melalui saluran Eustachius, mereka dapat menyebabkan infeksi di saluran tersebut sehingga terjadi pembengkakan di sekitar saluran, tersumbatnya saluran, dan datangnya sel-sel darah putih untuk melawan bakteri. Sel-sel darah putih akan membunuh bakteri dengan mengorbankan diri mereka sendiri. Sebagai hasilnya terbentuklah nanah dalam telinga tengah. Selain itu pembengkakan jaringan sekitar saluran Eustachius menyebabkan lendir yang dihasilkan sel-sel di telinga tengah terkumpul di belakang gendang telinga. </span></p> <p style="margin: 0in 0in 0.0001pt; text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="IN">Jika lendir dan nanah bertambah banyak, pendengaran dapat terganggu karena gendang telinga dan tulang-tulang kecil penghubung gendang telinga dengan organ pendengaran di telinga dalam tidak dapat bergerak bebas. Kehilangan pendengaran yang dialami umumnya sekitar 24 desibel (bisikan halus). Namun cairan yang lebih banyak dapat menyebabkan gangguan pendengaran hingga 45 desibel (kisaran pembicaraan normal). Selain itu telinga juga akan terasa nyeri. Dan yang paling berat, cairan yang terlalu banyak tersebut akhirnya dapat merobek gendang telinga karena tekanannya. OMA dapat berkembang menjadi otitis media supuratif kronis apabila gejala berlangsung lebih dari 2 bulan, hal ini berkaitan dengan beberapa faktor antara lain higiene, terapi yang terlambat, pengobatan yang tidak adekuat, dan daya tahan tubuh yang kurang baik.<o:p></o:p></span></p> <p class="MsoNormal" style="text-indent: 0.5in; line-height: 150%;">OMA memiliki beberapa stadium klinis antara lain:</p> <ol style="margin-top: 0in;" start="1" type="1"><li class="MsoNormal" style="line-height: 150%;">Stadium oklusi tuba eustachius</li><ol style="margin-top: 0in;" start="1" type="a"><li class="MsoNormal" style="line-height: 150%;">Terdapat gambaran retraksi membran timpani.</li><li class="MsoNormal" style="line-height: 150%;">Membran timpani berwarna normal atau keruh pucat.</li><li class="MsoNormal" style="line-height: 150%;">Sukar dibedakan dengan otitis media serosa virus.</li></ol><li class="MsoNormal" style="line-height: 150%;">Stadium hiperemis</li><ol style="margin-top: 0in;" start="1" type="a"><li class="MsoNormal" style="line-height: 150%;">Pembuluh darah tampak lebar dan edema pada membran timpani.</li><li class="MsoNormal" style="line-height: 150%;">Sekret yang telah terbentuk mungkin masih bersifat eksudat yang serosa sehingga sukar terlihat.</li></ol><li class="MsoNormal" style="line-height: 150%;">Stadium supurasi</li><ol style="margin-top: 0in;" start="1" type="a"><li class="MsoNormal" style="line-height: 150%;">Membran timpani menonjol ke arah luar.</li><li class="MsoNormal" style="line-height: 150%;">Sel epitel superfisila hancur.</li><li class="MsoNormal" style="line-height: 150%;">Terbentuk eksudat purulen di kavum timpani.</li><li class="MsoNormal" style="line-height: 150%;">Pasien tampak sangat sakit, nadi dan suhu meningkat, serta nyeri di telinga tambah hebat.</li></ol><li class="MsoNormal" style="line-height: 150%;">Stadium perforasi</li><ol style="margin-top: 0in;" start="1" type="a"><li class="MsoNormal" style="line-height: 150%;">Membran timpani ruptur.</li><li class="MsoNormal" style="line-height: 150%;">Keluar nanah dari telinga tengah.</li><li class="MsoNormal" style="line-height: 150%;">Pasien lebih tenang, suhu badan turun, dan dapat tidur nyenyak.</li></ol><li class="MsoNormal" style="line-height: 150%;">Stadium resolusi</li><ol style="margin-top: 0in;" start="1" type="a"><li class="MsoNormal" style="line-height: 150%;">Bila membran timpani tetap utuh, maka perlahan-lahan akan normal kembali.</li><li class="MsoNormal" style="line-height: 150%;">Bila terjadi perforasi, maka sekret akan berkurang dan mengering.</li><li class="MsoNormal" style="line-height: 150%;">Resolusi dapat terjadi tanpa pengobatan bila virulensi rendah dan daya tahan tubuh baik.</li></ol></ol> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">Diagnosis<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Pada anak, keluhan utama adalah rasa nyeri di dalam telinga dan suhu tubuh tinggi serta ada riwayat batuk pilek sebelumnya. Anak juga gelisah, sulit tidur, tiba-tiba menjerit waktu tidur, diare, kejang-kejang, dan kadang-kadang anak memegang telinga yang sakit. Bila terjadi ruptur membran timpani, maka sekret mengalir ke liang telinga, suhu tubuh<span style=""> </span>turun, dan anak tertidur tenang.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Pada anak yang lebih besar atau dewasa, selain rasa nyeri terdapat pula gangguan pendengaran dan rasa penuh dalam telinga.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Diagnosis terhadap OMA tidak sulit, dengan melihat gejala klinis dan keadaan membran timpani biasanya diagnosis sudah dapat ditegakkan. Penilaian membran timpani dapat dilihat melalui pemeriksaan lampu kepala dan otoskopi. Perforasi yang terdapat pada membran timpani bermacam-macam, antara lain perforasi sentral, marginal, atik, subtotal, dan total.</p> <p class="MsoNormal" style="line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">Penatalaksanaan<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Terapi OMA tergantung pada stadiumnya. Pada stadium oklusi, tujuan terapi dikhususkan untuk membuka kembali tuba eustachius. Diberikan obat tetes hidung HCl efedrin 0,5% dalam larutan fisiologik untuk anak <12 thn dan HCl efedrin 1% dalam larutan fisiologik untuk anak yang berumur >12 thn atau dewasa.. selain itu, sumber infeksi juga harus diobati dengan memberikan antibiotik.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Pada stadium presupurasi, diberikan antibiotik, obat tetes hidung, dan analgesik. Bila membran timpani sudah hiperemi difus, sebaiknya dilakukan miringotomi. Antibiotik yang diberikan ialah penisilin atau eritromisin. Jika terdapat resistensi, dapat diberikan kombinasi dengan asam klavunalat atau sefalosporin. Untuk terapi awal diberikan penisilin IM agar konsentrasinya adekuat di dalam darah. Antibiotik diberikan minimal selama 7 hari. Pada anak diberikan ampisilin 4x50-100 mg/KgBB, amoksisilin 4x40 mg/KgBB/hari, atau eritromisin 4x40 mg/kgBB/hari.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Pengobatan stadium supurasi selain antibiotik, pasien harus dirujuk untuk dilakukan miringotomi bila membran timpani masih utuh. <span style="" lang="SV">Selain itu, analgesik juga perlu diberikan agar nyeri dapat berkurang.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Pada stadium perforasi, diberikan obat cuci telinga H<sub>2</sub>O<sub>2</sub> 3% selama 3-5 hari serta antibiotik yang adekuat sampai 3 minggu.</p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Stadium resolusi biasanya akan tampak sekret mengalir keluar. Pada keadaan ini dapat dilanjutkan antibiotik sampai 3 minggu, namun bila masih keluar sekret diduga telah terjadi mastoiditis.</p> <p class="MsoNormal" style="line-height: 150%;"><o:p> </o:p></p> <p class="MsoNormal" style="line-height: 150%;"><b style=""><br /></b></p><p class="MsoNormal" style="line-height: 150%;"><b style="">Komplikasi<o:p></o:p></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;">Sebelum ada antibiotik, komplikasi paling sering pada OMA ialah abses subperiosteal sampai komplikasi yang berat seperti meningitis dan abses otak. <span style="" lang="IN">Otitis media yang tidak diatasi juga dapat menyebabkan kehilangan pendengaran permanen.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in; line-height: 150%;"><span style="" lang="IN"><o:p> </o:p></span></p> <p style="margin: 0in 0in 0.0001pt; line-height: 150%;"><span class="normal"><b style=""><span style="" lang="IN"><br /></span></b></span></p><p style="margin: 0in 0in 0.0001pt; line-height: 150%;"><span class="normal"><b style=""><span style="" lang="IN">Pencegahan </span></b></span></p> <p style="margin: 0in 0in 0.0001pt; text-indent: 0.5in; line-height: 150%;"><span style="" lang="IN">Beberapa hal yang tampaknya dapat mengurangi risiko OMA adalah: </span></p> <p style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span style="" lang="IN">Pencegahan ISPA pada bayi dan anak-anak.</span></p> <p style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span style="" lang="IN">Pemberian ASI minimal selama 6 bulan.</span></p> <p style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span style="" lang="IN">Penghindaran pemberian susu di botol saat anak berbaring.</span></p> <p style="margin: 0in 0in 0.0001pt 0.5in; text-indent: -0.25in; line-height: 150%;"><!--[if !supportLists]--><span style="">4.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span><!--[endif]--><span style="" lang="IN">Penghindaran pajanan terhadap asap rokok.</span></p> <p style="margin: 0in 0in 0.0001pt; line-height: 150%;"><span style="" lang="IN">Berenang kemungkinan besar tidak meningkatkan risiko OMA.</span></p> <br /><meta http-equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 11"><meta name="Originator" content="Microsoft Word 11"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CADMINI%7E1%5CLOCALS%7E1%5CTemp%5Cmsohtml1%5C01%5Cclip_filelist.xml"><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place"></o:smarttagtype><o:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="City"></o:smarttagtype><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><style> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-no-proof:yes;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline; text-underline:single;} span.normal {mso-style-name:normal;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p class="MsoNormal" style="text-align: center; line-height: 150%;" align="center"><b style="">DAFTAR PUSTAKA<o:p></o:p></b></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.5in; line-height: 150%;"><span class="normal"><span style="" lang="IN">Anonim. 2008. <i style="">Otitis Media Akut</i></span></span><span class="normal"><span style="" lang="IN">. Accessed: </span></span><i style=""><span style="" lang="IN"><a href="http://www.nlm.nih.gov/medlineplus/ency/imagepages/1092.htm"><span style="color: windowtext; text-decoration: none;">http://www.nlm.nih.gov/medlineplus/ency/imagepages/1092.htm</span></a>.</span></i><span style="" lang="IN"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.5in; line-height: 150%;"><strong><span style="font-weight: normal;">Revai, Krystal et al. 2007. </span></strong><strong><i style=""><span style="background: white none repeat scroll 0% 0%; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; font-weight: normal;">Incidence</span></i></strong><b style=""><i style=""> </i></b><i style="">of<b style=""> </b><strong><span style="background: white none repeat scroll 0% 0%; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; font-weight: normal;">Acute</span></strong><b style=""> </b><strong><span style="background: white none repeat scroll 0% 0%; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; font-weight: normal;">Otitis</span></strong><b style=""> </b><strong><span style="background: white none repeat scroll 0% 0%; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; font-weight: normal;">Media</span></strong> and Sinusitis Complicating Upper Respiratory Tract Infection: The Effect of Age</i>. PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1408-e1412. </p> <p class="MsoNormal" style="line-height: 150%;">Moses, Scott. 2008. <i style="">Otitis Media</i>. Accessed: www.fpnotebook.com.</p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.5in; line-height: 150%;">Djaafar, ZA. 2006. <i style="">Kelainan Telinga Tengah</i>. Dalam: Telinga Hidung Tenggorokan, cetakan ke-5. Balai Penerbit FKUI. <st1:place w:st="on"><st1:city w:st="on">Jakarta</st1:city></st1:place>.</p> <p class="MsoNormal" style="line-height: 150%;"><span style="" lang="IN"><o:p> </o:p></span></p> <br />Taufik Abidinhttp://www.blogger.com/profile/07690954313686984126noreply@blogger.com4