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Patogenesis dan diagnosis gangguan napas saat tidur dengan Drug Induce Sleep Endoscopy (DISE) Elvie Zulka Kautzia Rachmawati; Wresty Arief; Susyana Tamin; Rahmanofa Yunizaf; Fauziah Fardizza
Oto Rhino Laryngologica Indonesiana Vol 47, No 2 (2017): Volume 47, No. 2 July - December 2017
Publisher : PERHATI-KL

Latar belakang: Obstructive sleep apnea (OSA) ialah penyakit kronis yang terjadi akibat episode intermiten sumbatan jalan napas komplit atau sebagian saat tidur. OSA dapat menimbulkan komplikasi seperti hipertensi, diabetes melitus, stroke dan excessive daytime sleepiness yang dapat berakibat fatal. OSA merupakan bagian dari gangguan napas saat tidur. Tujuan: Mengindentifikasi letak atau level dan konfigurasi sumbatan pada saat tidur. Tinjauan pustaka: Cara untuk mendiagnosis OSA adalah nasofaringolaringoskopi dengan Muller`s maneuver, pemeriksaan polisomnography (PSG), dan drug induce sleep endoscopy (DISE). Pemeriksaan PSG merupakan standar baku emas untuk mendapakan nilai apnea-hipopnea index (AHI) yang menentukan derajat OSA. Pemeriksaan untuk mengidentifikasi lokasi sumbatan jalan napas yang menyebabkan peningkatan resistensi aliran udara adalah Muller`s maneuver dan DISE. Pada pemeriksaan DISE, digunakan propofol atau midazolam secara intravena untuk menstimulasi keadaan sumbatan pada saat tidur, dilanjutkan dengan pemeriksaan nasofaringolaringoskopi. Kesimpulan: Pemeriksaan ini merupakan cara yang sangat terpercaya untuk menentukan level sumbatan pada keadaan tidur, sehingga jenis tindakan operasi yang dilakukan menjadi lebih tepat. Kata kunci: Drug induced sleep endoscopy, midazolam, propofol, manuver Muller’s, obstructive sleep apnea, polisomnografi ABSTRACT Background: Obstructive sleep apnea (OSA) is a common chronic disorder caused by intermittent episodes of complete or partial upper airway obstruction during sleep. It may lead to complications such as hypertension, diabetes mellitus, stroke, as well as excessive daytime sleepiness which can be fatal. OSA is a part of sleep disorder breathing. Purpose: To identify the sites or the levels of obstruction and its configuration. Literature review: Muller’s maneuver upon nasopharyngoscopy, polysomnography (PSG), and drug-induced sleep endoscopy (DISE) are the modalities for diagnosing OSA. Polysomnography is the gold standard examination for OSA, one of the variables; the apnea-hipopnea index (AHI) is used to determine the presence and severity of OSA. Muller’s maneuver and DISE are the examination to identify the sites responsible for increase in airflow resistance. DISE technique uses intravena injection of propofol or midazolam to produce obstruction in a “natural sleep” condition followed by nasopharyngolaryngoscopy examination. Conclusion: DISE is considered as a very reliable means to define the level of obstruction during sleeping, thus could help to determine appropriate surgery. Keywords: Drug induced sleep endoscopy, midazolam, propofol, Muller’s maneuver, obstructive sleep apnea, polisomnography

Deteksi pepsin pada saliva pasien refluks laringofaring Ade Asyari; Deni Amri; Novialdi Novialdi; Fachzi Fitri; Eti Yerizal; Hafni Bachtiar; Elvie Zulka Kautzia Rachmawati
Oto Rhino Laryngologica Indonesiana Vol 48, No 1 (2018): Volume 48, No. 1 January - June 2018
Publisher : PERHATI-KL

Latar belakang: Refluks laringofaring (RLF) didefinisikan sebagai aliran balik cairan lambungke daerah laring dan faring, sehingga berkontak dengan saluran pencernaan dan pernapasan bagian atasyang menyebabkan keluhan suara serak, batuk, sensasi globus, throat clearing, dan post nasal drip. RLFmemberikan dampak negatif terhadap kualitas hidup terutama fungsi fisik dan emosi. Diagnosis RLFditegakkan dengan mengetahui riwayat penyakit, gejala klinis, pemeriksaan laringoskopi, serta menentukanadanya aliran balik cairan lambung ke laringofaring. Pemeriksaan ambulatory 24 hours double-probepHmetri merupakan baku emas untuk diagnosis RLF, tetapi pemeriksaan ini masih belum ideal. Salahsatu cara untuk menentukan RLF saat ini adalah dengan menentukan keberadaan pepsin pada laring danfaring, menggunakan metode Enzyme Linked Immunosorbent Assay (ELISA). Hal ini berdasarkan faktabahwa pepsin hanya dihasilkan pada lambung. Tujuan: Mengetahui karakteristik pasien, gambaran refluxsymptom index (RSI), gambaran reflux finding score (RFS) dan mengetahui kadar pepsin pada salivapasien RLF. Metode: Penelitian ini merupakan penelitian deskriptif untuk mengetahui gambaran hasilpemeriksaan RSI, RFS, dan kadar pepsin dalam saliva pasien RLF dengan metode ELISA di bagian TelingaHidung Tenggorok-Bedah Kepala dan Leher Rumah Sakit Dr. M. Djamil Padang, mulai Januari–Oktober2015. Hasil: Dari 30 responden yang terdiri dari perempuan 23 orang (76,7%), dan laki-laki 7 orang(23,3%), didapatkan kelompok usia terbanyak 48-57 tahun (40%), dengan rata-rata usia 47,2+12,06 tahun.Nilai rerata RSI 18,53+4,46, nilai rerata RFS 11,47+2,50, dan pada semua sampel didapatkan pepsin (+)dengan nilai rerata kadar pepsin dalam saliva responden 2,75+1,23 ng/ml. Kesimpulan: Pepsin terdeteksipada semua sampel saliva responden RLF. ABSTRACTBackground: Laryngopharyngeal reflux (LPR) is defined as the backflow of gastric contents intolarynx and pharynx areas, making contacts with upper digestive and respiratory tracks causing hoarseness,cough, globus sensation, throat clearing and post nasal drip. LPR has a negative impact on quality oflife. LPR diagnosis is confirmed by disease history, clinical symptoms, laryngoscopy examination andthe backflow of gastric fluid into laryngopharynx. Ambulatory examination of 24 hours double-probepHmetry is the gold standard for LPR diagnosis, although it is not yet ideal. To detect the presence ofpepsin in the larynx and pharynx using ELISA is now being used to determine LPR, based on the fact thatpepsin is only produced in the stomach. Purpose: To investigate patient characteristics, reflux symptomindex (RSI) and reflux finding score (RFS) descriptions, and pepsin level in the saliva of LPR patients.Methods: A descriptive research to describe RSI, RFS, and levels of pepsin in the saliva of LPR patientsusing ELISA at the Otorhinolaryngology Head and Neck Surgery Departement of Dr. M. Djamil Hospital,Padang, from January-October 2015. Results: Thirty respondents consisted of 23 females (76.7%),and 7 males (23.3%), revealed the largest age group was 48-57 years (40%), with an average age of 47.2+12.06 years. The average value of RSI 18.53+4.46, the average value of RFS 11.47+2.50, andpepsin result (+) in all samples, with an average value of pepsin level in respondents’ saliva 2.75+1.23ng ml. Conclusion: Pepsin was detected in all samples of LPR patients’ saliva.

A comparison of objective and subjective measurements of non-nutritive sucking in preterm infants Luh Karunia Wahyuni; Irawan Mangunatmadja; Risma Kerina Kaban; Elvie Zulka Kautzia Rachmawati; Melinda Harini; Budiati Laksmitasari; Agatha Geraldyne; Inez Ayuwibowo Sangwidjojo; Dini Prima Utami; Victor Prasetyo Poernomo; Adrian Prasetya Sudjono
Paediatrica Indonesiana Vol 62 No 4 (2022): July 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.4.2022.274-81

Background Of preterm infants born before 32 weeks of gestation, 40-70% have atypical and immature feeding skills, which could delay initiation of oral feeding. A formal objective measurement of non-nutritive sucking may increase the accuracy of determining the right time to initiate oral feeding, however, most hospital perinatology care units do not own a suction pressure measurement device to objectively measure non-nutritive sucking parameters. Objective To compare objective and subjective non-nutritive sucking (NNS) based on sucking pressure, number of suctions per burst, and time between bursts. Methods One hundred twenty preterm infants born at 28-34 weeks’ gestation were evaluated for objective and subjective NNS. Data were collected from August to November 2021 at five hospitals in Jakarta. Objective NNS was measured by a suction pressure measurement device, while subjective NNS was clinically examined. Number of suctions per burst, sucking pressure, and time between bursts were analysed by Spearman’s correlation test. Results A positive and significant correlation between objective and subjective NNS was found in all parameters (P<0.001). The highest correlation was found in time between bursts (r=0.74; P<0.001), followed by number of suctions per burst (r=0.60; P<0.001), and sucking pressure (r=0.58; P<0.001). Conclusion The correlation between objective and subjective NNS examination was moderate in preterm infants. Therefore, an objective NNS measurement is still required for optimizing the examination.

Non-nutritive sucking milestones of preterm infants in Indonesia: a descriptive study Luh Karunia Wahyuni; Irawan Mangunatmadja; Risma Kerina Kaban; Elvie Zulka Kautzia Rachmawati; Melinda Harini; Budiati Laksmitasari; Agatha Geraldyne; Inez Ayuwibowo Sangwidjojo; Dini Prima Utami; Victor Prasetyo Poernomo; Adrian Prasetya Sudjono
Paediatrica Indonesiana Vol 62 No 5 (2022): September 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.5.2022.311-7

Background Non-nutritive sucking (NNS) maturity has been used as one of the markers of oral feeding readiness in infants. Prematurity may hinder the attainment of NNS milestones. Depending on gestational age (GA) at birth, preterm infants may display various degrees of immaturity, potentially affecting the strength, coordination, and efficiency of skills required for NNS. Objective To identify the progression of NNS patterns across gestational age groups of preterm infants in Indonesia by comparing NNS parameters between moderate-to-late preterm and very preterm infants. Methods NNS evaluation was conducted in 120 preterm infants born at 28-34 weeks gestational age in five tertiary hospitals in Jakarta, Indonesia. Three aspects of NNS (suction pressure, number of suctions per burst, and time between bursts) were documented and arranged to present a descriptive overview. A suction pressure measurement device was used to record, identify, and analyze NNS parameters. We hypothesize that maturity, as determined by GA, positively affected the attainment of NNS milestones. Results Moderate-to-late preterm infants (GA 32 to <37 weeks), compared to very preterm infants (GA 28 to <32 weeks), had higher mean NNS pressure (-79.8 vs. -72.7 mmHg, respectively, P=0.041) and shorter mean time between bursts (6.63 vs. 7.36 s, respectively, P=0.030). Mean number of suctions per burst were also significantly different between the two GA groups (8.90 vs. 8.99 sucks/burst, respectively, P=0.048). Conclusion Maturity, as reflected by GA, had a positive effect on the attainment of NNS milestones in preterm infants in Indonesia. Significant differences in the three NNS parameters: number of suctions per burst, time between bursts, and suction pressure were found between moderate-to-late preterm and very preterm infants.

Pharyngeal transit time in different consistency of food using Fiberoptic Evaluation of Swallowing Susyana Tamin; Mochamad Iqbal; Elvie Zulka Kautzia Rachmawati; Rahmanofa Yunizaf; Ratna Dwi Restuti; Aria Kekalih
Oto Rhino Laryngologica Indonesiana Vol 52, No 2 (2022): VOLUME 52, NO. 2 JULY - DECEMBER 2022
Publisher : PERHATI-KL

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ABSTRACTBackground: In Indonesia, no research has been carried out or reported on pharyngeal transit time and a view of the swallowing process in a sample without complaints of dysphagia using the Flexible Endoscopic Evaluation of Swallowing (FEES) method and using five food consistencies. Purpose: To obtain the value of pharyngeal transit time and a view of the swallowing process in subjects without dysphagia problems. Method: Twenty-eight subjects without dysphagia (based on Ohkuma’s Dysphagia Screening) underwent FEES to determine pharyngeal transit time and dysphagia profile based on leakage, standing secretion, residue, penetration, and aspiration. Result: The median value of pharyngeal transit time on puree consistency was 0.799(0.499-5.666), gastric rice 0.966(0.433-5.733), oatmeal 0.849(0.533- 4.399), thick liquid 0.982(0.399-4.633), thin liquid 0.566(0.366-1.366). The pharyngeal delay time on the puree consistency was 0.566(0.199-5.333), gastric rice 0.799(0.233-2.799), oatmeal 0.899(0.099-3.633), thick liquid 0.833(0.033-3.733), and thin liquid mean was 0.294 (± 0.232). The pharyngeal response time on the puree consistency was 0.566(0.167-1.300), gastric rice 0.583(0.300-2.934), oatmeal 0.583(0.367- 1.233), thick liquid 0.549(0.333-1.533), thin liquid 0.549(0.366-1.399). There was no standing secretion, pre-swallowing leakage, penetration, and aspiration found in FEES. A grade 1 residue was found in 3(10.7%) subjects of puree, in 2(7.2%) subjects of gastric rice, in 3(10.7%) subjects of oatmeal, and in 9(32.2%) subjects of thick liquid. Conclusion: There was no prolonged pharyngeal transit time, pre-swallowing leakage, standing secretion, penetration, and aspiration in all subjects without dysphagia complaints at all food consistencies. There was minimal residue within normal limits in some subjects. ABSTRAKLatar belakang: Di Indonesia, belum pernah dilaporkan penelitian mengenai waktu transit faring dan gambaran proses menelan pada sampel tanpa keluhan disfagia dengan menggunakan metode Flexible Endoscopic Evaluation of Swallowing (FEES) dan menggunakan lima konsistensi makanan. Tujuan: Penelitian ini bertujuan untuk memperoleh nilai waktu transit faring dan gambaran proses menelan pada subjek tanpa masalah disfagia. Metode: Dua puluh delapan subjek tanpa disfagia (berdasarkan Skrining Disfagia Ohkuma) menjalani FEES untuk menentukan waktu transit faring dan profil disfagia berdasarkan leakage, standing secretion, residue, penetration, dan aspiration. Hasil: Nilai median waktu transit faring pada konsistensi puree adalah 0,799(0,499-5,633), gastric rice 0,966(0,433-5,733), oatmeal 0,849(0,533-4,399), thick liquid 0.982(0.399-4.633), thin liquid 0.566(0.366- 1.366). Waktu tunda faring pada konsistensi puree adalah 0,566 (0,199-5.333), gastric rice 0,799 (0,233-2,799), oatmeal 0,899 (0,099-3,633), thick liquid 0,833 (0,033-3,733), dan rerata thin liquid 0,294 (± 0,232). Waktu respon faring terhadap konsistensi puree adalah 0,566 (0,167-1,300), gastric rice 0,583 (0,300-2,934), oatmeal 0,583 (0,367-1,233), thick liquid 0,549 (0,333-1,533), thin liquid 0,549 (0,366-1,399). Tidak didapati adanya leakage, standing secretion, penetration, dan aspiration pada pemeriksaan FEES. Residu grade 1 ditemukan pada 3 (10,7%) subjek puree, pada 2 (7,2%) subjek gastric rice, pada 3 (10,7%) subjek oatmeal, dan pada 9 (32,2%) subjek thick liquid. Kesimpulan: Tidak terdapat perpanjangan waktu transit faring, leakage, standing secretion, penetration, dan aspiration pada semua subjek tanpa keluhan disfagia dengan semua konsistensi makanan. Terdapat residu minimal dalam batas normal pada beberapa subjek.

Disfagia pasca kemoradiasi pada karsinoma nasofaring Mayangsari, Ika Dewi; Rachmawati, Elvie Zulka Kautzia; Az Zahra, Amira
Oto Rhino Laryngologica Indonesiana Vol. 54 No. 1 (2024): VOLUME 54, NO. 1 JANUARY - JUNE 2024
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v54i1.679

Background: Dysphagia is one of the early and long-term consequences of nasopharyngeal carcinomamanagement. Chemotherapy with radiation may improve the local control and survival rate but also canlead to serious dysphagia caused by radiation damage, and chronic alteration of tissues leading to fibrosisthat can happen during or soon after the radiation therapy. Dysphagia can result in dehydration andmalnutrition, place people at risk of aspiration, and reduce the quality of life by increasing anxiety anddepression. Purpose: Identifying causes, relevant factors, clinical presentation, and management of postchemoradiation dysphagia in nasopharyngeal cancer patients. Literature review: Structures demonstratingpost-therapy changes were deemed as dysphagia aspiration-related structures (DARS). Management ofnasopharyngeal carcinoma is radiotherapy with fibrosis found in 38.2% of the nasopharyngeal carcinomapatients on at least one side of the neck post-treatment. The presence of fibrosis in the pharyngeal andlaryngeal muscles impacted hyoid bone anterior movement and upper esophageal sphincter relaxationcontributed to dysphagia. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is utilised to detectdysphagia in these patients. The treatment algorithm for dysphagia after chemoradiation consists of historytaking, clinical evaluation, instrumental examination, and management. The management options may bebehavioral, medical, surgical, or combination. Conclusion: Identifying the cause, the components of thedeficit, and the relevant patient factors has prime importance in managing dysphagia besides consideringthe options and weighing the risks versus benefits. Keywords: Dysphagia, chemoradiation, nasopharyngeal carcinoma, dysphagia aspiration-related structures, fiberoptic endoscopic evaluation of swallowing

Efektivitas Terapi Penghambat Pompa Proton pada Anak dengan Otitis Media Kronik: Sebuah Laporan Kasus Berbasis Bukti Hanrahan, Joanna Erin; Calista, Nabilla; Ardiantara, Sabda; Restuti, Ratna Dwi; Irawati, Nina; Rachmawati, Elvie Zulka Kautzia
Majalah Kedokteran Indonesia Vol 73 No 6 (2023): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.73.6-2024-870

Introduction: In Indonesia, 82% of children with otitis media have experienced chronic otitis media (COM). COM has a high recurrency rate and is multifactorial, one of which is caused by acid reflux. Proton pump inhibitor (PPI) therapy has been used to treat acid reflux and gives excellent result. Purpose: Reporting one case of a child with COM and laryngopharyngeal reflux (LPR) who received PPI therapy. An evidence-based literature review was done to evaluate the effectiveness of PPI therapy in patient with COM and LPR.Methods: Literature searching was done through 3 databases. Critical appraisal based on the Oxford Center for Evidence Based Medicine Checklists 2011.Results: After we sorted out duplications and screened articles according to our inclusion and exclusion criteria, we retrieved one article. This article is valid and applicable, yet PPI therapy did not give significant clinical improvement because of some reasons.Conclusion: From the literature review, PPI therapy on patient with COM did not give significant clinical improvement such as to stop middle ear discharge, yet in our case, PPI therapy could produce a clinical improvement and in line with previous experimental studies. Therefore, PPI therapy could still be considered given in children with COM.

Disfagia pasca kemoradiasi pada karsinoma nasofaring Mayangsari, Ika Dewi; Rachmawati, Elvie Zulka Kautzia; Az Zahra, Amira
Oto Rhino Laryngologica Indonesiana Vol. 54 No. 1 (2024): VOLUME 54, NO. 1 JANUARY - JUNE 2024
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v54i1.679

Background: Dysphagia is one of the early and long-term consequences of nasopharyngeal carcinomamanagement. Chemotherapy with radiation may improve the local control and survival rate but also canlead to serious dysphagia caused by radiation damage, and chronic alteration of tissues leading to fibrosisthat can happen during or soon after the radiation therapy. Dysphagia can result in dehydration andmalnutrition, place people at risk of aspiration, and reduce the quality of life by increasing anxiety anddepression. Purpose: Identifying causes, relevant factors, clinical presentation, and management of postchemoradiation dysphagia in nasopharyngeal cancer patients. Literature review: Structures demonstratingpost-therapy changes were deemed as dysphagia aspiration-related structures (DARS). Management ofnasopharyngeal carcinoma is radiotherapy with fibrosis found in 38.2% of the nasopharyngeal carcinomapatients on at least one side of the neck post-treatment. The presence of fibrosis in the pharyngeal andlaryngeal muscles impacted hyoid bone anterior movement and upper esophageal sphincter relaxationcontributed to dysphagia. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is utilised to detectdysphagia in these patients. The treatment algorithm for dysphagia after chemoradiation consists of historytaking, clinical evaluation, instrumental examination, and management. The management options may bebehavioral, medical, surgical, or combination. Conclusion: Identifying the cause, the components of thedeficit, and the relevant patient factors has prime importance in managing dysphagia besides consideringthe options and weighing the risks versus benefits. Keywords: Dysphagia, chemoradiation, nasopharyngeal carcinoma, dysphagia aspiration-related structures, fiberoptic endoscopic evaluation of swallowing

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