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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.

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

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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