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All Journal Oto Rhino Laryngologica Indonesiana eJournal Kedokteran Indonesia
Nina Irawati
Departemen Telinga Hidung Tenggorok – Bedah Kepala Leher Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Dr. Cipto Mangunkusumo
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Perbandingan terapi radiofrekuensi disertai steroid topikal dan steroid topikal saja pada rinitis alergi persisten Meila Sutanti; Retno Sulistyo Wardani; Nina Irawati; Arini Setiawati
Oto Rhino Laryngologica Indonesiana Vol 43, No 1 (2013): Volume 43, No. 1 January - June 2013
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (142.328 KB) | DOI: 10.32637/orli.v43i1.19

Abstract

Latar belakang: Kasus rinitis alergi dengan gejala persisten sedang-berat di RSCM ditemukan pada 357pasien selama 2 tahun. Terjadinya gejala sedang-berat pada rinitis alergi lebih sering menimbulkan penurunankualitas hidup dan produktivitas kerja. Efektivitas terapi steroid topikal adalah 67%, dibandingkan plasebo 39%.Penelitian yang menilai efek tambah reduksi konka radiofrekuensi terhadap terapi rinitis alergi persisten sedangberat(steroid topikal hidung) belum pernah ada. Tujuan: Untuk mendapatkan gambaran hasil terapi reduksikonka radiofrekuensi disertai dengan steroid topikal dibandingkan steroid topikal saja pada rinitis alergi persistensedang-berat. Metode: Penelitian pendahuluan dengan metode uji klinis acak. Sebanyak 14 pasien dilakukanreduksi konka radiofrekuensi disertai steroid topikal hidung, 16 pasien mendapat steroid topikal saja. Penilaianskala analog visual (SAV) terhadap 4 gejala utama rinitis alergi, nasoendoskopi untuk menilai ukuran konkainferior, pemeriksaan peak nasal inspiratory flow (PNIF) dilakukan sebelum terapi dan minggu ke-6 pascaterapi.Hasil: Perbedaan bermakna pada minggu ke-6 pascaterapi antara kedua kelompok didapati pada nilai SAV gatalhidung. Perbedaan bermakna nilai SAV bersin, gatal hidung, ingus encer, dan sumbatan hidung, sebelum terapidengan minggu ke-6 pascaterapi, ditemukan baik pada kelompok reduksi konka radiofrekuensi maupunkelompok steroid topikal saja. Perbedaan bermakna nilai PNIF sebelum terapi dengan minggu ke-6 pascaterapihanya ditemukan pada kelompok terapi reduksi konka radiofrekuensi disertai steroid topikal. Kesimpulan: Baikreduksi konka radiofrekuensi disertai steroid topikal maupun steroid topikal saja memberikan perbaikan gejalarinitis alergi persisten sedang-berat. Pada penelitian ini, penambahan terapi reduksi konka radiofrekuensimengurangi keluhan gatal hidung dan meningkatkan nilai PNIF pada minggu ke-6 pascaterapi.Kata kunci: rinitis alergi persisten sedang-berat, reduksi konka radiofrekuensi, steroid topikal hidung, skalaanalog visual, peak nasal inspiratory flow.ABSTRACTBackground: There were 357 patients with moderate/severe persistent allergic rhinitis in 2 years period at Dr.Cipto Mangunkusumo Hospital. Moderate/severe symptoms in allergic rhinitis reduce quality of life and productivity.Efectivity of nasal steroid in controlling allergic rhinitis symptoms is 67% compared to placebo 39%. The effect ofradiofrequency turbinoplasty added to nasal steroid in controlling allergic rhinitis symptoms were sought. Purpose:This study was performed to evaluate added value of radiofrequency turbinoplasty to nasal steroid in treatment ofmoderate/severe allergic rhinitis. Methods: A pilot study of randomized clinical trial was designed. Fourteen patientswere given combined treatment consist of radiofrequency turbinoplasty and nasal steroid, sixteen patients were givennasal steroid only. Visual analogue scale (VAS) for 4 major symptoms of allergic rhinitis (sneezing, nose itching,rhinorhea, nose obstruction), nasoendoscopy to evaluate inferior turbinate size, peak nasal inspiratory flow (PNIF)were performed before treatment and 6 weeks after treatment. Results: Statistical significance was found only in noseitching symptom if compared between 2 treatment group at 6 weeks after treatment. If comparison performed withintreatment group itself (before treatment and 6 weeks after treatment), there were improvement in all major symptomsof allergic rhinitis. Peak nasal inspiratory flow was found statiscally significance within group, only in group treatedwith combined treatment. Conclusion: Both treatment groups give improvement in all symptoms of allergic rhinitis. Inthis research, addition of radiofrequency turbinoplasty reduces nose itching compared to nasal steroid alone and alsoincreases result of PNIF within 6 weeks of treatment.Keywords: moderate/severe persistent allergic rhinitis, radiofrequency turbinoplasty, nasal steroid, visualanalogue scale, peak nasal inspiratory flow.
Diagnosis of occupational rhinitis to dust and gasses using peak nasal inspiratory flow Deasi Anggraini; Retno Sulistyo Wardani; Nina Irawati; Muchtarudin Mansyur; Rahajoe Dharmaningsih; De-Yun Wang
Oto Rhino Laryngologica Indonesiana Vol 44, No 2 (2014): Volume 44, No. 2 July - December 2014
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (406.084 KB) | DOI: 10.32637/orli.v44i2.91

Abstract

Background: The recent development in technology and industry has increased the incidence of occupational disorders of which eventually affect the productivity and cost of related industries. Whether the products or the waste-materials are harmful to airway function, it needs to be investigated. Purpose: To study the incidence of occupational \rhinitis (OR) caused by exposure of sodium lauryl sulfate dust and irritant gases in the workplace. Methods: In this prospective study, 115 industrial workers who were exposed daily to multi–irritant material were investigated with questionnaire, anterior rhinoscopy, nasal endoscopy, peak nasal inspiratory flow (PNIF) meter, skin prick test, and nasal mucous scrapping before (V1) and after 8 hours (V2) work. The diagnosis of OR was made when symptoms of rhinitis worsened on workdays and a decrease of PNIF (≥20%) at V2. In addition, hours of daily exposure to irritant, years of working, improper usage of personal protection device (nasal and oral mask), and smoking were assessed by bivariate and multivariate analysis. Result: 32 workers of 115 (27.8%) were diagnosed as OR based on increased rhinitis symptoms during workdays and decreased PNIF after work. Incidence of OR increased in workers who had worked >10 years=2.15 (IC 95%:1.19-3.87, p=0.009) and who did not use personal protective equipment properly (p=0.04, RR:2.3, IC 95%:1.29-4.28). Conclusion: Exposure to occupational reagent such as sodium lauryl sulfate dust and multi-irritant gasses was a causal factor of OR. A proper perusal of personal protection equipment (PPE) is mandatory in workplace to minimize the risk of developing OR. Keywords: Occupational rhinitis, nature exposure of occupational agents, peak nasal inspiratory flow,nasal obstruction, personal protection equipment. ABSTRAKLatar belakang: Kemajuan teknologi dan industri akhir-akhir ini, meningkatkan pemaparan saluran napas terhadap produk atau sisa industri yang merupakan zat iritan. Sebagai akibatnya, insidens kelainan akibat kerja semakin meningkat, yang dapat mempengaruhi produktivitas dan peningkatan beban biaya industri. Seberapa besar pengaruhnya terhadap fungsi saluran napas, hal ini masih perlu diteliti lebih lanjut. Tujuan: Penelitian dilakukan untuk mengetahui insidens Rinitis Akibat Kerja (RAK) yang diakibatkan pajanan debu sodium lauryl sulfate dan gas iritan di tempat kerja. Metode: Pada studi prospektif ini, 115 pekerja yang terpajan setiap hari dengan material multi-iritan diteliti berdasarkan kuesioner, pemeriksan rinoskopi anterior, nasoendoskopi, Peak Nasal Inspiratory Flow (PNIF) meter, uji cukit kulit dan kerokan mukosa hidung sebelum (V1) dan sesudah 8 jam (V2) bekerja. Diagnosis RAK ditegakkan jika didapati perburukan gejala hidung disertai dengan penurunan (>20%) hasil PNIF pada V2. Sebagai tambahan, waktu pajanan iritan (jam), masa kerja (tahun), penggunaan alat perlindungan diri (APD) seperti masker hidung dan mulut secara kurang benar, serta kebiasaan merokok dianalisis dengan analisis bivariat dan multivariat (model regresi logistik). Hasil: 32 dari 115 pekerja (27,8%) didiagnosis sebagai RAK berdasarkan perburukan gejala hidung selama bekerja dan penurunan PNIF sesudah bekerja. Insidens RAK meningkat pada pekerja yang telah bekerja lebih dari 10 tahun=2.15 (95% IK:1,19–3,87, p=0,009) dan para pekerja yang tidak menggunakan APD (masker hidung dan mulut) secara benar, yaitu (p=0,04, RR: 2.4, 95% IK:1,29–2,48). Kesimpulan: Pajanan bahan kimia seperti debu sodium lauryl sulfate dan berbagai gas iritan merupakan faktor penyebab RAK. Penggunaan APD secara benar adalah mutlak untuk menurunkan risiko terjadinya RAK. Kata kunci: Rinitis akibat kerja, pajanan alamiah bahan berbahaya di tempat kerja, peak nasal inspiratory flow, hidung tersumbat, alat pelindung diri
Perubahan kualitas hidup, eosinofil mukosa hidung, dan interleukin-5 serum pasien rinitis alergi pasca terapi Arinda Putri Pitarini; Nina Irawati; Niken Lestari Poerbonegoro; Dewi Wulandari; Saptawati Badarsono
Oto Rhino Laryngologica Indonesiana Vol 45, No 2 (2015): Volume 45, No. 2 July - December 2015
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (403.106 KB) | DOI: 10.32637/orli.v45i2.116

Abstract

 Latar belakang: Rinitis alergi adalah suatu penyakit inflamasi pada hidung yang dimediasi oleh imunoglobulin-E, yang terjadi setelah mukosa hidung terpajan alergen. Sel dan mediator inflamasi yang berperan penting adalah eosinofil, histamin, dan sitokin produk Th2. Penyakit ini ditandai dengan gejala rinorea, bersin berulang, hidung tersumbat dan/atau hidung gatal. Selain dari gejala yang mengganggu, rinitis alergi berdampak buruk terhadap kualitas hidup penderita. Tatalaksana komprehensif, meliputi penghindaran alergen, farmakoterapi, imunoterapi dan edukasi, ditujukan untuk menghilangkan gejala dan memperbaiki kualitas hidup pasien. Tujuan: Mengetahui perubahan kualitas hidup, jumlah eosinofil mukosa hidung, dan kadar IL-5 serum pada pasien rinitis alergi setelah mendapat terapi farmaka sesuai panduan. Metode: Penelitian ini merupakan studi pre-eksperimental analitik dengan pengambilan data sebelum dan sesudah pemberian farmakoterapi. Hasil: Sebanyak 31 dari 33 subjek mengalami perubahan kualitas hidup yang bermakna (MID>0,7). Seluruh pasien, 33 subjek memperlihatkan perubahan yang responsif dari jumlah eosinofil mukosa hidung. Sebanyak 30 subjek dinyatakan responsif dan terdapat penurunan kadar IL-5. Tidak ada hubungan yang bermakna antara perubahan kualitas hidup dan kadar IL-5. Kesimpulan: Perubahan kualitas hidup, jumlah eosinofil mukosa hidung, dan kadar IL-5 serum dapat digunakan sebagai penanda objektif keberhasilan terapi rinitis alergi yang dapat dipakai dalam praktik klinis sehari-hari maupun kepentingan riset. Kata kunci: rinitis alergi, kualitas hidup, eosinofil, interleukin-5ABSTRACT Background: Allergic rhinitis defined as an inflammatory disease of the nose mediated by immunoglobulin-E, induced after nasal mucosa exposure to allergen. Important inflammatory cells and mediators are eosinophils, histamine, and Th2-related cytokines. Symptoms include rhinorrhea, repeated sneezing, nasal congestion and/or nasal itching. Aside from its bothersome symptoms, allergic rhinitis decreases patient’s quality of life (QOL). Comprehensive management consist of allergen avoidance, medication, immunotherapy, and education, aimed to diminish symptoms and improve the patient’s quality of life. Purpose: To evaluate changes in quality of life, nasal mucosal eosinophil count, and level of interleukin-5 in allergic rhinitis after medicamentous treatment. Methods: This was an analytic pre-experimental study with data taken before and after medicamentous treatment. Results: Thirty-one of 33 subjects showed significant changes of QOL (MID>0,7). All samples, 33 subjects, experienced responsive changes in nasal mucosal eosinophil count. Thirty subjects were responsive, which showed decrease of IL-5 level. There was no significant relation between changes of QOL and changes of IL-5 level. Conclusion: Changes in quality of life, nasal mucosal eosinophil count, and IL-5 level are objective markers of treatment efficacy in Allergic Rhinitis, which can be used in clinical practices and researches. Keywords: allergic rhinitis, quality of life, eosinophil, interleukin-5, intranasal steroid, antihistamine
Gambaran fungsi penghidu dengan Sniffin’ sticks pada pasien rinitis alergi Nurul Endah Ardianti; Nina Irawati; Niken Lestari Poerbonegoro; Saptawati Bardosono
Oto Rhino Laryngologica Indonesiana Vol 42, No 2 (2012): Volume 42, No. 2 July - December 2012
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (408.837 KB) | DOI: 10.32637/orli.v42i2.27

Abstract

Background: Allergic rhinitis (AR) is defined as an inflammation of the lining mucosa of the nose induced by allergen exposure. The olfactory disturbance could affect around 21%-23% of AR patients.Purpose: To determine the olfactory performance of AR patients at the Allergy-Immunology outpatientclinic, ENT Department, Cipto Mangunkusumo Hospital. To find out the mean difference of olfactorythreshold, discrimination, and identification (TDI) score between intermittent AR group and persistent ARgroup, and also to determine the percentage of the AR patient who had olfactory disturbance. Method:Observational descriptive study with cross sectional method to assess the TDI in AR patients using theSniffin’ sticks extended test. Results: The olfactory performance characteristics of AR patients were:threshold score 0,25; discrimination score 7,00; identification score 10,10; TDI score 23,50. There wasno statistical difference of the TDI mean score between intermittent AR group and persistent AR group.In our study, 45% of all AR subjects were reported to have olfactory disturbance. Conclusion: The TDIresults which represent olfactory function of AR patients were lower compared to the healthy subjects. Key words: allergic rhinitis, olfactory function, Sniffin’ sticks  Abstrak :  Latar belakang: Rinitis alergi (RA) adalah penyakit inflamasi mukosa hidung akibat pajanan terhadap suatu alergen. Sekitar 21% sampai 23% pasien RA dapat mengalami gangguan penghidu. Tujuan: Mengetahui gambaran fungsi penghidu pada pasien rinitis alergi (RA). Menentukan perbedaan rerata nilai ambang, diskriminasi dan identifikasi (ADI) pada pasien RA intermiten dan persisten, dan mengetahui persentase pasien RA dengan gangguan fungsi penghidu di poliklinik Divisi Alergi-Imunologi, Departemen THT RSCM. Metode: Penelitian observasional dengan metode potong lintang untuk menilai ADI penghidu pada percontoh RA menggunakan pemeriksaan Sniffin’ sticks extended test. Hasil: Didapati karakteristik fungsi penghidu percontoh RA ambang 0,25; diskriminasi 7,00; identifikasi 10,10; nilai ADI 23,50. Tidak didapatkan perbedaan bermakna rerata nilai ADI antara kelompok rinitis alergi persisten dan intermiten. Diperoleh 45% dari seluruh percontoh RA mengalami gangguan fungsi penghidu. Kesimpulan: Nilai ADI yang merupakan fungsi penghidu pasien RA lebih rendah dibandingkan dengan subjek sehat.   Kata kunci: rinitis alergi, fungsi penghidu, Sniffin’ sticks
Pathophysiology and management of gustatory rhinitis Shally Adhina Putri; Nina Irawati
Oto Rhino Laryngologica Indonesiana Vol 50, No 2 (2020): Volume 50, No. 2 July - December 2020
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v50i2.404

Abstract

ABSTRACTBackground: Gustatory rhinitis is a syndrome that causes symptoms of annoying rhinorrhea, occurring immediately after consuming solid or liquid foods which are hot and /or spicy. Usually starts within a few minutes after the ingestion of the foods involved, and is not associated with itching, sneezing, nasal congestion or facial pain. Purpose: To discuss the pathophysiology and proper management of gustatory rhinitis. Literature Review: Recent studies suggest that gustatory rhinitis is likely associated with phenomenon of neurogenic inflammation. The ingestion of spicy foods  caused  the  stimulation of trigeminal sensory nerve endings located in the upper part of the aerodigestive track. Sensory   nerve stimulation seems to be correlated with an activation of post ganglionic cholinergic muscarinic parasympathetic fibers and sensitive to atropine. Conclusion: The initial management of gustatory rhinitis is avoiding the trigger foods. Using combination of topical steroid and anticholinergic intranasal had been proven more effective to treat the rhinorrhea caused by gustatory rhinitis than administration of single drug. ABSTRAKLatar belakang: Rinitis gustatori adalah sindroma yang menimbulkan gejala rinore yang mengganggu, sesaat setelah mengonsumsi makanan padat atau cair, yang bersifat pedas dan/atau berempah. Biasanya dimulai dalam beberapa menit setelah menelan makanan tersebut, dan tidak disertai dengan gatal, bersin, hidung tersumbat atau nyeri wajah. Tujuan: Untuk membahas patofisiologi dan tatalaksana yang tepat pada rinitis gustatori. Tinjauan Pustaka: Sejumlah studi terbaru mendapatkan rinitis gustatori berkaitan dengan fenomena inflamasi neurogenik. Proses menelan makanan pedas dapat menyebabkan stimulasi ujung saraf sensorik trigeminal yang terletak di jalur aerodigestif bagian atas. Stimulasi saraf sensorik tersebut berkaitan dengan pengaktifan serabut saraf parasimpatik muskarinik kolinergik post ganglion yang sensitif terhadap atropin. Kesimpulan: Tatalaksana awal yang dapat dilakukan untuk mengatasi rinitis gustatori adalah menghindari makanan pemicu. Kombinasi penggunaan antikolinergik intranasal dan steroid topikal, secara profilaksis atau sebagai terapi telah terbukti lebih efektif untuk mengatasi rinore akibat rinitis gustatori dibandingkan pemberian masing- masing obat tersendiri.
Comprehensive therapy in united airway disease: Evidence Based Case Report Nina Irawati; Elizabeth Vania; Niken Lestari Poerbonegoro; Raden Ayu Anatriera
Oto Rhino Laryngologica Indonesiana Vol 52, No 1 (2022): VOLUME 52, NO. 1 JANUARY - JUNE 2022
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v52i1.548

Abstract

ABSTRACTBackground: The concept of the united airway disease (UAD) recognises the association between allergic inflammation in the upper and lower airways. Patients with asthma and concomitant allergic rhinitis experience more asthma-related primary and secondary care visits. Purpose: To determine the best treatment option in the case of patients with asthma related allergic rhinitis, both in the control of nasal and pulmonary symptoms. Case report: A case case of 45 years old woman with asthma related to allergic rhinitis treated with combination of intranasal steroid and asthma therapy. Clinical question: In adult patient with allergic rhinitis related to asthma, does the combination of intranasal and inhaled steroids give better clinical improvement subjectively and objectively compared to monotherapy? Method: Literature search through two different databases (PubMed and Cochrane Library) and by searching the bibliography of articles to evaluate the outcome of combination therapy and monotherapy for the disease. Result: Two articles were found relevant with the topic fulfilled the requirements and relevant with the formulation or clinical question. Conclusion: Treating the inflammation associated with allergic rhinitis may have a true impact on the control of asthma, while the failure to treat rhinitis may impair asthma control.ABSTRAKLatar belakang: Konsep United Airway Disease (UAD) mengenali adanya hubungan antara inflamasi alergi pada saluran napas atas dan bawah. Pasien asma yang bersamaan dengan rinitis alergi melakukan lebih banyak kunjungan ke perawatan primer dan sekunder terkait asma. Tujuan: Menentukan pilihan pengobatan terbaik pada pasien dengan rinitis alergi terkait asma, baik dalam pengendalian keluhan hidung maupun paru. Laporan kasus: Satu kasus seorang wanita berusia 45 tahun dengan asma yang berhubungan dengan rinitis alergi. Metode: Mengumpulkan jurnal terkait dari dua database yang berbeda (PubMed dan Cochrane Library). Pencarian artikel juga dilakukan dengan mencari pada daftar pustaka artikel untuk mengevaluasi luaran dari terapi kombinasi dan terapi tunggal untuk penyakit ini. Pertanyaan klinis: Apakah terapi kombinasi dengan steroid intranasal dan steroid hirup dapat memberikan perbaikan lebih signifikan secara subjektif maupun objektif dibandingkan dengan terapi tunggal pada pasien dewasa dengan rinitis alergi dan asma? Hasil: Didapatkan dua artikel yang relevan dengan topik, sesuai dengan pertanyaan klinis serta memiliki penilaian kritis yang baik. Kesimpulan: Mengobati peradangan yang terkait dengan rinitis alergi dapat berdampak nyata pada pengendalian asma, sedangkan kegagalan untuk mengobati rinitis dapat mengganggu pengendalian asma.
Nasal and Sinus Diseases: Common Causes of Upper Airway Cough Syndrome Niken Lestari Poerbonegoro; Nina Irawati; Sonia Miyajima Anjani
eJournal Kedokteran Indonesia Vol 9, No. 3 - Desember 2021
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (210.974 KB) | DOI: 10.23886/ejki.9.33.243-8

Abstract

Upper airway cough syndrome (UACS), previously known as post-nasal drip syndrome, is a persistent cough that lasts more than four weeks in children or more than eight weeks in adults, which is associated with nasal and sinus diseases, such as allergic rhinitis (AR), chronic rhinosinusitis (CRS), and adenoid hypertrophy (AH). UACS is one of the major causes of chronic cough. Several theories support the pathophysiology of chronic cough in UACS, namely post-nasal drip, airway inflammation, and sensory neural hypersensitivity theories. Persistent and excessive cough generates a deterioration in patient’s quality of life and social interaction. This review summarizes the knowledge on pathophysiology and underlying disease of UACS, aims to help clinicians identify and treat this syndrome.
Co-Authors Arinda Putri Pitarini Arini Setiawati De-Yun Wang Deasi Anggraini Dewi Wulandari Elizabeth Vania Meila Sutanti Muchtarudin Mansyur Nurul Endah Ardianti Poerbonegoro, Niken Lestari Raden Ayu Anatriera Rahajoe Dharmaningsih Retno Sulistyo Wardani Saptawati Badarsono Saptawati Bardosono Shally Adhina Putri Sonia Miyajima Anjani