Tesis

Gangguan Penghidu Pasca-Virus: Tatalaksana Kombinasi Latihan Penghidu Ortonasal dan Protokol Terapi Hidung. Kajian Terhadap Uji Klinis Kombinasi Latihan Penghidu Ortonasal dan Protokol Terapi Hidung = Postviral Olfactory Dysfunction: Management of Combination Orthonasal Olfactory Training and Nasal Therapy Protocols. Review of Clinical Trials of Combination of Orthonasal Olfactory Training and Nasal Therapy Protocol.

Latar belakang : Gangguan penghidu pasca-virus adalah etiologi paling umum dari gangguan penghidu. Gangguan penghidu pasca-virus diperkenalkan untuk pertama kalinya sejak lebih dari 20 tahun yang lalu, saat ini menjadi lebih disadari oleh masyarakat akibat terjadinya pandemi COVID-19. Gangguan penghidu pasca-virus bisa berlangsung hingga waktu yang lama sampai permanen. Hal ini terkait kerusakan yang dapat terjadi tidak hanya di jalur penghidu perifer namun bisa juga di sentral. Tatalaksana gangguan penghidu pasca-virus yang bersifat kronis ini masih belum diketahui meskipun beberapa obat dan suplemen telah diuji coba, namun tatalaksana tersebut belum disepakati secara universal serta literatur dengan level of evidence yang tinggi masih belum ada. Tujuan: Penelitian ini dilakukan untuk mengetahui gambaran jenis dan derajat gangguan penghidu pasca-virus serta efektifitas kombinasi Latihan penghidu ortonasal dan protokol terapi penghidu terhadap perbaikan fungsi penghidu pascavirus di RSUPN Dr. Cipto Mangunkusumo. Metode: Penelitian dilakukan Februari - Mei 2022 di URJT THT-KL RSUPN Dr. Cipto Mangunkusumo. Desain penelitian yang digunakan adalah uji kuasi eksperimental 1 grup pre dan post test dengan jumlah subjek 12 pasien gangguan penghidu yang terjadi mendadak pasca infeksi virus. Subjek penelitian dilakukan penilain fungsi penghidu dengan menggunakan uji penghidu alkohol (UPA), uji penghidu intravena (UPI) dan sniffin stick test (SST). Subjek akan diberikan kombinasi latihan penghidu ortonasal dan protokol terapi hidung yang terdiri dari irigasi hidung, intranasal steroid, dekongestan topikal, omega-3 dan oles balsam aromatik selama 6 minggu kemudian dilakukan analisis statistik menggunakan uji wilcoxon. Hasil: Pada penelitian ini derajat gangguan penghidu pasca-virus didapatkan hiposmia 8 subjek dan ansomia 4 subjek. Pada subjek hiposmia terdapat 2 subjek pantosmia dan 3 subjek parosmia, sedangkan pada subjek anosmia didapatkan 1 subjek dengan pantosmia. Jenis gangguan penghidu pasca-virus pada penelitian ini adalah 9 subjek jenis sensorineural dan 3 subjek jenis konduktif. Pada pengukuran awal didapatkan nilai pengukuran UPA 7,1 (1,5-19,5), perlambatan onset UPI 22 (14-55), penurunan nilai durasi UPI 45 (11-150), ambang 6,4 (1,5-12,5), diskriminasi 7,5 (3-13), nilai identifikasi 9,5 (5-14) dan total ADI 23,8 (12,6-29,6). Hasil perhitungan statistik fungsi penghidu setelah terapi didapatkan siginifikan berdasarkan pemeriksaan UPA, onset UPI, durasi UPI, diskriminasi, identifikasi dan total ADI (p < 0,05). Kesimpulan: Karakteristik gambaran gangguan penghidu pada penelitian ini sesuai dengan jenis gangguan penghidu sensorineural dan konduksi. Subjek gangguan penghidu pasca-virus yang bersifat kronik ini dapat mengalami perbaikan fungsi penghidu setelah 6 minggu terapi. Kombinasi LPO dan protokol terapi hidung selama 6 minggu terbukti efektif terhadap perbaikan fungsi penghidu pada gangguan penghidu pasca-virus.
Kata kunci: gangguan penghidu pasca-virus, uji penghidu alkohol, uji penghidu intravena, sniffin’ stick test, latihan penghidu ortonasal, protokol terapi hidung


Background: Postviral olfactory dysfunction are the most common etiology of olfactory dysfunction. Postviral olfactory dysfunction were introduced for the first time in more than 20 years, and are now becoming more aware of the public due to the COVID-19 pandemic. Postviral olfactory dysfunction can last for a long time until they are permanent Post-viral olfactory disorders can last for a long time until they are permanent. This is related to damage that can occur not only in the peripheral olfactory pathways but also central pathway. The management of chronic postviral olfactory dysfunction is still unknown, although several drugs and supplements have been tried, but the treatment is not universally agreed yet and the literature with a high level of evidence does not exist. Objective: This study was conducted to describe the types and degrees of postviral olfactory dysfunction and the effectiveness of the combination of orthonasal olfactory training and nasal protocols therapy on the improvement of postviral olfactory function at Dr. Cipto Mangunkusumo hospital. Methode: The research was conducted from February to May 2022 at ENT outpatient clinic Dr. Cipto Mangunkusumo hospital. The research design used was a quasi-experimental test with 1 pre and post-test group with 12 subjects with olfactory dysfunction that occurred suddenly after viral infection. The research subjects will be assessed for olfactory function using the alcohol sniff test (AST), the intravenous olfactory test (IOT) and the sniffin stick test (SST). Subjects will be given a combination of orthonasal olfactory training and a nasal protocol therapy consisting of nasal irrigation, intranasal steroids, topical decongestants, omega-3 and aromatic balsam for 6 weeks then statistical analysis using the Wilcoxon test was performed. Results: There were 3 subjects who dropped out of the study and the final analysis was carried out on 12 subjects. In this study, the degree of post-viral olfactory disturbance was found in 8 subjects with hyposmia and 4 subjects with ansomia. In hyposmic subjects there are 2 phantosmia subjects and 2 parosmia subjects, while in anosmia subjects there are 1 subject with phantosmia. The types of post-viral olfactory disorders in this study were 9 sensorineural subjects and 3 conductive subjects. At the initial measurement, the AST measurement value was 7.1 (1.5-19.5), delayed onset of IOT 22 (14-55), decreased duration of IOT 45 (11-150), threshold 6.4 (1.5-12,5), discrimination 7.5 (3-13), identification 9.5 (5-14) and TDI 23.8 (12.6-29.6). The results of statistical calculations of olfactory function after therapy were found to be significant based on AST, onset of IOT, duration of IOT, discrimination, identification and TDI (p < 0.05). Conclusion: The characteristics of the olfactory dysfunction in this study are sensorineural and conduction olfactory dysfunction. Subjects of chronic postviral olfactory dysfunction can experience improvement in olfactory function after 6 weeks of therapy. The combination of orthonasal olfactory training and nasal protocol therapy for 6 weeks has been shown to be effective in improving olfactory function in postviral olfactory dysfunction.
Keywords: Postviral olfactory dysfunction, alcohol sniff test, intravenous olfaction test, sniffin stick test, orthonasal olfactory training, nasal protocol therapy