KARYA TULIS AKHIR

HUBUNGAN RINITIS ALERGI DENGAN RINOSINUSITIS KRONIS

DI RSU Dr.SAIFUL ANWAR MALANG PERIODE JANUARI-DESEMBER
2010

OLEH :
AIRA OKLATIHANA PUTRI
08020027

FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG
2011
HUBUNGAN RINITIS ALERGI DENGAN RINOSINUSITIS KRONIS
DI RSU Dr. SAIFUL ANWAR MALANG
PERIODE JANUARI-DESEMBER 2010

KARYA TULIS AKHIR

Diajukan kepada
Universitas Muhammadiyah Malang
untuk Memenuhi Salah Satu Persyaratan
dalam Menyelesaikan Program Sarjana
Fakultas Kedokteran

Oleh :
AIRA OKLATIHANA PUTRI
08020027

FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG
2011
 LEMBAR PENGESAHAN

LAPORAN HASIL PENELITIAN

Telah disetujui sebagai hasil penelitian

untuk memenuhi persyaratan

Pendidikan Sarjana Fakultas Kedokteran

Universitas Muhammadiyah Malang

Tanggal : 16 November 2011

Pembimbing I

dr. Nanang Mardiraharjo, SpTHT-KL

Pembimbing II

dr. Thontowi Djauhari, M.kes

Mengetahui,

Dekan Fakultas Kedokteran

Universitas Muhammadiyah Malang

dr. Irma Suswati, M.Kes

 LEMBAR PENGUJIAN

Karya Tulis Akhir oleh Aira Oklatihana Putri ini

telah diuji dan dipertahankan di depan Tim Penguji

Pada tanggal : 16 November 2011

Tim Penguji

dr. Nanang Mardiraharjo, SpTHT-KL , Ketua

dr.Thontowi Djauhari, M.Kes , Anggota

dr. Ruby Riana Asparini, SpBP , Anggota

 KATA PENGANTAR

Assalamualaikum Wr.Wb

Syukur alhamdulillah atas kehadirat Allah SWT yang telah melimpahkan

rahmat dan hidayah-Nya, sehingga penulis dapat menyelesaikan Karya Tulis Akhir

dengan judul “Hubungan Rinitis Alergi dengan Rinosinusitis Kronis di RSU Dr.

Saiful Anwar Malang Periode Januari-Desember 2010”.

Karya tulis ini disusun sebagai salah satu persyaratan dalam menyelesaikan

Program Sarjana Kedokteran S1 (Strata 1). Dalam kesempatan ini penulis

menyampaikan terima kasih kepada pihak yang telah mendukung penyelesaian Karya

Tulis Akhir ini :

1. dr. Irma Suswati, M.Kes selaku Dekan Fakultas Kedokteran Universitas

Muhammadiyah Malang.

2. dr.Nanang Mardiraharjo, SpTHT-KL selaku dosen pembimbing I dalam

penulisan Karya Tulis Akhir ini.

3. dr.Thontowi Djauhari, M.Kes selaku dosen pembimbing II dalam penulisan

Karya Tulis Akhir ini.

4. dr.Ruby Riana Asparini, SpBP selaku dosen penguji dalam Karya Tulis Akhir

ini.

5. Bagian rekam medis, diklit, dan poli THT di RSU Dr. Saiful Anwar Malang,

terimakasih atas kesempatan yang diberikan dalam proses penelitian ini.

 6. Kedua orang tua saya tercinta, Ibu Ekowati Sukrijantini dan Bapak Teguh

Latihantono terimakasih atas doa, dukungan dan kasih sayang yang selalu

diberikan kepada saya. Beserta kakak saya, Laras Antini Teguh Putri,

terimakasih atas doa dan dukungannya.

7. Seluruh sahabat-sahabat saya di Fakultas Kedokteran Universitas

Muhammadiyah Malang terimakasih atas doa dan dukungannya.

8. Seluruh pihak yang telah membantu dalam proses penyelesaian Karya Tulis

Akhir ini.

Penulis menyadari bahwa penyusunan Karya Tulis Akhir ini masih jauh dari

sempurna dan akhirnya penulis berharap semoga Karya Tulis Akhir ini dapat

bermanfaat bagi seluruh masyarakat, khususnya dalam bidang kesehatan.

Wassalamualaikum Wr.Wb

Malang, November 2011

Penulis
 ABSTRAK

Oklatihana Putri, Aira. 2011. Hubungan Rinitis Alergi dengan Rinosinusitis Kronis di
RSU Dr.Saiful Anwar Malang Periode Januari-Desember 2010. Karya Tulis
Akhir, Fakultas Kedokteran Universitas Muhammadiyah Malang.
Pembimbing : (1) Nanang Mardiraharjo, (2) Thontowi Djauhari.

Latar Belakang : Prevalensi rinosinusitis kronis mencapai 15% dan semakin

meningkat dalam dekade terakhir. Salah satu faktor penyebabnya diduga rinitis alergi.
Tujuan : Mengetahui hubungan rinitis alergi dengan rinosinusitis kronis di RSU
Dr.Saiful Anwar Malang periode Januari-Desember 2010.
Metode : Observasional analitik dengan pendekatan studi cross sectional.
Pengambilan sampel dengan metode total sampling. Berdasarkan pasien suspek
rinitis alergi yang telah menjalani tes cukit kulit dilakukan analisis menggunakan uji
chi square dan dihitung rasio prevalensi rinosinusitis kronis.
Hasil Penelitian : Sampel pada penelitian ini sebanyak 80 pasien. Dari 53 pasien
dengan hasil tes cukit kulit positif, 44 pasien (83,01%) diantaranya mengalami
rinosinusitis kronis. Dari 27 pasien dengan hasil tes cukit kulit negatif, terdapat 17
pasien (62,96%) yang mengalami rinosinusitis kronis. Berdasarkan uji chi square
untuk mengetahui hubungan antara rinitis alergi dengan rinosinusitis kronis diperoleh
nilai p=0,046 (p<0,05) dan rasio prevalensi sebesar 1,31 dengan interval kepercayaan
95%(0,607-0,832).
Kesimpulan : Terdapat hubungan yang signifikan antara rinitis alergi dengan
rinosinusitis kronis.

Kata Kunci : Rinitis alergi, tes cukit kulit, rinosinusitis kronis.

 ABSTRACT

Oklatihana Putri, Aira. 2011. Correlation between Allergic Rhinitis with Chronic
Rhinosinusitis at Dr. Saiful Anwar General Hospital Malang Period
January-December 2010. Final Assignment : Medical Faculty,
Muhammadiyah University of Malang. Advisors : (1) Nanang Mardiraharjo,
(2) Thontowi Djauhari.

Background : The prevalence of chronic rhinosinusitis was 15% and increase in last
decade. Allergic rhinitis is suspected as one of chronic rhinosinusitis predisposition
factor.
Objective : To determine the correlation between allergic rhinitis with chronic
rhinosinusitis at Dr. Saiful Anwar General Hospital Malang period January-
December 2010.
Method : Observational analytical study with cross sectional approach. Sample had
been being taken by total sampling method. Based on allergic rhinitis suspects who
have been being performed skin prick test then analyzed using chi square test and
determined the prevalence ratio of chronic rhinosinusitis.
Results : Samples of this study were 80 patients. Positive skin prick test were found
in 53 patients and there were 44 patients (83,01%) had chronic rinosinusitis. Negative
skin prick test were found in 27 patients and there were 17 patients (62,96%) had
chronic rinosinusitis. Based on chi square test to determined correlation between
allergic rhinitis with chronic rhinosinusitis, the value of p=0,046 (p<0,05) and
prevalence ratio was 1,31 with confidence interval 95% (0,607-0,832).
Conclusion : There was significant correlation between allergic rhinitis with chronic
rhinosinusitis.

Keywords : Allergic rhinitis, skin prick test, chronic rhinosinusitis.

 DAFTAR ISI

HALAMAN JUDUL .................................................................................................... i

KATA PENGANTAR……………………………………………………………..….ii

ABSTRAK …………………………………………………………………………. .iv

ABSTRACT……………………………………………….…...……………….….......v

DAFTAR ISI……………………………………………….…………………..…….vi

DAFTAR TABEL……………………………………………………………...……vii

DAFTAR GAMBAR……………………………………………………………….viii

DAFTAR SINGKATAN…………………………………………………………......ix

DAFTAR LAMPIRAN……………………………………………………………….x

BAB I PENDAHULUAN ............................................................................................ 1

1.1. Latar Belakang .......................................................................................... 1

1.2. Rumusan Masalah.......................................................................................3

1.3. Tujuan ........................................................................................................3

1.3.1. Tujuan umum ...................................................................................3

1.3.2. Tujuan khusus ..................................................................................3

1.4. Manfaat ......................................................................................................4

1.4.1. Manfaat Akademis............................................................................4

1.4.2. Manfaat Klinis..................................................................................4

1.4.3. Manfaat bagi Masyarakat..................................................................5

BAB II TINJAUAN PUSTAKA .................................................................................5

2.1. Sinus paranasal...........................................................................................5

 2.1.1. Sinus maksila....................................................................................6

2.1.2. Sinus frontal.....................................................................................7

2.1.3. Sinus etmoid.....................................................................................7

2.1.4. Sinus sfenoid.....................................................................................8

2.1.5. Kompleks ostio-meatal (KOM) .......................................................8

2.1.6. Sistem transport mukosiliar............................................................10

2.1.7. Fungsi sinus paranasal....................................................................11

2.2. Rinitis alergi .............................................................................................12

2.2.1. Definisi rinitis alergi ......................................................................12

2.2.2. Klasifikasi rinitis alergi...................................................................12

2.2.3. Etiologi rinitis alergi ......................................................................13

2.2.4. Patofisiologi rinitis alergi ...............................................................14

2.2.5. Gambaran histologik rinitis alergi..................................................16

2.2.6. Gejala klinik rinitis alergi...............................................................16

2.2.7. Diagnosis rinitis alergi....................................................................17

2.2.7.1. Anamnesis..........................................................................17

2.2.7.2. Pemeriksaan fisik...............................................................17

2.2.7.3. Pemeriksaan penunjang......................................................17

2.2.8. Penatalaksanaan rinitis alergi..........................................................20

2.2.9. Pencegahan rinitis alergi.................................................................21

2.2.10. Komplikasi rinitis alergi...............................................................22

2.3. Rinosinusitis kronik..................................................................................22

2.3.1. Definisi rinosinusitis kronik............................................................22

 2.3.2.Etiologi rinosinusitis kronik.............................................................23

2.3.3. Patofisiologi rinosinusitis kronik....................................................23

2.3.4. Gejala klinik rinosinusitis kronik....................................................24

2.3.5. Diagnosis rinosinusitis kronik........................................................26

2.3.5.1. Anamnesis...................................................................26

2.3.5.2. Pemeriksaan fisik........................................................28

2.3.5.3. Pemeriksaan penunjang..............................................28

2.3.6. Penatalaksanaan rinosinusitis kronik..............................................30

2.3.7. Komplikasi rinosinusitis kronik......................................................30

BAB III KERANGKA KONSEP DAN HIPOTESIS................................................32

3.1. Kerangka Konsep ..................................................................................32

3.2. Hipotesis ................................................................................................32

BAB IV METODE PENELITIAN ............................................................................33

4.1. Desain penelitian....................................................................................33

4.2. Lokasi dan waktu penelitian ..................................................................33

4.3. Populasi dan sampel...............................................................................33

4.4. Teknik pengambilan sampel...................................................................33

4.5. Kriteria inklusi dan eksklusi...................................................................33

4.6. Variabel penelitian..................................................................................34

4.6.1. Variabel bebas ........................................................................34

4.6.2. Variabel tergantung.................................................................34

4.7. Definisi operasional variabel .................................................................34

4.8. Instrumen penelitian ..............................................................................35

 4.9. Teknik pengumpulan data .....................................................................35

4.10. Analisis data ........................................................................................35

4.12. Alur penelitian .....................................................................................36

BAB V HASIL PENELITIAN

5.1 Deskripsi Karakteristik Sampel…………………………………….......37

5.1.1 Distribusi Sampel Berdasarkan Jenis Kelamin ………………….37

5.1.2 Distribusi Sampel Berdasarkan Usia …………………………….38

5.1.3 Distribusi Jenis Alergen pada Pasien Rinitis Alergi…………...…39

5.1.4 Distribusi Gejala Klinis pada Pasien Rinitis Alergi……………...40

5.2 Hasil Tabulasi Silang……………………………………………...……41

5.3 Analisis Hubungan Rinitis Alergi dengan Rinosinusitis Kronik………..41

BAB VI PEMBAHASAN……………………………..…………………………….42

BAB VII KESIMPULAN DAN SARAN

7.1 Kesimpulan……………………………………………………………..49

7.2 Saran …………………………………………………………………...49

DAFTAR PUSTAKA ………………………………………………………………51

LAMPIRAN ………………………………………………………………………..55
 DAFTAR TABEL

Tabel 2.1. Kriteria Rinosinusitis akut dan Kronik pada Anak dan Dewasa...............27

Tabel 2.2. Gejala dan tanda rinosinusitis kronik.........................................................28

Tabel 5.1. Distribusi Sampel Berdasarkan Jenis Kelamin……………………..…….37

Tabel 5.2. Distribusi Sampel Berdasarkan Usia……………………………….…….38

Tabel 5.3. Tabulasi Silang antara Rinitis Alergi dengan Rinosinusitis Kronik….…..41
 DAFTAR GAMBAR

Gambar 2.1. Sinus paranasal.........................................................................................5

Gambar 2.2. Muara kelompok sinus anterior dan posterior..........................................6

Gambar 2.3. Kompleks ostio-meatal.............................................................................9

Gambar 2.4. Sel Haller..................................................................................................9

Gambar 2.5. Sel Agger Nasi........................................................................................10

Gambar 2.6. Sistem transport mukosiliar....................................................................11

Gambar 2.7. Allergic shinner......................................................................................18

Gambar 2.8. Allergic crease........................................................................................18

Gambar 2.9. Siklus rinosinusitis kronik......................................................................23

Gambar 5.1. Distribusi Jenis Alergen pada Pasien Rinitis Alergi…….……………..39

Gambar 5.2. Distribusi Gejala Klinis pada Pasien Rinitis Alergi……………………40

 DAFTAR SINGKATAN

AAOA : American Academy of Otolaryngic Allergy

APC : Antigen Presenting Cell

ARIA : Allergic Rhinitis and Its Impact of Asthma

ARS : American Rhinology Society

ECP : Eosinophilic Cationic Protein

EDP : Eosinophilic Derived Protein

ELISA : Enzyme Linked Immuno Sorbent Assay Test

EPO : Eosinophilic Peroxidase

HLA : Human Leukocyte Antigen

IL : Interleukin

IOML : Inferior Orbital Meatal Line

IPDFT : Intracutaneous Provocative Dilutional Food Test

ISSAC : International Study of Asthma and Allergies in Childhood

KOM : Kompleks Ostio-Meatal

MBP : Major Basic Protein

MHC : Major Histocompatibility Complex

RAST : Rasio Immuno Sorbent Test

SET : Skin End-point Titration

Th : T helper

VAS : Visual Analogue Scale

VCAM : Vascular Cell Adhesion Mollecule

 DAFTAR LAMPIRAN

Lampiran 1………………………………………………………………………...…55

Lampiran 2………………………………………………………………………...…61

Lampiran 3…………………………………………………………………………...65

Lampiran 4…………………………………………………………………………...66
 DAFTAR PUSTAKA

Acala, W, Sudarman, K, Christanto, A, & Widodo, C 2010, „Validasi foto polos sinus
paranasal 3 posisi untuk diagnosis rinosinusitis kronik‟, Cermin Dunia
Kedokteran, Vol. 37, No. 13, pp.409-414.

ARIA-World Health Organisation Initiative, 2007, Allergic rhinitis and its impact on
asthma at a glance pocket reference, 1st edn, pp. 1-4.

Asha‟ari, Z, Yusof, S, Ismail, R & Hussin, C 2010, „Clinical features of allergic

rhinitis and skin prick test analysis based on the ARIA classification: a
preliminary study in Malaysia‟, Annals Academy of Medicine, Vol. 39, No. 8,
pp. 621-624.

Baratawidjaja, G & Rengganis, I 2009, Imunologi Dasar, Edisi ke-8, Fakultas

Kedokteran Universitas Indonesia, Jakarta, pp.54.

Ballenger, JJ 1994, „Hidung dan sinus paranasal‟, Dalam: Ballenger JJ (Ed). Penyakit
Telinga, Hidung, Tenggorok, Kepala dan Leher, Edisi ke-13, Diterjemahkan
oleh: Staf ahli bagian THT FK UI, Binarupa Aksara, Jakarta, pp. 1-25.

Bubun, J, Azis, A, Akil, A & Perkasa, F 2009, „Hubungan gejala dan tanda
Rinosinusitis kronik dengan gambaran CT-Scan berdasarkan skor Lund-
Mackay‟, Jurnal ORLI, Edisi II, No.3.

Ciprandi, Vissacarro, Cirillo, Tosca & Massolo, 2005, „Nasal eosinophils display the
best correlation with symptoms, pulmonary function and inflammation in
allergic rhinitis‟, In: International Archives of Allergy and Immunology, Vol.
136, no. 3, pp. 266-272.

Dhingra, PL 2004, Disease of Ear, Nose and Throat, 4th edn, Elsevier, New Delhi
India, pp.159.

Fatmah, 2006, „Respons imunitas yang rendah pada tubuh manusia usia lanjut‟,
Makara Jurnal Kesehatan, Vol. 10, No. 1, pp. 47-53.

Fokkens, W, Lund, V, Bachert, C, Clement, P, Hellings, P & Holmstom, M 2005,

„Position paper on rhinosinusitis & nasal polyps‟, European Academy of
Allergology and Clinical Immunology, vol. 60, no. 66, pp. 583-601.

Fokkens, W, Lund, V & Mullol, J 2007, EPOS-European Position Paper on

Rhinosinusitis & Nasal Polyps, pp. 81-83.
Groot, H, Brand, P, Fokkens, W & Berger, M 2005, „Allergic rhinoconjunctivitis in
children‟, viewed 20th February 2011,
<http://www.bmj.com/content/335/7627/985.extract>.

Karya, W, Aziz, A, Raharjo, S & Djufri, N 2008, „Pengaruh rinitis alergi (WHO
ARIA 2001) terhadap gangguan fungsi ventilasi tuba eustachius‟, Cermin
Dunia Kedokteran, vol. 35, no.7, pp. 405-410.

Kennedy, DW, Gwaltney, JM & Jones, JG 1995, „Medical management of sinusitis:

educational goals and management guideline‟, Annals of Otology Rhinology
Laryngology , vol.167, pp. 22-30.

Krouse, JH, Gordon, BR & Parker, MJ 2002, „Inhalant allergy‟, In: Allergy and
Imunnology an Otolarync Approach, Lippincott Williams & Wilkins,
Philadelphia, pp.35-49.

Mahr, TA 2010, A preschooler with persistent allergic rhinitis, viewed 20th Ferbruary
2011, <http://www.medscape.org/viewarticle/716090>.

Mangunkusumo, E & Soetjipto, D 2007, „Sinusitis‟, Dalam: Buku Ajar Ilmu

Kesehatan Telinga, Hidung, Tenggorok, Kepala dan Leher. Edisi ke-6, Balai
penerbit FK UI, Jakarta, pp.150-4.

Meltzer, EO, Hamilos, DL & Hadley, JA 2004, „Rhinosinusitis: establishing

definitions for clinical research and patient care‟, Otolaryngol Head Neck,
131(supl):S1-S62.

Mulyarjo, 2004, „Diagnosis klinik rinosinusitis‟, In: Mulyarjo, Soedjak S, Kentjono

WA, Harmadji S, Herawati S (eds), Prosiding Simposium Perkembangan
Terkini Diagnosis dan Penatalaksanaan Rinosinusitis, Surabaya, p.17-25.

Ogisi, F 2002, „Skin test reactions in chronic allergic rhinitis in Benin‟, The Nigerian
Journal of Surgical Research, Vol.4, No.3, pp.75-79.

Pawarti, DR 2004, „Tes Kulit dalam Diagnosis Rinitis Alergi’, Media Perhati, Jakarta,
p.18-23.

Phyllis, G 2007, „Location of sinuses‟, viewed 10th March 2011,

<http://www.ihacares.com/index.cfm/HealthAdvisors/AdultHealthAdvisor/crs-
aha-aha_obg_sinus>.

Pinheiro, AD, Facer, GW & Kern, EB 2001, „Rinosinusitis: current concept and
management‟. In: Bailey BJ, Calhoun KH, Healy GB, Pillsbury HC, Johnson
 JT, Tardy ME, Jackler RK (eds), In: Head and neck surgery otolaryngology,
3rd edn, Lippincott Williams and Wilkins, Philadephia, pp. 345-57.

Rahmawati, Punagi, A & Savitri, E 2008, „Hubungan antara beratnya rinitis,

reaktivitas tes cukit kulit dan kadar immunoglobulin E tungau debu rumah pada
pasien rinitis alergi di Makassar‟, The Indonesian Journal of Medical Science,
Vol. 1, No. 1, pp. 1-9.

Rusmono, N, Kasakeyan, E & Irawati, N 2007, „Rinitis alergi‟, Dalam: Buku Ajar
Ilmu Kesehatan Telinga, Hidung, Tenggorok, Kepala dan Leher. Edisi ke-6,
Balai penerbit FK UI, Jakarta, pp.128-133.

Sastroasmoro, S & Ismael, S 2009, Dasar-dasar metodologi penelitian klinis,

Binarupa Aksara, Jakarta.

Silverman, PM 1998, ‘Helical (spiral) computed tomography, a practical approach

to clinical protocols’, Lippincott Williams and Wilkins, Philadelphia, pp: 38-
41.

Skoner, D 2001, ‟Allergic rhinitis: definition, epidemiology, pathophysiology

detection, and diagnosis‟, J Allergy Clin Immunol, 108(supl):S2-S8.

Slack, R & Bates, G 1998, Functional endoscopic sinus surgery, viewed 15th March
2011, <http://www.aafp.org/afp/980901ap/slack.html>.

Soetjipto, D & Mangunkusumo, E 2007, „Sinus Paranasal‟, Dalam: Buku Ajar Ilmu
Kesehatan Telinga, Hidung, Tenggorok, Kepala dan Leher. Edisi ke-6, Balai
penerbit FK UI, Jakarta, pp.145-9.

Stammberger, HR 1995, „Paranasal sinuses: anatomic terminology and nomenclature‟,

viewed 21st March 2011,
<http://ws.ajou.ac.kr/~ent/new/case_topic/RHINODATA/AnatomyPNS.html>.

Suprihati, 2005, „The prevalence of allergic rhinitis and its relation to some risk
factors among 13-14 years old students in Semarang Indonesia‟, Indonesian
Journal of Otorhinolaryngology, Head and Neck Surgery,Vol. 35,No.1,pp.64-
70.

Utami, T, Sudarman, K, Rianto, B & Christanto, A 2010, „Rinitis alergi sebagai faktor
resiko terjadinya otitis media supuratif kronik‟, Cermin Dunia Kedokteran,
Vol. 37, No. 6, pp. 425-429.

Vichanond, P & Jirapongsananuruk, O 1998, „Nasal cytology in the diagnosis of allergic

rhinitis in children‟, Annals of Allergy Asthma & Immunology, Vol. 80, No. 2, pp.
165-70.
Wickens K, de Bruyne J, Calvo, M 2004, „The determinants of dust mite allergen and
its relationship to the prevalence of symptoms of asthma in the Asia-Pacific
region‟, Paediatric Allergy Immunol, 15(supl):S55-61.

Yuen, A, Cheung, S, Tang, K, Ho, W, Brigitta, Y, Cheung, A & Ambrose, C 2007,

„The skin prick test results of 977 patients suffering from chronic rhinitis in
Hong Kong‟, Hong Kong Medical Journal, Vol. 13, No.3, pp.131-136.