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HUBUNGAN KADAR PEPSIN DAN TNF- α SEKRET TELINGA

PADA OTITIS MEDIA SUPURATIF KRONIK FASE AKTIF DENGAN
LARYNGOPHARYNGEAL REFLUX

TESIS

Disusun untuk memenuhi sebagai persyaratan menyelesaikan Program Studi Pendidikan

Dokter Spesialis – I
Program Studi Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala Leher

Oleh:
Defitaria Permatasari
NIM S921902002

PROGRAM PENDIDIKAN DOKTER SPESIALIS 1 ILMU KESEHATAN

TELINGA HIDUNG TENGGOROK BEDAH KEPALA-LEHER
FAKULTAS KEDOKTERAN UNIVERSITAS SEBELAS MARET
RSUD Dr. MOEWARDI
SURAKARTA
2023
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DAFTAR ISI

JUDUL .................................................................................................................. i

LEMBAR PENGESAHAN ................................................................................ ii

PERNYATAAN KEASLIAN DAN PERNYATAAN PUBLIKASI ................. iv

DAFTAR ISI ...................................................................................................... ix

DAFTAR GAMBAR ........................................................................................... xi

DAFTAR TABEL .............................................................................................. xii

DAFTAR SINGKATAN ................................................................................. xiii

ABSTRAK ........................................................................................................ xiv

ABSTRACT ........................................................................................................xv

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

A. Latar Belakang .........................................................................................1

B. Rumusan Masalah....................................................................................3

C. Tujuan Penelitian .....................................................................................3

D. Manfaat Penelitian ...................................................................................4

BAB II LANDASAN TEORI ................................................................................6

A. Tinjauan Pustaka......................................................................................6

1. Anatomi Telinga ................................................................................6

a. Telinga luar ...................................................................................6

b. Telinga Tengah .............................................................................6

c. Telinga Dalam ..............................................................................8

2. Otitis Media Supuratif Kronik ............................................................9

a. Definisi .........................................................................................9

b. Prevalensi ......................................................................................9

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c. Klasifikasi .....................................................................................9

d. Etiologi .......................................................................................10

e. Patogenesis .................................................................................11

f. Gejala klinis ................................................................................14

g. Diagnosis ....................................................................................14

h. Tatalaksana .................................................................................15

i. Komplikasi ..................................................................................17

3. Laryngopharyngeal Reflux (LPR) ...................................................18

a. Pepsin .........................................................................................20

4. Hubungan Pepsin dan OMSK Fase Aktif .........................................22

B. Kerangka Teori ......................................................................................25

C. Kerangka Konsep ..................................................................................26

D. Hipotesis ................................................................................................26

BAB III METODE PENELITIAN ......................................................................24

A. Tempat dan Waktu Penelitian ...............................................................27

B. Jenis Penelitian ......................................................................................27

C. Subjek Penelitian ...................................................................................28

D. Rancangan Penelitian ............................................................................29

E. Definisi Operasional ..............................................................................30

F. Pelaksanaan Penelitian ..........................................................................30

G. Prosedur Penelitian ................................................................................31

H. Analisa Data .........................................................................................33

BAB IV HASIL PENELITIAN DAN PEMBAHASAN ....................................34

BAB V KESIMPULAN DAN SARAN ..............................................................45

DAFTAR PUSTAKA ..........................................................................................46

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DAFTAR GAMBAR

Gambar 1 Anatomi telinga .......................................................................................4

Gambar 2 Middle ear cleft .....................................................................................5
Gambar 3 Dinding telinga tengah dan strukutr yang terkait ..................................6
Gambar 4 Toll-like receptor (TLR) dan ligand terpentingnya.............................10
Gambar 5 Jalur pensinyalan intraseluler mukosa telinga tengah .......................11
Gambar 6 Algoritma tatalaksana OMSK .............................................................15
Gambar 7 Komplikasi OMSK intrakranial dan ekstrakranial .............................16
Gambar 8 Komplikasi OMSK ekstrakranial ........................................................16
Gambar 9 Komponen cairan lambung .................................................................17
Gambar 10 Mekanisme potensial material refluks pada pasien LPR ..................20
Gambar 11 Kerangka teori ...................................................................................22
Gambar 12 Kerangka konsep ...............................................................................23

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DAFTAR TABEL

Tabel 1 Tabel Skoring RSI.....................................................................................20

Tabel 2 Jadwal Penelitian ....................................................................................27
Tabel 3 Karakteristik Subjek Penelitian...............................................................34
Tabel 4 Derajat Gangguan Pendengaran Subjek Penelitian ................................35
Tabel 5 Tipe Penurunan Pendengaran Subjek Penelitian ....................................36
Tabel 6 Karakteristik kadar pepsin dan TNF-α sekret telinga .............................36
Tabel 7 Hubungan Kadar Pepsin dan TNF-α sekret telinga ................................37

DAFTAR SINGKATAN

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BCL-2 : B cell lymphoma 2

CCL3 : C-Cmotif chemokine ligand 3
CT : Computed tomography
CWD : canal wall down
CWU : canal wall up
EGFR : Epidermal Growth Factor Receptor
ELISA : Enzyme-linked immunosorbent assay
GERD : Gastroesophageal Reflux Disease
HCl : Hydrocloride
IRF : Interferon regulation factor
IL : Interleukin
LPR : Laryngopharyngeal reflux
LPS : Lipopolisakarida
MMP-9 : Matrix Mtalloproteinase-9
mRNA : mithocondrial RNA
mTOR : Mammalian Target Of Rapamycin
NF-κB : Nuclear Factor Kappa B
NLRs : Nod-like receptors
OMA : Otitis Media Akut
OME : Otitis Media Efusi
OMSK : Otitis Media Supuratif Kronik
PAMP : Pathogen Associated Molecular Patterns
PRR : Pattern Recognition Receptors
RSI : Reflux Symptom Index
SPSS : Statistic Product and Service Solution
STAT3 : Signal Transducer and Activator of Transcription 3
TLR : Toll Like Receptor
TNF-α : Tumor Necrotic Factor Alpha
VHI : Voice handicap index

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WHO : World Health Organization

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