Manifestasi Klinis Refluks Laringofaring: Studi pada Anak Usia 0–24 Bulan dengan Laringomalasia

Melati Sudiro, R. Ayu Hardianti Saputri, Teti Madiadipoera, M. Thaufiq S. Boesoirie, Budi Setiabudiawan

Abstract


Laringomalasia merupakan kelainan kongenital anomali laring yang banyak ditemukan pada bayi baru lahir dan penyebab tersering stridor serta obstruksi saluran napas. Pemeriksaan laringoskopi serat lentur memperlihatkan terlipat atau terhisapnya struktur supraglotik ke dalam laring selama inspirasi. Obstruksi saluran napas pada laringomalasia akan menyebabkan tekanan negatif intratorakal, menyebabkan asam lambung naik ke jaringan laringofaring dan diduga menimbulkan refluks laringofaring (RLF). Telah dilakukan penelitian dengan pendekatan potong lintang yang bertujuan mengidentifikasi dan menilai hubungan antara laringomalasia dan gambaran refluks laringofaring pada usia 0–24 bulan yang datang ke poliklinik THT-KL RSHS Bandung periode Januari 2012–Maret 2015 berdasar atas data rekam medis dan hasil pemeriksaan laringoskopi serat lentur.  Seratus tujuh pasien laringomalasia dengan keluhan stridor mengikuti penelitian ini, 69 laki-laki (64,5%) dan 38 perempuan (35,5%) dengan usia rata-rata 4,19 bulan. Laringomalasia tipe 1 merupakan tipe terbanyak (57,9%). Gambaran RLF yang berhubungan dengan tingkat berat laringomalasia adalah edema plika ventrikularis dengan OR 3,71 (IK 95%=1,07–12,91; p=0,039) dan edema aritenoid dengan OR 4,74 (IK 95%=1,19–18,89; p=0,027). Edema ventrikular dan aritenoid merupakan gambaran RLF yang berhubungan dengan tingkat berat laringomalasia pada pada anak usia 0–24 bulan. [MKB. 2017;49(2):115–21]

Kata kunci: Edema aritenoid, edema plika ventrikularis, laringomalasia, refluks laringofaring


Laryngopharyngeal Reflux Manifestation: a Case Study of Laryngomalacia in Children Aged 0–24 Months

Laryngomalacia is the most common laryngeal anomaly of the newborn and the main cause of stridor and airway obstruction in infants. From a flexible laryngoscopy examination, this anomaly is observed as curled or collapsed supraglottic structures into larynx during inspiration. Airway obstruction in laryngomalacia creates a negative intra-thoracal pressure that causes acid reflux to laryngopharynx tissue and is suspected to cause laryngopharyngeal reflux (LPR). A cross-sectional study was conducted with the objectives of identifying and assessing the relationship between laryngomalacia and LPR in patients aged 0–24 months who visited the Ear, Nose, Throat, Head, and Neck Clinic of Dr. Hasan Sadikin General Hospital Bandung in the period of January 2012–March 2015, which was based on medical records and results of flexible laryngoscopy. A hundred and seven patients diagnosed with laryngomalacia  who experienced stridor symptoms in this study consisted of 69 males (64.5%) and 38  females (35.5%) with mean age of 4.19 months. Type-1 laryngomalacia represents the most cases (57.9%). Indication of LPR sign correlated with type of laryngomalacia is ventricular edema OR 3.71 (CI 95%=1.07–12.91; p=0.039) and arytenoid edema OR 4,74 (CI 95%=1.19-18.89; p=0.027). Ventricular and arytenoid edemas are signs of LPR that correlate with laryngomalacia level in patients  aged 0–24 months. [MKB. 2017;49(2):115–21]

Key words: Arytenoid edema, laringomalacia, laringopharyngeal reflux, ventricular edema

 
DOI: 10.15395/mkb.v49n2.1057

 


Keywords


Edema aritenoid, edema plika ventrikularis, laringomalasia, refluks laringofaring

Full Text:

PDF

References


Hartl TT, Chadha NK. A systematic review of laryngomalacia and acid reflux. Otolaryngol Head Neck Surg. 2012;147(4):619–26.

Landry AM, Thompson DM. Laryngomalacia: disease presentation, spectrum, and management. Int J Pediatr. 2012;2012:1–6.

Ayari S, Aubertin G, Girschig H, Van Den Abbeele T, Mondain M. Pathophysiology and diagnostic approach to laryngomalacia in infants. Eur Ann Otorhinolaryngol Head Neck Dis. 2012;129(5):257–63.

Thorne MC, Garetz SL. Laryngomalacia: review and summary of current clinical practice in 2015. Paediatr Respir Rev. 2016;17:3–8.

van der Heijden M, Dikkers FG, Halmos GB. The groningen laryngomalacia classification system--based on systematic review and dynamic airway changes. Pediatr Pulmonol. 2015;50(12):1368–73.

Ayari S, Aubertin G, Girschig H, Van Den Abbeele T, Denoyelle F, Couloignier V, dkk. Management of laryngomalacia. Eur Ann Otorhinolaryngol Head Neck Dis. 2013;130(1):15–21.

Galluzzi F, Schindler A, Gaini RM, Garavello W. The assessment of children with suspected laryngopharyngeal reflux: an Ootorhinolaringological perspective. Int J Pediatr Otorhinolaryngol. 2015;79(10): 1613–9.

Patel D, Vaezi MF. Normal esophageal physiology and laryngopharyngeal reflux. Otolaryngol Clin North Am. 2013; 46(6):1023–41.

Venkatesan NN, Pine HS, Underbrink M. Laryngopharyngeal reflux disease in children. Pediatr Clin North Am. 2013;60(4):865–78.

Campagnolo AM, Priston J, Thoen RH, Medeiros T, Assuncao AR. Laryngopharyngeal reflux: diagnosis, treatment, and latest research. Int Arch Otorhinolaryngol. 2014;18(2):184–91.

May JG, Shah P, Lemonnier L, Bhatti G, Koscica J, Coticchia JM. Systematic review of endoscopic airway findings in children with gastroesophageal reflux disease. Ann Otol Rhinol Laryngol. 2011;120(2):116–22.

Kay DJ, Goldsmith AJ. Laryngomalacia: a classification system and surgical treatment strategy. Ear Nose Throat J. 2006;85(5):328–36.

Nasution DP, Tamin S, Hutauruk S, Bardosono S. Prevalensi refluks laringofaring pada bayi laringomalasia primer. Oto Rhino Laryngologica Indonesia. 2012;42(2):112–8.

Edmondson NE, Bent JP, Chan C. Laryngomalacia: the role of gender and ethnicity. Int J Pediatr Otorhinolaryngol. 2011;75(12):1562–4.

Fattah HA, Gaafar AH, Mandour ZM. Laryngomalacia: diagnosis and management. j.ejenta. 2011;12(3):149–53.

Vijayasekaran D, Gowrishankar NC, Kalpana S, Vivekanandan VE, Balakrishnan MS, Suresh S. Lower airway anomalies in infants with laryngomalacia. Indian J Pediatr. 2010;77(4):403–6.

Habesoglu M, Habesoglu TE, Gunes P, Kinis V, Toros SZ, Eriman M, dkk. How does reflux affect laryngeal tissue quality? An experimental and histopathologic animal study. Otolaryngol Head Neck Surg. 2010;143(6):760–4.


Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


 

This Journal indexed by

             


Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 


View My Stats