LAPORAN TUTORIAL BLOK THT SKENARIO 2
KENAPA SAYA PILEK TERUS MENERUS?
“
”
KELOMPOK XIX PRIMA ANUGRAH ANUGRAH
G0016174
RADIET ADHRA NUGROHO
G0016176
RIO WIJAYANTO
G0016184
SEISHA MEI ZERLINA
G0016200
SINDY FAJRIYATUL FAJRIYATUL R
G0016204
SITI ZAHRA AFIFAH
G0016206
STEFANI DYAH M
G0016208
SUSANTI WAHYUDI
G0016210
SYAFALIKHA DWIZAHRA
G0016212
THARRA AUDREYA
G0016214
TUTOR : RATNA KUSUMAWATI, dr., M.Biomed
FAKULTAS KEDOKTERAN UNIVERSITAS SEBELAS MARET SURAKARTA TAHUN 2018
1
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BAB 1 PENDAHULUAN SKENARIO 3 KENAPA SAYA PILEK TERUS MENERUS ?
Seorang laki-laki 25 tahun, datang dengan keluhan hidung meler dengan lendir berwarna kuning kehijauan. Pasien merasa kalo pileknya kambuhkambuhan, dan memberat sejak 3 bulan terakhir. Keluhan disertai dengan keluar
lender
di
tenggorokan
yang
dirasakan
terutama
saat
pasien
menunduk/bersujud.
Pasien juga merasakan hidung terasa buntu, penciumannya berkurang dan terasa agak nyeri di pipi kanan dan kiri. Dari hidung keluar lendir kentar berwarna kuning. Pasien mempunyai riwayat bersin-bersin di pagi hari
atau bila terpapar debu. Dalam 1 minggu terakhir keluhan bersin-bersin kambuh lebih dari 4x dalam sehari, dan keluhan tersebut menyebabkan pasien seringkali tidak masuk kerja. Pasien tidak mempunyai riwayat sakit gigi di gigi rahang atas . Pada pemeriksaan didapatkan kesadaran compos mentis, tekanan darah 120/80 mmHg, denyut nadi 80 x/menit, respiration rate 18 x/menit, suhu 36 o c. Pada pemeriksaan palpasi sinus paranasal didapatkan nyeri pada penekanan. Pemeriksaan hidung dengan rhinoskopi anterior didapatkan mukosa cavum nasi dekstra dan sinistra livid edema, konka hipertrofi +/+ tampak sekret kuning kental dari meatus nasi medius dextra dan sinistra, deviasi septum nasi (+) ke kiri (spina septi).
Pemeriksaan rhinoskopi posterior tampak choanae lapang, discharge mukopurulen (+/+). Pada pemeriksaan tenggorok didapatkan tonsil T1-T1,
post nasa nasall dri p di dinding pharynx posterior. tampak po
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BAB II DISKUSI DAN TINJAUAN PUSTAKA
-
Langkah I : Membaca skenario dan memahami pengertian beberapa istilah dalam skenario. Dalam skenario kali ini, kami mengklarifikasi istilah-istilah berikut ini -: 1. Post nasal drip: hipersekresi sekret dari da ri hidung hingga faring 2. Skin prick test: tes alergi dengan menggesekkan alergen 3. Spina septi: deviasi septum nasi yang berat 4. Livid edema: bengkak keunguan 5. Sinus paranasal: pneumatisasi cranium yang membentuk rongga disekitar rongga hidung
-
Langkah II : Menentukan/ mendefinisikan permasalahan Masalah yang terdapat pada skenario “ Kenapa “ Kenapa Saya Pilek Terus Menerus ? ” adalah : 1.
Mengapa keluhan terutama saat sujud?
2.
Mengapa disertai lendir? Bagaimana Patofisiologinya?
3.
Apa penyebab hidung buntu, penciuman berkurang, nyeri pada pipi?
4.
Bagaimana anatomi dan fisiologi hidung?
5.
Bagaimana interpretasi warna lendir?
6.
Mengapa ditanyakan riwayat sakit gigi?
7.
Bagaimana interpretasi rhinoskopi anterior?
8.
Mengapa perlu pemeriksaan radiologi dan skin dan skin prick test ?
9.
Bagaimana mekanisme post mekanisme post nasal drip? drip?
10. Apakah adanya riwayat deviasi septum nasi mempengaruhi terjadinya
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11. Bagaimana mekanisme bersin di pagi hari hingga kambuhan 4x sehari? 12. Apa hubungan riwayat pilek dengan keluhan pasien? 13. Bagaimana interpretasi pemeriksaan fisik? 14. Bagaimana DD dan Diagnosis dari pasien?
-
Langkah III : Menganalisis permasalahan dan membuat pernyataan sementara mengenai permasalahan ( tersebut dalam langkah II ) 1.
Mengapa keluhan terutama saat sujud? Karena kemungkinan keluhan yang terjadi akibat adanya penumpukan mukus pada sinus maxillaris yang muaranya berada pada bagian atas sinus dan untuk mengeluarkannya bergantung pada kemampuan sillia pada sinus untuk menggerakkan mukus keluar. Sehingga pada saat pasien pada posisi bersujud mukus akan lebih mudah keluar karena bantuan gravitasi.
2.
Mengapa disertai lendir? Bagaimana Patofisiologinya? Lendir warna kuning gelap dan kental mungkin adalah merupakan tanda infeksi virus atau bakteri, infeksi sinus, atau infeksi saluran pernapasan
bawah.
Biasanya,
ini
terjadi
saat
sistem
imun
mengirimkan neutrophil ke area infeksi. Sel-sel ini mengandung protein hijau yang apabila ada dalam jumlah banyak bisa mengubah lendir menjadi berwarna kehijauan.
3.
Apa penyebab hidung buntu, penciuman berkurang, nyeri pada pipi? Reseptor organ penghidu terdapat di regio olfaktorius di hidung bagian sepertiga atas. Serabut saraf olfaktorius berjalan melalui
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reseptor penghidu bila menarik napas dengan kuat atau partikel tersebut larut dalam lendir yang selalu ada di permukaan mukosa daerah ollfaktorius. Adapun pada pasien terjadi sekresi mukus yang berlebihan yang dapat mengakibatkan terhalangnya regio olfaktorius hidung, sehingga partikel bau tidak bisa sampai ke reseptor saraf. Keluhan hidung terasa buntu pada pasien dapat disebabkan karena obstruksi pada rongga hidung yang disebabkan oleh penumpukan mukus pada rongga hidung pasien. Keluhan rasa nyeri pada pipi kanan dan kiri pasien bisa terjadi karena terjadi inflamasi pada sinus pasien yaitu sinus maksila. Selain karena inflamasi, nyeri pada sinus bisa dikarenakan penumpukan cairan mukus serta obstruksi pada sinus pasien yang menyebabkan terjadinya penekanan pada daerah sekitar sinus, sehingga terjadi nyeri. Adapun penyebab lain rasa nyeri pada sinus adalah karena terjadinya perubahan tekanan yang disebabkan oleh obstruksi pada ostium sinus maksilaris. 4.
Bagaimana anatomi dan fisiologi hidung? 1. Anatomi Hidung a. Hidung Luar Hidung luar berbentuk piramid menonjol pada garis tengah di antara pipi dengan bibir atas. Struktur hidung luar dapat dibedakan atas tiga bagian : yang paling atas berupa kubah tulang yang tak dapat digerakkan, di bawahnya terdapat kubah kartilago yang sedikit dapat digerakkan, dan yang paling bawah adalah lobulus hidung yang mudah digerakkan. digerakkan. Berikut bagian-bagiannya dari atas ke bawah: i. pangkal hidung (bridge (bridge)) ii. dorsum nasi iii. puncak iii. puncak hidung
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vi. lubang hidung (nares ( nares anterior ). ). Hidung luar dibentuk oleh kerangka tulang dan tulang rawan yang dilapisi oleh kulit, jaringan ikat dan beberapa otot kecil yang berfungsi untuk melebarkan atau menyempitkan lubang hidung. Sedangan kerangka tulang rawan terdiri dari beberapa pasang tulang rawan yang terletak dibagian bawah hidung, yaitu : i. sepasang kartilago nasalis lateralis superior ii. sepasang kartilago nasalis lateralis inferior yang disebut juga sebagai kartilago alar mayor iii. beberapa iii. beberapa pasang kartilago alar minor iv. tepi anterior kartilago septum. Bagian dari kavum nasi yang letaknya sesuai dengan ala nasi, tepat dibelakang nares anterior, disebut vestibulum. Vestibulum ini dilapisi oleh kulit yang mempunyai banyak kelenjar sebasea dan rambutrambut panjang yang disebut vibrise. Tiap kavum nasi mempunyai 4 buah dinding, yaitu yaitu dinding medial, lateral, inferior dan superior. Dinding medial hidung adalah septum nasi. Septum dibentuk oleh tulang dan tulang rawan. Bagian tulang adalah: i.
lamina perpendikularis os etmoid
ii.
vomer
iii.
krista nasalis os maksila
iv.
krista nasalis os palatina.
Septum dilapisi oleh perikondrium pada bagian tulang rawan dan periostium pada bagian tulang, sedangkan s edangkan diluarnya dilapisi pula oleh mukosa hidung. Bagian depan dinding lateral hidung licin, yang disebut ager nasi dan di belakangnya terdapat konka-konka yang mengisi sebagian besar dinding lateral hidung. Pada dinding lateral terdapat 4 buah konka. Diantara konka-konka dan dinding lateral hidung terdapt rongga sempit yang disebut meatus.
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inferior dengan dasar hidung dan dinding lateral rongga hidung. Pada meatus inferior terdapat muara (ostium) duktus nasolakrimalis. Meatus medius terletak diantara konka media dan dinding lateral rongga hidung. Pada meatus medius terdapat bula etmoid, prosesus unsinatus, hiatus semilunaris, dan infundibulum etmoid. Hiatus semilunaris merupakan suatu celah sempit melengkung dimana terdapat muara sinus frontal, sinus maksila, dan sinus etmoid anterior. b. Hidung Dalam Struktur ini membentang dari os internum di sebelah anterior hingga koana di posterior, yang memisahkan rongga hidung. Septum nasi merupakan struktur tulang di garis tengah, secara anatomi membagi organ menjadi dua hidung. Selanjutnya, pada dinding lateral hidung terdapat pula konka dengan rongga udara yang tak teratur diantaranya meatus superior, media dan inferior. Sementara kerangka tulang tampaknya menentukan diameter yang pasti dari rongga gubah resistensi, dan akibatnya tekanan dan volume aliran udara inspirasi dan eksprasi. Diameter yang berbeda-beda disebabkan oleh kongesti dan dekongesti mukosa, perubahan badan vaskular yang dapat mengembang pada konka dan septum atas, dan dari krusta dan deposit atau sekret mukosa. Hiatus semilunaris dari meatus media merupakan muara sinus frontalis, etmoidalis dan sinus maksilaris. Sel-sel sinus etmoidalis posterior bermuara pada resesus sfenoetmoidalis.
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modifikasi dan mampu menghasilkan mukus dan bersilia, sekret disalurkan ke dalam rongga hidung. Pada orang sehat, sinus terutama berisi udara. Sinus maksilaris rudimenter atau antrum umumnya telah ditemukan pada saat lahir. Sinus paranasalis lainnya timbul pada anak-anak dalam tulang wajah. Tulang-tulang ini bertumbuh melebihi kranium yang menyangganya. Dengan teresorpsinya bagian tengah yang keras, maka membran mukosa hidung menjadi tersedot ke dalam rongga yang baru terbentuk. 1. Fungsi Hidung a. Fungsi Respirasi Udara inspirasi masuk ke hidung menuju sistem respirasi melalui nares anterior, lalu naik ke atas setinggi konka media dan kemudian turun ke bawah arah nasofaring. Aliran udara di hidung ini berbentuk lengkungan atau arkus. Udara yang dihirup akan mengalami humidifikasi oleh palut lendir. Pada musim panas, udara hampir jenuh oleh uap air, sehingga terjadi sedikit penguapan udara inspirasi oleh palut lendir, sedangkan pada musim dingin dingin akan terjadi sebaliknya. b. Fungsi Penghidu Hidung juga bekerja sebagai indra penghidu dan pengecap dengan adanya mukosa olfaktorius pada atap rongga hidung, konka superior dan sepertiga bagian atas septum, Partikel bau dapat mencapai daerah ini dengan cara difusi dengan palut lendir atau bila menarik napas
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d. Fungsi Statik Hidung memiliki fungsi statik dan mekanik untuk meringankan beban kepala, proteksi terhadap trauma, dan perlindungan terhadap panas. e. Refleks Nasal Mukosa hidung merupakan reseptor refleks yang berhubungan dengan saluran cerna, kardiovaskuler dan pernapasan. Iritasi mukosa hidung akan menyebabkan refleks bersin dan napas berhenti. Rangsang bau tertentu akan menyebabkan sekresi kelenjar liur, lambung dan pankreas. 2. Fungsi Sinus Paranasales a. Pengatur Kondisi Suara (Air Conditioning) Sinus berfungsi sebagai ruangan tambahan untuk memanaskan dan mengatur kelembaban udara respirasi. Keberatan karena teori ini ialah karena ternyata tidak didapati pertukaran udara yang definitif antara sinus dan rongga hidung. b. Sebagai Penahan Suhu Sinus paranasal berfungsi sebagai penahan (buffer) panas, melindungi orbita dan fosa serebri dari suhu rongga hidung yang berubah- ubah. Akan tetapi kenyataanya sinus- sinus yang besar tidak terletak diantara hidung dan organ- organ yang dilindungi. c. Pembantu Keseimbangan Kepala Sinus membantu keseimbangan kepala karena mengurangi berat tulang muka. Akan tetapi bila udara dalam sinus diganti dengan
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resonansi suara dan besarnya sinus pada hewan- hewan tingkat rendah. e. Peredam Perubahan Tekanan Udara Fungsi ini berjalan bila ada perubahan tekanan yang besar dan mendadak, misalnya pada waktu bersin atau membuang ingus. f. Produksi Mukus Mukus yang dihasilkan oleh sinus paranasal memang jumlahnya kecil dibandingkan dengan mukus dari rongga hidung, namun efektif untuk membersihkan partikel yang turut masuk dengan udara inspirasi karena mukus ini keluar dari meatus medius, tempat yang paling strategis.
5.
Bagaimana interpretasi warna lendir? Bening
: Rhinitis Alergika, infeksi tahap awal
Kuning kehijauan
: Infeksi hidung : haemopilus influenza,
paranasal Kehitaman
: sering menghirup polusi
Orange / merah kecoklatan : ada perdarahan biasanya disertai bau menyengat Kebiruan
6.
: bakteri
Mengapa ditanyakan riwayat sakit gigi? Karena ada sinus maxillaris yaitu sinus yang paling dekat dengan gigi,
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-
Deviasi septum nasi: septum nasi bengkok, merupakan salah satu faktor predisposisi terjadinya sinusitis
-
Konka
hipertrofi
(+/+):
menunjukkan
adanya
edema
atau
pembesaran pada konka nasalis pasien yang simetris kanan kiri yang menunjukkan bahwa pasien tidak mengalami keluhan yang unilateral -
Sekret kuning kental: menunjukkan adanya infeksi
-
Discharge mukopurulen (+/+): menunjukkan adanya infeksi pada kedua kavum nasi bukan hanya unilateral
-
Choanae lapang: menunjukkan tidak adanya pembesaran kelenjar adenoid maupun edema pada sekitar nasopharynx
-
Tonsil T1/T1: menunjukkan tidak adanya pembesaran tonsil
-
Post nasal drip: menunjukkan tersumbatnya pengeluaran sekret pada muara kavum nasi sehingga sekret s ekret keluar lewat jalur satunya ke nasopharynx
8.
Mengapa perlu pemeriksaan radiologi dan skin dan skin prick test ? Pemeriksaan radiologi yang dapat membantu menegakkan diagnosa sinusitis frontalis adalah sebagai berikut ; 1. Posisi Caldwell Posisi ini didapt dengan meletakkan hidung dan dahi diatas meja sedemikian rupa sehingga garis orbito-meatal (yang
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meja. Bidang yang melalui kantus medial mata dan tragus membentuk sudut lebih kurang 37 derajat dengan film.proyeksi waters dengan mulut terbuka memberikan pandangan terhadap semua sinus paranasal. 3. Posisi lateral Kaset dan film diletakkan paralel terhadap bidang sagital utama tengkorak.
Ski n Pri Pr i ck Test Test , mendeteksi alergi terhadap berbagai substansi biasanya 40 jenis. Satu tetesan konsentrat antigen ke dalam kulit, kemudian jarum steril 26 G melalui tetesan tadi ditusukkan ke dalam kulit bagian superficial sehingga tidak berdarah. Variasi dari tes ini adalah dengan menggunakan applikator sekali pakai dengan delapan mata jarum yang bisa digunakan. Digunakan secara simultan dengan 6 antigen dan control positif (histmin) dan kontrol negative (glyserin). Keuntungan :
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-
Penderita dengan riwayat yang meyakinkan adanya reaksi
anafilaksis terhadap allergen. -
Penderita dengan gejala alergi terhadap makanan sampai dengan
gejala yang timbul stabil. -
Penderita dengan penyakit penyakit kulit misalnya urtikaria, SLE dan lesi
yang luas pada kulit. 9.
Bagaimana mekanisme post mekanisme post nasal drip? drip? Post nasal drip (secret pasca-nasal) terjadi ketika sekresi mucus yang berlebihan baik dari rongga hidung maupun sinus sehingga terasa akumulasi mukus di belakang tenggorokan. Sekresi mukus terasa mengalir dari hidung ke belakang tenggorokan, biasanya akan tertelan atau dibatukkan. Dapat disebabkan oleh perubahan suhu dan kelembapan, alergi, rhinitis, common cold, sinusitis, rhinosinusitis, dan upper airway cough syndrome. Pada sinusitis post-nasal drip disebabkan oleh sistem transport mukosilier, Mukus yang berasal dari sinus anterior akan dialirkan melalui depan muara tuba Eustachii dan mukus dari sinus posterior
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dapat
menyebabkan
saluran
hidung
Anda
membengkak
dan
menyempit.
Mimisan
Permukaan septum nasal Anda bisa menjadi kering, meningkatkan risiko mimisan.
Nyeri wajah
Meskipun ada perdebatan mengenai kemungkinan nyeri wajah karena penyebab hidung, septum yang sangat menyimpang yang berdampak pada dinding dalam hidung, ketika ada ad a di sisi yang sama dengan nyeri wajah, terkadang dianggap sebagai penyebab yang dimungkinkan.
Napas berisik selama tidur
Ini dapat terjadi pada bayi dan anak-anak usia dini yang menderita deviasi septum atau pembengkakan jaringan intranasal.
Kesadaran atas siklus nasal
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Bersin merupakan suatu respon semi-otonom yang terjadi karena rangsangan partikel asing yang mengiritasi mukosa hidung atau pun stimulus pada mukosa hidung. Rangsangan ini menyebabkan pelepasan
histamin
pada
mukosa
hidung
yang menyebabkan
rangsangan pada sel-sel saraf pada hidung. Sinyal rangsangan ini akan dihantarkan ke otak melalui nervus trigerminal yang kemudian akan mengaktivasi otot pharing dan laring, sehingga terjadi bersin. Pada kasus skenario, bersin pada pagi hari disebabkan ketika tidur (fase REM) pasien tidak mengalami bersin yang disebabkan atonia pada fase REM. Hal ini menyebabkan penumpukan partikel-partikel asing pada hidung, sehingga pada pagi hari partikel-partikel tersebut dikeluarkan dengan bersin. Sedangkan penyebab pasien bersin lebih dari 4 kali bisa dikarenakan ada infeksi pada mukosa hidung, sehingga terjadi
pelepasan
histamine
yang
berlebih
yang
merangsangan otak untuk mengaktivasi respon bersin. 12. Apa hubungan riwayat pilek dengan keluhan pasien?
kemudian
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RHINITIS ALERGI
Rhinitis alergi ada inflamasi pada membran mukosa hidung yang dimediasi oleh antibody IgE dan sel mast. Penyakit ini memiliki gejala bersin, kongesti, lendir jernih, dan rasa gatal pada hidung atau palatum mulut. Rhinitis alergi bisa seasonal, perennial, atau terjadi secara sporadic setelah terpapar allergen. Rhinitis alergi memiliki 2 bentuk. Rhinitis alergi musiman (Seasonal ( Seasonal allergic rhinitis) rhinitis) biasa dikaitkan dengan perubahan siklus pada lingkungan. Sedangkan, rhinitis alergi perennial terjadi tidak mengikuti perubahan musim; hal ini dapat terjadi karena pasien terekspos oleh allergen terus menerus. RHINITIS VASOMOTOR
Gangguan vasomotor hidung adalah terdapatnya gangguan fisiologik lapisan mukosa hidung yang disebabkan oleh bertambahnya aktivitas parasimpatis. Rinitis vasomotor adalah gangguan pada mukosa hidung yang ditandai dengan adanya edema yang persisten dan hipersekresi
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2. faktor fisik, seperti iritasi oleh asap rokok, udara dingin, kelembaban udara yang tinggi dan bau yang merangsang. me rangsang. 3. faktor endokrin, sepeti keadaan kehamilan, pubertas, pemakaian pil anti hamil dan hipotiroidisme. 4. faktor psikis, seperti stress, ansietas dan fatigue SINUSITIS MAXILLARIS
Sinusitis didefinisikan sebagai inflamasi mukosa sinus parasanal. Umumnya disertai atau dipicu oleh rinitis sehingga sering disebut rinosinusitis. Penyebab utamanya ialah selesma (common ( common cold ) yang
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M.Catarrhalis lebih banyak ditemukan (20%). Pada sinusitis kronik, faktor predisposisi lebih berperan, tetapi umumnya bakteri yang ada lebih condong ke arah bakteri gram negatif dan anaerob.
-
Langkah IV: Menginventarisasi permasalahan secara sistematis dan pernyataan sementara mengenai permasalahan pada langkah III Hidung meler, keluar sekret terutama saat sujud, nyeri pada pipi, riwayat bersin dengan kambuh 4x sehari, tidak ada riwayat sakit gigi
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-
2.
Menentukan hasil anamnesis dan pemeriksaan fisik
3.
Menentukan DD dari skenario
4.
Menentukan pemeriksaan penunjang
Langkah VI: Mengumpulkan informasi baru Pengumpulan informasi telah dilakukan oleh masing-masing anggota kelompok kami dengan menggunakan sumber referensi ilmiah seperti buku, jurnal, review, dan artikel ilmiah yang berkaitan dengan skenario ini.
-
Langkah VII: Melaporkan, membahas, dan menata kembali informasi baru yang diperoleh Pembahasan LO ( Learning Objective )
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kerangka tulang rawan terdiri dari beberapa pasang tulang rawan yang terletak dibagian bawah hidung, yaitu : v. sepasang kartilago nasalis lateralis superior vi. sepasang kartilago nasalis lateralis inferior yang disebut juga sebagai kartilago alar mayor vii.
beberapa pasang kartilago alar minor
viii.
tepi anterior kartilago septum.
Bagian dari kavum nasi yang letaknya sesuai dengan ala nasi, tepat dibelakang nares anterior, disebut vestibulum. Vestibulum ini dilapisi oleh kulit yang mempunyai banyak kelenjar sebasea dan rambutrambut panjang yang disebut vibrise. Tiap kavum nasi mempunyai 4
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unsinatus, hiatus semilunaris, dan infundibulum etmoid. Hiatus semilunaris merupakan suatu celah sempit melengkung dimana terdapat muara sinus frontal, sinus maksila, dan sinus etmoid anterior. d. Hidung Dalam Struktur ini membentang dari os internum di sebelah anterior hingga koana di posterior, yang memisahkan rongga hidung. Septum nasi merupakan struktur tulang di garis tengah, secara anatomi membagi organ menjadi dua hidung. Selanjutnya, pada dinding lateral hidung terdapat pula konka dengan rongga udara yang tak teratur diantaranya meatus superior, media dan inferior. Sementara kerangka tulang tampaknya menentukan diameter yang pasti dari rongga gubah
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Sinus maksilaris rudimenter atau antrum umumnya telah ditemukan pada saat lahir. Sinus paranasalis lainnya timbul pada anak-anak dalam tulang wajah. Tulang-tulang ini bertumbuh melebihi kranium yang menyangganya. Dengan teresorpsinya bagian tengah yang keras, maka membran mukosa hidung menjadi tersedot ke dalam rongga
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e. Refleks Nasal Mukosa hidung merupakan reseptor refleks yang berhubungan dengan saluran cerna, kardiovaskuler dan pernapasan. Iritasi mukosa hidung akan menyebabkan refleks bersin dan napas berhenti. Rangsang bau tertentu akan menyebabkan sekresi kelenjar liur, lambung dan
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Fungsi ini berjalan bila ada perubahan tekanan yang besar dan mendadak, misalnya pada waktu bersin atau ata u membuang ingus. l. Produksi Mukus Mukus yang dihasilkan oleh sinus paranasal memang jumlahnya kecil dibandingkan dengan mukus dari rongga hidung, namun efektif untuk
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mulut. Rhinitis alergi bisa seasonal, perennial, atau terjadi secara sporadic setelah terpapar allergen. Epidemiologi Rhinitis alergi memiliki 2 bentuk. Rhinitis alergi musiman (Seasonal ( Seasonal
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pelepasan kemokin-kemokin dan sitokin sit okin yang mengatur influx sel-sel inflamasi (eosinofil, basofil, neutrofil, sel T, dan sel B) ke dalam mukosa. Inflamasi oleh Th2 ini menyebabkan mukosa nasal lebih sensitif
terhadap
alergen
dan
iritan.
Mediator-mediator
yang
dilepaskan oleh sel mast dan basofil dapat secara langsung
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