Pengaruh N–asetilsistein terhadap transpor mukosilia tuba Eustachius penderita otitis media supuratif kronis tanpa kolesteatoma

Abstract

Latar belakang: Otitis Media Supuratif Kronik (OMSK) adalah radang telinga tengah dengan perforasi membran timpani dan keluarnya sekret lebih dari 2 bulan. Pengobatan OMSK saat ini masih belum memuaskan. Peneliti mengharapkan dengan kelebihan dari N–asetilsistein (NAC) dapat memperbaiki transpor mukosilia tuba Eustachius. Tujuan: Penelitian ini bertujuan membandingkan waktu transpor dan penurunan waktu transpor mukosilia tuba Eustachius penderita OMSK tanpa kolesteatoma sebelum dan setelah diberikan pengobatan, baik pada kelompok pemberian NAC maupun pada kelompok kontrol. Metode: Uji klinis pada 24 subjek penelitian dengan desain penelitian non randomized double blind pre post test control group dengan pendekatan cohort. Hasil: Waktu transpor mukosilia yang dinilai dengan siprofloksasin pada kelompok pemberian NAC sebelum pengobatan sebesar 683,00 detik dan setelah pengobatan sebesar 279,83 detik dengan rerata selisih sebesar 403,17 detik, sedangkan pada kelompok kontrol sebelum pengobatan 538,33 detik dan sesudah pengobatan 225,00 detik dengan rerata selisih sebesar 313,33 detik. Pada penilaian dengan Methylene blue (MB) pada kelompok pemberian NAC sebelum pengobatan sebesar 118,50 detik dan setelah pengobatan sebesar 244,25 detik dengan rerata selisih sebesar 125,75 detik, pada kelompok kontrol sebelum pengobatan 100,67 detik dan sesudah pengobatan 38,33 detik dengan rerata selisih sebesar 62,33 detik. Kesimpulan: Tidak didapatkan perbedaan yang bermakna pada waktu transpor dan penurunan waktu transpor mukosilia tuba Eustachius penderita OMSK tanpa kolesteatoma sebelum dan setelah diberikan pengobatan NAC baik pada kelompok pemberian NAC maupun kelompok kontrol. Kata kunci: OMSK tanpa kolesteatoma, transpor mukosilia, N-asetilsisteinABSTRACT Background: Chronic Suppurative Otitis Media (CSOM) is a chronic inflammation of the middle ear with tympanic membrane perforation and discharges, for more than 2 months. Treatment of CSOM is still unsatisfactory. We hoped that N–acetylsistein (NAC) could improve the mucociliary transport of Eustachian tube. Purpose: To compare mucociliary transport time and the decrease of Eustachian tube mucociliary transport time in patients after and before treatment between NAC treated group and control group. Method: This was a randomized double blind pre and post test control group clinical trial with cohort approach involving 24 subjects. Result: Mucociliary transport time subjectively in NAC-treated group before and after NAC therapy were 683,00 seconds and 279,83 seconds respectively, with mean difference -403,17 seconds. Mucociliary transport time in control group before and after therapy were 538,33 seconds and 225,00 seconds respectively, with mean difference -313,33 seconds. Mucociliary transport time objectively in NAC-treated group before and after NAC therapy were 118,50 seconds and 244,25 seconds respectively, with mean difference -125,75 seconds. Mucociliary transport time in control group before and after therapy were 100,67 seconds and 38,33 seconds respectively, with mean difference -62,33 seconds. Conclusion: There was no significant difference of mucociliary transport time and the decrease of mucociliary transport time of Eustachian tube in CSOM without cholesteatoma before and after NAC treatment in both of group Keywords: CSOM without cholesteatoma, mucociliary transport, N-acetylcysteine

Erdosteine for mucociliary transport in benign chronic suppurative otitis media

“…Otorrhoea is the most common complaint in this study because the inflammatory process will affect the middle ear mucociliary transport system where goblet cells increase so that mucus production will also increase. Chao et al in Sari et al reported that the anterior two thirds of the Eustachian tube had the most active mucociliary transport activity (17). Based on the length of suffering CSOM, it was found that CSOM 1-5 years were 8 patients (50%) and >5 years were 8 patients (50%).…”

“…This is in line with this study, it was found that patients with active phase safe type CSOM who had the most ear complaints were otorrhoea as many as 9 people (56.3%) and hearing loss as many as 5 people (31.3%) followed by complaints of tinnitus as many as 1 person (6.3%) and ear pain as much as 1 person (6.3%).While suffering from CSOM, an inflammatory process occurs that releases various inflammatory mediators. This process due to the proinflammatory cytokines TNF-, IL1-ß, and IL-8 play an important role in mucus production by middle ear goblet cells, then caused mucociliary dysfunction in the middle ear, mucus build up and ultimately decrease mucociliary transport in the tube Eustachius (17).…”

The Effectiveness of High-dose N-acetylcysteine in Severe COVID-19 Patients

“…In this study, we focused on N-acetylcysteine (NAC) because most COVID-19 patients had severe pneumonia with excess mucus in the respiratory tract (Ochs et al, 2012;Sari et al, 2015;Yuliana, 2020). The usual dose of NAC in pneumonia is (3x200 mg) po, used as a mucolytic agent.…”

“…It is also supported by evidence-based medicine research journals, which in practice at the hospital is used N-Acetylcysteine at a dose of 5 grams per day intravenously given in 500 ml PZ infusion over 6-8 hours. In addition, in the COVID-19 Hospital Clinical Practice Guidebook, Dr. Soetomo Surabaya, high dose of N-Acetylcysteine (NAC) 5 grams per day given in 500 ml NaCl 0.9% or Dextrose 5% intravenous drip 4 hours (Damayanti & Ryusuke, 2017;Sari et al, 2015Sari et al, , 2017. SARS-CoV-2 infection is associated with an imbalance of oxidants and antioxidants, resulting in inflammation and tissue damage (Damayanti and Ryusuke, 2017).…”

“…Research from Sari et al (Sari et al, 2015) related the effectiveness of high doses of N-Acetylcysteine in severe COVID-19 patients with oxygen saturation less than 94% or an average respiratory rate higher than 24 breaths per minute. Patients were randomly assigned to NAC 21 g for 20 hours, or 5% dextrose to the placebo group.…”