Gambaran Otitis Media Supuratif Kronis (OMSK) Dengan Kolesteatoma pada Pemeriksaan Foto Polos Mastoid Proyeksi Schüller dan Mayer yang Dibandingkan Dengan Temuan Saat Operasi Di RSUP. H. Adam Malik Medan

Abstract

Introduction: In most cases of CSOM with cholesteatoma, Schüller’s and Mayer’s views should be sufficient as they make it possible to evaluate the cholesteatoma and mastoid pneumatization which determines the surgical approach. In fact, there are many health care facilities on concession that are supported only by conventional radiography. Purpose: To identify the descriptions of CSOM with cholesteatoma on Schüller’s and Mayer’s views that compared with surgical findings at H. Adam Malik General Hospital Medan. Method: This cross sectional study used 40 cases. After ENT examinations, the patients were examined by Schüller’s and Mayer’s views. The results of mastoid views were compared with surgical findings as gold standard. Result: In detecting cholesteatoma, Schuller's view had an accuracy of 70,00%, sensitivity of 71,88%, specificity of 62,50%, positive predictive value of 88,46%, negative predictive value of 35,71%, positive likelihood ratio of 1,92, negative likelihood ratio of 0,45, pre-test probability of 80,00%, and post-test probability of 88,48%. Projection Mayer had an accuracy of 67,50%, sensitivity of 68,75%, specificity of 62,50%, positive predictive value of 88,00%, negative predictive value of 33,33%, positive likelihood ratio of 1,84, negative likelihood ratio of 0,50, pre-test probability of 80,00%, and post-test probability of 88,04%. In assessing the sclerotic of mastoid pneumatization, Schuller’s and Mayer’s views had the same accuracy of 92,50%, sensitivity of 97,22%, specificity of 50,00%, positive predictive value of 94,59%, negative predictive value of 66,67%, positive likelihood ratio of 1,94, negative likelihood ratio of 0,06, pre-test probability of 90,00%, and post-test probability of 94,58%. Conclusion: Schüller’s view is better than Mayer’s in assessing cholesteatoma, but both had similar diagnostic values to identify mastoid pneumatization.

Pendahuluan: Pada kebanyakan kasus OMSK dengan kolesteatoma, proyeksi Schüller dan Mayer seharusnya cukup karena memungkinkan penilaian terhadap kolesteatoma dan pneumatisasi mastoid yang membantu pendekatan operasi. Pada kenyataannya, masih banyak sarana pelayanan kesehatan di daerah-daerah yang hanya didukung oleh alat-alat radiologi konvensional. Tujuan: Mengetahui gambaran OMSK dengan kolesteatoma pada pemeriksaan foto polos mastoid proyeksi Schüller dan Mayer yang dibandingkan dengan temuan saat operasi di RSUP. H. Adam Malik Medan. Metode: Penelitian ini menggunakan pendekatan cross sectional study dengan total sampel 40 orang. Setelah pemeriksaan rutin, penderita diperiksa foto polos mastoid proyeksi Schüller dan Mayer. Hasil pemeriksaan foto polos mastoid diuji dengan temuan saat operasi sebagai baku emas. Hasil Penelitian: Dalam mendeteksi kolesteatoma, proyeksi Schüller memiliki akurasi 70,00%, sensitivitas 71,88%, spesifisitas 62,50%, nilai prediksi positif 88,46%, nilai prediksi negatif 35,71%, rasio kemungkinan positif 1,92, rasio kemungkinan negatif 0,45, pre-test probability 80,00%, dan post-test probability 88,48%. Proyeksi Mayer memiliki akurasi 67,50%, sensitivitas 68,75%, spesifisitas 62,50%, nilai prediksi positif 88,00%, nilai prediksi negatif 33,33%, rasio kemungkinan positif 1,84, rasio kemungkinan negatif 0,50, pre-test probability 80,00%, dan post-test probability 88,04%. Dalam menilai pneumatisasi mastoid yang sklerotik, proyeksi Schüller dan Mayer sama-sama memiliki akurasi 92,50%, sensitivitas 97,22%, spesifisitas 50,00%, nilai prediksi positif 94,59%, nilai prediksi negatif 66,67%, rasio kemungkinan positif 1,94, rasio kemungkinan negatif 0,06, pre-test probability 90,00%, dan post-test probability 94,58%. Kesimpulan: Proyeksi Schüller lebih baik dibandingkan Mayer dalam mendeteksi kolesteatoma, namun sama-sama memiliki nilai diagnostik yang tinggi dalam menilai pneumatisasi mastoid.