Hubungan Antara Gambaran Timpanometri dengan Letak dan Stadium Tumor pada Penderita Karsinoma Nasofaring di Departemen THT-KL RSUP H. Adam Malik Medan

Abstract

Background: Close correlation between nasopharyngeal carcinoma and disturbance of ear function has been known for long. The disturbance in ear function usually is a symptom of the site of a tumour (fossa Rosenmuller) that is close to tuba Eustachius end. Disturbance in tuba Eustachius would cause disturbance of middle ear function. Tympanometry examination is sensitive to evaluate the integrity of membrane tympany and the function of the middle ear. The purpose of this research is to know the correlation between tympanometry result with the site and stadium of tumour in nasopharyngeal carcinoma patients. Study Design and Methods: Research was done in cross sectional study in Ear Nose and Throath-Head and Neck Surgery Department Medical Faculty University of North Sumatera / H. Adam Malik General Hospital Medan, with consecutive sampling method, start from October 2008. The nasopharyngeal carcinoma patients was examined for a routine ENT examination, tympanometry, nasopharyngoscopy, biopsy of tumour in nasopharyng and nasopharyng CT-Scan, then tympanogram result, the site and stadium of tumour in nasopharyngeal carcinoma patients was evaluated. Data was analyzed using Spearman correlation test with p < 0,05. Results: Twenty one (21) of 55 sampel was found to have abnormal unilateral tympanogram (type B / C), that is nasopharyngeal carcinoma patients with the site of tumour in fossa Rossenmuller that extend to the roof / posterior wall of nasopharyng and covers the end of tuba Eustachius, 16 patients with abnormal bilateral tympanogram (29,1%), that is nasopharyngeal carcinoma patients with the site of tumour in all part of nasopharyng. Spearman correlation test, (r) = 0,401, p = 0,002 (p < 0,05). Abnormal unilateral tympanogram result (type B / C) was most found in stadium IV patients, 15 sample (27,3%). Whereas abnormal bilateral tympanogram (type B / C) was most found in stadium III patients, 17 sample (30,9%). Spearman correlation test, (r) = 0,078, p = 0,570 (p > 0,05). Conclusions: There is a correlation between tympanometry result with the site of tumour in nasopharyngeal carcinoma patients. There is not a correlation between tympanometry result with the stadium of tumour in nasopharyngeal carcinoma patients.

Latar Belakang: Hubungan yang erat antara karsinoma nasofaring dan gangguan pada telinga telah lama diketahui. Gangguan pada telinga biasanya merupakan gejala yang timbul karena letak tumor nasofaring (fossa Rosenmuller) dekat dengan muara tuba Eustachius. Gangguan pada tuba Eustachius akan menyebabkan terganggunya fungsi telinga tengah. Pemeriksaan timpanometri sensitif dalam menilai integritas membran timpani dan fungsi telinga tengah. Penelitian ini dilakukan untuk mengetahui hubungan gambaran timpanometri dengan letak dan stadium tumor pada penderita KNF. Metode Penelitian: Penelitian dilakukan dengan studi potong lintang (cross sectional study) di Departemen THT-KL FK-USU / RSUP H. Adam Malik Medan, secara consecutive sampling mulai Oktober 2008. Terhadap penderita KNF dilakukan pemeriksaan rutin THT, timpanometri, nasofaringoskopi, biopsi tumor di nasofaring dan CT-Scan nasofaring, kemudian dilakukan penilaian terhadap gambaran timpanogram, letak dan stadium tumor pada penderita KNF. Data dianalisa dengan uji korelasi Spearman dengan batas kebermaknaan p < 0,05. Hasil Penelitian: Dari 55 sampel didapatkan 21 sampel (38,2%) dengan timpanogram abnormal (tipe B / C) unilateral pada pada penderita KNF dengan letak tumor di fossa Rosenmuller yang meluas ke atap / dinding posterior nasofaring dan menutupi muara tuba Eustachius, sebanyak 16 sampel (29,1%) dengan timpanogram abnormal (tipe B / C) bilateral pada pada penderita KNF dengan letak tumor di seluruh rongga nasofaring. Uji korelasi Spearman (r) = 0,401, p = 0,002 (p < 0,05). Gambaran timpanogram abnormal (tipe B / C) unilateral yang terbanyak dijumpai pada stadium IV, yaitu pada 15 sampel (27,3%), sedangkan timpanogram abnormal (tipe B / C) bilateral yang terbanyak dijumpai pada stadium III, yaitu 17 sampel (30,9%). Uji korelasi Spearman (r) = 0,078, p = 0,570 (p > 0,05). Kesimpulan: Terdapat hubungan bermakna antara gambaran timpanometri dengan letak tumor pada penderita KNF. Tidak terdapat hubungan bermakna antara gambaran timpanometri dengan stadium tumor pada penderita KNF.