Pengaruh tonsilektomi terhadap ukuran dan ekspresi IL-6 tonsil lingualis pada pasien OSA

Abstract

Background: Obstructive sleep apnea (OSA) is a sleep breathing disorder caused by upper airway  obstruction. It occurs on 51% adult and could cause systemic side effects. Hypertrophy of the palatine  and lingual tonsils cause upper airway obstruction and increasing cytokine IL-6 production. Obstruction and inflammation products have an important role in causing OSA. Inflammation of the palatine tonsil causes lingual tonsil to be inflamed. Purpose: To find out the impact of tonsillectomy on size and IL-6 expression of lingual tonsil. Method:The quasiexperimental open label pre and post test design was done on August 2010 – October 2011. There were 20 adult subjects with snoring, palatine and lingual tonsil hypertrophy. All subjects filled the Epworth Sleepiness Scale (ESS) questionnaire, underwent ENT examination and biopsy using fiber optic rhinolaryngoscope. Immunohistochemistry examination for IL-6  were performed on all biopsy specimens. Results: There is highly significant improvement on lingual  tonsil size score from 3 to 1 after tonsillectomy. IL-6 expression was significantly decreased from 12 to 2 after tonsillectomy. ESS score was also significantly decreased from 16 to 5. The reducing size of lingual tonsil correlates with decreasing of IL-6 expressions. Conclusion:Tonsillectomy on OSA patients reduced the IL-6 expression of the lingual tonsil and that cause the reducing of its size. Decreasing of obstruction and inflammation could lead to the decrease of the ESS score.
Keywords: OSA, tonsillectomy, Epworth Sleepiness Scale, lingual tonsil size, IL-6 expression  

Abstrak :
Latar belakang: Henti napas obstruktif saat tidur (OSA) merupakan gangguan napas saat tidur yang terjadi karena obstruksi saluran napas atas. Keluhan ini terjadi pada 51% orang dewasa dan menimbulkan efek samping sistemik berat. Pembesaran ukuran tonsil palatina dan tonsil lingualis akan menyebabkan obstruksi saluran napas atas dan mengakibatkan peningkatan produksi IL-6, sehingga akan menyebabkan OSA. Inflamasi yang terjadi pada tonsil palatina membuat tonsil lingualis mengalami inflamasi. Tujuan: Untuk melihat pengaruh tonsilektomi terhadap ukuran dan ekspresi IL-6 tonsil lingulis. Metode: Penelitian quasiexperimental open label pre and post test design di Poliklinik IK. THT-KL RSHS Bandung sejak Agustus 2010 – Oktober 2011. Subjek 20 orang dewasa dengan keluhan mendengkur, pembesaran tonsil palatina dan tonsil lingualis. Seluruh subjek mengisi kuesioner skala kekantukan Epworth (Epworth Sleepiness Scale/ESS), biopsi tonsil lingualis dengan rinolaringoskopi serat optik lentur dan imunohistokimia IL-6 jaringan biopsi. Hasil: Didapatkan perbaikan yang sangat bermakna skor ukuran tonsil lingualis sebelum tonsilektomi (3) dibandingkan setelah tonsilektomi (1). Nilai ekspresi IL-6 menurun sangat bermakna dari 12 menjadi 2. Skor ESS menurun secara bermakna dari 16 menjadi 5. Pengecilan ukuran tonsil lingualis berhubungan dengan penurunan ekspresi IL-6. Kesimpulan: Tonsilektomi pada pasien OSA dapat menurunkan ekspresi IL-6 pada tonsil lingualis, sehingga ukuran tonsil lingualis mengecil. Hilangnya obstruksi dan inflamasi mengakibatkan skor ESS menurun.
Kata kunci: henti napas obstruktif saat tidur, tonsilektomi, Epworth Sleepiness Scale, ukuran tonsil lingualis, ekspresi IL-6