Efektivitas Pelargonium sidoides terhadap penurunan gejala rinosinusitis kronik alergi tanpa polip disertai gangguan tidur

Abstract

Latar Belakang: Rinosinusitis kronik tanpa polip adalah inflamasi mukosa hidung dan sinus
paranasal lebih dari 12 minggu. Etiologinya multifaktorial, terbanyak alergi. Gejala utamanya kongesti hidung, hidung berair, nyeri wajah, gangguan penciuman, dan menyebabkan gangguan tidur. Gangguan tidur disebabkan kongesti hidung dan peningkatan mediator inflamasi IL-1, IL-6, dan TNF-α. Tujuan: Membuktikan efektivitas terapi adjuvan rinosinusitis kronik alergi tanpa polip disertai gangguan tidur menggunakan ekstrak Pelargonium sidoides. Perbaikan gejala dan tanda klinis, serta penurunan kadar IL-1, IL-6, dan TNF- α sekret hidung sebagai indikator. Metode: Quasi-experimental open labelled
pre and posttest design pada 20 sampel, dibagi menjadi dua kelompok. Kelompok pertama diterapi larutan cuci hidung NaCl isotonis, semprot hidung kortikosteroid dan ekstrak Pelargonium sidoides. Kelompok kedua (kontrol) tidak diberikan ekstrak Pelargonium sidoides. Gejala klinis dinilai dengan Total Nasal Score Symptoms (TNSS), Visual Analog Scale (VAS), dan nasoendoskopi. Kualitas hidup dengan Rhinoconjuntivitis Quality of Life Questionnaires (RQLQ), dan Sinonasal Outcame Test-20 (SNOT-20). Hasil: Penurunan skor Total Nasal Score Symptoms (TNSS) (p=0,001), Visual Analog Scale (VAS) hidung tersumbat (p=0.018), VAS hidung berair (p=0,02), VAS nyeri wajah (p=0,008),
skor nasoendoskopi (p=0,03), dan Rhinoconjuntivitis Quality of Life Questionnaires (RQLQ) activity (p=0,003), sleep (p=0,001), non-nose/eye symptoms (p=0,005), dan emotional (p=0,01) pada kelompok perlakuan berbeda bermakna dibandingkan kelompok kontrol berdasarkan uji Mann-Whitney. Tidak ada perbedaan bermakna pada skor SNOT-20 (p=0,096), penurunan kadar IL-1 (p=0,529), IL-6 (p=0,529), dan TNF-α (p=0,971). Kesimpulan: ekstrak Pelargonium sidoides secara klinis efektif sebagai terapi
adjuvan rinosinusitis kronik alergi tanpa polip disertai gangguan tidur, namun tidak didukung penurunan kadar IL-1, IL-6, dan TNF-α sekret hidung. 

Kata kunci: gangguan tidur, IL-1, IL-6, TNF-α, Pelargonium sidoides, rinosinusitis kronik alergi tanpa polip.

ABSTRACT
Background: Chronic rhinosinusitis without nasal polyps is inflammation of the nasal and
paranasal sinus mucosa that lasts more than 12 weeks. It has multifactorial etiologies, and allergy is the most common. Its main symptoms are nasal congestion, runny nose, facial pain, smell disturbance, and can cause sleep disturbances. Sleep disturbances caused by nasal congestion and increased of inflammatory mediators IL-1, IL-6, and TNF-α. Purpose: To prove effectiveness of Pelargonium sidoides extract as adjuvant therapy in allergic chronic rhinosinusitis without nasal polyps accompanied by sleep disturbances. The indicators are improvement of clinical signs and symptom, and decreased level of IL-1, IL-6, and TNF-α nasal secretions. Methods: Quasi-experimental design with 20 samples, divided
into two groups. First group treated with isotonic nasal saline solution, corticosteroid nasal spray, and extract of Pelargonium sidoides. Second group (control) were not given extract of Pelargonium sidoides. Clinical symptoms were measured with TNSS, VAS, and nasoendoscopy. Qualityof Life measured by RQLQ and SNOT-20. Results: TNSS (p= 0.001), nasoendoscopy score, VAS nasal congestion (p=0,018), rinorrhea (p=0,02) facial pain (0,008), and improving RQLQ activity (p= 0.003), sleep (p=0.001), non-nose/eye symptoms (p=0,005), and emotional (p=0,01) in the treated group significanly difference compare to the control group based on Mann-Whitney tes. No significant difference in SNOT-20 score , and decreased levels of IL-1, IL-6, and TNF-α. Conclusion: Pelargonium sidoides extract can be used as adjuvant therapy of chronic allergic rhinosinusitis without nasal polyps with sleep disturbance, but not supported by decrease of IL-1, IL-6, and TNF-α.nasal secretion.

Keywords: IL-1, IL-6, TNF-α, Pelargonium sidoides, allergic chronic rhinosinusitis without nasal polyps, sleep disturbance.