GANGGUAN KESEIMBANGAN PERIFER
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Transcript of GANGGUAN KESEIMBANGAN PERIFER
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GANGGUAN KESEIMBANGAN PERIFER
Dr. JACKY MUNILSON, Sp. THT-KLBagian THT-KL RS Dr. M. Djamil
Padang
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Fisiologi KeseimbanganSISTEM: Visual Somatosensori
Vestibuler (Proprioseptif)
OrganReseptor : Retina Sendi + otot
Labirin
Keseimbangan
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KELUHAN PASIEN
1. VERTIGO : YA ? BUKAN?
2. JENIS VERTIGOLETAK LESI
3. PENYEBAB
4. TERAPI
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Pastikan Vertigo atau Bukan Vertigo
KELUHAN PASIEN(Pusing, Pening, Melayang, Berat, Kosong, Goyang)
VERTIGO BUKAN VERTIGO- Nyeri Kepala- Presyncope/ Syncope- Gangguan
Keseimbangan- Paresis
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VERTIGO
Suatu ilusi dimana seseorang merasa tubuhnya bergerak terhadap
lingkungannya, atau lingkungan bergerak terhadap dirinya
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Jenis Vertigo / Letak Vertigo
VERTIGO
JENIS : Vestibuler Non Vestibuler
LETAK LESI : Sistem Sistem Sistem Vestibuler Visual
Somatosensory
(Proprioseptif)
Sentral Perifer- Batang Otak - Labirin - Otak - N. Vestibularis
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Perbedaan Vertigo Vestibuler dan Non Vestibuler
Vertigo Vestibuler Vertigo Non Vestibuler
Sifat Berputar Goyang, melayang
Waktu Episodik Konstan
Faktor Pencetus Gerakan kepalaPerubahan posisi
Stress
Gejala Mual, muntah, tuli, tinitus, osilposia
Pucat, kesemutan, syncope, palpitasi
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Perbedaan Vertigo Vestibuler Perifer dan Sentral
PERIFERVertigo beratAda kelelahan (decay)Pengaruh gerakan
kepala +Arah obyek
horizontal/rotatoarBuka mata lebih ringanGejala otonom ++Tanda fokal SSP -
SENTRALVertigo ringanTidak ada decayTidak ada pengaruh
gerakan kepala Arah obyek vertikalGejala otonom +/-Tidak ada gangguan
pendengaran Tanda fokal SSP +
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Penyebab Vertigo Vestibuler
Perifer : Benign Paroxymal Positional Vertigo (BPPV)- Meniere’s – Neuritis – Oklusi A. Labirin – Labirinitis – Ototoksik – Auto Imun – Tumor N.VIII – Microvascular Compression – Perylymph Fistel.
Sentral : CVD – Tumor – Epilepsy – Demielinisasi - Degenerasi – Wernicke
Encepalophaty
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Penyebab Vertigo Non Vestibuler
Polineuropati – Mielopati – Artrosis Servikalis – Trauma Leher – Presinkop – Hipotensi Ortostatik – Hiperventilasi – Tension Headache – Hipoglikemi – Penyakit Sistemik
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Vestibuler Perifer
Terletak di telinga dalam
Terdiri dari labirin tulang dan labirin membran (berbentuk kanalis semi
sirkularis)
Sel reseptor bersilia
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Kanalis Semisirkularis
(KSS)
Terdiri dari:
Horizontal (lateral) Anterior Posterio
r
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BENIGN PAROXYSMAL POSITIONAL VERTIGO(BPPV)
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ETIOLOGI BBPV1. Degeneratif yang idiopatik dewasa muda
dan usia lanjut2. Trauma kepala3. Labirinitis virus4. Neuritis vestibuler5. Pasca stapedectomi6. Fistula perilimfa7. Meniere diseases
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PATOGENESISAda 2 teori :1. Teori kupulolitiasis
Debris-debris degeneratif atau fragmen otokonia dari utrikulus yang terlepas dan melekat pada permukaan kupula KSSP yang menghadap utrikulus
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2. Teori kanalitiasisoleh Epley pada tahun 1980, dasarnya adalah adanya partikel padat ( debris ) yang mengapung dan bergerak dalam KSSP. Ketika kepala tegak, partikel dalam KSS berada pada posisi sesuai gaya gravitasi. Ketika kepala dimiringkan, partikel tersebut bergerak berputar 90 derajat sepanjang arkus KSSP, setelah terjadi perlambatan , partikel akan berada pada bagian paling bawah sesuai dengan gaya gravitasi. Hal ini menyebabkan endolimfe mengalir menjauhi ampulla dan menyebabkan kupula mengalami deflesi dan menimbulkan nistagmus. Pembalikan arah posisi menyebabkan pembalikan deflesi kupula dan rasa pusing serta nistagmus keposisi yang berlawanan.
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KANALOLITIASIS DAN KUPULOLITIASIS
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Diagnosis1.Anamnesis 2. Vestibuler nystagmus3. Dix-Hallpike and Sidelying manuver untuk
KSS posterior dan anterior 4. Roll manuver untuk KSS lateral
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Vestibuler nystagmus
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in-torsionex-torsion
nose
left right
up
down
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Kaca-mata Frenzel
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DIX-HALLPIKE MANUVER
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Dix Hallpike
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SIDELYING MANUVER
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ROLL MANUVER
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TATALAKSANA1 Canalith Repositioning Treatment (CRT) dan
Liberatory maneuver KSS posterior and anterior
2.Rolling (Barbecue) maneuver KSS horizontal
3. Brandt-Daroff exercises gejala sisa
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Canalith Repositioning Treatment
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LIBERATORY MANUVER
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Latihan Brandt-Daroff
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TERIMA KASIH