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PEMBIMBING : DR. NOVIATI SRI RACHA, SP. THT-KL

CASE BESAR

Adi Wibowo (2013-061-068)

Sanchia Theresa (2013-061-146)

wi!"a A!#a$a %er!i"asa (2013-061-1&0)

%e'ani!eraan %ini$ #* %eseha!an T+T-%,

ni.ersi!as %a!oi$ A!#a /a"a /a$ar!a

RS San!o An!oni*s on!iana$

eriode 26 $!ober 201& 21 o.e#ber 201&

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BAB E5A/A %ASS

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ETTAS

• a#a Tn7 R

• sia 2& !ah*n

• S!a!*s erni$ahan Be*# eni$ah

• endidi$an SA• e$er9aan %ar"awan

• A:a#a sa#

• Aa#a! *s*n 7 a"a#

%eca#a!an :aban:on!iana$

• Tan::a as*$ 02 o.e#ber 201&

• Tan::a e#eri$saan 03 o.e#ber 201&

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ANAMNESIS

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AAESS

Keluhan Utaa :

Keluhan Ta!ahan :

Tel"n#a $anan t"%a$ en%en#a& se9a$ ; 1hari SRS

Tel"n#a $anan !e&%en#un# se9a$ ; 1 hari

SRS

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RWA5AT E5A%T SE%ARA<

• ± 1 hari SMRS pasien merasa telinga kanannya berdengung.

Keluhan dirasakan pasien secara tiba-tiba saat bangun tidur pada

 pagi hari. Selain itu, pasien juga mengeluhkan telinga kanannya

tidak dapat mendengar seperti perasaan tertutup pada telinganya

yang muncul bersamaan dengan keluhan berdengung pada

telinganya.

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RWA5AT E5A%T SE%ARA<

• Keluhan tambahan seperti rasa ngambang juga dirasakan oleh

 pasien. Pasien menyangkal adanya mual, muntah, dan nyeri kepala.

• Kejadian ini merupakan kejadian yang pertama kali dialami oleh

 pasien.

• Saat ini pasien bekerja di bagian teknisi salah satu perusahaan

kelapa sait di Kalimantan !arat. Setiap hari pasien terpapar oleh

suara bising dan tidak pernah menggunakan alat pelindung diri saat

 bekerja.

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RWA5AT E5A%T %E,AR<A

• Riayat keluhan yang sama dengan pasien di keluarga "-#

• Riayat hipertensi di keluarga "-#

• Riayat penyakit jantung di keluarga "-#

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RWA5AT %EBASAA

• Riayat merokok sejak $ tahun yang lalu. Pasien merokok sebanyak

1 bungkus%hari.

• Riayat konsumsi alkohol disangkal.

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PEMERIKSAAN 'ISIK 

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EER%SAA =S% 03 >EBER 201&

• Keadaan &mum ' (ampak sakit sedang

• Kesadaran ' )ompos mentis "*)S 1$#

• (anda-(anda +ital '

• (ekanan arah ' 11% mm/g

•  0adi ' 2 3%menit "(KP#

• 4aju 0a5as ' 1 3%menit

• Suhu ' 67.8)

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EER%SAA =S% 

• Kepala ' de5ormitas -, jejas%luka -

• Mata ' Konjungti9a anemis -%-, sklera ikterik -%-, pupil

isokor 6mm%6mm, re5leks cahaya langsung :%:,

re5leks cahaya tak langsung :%:, edema periorbital -%-,

sekret darah -%-

• Mulut ' Mukosa oral basah, darah -

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EER%SAA =S% 

• (hora3

  Paru

• ;nspeksi ' *erakan na5as simetris "statis < dinamis#

• Palpasi ' *erakan na5as teraba simetris, 5remitus taktil :%:

• Perkusi ' Sonor :%: di seluruh lapang paru

• =uskultasi' Suara na5as 9esikuler :%:, rhonki -%-, wheezing  -%-

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EER%SAA =S% 

  >antung

• ;nspeksi ' ;ktus kordis tidak terlihat

• Palpasi ' ;ktus kordis teraba pada ;)S + lineamidkla9ikula sinistra

• Perkusi ' Kardiomegali ? 

• =uskultasi ' !> 1 dan @ reguler, gallop -, murmur -

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EER%SAA =S% 

• =bdomen '

• ;nspeksi ' (ampak cembung, striae "-#, scar  "-#,

 pelebaran 9ena "-#

• Palpasi ' Supel, nyeri tekan "-#, hepar dan lien tak teraba,

undulasi "-#

• Perkusi ' (impani, shifting dullness "-#

• =uskultasi' !ising usus ":#, $3%menit

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EER%SAA =S% 

• Akstremitas '

• =kral hangat

• )R( B @ detik

• Adema -%-%-%-

• Motorik $%$%$%$, sensorik :%:%:%:

• Re5leks 5isiologis :%:%:%:, re5leks patologis "-#

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EER%SAA T+T

AD Pee&"$(aan ASor#a Ben!*$ or#a

(-) ,aserasi (-)

(-) +e#a!o#a (-)

(-) Ede#a (-)

(-) assa (-)

(-) %is!a (-)

(-) "eri !ari$ a*ri$*a (-)

(-) ,ain-ain (-)

Tel"n#a Ba#"an Lua&•A*ri$*a

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AD Pee&"$(aan AS

(-) "eri !e$an !ra:*s (-)

(-) +i'ere#is (-)(-) Ede#a (-)

(-) =is!*a (-)

(-) Abses (-)

(-) ,ain-ain (-)

• re-a*ri$*a

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AD Pee&"$(aan AS

(-) "eri !e$an #as!oid (-)

(-) +i'ere#is (-)

(-) Ede#a (-)

(-) =is!*a (-)

(-) ,ain-ain (-)

• Re!ro-a*ri$*a

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Tel"n#a Ba#"an Dala•,ian: Tein:a

AD Pee&"$(aan AS

,a'an: ,a'an:?se#'i! ,a'an:

(-) +i'ere#is (-)

(-) ,aserasi (-)

(-) assa (-)

(-) Benda asin: (-)

(-) ,ain-ain (-)

(-) Se&uen /*#ah

%onsis!ensi

(-)

(-) Se$&et /*#ah

Si@a!Ba*

,endir?darah

(-)

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• e#bran Ti#'ani

AD Pee&"$(aan AS

() Ree$ caha"a ()

*!ih *!iara Warna *!ih *!iara

!*h %e*!*han !*h(-) er@orasi (-)

(-) ,ain-ain (-)

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AD Te( Penala AS

e:a!i@ Rinne osi!i@  

 Tida$ ada a!eraisasi Weber ,a!eraisasi $e !ein:a

$irie#ende$ Schwabach Sa#a den:an

'e#eri$sa

Pee&"$(aan 'un#(" Pen%en#a&an

%esan T*i sensorione*ra

P "$ U % Rh" $ "

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Na&e( De)t&a Pee&"$(aan Na&e( S"n"(t&a

H"%un# lua&Ben!*$ nor#a !ida$

ada de@or#i!as

(-)(-)(-)(-)(-)(-)(-)

Ve(t"!uluSe$re!Ede#a

+i'ere#i,aserasi%r*s!a

=*r*n$e,ain-ain

(-)(-)(-)(-)(-)(-)(-)

,a'an:erah *da(-)(-)(-)(-)(-)(-)

Ca*u na("

,a'an:?se#'i!*$osaSe$re!Ede#a

+i'ere#i%r*s!aarahoi'

,a'an:erah #*da(-)(-)(-)(-)(-)(-)

Pee&"$(aan Uu %an Rh"n+($+"Ante&"+&

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Na&e( De)t&a Pee&"$(aan Na&e( S"n"(t&a

Setu na("or#a !ida$ ada

de.iasi

or#a Da(a& h"%un# or#a

E*!roerah #*da

(-)

(-)

K+n$a "ne&"+&A!ro?e*!ro?hi'er!ro

,i.id?'*ca!?hi'ere#i

%on:es!i,ain-ain

E*!roerah *da

(-)

(-)

Pee&"$(aan Uu %an Rh"n+($+"Ante&"+&

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Na&e( De)t&a Pee&"$(aan Na&e( S"n"(t&a

 Tida$ dia$*$an +e#b*san Tida$ dia$*$an

Te( Al"&an U%a&a H"%un#

Pee&"$(aan S"nu(

De)t&a Pee&"$(aan S"n"(t&a

 Tida$ dia$*$an Sin*s #aDiaris Tida$ dia$*$an

 Tida$ dia$*$an Sin*s @ron!ais Tida$ dia$*$an

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Pee&"$(aan

Ar$*s @arin: Si#e!ris #assa (-)

iar an!erior Si#e!ris

.*a $*ran dan ben!*$ nor#a e!a$ di !en:ah

indin: @arin: <ran*a (-) cobbe s!one a''earance (-)

*$osa @arin: +i'ere#is (-) 'os! nasa dri' (-)

#assa (-) 'se*do#e#bran (-) :ran* (-)

 Tonsi T1  T1 hi'ere#is -?- $ri'!a nor#a de!ri!*s -?-

<i:i :ei:i ,en:$a' $aries :i:i () !a#baan () di #oar $anan

a!as

aa!*# *r*# Si#e!ris #assa (-)

aa!*# oe Si#e!ris #assa (-) berca$-berca$ $e'*!ihan (-)

Ten##+&+$ 

,eher !ida$ ada 'e#besaran %<B

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PEMERIKSAAN PENUNANG

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EER%SAA E/A<

02 o.e#ber 201&

PEMERIKSAAN HASIL NILAI NORMAL

Da&ah Rut"n

+e#o:obin

+e#a!o$ri!

Eri!rosi!

,e*$osi!

 Tro#bosi!

137 :?d,

4270 F

/.0 1t2uL G

873rib*?*,

316 rib*?*,

12-16

3H-4H

47&-&7&

4-10

140-400

C>

C+

C+C

30.4 5 ↓

67.7 # ↓

3371 :?d,

84-6

28-34

31-3&

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EER%SAA E/A<

02 o.e#ber 201&

PEMERIKSAAN HASIL NILAI

NORMAL

'un#(" Hat"

S<T

S<T

'&a$(" l""%

%oes!ero !o!a

Ka&!+h"%&at

<*a darah

16 ?

36 ?

148 #:?d,

8 #:?d,

I 3H

I 42

I 220

H0-1&0

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EER%SAA E/A<

02 o.e#ber 201&

PEMERIKSAA

N

HASIL NILAI

NORMAL

Heat+l+#"

T

ATT

R

8.0 %et"$ 9

27 de!i$

0,34 INR 9

78-1271

2&70-3378

1-3

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EER%SAA E/A<

02 o.e#ber 201&

%esan E%<

Sin*s Rh"!h#

Heart rate HHD?#eni!

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EER%SAA E/A<

•02 o.e#ber 201&

A*dio#e!ri dan Ti#'ano#e!ri

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• @ 0o9ember @1$

Audiometri

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• @ 0o9ember @1$

Timpanometri

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EER%SAA E/A<

03 o.e#ber 201&

PEMERIKSAAN HASIL NILAI

NORMAL'&a$(" l""%

%oes!ero !o!a

+, $oes!ero

,, $oes!ero Tri:iserida

182 #:?d,

4 #2%L ↓

8 #:?d,H& #:?d,

I 220

J 6&

I 1&0I 200

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RESE

• Pasien pria, usia @$ tahun datang ke RS& St =ntonius dengan

keluhan ± 1 hari SMRS pasien merasa telinga kanannya

 berdengung. Keluhan dirasakan pasien secara tiba-tiba saat bangun

tidur pada pagi hari.

• Keluhan tambahan → telinga kanannya tidak dapat mendengar

seperti perasaan tertutup pada telinganya serta rasa ngambang.

• Kejadian ini baru pertama kali dialami oleh pasien.

• Riayat demam dan diare dirasakan oleh pasien ± 1 minggu

sebelum keluhan berdengung pada telinga kanan muncul.

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RESE

• Pada pemeriksaan 5isik yang bermakna

• ( 11% mm/g

• (es Rinne

• = ' 0egati5  

• =S ' Positi5

• (es Ceber ' 4ateralisasi ke telinga kiri

• (es Sabach

• = ' Memendek  

• =S ' Sama dengan pemeriksa

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RESE

• Pada pemeriksaan penunjang yang bermakna'

• Aritrosit 7. jt%u4 D

• M)+ .2 5l E

• M)/ @6.6 pg E

• P( . detik E

•;0R .2 ;0R E

• /4 kolesterol $2 mg%d4 E

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A<SS %ER/A

•  Idiopathic Sudden sensorineural hearing loss (SSNHL)

Auricula Dextra

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 TATA,A%SAA

• (irah baring total

• ;n5us Reotal @ 3 1 kol5 

• iet rendah garam, rendah kolesterol

• Metil prednisolon 6 3 1@$ mg ;+

• PantopraFole 1 3 2 mg ;+

• Methycobal 6 3 $ mg ;+

• +itamin ) 6 3 1 mg ;+

• (ebokan tab 6 3 1

• Merislon tab 6 3 1

• Gibrinose 1 3 1

• =lpraFolam @ 3 ,@$ mg

• ;nhalasi oksigen 2 3 1$ menit 2 4%menit

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=,,W

04 N+*e!e& 60; 0 N+*e!e& 60;

S : Tini!*s ber$*ran: #asih be*#den:ar s*ara dirasa 'ecah

S : Tini!*s ber$*ran: #asih be*##enden:ar

O :(!ein:a $anan) ian: !ein:a a'an:#e#bran !i#'ani *!*h ree$scaha"a

O :(!ein:a $anan) ian: !ein:a a'an:#e#bran !i#'ani *!*h ree$scaha"a

A :SS+, A

A :SS+, A

P :Beso$ a*dio#e!ri *an: Tera'i dian9*!$an

P :+asi $ons*!asi den:an en"a$i!aa# C< s!o'=ibrinose s!o'rada$sa 2 D 110 #:

 Tera'i ain dian9*!$an

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• $ 0o9ember @1$

Audiometri

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=,,W

0/ N+*e!e& 60; 03 N+*e!e& 60;

S :Rasa !er!*!*' ber$*ran: #asihbe*# #enden:ar

S : Tini!*s ber$*ran: 'enden:arans*dah #*ai !erden:ar

O :(!ein:a $anan) ian: !ein:aa'an: #e#bran !i#'ani *!*hree$s caha"a

O :(!ein:a $anan) ian: !ein:aa'an: #e#bran !i#'ani *!*hree$s caha"a

A :SS+, A

A : SS+, A

P :e!h" 'rednisoon ↓ 2 x 125 mgIVExtrace ↓ 2 x 500 mg Arixtra 1 x 1 IM di perutTerapi lain dilanjutkan

P :erison s!o'=ibrinose s!o'C< s!o'e!h" 'rednisoon ↓ 1x125 mgPradaka dan apilet menunggu accdari Pen!akit "alam

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=,,W

08 N+*e!e& 60; 0< N+*e!e& 60;

S : Tini!*s ber$*ran:'enden:aran s*dah #*ai!erden:ar

S : Tini!*s ber$*ran: 'enden:arans*dah #*ai !erden:ar

O :(!ein:a $anan) ian: !ein:aa'an: #e#bran !i#'ani *!*hree$s caha"a

O :(!ein:a $anan) ian: !ein:aa'an: #e#bran !i#'ani *!*hree$s caha"a

A :SS+, A

A :SS+, A

P :rada$sa s!o'As'ie! dian9*!$anC< dian9*!$an Tera'i ain dian9*!$an

Beso$ a*dio#e!ri *an:

P :,ancid 1 D 1 Tera'i dian9*!$an

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• H 0o9ember @1$

Audiometri

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=,,W

;0 N+*e!e& 60; ;; N+*e!e& 60;

S :Rasa !er!*!*' 'ada !ein:a $anandirasa ber$*ran: 'enden:aran#asih $*ran: #enden:ar

S : Tini!*s ber$*ran: 'enden:aran#asih $*ran: #enden:ar

O :(!ein:a $anan) ian: !ein:aa'an: #e#bran !i#'ani *!*hree$s caha"a

O :(!ein:a $anan) ian: !ein:aa'an: #e#bran !i#'ani *!*hree$s caha"a

A :SS+, A

A :SS+, A

P :e!h" 'rednisoone :an!i ora+eDion 3 D 4 #:e!h"coba :an!i ora 3 D &00 #:!ab

ED!race > s!o'Beso$ a*dio#e!ri *an:

P :Boeh '*an: den:an oba!

e!h" 'rednisoone !ab 3 D 4 #: Tebo$an !ab 3 D 1

e!hcoba !ab 3 D &00 #:K"'raL 1 D 0& #:

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• 11 0o9ember @1$

Audiometri

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BAB  T/AA STA%A

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%,AS=%AS +EAR< ,SS

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ERA/AT +EAR< ,SS

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E=S

<an::*an 'enden:aran sensorine*ra 'ada

a#'i!*do 30dB a!a* ebih 'ada #ini#a 3@re$*ensi a*dio#e!ri "an: ber*r*!an dan !er9adisea#a 3 hari a!a* $*ran:

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EE,<

• nsidensi di A#eri$a Seri$a! &-20?1007000 !ia'!ah*nn"a

• ,a$i-a$i M ere#'*an

• a'a! !er9adi 'ada se#*a :r*' *sia  insidensi!er!in::i *sia 60-6 !ah*n7

• 8F $as*s *nia!era

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ET,<

• <an::*an >as$*ar 'ada %o$ea  +i'o'er@*si

• i$roe#boi >ena s!asis isi'ide#ia

+i'er!ensi %eainan /an!*n:• n@e$si

• A*!oi#*n

• Co:an S"ndro#e S,E• +eredi!er

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AT=S,<

• %er*sa$an !ein:a daa#   'enin:$a!an se$resine*ro!rans#i!!er :*!a#a! 'ada sina's an!ara hairce dan ne*ron   hian:n"a sina's  :an::*an!ransd*$si  hearin: oss

• is@*n:si hair ce 'resis!en   se$resine*ro!rans#i!!er :*!a#a! berebih 'ada sina's  'enin:$a!an $onsen!rasi si!o'as#a dan ion Cain!ra#i!o$ondria   #i!o$ondria de'oarisasi  

a'o'!osis  $er*sa$an ne*ron a@eren

• +i'o'er@*si $o$ea  did*:a seba:ai 'en"ebab *!a#a

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A<SS

• Ka(u( emergency  tel"n#a

• Sin:$ir$an $e#*n:$inan Conductive Hearing Loss

• Ana#nesis• nse! dan d*rasi #ani'*asi 'ada ian: !ein:a

• <e9aa 'en"er!a .er!i:o !inni!*s rasa 'en*h di !ein:a

• A$!i.i!as "an: #e#'en:ar*hi !ein:a berenan:

#en"ea# nai$ 'esawa! !erban:• Riwa"a! !ra*#a $e'aa !ra*#a bisin:

• Riwa"a! 'en"a$i! $ons*#si oba! dan o'erasi !ein:a

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A<SS

• e#eri$saan =isi$

• Tein:a ser*#en benda asin: $ondisi#e#bran !i#'ani e@*si #assa aserasi

• +id*n: dan Ten::oro$an #encari $eainan"an: da'a! berh*b*n:an den:an !ein:a

• e#eri$saan Rinne dan Webber  $ond*$!i@?sensori

• e#eri$saan ne*roo:is  :an::*an .es!ib*ar• Ro#ber: iD-+a'i$e

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A<SS

• e#eri$saan en*n9an:• A*dio#e!ri

• arah ,en:$a'

• <S  

• +, ,, %oes!ero !o!a Tri:iserid  d"si'ide#ia

• CT Scan  deci! @o$a riwa"a! !ra*#a 'en"a$i! !ein:a$ronis

• R  #e#eri$sa re!ro$o$ea

• %ons* S'esiais en"a$i! aa#?/an!*n:  $eainan /an!*n: dan >as$*ar

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A<SS BA<

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 TERA

Sa#'ai saa! ini be*#di!e#*$an !era'i *!a#a

*n!*$ SS+,

Berdasar$an'er!i#ban:an dari hasi

ana#nesis 'e#eri$saansi$ dan 'e#eri$saanabora!ori*#

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 TERA

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 TERA

• Saah sa!* s!*di#en"a!a$ane@e$!i!as si:ni$an'e#a$aian !era'iawa $or!i$os!eroid

#enca'ai 61Fdibandin:$an 'acebo(32F) sedan:$ans!*di ain !ida$#en*n9*$$an adan"a

hasi si:ni$an7

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 TERA

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 TERA

• +i'erbari$ $si:en• a'aran !erhada' o$si:en #*rni (100F) daa# !e$anan

J 1 a!#os@er sehin::a #eni#b*$an 'er@*si o$si:ensecara an:s*n: 'ada 9arin:an7

• E@e$ !erbai$ dida'a!$an 'ada inisiasi !era'i dini (2#in::* 3 b*an)

• E@e$ benesia ebih ban"a$ dida'a!$an 'ada 'enderi!aden:an $ondisi #odera!e s?d se.ere hearin: ossdari'ada #id hearin: oss

• ,ebih e@e$!i@ 'ada *sia #*da I &0 !ah*n

• ia$*$an & 10 sesi !era'i

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 TERA

• A:en Rheoo:i$ N >asodia!or

• %e#*n:$inan e!ioo:i dari SS+, adaah is$e#ia dari $o$ea

e#ban!* #en:*ran:i .is$osi!as darah dan #e#'erancarairan darah $e $o$ea

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 TERA

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 TERA

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 TERA

• Ant" V"&al

• %e#*n:$inan e!ioo:i dari SS+, adaah ina#asi sara@ $o$eara$iba! in.asi an:s*n: oeh .ir*s dan ina#asi a$iba! res'on i#*n!*b*h !erhada' in@e$si .ir*s7

ene$an in@e$si .ir*s

• D"u&et"$ 

• %e#*n:$inan e!oo:i SS+, adaah endoi#@a!i$ h"dro's 'ada$o$ea ('en*#'*$an cairan didaa# $o$ea   !e$ananin!ra$o$ear nai$  $er*sa$an sara@ $o$ea)

e#ban!* #en*r*n$an !e$anan in!ra$o$ear7

• Ant"+$("%an

• %e#*n:$inan e!ioo:i SS+, adaah is$e#ia a$iba! !erben!*$n"aradi$a bebas 'ada $o$ea

e#ban!* #en:*ran:i 'e#ben!*$an radi$a bebas 'ada !*b*h7

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R<SS

• ro:nosis di!en!*$an #ea*i 'e#eri$saana*dio#e!ri I6 b*an dia:nosis SS+,

• %ri!eria $ese#b*han SS+, (di*$*r dari niai TAN SRT 'ada onse! Hearing Loss)• Co#'e!e

• erbai$an TA N SRT hin::a #enca'ai I 10 dB dari baseine(Tein:a seha!)

• ar!ia• erbai$an TA N SRT J10 dB

• o Reco.er"

• erbai$an TA N SRT I 10 dB

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BAB AA,SS %ASS

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AA,SS %ASS

VARIABEL KASUS TEORI

E'ide#ioo:i 2& !ah*n nsidensi !erban"a$ 60

6 !ah*n

ani@es!asi $inis - A*ri$*a eD!ra

Sensorine*ra hearin: oss

() Tinni!*s () >er!i:o

(-) Ear @*ness (-)

!ida$ ada $eainan 'ada

'e#eri$saan !ein:a *ar

- A*ri$*a eD!ra dbn

- <e9aa !a#a

Sensorine*ra hearin:

oss

- <e9aa Ta#bahan

 Tinni!*s >er!i:o Ear@*ness

- nia!era (8F)

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AA,SS %ASS

VARIABEL KASUS TEORI

e#eri$saan

'en*n9an:

- A*dio#e!ri 8& db (1 $+L)O

H0 dB (2+L)O 80 dB (4$+L)

 'en*r*nan J 30 dB

'ada 3 @re$*ensi ber*r*!an

- arah en:$a'  eri!rosi!

(G)

- +e#a!oo:i T

(#e#ende$)

- R  07H4 (P)

- %oes!ero darah  dbn

- A*dio#e!ri 'en*r*nan

J 30dB 'ada 3

@re$*ensi ber*r*!an

- arah en:$a'  #eiha! adan"a

$eainan darah N !anda

in@e$si

- <S  iabe!es

(>as$*o'a!h")

- %oes!ero darah

(+,,, %oes!ero

!o!a dan Tri:iserida)

- R  #eiha! adan"a

$eainan re!ro$o$ear

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AA,SS %ASS

VARIABEL KASUS TEORI

 Ta!a a$sana - n@*s Reo!a (en!oDi@"ine) 2 D1 $o@ 

- e!h"'rednisoone 3 D 12& #:n9

- an!o'raLoe 1 D 40 #: n9- e!icoba 3 D &00 #: n9- ED!race (>i! C) 3 D 1000 #: n9- AriD!ra 1 D 1 - Tebo$an (<in:$o Bioba) 3 D 1

!ab- erison (B-+is!ine) 3 D 1 !ab- K"'raL (A'raLoa#) 2 D 07&#:

!ab- As'ie! (As'irin) 1 D 1 !ab- Co'ido:re 1 D H& #: !ab- radaDa 2 D 110 #: ca's

- %or!i$os!eroid- ra rednison 1 #:?$:?hari e!i'rednisoon 48

#:?hari eDa#e!hasone 10

#:?hari- n!ra!i#'ani$ eDa#e!hasone 24

#:?# (co#'o*nd) eDa#e!hasone 10

#:?# (s!oc$)

e!h"'rednisoone 40#:?#- +i'erbari$ o$si:en  & - 10

sesi !era'i- An!i.ira- >asodia!or- A:en Rheoo:i$- An!io$sidan

- i*re!i$

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