Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV)

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Definisi

Benign paroxysmal positional vertigo (BPPV) atau vertigo posisi paroksismal jinak adalah salah satu jenis vertigo yang cukup sering ditemukan. Vertigo adalah sensasi berputar, baik Anda yang berputar atau lingkungan sekitar Anda yang berputar. Sensasi berputar pada BPPV bervariasi dari ringan hingga berat, muncul tiba-tiba, dan umumnya berlangsung singkat.

Gangguan ini terjadi karena adanya masalah di telinga bagian dalam. Sensasi berputar atau pusing ini biasanya dipicu oleh perubahan kepala pada posisi tertentu, seperti saat menggerakan kepala ke atas atau ke bawah, ketika berbaring di tempat tidur, membalikkan badan, atau saat Anda terbangun dan duduk di tempat tidur. BPPV cenderung tidak menjadi masalah serius, hanya saja vertigo dapat meningkatkan risiko jatuh karena pasien merasa berputar, tubuhnya bergoyang, atau menjadi tidak seimbang.

Penyebab

Penyebab vertigo bisa beragam, mulai dari karena adanya gangguan sistem vestibular di telinga bagian dalam, reinfeksi virus varicella zoster pada telinga, cedera kepala, bahkan sampai penyakit pada otak.

Pada BPPV sendiri, vertigo bisa terjadi karena adanya gangguan pada telinga bagian dalam, gangguan saat operasi telinga, atau yang disebabkan oleh posisi terlentang dalam waktu lama seperti saat berbaring di kursi dokter gigi. BPPV juga dapat berhubungan dengan migrain.

Hubungan vertigo dengan telinga

Di dalam telinga ada organ kecil yang disebut labirin vestibular. Labirin ini terdiri atas tiga kanal yang berbentuk setengah lingkaran (kanalis semisirkularis). Kanal ini berisi cairan dan rambut halus sebagai sensor saat kepala berputar ke berbagai arah. Struktur lain yaitu organ otolith, bertugas untuk memantau gerakan kepala ke atas dan ke bawah, kanan dan kiri, bolak-balik, dan posisi kepala terkait dengan gravitasi. Organ otolith ini mengandung kristal kalsium karbonat yang membuat Anda sensitif terhadap gravitasi.

Karena berbagai hal, pada penderita vertigo, kristal ini dapat terlepas dan berpindah ke dalam kanalis semisirkularis yang berada di telinga bagian dalam. Hal ini terutama terjadi saat penderita sedang berbaring. Adanya kristal ini menyebabkan sensor kanalis semisirkularis menjadi sensitif terhadap perubahan posisi kepala sehingga penderita merasa pusing.

Faktor Risiko

Tidak ada faktor risiko khusus pada BPPV. Namun, beberapa studi menunjukkan bahwa BPPV dapat diturunkan. Banyak orang dengan BPPV memiliki keluarga yang juga menderita BPPV.

Beberapa kondisi berikut membuat seseorang lebih rentan terkena BPPV, antara lain:

  • Berusia 50 tahun ke atas, walaupun vertigo dapat terjadi pada semua usia
  • Lebih sering terjadi pada wanita dibandingkan pria
  • Riwayat cedera kepala atau gangguan lain pada organ keseimbangan telinga
  • Diabetes
  • Osteoporosis

Gejala

Tanda dan gejala vertigo posisi paroksismal jinak antara lain:

  • Pusing berputar
  • Perasaan bahwa Anda atau lingkungan berputar (vertigo)
  • Kehilangan keseimbangan dan tidak stabil
  • Mual
  • Muntah

Tanda dan gejala biasanya hilang timbul dan berlangsung kurang dari satu menit. Episode BPPV dapat menghilang untuk beberapa waktu dan kemudian muncul kembali.

Aktivitas yang memicu keluhan dapat bervariasi antar orang, namun hampir selalu disebabkan oleh perubahan posisi kepala. Beberapa orang juga merasa tidak seimbang saat berdiri atau berjalan. Gerakan mata abnormal biasanya dapat menyertai gejala vertigo posisional paroksismal jinak. Biasanya gejala pusing berputar pada BPPV tidak akan disertai gangguan fungsi pendengaran dan penurunan fungsi saraf.

Diagnosis

Dokter akan melakukan serangkaian tes untuk menentukan penyebab dari pusing yang Anda rasakan. Selama pemeriksaan fisik, dokter Anda akan mencari:

  • Tanda dan gejala pusing yang dipicu oleh gerakan mata atau kepala dan kemudian berkurang dalam waktu kurang dari satu menit 
  • Pusing yang disertai gerakan mata tertentu saat berbaring telentang dengan kepala menoleh ke satu sisi dan sedikit miring ke tepi tempat tidur pemeriksaan
  • Gerakan mata yang tidak disengaja dari sisi ke sisi
  • Ketidakmampuan untuk mengontrol gerakan mata

Jika dokter belum dapat menemukan penyebab dari keluhan Anda, dokter dapat memerlukan pemeriksaan penunjang, seperti:

  • Electronystagmography (ENG) atau videonystagmography (VNG). Tujuan dari pemeriksaan ini adalah mendeteksi gerakan mata yang tidak normal. ENG (yang menggunakan elektroda) atau VNG (yang menggunakan kamera kecil) dapat menentukan apakah pusing disebabkan oleh penyakit telinga dalam dengan mengukur gerakan mata yang tidak disengaja saat kepala pasien ditempatkan pada posisi yang berbeda atau saat organ keseimbangan dirangsang dengan air atau udara
  • Magnetic resonance imaging (MRI). Tes ini menggunakan medan magnet dan gelombang radio untuk menghasilkan gambar kepala dan tubuh Anda. Dokter menggunakan gambar-gambar ini untuk mengidentifikasi dan mendiagnosis berbagai kondisi, serta menyingkirkan penyebab lain dari vertigo selain BPPV.

Tatalaksana

Vertigo posisi paroksismal jinak dapat hilang dengan sendirinya dalam beberapa minggu atau bulan. Namun, untuk membantu meringankan gejala, dokter akan menangani keluhan Anda melalui serangkaian gerakan kepala yang dikenal sebagai prosedur reposisi kanalit. Kanalit adalah kristal yang terlepas dari organ otolith dan berpindah ke kanalis semisirkularis sehingga menimbulkan gejala BPPV.

Reposisi kanalit

Prosedur ini dapat dilakukan di tempat praktik dokter. Prosedur reposisi kanalit terdiri dari beberapa manuver sederhana dan lambat untuk memposisikan kepala Anda. Tujuannya untuk memindahkan partikel kanalit dari kanalis semisirkularis ke area terbuka seperti kantong kecil (vestibulum) yang menampung salah satu organ otolith, yaitu tempat yang sesuai untuk kanalit.

Setiap posisi ditahan selama sekitar 30 detik setelah gejala atau gerakan abnormal mata berhenti. Prosedur ini biasanya menimbulkan perubahan yang signifikan setelah satu atau dua kali tindakan. Dokter akan mengajarkan cara melakukan prosedur ini sehingga Anda dapat melakukannya di rumah jika diperlukan.

Obat-obatan

Dokter juga dapat meresepkan obat-obatan untuk mengurangi keluhan pusing berputar. Obat-obatan tersebut antara lain obat-obatan sedatif yang memberi efek mengantuk, obat antihistamin, obat untuk mengatasi gejala sensasi berputar dan mual-muntah bila muncul serangan lagi. Namun, obat-obatan saja seringkali tidak efektif untuk mengobati vertigo.

Perubahan gaya hidup dan perawatan di rumah

Hidup dengan BPPV akan menjadi tantangan tersendiri bagi penderitanya. Gangguan ini dapat memengaruhi hubungan dengan teman dan keluarga, produktivitas di tempat kerja, serta kualitas hidup. Namun, meskipun BPPV terkadang tidak nyaman, keluhan ini dapat membaik seiring waktu jika dikelola dengan tepat.

Terapi fisik dan perawatan di rumah dapat membantu mengurangi keluhan pusing. Jika Anda mengalami pusing yang berhubungan dengan BPPV, pertimbangkan tips berikut:

  • Waspadai kemungkinan kehilangan keseimbangan yang dapat menyebabkan jatuh dan cedera serius
  • Hindari gerakan yang menimbulkan gejala, seperti melihat ke atas
  • Segera duduk saat Anda merasa pusing
  • Gunakan pencahayaan yang baik jika Anda bangun di malam hari
  • Berjalanlah dengan tongkat agar lebih stabil jika Anda berisiko jatuh
  • Konsultasi dengan dokter untuk mengatasi gejala Anda

Alternatif pembedahan

Pada situasi yang jarang terjadi, ketika prosedur reposisi kanalit dan pengobatan tidak berhasil, serta gejala sangat mengurangi kualitas hidup pasien, dokter akan merekomendasikan prosedur pembedahan. Pada prosedur ini, sumbat tulang digunakan untuk menutup bagian telinga dalam yang menyebabkan pusing. Sumbat tersebut mencegah kanalis semisirkularis merespons gerakan partikel kanalit atau gerakan kepala secara umum. Tingkat keberhasilan operasi sumbatan kanal ini adalah sekitar 90%.

Komplikasi

BPPV akan menimbulkan ketidaknyamanan bagi penderitanya. Rasa pusing yang timbul dapat membuat penderita berjalan atau berdiri dengan tidak stabil sehingga meningkatkan risiko jatuh.

Anda perlu segera menghubungi dokter jika terdapat keluhan lain yang lebih berat, seperti pengobatan yang tidak berhasil, atau jika Anda mengalami kelemahan anggota gerak, bicara menjadi pelo, atau  muncul masalah penglihatan. Karena terkadang, gejala vertigo juga dapat berhubungan dengan kondisi medis lain yang lebih serius seperti gangguan saraf di daerah kepala atau telinga.

Pencegahan

Pada kebanyakan kasus, vertigo posisional paroksismal jinak tidak dapat dicegah. Namun, beberapa kasus BPPV yang terjadi akibat cedera kepala dapat dicegah dengan menghindari cedera tersebut. Mengenakan helm saat bersepeda, bersepeda motor, bermain baseball, atau melakukan aktivitas olahraga lainnya dapat melindungi Anda dari cedera kepala dan BPPV.

Kapan harus ke dokter?

Secara umum, konsultasi dengan dokter jika Anda mengalami pusing atau vertigo yang berulang, muncul tiba-tiba, memberat, atau berkepanjangan dan tidak diketahui pasti apa penyebabnya.

Meskipun pusing jarang menjadi tanda penyakit yang serius, segera temui dokter jika Anda mengalami pusing atau vertigo yang disertai salah satu gejala berikut:

  • Sakit kepala baru, berbeda dari biasanya, atau terasa parah
  • Demam
  • Penglihatan ganda atau kehilangan penglihatan
  • Kehilangan pendengaran
  • Kesulitan berbicara
  • Kelemahan kaki atau lengan
  • Hilang kesadaran
  • Jatuh atau kesulitan berjalan
  • Mati rasa atau kesemutan
Writer : dr Aprilia Dwi Iriani
Editor :
  • dr Hanifa Rahma
Last Updated : Senin, 26 Agustus 2024 | 09:14

Mayo Clinic Staff (2020). Benign paroxysmal positional vertigo (BPPV). Retrieved 21 Desember 2021, from https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055.

Normandin, B. (2018). Benign Positional Vertigo (BPV). Retrieved 21 Desember 2021, from https://www.healthline.com/health/benign-positional-vertigo.

University of Michigan Health (2020). Benign Paroxysmal Positional Vertigo (BPPV). Retrieved 21 Desember 2021, from https://www.uofmhealth.org/health-library/hw263714#aa38374.

Palmeri, R., Kumar, A. (2021). Benign Paroxysmal Positional Vertigo. NCBI Statpearl. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470308/

Stanton, M., Freeman, A. (2021). Vertigo. NCBI Statpearl. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482356/

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      Backtrace
      • app/Http/Controllers/WebController.php:1385
      • app/Http/Controllers/WebController.php:372
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • WebController.php#1385aicare_prod_new13.74msselect `posts`.*, `post_tag`.`tag_id` as `pivot_tag_id`, `post_tag`.`post_id` as `pivot_post_id` from `posts` inner join `post_tag` on `posts`.`id` = `post_tag`.`post_id` where `post_tag`.`tag_id` = 4029
      Bindings
      • 0: 4029
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • app/Http/Controllers/WebController.php:1385
      • app/Http/Controllers/WebController.php:372
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • CategoryHealtTopics.php#11aicare_prod_new1.01msselect * from `categories` where (`slug` != 'penyakit-a-z' and `slug` != 'obat-a-z' and `slug` != 'pemeriksaan-a-z' and `parent_id` = '0') and `categories`.`deleted_at` is null order by `order` asc
      Bindings
      • 0: penyakit-a-z
      • 1: obat-a-z
      • 2: pemeriksaan-a-z
      • 3: 0
      Hints
      • Use SELECT * only if you need all columns from table
      • The != operator is not standard. Use the <> operator to test for inequality instead.
      Backtrace
      • app/Repositories/Categories/CategoryHealtTopics.php:11
      • app/Http/Controllers/WebController.php:376
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • WebController.php#377aicare_prod_new150msselect * from `posts` where `status` = 1 and `publish_date` <= '2025-01-13 07:40:26' and `content_type` = 'article' order by RAND() limit 7
      Bindings
      • 0: 1
      • 1: 2025-01-13 07:40:26
      • 2: article
      Hints
      • Use SELECT * only if you need all columns from table
      • ORDER BY RAND() is slow, try to avoid if you can. You can read this or this
      Backtrace
      • app/Http/Controllers/WebController.php:377
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • WebController.php#391aicare_prod_new8.87msupdate `posts` set `views_count` = 916 where `id` = 2140
      Bindings
      • 0: 916
      • 1: 2140
      Backtrace
      • app/Http/Controllers/WebController.php:391
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • ActivityLogger.php#174aicare_prod_new6.31msinsert into `activity_log` (`log_name`, `properties`, `batch_uuid`, `event`, `subject_id`, `subject_type`, `description`, `updated_at`, `created_at`) values ('default', '[]', null, 'updated', 2140, 'App\\Models\\Admin\\Post', 'updated', '2025-01-13 07:40:26', '2025-01-13 07:40:26')
      Bindings
      • 0: default
      • 1: []
      • 2: 
      • 3: updated
      • 4: 2140
      • 5: App\Models\Admin\Post
      • 6: updated
      • 7: 2025-01-13 07:40:26
      • 8: 2025-01-13 07:40:26
      Backtrace
      • vendor/spatie/laravel-activitylog/src/ActivityLogger.php:174
      • vendor/spatie/laravel-activitylog/src/Traits/LogsActivity.php:88
      • app/Http/Controllers/WebController.php:391
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
    • single-post-healthpedia.blade.php#37aicare_prod_new930μsselect * from `users` where `users`.`id` = 27 limit 1
      Bindings
      • 0: 27
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.single-post-healthpedia:37
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new6.37msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 24 and `categories`.`deleted_at` is null
      Bindings
      • 0: 24
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#11aicare_prod_new750μsselect * from `categories` where `categories`.`id` = 4 and `categories`.`deleted_at` is null limit 1
      Bindings
      • 0: 4
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.partials.article-popular:11
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new10.7msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2370 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2370
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new6.14msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 5126 and `categories`.`deleted_at` is null
      Bindings
      • 0: 5126
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new6.2msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 9467 and `categories`.`deleted_at` is null
      Bindings
      • 0: 9467
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new5.96msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 9655 and `categories`.`deleted_at` is null
      Bindings
      • 0: 9655
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new5.86msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 137 and `categories`.`deleted_at` is null
      Bindings
      • 0: 137
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new7.51msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 7111 and `categories`.`deleted_at` is null
      Bindings
      • 0: 7111
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new10.58msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2091 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2091
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new7.51msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2011 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2011
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new10.44msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2998 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2998
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new5.94msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2983 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2983
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new5.65msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 3029 and `categories`.`deleted_at` is null
      Bindings
      • 0: 3029
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#122aicare_prod_new770μsselect * from `pages` where `slug` = 'about-us' limit 1
      Bindings
      • 0: about-us
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:122
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#547aicare_prod_new600μsselect * from `faqs` limit 1
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:547
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#551aicare_prod_new740μsselect * from `term_policies`
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      Backtrace
      • view::layouts.v2.web_layout:551
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    App\Models\Admin\Post
    56Post.php#?
    App\Models\Admin\Category
    24Category.php#?
    App\User
    4User.php#?
    App\Models\Admin\Tag
    3Tag.php#?
    App\Models\TermPolicy
    3TermPolicy.php#?
    App\Models\Admin\Page
    1Page.php#?
    App\Models\Admin\Faq
    1Faq.php#?
        locale
        id
        _token
        pSX9XkJ4TYJKowSe2IRgCDtrFQGfNHXCnkWPKv4q
        _previous
        array:1 [ "url" => "https://ai-care.atmatech.id/healthpedia-penyakit/benign-paroxysmal-positional-...
        _flash
        array:2 [ "old" => [] "new" => [] ]
        path_info
        /healthpedia-penyakit/benign-paroxysmal-positional-vertigo-bppv
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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