Irawan Mangunatmadja
Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas RS Dr. Cipto Mangunkusumo, Jakarta

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Ouvrier’s Modified Mini Mental State Examination as a screening test for cognitive impairment in school-aged children with epilepsy Hariadi Edi Saputra; Setyo Handryastuti; Irawan Mangunatmadja; Dwi Putro Widodo; Sudung O. Pardede
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (183.92 KB) | DOI: 10.14238/pi60.3.2020.137-41

Abstract

Background Epilepsy may affect children's development, including their cognitive function. The prevalence of cognitive impairment in epilepsy patients is quite high. Weschler Intelligence Scale for Children (WISC) takes a long time to administer and is expensive, so a simpler screening tool for cognitive evaluation is needed in pediatric epilepsy patients. Objective To assess the diagnostic value of Ouvrier’s Modified Mini Mental State Examination (MMSE) for detecting cognitive impairment in children aged 8-11 years with epilepsy. Methods This diagnostic study was conducted in December 2018 to February 2019 at Cipto Mangunkusumo and Fatmawati Hospitals in Jakarta. Data were collected with purposive sampling of children with epilepsy aged 8 to 11 years. Cognitive function was assessed by Ouvrier’s Modified MMSE and WISC. Ouvrier’s Modified MMSE was compared to WISC as and the gold standard. Results were analyzed using a 2x2 table. Results The prevalence of cognitive impairment in 8-11-year-old epilepsy patients was 72.9%. Ouvrier’s Modified MMSE had 83% sensitivity, 85% specificity, 94% positive predictive value, 65% negative predictive value, and 83% accuracy. Conclusions Ouvrier’s Modified MMSE has good diagnostic value, thus it may be useful for early detection of cognitive impairment in pediatric epilepsy.
Impact of albumin levels on clinical outcomes in children underwent abdominal surgery Rismala Dewi; Freddy Guntur Mangapul Silitonga; Irawan Mangunatmadja
Paediatrica Indonesiana Vol 60 No 3 (2020): May 2020
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (211.056 KB) | DOI: 10.14238/pi60.3.2020.149-53

Abstract

Background Patients underwent abdominal surgery and had hypoalbuminemia were at risk of post-operative complications. The prognostic role of albumin levels in children with abdominal surgery remains unclear. Objective To investigate the impact of albumin levels on clinical outcomes related to the complications in children with abdominal surgery. Methods This was a retrospective cohort study on children aged 29 days to 18 years, who underwent abdominal surgery, had serum albumin levels measured at pre-operative and within 48 hours post-operatively, and hospitalized in Paediatric Intensive Care Unit of Dr. Cipto Mangunkusumo Hospital, Indonesia. The primary outcomes were post-operative complications (sepsis, surgical site infection, shock), length of stay in PICU, dehiscence, relaparotomy, and postoperative mortality. Results This study recruited a total of 201 children. Pre- and post-operative serum albumin levels of ≤ 3.00 g/dL were found in 15.4% and 51.2%, respectively. Pre- and post-operative serum albumin levels of ≤ 3.00 g/dL were associated with higher risk of post-operative sepsis (RR 3.4; 95%CI 1.54 to 7.51) and relaparotomy (RR 3.84; 95%CI 1.28 to 1.49). The median of length of PICU stay was 4 days longer in children with pre-operative serum albumin levels ≤ 3.00 g/dL (P<0.001). Conclusions Hypoalbuminemia condition in children undergo abdominal surgery is associated with increased risk of post-operative sepsis, longer length of stay in PICU, and risk of relaparotomy.
The role of clinical diagnostic criteria for anti-N-methyl-D-aspartate receptor encephalitis in children: A case report Irawan Mangunatmadja; Ricca Fauziyah; Achmad Rafli
Paediatrica Indonesiana Vol 62 No 1 (2022): January 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.1.2022.66-71

Abstract

Encephalitis is a neurological disorder that develops rapidly into a progressive encephalopathy caused by inflammatory processes in the brain. The incidence of encephalitis in developed countries is 5-10 per 100,000 per year. Encephalitis can affect all ages and cause long-term effects on patients, their families, and society.1-3 Autoimmune encephalitis, including anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, is increasingly recognized as a cause of encephalitis in children and has a considerable mortality rate of 5-7%.4 Physicians should suspect anti-NMDAR encephalitis in patients with prominent neuropsychiatric symptoms and movement disorder.1-3 We report here a case of anti-NMDAR encephalitis and discuss the role of clinical criteria in diagnosing anti-NMDAR encephalitis in children.
Peran implanted electrically evoked auditory brainstem responses(Imp-eABR) pada pasien tuli kongenital Fikri Mirza Putranto; Jenny Bashiruddin; Semiramis Zizlavsky; Irawan Mangunatmadja; Jacub Pandelaki; Saptawati Bardosono; Wijana Hasansulama
Oto Rhino Laryngologica Indonesiana Vol 49 (2019): Volume 49, No. 2 July - December 2019
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (788.096 KB) | DOI: 10.32637/orli.v49i20.320

Abstract

Latar belakang: Variasi performa pasca implan koklea menunjukkan adanya variasi patologi yang belum dapat dijelaskan melalui pemeriksaan standar pra-operasi. Untuk itu dibutuhkan pemeriksaan yang dapat menunjukkan variasi integritas jaras auditori sebagai petunjuk variasi potensi internal tiap individu. Tujuan: Mendapatkan variasi respons jaras auditori terhadap stimulus listrik pasca implan berdasarkan pemeriksaan Implanted Electrically evoked Auditory Brainstem Respons (Imp-eABR), serta korelasinya dengan faktor internal pra-implan lain berupa usia, luas area n. koklearis dan kemampuan komunikasi pra-operasi. Metode: Kriteria subjek penelitian adalah pasien operasi implan koklea berusia kurang dari 10 tahun, memiliki koklea dan n. koklearis normal, dan pada pasien berusia lebih dari 4 tahun sudah memakai alat bantu dengar minimal 1 tahun. Pemeriksaan Imp-eABR dilakukan terhadap 5 elektrode yang mewakili area apikal, medial dan basal koklea. Dicari hubungan respons dari stimulasi terhadap ketiga faktor internal.Hasil:Pemeriksaan Imp-eABR dilakukan terhadap 28 telinga dari 19 pasien yang dilakukan operasi secara unilateral dan bilateral. Rerata skor total respons Imp-eABR adalah 6,3 + 2,63; dengan 60,7% telinga memiliki skor total kurang dari 8. Uji regresi linear menunjukkan faktor usia, luas area n. koklearis dan kemampuan komunikasi berkorelasi secara bermakna dan dapat memprediksi variasi skor Imp-eABR sebanyak 49,2%. Kesimpulan:Variasi skor total Imp-eABR pada pasien dengan faktor internal pra-operasi menunjukkan adanya patogenesis lain yang mendasari kemampuan transmisi jaras pendengaran retrokoklea terhadap stimulasi listrik dari implan koklea. Faktor internal pra-operasi dapat menjelaskan kurang dari 50% variasi respons Imp-eABR. Kata kunci: Imp-eABR, luas area n. koklearis, implant koklea, integritas jaras auditori ABSTRACT Background:Variations in performance after cochlear implant indicates pathology variations that cannot be explained through standard preoperative examination. Therefore, an examination is needed to show variations in the integrity of auditory pathways as a guide to internal potential variations of each individual. Objectives: To show variations of auditory pathways responses to electrical stimulation from cochlear implant by performing Implanted Electrically evoked Auditory Brainstem Response (Imp-eABR) examination and to find its correlation to age, cochlear nerve area and preoperative communication skills. Methods: Subjects were cochlear implant patients with age less than 10 years, had normal cochlear and cochlear nerve,and patients over 4 years old with history of wearing hearing aids for at least 1 year. The Imp-eABR examination was performed to 5 electrodes representing the apical, medial and basal areas of the cochlea. Results:Imp-eABR examination was performed on 28 ears from 19 patients who underwent unilateral and bilateral surgery. The average total score of Imp-eABR responses was 6.3 + 2.63; with 60.7% of the ears having a total score of less than 8. Linear regression tests showed age,cochlear nerve area,andcommunicationabilitysignificantlycorrelate,it canexplain49.2%ofthevariationinthetotal Imp-eABR score. Conclusion: The variation in the total Imp-eABR score in patients with preoperative internal factors indicated that another pathogenesis also underlines the ability of transmission of the retrocochlear auditory pathway to electrical stimulation from the cochlear implant. Preoperative internal factors can only explain less than 50% of the variation of the Imp-eABR response.   
Lennox-Gastaut syndrome and its impact on quality of life: hearing and speech perspective Semiramis Zizlavsky; Shally Adhina Adhina Putri; Indra Parmaditya Pamungkas; Khoirul Anam; Irawan Mangunatmadja
Oto Rhino Laryngologica Indonesiana Vol 52, No 1 (2022): VOLUME 52, NO. 1 JANUARY - JUNE 2022
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v52i1.549

Abstract

ABSTRACTBackground: Lennox-Gastaut syndrome (LGS) is a severe pediatric epilepsy syndrome characterized by multiple seizure types including tonic, atonic, atypical absence, and generalized tonic-clonic seizures. LGS is also associated with cognitive decline and various neural disturbance, including hearing loss. Purpose: To report a case of Lennox-Gastaut syndrome with unilateral hearing loss and delayed speech. Case report: Four years old boy with LGS and delayed speech was referred to the Otolaryngology Outpatient Clinic, Dr Cipto Mangunkusumo Hospital for hearing and speech ability evaluation. He had had repeated seizures since he was three weeks old, and also had cortical lesion and mild atrophy in the left hemisphere brain. Hearing tests with Otoacoustic Emission (OAE), Brainstem Evoked Response Audiometry (BERA), and Auditory Steady State Response (ASSR) revealed profound unilateral hearing loss in the left ear, which required hearing aid and also speech therapy. Clinical question: Is there any correlation between brain abnormality/damage with unilateral hearing loss and delayed speech in Lennox-Gastaut syndrome? Method: Using Pubmed, Proquest Database, and Hand Searching to search the evidence. The evidence selected will be appraised by at least two members of our group using Oxford Center of Evidence-Based Medicine (CEBM) worksheet. Result: Following screening of double publication and its suitability to our clinical questions over ten years, no literature was found. Conclusion: The patient was given antiepileptic drugs (AEDs) and postural control training. For the hearing and speech problems, as the best comprehensive treatment the patient was suggested to use hearing aids and undergo speech therapy program. ABSTRAKLatar belakang: Lennox-Gastaut syndrome (LGS) adalah kumpulan gejala epilepsi berat pada anak dengan ciri khas kejang multipel, tonik, atonik, kejang absans atipik dan tonik klonik menyeluruh. LGS juga berkaitan dengan penurunan kognitif dan berbagai gangguan saraf, termasuk gangguan pendengaran. Tujuan: melaporkan kasus sindrom Lennox-Gastaut dengan gangguan pendengaran satu sisi dan keterlambatan bicara. Laporan Kasus: Seorang anak laki-laki berusia 4 tahun dengan sindroma Lennox-Gastaut mengalami keterlambatan bicara dirujuk ke Departemen Telinga Hidung Tenggorok, Rumah Sakit Dr.Cipto Mangunkusumo untuk evaluasi ambang dengar dan penanganannya. Riwayat penyakit menunjukkan kejang berulang sejak berusia tiga minggu, yang ditemukan juga lesi di korteks serebri dan atrofi ringan pada hemisfer otak kiri. Berdasarkan Otoacoustic Emission (OAE), Brainstem Evoked Response Audiometry (BERA), dan Auditory Steady State Response (ASSR) ditemukan adanya gangguan pendengaran sangat berat unilateral pada telinga kiri dan membutuhkan Alat Bantu Dengar dan terapi wicara. Pertanyaan klinis:Apakah terdapat korelasi antara abnormalitas otak atau kerusakan otak dengan gangguan pendengaran unilateral dan keterlambatan bicara pada LGS? Metode: Pencarian bukti dilakukan melalui PubMed, Proquest, dan pencarian manual. Artikel yang didapatkan kemudian ditelaah oleh setidaknya dua anggota kelompok dengan menggunakan lembar kerja yang diperoleh dari Oxford Center of Evidence-Based Medicine (CEBM) Hasil: Setelah dilakukan skrining publikasi ganda dan kesesuaian dengan pertanyaan klinis dari sepuluh tahun terakhir tidak ditemukan literatur yang sesuai. Kesimpulan:  Pasien ditangani dengan obat antiepilepsi dan latihan psikomotorik. Untuk gangguan pendengaran pasien dianjurkan untuk menggunakan Alat bantu Dengar dan terapi wicara. Penanganan kasus LGS harus menyeluruh untuk memperoleh hasil yang baik.
A comparison of objective and subjective measurements of non-nutritive sucking in preterm infants Luh Karunia Wahyuni; Irawan Mangunatmadja; Risma Kerina Kaban; Elvie Zulka Kautzia Rachmawati; Melinda Harini; Budiati Laksmitasari; Agatha Geraldyne; Inez Ayuwibowo Sangwidjojo; Dini Prima Utami; Victor Prasetyo Poernomo; Adrian Prasetya Sudjono
Paediatrica Indonesiana Vol 62 No 4 (2022): July 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.4.2022.274-81

Abstract

Background Of preterm infants born before 32 weeks of gestation, 40-70% have atypical and immature feeding skills, which could delay initiation of oral feeding. A formal objective measurement of non-nutritive sucking may increase the accuracy of determining the right time to initiate oral feeding, however, most hospital perinatology care units do not own a suction pressure measurement device to objectively measure non-nutritive sucking parameters. Objective To compare objective and subjective non-nutritive sucking (NNS) based on sucking pressure, number of suctions per burst, and time between bursts. Methods One hundred twenty preterm infants born at 28-34 weeks’ gestation were evaluated for objective and subjective NNS. Data were collected from August to November 2021 at five hospitals in Jakarta. Objective NNS was measured by a suction pressure measurement device, while subjective NNS was clinically examined. Number of suctions per burst, sucking pressure, and time between bursts were analysed by Spearman’s correlation test. Results A positive and significant correlation between objective and subjective NNS was found in all parameters (P<0.001). The highest correlation was found in time between bursts (r=0.74; P<0.001), followed by number of suctions per burst (r=0.60; P<0.001), and sucking pressure (r=0.58; P<0.001). Conclusion The correlation between objective and subjective NNS examination was moderate in preterm infants. Therefore, an objective NNS measurement is still required for optimizing the examination.
Non-nutritive sucking milestones of preterm infants in Indonesia: a descriptive study Luh Karunia Wahyuni; Irawan Mangunatmadja; Risma Kerina Kaban; Elvie Zulka Kautzia Rachmawati; Melinda Harini; Budiati Laksmitasari; Agatha Geraldyne; Inez Ayuwibowo Sangwidjojo; Dini Prima Utami; Victor Prasetyo Poernomo; Adrian Prasetya Sudjono
Paediatrica Indonesiana Vol 62 No 5 (2022): September 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.5.2022.311-7

Abstract

Background Non-nutritive sucking (NNS) maturity has been used as one of the markers of oral feeding readiness in infants. Prematurity may hinder the attainment of NNS milestones. Depending on gestational age (GA) at birth, preterm infants may display various degrees of immaturity, potentially affecting the strength, coordination, and efficiency of skills required for NNS. Objective To identify the progression of NNS patterns across gestational age groups of preterm infants in Indonesia by comparing NNS parameters between moderate-to-late preterm and very preterm infants. Methods NNS evaluation was conducted in 120 preterm infants born at 28-34 weeks gestational age in five tertiary hospitals in Jakarta, Indonesia. Three aspects of NNS (suction pressure, number of suctions per burst, and time between bursts) were documented and arranged to present a descriptive overview. A suction pressure measurement device was used to record, identify, and analyze NNS parameters. We hypothesize that maturity, as determined by GA, positively affected the attainment of NNS milestones. Results Moderate-to-late preterm infants (GA 32 to <37 weeks), compared to very preterm infants (GA 28 to <32 weeks), had higher mean NNS pressure (-79.8 vs. -72.7 mmHg, respectively, P=0.041) and shorter mean time between bursts (6.63 vs. 7.36 s, respectively, P=0.030). Mean number of suctions per burst were also significantly different between the two GA groups (8.90 vs. 8.99 sucks/burst, respectively, P=0.048). Conclusion Maturity, as reflected by GA, had a positive effect on the attainment of NNS milestones in preterm infants in Indonesia. Significant differences in the three NNS parameters: number of suctions per burst, time between bursts, and suction pressure were found between moderate-to-late preterm and very preterm infants.
Dampak COVID-19 pada Anak dengan Epilepsi: Perspektif Orangtua dan Pengasuh Setyo Handryastuti; Irawan Mangunatmadja; Amanda Seobadi; Asep Aulia Rachman; Iqbal Taufiqqurrachman; Achmad Rafli
Sari Pediatri Vol 24, No 4 (2022)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp24.4.2022.232-8

Abstract

Latar belakang. Pandemi coronavirus disease 2019 (COVID-19) yang disebabkan severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) telah memengaruhi pelayanan kesehatan. Hal ini dapat berdampak pada keterlambatan diagnosis dan terapi termasuk pelayanan kesehatan pada anak dengan epilepsi. Hal ini menimbulkan risiko anak dengan epilepsi tidak mendapatkan pelayanan kesehatan yang optimal yang dapat menyebabkan kambuhnya kejang dan penurunan kualitas hidup anak dengan epilepsi.Tujuan. Untuk mengetahui dampak COVID-19 terhadap pelayanan kesehatan anak dengan epilepsi dari perspektif orangtua atau pengasuh.Metode. Penelitian deskriptif dilakukan dengan metode potong lintang. Sampel diperoleh dengan metode survei wawancara langsung menggunakan kuesioner yang terdiri dari 23 pertanyaan pada bulan Februari-April 2022 kepada 252 orangtua/pengasuh yang berasal dari beberapa rumah sakit besar dan klinik di Jakarta.Hasil. Sebagian besar pasien tidak memiliki masalah perilaku (58,3%), tidak terdapat gangguan tidur (59,1%) serta tidak terdapat perubahan kepatuhan berobat (63,1%).Mayoritas pasien tidak pernah mendapat terapi diazepam rektal untuk mengatasi kekambuhan kejang (61,9%) selama pandemi. Masalah terbesar bagi orang tua dan pengasuh adalah rasa takut mengunjungi rumah sakit (27,4%%) dan lebih memilih untuk berkonsultasi secara langsung (86,9%) dibandingkan telekonsultasi atau tidak kontrol. Manfaat telekonsultasi bervariasi, antara lain, penurunan kebutuhan pergi keluar rumah (24,7%), hemat waktu (28,6%), dan menurunkan biaya transportasi (28,6%). Terdapat beberapa kekurangan telekonsultasi, yaitu miskomunikasi antara dokter dan pasien (39,4%). Kualitas pelayanan poliklinik neurologi masih cukup baik (68,3%), dengan pelayanan elektroensefalografi dan perawatan rehabilitasi selama pandemi masih berjalan seperti biasa (96% dan 46%). Sekitar 45,2% orang tua dan pengasuh setuju bahwa anak perlu divaksinasi, meskipun baru 22,2% dari seluruh subyek telah memperoleh vaksinasi.Kesimpulan. Pandemi COVID-19 tidak hanya berdampak pada manusia, melainkan juga pada sistem pelayanan kesehatan khususnya anak dengan epilepsi. Oleh karena itu, modifikasi pelayanan kesehatan selama pandemi COVID-19 merupakan kunci untuk mempertahankan kualitas pelayanan anak dengan epilepsi seperti, telekonsultasi.
Peran Puasa Ramadhan pada Anak dengan Epilepsi: Studi Pendahuluan Achmad Rafli; Ryan Pramana Putra; Irawan Mangunatmadja; Setyo Handryastuti; Amanda Soebadi
Sari Pediatri Vol 25, No 3 (2023)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp25.3.2023.170-3

Abstract

Latar belakang. Pada bulan Ramadhan semua umat Muslim diwajibkan untuk berpuasa, menahan diri untuk tidak makan, minum, atau meminum obat dari terbit hingga tenggelamnya fajar. Keadaan ini akan menimbulkan tantangan baru bagi anak dengan epilepsi yang berpuasa, berupa kontrol frekuensi kejang, perubahan jadwal minum obat, dan kepatuhan minum obat. Berpuasa dapat menyebabkan perubahan metabolisme otak yang berdampak pada peningkatan fungsi otak dalam hal kognitif, peningkatan neuroplastisitas dan ketahanan terhadap cedera dan penyakit. Adanya perubahan metabolisme otak pada saat berpuasa dapat membantu dalam mengontrol kejang pada anak dengan epilepsi.Tujuan. Penelitian ini bertujuan untuk menilai frekuensi kejang dan efek samping pada anak dengan epilepsi yang berpuasa di bulan Ramadhan tahun 2023. Metode. Penelitian ini merupakan penelitian observasional prospektif yang dilakukan selama 1 bulan. Sampel pada penelitian ini merupakan semua anak dengan epilepsi yang berpuasa pada bulan Ramadhan, April 2023. Anak dengan epilepsi yang berpuasa dipantau frekuensi kejang, jadwal minum obat dan kepatuhannya (sebelum dan setelah berpuasa). Hasil. Total pasien pada penelitian ini adalah dua belas (6 laki-laki, 6 perempuan, rentang usia 6-17 tahun). Jenis kejang absans merupakan jenis kejang yang paling banyak (50%). Tujuh pasien mendapatkan antiepilepsi monoterapi (58,33%) dengan variasi pemberian antiepilepsi 1-4 jenis. Frekuensi kejang pada seluruh pasien mengalami penurunan selama puasa Ramadhan dibandingkan dengan satu bulan sebelumnya sebesar 27%. Tidak ada efek samping yang timbul akibat berpuasa dan perubahan jadwal minum obat. Kesimpulan. Puasa Ramadhan bermanfaat menurunkan frekuensi kejang bagi anak dengan epilepsi.
Peran implanted electrically evoked auditory brainstem responses(Imp-eABR) pada pasien tuli kongenital Fikri Mirza Putranto; Jenny Bashiruddin; Semiramis Zizlavsky; Irawan Mangunatmadja; Jacub Pandelaki; Saptawati Bardosono; Wijana Hasansulama
Oto Rhino Laryngologica Indonesiana Vol. 49 (2019): Volume 49, No. 2 July - December 2019
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v49i20.320

Abstract

Latar belakang: Variasi performa pasca implan koklea menunjukkan adanya variasi patologi yang belum dapat dijelaskan melalui pemeriksaan standar pra-operasi. Untuk itu dibutuhkan pemeriksaan yang dapat menunjukkan variasi integritas jaras auditori sebagai petunjuk variasi potensi internal tiap individu. Tujuan: Mendapatkan variasi respons jaras auditori terhadap stimulus listrik pasca implan berdasarkan pemeriksaan Implanted Electrically evoked Auditory Brainstem Respons (Imp-eABR), serta korelasinya dengan faktor internal pra-implan lain berupa usia, luas area n. koklearis dan kemampuan komunikasi pra-operasi. Metode: Kriteria subjek penelitian adalah pasien operasi implan koklea berusia kurang dari 10 tahun, memiliki koklea dan n. koklearis normal, dan pada pasien berusia lebih dari 4 tahun sudah memakai alat bantu dengar minimal 1 tahun. Pemeriksaan Imp-eABR dilakukan terhadap 5 elektrode yang mewakili area apikal, medial dan basal koklea. Dicari hubungan respons dari stimulasi terhadap ketiga faktor internal.Hasil:Pemeriksaan Imp-eABR dilakukan terhadap 28 telinga dari 19 pasien yang dilakukan operasi secara unilateral dan bilateral. Rerata skor total respons Imp-eABR adalah 6,3 + 2,63; dengan 60,7% telinga memiliki skor total kurang dari 8. Uji regresi linear menunjukkan faktor usia, luas area n. koklearis dan kemampuan komunikasi berkorelasi secara bermakna dan dapat memprediksi variasi skor Imp-eABR sebanyak 49,2%. Kesimpulan:Variasi skor total Imp-eABR pada pasien dengan faktor internal pra-operasi menunjukkan adanya patogenesis lain yang mendasari kemampuan transmisi jaras pendengaran retrokoklea terhadap stimulasi listrik dari implan koklea. Faktor internal pra-operasi dapat menjelaskan kurang dari 50% variasi respons Imp-eABR. Kata kunci: Imp-eABR, luas area n. koklearis, implant koklea, integritas jaras auditori ABSTRACT Background:Variations in performance after cochlear implant indicates pathology variations that cannot be explained through standard preoperative examination. Therefore, an examination is needed to show variations in the integrity of auditory pathways as a guide to internal potential variations of each individual. Objectives: To show variations of auditory pathways responses to electrical stimulation from cochlear implant by performing Implanted Electrically evoked Auditory Brainstem Response (Imp-eABR) examination and to find its correlation to age, cochlear nerve area and preoperative communication skills. Methods: Subjects were cochlear implant patients with age less than 10 years, had normal cochlear and cochlear nerve,and patients over 4 years old with history of wearing hearing aids for at least 1 year. The Imp-eABR examination was performed to 5 electrodes representing the apical, medial and basal areas of the cochlea. Results:Imp-eABR examination was performed on 28 ears from 19 patients who underwent unilateral and bilateral surgery. The average total score of Imp-eABR responses was 6.3 + 2.63; with 60.7% of the ears having a total score of less than 8. Linear regression tests showed age,cochlear nerve area,andcommunicationabilitysignificantlycorrelate,it canexplain49.2%ofthevariationinthetotal Imp-eABR score. Conclusion: The variation in the total Imp-eABR score in patients with preoperative internal factors indicated that another pathogenesis also underlines the ability of transmission of the retrocochlear auditory pathway to electrical stimulation from the cochlear implant. Preoperative internal factors can only explain less than 50% of the variation of the Imp-eABR response.   
Co-Authors A. C. Van Huffelen Abdul Latief Adrian Prasetya Sudjono Agatha Geraldyne Agung Putra Agung Triono Agus Firmansyah Agus Firmansyah Agus Firmansyah Agustina, Nenden Nursyamsi Alan Roland Tumbelaka Alifiani H. Putranti Aman Pulungan Amanda Seobadi Amanda Soebadi Andreas, Yana Anna Tjandradjani Anna Tjandrajani Anton Dharma Saputra Antonius H. Pudjiadi Aria Kekalih Aryono Hendarto Asep Aulia Rachman Ayuningtyas, Talitha Rahma Bambang Tridjadja Bambang Tridjadja, Bambang Bambang Tridjaja AAP, Bambang Tridjaja Bernie Endyarni Medise Budiati Laksmitasari Citra Raditha Citra Raditha Citra Raditha Conny Tanjung Cut Nurul Hafifah Daisy Widiastuti Danu, Nugroho Darlan, Dewi M. Darmawan B. Setyanto Daulay, Rini S. Deasy Grafianti Dedy Rahmat Dheeva Noorshintaningsih Dian Puspitasari Dina Indah Mulyani Dina Indah Mulyani, Dina Indah Dini Prima Utami Dwi P. Widodo E S Herini Elisabeth Herini Elisabeth Siti Herini Endang Windiastuti Eva Devita Harmoniati Evita Bermansyah Ifran Fathy Pohan Fatmawaty Fatmawaty Fijri Auliyanti Fikri Mirza Putranto Freddy Guntur Mangapul Silitonga Gayatri, Anggi H F Wulandari Hanifah Oswari Hardiono D Pusponegoro Hardiono D. Pusponegoro Hardiono D. Pusponegoro Hardiono D. Pusponegoro, Hardiono D. Hariadi Edi Saputra Harjanti F Wulandari Hartono Gunardi Haryanti Fauziah Wulandari Herlina Herlina Hidra Irawan Satari Hikari Ambara Sjakti, Hikari Ambara I. Budiman Idham Amir, Imral Chair Indra Parmaditya Pamungkas Inez Ayuwibowo Sangwidjojo Iqbal Taufiqqurrachman Irene Yuniar, Irene Irma Rochima Puspita Iskandar Japardi Isman Jafar Ismy, Jufitriani Jasin, Madeleine Ramdhani Jenny Bashiruddin Joanna Erin Hanrahan Khoirul Anam KHOIRUL ANAM Kristian Kurniawan Lee, Hee Jae Lenny S. Budi Lily Rundjan Luh Karunia Wahyuni, Luh Karunia Mardjanis Said Mardjanis Said Marissa Tania Stephanie Pudjiadi Masayu Rita Dewi Maulena, Ufik Melinda Harini Melinda Harini Merci Monica br Pasaribu Muhammad Irsan Saleh Mulya Rahma Karyanti, Mulya Rahma Mulyadi M. Djer Murti Andriastuti, Murti Muzal Kadim Nadia Chairunnisa Nahari Arifin Najib Advani Nastiti Kaswandani Nia Kurniati Nur Hayati NURUL HIDAYAH Pamungkas, Indra Parmaditya Pandelaki, Jacub Pandu Caesaria Lestari Partini Pudjiastuti Trihono Purboyo Solek Pustika Amalia Pustika Amalia Putri, Armitha Putri, Shally Adhina Adhina R. H. J. M Gooskens Rachmawati, Elvie Zulka Kautzia Raden Muhammad Indra Rafli, Achmad Rahmad Mulyadi Ricca Fauziyah Rina W Sundariningrum Rinawati Rohsiswatmo Rini Sekartini Risma Kerina Kaban Risma Kerina Kaban Rismala Dewi Rizal Agus Tiansyah Ronny Suwento, Ronny Roro Rukmi Windi Perdani, Roro Rukmi Rosalina Roeslani Rosary Rosary Rulina Suradi Rulina Suradi Rulina Suradi Rusda, Muhammad Ryan Pramana Putra Sabrina Tan Safarina G. Malik Santoso, Dara Ninggar Saptawati Bardosono Sari, Teny T. Setyanto, Darmawan Budi Setyo Handryastuti Shally Adhina Adhina Putri Sisca Silvana, Sisca Soedjatmiko Soepardi Soedibyo Sri Rezeki Hadinegoro Sri Sofyani, Sri Sudigdo Sastroasmoro Sudjatmiko Sudjatmiko Sudung O Pardede Sudung O Pardede, Sudung O Sudung O. Pardede Sudung O. Pardede Sudung O. Pardede, Sudung O. Sukman Tulus Putra Sukmono, Suryawati Susanti Himawan Talitha Rahma Ayuningtyas Tantri, Aida Rosita Taralan Tambunan Taralan Tambunan Taralan Tambunan Taralan Tambunan Tatang M. Puspandjono Teny Tjitra Sari, Teny Tjitra Thandavarayan, Rajarajan Amirthalingam Tiara Aninditha Titis Prawitasari, Titis Tjhin Wiguna Tri Lestari Handayani Tuty Valensia Vivian The Victor Prasetyo Poernomo Vimaladewi Lukito Wahyuni Indawati Wardani, Amanda Saphira Wawaimuli Arozal Wicaksono, Yuda Satrio Widodo Dwi Putro Winny N Wishwadewa Wisnu Ananta Kusuma Wulandari, Harjanti F Yarmaniani Miliati Muchtar Yazid Dimyati Yeti Ramli Yeti Ramli Yulia Iriani Yuliarti, Klara Zen Hafy Zizlavsky, Semiramis