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Age, duration of work, noise and vibration in inducing hearing and balance impairments Bashiruddin, Jenny
Medical Journal of Indonesia Vol 14, No 2 (2005): April-June
Publisher : Faculty of Medicine Universitas Indonesia

Noisy and vibrating bajaj, a public transportation in Jakarta, is a potential risk in inducing hearing and balance problems. BajajÂ drivers in the Jakarta area were chosen by consecutive sampling and examined medically in the Neurotological Subdivision of theÂ ENT Department of the Cipto Mangunkusumo Hospital, Jakarta. Hearing and balance impairments were then diagnosed fromÂ audiometric and posturographic tests. The study was carried out from March 2000 until October 2001. A number of 350 bajaj driversÂ participated in this study. There were 97 subjects without hearing and balance impairments, and 96 subjects suffered from hearingÂ and balance impairments. Compared to drivers aged less than 40 years, those aged 41 years or more had a four-fold increased risk ofÂ developing hearing and balance impairments [adjusted odds ratio (OR) = 3.90; 95% confidence interval (CI) = 1.67-9.01. DriversÂ working 9 hours or more a day had an increased risk 2.3 times of developing hearing and balance impairments compared thoseÂ working less than 9 hours a day (adjusted OR = 2.32; 95% CI=I.22-4.41). Furthermore, when compared to those who had beenÂ working for 1-5 years, those who had been working for 5 years had an increased tendency of developing hearing and balanceÂ impairments. Those who had been working 21-30 years had a seven-fold increased risk of developing hearing and balanceÂ impairments (adjusted OR = 7.11; 95% CI = 1.88-26.92). To minimize hearing and balance impairments bajaj drivers areÂ recommended to work less than 8 hours a day. (Med J Indones 2005; 14: 101-6)Keywords: noise, vibration, hearing, balance impairments, driver

Validity and reliability of the Indonesian version of tinnitus handycap inventory Bashiruddin, Jenny E.; Alviandi, Widayat; Reinaldo, Alvin; Safitri, Eka D.; Pitoyo, Yupitri; Ranakusuma, Respati W.
Medical Journal of Indonesia Vol 24, No 1 (2015): March
Publisher : Faculty of Medicine Universitas Indonesia

Background: To translate and assess the validity and reliability of the Indonesian version of Tinnitus Handycap Inventory (THI) as an psychometric instrument for evaluating the quality of life in tinnitus patients. This instrument will support the clinicians to determine the appropriate tinnitus management for them.Methods: A cross-sectional psychometric validation study was performed to assess the internal consistency, reliability and validity of the Indonesian version of THI in 50 subjective tinnitus patients at ENT outpatient clinic of Cipto Mangunkusumo Hospital between May-August 2010. 25 question items of original THI were translated, back-translated and validated using the transcultural validation by WHO.Results: The validity test demonstrated a significant correlation in the emotional and the catastrophic scale whilst there was no significant correlation in the functional scale for item F2 and particularly for item F15. Nevertheless, the validity test on the functional scale showed a good result. This study also showed high internal consistency and reliability for the total scale (Cronbach-Î± = 0.91)Conclusion: The evaluation result indicated that the reliability of adapted Indonesian version of the THI in our study is relatively high and could be applied in clinical examination or further otolaryngology study by both specialists and general physicians.

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

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.

Fibrin glue and demineralized bone matrix effect on autologus cartilage graft in microtia reconstruction Dini Widiarni Widodo; Jenny Bashiruddin; Helmi Helmi; Alida Harahap; Nurjati Chairani Siregar
Oto Rhino Laryngologica Indonesiana Vol 45, No 1 (2015): Volume 45, No. 1 January - June 2015
Publisher : PERHATI-KL

Background: Microtia reconstruction is a challenge for ENT Head and Neck surgeons. Varioussurgical techniques using autograft cartilage have been done to perform auricular reconstruction.Knowledge of cartilage graft concerning resorption process that affected the size, form, and aestheticsubunit of the ear is mandatory. Purpose: To evaluate the success of cartilage autograft by identifyingchondrocyte apoptosis, tissue degradation based on cell character, matrix homogeneity, fibrosis,proteoglycans, collagen and Transforming Growth Factor β (TGF β) expression in application of FibrinGlue (FG) and or Demineralized Bone Matrix (DBM) after 12 weeks in microtia reconstruction by Nagatatechnique. Methods: Quasi-experiments. FG and/or DBM were applied on the rest of the 12 ear cartilageframework which was implanted on mastoid area. Apoptosis was examined by TUNEL. Safranin Ostaining and modified Mankin’s score was used to evaluate cartilage degradation and TGF β expressionby ELISA. Results: FG or DBM on cartilage graft showed significant increase in chondrocyte viabilitycompare with control group (p=0.00). Minimal fibrosis, more homogeneous extracellular matrix, decreasedproteoglycan and minimal thickening of collagen, had significant differences compared with control orFG-DBM group. Structure differences occurred among cartilage graft after 12 week implantation whereasFG showed minimal fibrous tissue, normal cell character, proteoglycan, collagen, and tissue homogeneity(p< 0.05). Conclusion: FG is highly recommended to reduce degradation of cartilage graft in microtiareconstruction. DBM can be still used to maintain chondrocyte viability, proteoglycans, and collagen. Keywords: cartilage graft, fibrin glue, demineralized bone matrix, transforming growth factor β, Mankinscore.ABSTRAK Latar belakang: Rekonstruksi mikrotia merupakan tantangan bagi ahli bedah THT-KL. Berbagaiteknik operasi menggunakan rangka telinga dengan tandur kartilago autologus telah dilakukan untukrekonstruksi mikrotia. Pengetahuan mengenai tandur kartilago sangat diperlukan, mengingat tandurdapat mengalami resorpsi dengan berjalannya waktu, sehingga mempengaruhi ukuran, bentuk, dan detilestetik subunit daun telinga. Tujuan: Mengetahui viabilitas kondrosit, degradasi jaringan berdasarkanperubahan karakter kondrosit, fibrosis, homogenitas matriks, ekspresi proteoglikan dan kolagenserta ekspresi transforming growth factor β (TGF β ) dengan atau tanpa fibrin glue (FG) dan/ataudemineralized bone matrix (DBM) pada rekonstruksi mikrotia setelah 12 minggu penanduran. Metode:Quasi-eksperimen. FG dan/atau DBM digunakan pada sisa tandur autologus kartilago rangka telinga,dilanjutkan pemeriksaan apoptosis dengan TUNEL. Pewarnaan Safranin O untuk menilai degradasijaringan dengan skor modifikasi Mankin dan ekspresi TGF β dengan ELISA. Hasil: penambahan FGatau DBM pada tandur kartilago, viabilitas sel meningkat berbeda bermakna dengan tanpa perlakuanatau FG-DBM.(p=0.00), fibrosis minimal, matriks lebih homogen, penurunan proteoglikan dan penebalankolagen minimal berbeda bermakna dengan kelompok tanpa perlakuan dan campuran FG-DBM. Terjadiperbedaan struktur jaringan setelah 12 minggu, FG mempunyai nilai fibrosis yang terendah, karaktersel normal, proteoglikan, kolagen, dan homogenitas jaringan (p<0,05). Kesimpulan: Penggunaan FGsangat dianjurkan untuk mengurangi degradasi tandur kartilago autologus pada rekonstruksi mikrotia. Dalam keadaan tidak memungkinkan dapat digunakan DBM karena masih baik dalam mempertahankanviabilitas kondrosit, proteoglikan dan kolagen. Kata kunci: tandur kartilago, fibrin glue, demineralized bone matrix (DBM), transforming growth factorβ (TGF β), Mankin score.

Pemeriksaan Otoacoustic Emission (OAE) untuk menilai keberhasilan terapi metilprednisolon Brastho Bramantyo; Jenny Bashiruddin; Widayat Alviandi; Risdawati Risdawati
Oto Rhino Laryngologica Indonesiana Vol 49, No 1 (2019): Volume 49, No. 1 January-June 2019
Publisher : PERHATI-KL

Latar belakang: Penatalaksanaan tuli mendadak menggunakan steroid sebagai terapi utama merupakan hasil konsensus terapi tuli mendadak tahun 2010 di Madrid-Spanyol dan Cochrane systematic review tahun 2009, yang saat ini diterapkan di Divisi Neurotologi Departemen Telinga Hidung Tenggorok-Kepala Leher Rumah Sakit Cipto Mangunkusumo. Evaluasi hasil pengobatan dilakukan dengan pemeriksaan audiometri dan Distortion Product Otoacoustic Emission (DPOAE). Pasien yang mengalami kesembuhan akan memperlihatkan peningkatan ambang dengar dan nilai Signal to Noise Ratio (SNR) emisi otoakustik. Tujuan: Mengevaluasi hasil terapi metilprednisolon dosis terbaru pada tuli mendadak dengan pemeriksaan DPOAE dan audiometri nada murni. Metode: Penelitian ini menggunakan desain pre dan post eksperimental. Diberikan terapi metilprednisolon 1 mg/kgBB dengan tapering off 20 mg setiap 5 hari. Dilakukan pemeriksaan DPOAE dan audiometri sebelum dan setelah terapi. Hasil: Total sampel yang diolah adalah 22 subjek. Penelitian ini mendapatkan perubahan yang bermakna nilai audiometri nada murni sebelum dan sesudah terapi pada semua frekuensi. Nilai SNR pada OAE sebelum dan setelah terapi rata-rata mengalami perubahan nilai pass, dengan perubahan nilai SNR pass terbanyak adalah pada frekuensi 8000 Hz (6 subjek). Tingkat perubahan ambang dengar sesudah terapi yang mengalami perbaikan paling banyak pada frekuensi 2000 Hz, 3000 Hz, 6000 Hz dengan masing-masing 16 subjek. Perbaikan emisi terjadi lebih awal dibandingkan perbaikan ambang dengar. Kesimpulan: Pada penelitian ini terdapat perubahan bermakna nilai audiometri, dan nilai DPOAE. Didapatkan hubungan bermakna perubahan SNR pada OAE dengan tingkat perubahan ambang dengar frekuensi 8000 Hz dan 10.000 Hz, setelah pengobatan metilprednisolon sesuai protokol penelitian ini. Background: Methylprednisolone as a drug of choice in sudden deafness was consented in Madrid, Spain 2010 and in Cochrane systematic review in 2009, and already applied in Neurotology Division, ENT Department Cipto Mangunkusumo Hospital. Sudden deafness treatment evaluation conducted by audiometry and Distortion Product Otoacoustic Emission (DPOAE) examinations. Hearing recovery could be assessed from the improvement of hearing threshold and Signal to Noise Ratio (SNR) of otoacoustic emission (OAE). Objective: To evaluate the current dose of methylprednisolone therapy for sudden deafness, by DPOAE and pure tone audiometry. Methods: This was a pre-post experimental study using methylprednisolone 1 mg/kg body weight tapered off 20 mg in every 5 days. DPOAE and audiometry examination were conducted pre and post therapy. Result: Total sample were 22 subjects. Significant improvement was seen in overall frequencies of audiometry examination. Pass result in SNR of OAE showed remarkable improvement in 8000 Hz (6 subjects). The level of pure tone threshold mainly increased in frequencies of 2000 Hz, 3000 Hz, and 6000 Hz, each 16 subjects. Improvement of the emision level occurred earlier than the hearing threshold. Conclusion: This study revealed significant improvement of audiometry threshold and OAE level. Significant correlation was found between SNR of OAE improvement with increased pure tone level in 8000 Hz and 10.000 Hz after methylprednisolone therapy according to the protocol of this study.

Validitas, reliabilitas dan adaptasi transkultural Dizziness Handicap Inventory dalam Bahasa Indonesia Jenny Bashiruddin; Widayat Alviandi; Brastho Bramantyo; D. Daneswarry
Oto Rhino Laryngologica Indonesiana Vol 49 (2019): Volume 49, No. 2 July - December 2019
Publisher : PERHATI-KL

Latar belakang: Keluhan gangguan keseimbangan berupa dizziness sulit untuk diukur, sementara itu individu dengan keluhan dizziness sering mengalami kesulitan untuk beraktivitas dan terganggu kualitas hidupnya. Salah satu perangkat yang paling sering digunakan untuk menilai kecacatan (handicap) pasien gangguan keseimbangan adalah kuesioner Dizziness Handicap Inventory (DHI). Sampai sekarang, kuesioner ini belum pernah diadaptasi ke bahasa Indonesia. DHI versi adaptasi yang valid dan handal (reliable) dapat digunakan untuk mengukur kualitas hidup, dan sebagai modalitas untuk menilai efektivitas terapi pasien gangguan keseimbangan. Tujuan: Mendapatkan instrumen DHI adaptasi bahasa Indonesia dengan validitas dan reabilitas yang teruji. Metode: Desain potong lintang digunakan pada studi yang dilaksanakan di poliklinik THT Divisi Neurotologi Departemen THT RS Dr. Cipto Mangunkusumo sejak Agustus 2012 sampai Februari 2013, pada pasien gangguan keseimbangan usia dewasa. Kuesioner DHI yang terdiri dari 25 pertanyaan diterjemahkan ke bahasa Indonesia, kemudian dilakukan terjemahan balik dengan proses validasi dan juga adaptasi kultural. Hasil: Uji validitas dilakukan dengan uji korelasi Spearman dan mendapatkan korelasi yang bermakna pada seluruh butir pertanyaan pada tingkat signifikansi p < 0,1 dengan nilai r sebesar 0,409- 0,783. Uji reliabilitas mendapatkan hasil nilai Cronbach-α total 0,9265 yang sangat baik untuk semua skala. Kesimpulan: Instrumen DHI adaptasi bahasa Indonesia valid dan handal berdasarkan kaidah validasi transkultural WHO sehingga dapat digunakan sebagai instrumen psikometrik untuk menilai kualitas hidup pasien gangguan keseimbangan.Kata kunci: Dizziness Handicap Inventory, gangguan keseimbangan, kecacatanABSTRACT Background: Balance disorder symptoms, such as dizziness is difficult to be assessed, it could caused difficulties in doing daily activities, and declining the quality of life. The most frequent tools used to measure handicap in patients with balance disorder is Dizziness Handicap Inventory (DHI). This questionnaire has never been adapted to Indonesian language. A valid and reliable version of the DHI adaptation can be used to measure the quality of life and also as a modality for assessing the effectiveness of therapeutic outcomes in balance disorders patients. Purpose: To obtain an Indonesian adaptation of DHI instrument which is valid and reliable. Methods: A cross-sectional research design in Outpatient Clinic of Neurotology Division, Department of Otorhinolaryngology, Cipto Mangunkusumo General Hospital, from August 2012 to February 2013. Respondents were all adult patients with balance disorders. DHI questionnaire contained 25 questions was translated into Indonesian language and re-translated with validation process and cultural adaptation. Results: The validity test was carried out with Spearman correlation test and obtained a significant correlation on all questions at a significance level of p<0.1 with r value of 0.409-0.783. The reliability test obtained a Cronbach-α value of 0.9265 which was very good for all scales. Conclusion: The Indonesian adaptation of DHI instrument was valid and reliable based on WHO transcultural validation rules, therefore it can be used as a psychometric instrument to assess the quality of life of patients with balance disorders.

A survey of Indonesian otolaryngologist behavior in medical service during the CoVid-19 pandemic Indra Zachreini; Jenny Bashiruddin; Susyana Tamin; Harim Priyono; Ika Dewi Mayangsari; Respati Ranakusuma; Natasha Supartono; Fikri Mirza Putranto; Dewo Aksoro; Selfiyanti Bimantara; Yussy Afriana Dewi; Kote Noordhianta; Bintang Napitupulu; Sagung Rai Indrasari; Nyilo Purnami; Tengku Siti Hajar Haryuna; Juliandi Harahap; Eka Savitri; Tjandra Manukbua
Oto Rhino Laryngologica Indonesiana Vol 51, No 1 (2021): Volume 51, No. 1 January - June 2021
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v51i1.444

Background: World Health Organization (WHO) announced a newly discovered virus that first identified in Wuhan, China on December 2019, namely SARS-CoV-2 as the cause of corona virus disease (COVID-19) which had become global pandemic. Doctors as medical practitioners are categorized as vulnerable group to be infected by corona virus, and many otorhinolaryngologists had been infected and even died in performing medical services. Among the causative factors why otorhinolaryngologists could get infected by corona virus is their behavior. Purpose: To assess the behavioral level of otorhinolaryngologists in medical services during Covid-19 pandemic. Method: Descriptive study with a cross sectional design. Research samples were otorhinolaryngologists in Indonesia who met the inclusions criteria. The samples were selected by consecutive sampling method, and obtained 1299 subjects. Behavioral level was assessed from 3 aspects: knowledge, attitude, and practice, which comprised of 12 questions. Result: It was found that 461 respondents had a good behavioral level (35.5%), 677 respondents had moderate levels (52.1%) and 161 respondents had low level (12.4%). There was a statistically significant correlation between knowledge with behavioral level, attitude with behavioral level, and practice with behavioral level (p=0.001). Conclusion: The study of behavioral level of otorhinolaryngologists in medical service during Covid-19 pandemic obtained the highest number was moderate level 677 respondents (57.2%), and there was a statistically significant correlations between the variable of knowledge with behavioral level, the variable of attitude with behavioral level, and the variable of practice with behavioral level (p=0.001).ABSTRAK Latar belakang: Organisasi kesehatan dunia (WHO) mengumumkan virus baru yang pertama kali muncul di Wuhan China, pada Desember 2019, yaitu SARS-CoV-2 sebagai penyebab corona virus disease 19 (Covid 19) dan menyatakan sebagai pandemi. Dokter sebagai tenaga kesehatan merupakan kelompok yang rentan terinfeksi virus corona dan berdasarkan laporan, sudah banyak dokter Telinga Hidung Tenggorok - Bedah Kepala Leher (THT-KL) yang terinfeksi bahkan meninggal dunia dalam pelayanan medis. Salah satu faktor penyebab dokter THT-KL terinfeksi oleh virus corona adalah tingkat perilaku dokter THT-KL. Tujuan: Mengetahui tingkat perilaku dokter THT-KL dalam melakukan pelayanan medis saat pandemi Covid 19. Metode: Penelitian deskriptif dengan rancangan studi potong lintang. Sampel penelitian adalah dokter THT-KL di Indonesia yang memenuhi kriteria inklusi. Teknik pengambilan sampel secara berurutan, dan mendapatkan 1299 sampel. Tingkat perilaku dinilai dari 3 aspek yaitu dimulai dari pengetahuan, sikap dan tindakan yang terdiri dari 12 pertanyaan. Hasil: Didapatkan tingkat perilaku responden dokter THT-KL dalam pelayanan medis pada pandemi Covid 19, tingkat perilaku baik sebanyak 461 responden (35,4%), tingkat sedang 677 responden (52,1%), dan tingkat kurang 161 responden (12.4%). Terdapat hubungan yang signifikan antara pengetahuan dan tingkat perilaku, sikap dengan tingkat perilaku dan tindakan dengan sikap perilaku (p=0,001). Kesimpulan: Didapatkan tingkat perilaku dokter THT-KL dalam pelayanan medis pada pandemi covid 19, terbanyak adalah tingkat perilaku sedang sebanyak 677 responden (57,2%), dan terdapat hubungan yang bermakna antara variabel pengetahuan dengan tingkat perilaku, variabel sikap dengan tingkat perilaku dan variabel tindakan dengan tingkat perilaku dokter THT-KL dalam pelayanan medis pada pandemi Covid 19, dimana nilai p = 0,001. Kata kunci: perilaku, dokter THT-KL, pandemic, Covid-19

Peran Tes Dynamic Visual Acuity dan Tes Kalori dalam Menilai Gangguan Keseimbangan pada Pasien Tuberkulosis yang Mendapat Terapi Streptomisin Widayat Alviandi; Brashto Bramantyo; Jenny Bashiruddin; Novra Widayanti
Oto Rhino Laryngologica Indonesiana Vol 48, No 2 (2018): Volume 48, No. 2 July - December 2018
Publisher : PERHATI-KL

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32637/orli.v48i2.249

Latar belakang: Gangguan keseimbangan merupakan efek samping pemberian streptomisin yang dapat menurunkan kualitas hidup. Saat ini belum didapatkan penelitian gangguan keseimbangan pada pasien tuberkulosis yang mendapat terapi streptomisin diperiksa menggunakan tes dynamic visual acuity (DVA) dan tes kalori. Tujuan: Penelitian ini bertujuan untuk melihat akurasi pemeriksaan keseimbangan dengan DVA pada pasien TB yang mendapatkan streptomisin dibandingkan dengan elektronistagmografi (ENG). Metode: Penelitian ini merupakan penelitian pra-eksperimental untuk mengetahui perubahan hasil pemeriksaan fungsi keseimbangan vestibuler pada suatu kelompok pasien TB sebelum dan setelah 56 kali pemberian streptomisin, atau bila timbul keluhan gangguan keseimbangan dengan tes DVA dan tes kalori selama April-Oktober 2014. Digunakan rancangan uji diagnostik untuk membandingkan kedua cara pengukuran setelah pengobatan. Hasil: Setelah pemberian terapi didapatkan 31 (77,5%) dari 40 subjek dengan pemeriksaan kalori dan 30 (75%) dengan pemeriksaan DVA. Rerata nilai kalori sebelum terapi sebesar 93,5±32,07°/detik dan setelah terapi sebesar 82,30±38,43°/detik, terjadi perubahan sebesar -11,25±50,55°/detik. Median nilai kenaikan DVA sebelum terapi adalah 0 (minimal 0-maksimal 2) baris dan setelah terapi adalah 3 (minimal 0-maksimal 6) baris, terjadi perubahan sebesar 3 (minimal 0-maksimal 5) baris. Sensitivitas pemeriksaan DVA 83%, spesifisitas 27%, nilai duga positif 17%, nilai duga negatif 90%, rasio kemungkinan positif 1,13, dan rasio kemungkinan negatif 0,63 dengan pemeriksaan kalori sebagai baku emas. Kesimpulan: Pemeriksaan DVA dapat digunakan sebagai skrining pemeriksaan kelemahan vestibuler perifer bilateral pada pasien tuberkulosis yang mendapat terapi streptomisin.Background: Impaired balance is the side effect of Streptomycin administration which can decrease the quality of life Up till now, there is no research yet on dynamic visual acuity (DVA) and caloric test in tuberculosis (TB) patients receiving streptomycin therapy. Objective: This study aims to look at the accuracy of the examination using DVA in TB patients receiving Streptomycin, compared to using electronistagmography (ENG). Methods: A pre-experimental study was used to determine changes in the vestibular function test results in a group of TB patients before and after56times administrationof Streptomycin, or when subjects complained of balance disorders, with DVA test and caloric test during April-October 2014. Designed diagnostic test was used after treatment to compare the two methods of measurement. Result: After therapy there was 31 (77.5%) out of 40 subjects with caloric examination and in 30 (75%) with DVA examination. The mean value of caloric examination before therapy was 93.5±32.07°/sec and after therapy was 82.30±38.43°/sec, the change was -11.25±50.55°/sec. The median value of increased DVA line before therapy was 0 line and after therapy was 3 line, there was a change of 3 (minimum 0-maximum 5) line. DVA examination has a sensitivity of 83%, a specificity of 27%, positive predictive value 17%, negative predictive value 90%, a positive likelihood ratio 1.13 and a negative likelihood ratio 0.63 with caloric examination as the gold standard. Conclusion: DVA examination can be used as a screening tool in bilateral peripheral vestibular weakness in TB patients who received Streptomycin therapy.

Words in noise audiometry in adult subjects with normal hearing Widayat Alviandi; Jenny Bashiruddin; Brastho Bramantyo; Farisa Rizky
Oto Rhino Laryngologica Indonesiana Vol 50, No 1 (2020): Volume 50, No. 1 January - June 2020
Publisher : PERHATI-KL

Background: Patients with hearing disturbance will generally undergo pure tone audiometry andspeech audiometry in a quiet room, but those examinations cannot evaluate the ability to understand speech in daily environment with a noisy background. Words in noise test will provide valuable informationregarding patient’s hearing problem in noise. Purpose: To evaluate the hearing threshold using wordsin noise test in adults with normal hearing. Method: This cross-sectional study was conducted in CiptoMangunkusumo Hospital from January to April 2017. All subjects who fulfilled the inclusion and exclusioncriteria underwent pure tone audiometry, speech audiometry, and words in noise test. Results: A total of71 individuals with normal hearing were recruited for this study. Words in noise test showed the medianvalue of 67 dB and 100 dB for Speech Recognition Threshold (SRT) 50% and Speech DiscriminationScore (SDS) 100%, respectively. The SRT 50% and SDS 100% were significantly higher in the age group40–60 years compared to the age group 18–39 years. There was also a statistically significant differencebetween males and females at SRT 50% assessed by words in noise audiometry. Conclusion: Wordsin noise test showed a statistically significant difference in SRT 50% and SDS 100% between two agegroups, but no difference was found between genders. The result of this study can be used as a referencefor SRT and SDS values of speech audiometry test in noise.Keywords: words in noise, speech audiometry, speech recognition threshold, speech discrimination score ABSTRAKLatar belakang: Pasien dengan gangguan pendengaran umumnya menjalani pemeriksaanaudiometri nada murni dan audiometri tutur di ruangan yang sunyi, tetapi pemeriksaan ini tidakdapat menggambarkan kemampuan pemahaman wicara di lingkungan sehari-hari yang ramai. Testutur dalam bising dapat mengevaluasi masalah pendengaran pasien dalam keadaan bising. Tujuan:Untuk mengevaluasi ambang pendengaran menggunakan tes tutur dalam bising pada orang dewasadengan pendengaran normal. Metode: Penelitian potong lintang ini dilakukan di Rumah Sakit CiptoMangunkusumo dari Januari hingga April 2017. Semua subjek yang memenuhi kriteria inklusi daneksklusi menjalani pemeriksaan audiometri nada murni, audiometri tutur, dan tes tutur dalam bising.Hasil: Sebanyak 71 orang dengan pendengaran normal diikutsertakan dalam penelitian ini. Tes tuturdalam bising menunjukkan nilai median masing-masing 67 dB dan 100 dB pada Speech RecognitionThreshold (SRT) 50% dan Speech Discrimination Score (SDS) 100%. SRT 50% dan SDS 100% secarasignifikan lebih tinggi pada kelompok usia 40–60 tahun dibandingkan dengan kelompok usia 18–39 tahun. Hasil pemeriksaan tes tutur dalam bising menunjukkan perbedaan yang signifikan antara laki-laki dan wanita pada nilai SRT 50%. Kesimpulan: Tes tutur dalam bising menunjukkan perbedaan yang bermakna secara statistik pada SRT 50% dan SDS 100% antara dua kelompok umur, tetapi tidak ada perbedaan signifikan diantara jenis kelamin. Hasil penelitian ini dapat digunakan sebagai acuan untuk nilai SRT dan SDS pada pemeriksaan audiometri tutur dalam bising.

Pengaruh latihan Brandt Daroff dan modifikasi manuver Epley pada vertigo posisi paroksismal jinak Widjajalaksmi Kusumaningsih; Andy Ardhana Mamahit; Jenny Bashiruddin; Widayat Alviandi; Retno Asti Werdhani
Oto Rhino Laryngologica Indonesiana Vol 45, No 1 (2015): Volume 45, No. 1 January - June 2015
Publisher : PERHATI-KL

Latar belakang: Latihan Brandt Daroff (BD) dan latihan Modifikasi Manuver Epley (MME) merupakan rehabilitasi vestibular sebagai terapi latihan mandiri di rumah bagi penderita Vertigo PosisiParoksismal Jinak (VPPJ) yang menggunakan sistem sensori terintegrasi. Secara fisiologis, BD berperandalam proses adaptasi sistem vestibular dan MME berperan dalam reposisi otolit. Tujuan: Untukmengetahui dan membandingkan efek terapi latihan vestibular mandiri BD dan MME terhadap perbaikangangguan keseimbangan penderita VPPJ. Metode: Studi pendahuluan dengan desain kuasi eksperimenpada 23 subjek VPPJ yang diperoleh secara consecutive sampling, laki-laki dan perempuan berusia 2060 tahun. Secara random dibagi menjadi dua kelompok yaitu kelompok BD(n=12) dan kelompokMME(n=11)untuk latihan mandiri di rumah. Nilai Symptoms Severity Score (SSS) dianalisis menggunakanuji McNemar dan nilai posturografi dianalisis dengan uji t berpasangan atau uji Wilcoxon Signed Rank bila sebaran data tidak normal. Hasil: Terdapat perbedaan bermakna pada nilai SSS pada latihan BD danlatihan MME (p<0,05). Tidak ditemukan perbedaan bermakna pada nilai posturografi dengan latihan MME.Ditemukan perbedaan bermakna (p<0,05) pada sepuluh variabel posturografi dengan latihan BD. Tidakditemukan perbedaan bermakna (p>0,05) dari nilai SSS dan posturografi antara latihan Brandt Daroff dan MME. Kesimpulan: Terdapat perbaikan bermakna nilai SSS yang lebih cepat pada kelompok yang diberi latihan Brandt Daroff dibandingkan dengan kelompok MME. Kata kunci: VPPJ, BD, MME , SSS, PosturografiABSTRACT Background: Brandt Daroff (BD) and modified Epley maneuver (MEM) are independent vestibular rehabilitation therapeutic home program exercises for Benign Poxysmal Positional Vertigo (BPPV)patients using sensory integration. BD is an adaption process in vestibular system and MEM is based oncanalith reposition. Purpose: To find out and compare the effects of BD and MEM on improving symptomsof balance disorder in BPPV patients. Methods: A pilot study with quasi experimental design for 23BPPV subjects, taken by consecutive sampling. Subjects are male and female, aged 20-60 years old. Byrandomization, subjects were allocated into two groups, group BD (n=12) and group MEM (n=11). Thevalue of symptoms severity was scored using McNemar test. The posturography result was evaluated byPair t test or Wilcoxon Signed Rank test. Result: There was a significant difference on SSS value (p<0,05)of BD exercise and MEM exercise. No significant difference was found on posturography scores withMEM exercise. There was a significant difference (p<0,05) on ten posturography variables using BDexercise. No significant difference was found between BD and MME from SSS and posturography value(p>0,05). Conclusion: This study found out that there was a significantly faster improvement of SSS inthe BD group compared with the MME group. Keywords: BPPV, BrandtDaroff, MEP, SSS, posturography

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