208733955 referat tuli sensorineural

8/16/2019 208733955 Referat Tuli Sensorineural

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KEPANITERAAN KLINIK

STATUS ILMU PENYAKIT THT

FAKULTAS KEDOKTERAN UKRIDA

SMF PENYAKIT THT

RUMAH SAKIT UMUM DAERAH TARAKAN

Nama : M. Sany Armansah

NIM : 11.2012.03

!r. "#m$%m$%n& : !r. R%'a R%'a(!%) S". THT*KL

IDENTITAS PASIEN

Nama : Tn. Ir% +#n%s ,#(am%n : La,%*(a,%

Um-r : ah-n A&ama : Is(am

P#,#r/aan : T%!a, $#,#r/a P#n!%!%,an : SMA

A(ama : Tan&#ran& Sa-s m#n%,ah : M#n%,ah

I. ANAMNESIS

D%am$%( s#ara a-*anamn#s%s) "a!a an&&a( O,$#r 2013) "-,-( : 10.00 I4

Keluhan utama : P#n!#n&aran ,-ran& /#(as "a!a ,#!-a #(%n&a.

Keluhan tambahan : *

Riwayat perjalanan penyakit

Pas%#n !aan& ,# "(% ,(%n%, THT RSUD Tara,an !#n&an ,#(-han "#n!#n&arannya

,-ran& /#(as s#/a, 51 ah-n #ra,h%r. P#n!#n&aran !%rasa,an $#r,-ran& #r-ama a"a$%(a

s#!an& $#ra!a !%#m"a yan& rama%) aa- s-m$#r s-ara !aan& !ar% #m"a yan& /a-h) s#"#r%

saa !%"an&&%( namanya !ar% ,#/a-han. K#(-han "#n!#n&aran !%rasa,an ma,%n m#m$-r-,

s#%r%n& 6a,-.



Pas%#n m#n&aa,an %!a, "#rnah a!a r%6aya #!#ra "a!a ,#"a(a) r%6aya -(% s#/a,

(ah%r) -(% s#ara m#n!a!a,) r%6aya "#n&$aan T4 "ar- #r-ama !#n&an sr#"m%s%n)

aa-"-n r%6aya s#r%n& #r"a"ar "a/anan $%s%n&.

Pas%#n m#n&aa,an %!a, "#rnah "-nya ,#(-han sa,% ,#"a(a) ny#r% #(%n&a aa-

"#nya,% "a!a #(%n&a) ,#(-ar a%ran) ,#(-han $a-, "%(#, yan& s#r%n&) aa-"-n a(#r&%.

Riwayat penyakit dahulu :

Pas%#n m#n&aa,an %!a, "#rnah m#m%(%,% ,#(-han "a!a #(%n&a) h%!-n& ma-"-n

#n&&r,an s#$#(-mnya. Ta"% "#rnah $#r$a ,# "(%,(%n%, THT ,ar#na a!a ,ran yan&

m#ny-m$a !% #(%n&a.

Riwayat penyakit keluarga:

Pas%#n m#n&aa,an ,-ran& ah- /%,a !% ,#(-ar&a a!a yan& m#n!#r%a asma aa- a(#r&%.

II. PEMERIKSAAN FISIK

. S!A!"S #ENERA$IS

* K#a!aan -m-m : am"a, sa,% r%n&an

* K#sa!aran : m"s m#n%s

* Sa-s &%'% : -,-"

* Na!% : ,a(% 7 m#n%* T#ns% : 130780 mmH&

* S-h- : 3) 9

* P#rna"asan : 20 ,a(% 7 m#n%

%. KEPA$A &AN $E'ER

* K#"a(a : nrms#;a(%

* a/ah : s%m#r%s

* L#h#r an#r%r : K<4 %!a, m#m$#sar) ny#r% #,an =*>

* L#h#r "s#r%r : K<4 %!a, m#m$#sar) ny#r% #,an =*>

(. !E$IN#A

KANAN KIRI

4#n-, !a-n #(%n&a Nrm%a Nrm%a

K#(a%nan ,n&#n%a( T%!a, a!a T%!a, a!aRa!an&) -mr T%!a, a!a T%!a, a!a



Ny#r% #,an ra&-s T%!a, a!a T%!a, a!a

P#nar%,an !a-n #(%n&a T%!a, a!a T%!a, a!a

K#(a%nan "r#) %n;ra)

r#ra-r%,-(#r

A$s#s =*>

h%"#r#m%s =*>

ny#r% #,an =*>

-mr =*>

A$s#s =*>

h%"#r#m%s =*>

ny#r% #,an =*>

-mr =*>

R#&%n mas%! A$s#s =*>

ny#r% #,an =*>

A$s#s =*>

ny#r% #,an =*>

L%an& #(%n&a La"an&) ;-r-n,#( =*>

/ar%n&an &ran-(as% =*>

s#r-m#n =*>

s#,r# =*>)

h%"#r#m%s =*>

#!#ma =*>

La"an&) ;-r-n,#( =*>

/ar%n&an &ran-(as% =*>

s#r-m#n =*>

s#,r# =*>

h%"#r#m%s =*>

#!#ma =*>

M#m$ran# %m"an% U-h) "#r;ras% =*>

r#;(#, ahaya =?>

H%"#r#m%s =*>

U-h) "#r;ras% =*>

r#;(#,s ahaya =?>

h%"#r#m%s =*>

!ES PE$ANA

KANAN KIRI

R%nn# Ps%%; Ps%%;

#$#r T%!a, a!a (a#ra(%sas% T%!a, a!a (a#ra(%sas%

S6a$ah M#m#n!#, M#m#n!#,

P#na(a yan& !% "a,a% @12 H' @12 H'

Ke)an : T-(% s#nsr%n#-ra(

*. 'I&"N#• 4#n-, : S%m#r%s

• Tan!a "#ra!an&an : T%!a, !%#m-,an an!a "#ra!an&an !ar% (-ar



+.

+.

+.

+.

+.

+.

+.

+.

+.

+.

+.

+.

+.

+.

+.

+.

+.+.

+.

+.

+.

R'IN,P'AR-N

• Kana : T#r$-,a

• S#"-m nas% "s#r%r : T%!a, !#%as%

•M-ara -$a #-sah%-s : E!#ma=*>) %!a, #r--" s#,r#

• T-$a #-sah%-s : E!#ma=*>) %!a, #r--" s#,r#

• Tr-s -$ar%-s : E!#ma=*>

• Ps nasa( !r%" : T%!a, a!a

/. PEMERIKSAAN !RANSI$"MINASI

• S%n-s ;rna(%s ,anan) &ra!# : T%!a, !%(a,-,an

• S%n-s ;rna(%s ,%r%) &ra!# : T%!a, !%(a,-,an

• S%n-s maB%((ar%s ,anan) &ra!# : T%!a, !%(a,-,an

• S%n-s maB%((ar%s ,%r%) &ra!# : T%!a, !%(a,-,an

0. !EN##,R,K

KANAN KIRI

C#s%$-(-m Tam"a, $-(- h%!-n&

S#,r# =*>

;-r-n,#( =*>

,r-sa =*>

Tam"a, $-(- h%!-n&

S#,r# =*>

;-r-n,#( =*>

,r-sa =*>

a-m nas% La"an&

S#,r# =*>

La"an&

S#,r# =*>

Kn,a %n;#r%r H%"#r#m%s =*>

E!#ma =*>

H%"#rr;% =*>

S#,r# =*>

H%"#r#m%s =*>

E!#ma =*>

H%"#rr;% =*>

S#,r# =*>

Kn,a m#!%-s H%"#r#m%s =*>

E!#ma =*>

S#,r# =*>

H%"#r#m%s =*>

E!#ma =*>

S#,r# "-r-(#n =*>

M#a-s nas% m#!%-s T%!a, am"a,

s-(% !%n%(a%

T%!a, am"a,

s-(% !%n%(a%

S%n-s Frna(%s

=ny#r% #,an ? ny#r% ,#-,>

* *

S%n-s Ma,s%(ar%s

=ny#r% #,an ? ny#r% ,#-,>

* *

S#"-m nas% S%m#r%s) %!a, a!a

!#%as%

S%m#r%s) %!a, a!a

!#%as%



FARIN#

• D%n!%n& ;ar%n& : H%"#r#m%s =*>) &ran-( =*>) "s nasa( !r%" =*>

• Ar-s : H%"#r#m%s =*>

• Tns%( : T1*T1 #nan&) h%"#r#m%s =*>),r%"a =*>)m#(#$ar =*>) !#r%-s =*>.

• U-(a : 4#n-, nrma() (#a, !%#n&ah) h%"#r#m%s =*>

• <%&% : A!a $#$#ra"a &%&% yan& s-!ah an&&a(

$ARIN#

• E"%&(%s : %!a, !%(a,-,an.

• P(%a ary#"%&(%s : %!a, !%(a,-,an.

• Ary#n%!s : %!a, !%(a,-,an.

• C#nr%-(ar $an! : %!a, !%(a,-,an.

• P%a s-ara : %!a, !%(a,-,an.

• R%ma &(%s : %!a, !%(a,-,an.• %n%n) ra,#a : %!a, !%(a,-,an.

• S%n-s "%r%;rm%s : %!a, !%(a,-,an.

• K#(#n/ar (%m;# s-$man!%$-(a !an #r%a( : %!a, !%(a,-,an.

III. RES"ME

S#ran& "as%#n Tn. I) -s%a ah-n) !aan& ,# "(% ,(%n%, THT RSUD Tara,an !#n&an

,#(-han "#n!#n&arannya ,-ran& /#(as s#/a, 51 ah-n #ra,h%r. P#n!#n&aran !%rasa,an

$#r,-ran& #r-ama a"a$%(a s#!an& $#ra!a !%#m"a yan& rama%) aa- s-m$#r s-ara !aan&

!ar% #m"a yan& /a-h. K#(-han !%rasa,an $#raha" m#n-r-n) %!a, %$a*%$a.

Pa!a "#m#r%,saan ;%s%, !%!a"a,an :

- K#a!aan -m-m am"a, sa,% s#!an&) ,#sa!aran M) #,anan !arah 13070 mmH&)

na!% ,a(%7m#n%) "#rna"asan 20 ,a(%7m#n%) !an s-h- 3)9.

- T#(%n&a ,anan : (%an& #(%n&a (a"an&) h%"#r#m%s =*>) #!#ma =*>) s#,r# =*>) s#r-m#n =*>)

m#m$ran# %m"an% --h. $#r6arna ,#a$-*a$-an) r#;(#,s ahaya =?>.

- T#(%n&a ,%r% : (%an& #(%n&a (a"an&) h%"#r#m%s =*>) #!#ma =*>) s#,r# =*>) s#r-m#n =*>)

m#m$ran# %m"an% --h) $#r6arna ,#a$-*a$-an) r#;(#,s ahaya =?>.

- Pa!a #s "#na(a !%!a"a,an r%nn# "s%%; "a!a #(%n&a ,anan !an ,%r%) 6#$#r %!a, a!a

(a#ra(%sas%) !an s6a$ah m#m#n!#,.

- H%!-n& : %!a, a!a ,#(a%nan

-

T#n&&r, : %!a, a!a ,#(a%nan



I1. &IA#N,SIS

- 2,RKIN# &IA#N,SIS : Pr#s$%a,-s%s

Dasar !%a&ns%s: * #s "#na(a ,#san -(% s#nsr%n#-ra(

* -s%a @ ah-n !an s%m#r%s =s#s-a% "r#s$%a,-s%s>

* anamn#s%s m#n&arah -(% sara; "a!a &#r%ar%

* "#m#r%,saan ;%s%, a, !%#m-,an an!a -(% ,n!-,s%1. PENA!A$AKSANAAN

- M#!%,a m#nsa: *

- Nn m#!%,a m#nsa:

o M#n&&-na,an A(a 4an- D#n&ar 7 H#ar%n& A%!

1I. PR,#N,SIS

A! %am : !-$%a

A! ;-n&s%nam : !-$%a

A! sana%nam : !-$%a

TIN+AUAN PUSTAKA

ANA!,MI !E$IN#A 1)2

T#(%n&a #r!%r% aas #(%n&a (-ar) #(%n&a #n&ah) !an #(%n&a !a(am.

!elinga $uar

T#(%n&a (-ar #r!%r% !ar% !a-n #(%n&a !an (%an& #(%n&a sam"a% m#m$ran %m"an%.



&aun telinga

Da-n #(%n&a #r!%r% !ar% -(an& ra6an #(as%n !an ,-(%. 4a&%an !a-n #(%n&a $#r;-n&s% -n-,

m#m$an- m#n&arah,an s-ara ,# !a(am (%an& #(%n&a !an a,h%rnya m#n-/- m#m$ran %m"an%.

$iang telinga

L%an& #(%n&a $#r$#n-, h-r-; S) !#n&an ran&,a -(an& ra6an "a!a s#"#r%&a $a&%an (-ar)

s#!an&,an !-a "#r%&a $a&%an !a(amnya #r!%r% !ar% -(an&. Pan/an&nya ,%ra*,%ra 2) @ 3 m.

Ranan&an yan& $#&%- ,m"(#,s "a!a #(%n&a (-ar $#r;-n&s% -n-, m#nan&,a" s-ara !an

$a&%an #r"#n%n& a!a(ah (%an& #(%n&a. Sa(-ran %n% m#r-"a,an has%( s-s-nan -(an& !an ra6an

yan& !%(a"%s% ,-(% %"%s. Pa!a s#"#r%&a $a&%an (-ar ,-(% (%an& #(%n&a #r!a"a $anya, ,#(#n/#r

s#r-m#n !an ram$-. K#(#n/#r ,#r%n&a #r!a"a "a!a s#(-r-h ,-(% (%an& #(%n&a. Pa!a !-a

"#r%&a $a&%an !a(amnya hanya s#!%,% !%/-m"a% ,#(#n/#r s#r-m#n. 2

M#m$ran T%m"an%

M#m$ran %m"an% m#r-"a,an s-a- $an&-nan $#r$#n-, ,#r-- !#n&an "-na,nya -m$)

m#n&arah ,# m#!%a(. M#m$ran %m"an% #rs-s-n (#h s-a- (a"%san #"%!#rm%s !% $a&%an (-ar)

(a"%san ;%$rsa !% $a&%an #n&ah !%mana an&,a% ma(#-s !%(#,a,an) !an (a"%asan m-,sa

$a&%an !a(am. La"%san F%$rsa %!a, #r!a"a !% aas "rs#s-s (a#ra(%s ma(#-s !an %n%

m#ny#$a$,an $a&%an m#m$rana %m"an% yan& !%s#$- m#m$ran Shra"n#(( m#n/a!% (#mas

= ;(a,s%! >.

M#m$ran %m"an% #r(%ha $-n!ar !an #,-n& $%(a !%(%ha !ar% arah (%an& #(%n&a !an #r(%ha

$(%, #rha!a" s-m$- (%an& #(%n&a. 4a&%an aas !%s#$- "ars ;(a,s%!a =m#m$ran sha"hrn#((>)

s#!an&,an $a&%an $a6ah "ars #nsa =m#m$ran "r"r%a>. Pars F(a,s%!a #r!%r% !ar% 2 (a"%s:

#"%#( ,-(% (%an& #(%n&a !an s#( ,-$-s $#rs%(%a s#"#r% #"%#( m-,sa sa(-ran na;as. Pars T#nsa

m#m"-nya% sa- (a"%s $a&%an #n&ahya ya%- (a"%san yan& #r!%% !ar% s#ra ,(a&#n yan&

$#r/a(n s#ara ra!%#r !% $a&%an (-ar !an s%r,-(#r "a!a $a&%an !a(am.1)2



<am$ar 2 : Anam% T#(%n&a

!elinga !engah

4a&%an %n% m#r-"a,an rn&&a yan& $#r%s% -!ara -n-, m#n/a&a #,anan -!ara a&ar s#%m$an&.

D% !a(amnya #r!a"a sa(-ran Eustachio yan& m#n&h-$-n&,an #(%n&a #n&ah !#n&an ;ar%n&.

Rn&&a #(%n&a #n&ah $#rh-$-n&an !#n&an #(%n&a (-ar m#(a(-% m#m$ran %m"an%.

H-$-n&an #(%n&a #n&ah !#n&an $a&%an #(%n&a !a(am m#(a(-% /#n!#(a a( !an /#n!#(a

$-n!ar yan& ,#!-anya !%(a"%s% !#n&an m#m$ran yan& rans"aran.

S#(a%n %- #r!a"a "-(a %&a -(an& "#n!#n&aran yan& #rs-s-n s#"#r% rana% yan&

m#n&h-$-n&,an &#n!an& #(%n&a !#n&an /#n!#(a a(. K#%&a -(an& #rs#$- a!a(ah tulang

martil (maleus) m#n#m"#( "a!a &#n!an& #(%n&a !an tulang landasan (inkus). K#!-a -(an&

%n% #r%,a #ra (#h (%&am#n-m s#h%n&&a m#r#,a $#r&#ra, s#$a&a% sa- -(an&. T-(an& yan&

,#%&a a!a(ah tulang sanggurdi (stapes) yan& $#rh-$-n&an !#n&an /#n!#(a a(. Anara

-(an& (an!asan !an -(an& san&&-r!% #r!a"a s#n!% yan& m#m-n&,%n,an &#ra,an $#$as.

F-n&s% ran&,a%an -(an& !#n&ar a!a(ah -n-, m#n&%r%m,an &#aran s-ara !ar% m#m$ran

%m"an% m#ny#$#ran&% rn&&a #(%n&a #n&ah ,# %n&,a" (n/n&.1

!elinga &alam



<am$ar 3. T#(%n&a Da(am

La$%r%n =#(%n&a !a(am> m#n&an!-n& r&an "#n!#n&aran !an ,#s#%m$an&an !an #r(#a, "a!a

"ars "#rsa s #m"ra(. La$%r%n #r!%r% !ar%:

a. La$%r%n $a&%an -(an&) #r!%r% !ar% : ,ana(%s s#m%s%r,-(ar%s) #s%$-(-m) !an ,,(#a.

$. La$%r%n $a&%an m#m$ran) yan& #r(#a, !%!a(am (a$%r%n $a&%an -(an&) yan& #r!%r% !ar%

,ana(%s s#m%s%r,-(ar%s) -r%,-(-s) sa,-(-s) sa,-s !an !-,-s #n!(%m;a%,-s) s#ra ,,(#a.

Anara (a$%r%n $a&%an -(an& !an m#m$ran #r!a"a s-a- r-an&an yan& $#r%s% a%ran

"#r%(%m;# yan& $#rasa( !ar% a%ran s#r#$rs"%na(%s !an ;%(ras% !arah. D% !a(am (a$%r%n $a&%an

m#m$ran #r!a"a a%ran #n!(%m;# yan& !%"r!-,s% (#h sr%a as,-(ar%s !an !%r#sr$s% "a!a

sa,-s #n!(%m;a%,-s. La$%r%n m#m$ran !%,#(%(%n&% (#h a%ran "#r%(%m;# = %n&&% nar%-m !an

r#n!ah ,a(%-m> yan& #r!a"a !a(am ,a"s-(a %,a $#r-(an&.2

C#s%$-(-m a!a(ah s-a- r-an&an ,#%( yan& $#r$#n-, a() $#r-,-ran 5 @ B 3 mm

yan& m#m%sah,an ,,(#a !ar% ,ana(%s s#m%s%r,-(ar%s. Pa!a !%n!%n& (a#ra( #r!a"a ;ram#n

a(# =;#n#sra #s%$-(%> s#!an&,an ;ram#n r-n!-m #r!a"a "a!a (a#ra( $a6ah. Pa!a

!%n!%n& m#!%a( $a&%an an#r%r #r!a"a (#,-,an $#r$#n-, s"h#r%s yan& $#r%s% ma,-(asa,-(%

!an #r!a"a (-$an& ,#%( yan& $#r%s% s#ra$- sara; #s%$-(ar %n;#r%r. Pa!a !%n!%n& "s#r%r



#r!a"a m-ara !ar% ,ana(%s s#m%s%r,-(ar%s !an $a&%an an#r%r $#rh-$-n&an !#n&an s,a(a

#s%$-(% ,,(#a.

Kana(%s S#m%s%r,-(ar%s #r!%r% !ar% 3 $-ah) ya%- s-"#r%r) "s#r%r) !an (a#ra( yan&

m#m$#n-, s-!- 809 sa- sama (a%n. Mas%n&*mas%n& ,ana( m#m$#n-, 273 (%n&,aran) !#n&an

!%am##r 0) 1 mm !an m#m$#sar ham"%r !-a ,a(% (%"a "a!a $a&%an am"-(a. Pa!a

#s%$-(-m #r!a"a (%ma m-ara ,ana(%s s#m%s%r,-(ar%s !%mana ,ana(%s s-"#r%r !an "s#r%r

$#rsa- m#m$#n-, ,r-s ,mm-n# s#$#(-m m#mas-,% #s%$-(-m.

K,(#a #r(#a, !% !#"an #s%$-(-m m#ny#r-"a% r-mah s%"- !#n&an "an/an& 5 30*3@

mm. K,(#a m#m$#n-, 2 * 2 G ,a(% "-aran !#n&an s-m$-nya yan& !%s#$- m!%(-s

yan& $#r%s% $#r,as sara; !an s-"(a% !arah !ar% ar#r% #r#$ra(%s. K#m-!%an s#ra$- sara; %n% $#r/a(an ,# (am%na s"%ra(%s ss#a -n-, m#na"a% s#(*s#( s#nsr%, r&an r%. K,(#a $a&%an

-(an& !%$a&% !-a (#h s-a- s#,a. 4a&%an !a(am s#,a %n% a!a(ah (am%na s"%ra(%s ss#a !an

$a&%an (-arnya a!a(ah (am%na s"%ra(%s m#m$ranas#a) s#h%n&&a r-an& yan& m#n&an!-n&

"#r%(%m;#. Rn&&a ,,(#a $#r-(an& !%$a&% m#n/a!% %&a $a&%an :

• S,a(a #s%$-(% = $a&%an aas>) Dasar s,a(a #s%$-(% !%s#$- s#$a&a% m#m$ran %m"an%

=R#%ssn#r s m#m$ran#>. Pa!a s,a(a %n% $#r%s% a%ran "#r%(%m;#

• S,a(a m#!%a =!-,-s ,,(#ar%s> yan& "an/an&nya 3@ mm !an $#r%s% #n!(%m;#. Pa!a

s,a(a m#!%a #r!a"a $a&%an yan& $#r$#n-, (%!ah yan& !%s#$- m#m$ran

#,r%a.M#m$ran #,r%a !%s#,r#s% !an !%s,n& (#h s-a- "an&&-n& yan& #r(#a,

!% m#!%a !%s#$- s#$a&a% (%m$-s

• S,a(a %m"an% = $a&%an $a6ah > /-&a m#n&an!-n& a%ran "#r%(%m;# !an !%"%sah,an

(#h (am%na s"%ra(%s s#-s !an m#m$rana $as%(ar%s. Pa!a m#m$rana $as%(ar%s #r(#a,

r&an r% yan& #r!a"a J (a"%san s#( ram$- yan& "#n%n& -n-, m#,an%sm#

"#n!#n&aran) !% mana 1 (a"%san s#( ram$- #r(#a, "a!a s%s% !a(am !ar% #r6n&r% =T-nn#( ; r%> !an !%,#na( s#$a&a% s#( ram$- !a(am s#!an&,an 3 (a"%san s#(

ram$- (-ar #r(#a, "a!a s%s% (-ar #r6n& #rs#$-.



K#!-a s,a(a #s%$-(% !an s,a(a %m"an% %n% $#r#m- "a!a -/-n& ,,(#a yan& !%s#$-

h#(%,r#ma. S,a(a #s%$-(% $#ra6a( "a!a ;ram#n a(# !an s,a(a %m"an% $#ra,h%r "a!a

;ram#n r-n!-m. P#r#m-an anara (am%na s"%ra(%s ss#a !an m#m$ranas#a ,# arah "#r%;#r

m#m$#n-, s-a- m#m$ran yan& %"%s yan& !%s#$- m#m$ran R#%ssn#r yan& m#m%sah,an

s,a(a #s%$-(% !#n&an s,a(a m#!%a =!-,-s ,,(#ar%s>. D-,-s ,,(#ar%s $#r$#n-, s#&%%&a)!%h-$-n&,an !#n&an (a$%r%n -(an& (#h /ar%n&an %,a "#nyam$-n& "#r%s#a( !an

m#n&an!-n& #n! r&an !ar% N. ,,(#ar%s !an r&an r%. D-,-s ,,(#ar%s $#rh-$-n&an

!#n&an sa,-(-s !#n&an "#ranaraan !-,-s R#-n%#ns.

Or&an r% #r(#a, !%aas m#m$ran $as%(ar%s yan& m#n&an!-n& r&an#(*r&an#(

"#n%n& -n-, m#,an%sm# sara; "#r%;#r "#n!#n&aran. Or&an r% #r!%r% !ar% sa- $ar%s s#(

ram$- !a(am yan& $#r%s% ,%ra*,%ra 3000 s#( !an 3 $ar%s s#( ram$- (-ar yan& $#r%s% ,%ra*,%ra

12.000 s#(. S#(*s#( %n% m#n&&an-n& (#6a (-$an&*(-$an& (#n&an hr%'na( !ar% s-a-

/-n&,a*/-n&,% yan& !%$#n-, (#h s#(*s#( "#ny,n&. U/-n& sara; a;#r#n !an #;#r#n

m#n#m"#( "a!a -/-n& $a6ah s#( ram$-. Pa!a "#rm-,aan s#( ram$- #r!a"a sr#r#s%(%a

yan& m#(#,a "a!a s-a- s#(-$-n& yan& #n!#r-n& !aar yan& !%,#na( s#$a&a% m#m$ran

#,r%a. M#m$ran #,r%a !%s#,r#s% !an !%s,n& (#h (%m$-s.

Sa,-(-s !an -r%,-(-s #r(#a, !% !a(am #s%$-(-m yan& !%(a"%s% (#h "#r%(%m;#.

Sa,-(-s /a-h (#$%h ,#%( !ar% -r%,-(-s #a"% sr-,-rnya sama. Sa,-(-s !an -r%,-(-s $#rh-$-n&an sa- sama (a%n !#n&an "#ranaraan !-,-s -r%,-(sa,-(ar%s yan& $#ra$an&



m#n/a!% !-,-s #n!(%m;a%,-s !an $#ra,h%r "a!a s-a- (%"aan !ar% !-rama#r "a!a $a&%an

$#(a,an& s "%ram%!a(%s yan& !%s#$- sa,-s #n!(%m;a%,-s. Pa!a sa,-(-s #r!a"a ma,-(a

sa,-(% !an "a!a -r%,-(-s #r!a"a ma,-(a -r%,-(%.1)2

1ASK"$ARISASI !E$IN#A &A$AM

T#(%n&a !a(am m#n!a"a,an !arah !ar% a. a-!%r% %n#rna =a. (a$%r%n%n> yan& $#rasa(

!ar% a. s#r#$#((% %n;#r%r an#r%r aa- !ar% a. $as%(ar%s yan& m#r-"a,an s-a- end artery !an

%!a, m#m"-nya% "#m$-(-h !arah anasms%s. S##(ah m#mas-,% m#a-s a,-s%,-s %n#rn-s)

ar#r% %n% $#ra$an& m#n/a!% %&a) ya%-:

a. Ar#r% #s%$-(ar%s an#r%r yan& m#n!arah% ma,-(a -r%,-(%) s#$a&%an ma-(a sa,-(%)

,r%sa am"-(ar%s) ,ana(%s s#m%s%r,-(ar%s s-"#r%r !an (a#ra( s#ra s#$a&%an !ar% -r%,-(-s

!an sa,-(-s.

$. Ar#r% #s%$-(,,(#ar%s) m#n!arah% ma,-(a sa,-(%) ,ana(%s s#m%s%r,-(ar%s "s#r%r)

$a&%an %n;#r%r -r%,-(-s !an sa,-(-s s#ra "-aran $asa( !ar% ,,(#a.

. Ar#r% ,,(#ar%s yan& m#mas-,% m!%(-s !an m#n/a!% "#m$-(-h*"#m$-(-h ar#r% s"%ra(

yan& m#n!arah% r&an r%) s,a(a #s%$-(%) s,a(a %m"an% s#$#(-m $#ra,h%r "a!a sr%a

as,-(ar%s.

A(%ran #na "a!a #(%n&a !a(am m#(a(-% %&a /a(-r -ama ya%- #na a-!%r% %n#rna

m#n!arah% "-aran #n&ah !an a"%,a( ,,(#a. C#na a,-a!-,-s ,,(#ar%s m#n!arah% "-aran

$as%(#r ,,(#a) sa,-(-s !an -r%,-(-s !an $#ra,h%r "a!a s%n-s "#rs-s %n;#r%r. C#na

a,-a!-,-s #s%$-(ar%s m#n!arah% ,ana(%s s#m%s%r,-(ar%s sam"a% -r%,-(-s. C#na %n%

m#n&%,-% !-,-s #n!(%m;a%,-s !an mas-, ,# s%n-s s%&m%!. 1

PERSARAFAN !E$IN#A

N. a,-s%,-s !an N. ;as%a(%s mas-, ,# !a(am "r-s !ar% m#a-s a,-s%,-s %n#rn-s !an

$#ra$an& !-a s#$a&a% N. #s%$-(ar%s !an N. ,,(#ar%s. Pa!a !asar m#a-s a,-s%,-s %n#rn-s

#r(#a, &an&(%n #s%$-(ar# !an "a!a m!%(-s #r(#a, &an&(%n s"%ra(#.

FISI,$,#I PEN&EN#ARAN

Prs#s m#n!#n&ar !%a6a(% !#n&an !%an&,a"nya #n#r&% $-ny% (#h !a-n #(%n&a !a(am

$#n-, &#(m$an& yan& !%a(%r,an m#(a(-% -!ara aa- -(an& ,,(#a. <#aran #rs#$-



m#n&&#ar,an m#m$ran %m"an%) !%#r-s,an ,# #(%n&a #n&ah m#(a(-% ran&,a%an -(an&

"#n!#n&aran yan& m#n&am"(%;%,as% &#aran m#(a(-% !aya -n&,% -(an& "#n!#n&aran !an

"#r,a(%an "#r$an!%n&an (-as m#m$ran %m"an% !an %n&,a" (n/n&. En#r&% &#ar yan& #(ah

!%am"(%;%,as% %n% !%#r-s,an ,# sa"#s yan& m#n&&#ra,,an %n&,a" (n/n&) s#h%n&&a "#r%(%m;

"a!a s,a(a #s%$-(% $#r&#ra,.<#aran !%#r-s,an m#(a(-% m#m$ran R#%ssn#r yan& m#n!rn&

#n!(%m;) s#h%n&&a m#n%m$-(,an &#ra, r#(a%; anara m#m$ran $asa(%s !an m#m$ran #,r%a.

Prs#s %n% m#r-"a,an ran&san& m#,an%, yan& m#ny#$a$,an #r/a!%nya !#;(#,s%

s#r#s%(%a s#(*s#( ram$-) s#h%n&&a %n #r$-,a !an #r/a!% "#n&(#"asan %n $#rm-aan (%sr%,

!ar% $a!an s#(. K#a!aan %n% m#n%m$-(,an "rs#s !#"(ar%sas% s#( ram$-) s#h%n&&a

m#(#"as,an n#-rransm%#r ,# !a(am s%na"s%s yan& a,an m#n%m$-(,an "#ns%a( a,s% "a!a

syara; a-!%r%-s) (a(- !%(an/-,an ,# n-(#-s a-!%r%-s sam"a% ,# ,r#,s "#n!#n&aran =ar#a

38 J0> !% ($-s #m"ra(%s.

P#n!#n&aran a!a(ah "#rs#"s% sara; m#n&#na% #n#r&% s-ara. <#(m$an& s-ara a!a(ah

&#aran -!ara yan& m#ram$a !an #r!%r% !ar% !a#rah*!a#rah $#r#,anan %n&&% ,ar#na

,m"r#s% ="#mam"aan> m(#,-(*m(#,-( -!ara yan& $#rs#(an& s#(%n& !#n&an !a#rah*!a#rah

$#r#,anan r#n!ah a,%$a "#n/aran&an m(#,-( #rs#$-. P#n!#n&aran s#"#r% ha(nya %n!ra

sma%, (a%n m#r-"a,an %n!ra m#,anr#s#"r. Ha( %n% ,ar#na #(%n&a m#m$#r%,an r#s"n

#rha!a" &#aran m#,an%, &#(m$an& s-ara yan& #r!a"a !% -!ara.1)2

S-ara !%an!a% (#h na!a) %n#ns%as) ,#"#,aan.1

Na!a s-a- s-ara !%#n-,an (#h ;r#,-#ns% s-a- &#aran. S#ma,%n %n&&% ;r#,-#ns% &#aran)

s#ma,%n %n&&% na!a. T#(%n&a man-s%a !a"a m#n!##,s% &#(m$an& s-ara !ar% 20 sam"a%

20.000 s%,(-s "#r !#%,) #a"% "a(%n& "#,a #rh!a" ;r#,-#ns% 1000 !an J000 s%,(-s "#r !#%,.

In#ns%as aa- K#"#,aan. S-a- s-ara $#r&an-n& "a!a am"(%-! &#(m$an& s-ara) aa-

"#r$#!aan #,anan anara !a#rah $#r#,anan %n&&% !an !a#rah $#r"#n/aran&an yan&

$#r#,anan r#n!ah. S#ma,%n $#sar am"(%-! s#ma,%n ,#ras s-ara. K#"#,aan !%nyaa,an

!a(am !#s%$(# =!4>. P#n%n&,aan 10 ,a(% (%"a #n#r&% s-ara !%s#$- 1 $#() !an 0)1 $#( !%s#$-

!#s%$#(. Sa- !#s%$#( m#6a,%(% "#n%n&,aan #n#r&% s-ara yan& s#$#narnya ya,n% 1)2 ,a(%.

S-ara yan& (#$%h ,-a !ar% 100 !4 !a(am m#r-sa, "#ran&,a s#nsr%, !% ,,(#a.

K-a(%as s-ara aa- 6arna na!a =%m$r#> $#r&an-n& "a!a na!a am$ahan) ya%- ;r#,-#ns%

am$ahan yan& m#n%m"a na!a !asar. Na!a*na!a am$ahan /-&a yan& m#ny#$a$,an "#r$#!aan ,has s-ara man-s%a



Fr#,-#ns% s-ara yan& !a"a !%!#n&ar (#h rna& m-!a a!a(ah anara 20 !na 20.000

s%(,-(s "#r !#%,. Nam-n) r#nan& s-ara $#r&an-n& "a!a "#r(-asan ,#,#rasan s-ara yan&

san&a $#sar. +%,a ,#,#rasannya 0 !#s%$#( !%$a6ah 1 !yn#7m2 %n&,a #,anan s-ara)

r#nan& s-ara a!a(ah sama"a% @00 h%n&&a @000 s%,(-s "#r !#%,. Hanya !#n&an s-ara ,#ras

r#nan& 20 sam"a% 20.000 s%,(-s !a"a !%a"a% s#ara (#n&,a". Pa!a -s%a -a) r#nan&

;r#,-#ns% $%asanya m#n-r-n m#n/a!% @0 sam"a% .000 s%,(-s "#r !#%, aa- ,-ran&. S-ara

3000 s%,(-s "#r !#%, !a"a !%!#n&ar $ah,an $%(a %n#ns%asnya s#r#n!ah 0 !#s%$#( !%$a6ah 1

!yn#7m2 %n&,a #,anan s-ara. S#$a(%,nya) s-ara 100 s%,(-s "#r !#%, !a"a !%!##,s% hanya

/%,a %n#ns%asnya 10.000 ,a(% (#$%h $#sar !ar% %n%.

A. M#,an%sm# P#n!#n&aran

Prs#s "#n!#n&aran #r/a!% m#n&%,-% a(-r s#$a&a% $#r%,-: &#(m$an& s-ara

m#na"a% m#m$ran ym"an%. <#(m$an& s-ara yan& $#r#,anan %n&&% !an r#n!ah $#rs#(an&

s#(%n& m#ny#$a$,an &#n!an& #(%n&a yan& san&a "#,a #rs#$- m#n#,-, ,#(-ar*mas-,

s#%rama !#n&an ;r#,-#ns% &#(m$an& s-ara. K#%,a m#m$ran %m"an% $#r&#ar s#$a&a%

r#s"ns #rha!a" &#(m$an& s-ara) rana% -(an&*-(an& #rs#$- /-&a $#r&#ra, !#n&an

;r#,-#ns% sama) m#m%n!ah,an ;r#,-#ns% &#ra,an #rs#$- !ar% m#m$rana %m"an% ,# /#n!#(a

a(. T-(an& sa"#s yan& $#r&#ar mas-,*,#(-ar !ar% %n&,a a( m#n%m$-(,an &#aran "a!a

"#r%(ym"h !% sa(a #s%$-(%. O(#h ,ar#na (-as "#rm-,aan m#m$ran ym"an% 22 ,a(% (#$%h

$#sar !ar% (-as %n&,a" a() ma,a #r/a!% "#n&-aan #,anan &#(m$an& s-ara1@*22 ,a(% "a!a

%n&,a" a(. S#(a%n ,ar#na (-as "#rm-,aan m#m$ran %m"an% yan& /a-h (#$%h $#sar) #;#, !ar%

"#n&-n&,% -(an&*-(an& "#n!n#&aran /-&a -r- $#r,nr%$-s% !a(am "#n%n&,aan #,anan

&#(m$an& s-ara.1)2)3

<#ra,an sa"#s yan& m#ny#r-"a% "%sn #rha!a" /#n!#(a a( m#ny#$a$,an %m$-(nya

&#(m$an& #,anan !% ,m"ar#m#n aas. Kar#na a%ran %!a, !a"a !%#,an) #,anan

!%ham$-r,an m#(a(-% !-a ara s#6a,- sa"#s m#ny#$a$,an /#n!#(a a( m#nn/( ,# !a(am

ya%-) "#r-$ahan "s%s% /#n!#(a $-n!ar !an !#;(#,s% m#m$rana $as%(ar%s.

Pa!a /a(-r "#rama) &#(m$an& #,anan m#n!rn& "#r%(%m;# ,# !#"an !%

,m"ar#m#n aas) ,#m-!%an m#n&#(%(%n&% h#(%,#rma) !an ,# ,m"ar#m#n $a6ah) #m"a

&#(m$an& #rs#$- m#ny#$a$,an /#n!#(a $-n!ar m#nn/( ,# (-ar -n-, m#n&,m"#nsas%

"#n%n&,aan #,anan. K#%,a sa"#s $#r&#ra, m-n!-r !an m#nar%, /#n!#(a a( ,# (-ar)

"#r%(%m;# m#n&a(%r ,#arah yan& $#r(a6anan m#n&-$ah "s%s% /#n!#(a $-n!ar ,# arah

!a(am.Pa!a /a(-r ,#!-a) &#(m$an& #,anan ;r#,-#ns% yan& $#r,a%an !#n&an "#n#r%maan



s-ara m#n&am$%( /a(an "%nas. <#(m$an& #,anan !% ,m"ar#m#n aas !%"%n!ah,an m#(a(-%

m#m$rana #s%$-(ar%s yan& %"%s) ,# !a(am !-,-s ,,(#ar%s !an ,#m-!%an m#(a(-% m#$rana

$as%(ar%s ,# ,m"ar#m#n $a6ah) #m"a &#(m$an& #rs#$- m#ny#$a$,an /#n!#(a $-n!ar

m#nn/( ,# (-ar*mas-, $#r&an%an.

M#m$ran $as%(ar%s yan& #r(#a, !#,a #(%n&a #n&ah (#$%h "#n!#, !an ,a,-) a,an

$#r&#ar $%(a a!a &#aran !#n&an na!a r#n!ah. Ha( %n% !a"a !%%$ara,an !#n&an s#nar &%ar

yan& "#n!#, !an #&an&) a,an $#r#snans% !#n&an na!a %n&&%. <#aran yan& $#rna!a %n&&%

"a!a "#r%(ym" sa(a #s%$-(% a,an m#(%nas% m#m$rana #s%$-(ar%s yan& #r(#a, !#,a ,#

#(%n&a #n&ah. S#$a(%,nya na!a r#n!ah a,an m#n&&#ar,an $a&%an m#m$rana $as%(ar%s !%

!a#rah a"#B. <#aran %n% ,#m-!%an a,an -r-n ,# "#r%(ym" sa(a ym"an%) ,#m-!%an ,#(-ar

m#(a(-% %n&,a" $-(a ,# #(%n&a #n&ah -n-, !%r#!am.

Kar#na r&an r% m#n-m"an& "a!a m#m$rana $as%(ar%s) s#6a,- m#m$rana

$as%(ar%s $#r&#ar) s#(*s#( ram$- /-&a $#r&#ra, na%, -r-n !an ram$-*ram$- #rs#$- a,an

m#m$#n&,, ,# !#"an !an $#(a,an& s#6a,- m#m$rana $as%(ar%s m#n&&#s#r "s%s%nya

#rha!a" m#m$rana #,r%a(. P#r-$ahan $#n-, m#,an%s ram$- yan& ma/- m-n!-r %n%

m#ny#$a$,an sa(-ran*sa(-ran %n &#r$an& m#,an%s !% s#(*s#( ram$- #r$-,a !an #r--"

s#ara $#r&an%an. Ha( %n% m#ny#$a$,an "#r-$ahan "#ns%a( !#"(ar%sas% !an h%"#r"(ar%sas%

yan& $#r&an%an. S#(*s#( ram$- $#r,m-n%,as% m#(a(-% s%na"s ,%m%a6% !#n&an -/-n&*-/-n&

s#ra sara; a;#r#n yan& m#m$#n-, sara; a-!%r%-s =,,(#ar%s>. D#"(ar%sas% s#(*s#( ram$-

m#ny#$a$,an "#n%n&,aan ,##"aan "#n&#(-aran 'a "#ranara m#r#,a yan& m#na%,an

"#ns%a( a,s% !% s#ra*s#ra a;#r#n.

S#$a(%,nya) ,##"aan "#m$#n-,an "#ns%a( a,s% $#r,-ran& ,#%,a s#(*s#( ram$-

m#n&#(-ar,an s#!%,% 'a "#ranara ,ar#na m#n&a(am% h%"#r"(ar%sas% =s#6a,- m#m$rana

$as%(ar%s $#r&#ra, ,# $a6ah>. P#r-$ahan "#ns%a( $#r/#n/an& !% r#s#"r m#n&a,%$a,an

"#r-$ahan ,##"aan "#m$#n-,an "#ns%a( a,s% yan& m#ram$a ,# a,. Im"-(s ,#m-!%an

!%/a(ar,an m#(a(-% sara; a, saa-s%,-s =sara; "#n!#n&aran> ,# m#!-((a $(n&aa

,#m-!%an ,# ((%-(-s. P#rs#"s% a-!%%; #r/a!% s##(ah "rs#s s#nsr% aa- s#nsas% a-!%%;.

4. +aras P#rsara;an P#n!#n&aran

D%"#r(%ha,an $ah6a s#ra$- !ar% &an&(%n s"%ra(%s r&an r% mas-, ,# n-,(#-s ,,(#ar%s

yan& #r(#a, "a!a $a&%an aas m#!-((a $(n&aa. Pa!a #m"a %n% s#m-a s#ra$- $#rs%na"s

!an n#-rn %n&,a !-a $#r/a(an #r-ama ,# s%s% yan& $#r(a6anan !ar% $aan& a, !an



$#ra,h%r !% n-,(#-s (%ar%-s s-"#r%r. 4#$#ra"a s#ra$- %n&,a ,#!-a (a%nnya /-&a $#r/a(an

,# n-,(#-s (%ar%-s s-"#r%r "a!a s%s% yan& sama. Dar% n-,(#-s #rs#$-) $#r/a(an ,# aas

m#(a(-% (#mn%s,-s (a#ra(%s. 4#$#ra"a s#ra$- $#ra,h%r !% n-,(#-s (#mn%s,-s (a#ra(%s) #a"%

s#$a&%an $#sar m#(#6a% n-,(#-s %n% !an $#r/a(an ,# ,(%,-(-s %n;#r%r) #m"a s#m-a aa-

ham"%r s#m-a s#ra$- "#n!#n&aran $#rs%na"s. Dar% s%n% /aras $#r/a(an ,# n-,(#-s &#n%,-(a-m

m#!%a() #m"a s#m-a s#ra$- $#rs%na"s. A,h%rnya) /aras $#r(an/- m#(a(-% ra!%as% a-!%r%-s

,# ,r#,s a-!%r%,) yan& #r-ama #r(#a, "a!a &%r-s s-"#r%r ($-s #m"ra(%s.4#$#ra"a

#m"a "#n%n& har-s !%aa !a(am h-$-n&anya !#n&an (%nasan "#n!#n&aran "#rama %m"(-s

!ar% mas%n&*mas%n& #(%n&a !%hanar,an m#(a(-% (%nasan "#n!#n&aran ,#!-a $aan& s%s% a,

hanya !#n&an s#!%,% (#$%h $anya, "#n&hanaran "a!a (%nasan ,nra(a#ra(.K#!-a $anya,

s#ra$- ,(a#ra( !ar% ra,-s a-!%r%-s $#r/a(an (an&s-n& ,# !a(am sys#m r#%,-(ar%s $aan&

a, s#h%n&&a $-ny% !a"a m#n&a,%;,an ,#s#(-r-han a,.

. F-n&s% ,r#,s s#r#$r% "a!a "#n!#n&aran

S#%a" !a#rah !% m#m$rana $as%(ar%s $#rh-$-n&an !#n&an !a#rah #r#n- !% ,r#,s

"#n!#n&aran !a(am ($-s #m"ra(%s. D#n&an !#m%,%an) s#%a" n#-rn ,r#,s hanya

!%a,%;,an (#h na!a*na!a #r#n-. N#-rn*n#-rn a;#r#n yan& m#nan&,a" s%nya( a-!%r%-s

!ar% s#(*s#( ram$- ,#(-ar !ar% ,,(#a m#(a(-% sara; a-!%r%-s. +a(-r sara; anara r&an r%

!an ,r#,s "#n!#n&aran m#(%$a,an $#$#ra"a s%na" !a(am "#r/a(anannya) #r-ama a!a(ah

s%na"s !% $aan& a, !an n-,(#-s &#n%,-(a-s m#!%a(%s a(am-s. 4aan& a, m#n&&-na,an

mas-,an "#n!#n&aran -n-, ,#6as"a!aan. S%nya( "#n!#n&aran !ar% ,#!-a #(%n&a !%sa(-r,an

,# ,#!-a ($-s #m"ra(%s ,ar#na s#ra*s#ranya $#rs%(an&an s#ara "ars%a( !% a,. Kar#na

%-) &an&&-an !% /a(-r "#n!#n&aran "a!a sa(ah sa- s%s% m#(#6a% $aan& a, %!a, a,an

m#n&&an&&- "#n!#n&aran ,#!-a #(%n&a. Kr#,s "#n!#n&aran #rs-s-n aas ,(m*,(m.

Kr#,s "#n!#n&aran "r%m#r m#"#rs#"s%,an s-ara !%s,r# s#m#nara ,r#,s "#n!#n&aran

yan& (#$%h %n&&% !% s#,%arnya m#n&%n#&ras% s-ara*s-ara yan& $#r$#!a m#n/a!% "(a yan&

,h#r#n !an $#rar%. Pry#,s% (%nasan "#n!#n&aran ,r#,s s#r#$r% m#n-n/-,an $ah6a

,r#,s "#n!#n&aran #r(#a, #r-ama %!a, hanya "a!a !a#rah s-"ra#m"ra( &%r-s #m"ra(%s

s-"#r%r #a"% /-&a m#(-as m#(#6a% $aas (a#ra( ($-s #m"ra(%s /a-h m#(#6a% ,r#,s

%ns-(a !an sam"a% ,# $a&%an "a(%n& (a#ra( ($-s "ar%#a(%s. 1)3

D. P#n#n-an Fr#,-#ns% S-ara2

S-ara !#n&an %n&&% na!a yan& r#n!ah m#ny#$a$,an "#n&a,%;an ma,s%m-m

m#m$ran# $as%(%s !% !#,a a"#,s ,,(#a !an s-ara !#n&an ;r#,-#ns% yan& %n&&% m#n&a,%;,an



m#m$ran# $as%(ar%s !#,a $as%s ,,(#a) s#!an&,an s-ara !#n&an ;r#,-#ns% m#n#n&ah

m#n&a,%;,an m#m$rana !% anara ,#!-a n%(a% yan& #,sr%m #rs#$-. S#(an/-nya) a!a

"#n&a-ran s"as%a( "a!a s#ra$- sara; !% /aras ,,(#ar%s) yan& $#rasa( !ar% ,,(#a sam"a%

,r#,s s#r#$r%. P#r#,aman s%nya( !% ra,-s a-!%r%-s "a!a $aan& a, !an !% ar#a "#n#r%ma

"#n!#n&aran "a!a ,r#,s s#r#$r% m#m"#r(%ha,an n#-rn*n#-rn a, yan& s"#s%;%,

!%a,%as% (#h ;r#,-#ns% s-ara #r#n-. O(#h ,ar#na %- ara yan& !%&-na,an (#h s%s#m

sara; -n-, m#n!##,s% "#r$#!aan ;r#,-#ns% s-ara a!a(ah !#n&an m#n#n-,an "s%s% !%

s#"an/an& m#m$ran# $as%(ar%s yan& "a(%n& #ran&san&. In% !%nama,an "r%ns%" (#a, -n-,

m#n#n-,an ;r#,-#ns% s-ara.

E. P#n#n-an ,#ras s-ara

K#,#rasan s-ara !%#n-,a (#h s%s#m "#n!#n&aran s#,-rna&*,-ran&nya m#(a(-% %&a

ara. P#rama) ,#%,a s-ara m#n/a!% (#$%h ,#ras #r/a!% "#n%n&,aan am"(%-! &#aran yan&

m#ran&san& -/-n&*-/-n& sara; $#r#,s%as% (#$%h #"a. K#!-a) ,#%,a am"(%-! m#n%n&,a

a,an m#ny#$a$,an s#ma,%n $anya, s#(*s#( ram$- !% "%n&&%r $a&%an m#$ran $as%(ar yan&

$#r#snas%) s#h%n&&a #r/a!% "#m/-m(ahan s"as%a( %m"-(s) !%mana ransm%s% m#(a(-% $anya,

s#ra$- sara;. K#%&a) s#(*s#( ram$- (-ar %!a, #ran&san& s#ara $#rma,na sam"a% &#aran

m#m$ran $as%(ar m#na"a% %n#ns%as yan& %n&&%.

S-ara yan& san&a ,#ras yan& %!a, !a"a !%"#r(#m$- s#ara a!#,-a (#h r#;(#,s*r#;,#s

"r#,%; #(%n&a !a"a m#ny#$a$,an &#aran m#m$rana $as%(ar%s yan& h#$a s#h%n&&a s#(*s#(

ram$- yan& %!a, !a"a !%&an%,an %- #r(#"as aa- r-sa, s#ara "#rman#n !an m#n%m$-(,an

&an&&-an "#n!#n&aran "ars%a(.

F. D%s,r%m%nas% arah asa( s-ara

D#sr-,s% ,r#,s "#n!#n&aran "a!a ,#!-a s%s% a, $a%, "a!a man-s%a aa- "a!a

mama(%a yan& (#$%h r#n!ah m#ny#$a$,an ,#h%(an&an s#$a&%an $#sar ,#mam"-annya

m#n!##,s% arah asa( s-ara. Nam-n) m#,an%sm# -n-, !##,s% %n% !%m-(a% "a!a n-,(#%

(%ar%-s s-"#r%r !% !a(am $aan& a,.

N-,(#-s (%ar%-s s-"#r%r !%$a&% m#n/a!% !-a ya,n% n-,(#-s (%ar%-s s-"#r%r m#!%a(

!an (a#ra(. N-,(#-s (a#ra( $#ran&&-n& /a6a$ -n-, m#n!##,s% arah s-m$#r s-ara) a&a,nya

m#(a(-% "#r$an!%n&an s#!#rhana !%anara "#r$#!aan %n#ns%as s-ara yan& m#na"a% ,#!-a

#(%n&a) !an m#n&%r%m,an s%nya( yan& #"a ,# ,r#,s a-!%r%, -n-, m#m"#r,%ra,anarahnya. N-,(#-s (%ar%-s s-"#r%r m#!%a( m#m"-nya% m#,an%sm# s"#s%;%, -n-,



m#n!##,s% "#r$#!aan 6a,- anara s%nya( a,-s%, yan& m#mas-,% ,#!-a #(%n&a. N-,(#-s %n%

#r!%r% aas s#/-m(ah $#sar n#-rn yan& m#m"-nya% !-a !#n!r% -ama yan& m#nn/( ,# arah

,anan !an ,%r%. In#ns%as #,s%as% !% s#%a" n#-rn san&a s#ns%%; #rha!a" "#r$#!aan 6a,-

yan& s"#s%;%, anara !-a s%nya( a,-s%, yan& $#rasa( !ar% ,#!-a #(%n&a. Pa!a n-,(#-s #rs#$-

#r/a!% "(a s"as%a( "#ran&san&an n#-rn. S-ara yan& !aan& (an&s-n& !ar% !#"an ,#"a(a

m#ran&san& sa- "#ran&,a n#-rn (%ar%-s s#ara ma,s%ma( !an s-ara !ar% s-!- s%s% yan&

$#r$#!a m#ns%m-(as% "#rna&,a n#-rn (a%nnya !ar% s%s% yan& $#r(a6anan.

<. K#-(%an

T-(% $%asanya !%$a&% !a(am !-a /#n%s. P#rama yan& s%s#$a$,an (#h &an&&-an ,,(#a

aa- sara; "#n!#n&aran) yan& $%asanya !%mas-,,an !a(am -(% sara; !an ,#!-a yan&

!%s#$a$,an (#h &an&&-an m#,an%sm# #(%n&a #n&ah -n-, m#n&hanar,an s-ara ,# ,,(#a)

yan& $%asanya !%nama,an -(% hanaran s#$#narnya $%(a ,,(#a aa- sara; "#n!#n&aran

!%r-sa, a( ma,an ran& #rs#$- a,an -(% a( a,an #a"% $%(a ,,(#a !an sara; mas%h --h

#a"% sys#m s%,-(ar r-sa, aa- m#n&a(am% an,%(s%s ,a,- ,ar#na ;%$rs%s aa- ,a(s%;%,as%)

&#(m$an& s-ara #a" !a"a !%hanar,an ,# ,,(#a !#n&an ara ,n!-,s% -(an& s#"#r%

"#n&hanaran $-ny% !ar% -/-n& &ar"-a(a yan& $#r&#ar) yan& !%#m"#(,an (an&s-n& "a!a

#n&,ra,.

H. Ham$aan P#rs#"s% A-!%%;

S#nsr% a-!%%; !%a,%;,an (#h a!anya ran&san& $-ny% aa- s-ara. P#rs#"s% a-!%%;

$#r,a%an !#n&an ,#mam"-an a, -n-, m#m"rs#s !an m#n&%n#r"r#as%,an $#r$a&a%

$-ny% aa- s-ara yan& !%!#n&ar (#h #(%n&a. K#mam"-an "#rs#"s% a-!%%; yan& $a%,

m#m-n&,%n,an s#ran& ana, !a"a m#m$#!a,an $#r$a&a% $-ny% !#n&an s-m$#r) r%m#)

(-m#) !an "%h yan& $#r$#!a. K#mam"-an %n% san&a $#r&-na !a(am "rs#s $#(a/ar

m#m$aa. P#rs#"s% a-!%%; m#na,-" ,#mam"-an*,#mam"-an $#r%,- :

a. K#sa!aran ;n(&%s ya%- ,#sa!aran $ah6a $ahasa !a"a !%"#ah ,# !a(am ,aa)

s-,- ,aa) !an ;n#m =$-ny% h-r-;>

$. D%s,r%m%nas% a-!%%; ya%- ,#mam"-an m#n&%n&a "#r$#!aan anara $-ny%*$-ny%

;n#m !an m#n&%!#n%;%,as% ,aa*,aa yan& sama !#n&an ,aa*,aa yan& $#r$#!a.

. In&aan =m#mr%> a-!%%; ya%- ,#mam"-an -n-, m#ny%m"an !an m#n&%n&a

s#s-a- yan& !%!#n&ar



!. Ur-an a-!%%; ya%- ,#mam"-an m#n&%n&a -r-an ha(*ha( yan& !%sam"a%,an s#ara

(%san

#. P#r"a!-an a-!%%; ya%- ,#mam"-an m#ma!-,an #(#m#n*#(#m#n ;n#m -n&&a(

aa- $#r$a&a% ;n#m m#n/a!% s-a- ,aa yan& --h

Ham$aan "#rs#"s% a-!%%; !a"a #r/a!% s#$a&a% $a&%an !ar% a-!%ry "r#ss%n&

!%sr!#r=&an&&-an "rs#s a-!%r%> yan& "#ny#$a$nya $#(-m !%,#ah-% s#ara "as%.

<an&&-an %n% m-n&,%n !%s#$a$,an (#h a!anya &an&&-an "rs#s !% a, aa- $#rh-$-n&an

!#n&an ,n!%s% ,n!%s% (a%n s#"#r% !%s(#,s%a) A#n%n D#;%s% D%sr!#r) A-%sm S"#r-m

D%sr!#r) &an&&-an $ahasa s"#s%;%,) aa- ham$aan "#r,#m$an&an. Ana, yan& m#n&a(am%

&an&&-an "rs#s a-!%r% $%asanya !a"a m#n!#n&ar s-ara =%n;rmas% $-ny%> #a"% m#m%(%,%

,#s-(%an -n-, m#maham%) m#ny%m"an) m#n#m"a,an) m#n&#m-,a,an ,#m$a(% aa-

m#n/#(as,an %n;rmas% #rs#$- -n-, ,#"#n%n&an a,a!#m%, ma-"-n ss%a(.

Ham$aan "#rs#"s% a-!%%; !a"a m#na,-" $#$#ra"a ha( s#"#r%:

,#s-(%an m#n#n-,an ;%&-r !an (aar $-ny%

,#s-(%an m#n&%n&a =m#mr%> $-ny%

,#s-(%an !%s,r%m%nas% $-ny%

,#s-(%an -n-, m#m"#rha%,an $-ny%

,#s-(%an -n-, "rs#s ,h#s% =m#ma!-,an> $-ny%

!"$I SENS,RINE"RA$ 2)3

&EFINISI

K#(a%nan #(%n&a !a"a m#ny#$a$,an -(% ,n!-,%; aa- -(% s#nsr%n#-ra(. T-(%

,n!-,%; $%asanya !%s#$a$,an (#h ,#(a%nan yan& #r!a"a !% #(%n&a (-ar aa- #(%n&a #n&ah.

T-(% s#nsr%n#-ra( !%$a&% aas -(% s#nsr%n#-ra( ,,(#a !an r#r,,(#a.



T-(% s#nsr%n#-ra( a!a(ah $#r,-ran&nya "#n!#n&aran aa- &an&&-an "#n!#n&aran

yan& #r/a!% a,%$a ,#r-sa,an "a!a #(%n&a $a&%an !a(am) sara; yan& $#r/a(an !ar% #(%n&a ,#

a, =sara; "#n!#n&aran>) aa- a,.3

INSI&ENSI

K##ram"%(an ,m-n%,as% a!a(ah "-sa ,#h%!-"an yan& s-,s#s -n-, s#m-a ran&.<an&&-an

,m-n%,as% san&a m#m"#n&ar-h% "#n!%!%,an) "#,#r/aan) !an ,#s#/ah#raan $anya, ran&.

+-m(ah ran& Am#r%,a !#n&an &an&&-an "#n!#n&aran m#m%(%,% an&,a ,#/a!%an !-a ,a(% (%"a

s#(ama 30 ah-n #ra,h%r. 4#r!asar,an !aa yan& !%"#r(#h !ar% s-r#% ;#!#ra()

!%!a"a,an "r#a(#ns% -n-, %n!%%!- yan& $#r-s%a %&a ah-n aa- (#$%h yan& m#n&a(am%

&an&&-an "#n!#n&aran $#r,%sar 13)2 /-a =181>) 1J)2 /-a =18>) 20)3 /-a=1881>) !an 2J)2

/-a =1883>. S#ran& "#n#(%% %n!#"#n!#n m#m"#r,%ra,an $ah6a 2) /-a ran& Am#r%,a

m#m%(%,% &an&&-an "#n!#n&aran "a!a ah-n 2000. <an&&-an "#n!#n&aran s#nsr%n#-ra(

m#n!a!a, !%#m-,an hanya 10*1@ !ar% /-m(ah "as%#n. Ins%!#ns% ah-nan &an&&-an

"#n!#n&aran s#nsr%n#-ra( !%"#r,%ra,an a!a(ah @ sam"a% 20 ,as-s "#r 100.000 ran&.

Pa"aran !#n&an ,#$%s%n&an #(ah (ama !%,#na( s#$a&a% ;a,r r%s%, -n-, &an&&-an

"#n!#n&aran.L#$%h !ar% 30 /-a ran& Am#r%,a yan& #r,#na %n&,a s-ara $#r$ahaya s#ara

#ra-r.2)3

E!I,$,#I

T-(% s#nsr%n#-ra( ,,(#a !%s#$a$,an (#h a"(as%a =n&#n%a(>) (a$%r%n%%s =(#h

$a,#r%7%r-s>) %n,s%,as% $a sr#"m%s%n) ,anam%s%n) &aram%s%n) n#m%s%n) ,%na) as#sa(

aa- a(,h(. S#(a%n %-) -(% s#nsr%n#-ra( /-&a !a"a !%s#$a$,an (#h -(% m#n!a!a, = sudden

deafness>) ra-ma ,a"%%s) ra-ma a,-s%,) !an "a/anan $%s%n&.



T-(% s#nsr%n#-ra( r#r,,(#a !%s#$a$,an (#h n#-rma a,-s%,) -mr s-!- "ns

s#r#$#(-m) m%#(ma m-(%"#() #!#ra a,) "#r!arahan a,) !an s#$a&a%nya.

PA!,FISI,$,#I

P#r/a(anan "#nya,% !ar% -(% s#nsr%n#-ra( !%s#$a$,an (#h $#$#ra"a ha( s#s-a%

!#n&an #%(&% yan& s-!ah !%s#$-,an !%aas. Pa!a -(% s#nsr%n#-ra( ="#rs#"%;> ,#(a%nan

#r!a"a "a!a ,,(#a =#(%n&a !a(am>) n#r-s CIII aa- !% "-sa "#n!#n&aran. S#( ram$-

!a"a !%r-sa, (#h #,anan -!ara a,%$a #r"a"ar (#h s-ara yan& #r(a(- ,#ras -n-, /an&,a

6a,- yan& (ama !an %s,#m%a. Kan!-n&an &(%,&#n yan& %n&&% m#m$-a s#( ram$- !a"a

$#rahan #rha!a" %s,#m%a m#(a(-% &(%,(%s%s ana#r$.

S#( ram$- /-&a !a"a !%r-sa, (#h $a*$aan) s#"#r% an%$%%, am%n&(%,s%!a !an

a&#n ,#m#ra"#-%, %s"(a%n) yan& m#(a(-% sr%a as,-(ar%s a,an #ra,-m-(as% !% #n!(%m;#.

Ha( %n% yan& m#ny#$a$,an -(% #(%n&a !a(am yan& nan%nya m#m"#n&ar-h% ,n!-,s% -!ara

!an -(an&. Am$an& "#n!#n&aran !an "#r"%n!ahan ,m"n#n a,%; m#m$ran $as%(ar a,an

#r"#n&ar-h s#h%n&&a ,#mam"-an -n-, m#m$#!a,an $#r$a&a% na!a ;r#,-#ns% yan& %n&&%

m#n/a!% #r&an&&-. A,h%rnya) !#"(ar%sas% s#( ram$- !a(am %!a, a!#,-a !a"a

m#n&has%(,an s#nsas% s-ara yan& %!a, $%asa !an m#n&&an&&- =%nn%-s s-$y#,%;>. Ha( %n%

$%as /-&a !%s#$a$,an (#h #,s%as% n#-rn yan& %!a, a!#,-a "a!a /aras "#n!#n&aran aa-

,r#,s a-!%r%,.

K#,a,-an m#m$ran $as%(ar m#n&&an&&- m%,rm#,an%, yan& a,an $#r"#ran !a(am

,#-(%an "a!a -s%a (an/-. T-(% #(%n&a !a(am /-&a !%s#$a$,an (#h s#,r#s% #n!(%m;# yan&

a$nrma(. +a!%) loop diuretics "a!a !s%s% %n&&% %!a, hanya m#n&ham$a ,rans"r Na? *K ?

*2(* &%n/a() #a"% /-&a !% "#n!#n&aran. K#(a%nan &#n#%, "a!a ,ana, K ? !% (-m#n /-&a

!%,#ah-% m#ny#$a$,an ha( #rs#$-. Kana( K ? #r!%r% aas !-a s-$-n% =IsK7KLT1> yan& /-&a

!%#,s"r#s%,an "a!a r&an (a%n) $#r"#ran !a(am "rs#s r#"(ar%sas%. D#;#, KLT1 aa- IsK

%!a, hanya m#n&a,%$a,an ,#-(%an) #a"% /-&a "#r(am$aan r#"(ar%sas% m%,ar!%-m.



<an&&&-an "#ny#ra"an #n!(%m;# /-&a !a"a m#ny#$a$,an -(% !% mana r-an&

#n!(%m;# m#n/a!% m#nn/( ,#(-ar s#h%n&&a m#n&&an&&- h-$-n&an anara s#( ram$- !an

m#m$ran #,r%a( =#!#ma #n!(%m;#>. A,h%rnya) "#n%n&,aan "#rm#a$%(%as anara r-an&

#n!(%m;# !an "#r%(%m;# yan& $#r"#ran !a(am "#nya,% M#n%#r# yan& !%an!a% !#n&an

s#ran&an -(% !an #r%&.3)J

MANIFES!ASI K$INIS

<an&&-an "#n!#n&aran m-n&,%n %m$-( s#ara $#raha" aa- %$a*%$a. <an&&-an

"#n!#n&aran m-n&,%n san&a r%n&an) m#n&a,%$a,an ,#s-(%an ,#%( !a(am $#r,m-n%,as%

aa- $#ra s#"#r% ,#-(%an. K#h%(an&an "#n!#n&aran s#ara #"a !a"a m#m$#r%,an "#-n/-,

-n-, "#ny#$a$nya. +%,a &an&&-an "#n!#n&aran #r/a!% s#ara m#n!a!a,) m-n&,%n

!%s#$a$,an (#h ra-ma aa- a!anya &an&&-an !ar% s%r,-(as% !arah. S#$-ah ns# yan& #/a!%

s#ara $#raha" $%sa !a"a !%s#$a$,an (#h "#n-aan aa- -mr.

<#/a(a s#"#r% %n%-s =#(%n&a $#r!#n&%n&> aa- #r%& =$#r"-ar s#nsas%>) m-n&,%n

m#n-n/-,,an a!anya masa(ah !#n&an sara; !% #(%n&a aa- a,. <an&&-an "#n!#n&aran

!a"a #r/a!% -n%(a#ra( aa- $%(a#ra(. K#h%(an&an "#n!#n&aran -n%(a#ra( yan& "a(%n& s#r%n&

!%,a%,an !#n&an "#ny#$a$ ,n!-,%;) ra-ma) !an n#-rmas a,-s%,. Ny#r% !% #(%n&a

!%,a%,an !#n&an %n;#,s% #(%n&a) ra-ma) !an $sr-,s% "a!a ,ana(. In;#,s% #(%n&a /-&a !a"a

m#ny#$a$,an !#mam.

&IA#N,SIS

A. Anamn#s%s

D%"#r(-,an anamn#s%s yan& #rarah -n-, m#n&&a(% (#$%h !a(am !an (-as ,#(-han

-ama "as%#n. K#(-han -ama #(%n&a anara (a%n "#,a, =-(%>) s-ara $#r!#n&%n&

=%nn%-s>) rasa "-s%n& $#r"-ar =#r%&>) rasa ny#r% !% !a(am #(%n&a =a(&%a>) !an



,#(-ar a%ran !ar% #(%n&a =r#>. P#r(- !%anya,an a"a,ah ,#(-han #rs#$- "a!a

sa- aa- ,#!-a #(%n&a) %m$-( %$a*%$a aa- $#ram$ah $#ra) s-!ah $#ra"a (ama

!%!#r%a) r%6aya ra-ma ,#"a(a) #(%n&a #ram"ar) ra-ma a,-s%,) #r"a/an $%s%n&)

"#ma,a%an $a ,s%,) "#rnah m#n!#r%a "#nya,% %n;#,s% %r-s) a"a,ah

&an&&-an "#n!#n&aran %n% s-!ah !%!#r%a s#/a, $ay% s#h%n&&a #r!a"a &an&&-an

$%ara !an ,m-n%,as%) !an a"a,ah &an&&-an (#$%h #rasa !% #m"a yan& $%s%n&

aa- (#$%h #nan&.

4. P#m#r%,saan a-!%(&% ,h-s-s 3)@

Un-, m#m$#!a,an -(% ,,(#a !an -(% r#r,,(#a !%"#r(-,an "#m#r%,saan yan&

#r!%r% !ar% a-!%m#r% ,h-s-s) a-!%m#r% $/#,%;) "#m#r%,saan -(% anr&an%,)

!an "#m#r%,saan a-!%m#r% ana,.

1. A-!%m#r% ,h-s-s

P#r(- !%,#ah-% a!anya %s%(ah r#,r-m#n ya%- "#n%n&,aan s#ns%%;%as

"#n!#n&aran yan& $#r(#$%han !% aas am$an& !#n&ar !an ,#(#(ahan m#r-"a,an

a!a"as% a$nrma( yan& m#r-"a,an an!a ,has -(% r#r,,(#a.

K#!-a ;#nm#na %n% !a"a !%(aa, !#n&an $#$#ra"a "#m#r%,saan ,h-s-s)

ya%-:

• T#s SISI = short increment sensitivity index>

P#m#r%,saan %n% $#r-/-an -n-, m#n&#ah-% a"a,ah "as%#n !a"a

m#m$#!a,an s#(%s%h %n#ns%as yan& ,#%( =sama"a% 1 !4>.

• T#s A4L4 =alternate binaural loudness balans test >

D%$#r%,an %n#ns%as $-ny% #r#n- "a!a ;r#,-#ns% yan& sama "a!a ,#!-a

#(%n&a sam"a% ,#!-a #(%n&a m#na"a% "#rs#"s% yan& sama.

• T#s K#(#(ahan =Tone decay>T#(%n&a "as%#n !%ran&san& #r-s*m#n#r-s !an #r/a!% ,#(#(ahan. Tan!anya

a!a(ah %!a, !a"a m#n!#n&ar !#n&an #(%n&a yan& !%"#r%,sa.

• A-!%m#r% T--r =Speech audiometri>

T-/-an "#m#r%,saan a!a(ah -n-, m#n%(a% ,#mam"-an "as%#n $#r$%ara

!an -n-, m#n%(a% "#m$#r%an a(a $an- !#n&ar =hearing aid >.

• A-!%m#r% 4#,#sy

T-/-an "#m#r%,saan a!a(ah m#n%(a% am$an& "#n!#n&aran s#s#ran&

!#n&an m#n&&-na,an &ra;%,.



2. A-!%m#r% $/#,%;

• A-!%m#r% Im"#!ans

T-/-an "#m#r%,saan a!a(ah -n-, m#m#r%,sa ,#(#n-ran m#m$ran %m"an%

!#n&an #,anan #r#n- "a!a m#a-s a,-s%,-s #,s#rna.

• E(#,r,,(#&ra;%D%&-na,an -n-, m#r#,am &#(m$an&*&#(m$an& yan& ,has !ar% evoke

electropotential cochlea.

• Evoked Response Audiometry

P#m#r%,saan %n% $#r-/-an -n-, m#n%(a% "#r-$ahan "#ns%a( (%sr%, !% a,

s##(ah "#m$#r%an ran&san& s#nsr%s $#r-"a $-ny%. P#m#r%,saan %n%

$#rman;aa "a!a ,#a!aan %!a, m#m-n&,%n,an -n-, !%(a,-,an

"#m#r%,saan $%asa !an -n-, m#m#r%,sa ran& yan& $#r"-ra*"-ra -(%

=malingering > aa- ,#-r%&aan -(% sara; r#r,,(#a.

• toacoustic Emission7OAE

Em%s% a,-s%, m#n-n/-,,an &#ra,an s#( ram$- (-ar !an m#r#;(#,s%,an

;-n&s% ,,(#a.

3. P#m#r%,saan -(% anr&an%,

• ara S#n&#r

M#m$#r%,an 2 na!a yan& $#rsamaan "a!a ,#!-a #(%n&a) ,#m-!%an na!a

!%/a-h,an "a!a s%s% yan& s#ha.

• A-!%m#r% na!a m-rn% !%(a,-,an s#ara $#r-(an& !a(am sa- m%n&&-.

• D#n&an Im"#!ans.

• D#n&an 4ERA.

J. A-!%(&% ana,

• !ree field test

4#r-/-an -n-, m#n%(a% ,#mam"-an ana, !a(am m#m$#r%,an r#s"ns

#rha!a" ran&san& $-ny% yan& !%$#r%,an.

• A-!%m#r% $#rma%n = play audiometry>.• 4ERA = "rainstem Evoke Response Audiometry>.

• Echocheck !an #m%s% Oa,-s%, =toacoustic emissions7OAE>.

&IA#N,SIS 3AN&IN#



A. DEFINISI

Pr#s$%a,-s%s a!a(ah h%(an&nya "#n!#n&aran #rha!a" na!a m-rn% $#r;r#,-#ns% %n&&%) yan&

m#r-"a,an s-a- ;#nm#na yan& $#rh-$-n&an !#n&an (an/-nnya -s%a.

Pr#s$%a,-s%s a!a(ah "#n-r-nan "#n!#n&aran nrma( $#r,#naan !#n&an "rs#s "#n-aan.

Pr#s$%a,-s%s a!a(ah -(% s#nsr%n#-ra( "a!a -s%a (an/- a,%$a "rs# !#&#n#ras% r&an

"#n!#n&aran) s%m#r%s =#r/a!% "a!a ,#!-a s%s% #(%n&a> yan& #r/a!% s#ara "r&r#s%; (am$a)

!a"a !%m-(a% "a!a ;r#,-#ns% r#n!ah aa- %n&&% s#ra %!a, a!a ,#(a%nan yan& m#n!asar%

s#(a%n "rs#s m#n-a s#ara -m-m. Pr#s$%,-s%s a!a(ah -(% s#nsr%n#-ra( yan& $%asanya

s%m#r%s !an "a!a "as%#n yan& $#r-s%a !%aas 0 ah-n. Oran&*ran& !%aas 0 ah-n nrma(

m#n&a(am% "#n-r-nan "#n!#n&aran. Pr#s$%,-s%s !a"a m-(a% "a!a ;r#,-ans% 100 H' aa-

(#$%h !an m#n%n&,a s#ara "#r(ahan*(ahan sam"a% !#n&an ;r#,-#ns% !%aas 2000 H'.

S#"#r% r&an*r&an yan& (a%n) #(%n&a "-n m#n&a(am% ,#m-n!-ran "a!a -s%a (an/-.

K#m-n!-ran %n% !%rasa,an s#$a&a% ,-ran&nya "#n!#n&aran) !ar% !#ra/a yan& r%n&an sam"a%

!#n&an yan& $#ra. 4%(a ,#,-ran&an "#n!#n&aran %n% $#ra) a,an m#n%m$-(,an $anya,

masa(ah $a&% "#n!#r%a !#n&an ran&*ran& s#,%arnya. M%sa(nya sa(ah ;aham !a(am

,m-n%,as%. P#n!#r%a s#r%n& m#m$anah ,ar#na m#n&%ra ran& (a%n marah*marah

,#"a!anya) a, "#r!-(% ,#"a!anya) aa- ma(ah m#n#ra6a,annya) m#n&#/#,nya aa- (a%n*(a%n

(a&%. Da(am "#r/a(anan m#na"a% -s%a (an/-) a(a "#n!#n&aran !a"a m#n&a(am% $#r$a&a%

&an&&-an. <an&&-an %n% !%$a&% !a(am !-a $a&%an $#sar ya%- &an&&-an !% $a&%an ,n!-,s%

yan& $%asanya !a"a !%$a% !#n&an has%( m#m-as,an) !an "a!a $a&%an "#rs#"s% yan&

$%asanya s-(% !%$a%.

4#r,-ran&nya ;-n&s% s%s#m "#n!#n&aran ,%a "a!a -s%a s#n/a) a!a(ah s#$a&%an !ar% "rs#s

"#n-aan yan& /-&a #r/a!% "a!a s%s#m*s%s#m (a%n !% -$-h ,%a. Prs#s $#r,-ran&nya ;-n&s%

(#h ,ar#na "#n-aan %n% !%s#$- /-&a "rs#s !#&#n#ras%. Prs#s !#&#n#ras% yan& #r/a!% "a!a

s%s#m "#n!#n&aran ,%a s#h%n&&a m#n&a,%$a,an ;-n&s%nya $#r,-ran& sam"a% h%(an& !%s#$-

"r#s$%,-s%s.

M-(a%nya "rs#s !#&#n#ras% %!a, sama -n-, s#%a" ran&) a"% #r&an-n& "a!a ;a,r

,#-r-nan !an (%n&,-n&an #m"a %n&&a(nya. S#!an&,an ,#(a%nan yan& #r/a!% %!a, hanya

"a!a ,,(#a) a"% /-&a #(%n&a #n&ah) sara; "#n!#n&aran) !% n-,(#-s ,,(#a !an !% "-sa

"#n!#n&aran !% s-s-nan sara; "-sa.



4. ETIOLO<I

T#r/a!% a,%$a "rs#s !#&#n#ras% yan& $#rh-$-n&an !#n&an ;a,r*;a,r h#r#!%#r)

,#$%s%n&an (%n&,-n&an h%!-" !an ,#r/a) "#nya,% s%s#m%,) h%"#r#ns%) !%a$##s m#((%-s)

an#m%a) ar#r%s,(#rs%s) %n;#,s%) $%s%n&) &aya h%!-" aa- $#rs%;a m-(%;a,r. 4%asanya

#r/a!% "a!a -s%a (#$%h !ar% 0 ah-n. Pr&r#s%%asnya !%"#n&ar-h% -s%a !an /#n%s

,#(am%n.)8

1. In#rna(

D#&#n#ras% "r%m#r a;#r#n !an #;#r#n !ar% ,,(#a) !#&#n#ras% "r%m#r r&an r% "#n-r-nan

as-(ar%sas% !ar% r#s#"r n#-r s#nsr%, m-n&,%n /-&a m#n&a(am% &an&&-an. S#h%n&&a $a%,

/a(-r a-!%r%, !an ($-s #m"ra(%s a, s#r%n& #r&an&&- a,%$a (an/-nya -s%a.

2. E,s#rna(

T#r"a"ar $%s%n& yna& $#r(#$%han) "#n&&-naan $a ,s%, !an r#a,s% "asa ra!an&.

Sh-,n#h m#n#ran&,an "#ny#$a$ ,-ran& "#n!#n&aran "a!a "r#s$%,-s%s anara (a%n :

a. D#&#n#ras% "r%m#r a;#r#n !an #;#r#n !ar% ,,(#a) !#&#n#ras% %n% !%m-(a% !#n&an

#r/a!%nya ar;% !%$a&%an #"%#( !an sara; "a!a r&an r%. Lam$a (a-n s#ara "r&r#s%;

#r/a!% !#&#n#ras% s#( &an&(%n s"%ra( "a!a !a#rah $asa( h%n&&a ,#!a#rah a"#,s yan& "a!a

a,h%rnya #r/a!% !#&#n#ras% s#(*s#( "a!a /aras sara; "-sa !#n&an man%;#sas% &an&&-an

"#mahaman $%ara ,ar#na "#n-r-nan as-(ar%sas% !ar% r#s#"r n#-r s#nsr%, yan&

m#n&a(am% &an&&-an. S#h%n&&a $a%, /a(-r a-!%r%, !an ($-s #m"ra(%s a, s#r%n&

#r&an&&- a,%$a (an/-nya -s%a.

$. P#n#(%%an #nan& "#ny#$a$ "r#s$%a,-s%s s#$a&%an $#sar m#n%%, $#ra,an "a!a

a$nrma(%as &#n#%, yan& m#n!asar%nya =D%(a"r,an $ah6a sa(ah sa- sra%n yan& $#r"#ran

#rha!a" #r/a!%nya "r#$%,-s%s ) ya%- @4L7+ s#$a&a% "#nyan!% sara; &an&(%n s"%ra( !an

s#( sr%a as,-(ar%s "a!a ,,(#a>) !an sa(ah sa- "#n#m-an yan& "a(%n& #r,#na( s#$a&a%

"#ny#$a$ "#ns%a( "r#s$%,-s%s a!a(ah m-as% &#n#%, "a!a DNA m%,n!r%a(.

P#ny#$a$ &an&&-an "#n!#n&aran "a!a "r#s$%,-s%s -m-mnya m#r-"a,an ,m$%nas% !ar%

$#$#ra"a ha( s#$a&a% $#r%,- :

•D#&#n#ras% #(as%s%as &#n!an& #(%n&a

• D#&#n#ras% s#( ram$- !% ,,(#a.



• D#&#n#ras% ;(#,s%$%(%as !ar% m#m$ran $as%(ar

• 4#r,-ran&nya n#-rn "a!a /a(-r "#n!#n&aran

• P#r-$ahan "a!a s%s#m "-sa "#n!#n&aran !an $aan& a,

• D#&#n#ras% /an&,a "#n!#, !an auditory memory

•

M#n-r-nnya ,##"aan "rs#s "a!a "-sa "#n!#n&aran !% a, =central auditorycortex >

• !#&#n#ras% * "a!a #(%n&a #n&ah !an arhr%%s -(an&*-(an& !% #(%n&a #n&ah.

#"a (am$anya "rs#s !#&#n#ras% %n% !%"#n&ar-h% /-&a (#h #m"a !%mana s#s#ran&

%n&&a( s#(ama h%!-"nya. Oran& ,a (#$%h #"a !aan&nya "r#s$%,-s%s %n% !%$an!%n&,an

!#n&an ran& !#sa. La(- a!a ,r#(as% anara $anya,nya ma,an ma,anan yan& m#n&an!-n&

(#ma, !#n&an "r#s$%,-s%s. S#s#ran& yan& $anya, m#ma,an ma,anan yan& $anya,

m#n&an!-n& (#ma, (#$%h $#sar ,#m-n&,%nan -n-, (#$%h #"a m#n!#r%a "r#s$%,-s%s. =2>D%!-&a ,#/a!%an "r#s$%,-s%s -s%a m#m"-nya% h-$-n&an !#n&an ;a,r*;a,r h#r#!%#r)

m#a$(%sm#) ar#rs,(#rs%s) %n;#,s%) $%s%n&) &aya h%!-" aa- $#rs%;a m-(%;a,r.

M#n-r-nnya ;-n&s% "#n!#n&aran s#ara $#ran&s-r m#r-"a,an #;#, ,-m-(a%; !ar% "#n&ar-h

;a,r*;a,r !%aas.

Fa,r r#s%, yan& !a"a m#m"#r$#ra "#n-r-nan "#n!#n&aran "a!a "r#s$%,-s%s anara (a%n :

a> Us%a !an /#n%s ,#(am%n

$> H%"#r#ns%

> D%a$##s M#(%-s

!> M#r,,

#> H%"#r,(#s#r(

;> R%6aya 4%s%n&

. EPIDEMIOLO<I

S#ara &($a( "r#a(#ns% "r#s$%,-s%s $#rar%as%) !%"#r,%ra,an #r/a!% "a!a 30*J@ ran&

!#n&an -s%a !% aas @ ah-n. M#n-r- HO "a!a ah-n 200@ a,an #r!a"a 1.2 m%(yar ran&a,an $#r-s%a (#$%h !ar% 0 ah-n) !ar% /-m(ah #rs#$- 0 !%anaranya %n&&a( !% n#&ara

$#r,#m$an&. M#n-r- "#r,%raan HO "a!a ah-n 2020 ""-(as% !-n%a $#r-s%a !%aas 0

ah-n /-&a a,an m#n%n&,a sam"a% 200 .

Pa!a S-r#% K#s#haan In!#ra P#nn&(%haan P#n!#n&aran ah-n 188J *188 !% Pr"%ns%

=S-mara 4ara) S-mara S#(aan ) +a6a T#n&ah) NT4) S-(a6#s% S#(aan !an S-(a6#s% Uara>

!#n&an 18)3@ r#s"n!#n !%!a"a,an "r#a(#ns% "r#s$%,-s%s s#$#sar 2. aa- s#,%ar .

!ar% s#(-r-h "as%#n THT yan& !%!%a&nsa !#n&an Pr#s$%,-s%s



D% In!n#s%a /-m(ah "#n!-!-, $#r-s%a (#$%h !ar% 0 ah-n "a!a ah-n 200@ !%"#r,%ra,an

m#na"a% 18.8 /-a aa- .J !ar% /-m(ah ""-(as%. Pa!a ah-n 202@ /-m(ah s$ a,an

m#n%n&,a m#n/a!% J ,a(% (%"a !ar% /-m(ah ah-n 1880) !an m#r-"a,an /-m(ah #r%n&&% !%

!-n%a. +-&a #r/a!% "#n%n&,aan -s%a hara"an h%!-" !ar% -s%a @8. ah-n = 1880 > m#n/a!% 1.

"a!a ah-n 2020.

D% Am#r%,a S#r%,a %!a, a!a !aa %ns%!#ns "r#s$%,-s%s yan& a,-ra. K%ra*,%ra 2@*30 "a!a

Us%a @*J ah-n #r(%ha a!anya &an&&-an "#n!#n&aran. Pa!a -s%a (#$%h !ar% @ ah-n)

%ns%!#ns m#n%n&,a sam"a% J0*@0 . ))

• Um-r. S#s-a% !#n&an !#;%n%s%) "r#a(#ns% "r#s$%,-s%s m#n%n&,a s#/a(an !#n&an

"#n%n&,aan -s%a.

• +#n%s ,#(am%n. %!a, a!a "#r$#!aan "r#a(#ns% #r/a!%nya "r#s$%,-s%s #rha!a" /#n%s

,#(am%n yan& !%#m-,an.

• Ras. %!a, !%,#ah-% a!anya "#n&ar-h "#r$#!aan ras #rha!a" "r#a(#ns% #r/a!%nya

"r#s$%,-s%s.

D. KLASIFIKASI

1. Pr#s$%a,-s%s S#nsr%

Pa(&%nya $#r!asar,an #ra !#n&an h%(an&nya s#( ram$- !% m#m$rana $asa(%s ,,(#a !an

,ar#na %- ,has $#r-"a h%(an&nya "#n!#n&aran na!a %n&&%.

2. Pr#s$%a,-s%s N#-ra(

Pa(&%nya $#r-"a h%(an&nya s#( n#-rna( !% &an&(%n s"%ra(%s. L#a, !an /-m(ah ,#h%(an&an

s#( n#-rna( a,an m#n#n-,an a"a,ah &an&&-an "#n!#n&aran yan& %m$-( $#r-"a &an&&-an

aas ;r#,-#ns% "#m$%araan aa- "#n&#r%an ,aa*,aa.

3. Pr#s$%a,-s%s Sr%a(

Pa(&% yan& #r/a!% a!a(ah a$nrma(%as as,-(ar%s sr%a( $#r-"a ar"% !a#rah a"%,a( !an

#n&ah !ar% ,,(#a.Pr#s$%a,%s%s /#n%s %n% $%asanya #r/a!% "a!a -s%a (#$%h m-!a !%$an!%n& /#n%s

(a%n.



J. Pr#s$%a,-s%s Kn!-s%; K,(#a

Pa!a Pr#s$%a,-s%s /#n%s %n% !%!-&a !%a,%$a,an (#h #r/a!%nya "#r-$ahan m#,an%,a( "a!a

m#m$rana $asa(%s ,,(#a s#$a&a% a,%$a "rs#s m#n-a. S#ara a-!%&ram !%an!a% !#n&an

"#n-r-nan "r&r#s%; !ar% s#ns%%;%as !% s#(-r-h !a#rah #s.

E. PATOFISIOLO<I

T#r/a!% "#r-$ahan sr-,-r ,,(#a !ar% n#r#-s a,-s%,) $#r-"a ar;% !an !#&#n#ras% s#(*

s#( ram$- "#n-n/an& "a!a r&an r%) !% s#ra% "#r-$ahan as,-(ar "a!a sr%a

as,-(ar%s. +-m(ah !an -,,-ran s#(*s#( &an&(%n !an sara; /-&a $#r,-ran&.

D#n&an ma,%n (an/-nya -s%a #r/a!% !#&#n#ras% "r%m#r !% r&an r% $#r-"a h%(an&nya s#(

#"%#( sara; yan& !%m-(a% "a!a -s%a "#r#n&ahan. /-&a !%(a"r,an $ah6a ,#a!aan yan& sama

#r/a!% "-(a "a!a s#ra$- a;#r#n !an #;#r#n s#( s#nsr%, !ar% ,,(#a. T#r/a!% "-(a "#r-$ahan

"a!a s#( &an&(%n s%ra(%s !% $asa( ,,(#a. D% sam"%n& %- /-&a #r!a"a "#n-r-nan #(as%s%as

m#m$ran $asa(a%s !% ,,(#a !an m#m$rana %m"an%.

D% sam"%n& $#r$a&a% "#n-r-nan yan& #r/a!% "a!a r&an "#n!#n&aran) "as,an !arah !ar%

r#s#"r n#-rs#nsr%, m-n&,%n m#n&a(am% &an&&-an) s#h%n&&a $a%, /a(-r a-!r%, !an

($-s #m"ra(%s a, s#r%n& #r&an&&- a,%$a (an/-nya -s%a. Dar% "#n/#(asan !%aas #r(%ha $ah6a &an&&-an "#n!#n&aran "a!a -s%a (an/- !a"a !%s#$a$,an (#h $#r$a&a% s#$a$) !%

sam"%n& ,#nyaaan $ah6a /#n%s ,#(a%nan "#n!#n&ran %- s#n!%r% yan& $%sa $#r$a&a% /#n%s.

Prs#s !#&#n#ras% m#ny#$a$,an "#r-$ahan sr-,-r ,,(#a !an NCIII. Pa!a ,,(#a

"#r-$ahan yan& m#n(, %a(ah ar;% !an !#&#n#ras% s#(*s#( ram$- "#n-n/an& "a!a r&an

r%. Prs#s ar;% !%s#ra% !#n&an "#r-$ahan as,-(ar /-&a #r/a!% "a!a sra%n as,-(ar%s.

S#(a%n %- #r!a"a "-(a "#r-$ahan $#r-"a $#r,-ran&nya /-m(ah !an -,-ran s#(*s#( &an&(%n

!an sara;. Ha( yan& sama #r/a!% /-&a "a!a my#(%n a,sn sara;.

P#r-$ahan h%s(&%s $#r,a%an !#n&an $#ram$ahnya -s%a #r/a!% s#"an/an& s%s#m

"#n!#n&aran !ar% ram$- s#( ,,(#a ,# ,r#,s a-!%r% !% ,r#,s "#n!#n&aran "a!a ($-s

#m"ra( !% a,. P#r-$ahan h%s(&%s %n% ,%ra*,%ra $#rh-$-n&an !#n&an &#/a(a !ar%

"#n!#n&aran. A!a $#r$a&a% maam ;a,r yan& !a"a m#ny#$a$,an #r/a!%nya "r#s$%,-s%s

anara (a%n :

1> S#nsry "r#s$ya-s%s



Or&an r% #r(#a, "a!a s,a(a m#!%a. S#(*s#( s#nsr% !ar% r&an r% %n% #r!%r% !ar% s#(

ram$- s#$#(ah !a(am !an s#$#(ah (-ar. F-n&s%nya s#(*s#( ram$- %n% m#r$ah #n#r&% m#,an%s

!ar% &#a%an s-ara ,# %m"-( (%sr%, yan& a,an m#n#r-s,an ,# "-sa "#n!#n&aran m#(a(-% n.

,,(#ar%s. Prs#s !#&#n#ras% !ar% r&an r% %n% s-!ah m-(a% s#/a, m-!a) $ah,an s#/a, ana,*

ana, !an #r-s $#r(an/- #r-s s#ara "#r(ahan*(ahan. Kar#na "rs#snya $#r(an&s-n& s#ara

"#r(ahan*(ahan) %!a, $#ra"a m#n&&an&&- "#n!#n&aran) #r-ama "a!a ;r#,-#ns% $%ara. Dan

"a!a -s%a (an/- !#&#n#ras% %- #r$aas hanya "a!a $a&%an $asa( ,,(#a. D#&#n#ras% m-(a%

!#n&an !#srs% !an "#m%a,an !ar% s#(*s#( ram$-) !%%,-% (#h h%(an&nya s#(*s#( ram$- !an

s#(*s#( "#ny,n& yan& "#r(- -n-, m#n/a&a ,#(an&s-n&an h%!-" !ar% s#ra$- &an&(%n

s"%ra(%s. 4%(a %n!a,an sam"a% ,# ;as# %n% ma,a r&an r%"-n m#n&h%(an&. K#,h-s-san !ar%

%"# s#nsry "r#s$ya-s%s %n% a!a(ah -r-nnya s#ara %$a*%$a "#n!#n&aran -n-, ;r#,-#ns%

%n&&%.

2> N#-ra( "r#s$ya-s%s

M#n-r- O#) Sh-,n#h !an K#rr s#$a&a% has%( "#ny#(%!%,annya "a!a s#(*s#( &an&(%n !ar%

,,(#a) !%!a"a,an*nya $ah6a /-m(ah s#(*s#( &an&(%n =n#-rn#s> a,an $#r,-ran& !ar% 3.000

"a!a !#,a!# "#rama sam"a% 20.000 "a!a !#,a!# ,#*8. P#n&-ran&an /-m(ah s#(*s#( n#-rn#s

%n% s#s-a% !#n&an nrma( s"##h !%sr%m%na%n. 4%(a /-m(ah n#-rn#s %n% $#r,-ran& !% $a6ah

yan& !%$--h,an -n-, ranm%s% &#aran) #r/a!%(ah n#-ra( "r#s$ya-s%s. 4%asanya

,#,-ran&annya n#-rn#s !ar% ,,(#a (#$%h "arah "a!a $asa( ,,(#a .

<am$aran ,(as%, : s"##h !%sr%m%na%n san&a $#r,-ran& !an ar;% yan& (-as !ar% &an&(%n

s"%ra(%s

3> Sr%a( "r#s$ya-s%s

F-n&s% !ar% sr%a as-(ar%s %n% $#(-m !%,#ah-% $#-(. A!a an&&a"an $ah6a m-n&,%n sr%a

as-(ar%s #m"a s#,r#s% #n!(%m;#) ya%- s-a- s-m$#r "#ns%( (%sr%, !% s,a(a m#!%a aa-

m-n&,%n /-&a s-m$#r #n#r&% -n-, s#(*s#( "a!a m#m$rana $as%(ar%s. Sr%a( "r#s$ya-s%s %n%

m#r-"a,an %"# "r#s$%a,-s%s yan& s#r%n& !%!a"a%. K#,hasannya %a(ah) ,#,-ran&an

"#n!#n&aran m-(a% !aan& "a!a !#,a!# ,#*3 sam"a% !#,a!# ,#* !an $#r(an&s-n& s#ara

"#r(ahan*(ahan. D%$#!a,an !ar% %"# "r#s$%a,-s%s (a%n ya%- "a!a sr%a( "r#s$ya-s%s %n%

&am$aran a-!%&ramnya raa) s"##h !%sr%m%na%n $a&-s sam"a% $aas m%n%m-m

"#n!#n&arannya m#(#$%h% @0 !4.



H%s(&% : Ar;% "a!a sr%a as-(ar%s) !% mana (#$%h "arah "a!a ,,(#a s##n&ah $a&%an

a"#B.

J> h(#ar n!-%# "r#s$ya-s%s

h(#ar n!-%# "r#s$ya-s%s ya%- s-a- %"# ,#,-ran&an "#n!#n&aran !#n&an s-a-

&am$aran ,has a-!%&ram yan& m#n-r-n !an s%m#r%s.

H%s(&% : T%!a, a!a "#r-$ahan mr"(&% "a!a sr-,-r ,,(#a -n-, m#n#ran&,an

,#,-ran&an "#n!#n&aran %n%. +a!% ,#,-ran&an "#n!#n&aran %n% !%s#$a$,an (#h &an&&-an

&#ra,an m#,an%s !% m#m$rana $asa(%s. P#r-$ahan aas r#s"n ;%s%, ,h-s-s !ar% m#m$rana

$asa(%s (#$%h $#sar !% $a&%an $asa( ,ar#na (#$%h #$a( !an /a-h (#$%h ,-ran& !% a"%a() !% mana

!% s%n% (#$%h (#$ar !an (#$%h %"%s. Nm-ra =180> m#n&aa,an) #r/a!% !#"s% !ar% (#ma,

,(#s#r( !% m#m$rana $asa(%s) !an %n% !a"a m#ny#$a$,an "#r-$ahan "a!a r#s"n ;%s%, !ar%

m#m$rana $as%(ar%s. S#(a%n "a!a ,,(#a /-&a !%(a"r,an #r/a!%nya "#r-$ahan "a!a "-sa

"#n!#n&aran) #r/a!%nya ar;% !% n-,(#% "a!a "-sa "#n!#n&aran) !an %n% m#ny#$a$,an

"#n-r-nan !ar% s"##h !%sr%m%na%n.

Sa- !ar% "#n#(%%an yan& san&a $#r"#ns% -n-, m#(-as !%s#$a$,an (#h m-as% &#n#%,

"a!a DNA m%,n!r%a. P#r;-s% yan& $#r,-ran& "a!a ,,(#a s#%r%n& !#n&an -s%a m#m$#r%,an

!am"a, "a!a "a!a $#n-, !ar% m#a$(%, ,s%&#n r#(a%;) yan& m#m$#r%,an !am"a, "a!a

sr-,-r sara; #(%n&a !a(am s#%r%n& !#n&an ,#r-sa,an DNA m%,n!r%a. K#r-sa,an "a!a

DNA m%,n!r%a m#ny#$a$,an $#r,-ran&nya "s"r%(as% ,s%!a%;) yan& !a"a m#m$#r%,an

masa(ah "a!a ;-n&s% n#-ra( #(%n&a !a(am.

F. MANIFESTASI KLINIS

K#(-han -ama "r#s$%,-s%s $#r-"a $#r,-ran&nya "#n!#n&aran s#ara "#r(ahan*(ahan !an

"r&r#s%;) s%m#r%s "a!a ,#!-a #(%n&a. Ka"an $#r,-ran&nya "#n!#n&aran %!a, !%,#ah-%

!#n&an "as%. P#rama*ama #r/a!% s#!%,% !#m% s#!%,% ,#,-ran&an "#n!#n&aran "a!a

;r#,-#ns% %n&&%) !an ,#m-!%an !%%,-% (#h %!a, $%sa m#n!#n&ar !#n&an /#(as a,%$a

s-,arnya m#nan&,a" h-r-; ,nsnan yan& $#rs-ara m#n!#s%s =S) SH) ) !an T>. K#(-han

(a%nnya a!a(ah #(%n&a $#r!#n&%n& =%n%-s na!a %n&&%>. Pas%#n !a"a m#n!#n&ar s-ara

"#ra,a"an) #a"% s-(% -n-, m#maham%nya) #r-ama $%(a !%-a",an !#n&an #"a !% #m"a

!#n&an (aar $#(a,an& yan& rama% =,a%( "ary !#a;n#ss>. 4%(a %n#ns%as s-ara !%%n&&%,an



a,an %m$-( rasa ny#r% !% #(%n&a) ha( %n% !%s#$a$,an (#h ;a,r ,#(#(ahan sara; =r#r-%m#n>.

Pa!a ,as-s "r#s$%,-s%s yan& $#ra ,m-n%,as% !#n&an "#n!#r%a (#$%h s-,ar. Um-mnya

"#n!#r%a "r#s$%,-s%s %n% (#$%h s-,a $%(a ,%a $#r$%ara (am$a*(am$a) /#(as) ,aa*,aa yan&

"#n!#, !an $%ara a&a, ,# !#,a ,-"%n&) !ar%"a!a s-ara yan& ,#ras.

P#n!#n&aran $#r,-ran& s#ara "#r(ahan*(ahan) "r&r#s%;) !an s%m#r%s "a!a ,#!-a

#(%n&a. T#(%n&a $#r!#n&%n&. Pas%#n !a"a m#n!#n&ar s-ara "#ra,a"an a"% s-(%(

m#maham%nya) #r-ama $%(a #"a !an (aarnya r%-h. 4%(a %n#ns%as !%%n&&%,an a,an

%m$-( rasa ny#r%. Da"a !%s#ra% %n%-s !an %n#r%&.

Pa!a "#m#r%,saan s," am"a, m#m$ran %m"an% s-ram !an m$%(%asnya

$#r,-ran&.

P#r-$ahan*"#r-$ahan !a(am sr-,-r !an ;-n&s% "a!a #(%n&a $a&%an !a(am m#m$-a s-(%

-n-, m#maham% %"# $-ny% $%ara #r#n- !an m#ny#$a$,an %n(#ran #rh!a" $-ny% ,#ras.

4-ny%*$-ny% yan& $%asanya h%(an& "#rama ,a(% a!a(ah: f# s# th# ch !an sh. Saa "#n-r-nan

"#n!#n&aran $#r(an/-) ,#mam"-an -n-, m#n!#n&ar $-ny% b# t# p# k !an t /-&a r-sa,

4#$#ra"a !ar% an!a !an &#/a(a yan& "a(%n& -m-m !ar% "#n-r-nan "#n!#n&aran :

1. K#s-(%an m#n&#r% "#m$%araan

2. K#%!a,mam"-an -n-, m#n!#n&ar,an $-ny%*$-ny% !#n&an na!a %n&&%.

3. K#s-(%an m#m$#!a,an "#m$%araan $-ny% $%ara (a%n yan& "ara- aa- $#r&-mam

J. Masa(ah "#n!#n&aran "a!a ,-m"-(an yan& $#sar) #r-ama !#n&an (aar $#(a,an& yan&

$%s%n&

@. Laar $#(a,an& $-ny% $#r!#r%n& aa- $#r!#s%s yan& ,nsan

. P#r-$ahan ,#mam"-an m#n!#n&ar ,nsnan s#"#r% s) ') ) ; !an &

. S-ara ,a( yan& ;r#,-#ns%nya r#n!ah s#"#r% a) #) %) ) - -m-mnya r#(a%; !%#r%ma

!#n&an (#n&,a".

<. DIA<NOSIS

D%a&ns%s !%#&a,,an $#r!asar,an:

a. Anamn#s%s



$. P#m#r%,saan #(%n&a =Os,"%>

D#n&an "#m#r%,saan s,"%) am"a, m#m$ran %m"an% s-ram) m$%(%asnya

$#r,-ran&.

. T#s P#n!#n&aran

* T#s &ar"- a(a : Pa!a #s &ar"- a(a !%!a"a,an -(% s#nsr%n#-ra(.

* A-!%m#r% na!a m-rn%

Pa!a "#m#r%,saan a-!%m#r% na!a m-rn% m#n-n/-,,an s-a- -(% sara; na!a %n&&%) $%(a#ra()

!an s%m#r%s.

* A-!%m#r% $%ara

A-!%m#r% $%ara !%(a,-,an -n-, m#n&#ah-% S"##h !%sr%m%na%n sr#) ya%-

,#mam"-an "#n!#n&aran "#n!#r%a !a(am m#m$#!a*$#!a,an maam*maam ,aa yan&

!%!#n&ar. 8

PENA!A$AKSANAAN

Pr#s$%a,-s%s %!a, !a"a !%"#r$a%,% !#n&an #ra"% m#!%s aa- $#!ah #a"% !a"a

!%sa$%(,an !#n&an m#ny#!%a,an a(a $an- !#n&ar =am"(%;%,as%> ,h-s-s. C(-m# s-ara a,an

!%%n&,a,an m#(a(-% am"(%;%,as%) #a"% s-ara a,an #a" #r#!am. Saa %n%) a(a $an- !%&%a(

yan& !% "r&ram s-!ah #rs#!%a) !%mana !a"a !%a-r -n-, m#n&ha!a"% ,#a!aan yan& s-(%

-n-, m#n!#n&ar,an. @))8

&AF!AR P"S!AKA

1. Anam% !an ;%s%(&% "#n!#n&aran. 2003. A#ss#! n: 12 2013. Aa%(a$(# ;rm:

h":77r#"s%ry.-s-.a.%!7$%sr#am7123J@873J717h*an!r%na1."!; .

http://repository.usu.ac.id/bitstream/123456789/3468/1/tht-andrina1.pdf







2. ASHA. H#ar%n& Lss. 2011. A#ss#! n: 12h $#r 2013. Aa%(a$(# ;rm:

h":77666.asha.r&7"-$(%7h#ar%n&7H#ar%n&*Lss7 .

3. AARP. S#nsr%n#-ra( !#a;n#ss. 2008. A#ss#! n: 12 $#r 2013. Aa%(a$(# ;rm:

h"s:77666.aar"h#a(har#.m7a!amn#n7s#nsr%n#-ra(!#a;n#ssQ

h("a&#ar%(#( a$(#;n#nsna!#;%n%%n .

J. MD <-%!#(%n#s. H#ar%n& Lss. 2010. A#ss#! n: 12 $#r 2013. Aa%(a$(#

;rm:h":77666.m!&-%!#(%n#s.m7h#ar%n&*(ss .

@. P#m#r%,saan a-!%m#r%. A#ss#! n 12 $#r 2013.Aa%(a$(# ;rm :

h":77%!.sr%$!.m7!7103081J07T-(%*S#nsr%n#-ra(

. AE n(%n. =200>. Tr#am#n ; S-!!#n S#nsr%n#-ra( H#ar%n& LssV. ARH

OTOLARYN<OLO<Y HEAD NEK SUR<. 133) @3*@1

. S#%r I) H#n!arm%n H) 4ash%r-!!%n +. <an&&-an P#n!#n&aran =T-(%>.

Da(am: S#"ar!%EA) Is,an!ar N. 4-,- A/ar I(m- K#s#haan T#(%n&a H%!-n&

T#n&&r, K#"a(a L#h#r.E!%s% ,#*. +a,ara: 4a(a% P#n#r$% FK UI) 200. h.

122.@.

. S#"ar!% EA) Is,an!ar. P#m#r%,saan T#(%n&a) H%!-n&) T#n&&r,) K#"a(a !an

L#h#r.Da(am: S#"ar!% EA) Is,an!ar N. 4-,- A/ar I(m- K#s#haan T#(%n&a H%!-n&

T#n&&r, K#"a(a L#h#r. E!%s% ,#*. +a,ara : 4a(a% P#n#r$% FK UI) 200. h. 1*2

8. Pr#s$%a,-s%s. 2012. A#ss#! n: 21h $#r 2013. Aa%(a$(# ;rm:

h":77#m%r'an-r6%a,sn.$(&.-n%ss-(a.a.%!7201370J7107"r#s$%a,-s%s7.

http://www.asha.org/public/hearing/Hearing-Loss/

https://www.aarphealthcare.com/adamcontent/sensorineuraldeafness?hlpage=article&loc=table_of_contents_nav#definition


http://www.mdguidelines.com/hearing-loss

http://id.scribd.com/doc/103709140/Tuli-Sensorineural

http://emirzanurwicaksono.blog.unissula.ac.id/2013/04/10/presbiakusis/










http://id.scribd.com/doc/103709140/Tuli-Sensorineural


208733955 referat tuli sensorineural

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