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HUBUNGAN GANGGUAN PENDENGARAN DENGAN

KEMAMPUAN BAHASA PADA ANAK SINDROM DOWN

LAPORAN HASIL PENELITIAN

KARYA TULIS ILMIAH

Diajukan sebagai syarat untuk mengikuti ujian hasil

Karya Tulis Ilmiah mahasiswa program strata-1 kedokteran umum

ARGE RAVIADI MUHAMMAD

22010111130067

PROGRAM PENDIDIKAN SARJANA KEDOKTERAN

FAKULTAS KEDOKTERAN

UNIVERSITAS DIPONEGORO

2015

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KATA PENGANTAR

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DAFTAR ISI

HALAMAN JUDUL ................................................................................................ i

LEMBAR PENGESAHAN PROPOSAL KTI ...... Error! Bookmark not defined.

PERNYATAAN KEASLIAN ................................ Error! Bookmark not defined.

KATA PENGANTAR ........................................... Error! Bookmark not defined.

DAFTAR ISI .......................................................................................................... vi

DAFTAR TABEL ................................................................................................... x

DAFTAR GAMBAR ............................................................................................. xi

DAFTAR LAMPIRAN ......................................................................................... xii

DAFTAR SINGKATAN ..................................................................................... xiii

ABSTRAK ........................................................................................................... xiv

ABSTRACT .......................................................................................................... xv

BAB I PENDAHULUAN ....................................................................................... 1

1.1 Latar belakang ................................................................................................... 1

1.2 Permasalahan penelitian .................................................................................... 3

1.3 Tujuan penelitian ............................................................................................... 3

1.3.1 Tujuan umum ................................................................................................. 3

1.4 Manfaat penelitian ............................................................................................. 4

1.5 Keaslian penelitian ............................................................................................ 4

BAB II TINJAUAN PUSTAKA ............................................................................. 6

2.1 Sindrom down ................................................................................................... 6

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2.1.1 Manifestasi klinis sindrom down ................................................................... 7

2.1.2 Kondisi spesifik sindrom down ...................................................................... 8

2.2 Sistema auditorik manusia ................................................................................ 9

2.2.1 Anatomi dan fisiologi pedengaran normal ..................................................... 9

2.2.1.1 Mekanisme konduksi suara ....................................................................... 10

2.2.1.1.1 Telinga luar ............................................................................................ 10

2.2.1.1.2 Telinga tengah ........................................................................................ 12

2.2.1.2 Mekanisme transduksi suara ..................................................................... 14

2.2.1.2.1 Telinga dalam ......................................................................................... 14

2.2.2 Patologi pendengaran manusia ..................................................................... 16

2.2.2.1 Conductive hearing loss (CHL) ................................................................ 17

2.2.2.2 Sensory-neural hearing loss (SNHL) ........................................................ 18

2.2.2.3 Mixed hearing loss (MHL) ....................................................................... 18

2.2.3 Pendengaran pada anak sindrom down ........................................................ 19

2.2.4 Screening pendengaran ................................................................................ 20

2.3 Kemampuan berbicara dan berbahasa anak normal ........................................ 21

2.3.1 Kemampuan berbicara dan berbahasa anak sindrom down ........................ 22

2.4 Hubungan ISPA dengan Gangguan Berbicara dan Berbahasa ...................... 26

2.5 Hubungan Faktor Stimulasi dengan Perkembangan Berbicara dan Berbahasa

............................................................................................................................... 26

2.6 Hubungan Faktor Retardasi Mental dengan Perkembangan Berbicara dan

Berbahasa ............................................................................................................. 27

BAB III KERANGKA TEORI, KERANGKA KONSEP, HIPOTESIS .............. 28

3.1 Kerangka teori ................................................................................................. 28

3.2 Kerangka konsep ............................................................................................. 29

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3.3 Hipotesis .......................................................................................................... 29

3.3.1 Hipotesis mayor ........................................................................................... 29

BAB IV METODOLOGI PENELITIAN ............................................................. 30

4.1 Ruang lingkup penelitian ................................................................................ 30

4.2 Tempat dan waktu penelitian .......................................................................... 30

4.3 Jenis dan rancangan penelitian ........................................................................ 30

4.4 Populasi dan sampel penelitian ....................................................................... 30

4.4.1 Populasi target .............................................................................................. 30

4.4.2 Populasi terjangkau ...................................................................................... 30

4.4.3 Sampel .......................................................................................................... 31

4.4.3.1 Kriteria inklusi .......................................................................................... 31

4.4.3.2 Kriteria eksklusi ........................................................................................ 31

4.4.4 Cara sampling............................................................................................... 31

4.4.5 Besar sampel ................................................................................................ 31

4.5 Variabel penelitian .......................................................................................... 32

4.5.1 Variabel bebas .............................................................................................. 32

4.5.2 Variabel terikat ............................................................................................. 32

4.5.3 Variabel perancu .......................................................................................... 32

4.6 Definisi operasional ........................................................................................ 32

4.7 Cara pengumpulan data ................................................................................... 33

4.7.1 Bahan dan alat .............................................................................................. 33

4.7.2 Jenis data ...................................................................................................... 33

4.7.3 Cara kerja ..................................................................................................... 33

4.8 Alur penelitian ................................................................................................. 34

4.9 Analisa data ..................................................................................................... 35

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4.10 Etika penelitian.............................................................................................. 35

4.11 Jadwal penelitian ........................................................................................... 35

BAB V HASIL PENELITIAN ............................................................................. 36

5.1 Karakteristik Subjek Penelitian ....................................................................... 36

5.1.1 Fungsi pendengaran subjek penelitian ......................................................... 37

5.1.2 Tipe gangguan pendengaran subjek penelitian ............................................ 38

5.2 Analisis interferensial ..................................................................................... 39

5.2.1 Hubungan derajat gangguan pendengaran dengan derajat perkembangan

bahasa (DDST) ...................................................................................................... 39

5.2.2 Hubungan gangguan pendengaran dengan perkembangan bahasa (DDST) 40

5.2.3 Hubungan Periode Umur dengan Perkembangan Bahasa (DDST).............. 40

BAB VI PEMBAHASAN ..................................................................................... 42

BAB VII SIMPULAN DAN SARAN .................................................................. 47

7.1 Simpulan ......................................................................................................... 47

7.2 Saran ................................................................................................................ 47

DAFTAR PUSTAKA ........................................................................................... 48

LAMPIRAN

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DAFTAR TABEL

Tabel 1. Keaslian Penelitian…………………………………….………...…….....4

Tabel 2. Gambaran Fisik Sindrom Down..……………………….......….…..……8

Tabel 3. Kondisi Spesifik Sindrom Down……………………..…….............…...8

Tabel 4. Klasifikasi Gangguan Pendengaran Menurut WHO……………………17

Tabel 5. Periode Perkembangan Bahasa Anak Normal.........................................21

Tabel 6. Perbandingan Perkembangan Bahasa Anak Normal dengan Anak

Sindrom Down.........................................................................................23

Tabel 7. Definisi Operasional………………………………….………...……....32

Tabel 8. Jadwal Penelitian…………………………………….………...……......35

Tabel 9. Karakteristik Subjek Penelitian................................................................36

Tabel 10. Kategori Fungsi Pendengaran Secara Umum........................................38

Tabel 11. Distribusi Tipe Gangguan Pendengaran................................................38

Tabel 12. Hubungan Fungsi Pendengaran dengan Perkembangan Bahasa

(DDST)..................................................................................................40

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DAFTAR GAMBAR

Gambar 1. Telinga Luar.........................................................................................11

Gambar 2. Pinna (Auriculla).............……………….....………………………....11

Gambar 3. Telinga Tengah………………………...............................…………..13

Gambar 4. Tulang Pendengaran Telinga Tengah...................................................14

Gambar 5. Cavum Tymphani.................................................................................14

Gambar 6. Potongan Melintang Choclea (A), Organa Corti (B)..........................16

Gambar 7. Kerangka Teori.....................................................................................28

Gambar 8. Kerangka Konsep.................................................................................29

Gambar 10. Nilai Rerata (Mean) DQ Perkembangan Bahasa (DDST).................39

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DAFTAR LAMPIRAN

Lampiran 1. Ethical Clearance..............................................................................52

Lampiran 2. Surat Ijin Penelitian dan Peminjaman Data Rekam Medis...............53

Lampiran 3. Surat Pernyataan Penelitian di RSUP Dr. Kariadi Semarang ..........54

Lampiran 4. Data output SPSS Hasil Penelitian....................................................55

Lampiran 5. Biodata Peneliti..................................................................................61

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DAFTAR SINGKATAN

AABR : Automated Auditory Brainstem Response

BERA : Brainsteam Electric-Response Audiometry

CHL : Conductive Hearing Loss

dB : Decibels

DDST : Denver Developmental Screening Test

DQ : Developmental Quotient

Hz : Hertz

IQ : Intelligence Quotient

ISPA : Infeksi Saluran Pernafasan Atas

KEPK : Komisi Etik Penelitian Kesehatan

KHz : Kilo Hertz

MHL : Mixed Hearing Loss

NHS : Newborn Hearing Screening

OAE : Otoacoustic Emission

OME : Otitis Media Efusi

POTADS : Persatuan Orang Tua Anak dengan Down Syndrome

PTA : Pure Tone Audiometry

Riskesdas : Riset Kesehatan Dasar

RSUD : Rumah Sakit Umum Daerah

RSUP : Rumah Sakit Umum Pusat

SLBN : Sekolah Luar Biasa Negeri

SNHL : Sensory-Neural Hearing Loss

WHO : World Health Organization

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ABSTRAK

Latar Belakang: Sindrom Down adalah kelainan kromosom genetik yang disebut

trisomi. Pasien sindrom Down memiliki ekstra kromosom 21. Hal ini dikarenakan

adanya gagguan pembelahan kromosom yang disebut non-disjungsi atau

aneuploidi. Bertambahnya kromosom berdampak pada ketidak seimbangan

genetik, retardasi mental dan terganggunya fungsi fisik, intelektual bahkan

fisiologi tubuh. Beberapa gangguan atau masalah kesehatan terbesar yang dialami

oleh anak-anak dengan sindrom Down adalah gangguan pendengaran dan

perkembangan bahasa gangguan.

Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan antara gangguan

pendengaran dengan perkembangan bahasa pada anak sindrom Down.

Metode: Penelitian ini menggunakan metode analytic observasional

retrospektive. Data diambil dari catatan medis pasien sindrom Down di RSUP dr.

Kariadi pada tahun 2008-2015. Sampel adalah anak sindrom Down yang

melakukan kontrol di RSUP dr. Kariadi Semarang. Pengambilan data berupa data

karakteristik, data fungsi pendengaran kedua telinga yang dilakukan pemeriksaan

BERA , dan data perkembangan bahasa yang diperiksa dengan DDST. Uji

statistik dilakukan dengan uji Chi-square dan uji Fisher.

Hasil: Penelitian ini menggunakan 32 sampel anak sindrom Down. Sebanyak 8

(25%) subjek dengan pendengaran normal dan 24 (75%) adalah subjek dengan

gangguan pendengaran. Analisis hubungan gangguan pendengaran ringan dengan

perkembangan bahasa (DDST) mempunyai nilai p = 1,00. Hubungan gangguan

pendengaran sedang dengan perkembangan bahasa (DDST) mempunyai nilai p =

0,538. Dan hubungan gangguan pendengaran berat – sangat berat dengan

perkembangan bahasa (DDST) mempunyai nilai p = 0,569.

Kesimpulan: Tidak ada hubungan gangguan pendengaran pada perkembangan

bahasa pada anak sindrom Down.

Kata kunci: Down syndrome, gangguan pendengaran, perkembangan bahasa

(DDST).

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ABSTRACT

Background: Down syndrome is a genetic chromosomal disorder called trisomy.

Patients with Down syndrome have an extra chromosome 21. This is because of

non-disjunction or aneuploidy of the chromosomes. Increased chromosomal

imbalance impact on genetic, mental retardation and disruption of physical

functions, intellectual and even physiology. Some of the largest health problems

experienced by children with Down syndrome are hearing impairment and

impaired language development.

Aim: To analyze the correlation between hearing impairment and language

development in Down Syndrome children.

Methods: This study uses an observational analytic retrospective. Data taken

from the medical records of Down Syndrome patients in the dr Kariadi Hospital

Semarang in 2008-2015. The data include characteristic of the subject, hearing

function on both ears with BERA examination, and examined language

development with DDST. Statistical tests performed by Chi-Square test and

Fisher's exact test. Results: This study used 32 samples of children with Down syndrome. A total of 8

(25%) us subjects with normal hearing and 24 (75%) is subjects with hearing

impairment. Analysis of the relationship beetwen mild hearing impairment and

the development of language (DDST) has a value of p = 1.00. Analysis of the

relationship beetwen moderate hearing impairment and the development of

language (DDST) has a value of p = 0.538. And the analysis of the relationship

beetwen severe – profound hearing impairment and the development of language

(DDST) has a value of p = 0.569.

Conclusion: There is no correlation between hearing impairment and language

development in children with Down syndrome.

Keywords: Down syndrome, hearing impairment, language development (DDST).