Preface

First of all, I want to thank God, for blessing me so I can finish my paper on time.I would like to thank to; 1. dr. David ". dr. #. y Family, $asmine and all my friends in &niversity. %his paper far from perfect and maybe there are a lot of mistake. $our critics and suggestions are accepted to help me improve this paper to something much better. 'nd last but not least, I hope this paper can be useful for all of us. edical Faculty of %risakti !c. as my supervisor, who guide me to finish my paper

(akarta,

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!tanley *ermana

CONTENTS

*reface+++++++++++++++++++++++++++++++i ,ontents++++++++++++++++++++++++++++++.ii 'bstract++++++++++++++++++++++++++++++..1 Introduction+++++++++++++++++++++++++++++" *hysiological and 'natomy of 'uditory+++++++++++++++++....# *atofisiology of -I./

ABSTRACT -oise induced hearing loss 0-I./1 is a sensori2neural hearing deficit that begin at the higher fre3uencies 0#))) to 4))) .51 and develops gradually as a result of chronic e6posure to e6cessive sound level. It is mostly found in the developing and industrial countries workers. %he ob7ective of this study was to prove that chronic e6posure noise of machine could lead to -I./ on factory workers. ' cross section study of 8) factory workers in %angerang of 9anten was done during the periode of (anuary to (une ")1). %he method of this study included: interview, noise measurement in the steel production machine room and in the adminitration room , ;-% e6amination and hearing test with audiometer of 8) workers. %his sample divided into two groups, a group of "8 workers of the production machine division as case group, and another "8 workers of the administrative division as control group. %he results of this study was as follows: %he noise intensity in the steel production machine room was 1)" d9 and in the administration room was 4).< d9 and a number of "1 workers 0=< >1 of the case group got -I./, compared to 1 worker 0< >1 of the control group. %here was a significant difference in the incidence of -I./ between the two groups. %here was also a significant difference in correlation between -I./ and working period.

INTRODUCTION ;nvironmental noise is a common cause of hearing loss in industriali5ed societies. .earing loss that is caused by the noise e6posure due to recreational or nonoccupational activities is termed socioacusis. .earing loss due to in7urious noise at workplace is referred to as occupational noise2induced hearing loss 0?-I./1. %he term acoustic trauma means the hearing loss due to single e6posure to intense sound.?-I./ is a more common cause of noise2induced hearing loss 0-I./1 and much more serious problem than socioacusis for the following " reasons: 011 %he threat of loss of employment may convince people to remain in environments with noise levels higher than they would otherwise accept, and 0"1 in the workplace, high levels of noise may be sustained on a regular basis for many hours each day over many years. ,onse3uently, occupational noise e6posure has drawn the most attention. 9ecause of that case, this paper will be e6plain from physiology auditory, pathofisiology, clinical manifestation, physical e6amination until rehabilitation and prevention effort.

Physiology of Auditory ,aptured by the sound vibrations are transmitted into the ear the ear canal and the tympanic membrane to vibrate the tympanic membrane. %hese vibrations forwarded -e6t to the the bones foramen of hearing are is related also to one another. perilimfe move ovale stapes moving

the scale vestibuli. %remors continued through the membrane of @eissner encourage endolimfe and basal membrane towards the bottom and perilimfe tympanic scale will move up to foramen rotundum pushed to the outside. 't rest, end winding ,orti hair cells, and the terdorongnya basal membrane, the tip of the hair cells to be straight. *hysical stimulus is change the electrical stimulation caused by the different sodium and potassium ions that forwarded to the branches of the -. AIII, and then proceed to the second stimulus sensory center of hearing in the brain through the nerve center is in the lobe temporalis.

Patofisiology e6posed to noise for a long time Direct damage at sterocilia in hair cell Death of hair cell

@upture of reissner membrane

disturbance impulse formation

vibration could not be delivered to the scale of the media and organ corti

no impulses are transmitted to the brain

Deafness

Clinical Manifestation -oise2induced hearing loss 0-I./1 develops slowly after many years of e6posure. %he following are the criteria to diagnosis -I./ are: 1. ?-I./ is always a neurosensory loss. ". ?-I./ is almost always bilateral. #. .igh2fre3uency losses rarely e6ceed B8 d9, and low2fre3uency losses rarely e6ceed <) d9. <. .earing loss does not progress after noise e6posure is discontinued. 8. 's hearing loss progresses, the rate of hearing loss decreases.

4. /oss is always greater at the fre3uencies #)))24))) .5 than at 8))2 "))) .5. /oss is usually greatest at <))) .5. %he <)))2.5 notch is often preserved even in advanced stages. B. In stable e6posure conditions, losses at #))), <))), and 4))) .5 usually reach a ma6imum level in 1)218 years. Chen hearing loss is limited to the high fre3uencies, individuals are unlikely to have difficulty in 3uiet conversational situations. %he first difficulty the patient usually notices is trouble understanding speech when a high level of ambient background noise is present. 's -I./ progresses, individuals may have difficulty understanding high2pitched voices 0eg, womenDs, childrenDs1 even in 3uiet conversational situations. ,onversation on the telephone is generally unimpaired because telephones do not use fre3uencies above #))) .5. ,linically, -I./ begins with a temporary threshold shift 0%%!1. ' %%! is defined as a temporary neurosensory hearing loss that recovers almost completely once the no6ious stimulus is removed. %he amount of time over which recovery occurs is unclear and controversial. !i6teen hours has been used in the past, but some people with %%! re3uire longer periods to recover. Doctors uses a "<2 hour threshold; however, some argue that days or months may be re3uired to recover %%!, especially if the case is associated with acoustic trauma. -onetheless, as a practical matter, Doctors time limit of "< hours is commonly used. In a fact, -I./ most common in fre3uency <))) h5 because the ear only ma6imal receive in this fre3uency. Other Test ?ther than the clinical manifestation, to diagnose -I./ can also do some additional checks 7ust as audiometry, sound level meters, ?!.', and 9;@'. 9ut of all the above mentioned e6amination with audiometry is more often used for audiometric testing is the only diagnostic evaluation is relevant to the diagnosis of noise2induced hearing loss 0-I./1. 9ecause of that reason in this paper will be more e6plain audiometric test rather than other test 0e6: 9;@', ?!.' and !ound /evel eter1. %he audiometry in this case have a function to know the limit of the hearing threshold in the right ear and left in the air and electrical conductivity of bone. -ormal intensity values in both normal delivery is underlined that at "8 db at all fre3uencies which the

test 08)), 1))), and "))) .51.Cith this audiometry test, we can also note the degree of deafness someone by Fletcher way. Cith summing the intensity in the fre3uency of 8)), 1))), "))) and <))) and then divide by < then we will get results that will be incorporated into e6isting classification. ,lassification of the degree of deafness is )2"8 db "82<) db <)288 db 882B) db B)2E) db F E) db : normal : mild deafness : moderately deafness : moderately severe deafness : severe deafness : very severe deafness.

In -I./ condition it will get a picture on 'udiometry is air conduction line and bone conduction line will be coincide. Treat ent and Pre!ention non2medical 2;ducation: In principle, the management of these patients more toward preventive to prevent similar incidents and prevent further complications. *reventive form is done not only to patients but also the company that the engine has a sound intensity of noise above =8d9. *reventive efforts can be: < steps hearing conservations, covering: o Identification of sound sources, such as conducting surveys 0Calk %hrough !ound /evel o o o !urvey1 on a machine that became the source noise through a device called a eter or ?ctave band analy5er. of noise by analy5ing and megukur

&sing *ersonal *rotective ;3uipment 0**;1, using an ear2plug in order to reduce noise generated from noise sources ,onduct periodic audiometric testing at2risk workers. ;fforts to reduce the intensity of noise for e6ample:

*erform administrative control as an e6ample of the division held a working time 0shift1 that was meant for the workers at minimi5ing the risk of e6posure from noise sources and others.

*sychotherapy: in this case is necessary for patients to receive a state that the deafness can permanent when the noise e6posure in long time. 2 @eferring patients to those who have more competence in this case the ;-% specialist in order to get further action.

Prognosis .earing loss should not progress if e6posure to the in7urious noise is eliminated. oreover, as the severity of the hearing loss increases, the rate of progression decreases, provided the in7urious stimulus remains constant. Conclusion -I./ is a situation where the ear as a means of hearing of e6posure to the noise in a long time and repeated so that the membrane can reisner impaired until rupture besides sterocillia in hair cells susceptible to interference and so can not continue impluls to the brain. %his condition is closely related to the type of work someone, especially those working in the industry which is a region vulnerable to noise e6posure. %o know the e6act diagnosis of -I./ can be made supporting such audiometric test that can also know the degree ketuian e6perienced by the patient. -I./ treatment performed essentially preventive and rehabilitative only so much needed role and not only from workers but also in terms of companies that more health workers so that the incidence and complications of -I./ can be minimi5ed so that eventually the company can ma6imi5e its potential by workers.

References 1. 'dams G/.9oeis fundamentals of otolaryngology . ' te6tbook of ;ar, -ose and %hroat Diseases. 4th ;d.C9 !aunders ,o, 1E=E: p."B2B4. ". (ack Gat5, *hD. .andbook of clinicall audiology, third edition, 1E=8: p.182#=. #. Gemp D%. ?toacustic emission in *erspective. In: @obinette p.12"1. <. *rieve 9', Fit5gerald %!. ?toacoustic emissions In; Gat5 ( ed. .andbook of clinical audiology, 8th edition , *hiladelphia : /ippincott Cilliams and Cilkins ; "))" : p.<<)241 8. Donoghue G , 9ates G(, -arula '', In ,linical ;-%. %e6tbook ?6ford &niversity *ress -ew $ork 1EE": p.1)2"1, =B2E#, 14E21B<. !, Glattke %( eds. ?toacoustic ;mission ,linical 'pplications -ew $ork: %hieme; 1EEB: