PENDEKATAN KLINIS

PENURUNAN PENDENGARAN
 TULI KONDUKTIF
1. Negative Rinne test, i.e. BC > AC.
2. Weber lateralized to poorer ear.
3. Normal absolute bone conduction.
4. Low frequencies affected more.
5. Audiometry shows bone conduction better
than air conduction with air-bone gap. Greater
the air-bone gap, more is the conductive loss
(Figure 5.1).
6. Loss is not more than 60 dB.
7. Speech discrimination is good.
 Etiologi
Kongenital
Didapat
 RATA2 Penurunan Ambang
1. Complete obstruction of ear canal: 30 dB
2. Perforation of tympanic membrane (It varies
and is directly proportional to the size of
perforation): 1040 dB
3. Ossicular interruption with intact drum: 54 dB
4. Ossicular interruption with perforation: 38 dB
5. Malleus fixation: 1025 dB
6. Closure of oval window: 60 dB
 TATALAKSANA
1. Removal of canal obstructions, e.g. impacted wax, foreign body,
osteoma or exostosis, keratotic mass, benign or malignant tumours,
or meatal atresia.
2. Removal of fluid. Myringotomy with or without grommet
insertion.
3. Removal of mass from middle ear. Tympanotomy and removal of
small middle ear tumours or cholesteatoma behind intact tympanic
membrane.
4. Stapedectomy, as in otosclerotic fixation of stapes footplate.
5. Tympanoplasty. Repair of perforation, ossicular chain or both.
6. Hearing aid. In cases, where surgery is not possible, refused or
has failed.
 TULI SENSORINEURAL
Sensorineural hearing loss (SNHL) results from
lesions of the cochlea, VIIIth nerve or central
auditory pathways. It may be present at birth
(congenital) or start later in life (acquired).
 1. A positive Rinne test, i.e. AC > BC.
2. Weber lateralized to better ear.
3. Bone conduction reduced on Schwabach and
absolute bone conduction tests.
4. More often involving high frequencies.
5. No gap between air and bone conduction curve on
audiometry (Figure 5.6).
6. Loss may exceed 60 dB.
7. Speech discrimination is poor.
8. There is difficulty in hearing in the presence of noise.
 Etiologi
Kongenital
Didapat
 Didapat
1. Infections of labyrinthviral, bacterial or spirochaetal
2. Trauma to labyrinth or VIIIth nerve, e.g. fractures of temporal
bone or concussion of the labyrinth or the ear surgery
3. Noise-induced hearing loss
4. Ototoxic drugs
5. Presbycusis
6. Mnires disease
7. Acoustic neuroma
8. Sudden hearing loss
9. Familial progressive SNHL
10. Systemic disorders, e.g. diabetes, hypothyroidism, kidney
disease, autoimmune disorders, multiple sclerosis, blood dyscrasias.
 Tx
Tergantung etiologi
 TULI ANORGANIK
Penurunan pendengaran tanpa penyebab
organik
Malingering atau psikogenik
 CURIGA ANORGANIK
(i) Total hearing loss in both ears,
(ii) total loss in only one ear or
(iii) exaggerated loss in one or both ears
 1. High index of suspicion
2. Inconsistent results on repeat pure tone
and speech audiometry tests
3. Absence of shadow curve
4. Inconsistency in PTA and SRT
5. Stenger test
Acoustic reflex threshold
Electric response audiometry (ERA).
 High index of suspicion
Suspicion further rises when
the patient makes exaggerated efforts to hear,
frequently
making requests to repeat the question or
placing a cupped
hand to the ear.
 Inconsistent results on repeat pure
tone and speech audiometry tests
Normally, the results of repeat tests are within
5 dB. A variation greater than 15 dB is
diagnostic of NOHL.
 Inconsistency in PTA and SRT.
Normally, pure tone average (PTA) of three
speech frequencies (500, 1000 and 2000 Hz) is
within 10 dB of speech reception threshold
(SRT).
An SRT better than PTA by more than 10 dB
points to NOHL
 Acoustic reflex threshold

Refleks stapedius tetap ada

Electric response audiometry (ERA).
 ASPEK SOSIAL TULI
Hearing loss: penurunan pendengaran
Tuli: tidak ada fungsi pendengaran sama sekali
Standar antar negara berbeda
WHO 1980: applied only to those individuals
whose hearing impairment is so severe that
they are unable to benefit from any type of
amplification
 DERAJAT TULI
WHO: average of the thresholds of hearing for
frequencies of 500, 1000 and 2000
 KECACATAN
Impairment: penurunan anatomis dan
fisiologis
Disability: keterbatasan melakukan aktifitas
tertentu
Handicap: keterbatasan fungsi status sosial
Disease Impairment Disability
Handicap.
 DERAJAT KECACATAN
(i) Take an audiogram and calculate the average
of
thresholds of hearing for frequencies of 500,
1000 and
2000 Hz say = A.
(ii) Deduct from it 25 dB (as there is no
impairment up to
25 dB), i.e. A25.
(iii) Multiply it by 1.5, i.e. (A25) 1.5.