GANGGUAN PENDENGARAN BILATERAL Binaural summation

PROGRAM REHABILITASI
PENDENGARAN PADA
PRESBIAKUSIS
Pemilihan Alat Bantu Dengar & Konseling
Siti Faisa Abiratno
JAKARTA
Usia
Perubahan fungsi secara alami
 Visus
 Pendengaran
 Keseimbangan tubuh
 Peraba
 Kekuatan otot
• Penyakit kronis
EFEK USIA
Fungsi pendengaran perifer & sentral
 Ambang dengar >
 << Pemahaman wicara di tempat
ramai dan ruangan yang bergema /
reverberasi
 Kecepatan wicara  persepsi <<
 Menentukan lokasi sumber suara <<
Gangguan Pendengaran spesifik presbikusis
 Gangguan dengar :
 SNHL - bilateral
 Menurun di frekuensi tinggi
 S/N <<
 Progresif
 Gangguan diskriminasi wicara
REGRESSION
PHONEMIC
Keluhan utama
“ Saya mendengar anda berbicara tapi tidak
mengerti apa yang anda katakan “
PRESBIKUSIS
&
Kemampuan diskriminasi kata
Jenis Presbikusis
• Presbikusis sensorik
• Presbikusis neural
• Presbikusis strial atau
metabolik
• Presbikusis koklear
konduktif
Incidens
Skor
Diskriminasi kata
56%
36%
80%
72%
Kondisi
F
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G
S
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D
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T
O
R
I
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Kesehatan
Umum
Kognitif
Hearing
Listening
Comprehending
Communicating
Fungsi
Penglihatan
 Retrokoklear
Auditorius sentral
Koklear
F
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n
G
S
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A
U
D
I
T
O
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I
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Presbiakusis
Hearing
Listening
Comprehending
Communicating
• Ambang dengar >>
• Dynamic range <
• Spectral processing <
 Freq.selectivity <
 DLI >
• Temporal processing
 Detection gap >
• Identifikasi fonem <
• Mispersepsi : <
 deteksi
 diskriminasi
 identifikasi
Mispersepsi & interpretasi
F
U
n
G
S
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A
U
D
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T
O
R
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U
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Presbiakusis
Hearing
Listening
Comprehending
 Gangguan binaural
processing
 ggn.pend.perifer
 sentral
 Deteksi sinyal <
ruangan : ramai &
reverberasi  <<
Communicating
 Perception in noise <<
 Lokalisasi sumber
suara <<
F
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G
S
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U
D
I
T
O
R
I
U
S
Fungsi
Penglihatan
Hearing
Listening
Comprehending
Communicating
 Gangguan visus 
ggn. petunjuk visual
 Artikulasi segmental
dan suprasegmental
 Informasi kondisi
lingkungan
REHABILITASI
PENDENGARAN
WHO :
ETIOLOGY
PATHOLOGY
IMPAIRMENT
Active limitation
DISABILITY
Participation
restriction
HANDICAP
RE /
HABILITATION
REHABILITASI AUDIOLOGI
Traditional
approach
Progressive
approach
• Auditory training
• Speech reading
Counseling
oriented
methodology
Evaluation
Remediation
Alpiner & Stephens SDG ‘93
AUDITORY REHABILITATION
REMEDIATION
INSTRUMENTAL
NON-INSTRUMENTAL
HEARING DEVICE
COUNSELING
• H.A
• ALD
BAHA
Middle Ear
Implant
Cochlear
Implant
A
COMMUNICATION
STATUS
E
V
A
L
U B ASSOCIATED
A
VARIABLES
T
I
O
RELATED
N C
CONDITIONS
Stephens,DG
1
2
3
4
5
6
1.
2.
3.
4.
AUDITORY
VISUAL
LANGUAGE
MANUAL
PREVIOUS REHAB.
OVERALL
PSYCHOLOGICAL
SOCIOLOGICAL
VOCATIONAL
EDUCATIONAL
1. MOBILITY
2. UPPER LIMB
3. AURAL PATHOLOGY
R
E
M
E
D
I
A
T
I
O
N
A
B
C
ATTITUDE
INSTRUMENTAL
STRATEGY
D
ANCILLARY
E
COMMUNICATION
TRAINING
Stephens,DG
1
2
3
ACCEPTANCE
UNDERSTANDING
EXPECTATION
1.
2.
3.
4.
AMPLIFICATION
ALERT/ WARN
OTHER SENS AID
INSTRUCTION
1
2
3
GOALS
PHILOSOPHY
TACTICS
1
2
3
4
VOCATIONAL
EDUCATIONAL
SOCIAL WORK
MEDICAL
1
2
3
4
INFORMATION
SKILL BUILD
INSTRUMENTAL II
COUNSELING
3 PROSES FUNDAMENTAL  USIA
Proses kognitif
Sistem pendengaran sentral
Sistem pendengaran perifer
Koklea
Usia
Kognitif
 Memori jangka pendek – panjang
 Pengambilan keputusan
 Atensi
 Kemampuan belajar sesuatu yang baru
 Waktu reaksi
ALAT BANTU DENGAR
Instrumentasi dalam program re / habilitasi
fungsi pendengaran
•
Alat Bantu Dengar
•
•
Vibrotactile
BAHA ; implan telinga tengah ; Implan koklea
• FM,
Alat bantu lain : ALD / Assistive Listening
Device
sfaisa
ALAT
BANTU
DENGAR
INPUT
AMPLIFIKASI
OUTPUT
sfaisa
Jenis ABD
• Tipe : Body worn ,
BTE, ITE, ITC,CIC
• Monaural / binaural
• Karakteristik : gain
dan output
• Circuit
• Efek background noise
sfaisa
Pemilihan ABD
 Tipe
 Circuit :
 Compression circuit
 Compression limiting ( PC )
 Whole range syllable compression APV
 ASP ( automatic signal processing )
 Monaural / bilateral ?
ABD
 Monaural / bilateral ?
Bilateral
 Head shadow effect
 Bilateral summation
 Bilateral squelch
 Sound localization
Unilateral
 Hemisphere lateralization
 Right ear advantage
BINAURAL
OTAK
 Meningkatkan kemampuan  lokalisasi
sumber suara
 Binaural summation :
 Penjumlahan input dari 2 telinga 
menghasilkan peningkatan -> 3-6 dB
 Squelch effect
 Speech recognition >>  terutama di
lingkungan ramai ( Cocktail party effect )
sfaisa
GANGGUAN PENDENGARAN
BILATERAL
FITTING
ALAT BANTU DENGAR
UNI / BILATERAL ?
BINAURAL HEARING
sfaisa
EFFEK
GANGGUAN PENDENGARAN
UNILATERAL
 Binaural summation :  Squelch effect :  Efek negatif noise : >>
 Kesulitan : lokalisasi suara
 Impact head shadow effect : +
sfaisa
BINAURAL HEARING
 Telinga membantu mengetahui keadaan disekeliling kita
( fungsi orientasi )
 Dua telinga  > membantu mengetahui arah / posisi /
lokasi suara
 Keseimbangan binaural hearing  sangat penting 
mengetahui lokasi sumber suara  otak menilai beda
waktu ( ITD ) dan beda kekerasan suara ( ILD ) suara
yang masuk ke kedua telinga
BINAURAL HEARING
 Dua telinga  membantu otak > fokus pada
satu suara  mengabaikan suara lain yang
oleh otak dianggap tidak penting
 Gangguan pendengaran bilateral 
penanganan  bilateral  manfaat binaural
hearing
sfaisa
Two ears are better than one
BINAURAL HEARING
HIDUP DI LINGKUNGAN STEREOFONIK
sfaisa
Assistive Listening Device / ALD
ABD
Awal program rehabilitasi
“ The brain hears ,
the ears convey”
Kunci sukses pemakaian ABD
Orientasi & Konseling
Pemahaman masalah pendengaran &
peran amplifikasi
Penolakan pemakaian ABD
Counseling…… is "the most overlooked aspect of
the process of fitting amplification" and the "most
important professional service an audiologist can provide
for patients and their families“
( Citron 2000)
Konseling:
 Masalah penyebab/ kausa
 Mengatasi aspek emosional
 Memahami masalah telinga dan fungsi
pendengaran
 Peranan amplifikasi
sfaisa
Kesimpulan
PRESBIAKUSIS
 Sensorik
 Neural
 Auditory processing disorder
 Phonemic regression
 << rasio S / N
 Memori:
 implisit
 eksplisit
REHABILITASI
PENDENGARAN
 Orientasi
 Konseling
REHABILITASI PRESBIAKUSIS

Pendekatan BIOPSIKOSOSIAL
 Pemahaman masalah gangguan pendengaran
& efek gangguan pendengaran
 Psikologi
 Metode amplifikasi : ABD, ALD
 Variabel komunikasi

Strategi program rehabilitasi
SASARAN
REHABILITASI AUDIOLOGI

o

Komunikasi interaktif
Strategi komunikasi
Komunikasi di lingkungan keluarga
o Informasi  anggota keluarga
o Atasi masalah spesifik  individu
+
Efektifitas
Amplifikasi
Proces patofisiologi faktor usia 
sistema auditorius & non auditorius
1.
2.
3.
4.
5.
References :
Montgomery,AA: Management of the Hearing-impaired
Adult.In: Rehabilitative Audiology : Children and Adults.
Alpiner and McCarthy (Ed) 2nd ed. 1993 . pp 311-327
Kasten,RN : Amplifications for Elderly individuals. 1981.
In : Hearing Aid Assessment and use in Audiologi
Rehabilitation. 2nd ed. Hodgson,WR & Skinner,PH ( ed ).
Wiiliams & Wilkins. Baltimore pp 226-233
Stephen,SDG : Adult Audiologial Rehabilitation. M.Sc
Course in Audiologial Medicine. University College
London 1989-1990
McKenna,L. 1987: Goal Planning in Audiologial
Rehabilitation. Brit J.Audiol 21 : 5-11
Goldstein,DP and Stephens SDG .1981. Audiologial
Rehabilitation .Audiol 20 : 432-452
6. McCarthy,PAA : Rehabilitative Considerations with
Geriatric Population. In: Rehabilitative Audiology :
Children and Adults.2nd ed. 1993. Alpiner and McCarthy
(ed) Williams & Wilkins. pp 331-357
7. Hull,RH : Hearing Evaluation of the Elderly. In : Handbook
of Clinical Audiology. Katz,J ( ed) 2nd ed. 1978. Williams
& Wilkins USA. Pp 426-441
8. Compton,C.L : Assistive Technology for Deaf and Hard of
Hearing People. In: Rehabilitative Audiology : Children
and Adults. Alpiner and McCarthy (ed).2nd ed. 1993.
Williams & Wilkins USA.pp 441- 468
9. Montgomery,A.A : Management of the Hearing-impaired
Adults.In:Rehabilitative Audiology : Children and Adults.
2nd ed .1993 ( Alpiner & McCarthy (ed).pp 311- 327
10.Compton,C.L : Assistive Technology for Deaf and Hard of
Hearing People. In: Rehabilitative Audiology : Children
and Adults. Alpiner and McCarthy (ed).2nd ed. 1993.
Williams & Wilkins USA.pp 441- 468
11. Muller,HG and Brimes,AM : Hearing Aid Selection and
Assessment. In: Rehabilitative Audiology : Children and
Adult. 2nd ed. 1993. Alpiner JG and McCarthy PA (ed).
Williams & Wilkins .Baltimore. pp 284 – 308
12. Sanders,DA.1971: Aural Rehabilitation. Prentice Hall inc.
pp 349