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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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).
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