Tesis

Perubahan Ambang Dengar dan Signal to Noise Ratio pada Pasien Penyakit Ginjal Tahap Akhir yang Menjalani Hemodialisis di Rumah Sakit Cipto Mangunkusumo. = Changes in Hearing Threshold and Signal to Noise Ratio in End Stage Kidney Disease Patients Undergoing Hemodialysis at Cipto Mangunkusumo Hospital.

Latar belakang: Gangguan pendengaran dapat menurunkan kualitas hidup seseorang. Gangguan pendengran tipe sensorineural dapat terjadi pada Penyakit Ginjal Kronik (PGK) yang dapat berkembang menjadi Penyakit Ginjal Tahap Akhir (PGTA) dan membutuhkan terapi hemodialisis (HD). Pada beberapa kasus, dilaporkan adanya hubungan penurunan pendengaran dengan HD. Penurunan pendengaran yang terjadi diduga adanya faktor risiko lain seperti usia, hipertensi, diabetes melitus dan riwayat/lamanya dilakukan HD. Beberapa penelitian, dikatakan masih kontroversi sehingga dibutuhkan penelitian lebih lanjut. Tujuan: Mengetahui hubungan perubahan ambang dengar dan Signal to Noise Ratio (SNR) pada pasien Penyakit Ginjal Tahap Akhir (PGTA) yang mendapatkan terapi HD. Metode: Penelitian ini melibatkan 50 sampel penelitian pasien PGTA yang mendapatkan terapi HD sesuai kriteria inklusi dan ekslusi. Pemeriksaan dilakukan dengan menilai pemeriksaan otoskopi, dilanjutkan dengan pemeriksaan timpanometri, audiometri nada murni dan DPOAE (Disortion Product Otoacoustic Emissions). Pemeriksaan fungsi pendengaran dilakukan secara pre post HD. Pengolahan data dilakukan dengan uji t berpasangan dan Wilcoxon Signed Ranks Test, P-value. Hasil : Pada penelitian ini didapatkan adanya hubungan bermakna (p < 0,001) antara perubahan rerata ambang dengar dan SNR dengan terapi HD pada pasien PGTA. Pada hasil audiometri didapatkan penurunan pendengaran terbanyak pada frekuensi 8000 Hz sedangkan hasil DPOAE menunjukkan perubahan gangguan emisi sel rambut luar koklea terbanyak pada frekuensi tinggi diatas 4000 Hz. Kesimpulan : Hemodialisis dapat menurunkan ambang dengar dan perubahan SNR terutama pada frekuensi tinggi. Pada penelitian ini perubahan ambang dengar dan SNR bersifat reversibel, diperlukan penelitian lanjutan untuk mengetahui perubahan ambang dengar dan SNR yang bersifat irreversibel.
Kata kunci: Gangguan pendengaran tipe sensorineural, penyakit ginjal tahap akhir, hemodialisis.


Backgroud : Hearing loss can reduce quality of life. Sensorineural type hearing disorders can occur in Chronic Kidney Disease (CKD) can progress to End Stage Renal Disease (ESRD) and requires hemodialysis (HD) therapy. In several cases, a relationship between hearing loss and HD has been reported. Hearing loss is also suspected to be due to other risk factors such as age, hypertension, diabetes mellitus and history/long history of having HD. In several studies, it is said that it is still controversial so further research is needed. Aims : To determine the relationship between changes in hearing threshold and Signal to Noise Ratio (SNR) in End Stage Renal Disease (ESRD) patients receiving HD therapy. Methods : This study involved 50 research samples of ESRD patients who received HD therapy according to the inclusion and exclusion criteria. The examination is carried out by assessing the otoscopic physical examination, followed by tympanometry, pure tone audiometry and DPOAE (Disortion Product Otoacoustic Emissions) examinations. Hearing function examination was carried out pre-post HD. Data processing was carried out using the paired t test and Wilcoxon Signed Ranks Test, P-value. Result : In this study, it was found that there was a significant relationship (p < 0.001) between mean changes in hearing threshold and SNR with HD in ESRD patients. The audiometry results showed that the greatest decrease in hearing was at a frequency of 8000 Hz, while the DPOAE results showed that the change in emission interference from the outer cochlear hair cells was greatest at high frequencies above 4000 Hz. Conclusion : Hemodialysis can lower the hearing threshold and change SNR, especially at high frequencies. In this study, changes in hearing threshold and SNR are reversible, further research is needed to determine whether changes in hearing threshold and SNR are irreversible.
Keywords : Sensorineural hearing loss, end stage renal disease, hemodialysis