LAPORAN INDIVIDU

SISTEM PERSEPSI SENSORI

OTOSKLEROSIS

Disusun Oleh:
Clara Vika Betarahmawati
NIM : 10-02-021

PROGRAM STUDI S1 KEPERAWATAN

SEKOLAH TINGGI ILMU KESEHATAN BETHESDA YAKKUM
YOGYAKARTA
T.A 2012/2013

OTOSKLEROSIS
A. KONSEP MEDIS
1. Pengertian
Otosklerosis adalah suatu penyakit pada tulang pada bagian telinga tengah
khususnya pada stapes yang disebabkan pembentukan baru tulang
spongiosus dan sekitar jendela ovalis sehingga dapat mengakibakan fiksasi
pada stapes(Brunner & Sudart, 2001).
Otosklerosis adalah suatu penyakit dimana tulang-tulang di sekitar telinga
tengah dan telinga dalam tumbuh secara berlebihan sehingga menghalangi
pergerakan tulang stapes (ulang telinga tengah yang menempel pada telinga
dalam), akibatnya tulang stapes tidak dapat menghantarkan suara
sebagaimana mestinya(Mediastore.2004).
2. Anatomi Fisiologi
Telinga adalah organ penginderaan dengan fungsi ganda dan kompleks
(pendengaran dan keseimbanga Anatominya juga sangat rumit . Indera
pendengaran berperan penting pada partisipasi seseorang dalam aktivitas
kehidupan sehari-hari. Sangat penting untuk perkembangan normal dan
pemeliharaan bicara, dan kemampuan berkomunikasi dengan orang lain
melalui bicara tergantung pada kemampuan mendengar. Deteksi awal dan
diagnosis akurat gangguan otologik sangat penting. Di antara mereka yang
dapat membantu diagnosis dan atau menangani kelainan otologik adalah ahli
otolaringologi, pediatrisian, internis, perawat, ahli audiologi, ahli patologi
wicara dan pendidik. Perawat yang terlibat dalam spesialisasi otolaringologi,
saat

ini

dapat

otorinolaringologi

raemperoleh

sertifikat

leher

kepala

dan

otorhinolaringology-head and neck nursing).

di

bidang

(CORLN=

keperawatan
cerificate

in

Anatomi Telinga Luar

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Telinga luar, yang terdiri dari aurikula (atau pinna) dan
kanalis auditorius eksternus, dipisahkan dari telinga tengan
oleh struktur seperti cakram yang dinamakan membrana
timpani (gendang telinga). Telinga terletak pada kedua sisi
kepala kurang lebih setinggi mata. Aurikulus melekat ke sisi

kepala oleh kulit dan tersusun terutama oleh kartilago,

kecuali lemak dan jaringan bawah kulit pada lobus telinga.
Aurikulus membantu pengumpulan gelombang suara dan
perjalanannya sepanjang kanalis auditorius eksternus. Tepat
di depan meatus auditorius eksternus adalah sendi temporal
mandibular.

Kaput

mandibula

dapat

dirasakan

dengan

meletakkan ujung jari di meatus auditorius eksternus ketika

membuka dan menutup mulut. Kanalis auditorius eksternus
panjangnya

sekitar

2,5

sentimeter.

Sepertiga

lateral

mempunyai kerangka kartilago dan fibrosa padat di mana

kulit terlekat. Dua pertiga medial tersusun atas tulang yang
dilapisi kulit tipis. Kanalis auditorius eksternus berakhir pada
membrana timpani. Kulit dalam kanal mengandung kelenjar
khusus, glandula seruminosa, yang mensekresi substansi
seperti lilin yang disebut serumen. Mekanisme pembersihan
diri telinga mendorong sel kulit tua dan serumen ke bagian
luar

tetinga.

Serumen

nampaknya

mempunyai

sifat

antibakteri dan memberikan perlindungan bagi kulit.

Anatomi Telinga Tengah

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000000000000000000000000000005000020030000400100
00c800000000000000000000000000000000e20400400d03
00460000002c00000020000000454d462b014001001c0000
00100000000210c0db010000006000000060000000460000

00583b00004c3b0000454d462b224004000c0000000000000
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000000000000000000000000000000001000000ffd8ffe0001
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Telinga tengah tersusun atas membran timpani (gendang
telinga) di sebelah lateral dan kapsul otik di sebelah medial
celah telinga tengah terletak di antara kedua Membrana
timpani terletak pada akhiran kanalis aurius eksternus dan
menandai batas lateral telinga, Membran ini sekitar 1 cm dan
selaput tipis normalnya berwarna kelabu mutiara dan
translulen.Telinga tengah merupakan rongga berisi udara
merupakan rumah bagi osikuli (tulang telinga tengah)
dihubungkan

dengan

tuba

eustachii

ke

nasofaring

berhubungan dengan beberapa sel berisi udara di bagian

mastoid

tulang

temporal.

Telinga tengah mengandung tulang terkecil (osikuli) yaitu

malleus, inkus stapes. Osikuli dipertahankan pada tempatnya
oleh sendian, otot, dan ligamen, yang membantu hantaran
suara. Ada dua jendela kecil (jendela oval dan dinding medial
telinga tengah, yang memisahkan telinga tengah dengan
telinga dalam. Bagian dataran kaki menjejak pada jendela
oval, di mana suara dihantar telinga tengah. Jendela bulat
memberikan jalan ke getaran suara. Jendela bulat ditutupi
oleh membrana sangat tipis, dan dataran kaki stapes ditahan
oleh yang agak tipis, atau struktur berbentuk cincin. anulus
jendela bulat maupun jendela oval mudah mengalami
robekan. Bila ini terjadi, cairan dari dalam dapat mengalami
kebocoran ke telinga tengah kondisi ini dinamakan fistula
perilimfe.
Tuba eustachii yang lebarnya sekitar 1mm panjangnya
sekitar 35 mm, menghubngkan telingah ke nasofaring.
Normalnya, tuba eustachii tertutup, namun dapat terbuka
akibat kontraksi otot palatum ketika melakukan manuver

Valsalva atau menguap atau menelan. Tuba berfungsi

sebagai

drainase

untuk

sekresi

dan

menyeimbangkan

tekanan dalam telinga tengah dengan tekanan atmosfer.

Anatomi Telinga Dalam
Telinga dalam tertanam jauh di dalam bagian tulang
temporal.

Organ

untuk

pendengaran

(koklea)

dan

keseimbangan (kanalis semisirkularis), begitu juga kranial VII

(nervus

fasialis)

dan

VIII

(nervus

koklea

vestibularis)

semuanya merupakan bagian dari komplek anatomi. Koklea

dan kanalis semisirkularis bersama menyusun tulang labirint.
Ketiga kanalis semisi posterior, superior dan lateral erletak
membentuk

sudut

mengandung

90

organ

derajat

satu

sama

yang

berhubungan

lain

dan

dengan

keseimbangan. Organ ahir reseptor ini distimulasi oleh

perubahan kecepatan dan arah gerakan seseorang.
Koklea berbentuk seperti rumah siput dengan panjang
sekitar 3,5 cm dengan dua setengah lingkaran spiral dan
mengandung organ akhir untuk pendengaran, dinamakan
organ Corti. Di dalam lulang labirin, namun tidak sem-purna
mengisinya,Labirin membranosa terendam dalam cairan
yang dinamakan perilimfe, yang berhubungan langsung
dengan cairan serebrospinal dalam otak melalui aquaduktus
koklearis. Labirin membranosa tersusun atas utrikulus,
akulus, dan kanalis semisirkularis, duktus koklearis, dan
organan Corti. Labirin membranosa memegang cairan yang
dinamakan

endolimfe.

Terdapat

keseimbangan

yang

sangat tepat antara perilimfe dan endolimfe dalam telinga

dalam;

banyak

keseimbangan

kelainan
ini

telinga

terganggu.

dalam

terjadi

Percepatan

bila

angular

menyebabkan gerakan dalam cairan telinga dalam di dalam

kanalis dan merang-sang sel-sel rambut labirin membranosa.
Akibatnya terjadi aktivitas elektris yang berjalan sepanjang
cabang vesti-bular nervus kranialis VIII ke otak. Perubahan
posisi kepala dan percepatan linear merangsang sel-sel
rambut utrikulus. Ini juga mengakibatkan aktivitas elektris
yang akan dihantarkan ke otak oleh nervus kranialis VIII. Di
dalam kanalis auditorius internus, nervus koklearis (akus-dk),
yang

muncul

vestibularis,

dari
yang

koklea,
muncul

bergabung
dari

dengan

kanalis

nervus

semisirkularis,

utrikulus, dan sakulus, menjadi nervus koklearis (nervus

kranialis VIII). Yang bergabung dengan nervus ini di dalam
kanalis auditorius internus adalah nervus fasialis (nervus
kranialis VII). Kanalis auditorius internus mem-bawa nervus
tersebut dan asupan darah ke batang otak
3. Etiologi
Beberapa penyebab terjadinya otosklerosis :
a. Idiopatik
b. Pendapat umumnya diturunkan secara autosom dominan
c. Bukti

ilmiah

yang

menyatakan

adanya

virus

measles

yang

mempengaruhi otosklerosis
d. Beberapa pendapat bahwa infeksi kronik measles di tulang merupakan
presipitasi pasien untuk terkena otosklerosis. Materi virus dapat
ditemukan di osteoblas pada lesi sklerotik.
e. Kolessteatoma
f. Sekresi, granulasi atau polip yang diakibakan oleh otitis media yang
kronik, gangguan pendengaran pun mudah terjadi, karena bentuk tubanya
lebih pendek, lebar, dan mendatar. Kalau ada infeksi di saluran
pernapasan atas, misalnya batuk pilek atau influensa, kuman-kumannnya
lebih leluasa untuk sampai ke rongga telinga tengah. Maka OMA pun

cepat terjadi. Infeksi dapat menimbulkan perubahan lapisan mukosa

telinga tengah. Perubahan ini terjadi berangsur-angsur, tidak langsung.
Mula-mula tuba eustachius tersumbat, sehingga penderita merasa
pendengarannya terganggu. Lalu terjadi perubahan pada lapisan mukosa
di dalam telinga, terbentuk cairan di rongga telinga, dan gendang telinga
membengkak. Penderita akan merasa sangat sakit dengan demam tinggi
dan nyeri di telinga semakin bertambah. Kalau cairan tidak segera
dikeluarkan, gendang telinga bisa pecah atau robek (perforasi), dan
meninggalkan lubang. Tuli pun bisa terjadi. Berdasarkan bagian yang
mengalami gangguan atau kerusakan, tuli dibedakan menjadi tuli
kondusif dan tuli saraf. Pada tuli kondusif, pendengaran menjadi
terganggu karena ada gangguan hantaran suara akibat kelainan infeksi di
telinga tengah hampir selalu menimbulkan tuli konduktif. Walaupun
gendang telinga masih utuh, tulang-tulang pendengaran kita bisa
terputus(www.indomedia.com/intisari)
g. Kelainan kongenital yang berupa tidak terbentuknya satu atau lebih dari
tulang pendengaran
h. Perubahan-perubahan patologik kapsul labyrinth karena virus atau
bakteri (rubella,influenza). Perubahan atau kerusakan kapsul labyrinyh
yang menyebabkan stapes kaku.(Brunner&Sudah,2001)
i. Otosklerosis merupakan suatu penyakit keturunan dan merupakan
penyebab tersering dari tuli konduktif progresif pada dewasa yang
gendang telinganya normal. Jika pertumbuhan berlebih ini menjepit dan
menyebabkan kerusakan pada saraf-saraf yang menghubungkan telinga
dalam dengan otak, maka bisa terjadi tuli sensorineural(Mediastore.2004)
4. Patofisiologi
Patofisiologi dari otosklerosis sangat kompleks. Kunci utama lesi dari
otosklerosis adalah adanya multifokal area sklerosis diantara tulang
endokondral temporal. Ada 2 fase patologik yang dapat diidentifikasi dari
penyakit ini yaitu:

a. Fase awal otospongiotic

Gambaran histologis: terdiri dari histiosit, osteoblas, osteosit yang
merupakan grup sel paling aktif. Osteosit mulai masuk ke pusat tulang
disekitar pembuluh darah sehingga menyebabkan pelebaran lumen
pembuluh darah dan dilatasi dari sirkulasi. Perubahan ini dapat terlihat
sebagai gambaran kemerahan pada membran timpani. Schwartze sign
berhubungan dengan peningkatan vascular dari lesi yang mencapai
daerah permukaan periosteal.
Dengan keterlibatan osteosit yang semakin banyak, daerah ini menjadi
kaya akan substansi dasar amorf dan kekurangan struktur kolagen yang
matur dan menghasilkan pembentukkan spongy bone. Penemuan
histologik ini dengan pewarnaan Hematoksilin dan Eosin dikenal dengan
nama Blue Mantles of Manasse.
b. Fase akhir otosklerotik
c. Fase otosklerotik dimulai ketika osteoklas secara perlahan diganti oleh
osteoblas dan tulang sklerotik yang lunak dideposit pada area resorpsi
sebelumnya. Ketika proses ini terjadi pada kaki stapes akan
menyebabkan fiksasi kaki stapes pada fenestra ovale sehingga
pergerakan stapes terganggu dan oleh sebab itu transmisi suara ke
koklear terhalang. Hasil akhirnya adalah terjadinya tuli konduktif.
Jika otosklerosis hanya melibatkan kaki stapes, hanya sedikit fiksasi
yang terjadi. Hal seperti ini dinamakan biscuit footplate. Terjadinya tuli
sensorineural pada otosklerosis dihubungkan dengan kemungkinan
dilepaskannya hasil metabolisme yang toksik dari luka neuroepitel,
pembuluh darah yang terdekat, hubungan langsung dengan lesi
otosklerotik ke telinga dalam. Semuanya itu menyebabkan perubahan
konsentrasi elektrolit dan mekanisme dari membran basal.
Kebanyakan kasus dari otosklerosis menyebabkan tuli konduktif atau
campur. Untuk kasus dari sensorineural murni dari otosklerosis itu
sendiri masih kontroversial. Kasus sensorineural murni karena
otosklerosis dikemukakan oleh Shambaugh Sr. tahun 1903. Tahun 1967,

Shambaugh Jr. menyatakan 7 kriteria untuk mengidentifikasi pasien yang

menderita tuli sensorineural akibat koklear otosklerosis :
1) Tanda Schwartze yang positif pada salah satu/ke dua telinga
2) Adanya keluarga yang mempunyai riwayat otosklerosis
3) Tuli sensorineural progressive pendengaran secara simetris, dengan
fiksasi stapes pada salah satu telinga
4) Secara tidak biasa adanya diskriminasi terhadap ambang dengar
untuk tuli sensorineural murni
5) Onset kehilangan pendengaran pada usia yang sama terjadinya fiksasi
stapes dan berjalan tanpa etiologi lain yang diketahui
6) CT-scan pada pasien dengan satu atau lebih kriteria yang
menunjukan demineralisasi dari kapsul koklear
7) Pada timpanometri ada fenomena on-off.
5. Tanda dan Gejala
Tanda dan gejala otosklerosis :
a. Pedengaran menurun secara progresif
b. Tinitus
Tinitus adalah bunyi abnormal yang didengar penderita yang berasal dari
dalam kepala,biasanya disebut juga telinga berdengung.Ini bisa karena
berbagai

keadaan,tinnitus

merupakan

gejala

medis

yang

agak

membingungkan untuk di evaluasi,karena patologi hanya dapat dideteksi

pada sekitar 5%kesempatan.Dalam sebagian besar kasus,tak ada terapi
yang

tersedia.Kadang-kadang

orang

akan

menyalahkan

denyut

jantungnya bagi bising di dalam telinga.Ini bisa juga dikacaukan dengan

bunyi vaskular,kongesti vena atau pulsasi sekunder terhadap masalah
kardio sistemik.Tinnitus dibagi atas tinnitus objektif,bila suara tersebut
dapat didengar juga oleh pemeriksa atau dengan auskultasi di sekitar
telinga dan tinnitus subjektif,bila suara tersebut hanya didengar oleh
penderita dan jenis ini sering terjadi.Tinnitus merupakan gejala yang
sering terjadi dan dapat tidak dikenalai oleh kebanyakan orang sampai

penyebabnya ditemukan dan dapat ditentramkan bahwa tidak ada

problema yang gawat.Tinnitus dapat timbul pada usia kapanpun,tetapi
gejala ini sering timbul pada usia 40-80 tahun.
c. Vertigo
d. Sulit mendengarsuara yang lembut dan nada rendah (tuli 30-40 db)
6. Pemeriksaan Diagnostik
a. Otoskopik
Untuk menemukan membran timpani yang normal
b. Pemeriksaan Audiometri/Audiologi
Untuk menguatkan adanya kehilangan pendengaran kondusif atau
campuran khususnya pada frekuensi rendah.
Hasil dari tes pendengaran dengan audiometer ini digambar dalam grafik
yang disebut audiogram. Apabila pemeriksaan dengan audiometer ini
dilakukan, tes-tes suara bisik dan garpu suara tak banyak diperlukan lagi,
sebab hasil audiogram lebih lengkap. Dengan audiometer dapat dibuat 2
macam audio-gram :
1) Audiogram nada murni (pure tone audiogram)
2) Audiogram bicara (speech audiogram)
Dengan audiometer dapat pula dilakukan tes-tes :
1) Tes SISI (Short Increment Sensitivity Index), tes Fowler dimana
dapat diketahui bahwa kelainan ada di koklear atau bukan.
2) Tes Tone Decay dimana dapat diketahui apakah kelainan dibelakang
koklea (retro cochlear) atau bukan. Kelainan retro coklear ini
misalnya ada tumor yang menekan N VIIIKeuntungan pemeriksaan
dengan audiometer kecuali dapat ditentukan dengan lebih tepat
lokalisasi kelainan yang me-nyebabkan ketulian juga dapat diketahui
besarnya ketulian yang diukur dengan satu db (desibel).
c. CT scan atau roentgen
Untuk mengidentifikasi adanya kerusakan dan keabnormalan pada
struktur telinga.

d. Test Rine
Dengan garpu suara frekuensi 64, 128, 256, 512, 1024, 2048 dan 4096
hz, dibunyikan dengan cara tertentu lalu disuruh mendengarkan pada
orang yang dites. Bila penderita banyak tak mendengar pada frekuensi
rendah berarti tuli konduksi. Bila banyak tak mendengar pada frekuensi
tinggi berarti tuli persepsi Kemudian dengan garpu suara frekuensi 256
atau 512 hz dilakukan tes-tes Rinne, Weber dan Schwabach sehingga
lebih jelas lagi apakah tuli penderita dibagian konduksi atau persepsi.
Test tersebut menggunakan garputala, untuk mengetahui perbedaan
antara hantaran udara degan hantaran tulang.
e. Test Weber
Yaitu test yang menggunakan garputala, untuk mengetahui daya tangkap
suara antara telinga kanan dengan teliga kiri(Brunner&Suddarth,2001).
f. Test Bisik
Test ini digunakan untuk mendeteksi pendengaran pasien pada jarak 5
meter dengan mendengarkan kata-kata yang dibisikkan yang memiliki
nada rendah sampai dengan yang yang memiliki nada tinggi.
Caranya ialah dengan membisikkan kata-kata yang dikenal penderita
dimana kata-kata itu mengandung huruf lunak dan huruf desis. Lalu
diukur berapa meter jarak penderita dengan pembisiknya sewaktu
penderita dapat mengulangi kata-kata yang dibisikan dengan benar. Pada
orang normal dapat mendengar 80% dari kata-kata yang dibisikkan pada
jarak 6 s/d 10 meter. Apabila kurang dari 5 - 6 meter berarti ada
kekurang pendengaran. Apabila penderita tak dapat mendengarkan katakata dengan huruf lunak, berarti tuli konduksi. Sebaliknya bila tak dapat
mendengar kata-kata dengan huruf desis berarti tuli persepsi. Apabila
dengan suara bisik sudah tidak dapat mendengar dites dengan suara
konversasi atau percakapan biasa. Orang normal dapat mendengar suara
konversasi pada jarak 200 meter.
g. Diskriminasi
h. Dengan diskriminasi dilakukan penilaian terhadap kemampuan untuk

membedakan kata-kata yang bunyinya hampir sama dan digunakan katakata yang terdiri dari 1 suku kata, yang bunyinya hampir sama.
Pada tuli kondusif, nilai diskriminasinya (presentasi kata-kata yang
diulang dengan benar) biasanya berada dalam batas normal. Pada tuli
sensori, nilai diskriminasi berada di bawah normal.
i. Timpanometri
Timpanometri merupakan sejenis audiometri, yang mengukur impedansi
(tahanan terhadap tekanan) pada telinga tengah. Timpanometri
digunakan untuk membantu menentukan penyebab dari tuli kondusif.
Prosedur ini tidak memerlukan partisipasi aktif dari penderita dan
bisanya digunakan pada anak-anak. Timpanometri terdiri dari sebuah
mikrofon dan sebuah sumber suara yang terus menerus menghasilkan
suara dan dipasang di saluran telinga. Dengan alat ini bisa diketahui
berapa banyak suara yang melalui teling tengah dan berapa banyak suara
yang dipantulkan kembali sebagai perubahan tekanan di saluran telinga.
Hasil pemeriksaan menunjukkan apakah masalahnya berupa:
1) Penyumbatan tuba eustachius (saluran yang menghubungkan telinga
tengah dengan hidung bagian belakang)
2) Cairan di dalam telinga tengah
3) Kelainan pada rantai ketiga tulang pendengaran yang menghantarkan
suara melalui telinga tengah
Timpanometri juga bisa menunjukkan adanya perubahan pada kontraksi
otot stapedius, yang melekat pada tulang stapes salah satu tulang
pendengaran di telinga tengah). Dalam keadaan normal, otot ini
memberikan respon terhadap suara-suara yang keras atau gaduh (reflek
akustik) sehingga mengurangi penghantaran suara dan melindungi
telinga tengah. Jika terjadi penurunan fungsi pendengaran neutral, maka
refleks akustik akan berubah atau menjadi lambat. Dengan refleks yang
lambat, otot stapedius tidak dapat tetap berkontraski selama telinga
menerima suara yang gaduh.
j. Tes dengan Impedance

Tes ini paling obyektif dari tes-tes yang terdahulu. Tes ini hanya
memerlukan sedikit kooperasi dari penderita sehingga pada anak-anak di
bawah 5 tahun pun dapat dikerjakan dengan baik. Dengan mengubahubah tekanan pada meatus akustikus ekterna (hang telinga bagian luar)
dapat diketahui banyak tentang keadaan telinga bagian tengah (kavum
timpani). Dari pemeriksaan dengan Impedancemeter dapat diketahui :
1) Apakah kendang telinga (membrana timpani) ada lobang atau tidak?
2) Apakah ada cairan (infeksi) di dalam telinga bagian tengah?
3) Apakah ada gangguan hubungan antara hidung dan telinga bagian
tengah yang melalui tuba Eustachii?
4) Apakah ada perlekatan-perlekatan di telinga bagian tengah akibat
suatu radang?
5) Apakah rantai tulang-tulang telinga terputus karena kecelakaan
(trauma kepala) atau sebab infeksi?
6) Apakah ada penyakit di tulang telirigastapes (otosklerosis)?
7) Berapa besar tekanan pada telinga bagian tengah?
k.

CT Scan
Fine cut CT scan dapat mengidentifikasi pasien dengan vestibular atau
koklear otosklerosis, walaupun keakuratannya masih dipertanyakan. CT
dapat memperlihatkan gambaran tulang-tulang pendengaran, koklea dan
vestibular organ. Adanya area radiolusen didalam dan sekitar koklea
dapat ditemukan pada awal penyakit ini, dan gambaran diffuse sclerosis
pada kasus yang lebih lanjut. Hasil yang negative bukan berarti non
diagnostik karena beberapa pasien yang menderita penyakit ini
mempunyai kemampuan dibawah dari metode CT paling canggih sekali.

DERAJAT KETULIAN
Tuli amat berat bila lebih dari 80 db Untuk mengetahui derajat ketulian dapat
memakai suara bisik sebagai dasar yaitu sebagai berikut :

a. Normal bila suara bisik antara 5 - 6 meter

b. Tuli ringan bila suara bisik 4 meter
c. Tuli sedang bila suara bisik antara 2 - 3 meter
d. Tuli berat bila suara bisik antara 0 - 1 meter.
Apabila yang dipakai dasar audiogram nada murni, derajat ketulian
ditentukan oleh angka rata-rata intensitas pada frekuensi-frekuensi 500, 1000
dan 2000 Hz yang juga disebut speech frequency. Konversasi biasa besarnya
kurang lebih 50 db.Derajat ketulian berdasar audiogram nada murni adalah
sebagaiberikut :
a. Normal antara 0 s/d 20 db
b. Tuli ringan antara 21 s/d 40 db
c. Tuli sedang antara 41 s/d 60 db
d. Tuli berat antara 61 s/d 80 db
7. Penatalaksanaan
90% pasien hanya dengan bukti histologis dari otosklerosis adalah
simptomatik karena lesi barlangsung tanpa fiksasi stapes atau gangguan
koklear. Pada pasien yang asimptomatik ini, penurunan pendengaran
progressif secara konduktif dan sensorineural biasanya dimulai pada usia 20.
Penyakit akan berkembang lebih cepat tergantung pada faktor lingkungan
seperti kehamilan. Gangguan pendengaran akan berhenti stabil maksimal
pada 50-60 db.

a. Amplifikasi
Alat Bantu dengar baik secara unilateral atau bilateral dapat merupakan
terapi yang efektif. Beberapa pasien yang bukan merupakan kandidat
yang cocok untuk operasi dapat menggunakan alat bantu dengar ini.
1) Alat bantu dengar hantarn udara
Alat ini paling banyak digunakan, biasanya dipasang di dalam
saluran telinga dengan sebuah penutup kedap udara atau sebuah

selang kecil yang terbuka. Alat ini ada 4 macam yaitu:

a) Alat bantu dengar yang dipasang di badan, digunakan pada
penderita tuli dan merupakan alat bantu dengar yang paling kuat.
Alat ini disimpan dalam saku kemeja atau celana dan
dihubungkan dengan sebuah kabel ke alat yang dipasang di
saluran telinga. Alat ini seringkali dipakai oleh bayi dan anakanak karena pemakaiannya lebih mudah dan tidak mudah rusak.
b) Alat bantu dengar yang dipasang di belakang telinga digunakan
untuk penderita gangguan fungsi pendengaran sedang sampai
berat. Alat ini dipasang di belakang telinga dan relatif tidak
terlihat oleh orang lain.
c) CROS (contralaterl routing of signals). Alat ini digunakan oleh
penderita yang hanya mengalami gangguan fungsi pendengaran
pada salah satu telinganya. Mikrofon dipasang pada telinga yang
tidak berfungsi melalui sebuah kabel atau sebuah transmitter
radio berukuran mini. Dengan alat ini penderita dapat
mendengarkan suara dari sisi telinga yang tidak berfungsi.
d) BICROS (Bilateral CROS) Jika telinga yang masih berfungsi
juga mengalami penurunan fungsi pendengaran yang ringan,
maka suara dari kedua telinga bisa diperkeras dengan alat ini.
2) Alat bantu dengar hantaran tulang
Alat ini digunakan oleh penderita yang tidak dapat memakai alat
bantu dengar hantaran udara, misalnya penderita yang terlahir tanpa
saluran telinga atau jika dari telinganya keluar cairan (otore). Alat ini
dipasang di kepala, biasanya di belakang telinga dengan bantuan
sebuah pita elastis. Suara dihantarkan melalui tulang tengkorak ke
telinga dalam. Beberapa alat bantu dengan hantaran tulang bisa
ditanamkan pada tulang di belakang telinga.
b. Terapi Medikamentosa
Tahun 1923 Escot adalah orang pertama yang menemukan kalsium
florida untuk pengobatan otosklerosis. Hal ini diperkuat oleh Shambough

yang memprediksi stabilasi dari lesi otosklerotik dengan penggunaan

sodium florida. Ion florida membuat komplek flourapatit. Dosis dari
sodium florida adalah 20-120 mg/hari. Brooks menyarankan penggunaan
florida yang dikombinasi dengan 400 U vitamin D dan 10 mg Calcium
Carbonate berdasar teori bahwa vit D dan CaCO3 akan memperlambat
lesi dari otosklerosis. Efek samping dapat menimbulakan mual dan
muntah tetapi dapat diatasi dengan menguarangi dosis atau menggunakan
enteric-coated tablets. Dengan menggunakan regimen ini, sekitar 50 %
menunjukan symptom yang tidak memburuk, sekitar 30 % menunjukan
perbaikan.
c. Terapi Bedah
Pembedahan akan membutuhkan penggantian seluruh atau sebagian dari
fiksasi stapes. Seleksi pasien kandidat utama stapedectomy adalah yang
mempunyai kehilangan pendengaran dan menganggu secara sosial, yang
dikonfirmasi dengan garputala dan audiometric menunjukan tuli
konduktif atau campur. Speech discrimination harus baik. Secara umum,
pasien dengan penurunan pendengaran lebih dari 40 db dan Bone
conduction lebih baik dari Air Conduction pada pemeriksaan garputala
akan memperoleh keuntungan paling maksimal dari operasi. Pasien harus
mempunyai resiko anaestesi yang minimal dan tidak memiliki
kontraindikasi.
Indikasi bedah :
1) Tipe otosklerosis oval window dengan berbagai variasi derajat fiksasi
stapes
2) Otosklerosis atau fiksasi ligamen anularis oval window pada otitis
media kronis (sebagai tahapan prosedur)
3) Osteogenesis imperfekta
4) Beberapa keadaan anomali congenital
5) Timpanosklerosis di mana pengangkatan stapes diindikasikan

(sebagai tahapan operasi)

d. Implan koklea

Dengan mengganti koklea yang mengalami kerusakan. Pencangkokan

koklea dilakukan pada penderita tuli berat yang tidak dapat mendengar
meskipun telah menggunakan alat bantu dengar. Suatu implan tidak
mengembalikan ataupun menciptakan fungsi pendengaran yang normal,
tetapi bisa memberikan pemahaman auditoris kepada penderita tuli dan
membantu merek dalam memahami percakapan. Implan koklea sangat
berbeda dengan alat bantu dengar. Alat bantu dengar berfungsi
memperkeras suara. Implan koklea menggantikan fungsi dari bagian
telinga dalam yang mengalami kerusakan. Jika fungsi pendengarannya
normal, gelombang suara diubah menjadi gelombang listrik oleh telinga
dalam. Gelombang listrik ini lalu dikirim ke otak dan kita menerimanya
sebagai suara, Implan koklea bekerja dengan cara yang sama. Secara
elektonik, implan koklea menemukan bunyi yang berarti dan kemudian
mengirimnya ke otak (Brunner&Suddart,2001).
e. Pengangkatan tulang stapes dan menggantinya dengan tulang buatan bisa
mengembalikan pendengaran penderita.
Ada 2 pilihan prosedur, yaitu:
1) Stapedektomi (pengangkatan tulang stapes dan penggantian dengan
protese)
2) Stapedotomi

(pembuatan

lubang

pada

tulang

stapes

untuk

memasukkan protese).

8. Komplikasi
a. Tuli kondusif
b. Glomus jugulare (tumor yang tumbuh dari bulbus jugularis)
c. Neuroma nervus fasialis (tumor yang berada pada nervus VII, nervus
fasialis)
d. Granuloma Kolesterin. Reaksi system imun terhadap produksi samping
darah (kristal kolesterol)

e. Timpanosklerosis. Timbunan kolagen dan kalsium didalam telinga

tengah yang dapat mengeras disekitar osikulus sebagai akibat infeksi
berulang(Bruer & Suddart, 2001).

9. Epidemiologi
a. Ras
Beberapa studi menunjukan bahwa otosklerosis umumnya terjadi pada
ras Kaukasian. Sekitar setengahnya terjadi pada populasi oriental. Dan
sangat jarang pada orang negro dan suku Indian Amerika. Populasi
multiras yang termasuk Kaukasian memiliki resiko peningkatan insiden
terhadap otosklerosis.
b. Faktor Keturunan
Otosklerosis biasanya dideskripsikan sebagai penyakit yang diturunkan
secara autosomal dominant dengan penetrasi yang tidak lengkap (hanya
berkisar 40%). Derajat dari penetrasi berhubungan dengan distribusi dari
lesi otosklerotik lesi pada kapsul tulang labirin.
c. Gender
Otosklerosis sering dilaporkan 2 kali lebih banyak pada wanita
disbanding pria. Bagaimanapun, perkiraan terbaru sekarang mendekati
ratio antara pria:wanita 1:1. Penyakit ini biasanya diturunkan tanpa
pengaruh sex- linked, jadi rasio 1:1 dapat terjadi. Ada beberapa bukti
yang menyatakan bahwa perubahan hormonal selama kehamilan dapat
menstimulasi

fase

aktif

dari

otosklerosis,

yang

menyebabkan

peningkatan gambaran klinis kejadian otosklerosis pada wanita. Onset

klinik selama kehamilan telah dilaporkan sebanyak 10% dan 17%. Risiko

dari peningkatan gangguan pendengaran selama kehamilan atau

pemakaian oral kontrasepsi pada wanita dengan otosklerosis adalah
sebesar 25 %. Penjelasan lain yang mungkin akan peningkatan prevalensi
otosklerosis pada wanita adalah bilateral otosklerosis tampaknya lebih
sering pada wanita dibanding pria (89% dan 65 %). Memiliki dua telinga
yang terkena kelihatan akan meningkatkan kunjungan ke klinik.
d. Sejarah keluarga
Sekitar 60% dari pasien dengan klinikal otosklerosis dilaporkan memiliki
keluarga dengan riwayat yang sama.
e. Usia
Insiden dari klinikal otosklerosis meningkat sesuai bertambahnya umur.
Evidence mikroskopik terhadap otospongiosis ditemukan pada autopsi
0,6 % individu yang berumur kurang dari 5 tahun. Pada pertengahan
usia, insiden ditemukannya adalah 10 % pada orang kulit putih dan
sekitar 20% pada wanita berkulit putih. Baik aktif atau tidak fase
penyakitnya, terjadi pada semua umur, tetapi aktivitas yang lebih tinggi
lebih sering terjadi pada mereka yang berumur kurang dari 50 tahun. Dan
aktivitas yang paling rendah biasanya setelah umur lebih dari 70 tahun.
Onset klinikal berkisar antara umur 15-35 tahun, tetapi manifestasi
penyakit itu sendiri dapat terjadi paling awal sekitar umur 6 atau 7 tahun,
dan paling lambat terjadi pada pertengahan 50-an.
f. Predileksi
Menurut data yang dikumpulkan dari studi terhadap tulang temporal,

tempat yang paling sering terkena Otosklerosis adalah fissula ante

fenestram yang terletak di anterior jendela oval (80%-90%). Tahun 1985,
Schuknecht dan Barber melaporkan area dari lesi otosklerosis yaitu :
1) Tepi dari tempat beradanya fenestra rotundum
2) Dinding medial bagian apeks dari koklea
3) Area posterior dari duktus koklearis
4) Region yang berbatasan dengan kanalis semisirkularis
5) Kaki dari stapes sendiri.
10. Prognosis
Pemeriksaan garpu tala preoperative menentukan keberhasilan dari tindakan
bedah, diikuti dengan alat-alat bedah dan teknik pembedahan yang
digunakan ikut menentukan prognosis.

B. KONSEP KEPERAWATAN
1. Pengkajian
a. Pengumpulan Dataa
1) Anamnesa
Biodata KlienOtosklerosis lebih sering pada wanita dari pada lakilaki dan seringmulainya tuli menyertai kehamilan atau tampak
kehamilanmempercepat pemburukanya.( Cody.R. 1993)

2) Keluhan Utama
Klien mengeluh pendegarannya mulai berkurang secara bertahapdan
terdapat sensasi tekanan atau rasa penuh ditelinga yang terkena.
3) Riwayat kesehatan sekarang
Klien dengan atosklerosis menunjukkan tuli konduktif,sensorineural
atau campuran bilateral atau unilateral.
4) Riwayat kesehatan dahulu
Klien pernah terpapar virus measles. Beberapa berpendapat
bahwainfeksi kronik measles di tulang merupakan predisposisi
pasienuntuk terkena otosklerosis. Materi virus dapat ditemukan
diosteoblas pada lesi sklerotik.
5) Riwayat kesehatan
Keluarga Otosklerosis biasanya dideskripsikan sebagai penyakit
yangditurunkan secara autosomal dominant dengan penetrasi yang
tidak lengkap (hanya berkisar 40%). Derajat dari penetrasi
berhubungandengan distribusi dari lesi otosklerotik lesi pada kapsul
tulang labirin.
b. Pengkajian Bio-Psiko-Sos-Spiritual (Gordon)
1) Pola Persepsi Kesehatan
Adanya riwayat trauma sebelumya
2) Pola Nutrisi Metabolik
a) Muntah-muntah
b) Penurunan berat badan
3) Pola Eliminasi
a) Sering berkeringat
b) Adanya kesulitan dalam berkemih
c) Tanyakan pola berkemih dan bowel
4) Pola Aktivitas dan Latihan
a) Pemenuhan sehari-hari terganggu
b) Toleransi terhadap aktivitas rendah
c) Perubahan pola napas saat melakukan aktivitas

5) Pola Tidur dan Istirahat

a) Kesulitan tidur pada malam hari karena stress
b) Mimpi buruk
6) Pola Persepsi Kognitif
a) Perubahan dalam konsentrasi dan daya ingat
b) Pengetahuan akan penyakitnya
7) Pola Persepsi dan Konsep Diri
a) Perasaan tidak percaya diri atau minder akibat penurunan
pendengaran
b) Perasaan terisolasi
8) Pola Hubungan dengan Sesama
a) Hidup sendiri atau berkeluarga
b) Frekuensi interaksi berkurang
9) Pola Reproduksi Seksualitas
Gangguan pemenuhan kebutuhan biologis dengan pasangan
10) Pola Mekanisme Koping dan Toleransi Terhadap Stress
a) Emosi tidak stabil
b) Ansietas, takut akan penyakitnya
c) Disorientasi, gelisah
11) Pola Sistem Kepercayaan
a) Perubahan dalam diri klien dalam melakukan ibadah
b) Agama yang dianut
2. Diagnosa Keperawatan
a. Perubahan persepsi sensori pendengaran berhubungan dengan penurunan
atau hilang pendengaran
b. Gangguan rasa nyaman nyeri berhubungan dengan adanya penekanan
massa pada tulang teliga
c. Gangguan harga diri berhubungan dengan perubahan fungsi tubuh

d. Resiko cidera berhubungan dengan adanya vertigo

e. Intoleransi aktivitas berhubungan dengan adanya vertigo
f. Ketidakseimbangan nutrisi kurang dari kebutuhan tubuh berhubungan
dengan mual dan muntah.
g. Kurang pegetahuan berhubungan dengan keterbatasan kognisi dan tidak
mengenal informasi
h. Gangguan rasa nyaman nyeri berhubunga dengan pembedahan telinga
ekstensif
i. Resiko infeksi berhubungan dengan kerusakan jaringan sekunder
terhadap pembedahan telinga
3. Intervensi
a. Perubahan persepsi sensori pendengaran berhubungan dengan penurunan
atau hilang pendengaran
Intervensi :
1) Gunakan bahasa non verbal ketika berkomunikasi dengan pasien
2) Bertatap muka ketika berkomunikasi dengan paien
3) Anjurkan untuk periksa telinga secara teratur
4) Berikan penjelasan tentang proses perjalanan penyakit dan prosedur
pengobatan
b. Gangguan rasa nyaman nyeri berhubungan dengan adanya penekanan
massa pada tulang telinga
Intervensi :
1) Observasi tanda-tanda vital
2) Ajarkan teknik relaksasi

3) Lakukan teknik distraksi

4) Kolaborasi dengan dokter untuk pemberian analgetik
c. Gangguan harga diri berhubungan dengan perubahan fungsi tubuh
Intervensi :
1) Kaji kapasitas fisiologi yang bersifat umum
2) Sarankan klien untuk mengekspresikan perasaanya
3) Berikan informasi mengenai penyakitnya
4) Dekati pasien dengan ramah dan penuh perhatian
d. Resiko tinggi cidera berhubungan dengan adanya vertigo
Intervensi :
1) Bantu klien dalam memenuhi ADL
2) Berikan penjelasan pada klien mengenai kondisinya
e. Intoleransi aktivitas berhubungan dengan adanya vertigo
Intervensi :
1) Ajarkan mobilisasi pasif
2) Bantu klien dalam memenuhi ADL
f. Gangguan pemenuhan nutrisi kurang dari kebutuhan berhubungan
dengan mual dan muntah
Intervensi :
1) Berikan makan dalam porsi kecil tapi sering
2) Sajikan makann dalam keadaan hangat dan menarik
3) Kolaborasi medis untuk pemberian anti emesis
g. Kurang pegetahuan berhubungan dengan keterbatasan kognitif dan tidak

mengenal informasi
Intervensi :
1) Kaji tingkat pengetahuan klien dan keluarga tentang penyakitnya
2) Beri penjelasan pada klien dan keluarga tentang tentang penyakit dan
kondisinya
3) Diskusikan mengenai penyebab dari penyakitnya
4) Minta klien dan keluarga untuk menjelaskan kembali tentang materi
yang sudah dijelaskan
h. Gangguan rasa nyaman nyeri berhubungan dengan adanya luka post
operasi
Intervensi :
1) Observasi tanda-tanda vital
2) Ajarkan teknik relaksasi
3) Lakukan teknik distraksi
4) Kolaborasi dengan dokter untuk pemberian analgetik
i. Resiko tinggi terhadap infeksi berhubungan dengan kerusakan jaringan
sekunder terhadap pembedahan telinga
Intervensi :
1) Lakukan perawatan luka dengan teknik aseptik anti septik
2) Observasi tanda-tanda infeksi

SATUAN ACARA PENYULUHAN

(SAP)

Tema

: Penyakit Otosklerosis

Sub Tema

: Penanganan Otosklerosis

Sasaran

: Ny. B

Tempat

: Bangsal Di rumah sakit

Hari/Tanggal

: Selasa, 11 September 2012

Waktu

: 20 Menit

A. Tujuan Instruksional Umum

Setelah mengikuti penyuluhan selama 20 menit, diharapkan Ny. B dapat
menjelaskan penyakit Otosklerosis.
B. Tujuan Instruksional Khusus
Setelah mengikuti penyuluhan selama 20 menit, diharapkan Klien Dapat:

Menjelaskan

pengertian

penyakit

Otosklerosis

dengan benar

Menyebutkan

faktor

penyebab

yang

dapat

menimbulkan penyakit Otosklerosis

Menyebutkan tanda/gejala dari penyakit Otosklerosis

Mengetahui

penatalaksanaan

pada

penyakit

Otosklerosis

Menjelaskan patofisiologi penyakit Otosklerosis

C. Materi
1. Pengertian penyakit Otosklerosis
2. Faktor penyebab dari penyakit Otosklerosis
3. Tanda/gejala penyakit Otosklerosis
4. Penatalaksanaan penyakit Otosklerosis
5. Patofisiologi penyakit Otosklerosis

D. Metode

1. Ceramah
2. Tanya jawab
E. Kegiatan Penyuluhan
No Kegiatan
1.

Pembukaan

Penyuluh

Peserta

Salam pembuka

Menyampaikan
tujuan
penyuluhan

Waktu
Menjawab
salam

Menyimak,

5 Menit

Mendengarkan,
menjawab
pertanyaan

2.

Kerja/ isi

Penjelasan

Mendengark

pengertian,

an dengan

penyebab,

penuh

gejala,

perhatian

penatalaksan
aan dan
patofisiologi
penyakit
Otosklerosis

Memberi
kesempatan

Menanyakan

peserta

hal-hal yang

untuk

belum jelas

bertanya

Menjawab
pertanyaan

Memperhatik
an jawaban

10
menit

dari

penceramah

Evaluasi

Menjawab
pertanyaan

3.

Menyimpulkan

Mendengarkan

Salam penutup

Menjawab salam

Penutup

5 Menit

F. Media
1. Leaflet : Tentang penyakit Otosklerosis
2. Kertas balik
G. Sumber/Referensi
Brunner & Suddarth. Keperawatan Medical Bedah. Jakarta : EGC, 2002
Dongoes, Marilyan Eet all. Rencana Asuhan Keperawatan. Edisi III.
Jakarta : EGC, 1999
Boies, L.R. Buku Ajar Penyakit THT. Edisi 6. Cetakan ke III. Jakarta : EGC,
1997

Staf Pengajar Ilmu Penyakit THT FKUI. Buku Ajar Ilmu Kesehatan Telinga
Hidung Tengorok Kepala Leher. Edisi ke 5 Cetakan ke2. Jakarta : Balai
Penerbit FKUI, 2002.
H. Evaluasi
Formatif :
Klien dapat menjelaskan pengertian penyakit Otosklerosis
Klien mampu menjelaskan faktor penyebab dari penyakit Otosklerosis
Klien dapat menjelaskan penatalaksanaan penyakit Otosklerosis
Sumatif :
Klien dapat memahami tentang penyakit Otosklerosis
Yogyakarta, 9 September 2012
Pembimbing

Penyuluh

ttd

ttd

(...)

(Clara Vika Betarahmawati)

DAFTAR PUSTAKA
Brunner & Suddarth. Keperawatan Medical Bedah. Jakarta : EGC, 2002
Dongoes,

Marilyan

Eet all.

Rencana Asuhan Keperawatan. Edisi III.

Jakarta : EGC, 1999

Boies, L.R. Buku Ajar Penyakit THT. Edisi 6. Cetakan ke III. Jakarta : EGC, 1997
Staf Pengajar Ilmu Penyakit THT FKUI. Buku Ajar Ilmu Kesehatan Telinga
Hidung Tengorok Kepala Leher. Edisi ke 5 Cetakan ke2. Jakarta : Balai Penerbit
FKUI, 2002.

http://ariesblog-ariesblog.blogspot.com/2012/03/askep-otosklerosis_16.html
http://wwwdagul88.blogspot.com/2009/11/asuhan-keperawatan-otosklerosis.html
http://nursecerdas.wordpress.com/2009/02/05/217/
http://id.scribd.com/doc/58802487/otosklerosis