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Abstrak :
Pendahuluan :Implan koklea merupakan alat elektronik yang saat ini banyak digunakan di seluruh dunia sebagai salah satu cara habilitasi dan rehabilitasi tuli sensorineural yang tidak atau sedikit mendapat manfaat dengan alat bantu dengar. Keberhasilan implan koklea bergantung banyak faktor antara lain usia saat operasi dan alat yang digunakan. Mengerti apa yang didengar tidak terjadi secara instan tetapi membutuhkan suatu proses panjang yang harus dijalani setelah operasi. Tujuan : Menilai outcome pengguna implan koklea. Cara :Dilaporkan tiga kasus tuli sensorineural yang menggunakan implan koklea dengan faktor yang berbeda antara lain etiologi dan usia saat operasi. Hasil :Terdapat perbedaan kemajuan untuk memahami apa yang didengar disebabkan faktor usia saat operasi, etiologi dan kemampuan mendengar dan berbicara sebelum menggunakan implant koklea.

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ABSTRACT
Introduction: Cochlear implant is an electronic device that is widely used around the world as one of the ways to habilitate and rehabilitate people with sensoryneural hearing loss who do not or barely benefit from the use of hearing aid. The successful use of cochlear implant rely on few factors, including the age at implantation and the devices used. To understand what one hears is not an instant process, but requires an exhaustive one, which takes place after the implantation. Purpose: To determine the outcome of cochlear implant use. Method: Three cases of patients with sensorineural hearing loss who receive cochlear implants are observed, each differs among others in etiology of deafness and age at implantation. Results: The different results achieved in understanding what one hears depend on the age at implantation, etiology of deafness, as well as hearing and speaking ability prior to the use of cochlear implant.

Abstrak :
Pendahuluan: Gangguan pendengaran sensorineural (GPSN) merupakan penyakit kronis yang insidennya meningkat seiring dengan pertambahan usia. Implantasi koklea menjadi tatalaksana utama dengan kalibrasi menggunakan prosedur baku emas yaitu audiometer nada murni (PTA) yang bersifat subjektif. Akan tetapi, PTA tidak dapat dilakukan pada pasien yang kurang kooperatif dan kebingungan akibat demensia, seperti pada pasien geriatrik sebagai mayoritas pasien GPSN. Pengukuran objektif lainnya dapat dilakukan dengan mendeteksi auditory evoked potential (AEP) yang direkam pada batang otak menggunakan stimulus listrik (E-ABR) dan kortikal melalui perekaman local field potential (LFP). Namun, belum terdapat penelitian yang merekam AEP menggunakan elektrode intrakortikal serta membandingkan dan mengkorelasikan ambangnya dengan respons batang otak. Penelitian ini bertujuan sebagai pemodelan awal kasus tuli didapat dengan implan koklea untuk mengevaluasi ambang respons auditorik pada batang otak, korteks auditorik primer (A1), dan posterior auditory field (PAF) menggunakan hewan coba kucing. Selain itu, penelitian ini juga bertujuan untuk mencari perbedaan bermakna antara ambang respons auditorik kortikal menggunakan metode perbandingan amplitudo pre-stimulus-post-stimulus (Z-score) dan inter-trial phase coherence (ITPC). Metode: Perekaman dilakukan pada 5 ekor kucing dengan implan koklea yang ditulikan terlebih dahulu dengan injeksi neomisin interskalar. Respons auditorik batang otak direkam menggunakan elektrode permukaan, sedangkan respons auditorik kortikal direkam menggunakan elektrode intrakortikal dalam kondisi teranestesi isoflurane. Ambang respons auditorik ditetapkan menggunakan metode Z-score dan ITPC, sedangkan ambang respons auditorik batang otak ditetapkan dengan metode ITPC karena kurangnya data pre-stimulus. Hasil: Tidak terdapat perbedaan bermakna pada ambang respons auditorik kortikal menggunakan metode Z-score dan ITPC (p = 0,455). Terdapat perbedaan bermakna antara ambang respons auditorik batang otak dan kortikal (p<0,001), dengan median paling kecil pada batang otak dan terbesar pada PAF. Korelasi positif yang bermakna juga ditemukan antar keseluruhan titik perekaman, dengan korelasi terbesar secara kortikokortikal A1 dan PAF (r=0.835, p<0.001). Kesimpulan: Penelitian ini menunjukkan bahwa pengukuran ambang respons auditorik batang otak dan kortikal secara objektif memiliki potensi dalam aplikasi klinis untuk menilai kesuksesan implantasi koklea pasien tuli didapat. Peningkatan ambang respons auditorik sepanjang jaras pendengaran menunjukkan kompleksitas jaras pendengaran. ......Introduction: Sensorineural hearing loss (SNHL) is a chronic disease whose incidence increases with age. The primary treatment of SNHL is cochlear implantation with the subjective pure-tone audiometer (PTA) as the gold standard calibration procedure. However, PTA cannot be performed on patients who are less cooperative and confused due to dementia, such as geriatric patients, who make up the majority of SNHL patients. Another objective test is to detect auditory evoked potentials (AEP) recorded in the brainstem (E-ABR) and auditory cortex via the brain local field potential (LFP) using electric stimulus. However, no studies have used intracortical electrodes to record AEP as well as compare and correlate its threshold with auditory brainstem response. This study aims as an early model of acquired deafness with cochlear implant to evaluate auditory responses in the brainstem, primary auditory cortex (A1), and posterior auditory field (PAF) using cats as an animal model. In addition, this study also aims to compare the cortical auditory response threshold determined using the pre-stimulus-post-stimulus amplitude comparison (Z-score) and inter-trial phase coherence (ITPC) methods. Method: Recording was performed on 5 cochlear implanted cats, previously deafened using interscalar neomycin injection. Brainstem auditory responses were recorded using surface electrodes, while cortical auditory responses were recorded using intracortical electrodes under isoflurane anaesthetic. The auditory response threshold was determined using the Z-score and ITPC methods, while the brainstem auditory response threshold was determined using the ITPC method due to the lack of pre-stimulus data. Result: There was no significant difference in the cortical auditory response threshold using the Z-score and ITPC methods (p = 0.455). There was a significant difference between the brainstem and cortical auditory response thresholds (p<0.001), with the smallest median in the brainstem and the largest in PAF. A significant positive correlation was also found at all recording points, with the largest positive correlation found between A1 and PAF (r=0.835, p<0.001). Conclusion: This study demonstrates that objective measurements of brainstem and cortical auditory response thresholds have the potential to be used to evaluate the success of cochlear implantation in patients with acquired hearing loss. An increase in the auditory response threshold along the auditory pathway indicates complexity in the auditory pathway.

Abstrak :
ABSTRAK Anak tuli prelingual akan kehilangan fungsi mendengar dan bicara, sehingga akan berpengaruh pada komunikasi, psikologis, dan kualitas hidup. Implan koklea hadir sebagai alat habilitasi terutama pada anak dengan tuli derajat berat dan sangat berat. Tesis ini akan membahas mengenai data karakteristik anak 6 ndash; 12 bulan pasca implantasi koklea, evaluasi perkembangan auditori dan bicara anak serta faktor-faktor yang mempengaruhi hasil keluaran. Penelitian ini bersifat deskriptif potong lintang, menggunakan metode penilaian berupa pengamatan yang bersifat global yaitu Categories Auditory Performance CAP - II dan Speech Intelligibility Rate SIR . Penelitian ini dilakukan pada 36 subjek, median CAP-II pada anak 6 ndash; 12 bulan pasca implantasi koklea ialah 3 skor minimal 2 - maksimal 7 . Penilaian kemampuan bicara dengan menggunakan metode SIR anak pasca 6 -12 bulan implantasi koklea didapatkan median 2 skor minimal 1 dan maksimal 4 . Median waktu saat evaluasi 8,9 bulan dengan pencapaian 33,3 subjek dalam kategori CAP tinggi skor 5 atau lebih , dan 38,89 subjek yang mencapai kategori SIR tinggi skor 3 atau lebih.

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ABSTRACT Prelingual deaf children caused the child unable to hear and speak, impacting his or her ability to communicate, psychological growth, and overall life quality of the child. Cochlear implant comes as habilitating device mainly for children with severe and profound deafness. This thesis will discuss and explain in children 39 s characteristic data on 6 ndash 12 months after cochlear implantation, evaluating their speech and auditory development and other influencing factors. This research is descriptive cross sectional study and observe child using global method Categories Auditory Performance CAP II and Speech Intelligibility Rate SIR . This research is conducted on 36 subjects, with median CAP II score of 3 minimum 2 maximum 7 at 6 ndash 12 months post cochlear implantation. Speech ability evaluation using SIR method with median score of 2 minimum 1 maximum 4 . Median hearing age for this study sample was 8,9 months. After 6 12 months cochlear implantation, 33.3 children that reach high CAP scores CAP score of 5 or greater , and only 38.9 reaching high SIR scores SIR score of 3 or greater.

Abstrak :
Latar belakang: Gangguan pendengaran merupakan keluhan umum yang sering dirujuk ke spesialis Telinga Hidung Tenggorok (THT), dengan kasus terbanyak di wilayah Pasifik Barat dan Asia Tenggara. Gangguan pendengaran dapat mengganggu kemampuan wicara dan bahasa anak, mengakibatkan kesulitan dalam sosialisasi dan prestasi akademik yang buruk. Implantasi koklea merupakan metode rehabilitasi efektif untuk pasien gangguan pendengaran sensorineural. Terdapat bukti variasi jangkauan komunikasi reseptif pascaimplantasi koklea. Korelasi antara luas penampang nervus koklearis, diameter kanalis auditori interna dan usia saat implantasi terhadap luaran auditori pascaimplantasi koklea diharapkan dapat menjadi parameter kandidat implantasi serta prediktor luaran auditori pascaimplantasi koklea. Metode: Studi korelasi dengan desain cross-sectional. Terdapat 40 sampel yang telah menjalani implantasi koklea. Dilakukan pengukuran luas penampang nervus koklearis pada MRI koklea dan diameter kanalis auditori interna pada HRCT scan tulang temporal pada masing-masing sampel, kemudian dikorelasikan terhadap luaran auditori pascaimplantasi koklea berdasarkan skor CAP-II Hasil: Median luas penampang nervus koklearis sampel 0,52 mm2 (+/- 0,14), median diameter kanalis auditori interna sampel 2,14 mm (+/- 0,35), dan median usia sampel saat implantasi koklea 4 tahun (1-11). Tidak terdapat korelasi antara luas penampang nervus koklearis terhadap luaran auditori pascaimplantasi koklea (r = 0,29; p = 0,075). Tidak terdapat korelasi antara diameter KAI terhadap luaran auditori pascaimplantasi koklea (r = - 0,02; p = 0,929). Tidak terdapat korelasi antara usia saat implantasi terhadap luaran auditori pascaimplantasi koklea (r = 0,07; p = 0,687). Kesimpulan: Tidak terdapat korelasi antara luas penampang nervus koklearis terhadap luaran auditori pascaimplantasi koklea. Tidak terdapat korelasi antara diameter KAI terhadap luaran auditori pascaimplantasi koklea. Tidak terdapat korelasi antara usia saat implantasi terhadap luaran auditori pascaimplantasi koklea. Diperlukan penelitian lanjutan secara prospektif untuk menentukan parameter kandidat implantasi serta prediktor luaran auditori pascaimplantasi koklea. ......Background: Hearing loss is a common complaint that is often referred to an Ear Nose Throat (ENT) specialist, with the most cases occurring in the West Pacific and Southeast Asia regions. Hearing loss can interfere with a child's speech and language skills, resulting in difficulties in socialization and poor academic performance. Cochlear implantation is an effective rehabilitation method for sensorineural hearing loss patients. There is evidence of variation in the range of receptive communication after cochlear implantation. The correlation between cochlear nerve cross-sectional area (CSA), internal auditory canal diameter and age at implantation with postcochlear implantation auditory outcome is expected to be a candidate parameter for implantation as well as a predictor of postcochlear implantation auditory outcome. Methods: Correlation study with cross-sectional design. There were 40 samples that had undergone cochlear implantation. The cross-sectional area of ​​the cochlear nerve was measured on cochlear MRI and the diameter of the internal auditory canal on the HRCT scan of the temporal bone in each sample, then correlated with the postcochlear implantation auditory outcome based on the CAP-II score. Results: The median CSA of ​​the cochlear nerve sample was 0,52 mm2 (+/- 0,14), the median diameter of the internal auditory canal sample was 2,14 mm (+/- 0,35), and the median age of the sample at cochlear implantation was 4 years (1- 11). There was no correlation between the cross-sectional area of​​the cochlear nerve and the auditory output after cochlear implantation (r = 0,29; p = 0,075). There was no correlation between KAI diameter and postcochlear implantation auditory output (r = -0,02; p = 0,929). There was no correlation between age at implantation and postcochlear implantation auditory outcomes (r = 0,07; p = 0,687). Conclusion: There is no correlation between the cross-sectional area of ​​the cochlear nerve and the auditory output after cochlear implantation. There is no correlation between KAI diameter and postcochlear implantation auditory output. There is no correlation between age at implantation and postcochlear implantation auditory outcomes. Further research is needed prospectively to determine the parameters of implantation candidates and predictors of postcochlear implantation auditory outcome.

Abstrak :
This proposed volume takes off from Volume 20, and expands the examination of implants into new and highly exciting areas. This edited book starts with an overview and introduction by Dr. Fan-Gang Zeng. Chapters 2-9 cover technological development and the advances in treating the full spectrum of ear disorders in the last ten years. Chapters 10-15 discuss brain responses to electric stimulation and their perceptual impact. This volume is particularly exciting because there have been quantum leap from the traditional technology discussed in Volume 20.