Download 1. pak pertemuan 1 nihl - Keluarga IKMA FKMUA 2010

Noise Induced Hearing Loss
Erwin Dyah N
KEBISINGAN (NOISE)
•
•
•
•
UNWANTED/UNDESIRED SOUND
HIGH INTENSITY AND OR FREQUENCY
DIJUMPAI DI HAMPIR SEMUA TEMPAT KERJA
MENIMBULKAN GANGGUAN KESEHATAN
Pendahuluan
• Pendengaran indra penting untuk komunikasi
penurunan pendengaran / ketulian  dampak
psikologis & sosial
• Occupational Hearing Loss : NIHL, Trauma akustik
• NIHL berhubungan dengan paparan kebisingan
jangka lama. Kerusakan terjadi pelan dan baru
disadari setelah beberapa tahun kemudian.
Irreversible HL  Tindakan preventif penting
• Trauma akustik akibat paparan tunggal dengan
intensitas tinggi dan mendadak ( ledakan )
WHY IS THERE SO MUCH NOISE?
• INDUSTRIALISASI
MEKANISASI
• PENGGUNAAN POWER DI INDUSTRI
MENINGKAT
• PENGEMBANGAN MESIN-MESIN BARU
LEBIH CEPAT DARI PADA
PENGEMBANGAN METODE UNTUK REDUKSI
KEBISINGAN (DIANGGAP KURANG
MENGUNTUNGKAN)
Noise Induced Hearing Loss
- Levels of Environmental Sounds
Source—Safe Levels
dBA SPL
Heavy Traffic
Automobile (at 20 meters)
Vacuum Cleaner
Conversational Speech (at 1 meter)
Quiet Business Office
Residential Area at Night
Whisper, Rustle of Leaves
Rustle of Leaves
Threshold of Audibility
80
70
65
60
50
40
20
10
0
KEBISINGAN DIANGGAP MEMBAHAYAKAN
JIKA
• DI TEMPAT KERJA KITA HARUS BERTERIAK AGAR
SUARA DAPAT DIDENGAR
• KURANG DAPAT MENDENGAR / TELINGA
BERDENGING SEHABIS BEKERJA
• ORANG LAIN/ KELUARGA YG MENGENALI
• COCKTAIL PARTY DEAFNESS
• NAKER BANYAK YANG TULI
• SAKIT KEPALA SAAT KERJA DI TEMPAT BISING
PENGARUH BISING PADA PEKERJA
• Masalah Pendengaran
• Masalah lain:
a. Gangguan fisiologi : meningkatnya Tekanan Darah,
Denyut Nadi, Metabolisme Basal, Vasokonstriksi
Pembuluh Darah, ischemic heart disease, ketegangan
otot (rangsangan sistem syaraf otonom)
b.Gangguan Psikologi : Stress, lelah, emosioal,gangguan
komunikasi dan konsentrasi, gelisah
EFEK KEBISINGAN TERHADAP PENDENGARAN
1. TRAUMA AKUSTIK
• AKIBAT PAJANAN TUNGGAL (SINGGLE EXPOSURE) DG
INTENSITAS SANGAT TINGGI & TIBA-2 (EX: LEDAKAN
BOM)
• EFEK :
• MT ROBEK
• DISLOKASI ATAU KERUSAKAN TL PENDENGARAN &
SEL SENSORIS ORGANON CORTI
• AUDIOGRAM : FLAT RESPONSE (KOMBINASI TULI
KONDUKTIF DAN PERSEPTIF)
Masalah Pendengaran
• 2 KATEGORI KETULIAN
– TULI KONDUKSI
– TULI PERSEPSI (SENSORINEURAL )
TUL KONDUKTIF
• GANGGUAN PADA TELINGA BAGIAN LUAR DAN
TENGAH
• SERUMEN OBSTRUKTIF
• RUPTURA MEMBRANA TYMPANI (EXPLOSION,
MEASLES) ROBEK 1/3 BAGIAN
PULIH DLM 9
BLN
• TERSUMBATNYA TUBA EUSTACHI (KOTORAN,
BENGKAK)
• DISLOKASI TL PENDENGARAN (EXPLOSION, CEDERA
KEPALA, OTOSCLEROSIS PD STAPES JOINT---FIXED)
TULI PERSEPTIF
• GANGGUAN PADA TELINGA BAGIAN DALAM
• KERUSAKAN TELINGA BAGIAN DALAM :
RAMBUT GETAR, N. AUDITORIUS (N. VIII),
OTAK
PRESBYACUSIS
• BEGIN AT A EARLY AGE (EARLY TEENS)
• THE HAIR CELLS AT THE BASE OF THE COCHLEA
WHICH RESPOND TO THE HIGHER FREQUENCY
ARE AFFECTED FIRST
• LAKI-LAKI > PEREMPUAN
• ORANG KOTA > DESA
BERBAGAI PENYEBAB TULI PERSEPTIF
• KONGENITAL (RUBELLA, INFLUENSA PADA IBU PD
TRIMESTER I KEHAMILAN, OBAT-OBATAN)
• ACCIDENTS AT BIRTH (MEASLES---BILATERAL,
MUMPS ----UNILATERAL)
• OTOTOXICITY
• FRACTUR BASIS CRANII
• NERVE DEAFNESS (COMPLETE LOSS OF HEARING)
• PRESBYACUSIS
• NOISE INDUCED HEARING LOSS (NIHL)
PRESBYACUSIS DAN NIHL
• MERUPAKAN PENYEBAB TULI PERSEPTIF YANG
TERBANYAK
PRESBYACUSIS
Presbyacusis
• Accounting for presbycusis is not mandatory but it is
often done in the legal setting. What is actually
sought is to account for non-occupational hearing
loss. Seven states allow deductions for presbycusis.
• Or to answer the question: Is the progression of
hearing loss in the worker more than which can be
expected from non-occupational hearing loss?
Presbyacusis
• NIOSH does NOT recommend accounting for
presbycusis when looking for Medical Causation of a
progressive hearing loss. If a worker has a
progressive hearing loss it is assumed to be due to
noise trauma and corrective measures should be
taken.
• However, estimation of presbycusis is used for
compensation purposes. The test for compensation
is whether the hearing loss is medically more likely
than not caused by noise exposure.
Presbycusis
--Sex Difference
• Several researchers have studied primitive cultures to
determine the influence of aging on hearing acuity in the
absence of occupational noise. These studies found aging
effects on hearing, but observed no sex difference in the
hearing loss. Goycoolea MV, 1986; Rosen S, 1962
• Animal studies have also found no sex difference.
Hunter KP, 1987
• It has been proposed that the difference between male and
female thresholds as a function of age, is due to
environmental factors. The most important of which is noise
exposure. Kryter KD, 1983
Handicap Equations
Presbycusis used to Project Hearing Loss
• It is assumed with all of the calculators that
hearing loss due to noise and presbycusis are
additive.
• ISO 1999 compression factor is applied when
projecting audiometric data.
Hearing Loss = ARL + NIL - (ARL * NIL)/120
ARL: Age Related Loss, NIL: Noise Induced Loss
NIHL
• NIHL mengenai kedua telinga
• Tahap awal hanya dapat diketahui dengan tes
pendengaran. Pekerja yang terkena bisa tidak
menyadarinya ( walaupun audiogram ada dip di
4000Hz)
• Keluhan lain bisa menyertai yaitu mendenging
(Tinnitus), recruitment, vertigo
• Tahap berat timbul kesulitan menangkap
pembicaraan dan terganggu komunikasinya 
berpengaruh pada kehidupan
Pekerja beresiko :
Intensitas kebisingan tinggi dengan akitivitas
menggunakan peralatan kecepatan tinggi :
• Grinding
• Sawing
• Drilling
Biasanya pada tempat produksi :
• Metal
• Pengolahan perkayuan
• Konstruksi
Anatomi Telinga dan Fisiology
Pendengaran
ANATOMI TELINGA
ORGANON CORTI
This is your ear.
This is your ear on noise.
Patogenesis NIHL
• Adaptasi : fisiologis, sebagai pertahanan tubuh, reversibel 
kembali cepat
Fenomena Fisiologis
Terjadi bila terpajan bising 70 db
Nama lain : per-Stimulatory Fatigue, pemulihan biasanya terjadi
dalam setengah detik
• Ambang Pendengaran berkurang sementara
TTS : patologis, terjadi perubahan metabolik
reversibel  kembali lambat (bbrp menit—jam)
TERJADI PADA PAJANAN > 85 dBA
• Berkurang secara menetap
PTS : patologis, terjadi kerusakan sel
irreversibel  menetap
2. TEMPORARY THRESHOLD SHIFT (TTS)
• GANGGUAN BERSIFAT SEMENTARA
• TIMBUL KARENA KELELAHAN SYARAF
• WAKTU PULIH BEBERAPA MENIT SAMPAI
BEBERAPA JAM (MAKSIMUM 10 JAM
• JIKA DALAM 10-14 JAM BELUM PULIH ---PERSISTEN THRESHOLD SHIFT
• JIKA DALAM 40 JAM BELUM PULIH ---PERMANENT THRESHOLD SHIFT
3.PERMANEN THRESHOLD SHIFT
• = NIHL (NOISE INDUCED HEARING LOSS)
• AKIBAT PAPARAN BISING BERULANG ,
SEBELUM PEMULIHAN SECARA LENGKAP--AKUMULASI SISA TTS
• SETELAH ≥10 TAHUN
• TERJADI PERLAHAN-LAHAN –NAKER TAK
MENYADARI
Histopatologi
• Degenerasi sel rambut (luar) organ corti
• Fase awal : 3  6 kHz (terutama 4 kHz )
• Fase lanjut mengenai frekwensi yang lebih
luas
• Kebisingan intensitas sedang menyebabkan
gangguan metabolisme  degenerasi
• Intensitas tinggi akan menimbulkan
kerusakan mekanis
Kerusakan organ :
Organ Corti ,
membrane, stereocilia,
haircell,
Subceluler organ ,
stria vascularis
Source –dangerous level
Produces pain
Jet aircraft during takeoff (20 meters)
Discomfort level, tractor without cab
Rock concert
Hammer,chain saw, pneumatic drill
Semi-trailers (20 meters)
dBA SPL
140 – 150
130
120
110
100 – 105
90
Source
dBA SPL
Heavy traffic
80
Automobile (20 meters)
70
Vacuum cleaner
65
Conversational speech (1 meter)
60
Quiet business office
50
Residential area at night
40
Whisper,
20
Rustle of leaves
10
CIRI KHAS NIHL
• TINNITUS
• SULIT MENDENGAR DERING TELEPHONE
• SULIT MENDENGAR PERCAKAPAN ORANG LAIN
DENGAN JELAS TERUTAMA DI TEMPAT YANG RAMAI
DAN BISING
• TANPA RASA NYERI (TIDAK DISADARI)
• After 10 years of exposure, the damage caused by
noise remains constant, but presbycusis progresses
as predicted.
Noise Induced Hearing Loss
- Characteristics
• Sensory hearing loss with loss of
discrimination commensurate with the loss in
hearing.
• Maximum in the high frequencies sometimes
with a 4000 Hz Notch.
• 23% will have tinnitus (Phoon WH, 1983)
• Vertigo is not present
NIHL
• ORANG B ARU SADAR AKAN ADANYA NIHL JIKA :
– KEHILANGAN PENDENGARAN MENCAPAI FREK
PEMBICARAAN (500-1000-2000 Hz)
– GEJALA AWAL :TINNITUS , TELINGA TERASA TERSUMBAT
– KURANG DENGAR FREKUENSI TINGGI (“T” , “D” PADA
AHIR KATA), SUARA ANAK-ANAK PADA JARAK JAUH ,
PEMBICARAAN PADA TEMPAT RAMAI, WALAU JARAK
LAWAN BICARA DEKAT)
– ORANG LAIN YANG PERTAMA KALI MENGENALI
Diagnosa NIHL
• Anamnesis :
- Usia- atherosclerosis; hipertensi;proses
penuaan
- Lama bekerja
- Riwayat penyakit (peny.telinga sebelumnya)
- Riwayat trauma
- Onset Penurunan pendengaran
 mendadak, berangsur-angsur
- Riwayat Pekerjaan :Bising di tempat kerja > 85 dBA,
lama pajanan per hari, penggunaan APT
- Riwayat Keluarga PENEGAKAN DIAGNOSIS
pemeriksaan pendengaran berkala
FAKTOR YANG BERPENGARUH
Riwayat penyakit
•
•
•
•
•
Masalah telinga dan gejalanya
Riwayat trauma kepala atau telinga
Pemakaian obat-obatan
Pekerjaan sebelumnya, militer
Paparan bahan beracun /
toxic(CO,CS2,Trichlorethylene)
• Aktivitas diluar pekerjaan
• Riwayat gagguan pendengaran pada keluarga
FAKTOR YANG BERPENGARUH
Riwayat paparan kebisingan
•
•
•
•
•
•
•
Intensitas bising
Tipe bising ( spektrum frekwensi )
Sifat bising
Jarak dengan sumber bunyi
Posisi telinga
Lama bekerja ( paparan kumulatif )
Kerentanan individu
Pemeriksaan Fisik :
a. Keadaan Umum.
b. Pemeriksaan
telinga.
c. Otoskopi.
d. pem. audiometri
TES AUDIOMETRI
• NADA MURNI
• AIR CONDUCTION
• PEMERIKSAAN AMBANG PENDENGARAN MINIMAL
PADA FREKUENSI 500,1000,2000,30000,4000 DAN
6000 HZ
• JIKA DITEMUKAN PERGESERAN NAD YG BERMAKNA
(>10dB) PADA 2000,3000,4000 HZ DIBANDING
AUDIOGRAM AWAL –PERIKSA ULANG 1 BULAN
KEMUDIAN
d. Tes Audiometri.
PERSYARATAN UNTUK TES AUDIOMETRI
• TEMPAT PEMERIKSAAN HARUS SUNYI (MAKS.
40 dB)
• KALIBRASI
• CERTIFIED OPERATOR/ YANG TELAH
BERPENGALAMAN
Indikasi NIHL-audiogram
1.KETULIAN PADA FREK 3000-6000 Hz
2. ACCOUSTICAL DIP PADA4000 Hz
3. PADA TRAUMA AKUSTIK , KETULIAN
BIASANYA BILATERAL
4. JIKA UNILATERAL SERING KARENA OMP
5. NIHL JUGA SERING UNILATERAL PADA
TELINGA YANG LEBIH DEKAT DENGAN
SUMBER BISING
AUDIOMETRI
BANDINGKAN HASIL AUDIOGRAM DENGAN
PEMERIKSAAN SEBELUMNYA
JIKA ADA PENINGKATAN YANG SIGNIFIKAN ,
ULANG 1 BULAN KEMUDIAN
JIKA PERSISTEN: PINDAHKAN KE TEMPAT YANG
TIDAK BISING; UKUR KEBISINGAN,
KENDALIKAN
AUDIOMETRI
• PALING SEDIKIT DILAKUKAN 14 JAM (TANPA
PAJANAN) , PERLU DIGUNAKAN ALAT PELINDUNG
TELINGA
• FREKUENSI 250-8000 HZ
• RUANGAN SUNYI
• NADA MURNI
• NAIKKAN INTENSITAS tiap 10 dB
• SETELAH PASIEN MERESPON, TURUNKAN 5 dB-5 dB
dst, sampai tak dapat didengar
• Ulangi 3 kali
Penanganan NIHL
• Fase akut dengan terapi vasodilatator
• Ketulian berakibat gangguan komunikasi
- diperlukan konseling
- rehabilitatif :  latihan mendengar
 latihan membaca gerak bibir
 Alat Bantu Dengar
• HLPP
Noise Induced Hearing Loss
- Noise Levels
• Individuals have different susceptibilities to
noise.
(Kyong-Myong Chon, 1996)
• Noise levels are measured in dB SPL on the A
Scale.
• Impulse Noise is more damaging than a
constant noise.
Noise Levels
Duration of
Exposure
(hrs/day)
Sound Level dB(A)
INA
16
8
4
2
1
½
¼
1/8
dst
85
88
91
94
97
100
103
***
ACGIH
82
85
88
91
94
97
100
103
NIOSH
82
85
88
91
94
97
100
103
**
OSHA
85
90
95
100
105
110
115*
--
Plaintiff Evaluation
-History is very important
• Other ear diseases can cause a hearing loss.
• Other associated systemic diseases which can cause
a hearing loss.
• Other exposure to noise trauma. This is very
important because noise exposure’s effects on the
inner ear are finite and will cause no further damage
after approximately 10 years. Thus, it could be
argued that the plaintiff's occupational exposure to
noise caused no harm because of his
home/recreational exposure.
Plaintiff Evaluation
- Other ear diseases can cause a hearing loss
• Vertigo
- Endolymphatic Hydrops
- Perilymph Fistula
•
•
•
•
Dizziness
Eustachian Tube Dysfunction
Tympanic Membrane Perforation
Ossicular Fixation or Discontinuity
Plaintiff Evaluation
- Other systemic diseases which are associated with hearing loss (nosocusis)
Vascular Disease
•
•
•
•
Diabetes
Heart Disease
Smoking
Hyperlipidemia
Rosenhall U, Penderson KE
Presbycusis and
Occupational Hearing Loss
Occup Med 10(3):593607,1995
• Ototoxic Drug Use
• Otologic Ear Infections
• Meningitis
• Head Trauma
• Alcohol Usage
Plaintiff Evaluation
- Other exposure to noise trauma (Sociocusis)
• Hunting. Kryter KD, 1991 found that 69% of
9800 railroad workers used guns.
Most have an asymmetrical hearing loss.
(Job A, Grateau P, Picard J, 1998)
• Home machinery – Lawn mowers, weed
trimmers, etc.
• Chain saws
• Loud Music, Rock Concerts
(Yassi A et al Canadian Family Physician, 1993)
FAKTOR YANG BERINTERAKSI DENGAN BISING
• USIA : ATHEROSCLEROSIS; HIPERTENSI;PROSES
PENUAAN
• GETARAN
• PENGGUNAAN ZAT OTOTOXIC
• MEROKOK (BELUM DAPAT DIBUKTIKAN)
• RIWAYAT PAJANAN BISING SEBELUMNYA
Ototoxins
• Organic solvents
Metals
Drugs
–** Toluene (printing)
* Mercury and derivatives  Aminoglycosides
–** Xylenes (plastics)
* Lead and derivatives
 Loop diuretics
* Arsenic (atoxyl)
–** Styrenes (plastics)
 Anti-neoplastic agents
* Manganese
 ASA (acetyl salyilic acid)
–** Trichloroethylene (degrease)
 Quinine compounds
–* Carbon Disulfide (textile)  Trimethyltin (organic
tin)
–* Stoddard/white spirits
 Cobalt
–* N-hexane
Others
– Fuels (JP-8 fuel)
Asphyxiants
 Chem. warfare nerve
– Ethyl benzene
** Carbon Monoxide
agents (ex: sarin)
– Perchloroethylene
* Cyanide
 Organophosphate
– Butyl Nitrite
(pesticide)
– Methylene chloride
 Paraquat (pesticide)
Army ID:
* potential
** high-priority
Morata,TC., Dunn,DE., Kretschmer, LW., Lemasters, GK., Keith,
RW., Scandinavian Journal of Work, Environment & Health, 19(4):
245-54, 1993 Aug.
• Paint and print industries - risk of hearing loss
–
–
–
–
Unexposed (no noise or solvent)
Noise exposed only – hearing loss risk 4x
Toluene solvent only – hearing loss risk 5x
Toluene solvents and noise –hearing loss risk 11x
Controls: previous exposure to noise and/or chemicals,
medical and audiological history, age, length of
employment, recreational exposure, and military service
Tests: puretones, immittance (tympanograms, reflexes,
reflex decay)
Problems caused by solvents
• Hearing Loss
– Sensorineural Hearing Loss - Inner Ear
• Tuning (clarity and loudness)
• Testing: common audiometric procedures (Puretones, Speech, Other)
– Central/Retrocochlear Hearing Loss - Brainstem and Cortex
• Processing (transmission, cognition, varying degrees of tuning and loudness)
• Testing:
–
–
–
–
–
Speech Processing (interrupted speech, speech in noise, temporal integration)
Evoked Potentials (brainstem or cortical potentials),
DPOAE: Contra-lateral suppression (efferent testing)
Reflex and Reflex Decay
Modified Puretone: masking level difference, gap detection, duration pattern, pitch
pattern, temporal integration, high frequency audiometry, step size less 5dB
– Questionnaire on speech discrimination difficulties or other auditory problems that
are inconsistent with thresholds
• Disequilibrium, Headaches, Vision Problems, Neurological
Lead (pb)
• Example Audiogram taken from literature.
.5K 1K 2K 3K 4K 6K 8K
30
35 40 45 40 60 70
Biasanya disertai Vertigo
Arsenic (As)
• Example Audiogram taken from literature.
.5K 1K 2K 3K 4K 6K 8K
45 30 10 05 10 15 15
• Hearing losses are greater in the lower
frequencies at 125, 250, and 500 Hz.
Balance problems are also noted.
Mercury (Hg)
Example Audiogram taken from literature.
.5K 1K 2K 3K 4K 6K 8K
25
30 35
40 45 50
55
• Hearing loss is in the entire range with greater
losses in the high frequencies.
• However, loss does not always occur even with
severe neurological symptoms.
• Hearing loss reportedly occurs 80% of the time.
Organic Solvents
• In the early stages oto-neurologic
disturbances may include vertigo and nausea.
• Histopathologic studies have shown damage
in the sensory cells of the inner ear.
Organic Solvent- CS2
• Used in solvents and insecticide
• Noise 86-89 dBA + CS2  hearing loss within
2 years of exposure : 47%
• Within 3 years  incidence 71%
• Audiometric losses in high freq
• Example Audiogram taken from literature.
.5K 1K 2K 3K 4K 6K 8K
30 35 45 55 70 75 NR
Organic Solvents-Tri Chlor Ethylene
• This solvent is used as a degreaser, dry
cleaning agent, spot remover and rug cleaner.
• It is used in the production of paints, waxes,
pesticides, adhesives and lubricants.
• Destruction of sensory cells of the inner ear is
suspected.
Organic Solvents-Tri Chlor Ethylene
• It results in a bilateral symmetrical high
frequency dip beginning at 2K or 3K Hz and is
associated with balance problems
Example Audiogram taken from literature.
.5K 1K 2K 3K 4K 6K 8K
20 20 40 60 65 65 50
Styrene
• Styrene is used in the production of plastics,
synthetic rubber, resins and insulating materials
• Lower concentrations of styrene show losses
above 8 KHz and do not indicate loss other than
noise (gambaran mirip dengan NIHL)
Example Audiogram taken from literature.
.5K 1K 2K 3K 4K 6K 8K
10 10 10 30 50 45 30
Styrene
• Higher concentrations (1200 ppm) have losses
at all frequencies.
Example Audiogram taken from literature.
.5K 1K 2K 3K 4K 6K 8K
25 30 40 60 65 70 65
Xylene
•
•
•
•
the most prevalent, exposing more people
the most toxic of all the organic solvents
found in paints, varnishes, and thinners.
It produces damage in the sensory cells of the
inner ear.
• No configurations were found discussed in
the literature
Toluene
• the most studied organic solvent.
• Uses: manufacturing of chemicals, paints,
lacquers (pernis), adhesives, rubber, printing,
leather tanning, spray painting, glue, etc.
• It produces cochlear damage.
Toluene
• Noise + toluene increased risk 27.5 times.
• Balance problems and abnormal acoustic
reflexes are significant symptoms.
• The audiogram configuration can be flat,
bilateral or unilateral;
• however the most common configuration is a
dip at 3K to 6K Hz (as noise) even in the
absence of noise.
Toluene
• Example Audiogram taken from literature.
.5K 1K 2K 3K 4K 6K 8K
20 20 30 40 45 60 40
PENATALAKSANAAN
• GUNAKAN APT
• PEMERIKSAAN PENDENGARAN : AUDIOMETRI
NADA MURNI : 16-36 JAM BEBAS PAJANAN
BISING, LAKUKAN SECARA BERKALA
• SESUAI DENGAN PENYEBAB KETULIAN--PINDAH TEMPAT KERJA (KE TEMPAT YG TDK
BISING)
• BILA DIPERLUKAN : Alat bantu dengar
Macam Alat Bantu Dengar
Behind The ear
In the Canal
In the Ear
Completely in the canal
Penanganan NIHL
• Fase akut dengan terapi vasodilatator
• Ketulian berakibat gangguan komunikasi
- diperlukan konseling
- rehabilitatif :  latihan mendengar
 latihan membaca gerak bibir
 Alat Bantu Dengar
• HLPP/HCP
PROGNOSIS
• IRREVERSIBLE
• PENCEGAHAN MERUPAKAN HAL YANG
TERPENTING
PROGRAM PEMELIHARAAN
PENDENGARAN
• PERLU KERJA SAMA ANTARA:
MANAGE
MENT
LABOR
HEALTH
PROV.
OBJECTIVES OF HCP
• EDUCATES EMPLOYERS AND EMPLOYEES
ABOUT THE NATURE OF HEARING LOSS
(IRREVERSIBLE, SUBTLE IN ONSET,
PSYCHOLOGICALLY DISTRESSING IF
SEVERE)
• DIAGNOSIS HEARING LOSS AT EARLY STAGES
• PROVIDES AND DEMONSTRATES THE PROPER
USE OF PPE (WHEN ENGINERING REMEDIES
ARE NOT SUFFICIENT)
WHAT IS THE MINIMUM OF HCP?
• A BASELINE AUDIOGRAMS FOR ALL
EMPLOYEES (AT RISK)
• ANNUAL AUDOGRAM FOR EACH EMPLOYEE
EXPOSED TO 85 dB/greater
SUCH SERIAL AUDIOGRAMS CAN DETECT NIHL
EARLY AND PREVENT FURTHER PROGRESSION
OF IT BEFORE THE NOTCH WIDENS TO IMPAIR
THE SPEACH FREQUENCIES (500-1000-2000
HZ)
Pengendalian secara teknis
• Substitusi, eliminasi, upgrade : penggantian
alat dgn kebisingan tinggi
• Isolasi : sound box, sound enclosure
• Sound Barrier : sound proof materials to
block the transmission
of noise
• Acoustic Design : sound absorbent
materials
Kontrol Administratif
• Rotasi
• Jadwal produksi  mengurangi kontinuitas
kebisingan
• Menggunakan kontrol dan monitoring
kebisingan
• Edukasi dan training tentang :
Kesehatan telinga, bagaimana menggunakan
alat pelindung / proteksi
• Tes pendengaran
Personal Protective Equipment
• Earplugs
• Earmuffs
• Helmet
Macam Ear plugs :
- Ear plug Bilsom 556 (ANSI S3.19- 1974) NRR : 27 dB
- Ear plug 3M 1270 (C.A. 9584) NRR : 25 dB
- Ear Muff Bilsom 815 NST (EN 352-1 : 1993) NRR 20 dB
Keberhasilan HLPP
• Parameter :
–Menerapkan secara benar program
prevensi ( HLPP )
–Mengendalikan intensitas kebisingan di
tempat kerja
–Penemuan kasus, insiden and prevalensi
NIHL
Hambatan HLPP
• Kesulitan diagnosis NIHL sebagai penyakit
akibat kerja :
– Paparan kebisingan diluar pekerjaan
– Penyakit lain yang berpengaruh terhadap
pendengaran
– Tidak adanya data dasar audiogram
• Kurang disiplin memakai Alat proteksi
• Mesin dan peralatan yang digunakan sudah
tua
Penelitian di Surabaya
Pengaruh kebisingan terhadap pendengaran
Rus Suheryanto ( 1993)
•
•
•
•
64 Karyawan pabrik textil
Kebisingan 95-99 dBA
30 orang NIHL
Masa kerja 5-9 th : 4 orang (44,44%)
10-14 th : 8 orang ( 66,67%)
15-19 th : 18 orang ( 85,91%)
Penelitian di Surabaya
NOISE INDUCED HEARING LOOS IN
STEEL FACTORY WORKERS
Heri Kabullah, Sri Harmadji ( 2004)
 50 Karyawan pabrik baja
 Kebisingan di pabrik : 102 dB, 21 orang NIHL ( 84 % ).
 Administrasi : 60.4 dB, 1 orang NIHL (4%)

Masa kerja 6-10 th : 2 orang (40%)
11-15 th : 7 orang (87,5%)
16-20 th : 3 orang (100%)
>20 th : 9 orang (100%)
Penelitian lain
• Hendarmin 1971 : NIHL pada 50% karyawan
Manufactur Plant Pertamina
• Hendarmin,Hadjar : kebisingan jalan 95 dbA
• Sundari 1994 : NIHL 31,55% pada karyawan
Industri besi di Jakarta , noise intensity : 85-105 db
• Lusianawaty 1998 : NIHL 31,8% pada pekerja
industri kayu di Jawa Barat , noise intensity : 84,9108,2 db
• Bashiruddin 2002 NIHL 44,5% pada sopir bajaj,
noise intensity : 91 db