323178971-Refarat-Bagian-Tht-Penatalaksanaan-Perforasi-Membran-Timpani.doc

BAGIAN THT-KL

REFERAT

FAKULTAS KEDOKTERAN

JULI 2016

UNIVERSITAS MUSLIM INDONESIA

PENATALAKSANAAN PERFORASI MEMBRAN TIMPANI

Oleh: MUHAJIR ABBAS 111 207 0140

Pem!m!"#: dr. Syahriji!a" S#.THT

DIBA$AKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK  BAGIAN THT FAKULTAS FAKULTAS KEDOKTERAN KEDOKT ERAN UNIVERSITAS MUSLIM INDONESIA MAKASSAR  2016

HALAMAN PEN$ESAHAN

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J)l Re4e'&( : PERFORAS PERFORASII MEMBRAN MEMBRAN TIMPAN TIMPANII Tel&h me"+ele/&!,&" (#&/ )&l&m '&"#,& ,e5&"!(e'&&" ,l!"!, 5&)& &#!&" THT-KL F&,l(&/ Ke),(e'&" U"!3e'/!(&/ M/l!m I")"e/!&

M&,&//&'7

JLI 2016

Me"#e(&h!7 Pe"+//"

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)' S+&h'!.!(&7 S5THT

HALAMAN PEN$ESAHAN

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J)l Re4e'&( : PERFORAS PERFORASII MEMBRAN MEMBRAN TIMPAN TIMPANII Tel&h me"+ele/&!,&" (#&/ )&l&m '&"#,& ,e5&"!(e'&&" ,l!"!, 5&)& &#!&" THT-KL F&,l(&/ Ke),(e'&" U"!3e'/!(&/ M/l!m I")"e/!&

M&,&//&'7

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)' S+&h'!.!(&7 S5THT

DAFTAR DAFTAR ISI

HALAMAN HALAMAN JUDUL.. JUDUL...... ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........... ............... ............... .............. .......... ...

i

LEMBA LEMBAR R PENGES PENGESAH AHAN AN ...... ......... ...... ...... ...... ..... ..... ...... ...... ...... ..... ..... ...... ...... ...... ..... ..... ...... ...... ...... ..... ..... ...... ...... .....

ii

DAFT DAFTAR ISI .... ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ...... ..

iii

BAB I PENDAHUL PENDAHULUAN....... UAN................. ..................... ..................... ..................... ..................... ....................... .............

1

BAB II TINJAUAN TINJAUAN PUSTAKA... PUSTAKA.............. ..................... ..................... ........................................ .............................

7

A. ANATOMI ANATOMI PENDENGA PENDENGARA RAN... N....... ........ ........ ........ ........ ........ ........ .......... ............. ............... ........... ... B. FISIOLOGI FISIOLOGI PENDENGA PENDENGAR RAN...... AN.......... ........ ........ ........ ........ ........ ........ ......... ............ .............. ......... C. DEFENISI............. DEFENISI....................... ..................... ..................... .............................................. .................................... D. ETIOLOGI......... ETIOLOGI................... ..................... ..................... ..................... ..................... ............................. ................... E. EPIDEMIOLOGI......... EPIDEMIOLOGI................... ..................... ..................... ..................... ................................ ..................... F. GEJALA KLINIS.............. KLINIS......................... ..................... ............................................... ..................................... G. JENIS – JENIS PERFORASI......... PERFORASI................... ............................................... ..................................... H. FAKTOR AKTOR RESIKO RESIKO PERFORASI....... PERFORASI.................. ..................... ..................... ........................ ............. I. DIAGNOSIS........... DIAGNOSIS..................... ..................... ..................... ..................... ................................... ........................  J. PENAT PENATALAKSANAAN.................. ALAKSANAAN............................ ............................................. ................................... K. KOMPLIKASI OMPLIKASI BAB III ..................... ............................... ..................... ..................... ..................... ..................... ..................... ..................... .......... KESIMPULAN .................... ............................... ..................... ..................... ..................... ..................... ...................... ...........

7 8 10 17 21 23 23 29 30 32

DAFTAR PUSTAKA

BAB I PEN%AHULUAN

3 3

Ge")&"# (el!"#& &(& mem'&" (!m5&"! &(& tympanic membrane 8eardrum9 &)&l&h /&( mem'&" &(& /el&5( +&"# (e'le(&, &"(&'& (el!"#& l&' )&" (el!"#& (e"#&h F"#/! mem'&" !"! /&"#&( 3!(&l )&l&m 5'/e/ me")e"#&' B!l& (e'.&)! ,e'/&,&" 5&)& mem'&" !"! )&5&( )!5&/(!,&" &h*& 4"#/! 5e")e"#&'&" /e/e'&"# (e'#&"## Re,"+& mem'&" !"! me'5&,&" /&l&h /&( ,e'/&,&" +&"# /e'!"# )!&l&m! &!, 5&)& &"&,-&"&, m&5" )e*&/& Pe"+e& 'e,"+& mem'&" !"! &"(&'& l&!" )!/e&,&" leh !"4e,/! (el!"#& (e"#&h 8(!(!/97 ('&m& &!, /e&'& l&"#/"# m&5" (!)&, l&"#/"# m!/&l"+& (e'(/, &l&( 5eme'/!h ,5!"#7 /&'& le)&,&" +&"# e'&)& )! )e,&( (el!"#& ,!(&7 me"+el&m )e"#&" ,e)&l&m&" +&"# )!&"##&5 (!)&, &m&"7 ('&m& ,e5&l& &,!&( ,eel&,&&" ,e")&'&&" e'm(' )&" /e&#&!"+& Umm"+& (&")& )&" #e.&l& 'e,"+& #e")&"# (el!"#& &"(&'& l&!" "+e'! (el!"#& +&"# he&( )!/e'(&! ,el&' )&'&h )&'! (el!"#& 8+&"# )!/e&,&" ('&m&9 /e)&"#,&" +&"# )!/e&,&" !"4e,/! mm"+& (e')&5&( )em&m (!"##!7 "+e'! (el!"#& 8(&l#!&97 #el!/&h )&" (!&-(!& ,el&'  &!'&" &(& "&"&h )e"#&" &(& (&"5& )&'&h Umm"+& ),(e' THT &,&" me"&"#&"! ,e&)&&" &,( !"! )&hl )e"#&" me'e)&,&" #e.&l& )&" /me' 5e"+e&"+& /&m!l )!e3&l&/! ,")!/! mem'&" &(& #e")&"# (el!"#&"+& B!l& #e.&l& )&" /me' 5e"+e&"+& (el&h (e'(&"#&"! )&" )&l&m 5e"!l&!&" /el&m& 1 l&" #e")&"# (el!"#& !"! (!)&, me"(5 /5"(&"7 !&/&"+& &,&" )!/&'&",&" 5e"(5&" #e")&"# (el!"#& !"! mel&l! 5'/e)' 5eme)&h&" &(& 5e'&/! 8(e"( /e(el&h )!e3&l&/! m&"4&&(  5e"(5&" mem'&" !"! )!h&'&5,&" )&5&( me"#em&l!,&" 4"#/! 5e")e"#&'&"7 me"e#&h  &h&+& !"4e,/! e'l&"# 5&)& (el!"#& (e"#&h9 T!m5&"5l&/(! &)&l&h 5'/e)' 5eme)&h&" +&"# )!'&"&"# "(, )&5&( me"(5 'e,"+& mem'&" (!m5&"! A)& l!m& (!5e (!m5&"5l&/(! me"'( $ll/(e!" )&" +&"# 5&l!"# /e'!"# )!l&,,&" )&" mem(h,&" me()e +&"# /&"#&( (el!(! Oleh ,&'e"& !(7 'e4e'&( !"! &,&" mem&h&/ (e"(&"# (!m5&"5l&/(!

BAB II TINJAUAN PUSTAKA

A. ANATOMI TELIN$A

A'!/ 8(el!"#&9 )!e)&,&" &(&/ &#!&" l&'7 (e"#&h7 )&" )&l&m A'!/ e'4"#/! #&")& +&!( "(, ,e/e!m&"#&" )&" "(, 5e")e"#&'&" Mem'&"& (+m5h&"!& mem!/&h,&" &'!/ e;(e'"& )&'! &'!/ me)!& &(& &3m (+m5h&"! T& &)!(!3& 8(& E/(&h!/9 me"#h"#,&" &'!/ )e"#&" "&/5h&'+";

G&m&' 1 A"&(m! Tel!"#&

T&'i()a T&()ah 819

819

A'!/ me)!& (e'le(&, )! )&l&m 5&'/ 5e('/& //!/ (em5'&l!/ A'!/ me)!& (e')!'! )&'! &3!(&/ (+m5h&"!&7 +&,"! '"##& +&"# (e'le(&, l&"#/"# )! /eel&h )&l&m mem'&"& (+m5h&"!&7 )&" 'ee//// e5!(+m5h&"!/ Ke)e5&" &'!/ me)!& e'h"#&" )e"#&" "&/5h&'+"; mel&l! (& &)!(!3& Ke&'&h 5(e'/5e'!' &3!(&/ (+m5&"!& e'h"#&" )e"#&" elll&e m&/(!)e& mel&l! &"('m m&/(!)em <&3!(&/ (+m5&"!& )!l&5!/! mem'&" m,/& +&"# e'/!"&m"#&" )e"#&" mem'&" m,/& 5el&5!/ (& &)!(!3&7 elll&e m&/(!)e&7 )&" &"('m m&/(!)em D! )&l&m &'!/ me)!& (e')&5&( : = = = =

O//!l& &)!('!/ 8m&lle/7 !"/7 /(&5e/9 M/l/ /(&5e)!/ )&" m/l/ (e"/' (+m5&"!
D!")!"#-)!")!"# A'!/ Me)!& 8<&3m T+m5&"!&9

819

A'!/ me)!& +&"# e'e"(, /e5e'(! ,(&, /em5!(7 mem!l!,! /e&h &(&57 /e&h )&/&'7 )&" em5&( )!")!"# A(&5"+& 8)!")!"# (e#me"(&l9 )!e"(, leh /elem&' (l&"# +&"# (!5!/7 +&!( (e#me" (+m5&"!7 +&"# mem!/&h,&" &3m (+m5&"!& )&'! )'& 5&)& )&/&' 4//& '&"!! me)!& D&/&'"+& 8)!")!"# .#l&'9 )!e"(, leh /el&5!/ (l&"# +&"# mem!/&h,&" &3m (+m5&"!& )&'! l/ /5e'!' 3e"& .#l&'!/ !"(e'"& D!")!"# l&(e'&l 8&#!&" e'5& /el&5(9 )!e"(, h&m5!' /el'h"+& leh mem'&"& (+m5&"!&> )! /eel&h /5e'!'7 )!")!"# !"! )!e"(, leh )!")!"# l&(e'&l 'ee/// e5!(+m5&"!/ +&"# e'5& (l&"# 8m&"'!m m&lle! (e'&' )&l&m mem'&"& (+m5&"!&7 )&" &5( m&lle! me"".l ,e )&l&m 'ee/// e5!(+m5&"!/9 D!")!"# me)!&l &(& )!")!"# l&!'!"(&l mem!/&h,&" &3!(&/ (+m5&"!& )&'! &'!/ !"(e'"& D!")!"# &"(e'!' 8)!")!"# ,&'(!)9 mem!/&h,&" &3!(&/ (+m5&"!& )&'! &"&l!/ &'(!/7 5&)& &#!&" /5e'!' )!")!"# !"! (e')&5&( /(!m 5h&'+"#em (&e &)!('!&e )&" (e'/&" m/l/ (e"/' (+m5&"! D!")!"# 5/(e'!' 8)!")!"# m&/(!)9 )!h"#,&" )e"#&" &"('m m&/(!) mel&l! &)!(/ )&" /el&".("+& )e"#&" elll&e m&/(!)e/> ,e &'&h &"(e'!"4e'!' &"('m m&/(!)em e'h"#&" )e"#&" &"&l!/ 4&!&l!/

G&m&' 2 <&3m T!m5&"!& Mem'&"& (!m5&"! 8e&')'m9 829 Mem'&" (!m5&"! )!e"(, )&'! )!")!"# l&(e'&l ,&3m (!m5&"! )&" mem!/&h,&" l!&"# (el!"#& l&' )&'! &3m (!m5&"!& Mem'&"& !"! 5&".&"# 3e'(!,&l '&(&-'&(& ?-10 mm )&" )!&me(e' &"(e'-5/(e'!' ,!'& -,!'& @-? mm7 ,e(e&l&""+& '&(&-'&(& 071 mm Le(&, mem'&"& (!m5&"! e'e"(, ")&' )&" e,"# !l& )!l!h&( )&'! &'&h l!&"# (el!"#& )&" (e'l!h&( l!, (e'h&)&5 /m l!&"# (el!"#& )&" mem&( /)( 0 )&'! )&(&'&" /&#!(&l )&" h'!"(&l Se&'& A"&(m!/ mem'&"& (!m5&"! )!&#! )&l&m 2 &#!&" : 1 P&'/ (e"/&7 me'5&,&" &#!&" (e'e/&' )&'! mem'&" (!m5&"! /&( 5e'm,&&" +&"# (e#&"# )&" e'#e(&' /e,el!l!"# me"e&l )&" mele,&( 5&)& &"l/ 4!'//  5&)& /l,/ (!m5&"!,/ &#!&" (l&"# )&'! (l&"# (em5'&l 2 P&'/ 4l&,/!)& &(& mem'&" Sh'&5"ell7 le(&,"+& )!&#!&" &(&/ m,& )&" le!h (!5!/ )&'! 5&'/ (e"/& )&" 5&'/ 4l&,/!)& )!&(&/! leh 2 l!5&(&" +&!( : 1 Pl!,& m&lel&'!/ &"(e'!' 8 l!5&(&" m,&9 2 Pl!,& m&lel&'!/ 5/(e'!' 8 l!5&(&" el&,&"#9

P&'/ 4l&,/!)& h&"+& e'l&5!/ )&7 +&!( &#!&" l&' !&l&h l&".(&" e5!(el ,l!( l!&"# (el!"#& )&" &#!&" )&l&m )!l&5!/! leh /e( ,/ e'/!l!&7 /e5e'(! e5!(el m,/& /&l'&" "&5&/ P&'/ (e"/& mem5"+&! /&( l&5!/ l&#! )! (e"#&h7 +&!( l&5!/&" +&"# (e')!'! )&'! /e'&( ,l&#e" )&" /e)!,!( /e'&( el&/(!" +&"# e'.&l&" /e&'& '&)!e' )! &#!&" l&' )&" /!',le' 5&)& &#!&" )&l&m B&+ &" #&" 5e "" . l& " & #!& " & *& h m&le/ 5&)& mem'&" (!m5&"! )!/e( /e&#&! m D&" m e'ml& /&( 'e4le,/ &h&+& (cone of light) ,e &'&h &*&h7 +&!( 5&)&  5,l  "(, mem'&" (!m5&"! ,!'! )&" 5,l  "(, mem'&" (!m5&"! ,&"&" Re4le,/ &h&+& (cone of light) !&l&h &h&+& )&'! l&' +&"# )!5&"(l,&" leh mem'&" (!m5&"! D! mem'&" (!m5&"! (e')&5&( 2 m&&m /e'&(7 /!',le' )&" '&)!e' Se'&( !"!(&h +&"# me"+e&,&" (!ml"+& 'e4le,/ &h&+& +&"# e'5& ,e'( !( Se&'& ,(!"!/ 'e4le,/ &h&+& !"! )!"!l&!7 m!/&("+& !l& le(&, 'e4le,/ &h&+& me")&(&'7 e'&'(! (e')&5&( #&"##&"  5&)& (& e/(&h!/ Mem'&" (!m5&"! )!&#! )&l&m  ,&)'&"7 )e"#&" me"&'!, #&'!/ /e&'&h )e"#&"  5'/e// l"#/ m&le/ )&" #&'!/ +&"# (e#&, l'/ 5&)& #&'!/ !( )! m7 /eh!"##& )!)&5&(,&" &#!&" &(&/-)e5&"7 &(&/-e(&,&"#7 &*&h-)e5&" /e'(& &*&h-el&,&"#7 "(,  me" +&(& ,&" le( &, 5e'4'&/! mem'&" (!m5&"! P&)& 5&'/ 4l&,/!)& (e')&5&( )&e'&h +&"# )! /e( &(!, D! (em5&( !"! (e')&5&( &)!(/ &) &"('m7 +&!( l&"# +&"# me"#h"#,&" (el!"#& (e"#&h )e"#&" &"('m m&/(!) Pe'm,&&" l&' )&'! mem'&"& (!m5&"! )!/&'&4! leh &&"# " A'!,l (em5'&l!/ )&'! "e'3/ m&")!l& )&" "e'3/ 3&#/ Pe'm,&&" )&l&m )!/&'&4! leh " (!m5&"! &&"# )&'! "e'3/ #l/4&'!"#e&l Al!'&" )&'&h mem'&"& (!m5&"! e'&/&l )&'! 5e'm,&&" l&' )&" )&l&m Pemlh-5emlh e5!)e'm&l e'&/&l )&'! &'!,l& +&"# )&l&m &&"# )&'! &'(e'! m&,/!l&'!/ !"(e'"& Pe'm,&&" m,/& (el!"#& (e"#&h )!)&'&h! leh (!m5&"! &"(e'!' &&"#

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G&m&' C Mem'&"& (!m5&"!

T& A)!(!3& 8(& E/(&h!/9 819 T& &)!(!3& me"#h"#,&" &3!(&/ (+m5&"!& )e"#&" "&/5h&'+";> m&'&"+& )!/!"! (e')&5&( )! &#!&" el&,&"# me&(/ "&/&l!/ !"4e'!' 5&)& &3m "&/! B&#!&" /e5e'(!#&  5/(e'!' (& &)!(!3& (e')!'! )&'! (l&"# )&" /!/&"+& e'5& (l&"# '&*&" T& &)!(!3& )!l&5!/! mem'&" m,/& +&"# ,e 5/(e'!' /!"&m"# )e"#&" mem'&" m,/& "&/5h&'+"; T& &)!(!3& e'4"#/! /e&#&! 5eme'&(& (e,&"&" )&l&m &'!/ me)!& )&" (e,&"&" )&'& l!"#,"#&"7 )&" )e"#&" )em!,!&" me".&m!" &h*& mem'&" (+m5&"! )&5&(  e'#e'&, /e&'& e&/ De"#&" mem"#,!",&" )&'& mem&/,! )&" me"!"##&l,&" &3m (+m5&"!7 (e,&"&" )! ,e)& /!/! mem'&" (+m5&"! )!/&m&,&"

O//!l& A)!('!& 8(l&"#-(l&"# 5e")e"#&'&"9

819

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m&lle! e'/e")! )e"#&" !"/7

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m&lle!
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!")!/ e'h"#&" )e"#&" )!")!"# 5/(e'!' 

&3m (+m5&"! mel&l! /e&h l!#&me"(m

B&/!/ /(&5e)!/7 (l&"# 5e")e"#&' (e',e!l7

me"em5&(! 4e"e/('& 3e/(!l! 5&)& )!")!"# me)!&l

&3m (+m5&"! <&5( /(&5e)!/ +&"#

me"#&'&h ,e l&(e'&l7 e'/e")! )e"#&" !"/ M&lle/ e'4"#/! /e&#&! 5e"#"#,!( +&"# le"#&" 5&".&"#"+& mele,&( 5&)&

mem'&" (+m5&"! B&/!/ /(&5e)!/ e','&" .&h le!h

,e!l )&'!5&)& mem'&" (+m5&"!

A,!&("+& !&l&h &h*& #&+& #e(&' /(&5e/ 10 ,&l! #&+&

#e(&' mem'&" (+m5&"! M&,&//!l& &)!('!/ me"!"#,&(,&" #&+& #e(&'&"7 (e(&5! me"'",&" &m5l!()! #e(&'&" +&"#

)!/&l',&" )&'! mem'&" (+m5&"! Te')&5&( )& ((

me"##e'&,,&" //!l& &)!('!/ )&" )e"#&" )em!,!&"

mem5e"#&'h! mem'&" (+m5&"!7

+&!( : m/l/ (e"/' (+m5&"! )&" m/l/ /(&5e)!/  e'!"/e'/! )! m&"'!m m&lle! )!5e'/&'&4! leh "e'3/

M/l/ (e"/' (+m5&"!

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&'!/ !"(e'"& /e*&,( h&'/

me"e'!m& "+! +&"# ,e'&/ M/l/ /(&5e)!/ e'!"/e'/! )!

llm /(&5e)!/ )!5e'/&'&4!

leh "e'3/ '&"!&l!/ VII7 me"&'!, /(&5e/ ,e 5/(e'!' )&"  5&)& 4e"e/('& 3e/(!l!7 )&" )e"#&" )em!,!&" me"&'!, ,e(&(

me"."#,!(,&" &/!/ /(&5e)!/ l!#&me"(m &""l&'e /(&5e)!&le

)&" mem5e',e!l &m5l!() #e(&'&" O(( !"! .#& me"e#&h

(e'.&)!"+& #e'&, /(&5e/ +&"#

 e'le!h

B. FISIOLO$I PEN%EN$ARAN

Pe")e"#&'&" &)&l&h 5e'/e5/! /&'&4 me"#e"&! e"e'#! /&'& Gelm&"# /&'& &)&l&h #e(&'&" )&'& +&"# me'&m&( )&" (e')!'! )&'! )&e'&h-)&e'&h e'(e,&"&" (!"##! ,&'e"& ,m5'e/! 85em&m5&(&"9 mle,l-mle,l )&'& +&"# e'/el&"#-/el!"# )e"#&" )&e'&h-)&e'&h

 e'(e,&"&" 'e")&h ,&'e"& 5e".&'&"#&" 8rarefaction9 mle,l (e'/e( Se(!&5 &l&( +&"# m&m5 me"#h&/!l,&" 5l& #&"##&" mle,l )&'& /e5e'(! !( &)&l&h /me' /&'& Gelm&"# /&'& .#& )&5&( e'.&l&" mel&l! me)!m /el&!" )&'&7 m!/&l"+& &!' N&m"7  5e'.&l&"&" #elm&"# /&'& )&l&m me)!& (e'/e( ,'&"# e4!/!e"> )!5e'l,&" (e,&"&" +&"# le!h e/&' "(, me"!ml,&" 5e'#e'&,&" &!'&" )&'!5&)& 5e'#e'&,&" )&'& ,&'e"& !"e'/!& 8'e/!/(e"/! (e'h&)&5 5e'&h&"9 &!'&" +&"# le!h e/&' Gelm&"# /&'& (e')!'! )&'! )&e'&h-)&e'&h 5em&m5&(&" )&" 5e".&'&"#&" mle,l )&'& +&"# e'l&"#/"# /e&'& e'#&"(!&" 8C9 P'/e/ me")e"#&' )!&*&l! )e"#&" )!(&"#,&5"+& e"e'#! "+! leh )&" (el!"#& )&l&m  e"(, #elm&"# +&"# )!&l!',&" mel&l! )&'& &(& (l&"# ,e ,,le& Ge(&'&" (e'/e( me"##e(&',&" mem'&" (!m5&"! )!(e'/,&" ,e (el!"#& (e"#&h mel&l! '&"#,&!&" (l&"#  5e")e"#&'&" +&"# &,&" me"#&m5l!4!,&/! #e(&'&" mel&l! )&+& "#,!( (l&"# 5e")e"#&'&" )&"  5e',&l!&" 5e'&")!"#&" l&/ mem'&" (!m5&"! )&" (!"#,&5 l"."# E"e'#! #e(&' +&"# (el&h )!&m5l!4!,&/! !"! &,&" )!(e'/,&" ,e /(&5e/ +&"# me"##e'&,&" (!"#,&5 l"."# /eh!"##&  5e'!l!m4 5&)& /,&l& 3e/(!le e'#e'&, Ge(&'&" )!(e'/,&" mel&l! mem'&" Re!//"e' +&"# me")'"# e")l!m4&7 /eh!"##& &,&" me"!ml,&" #e'&, 'el&(!4 &"(&'& mem'&" &/!l&'!/ )&" mem'&" (e,('!& P'/e/ !"! me'5&,&" '&"#/&"#&" me,&"!, +&"# me"+e&,&" (e'.&)!"+& )e4le,/! /(e'e/!l!& /el-/el '&m(7 /eh!"##& ,&"&l !" (e',& )&" (e'.&)!  5e"#le5&/&" !" e'm&(&" l!/('!, )&'! &)&" /el Ke&)&&" !"! me"!ml,&" 5'/e/ )e5l&'!/&/! /el '&m(7 /eh!"##& mele5&/,&" "e'('&"/m!((e' ,e )&l&m /!"&5/!/ +&"# &,&" me"!ml,&" 5(e"/!&l &,/! 5&)& /&'&4 &)!('!/ l&l )!l&".(,&" ,e "le/ &)!('!/ &m5&! ,e ,'((e,/ 5e")e"#&'&" 8&'e& C?-09 )! l/ (em5&l!/ 829 FUN$SI KOMPONEN UTAMA TELIN$A 817C9 S!r*!r

L&!a*

T&'i()a 'ar

F()+i M&(),#'*a( da( ,&,i(dah*a( )&'-,a() +ara *& !&'i()a !&()ah 

 Pinna

Lem5e"# (l&"# '&*&" +&"# (e'"#,/ ,l!( )&" (e'le(&, )! ,e)& /!/! ,e5&l&

Me"#m5l,&" #elm&"# /&'& )&" me"+&l',&""+& ,e /&l'&" (el!"#&>e'5e'&" )&l&m l,&l!/&/! /&'&

 Meatus auditorius internus 8/&l'&" (el!"#&9

S&l'&" )&'! e,/(e'!' mel&l! (l&"# (em5'&l!/ ,e mem'&"e (!m5&"!

Me"#&'&h,&" /&'& ,e mem'&" (!m5&"> me"#&")"# '&m(-'&m( 5e"+&'!"# )&" me"/e,'e/!,&" ,('&" (el!"#& 8e&' *&;9 "(, me"&"#,&5 5&'(!,el-5&'(!,el &/!"#

T&'i()a T&()ah

M&,i(dah*a( )&!ara( ,&,ra( !i,#a(i *& /aira( di *-*'&a" da'a, #r-+&+(ya ,&,#&r*a! &(&r)i +ara

 Membran timpani 8#e")&"# (el!"#&9

Mem'&"e (!5!/ +&"# mem!/&h,&" (el!"#& l&' )&" (e"#&h

Be'#e(&' /e&'& /!",'" )e"#&" #elm&"# /&'& +&"# me"#e"&!"+&7 me"+e&,&" (l&"#(l&"# 5e")e"#&'&" (el!"#& (e"#&h e'#e(&'

 Maleus, inkus,  stapes

R&"#,&!&" (l&"# +&"# )&5&( e'#e'&, +&"# e'.&l&" mel!"(&/! '"##& (el!"#& (e"#&h> m&le/ mele,&( ,e mem'&" (!m5&"! )&" /(&5e/ mele,&( ,e .e")el& 3&l

Be'/!l&/! /e&'& /!",'" )e"#&" #e(&'&" mem'&" (!m5&"! /e'(& me"!ml,&" #e'&,&" /e5e'(! #elm&"# )! 5e'!l!m4e ,,le& )e"#&" 4'e,e"/! +&"# /&m&

T&'i()a da'a,

T&,#a! +i+!&, +&(+-ri* (!* ,&(d&()ar

K-*'&a

 Jendela oval 

Mem'&" (!5!/ )!5!"( ,,le&> mem!/&h,&" (el!"#& (e"#&h )&'! /,&l& 3e/(!l!

Be'#e(&' e'/&m& #e'&,&" /(&5e/ +&"# mele,&(  5&)&"+&> #e'&,&" .e")el& 3&l me"+e&,&"  5e'!l!m4e ,,le& e'#e'&, 

Skala vestibule

Km5&'(eme" &(&/ ,,le&

Skala timpani

Km5&'(eme" &*&h ,,le&

Me"#&")"# 5e'!l!m4e +&"# )!&( e'#e'&, leh #e'&,&" .e")el& 3&l +&"# )! )'"# leh #e(&'&" (l&"#-(l&"# (el!"#& (e"#&h

 Duktus koklearis (skala media)

Km5&'(eme" (e"#&h ,,le&

Me"#&")"# e")l!m4e> (em5&( mem'&"e  &/!l&'!/

 Membran basilaris

Meme"(, l&"(&! ),(/ ,,le&'!/

Be'#e(&' e'/&m& )e"#&" #e'&,&" 5e'!l!m4e> me"#&")"# '#&" <'(!7 '#&" !")e'& "(, me")e"#&'

Organ orti

Te'le(&, )! &#!&" &(&/ )&" )! /e5&".&"# mem'&"e  &/!l&'!/

Me"#&")"# /el '&m(7 'e/e5(' "(, /&'&7 +&"# me"#el&',&" 5(e"/!&l 'e/e5(' /e*&,( (e'(e,, &,!&( #e'&,&" &!'&" )! ,,le&

 Membran tektorial 

Mem'&"e /(&/!"e' +&"# (e'#&"("# )! &(&/ '#&" <'(! )&" (em5&( /el-/el '&m( 'e/e5(' 5e'm,&&" (e'e"&m )! )&l&m"+&

Tem5&( '&m( /el-/el 'e/e5(' +&"# (e'e"&m )! )&l&m"+& me"e,, )&" meme"(, 5(e"/!&l 'e/e5(' ,e(!,& mem'&" &/!l&'!/ +&"# e'#e(&'  (e'h&)&5 mem'&" (e,('!&l +&"# /(&/!"e'

 Jendela bundar 

Mem'&"e (!5!/ +&"# mem!/&h,&" /,&l& (!m5&"! )&'! (el!"#& (e"#&h

Be'#e(&' e'/&m& )e"#&" #e'&,&" &!'&" )!  5e'!l!m4e "(, me'e)&m (e,&"&" )! )&l&m ,,le&> (!)&, e'5e'&" )&l&m 5e"e'!m&&" /&'&

T&'i()a da'a,

T&,#a! +i+!&, +&(+-ri* (!* *&+&i,a()a(" da( ,&,&ri*a( ,a+*a( ya() #&(!i() (!* ,&,#&r!aha(*a( #-+!r da( *&+&i,a()a(

A#ara!+ &+!i'ari+

 !analis  semisirkularis

T!#& /&l'&" /em!/!',le' +&"# (e'//" (!#& )!me"/! )&l&m !)&"#-!)&"# +&"# (e#&, l'/ /&( /&m& l&!" )! )e,&( ,,le& .&h )! )&l&m (l&"# (em5'&l!/

Me")e(e,/! &,/ele'&/! 85e'e5&(&"9 &(& )e/ele'&/! 85e'l&m&(&"9 '(&/!"&l &(& &"#le' 

"trikulus

S(',(' /e5e'(! ,&"("# )! '"##& e'(l&"# &"(&'& ,,le& )&" ,&"&l!/ /em!/!',l&'!/

Me")e(e,/! 19 5e'&h&" 5/!/! ,e5&l& mee".&h! /m 3e'(!&l )&" 29 me"#&'&h,&" &,/ele'&/! )&" )e/ele'&/ l!"e&' /e&'& h'!"(&l

Sakulus

Te'le(&, )! /&m5!"# ('!,l/ Me")e(e,/! 19 5e'&h&" 5/!/! ,e5&l& me".&h! /m h'!"(&l )&" 29 me"#&'&h,&" &,/ele'&/! )&" )e/ele'&/! l!"e&' /e&'& 3e'(,&l

. %EFENISI

Pe'4'&/! mem'&" (!m5&"! &)&l&h /&( ,e&)&&" )!m&"& )!(em,&" l&"# 5&)& #e")&"# (el!"#& mm"+& (!ml /e&#&! &,!&( )&'! ('&m&7 (!(!/ me)!& &(& ,m5l!,&/! e)&h Mem'&" (!m5&"! (el&h me"".,,&" ,em&m5&" l&' !&/& "(, 'e#e"e'&/! )&"  5e"+emh&" /e&'& /5"(&"7 "&m" 5e'4'&/! ,'"!/ m&/!h )&5&( m"l /eh!"##& mem(h,&" m!'!"#5l&/(! "(, 5e'&!,&" Bee'&5& (e,"!, m!'!"#5l&/(! +&"# (!)&,  !"3&/!47 m)&h )&" e4e,(!4 /e5e'(! ,&(e'!/&/!7 ,em(e'&5!7 me()e  patch )&" (&")' lem&, 

(el&h )!l&,,&" &!, /e&'& /e")!'! &(& ,m!"&/!7 "&m"7 e4e,(!3!(&/ 5e"#&(&" (e'/e( (e(&5 ,"('3e'/!&l

%. ETIOLO$I

I"4e,/! &)&l&h /e& (&m& 5e'4'&/! mem'&" (!m5&"! I"4e,/! &,( )&'! (el!"#& )&5&( me"#&,!&(,&" !/,em!, 'el&(!3e 5&)& mem'&" (!m5&"! e'/&m&&" )e"#&" (e,&"&" +&"# me"!"#,&( )&l&m '&"# (el!"#& (e"#&h P&)& ,")!/! !"!7 '5('e mem'&" (!m5&"! )!)&hl! "+e'! he&( 5&)& (el!"#& Pe'4'&/! ('&m&(! )&5&( (e'.&)! )&'! e")& &/!"# +&"# m&/, ,e l!&"# (el!"#& 8m!//&l : )!5,l )e"#&" (&"#&"7 .&(h ,e &!' )e"#&" ,e5&l& le!h )l m&/, ,e &!'9 P&5&'&" (e,&"&" (!"##! )&'! /e&h le)&,&" )&5&( me'e, mem'&" (!m5&"! Pe'4'&/! mem'&" (!m5&"! +&"# (e'.&)! )&'! (e,&"&" &!'7 5&)& l&h'&#& +&"# me"e'.",&" ,e5&l& (e'le!h )&hl ,e)&l&m &!'7 )&5&( (e'.&)! 5&)& mem'&"e (!m5&"! +&"# /)&h &('4! ,&'e"&  5e"+&,!( /eelm"+& O.e, +&"# )!#"&,&" "(, meme'/!h,&" l!&"# (el!"#& )&5&( me"#&,!&(,&" 5e'4'&/!3

E. EPI%EMIOLO$I

S&m5&! /&&( !"!7 elm &)& /'3e! e5!)em!l#! (e"(&"# &"#,& ,e.&)!&" 5e")e'!(& 5e'4'&/! mem'&"& (!m5&"! D&l&m l!"#,5 !"(e'"&/!"&l5" &"#,& ,e.&)!&" 5e'4'&/! mem'&"& (!m5&"! .#& elm )!,e(&h! Pe"el!(!&" (e'h&)&5 &"&,-&"&, /, A'!#!"7 me")&5&(,&" 1C6 )&'! C6 (el!"#& 8C1729 me"#&l&m! 5e'4'&/! mem'&"& (!m5&"!  D! Me)&" me")&5&(,&" C6 (el!"#& 5e'4'&/! ((&l7 5e'4'&/! /e"('&l /e&"+&, 26 (el!"#&7  5e'4'&/! /((&l )&" &(!, m&/!"#-m&/!"# 1 (el!"#& Ol#e )&" N*&*l me")&5&(,&" 6 /!/*& SD "e#e'! )! )e/& )e"#&" OMSK +&"# )!(&")&! )e"#&" 5e'4'&/! 5e'/!/(e" mem'&" (!m5&"! le!h )&'! C l&"  F. $EJALA KLINIS

Ge.&l& (!(!/ me)!& )&5&( e'4&'!&/! e'&("+& !"4e,/! )&" !/& /&"#&( '!"#&" )&" /eme"(&'& &(& /&"#&( e'&( Ke&)&&" !"! !&/&"+& "!l&(e'&l 5&)& '&"# )e*&/&7 )&" m"#,!" (e')&5&( (&l#!& S5"(&" mem'&"& (!m5&"! &(& /e(el&h m!'!"#(m! 8!"/!/! mem'&"& (!m5&"!9 Ge.&l& l&!" )&5&( e'5& ,el&'"+& &!'&" )&'! (el!"#&7 )em&m7 ,eh!l&"#&" 5e")e"#&'&"7 )&" (!"!(/ P&)& 5eme'!,/&&" (/,5!/7 ,&'e"& &)!('!/ &/(e'"/ /e'!"# (&m5&, "'m&l7 )&" (&, (e'.&)! "+e'! !l& &'!,l& )!#e'&,,&" Mem'&"& (!m5&"! (&m5&, me'&h )&" /e'!"# me"##elem"#

P&/!e" m"#,!" me"#elh ,eh!l&"#&" 5e")e"#&'&"7 '&/& 5e"h )&l&m (el!"#& &(&  5e'&/&&" e")"#&"7 )&" &h,&" /&'& le(5 &(& e')e'!"#7 +&"# (e'.&)! ,e(!,& (& e/(&!!  e'/&h& mem,& Mem'&"& (!m5&"! (&m5&, ,/&m 5&)& /(,5!7 )&" )&5&( (e'leh!( #elem"# )&'(& )&l&m (el!"#& (e"#&h A)!#'&m !&/&"+& me"".,,&" &)&"+& ,eh!l&"#&" 5e")e"#&'&" ,"),(!4 Ge.&l& )&5&( m!"!m&l7 )e"#&" e'&#&! )e'&.&( ,eh!l&"#&" 5e")e"#&/'&" )&" (e')&5&( ('e& !"(e'"!(e" &(& 5e'/!/(e" +&"# e'& /, !&/&"+& (!)&, &)& "+e'! ,e&l! 5&)& ,&// m&/(!)!(!/ &,(7 )!m&"& )&e'&h 5/(-&'!,le' me".&)! "+e'! (e,&" )&" &h,&" me'&h )&" e)em& Kle/(e&(m&7 /e")!'!7 !&/&"+& (!)&, me"+e&,&" "+e'! E3&l&/! (/,5!,  mem'&" (!m5&"! mem5e'l!h&(,&" &)&"+& 5'4'&/!7 )&" ,le/(e&(m& )&5&( (e'l!h&( /e&#&! m&/& 5(!h )!el&,&"# mem'&" (!m5&"! &(& ,el&' ,e,&"&l!/ e,/(e'"/ l&"# 5e'4'&/! Kle/(e&(m& )&5&( .#& (!)&, (e'l!h&( 5&)& 5eme'!,/&&" leh &hl! (/,5! H&/!l &)!me('!  5&)& ,&// ,le/(e&(m& /e'!"# mem5e'l!h&(,&" ,eh!l&"#&" 5e")e"#&'&" ,"),(!4 &(& &m5'&" $. JENIS JENIS PERFORASI

Pe'4'&/! mem'&"& (!m5&"!7 &)& +&"# e'/!4&( &,( &)& 5l& +&"# ,'"!, Pe'4'&/! &,(7 (e'(&m& +&"# e','&" ,'&"# )&'! &(& /&m& )e"#&" 2 /e&'& (e'! )&5&( me"(5 /5"(&" )&l&m *&,( ee'&5& h&'! /&m5&! ee'&5& l&" Me"'( &"+&, &hl! (!")&,&" 5e'&/! me'5&,&" me()e 5!l!h&" "(, 5e"&(&l&,/&"&&" 5e'4'&/!7 /e)&"#,&" &'& l&!" &)&l&h (&"5& 5e'&/! +&!( )e"#&" me"#/&h&,&" e5!(el!/&/! (e5! 5e'4'&/!"+& Sel&m& !"!  5e"(5&" 5e'4'&/! mem'&"& (!m5&"! 5&)& m&"/!& (&"5& 5e'&/! /el&l me"##"&,&"  .em&(&"7 "(, mem5e'm)&h e5!(el me"+ee'&"# mel!"(&/! 5e'4'&/!7 /eh!"##& )&5&( (e'.&)! 5e"(5&" A)& e'&#&! m&&m &'& +&"# )&5&( )!l&,,&"7 )! &"(&'&"+& ,e'(&/ /!#&'e( +&"# )!(em5el,&" )! &(&/ 5e'4'&/! /e(el&h (e5!"+& )!l,&! )e"#&" &/&m ('!,l'&/e(&( 8('!hl'&e(! &!) T
1 Pe'4'&/! /e"('&l : L,&/! 5&)& 5&'/ (e"/&7 !/& &"(e'-!"4e'!'7 5/(e'-!"4e'!' )&" 5/(e'/5e'!'7 ,&)&"#-,&)&"# / ((&l

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2 Pe'4'&/! m&'#!"&l : Te')&5&( 5&)& 5!"##!' mem'&" (!m5&"! )e"#&" &)&"+& e'/! )&'! annulus fibrosus +&"# /e'!"# )!/e'(&! .&'!"#&" #'&"l&/! Pe'4'&/! m&'#!"&l +&"# /&"#&( e/&'  )!#&m&',&" /e&#&! 5e'4'&/! ((&l Pe'4'&/! 5&)& 5!"##!' 5/(e'-/5e'!' e'h"#&" )e"#&",le/(e&(m

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H. Fa*!-r Ri+i*- P&r5-ra+i M&,ra( Ti,#a(i

F&,(' '!/!, OMSK me'5&,&" 4&,(' +&"# mem5e'm)&h (e'.&)!"+& OMSK7 &"(&'& l&!": a. Li()*()a(

A"&,-&"&, +&"# (!"##&l )! )&l&m 'm&h +&"# 5e"h /e/&,7 5e'&*&(&" /&,!( +&"# m!"!m7 (e'5&5&' )e"#&" &"&, l&!" +&"# (e'!"4e,/!7 &(& (e'5&5&' )e"#&" &/&57 )!5e'&+& me"!"#,&(,&" !"/!)e"/! OMSK 8Ke""& )&" L&(7 20069

. S-+ia' &*-(-,i

F&,(' //!&l e,"m! mem5e"#&'h! ,e.&)!&" OMSK )!m&"& ,elm5, //!e,"m! 'e")&h mem!l!,! !"/!)e" +&"# le!h (!"##! Pe"el!(!&" me"".,,&" &h*& ,e/eh&(&" /e&'& mm (e'm&/, /(&(/ !m"!/&/!7 )!e( )&" (em5&( (!"##&l +&"# 5&)&( .#& meme"#&'h! ,e.&)!&" OMSK 8B'*"!"#7 1??> A,!"5el et al 7 200@9

/. $a())a( 5()+i !a

P&)& (!(!/ ,'"!/ &,(!47 (& E/(&h!/ /e'!"# (e'/m&( leh e)em& (e(&5! &5&,&h h&l !"! me'5&,&" 4e"me" 5'!me' &(& /e,")e' m&/!h elm )!,e(&h! 8B'*"!"#7 1??9 Ah&)!&h 8200@9 )! S'&&+& mem5e'leh 11 5e")e'!(& )e"#&" 16 (el!"#& +&"# me"#&l&m! OMSK 811 (!5e ((!m5&"&l )&"  (!5e &(!,&"('&l97 /e&"+&, 16 #&m&'&" e")/,5! m&'& (& E/(&h!/ 4&'!"#e&l (e')&5&( ,el&!"&" M,/& )em ? ,&// 867297 m,/& h!5e'em!/  ,&// 8297 (e')&5&( /e,'e( /e'm,/ 12 ,&// 89

d. O!i!i+ ,&dia +&&',(ya

Se&'& mm )!,&(&,&" (!(!/ me)!& ,'"!/ me'5&,&" ,el&".(&" )&'! (!(!/ me)!& &,( &(& (!(!/ me)!& )e"#&" e4/!7 (e(&5! (!)&, )!,e(&h! 4&,(' &5& +&"# me"+e&,&" /&( (el!"#& )&" ,&" +&"# l&!""+& e',em&"# me".&)! ,e&)&&" ,'"!/ 8B'*"!"#7 1??9 Hme et  al 81???9 me")&5&(,&" C &"&,-&"&, )e"#&" OMSK )!)&hl! )e"#&" (!(!/ me)!& &,( +&"# e'l&"# /e)&"#,&" L&/!/! et al 8200@9 me")&5&(,&" 0 OMSK )e"#&" "/e( (!(!/ me)!& /eelm"+& 5&)& /!& +&"# le!h )!"!

&. I(5&*+i +a'ra( #&r(a5a+a( a!a+

B&"+&, 5e")e'!(& me"#elh /e,'e( (el!"#& /e/)&h (e'.&)! !"4e,/! /&l'&" "&4&/ &(&/ I"4e,/! 3!'/ )&5&( mem5e"#&'h! m,/& (el!"#& (e"#&h me"+e&,&" me"'""+& )&+& (&h&" (h (e'h&)&5 '#&"!/me +&"# /e&'& "'m&l e'&)& )&l&m (el!"#& (e"#&h7 /eh!"##& mem)&h,&" 5e'(mh&" &,(e'! 8B'*"!"#7 1??9 L&/!/! et al 82009 )! N!#e'!& 5&)& 1@? &"&, me")&5&(,&" /e&"+&,  &"&, )e"#&" OMSK )!)&hl! )e"#&" !"4e,/! /&l'&" "&4&/ &(&/

5. I(5&*+i

B&,(e'! +&"# )!!/l&/! )&'! m,5/ &(& m,/& (el!"#& (e"#&h &!, &e' &(&5" &"&e' me"".,,&" '#&"!/me +&"# ml(!5el O'#&"!/me +&"# (e'(&m& )!.m5&! &)&l&h #'&m "e#&(!47 bo%el&type flora )&" ee'&5& '#&"!/me l&!""+& 8B'*"!"#7 1??9 N'/!&h )! Me)&" 820009 me")&5&(,&" .e"!/ ,m&" &e' (e'&"+&, &)&l&h S &'e/ 8C67197 )!!,(! E l! 82797 P'(e/ /5 81?797 S &l/ 87697 S 3!'!)&" 87697 Kle/!ell& /5 827@9 )&" P &e'#!"/& 827@9 P&', 8200@9 meme'!,/& 1C60 5&/!e" OMSK )&" me")&5&(,&"  me'5&,&" ,m&" /(&5h+l/ %e et al mel&,,&" /()! 'e('/5e,(!4 5&)& 1102 5&/!e" )e"#&" OMSK )&'! 6 RS )! K'e& /e.&, J&"&'! 2001 h!"##& De/eme' 2007 h&/!l"+&  &,(e'! 5&(h#e" +&"# 5&l!"# &"+&, &)&l&h 5/e)m"&/ 8%e et al 7 2009

). $&(&!i*

F&,(' #e"e(!, m&/!h )!5e')e&(,&" /&m5&! /&&( !"!7 (e'(&m& &5&,&h !"/!)e" OMSK   e'h"#&" )e"#&" l&/"+& /el m&/(!) +&"# )!,&!(,&" /e&#&! 4&,(' #e"e(!, S!/(em /el/el )&'& m&/(!) le!h ,e!l 5&)& 5e")e'!(& (!(!/ me)!&7 (&5! elm )!,e(&h! &5&,&h h&l !"!  5'!me' &(& /e,")e' 8B'*"!"#7 1??9 Pe"el!(!&" 5&)& 5&/&"#&" ,em&'7 ,em&' m"+#( mem!l!,! '!*&+&( (!(!/ me)!& +&"# le!h e/&' )!&")!"#,&" ,em&' )!+#(7 +&"# ,em"#,!"&" leh ,&'e"& ,m5"e" #e"e(!,  +&"# le!h ,&( F&,(' #e"e(!, 5&)& (!(!/ me)!& e'/!4&( ,m5le, )e"#&" ,"('!/! )&'!  &"+&, #e" 8R3e'/ e( &l7 2009

h. A!-i,(

Pe")e'!(& )e"#&" 5e"+&,!( &(!m" &,&" mem!l!,! !"/!)e" le!h e/&' (e'h&)&5 (!(!/ me)!& ,'"!/ 8B'*"!"#7 1??9 A,!"5el et al 8200@9 )&'! 160 5&/!e" OMSK7 27 )e"#&"  5e"+&,!( !m")e4!/!e"/!7 /e)&"#,&" $ee' et al 820069 me"el!(! ? &"&, )e"#&" HIV (e')&5&( 172 +&"# me")e'!(& OMSK

i. A'&r)i

Pe")e'!(& &le'#! mem5"+&! !"/!)e" (!(!/ me)!& ,'"!/ +&"# le!h (!"##! )!&")!"# +&"#  ,&" &le'#! 8B'*"!"#7 1??9 S/!l 820109 )! Me)&" meme'!,/&  .e, )&" me")&5&(,&" 'e&,/! &le'#! 5&)& 5e")e'!(& OMSK ((!m5&"&l le!h e/&' )!&")!"#,&" )e"#&" 'e&,/! &le'#! 5&)& 5e")e'!(& "" OMSK +&!( /ee/&' 1 5&)& ,elm5, 5e")e'!(& OMSK (!5e ((!m5&"&l )&" 0 5&)& ,elm5, "" OMSK L&/!/! et al 82009

me")&5&(,&" )&'! 1@? &"&, )e"#&" OMSK /e&"+&, 2@ me")e'!(& &le'#! L&/!/! et al  8200@9 mel&,,&" (e/ ,l!( ,e5&)& 20 5&/!e" )e"#&" OMSK7 /e&"+&, @0 (e/ ,l!( 5/!(!4 (e'h&)&5 /&( &(& le!h .el&/ &le'#e" 

I. %ia)(-+a

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8?9

1 Pe'4'&/! /e"('&l 8/ ((&l9 Le(&, 5e'4'&/! )! /e"('&l )&" 5&'/ (e"/& mem'&" (!m5&"! Sel'h (e5! 5e'4'&/! m&/!h me"#&")"# /!/& mem'&" (!m5&"! 2 Pe'4'&/! m&'#!"&l Se&#!&" (e5! 5e'4'&/! l&"#/"# e'h"#&" )e"#&" &"l/ &(& /l,/ (!m5&"!,m C Pe'4'&/! &(!, Le(&, 5e'4'&/! )! 5&'/ 4l&,/!)& mem'&" (!m5&"! Ge.&l& )&" (&")& 5e'4'&/! mem'&" (!m5&"! )&5&( e'5& "+e'! 5&)& (el!"#&7 #&"##&"  5e")e"#&'&"7 ,el&' &!'&" 8)&5&( e'5& "&"&h )&" )&'&h9 )&'! (el!"#&7 (!""!(/ 8"+!  e')e"#!"# )! (el!"#&97 3e'(!# T.&" )&'! (!m5&"5l&/(! &)&l&h "(, mem5e'&!,! #e")&"# (el!"#& e'l&"#7 )&" ,&)&"#-,&)&"# (l&"# (el!"#& (e"#&h 8//!le/9 +&"# (e')!'! )&'! !",/7 m&le/7 )&" /(&5e/ <&"#,, mem'&" (!m5&"! m"#,!" )&5&( )!5e'l,&" J!,& )!5e'l,&"7 &"#,, !&/&"+& )!&m!l )&'! 3e"& &(& 4&/!& 8(( ,el5&,9 .&'!"#&" 5&)& 5!"# (el!"#& B&h&" /!"(e(!/ )&5&( )!#"&,&" .!,& 5&/!e" mem!l!,! 5e'&/! /eelm"+& )&" (el&h &"#,, mem'&" (!m5&"!  89 I")!,&/! )&" ,e&)&&" )!5e'l,&" "(, )!l&,,&""+& (!m5&"5l&/(!:

8@9

1 Pe")e'!(& )e"#&" (l! ,"),/! ,&'e"& 5e'4'&/! mem'&" (!m5&"! &(& )!/4"#/! //!,l&' 2 O(!(!/ me)!& ,'"!, &(& 'e,'e" /e,")e' (e'h&)&5 ,"(&m!"&/! C Tl! ,"),/! 5'#'e/!4 ,&'e"& 5&(l#! (el!"#& (e"#&h  Pe'4'&/! &(& (l! 5e'/!/(e" le!h )&'! C l&" ,&'e"& ('&m&7 !"4e,/! &(& 5eme)&h&"  Ke(!)&,m&m5&" "(, m&")! &(& e'5&'(!/!5&/! )&l&m l&h'&#& &!' )e"#&" &m&" Se)&"#,&" /+&'&( )!l&,,&""+& (!m5&"5l&/(! &)&l&h: 1

Pe'4'&/! (e'.&)! )! /e"('&l )!m&"& ,e&)&&" (el!"#& /)&h ,e'!"# 5&l!"# (!)&, 6 m!"##

2

M,/& (el!"#& (e"#&h "'m&l

C

O/!,l&' +&"# (h



Ke&)&&" ,,le& &!,

K-(!rai(di*a+i

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Ti#& Ti,#a(-#'a+!i

A)& l!m& (!5e )&/&' )&'! 5'/e)' (!m5&"5l&/(! me"'( ll"e' )&" $ll/(e!" 81?29: •

T!5e I (!m5&"5l&/(! )!/e( M!'!"#5l&/(! H&"+& me'e,"/(',/! mem'&" (!m5&"! +&"# e'l&"#

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T!5e II (!m5&"5l&/(! )!#"&,&" "(, 5e'4'&/! mem'&" (!m5&"! )e"#&" e'/! m&le/ I"! mel!&(,&" 5e"&"#,,&" 5&)& !",/ &(& /!/&-/!/& m&le/ (e'/e(

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T!5e III (!m5&"5l&/(! )!!")!,&/!,&" "(, 5e"#h&"'&" )& //!le/7 )e"#&" /(&5e/ m&/!h (h )&" m!le I"! mel!&(,&" 5e"em5&(&" &"#,,&" ,e /(&5e/7 )&" me"+e)!&,&" 5e'l!")"#&" "(, 5e'&,!(&"

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T!5e IV (!m5&"5l&/(! )!#"&,&" "(, 5e"#h&"'&" (l&"# 5e")e"#&'&"7 +&"# me"&,5 /em& &(& &#!&" )&'! le"#,"#&" /(&5e/ I"! mel!&(,&" 5e"em5&(&" &"#,,&" 5&)& &(& /e,!(&' ,&,! /(&5e/ m!le

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T!5e V (!m5&"5l&/(! )!#"&,&" ,e(!,& ,&,! )&'! /(&5e/ me"e(&5

G&m&'  T!5e T!m5&"5l&/(! Ea'a+i Pr&-#&ra!i5

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(!m5&"!7 )!&"(&'&"+& (!m5&"5l&/(! me)!&l 8")e'l&+97 (!m5&"5l&/(! l&(e'&l 83e'l&+97 )&" +&"# 5&l!"# 55le' /&&( !"! &)&l&h (e,"!, (!m5&"5l&/(! me)!&l )&" l&(e'&l 8")e'-3e'  (e,"!,9 1. O&r'ay !&/h(i;& 'a!&ra' )ra5!i()8 4"98 Te,"!, !"! ,5 /l!( /eh!"##& h&'/ )!l&,,&" leh &hl!"+& P&)& 3e'l&+ (eh"!e7

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(+m5&"me&(&l 4l&5 +&"# (el&h )!ele3&/! m&,&"+& (e,"!, !"! )!"&m&! /e&#&! ")e'l&+ (eh"!e Ke"("#&" )&'! (e,"!, !"! &)&l&h m)&h )!l&,,&" )e"#&" h&/!l +&"# ,5 mem&/,&" Sel&!" !(7 me"#h!")&'! '!/!, l&(e'&l!/&/! )&" l"(!"# 5&)& /l,/ &"(e'!' )&" mem!l!,! &"#,& ,ee'h&/!l&" (!"##! (e'(&m& 5&)& 5e'4'&/! mem'&" (!m5&"! 5/(e'!' Ke'#!&" (e,"!, !"! &)&l&h (!)&, (e')&5&("+& 3!/&l!/&/! +&"# &)e,&( 5&)& )&e'&h &"(e'!'  (el!"#& (e"#&h (e'(&m& !l& )!l&,,&" )e"#&" 5e")e,&(&" ('&"/,&"&l7 ,em"#,!"&" .&(h"+& (&")' &"(e'!' ,e )&l&m ,&3m (!m5&"! )&" 'e),/! '&"# (el!"#& (e"#&h )e"#&" ,"/e,e"/! me"!"#,&("+& '!/!, &)he/! (&")' 5&)& 5'm"('!m (e'(&m& 5&)& 5e'4'&/! &"(e'!' )&" /((&l Pe"el!(!&" l&!" mel&5',&" ,ee'h&/!l&" m!'!"#5l&/(! )e"#&" (e,"!,  me)!&l 8")e'l&+9 /ee/&' ?2 )&'! ?6 ,&// m!'!"#5l&/(! )e"#&" 5e")e,&(&" ('&"/,&"&l P&)& (e,"!, me)!&l 5'/e)' &"e/(e/! +&"# )!#"&,&" &)&l&h &"e/(e/! l,&l )e"#&"  5e")e,&(&" ('&"/,&"&l <'"# (el!"#& )!(em5&(,&" 5&)& me&(/ &,/(!,/ e,/(e'"/ Sel'h  5!"##!'&" 5e'4'&/! mem'&" (!m5&"! )!l,&! )&" )!&"# )e"#&" me"##"&,&" "&m  5e"#"#,!( )&" "&m 5eme#&"# S!/& mem'&" (!m5&"! )! &(&/ m&"'!m m&le! )!e'/!h,&" M,/& )! &#!&" me)!&l /e,el!l!"# /!/& mem'&" (!m5&"! )!l,&! /e,5"+& "(, (em5&( me"em5el 4&/!& (em5'&l D!&( 4l&5 (!m5&"me&(&l )! &#!&" 5/(e'!' )e"#&" &'& !"/!/! /em!/!',le' ,l!( ,&"&l!/ &,/(!,/ e,/(e'"/ /e.&.&' &"l/ 4!'// )e"#&" .&'&, - mm )&'! mem'&" (!m5&"! De"#&" me"##"&,&" 5!/& l&(7 )!&( !"/!/! 5&)& ,l!( ,&"&l!/ )!ml&! )&'! "(h R!3!"/ /&m5&! ,e 5/!/! .&m 6 Kem)!&" ,l!( (e'/e( )!le5&/,&" )&'! (l&"# ,&"&l!/ &,/(!,/ e,/(e'"/ )e"#&" me"##"&,&" )!/e,(' ,e &'&h me)!&l /&m5&! mele5&/,&" &"l/ /e'(& /!/& mem'&" (!m5&"! Fl&5 +&"# (e'e"(, )!ele3&/!,&" ,e &'&h &"(e'!' /&m5&! ,&3m (!m5&"! K&3m (!m5&"! )!!/! )e"#&" 5("#&"-5("#&" ,e!l /5"#/(&" +&"# (el&h )!el5,&" ,e )&l&m l&'(&" ,em!/e(!" Mel&l! (e'*"#&" +&"# (e'e"(, )! &*&h 4l&5

(!m5&"me&(&l7 #'&4( )!(em5&(,&" /e)em!,!&" '5& )! &#!&" me)!&l m&"'!m m&le! /eh!"##& me"(5 /el'h 5e'4'&/! mem'&" (!m5&"! Kem)!&" /el'h 5!"##!'&" #'&4( )!(em5&(,&" /e'(& )!/el!5,&" )! &#!&" me)!&l /e,el!l!"# /!/& mem'&" (!m5&"! /e.&h ,!'&,!'& 2 mm /e&'& me'&(& ,e&l! /e&#!&" #'&4( +&"# (e'le(&, )! &#!&" 5/(e'!' )!le(&,,&" )! &(&/ (l&"# ,&"&l!/ &,/(!,/ e,/(e'"/ )! &*&h 4l&5 (!m5&"me&(&l Fl&5 ,em)!&" )!,em&l!,&" ,e (em5&( /eml&7 /eh!"##& /e&#!&" #'&4( (e'le(&, )! &"(&'& 4l&5 )&" (l&"# ,&"&l!/ &,/(!,/ e,/(e'"/ P&)& &#!&" l&(e'&l mem'&" (!m5&"! &' (e'/e( ,em)!&" )!le(&,,&" 5("#&"-5("#&" /5"#/(&" +&"# (el&h )!el5,&" ,e )&l&m l&'(&" ,em!/e(!" /eh!"##& meme"h! /e(e"#&h ,&"&l!/ &,/(!,/ e,/(e'"/ Tel!"#& ,em)!&" )!&l(

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 5&)& (e,"!, me)!&l m&5" l&(e'&l +&"# )!l&,,&" 5&)& 5e")e,&(&" ('&"/,&"&l Oleh ,&'e"& !( )!5e'(!m&"#,&" &5&,&h (e,"!, me)!l&(e'&l )e"#&" 5e")e,&(&" ('&"/,&"&l )&5&( me"#'&"#! ,e#&#&l&" m!'!"#5l&/(! 5&)& ,e)& (e,"!, (e')&hl A"e/(e/! l,&l )!#"&,&" )e"#&" 5e'(!m&"#&" !&+& +&"# le!h m'&h7 )&5&( )!#"&,&" 5&)& 5&/!e" +&"# le!h ,5e'&(!47 /e'(& me"#h!")&'! m&/,"+& N2O 5&)& '"##& ,&3m (!m5&"! +&"# )&5&( me")'"# #'&4( ,el&' !l& )!l&,,&" &"e/(e/! mm <&'& Te,"!, Me)!l&(e'&l: P'/e)' +&"# )!#"&,&" &)&l&h &"e/(e/! l,&l )e"#&"  5e")e,&(&" ('&"/,&"&l F&/!& (em5'&l!/ )!&m!l7 )!5'e/7 )&" )!,e'!"#,&" )!&*&h l&m5 5e'&/! Te5! 5e'4'&/! )!/e#&',&" )e"#&" &'& mel,&! ,em&l! (e5! 5e'4'&/! (e'/e( I"/!/! ,l!( ,&"&l!/ e,/(e'"/ /e&'& 3e'(!,&l )!&( 5&)& .&m 12 )&" .&m 6 I"/!/! 5&)& .&m 6 !/& )!le&',&" /&m5&! ,e ,&"&" &(&/ &"l/ I"/!/! 5&)& .&m 12 )!5e'l&/ ,e &'&h !"4e'!' /&m5&!  ee'&5& m!ll!me(e' )! &(&/ &"l/ "(, mem5e'(&h&",&" /5l&! 5emlh )&'&h ,l!( ,&"&l!/ e,/(e'"/ &"(e'!' +&"# )!#"&,&" /e&#&! )&/&' (&")' &#!&" /5e'!' T!m5&"me&(&l 4l&5 &#!&" 5/(e'!' )!ele3&/!,&"7 )&" (l&"#-(l&"# 5e")e"#&'&" )!e3&l&/! A5&!l& (!)&, (e')&5&( 4!,/&/! 5&)& (l&"#-(l&"# 5e")e"#&'&"7 5eme)&h&" )!l&,,&" )e"#&" mem&( !"/!/! h'!"(&l me"##"&,&" 5!/& /e(e"#&h l!"#,&'&" 5&)& ,l!( ,&"&l!/ e,/(e'"/ &"(e'!' J&'&, !"/!/! ,&"&l!/ &"(e'!'-h'!"(&l )&'! &"l/ &"(e'!' h&'/ /&m& )e"#&" )!&me(e' 5e'4'&/! Se(el&h !"/!/!7 ,l!( ,&"&l!/ e,/(e'"/ &#!&" &"(e'!' )!ele3&/!,&" ,e l&(e'&l )&" me)!&l K&"&l5l&/(! )!l&,,&" )e"#&" mem&"# (l&"# &"(e'!' +&"# e'&)& )!&(&/"+& me"##"&,&" ' (l&"# e'm&(& )!&m") /eh!"##& &"l/ 5/(e'!' )&5&( (e'l!h&(  .el&/ Fl&5 ,l!( ,&"&l!/ &"(e'me)!&l )!ele3&/!,&" ,e &(&/ /&m5&! me"&5&! &"l/ &(& (e5! mem'&" (!m5&"! P&)& &#!&" &"l/ !"!7 h&"+& l&5!/&" e5!(el /&m/& mem'&" (!m5&"! /&.& +&"# )!ele3&/! )e"#&" h&(!-h&(! ,e&'&h /e(e"#&h &#!&" &"(e'!' (e5! 5e'4'&/!7 /eh!"##&  &#!&" &"l/ &"(e'!' (e(&5 !"(&, Ke )&l&m ,&3m (!m5&"! )!le(&,,&" 5("#&"-5("#&" /5"#/(&" +&"# (el&h )!&/&h! (e(e/ (el!"#& &"(!!(!, 4l',!"l" +&"# e'/!4&( ""(,/!, Be'e)& )e"#&" (e,"!, (!m5&"5l&/(! me)!&l7 5&)& (e,"!, !"! 5&,!"# (el!"#& (e"#&h +&"# (e')!'! )&'! 5("#&" /5"#/(&" (e'/e( (!)&, h&'/ 5&)&( F&/!& #'&4( (em5'&l!/ ,em)!&" )!(em5&(,&" )! &#!&" me)!&l 5e'4'&/! "(, me"(5! /e(e"#&h &#!&" 5/(e'!'   5e'4'&/! (e'/e( P&)& 5e'4'&/! &#!&" &"(e'!'7 #'&4( )!le(&,,&" l&(e'&l (e'h&)&5 5!"##!'   5e'4'&/! +&!( )! &(&/ &"l/ &"(e'!' "(, me"(5! /e(e"#&h 5e'4'&/! /!/&"+& U"(,  me"#h!")&'! &"(e'!' l"(!"#7 #'&4( )!(em5&(,&" h&"+& /&m5&! )e"#&" /l,/ &"(e'!' )! &(&/ &"l/ (e'/e( Se&#&! l&5!/&" 5e"(5 ,e)&7 ,l!( ,&"&l!/ &"(e'me)!&l )!'(&/!,&" "(,  me"(5! 5e'4'&/! )e"#&" 4&/!& /e&#&! )&/&' .&!' /5e'!'

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867119

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DAFTAR PUSTAKA

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