DISFONIA
PEMBIMBING: dr. Noviati Sri Racha, Sp. THT-KL
DISUSUN OLEH : Betharia Susi
(2015-061-099
Natha!ie" Her"a#$a!%
(2015-061-100
Shei"a &'ii!ata
(2015-061-101
Kepaniteraan Klinik Ilm !en"akit THT #niver$ita$ Katolik Indone$ia Atma %a"a !eriode &' April ( &) *ei &+)
KATA !NANTAR Pu)i 'a! s*u+ur ,e!u"is ,a!)at+a! +e,a'a uha! .a!% Maha Esa /"eh +are!a $er+at 'a! rah#at-N*a sehi!%%a ,e!u"is 'a,at #e!*e"esai+a! eerat $er)u'u" Dis/!ia3 i!i te,at ,a'a a+tu!*a4 eer eerat at i!i 'i$u 'i$uat at 'e!% 'e!%a! a! tu)ua tu)ua! ! u!tu u!tu+ + #e#$ #e#$eri eri+a +a! ! i!/ i!/r# r#as asii +e,a +e,a'a 'a ,e#$aa #e!%e!ai ,e!%ertia! ,e!*e$a$ 'a! ,e!a!%a!a! 'is/!ia4 Se"ai! itu eerat eerat i!i sa*a sa*a a)u+a! a)u+a! se$a%ai se$a%ai sa"ah sa"ah satu satu ,ers*a ,ers*arata rata! ! +e"u"u +e"u"usa! sa! 'i 7e,a!i 7e,a!itera teraa! a! 7"i!i+ I"#u Pe!*a+it H U!i8ersitas 7at/"i+ 7at/" i+ I!'/!esia &t#a a*a 7e$erhasi"a! 7e$erhasi"a! 'a"a# ,e!u"isa! ,e!u"isa! eerat i!i ti'a+ ti'a+ "e,as 'ari $a!tua! $a!tua! $er$a%ai $er$a%ai ,iha+ +husus!*a 'r4 N/8iati Sri aha S,4H-7L S,4H-7L se"a+u ,e#$i#$i!% 'a! ,e!%u)i se"uruh '/se! 'a! te#a!-te#a! *a!% te"ah #e!'u+u!% ter"a+sa!a!*a ,e!u"isa! eerat i!i serta setia, ,iha+ *a!% te"ah #e#$eri+a! $a!tua! $ai+ seara "a!%su!% #au,u! ti'a+ "a!%su!%4 Pe!u"is Pe!u"is #e!*a'ari #e!*a'ari $aha eerat i!i #asih )auh 'ari +ese#,ur!aa +ese#,ur!aa! ! /"eh +are!a itu ,e!u"is $erhara, u!tu+ $isa #e!'a,at+a! sara! atau,u! +riti+a! *a!% #e#$ #e#$a! a!%u %u! ! 'ari 'ari ,ara ,ara ,e#$a ,e#$aa a u!tu u!tu+ + +e#a)u +e#a)ua! a! $ersa $ersa#a #a44 &+hir +hir +ata +ata ,e!u ,e!u"i "iss ua,+a! se#/%a eerat i!i 'a,at $er#a!aat $a%i se#ua ,iha+4
a+arta 9 Mei 2016
Pe!u"is
DAFTAR ISI H&L&M&N UDUL44444444444444444444444444444444444444 UDUL4444444444444444444444444444444444444444444444444444444444444 444444444444444444444444444444444444444444444444444444444444444 4444444444444444444444444444444444444444 i 7& 7&& PENG&N&44444 PENG&N&4444444444444444444444444444 4444444444444444444444444444444444444444444444 4444444444444444444444444444444444444444444444 4444444444444444444444444444444444444 4444444444444444444444444 44444444444ii ii D&& D&& ISI4444444444444444444444444444444444444444444 ISI444444444444444444444444444444444444444444444444444444444444444444 4444444444444444444444444444444444444444444444 4444444444444444444444444444444444444444444444iii 44444444444444444444444iii D&& D&& &BEL44444444444444444444444 &BEL4444444444444444444444444444444444444444444444 4444444444444444444444444444444444444444444444 44444444444444444444444444444444444444444444444444444 444444444444444444444444444444 4444448 B&B I4 PEND&HULU&N4444444 PEND&HULU&N444444444444444444444444444444 4444444444444444444444444444444444444444444444 44444444444444444444444444444444444444444444444 4444444444444444444444444444444444444441 4444444444444441 1414 Latar Be"a+a!%44444444444444444444444444444444444444444444 Be"a+a!%4444444444444444444444444444444444444444444444444444444444444444444 444444444444444444444444444444444444444444444441 4444444444444444444444441 1424 u#usa! #asa"ah4444444444444444444444444 #asa"ah444444444444444444444444444444444444444444444444 44444444444444444444444444444444444444444444444444444444 444444444444444444444444444444444 44442 2
14;4 u)ua!444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444442 14<4 Ma!aat444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444 2 B&B II4 IN&U&N PUS&7&4444444444444444444444444444444444444444444444444444444444444444444444444444444444; 2414 Dis/!ia44444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444; 241414 E,i'e#i/"/%i44444444444444444444444444444444444444444444444444444444444444444444444444444444444; 241424 7"asii+asi444444444444444444444444444444444444444444444444444444444444444444444444444444444444444 ; 2414;4 i!itus su$)e+ti !/!-,u"sati"444444444444444444444444444444444444444444444444444444444 4< 2414;414 Eti/"/%i444444444444444444444444444444444444444444444444444444444444444444444444444444< 2414;424 Pat/isi/"/%i44444444444444444444444444444444444444444444444444444444444444444444445 2414;4;4 ata"a+sa!a444444444444444444444444444444444444444444444444444444444444444444444444 6 2414<4 i!itus ,u"sati"444444444444444444444444444444444444444444444444444444444444444444444444444444444= 2424 Ginkgo biloba444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444449 242414 E+stra+ 'a! +/#,/!e! a+ti444444444444444444444444444444444444444444444444444444444449 242424 Ee+ ar#a+/"/%i4444444444444444444444444444444444444444444444444444444444444444444444444410 2424;4 I!tera+si 'a! +ea#a!a!44444444444444444444444444444444444444444444441< 24;4 Ee+ ,e!%%u!aa! e+stra+ 'au! Gi!+%/ terha'a, ,e!%/$ata! ti!itus4444415 B&B III4 PENUUP444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444 1= ;414 7esi#,u"a!4444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444441= ;424 Sara!4444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444419 D&& PUS&7&4444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444420
3
DAFTAR TA/L
4
DAFTAR A*/AR
5
/A/ I !NDAH#L#AN ).)
Latar /elakan0 Dis/!ia a'a"ah %a!%%ua! suara *a!% 'ise$a$+a! +e"ai!a! ,a'a
/r%a!-/r%a! /!asi teruta#a "ari!% $ai+ $ersiat /r%a!i #au,u! u!%si/!a"4 Dis/!ia $u+a! #eru,a+a! suatu ,e!*a+ti teta,i #eru,a+a! %e)a"a ,e!*a+it atau +e"ai!a! ,a'a "ari!%4 i!!itus a'a"ah ,erse,si suara ta!,a a'a!*a sti#u"us 'ari "uar4 i!!itus #eru,a+a! suatu ,e!*a+it *a!% u#u# 'i'erita /ra!% ,a'a usia tua4 1 Se+itar ;0> /ra!% 'e!%a! usia 'i atas 55 tahu! #e!'erita ti!!itus 'e!%a! i!si'e! ,er tahu!!*a se$a!*a+ 5> 'e!%a! ,re8a"e!si ter$a!*a+!*a a!tara usia <0 'a! ?0 tahu! 'a! "e$ih seri!% ter)a'i ,a'a "a+i-"a+i 'i$a!'i!%+a! 'e!%a! ,ere#,ua!4 12 i!!itus *a!% #e!%%a!%%u 'a! #e#,e!%aruhi a+ti8itas sehari hari #e#,e!%aruhi ;>-5> i!'i8i'u 'e!%a! ti!!itus4 1 Se+itar <0-60 )uta /ra!% 'i &#eri+a Seri+at #e!%a"a#i ti!!itus 'a! 10-12 )uta /ra!% #e#i"i+i %e)a"a *a!% $erat atau #e!%a!%%u4 2 Sa"ah satu *a!% u+u, seri!% a'a"ah ti!!itus *a!% ter)a'i sete"ah hi"a!%!*a ,e!'e!%ara! a+i$at noise-induced hearing loss (NIHL ,re8a"e!si ti!!itus +r/!i+ *a!% $erhu$u!%a! 'e!%a! NIHL a'a"ah 50-?0>4 Sa#,ai a+hir-a+hir i!i tera,i *a!% a'a u!tu+ #e!%/$ati ti!!itus *a!% #e!%a!%%u i!i sa!%at ter$atas41 Ha" i!i )u%a 'i+are!a+a! ti!!itus #eru,a+a! suatu %e)a"a *a!% +/#,"e+s 'a! $u+a! #eru,a+a! suatu ,e!*a+it sehi!%%a tata "a+sa!a!*a #e#$utuh+a! a"at 'a! strate%i *a!% $ai+ #e"a"ui e8a"uasi "e!%+a, 'a! a,"i+asi *a!% sesuai42 &'a!*a ,a,ara! suara *a!% +uat #e#iu ,e!uru!a! a"ira! 'arah 'a! +as+a'e #eta$/"i+ ,a'a +/+"ea 'e!%a! ,e#$e!tu+a! /+si%e! rea+ti 'a! s,esies !itr/%e! *a!% #erusa+ se" "e#a+ ,r/tei! 'a! DN& sehi!%%a #e!i!%+at+a! +e#atia! se"4 O"eh +are!a itu sa"ah satu tera,i *a!% #e!ar%et+a! i!ter8e!si terha'a, #e+a!is#e #/"e+u"ar 'ari NIHL i!i a'a"ah 'e!%a! ,e#$eria! a!ti/+si'a!4 E+stra+ 'au! Ginkgo biloba $erisi $a!*a+ +/#,/!e! 8as/tr/,i+ 'e!%a! ,/te!si !eur/,r/te+si 'a! ee+ a!ti/+si'a!41 a!a#a! Gi!+%/ i!i su'ah 'i%u!a+a! se$a%ai /$at tra'isi/!a" 'i @hi!a se)a+ 5000 tahu! *a!% "a"u4; Pe!%%u!aa!!*a #e!)a'i se#a+i! ,/,u"er 'i &#eri+a Seri+at +are!a te"ah ter$u+ti #e#$eri+a! +eu!tu!%a! terha'a, ,e!%/$ata! i!suisie!si sere$ra"4< Se"ai! itu )u%a te"ah a'a ,re,arat
6
sta!'ar e+stra+ 'au! Ginkgo biloba 'a! 'ari ,e!e"itia! #e!%e!ai t/+sisitas e+stra+ i!i a#a! u!tu+ 'i+/!su#si4 5 O"eh +are!a itu 'i 'a"a# reerat i!i 'i"a+u+a! ,e#$ahasa! #e!%e!ai hu$u!%a! a!tara ,e#$eria! e+stra+ 'au! Ginkgo biloba terha'a, ,e!%/$ata! ti!!itus4 ).&
Rm$an ma$alah
Ba%ai#a!a ,era!a! e+stra+ 'au! Ginkgo biloba terha'a, ,e!%/$ata! ti!itusA ).'
T1an ).'.) u)ua! U#u# U!tu+ #e!%etahui ,era!a! e+stra+ 'au! Ginkgo biloba ).'.&
terha'a, ,e!%/$ata! ti!itus4 u)ua! 7husus U!tu+ #e!%etahui hu$u!%a! a!tara ,e#$eria! e+stra+ 'au! • •
Ginkgo biloba 'e!%a! ,e!%/$ata! ti!itus4 U!tu+ #e!%etahui #e+a!is#e a+si e+stra+ 'au! Ginkgo biloba terha'a, ,e!%/$ata! ti!itus4
).2 *an3aat ).2.) Bi'a!% &+a'e#i+ Me!a#$ah ,e!%etahua! a+a! ,e!%aruh e+stra+ 'au! Ginkgo ).2.&
biloba terha'a, ,e!%/$ata! ti!itus4 Mas*ara+at Me#$eri+a! i!/r#asi +e,a'a
#as*ara+at
,e!%/$ata! a"ter!ati terha'a, ti!itus $er'asar+a! ,e!e"itia!4
/A/ II TIN%A#AN !#STAKA
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241414 E,i'e#i/"/%i
7
#e!%e!ai
Le$ih 'ari 50 )uta /ra!% 'i &#eri+a Seri+at 'i"a,/r+a! #e!%a"a#i ti!itus #e!%hasi"+a! ,re8a"e!si se$esar 10> - 15> ,a'a /ra!% 'easa4 Se+itar 20> 'ari /ra!% 'easa *a!% #e!%a"a#i ti!itus #e#$utuh+a! i!ter8e!si +"i!is4 Pre8a"e!si 'ari ti!itus 'i,er+ira+a! ,a'a National Health Interview Survey tahu! 199< 'i &#eri+a Seri+at 'e!%a! #e!a!*a+a! ,a'a i!'i8i'u a,a+ah #ere+a #e!%a"a#i rasa $er'e!%i!% atau $er'e!%u!% ,a'a te"i!%a *a!% #e!eta, ,a"i!% se'i+it se"a#a ; $u"a!4 Ge)a"a terse$ut 'ite#u+a! ,a'a 146> 'easa $eru#ur 1=-<< tahu! <46> 'easa $eru#ur <5-6< tahu! 'a! 940> 'easa $eru#ur 60 tahu! +eatas4 Pa'a ,e!e"itia! Bea8er Da# /s,ri!% stu'* 'ari ;000 /ra!% 'easa $eru#ur a!tara 21-=< tahu! ,a'a tahu! 2005 sa#,ai 200= 104=> #e"a,/r+a! ti!itus 'e!%a! ti!%+at +e,araha! se'a!% atau #e!*e$a$+a! %a!%%ua! ti'ur42 241424 7"asii+asi Ber$a%ai #aa# +"asii+asi ti!itus te"ah 'ia)u+a! !a#u! sa#,ai se+ara!% $e"u# a'a siste# *a!% 'iteri#a seara u#u#4 Se+ara!% i!i *a!% ,a"i!% $er#a+!a seara +"i!is $a%i ,ara /t/"ari!%/"/%is a'a"ah ti!itus su$)e+ti atau /$)e+ti 'a! ti!itus ,u"sati"e atau !/!-,u"sati"e4 Per$e'aa! a!tara ti!itus ,u"sati"e 'a! !/!-,u"sati"e 'i'asar+a! atas 'es+ri,si suara *a!% 'i'e!%ar /"eh ,asie!4 i!itus ,u"sati"e 'a,at 'i$a%i +e#$a"i #e!)a'i arteria" 'i#a!a suara #e!%i+uti 'e!*ut )a!tu!% 'a! 8e!a 'e!%a! suara #e!'eru4 i!itus )u%a 'i$a%i #e!)a'i su$)e+ti 'i#a!a suara ha!*a 'i'e!%a! /"eh ,asie! 'a! /$)e+ti 'i#a!a suara 'a,at 'i'e!%a! /"eh ,asie! 'a! ,e#eri+sa +e'ua!*a ,e!ti!% 'a"a# 'ia%!/sis 'a! tera,i ti!itus4 i!itus /$)e+ti ,a"i!% seri!% ter'e!%ar /"eh ,e#eri+sa #e"a"ui aus+u"tasi ,a'a re%i/ ,eriauri+u"ar "ia!% te"i!%a "eher 'a! )u%a 'a'a4 7/!ir#asi 'ari ,asie! #e!%e!ai suara *a!% 'i'e!%ar /"eh ,e#eri+sa a,a+ah sa#a 'e!%a! *a!% 'i'e!%ar /"eh ,asie! 'i$utuh+a! u!tu+ i'e!tii+asi ,asti4 i!itus /$)e+ti )ara!% 'ite#u+a! 'a! #e!u!)u+a! a'a!*a su#$er 'ari sti#u"us a+usti+ *a!% #e!*e$a$+a! suara *a!% 'i'e!%ar /"eh ,asie! se,erti $ruit 8as+u"ar tu#/r 8as+u"ar 'a! #i/+"/!us te!s/r ti#,a!i4
8
i!itus ,u"sati" 'a,at $eru,a su$)e+ti atau /$)e+ti se'a!%+a! ti!!tius !/!-,u"sati" ha#,ir se"a"u $eru,a su$)e+ti4 Seri!%+a"i ti!itus !/!-,u"sati" 'i'es+ri,si+a! /"eh ,asie! se$a%ai suara $er'eri!% $er'esis $er'e!%u!% atau $er%e#uruh4 Se'a!%+a! ti!itus ,u"sati" 'i'es+ri,si+a! se$a%ai suara *a!% $erira#a sesuai 'e!%a! 'e!*ut !a'i ,asie! $eru$ah 'e!%a! ,er%era+a! atau ,er,i!'aha! ,/sisi4 2 2414;4
i!itus su$)e+ti !/!-,u"sati"
2414<414 Eti/"/%i Ber$a%ai
#aa#
+/!'isi
+"i!is
'a,at
#e!)a'i
,e!*e$a$ ter)a'i!*a ti!itus4 Seri!%+a"i +/!'isi terse$ut #e!*e$a$+a!
%a!%%ua!
,e!'e!%ara!
*a!%
'i,era*a
#eru,a+a! "a!%+ah ,erta#a 'ari ter)a'i!*a ti!itus4 Ga!%%ua! ,e!'e!%ara! *a!% 'ise$a$+a! /"eh $isi!% suara ,res$ia+usis /$at-/$ata! /t/t/+si+ "a$ri!itis her,es /ster /ti+us Me!iereCs 'isease 'a! %a!%%ua! ,e!'e!%ara! a+i$at +e"ai!a! %e!eti+ #e!*e$a$+a! +erusa+a! se" ra#$ut 'a"a# ,a'a te"i!%a sehi!%%a ter)a'i %a!%%ua! ,e!e!%ara! *a!% $era+hir ,a'a ti!itus !/!-,u"sati"4 Pe!*a+it "ai! *a!% 'a,at #e!*e$a$+a! ti!itus /"eh +are!a tu"i +/!'u+ti a'a"ah /titis
#e'ia
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+/"esteat/#a
/+"usi
+a!a" 'a!
/t/s+"er/sis4 Pe!*a+it "ai! *a!% 'a,at #e!*e$a$+a! ti!itus #e"a"ui "esi ,a'a sara +/+"ear 'a! siste# sara ,usat se,erti !eur/#a a+usti+ #e!i!%i/#a s+e"r/sis #u"ti,e"4 (a$e" 1 Per"u 'ii!%at $aha ti'a+ se#ua ,asie! 'e!%a! %a!%%ua! ,e!'e!%ara! #e!%a"a#i ti!itus4 Pe!*e$a$ uta#a "ai! 'ari ti!itus ter#asu+ /$at-/$ata! trau#a +e,a"a serta %a!%%ua! ,si+iatri4 O$at-/$ata! *a!% #e!i!%+at+a! e+sitasi sara se,erti as,iri! /$at a!ti i!"a#asi !/!-ster/i' !i+/ti! eta!/" 'a! +aei! 'a,at #e!*e$a$+a! atau #e#,er$uru+ ti!itus !/!-,u"sati"42 a$e" 14 Eti/"/%i ti!itus !/!-,u"sati" @har/t-Marie-//th #e!i!%itis Sara3 Kranial 4III5 SS! Diet O6at-o6atan
#e!i!%i/#a s+"er/sis #u"ti,e" 8esti$u"ar sha!!/#a 7aei! etha!/" &!ti$i/ti+ a!ti'e,resa! 9
7ternal Aditor" 8anal Ker$akan Inner Hair 8ell !en"akit Telin0a Ten0ah
i##u!/#/'u"at/r !i+/ti! &uire' ste!/sis seru#e! $e!'a asi!% Ge!eti+ heari!% "/ss her,es /ster /ti+us "a$iri!itis #e!iere 'isease NIHL /t/t/+si+ ,res$ia+usis 7/"esteat/#a OM7 /t/s+"er/sis
2414<424 Pat/isi/"/%i e/ri aa" ,e!*e$a$ ti!itus !/!-,u"sati" 'i,usat+a! ,a'a u!%si 'ari +/+"ea teruta#a u!%si stru+tur terte!tu se,eri se" ra#$ut "uar4 e/ri i!i 'i'asari /"eh /$ser8asi 'i#a!a ti!!itus !/!-,u"sti" seri!%+a"i 'ite#u+a! ,a'a i!'i8i'u 'e!%a! %a!%%ua! ,e!'e!%ara! atau #e!%a"a#i +e)a'ia! /t/t/+si+ se,erti ,a,ara! /$at-/$ata! ,a,ara! $isi!% 'a! trau#a +e,a"a4 Pe!e"itia! a+hir-a+hir
i!i
,a'a ,e!'erita
ti!itus
#e!u!u!)u+a! ,eru$aha! ,a'a a+tiitas sara 'a! hu$u!%a! 'ise"uruh siste# ,e!'e!%ara! sete"ah
hi"a!%!*a
u!%si
,e!'e!%ara!4 7ee,ata! i#,u"s sara ,e!'e!%ara! )auh #e!i!%+at sete"ah ter)a'i!*a %a!%%ua! ,e!'e!%ara! *a!% 'i,era*a #e!*e$a$+a! ter)a'i!*a ti!itus4 Ba!*a+ ,e!e"itia! #e!e#u+a! $er+ura!%!*a si!*a" i!hi$isi ,a'a )a"ur sara ,e!'e!%ara! *a!% #e!*e$a$+a! #e!i!%+at!*a e+sitasi sara ,e!'e!%ara!42 2414<4;4
E8a"uasi 'ia%!/sti+ Pasie! 'e!%a! tititus su$)e+ti !/!-,u"sati" harus se"a"u
#e#i"i+i hasi" sta!'ar 'ari au'i/%ra# +/#,"it se$a%ai "a!%+ah aa" 'ari e8a"uasi4 Pa'a ,asie! 'e!%a! ti!tius $i"atera" ,e#eri+saa! au'i/%ra# re+ue!si ti!%%i 'a,at $er%u!a 'a"a# #e!e!tu+a! eti/"/%i 'ari ti!itus *a!% 'i'erita4 Pasie! 'e!%a! ti!itus u!i"atera" 'isara!+a! u!tu+ #e"a+u+a! magnetic resonance imaging (MI 'e!%a! at +/!tras %a'/"i!iu#4 Pa'a ,asie! 'e!%a! ti!tius !/!-,u"sati" a+ut 'e!%a! %e)a"a su''e! se!s/ri!eura" heari!% "/ss (SSNHL 'a,at 'i"a+u+a!
MI
'e!%a!
at
+/!tras
%a'/"i!u#
u!tu+
#e#asti+a! 'ia%!/sis SSNHL4 Pa'a ,asie! 'e!%a! ti!itus !/!-,u"sati" *a!% #e!'a'a+ 'a,at 'iuri%ai a'a!*a e,i"e,si 10
+/#,resi sara 'a! #i/+"/!us4 Pa'a ,asie! 'e!%a! ti!itus *a!% terus-#e!erus: (1 'e!%a! %a!%%ua! ,e!'e!%ara! 'a,at 'iuri%ai a'a!*a tu"i +/!'u+ti atau tu"i se!s/ri!eura"4 Pa'a tu"i +/!'u+ti 'a,at 'ise$a$+a! /"eh /t/s+"er/sis /titis #e'ia a+ut /titis #e'ia +r/!is atau /titis #e'ia +r/!is su,,urati8a4 Pa'a %a!%%ua! tu"i se!s/ri!eura" 'a,at 'ise$a$+a! /"eh $isi!% suara ,res$ia+usis 'a! aut/i#u!4 (2 'e!%a! 8erti%/ 'a,at 'iuri%ai
a'a!*a Meniere’s
disease
'ehise!s
+a!a"is
se#isir+u"aris 'a! tu#/r ,a'a !er8us +ra!ia" III4 (; 'e!%a!
sa+it +e,a"a 'a,at 'iuri%ai a'a!*a hi,erte!si i!tra+ra!ia" $e!i%!a hiari 'a! tu#/r ,a'a !er8us +ra!ia" III4 (< 'e!%a! %a!%%ua! )ia
'a,at 'iuri%ai a'a!*a 'e,resi %a!%%ua!
a!Fietas i!s/#!ia 'a! %a!%%ua! somatoform4 (5 'e!%a! +e"uha! s/#at/se!s/ri+ 'a,at 'iuri%ai a'a!*a %a!%%ua! ,a'a "eher atau temporo mandibular oint (M4 (6 'e!%a! ria*at trau#a 'a,at 'iuri%ai a'a!*a istu"a ,eri"i#ati+ /ssiu"ar 'isru,ti/! /ti $ar/trau#a 'a! +/!tusi +/+"ear (Ga#$ar 14 1 Ga#$ar 14 &"%/rit#a E8a"uasi i!itus N/!-,u"sati"4 2
2414<4<4
ata"a+sa!a er+a'a!% ,e!%/$ata!
,a'a
,e!*e$a$
%a!%%ua!
,e!'e!%ara! 'a,at #e!%i"a!%+a! ti!!itus !/!-,u"sati"4 Se$a%ai /!t/h a'a"ah ,e!%a+ata! seru#e! *a!% #e!utu,i "ia!% te"i!%a 'a,at #e!%hi"a!%+a! ,e!uru!a! ,e!'e!%ara! 'a! ti!itus *a!% 'ia"a#i /"eh ,asie!4 Na#u! seri!%+a"i ,e!%/$ata! ti!itus
!/!-,u"sati"
ti'a+
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,e!*e$a$!*a #a!a%e#e! ,a'a ,asie! 'a,at $eru,a: &#,"ii+asi •
11
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Pe!%%u!a!
a"at
$a!tu
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ti!itus *a!%
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su$)e+ti si%!ii+a!4
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#e!%ura!%i ti!itus ,a'a 50> ,asie! 'e!%a! %a!%%ua! ,e!'e!%ara! 'a! ti!itus4 &"at $a!tu 'e!%ar #e!%i!%+at+a! suara se+itar *a!% 'a,at 'i'e!%ar /"eh ,asie! sehi!%%a #e!%ura!%i +ee,ata! i#,u"s sara ,e!'e!%ara! 'a! #e!%ura!%i ,r/'u+si suara ti!itus 4 2 •
i!!itus #as+i!% i!itus ,u"sati" 'a! !/!-,u"sati" 'a,at 'itutu,i /"eh suara e+ster!a" #e!%hi"a!%+a! ,erse,si ti!itus 'a! se!sasi ti'a+
!*a#a!
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U!tu+
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#e!%%u!a+a! tera,i i!i 'e!%a! $ai+ '/+ter harus #e!%e+s+"usi *a!% ti!itus!*a ti'a+ 'a,at 'itutu,i +are!a $a%i $e$era,a ,asie! suara e+ster!a" terse$ut 'irasa+a! "e$ih $uru+ 'ari,a'a ti!itus *a!% 'i'e!%ar!*a4 Ba%i $a!*a+
,asie!
suara
te"e8isi
#au,u!
ra'i/
'a,at
#e!%ura!%i rasa ti'a+ !*a#a! *a!% $erasa" 'ari ti!itus4 Pa'a $e$era,a +asus 'i#a!a ,e!%%u!a+a! suara e+ster!a" ti'a+ #e#u!%i!+a! ,e!%%u!aa! ear-level tinnitus masker a"at +ei" *a!% #e!%hasi"+a! suara sa#a 'e!%a! ti!!itus *a!% 'ihasi"+a! /"eh ,asie! #e!%hasi"+a! ,er$ai+a! t/ta" •
,a'a 6> ,asie! ,er$ai+a! ,arsia" ,a'a 2;-6<> ,asie!42 i!!itus etrai!i!% hera,* 'i'asar+a! ,a'a ha$ituasi terha'a, sti#u"us *a!% #e!%%a!%%u sehi!%%a #e!i!i#a"isasi rea+si ,asie! terha'a, sti#u"us terse$ut4 Se+itar =0> ,asie! #e!%a"a#i ti!itus *a!% 'irasa+a! ti'a+ #e!%%a!%u4 i'a+ se,erti tera,i "ai! u!tu+ ti!itus ti'a+ $ertu)ua! u!tu+ #e!%ura!%i ,r/'u+si 'ari suara ti!itus #e"ai!+a! u!tu+ #eru$ah hu$u!%a! a!tara ,erse,si ti!itus 'e!%a! siste# /t/!/# 'a! "i#$i+ 'e!%a! ara +/!se"i!% 'a! tera,i suara42 'i'asari /"eh "i#a ti!%+ata! tera,i *a!% 'itu)u+a! ,a'a +e"/#,/+ ,asie! *a!% $er$e'a: (1 ,asie! 'e!%a! ti!itus *a!% #e!*e$a$+a! %a!%%ua! #i!i#a" (+ate%/ri 0 (2 ,asie! 'e!%a! ti!itus *a!% #e!*e$a$+a! 12
%a!%%ua! (+ate%/ri 1 (; ,asie! 'e!%a! ti!itus *a!% #e!%%a!%u serta %a!%%ua! ,e!'e!%ara! (+ate%/ri 2 (< ,asie! 'e!%a! ti!tius *a!% #e!%%a!%u ,e!'e!%ara! !/r#a" 'a! hi,era+usis (+ate%/ri ; (5 ,asie! 'e!%a! ti!itus *a!% #e!%%a!%u ,e!'e!%ara! !/r#a" hi,era+usis 'a! e+saser$asi )a!%+a ,a!)a!% ti!itus /"eh $isi!% suara (+ate%/ri <4 Per"a+ua! ,a'a #asi!%-#asi!% +e"/#,/+ $er$e'a-$e'a
#e!%%u!a+a!
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enrichment a"at $a!tu 'e!%ar 'a! a"at %e!erasi suara4 astre$/ 'a! Hae"" #e!)e"as+a! $aha +/!se"i!% a'a"ah sesi 'i#a!a ,asie! 'ia)ar+a! #e!%e!ai #e+a!is#e 'ari ter)a'i!*a ti!itus4 7/!se"i!% #e#$uat ti!itus #e!)a'i ti'a+ asi!% 'a! #e!)auh+a! ,asie! 'ari rasa e#as 'a! ta+ut a+a! ti!itus #e"a"ui e'u+asi4 !uditory
enrichment 'i"a+u+a! 'e!%a! #e#$eri+a!
,asie! ,a,ara! $isi!% 'e!%a! #e!%%u!a+a! a"at ,r/'u+si suara 'e!%a! 8/"u#e *a!% re!'ah sehi!%%a #e!*eru,ai •
suara "atar atau se+itar41 I#,"a!tasi 7/+"ear Ha#,ir =0> 'ari #e!%a"a#i #e!%e!ai
ti!itus ti!itus
,e!eri#a
i#,"a! +/+"ear
se'a!% sa#,ai
$erat4
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i#,"a!
,e!eri#a
Pe!e"itia! +/+"ear
#e!u!)u+a! ,er$ai+a! #e!%i+uti i#,"a!tasi u!i"atera" ,a'a 60-90> ,e!eri#a 'e!%a! $e$era,a #e!%a"a#i ,er$ai+a! ,a'a ti!itus +/!tra"atera" #e"a"ui i!hi$isi resi'ua"4 Per$uru+a! 'ari ti!itus atau ti#$u"!*a ti!itus "e$ih seri!% 'i'a,at+a! ,a'a ,asie! 'e!%a! i#,"a! +/+"ear $i"atera"42 •
ar#a+/tera,i Ber$a%ai #aa# /$at-/$ata! sta!'ar
'a!
her$a" te"ah 'i%u!a+a! /"eh ,asie! u!tu+ #e!%ura!%i atau #e!%hi"a!%+a! ti!itus *a!% 'i'erita!*a ter#asu+ a%e!
a!asteti+
("i'/+ai!
I
a!ti+/!8u"sa!
a!ti'e,ressa! a!tihista#i! $e!/'iae,i! 'iureti+ G&B& a%/!is e+stra+ Ginkgo biloba hista#i! ster/i' 'a! 8ita#i!42 13
2414<4
i!itus Pu"sati" i!itus ,u"sati" $er$e'a 'e!%a! ti!itus !/!-,u"sati" +are!a harus 'a,at 'i'e!%ar /"eh ,e#eri+sa #a+a 'ari itu 'ise$ut )u%a
tit!itus /$)e+ti4 7ura!% 'ari 10> /ra!% #e!'erita ti!itus ,u"sati"4 2414<414 Eti/"/%i er'a,at 'ua +e#u!%i!a! ter)a'i!*a ti!itus ,u"sati"4 Perta#a ,e!i!%+ata! +ee,ata! a"ira! 'arah sehi!%%a ter)a'i tur$u"e!si "/+a" *a!% 'a,at 'i'e!%ar4 7e'ua a"ira! 'arah !/r#a" ,a'a tu$uh 'ita!%+a, "e$ih +eras /"eh te"i!%a 'ise$a$+a! /"eh ,eru$aha! ,a'a te"i!%a 'a"a# 'e!%a! ,e!i!%+ata! +/!'u+si tu"a!% atau hi"a!%!*a +/!'u+si u'ara *a!% #e!%a+i$at+a! hi"a!%!*a masking effect 'ari suara e+ster!a"4 i!itus ,u"sati" +e$a!*a+a! $ersiat u!i"atera" +eua"i ,e!*e$a$!*a a'a"ah suatu %a!%%ua! 8as+u"ar $i"atera"4 Seri!%+a"i ,e#eri+sa 'a,at #e!%i'e!tii+asi ,e!*e$a$ 'ari ti!itus ,u"sati"4 Pa'a ha#,ir ;0> +asus ti'a+ 'a,at 'ii'e!tii+asi
,e!*e$a$!*a
#es+i,u!
su'ah
'i"a+u+a!
,e#eri+saa! *a!% #e!'eti"4 er'a,at $er$a%ai #aa# ,e!*e$a$ 'ari ti!itus ,u"sati"4 Pe!*e$a$ ter$a!*a+ sa#,ai se+ara!% a'a"ah *a!% $erasa" 'ari arteri 'a! 8e!a4 u#/r 8as+u"ar 'ari tu"a!% te#,/ra"
se,erti
,ara%a!%"i/#a
ti#,a!i
'a!
)u%u"ar
#a"/r#asi 8as+u"ar 'i8erti+u"a )u%u"ar 'a! vascular loop 'ari #eatus a+usti+us i!ter!us 'a,at #u!u" 'e!%a! ti!itus ,u"sati" u!i"atera"4 Eti/"/%i !/!8as+u"ar ter#asu+ #i/+"/!us te"i!%a te!%ah dehiscent +a!a"is se#isir+u"aris hi,erte!si i!tra+ra!ia" $e!i%!a /titis #e'ia eusi serta 'isu!%si se!'i te#,/r/#a!'i$u"ar (a$e" 24 26
a$e" 24 Eti/"/%i 'ari ti!itus ,u"sati" 2 4a$clar 14
e!/us
&!/#a"i ugular bulb hi,erte!si i!tra+ra!ia" i'i/,ati+ a!euris#e si!us 8e!a 'ura" a!/#a"i 8e!a #ast/i' ste!/sis 8e!a si%#/i'tra!s8ersus &ter/s+"er/sis #a"/r#asi arteri 'a! 8e!a 'ura"
&rteria"
a!/#a"i Developmental In3ectio$ Neopla$tic *i$c.
arteri
+ar/tis
+/#,resi
8as+u"ar
a!euris#a hyperdynamic flow state Disu!%si tu$a eustahius "aget disease /titis #e'ia Otitis #e'ia ser/sa tu#/r %"/#us He#a!%i/#a tu#/r i!tra+ra!ia" #ehisence +a!a"is se#isir+u"aris
(S@@D
/t/s+"er/sis #i/+"/!us te"i!%a te!%ah
2414<424 E8a"uasi 'ia%!/sti+ Pasie!
'e!%a!
+e"uha!
behavioural audiogram$ speech
ti!itus
harus
discrimination
'i"a+u+a! testing$
tympanogram 'a! acoustic refle% testing 4 er'a,at $a!*a+ ,e#eri+saa! *a!% 'a,at 'i%u!a+a! se,erti u"tras/!/%rai '/,,"er @ sa! @ a!%i/%rai (@& MI4 M a!%i/%rai (M& M 8e!/%rai (M 'a! four-vessel angiografi4 i!itus ,u"sati" 'i$a%i #e!)a'i su$)e+ti 'a! /$)e+ti4 Pa'a ti!itus ,u"sati" su$)e+ti 'e!%a! (1 /$esitas 'a,at 'iuri%ai a'a!*a hi,erte!si i!tra+ra!ia" i'i/,ati+ 'a! 'a,at 'i,asti+a! 'e!%a! MI4 (2 #asa retr/ti#,a!i atau !/r#a" ,a'a /t/s+/,i 'a,at 'iuri%ai a'a!*a tu#/r 8as+u"ar a$!/r#a"itas )u%u"ar $u"$ S@@D 'istr/i 'ari tu"a!% ,e!'e!%ara! ,e!*e$a$ i!tra+ra!ia" atau istu"a arteri 8e!a 'ura"4 (; $ruit 8as+u"ar ,a'a "eher 'a,at 'iuri%ai a'a!*a ater/s"er/sis 'a! 'i,asti+a! 'e!%a! USG +ar/tis4 Pa'a ti!itus ,u"sati" /$)e+ti 'a,at 'ite#u+a! (1 $ruit ,eriauri+u"a atau #ast/i' *a!% 'ise$a$+a! /"eh #a"/r#asi atau istu"a arteri 'a! 8e!a4 (2 i$ri"asi 'ari #e#$ra! ,a"ata" atau ti#,a!i *a!% 'ise$a$+a! /"eh #i/+"/!us te"i!%a te!%ah4 Ga#$ar 24 &"%/rit#a e8a"uasi ti!itus ,u"sati" 2
&.&.
Ginkgo biloba 15
Ginkgo biloba ter%/"/!% 'a"a# a#i"i Gi!+%/eae 'e!%a! si!/!i# Salisburia
adiantifolia$
Salisburia
macrophylla$
'a!
"terophylla
salisburiensis& P/h/! %i!+%/ i!i su'ah a'a se)a+ 150 )uta tahu! *a!% "a"u 'au! 'a! +aa!% 'ari ,/h/! i!i su'ah 'i%u!a+a! se)a+ $e$era,a a$a' *a!% "a"u 'a"a# ,e!%/$ata! tra'isi/!a" @hi!a45 I!'i+asi 'ari ,e!%%u!aa!*a ter#asu+ ,e!%/$ata! )a!tu!% 'a! ,aru4 Pa'a tahu! 196< /r#u"a sta!'ar e+stra+!*a 'i$uat /"eh ,erusahaa! ar#asi er#a! 'a! 'a,at 'i%u!a+a! se$a%ai ,e!%/$ata! si#,t/#ati+ 'ari 'eisit #e#/ri +/!se!trasi 'a! 'e,resi +are!a %a!%%ua! /ta+ /r%a!i+ . Pa'a saat i!i Ginkgo biloba #eru,a+a! ,re,arat her$a" *a!% ,a"i!% seri!% 'irese,+a! 'i er#a! 'a! #eru,a+a! ,re,arat her$a" over the counter *a!% u#u# 'i%u!a+a! 'i &#eri+a Seri+at4 ? 242414 E+stra+ 'a! +/#,/!e! a+ti 7are!a $a!*a+!*a +/#,/sisi 'ari 'au! Gi!+%/ 'i$uat suatu sta!'arisasi u!tu+ #e!'a,at+a! +/#,/sisi $i/a+ti!*a 'ise$ut EG$ ?61®4 Dau! 'ia#$i" se"a#a #usi# ,a!as 'a! #usi# %u%ur 'i a!tara $u"a! u"i 'a! Se,te#$er +eti+a #asih $erar!a hi)au4 7e#u'ia! 'i+eri!%+a! 'a! 'ia!a"isa a,a+ah ter'a,at su$sta!si ,/"uta! 'a! t/+si+ se,erti #eta" $erat 'a! a"at/+si!4 Sete"ah +eri!% 'ie+stra+ 'e!%a! #e!%%u!a+a! a#,ura! aset/!:air (;5-6?:14 7e#u'ia! 'i$uat ,re,arat 'e!%a! #e!%hitu!% )u#"ah "a8/!/i' 'a! ter,e!/i'4 = Pre,arat sta!'ar 'ari 'au! Gi!+%/ a'a"ah EG$ ?61 ® *a!% #e!%a!'u!% 2<-26>
"a8/!/i' %"i+/si'a 5-?> ter,e!e/i' 'a!
+ura!% 'ari 5 ,,# asa# %i!+%/"i+4 ;5 &'a 'ua +/#,/!e! a+ti ar#a+/"/%i uta#a *a!% a'a ,a'a e+stra+ 'au! Gi!+%/ *aitu "a8/!/i' 'a! ter,e!/i'4 "a8/!/i' atau 'ise$ut )u%a e!i"$e!/,ir/! atau e!i"+r/#/! a'a"ah +e"/#,/+ su$sta!si 'e!%a! $erat #/"e+u" re!'ah *a!% ter+a!'u!% ha#,ir ,a'a se"uruh ta!a#a!4 "a8/!/i' *a!% a'a ,a'a e+stra+ 'au! Gi!+%/ a'a"ah "a8/! "a8/!/" ta!i! $i"a8/! 'a! %"i+/si'a 'ari +uersiti! 'a! +ae#,er/" *a!% teri+at ,a'a ;-ra#!/si'a ;-ruti!/si'a atau ,/u#ari ester4 7/#,/!e! i!i 'i+e!a" se$a%ai a!ti/+si'a! i!hi$it/r e!i# 'a! cation chelators4 Pa'a u#u#!*a $i/a8ai$i"itas "a8/!/i' e!'eru!% re!'ah +are!a a$s/r$si!*a ter$atas 'a! e"i#i!asi!*a e,at4 "a8/!/i' 'a"a# 16
$e!tu+ %"i+/si'a a$s/r$si!*a +ura!% $ai+ ,a'a usus ha!*a 'a"a# $e!tu+ a%"i+/! *a!% 'a,at "a!%su!% 'isera,4 "a8/!/i' *a!% ti'a+ tersera, saat #e!a,ai +/"/! 'a,at 'i#eta$/"is#e /"eh $a+teri +e#u'ia! 'ia$s/r$si4 Pa'a saat 'ia$s/r$si "a8/!/i' #e!a,ai hati 'i#a!a 'i#eta$/"is#e #e!)a'i 'eri8at +/!)u%at a+ti8itas $i/"/%i ,a'a #eta$/"it "a8/!/i' ti'a+ se"a"u sa#a 'e!%a! +/#,/!e! as"i!*a4;5 er'a,at 'ua ti,e ter,e!/i' *a!% 'i'a,at+a! ,a'a Gi!+%/ se$a%ai "a+t/! *aitu %i!+%/"i'a 'a! $i"/$a"i'a49 Gi!+%/"i'a 'i$a%i #e!)a'i 5 ti,e: &B@ 'a! M 'i#a!a ti,e &B@ ter+a!'u!% se$a!*a+ ;41> 'ari t/ta" e+stra+ 'au! Gi!+%/ se'a!%+a! Bi"/$a"i'a ter+a!'u!% se$a!*a+ 249>4 10 E+stra+ i!i 'a,at 'i$eri+a! seara i!tra 8e!a $er$e!tu+ aira! atau #e"a"ui ta$"et4 Pa'a u#u#!*a 'i$eri+a! 'a"a# $e!tu+ +a,su" atau ta$"et4? i'a+ a'a ,e!e"itia! *a!% #e!e!tu+a! '/sis e+stra+ 'au! Gi!+%/ *a!% 'i$utuh+a! u!tu+ #e!a,ai ee+ *a!% 'ii!%i!+a! teta,i $e$era,a re+/#e!'asi 'ari sta!'ar e+stra+!*a a'a"ah <0-60#% ;-< +a"i sehari4 11
242424 Ee+ ar#a+/"/%i E+stra+ 'au! Gi!+%/ te"ah ter$u+ti #e#i"i+i ee+ *a!% #e!%u!tu!%+a! 'a"a# #e!%/$ati ,e!*a+it !eur/'e%e!erati se,erti &"hei#er ,e!*a+it )a!tu!% +a!+er stres hi"a!% i!%ata! ti!!itus +e"uha! %eriatri se,erti 8erti%/ 'e%e!erasi #a+u"ar *a!% $erhu$u!%a! 'e!%a! usia %a!%%ua! ,si+iatri se,erti s+i/re!ia4 Me+a!is#e *a!% 'i,er/"eh 'ari e+stra+ 'au! Gi!+%/ a'a"ah ee+ a!ti/+si'a! a+ti8asi a+t/r a!ti-,"ate"et i!hi$isi 'ari $eta a#*"/i' ,e,ti'a (& #e!%ura!%i e+s,resi rese,t/r $e!/'iae,i! ,erier 'a! sti#u"asi 'eri8at e!'/te"iu#45 2414<414
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19
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Me!urut ,e!e"itia! double blind$ placebo controlled trial 'i Bir#i!%ha# terha'a, 1121 /ra!% sehat 'e!%a! usia 1=-?0 tahu! 'e!%a! ti!!itus ti'a+ a'a ,er$e'aa! ee+ti8itas a!tara ,e#$eria! 50 #% e+stra+ Gi!+%/ $i"/$a *a!% 'i$eri+a! ;F sehari se"a#a 12 #i!%%u 'i$a!'i!%+a! 'e!%a! ,e#$eria! ,"ase$/ 'a"a# #e!%/$ati ti!!itus #au,u! 'a"a# #e!%ura!%i %e)a"a i!suisie!si sere$ra"41< Se'a!%+a! #e!urut suatu hasi" +esi#,u"a!
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randomised controlled trials 'e!%a! res,/!'e! 'easa (J1= tahu! 'e!%a! +e"uha! ti!!itus ti'a+ ter$u+ti $aha e+stra+ i!i e e+ti u!tu+ ,asie! 'e!%a! +e"uha! ,ri#er !*a $eru,a ti!!itus a+a! teta,i ,a'a ,asie! 'e!%a! 'e#e!sia 8as+u"ar 'a! &"hei#er 'i'a,at+a! ,er$ai+a! %e)a"a ti!!itus4 D/sis *a!% 'i$eri+a! a!tara 120-200#% hari4 15 Ha" i!i )u%a 'i'u+u!% /"eh suatu review #e!%e!ai ,e!%/$ata! i!suisie!si sere$ra" 'e!%a! #e!%%u!a+a! e+stra+ Ginkgo biloba #e!urut ,e!e"itia! Me*er 'e!%a! res,/!'e! $erusia rata-rata 50 tahu! 'e!%a! ti!!itus 'a! a'a!*a %e)a"a "ai! se,erti ,usi!% 'a! %a!%%ua! ,e!'e!%ara! *a!% su'ah 'ia"a#i se"a#a <-5 $u"a! 'i$eri+a! i!ter8e!si e+stra+ 'au! Gi!+%/ $i"/$a 160 #%hari atau ,"ase$/ 'e"a#a ; $u"a! +e#u'ia! 'i"a+u+a! follow-up se"a#a 1; $u"a! 'i'a,at+a! ,e!i!%+ata! se#$uh 'ari %e)a"a sete"ah rata-rata ?0 hari ,a'a *a!% 'i$eri+a! Gi!+%/ 'i$a!'i!%+a! 'e!%a! ,a'a ,"ase$/ *aitu se+itar 119 hari4 Me!urut ,e!e"itia! /"eh Ha%ue!auer et a" 'e!%a! ?0 res,/!'e! $erusia rata-rata 50 tahu! 'e!%a! 8erti%/ 'a! %e)a"a "ai! (ti!!itus !*eri +e,a"a !ausea %a!%%ua! ,e!'e!%ara! *a!% $aru-$aru ter)a'i 'a! ti'a+ 'i+etahui ,e!*e$a$!*a 'i$eri+a! i!ter8e!si 160#% e+stra+ Gi!+%/ hari 'a! ,"ase$/ se"a#a ; $u"a! 'a! 'i'a,at+a! %e)a"a hi"a!% ,a'a ,asie! *a!% #e!'a,at+a! Gi!+%/ 'i$a!'i!%+a! 'e!%a! 1=> ,a'a ,"ase$/4 < Pa'a review /"eh H/"stei! *a!%
22
#e!%u#,u"+a! $e$era,a clinical trial = ,e!e"itia! 'e!%a! +/!tr/" 'a! 11 ,e!e"itia! ta!,a a'a!*a +/!tr/" 'isi#,u"+a! $aha ter'a,at ei+asi 'a! t/"era!si *a!% $a%us ,a'a ,e#$eria! e+stra+ Gi!+%/4 Pa'a ,e!e"itia! 'e!%a! +/!tr/" 'i'a,at+a! ,er$ai+a! %e)a"a ,asie! *a!% 'i$eri+a! Gi!+%/ $i"a 'i$a!'i!%+a! 'e!%a! *a!% 'i$eri+a! ,"ase$/ atau su$sta!si "ai! (8as/'i"at/r ta,i ha#,ir ,a'a se"uruh ,e!e"itia! res,/!'e! *a!% 'i%u!a+a! #e#i"i+i ,e!*a+it "ai! *a!% $erhu$u!%a! 'e!%a! 8as+u"ar se,erti %a!%%ua! 8as+u"ar /ta+ atau,u! %a!%%ua! 8as+u"ar ,a'a te"i!%a 'a"a#4 Se'a!%+a! ,a'a ,e!e"itia! ta!,a #e!%%u!a+a! +/!tr/" )u%a 'i'a,at+a! ,er$ai+a! ,a'a se$a%ia! $esar ,asie! ta,i 'e!%a! ,asie! *a!% ha!*a 'e!%a! +e"uha! ti!!itus ti'a+ 'i'a,at+a! ei+asi ,a'a ,e!%/$ata! 'e!%a! Gi!+%/4 16 Pa'a ,e!e"itia! /"eh H/"%ers 'i"a+u+a! 'ua taha, ,e!e"itia!4 Perta#a 'e!%a! 'esai! stu'i ta!,a +/!tr/" ,"ase$/ =0 res,/!'e! 'e!%a! ti!itus $erat ,ersiste! 'i$eri+a! 1<46 #% 2 +a"i sehari se"a#a 2 #i!%%u ,a'a ,asie! 'e!%a! ee+ ,/siti sete"ah ,e#$eria! 'i#asu+a! 'a"a# ,e!e"itia! +e'ua *aitu double-blind placebo-controlled study 'e!%a! 20 res,/!'e! 'i$eri+a! ,r/'u+ Gi!+%/ 2942 #%hari se"a#a 2 #i!%%u 'a! ,"ase$/ ,a'a 2 #i!%%u $eri+ut!*a4 Pa'a a+hir stu'i 'ita!*a+a! /$at #a!a *a!% 'i,i"ih /"eh ,asie!4 D/sis *a!% 'i,a+ai 'a"a# ,e!e"itia! i!i u+u, re!'ah )i+a 'i$a!'i!%+a! 'e!%a! ,re,arat tersta!'arisasi EG$ ?61 ® *aitu 120-2<0#% 'a! ,e#$eria! se"a#a 2 #i!%%u ter"a"u ,e!'e+ u!tu+ ti!!itus +r/!i+4 Pasie! *a!% #e"a,/r+a! a'a!*a ,er$ai+a! se"a#a 2 #i!%%u 'i#u!%+i!+a! +are!a a'a!*a ee+ ,"ase$/ *a!% $esar +are!a ,e!*a+it ti!!itus i!i )u%a $erhu$u!%a! 'e!%a! ,si+/"/%i ,asie!4 1? Pa'a ,e!e"itia! "ai! 'e!%a! 909 /ra!% *a!% #e!'erita ti!!itus sta$i" 'i"a+u+a! ,e!%/$ata! se"a#a 12 #i!%%u4
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Pe!e"itia! se,erti *a!% 'i"a+u+a! /"eh S#ith et a" #e!%%a$u!%+a! se#ua ,e!e"itia! #e!%e!ai ei+asi 'ari Ginkgo biloba ta!,a #e#,erhati+a! +ua"itas serta '/sis Ginkgo biloba *a!% 'i$eri+a! ,a'a #asi!%-#asi!% ,e!e"itia! 'a! #e#$uat +esi#,u"a! $aha ti'a+ a'a $u+ti $aha Ginkgo biloba ee+ti u!tu+ ,e!%/$ata! ti!itus 'i$a!'i!%+a! 'e!%a! ,"ase$/4 Ba%i ,e!e"iti +esi#,u"a! sa!%at ,e!ti!% +are!a ,e!%/$ata! *a!% ti'a+ #e#i"i+i ei+asi tera,i ha!*a #e#$ua!% ua!% 'a! #e!e%ah ,asie! u!tu+ #e!ari ,e!%/$ata! *a!% #e#i"i+i ei+asi *a!% "e$ih $ai+419 Pe!e"itia! /"eh e)a"i et a" 'e!%a! 'e!%a! 'esai! ,e!e"itia! (andomi)ed double blind trial 'ari Ginkgo biloba 8ersus ,"ase$/ 'a! 'e!%a! meta-analysis of randomi)ed placebo controlled double blind trials4 Pa'a ,e!e"itia! 'i,i"ih 66 res,/!'e! 'easa 'e!%a! ti!itus 'a! ,a'a $a%ia! meta-analysis #e!%%u!a+a! 6 (ter#asu+ ,e!e"itia! itu se!'iri randomi)ed placebo controlled double blind trials4 Hasi" *a!% 'i'a,at+a! 'e!%a! #e#$a!'i!%+a! *innitus Handicap Inventory (HI Glasgow Health Status Inventory (GHSI a!' rata-rata a#$a!% ,e!'e!%ara! ,a'a 045 1 2 < +H4 Pa'a Meta-analysis 'i'a,at+a! 2146> ,asie! *a!% 'i$eri+a! Ginkgo biloba #e#,er/"eh +eu!tu!%a! 8ersus
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24
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25
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Maha'e8a! S Par+ .4 Mu"tiaete' hera,euti Be!eits / Gi!+%/ $i"/$a L 4: @he#istr* Eia* Saet* a!' Uses4 //' Si4 200=?;(14
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H/#a!! E Behr Neu#a!!-Haee"i! Sha%er 74 Pu"sati"e ti!!itus: i#a%i!% a!' 'iere!tia" 'ia%!/sis4 Dtsh &rte$" I!t I!ter!et4 201;110(26:<51=4 &8ai"a$"e r/#: 26
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Maha'* GB4 Gi!+%/ $i"/$a: a re8ie / ua"it* saet* a!' eia*4 Nutr @"i! @are4 2001<(;:1<0?4
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Oh!ishi N 7usuhara M ./shi/+a M 7ur/'a 7 S/%a & Nishi+aa et a"4 Stu'ies /! i!terati/!s $etee! u!ti/!a" //'s /r 'ietar* su,,"e#e!ts a!' #e'ii!es4I4Eets / Gi!+%/ $i"/$a "ea eFtrat /! the ,har#a/+i!etis / 'i"tiae# i! rats4 Bi/" Phar# Bu""4 200;26:1;15204
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